1
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Berna R, Hasbun T, Adams D, Moon AT, Treat JR. Significant improvement of a nevus spilus-type congenital melanocytic nevus with oral selumetinib. Pediatr Dermatol 2024. [PMID: 38886992 DOI: 10.1111/pde.15666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/12/2024] [Indexed: 06/20/2024]
Abstract
Giant congenital melanocytic nevi (GCMN) can be cosmetically significant and can lead to melanoma. There is no standard pharmacologic treatment for GCMN. We present the case of an 8-year-old female with kaposiform lymphangiomatosis caused by an NRAS mutation whose nevus spilus-type GCMN improved on oral selumetinib.
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Affiliation(s)
- R Berna
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - T Hasbun
- Dermatology Department, Clínica Alemana de Santiago - Facultad de Medicina Universidad del Desarrollo and Hospital Exequiel González Cortés, Santiago, Chile
| | - D Adams
- Division of General Pediatrics, Section of Pediatric Hematology and Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - A T Moon
- Division of General Pediatrics, Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - J R Treat
- Division of General Pediatrics, Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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2
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Bryant D, Barberan-Martin S, Maeshima R, Torres IDV, Rabii M, Baird W, Sauvadet A, Demetriou C, Jones P, Knöpfel N, Michailidis F, Riachi M, Bennett DC, Zecchin D, Pittman A, Polubothu S, Hart S, Kinsler VA. RNA therapy for oncogenic NRAS-driven naevi induces apoptosis. J Invest Dermatol 2024:S0022-202X(24)00449-4. [PMID: 38897541 DOI: 10.1016/j.jid.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 06/21/2024]
Abstract
RAS proteins regulate cell division, differentiation and apoptosis via multiple downstream effector pathways. Oncogenic RAS variants are the commonest drivers in cancers, however they also drive many benign lesions predisposing to malignancy, such as melanocytic naevi, thyroid nodules, and colonic polyps. Reversal of these benign lesions could reduce cancer incidence, however the effects of oncogenic RAS have been notoriously difficult to target with downstream pathway inhibitors. Here we show effective suppression of oncogenic and currently undruggable NRASQ61K in primary cells from melanocytic naevi using siRNA targeted to the recurrent causal variant. This results in striking reduction in expression of ARL6IP1, a known inhibitor of endoplasmic reticulum stress-induced apoptosis not previously linked to NRAS. We go on to show that a single dose of siRNA in primary cells triggers an apoptotic cascade, in contrast to treatment with a MEK inhibitor. Protective packaging of the targeted siRNA into lipid nanoparticles permits successful delivery into a humanised mouse model of melanocytic naevi, and results in variant NRAS knockdown in vivo. These data show that RAS-induced protection from apoptosis is involved in persistence of NRAS-driven melanocytic naevi and anticipate that targeted siRNA could form the basis of clinical trials for RAS-driven benign tumours.
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Affiliation(s)
- Dale Bryant
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Sara Barberan-Martin
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Ruhina Maeshima
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Ignacio Del Valle Torres
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Mohammad Rabii
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - William Baird
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Aimie Sauvadet
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | | | - Phoebe Jones
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Nicole Knöpfel
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - Fanourios Michailidis
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Melissa Riachi
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | | | - Davide Zecchin
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | | | - Satyamaanasa Polubothu
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK
| | - Stephen Hart
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Veronica A Kinsler
- Mosaicism and Precision Medicine Lab, The Francis Crick Institute, London, UK; Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, UK.
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3
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Tomás-Velázquez A, López-Gutiérrez JC, de Andrea C, Reyes-Múgica M, Salgado CM, Redondo P. Alpelisib decreases nevocytes of congenital melanocytic nevi. J Eur Acad Dermatol Venereol 2024; 38:1147-1151. [PMID: 38071601 DOI: 10.1111/jdv.19736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/26/2023] [Indexed: 05/26/2024]
Abstract
BACKGROUND Multiple, large or giant congenital melanocytic nevi (CMN) are uncommon and affected patients can show progressive growth and thickening, associate neurocutaneous melanocytosis or develop melanoma. Current treatment modalities are mostly complex surgeries that frequently do not solve the disease and its risks completely. Thus, investigation on new treatment options for CMN and its complications must continue. MAPK pathway inhibitors are being investigated, also targeting PI3K-AKT. Omipalisib (PI3K inhibitor, with no indications approved yet) has been studied for CMN in vitro and in mice with promising results. However, alpelisib, a PI3K inhibitor approved with an adequate safety profile for patients with severe manifestations of PROS (PIK3CA-Related Overgrowth Spectrum), had not yet been tested for CMN. OBJECTIVE To evaluate the effect of alpelisib in nevocytes of congenital melanocytic nevi. METHODS Nevomelanocytic tissue samples of 10 patients were collected prospectively and, following a previously reported preclinical ex vivo model, explants were placed in organotypic culture for 5 days, with or without alpelisib. Consecutively, tissue sections were stained and using scanned images with Qupath and ImageJ softwares, representative regions from the dermis were analysed (using Wilcoxon test and Spearman's correlation). RESULTS When comparing alpelisib-treated explants with respect to control explants, we found a decrease in cell density (p = 0.0273), in density of SOX10+-cells (p = 0.0391) and also in the % of S-100+ area (p = 0.0078), in alpelisib samples. The three markers showed a positive correlation (p < 0.05). CONCLUSIONS This study provides first-time evidence that alpelisib induces nevocyte reduction in CMN from patient-derived explants, probably inducted by autophagy. Alpelisib is an approved drug with an adequate safety profile used in another mosaicism affecting PI3K (PROS). Further studies are needed to evaluate its efficacy in treating CMN and potentially, their complications, either with local or systemic administration, alone or in combination.
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Affiliation(s)
| | | | - Carlos de Andrea
- Department of Pathology, University Clinic of Navarra, Pamplona, Spain
| | - Miguel Reyes-Múgica
- Department of Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claudia M Salgado
- Department of Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Pedro Redondo
- Department of Dermatology, University Clinic of Navarra, Madrid, Spain
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4
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Nikanjam M, Wells K, Kato S, Adashek JJ, Block S, Kurzrock R. Reverse repurposing: Potential utility of cancer drugs in nonmalignant illnesses. MED 2024:S2666-6340(24)00178-8. [PMID: 38749442 DOI: 10.1016/j.medj.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 06/02/2024]
Abstract
Growth and immune process dysregulation can result in both cancer and nonmalignant disease (hereditary or acquired, with and without predisposition to malignancy). Moreover, perhaps unexpectedly, many nonmalignant illnesses harbor genomic alterations indistinguishable from druggable oncogenic drivers. Therefore, targeted compounds used successfully to treat cancer may have therapeutic potential for nonmalignant conditions harboring the same target. MEK, PI3K/AKT/mTOR, fibroblast growth factor receptor (FGFR), and NRG1/ERBB pathway genes have all been implicated in both cancer and noncancerous conditions, and several cognate antagonists, as well as Bruton's tyrosine kinase inhibitors, JAK inhibitors, and CD20-directed antibodies, have established or theoretical therapeutic potential to bridge cancer and benign diseases. Intriguingly, pharmacologically tractable cancer drivers characterize a wide spectrum of disorders without malignant potential, including but not limited to Alzheimer's disease and a variety of other neurodegenerative conditions, rheumatoid arthritis, achondroplastic dwarfism, and endometriosis. Expanded repositioning of oncology agents in order to benefit benign but serious medical illnesses is warranted.
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Affiliation(s)
- Mina Nikanjam
- Division of Hematology-Oncology, University of California, San Diego, La Jolla, CA, USA.
| | - Kaitlyn Wells
- Department of Pharmacy, University of California, San Diego, La Jolla, CA, USA
| | - Shumei Kato
- Division of Hematology-Oncology, University of California, San Diego, La Jolla, CA, USA
| | - Jacob J Adashek
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Shanna Block
- Department of Pharmacy, University of California, San Diego, La Jolla, CA, USA
| | - Razelle Kurzrock
- Division of Hematology-Oncology, Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA; WIN Consortium, Chevilly-Larue, France.
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5
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Jiang R, Wang Y, Ma X, Xuanyuan X, Zhang Y, Jiang B, Zhang W, Zeng H. Clinical management of a rare melanoma case arising from congenital melanocytic nevus. Genes Dis 2024; 11:101005. [PMID: 38274383 PMCID: PMC10808914 DOI: 10.1016/j.gendis.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 01/27/2024] Open
Affiliation(s)
- Ruixin Jiang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
- Shanghai Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Yan Wang
- Department of Oncology, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, China
| | - Xuhui Ma
- Department of Oral & Maxillofacial- Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Xinyang Xuanyuan
- Department of Dermatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200000, China
| | - Yanjie Zhang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
- Shanghai Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
| | - Bin Jiang
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
| | - Weizhen Zhang
- Department of Oncology, The Third People's Hospital of Zhengzhou, Zhengzhou, Henan 450000, China
| | - Hanlin Zeng
- Department of Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201900, China
- Shanghai Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200125, China
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Haller CN, Leszczynska MA, Brichta L, Maier E, Riddington IM, Choate KA, Levy ML. Topical trametinib for epidermal and sebaceous nevi in a child with Schimmelpenning-Feuerstein-Mims syndrome. Pediatr Dermatol 2024; 41:523-525. [PMID: 38273779 PMCID: PMC11096062 DOI: 10.1111/pde.15523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/16/2023] [Indexed: 01/27/2024]
Abstract
We present the case of a 20-month-old girl with Schimmelpenning-Feuerstein-Mims (SFM) syndrome with extensive head, neck, and torso skin involvement successfully managed with topical trametinib. Trametinib interferes downstream of KRAS and HRAS in the MAPK signaling pathway, of which KRAS was implicated in our child's pathogenic variant. Although other dermatologic conditions have shown benefit from oral trametinib, its topical use has not been well reported. Our patient showed benefit from the use of twice-daily topical trametinib, applied to the epidermal and sebaceous nevi over a 16-month period, leading to decreased pruritus and thinning of the plaques.
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Affiliation(s)
- Courtney N. Haller
- Department of Internal Medicine, Division of Dermatology, Dell Medical School, University of Texas at Austin
| | | | - Lars Brichta
- Chemistry Rx Compounding and Specialty Pharmacy, Folcroft, Pennsylvania
| | - Esther Maier
- Drug Dynamics Institute, College of Pharmacy, The University of Texas at Austin
| | | | - Keith A. Choate
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
- Department of Genetics, Yale University School of Medicine, New Haven, Connecticut
| | - Moise L. Levy
- Department of Internal Medicine, Division of Dermatology, Dell Medical School, University of Texas at Austin
- Department of Pediatrics, Division of Pediatric Dermatology, Dell Medical School, University of Texas at Austin
- Dell Children’s Medical Center, Austin, Texas
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7
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Zhao Y, Zou Y, Chen H, Rao Y, Lin X. Erbium: YAG laser treatment efficacy and association with histologic features for giant congenital melanocytic nevi management. Lasers Surg Med 2024; 56:361-370. [PMID: 38506244 DOI: 10.1002/lsm.23776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/30/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Limited research exists on laser treatment of giant congenital melanocytic nevus (GCMN). OBJECTIVE We sought to elucidate the efficacy of the Erbium: YAG laser on GCMN and the histologic factors associated with a positive clinical response. METHODS AND MATERIALS Between 2019 and 2022, we enrolled 30 medium-to-giant CMN patients who underwent Er: YAG laser treatment. All patients received biopsies before and after laser treatments. Clinical efficacy outcomes were evaluated by the investigator's global assessment (IGA), 5-point scale of depigmentation, and Vancouver Scar Scale (VSS) scores at least 6 months after treatment. RESULTS Of the 30 cases, 18 (60.0%) showed improvement (IGA score ≥3). Eight (26.7%) patients showed repigmentation. Eight (26.7%) patients developed hypertrophic scars. The average IGA, depigmentation, and VSS scores were 2.93, 3.57, and 3.20. The IGA score was higher (3.24 ± 1.18 vs. 2.22 ± 0.97, p = 0.031) and a lower repigmentation rate (14.3% vs. 55.6%, p = 0.032) was observed in the cases with Grenz zone. The IGA score was higher (3.33 ± 1.24 vs. 2.13 ± 0.89, p = 0.023) and the repigmentation rate was lower (11.1% vs. 50.0%, p = 0.034) also in the cases with the melanocytes nests with aggregation of melanin. Lesions with superficial ablation resulted in less hypertrophic scar formation than those with deep ablation (5.9% vs. 53.8%, p < 0.05). CONCLUSION The Er: YAG laser demonstrated effective clinical results for GCMNs. The grenz zone and the melanocytes nests with aggregation of melanin are promising predictors of laser efficacy.
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Affiliation(s)
- Yifei Zhao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yun Zou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yamin Rao
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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8
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Alos L, Carrasco A, Teixidó C, Szumera-Ciećkiewicz A, Vicente A, Massi D, Carrera C. Melanoma on congenital melanocytic nevi. Pathol Res Pract 2024; 256:155262. [PMID: 38518732 DOI: 10.1016/j.prp.2024.155262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Among nevus-associated melanomas, which overall account for 20%-30% of all melanomas, those arising specifically in congenital melanocytic nevi are infrequent, but can be disproportionately frequent in childhood and adolescence. Congenital melanocytic nevi (CMNi) are common benign melanocytic tumors that are present at birth or become apparent in early childhood. They are classified based on the projected adult size. Small and medium-sized CMNi are frequent, whereas large/giant CMNi (over 20 cm in diameter) are rare, but can be associated with high morbidity due to marked aesthetic impairment and the risk of neurocutaneous syndrome or melanoma development. In this setting, melanomas can appear in early childhood and are very aggressive, while the risk of small-medium CMNi of developing melanoma is low and similar to non-congenital melanocytic nevi. Histologically, most melanomas on CMNi initiate their growth at the epidermal-dermal junction, but in large/giant CMNi they can develop entirely in the dermis, in deeper tissues, or in extracutaneous sites (especially in the central nervous system). Most CMNi harbour an NRAS mutation, but other genes are rarely involved, and gene translocations have recently been described. However, no prognostic implications have been associated with the CMN genotype. Melanomas developed on CMNi harbour additional molecular alterations to which the aggressive clinical course of these tumors has been attributed. This review covers the distinctive clinical and pathological aspects of melanomas on CMNi, and includes the epidemiology, etiopathogenesis, clinical and dermoscopic presentation, histological and molecular characteristics, as well as tumour behaviour.
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Affiliation(s)
- Llucia Alos
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group
| | - Antonio Carrasco
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Cristina Teixidó
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Molecular Biology Core, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Anna Szumera-Ciećkiewicz
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Maria Sklodowska-Curie National Research Institute of Oncology, Department of Pathology, Warsaw, Poland
| | - Asunción Vicente
- Pediatric Dermatology Department, Hospital Sant Joan de Déu, Esplugues del Llobregat, Barcelona, Spain
| | - Daniela Massi
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Pathology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Carrera
- University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Dermatology, Hospital Clínic de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain.
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9
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Martin SB, Polubothu S, Bruzos AL, Kelly G, Horswell S, Sauvadet A, Bryant D, Zecchin D, Riachi M, Michailidis F, Sadri A, Muwanga-Nanyonjo N, Lopez-Balboa P, Knöpfel N, Bulstrode N, Pittman A, Yeh I, Kinsler VA. Mosaic BRAF Fusions Are a Recurrent Cause of Congenital Melanocytic Nevi Targetable by MAPK Pathway Inhibition. J Invest Dermatol 2024; 144:593-600.e7. [PMID: 37716647 DOI: 10.1016/j.jid.2023.06.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 09/18/2023]
Abstract
Among children with multiple congenital melanocytic nevi, 25% have no established genetic cause, of whom many develop a hyperproliferative and severely pruritic phenotype resistant to treatment. Gene fusions have been reported in individual cases of congenital melanocytic nevi. We studied 169 patients with congenital melanocytic nevi in this study, 38 of whom were double wild type for pathogenic NRAS/BRAF variants. Nineteen of these 38 patients had sufficient tissue to undergo RNA sequencing, which revealed mosaic BRAF fusions in 11 of 19 patients and mosaic RAF1 fusions in 1 of 19. Recurrently, fusions involved the loss of the 5´ regulatory domain of BRAF or RAF1 but preserved the kinase domain. We validated all cases and detected the fusions in two separate nevi in 5 of 12 patients, confirming clonality. The absence of the fusion in blood in 8 of 12 patients indicated mosaicism. Primary culture of BRAF-fusion nevus cells from 3 of 12 patients demonstrated highly increased MAPK activation, despite only mildly increased BRAF expression, suggesting additional mechanisms of kinase activation. Trametinib quenched MAPK hyperactivation in vitro, and treatment of two patients caused rapid improvement in bulk tissue, improving bodily movement and reducing inflammation and severe pruritus. These findings offer a genetic diagnosis to an additional group of patients and trametinib as a treatment option for the severe associated phenotypes.
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Affiliation(s)
- Sara Barberan Martin
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Satyamaanasa Polubothu
- Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Alicia Lopez Bruzos
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Gavin Kelly
- Bioinformatics and Biostatistics, The Francis Crick Institute, London, United Kingdom
| | - Stuart Horswell
- Open Targets, Welcome Sanger Institute, Cambridge, United Kingdom
| | - Aimie Sauvadet
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Dale Bryant
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Davide Zecchin
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Melissa Riachi
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Fanourios Michailidis
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Amir Sadri
- Plastic and Reconstructive Surgery, Great Ormond Street Hospital for Children and UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Noreen Muwanga-Nanyonjo
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom
| | - Pablo Lopez-Balboa
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Nicole Knöpfel
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Neil Bulstrode
- Paediatric Dermatology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Alan Pittman
- Genetics Research Centre (A.P.), St George's University of London, London, United Kingdom
| | - Iwei Yeh
- Dermatology and Pathology, University of California, San Francisco, San Francisco, California, USA
| | - Veronica A Kinsler
- Mosaicism and Precision Medicine laboratory, The Francis Crick Institute, London, United Kingdom; Genetics and Genomic Medicine, UCL Great Osmond Street Institute of Child Health, London, United Kingdom; Paediatric Dermatology, Great Ormond Street Hospital for Children, London, United Kingdom.
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10
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Flesher JL, Fisher DE. MAPK-Activating Gene Fusions in Congenital Nevi. J Invest Dermatol 2024; 144:446-448. [PMID: 37978981 DOI: 10.1016/j.jid.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/11/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Jessica L Flesher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
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11
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Mologousis MA, Tsai SYC, Tissera KA, Levin YS, Hawryluk EB. Updates in the Management of Congenital Melanocytic Nevi. CHILDREN (BASEL, SWITZERLAND) 2024; 11:62. [PMID: 38255375 PMCID: PMC10814732 DOI: 10.3390/children11010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/24/2024]
Abstract
Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations.
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Affiliation(s)
- Mia A. Mologousis
- School of Medicine, Tufts University, Boston, MA 02111, USA
- Dermatology Program, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Serena Yun-Chen Tsai
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
| | - Kristin A. Tissera
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Duke University, Durham, NC 27710, USA
| | - Yakir S. Levin
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elena B. Hawryluk
- Dermatology Program, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Medicine, Harvard University, Boston, MA 02115, USA
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12
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Tan S, Hu H, Xin X, Wu D. A clinical and biologic review of congenital melanocytic nevi. J Dermatol 2024; 51:12-22. [PMID: 37955315 DOI: 10.1111/1346-8138.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
Congenital melanocytic nevi (CMN) are the result of aberrations in the mitogen-activated protein kinase signal transduction pathway caused by postzygotic somatic mutations. The estimated incidence of newborns with CMN is 1%-2%. The main complications of CMN include proliferative nodules, melanomas, and neurocutaneous melanosis, and the latter two are the most troublesome issues to address. Treatments are primarily taken into account for aesthetic purposes and the reduction of melanoma risk. Due to the much lower incidence of malignant transformation observed in recent studies than in previous data, clinical management paradigms for CMN patients have gradually shifted towards conservative observation and close monitoring. Surgery and lasers are still the main treatments, and targeted therapy may be a promising strategy to help manage complications. With the increase in awareness of mental health, increasing focus has been placed on the quality of life (QoL) and psychological issues of both CMN patients and their parents. Recent studies have revealed that families coping with CMN might endure intense pressure, a major loss in QoL, and psychological problems after diagnosis and during treatment. Here, we sought to present an overview of genetic basis, complications, treatments, and psychological issues related to CMN and hope to provide better management for patients with CMN.
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Affiliation(s)
- Songtao Tan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyue Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Xin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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13
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Measurement instruments for the core outcome set of congenital melanocytic naevi and an assessment of the measurement properties according to COSMIN: a systematic review. JPRAS Open 2022; 35:58-75. [PMID: 36691582 PMCID: PMC9860390 DOI: 10.1016/j.jpra.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background Congenital melanocytic naevi (CMN) can impact on patients' lives due to their appearance and the risk they carry of neurological complications or melanoma development. The development of a core outcome set (COS) will allow standardised reporting and enable comparison of outcomes. This will help to improve guidelines. In previous research, relevant stakeholders reached a consensus over which core outcomes should be measured in any future care or research. The next step of the COS development is to select the appropriate measurement instruments. Aim Step 1: to update a systematic review identifying all core outcomes and measurement instruments available for CMN. Step 2: to evaluate the measurement properties of the instruments for the core outcomes. Methods This study was registered in PROSPERO and performed according to the PRISMA checklist. Step 1 includes a literature search in EMBASE (Ovid), PubMed and the Cochrane Library to identify core outcomes and instruments previously used in research of CMN. Step 2 yields a systematic search for studies on the measurement properties of instruments that were either developed or validated for CMN, including a methodological quality assessment following the COSMIN methodology. Results Step 1 included twenty-nine studies. Step 2 yielded two studies, investigating two quality of life measurement instruments. Conclusion Step 1 provided an overview of outcomes and instruments used for CMN. Step 2 showed that additional research on measurement properties is needed to evaluate which instruments can be used for the COS of CMN. This study informs the instrument selection and/or development of new instruments.
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Michenko AV, Lvov AN, Kruglova LS, Romanov DV, Kuzma EA. Pruritus in cancer patients as a polyetiological symptom. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.8.201810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pruritus is one of the subjective sensations that significantly reduces the quality of life of patients. In patients with malignancies, itch can be caused by different universal or specific pathophysiological factors. This article discusses disorders that cause pruritus in cancer patients: the tumor growth on its own; pathophysiological changes associated with a number of malignancies, paraneoplastic itch, anticancer therapy, concomitant dermatoses, systemic diseases, psychosomatic disorders. Known or proposed mechanisms of the development of pruritus are presented for each of the mentioned provoking factors, and methods of treatment are described, according to the etiological factor. At the end of the article, universal methods for the correction of itching are presented, applicable in cancer patients, regardless of the pruritogenic factor. Special attention is paid to the correction of xerosis as a universal cause of itching in oncological patients.
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15
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Xie Y, Chen Q, Li T, Ding X, Xiao J, Liu Y, Qiu L. Surgical management of facial congenital melanocytic nevi: Experiences and outcomes at an academic center. J Cosmet Dermatol 2022; 21:5811-5818. [PMID: 35593524 DOI: 10.1111/jocd.15104] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/18/2022] [Accepted: 05/17/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Congenital melanocytic nevi (CMN), benign pigmented birthmarks caused by the mutation of melanocytic cells during embryofetal development, can cause aesthetic problem when it is located on the face. Surgical managements of facial CMN are required by both pediatric patients and their parents. Surgical management, including excision or staged excision, skin grafting, dermabrasion, tissue expansion or multiple re-expansion combined with flaps transplantation, have been reported previously. However, a systematical report about facial CMN management is still scarce. OBJECTIVE Herein, we have reviewed our serious of patients with facial CMN, noting their size, location, and histological examination, summarizing the surgical relation behind reconstructive and cosmetic treatment, and proposing a newly classification for facial CMN among pediatric patients, hoping to share a useful surgical algorithm for these lesions on this specific part. CONCLUSION Proper surgical strategy should be made based on the size and location of the nevi and the adjacent relationship between the location and relaxed skin tension lines and aesthetic units. Postoperative ant-scar treatment improves aesthetic outcomes. With our experience and surgical algorithm about facial CMN surgery, a favorable outcome can be achieved.
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Affiliation(s)
- Yue Xie
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Qiang Chen
- Department of Paediatrics Surgery, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Tianwu Li
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Xionghui Ding
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Jun Xiao
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Yan Liu
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
| | - Lin Qiu
- Department of Brun and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorder, Chongqing, China
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16
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Clark HE, Huang YYM, Vance GH, Alomari AK. Fatal melanoma with a novel MYO5A-BRAF fusion and small associated conventional nevus: A case report and review of literature. J Cutan Pathol 2022; 49:808-812. [PMID: 35596628 PMCID: PMC9545590 DOI: 10.1111/cup.14263] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022]
Abstract
Kinase fusions play an important role in the pathogenesis of Spitz neoplasms and occasionally non-Spitz neoplasms. We report a case of a 19-year-old woman with a growing nodule on the scalp, morphologically consistent with a diagnosis of melanoma with epithelioid features arising in association with small nevus. This tumor aggressively metastasized and failed to respond to immunotherapy. Next-generation sequencing of a metastatic focus revealed an MYO5A-BRAF kinase fusion with a low mutational burden and fluorescence in situ hybridization (FISH) of the primary melanoma showed similar results. FISH testing of the associated nevus failed because of technical reasons. MYO5A has rarely been reported as the fusion partner with BRAF-rearranged melanocytic tumors. Moreover, this case raises speculations and contributes to the growing literature on the pathogenesis, nomenclature, and tumorigenic pathways in kinase-fusion melanomas. The patient succumbed to disease, which is in concordance with some literature suggesting aggressive behavior of BRAF fusion melanomas with TERT promoter mutations.
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Affiliation(s)
| | - Yuan Yu Michael Huang
- Department of DermatologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Gail H. Vance
- Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisIndianaUSA,Department of Medical and Molecular GeneticsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Ahmed K. Alomari
- Department of DermatologyIndiana University School of MedicineIndianapolisIndianaUSA,Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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17
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Grafanaki K, Merlino G, Day CP. Making a mouse out of a molehill: how precision modeling repurposes drugs for congenital giant nevi. Trends Cancer 2022; 8:626-628. [PMID: 35718707 PMCID: PMC9308749 DOI: 10.1016/j.trecan.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
Patients with congenital giant nevi (CGN), which can compromise quality of life and progress to melanoma, have limited treatment options. Choi et al. have demonstrated that topical application of a proinflammatory hapten for alopecia treatment [squaric acid dibutylester (SADBE)] caused nevus regression and prevented melanoma in an Nras mouse CGN model. Their results demonstrate the promise of repurposing drugs through precision modeling.
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Affiliation(s)
- Katerina Grafanaki
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Department of Dermatology, University Hospital of Patras, School of Medicine, University of Patras, Patras, Greece
| | - Glenn Merlino
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chi-Ping Day
- Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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18
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Choi YS, Erlich TH, von Franque M, Rachmin I, Flesher JL, Schiferle EB, Zhang Y, Pereira da Silva M, Jiang A, Dobry AS, Su M, Germana S, Lacher S, Freund O, Feder E, Cortez JL, Ryu S, Babila Propp T, Samuels YL, Zakka LR, Azin M, Burd CE, Sharpless NE, Liu XS, Meyer C, Austen WG, Bojovic B, Cetrulo CL, Mihm MC, Hoon DS, Demehri S, Hawryluk EB, Fisher DE. Topical therapy for regression and melanoma prevention of congenital giant nevi. Cell 2022; 185:2071-2085.e12. [PMID: 35561684 DOI: 10.1016/j.cell.2022.04.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/28/2022] [Accepted: 04/15/2022] [Indexed: 12/17/2022]
Abstract
Giant congenital melanocytic nevi are NRAS-driven proliferations that may cover up to 80% of the body surface. Their most dangerous consequence is progression to melanoma. This risk often triggers preemptive extensive surgical excisions in childhood, producing severe lifelong challenges. We have presented preclinical models, including multiple genetically engineered mice and xenografted human lesions, which enabled testing locally applied pharmacologic agents to avoid surgery. The murine models permitted the identification of proliferative versus senescent nevus phases and treatments targeting both. These nevi recapitulated the histologic and molecular features of human giant congenital nevi, including the risk of melanoma transformation. Cutaneously delivered MEK, PI3K, and c-KIT inhibitors or proinflammatory squaric acid dibutylester (SADBE) achieved major regressions. SADBE triggered innate immunity that ablated detectable nevocytes, fully prevented melanoma, and regressed human giant nevus xenografts. These findings reveal nevus mechanistic vulnerabilities and suggest opportunities for topical interventions that may alter the therapeutic options for children with congenital giant nevi.
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Affiliation(s)
- Yeon Sook Choi
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Tal H Erlich
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Max von Franque
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA 02139
| | - Inbal Rachmin
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jessica L Flesher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Erik B Schiferle
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yi Zhang
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - Marcello Pereira da Silva
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Alva Jiang
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - Allison S Dobry
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mack Su
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sharon Germana
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sebastian Lacher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Orly Freund
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ezra Feder
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jose L Cortez
- Department of Dermatology, University of New Mexico, Albuquerque, NM 87106, USA
| | - Suyeon Ryu
- Department of Translational Molecular Medicine, Saint John's Cancer Institute Providence Health and System, Santa Monica, CA 90404
| | - Tamar Babila Propp
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Yedidyah Leo Samuels
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Labib R Zakka
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Marjan Azin
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Christin E Burd
- Department of Cancer Biology and Genetics, The Ohio State University, Columbus, OH, USA
| | - Norman E Sharpless
- National Cancer Institute, National Institute of Health, Bethesda, MD 20892
| | - X Shirley Liu
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - Clifford Meyer
- Department of Data Science, Dana Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Boston, MA 02215
| | - William Gerald Austen
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Division of Plastic Surgery, Shriners Hospital for Children, Boston, Harvard Medical School, Boston, MA 02114, USA
| | - Branko Bojovic
- National Cancer Institute, National Institute of Health, Bethesda, MD 20892; Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Curtis L Cetrulo
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Division of Plastic Surgery, Shriners Hospital for Children, Boston, Harvard Medical School, Boston, MA 02114, USA
| | - Martin C Mihm
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Dave S Hoon
- Department of Translational Molecular Medicine, Saint John's Cancer Institute Providence Health and System, Santa Monica, CA 90404
| | - Shadmehr Demehri
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elena B Hawryluk
- Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - David E Fisher
- Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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19
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Yu Q, Aimaier R, Chung MH, Cui X, Li Y, Wang Z, Li Q. Establishment and characterization of an immortalized human giant congenital melanocytic nevi cell line. Pigment Cell Melanoma Res 2022; 35:356-368. [PMID: 35218152 DOI: 10.1111/pcmr.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/04/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
Treatments for giant congenital melanocytic nevi (GCMN) are extremely limited. Thus, there is an urgent need for development of relevant targeted therapies. However, current lack of preclinical cell models restricts progress in GCMN research. In this study, we aimed to establish and characterize an immortalized GCMN cell line. GCMN cells were successfully immortalized by means of lentivirus-mediated simian virus 40 large T transfection. The immortalized GNC cell line (ImGNC) showed lower proliferation rate and higher melanin content than primary melanocytes. Expression levels of the differentiation gene MITF and stemness genes TWIST1, SNAI1, and FOXD3 were elevated in ImGNCs; however, the established ImGNC cell line was immortalized but not transformed. Sanger sequencing detected the heterozygous NRASQ61K mutation in ImGNCs, but not the BRAFV600E mutation. Despite carrying the NRASQ61K allele, ImGNCs demonstrated suppressed MAPK activation and elevated PI3K/Akt activation, as compared with primary melanocytes. Drug sensitivity analysis showed that ImGNCs are more sensitive to PI3K/Akt and Bcl-2 inhibitors than to MEK or ERK inhibitors. Unlike the proliferation-inhibiting effect of PI3K/Akt inhibitors, the Bcl-2 inhibitor navitoclax promptly promoted apoptosis in ImGNCs. Considering the low proliferation characteristics of GCMN in vivo, Bcl-2 may be a potential therapeutic target that warrants further research.
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Affiliation(s)
- Qingxiong Yu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Rehanguli Aimaier
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Man-Hon Chung
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiwei Cui
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yuehua Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Zhichao Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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20
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Goto K, Pissaloux D, Fraitag S, Amini M, Vaucher R, Tirode F, de la Fouchardière A. RASGRF1-rearranged Cutaneous Melanocytic Neoplasms With Spitzoid Cytomorphology: A Clinicopathologic and Genetic Study of 3 Cases. Am J Surg Pathol 2022; 46:655-663. [PMID: 34799483 DOI: 10.1097/pas.0000000000001839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spitz neoplasms, according to 2018 WHO Blue Book, are morphologically defined by spindled and/or epithelioid melanocytes and genetically by either HRAS mutations or kinase gene fusions. The terminology "spitzoid" refers to lesions with similar morphology but with alternate or undefined genetic anomalies. Herein, we present 3 melanocytic neoplasms with a spitzoid cytomorphology, variable nuclear atypia, and harboring undescribed fusions involving RASGRF1. Two cases presented as unpigmented papules on the heel of a 26-year-old female (case 1) and the forearm of a 13-year-old boy (case 2). They were classified as low-grade melanocytomas (WHO 2018). The third case appeared as a pigmented ulcer on the sole of a 72-year-old female (case 3) that displayed diagnostic features of an invasive melanoma (Breslow thickness 6 mm, Clark level V). A wide skin reexcision identified an epidermotropic metastasis, and sentinel lymph node biopsy displayed multiple subcapsular metastatic deposits. RNA sequencing revealed CD63::RASGRF1, EHBP1::RASGRF1, and ABCC2::RASGRF1 fusions in cases 1 to 3, respectively. They were confirmed by a RASGRF1 break-apart fluorescence in situ hybridization technique. Translocations of RASGRF1, a gene coding a guanine nucleotide exchange factor but not a kinase, have rarely been reported in tumors. While all these cases showed spitzoid cytomorphology, it is too early to tell if they are true Spitz neoplasms as currently defined.
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Affiliation(s)
- Keisuke Goto
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital
- Department of Pathology, Itabashi Central Clinical Laboratory
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo
- Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Sunto
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute
- Department of Diagnostic Pathology, Osaka National Hospital, Osaka
- Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Daniel Pissaloux
- Departments of Biopathology
- Sword University Claude Bernard Lyon I, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon
| | - Sylvie Fraitag
- Department of Pathology, Necker-Enfants Malades Hospital
- Department of Pathology, Paris Hospitals - Public Assistance, Paris, France
| | | | - Richard Vaucher
- Plastic Reconstructive and Aesthetic Surgery, Center Léon Bérard
| | - Franck Tirode
- Departments of Biopathology
- Sword University Claude Bernard Lyon I, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon
| | - Arnaud de la Fouchardière
- Departments of Biopathology
- Sword University Claude Bernard Lyon I, INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Lyon
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21
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Hanft KM, Hamed E, Kaiser M, Würtemberger J, Schneider M, Pietsch T, Feige U, Meiss F, Krengel S, Niemeyer C, Hettmer S. Combinatorial effects of azacitidine and trametinib on NRAS-mutated melanoma. Pediatr Blood Cancer 2022; 69:e29468. [PMID: 34866327 DOI: 10.1002/pbc.29468] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/24/2021] [Accepted: 11/01/2021] [Indexed: 11/06/2022]
Abstract
Congenital melanocytic nevus (CMN) syndrome represents a mosaic RASopathy, typically caused by postzygotic NRAS codon 61 mutations, which originate in ectodermal precursor cells and result in melanocyte deposits in the skin and central nervous system (CNS). Affected patients are prone to develop uniformly fatal melanomas in the skin and CNS. Here, we report the case of a 2.7-year-old male with CMN syndrome, diffuse leptomeningeal melanosis and CNS melanoma, who underwent experimental therapy with the DNA methyltransferase inhibitor azacitidine in combination with the mitogen-activated protein kinase (MEK) inhibitor trametinib with exceptional clinical and radiological response. Response to combination therapy appeared to be more durable than the treatment response observed in several other severely affected patients treated with trametinib for late-stage disease. Correspondingly, concomitant exposure to trametinib and azacitidine prevented development of trametinib resistance in NRAS-mutated human melanoma cells in vitro. Also, azacitidine was shown to inhibit growth and mitogen-activated protein kinase 1/2 (ERK1/2) phosphorylation of melanoma cells and act synergistically with trametinib to inhibit the growth of trametinib-resistant melanoma cells. These observations suggest that azacitidine enhances trametinib monotherapy and may represent a promising candidate drug for combination therapies to enhance the efficacy of MEK inhibitors in RAS-driven diseases.
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Affiliation(s)
- Klara-Maria Hanft
- Division of General Pediatrics, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Ebrahem Hamed
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Max Kaiser
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Julia Würtemberger
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Michaela Schneider
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Torsten Pietsch
- Department of Neuropathology, DGNN Brain Tumor Reference Center, University of Bonn Medical Centre, Bonn, Germany
| | - Ursula Feige
- Department of Neuroradiology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Frank Meiss
- Department of Dermatology, Venerology and Allergology, University Medical Center Freiburg, Freiburg, Germany
| | | | - Charlotte Niemeyer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Centre Freiburg (CCCF), Medical Center - University of Freiburg, Freiburg, Germany
| | - Simone Hettmer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany.,Comprehensive Cancer Centre Freiburg (CCCF), Medical Center - University of Freiburg, Freiburg, Germany.,Spemann Graduate School of Biology and Medicine (SGBM), Freiburg, Germany
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22
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Jahnke MN, O'Haver J, Gupta D, Hawryluk EB, Finelt N, Kruse L, Jen M, Horii KA, Frieden IJ, Price H, Coughlin CC. Care of Congenital Melanocytic Nevi in Newborns and Infants: Review and Management Recommendations. Pediatrics 2021; 148:183438. [PMID: 34845496 DOI: 10.1542/peds.2021-051536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 01/06/2023] Open
Abstract
A pediatric dermatology expert working group performed a narrative review to describe care related to congenital melanocytic nevi (CMN) in neonates and infants. There are no published guidelines for most aspects of care, including routine skin care and visit intervals. Few guidelines exist for surgical management; newer recommendations favor conservative practice. Emerging evidence contributes to recommendations for screening MRI to evaluate for neural melanosis and related central nervous system complications, however, more research is needed. Risk for melanoma is generally low, but those with large, giant, or multiple CMN have a higher risk. Multidisciplinary care, with a focus on family and patient preferences, is of paramount importance. Without standardized screening and management guidelines, questions abound regarding appropriate physical examination intervals, potential treatment including full or partial excision, timing and frequency of imaging, melanoma risk, and assessment for neural melanosis. This review highlights the current state of knowledge concerning care of patients with CMN, reveals gaps in the literature surrounding skin care, and provides management recommendations. We additionally discuss cutaneous complications of CMN, such as pruritus, hypertrichosis, and wound healing. Resources and references for families and providers can help patients navigate this sometimes challenging diagnosis. Finally, we contribute expert care recommendations to the current body of literature as a foundation for the development of future, more comprehensive care guidelines.
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Affiliation(s)
- Marla N Jahnke
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Judith O'Haver
- Division of Dermatology, Phoenix Children's Hospital and College of Medicine, University of Arizona-Phoenix, Phoenix, Arizona
| | - Deepti Gupta
- Division of Dermatology, Seattle Children's Hospital, Seattle, Washington
| | - Elena B Hawryluk
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Nika Finelt
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Lacey Kruse
- Division of Dermatology, Lurie Children's Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melinda Jen
- Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kimberly A Horii
- Division of Dermatology, Children's Mercy-Kansas City, Kansas City, Missouri
| | - Ilona J Frieden
- Departments of Dermatology and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California
| | - Harper Price
- Division of Dermatology, Phoenix Children's Hospital and College of Medicine, University of Arizona-Phoenix, Phoenix, Arizona
| | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, School of Medicine, Washington University in St Louis, St Louis, Missouri
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23
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Abstract
Congenital pigmentary anomalies may be evident at birth or soon after, with some birthmarks becoming apparent later in infancy or early childhood. It is important to recognize various pigmentary anomalies in the neonate, most of which are benign but a subset of which are associated with cutaneous morbidity or systemic ramifications and require further evaluation. This review will focus on pigmentary mosaicism, congenital melanocytic nevi, nevus spilus, dermal melanocytosis, and pigmentary anomalies associated with neurofibromatosis type 1 (café au lait spots, freckling, plexiform neurofibromas, nevus anemicus), tuberous sclerosis (hypomelanotic macules), and incontinentia pigmenti.
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24
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Morimoto N, Mitsui T, Katayama Y, Kakudo N, Ogino S, Tsuge I, Sakamoto M, Hihara M, Kusumoto K. Cultured epithelial autografts for the treatment of large-to-giant congenital melanocytic nevus in 31 patients. Regen Ther 2021; 18:217-222. [PMID: 34377751 PMCID: PMC8313801 DOI: 10.1016/j.reth.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/01/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Giant congenital melanocytic nevus (GCMN) is a large melanocytic nevus, and its full-thickness removal is usually difficult due to the lack of skin available for reconstruction. Curettage is an alternative approach in cases of GCMN to remove the superficial dermis above the cleavage plane with a curette in the neonatal period, and its major complications include repigmentation, retarded epithelization, and hypertrophic scar formation. In Japan, the JACE® cultured epidermal autograft (CEA) was approved and covered by public healthcare insurance for the treatment of congenital melanocytic nevus (CMN) that is difficult to treat with conventional methods in 2016. We have used CEA for wounds after curettage in the neonatal period or following ablation after the neonatal period in combination with laser therapies to reduce the above-mentioned complications. Methods In this study, we summarized all consecutive CMN patients treated using CEA from December 2016 to April 2019 and evaluated the duration required for epithelialization, incidence of hypertrophic scar, and color change in the target nevus by comparing the L∗ values one year later between the Curettage group, the non-Curettage group with initial treatment or the subsequent group. Results No significant differences were seen in the epithelization period or incidence of hypertrophic scars among the groups, but the color of the target nevus was improved significantly in the Curettage group (p < 0.01) and non-Curettage group with initial treatment (p < 0.01). Conclusions In conclusion, CEA seems to accelerate epithelization after curettage or ablation of CMN, and this treatment could improve the color of CMN when applied initially.
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Affiliation(s)
- Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
- Corresponding author. 54,Kawahara-cho Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. Fax: + 81-75-751-4340
| | - Toshihito Mitsui
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Yasuhiro Katayama
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Natsuko Kakudo
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Shuichi Ogino
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Itaru Tsuge
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto University, Japan
| | - Masakatsu Hihara
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
| | - Kenji Kusumoto
- Department of Plastic and Reconstructive Surgery, Kansai Medical University, Japan
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25
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Mumtaz Hashmi H, Shamim N, Kumar V, Idrees S. Giant Congenital Melanocytic Nevi in a Pakistani Newborn. Cureus 2021; 13:e15210. [PMID: 34178529 PMCID: PMC8221640 DOI: 10.7759/cureus.15210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Congenital melanocytic nevi arise from overgrowth or disrupted migration of melanocyte precursor in the neural crest. They are also known as coat-sleeve, stocking, bathing trunk or garment nevi. The colour ranges from brown to black, with the lesions presenting as flat to raised nevi. Lesions presenting at birth with a diameter greater than 20cm are labelled giant congenital melanocytic nevi. Risk increases with an increase in the number of satellite lesions near the giant nevus. Management includes regular clinical follow-up monitoring of changes in the lesion and surgical procedures in cases with risk of melanoma and psychological support. The purpose of this case presentation is to describe a rare issue of giant congenital melanocytic nevi in a newborn, along with a literature review and discussion on possible management options.
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Affiliation(s)
| | - Nazia Shamim
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | - Vinod Kumar
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
| | - Sidra Idrees
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, PAK
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26
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Farabi B, Akay BN, Goldust M, Wollina U, Atak MF, Rao B. Congenital melanocytic naevi: An up-to-date overview. Australas J Dermatol 2021; 62:e178-e191. [PMID: 33591589 DOI: 10.1111/ajd.13535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1-6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature.
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Affiliation(s)
- Banu Farabi
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey.,Department of Dermatology, Robert Wood Johnson Medical Centre, Rutgers University, New Brunswick, New Jersey, USA
| | - Bengu Nisa Akay
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Mohamad Goldust
- Department of Dermatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Mehmet Fatih Atak
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Babar Rao
- Department of Dermatology, Robert Wood Johnson Medical Centre, Rutgers University, New Brunswick, New Jersey, USA
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27
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Genetische Mosaikerkrankungen der Haut. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01103-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Genomic and Clinicopathologic Characteristics of PRKAR1A-inactivated Melanomas: Toward Genetic Distinctions of Animal-type Melanoma/Pigment Synthesizing Melanoma. Am J Surg Pathol 2020; 44:805-816. [PMID: 32118628 DOI: 10.1097/pas.0000000000001458] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Melanocytic tumors with inactivation of protein kinase A regulatory subunit-α (PRKAR1A) have large oval nuclei and intense pigmentation. Historically, these tumors have been categorized under various names, including epithelioid blue nevus, pigmented epithelioid melanocytoma (PEM) and animal-type melanoma. Although a subset of PEM harbor BRAF activating mutations and biallelic inactivation of PRKAR1A, there are only a few reports of melanomas, or of tumors with genomic alterations beyond those of PEMs. Herein, we describe the clinicopathologic and genetic features of 8 melanomas and tumors that lack PRKAR1α expression by immunohistochemistry but do not fit with conventional PRKAR1A-inactivated melanocytomas. These tumors tended to affect younger patients than conventional melanomas (median age=38 y) and presented as dark brown/black papules and nodules. Histopathologically, they demonstrated nodularity, sometimes in a background of conventional melanoma, and large vesicular nuclei with prominent nucleoli. With the exception of 1 case, the mitotic index was not significantly elevated. Immunohistochemically, all cases showed loss of PRKAR1α and of p16 expression. Seven tumors underwent massively parallel short read (next-generation) sequencing of a panel of 480 cancer-associated genes. Five tumors demonstrated truncating mutations of PRKAR1A and the 2 in which such mutations were not identified demonstrated loss of heterozygosity of the PRKAR1A locus. Four of the tumors harbored BRAF V600E mutations, and 1 harbored a FAM39B-BRAF gene fusion. Another harbored a GNA11 activating mutation. A MAP kinase activating mutation was not identified in the remaining case. Four tumors displayed TERT promoter mutations and chromosomal copy number changes supporting the diagnosis of melanoma. Two cases without these alterations and were classified as "high-grade PRKAR1A-inactivated melanocytomas". The 1 case with widespread metastases demonstrated mutations in TP53 and RB1. Overall, we provide the first genetic characterization of PRKAR1A-inactivated melanomas, discuss the differential diagnosis of heavily pigmented epithelioid melanocytic neoplasms, and propose a new nomenclature for such tumors.
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29
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Ruggieri M, Polizzi A, Catanzaro S, Bianco ML, Praticò AD, Di Rocco C. Neurocutaneous melanocytosis (melanosis). Childs Nerv Syst 2020; 36:2571-2596. [PMID: 33048248 DOI: 10.1007/s00381-020-04770-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023]
Abstract
Neurocutaneous melanosis (NCM; MIM # 249400; ORPHA: 2481], first reported by the Bohemian pathologist Rokitansky in 1861, and now more precisely defined as neurocutaneous melanocytosis, is a rare, congenital syndrome characterised by the association of (1) congenital melanocytic nevi (CMN) of the skin with overlying hypertrichosis, presenting as (a) large (LCMN) or giant and/or multiple (MCMN) melanocytic lesions (or both; sometimes associated with smaller "satellite" nevi) or (b) as proliferative melanocytic nodules; and (2) melanocytosis (with infiltration) of the brain parenchyma and/or leptomeninges. CMN of the skin and leptomeningeal/nervous system infiltration are usually benign, more rarely may progress to melanoma or non-malignant melanosis of the brain. Approximately 12% of individuals with LCMN will develop NCM: wide extension and/or dorsal axial distribution of LCMN increases the risk of NCM. The CMN are recognised at birth and are distributed over the skin according to 6 or more patterns (6B patterns) in line with the archetypical patterns of distribution of mosaic skin disorders. Neurological manifestations can appear acutely in infancy, or more frequently later in childhood or adult life, and include signs/symptoms of intracranial hypertension, seizures/epilepsy, cranial nerve palsies, motor/sensory deficits, cognitive/behavioural abnormalities, sleep cycle anomalies, and eventually neurological deterioration. NMC patients may be symptomatic or asymptomatic, with or without evidence of the typical nervous system changes at MRI. Associated brain and spinal cord malformations include the Dandy-Walker malformation (DWM) complex, hemimegalencephaly, cortical dysplasia, arachnoid cysts, Chiari I and II malformations, syringomyelia, meningoceles, occult spinal dysraphism, and CNS lipoma/lipomatosis. There is no systemic involvement, or only rarely. Pathogenically, single postzygotic mutations in the NRAS (neuroblastoma RAS viral oncogene homologue; MIM # 164790; at 1p13.2) proto-oncogene explain the occurrence of single/multiple CMNs and melanocytic and non-melanocytic nervous system lesions in NCM: these disrupt the RAS/ERK/mTOR/PI3K/akt pathways. Diagnostic/surveillance work-ups require physical examination, ophthalmoscopy, brain/spinal cord magnetic resonance imaging (MRI) and angiography (MRA), positron emission tomography (PET), and video-EEG and IQ testing. Treatment strategies include laser therapy, chemical peeling, dermabrasion, and surgical removal/grafting for CMNs and shunt surgery and surgical removal/chemo/radiotherapy for CNS lesions. Biologically targeted therapies tailored (a) BRAF/MEK in NCM mice (MEK162) and GCMN (trametinib); (b) PI3K/mTOR (omipalisib/GSK2126458) in NMC cells; (c) RAS/MEK (vemurafenib and trametinib) in LCMNs cells; or created experimental NMC cells (YP-MEL).
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Affiliation(s)
- Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Stefano Catanzaro
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
- Unit of Neonatology and Neonatal Intensive Care Unit (NICU), AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Manuela Lo Bianco
- Postgraduate Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea D Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Concezio Di Rocco
- Pediatric Neurosurgery, International Neuroscience Institute (INI), Hannover, Germany
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30
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Zou Y, Sun Y, Zeng X, Liu Y, Cen Q, Gu H, Lin X, Cai R, Chen H. Novel genetic alteration in congenital melanocytic nevus: MAP2K1 germline mutation with BRAF somatic mutation. Hereditas 2020; 157:35. [PMID: 32847629 PMCID: PMC7449081 DOI: 10.1186/s41065-020-00147-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
Congenital melanocytic nevus (CMN) represent a benign proliferative skin disease in the epidermis and dermis. CMN are historically known to be associated with activating NRAS or BRAF mutations. Melanoma frequently harbors the BRAF p.Val600Glu mutation, which is also commonly found in benign nevi. A recent study reported mutation of MAP2K1, a downstream effector of the RAS-RAF-MEK pathway, in melanoma with an overall frequency of 8%. Later, in 2019, Jansen P detected one activating MAP2K1 mutation in acral nevi. However, it is unknown whether MAP2K1 mutations are common in CMN, and how MAP2K1 contributes to the pathogenesis of CMN remains to be determined.In this study, we report one patient clinically and histologically diagnosed with CMN, with the MAP2K1 germline mutation and a BRAF p.Val600Glu somatic hit in the lesion. To the best of our knowledge, this is the first report of the coexistence of mutated BRAF and MAP2K1 in CMN, which may suggest that MAP2K1 mutations contribute to the occurrence and development of nevus expanding our knowledge of the genetics of CMN.
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Affiliation(s)
- Yun Zou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Yi Sun
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Xiaojing Zeng
- Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Yun Liu
- Institutes of Biomedical Sciences, Fudan University, Shanghai, PR China
| | - Qingqing Cen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Hao Gu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
| | - Ren Cai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China. .,Bio-X Institute, Shanghai Jiao Tong University, Shanghai, China.
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
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31
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Abstract
PURPOSE OF REVIEW To update pediatric providers on new developments in our understanding of the clinical presentation, genetics, and systemic risks associated with congenital melanocytic nevi (CMN). RECENT FINDINGS CMN are primarily caused by sporadic postzygotic somatic mutations, most frequently in NRAS, and studies of the genetic underpinnings of CMN have demonstrated a diverse array of genetic drivers. The primary complications of large and giant CMN include neurocutaneous melanocytosis and malignant melanoma. Abnormalities in CNS MRI may predict a worse clinical course for patients and increased risk of melanoma. Targeted therapies of the MEK pathway have begun to be studied for the treatment of CMN and prevention of associated complications. SUMMARY Patients with large and giant CMN should be managed by an interdisciplinary care team for the monitoring of dermatologic, neurologic, and psychosocial concerns. Ongoing research is underway to better characterize the genetic drivers of CMN and to better guide development of targeted therapeutics.
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32
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Goto K, Pissaloux D, Durand L, Tirode F, Guillot B, de la Fouchardière A. Novel three-way complex rearrangement of TRPM1-PUM1-LCK in a case of agminated Spitz nevi arising in a giant congenital hyperpigmented macule. Pigment Cell Melanoma Res 2020; 33:767-772. [PMID: 32386465 DOI: 10.1111/pcmr.12884] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/06/2020] [Accepted: 04/20/2020] [Indexed: 11/28/2022]
Abstract
The genetic anomalies associated with the agminated variant of Spitz nevus have so far been limited to HRAS G13R mutations, especially when arising within a nevus spilus. A previous report exposed the case of a man with a giant pigmented macule involving his upper right limb and trunk. Since childhood, Spitz nevi have been periodically arising, within the pigmented area. The histopathology of several lesions displayed the usual criteria of junctional, compound, or intradermal Spitz nevi with a diversity of cytomorphological and architectural features. Some lesions spontaneously regressed. Genetic studies confirmed in three lesions an identical translocation involving TRPM1, PUM1, and LCK. No mutations in HRAS, NRAS, BRAF, or other known fusion genes linked to Spitz nevus were detected. LCK break-apart fluorescence in situ hybridization confirmed the rearrangement was present not only in the melanocytic proliferation but also in the surrounding non-spitzoid melanocytes. This report expands the list of genetic alterations involved both in giant congenital macules and in agminated Spitz nevi, and also extends the concept of mosaicism in melanocytes to gene translocations.
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Affiliation(s)
- Keisuke Goto
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.,Department of Diagnostic Pathology, Shizuoka Cancer Center Hospital, Nagaizumi, Japan.,Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan.,Department of Dermatology, Hyogo Cancer Center, Akashi, Japan
| | - Daniel Pissaloux
- Department of Biopathology, Center Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Franck Tirode
- Department of Biopathology, Center Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bernard Guillot
- Department of Dermatology, Saint Eloi University Hospital, CHU Montpellier, Montpellier, France
| | - Arnaud de la Fouchardière
- Department of Biopathology, Center Léon Bérard, Lyon, France.,INSERM 1052, CNRS 5286, Centre Léon Bérard, Cancer Research Center of Lyon, Equipe Labellisée Ligue contre le Cancer, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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33
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Sun Y, Zou Y, Wang L, Gu H, Cen Q, Chen H, Lin X, Cai R. Giant congenital melanocytic nevus of the scalp: from clinical-histological to molecular diagnosis. Hereditas 2020; 157:21. [PMID: 32430073 PMCID: PMC7236929 DOI: 10.1186/s41065-020-00133-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
Congenital melanocytic nevus (CMN) is a benign proliferative skin disease in the epidermis and dermis. Large to giant CMNs are estimated to be associated with an increased lifetime risk of malignancy. It is necessary to estimate and monitor the risk of malignant transformation for giant CMNs. To date, the clinical “ABCD” criteria and immunohistochemistry studies can be confusing and, to some extent, subjective. Accordingly, the elucidation of genomic analyses of nevi is required to better understand the malignant transformation of CMNs. Here, we describe two large to giant CMNs of the scalp with opposite clinical-histological and molecular evaluations of potential malignancy risk. To our knowledge, this is the first description of a genetic study of large to giant CMNs of the scalp in East Asia. We recommend reviewing the molecular diagnosis together with careful medical history and histological information to facilitate the evaluation of the potential malignancy risk.
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Affiliation(s)
- Yi Sun
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yun Zou
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lizhen Wang
- Department of oral pathology, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hao Gu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qingqing Cen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Ren Cai
- Department of Plastic and Reconstructive Surgery, Shanghai 9th Peoples Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China. .,Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, P. R. China. .,Institutes of Biomedical Sciences, Fudan University, Shanghai, P. R. China.
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Can Combination MEK and Akt Inhibition Slay the Giant Congenital Nevus? J Invest Dermatol 2020; 139:1857-1859. [PMID: 31445573 DOI: 10.1016/j.jid.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022]
Abstract
The clinical management of large and giant congenital melanocytic nevi (lgCMN) relies heavily upon iterative surgical procedures. In this issue Rouille et al. (2019) use lgCMN explants and a newly developed patient-derived xenograft model to show that the local administration of MEK and Akt inhibitors limits the lgCMN proliferative potential. These findings, along with emerging reports, support continued investigation of targeted therapies in lgCMN.
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Quoi de neuf en dermatologie pédiatrique ? Ann Dermatol Venereol 2019; 146:12S32-12S38. [DOI: 10.1016/s0151-9638(20)30104-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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