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Cloutier JM, Wang M, Vemula SS, Mirza S, Weier J, Aquino JD, McCalmont TH, LeBoit PE, Bastian BC, Yeh I. Amplification of mutant NRAS in melanocytic tumors with features of Spitz tumors. Mod Pathol 2024:100469. [PMID: 38467248 DOI: 10.1016/j.modpat.2024.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/13/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
NRAS activating mutations are prevalent in melanocytic neoplasia, occurring in a subset of common acquired melanocytic nevi and approximately 30% of cutaneous melanomas. In this study, we describe a cohort of seven distinctive melanocytic tumors characterized by activating point mutations in codon 61 of NRAS with amplification of the mutant NRAS allele and shared clinicopathologic features. These tumors occurred predominantly in younger patients, with a median age of 20 years (ranging from 6 to 56). They presented as papules on the helix of the ear (four cases) or extremities (three cases). Microscopically, the tumors were cellular, relatively well-circumscribed, compound or intradermal proliferations. The tumor cells often extended into the deep reticular dermis, and involved the superficial subcutaneous fat in some cases. The melanocytes were epithelioid to spindled with moderate amounts of cytoplasm and conspicuous nucleoli. They were arranged in short plexiform fascicles, nests, and cords. Some cases had occasional pleomorphic and multinucleated melanocytes. Rare dermal mitotic figures were present in all cases. The dermis contained thick collagen bundles and minimal solar elastosis. Follow-up data were available for five patients, with a median period of 4.2 years (ranging from 1 to 9 years), during which no recurrences or metastases were reported. Our series highlights a clinicopathologically and molecularly distinctive subset of NRAS-mutated tumors with amplification of the mutant NRAS allele.
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Affiliation(s)
- Jeffrey M Cloutier
- Department of Pathology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH.
| | - Meng Wang
- Department of Dermatology, University of California, San Francisco, CA
| | - Swapna S Vemula
- Department of Dermatology, University of California, San Francisco, CA
| | - Sonia Mirza
- Department of Dermatology, University of California, San Francisco, CA
| | - Jingly Weier
- Department of Dermatology, University of California, San Francisco, CA
| | - Jamie D Aquino
- Department of Pathology, University of California, San Francisco, CA
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, CA; Department of Pathology, University of California, San Francisco, CA; Golden State Dermatology Associates, Walnut Creek, CA
| | - Philip E LeBoit
- Department of Dermatology, University of California, San Francisco, CA; Department of Pathology, University of California, San Francisco, CA; Helen Diller Family Cancer Center, University of California, San Francisco, CA
| | - Boris C Bastian
- Department of Dermatology, University of California, San Francisco, CA; Department of Pathology, University of California, San Francisco, CA; Helen Diller Family Cancer Center, University of California, San Francisco, CA
| | - Iwei Yeh
- Department of Dermatology, University of California, San Francisco, CA; Department of Pathology, University of California, San Francisco, CA; Helen Diller Family Cancer Center, University of California, San Francisco, CA.
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Coudray N, Juarez MC, Criscito MC, Quiros AC, Wilken R, Cullison SRJ, Stevenson ML, Doudican NA, Yuan K, Aquino JD, Klufas DM, North JP, Yu SS, Murad F, Ruiz E, Schmults CD, Tsirigos A, Carucci JA. Self-supervised artificial intelligence predicts recurrence, metastasis and disease specific death from primary cutaneous squamous cell carcinoma at diagnosis. Res Sq 2023:rs.3.rs-3607399. [PMID: 38168253 PMCID: PMC10760225 DOI: 10.21203/rs.3.rs-3607399/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Primary cutaneous squamous cell carcinoma (cSCC) is responsible for ~10,000 deaths annually in the United States. Stratification of risk of poor outcome (PO) including recurrence, metastasis and disease specific death (DSD) at initial biopsy would significantly impact clinical decision-making during the initial post operative period where intervention has been shown to be most effective. In this multi-institutional study, we developed a state-of-the-art self-supervised deep-learning approach with interpretability power and demonstrated its ability to predict poor outcomes of cSCCs at the time of initial biopsy. By highlighting histomorphological phenotypes, our approach demonstrates that poor differentiation and deep invasion correlate with poor prognosis. Our approach is particularly efficient at defining poor outcome risk in Brigham and Women's Hospital (BWH) T2a and American Joint Committee on Cancer (AJCC) T2 cSCCs. This bridges a significant gap in our ability to assess risk among T2a/T2 cSCCs and may be useful in defining patients at highest risk of poor outcome at the time of diagnosis. Early identification of highest-risk patients could signal implementation of more stringent surveillance, rigorous diagnostic work up and identify patients who might best respond to early postoperative adjunctive treatment.
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Affiliation(s)
- Nicolas Coudray
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY, USA
- Department of Cell Biology, New York University School of Medicine, New York, NY, USA
| | - Michelle C. Juarez
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Maressa C. Criscito
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Reason Wilken
- Department of Dermatology, Northwell Health, New York, NY, USA
| | | | - Mary L. Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Nicole A. Doudican
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
| | - Ke Yuan
- School of Computing Science, University of Glasgow, Glasgow, Scotland, UK (Ke Yuan)
- School of Cancer Sciences, University of Glasgow, Glasgow, Scotland, UK (Ke Yuan)
- Cancer Research UK Beatson Institute, Glasgow, Scotland, UK (Ke Yuan)
| | - Jamie D. Aquino
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel M. Klufas
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey P. North
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Siegrid S. Yu
- Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA
| | - Fadi Murad
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Emily Ruiz
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Chrysalyne D. Schmults
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Aristotelis Tsirigos
- Applied Bioinformatics Laboratories, New York University School of Medicine, New York, NY, USA
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - John A. Carucci
- The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, NY, USA
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Wang M, Fukushima S, Sheen YS, Ramelyte E, Pacheco NC, Shi C, Liu S, Banik I, Aquino JD, Acosta MS, Levesque M, Dummer R, Liau JY, Chu CY, Shain AH, Yeh I, Bastian BC. The genetic evolution of acral melanoma. bioRxiv 2023:2023.10.18.562802. [PMID: 37904969 PMCID: PMC10614839 DOI: 10.1101/2023.10.18.562802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Acral melanoma is an aggressive type of melanoma with unknown origins, arising on the sole, palm, or nail apparatus. It is the most common type of melanoma in individuals with dark skin and is notoriously challenging to treat. Our study examined exome sequencing data from 139 tissue samples, spanning different progression stages, collected from 37 patients. We found that 78.4% of the melanomas displayed one or more clustered copy number transitions with focal amplifications, recurring predominantly on chromosomes 5, 11, 12, and 22. These genomic "hailstorms" were typically shared across all progression stages within individual patients. Genetic alterations known to activate TERT also arose early. By contrast, mutations in the MAP-kinase pathway appeared later during progression, often leading to different tumor areas harboring non-overlapping driver mutations. We conclude that the evolutionary trajectories of acral melanomas substantially diverge from those of melanomas on sun-exposed skin, where MAP-kinase pathway activation initiates the neoplastic cascade followed by immortalization later. The punctuated formation of hailstorms, paired with early TERT activation, suggests a unique mutational mechanism underlying the origins of acral melanoma. Our findings highlight an essential role for telomerase, likely in re-stabilizing tumor genomes after hailstorms have initiated the tumors. The marked genetic heterogeneity, in particular of MAP-kinase pathway drivers, may partly explain the limited success of targeted and other therapies in treating this melanoma subtype.
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Affiliation(s)
- Meng Wang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Satoshi Fukushima
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yi-Shuan Sheen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Egle Ramelyte
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Noel Cruz Pacheco
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Chenxu Shi
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Shanshan Liu
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Ishani Banik
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Jamie D. Aquino
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | | | - Mitchell Levesque
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zurich, Zurich, Switzerland
| | - Jau-Yu Liau
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - A. Hunter Shain
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- These authors jointly supervised this project
| | - Iwei Yeh
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
- These authors jointly supervised this project
| | - Boris C. Bastian
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
- These authors jointly supervised this project
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