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Sampath AJ, Westerkam LL, Blum FR, Alhusayen R, Bechara FG, Caffrey J, Carmona-Rivera C, Chandran NS, George R, Goldberg SR, Gudjonsson JE, Hansen SL, Ingram JR, Kirby B, Marzano AV, Matusiak Ł, Orgill DP, Prens E, van der Zee HH, van Straalen KR, Zouboulis CC, Byrd AS, Frew JW, Lowes MA, Naik HB, Sokumbi O, Mi QS, Miedema JR, Googe PB, Sayed CJ. Standardized Protocols for Clinical and Histopathological Characterization of Hidradenitis Suppurativa Tissue Specimens. J Invest Dermatol 2024:S0022-202X(24)00443-3. [PMID: 38901775 DOI: 10.1016/j.jid.2024.02.041] [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: 11/15/2023] [Revised: 02/07/2024] [Accepted: 02/26/2024] [Indexed: 06/22/2024]
Abstract
Methods for describing and reporting the clinical and histologic characteristics of cutaneous tissue samples from patients with hidradenitis suppurativa (HS) are not currently standardized, limiting clinicians' and scientists' ability to uniformly record, report, and communicate about the characteristics of tissue used in translational experiments. A recently published consensus statement outlined morphological definitions of typical HS lesions, but no consensus has been reached regarding clinical characterization and examination of HS tissue samples. In this study, we aimed to establish a protocol for reporting histopathologic and clinical characteristics of HS tissue specimens. This study was conducted from May 2023 to August 2023. Experts in clinical care, dermatopathology, and translational research were recruited, and a modified Delphi technique was used to develop a protocol for histologic reporting and clinical characterization of submitted tissue specimens from patients with HS. A total of 27 experts participated (14 dermatologists, 3 fellowship-trained dermatopathologists, 3 plastic surgeons, 3 general surgeons, and 4 research scientists) in creating and reviewing protocols for the clinical and histopathological examination of HS tissue specimens. The protocols were formatted as a synoptic report and will help to consistently classify specimens in biobanks on the basis of histologic features and more accurately report and select samples used in translational research projects.
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Affiliation(s)
- Ashwath Jonathan Sampath
- Department of Dermatology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Linnea L Westerkam
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Franklin R Blum
- Grand Strand Medical Center, Myrtle Beach, South Carolina, USA
| | - Raed Alhusayen
- Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Falk G Bechara
- Department of Dermatology, Venerology and Allergology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Julie Caffrey
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carmelo Carmona-Rivera
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Ralph George
- Department of Surgery, University of Toronto, Toronto, Canada
| | | | | | - Scott L Hansen
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, San Francisco, California, USA
| | - John R Ingram
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Brian Kirby
- Department of Dermatology, St Vincent's University Hospital, Dublin, Ireland; Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Łukasz Matusiak
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Dennis P Orgill
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Errol Prens
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hessel H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kelsey R van Straalen
- Laboratory for Experimental Immunodermatology, Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Angel S Byrd
- Department of Dermatology, Howard University College of Medicine, Washington, District of Columbia, USA
| | - John W Frew
- Laboratory of Translational Cutaneous Medicine, Ingham Institute, Sydney, Australia
| | - Michelle Anne Lowes
- Laboratory for Investigative Dermatology, The Rockefeller University, New York City, New York, USA
| | - Haley B Naik
- Division of Plastic and Reconstructive Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Olayemi Sokumbi
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Jayson R Miedema
- Department of Dermatology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul B Googe
- Department of Dermatology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher J Sayed
- Department of Dermatology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Maurichi A, Barretta F, Patuzzo R, Sala L, Miceli R, Gallino G, Mattavelli I, Leva A, Simonotti N, Taglione B, Cossa M, Belotti A, Valeri B, Cortinovis U, Santinami M. Association of Excision Margin Size With Local Recurrence and Survival in Patients With T1a Melanoma at Critical Structures. JAMA Dermatol 2023; 159:587-595. [PMID: 37043209 PMCID: PMC10099098 DOI: 10.1001/jamadermatol.2023.0620] [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: 10/13/2022] [Accepted: 02/16/2023] [Indexed: 04/13/2023]
Abstract
Importance Melanoma guidelines recommend surgical excision with 10-mm margins for T1 melanoma. However, this procedure may be problematic at sites close to critical structures such as the scalp, face, external genitalia, acral, periumbilical, and perineal areas. Objective To compare outcomes of wide (10-mm margins) vs narrow (5-mm margins) excision in patients with T1a melanoma near critical structures. Design, Setting, and Participants This cohort study was a retrospective comparison of 1341 consecutive patients aged 18 years or older from the National Cancer Institute of Milan, Italy, diagnosed between 2001 and 2020 with T1a cutaneous melanoma close to critical structures who accepted wide excision vs narrow excision. Exposures Local recurrence and melanoma-specific mortality (MSM) rates with 5-mm vs 10-mm excision margins. Main Outcomes and Measures The primary aim of the study was to ascertain whether a narrower (5-mm) vs wider (10-mm) excision margin was associated with local recurrence and MSM. The secondary aim was to compare the need for reconstructive surgery in the groups defined by excision margin width. Between April 28 and August 7, 2022, associations were assessed by weighted Cox and Fine-Gray univariable and multivariable models. Results A total of 1179 patients met the inclusion criteria (median [IQR] age, 50.0 [39.5-63.0] years; female, 610 [51.7%]; male, 569 [49.3%]). Six hundred twenty-six patients (53.1%) received a wide excision (434 [69.3%] with linear repair and 192 [30.7%] with flap or graft reconstruction) and 553 (46.9%) received a narrow excision (491 [88.8%] with linear repair and 62 [11.2%] with flap or graft reconstruction). The weighted 10-year MSM was 1.8% (95% CI, 0.8%-4.2%) in the wide group and 4.2% (95% CI, 2.2%-7.9%) in the narrow group; the weighted 10-year local recurrence rate was 5.7% (95% CI, 3.9%-8.3%) in the wide group and 6.7% (95% CI, 4.7%-9.5%) in the narrow group. Breslow thickness greater than 0.4 mm (subdistribution hazard ratio [sHR] for 0.6 vs 0.4 mm, 2.42; 95% CI, 1.59-3.68; P < .001) and mitotic rate greater than 1/mm2 (sHR for a single increment, 3.35; 95% CI, 2.59-4.32; P < .001) were associated with worse MSM. Multivariable analysis showed that acral lentiginous melanoma, lentigo maligna melanoma, and increasing Breslow thickness were associated with a higher incidence of local recurrence. Conclusions and Relevance The study's findings suggest that local excision with 5-mm margins for T1a melanoma may not be associated with an increased risk of local recurrence. Breslow thickness greater than 0.4 mm, mitotic rate greater than 1/mm2, and acral lentiginous melanoma and lentigo maligna melanoma subtypes were associated with a higher risk of recurrence. These findings may be useful for future melanoma treatment guidelines.
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Affiliation(s)
- Andrea Maurichi
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Francesco Barretta
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Roberto Patuzzo
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Sala
- Plastic and Reconstructive Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosalba Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Gianfranco Gallino
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Mattavelli
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Andrea Leva
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Nicolò Simonotti
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Bianca Taglione
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mara Cossa
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alessia Belotti
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Umberto Cortinovis
- Plastic and Reconstructive Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mario Santinami
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Bunnell AM, Nedrud SM, Fernandes RP. Classification and Staging of Melanoma in the Head and Neck. Oral Maxillofac Surg Clin North Am 2022; 34:221-234. [PMID: 35491079 DOI: 10.1016/j.coms.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The rates of melanoma continue to rise, with recent estimates have shown that 18% to 22% of new melanoma cases occur within the head and neck in the United States each year. The mainstay of treatment of nonmetastatic primary melanomas of the head and neck includes the surgical resection and management of regional disease as indicated. Thorough knowledge of the classification and staging of melanoma is paramount to evaluate prognosis, determine the appropriate surgical intervention, and assess eligibility for adjuvant therapy and clinic trials. The traditional clinicopathologic classification of melanoma is based on morphologic aspects of the growth phase and distinguishes 4 of the most common subtypes as defined by the World Health Organization: superficial spreading, nodular, acral lentiginous, and lentigo maligna melanoma. The data used to derive the AJCC TNM Categories are based on superficial spreading melanoma and nodular subtypes. Melanoma is diagnosed histopathologically following initial biopsy that will assist with classifying the tumor to guide treatment. Classification is based on tumor thickness and ulceration (T stage, Breslow Staging), Regional Lymph Node Involvement (N Stage), and presence of metastasis (M Stage). Tumor thickness (Breslow thickness) and ulceration are 2 independent prognostic factors that have been shown to be the strongest predictors of survival and outcome. Clark level of invasion and mitotic rate are no longer incorporated into the current AJCC staging system, but still have shown to be important prognostic factors for cutaneous melanoma. For patients with metastatic (Stage IV) disease Lactate Dehydrogenase remains an independent predictor of survival. The Maxillofacial surgeon must remain up to date on the most current management strategies in this patient population. Classification systems and staging provide the foundation for clinical decision making and prognostication for the Maxillofacial surgeon when caring for these patients.
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Affiliation(s)
- Anthony M Bunnell
- Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA.
| | - Stacey M Nedrud
- Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA
| | - Rui P Fernandes
- Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA
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Morrison S, Han G, Elenwa F, Vetto JT, Fowler G, Leong SP, Kashani-Sabet M, Pockaj B, Kosiorek HE, Zager JS, Messina JL, Mozzillo N, Schneebaum S, Han D. Is There a Relationship Between TILs and Regression in Melanoma? Ann Surg Oncol 2022; 29:2854-2866. [DOI: 10.1245/s10434-021-11251-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/12/2021] [Indexed: 12/11/2022]
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Tababa E, Teulings HE, Bhawan J. Differences Between Recommended Surgical Margins and Measured Histological Margins in Malignant Melanoma In Situ and Malignant Melanomas. Am J Dermatopathol 2021; 43:881-886. [PMID: 33534209 DOI: 10.1097/dad.0000000000001914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Wide local excision (WLE) using appropriate surgical margins is the standard surgical management for malignant melanoma in situ (MMIS) and primary cutaneous malignant melanoma (MM). The actual width of the histologic margins is frequently not assessed, whereas narrow histologic margins are associated with an increase in local melanoma recurrence. Our objective was to analyze the actual measured histological margins of WLE specimens of MMIS and MM cases and compare them with their recommended surgical margins. A retrospective study of formalin fixed specimens of MMIS and invasive MM treated with WLE from a large university-affiliated dermatopathology laboratory was conducted. Among a total of 164 MMIS and 128 MM cases, 14 MMIS (8.5%) and 7 MM (5.9%) had positive lateral margins. The median histologic margin for MMIS, after a 15% tissue shrinkage adjusted, was 2.7 mm [1.3-3.9] for LM type and 3.9 mm [2.3-5.6] for non-LM type, in contrast to the recommended 5-mm margin. In 96 MM of T1 type (≤1.0 mm), the median adjusted histologic margin was 6.7 mm [3.5-9.1] in contrast to the recommended 10-mm margin. These results show that measured and adjusted median histologic margins in WLE specimens in both MMIS and MM of T1 type were significantly narrower than the recommended surgical margins, regardless of anatomic location. These differences are concerning, whether they reflect clinicians' intentional or unintentional deviation from recommended guidelines.
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Affiliation(s)
- Erin Tababa
- Department of Dermatology, Dermatopathology Section, Boston University School of Medicine, Boston, MA
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Maurichi A, Barretta F, Patuzzo R, Miceli R, Gallino G, Mattavelli I, Barbieri C, Leva A, Angi M, Lanza FB, Spadola G, Cossa M, Nesa F, Cortinovis U, Sala L, Di Guardo L, Cimminiello C, Del Vecchio M, Valeri B, Santinami M. Survival in Patients With Sentinel Node-Positive Melanoma With Extranodal Extension. J Natl Compr Canc Netw 2021; 19:1165-1173. [PMID: 34311443 DOI: 10.6004/jnccn.2020.7693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prognostic parameters in sentinel node (SN)-positive melanoma are important indicators to identify patients at high risk of recurrence who should be candidates for adjuvant therapy. We aimed to evaluate the presence of melanoma cells beyond the SN capsule-extranodal extension (ENE)-as a prognostic factor in patients with positive SNs. METHODS Data from 1,047 patients with melanoma and positive SNs treated from 2001 to 2020 at the Istituto Nazionale dei Tumori in Milano, Italy, were retrospectively investigated. Kaplan-Meier survival and crude cumulative incidence of recurrence curves were estimated. A multivariable logistic model was used to investigate the association between ENE and selected predictive factors. Cox models estimated the effect of the selected predictors on survival endpoints. RESULTS Median follow-up was 69 months. The 5-year overall survival rate was 62.5% and 71.7% for patients with positive SNs with and without ENE, respectively. The 5-year disease-free survival rate was 54.0% and 64.0% for patients with positive SNs with and without ENE, respectively. The multivariable logistic model showed that age, size of the main metastatic focus in the SN, and numbers of metastatic non-SNs were associated with ENE (all P<.0001). The multivariable Cox regression models showed the estimated prognostic effects of ENE associated with age, ulceration, size of the main metastatic focus in the SN, and number of metastatic non-SNs (all P<.0001) on disease-free survival and overall survival. CONCLUSIONS ENE was a significant prognostic factor in patients with positive-SN melanoma. This parameter may be useful in clinical practice as a selection criterion for adjuvant treatment in patients with stage IIIA disease with a tumor burden <1 mm in the SN. We recommend its inclusion as an independent prognostic determinant in future updates of melanoma guidelines.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Laura Sala
- 4Plastic and Reconstructive Surgical Unit, and
| | - Lorenza Di Guardo
- 5Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carolina Cimminiello
- 5Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Michele Del Vecchio
- 5Melanoma Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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7
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Ronen S, Al-Rohil RN, Keiser E, Jour G, Nagarajan P, Tetzlaff MT, Curry JL, Ivan D, Middleton LP, Torres-Cabala CA, Gershenwald JE, Aung PP, Prieto VG. Discordance in Diagnosis of Melanocytic Lesions and Its Impact on Clinical Management. Arch Pathol Lab Med 2021; 145:1505-1515. [PMID: 33577643 DOI: 10.5858/arpa.2020-0620-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Accurate diagnosis of melanocytic lesions is fundamental for appropriate clinical management. OBJECTIVE.— To evaluate the degree of discordance, if any, between histopathologic diagnoses of melanocytic lesions at referring institutions and at a tertiary referral cancer center and the potential impact of such discordance on clinical management. DESIGN.— We retrospectively identified all patients referred to our comprehensive cancer center for evaluation of a melanocytic lesion from January 2010 to January 2011. For each patient, the histopathologic diagnosis from the referring institution was compared with the histopathologic diagnosis from a dermatopathologist at our center. Discordances were classified as major if they resulted in a change in clinical management and minor if they did not. RESULTS.— A total of 1521 cases were included. The concordance rates were 72.2% (52 of 72) for dysplastic nevus, 75.0% (15 of 20) for all other types of nevi, 91.1% (143 of 157) for melanoma in situ, 96.1% (758 of 789) for invasive melanoma, and 99.6% (478 of 480) for metastatic melanoma. Major discordances were found in 20.2% of cases (307 of 1521), and minor discordances were found in 48.8% of cases (742 of 1521). Compared with the guideline-based treatment recommendation based on the referring-institution diagnosis, the guideline-based treatment recommendation based on the cancer center diagnosis was more extensive in 5.9% (89 of 1521) of patients and less extensive in 5.0% (76 of 1521) of patients. CONCLUSIONS.— Our findings underscore the importance of secondary histopathologic review of melanocytic lesions by expert dermatopathologists because significant changes in the diagnosis, tumor classification, and/or staging may be identified; thus, resulting in critical changes in recommendations for clinical management.
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Affiliation(s)
- Shira Ronen
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto).,Ronen, Al-Rohil, and Keiser contributed equally to this work.,Ronen's current affiliation is the Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rami N Al-Rohil
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto).,Ronen, Al-Rohil, and Keiser contributed equally to this work.,Al-Rohil's current affiliation is the Department of Pathology, Duke University Hospital, Durham, North Carolina
| | - Elizabeth Keiser
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto).,Ronen, Al-Rohil, and Keiser contributed equally to this work
| | - George Jour
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto).,Jour's current affiliation is the Department of Pathology, New York University, New York City
| | - Priyadharsini Nagarajan
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto)
| | - Michael T Tetzlaff
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto)
| | - Jonathan L Curry
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto)
| | - Doina Ivan
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto)
| | - Lavinia P Middleton
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto)
| | - Carlos A Torres-Cabala
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto)
| | - Jeffrey E Gershenwald
- Surgical Oncology and Cancer Biology (Gershenwald), The University of Texas MD Anderson Cancer Center, Houston
| | - Phyu P Aung
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto).,Aung and Prieto contributed equally to this work
| | - Victor G Prieto
- From the Departments of Pathology (Ronen, Al-Rohil, Keiser, Jour, Nagarajan, Tetzlaff, Curry, Ivan, Middleton, Torres-Cabala, Aung, Prieto).,Aung and Prieto contributed equally to this work
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Maurichi A. Reply to R. Olofsson Bagge et al and G. Karakousis et al. J Clin Oncol 2020; 38:3235-3237. [DOI: 10.1200/jco.20.01832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrea Maurichi
- Andrea Maurichi, MD, Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Atique U, Mushtaq S, Rana IA, Hassan U. Clinicopathologic Features of Cutaneous Malignant Melanoma and Their Impact on Prognosis. Cureus 2020; 12:e10450. [PMID: 33072458 PMCID: PMC7560505 DOI: 10.7759/cureus.10450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Melanoma ranks 19th among malignancies overall and second among cutaneous types. The incidence worldwide has been on the rise over the last seven decades. Various prognostic factors have been assessed and found to have a profound impact on patient outcome. However, no such studies have been attempted in our population. Our study aimed to have an insight into the behavior of malignant melanoma in our population. Materials and Methods: Cases of cutaneous malignant melanoma treated and followed up at our institute were included in this study. Cases of mucosal and choroidal melanoma were excluded. The parameters noted were age, gender, tumor thickness, Clark level, and presence of ulceration. These parameters were individually correlated with development of distant metastasis, two-year survival, survival duration, and primary tumor and lymph node stage. Appropriate statistical analyses were done. Results: Thirty patients of cutaneous malignant melanomas were treated and followed up at our institution. There was male predilection of 1:1.5. Mean age at diagnosis was 50.1 years. Two-year survival was significantly better in females. Sun-exposed areas of the skin were most commonly involved followed by anal canal that has an unusually high incidence in our society. Majority of our cases were pT4(25) on tumor, nodal status, metastasis (TNM) staging at time of diagnosis. Increasing tumor thickness in terms of primary tumor staging was not found to have any significant impact on two-year survival, distant metastasis, lymph node stage, or survival duration. Sixty percent of cases had ulceration. There was no statistically significant effect on two-year survival (78% in ulcerated group vs 75% in nonulcerated group) and distant metastasis (61% vs 58.3%). In terms of Clark level, 20 cases were level V, seven cases were level IV, two were level III, and one was level I. There was no statistically significant difference between the Clark levels in terms of two years survival, development of distant metastasis, and lymph node stages. Conclusion: Melanoma is an aggressive malignancy that causes high morbidity and morality. It commonly presents at an advanced stage at time of diagnosis in our population. Broader studies are required with early-stage melanomas to compare the various prognostic factors and their impact on prognosis.
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Affiliation(s)
- Usman Atique
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Mushtaq
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Iftikhar Ali Rana
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Usman Hassan
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Maurichi A, Miceli R, Eriksson H, Newton-Bishop J, Nsengimana J, Chan M, Hayes AJ, Heelan K, Adams D, Patuzzo R, Barretta F, Gallino G, Harwood C, Bergamaschi D, Bennett D, Lasithiotakis K, Ghiorzo P, Dalmasso B, Manganoni A, Consoli F, Mattavelli I, Barbieri C, Leva A, Cortinovis U, Espeli V, Mangas C, Quaglino P, Ribero S, Broganelli P, Pellacani G, Longo C, Del Forno C, Borgognoni L, Sestini S, Pimpinelli N, Fortunato S, Chiarugi A, Nardini P, Morittu E, Florita A, Cossa M, Valeri B, Milione M, Pruneri G, Zoras O, Anichini A, Mortarini R, Santinami M. Factors Affecting Sentinel Node Metastasis in Thin (T1) Cutaneous Melanomas: Development and External Validation of a Predictive Nomogram. J Clin Oncol 2020; 38:1591-1601. [PMID: 32167862 PMCID: PMC7213590 DOI: 10.1200/jco.19.01902] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Thin melanomas (T1; ≤ 1 mm) constitute 70% of newly diagnosed cutaneous melanomas. Regional node metastasis determined by sentinel node biopsy (SNB) is an important prognostic factor for T1 melanoma. However, current melanoma guidelines do not provide clear indications on when to perform SNB in T1 disease and stress an individualized approach to SNB that considers all clinicopathologic risk factors. We aimed to identify determinants of sentinel node (SN) status for incorporation into an externally validated nomogram to better select patients with T1 disease for SNB. PATIENTS AND METHODS The development cohort comprised 3,666 patients with T1 disease consecutively treated at the Istituto Nazionale Tumori (Milan, Italy) between 2001 and 2018; 4,227 patients with T1 disease treated at 13 other European centers over the same period formed the validation cohort. A random forest procedure was applied to the development data set to select characteristics associated with SN status for inclusion in a multiple binary logistic model from which a nomogram was elaborated. Decision curve analyses assessed the clinical utility of the nomogram. RESULTS Of patients in the development cohort, 1,635 underwent SNB; 108 patients (6.6%) were SN positive. By univariable analysis, age, growth phase, Breslow thickness, ulceration, mitotic rate, regression, and lymphovascular invasion were significantly associated with SN status. The random forest procedure selected 6 variables (not growth phase) for inclusion in the logistic model and nomogram. The nomogram proved well calibrated and had good discriminative ability in both cohorts. Decision curve analyses revealed the superior net benefit of the nomogram compared with each individual variable included in it as well as with variables suggested by current guidelines. CONCLUSION We propose the nomogram as a decision aid in all patients with T1 melanoma being considered for SNB.
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Affiliation(s)
- Andrea Maurichi
- Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosalba Miceli
- Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Hanna Eriksson
- Department of Oncology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Julia Newton-Bishop
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Jérémie Nsengimana
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - May Chan
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Andrew J. Hayes
- Sarcoma Unit, Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Skin Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kara Heelan
- Sarcoma Unit, Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Skin Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Adams
- Experimental Cancer Genetics, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Roberto Patuzzo
- Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Francesco Barretta
- Medical Statistics, Biometry and Bioinformatics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Gianfranco Gallino
- Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | - Dorothy Bennett
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London, United Kingdom
| | - Konstantinos Lasithiotakis
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | | | | | - Ilaria Mattavelli
- Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Consuelo Barbieri
- Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Andrea Leva
- Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Umberto Cortinovis
- Plastic and Reconstructive Surgical Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Vittoria Espeli
- Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | - Cristina Mangas
- Istituto Oncologico Svizzera Italiana, Ospedale Regionale Bellinzona e Valli, Bellinzona, Switzerland
| | | | | | | | | | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | | | | | - Serena Sestini
- Ospedale S. Maria Annunziata, Tuscan Cancer Institute, Florence, Italy
| | | | - Sara Fortunato
- Division of Dermatology, University of Florence, Florence, Italy
| | | | - Paolo Nardini
- Institute for Cancer Research and Prevention, Florence, Italy
| | - Elena Morittu
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonio Florita
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mara Cossa
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Massimo Milione
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | - Andrea Anichini
- Immunobiology of Human Cancers Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Roberta Mortarini
- Immunobiology of Human Cancers Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mario Santinami
- Melanoma and Sarcoma Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale dei Tumori di Milano, Milan, Italy
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Routine retrieval of pelvic sentinel lymph nodes for melanoma rarely adds prognostic information or alters management. Melanoma Res 2018; 29:38-46. [PMID: 30161040 DOI: 10.1097/cmr.0000000000000498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pelvic sentinel lymph nodes (SLNs) are commonly identified during inguinal SLN biopsy for melanoma, but retrieval is not uniform among surgeons/centers. Few studies have assessed rates of micrometastases in pelvic versus superficial inguinal SLNs. Previous studies suggested that presence of pelvic SLNs was predicted by aggressive pathologic features and that their presence portended a worse prognosis. The objectives of this study were to examine presurgical predictors of pelvic SLNs among patients undergoing inguinal SLN biopsy, assess rates of micrometastases in superficial inguinal versus pelvic SLNs, and determine whether presence of pelvic SLNs was associated with long-term outcomes. Multivariable regression was used to assess presurgical factors associated with presence of pelvic SLNs. Rates of micrometastases in superficial inguinal versus pelvic SLNs in patients who had a pelvic SLN were compared with McNemar's test. Groin recurrence, disease-free survival (DFS), and disease-specific survival were analyzed by Kaplan-Meier method. A multivariable Cox model for DFS was performed. Pelvic SLNs were retrieved in 100/537 (18.6%) superficial inguinal SLN biopsies and no preoperative factors predicted their presence. In patients with a pelvic SLN, micrometastases were present in 3.0% of pelvic versus 34.0% of superficial inguinal SLN biopsies (P<0.001). There were no differences in groin recurrence, DFS, and disease-specific survival for patients with/without pelvic SLNs in univariate analyses (all P>0.2) or in the multivariable Cox model for DFS (hazard ratio: 1.1, 95% confidence interval: 0.6-2.1). In conclusion, pelvic SLNs harbor micrometastases less frequently than superficial inguinal SLNs do, suggesting that omission of pelvic SLN biopsy may be reasonable.
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Bagaria SP, Gatalica Z, Maney T, Serie D, Parasramka M, Attia S, Krishna M, Joseph RW. Association Between Programmed Death-Ligand 1 Expression and the Vascular Endothelial Growth Factor Pathway in Angiosarcoma. Front Oncol 2018; 8:71. [PMID: 29623256 PMCID: PMC5874284 DOI: 10.3389/fonc.2018.00071] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 03/01/2018] [Indexed: 12/13/2022] Open
Abstract
Angiosarcoma is a vascular malignancy associated with a poor prognosis and chemotherapy resistance. The tumor immune microenvironment of angiosarcoma has not been characterized. We investigated the expression of programmed death-ligand 1 (PD-L1) and programmed death 1 (PD-1) in angiosarcoma and correlated these findings with vascular endothelial growth factor (VEGF)-related gene expression and survival. Using archived formalin-fixed paraffin-embedded tissues of primary and metastatic angiosarcoma specimens, we characterized the immunohistochemical (IHC) expression of PD-L1 and PD-1. In addition, we extracted RNA from each tumor and quantified the expression of VEGF-related genes, and then tested if these genes were associated with PD-L1 and PD-1 expression and clinical outcomes. Retrospective review identified 27 angiosarcoma specimens collected between 1994 and 2012. IHC expression of tumor PD-L1, tumor-infiltrating immune cell PD-L1, and tumor-infiltrating immune cell PD-1 expression was identified in 5 (19%), 9 (33%), and 1 (4%) specimens, respectively. Expression of PD-L1 and PD-1 was not associated with VEGF-related gene expression or survival. PD-L1 tumor and tumor-infiltrating immune cells expression was identified in a large proportion of patients. Though neither was associated with VEGF-related gene expression or prognosis, targeting PD-1/PD-L1 may be of benefit for a significant proportion of angiosarcomas that do not respond to surgery, chemotherapy, or radiation.
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Affiliation(s)
- Sanjay P Bagaria
- Department of Surgery, Division of General Surgery, Mayo Clinic, Jacksonville, FL, United States
| | | | - Todd Maney
- Caris Life Sciences, Phoenix, AZ, United States
| | - Daniel Serie
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, United States
| | - Mansi Parasramka
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, United States
| | - Steven Attia
- Department of Medicine, Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Murli Krishna
- Department of Pathology, Mayo Clinic, Jacksonville, FL, United States
| | - Richard W Joseph
- Department of Medicine, Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, United States
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Shin TM, Shaikh WR, Etzkorn JR, Sobanko JF, Margolis DJ, Gelfand JM, Chu EY, Elenitsas R, Miller CJ. Clinical and pathologic factors associated with subclinical spread of invasive melanoma. J Am Acad Dermatol 2017; 76:714-721. [PMID: 28139264 DOI: 10.1016/j.jaad.2016.11.048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/23/2016] [Accepted: 11/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Indications to treat invasive melanoma with Mohs micrographic surgery (MMS) or analogous techniques with exhaustive microscopic margin assessment have not been defined. OBJECTIVE Identify clinical and histologic factors associated with subclinical spread of invasive melanoma. METHODS This retrospective, cross-sectional study evaluated 216 invasive melanomas treated with MMS and melanoma antigen recognized by T cells 1 immunostaining. Logistic regression models were used to correlate clinicopathologic risk factors with subclinical spread and construct a count prediction model. RESULTS Risk factors associated with subclinical spread by multivariate analysis included tumor localization on the head and neck (OR 3.28, 95% confidence interval [CI] 1.16-9.32), history of previous treatment (OR 4.18, 95% CI 1.42-12.32), age ≥65 (OR 4.45, 95% CI 1.29-15.39), and ≥1 mitoses/mm2 (OR 2.63, 95% CI 1.01-6.83). Tumor thickness and histologic subtype were not associated with subclinical spread. The probability of subclinical spread increased per number of risk factors, ranging from 9.22% (95% CI 2.57%-15.86%) with 1 factor to 80.32% (95% CI 68.13%-92.51%) with 5 factors. LIMITATIONS This study was conducted at a single academic institution with a small study population using a retrospective study design that was subject to potential referral bias. CONCLUSION Clinical and histologic factors identify invasive melanomas that are at increased risk for subclinical spread and might benefit from MMS or analogous techniques prior to reconstruction.
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Affiliation(s)
- Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Waqas R Shaikh
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Margolis
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel M Gelfand
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Y Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:17-30. [DOI: 10.1016/j.ad.2016.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/03/2016] [Accepted: 05/09/2016] [Indexed: 02/08/2023] Open
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15
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Nagarajan P, Tetzlaff M, Curry J, Prieto V. Use of New Techniques in Addition to IHC Applied to the Diagnosis of Melanocytic Lesions, With Emphasis on CGH, FISH, and Mass Spectrometry. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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16
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Fahy AS, Grotz TE, Keeney GL, Glasgow AE, Habermann EB, Erickson L, Hieken TJ, Jakub JW. Frozen section analysis of SLNs in trunk and extremity melanoma has a high false negative rate but can spare some patients a second operation. J Surg Oncol 2016; 114:879-883. [PMID: 27634587 DOI: 10.1002/jso.24430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/16/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the accuracy of frozen section (FS) analysis of sentinel lymph nodes (SLN) in melanoma. METHODS Five hundred seventy-one patients underwent FS analysis of SLN between 1/2000 and12/2010. Surgical and pathological characteristics, recurrence, and survival were analyzed. Comparisons were made using χ2 and Fisher's exact t-test. RESULTS One hundred thirty-three (23%) patients were SLN positive of which 63 (47.4%) were identified on FS. 16/70 SLN metastases not identified on FS (23%) were seen only on immunohistochemistry. FS analysis detected 84% of SLN metastasis >2 mm. SLN FS false negative rate was 53%, positive predictive value 100%, negative predictive value 88%, and overall accuracy 89%. Among patients with a FS positive SLN, 17/63 (27%) had additional positive nodes on CLND, versus 1 of 70 (1.4%) with a positive SLN identified only on permanent section pathology (P < 0.0001). The nodal recurrence rate following a negative SLN biopsy was 5%. CONCLUSIONS FS analysis for SLNs spared approximately half of patients a second operation. Patients with a positive SLN detected on FS were more likely to have further nodal involvement. In our experience intraoperative pathologic analysis of melanoma SLNs does not impair our ability to detect SLN metastasis or lead to a high rate of false positive results or nodal recurrences. J. Surg. Oncol. 2016;114:879-883. © 2016 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Travis E Grotz
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Gary L Keeney
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Amy E Glasgow
- Division of Health Care Policy and Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Elizabeth B Habermann
- Division of Health Care Policy and Research and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lori Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Ge L, Vilain RE, Lo S, Aivazian K, Scolyer RA, Thompson JF. Breslow Thickness Measurements of Melanomas Around American Joint Committee on Cancer Staging Cut-Off Points: Imprecision and Terminal Digit Bias Have Important Implications for Staging and Patient Management. Ann Surg Oncol 2016; 23:2658-63. [PMID: 27075324 DOI: 10.1245/s10434-016-5196-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Breslow thickness is the most important prognostic factor in patients with clinically localized primary cutaneous melanomas, and its accuracy has important implications for staging and management. A review of the Melanoma Institute Australia database and population-based data for the state of New South Wales, Australia, found an unexpectedly large number of melanomas reported as being exactly 1.0 mm thick. We sought to determine possible causes for this biologically implausible finding. METHODS The tumor thickness of 125 invasive cutaneous melanomas with a recorded Breslow thickness of 0.9-1.1 mm was remeasured and recorded by two pathologists. RESULTS Concordance of measurements between the two pathologists was high (intraclass correlation coefficient 0.816, 95 % CI 0.733-0.873). The original measurements showed clustering at 0.9, 1.0, and 1.1 mm, whereas the review measurements did not. The original measurements staged 84 cases (72 %) as T1 and 33 (28 %) as T2, while the reviewed measurements staged 58 cases (50 %) as T1 and 59 (50 %) as T2 (p < 0.001). CONCLUSIONS Our study demonstrated imprecision in Breslow thickness measurements and its significant impact on staging. Two potential sources of imprecision are failure to follow standardized thickness measurement guidelines and the phenomenon of terminal digit bias, not previously identified as a problem in this field. Educating pathologists about this phenomenon and the importance of utilizing ocular micrometers may improve the precision of melanoma thickness measurements around critical staging cut-off points. Clinicians must also be educated to appreciate that there is an inevitable margin of error with Breslow thickness measurements that should be considered when making management decisions.
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Affiliation(s)
- Ludi Ge
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ricardo E Vilain
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Karina Aivazian
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
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Kourea H, Kotoula V. Towards tumor immunodiagnostics. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:263. [PMID: 27563650 PMCID: PMC4971369 DOI: 10.21037/atm.2016.07.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 01/21/2023]
Abstract
Immunodiagnostic markers applicable on tissue or cytologic material may be prognostic or predictive of response to immunomodulatory drugs and may also be classified according to whether they are cell-specific or tumor-tissue-specific. Cell-specific markers are evaluated under the microscope as (I) morphological, corresponding to the assessment of tumor infiltrating immune cells on routine hematoxylin & eosin (H&E) sections; and (II) immunophenotypic, including the immunohistochemical (IHC) assessment of markers characteristic for tumor infiltrating immune cells. Tumor-tissue-specific markers are assessed in tissue extracts that may be enriched in neoplastic cells but almost inevitably also contain stromal and immune cells infiltrating the tumor. Such markers include (I) immune-response-related gene expression profiles, and (II) tumor genotype characteristics, as recently assessed with large-scale genotyping methods, usually next generation sequencing (NGS) applications. Herein, we discuss the biological nature of immunodiagnostic markers, their potential clinical relevance and the shortcomings that have, as yet, prevented their clinical application.
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Affiliation(s)
- Helen Kourea
- Department of Pathology, University Hospital of Patras, Rion, Greece
| | - Vassiliki Kotoula
- Department of Pathology, Aristotle University of Thessaloniki, School of Health Sciences, Faculty of Medicine, Thessaloniki, Greece
- Laboratory of Molecular Oncology, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki, Greece
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19
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Nielsen PS, Riber-Hansen R, Schmidt H, Steiniche T. Automated quantification of proliferation with automated hot-spot selection in phosphohistone H3/MART1 dual-stained stage I/II melanoma. Diagn Pathol 2016; 11:35. [PMID: 27062658 PMCID: PMC4826493 DOI: 10.1186/s13000-016-0484-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/19/2016] [Indexed: 12/15/2022] Open
Abstract
Background Staging of melanoma includes quantification of a proliferation index, i.e., presumed melanocytic mitoses of H&E stains are counted manually in hot spots. Yet, its reproducibility and prognostic impact increases by immunohistochemical dual staining for phosphohistone H3 (PHH3) and MART1, which also may enable fully automated quantification by image analysis. To ensure manageable workloads and repeatable measurements in modern pathology, the study aimed to present an automated quantification of proliferation with automated hot-spot selection in PHH3/MART1-stained melanomas. Methods Formalin-fixed, paraffin-embedded tissue from 153 consecutive stage I/II melanoma patients was immunohistochemically dual-stained for PHH3 and MART1. Whole slide images were captured, and the number of PHH3/MART1-positive cells was manually and automatically counted in the global tumor area and in a manually and automatically selected hot spot, i.e., a fixed 1-mm2 square. Bland-Altman plots and hypothesis tests compared manual and automated procedures, and the Cox proportional hazards model established their prognostic impact. Results The mean difference between manual and automated global counts was 2.9 cells/mm2 (P = 0.0071) and 0.23 cells per hot spot (P = 0.96) for automated counts in manually and automatically selected hot spots. In 77 % of cases, manual and automated hot spots overlapped. Fully manual hot-spot counts yielded the highest prognostic performance with an adjusted hazard ratio of 5.5 (95 % CI, 1.3–24, P = 0.024) as opposed to 1.3 (95 % CI, 0.61–2.9, P = 0.47) for automated counts with automated hot spots. Conclusions The automated index and automated hot-spot selection were highly correlated to their manual counterpart, but altogether their prognostic impact was noticeably reduced. Because correct recognition of only one PHH3/MART1-positive cell seems important, extremely high sensitivity and specificity of the algorithm is required for prognostic purposes. Thus, automated analysis may still aid and improve the pathologists’ detection of mitoses in melanoma and possibly other malignancies.
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Affiliation(s)
- Patricia Switten Nielsen
- Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus C, Denmark.
| | - Rikke Riber-Hansen
- Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus C, Denmark
| | - Henrik Schmidt
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus C, Denmark
| | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Nørrebrogade 44, DK-8000, Aarhus C, Denmark
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20
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Simionescu O, Blum A, Grigore M, Costache M, Avram A, Testori A. Learning from mistakes: errors in approaches to melanoma and the urgent need for updated national guidelines. Int J Dermatol 2015; 55:970-6. [PMID: 26712381 DOI: 10.1111/ijd.13165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 06/01/2015] [Accepted: 07/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The tracking and identification of errors in the detection and follow-up of melanoma are important because there is huge potential to increase awareness about the most vulnerable aspects of diagnosis and treatment, and to improve both from the perspective of healthcare economics. The present study was designed to identify where errors occur and to propose a minimum set of rules for the routine guidance of any specialist in melanoma management. METHODS This report describes the evaluation of a unique series of 33 cases in which errors applying to many steps in the diagnosis and treatment of melanoma were detected. Cases were collected at two centers in Romania, one public and one private, as part of a process of obtaining patient-requested second opinions. RESULTS A total of 166 errors were identified across the 33 patients, most of which were treatment errors. The errors fell into six categories: clinical diagnostic errors (36 errors among 30 patients); primary surgical errors (31 errors among 16 patients); pathology errors (24 errors among 17 patients); sentinel lymph node biopsy errors (13 errors among 13 patients); staging errors (17 errors among 13 patients); and treatment or management errors (45 errors among 33 patients). CONCLUSIONS Based on the present results, we propose that in countries lacking national guidelines, clinicians should adhere to international evidence-based guidelines for the diagnosis and treatment of melanoma.
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Affiliation(s)
- Olga Simionescu
- Department of Dermatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Andreas Blum
- Dermatology, Public, Private and Teaching Practice, Konstanz, Germany
| | - Mariana Grigore
- Department of Dermatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Avram
- Department of Dermatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alessandro Testori
- Dermato-Oncological Division, European Institute of Oncology, Milan, Italy
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21
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Retrospective Analysis of Clinicopathological Characteristics of Pregnancy Associated Melanoma. Pathol Oncol Res 2015; 21:1265-71. [DOI: 10.1007/s12253-015-9961-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/06/2015] [Indexed: 12/14/2022]
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22
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Gamsizkan M, Yilmaz I, Buyukbabani N, Demirkesen C, Demiriz M, Cetin ED, Ince U, Akalin T, Demirkan NC, Lebe B, Erdem O, Gokoz O, Sakiz D, Demireli PT, Astarci HM, Adim SB, Zemheri IE, Acikalin A, Yaman B, Aydin O, Bassorgun CI. A Retrospective Multicenter Evaluation of Cutaneous Melanomas in Turkey. Asian Pac J Cancer Prev 2015; 15:10451-6. [DOI: 10.7314/apjcp.2014.15.23.10451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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23
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Ascierto PA, Grimaldi AM, Anderson AC, Bifulco C, Cochran A, Garbe C, Eggermont AM, Faries M, Ferrone S, Gershenwald JE, Gajewski TF, Halaban R, Hodi FS, Kefford R, Kirkwood JM, Larkin J, Leachman S, Maio M, Marais R, Masucci G, Melero I, Palmieri G, Puzanov I, Ribas A, Saenger Y, Schilling B, Seliger B, Stroncek D, Sullivan R, Testori A, Wang E, Ciliberto G, Mozzillo N, Marincola FM, Thurin M. Future perspectives in melanoma research: meeting report from the "Melanoma Bridge", Napoli, December 5th-8th 2013. J Transl Med 2014; 12:277. [PMID: 25348889 PMCID: PMC4232645 DOI: 10.1186/s12967-014-0277-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 12/28/2022] Open
Abstract
The fourth "Melanoma Bridge Meeting" took place in Naples, December 5 to 8th, 2013. The four topics discussed at this meeting were: Diagnosis and New Procedures, Molecular Advances and Combination Therapies, News in Immunotherapy, and Tumor Microenvironment and Biomarkers.
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Affiliation(s)
- Paolo A Ascierto
- />Istituto Nazionale Tumori, Fondazione “G. Pascale”, Napoli, Italy
| | | | | | - Carlo Bifulco
- />Translational Molecular Pathology, Earle A. Chiles Research Institute, Providence Cancer Center, Portland, OR USA
| | - Alistair Cochran
- />Departments of Pathology and Laboratory Medicine and Surgery, David Geffen School of Medicine at University of California Los Angeles (UCLA), John Wayne Cancer Institute, Santa Monica, CA USA
| | - Claus Garbe
- />Center for Dermato Oncology, Department of Dermatology, University of Tübingen, Tübingen, Germany
| | | | - Mark Faries
- />Donald L. Morton Melanoma Research Program, John Wayne Cancer Institute, Santa Monica, CA USA
| | - Soldano Ferrone
- />Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jeffrey E Gershenwald
- />Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Thomas F Gajewski
- />Departments of Medicine and of Pathology, Immunology and Cancer Program, The University of Chicago Medicine, Chicago, IL USA
| | - Ruth Halaban
- />Department of Dermatology, Yale University School of Medicine, New Haven, CT USA
| | - F Stephen Hodi
- />Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA USA
| | - Richard Kefford
- />Westmead Institute for Cancer Research, Westmead Millennium Institute and Melanoma Institute Australia, University of Sydney, Sydney, NSW Australia
| | - John M Kirkwood
- />Division of Hematology/Oncology, Departments of Medicine, Dermatology, and Translational Science, University of Pittsburgh School of Medicine and Melanoma Program of the Pittsburgh Cancer Institute, Pittsburgh, PA USA
| | - James Larkin
- />Royal Marsden NHS Foundation Trust, London, UK
| | - Sancy Leachman
- />Department of Dermatology, Oregon Health Sciences University, Portland, OR USA
| | - Michele Maio
- />Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy
| | - Richard Marais
- />Molecular Oncology Group, The Paterson Institute for Cancer Research, Wilmslow Road, Manchester, M20 4BX UK
| | - Giuseppe Masucci
- />Department of Oncology-Pathology, The Karolinska Hospital, Stockholm, Sweden
| | - Ignacio Melero
- />Centro de Investigación Médica Aplicada, Clinica Universidad de Navarra, Pamplona, Navarra Spain
| | - Giuseppe Palmieri
- />Unit of Cancer Genetics, Institute of Biomolecular Chemistry, National Research Council, Sassari, Italy
| | - Igor Puzanov
- />Vanderbilt University Medical Center, Nashville, TN USA
| | - Antoni Ribas
- />Tumor Immunology Program, Jonsson Comprehensive Cancer Center (JCCC), David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA USA
| | - Yvonne Saenger
- />Division of Hematology and Oncology, Tisch Cancer Institute, Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Bastian Schilling
- />Department of Dermatology, University Hospital, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- />German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Barbara Seliger
- />Martin Luther University Halle-Wittenberg, Institute of Medical Immunology, Halle, Germany
| | - David Stroncek
- />Cell Processing Section, Department of Transfusion Medicine, Clinical Center, NIH, Bethesda, MD USA
| | - Ryan Sullivan
- />Center for Melanoma, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA USA
| | | | - Ena Wang
- />Division Chief of Translational Medicine, Sidra Medical and Research Centre, Doha, Qatar
| | | | - Nicola Mozzillo
- />Istituto Nazionale Tumori, Fondazione “G. Pascale”, Napoli, Italy
| | | | - Magdalena Thurin
- />Cancer Diagnosis Program, National Cancer Institute, NIH, Bethesda, MD USA
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Abstract
Staging of cancer is a shorthand system of describing the extent of disease. Pathological staging, often called microstaging, uses the methods of histopathology to achieve this goal. Microstaging for melanoma utilizes attributes that are associated with outcome, generally in association with prognostic models that allow for estimation of survival rates, based on large groups of patients with similar tumors. Microstaging can be performed on primary tumors and to a lesser extent on metastases. Attributes that are important in microstaging in primary tumors include, in particular, those that are utilized in the AJCC/UICC staging system. These are, more or less in order of importance, Breslow's thickness, ulceration, and mitogenicity (the presence or absence of mitoses). Other attributes that have relevance to prognosis at least in some well-conducted studies include tumor-infiltrating lymphocytes, lymphovascular invasion, perineural invasion, Clark's level of invasion, the presence or absence of vertical growth phase and of regression, and other attributes. The pathologic interpretation and significance of these "prognostic variables" are discussed in this chapter. In addition, prognostic models including the AJCC staging system are presented in some detail.
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25
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Nielsen PS, Riber-Hansen R, Jensen TO, Schmidt H, Steiniche T. Proliferation indices of phosphohistone H3 and Ki67: strong prognostic markers in a consecutive cohort with stage I/II melanoma. Mod Pathol 2013; 26:404-13. [PMID: 23174936 DOI: 10.1038/modpathol.2012.188] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cellular proliferation is correlated with the progression of melanoma. Accordingly, the proliferation index of H&E-stained thin melanomas was recently included in the staging system of the American Joint Committee on Cancer. Yet, the immunohistochemical markers of proliferation phosphohistone H3 and Ki67 may improve such indices. To accurately quantify these markers, they should be combined with a melanocytic marker, for example, MART1 in an immunohistochemical double stain; also enabling automated quantification by image analysis. The aim of the study was to compare the prognostic impact of phosphohistone H3/MART1, Ki67/MART1, and H&E stains in primary cutaneous melanoma, and to determine the difference between indices established in hot spots and the global tumor areas. The study included 153 consecutive stage I/II melanoma-patients. The follow-up time was 8-14 years for event-free melanoma. Recurrent disease occurred in 43 patients; 37 died of melanoma. Both events occurred in only three thin melanomas. Their paraffin-embedded tissue was stained for phosphohistone H3/MART1, Ki67/MART1, and with H&E. And proliferation indices were established in 1-mm(2) hot spots and in the global tumor areas. In multivariate Cox analyses, only hot spot indices of phosphohistone H3/MART1 and Ki67/MART1 were independent prognostic markers. Phosphohistone H3/MART1 tended to be better than Ki67/MART1 with adjusted hazard ratios of 3.66 (95% CI, 1.40-9.55; P=0.008) for progression-free survival and 3.42 (95% CI, 1.29-9.04; P=0.013) for melanoma-specific death. In all stains, prognostic performance was substantially improved by using hot spots instead of the global tumor areas. In conclusion, phosphohistone H3/MART1 and Ki67/MART1 were superior to H&E stains, and hot spots superior to the global tumor areas. Given the potential for automated analysis, these double stains seem to be robust alternatives to conventional mitotic detection by H&E in stage I/II melanomas in general. This was particularly true for thick melanomas whereas no specific analyses for thin melanomas only could be performed.
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[Standardized pathology report for melanoma. WHO classification evolution]. Ann Pathol 2011; 31:S111-2. [PMID: 22054444 DOI: 10.1016/j.annpat.2011.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Accepted: 09/05/2011] [Indexed: 11/23/2022]
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28
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Scolyer RA, Prieto VG. Melanoma pathology: important issues for clinicians involved in the multidisciplinary care of melanoma patients. Surg Oncol Clin N Am 2011; 20:19-37. [PMID: 21111957 DOI: 10.1016/j.soc.2010.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Histologic analysis remains the gold standard for diagnosis of melanoma. The pathology report should document those histologic features important for guiding patient management, including those characteristics on which the diagnosis was based and also prognostic factors. Pathologic examination of sentinel lymph nodes provides very important prognostic information. New techniques, such as comparative genomic hybridization and fluorescence in situ hybridization are currently being studied to determine their usefulness in the diagnosis of melanocytic lesions. Recent molecular studies have opened new avenues for the treatment of patients with metastatic melanoma (ie, targeted therapies) and molecular pathology is likely to play an important role in the emerging area of personalized melanoma therapy.
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Affiliation(s)
- Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
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Rondelli F, Vedovati M, Becattini C, Tomassini G, Messina S, Noya G, Simonetti S, Covarelli P. Prognostic role of sentinel node biopsy in patients with thick melanoma: a meta-analysis. J Eur Acad Dermatol Venereol 2011; 26:560-5. [DOI: 10.1111/j.1468-3083.2011.04109.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Batistatou A, Gököz O, Cook MG, Massi D. Melanoma histopathology report: proposal for a standardized terminology. Virchows Arch 2010; 458:359-61. [PMID: 21193926 DOI: 10.1007/s00428-010-1027-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 12/07/2010] [Indexed: 11/25/2022]
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32
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Wedemeyer G. Protocol for the Examination of Specimens From Patients With Invasive Carcinoma of the Breast. Arch Pathol Lab Med 2010; 134:505. [DOI: 10.5858/134.4.505.a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gerald Wedemeyer
- Department of Pathology, United Hospital Center, Clarksburg, WV 26302-1680
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33
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Rao P, Balzer BL, Lemos BD, Liegeois NJ, McNiff JM, Nghiem P, Prieto VG, Smith MT, Smoller BR, Wick MR, Frishberg DP. Protocol for the examination of specimens from patients with merkel cell carcinoma of the skin. Arch Pathol Lab Med 2010; 134:341-4. [PMID: 20196661 DOI: 10.5858/134.3.341] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Priya Rao
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048-1804, USA
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