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Cust AE, Scolyer Ao RA, Long Ao GV. What is behind the declining incidence of melanoma in younger Australians? Med J Aust 2024; 221:246-247. [PMID: 39217599 DOI: 10.5694/mja2.52411] [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: 06/05/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Anne E Cust
- The Daffodil Centre, the University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW
- Melanoma Institute Australia, the University of Sydney, Sydney, NSW
| | - Richard A Scolyer Ao
- Melanoma Institute Australia, the University of Sydney, Sydney, NSW
- The University of Sydney, Sydney, NSW
- Charles Perkins Centre, the University of Sydney, Sydney, NSW
- Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW
| | - Georgina V Long Ao
- Melanoma Institute Australia, the University of Sydney, Sydney, NSW
- The University of Sydney, Sydney, NSW
- Charles Perkins Centre, the University of Sydney, Sydney, NSW
- Royal North Shore Hospital, Sydney, NSW
- Mater Hospital, Sydney, NSW
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2
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Homer NA, Rieger KE. Melanocytoma of the eyelid: Case report and introduction of new nomenclature. Am J Ophthalmol Case Rep 2024; 34:102059. [PMID: 38690089 PMCID: PMC11059469 DOI: 10.1016/j.ajoc.2024.102059] [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: 11/13/2023] [Revised: 02/17/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose The term melanocytoma was recently proposed for intermediate-stage melanocytic lesions with specific histopathologic and molecular genetic features. Prior studies have demonstrated a heightened potential for these intermediate lesions to spread to regional lymph nodes, with decreased likelihood for distant spread, when compared to melanomas. Observations Herein we present a case of a 28-year-old male who presented with a recurrent right lower eyelid margin combined cutaneous and palpebral conjunctival pigmented lesion, ultimately classified as a melanocytoma, to highlight this new nomenclature, characteristic histopathologic and genetic findings, and prognostic implications. Conclusions Ophthalmologists should be aware of this new cutaneous histopathologic classification system and apply to the periorbital region to improve melanocytic lesion management and surveillance.
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Affiliation(s)
| | - Kerri E. Rieger
- Departments of Dermatology and Pathology, Stanford University, Palo Alto, CA, USA
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3
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Zhang W, Patterson NH, Verbeeck N, Moore JL, Ly A, Caprioli RM, De Moor B, Norris JL, Claesen M. Multimodal MALDI imaging mass spectrometry for improved diagnosis of melanoma. PLoS One 2024; 19:e0304709. [PMID: 38820337 PMCID: PMC11142536 DOI: 10.1371/journal.pone.0304709] [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: 09/20/2023] [Accepted: 05/17/2024] [Indexed: 06/02/2024] Open
Abstract
Imaging mass spectrometry (IMS) provides promising avenues to augment histopathological investigation with rich spatio-molecular information. We have previously developed a classification model to differentiate melanoma from nevi lesions based on IMS protein data, a task that is challenging solely by histopathologic evaluation. Most IMS-focused studies collect microscopy in tandem with IMS data, but this microscopy data is generally omitted in downstream data analysis. Microscopy, nevertheless, forms the basis for traditional histopathology and thus contains invaluable morphological information. In this work, we developed a multimodal classification pipeline that uses deep learning, in the form of a pre-trained artificial neural network, to extract the meaningful morphological features from histopathological images, and combine it with the IMS data. To test whether this deep learning-based classification strategy can improve on our previous results in classification of melanocytic neoplasia, we utilized MALDI IMS data with collected serial H&E stained sections for 331 patients, and compared this multimodal classification pipeline to classifiers using either exclusively microscopy or IMS data. The multimodal pipeline achieved the best performance, with ROC-AUCs of 0.968 vs. 0.938 vs. 0.931 for the multimodal, unimodal microscopy and unimodal IMS pipelines respectively. Due to the use of a pre-trained network to perform the morphological feature extraction, this pipeline does not require any training on large amounts of microscopy data. As such, this framework can be readily applied to improve classification performance in other experimental settings where microscopy data is acquired in tandem with IMS experiments.
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Affiliation(s)
- Wanqiu Zhang
- STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
- Aspect Analytics NV, Genk, Belgium
| | - Nathan Heath Patterson
- Frontier Diagnostics, LLC, Nashville, Tennessee, United States of America
- Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, United States of America
| | | | - Jessica L. Moore
- Frontier Diagnostics, LLC, Nashville, Tennessee, United States of America
| | - Alice Ly
- Aspect Analytics NV, Genk, Belgium
| | - Richard M. Caprioli
- Frontier Diagnostics, LLC, Nashville, Tennessee, United States of America
- Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Bart De Moor
- STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Jeremy L. Norris
- Frontier Diagnostics, LLC, Nashville, Tennessee, United States of America
- Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, United States of America
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4
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Witkowski A, Jarell AD, Ahmed KL, Siegel JJ, Russell BH, Rogers JH, Goldberg MS, Fernandes NF, Ludzik J, Farberg AS. A clinical impact study of dermatologists' use of diagnostic gene expression profile testing to guide patient management. Melanoma Manag 2024; 11:MMT68. [PMID: 38812731 PMCID: PMC11131342 DOI: 10.2217/mmt-2023-0002] [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: 06/02/2023] [Accepted: 03/19/2024] [Indexed: 05/31/2024] Open
Abstract
Aim: Cutaneous melanocytic neoplasms with diagnostic and/or clinical ambiguity pose patient management challenges. Methods: Six randomized case scenarios with diagnostic/clinical uncertainty were described with/without a benign or malignant diagnostic gene expression profile (GEP) result. Results: Clinical impact was assessed by reporting the mean increase/decrease of management changes normalized to baseline (n = 32 dermatologists). Benign GEP results prompted clinicians to decrease surgical margins (84.2%). Malignant GEP results escalated surgical excision recommendations (100%). A majority (72.2%) reduced and nearly all (98.9%) increased follow-up frequency for benign or malignant GEP results, respectively. There was an overall increase in management plan confidence with GEP results. Conclusion: Diagnostic GEP tests help guide clinical decision-making in a variety of diagnostically ambiguous or clinicopathologically discordant scenarios.
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Affiliation(s)
- Alexander Witkowski
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | | | | | | | | | - Matthew S Goldberg
- Castle Biosciences, Inc., Friendswood, TX, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Joanna Ludzik
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Aaron S Farberg
- Baylor Scott & White Health System, Dallas, TX 75235, USA
- Bare Dermatology, Dallas, TX 75235, USA
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5
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Fernandez C, Hoeltzel G, Werner-Wasik M, Kenyon LC, Shi W. Definitive radiotherapy for meningeal brainstem melanocytoma: a case report. Br J Neurosurg 2023; 37:1307-1310. [PMID: 33356599 DOI: 10.1080/02688697.2020.1864291] [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: 09/16/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
Meningeal melanocytomas are rare, benign tumours of the central nervous system arising from the melanocytes of the leptomeninges. First-line treatment consists of either gross or subtotal resection with or without radiotherapy. However, given the sensitive locations of these tumours, alternative treatment options such as definitive radiotherapy may be warranted in patients deemed high-risk or without accessible tumours. A 67-year-old male presenting with spastic gait, frequent falls, and vertical gaze palsy was diagnosed with a 2.4 cm primary meningeal melanocytoma arising from the interpeduncular fossa. Given the critical tumour position within the brainstem, definitive radiotherapy was recommended. He received fractionated stereotactic radiotherapy (FSRT) to a total dose of 54 Gy in 27 fractions, resulting in a gradual improvement in gait and ocular range of motion. Follow-up imaging over the next three years revealed largely stable disease and an increase in edema with mild upper extremity weakness that improved with steroids. He was followed for three years and expired four years after treatment due to pneumonia. For patients unable to receive surgical resection, definitive RT may provide local control with minimal morbidity.
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Affiliation(s)
- Christian Fernandez
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gerard Hoeltzel
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lawrence C Kenyon
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
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6
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Long GV, Swetter SM, Menzies AM, Gershenwald JE, Scolyer RA. Cutaneous melanoma. Lancet 2023:S0140-6736(23)00821-8. [PMID: 37499671 DOI: 10.1016/s0140-6736(23)00821-8] [Citation(s) in RCA: 116] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 07/29/2023]
Abstract
Cutaneous melanoma is a malignancy arising from melanocytes of the skin. Incidence rates are rising, particularly in White populations. Cutaneous melanoma is typically driven by exposure to ultraviolet radiation from natural sunlight and indoor tanning, although there are several subtypes that are not related to ultraviolet radiation exposure. Primary melanomas are often darkly pigmented, but can be amelanotic, with diagnosis based on a combination of clinical and histopathological findings. Primary melanoma is treated with wide excision, with margins determined by tumour thickness. Further treatment depends on the disease stage (following histopathological examination and, where appropriate, sentinel lymph node biopsy) and can include surgery, checkpoint immunotherapy, targeted therapy, or radiotherapy. Systemic drug therapies are recommended as an adjunct to surgery in patients with resectable locoregional metastases and are the mainstay of treatment in advanced melanoma. Management of advanced melanoma is complex, particularly in those with cerebral metastasis. Multidisciplinary care is essential. Systemic drug therapies, particularly immune checkpoint inhibitors, have substantially increased melanoma survival following a series of landmark approvals from 2011 onward.
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Affiliation(s)
- Georgina V Long
- Melanoma Institute Australia, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Medical Oncology, Mater Hospital, Sydney, NSW, Australia.
| | - Susan M Swetter
- Department of Dermatology and Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA; Department of Dermatology, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexander M Menzies
- Melanoma Institute Australia, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Medical Oncology, Mater Hospital, Sydney, NSW, Australia
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology and Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; NSW Health Pathology, Sydney, NSW, Australia
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7
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Nepal S, Santipas B, Yotchai W, Chairatchaneeboon M, Wilartratsami S, Luksanapruksa P. Pigmented epithelioid melanocytoma (PEM) of the spine with compression fracture: case report. BMC Musculoskelet Disord 2022; 23:13. [PMID: 34980046 PMCID: PMC8725277 DOI: 10.1186/s12891-021-04923-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Pigmented epithelioid melanocytoma (PEM) is a sporadic type of pigmented melanocytic tumor with uncertain malignant potential. PEM arises as a solitary neoplasm that predominantly occurs spontaneously in otherwise healthy patients. Due to its rarity, a gold standard treatment regimen does not exist; however, symptomatic cases should be managed with radiotherapy and surgery. Case presentation A 28-year-old Thai female presented with a sudden onset of back pain and weakness of the lower extremities during the postpartum period. Magnetic resonance imaging demonstrated abnormal soft tissue formation from T4 to T7; it extended to the vertebral bodies, left neural foramina, and posterior columns of T6 and T7. The patient underwent complete tumor debulking, decompressive laminectomy from T4 to T8, and posterior instrumentation from T3 to T10. The histopathology and immunohistochemistry suggested PEM. The patient fully resolved back pain after surgery. Nevertheless, as the patient re-presented with a neurological deficit a few months after the operative intervention, it was decided to perform a surgical resection via an en bloc vertebrectomy. At the one-year follow-up, although the patient reported continued improvement of her back pain, there was no motor power improvement. Conclusions Spinal cord compression due to PEM is uncommon, especially in adults. Early diagnosis and treatment provide a good prognosis and help to regain lost neurological functions. Complete tumor removal and decompression of the spinal cord must be considered as a treatment strategy. Perioperative radiotherapy and chemotherapy have also been highlighted as treatment modalities for spinal tumors. With our reported case, early operative intervention coupled with radiotherapy produced satisfying outcomes.
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Affiliation(s)
- Sarthak Nepal
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Borriwat Santipas
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Wasan Yotchai
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Sirichai Wilartratsami
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Panya Luksanapruksa
- Division of Spine Surgery, Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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8
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Chang OH, Elder DE, Barnhill RL, Piepkorn MW, Eguchi MM, Knezevich SR, Lee AC, Moreno RJ, Kerr KF, Elmore JG. Characterization of multiple diagnostic terms in melanocytic skin lesion pathology reports. J Cutan Pathol 2021; 49:153-162. [PMID: 34487353 PMCID: PMC10367580 DOI: 10.1111/cup.14126] [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: 04/14/2021] [Revised: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Histopathologically ambiguous melanocytic lesions lead some pathologists to list multiple diagnostic considerations in the pathology report. The frequency and circumstance of multiple diagnostic considerations remain poorly characterized. METHODS Two hundred and forty skin biopsy samples were interpreted by 187 pathologists (8976 independent diagnoses) and classified according to a diagnostic/treatment stratification (MPATH-Dx). RESULTS Multiple diagnoses in different MPATH-Dx classes were used in n = 1320 (14.7%) interpretations, with 97% of pathologists and 91% of cases having at least one such interpretation. Multiple diagnoses were more common for intermediate risk lesions and are associated with greater subjective difficulty and lower confidence. We estimate that 6% of pathology reports for melanocytic lesions in the United States contain two diagnoses of different MPATH-Dx prognostic classes, and 2% of cases are given two diagnoses with significant treatment implications. CONCLUSIONS Difficult melanocytic diagnoses in skin may necessitate multiple diagnostic considerations; however, as patients increasingly access their health records and retrieve pathology reports (as mandated by US law), uncertainty should be expressed unambiguously.
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Affiliation(s)
- Oliver H Chang
- Department of Laboratory Medicine and Pathology, University of Washington School of Medicine, Seattle, Washington, USA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raymond L Barnhill
- Departments of Pathology and Translational Research, Institut Curie, Paris Sciences and Lettres Research University, and Faculty of Medicine University of Paris Descartes, Paris, France
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Dermatopathology Northwest, Bellevue, Washington, USA
| | - Megan M Eguchi
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | | | - Annie C Lee
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Raul J Moreno
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Joann G Elmore
- Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California, USA
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9
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Crompton JG, Busam KJ, Bartlett EK. Interpretation of the Complex Melanoma Pathology Report. Surg Oncol Clin N Am 2021; 29:327-338. [PMID: 32482311 DOI: 10.1016/j.soc.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An ambiguous pathologic report can present a clinical dilemma to the treating surgeon. We describe lesions ranging from the potentially benign to the likely malignant. Correctly identifying features associated with higher-risk lesions has proven challenging given the overall good prognosis and low rate of events. An appropriate treatment plan generally requires discussion between the surgeon and an experienced dermatopathologist. When clinically indicated, additional testing may be used to further support or refute a diagnosis of melanoma. The indications for these techniques, the data to support their use, and the strengths and weakness of each are reviewed.
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Affiliation(s)
- Joseph G Crompton
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Edmund K Bartlett
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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10
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Ferrara G, Argenziano G. The WHO 2018 Classification of Cutaneous Melanocytic Neoplasms: Suggestions From Routine Practice. Front Oncol 2021; 11:675296. [PMID: 34277420 PMCID: PMC8283700 DOI: 10.3389/fonc.2021.675296] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/31/2021] [Indexed: 12/13/2022] Open
Abstract
The "multidimensional" World Health Organization (WHO) classification 2018 of melanocytic tumors encompasses nine melanoma pathways (seven of which for cutaneous melanoma) according to a progression model in which morphologically intermediate melanocytic tumors are cosidered as simulators and/or precursors to melanoma. These "intermediates" can be subclassified into: i) a "classical" subgroup (superficial/thin compound: dysplastic nevus), which is placed within the morphologic and molecular progression spectrum of classical (Clark's and McGovern's) melanoma subtypes (superficial spreading and, possibly, nodular); and ii) a "non-classical" subgroup (thick compound/dermal: "melanocytomas") whose genetic pathways diverge from classical melanoma subtypes. Such a progression model is aimed at giving a conceptual framework for a histopathological classification; however, routine clinicopathological practice strongly suggests that most melanomas arise de novo and that the vast majority of nevi are clinically stable or even involuting over time. Clinicopathological correlation can help identify some severely atypical but benign tumors (e.g.: sclerosing nevus with pseudomelanomatous features) as well as some deceptively bland melanomas (e.g.: lentiginous melanoma; nested melanoma), thereby addressing some ambiguous cases to a correct clinical management. The recently available adjuvant therapy regimens for melanoma raise the problem of a careful distinction between severely atypical (high grade) melanocytoma and "classical" melanoma: conventional morphology can guide an algorithmic approach based on an antibody panel (anti-mutated BRAF, BAP1, PRAME, ALK, TRKA, MET, HRAS-WT, ROS; beta catenin; R1alpha; p16; HMB45; Ki67), a first-line molecular study (identification of hot spot mutations of BRAF and NRAS) and an advanced molecular study (sequencing of NF1, KIT, BRAF, MAP2K1, GNAQ, GNA11, PLCB4, CYSLTR2, HRAS; fusions studies of BRAF, RET, MAP3K8, PRKCA); as a final step, next-generation sequencing can identify melanocytic tumors with rare genetic signatures and melanocytic tumors with a high tumor mutation burden which should be definitely ascribed to the category of classical melanoma with the respective therapeutic options.
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Affiliation(s)
- Gerardo Ferrara
- Anatomic Pathology Unit, Macerata General Hospital, Macerata, Italy
| | - Giuseppe Argenziano
- Department of Dermatology, 'Luigi Vanvitelli' University School of Medicine, Naples, Italy
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11
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Al-Rohil RN, Moore JL, Patterson NH, Nicholson S, Verbeeck N, Claesen M, Muhammad JZ, Caprioli RM, Norris JL, Kantrow S, Compton M, Robbins J, Alomari AK. Diagnosis of melanoma by imaging mass spectrometry: Development and validation of a melanoma prediction model. J Cutan Pathol 2021; 48:1455-1462. [PMID: 34151458 DOI: 10.1111/cup.14083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/24/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The definitive diagnosis of melanocytic neoplasia using solely histopathologic evaluation can be challenging. Novel techniques that objectively confirm diagnoses are needed. This study details the development and validation of a melanoma prediction model from spatially resolved multivariate protein expression profiles generated by imaging mass spectrometry (IMS). METHODS Three board-certified dermatopathologists blindly evaluated 333 samples. Samples with triply concordant diagnoses were included in this study, divided into a training set (n = 241) and a test set (n = 92). Both the training and test sets included various representative subclasses of unambiguous nevi and melanomas. A prediction model was developed from the training set using a linear support vector machine classification model. RESULTS We validated the prediction model on the independent test set of 92 specimens (75 classified correctly, 2 misclassified, and 15 indeterminate). IMS detects melanoma with a sensitivity of 97.6% and a specificity of 96.4% when evaluating each unique spot. IMS predicts melanoma at the sample level with a sensitivity of 97.3% and a specificity of 97.5%. Indeterminate results were excluded from sensitivity and specificity calculations. CONCLUSION This study provides evidence that IMS-based proteomics results are highly concordant to diagnostic results obtained by careful histopathologic evaluation from a panel of expert dermatopathologists.
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Affiliation(s)
- Rami N Al-Rohil
- Departments of Pathology and Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Nathan Heath Patterson
- Frontier Diagnostics, LLC, Nashville, Tennessee, USA.,Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | | | | | | | | | - Richard M Caprioli
- Frontier Diagnostics, LLC, Nashville, Tennessee, USA.,Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Jeremy L Norris
- Frontier Diagnostics, LLC, Nashville, Tennessee, USA.,Mass Spectrometry Research Center, Department of Biochemistry, Vanderbilt University, Nashville, Tennessee, USA
| | - Sara Kantrow
- Pathology Associates of Saint Thomas, Nashville, Tennessee, USA
| | - Margaret Compton
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jason Robbins
- Pathology Associates of Saint Thomas, Nashville, Tennessee, USA
| | - Ahmed K Alomari
- Departments of Pathology and Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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12
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Benton S, Zhao J, Asadbeigi S, Kim D, Zhang B, Gerami P. Pigmented Epithelioid Melanocytoma: Morphology and Molecular Drivers. Surg Pathol Clin 2021; 14:285-292. [PMID: 34023106 DOI: 10.1016/j.path.2021.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pigmented epithelioid melanocytoma (PEM) was originally described based on keen morphologic analysis identifying a group of melanocytic tumors sharing heavily pigmented epithelioid melanocytes. It is defined as heavily pigmented epithelioid, spindled, and dendritic melanocytes with characteristic vesicular nuclei, prominent nucleoli, and melanophages. PEM often involves regional lymph nodes. Recent advances in molecular analysis have allowed for subclassification of PEM into more specific subsets of melanocytic tumors. The most common subsets include PRKCA fusions, which result in pure PEMs with sheets of monomorphic epithelioid melanocytes, and PEMs with combined pattern and mutations in both PRKAR1A and BRAF.
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Affiliation(s)
- Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Sepideh Asadbeigi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA.
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13
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Gibson M, Scolyer RA, Soyer HP, Ferguson P, McGeechan K, Irwig L, Bell KJL. Estimating the potential impact of interventions to reduce over-calling and under-calling of melanoma. J Eur Acad Dermatol Venereol 2021; 35:1519-1527. [PMID: 33630379 DOI: 10.1111/jdv.17189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/19/2020] [Accepted: 02/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pathologists sometimes disagree over the histopathologic diagnosis of melanoma. 'Over-calling' and 'under-calling' of melanoma may harm individuals and healthcare systems. OBJECTIVES To estimate the extent of 'over-calling' and 'under-calling' of melanoma for a population undergoing one excision per person and to model the impact of potential solutions. METHODS In this epidemiological modelling study, we undertook simulations using published data on the prevalence and diagnostic accuracy of melanocytic histopathology in the U.S. POPULATION We simulated results for 10 000 patients each undergoing excision of one melanocytic lesion, interpreted by one community pathologist. We repeated the simulation using a hypothetical intervention that improves diagnostic agreement between community pathologist and a specialist dermatopathologist. We then evaluated four scenarios for how melanocytic lesions judged to be neither clearly benign (post-test probability of melanoma < 5%), nor clearly malignant (post-test probability of melanoma > 90%) might be handled, before sending for expert dermatopathologist review to decide the final diagnosis. These were (1) no intervention before expert review, (2) formal second community pathologist review, (3) intervention to increase diagnostic agreement and (4) both the intervention and formal second community pathologist review. The main outcomes were the probability of 'over-calling' and 'under-calling' melanoma, and number of lesions requiring expert referral for each scenario. RESULTS For 10 000 individuals undergoing excision of one melanocytic lesion, interpreted by a community pathologist, a hypothetical intervention to improve histopathology agreement reduced the number of benign lesions 'over-called' as melanoma from 308 to 164 and the number of melanomas 'under-called' from 289 to 240. If all uncertain diagnoses were sent for expert review, the number of referrals would decrease from 1500 to 737 cases if formal second community pathologist review was used, and to 701 cases if the hypothetical intervention was additionally used. CONCLUSIONS Interventions to improve histopathology agreement may reduce melanoma 'over-calling' and 'under-calling'.
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Affiliation(s)
- M Gibson
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Department of Dermatology, Royal Prince Alfred Hospital Sydney, Camperdown, NSW, Australia
| | - R A Scolyer
- Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute of Australia, The University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Camperdown, NSW, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Qld, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - P Ferguson
- Central Sydney Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute of Australia, The University of Sydney, Camperdown, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Camperdown, NSW, Australia
| | - K McGeechan
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - L Irwig
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - K J L Bell
- School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
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14
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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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15
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D'Souza P, Barr EK, Thirumala SD, Jacob R, Nagy L. Pigmented epithelioid melanocytoma: a rare lytic bone lesion involving intradural extension and subtotal resection in a 14-month-old girl. J Neurosurg Pediatr 2020; 25:625-628. [PMID: 32168491 DOI: 10.3171/2020.1.peds19359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
Pigmented epithelioid melanocytomas (PEMs) are low-grade, intermediate-type borderline melanocytic tumors with limited metastatic potential. To date, PEMs have been treated via gross-total resections. Postoperative recurrence and mortality are rare. This case highlights a unique presentation of a PEM that involved bone destruction and intradural infiltration, which required a subtotal resection. To the authors' knowledge, this is the first report of a PEM extending through the dura and necessitating subtotal resection, which is contrary to the standard of care, gross-total resection. Surveillance imaging 10 months after resection remained negative for clinical and radiological recurrence.
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Affiliation(s)
| | | | | | - Roy Jacob
- 3Department of Radiology, University Medical Center, Texas Tech University Health Sciences Center, Lubbock, Texas
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16
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Ferrara G, Bradamante M. Melanocytic Skin Tumors: Does the Molecular Progression Model Fit With the Routine Clinicopathological Practice? Dermatol Pract Concept 2019; 10:e2020001. [PMID: 31921489 DOI: 10.5826/dpc.1001a01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
- Gerardo Ferrara
- Anatomic Pathology Unit, Macerata General Hospital, Macerata, Italy
| | - Mirna Bradamante
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, Croatia
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17
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Papageorgiou C, Apalla Z, Bobos M, Gkentsidi T, Kyrgidis A, Lallas K, Manoli SM, Moutsoudis A, Nikolaidou C, Spyridis I, Lallas A. Dermoscopy of Spitz/Reed naevi and management. GIORN ITAL DERMAT V 2019; 154:457-465. [DOI: 10.23736/s0392-0488.19.06294-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Mancera N, Smalley KSM, Margo CE. Melanoma of the eyelid and periocular skin: Histopathologic classification and molecular pathology. Surv Ophthalmol 2019; 64:272-288. [PMID: 30578807 DOI: 10.1016/j.survophthal.2018.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/29/2022]
Abstract
Cutaneous melanoma, a potentially lethal malignancy of the periocular skin, represents only a small proportion of the roughly 87,000 new cases of cutaneous melanoma diagnosed annually in the United States. Most of our understanding of melanoma of the eyelid skin is extrapolated from studies of cutaneous melanoma located elsewhere. Recent years have witnessed major breakthroughs in molecular biology and genomics of cutaneous melanoma, some of which have led to the development of targeted therapies. The molecular insights have also kindled interest in rethinking how cutaneous melanomas are classified and assessed for risk. We provide a synopsis of the epidemiology, histopathologic classification, and clinical experience of eyelid melanoma since 1990 and then review major advances in the molecular biology of cutaneous melanoma, exploring how this impacts our understanding of classification and predicting risk.
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Affiliation(s)
- Norberto Mancera
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
| | - Keiran S M Smalley
- Departments of Tumor Biology, The Moffitt Cancer Center & Research Institute, Tampa, Florida, USA; Cutaneous Oncology The Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | - Curtis E Margo
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA; Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
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19
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Abstract
The human animal type melanoma (ATM) is a rare subtype of melanoma characterised by the proliferation of pigmented dermal epithelioid and spindled melanocytes. However, this variant of melanoma is still lacking a precise nosography definition and classification for the difficulty to be distinguished from other more common melanocytic lesions, as well as for its peculiar biological behaviour. On the other hand, the contribution of scientific literature to this issue is fragmented and limited to the description of very few cases. Starting from the presentation of a case with abnormally aggressive clinical features, here we revisit the current knowledge on ATM from its dermatologic patterns, epidemiology, demography and histopathology to the clinical management. Peculiar accuracy has also been reserved to several histopathologic criteria, which are critical for the differential diagnosis from other melanocytic diseases in junction with molecular data deriving from recent cytogenetic and mutational characterisation of this tumour.
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20
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Harvey NT, Wood BA. A Practical Approach to the Diagnosis of Melanocytic Lesions. Arch Pathol Lab Med 2018; 143:789-810. [PMID: 30059258 DOI: 10.5858/arpa.2017-0547-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Melanocytic lesions are common in routine surgical pathology. Although the majority of these lesions can be confidently diagnosed using well-established morphologic criteria, there is a significant subset of lesions that can be diagnostically difficult. These can be a source of anxiety for patients, clinicians, and pathologists, and the potential consequences of a missed diagnosis of melanoma are serious. OBJECTIVE.— To provide a practical approach to the diagnosis of melanocytic lesions, including classic problem areas as well as suggestions for common challenges and appropriate incorporation of ancillary molecular techniques. DATA SOURCES.— Literature search using PubMed and Google Scholar, incorporating numerous search terms relevant to the particular section, combined with contemporaneous texts and lessons from personal experience. CONCLUSIONS.— Although a subset of melanocytic lesions can be diagnostically challenging, the combination of a methodical approach to histologic assessment, knowledge of potential diagnostic pitfalls, opinions from trusted colleagues, and judicious use of ancillary techniques can help the pathologist navigate this difficult area.
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Affiliation(s)
- Nathan T Harvey
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
| | - Benjamin A Wood
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
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21
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Ensslin CJ, Hibler BP, Lee EH, Nehal KS, Busam KJ, Rossi AM. Atypical Melanocytic Proliferations: A Review of the Literature. Dermatol Surg 2018; 44:159-174. [PMID: 29059147 PMCID: PMC6639034 DOI: 10.1097/dss.0000000000001367] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ambiguous histopathologic diagnoses represent a challenge for clinicians because of a lack of definitive diagnosis and related uncertainty about management. OBJECTIVE To review the literature on atypical melanocytic proliferations and detail synonymous terms, epidemiology, diagnostic work-up, histopathology, treatment, and prognosis. METHODS Databases from PubMed and Web of Science were searched for articles related to atypical melanocytic proliferations. RESULTS Intraepidermal melanocytic proliferations with features worrisome for possible melanoma in situ (MIS) are generally excised as for MIS. Reported rates of upstaging of such cases to invasive melanoma on review of the excision are very low. Because invasion, lymph node spread, and metastasis can occur in atypical melanocytic lesions with a thick intradermal component, these are often treated as for malignant melanoma. CONCLUSION Because the diagnosis dictates treatment, it is incumbent to establish a diagnosis as definitive as possible, obtaining second or third opinions and using ancillary studies when appropriate. When the diagnosis remains uncertain, it is difficult to provide guidelines for treatment. Clinical care decisions for patients with an uncertain diagnosis are best done on a case-by-case basis weighing probabilities of adverse outcomes against potential benefits and risks from various treatment options.
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Affiliation(s)
| | - Brian P. Hibler
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Erica H. Lee
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Kishwer S. Nehal
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Dermatology, Weill Cornell Medical College, New York, New York
| | - Klaus J. Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anthony M. Rossi
- Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Dermatology, Weill Cornell Medical College, New York, New York
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22
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Johnson ER, Korchak ME, Goodglick TA, Johal JS, Dufresne CR, Sabet SJ. Pigmented Epithelioid Melanocytoma of the Cheek, Orbit, and Intracranial Cavity: A Case Report. Ocul Oncol Pathol 2018; 4:57-60. [PMID: 29344501 DOI: 10.1159/000477734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 05/22/2017] [Indexed: 11/19/2022] Open
Abstract
Pigmented epithelioid melanocytoma (PEM) of the skin has been rarely reported in ophthalmology. The purpose of this case report is to present a young male born with a progressive, hyperpigmented lesion involving the orbit and intracranial cavity diagnosed as PEM. The case is unique given the young age and the size, multifocality, and growth of this tumor. Identification of this lesion is paramount due to its low-grade malignant potential.
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Affiliation(s)
- Erik R Johnson
- Department of Ophthalmology, MedStar Georgetown University Hospital, Washington, DC
| | - Michael E Korchak
- Department of Ophthalmology, MedStar Washington Hospital Center, Washington, DC
| | - Todd A Goodglick
- Department of Ophthalmology, MedStar Georgetown University Hospital, Washington, DC
| | | | - Craig R Dufresne
- Department of Plastic Surgery, INOVA Fairfax Hospital, Falls Church, VA, USA
| | - Sina J Sabet
- Department of Ophthalmology, MedStar Georgetown University Hospital, Washington, DC
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23
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Keratinocyte Sonic Hedgehog Upregulation Drives the Development of Giant Congenital Nevi via Paracrine Endothelin-1 Secretion. J Invest Dermatol 2017; 138:893-902. [PMID: 29138054 DOI: 10.1016/j.jid.2017.10.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/21/2017] [Accepted: 10/23/2017] [Indexed: 01/20/2023]
Abstract
Giant congenital nevi are associated with clinical complications such as neurocutaneous melanosis and melanoma. Virtually nothing is known about why some individuals develop these lesions. We previously identified the sonic hedgehog (Shh) pathway regulator Cdon as a candidate nevus modifier gene. Here we validate this by studying Cdon knockout mice, and go on to establishing the mechanism by which Shh exacerbates nevogenesis. Cdon knockout mice develop blue nevi without the need for somatic melanocyte oncogenic mutation. In a mouse model carrying melanocyte NRASQ61K, we found that strain backgrounds that carry genetic variants that cause increased keratinocyte Shh pathway activity, as measured by Gli1 and Gli2 expression, develop giant congenital nevi. Shh components are also active adjacent to human congenital nevi. Mechanistically, this exacerbation of nevogenesis is driven via the release of the melanocyte mitogen endothelin-1 from keratinocytes. We then suppressed nevus development in mice using Shh and endothelin antagonists. Our work suggests an aspect of nevus development whereby keratinocyte cytokines such as endothelin-1 can exacerbate nevogenesis, and provides potential therapeutic approaches for giant congenital nevi. Furthermore, it highlights the notion that germline genetic variation, in addition to somatic melanocyte mutation, can strongly influence the histopathological features of melanocytic nevi.
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24
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Tatsi C, Bacopoulou F, Lyssikatos C, Belyavskaya E, Faucz F, Stratakis CA. Sporadic melanotic schwannoma with overlapping features of melanocytoma bearing a GNA11 mutation in an adolescent girl. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26400. [PMID: 28012237 PMCID: PMC6309823 DOI: 10.1002/pbc.26400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/08/2016] [Accepted: 10/13/2016] [Indexed: 12/23/2022]
Abstract
Melanotic schwannoma (MS) is a soft tissue neoplasm that shares histologic features with melanocytic tumors and schwannomas. A type of MS, called psammomatous MS (PMS), is associated with Carney complex (CNC), which is caused by PRKAR1A mutations. Other pigmented neoplasms, such as uveal melanomas and melanocytomas (MCs), are associated with genetic defects in other genes including GNA11. We report an adolescent female with a large sporadic mesenteric MS with complex histologic findings reminiscent of both PMS and MC. The lesion carried a mutation of the GNA11 gene. We conclude that sporadic MSs may occur rarely in adolescents without CNC; MSs may also be associated with somatic GNA11 mutations.
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Affiliation(s)
- Christina Tatsi
- Section on Endocrinology & Genetics, and Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,To whom correspondence should be addressed: Dr. Christina Tatsi, SEGEN, NICHD, NIH, 10 Center Drive, Building 10, NIH-Clinical Research Center, Room 1-3330, MSC1103, Bethesda, MD, 20892-1862,USA, Tel: 001-301-496-4686; 001-301-402-0574,
| | - Flora Bacopoulou
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Charalampos Lyssikatos
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Elena Belyavskaya
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Fabio Faucz
- Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | - Constantine A. Stratakis
- Section on Endocrinology & Genetics, and Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA.,Pediatric Endocrinology Inter-institute Training Program, Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD), National Institutes of Health (NIH), Bethesda, MD 20892, USA
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25
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Lee JJ, Vilain RE, Granter SR, Hu NR, Bresler SC, Xu S, Frank AH, Mihm MC, Saw RP, Fletcher CD, Scolyer RA, Murphy GF, Lian CG. 5-Hydroxymethylcytosine is a nuclear biomarker to assess biological potential in histologically ambiguous heavily pigmented melanocytic neoplasms. J Cutan Pathol 2017; 44:249-255. [DOI: 10.1111/cup.12880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/03/2016] [Accepted: 12/26/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Jonathan J. Lee
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Ricardo E. Vilain
- Melanoma Institute Australia; North Sydney Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Scott R. Granter
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Nina R. Hu
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Scott C. Bresler
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Shuyun Xu
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Alexander H. Frank
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Martin C. Mihm
- Department of Dermatology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Robyn P.M. Saw
- Melanoma Institute Australia; North Sydney Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
- Discipline of Surgery; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - Christopher D. Fletcher
- Department of Pathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Richard A. Scolyer
- Melanoma Institute Australia; North Sydney Australia
- Sydney Medical School; The University of Sydney; Sydney NSW Australia
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - George F. Murphy
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
| | - Christine G. Lian
- Program in Dermatopathology; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
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26
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Melanocytoma-like melanoma may be the missing link between benign and malignant uveal melanocytic lesions in humans and dogs: a comparative study. Melanoma Res 2016; 26:565-571. [DOI: 10.1097/cmr.0000000000000297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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27
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de la Fouchardière A. [Cutaneous melanocytic tumors. Case 7]. Ann Pathol 2016; 36:341-344. [PMID: 27639772 DOI: 10.1016/j.annpat.2016.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
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28
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Lee KC, Peacock S, Weinstock MA, Zhao GA, Knezevich SR, Elder DE, Barnhill RL, Piepkorn MW, Reisch LM, Carney PA, Onega T, Lott JP, Elmore JG. Variation among pathologists' treatment suggestions for melanocytic lesions: A survey of pathologists. J Am Acad Dermatol 2016; 76:121-128. [PMID: 27692732 DOI: 10.1016/j.jaad.2016.07.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/21/2016] [Accepted: 07/12/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND The extent of variability in treatment suggestions for melanocytic lesions made by pathologists is unknown. OBJECTIVE We investigated how often pathologists rendered suggestions, reasons for providing suggestions, and concordance with national guidelines. METHODS We conducted a cross-sectional survey of pathologists. Data included physician characteristics, experience, and treatment recommendation practices. RESULTS Of 301 pathologists, 207 (69%) from 10 states (California, Connecticut, Hawaii, Iowa, Kentucky, Louisiana, New Jersey, New Mexico, Utah, and Washington) enrolled. In all, 15% and 7% reported never and always including suggestions, respectively. Reasons for offering suggestions included improved care (79%), clarification (68%), and legal liability (39%). Reasons for not offering suggestions included referring physician preference (48%), lack of clinical information (44%), and expertise (29%). Training and caseload were associated with offering suggestions (P < .05). Physician suggestions were most consistent for mild/moderate dysplastic nevi and melanoma. For melanoma in situ, 18 (9%) and 32 (15%) pathologists made suggestions that undertreated or overtreated lesions based on National Comprehensive Cancer Network (NCCN) guidelines, respectively. For invasive melanoma, 14 (7%) pathologists made treatment suggestions that undertreated lesions based on NCCN guidelines. LIMITATIONS Treatment suggestions were self-reported. CONCLUSIONS Pathologists made recommendations ranging in consistency. These findings may inform efforts to reduce treatment variability and optimize patterns of care delivery for patients.
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Affiliation(s)
- Kachiu C Lee
- Department of Dermatology, Brown University, Providence, Rhode Island
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Martin A Weinstock
- Department of Dermatology, Brown University, Providence, Rhode Island; Department of Epidemiology, Brown University, Providence, Rhode Island; Dermatoepidemiology Unit, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island
| | - Ge Alice Zhao
- Division of Dermatology, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | | | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raymond L Barnhill
- Departments of Pathology, Institut Curie, and Faculty of Medicine, University of Paris Descartes, Paris, France
| | - Michael W Piepkorn
- Division of Dermatology, University of Washington School of Medicine, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Dermatopathology Northwest, Bellevue, Washington
| | - Lisa M Reisch
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Patricia A Carney
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tracy Onega
- Departments of Biomedical Data Science and Epidemiology, Norris Cotton Cancer Center, and Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jason P Lott
- Cornell Scott-Hill Health Center, New Haven, Connecticut
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
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Abstract
Cutaneous melanoma occurs only rarely in children under 10 years of age. Mimics of melanoma, including Spitz naevi and proliferative nodules in congenital melanocytic naevi are much more frequent in this age group. Melanoma arising in congenital melanocytic naevus is uncommon, but can show aggressive behaviour. Although spitzoid lesions constitute the majority of 'diagnostically challenging' cases, they are an uncommon cause of mortality in this age group. Among lesions with undoubted metastatic potential, there are biologically distinct tumours which differ significantly in behaviour from the common types of melanoma seen in adults. In patients over 10 years of age and increasingly into the late adolescent years, melanoma is a relatively common neoplasm. Just as in adult patients, care should be taken to exclude melanoma mimics. Particular care is warranted in this older age group in the assessment of lesions with spitzoid morphology as there is significant potential for both over-and under-diagnosis.
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Affiliation(s)
- Benjamin A Wood
- PathWest Laboratory Medicine, QEII Medical Centre, and School of Pathology and Laboratory Medicine, The University of Western Australia, WA, Australia.
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Advances in melanoma: revolutionary progress delivering improved patient management and outcomes. Pathology 2016; 48:105-7. [DOI: 10.1016/j.pathol.2015.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Ferrara G, Cavicchini S, Corradin MT. Hypopigmented atypical Spitzoid neoplasms (atypical Spitz nevi, atypical Spitz tumors, Spitzoid melanoma): a clinicopathological update. Dermatol Pract Concept 2015; 5:45-52. [PMID: 25692081 PMCID: PMC4325689 DOI: 10.5826/dpc.050106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 10/05/2014] [Indexed: 01/21/2023] Open
Affiliation(s)
- Gerardo Ferrara
- Department of Oncology, Anatomic Pathology Unit, Gaetano Rummo Hospital, Benevento, Italy
| | - Stefano Cavicchini
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore, Milan, Italy
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Lallas A, Kyrgidis A, Ferrara G, Kittler H, Apalla Z, Castagnetti F, Longo C, Moscarella E, Piana S, Zalaudek I, Argenziano G. Atypical Spitz tumours and sentinel lymph node biopsy: a systematic review. Lancet Oncol 2014; 15:e178-83. [PMID: 24694641 DOI: 10.1016/s1470-2045(13)70608-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sentinel lymph node biopsy has been proposed as a diagnostic method for estimation of the malignant potential of atypical Spitz tumours. However, although cell deposits are commonly detected in the sentinel lymph nodes of patients with atypical Spitz tumours, their prognosis is substantially better than that of patients with melanoma and positive sentinel lymph node biopsies. We did a systematic review of published reports to assess the role of sentinel lymph node biopsy as a prognostic method in the management of atypical Spitz tumours. The results of our analysis did not show any prognostic benefit of sentinel lymph node biopsy; having a positive sentinel lymph node does not seem to predict a poorer outcome for patients with atypical Spitz tumours. These findings indicate that, especially in the paediatric population, it might be prudent initially to use complete excision with clear margins and careful clinical follow-up in patients with atypical Spitz tumours.
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Affiliation(s)
- Aimilios Lallas
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Athanassios Kyrgidis
- Department of Otolaryngology Head and Neck Surgery, Medical School, Aristotle University, Thessaloniki, Greece
| | - Gerardo Ferrara
- Anatomic Pathology Unit, Department of Oncology, Gaetano Rummo General Hospital, Benevento, Italy
| | - Harald Kittler
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
| | - Zoe Apalla
- State Clinic of Dermatology, Hospital of Venereal and Skin Diseases, Thessaloniki, Greece
| | - Fabio Castagnetti
- Surgery Unit, Arcispedale Santa Maria Nuova Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Caterina Longo
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Elvira Moscarella
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Simonetta Piana
- Pathology Unit, Arcispedale Santa Maria Nuova Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Iris Zalaudek
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy; Department of Dermatology, Medical University, Graz, Austria
| | - Giuseppe Argenziano
- Skin Cancer Unit, Arcispedale Santa Maria Nuova Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy.
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Larson AR, Dresser K, Zhan Q, Lezcano C, Woda BA, Yosufi B, Thompson JF, Scolyer RA, Mihm MC, Shi YG, Murphy GF, Lian CG. Loss of 5-hydroxymethylcytosine correlates with increasing morphologic dysplasia in melanocytic tumors. Mod Pathol 2014; 27:936-44. [PMID: 24390216 PMCID: PMC4077910 DOI: 10.1038/modpathol.2013.224] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/16/2013] [Indexed: 12/31/2022]
Abstract
DNA methylation is the most well-studied epigenetic modification in cancer biology. 5-hydroxymethylcytosine is an epigenetic mark that can be converted from 5-methylcytosine by the ten-eleven translocation gene family. We recently reported the loss of 5-hydroxymethylcytosine in melanoma compared with benign nevi and suggested that loss of this epigenetic marker is correlated with tumor virulence based on its association with a worse prognosis. In this study, we further characterize the immunoreactivity patterns of 5-hydroxymethylcytosine in the full spectrum of melanocytic lesions to further validate the potential practical application of this epigenetic marker. One hundred and seventy-five cases were evaluated: 18 benign nevi, 20 dysplastic nevi (10 low-grade and 10 high-grade lesions), 10 atypical Spitz nevi, 20 borderline tumors, 5 melanomas arising within nevi, and 102 primary melanomas. Progressive loss of 5-hydroxymethylcytosine from benign dermal nevi to high-grade dysplastic nevi to borderline melanocytic neoplasms to melanoma was observed. In addition, an analysis of the relationship of nuclear diameter with 5-hydroxymethylcytosine staining intensity within lesional cells revealed a significant correlation between larger nuclear diameter and decreased levels of 5-hydroxymethylcytosine. Furthermore, borderline lesions uniquely exhibited a diverse spectrum of staining of each individual case. This study further substantiates the association of 5-hydroxymethylcytosine loss with dysplastic cytomorphologic features and tumor progression and supports the classification of borderline lesions as a biologically distinct category of melanocytic lesions.
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Affiliation(s)
- Allison R. Larson
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School,Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School
| | - Karen Dresser
- Department of Pathology, University of Massachusetts Medical Center
| | - Qian Zhan
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School
| | - Cecilia Lezcano
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School
| | - Bruce A. Woda
- Department of Pathology, University of Massachusetts Medical Center
| | - Benafsha Yosufi
- Royal Prince Alfred Hospital, Melanoma Institute Australia and Sydney Medical School, The University of Sydney
| | - John F. Thompson
- Royal Prince Alfred Hospital, Melanoma Institute Australia and Sydney Medical School, The University of Sydney
| | - Richard A. Scolyer
- Royal Prince Alfred Hospital, Melanoma Institute Australia and Sydney Medical School, The University of Sydney
| | - Martin C. Mihm
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School
| | - Yujiang G. Shi
- Divison of Endocrinology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
| | - George F. Murphy
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School,Co-corresponding authors, George F. Murphy, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149, Christine G. Lian, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149
| | - Christine Guo Lian
- Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School,Co-corresponding authors, George F. Murphy, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149, Christine G. Lian, MD, Program in Dermatopathology, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, EBRC Suite 401, Boston MA 02115, , telephone 617-525-7484, fax 617-264-5149
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Ferrara G, Gianotti R, Cavicchini S, Salviato T, Zalaudek I, Argenziano G. Spitz nevus, Spitz tumor, and spitzoid melanoma: a comprehensive clinicopathologic overview. Dermatol Clin 2014; 31:589-98, viii. [PMID: 24075547 DOI: 10.1016/j.det.2013.06.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Spitz nevus can clinically present either in the classical (reddish pink) or the pigmented (brownish black) variant. Dermoscopy demonstrates that the pigmented variant is much more common than the classical variant; however, none of these show dermoscopic patterns clearly distinguishable from melanoma. Even histopathologically, a clear-cut differentiation between benign and malignant spitzoid neoplasms is often difficult, so that intermediate diagnostic categories (atypical Spitz nevus and Spitz tumor) are admitted. Because of these difficulties in clinical and histopathologic evaluation, surgical excision is recommended for clinically atypical spitzoid lesions of childhood and for all spitzoid lesions of adulthood.
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Affiliation(s)
- Gerardo Ferrara
- Anatomic Pathology Unit, Department of Oncology, 'Gaetano Rummo' General Hospital, Via dell'Angelo 1, Benevento I-82100, Italy.
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Cipriani NA, Letovanec I, Hornicek FJ, Mullen JT, Duan Z, Borger DR, Nielsen GP. BRAFmutation in ‘sarcomas’: a possible method to detect de-differentiated melanomas. Histopathology 2013; 64:639-46. [DOI: 10.1111/his.12305] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Igor Letovanec
- Institut Universitaire de Pathologie; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Francis J Hornicek
- Center for Sarcoma and Connective Tissue Oncology; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - John T Mullen
- Division of Surgical Oncology; Department of Surgery; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Zhenfeng Duan
- Center for Sarcoma and Connective Tissue Oncology; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Darrell R Borger
- Division of Hematology-Oncology and Cancer Center; Massachusetts General Hospital; Harvard Medical School; Boston MA USA
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Scolyer RA, Judge MJ, Evans A, Frishberg DP, Prieto VG, Thompson JF, Trotter MJ, Walsh MY, Walsh NMG, Ellis DW. Data set for pathology reporting of cutaneous invasive melanoma: recommendations from the international collaboration on cancer reporting (ICCR). Am J Surg Pathol 2013; 37:1797-814. [PMID: 24061524 PMCID: PMC3864181 DOI: 10.1097/pas.0b013e31829d7f35] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An accurate and complete pathology report is critical for the optimal management of cutaneous melanoma patients. Protocols for the pathologic reporting of melanoma have been independently developed by the Royal College of Pathologists of Australasia (RCPA), Royal College of Pathologists (United Kingdom) (RCPath), and College of American Pathologists (CAP). In this study, data sets, checklists, and structured reporting protocols for pathologic examination and reporting of cutaneous melanoma were analyzed by an international panel of melanoma pathologists and clinicians with the aim of developing a common, internationally agreed upon, evidence-based data set. The International Collaboration on Cancer Reporting cutaneous melanoma expert review panel analyzed the existing RCPA, RCPath, and CAP data sets to develop a protocol containing "required" (mandatory/core) and "recommended" (nonmandatory/noncore) elements. Required elements were defined as those that had agreed evidentiary support at National Health and Medical Research Council level III-2 level of evidence or above and that were unanimously agreed upon by the review panel to be essential for the clinical management, staging, or assessment of the prognosis of melanoma or fundamental for pathologic diagnosis. Recommended elements were those considered to be clinically important and recommended for good practice but with lesser degrees of supportive evidence. Sixteen core/required data elements for cutaneous melanoma pathology reports were defined (with an additional 4 core/required elements for specimens received with lymph nodes). Eighteen additional data elements with a lesser level of evidentiary support were included in the recommended data set. Consensus response values (permitted responses) were formulated for each data item. Development and agreement of this evidence-based protocol at an international level was accomplished in a timely and efficient manner, and the processes described herein may facilitate the development of protocols for other tumor types. Widespread utilization of an internationally agreed upon, structured pathology data set for melanoma will lead not only to improved patient management but is a prerequisite for research and for international benchmarking in health care.
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Affiliation(s)
- Richard A Scolyer
- *Melanoma Institute Australia Disciplines of †Pathology **Surgery, Sydney Medical School, The University of Sydney Departments of ‡Tissue Pathology and Diagnostic Oncology ††Melanoma and Surgical Oncology, Royal Prince Alfred Hospital §Royal College of Pathologists of Australasia, Sydney, NSW ¶¶Royal Adelaide Hospital and Flinders University, Adelaide, SA, Australia ∥Department of Pathology, Ninewells Hospital and Medical School, Dundee, Scotland ¶Cedars-Sinai Medical Center, Los Angeles, CA #Departments of Pathology and Dermatology, University of Texas-MD Anderson Cancer Center, Houston, TX ‡‡Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB ∥∥Department of Pathology, Capital District Health Authority and Dalhousie University, Halifax, NS, Canada §§Royal Victoria Hospital, Belfast, UK
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Zulfiqar M, Thompson AD. Current Applications of Molecular Genetic Technologies to the Diagnosis and Treatment of Cutaneous Melanocytic Neoplasms. Clin Lab Med 2013; 33:881-90. [DOI: 10.1016/j.cll.2013.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Shahbain H, Cooper C, Gerami P. Molecular diagnostics for ambiguous melanocytic tumors. ACTA ACUST UNITED AC 2013; 31:274-8. [PMID: 23174498 DOI: 10.1016/j.sder.2012.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 09/05/2012] [Indexed: 11/15/2022]
Abstract
Certain subsets of melanocytic neoplasms are difficult to classify because of conflicting histologic features and the existence of a poorly defined intermediate grade of melanocytic tumors. The integration of molecular diagnostic information with a histologic impression may contribute significantly toward improving classification. This review discusses the development of and advances in molecular techniques, including comparative genomic hybridization and fluorescence in situ hybridization (FISH) as diagnostic and prognostic tools for melanocytic neoplasms. Further, we discuss how specific molecular aberrations identified via FISH correlate with certain morphologies in melanocytic neoplasms. We also examine the prognostic value of FISH in intermediate-grade melanocytic tumors, particularly atypical Spitz tumors.
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Affiliation(s)
- Hilmy Shahbain
- College of Science, Benedictine University, Lisle, IL, USA
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Ferrara G, Senetta R, Paglierani M, Massi D. Main clues in the pathologic diagnosis of melanoma: is molecular genetics helping? Dermatol Ther 2013; 25:423-31. [PMID: 23046021 DOI: 10.1111/j.1529-8019.2012.01485.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Although conventional histopathologic examination is still the undisputable mainstay for the diagnosis of melanocytic skin neoplasms, application of molecular testing has experienced tremendous growth and will continue to expand in the future as the need for more specific diagnoses and new targeted therapies evolve. Ancillary molecular methods, including comparative genomic hybridization and fluorescence in situ hybridization, have the potential to provide important new information to challenging cases, and will help improve diagnostic accuracy, particularly in cases in which morphology is not conclusive. Pathologists are increasingly involved in the prospective genotyping of melanoma, which leads to patient stratification in light of the novel personalized therapeutic approaches in the advanced setting.
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Affiliation(s)
- Gerardo Ferrara
- Anatomic Pathology Unit, Department of Oncology, Gaetano Rummo General Hospital, Benevento, Italy
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40
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Zembowicz A, Yang SE, Kafanas A, Lyle SR. Correlation Between Histologic Assessment and Fluorescence In Situ Hybridization Using MelanoSITE in Evaluation of Histologically Ambiguous Melanocytic Lesions. Arch Pathol Lab Med 2012; 136:1571-9. [DOI: 10.5858/arpa.2011-0673-oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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41
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Urso C. Tertium non datur? Legitimacy of a third diagnostic category in melanocytic lesions. Arch Pathol Lab Med 2012; 136:1181-3. [PMID: 23020718 DOI: 10.5858/arpa.2012-0071-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Carmelo Urso
- Anatomic Pathology Unit, Dermatopathology Section, S. M. Annunziata Hospital, Florence, Italy
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Campagne C, Julé S, Bernex F, Estrada M, Aubin-Houzelstein G, Panthier JJ, Egidy G. RACK1, a clue to the diagnosis of cutaneous melanomas in horses. BMC Vet Res 2012; 8:95. [PMID: 22747534 PMCID: PMC3543212 DOI: 10.1186/1746-6148-8-95] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 06/15/2012] [Indexed: 01/20/2023] Open
Abstract
Background Melanocytic proliferations are common in horses but the diagnosis of malignancy is not always straightforward. To improve diagnosis and prognosis, markers of malignancy are needed. Receptor for activated C kinase 1 (RACK1) protein may be such a marker. RACK1 was originally found to characterize malignant melanocytic lesions in the Melanoblastoma-bearing Libechov minipig (MeLiM) and, later, in human patients. Our purpose was to investigate the value of RACK1 in the classification of cutaneous melanocytic proliferations in horses. Results Using immunofluorescence, we report here that both MITF (Microphthalmia-associated transcription factor) and PAX3 (Paired box 3) allow the identification of melanocytic cells in horse skin samples. Importantly, RACK1 was detected in melanocytic lesions but not in healthy skin melanocytes. Finally, we found that RACK1 labeling can be used in horses to distinguish benign melanocytic tumors from melanomas. Indeed, RACK1 labeling appeared more informative to assess malignancy than individual histomorphological features. Conclusions This study confirms that horses provide an interesting model for melanoma genesis studies. It establishes MITF and PAX3 as markers of horse melanocytic cells. RACK1 emerges as an important marker of malignancy which may contribute to progress in the diagnosis of melanomas in both human and veterinary medicine.
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Affiliation(s)
- Cécile Campagne
- INRA, UMR955 de Génétique fonctionnelle et médicale, Ecole Nationale Vétérinaire d'Alfort, 7 avenue du Général de Gaulle, Maisons-Alfort, F-94704, France
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Sepehr A, Tahan SR. "Nevus/melanocytoma/melanoma": that which we call a rose by any other name would smell as sweet. Arch Pathol Lab Med 2012; 136:135; author reply 136-7. [PMID: 22288955 DOI: 10.5858/arpa.2011-0148-le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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46
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Scolyer RA, Zembowicz A. In Reply. Arch Pathol Lab Med 2012. [DOI: 10.5858/arpa.2011-0451-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Gerami P, Zembowicz A. Update on Fluorescence In Situ Hybridization in Melanoma: State of the Art. Arch Pathol Lab Med 2011; 135:830-7. [DOI: 10.5858/2011-0048-rair.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Recent advances in understanding the molecular basis of melanoma have resulted in development of fluorescence in situ hybridization (FISH) protocols designed to detect genetic abnormalities discriminating melanoma from nevi. The most extensively studied is a 4-probe multicolor FISH probe panel targeting chromosomes 6 and 11. Validation studies showed promising sensitivity and specificity for distinguishing benign nevi and malignant melanoma by FISH. Recent studies show that a melanoma FISH assay has great potential for becoming an important diagnostic adjunct in classification of melanocytic lesions and in diagnosis of melanoma.
Objective.—To present a comprehensive review of the science and practical aspects of FISH in melanoma for pathologists considering the use of melanoma FISH in their practice.
Data Sources.—Review of the literature and personal experience of the authors.
Conclusions.—Judicious use of a 4-probe multicolor melanoma FISH procedure can enhance accuracy for diagnosis of melanoma and improve classification of melanocytic proliferations.
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Evolving concepts in melanoma classification and their relevance to multidisciplinary melanoma patient care. Mol Oncol 2011; 5:124-36. [PMID: 21482206 DOI: 10.1016/j.molonc.2011.03.002] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/11/2011] [Indexed: 11/24/2022] Open
Abstract
In the initial period after melanoma was recognised as a disease entity in the early 1800's, it was subclassified on the basis of its presumed origin (from a precursor naevus, from a melanocytic precursor lesion acquired during adult life or in previously blemish-fee skin). In 1967 the eminent American pathologist, Dr Wallace Clark, proposed a histogenetic classification for melanoma in which the disease was subdivided predominantly on the basis of histopathological features of the intra-epidermal component of the tumour adjacent to any dermal invasive component. The subtypes were superficial spreading melanoma (SSM), lentigo maligna melanoma (LMM) and nodular melanoma (NM). Whilst additional entities, including acral lentiginous melanoma, mucosal melanoma, desmoplastic melanoma and naevoid melanoma have since been recognised, SSM, LMM and NM remain in the latest (2006) version of the WHO melanoma classification. Clark's histogenetic classification has been criticised because the criteria upon which it is based include clinical features (such as the site of the melanoma) and non-tumourous histopathological features (such as the character of the associated epidermis and the degree of solar elastosis) and also because of overlap in defining features, lack of an independent association with patient outcome and minimal relevance as a determinant of clinical management. However, such criticisms fail to acknowledge its importance in highlighting the myriad of clinical and histological guises of melanoma, which if not recognized by clinicians and pathologists will inevitably lead to a delay in diagnosis and a concomitant adverse clinical outcome. Recently, mutually exclusive oncogenic mutations in melanomas involving NRAS (15-20%), BRAF (50%), CKIT (2%), and GNAQ/GNA11 (50% of uveal melanomas) have been identified. This might herald the beginning of a new molecular classification of melanoma in which the biologically distinct subsets share a common oncogenic mechanism, behave clinically in a similar fashion and require similar clinical management. These discoveries are already being successfully exploited as therapeutic targets in clinical trials of metastatic melanoma patients with promising activity. Whilst there remains much to be discovered in this rapidly evolving field, there is already great optimism that more rational and effective therapies for melanoma patients will soon be widely available.
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