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Sondak VK, Messina JL. Melanoma in Pediatric and Young Adult Patients. Curr Oncol Rep 2024; 26:818-825. [PMID: 38780675 DOI: 10.1007/s11912-024-01542-5] [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] [Accepted: 05/01/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW Melanoma in younger individuals has different clinical presentations, histologic characteristics and prognosis from older patients. This review summarizes key differences and important new insights into pediatric and young adult melanoma, as well as recent evolutions in treatment. RECENT FINDINGS Molecular techniques have improved the classification of melanocytic neoplasms, and are especially useful in the workup of the diagnostically challenging lesions frequent in this age group. Molecular evaluation highlights differences between melanoma and atypical lesions with Spitz-like morphology, and should routinely be incorporated for diagnosing and classifying Spitzoid melanocytic to guide prognostication and treatment. Once diagnosed, the management of bona fide melanoma in children and young adults is largely similar to older patients, while the optimal management of lesions such as atypical Spitz tumors remains uncertain. Increased awareness of the presentation and diagnostic characteristics of melanoma in young individuals will allow earlier detection, and improved diagnostic techniques will allow optimum management without over- or under-treatment.
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Affiliation(s)
- Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, U.S.A..
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, U.S.A
- Department of Pathology, Moffitt Cancer Center, Tampa, FL, U.S.A
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2
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Behrendt N, Schultewolter T, Busam K, Frosina D, Spagnoli G, Jungbluth A. [Expression of cancer testis (CT) antigens in pediatric and adolescent melanomas]. DER PATHOLOGE 2018. [PMID: 28631119 DOI: 10.1007/s00292-017-0311-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the main problems in the diagnostics of pediatric melanomas is the differentiation from benign dermal lesions typical for this age group, such as Spitz nevus. The biological behavior of pediatric melanomas differs considerably from that of melanomas in adults. MATERIAL AND METHODS Cancer testis (CT) antigens are named after their typical expression pattern since they are present in various types of malignant tumors but in normal adult tissues are solely expressed in testicular germ cells. Because of this tumor-associated expression pattern, CT antigens are regarded as potential targets for vaccine-based immunotherapy of cancer and might be used as diagnostic tools in surgical pathology. In adults, melanoma is among the tumors showing a high incidence of CT antigen expression; however, while there is ample knowledge about adult melanomas, little is known about the presence of CT antigens in pediatric melanomas. Consequently, the expression of CT antigens MAGE-A1, MAGE-A4, CT7/MAGE-C1, NY-ESO-1, and GAGE was analyzed in a series of pediatric melanomas. The study was restricted to cases of metastatic disease and/or fatal outcome. A total of 12 cases were available and immunohistochemically analyzed with monoclonal antibodies (mAb). RESULTS The expression of CT antigens was generally low and present in only 4 of 12 cases. This is in stark contrast to the expression of these antigens in adult melanomas. Moreover, the extent of expression was very limited with most cases showing only a focal CT antigen expression and only marked in very small tumor areas (<5%). CONCLUSION Despite the low case numbers this study indicates that CT antigens are most likely not useful as diagnostic markers in pediatric melanomas or as targets for vaccine-based immunotherapy. It supports the notion that pediatric melanomas show a different biological behavior than their adult counterparts.
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Affiliation(s)
- N Behrendt
- Department of Surgical Pathology, Roskilde Hospital, Roskilde, Dänemark
| | - T Schultewolter
- Dermatologische Abteilung, Fachklinik Hornheide, Münster, Deutschland
| | - K Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10021, New York, NY, USA
| | - D Frosina
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10021, New York, NY, USA
| | - G Spagnoli
- Abteilung für Biomedizin, Universitätsklinikum Basel, Basel, Schweiz
| | - A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10021, New York, NY, USA.
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Bailey KM, Durham AB, Zhao L, Fullen D, Geiger J, Bradford C, Opipari V, Johnson T, Mody R. Pediatric melanoma and aggressive Spitz tumors: a retrospective diagnostic, exposure and outcome analysis. Transl Pediatr 2018; 7:203-210. [PMID: 30159246 PMCID: PMC6087836 DOI: 10.21037/tp.2018.01.03] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The diagnosis and management of pediatric melanomas is challenging given the presence of both melanomas and histologically aggressive Spitz tumors of undetermined biological significance (S-UBS) in this age group. Study objectives were to examine: factors leading to diagnostic delays, therapy side effects and patient outcomes in these diagnostic groups. METHODS A retrospective case review was performed using The University of Michigan's pediatric oncology database over a 13-year timespan. Patients referred to our clinic for consideration of interferon therapy due to a diagnosis of a stage III melanoma or aggressive appearing S-UBS with significant lymph node involvement were included. RESULTS We found two major causes of diagnosis delay: patients with amelanotic lesions misdiagnosed as having a wart and cases reviewed by non-expert pathologists upfront. The side effects from interferon therapy requiring dose adjustments included neutropenia, thrombocytopenia and mood disturbances. There was wide variability in surveillance scan utilization, therefore leading to variability in patient radiation exposure. Unlike melanoma patients, none of the S-UBS patients experienced disease progression or death. CONCLUSIONS This study highlights the challenges with the initial clinical diagnosis and pathological sub-categorization of the pediatric S-UBS/melanoma spectrum of skin lesions and emphasizes the role of expert pathology review upfront. Further, education at the primary care level could improve accurate and timely diagnoses. Earlier diagnosis could spare patients from more extensive interventions, metastatic spread or adverse outcomes in this patient population. This study is limited due to its retrospective, single-institution perspective.
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Affiliation(s)
- Kelly M Bailey
- Department of Pediatrics, The University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, The University of Pittsburgh, Pittsburgh, PA, USA
| | - Alison B Durham
- Department of Dermatology, The University of Michigan, Ann Arbor, MI, USA
| | - Lili Zhao
- Department of Biostatistics, The University of Michigan, Ann Arbor, MI, USA
| | - Doug Fullen
- Department of Pathology, The University of Michigan, Ann Arbor, MI, USA
| | - James Geiger
- Department of Pediatric Surgery, The University of Michigan, Ann Arbor, MI, USA
| | - Carol Bradford
- Department of Otolaryngology, The University of Michigan, Ann Arbor, MI, USA
| | - Valerie Opipari
- Department of Pediatrics, The University of Michigan, Ann Arbor, MI, USA
| | - Timothy Johnson
- Department of Dermatology, The University of Michigan, Ann Arbor, MI, USA
| | - Rajen Mody
- Department of Pediatrics, The University of Michigan, Ann Arbor, MI, USA
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Rabbie R, Rashid M, Arance AM, Sánchez M, Tell‐Marti G, Potrony M, Conill C, van Doorn R, Dentro S, Gruis NA, Corrie P, Iyer V, Robles‐Espinoza CD, Puig‐Butille JA, Puig S, Adams DJ. Genomic analysis and clinical management of adolescent cutaneous melanoma. Pigment Cell Melanoma Res 2017; 30:307-316. [PMID: 28097802 PMCID: PMC5435926 DOI: 10.1111/pcmr.12574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/11/2017] [Indexed: 12/21/2022]
Abstract
Melanoma in young children is rare; however, its incidence in adolescents and young adults is rising. We describe the clinical course of a 15-year-old female diagnosed with AJCC stage IB non-ulcerated primary melanoma, who died from metastatic disease 4 years after diagnosis despite three lines of modern systemic therapy. We also present the complete genomic profile of her tumour and compare this to a further series of 13 adolescent melanomas and 275 adult cutaneous melanomas. A somatic BRAFV600E mutation and a high mutational load equivalent to that found in adult melanoma and composed primarily of C>T mutations were observed. A germline genomic analysis alongside a series of 23 children and adolescents with melanoma revealed no mutations in known germline melanoma-predisposing genes. Adolescent melanomas appear to have genomes that are as complex as those arising in adulthood and their clinical course can, as with adults, be unpredictable.
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Affiliation(s)
- Roy Rabbie
- Experimental Cancer GeneticsThe Wellcome Trust Sanger InstituteHinxtonCambridgeshireUK
- Department of OncologyCambridge University Hospitals National Health Service Foundation TrustCambridgeUK
| | - Mamunur Rashid
- Experimental Cancer GeneticsThe Wellcome Trust Sanger InstituteHinxtonCambridgeshireUK
| | - Ana M. Arance
- Department of Medical Oncology and Targeted Therapeutics in Solid Tumors Group (IDIBAPS)Hospital Clınic de BarcelonaBarcelonaSpain
| | - Marcelo Sánchez
- Melanoma UnitRadiology ServiceHospital ClınicIDIBAPSUniversity of BarcelonaBarcelonaSpain
| | - Gemma Tell‐Marti
- Melanoma UnitDepartment of DermatologyHospital Clınic de BarcelonaBarcelonaSpain
- Centre of Biomedical Research on Rare Diseases (CIBERER)ISCIIIBarcelonaSpain
| | - Miriam Potrony
- Melanoma UnitDepartment of DermatologyHospital Clınic de BarcelonaIDIBAPSBarcelona UniversityBarcelonaSpain
| | - Carles Conill
- Melanoma UnitRadiotherapy OncologyHospital ClınicIDIBAPSBarcelona UniversityBarcelonaSpain
| | | | - Stefan Dentro
- Experimental Cancer GeneticsThe Wellcome Trust Sanger InstituteHinxtonCambridgeshireUK
| | | | - Pippa Corrie
- Department of OncologyCambridge University Hospitals National Health Service Foundation TrustCambridgeUK
| | - Vivek Iyer
- Experimental Cancer GeneticsThe Wellcome Trust Sanger InstituteHinxtonCambridgeshireUK
| | - Carla Daniela Robles‐Espinoza
- Experimental Cancer GeneticsThe Wellcome Trust Sanger InstituteHinxtonCambridgeshireUK
- Laboratorio Internacional de Investigacion sobre el Genoma HumanoUniversidad Nacional Autonoma de MexicoSantiago de QueretaroMexico
| | - Joan A. Puig‐Butille
- Centre of Biomedical Research on Rare Diseases (CIBERER)ISCIIIBarcelonaSpain
- Biochemistry and Molecular Genetics DepartmentMelanoma UnitHospital Clinic de BarcelonaIDIBAPSBarcelonaSpain
| | - Susana Puig
- Melanoma UnitDepartment of DermatologyHospital Clınic de BarcelonaBarcelonaSpain
- Centre of Biomedical Research on Rare Diseases (CIBERER)ISCIIIBarcelonaSpain
| | - David J. Adams
- Experimental Cancer GeneticsThe Wellcome Trust Sanger InstituteHinxtonCambridgeshireUK
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Abstract
Childhood melanoma is a rare pediatric malignancy, with fewer than 500 new diagnoses annually. The incidence is increasing, particularly in the adolescent population. This review highlights the epidemiology, clinical presentation, and histopathologic challenges of pediatric melanoma. Surgical resection remains the cornerstone for localized and regionally advanced disease. Adjuvant therapies, including current options and potential novel therapeutics for this unique population will be discussed.
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Affiliation(s)
- Elisabeth T Tracy
- Division of Pediatric Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children׳s Hospital, The Ohio State University College of Medicine, Nationwide Children׳s Dr, FB Suite 6B.1, Columbus, Ohio 43205.
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6
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Wu G, Barnhill RL, Lee S, Li Y, Shao Y, Easton J, Dalton J, Zhang J, Pappo A, Bahrami A. The landscape of fusion transcripts in spitzoid melanoma and biologically indeterminate spitzoid tumors by RNA sequencing. Mod Pathol 2016; 29:359-69. [PMID: 26892443 PMCID: PMC4811687 DOI: 10.1038/modpathol.2016.37] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/09/2016] [Accepted: 01/09/2016] [Indexed: 01/09/2023]
Abstract
Kinase activation by chromosomal translocations is a common mechanism that drives tumorigenesis in spitzoid neoplasms. To explore the landscape of fusion transcripts in these tumors, we performed whole-transcriptome sequencing using formalin-fixed, paraffin-embedded (FFPE) tissues in malignant or biologically indeterminate spitzoid tumors from 7 patients (age 2-14 years). RNA sequence libraries enriched for coding regions were prepared and the sequencing was analyzed by a novel assembly-based algorithm designed for detecting complex fusions. In addition, tumor samples were screened for hotspot TERT promoter mutations, and telomerase expression was assessed by TERT mRNA in situ hybridization (ISH). Two patients had widespread metastasis and subsequently died of disease, and 5 patients had a benign clinical course on limited follow-up (mean: 30 months). RNA sequencing and TERT mRNA ISH were successful in six tumors and unsuccessful in one disseminating tumor because of low RNA quality. RNA sequencing identified a kinase fusion in five of the six sequenced tumors: TPM3-NTRK1 (2 tumors), complex rearrangements involving TPM3, ALK, and IL6R (1 tumor), BAIAP2L1-BRAF (1 tumor), and EML4-BRAF (1 disseminating tumor). All predicted chimeric transcripts were expressed at high levels and contained the intact kinase domain. In addition, two tumors each contained a second fusion gene, ARID1B-SNX9 or PTPRZ1-NFAM1. The detected chimeric genes were validated by home-brew break-apart or fusion fluorescence in situ hybridization (FISH). The two disseminating tumors each harbored the TERT promoter -124C>T (Chr 5:1,295,228 hg19 coordinate) mutation, whereas the remaining five tumors retained the wild-type gene. The presence of the -124C>T mutation correlated with telomerase expression by TERT mRNA ISH. In summary, we demonstrated complex fusion transcripts and novel partner genes for BRAF by RNA sequencing of FFPE samples. The diversity of gene fusions demonstrated by RNA sequencing defines the molecular heterogeneity of spitzoid neoplasms.
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Affiliation(s)
- Gang Wu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Raymond L. Barnhill
- Department of Pathology, Institute Curie and Faculty of Medicine, University of Paris Descartes, Paris, France
| | - Seungjae Lee
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Yongjin Li
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Ying Shao
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - John Easton
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - James Dalton
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Jinghui Zhang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Alberto Pappo
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Armita Bahrami
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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7
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Sreeraman Kumar R, Messina JL, Reed D, Navid F, Sondak VK. Pediatric Melanoma and Atypical Melanocytic Neoplasms. Cancer Treat Res 2016; 167:331-369. [PMID: 26601871 DOI: 10.1007/978-3-319-22539-5_15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Melanoma is uncommon in the pediatric age range, but is increasing in frequency and often presents with atypical features compared to the classic ABCDE criteria common to adult melanoma cases. Moreover, many melanocytic neoplasms in childhood pose diagnostic challenges to the pathologist, and sometimes cannot be unequivocally classified as benign nevi or melanoma. This chapter addresses the evaluation and management of pediatric patients with melanoma and atypical melanocytic neoplasms, including the roles of and unresolved questions surrounding sentinel lymph node biopsy, completion lymphadenectomy, adjuvant therapy, and treatment of advanced disease.
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Affiliation(s)
| | - Jane L Messina
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Department of Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Damon Reed
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA
- Adolescent and Young Adult (AYA) Program, Sarcoma Department, Moffitt Cancer Center, Tampa, FL, USA
- Department of Hematology/Oncology , All Children's Hospital Johns Hopkins Medicine , St. Petersburg, FL, USA
| | - Fariba Navid
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
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8
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Abstract
Pediatric melanoma is rare and given the diagnostic challenges it presents in this age group, it is difficult to interpret the literature describing its natural history and outcome. Recent genomic analysis demonstrates that conventional melanoma in children and adolescents shares many of the genomic features that have been described in adult melanoma, including BRAF mutations. Thus, this patient group should be given the opportunity to enroll in National Cancer Institute and pharmaceutically sponsored trials that incorporate novel targeted agents.
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Affiliation(s)
- Alberto S Pappo
- From the Solid Tumor Division, St. Jude Children's Research Hospital, Memphis, TN
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9
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Zuluaga-Sepúlveda MA, Arellano-Mendoza I, Ocampo-Candiani J. [Update on surgical treatment of primary and metastatic cutaneous melanoma]. CIR CIR 2015; 84:77-84. [PMID: 26277601 DOI: 10.1016/j.circir.2015.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/10/2014] [Indexed: 11/27/2022]
Abstract
Melanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes. This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy. Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy.
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Affiliation(s)
| | - Ivonne Arellano-Mendoza
- Servicio de Dermatología, Hospital General de México Dr. Eduardo Liceaga, México D.F., México
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Hospital Universitario Dr. José E. González, Monterrey, Nuevo LeónMéxico.
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10
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Lee S, Barnhill RL, Dummer R, Dalton J, Wu J, Pappo A, Bahrami A. TERT Promoter Mutations Are Predictive of Aggressive Clinical Behavior in Patients with Spitzoid Melanocytic Neoplasms. Sci Rep 2015; 5:11200. [PMID: 26061100 PMCID: PMC4462090 DOI: 10.1038/srep11200] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 04/30/2015] [Indexed: 12/15/2022] Open
Abstract
Spitzoid neoplasms constitute a morphologically distinct category of melanocytic tumors, encompassing Spitz nevus (benign), atypical Spitz tumor (intermediate malignant potential), and spitzoid melanoma (fully malignant). Currently, no reliable histopathological criteria or molecular marker is known to distinguish borderline from overtly malignant neoplasms. Because TERT promoter (TERT-p) mutations are common in inherently aggressive cutaneous conventional melanoma, we sought to evaluate their prognostic significance in spitzoid neoplasms. We analyzed tumors labeled as atypical Spitz tumor or spitzoid melanoma from 56 patients with available follow-up data for the association of TERT-p mutations, biallelic CDKN2A deletion, biallelic PTEN deletion, kinase fusions, BRAF/NRAS mutations, nodal status, and histopathological parameters with risk of hematogenous metastasis. Four patients died of disseminated disease and 52 patients were alive and disease free without extranodal metastasis (median follow-up, 32.5 months). We found TERT-p mutations in samples from the 4 patients who developed hematogenous metastasis but in none of tumors from patients who had favorable outcomes. Presence of TERT-p mutations was the most significant predictor of haematogenous dissemination (P < 0.0001) among variables analyzed. We conclude that TERT-p mutations identify a clinically high-risk subset of patients with spitzoid tumors. Application of TERT-p mutational assays for risk stratification in the clinic requires large-scale validation.
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Affiliation(s)
- Seungjae Lee
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, 38105, USA
| | - Raymond L Barnhill
- Département de BioPathologie, Institut Curie, 26 rue d'Ulm, 75248, Paris cedex 05, France
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, CH-8091 Zurich, Switzerland
| | - James Dalton
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, 38105, USA
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, 38105, USA
| | - Alberto Pappo
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, 38105, USA
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Abstract
Spitzoid melanomas (SM) and atypical Spitz tumors (AST) are rare pediatric neoplasms. We performed a retrospective, single-institution review and report our institutional experience. We identified 10 patients (median age: 12.5 years). A sentinel node biopsy (SNB) was performed in 8/10 (80%) patients, and interestingly 7/8 (87.5%) were found to be positive for malignant cells. A complete regional lymphadenectomy was performed in all SNB-positive patients, but only 2/8 (25%) were found to have additional lymph node spread. Adjuvant therapy was administered in 5/8 SLNB-positive and 2/2 (100%) regional LN-positive cases. All patients had excellent long-term outcomes (100% survival). This report highlights the excellent outcomes associated with SNB + pediatric SM and AST.
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Affiliation(s)
- Sandeep Batra
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA.,Division of Pediatric Hematology-Oncology, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA.,Hematopoiesis, Hematologic Malignancies & Immunology, Indiana University Melvin & Bren Simon Cancer Center, 535 Barnhill Drive, Indianapolis, IN 46202, USA.,Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA
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14
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DeMarchis EH, Swetter SM, Jennings CD, Kim J. Fluorescence in situ hybridization analysis of atypical melanocytic proliferations and melanoma in young patients. Pediatr Dermatol 2014; 31:561-9. [PMID: 24924836 PMCID: PMC4282368 DOI: 10.1111/pde.12382] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Morphologic heterogeneity among melanocytic proliferations is a common challenge in the diagnosis of melanoma. In particular, atypical melanocytic lesions in children, adolescents, and young adults may be difficult to classify because of significant morphologic overlap with melanoma. Recently a four-probe fluorescence in situ hybridization (FISH) protocol to detect chromosomal abnormalities in chromosomes 6 and 11 has shown promise for improving the classification of melanocytic lesions. We sought to determine the correlation between FISH results, morphology, and clinical outcomes in a series of challenging melanocytic proliferations in young patients. We retrospectively performed the standard four-probe FISH analysis on 21 melanocytic neoplasms from 21 patients younger than 25 years of age (range 5-25 years, mean 14.6 years) from Stanford University Medical Center who were prospectively followed for a median of 51 months (range 1-136 months). The study cohort included patients with 5 confirmed melanomas, 2 melanocytic tumors of uncertain malignant potential (MelTUMPs), 10 morphologically challenging atypical Spitz tumors (ASTs), and 4 typical Spitz nevi. FISH detected chromosomal aberrations in all five melanomas and in one MelTUMP, in which the patient developed subsequent lymph node and distant metastasis. All 10 ASTs, 4 Spitz nevi, and 1 of 2 MelTUMPs were negative for significant gains or losses in chromosomes 6 and 11q. Our findings demonstrated a strong correlation between positive FISH results and the histomorphologic impression of melanoma. This finding was also true for the MelTUMP with poor clinical outcome. Therefore FISH may serve as a helpful adjunct in the classification of controversial melanocytic tumors in young patients.
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Abstract
PURPOSE OF REVIEW Children and their parents typically present to pediatricians to discuss treatment options for melanocytic nevi, nevus sebaceus, port-wine stains, and hemangiomas. Each of these conditions may be medically managed, but in some situations surgical intervention may be preferable. RECENT FINDINGS Although recent studies have improved our understanding of melanoma risk among patients with congenital nevi, prospective trials are needed to more accurately assess whether surgical excision mitigates this risk. The risk of basal cell carcinoma within nevus sebaceus appears to be low, but more conclusive data requires further studies with modern immunohistochemical analysis. Pulsed dye laser is effective for treating port-wine stains, although the optimal timing is controversial. While oral and topical beta blockers have revolutionized the treatment of proliferating infantile hemangiomas, laser and/or surgical excision are useful in selected situations. SUMMARY Excisional and/or laser surgery are indicated for certain common dermatologic conditions in children, although the optimal timing of these interventions is often subjective. Pediatricians should be familiar with why and when to refer patients for surgery of these common dermatological conditions.
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Affiliation(s)
- Julianne A Mann
- Department of Dermatology and Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
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