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Cazzato G, Cascardi E, Colagrande A, Cimmino A, Ingravallo G, Lospalluti L, Romita P, Demarco A, Arezzo F, Loizzi V, Dellino M, Trilli I, Bellitti E, Parente P, Lettini T, Foti C, Cormio G, Maiorano E, Resta L. Balloon Cell Melanoma: Presentation of Four Cases with a Comprehensive Review of the Literature. Dermatopathology (Basel) 2022; 9:100-110. [PMID: 35466242 PMCID: PMC9036264 DOI: 10.3390/dermatopathology9020013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND balloon cell melanoma represents less than 1% of all histological forms of malignant melanoma and represents a diagnostic challenge for the dermatopathologist. METHODS in this paper we present our cases of BCM found in our daily practice from 1 January 2008 to 31 December 2021, and we conduct a review of the literature relating to this entity in the period from the first description, 1970, to early 2022. RESULTS four cases of melanoma balloon cell have been extrapolated from our electronic database, while in the review of the literature we have identified 115 cases of patients with primary and/or metastatic BCM. CONCLUSIONS we believe that future studies with numerous case series are essential not only to increase the knowledge of the pathophysiology of this neoplasm but also to correctly evaluate the response of BCM patients to new oncological therapies.
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Affiliation(s)
- Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
- Correspondence:
| | - Eliano Cascardi
- Section of Pathology, Department of Medical Sciences, University of Turin, 10121 Turin, Italy;
| | - Anna Colagrande
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
| | - Antonietta Cimmino
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
| | - Giuseppe Ingravallo
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
| | - Lucia Lospalluti
- Section of Dermatology, Department of Biomedical Science and Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (A.D.); (C.F.)
| | - Paolo Romita
- Section of Dermatology, Department of Biomedical Science and Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (A.D.); (C.F.)
| | - Aurora Demarco
- Section of Dermatology, Department of Biomedical Science and Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (A.D.); (C.F.)
| | - Francesca Arezzo
- Section of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.); (M.D.); (G.C.)
| | - Vera Loizzi
- Section of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.); (M.D.); (G.C.)
| | - Miriam Dellino
- Section of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.); (M.D.); (G.C.)
- Clinic of Obstetrics and Gynecology, “San Paolo” Hospital, ASL Bari, 70124 Bari, Italy
| | - Irma Trilli
- Odontomatostologic Clinic, Department of Innovative Technologies in Medicine and Dentistry, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy;
| | - Emilio Bellitti
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
| | - Paola Parente
- Pathology Unit, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Teresa Lettini
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (L.L.); (P.R.); (A.D.); (C.F.)
| | - Gennaro Cormio
- Section of Gynecology and Obstetrics, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (F.A.); (V.L.); (M.D.); (G.C.)
| | - Eugenio Maiorano
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
| | - Leonardo Resta
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari “Aldo Moro”, 70124 Bari, Italy; (A.C.); (G.I.); (E.B.); (T.L.); (E.M.); (L.R.)
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Wei G, Hennessy K, Kevin Heard L, Gaudi S, Mhaskar R, Patel RR, Bennett AE. Balloon cell melanoma: a systematic review. Int J Dermatol 2021; 61:266-277. [PMID: 33645660 DOI: 10.1111/ijd.15448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/29/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
Balloon cell melanoma (BCM) is a rare presentation of malignant melanoma characterized by large, foamy melanocytes lacking pigmentation. This is a comprehensive review of the clinical, dermoscopic, and histological features among BCM cases reported in the literature. A systematic review of all case reports and series published since 1970 was conducted via MEDLINE, Embase, and Web of Science, using "balloon cell melanoma" and synonymous search terms. Our systematic search identified 76 cases (49% male, 51% female) of BCM in the literature. The mean age at presentation was 57.81 years. Prior skin cancer, particularly melanoma (47%), accounted for 58% of pertinent medical history. Prominent clinical exam findings included raised (46%), ulcerated (73%) lesions larger than 1 cm (68%) in the lower extremities (35%). Median Breslow thickness of primary BCM cases was 2.5 mm. Hairpin vessels (75%) and structureless architecture (75%) were predominant on dermoscopy. Notable histopathology included large (47%), vacuolated (58%) cells with foamy cytoplasm (62%) and conspicuous nucleoli (27%). Positive S-100 immunohistochemistry (73%) was most frequently employed to diagnose BCM. We observed 47% primary and 53% metastatic BCM cases. Of metastatic BCMs, balloon cells in the primary lesion were unknown in 48%, devoid in 33%, and present in 20% of cases. All metastases displayed predominant balloon cell morphology. BCM may represent an advanced phase in the progression of malignant melanoma. Improved awareness of BCM characteristics among clinicians may reduce the risk of misdiagnoses.
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Affiliation(s)
- Grace Wei
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Kerry Hennessy
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - L Kevin Heard
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sudeep Gaudi
- Dermatology Section, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Rahul Mhaskar
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Rishi R Patel
- Dermatology Section, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Adam E Bennett
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.,Dermatology Section, James A. Haley Veterans' Hospital, Tampa, FL, USA
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Friedman BJ, Stoner R, Sahu J, Lee JB. Association of Clinical, Dermoscopic, and Histopathologic Findings With Gene Expression in Patients With Balloon Cell Melanoma. JAMA Dermatol 2018; 154:77-81. [PMID: 29238799 PMCID: PMC5833572 DOI: 10.1001/jamadermatol.2017.4700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 09/19/2017] [Indexed: 11/14/2022]
Abstract
Importance Balloon cell melanoma is a rare subtype of melanoma that is underrecognized clinically and is challenging to diagnose on histologic studies. Objective To further characterize the clinical, dermoscopic, and histopathologic features of balloon cell melanomas and their correlation to gene expression. Design, Setting, and Participants Case series of 2 patients with balloon cell melanoma whose medical records were retrieved from the database of Thomas Jefferson University Dermatopathology Center in Philadelphia, Pennsylvania. Both cases had been referred to the institution's dermatopathology laboratory and provided complete data on clinical, dermoscopic, and histopathologic findings and gene-expression profiles. Main Outcomes and Measures Dermoscopic findings, histopathologic findings, and results of gene expression tests. Results In the 2 patients included, translucent hypopigmented areas on gross examination and a translucent white-gray veil and dull yellow globules on dermoscopic examination correlated with the balloon cell melanocytic region demonstrated on histologic studies with hematoxylin-eosin stain. Specifically, dull yellow globules corresponded to the balloon cell melanocytic nests. Both lesions presented with a second, morphologically distinct population of melanocytes, common in balloon cell melanocytic neoplasms. In both cases, a prominent junctional component that consisted of cells demonstrating ample clear-to-granular cytoplasm and a central nucleus were present. Cytologic atypia was minimal to lacking in both cases, and architectural disorder served as a better clue to the diagnosis. Findings of a gene expression profiling test corroborated the diagnosis in both cases. Conclusions and Relevance Balloon cell melanomas may present with characteristic clinical and dermoscopic findings, and a gene expression profiling test may provide additional useful diagnostic information in cases that are difficult to interpret.
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Affiliation(s)
- Ben J. Friedman
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rebecca Stoner
- Medical student at Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joya Sahu
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jason B. Lee
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
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