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Schlessinger DI, Reynolds KA, Dirr MA, Ibrahim SA, Yanes AF, Lazaroff JM, Godinez-Puig V, Chen BR, Kurta AO, Cotseones JK, Chiren SG, Furlan KC, Iyengar S, Behshad R, DeHoratius DM, Denes P, Drucker AM, Dzubow LM, Etzkorn JR, Harwood CA, Kim JYS, Lawrence N, Lee EH, Lissner GS, Marghoob AA, Matin RN, Mattox AR, Mittal BB, Thomas JR, Zhou XA, Zloty D, Schmitt J, Kirkham JJ, Armstrong AW, Basset-Seguin N, Billingsley EM, Bordeaux JS, Brewer J, Brown M, Brown M, Collins SAB, Fargnoli MC, De Azevedo SJ, Dummer R, Eggermont A, Goldman GD, Haedersdal M, Hale E, Hanlon A, Harms KL, Huang CC, Hurst EA, In GK, Kelleners-Smeets N, Kheterpal M, Leshin B, Mcdonald M, Miller SJ, Miller A, Mostow EN, Trakatelli M, Nehal KS, Ratner D, Rogers H, Sarin KY, Soon SL, Stasko T, Storrs PA, Tagliaferri L, Vidimos AT, Wong SL, Yu SS, Zalaudek I, Zeitouni NC, Zitelli JA, Poon E, Sobanko JF, Cartee TV, Maher IA, Alam M. Development of a Core Outcome Set for Basal Cell Carcinoma (BCC), Including Low-Risk and Advanced Tumors. J Am Acad Dermatol 2022; 87:573-581. [PMID: 35551965 DOI: 10.1016/j.jaad.2022.04.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/11/2020] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is variation in the outcomes reported in clinical studies of basal cell carcinoma (BCC). This can prevent effective meta-analyses to answer important clinical questions. OBJECTIVE To identify a recommended minimum set of core outcomes for BCC clinical trials. METHODS Patient and professional Delphi process to cull a long-list, culminating in a consensus meeting. To be provisionally accepted, outcomes needed to be deemed 'important' (score: 7-9, of maximum of 9) by 70% of each stakeholder group. RESULTS 235 candidate outcomes identified via a systematic literature review and survey of key stakeholders were reduced to 74 that were rated by 100 health care professionals and patients in two Delphi rounds. 27 outcomes were provisionally accepted. The final core set of 5 agreed-upon outcomes after the consensus meeting was: complete response; persistent or serious adverse events; recurrence-free survival; quality of life; and patient satisfaction, including with cosmetic outcome. LIMITATIONS English-speaking patients and professionals rated outcomes extracted from English-language studies. CONCLUSIONS A core outcome set (COS) for basal cell carcinoma has been developed. Use of relevant measures may improve the utility of clinical research and the quality of therapeutic guidance available to clinicians.
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Affiliation(s)
- Daniel I Schlessinger
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Kelly A Reynolds
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; University of Cincinnati College of Medicine, Cincinnati, OH
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Arianna F Yanes
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jake M Lazaroff
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Victoria Godinez-Puig
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian R Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Jill K Cotseones
- Medical & Cosmetic Dermatology Service, Northwestern Medicine Regional Medical Group, Naperville, IL
| | - Sarah G Chiren
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karina C Furlan
- Department of Pathology, Rush University Medical Center, Chicago, IL
| | - Sanjana Iyengar
- Department of Dermatology, West Virginia University, Morgantown, WV
| | - Ramona Behshad
- Department of Dermatology, Saint Louis University, St. Louis, MO
| | - Danielle M DeHoratius
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pablo Denes
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Aaron M Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Division of Dermatology, Department of Medicine and Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Jeremy R Etzkorn
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, Whitechapel, London, UK; Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Naomi Lawrence
- Division of Dermatologic Surgery, Department of Dermatology, Cooper University Hospital, Camden, NJ
| | - Erica H Lee
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gary S Lissner
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Ashfaq A Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Rubeta N Matin
- Department of Dermatology, Churchill Hospital, Oxford, UK
| | - Adam R Mattox
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | - Bharat B Mittal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - J Regan Thomas
- Department of Otolaryngology- Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Xiaolong Alan Zhou
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Zloty
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Medical Faculty, Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jamie J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - April W Armstrong
- Keck School of Medicine, Department of Dermatology, University of Southern California Los Angeles
| | | | | | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, OH, USA
| | | | - Marc Brown
- Professor of Dermatology and Oncology; University of Rochester, MN, USA
| | - Mariah Brown
- Department of Dermatology, University of Colorado Hospital and School of Medicine
| | | | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy
| | - Sergio Jobim De Azevedo
- Professor, Department of Medicine, Chief of Medical Oncology at Hospital de Clinicas de Porto Alegre, Brazil
| | - Reinhard Dummer
- University Hospital, Skin Cancer Center, Zurich, Switzerland
| | | | | | - Merete Haedersdal
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | | | - Kelly L Harms
- Department of Dermatology, the Comprehensive Cancer Center University of Michigan Medical School, Ann Arbor
| | - Conway C Huang
- Department of Dermatology, University of Alabama at Birmingham, AL, USA
| | - Eva A Hurst
- Distinctive Dermatology, Fairview Heights, IL, USA
| | - Gino K In
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | | | | | | | | | | | | | - Eliot N Mostow
- Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
| | - Myrto Trakatelli
- Associate Professor of Dermatology, Papageorgiou Hospital, Aristotle University Department of Medicine, Thessaloniki, Greece
| | - Kishwer S Nehal
- Attending Physician, Memorial Sloan Kettering Cancer Center; Director, Mohs and Dermatological Surgery; Professor of Dermatology, Weill Cornell Medical College, NY, USA
| | | | | | | | | | - Thomas Stasko
- Professor and Chair, The University of Oklahoma Department of Dermatology, OK, USA
| | - Paul A Storrs
- University of Illinois Chicago, Department of Dermatology, IL, USA
| | - Luca Tagliaferri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Italy
| | | | | | - Siegrid S Yu
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Iris Zalaudek
- Department of Dermatology and Venereology, University of Trieste, Italy
| | | | - John A Zitelli
- Clinical Associate Professor of Dermatology, Otolaryngology, Plastic Surgery, University of Pittsburgh Medical Center, PA, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joseph F Sobanko
- Department of Dermatology, Perelman Center for Advanced Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA; Division of Dermatologic Surgery, Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Todd V Cartee
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA
| | - Ian A Maher
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Otolaryngology- Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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2
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Harms KL, Zhao L, Johnson B, Wang X, Carskadon S, Palanisamy N, Rhodes DR, Mannan R, Vo JN, Choi JE, Chan MP, Fullen DR, Patel RM, Siddiqui J, Ma VT, Hrycaj S, McLean SA, Hughes TM, Bichakjian CK, Tomlins SA, Harms PW. Virus-positive Merkel Cell Carcinoma Is an Independent Prognostic Group with Distinct Predictive Biomarkers. Clin Cancer Res 2021; 27:2494-2504. [PMID: 33547200 DOI: 10.1158/1078-0432.ccr-20-0864] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 12/31/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma that can be divided into two classes: virus-positive (VP) MCC, associated with oncogenic Merkel cell polyomavirus (MCPyV); and virus-negative (VN) MCC, associated with photodamage. EXPERIMENTAL DESIGN We classified 346 MCC tumors from 300 patients for MCPyV using a combination of IHC, ISH, and qPCR assays. In a subset of tumors, we profiled mutation status and expression of cancer-relevant genes. MCPyV and molecular profiling results were correlated with disease-specific outcomes. Potential prognostic biomarkers were further validated by IHC. RESULTS A total of 177 tumors were classified as VP-MCC, 151 tumors were VN-MCC, and 17 tumors were indeterminate. MCPyV positivity in primary tumors was associated with longer disease-specific and recurrence-free survival in univariate analysis, and in multivariate analysis incorporating age, sex, immune status, and stage at presentation. Prioritized oncogene or tumor suppressor mutations were frequent in VN-MCC but rare in VP-MCC. TP53 mutation developed with recurrence in one VP-MCC case. Importantly, for the first time we find that VP-MCC and VN-MCC display distinct sets of prognostic molecular biomarkers. For VP-MCC, shorter survival was associated with decreased expression of immune markers including granzyme and IDO1. For VN-MCC, shorter survival correlated with high expression of several genes including UBE2C. CONCLUSIONS MCPyV status is an independent prognostic factor for MCC. Features of the tumor genome, transcriptome, and microenvironment may modify prognosis in a manner specific to viral status. MCPyV status has clinicopathologic significance and allows for identification of additional prognostic subgroups.
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Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | | | - Xiaoming Wang
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Shannon Carskadon
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Nallasivam Palanisamy
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | | | - Rahul Mannan
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Josh N Vo
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Jae Eun Choi
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - May P Chan
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Douglas R Fullen
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Rajiv M Patel
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Vincent T Ma
- Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.,Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan, Ann Arbor, Michigan
| | - Steven Hrycaj
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Scott A McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Tasha M Hughes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan.,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan
| | - Scott A Tomlins
- Strata Oncology, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Paul W Harms
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan. .,Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Pathology, University of Michigan, Ann Arbor, Michigan
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3
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Harms PW, Harms KL, Moore PS, DeCaprio JA, Nghiem P, Wong MKK, Brownell I. The biology and treatment of Merkel cell carcinoma: current understanding and research priorities. Nat Rev Clin Oncol 2019; 15:763-776. [PMID: 30287935 PMCID: PMC6319370 DOI: 10.1038/s41571-018-0103-2] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer associated with advanced age and immunosuppression. Over the past decade, an association has been discovered between MCC and either integration of the Merkel cell polyomavirus, which likely drives tumorigenesis, or somatic mutations owing to ultraviolet-induced DNA damage. Both virus-positive and virus-negative MCCs are immunogenic, and inhibition of the programmed cell death protein 1 (PD-1)–programmed cell death 1 ligand 1 (PD-L1) immune checkpoint has proved to be highly effective in treating patients with metastatic MCC; however, not all patients have a durable response to immunotherapy. Despite these rapid advances in the understanding and management of patients with MCC, many basic, translational and clinical research questions remain unanswered. In March 2018, an International Workshop on Merkel Cell Carcinoma Research was held at the US National Cancer Institute, at which academic, government and industry experts met to identify the highest-priority research questions. Here, we review the biology and treatment of MCC and report the consensus-based recommendations agreed upon during the workshop. Merkel cell carcinoma (MCC) is a rare and aggressive form of nonmelanoma skin cancer. The availability of immune checkpoint inhibition has improved the outcomes of a subset of patients with MCC, although many unmet needs continue to exist. In this Consensus Statement, the authors summarize developments in our understanding of MCC while also providing consensus recommendations for future research.
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Affiliation(s)
- Paul W Harms
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kelly L Harms
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Patrick S Moore
- Cancer Virology Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - James A DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paul Nghiem
- Department of Medicine, Division of Dermatology, University of Washington, Seattle, WA, USA
| | - Michael K K Wong
- Department of Melanoma Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Isaac Brownell
- Dermatology Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and National Cancer Institute (NCI), NIH, Bethesda, MD, USA.
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4
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Zoumberos NA, McMullen E, Wang L, Wang X, Harms KL, Tejasvi T, Chan MP, Fullen DR, Hristov AC, Harms PW. Merkel cell carcinoma arising in association with cutaneous T-cell lymphoma: A potential diagnostic pitfall. J Cutan Pathol 2018; 46:199-203. [PMID: 30561044 DOI: 10.1111/cup.13404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/25/2018] [Revised: 11/26/2018] [Accepted: 12/12/2018] [Indexed: 11/28/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous neuroendocrine carcinoma with increased prevalence in patients with immunosuppression or B-cell neoplasms. To the best of our knowledge, an association with cutaneous T-cell lymphoma (CTCL) has not been previously described. In this report, we present two cases of MCC arising in the setting of CTCL. The first case was a female during her 70s with previously diagnosed stage IVA1 Sezary syndrome. Biopsy of a scaly patch showed two distinct abnormal cell populations. The first population consisted of hyperchromatic dermal and epidermotropic lymphocytes, expressing CD3 and CD4 with diminished CD7. The second population consisted of intraepidermal clusters of larger atypical cells that expressed synaptophysin, neurofilament, CK20, and Merkel cell polyomavirus transcript. The combination of findings was consistent with intraepidermal MCC in a background of CTCL. Excision showed residual intraepidermal MCC without dermal involvement. The second case was a male during his 50s with a longstanding history of mycosis fungoides, who presented with a new lesion on his right thigh. Biopsy and excision showed dermal MCC without secondary involvement by CTCL. Our cases show that MCC may rarely occur in the setting of T-cell lymphoma, and that intraepidermal MCC may mimic epidermotropic T-cells.
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Affiliation(s)
| | - Emily McMullen
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Lisha Wang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Xiaoming Wang
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Michigan Medicine, Ann Arbor, Michigan
| | - Kelly L Harms
- Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | | | - May P Chan
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Douglas R Fullen
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Alexandra C Hristov
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Paul W Harms
- Department of Pathology, Michigan Medicine, Ann Arbor, Michigan.,Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan.,Michigan Center for Translational Pathology, Michigan Medicine, Ann Arbor, Michigan
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5
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Lee JS, Durham AB, Bichakjian CK, Harms PW, Hayman JA, McLean SA, Harms KL, Burns WR. Completion Lymph Node Dissection or Radiation Therapy for Sentinel Node Metastasis in Merkel Cell Carcinoma. Ann Surg Oncol 2018; 26:386-394. [DOI: 10.1245/s10434-018-7072-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Indexed: 11/18/2022]
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6
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Stanoszek LM, Chan MP, Palanisamy N, Carskadon S, Siddiqui J, Patel RM, Harms KL, Lowe L, Fullen DR, Harms PW. Neurofilament is superior to cytokeratin 20 in supporting cutaneous origin for neuroendocrine carcinoma. Histopathology 2018; 74:504-513. [PMID: 30239030 DOI: 10.1111/his.13758] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 07/05/2018] [Accepted: 09/17/2018] [Indexed: 11/28/2022]
Abstract
AIM Primary cutaneous neuroendocrine carcinoma, or Merkel cell carcinoma (MCC), cannot be distinguished morphologically from small-cell neuroendocrine carcinomas (SmCC) from other sites. Immunohistochemistry is required to confirm cutaneous origin, and is also used for detection of sentinel lymph node (SLN) metastases of MCC. Cytokeratin 20 (CK20) expression is commonly used for these purposes, but is negative in some MCC cases, and has unclear specificity. We evaluated immunohistochemistry for neurofilament and CK20 in MCC compared with SmCC from other sites. METHODS AND RESULTS We evaluated neurofilament expression in 55 MCC specimens from 39 unique patients, including nine CK20-negative MCC tumours. Neurofilament expression was observed in 42 of 55 (76.4%) MCC cases, including seven of nine (77.8%) CK20-negative MCC cases. Neurofilament was expressed in nine of 12 (75%) Merkel cell polyomavirus-positive tumours and five of 10 (50%) virus-negative tumours. Compared to a standard immunohistochemical panel (cytokeratin cocktail and CK20), neurofilament was 87.5% sensitive for detecting SLN metastases. Neurofilament and CK20 expression was also assessed in 61 extracutaneous SmCC from 60 unique patients, with primary sites including lung (27), bladder (18), cervix (3), gastrointestinal tract (3), sinonasal tract (2) and other sites (7). The specificity of neurofilament and CK20 for MCC versus non-cutaneous SmCC was 96.7% and 59.0%, respectively. CONCLUSIONS Neurofilament has superior specificity to CK20 in distinguishing MCC from non-cutaneous SmCC. Neurofilament is frequently expressed in CK20- and virus-negative MCC tumours. Limitations of neurofilament immunohistochemistry include lower sensitivity than CK20 and subtle staining in some tumours. However, our findings indicate that neurofilament is useful for excluding non-cutaneous SmCC.
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Affiliation(s)
- Lauren M Stanoszek
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Nallasivam Palanisamy
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Shannon Carskadon
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Javed Siddiqui
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Rajiv M Patel
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Kelly L Harms
- Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Lori Lowe
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Douglas R Fullen
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
| | - Paul W Harms
- Department of Pathology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA.,Department ofDermatology, Michigan Medicine/University of Michigan Health System, Ann Arbor, MI, USA
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Harms KL, Bichakjian CK. The Case for a Primary Surgical Approach. Int J Radiat Oncol Biol Phys 2018; 100:15-16. [PMID: 29254770 DOI: 10.1016/j.ijrobp.2017.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kelly L Harms
- Multidisciplinary Merkel Cell Carcinoma Program, Comprehensive Cancer Center, Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
| | - Christopher K Bichakjian
- Multidisciplinary Merkel Cell Carcinoma Program, Comprehensive Cancer Center, Department of Dermatology, Michigan Medicine, Ann Arbor, Michigan
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8
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Durham AB, Schwartz JL, Lowe L, Zhao L, Johnson AG, Harms KL, Bichakjian CK, Orsini AP, McLean SA, Bradford CR, Cohen MS, Johnson TM, Sabel MS, Wong SL. In reply: Management of thin melanoma. J Surg Oncol 2017; 117:536. [PMID: 29127705 DOI: 10.1002/jso.24858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alison B Durham
- Department of Dermatology, University of Michigan Hospital, Ann Arbor, Michigan
| | - Jennifer L Schwartz
- Department of Dermatology, University of Michigan Hospital, Ann Arbor, Michigan
| | - Lori Lowe
- Department of Dermatology, University of Michigan Hospital, Ann Arbor, Michigan.,Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Kelly L Harms
- Department of Dermatology, University of Michigan Hospital, Ann Arbor, Michigan
| | | | - Amy P Orsini
- Department of Dermatology, University of Michigan Hospital, Ann Arbor, Michigan
| | - Scott A McLean
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan
| | - Mark S Cohen
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Hospital, Ann Arbor, Michigan.,Department of Otolaryngology, University of Michigan Health System, Ann Arbor, Michigan.,Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael S Sabel
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Harms KL, Chubb H, Zhao L, Fullen DR, Bichakjian CK, Johnson TM, Carskadon S, Palanisamy N, Harms PW. Increased expression of EZH2 in Merkel cell carcinoma is associated with disease progression and poorer prognosis. Hum Pathol 2017; 67:78-84. [PMID: 28739498 DOI: 10.1016/j.humpath.2017.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/24/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022]
Abstract
Enhancer of zeste homolog 2 (EZH2) is a histone methyltransferase that affects tumorigenesis by epigenetic gene silencing. Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine carcinoma that has a high risk of disease progression with nodal and distant metastases. Here, we evaluated EZH2 expression by immunohistochemistry in a cohort of 85 MCC tumors (29 primary tumors, 41 lymph node metastases, 13 in-transit metastases, and 2 distant metastases) with clinical follow-up. We show strong/moderate EZH2 expression in 54% of tumors. Importantly, weak expression of EZH2 in the primary tumor, but not nodal metastases, correlated with improved prognosis compared to moderate/strong EZH2 expression (5-year MCC-specific survival of 68% versus 22%, respectively, P=.024). In addition, EZH2 was expressed at higher levels in nodal metastases compared to primary tumors (P=.005). Our data demonstrate that EZH2 has prognostic value and may play an oncogenic role in MCC.
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Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Heather Chubb
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Douglas R Fullen
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Shannon Carskadon
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Nallasivam Palanisamy
- Vattikuti Urology Institute, Department of Urology, Henry Ford Health System, Detroit, MI 48202, USA
| | - Paul W Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, MI 48109, USA; Department of Pathology, University of Michigan Health System, Ann Arbor, MI 48109, USA.
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10
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Durham AB, Schwartz JL, Lowe L, Zhao L, Johnson AG, Harms KL, Bichakjian CK, Orsini AP, McLean SA, Bradford CR, Cohen MS, Johnson TM, Sabel MS, Wong SL. The natural history of thin melanoma and the utility of sentinel lymph node biopsy. J Surg Oncol 2017; 116:1185-1192. [PMID: 28715140 DOI: 10.1002/jso.24765] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 03/02/2017] [Accepted: 06/21/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Current literature may overestimate the risk of nodal metastasis from thin melanoma due to reporting of data only from lesions treated with SLNB. Our objective was to define the natural history of thin melanoma, assessing the likelihood of nodal disease, in order to guide selection for SLNB. METHODS Retrospective review. The primary outcome was the rate of nodal disease. Clinicopathologic factors were evaluated to find associations with nodal disease. RESULTS Five hundred and twelve lesions, follow up available for 488 (median: 48 months). Lesions treated with WLE/SLNB compared to WLE alone were more likely to have high-risk features. The rate of nodal disease was higher in the WLE/SLNB group (24 positive SLNB, five false-negative SLNB with nodal recurrence: 10.2%) compared to WLE alone (four nodal recurrences: 2.0%). Univariate analysis showed age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm2 , and ulceration were associated with nodal disease. Multivariate analysis confirmed the association of age ≤45 and ulceration. CONCLUSIONS SLNB for melanoma 0.75-0.99 mm should be considered in patients age ≤45, Breslow depth ≥0.85 mm, mitotic rate >1 mm2 , and/or with ulceration. Thin melanoma <0.85 mm without high-risk features may be treated with WLE alone.
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Affiliation(s)
- Alison B Durham
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Jennifer L Schwartz
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Lori Lowe
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Lili Zhao
- Department of Biostatistics, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Kelly L Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | | | - Amy P Orsini
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Scott A McLean
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Mark S Cohen
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan.,Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan.,Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Michael S Sabel
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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11
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Harms KL, Lazo de la Vega L, Hovelson DH, Rahrig S, Cani AK, Liu CJ, Fullen DR, Wang M, Andea AA, Bichakjian CK, Johnson TM, Tomlins SA, Harms PW. Molecular Profiling of Multiple Primary Merkel Cell Carcinoma to Distinguish Genetically Distinct Tumors From Clonally Related Metastases. JAMA Dermatol 2017; 153:505-512. [PMID: 28403382 DOI: 10.1001/jamadermatol.2017.0507] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. In rare cases, the development of an additional cutaneous MCC tumor is clinically consistent with a second primary MCC tumor rather than a cutaneous metastasis, which has important treatment and prognostic implications. Objective To evaluate genetic relatedness in 4 cases with the clinical diagnosis of multiple primary MCCs. Design, Setting, and Participants In this case series, 7 cases of clinically designated multiple primary MCC were identified; 4 cases met inclusion criteria for next-generation sequencing (NGS) analysis. Mutations, copy number alterations, and Merkel cell polyomavirus (MCPyV) sequence were analyzed and compared between clinically designated multiple primary tumors to characterize genetic relatedness and hence assess clonality. Patients with clinically designated multiple primary MCC were identified from the multidisciplinary MCC Program at the University of Michigan, a tertiary care center. Main Outcomes and Measures Four cases of clinically designated multiple primary MCC were characterized by tumor sequencing and targeted MCPyV sequencing to distinguish independent primary tumors from related metastases. Results Overall, 4 patients in their 70s or 80s were included and analyzed. Cases 1 and 4 were verified as genetically distinct primary tumors and did not harbor similar copy number alterations or demonstrate significant mutational overlap. Cases 2 and 3 were designated as clonally related based on overlapping copy number alterations. In clonally related tumors, chromosomal copy number changes were more reliable than mutations for demonstrating clonality. Regardless of clonality, we found that MCPyV status was concordant for all tumor pairs and MCPyV positive tumors harbored predominatly subclonal mutations. Conclusions and Relevance Our findings suggest that patients with MCC may develop a second genetically distinct primary tumor; in this case, the subsequent tumor is likely to develop through similar mechanisms of pathogenesis, either MCPyV-mediated or ultraviolet light-mediated. Next-generation sequencing analysis of chromosomal copy number changes and mutations is useful in distinguishing multiple primary MCCs from progression of MCC clinically resembling multiple primaries, allowing appropriate staging of the patient.
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Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan Medical School, Ann Arbor2Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor
| | - Lorena Lazo de la Vega
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Daniel H Hovelson
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Samantha Rahrig
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Andi K Cani
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Chia-Jen Liu
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Douglas R Fullen
- Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Min Wang
- Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Aleodor A Andea
- Department of Dermatology, University of Michigan Medical School, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Medical School, Ann Arbor2Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor2Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor
| | - Scott A Tomlins
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor3Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor5Department of Urology, University of Michigan Medical School, Ann Arbor
| | - Paul W Harms
- Department of Dermatology, University of Michigan Medical School, Ann Arbor3Michigan Center for Translational Pathology, University of Michigan, Ann Arbor4Department of Pathology, University of Michigan Medical School, Ann Arbor
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12
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Frohm ML, Griffith KA, Harms KL, Hayman JA, Fullen DR, Nelson CC, Wong SL, Schwartz JL, Bichakjian CK. Recurrence and Survival in Patients With Merkel Cell Carcinoma Undergoing Surgery Without Adjuvant Radiation Therapy to the Primary Site. JAMA Dermatol 2017; 152:1001-7. [PMID: 27248515 DOI: 10.1001/jamadermatol.2016.1428] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The use of adjuvant radiation therapy (RT) to the primary site in Merkel cell carcinoma (MCC) is not uncommon. However, the need for adjuvant RT to the primary site in patients at low risk for local recurrence is questionable. OBJECTIVES To examine the occurrence of true local, satellite, in-transit, regional, and distant recurrences in patients undergoing surgery alone without adjuvant RT to the primary site. To establish overall survival (OS), MCC-specific survival (MCCSS), and disease-free survival (DFS) relationships in a cohort of patients with MCC. DESIGN, SETTING, AND PARTICIPANTS Our University of Michigan Multidisciplinary MCC Program database was used to obtain characteristics and outcome measures for 104 patients (105 primary MCCs) with tumors less than 2 cm in diameter. The majority of patients were treated between July 2006 and November 2012. MAIN OUTCOMES AND MEASURES Outcome measures included the occurrence of true local, satellite, in-transit, regional, and distant recurrences. End points included OS, MCCSS, and DFS. RESULTS Overall, information for 55 men and 49 women with 105 primary MCCs was obtained; 19 patients developed recurrent disease, and the mean time to first recurrence was 10.7 months. True local recurrence occurred in 1 patient with concurrent in-transit recurrence. Satellite recurrence occurred in 1 patient with concurrent regional recurrence. Four additional patients developed in-transit metastases. Thirteen patients had a regional recurrence component, 4 patients had distant metastases, and 6 patients developed subsequent regional and/or distant recurrences. Stratified by initial pathologic stage, the OS and MCCSS at 48 months were estimated to be 85.0% (95% CI, 71.8%-92.3%) and 94.4% (95% CI, 83.4%-98.2%) for patients with stage 1A/B disease and 63.2% (95% CI, 36.6%-81.1%) and 78.1% (95% CI, 50.0%-91.5%) for patients with stage 3A disease. The OS and MCCSS at 24 months for patients with stage 3B disease were both 50.0% (95% CI, 5.8%-84.5%). CONCLUSIONS AND RELEVANCE In selected MCC patients with primary tumors less than 2 cm in diameter treated with surgery alone without adjuvant RT to the primary site, we found a low occurrence of true local recurrences and satellite recurrences. This relatively low rate of local recurrence questions the need for adjuvant RT to the primary tumor site in patients with small low-risk lesions.
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Affiliation(s)
- Marcus L Frohm
- Department of Dermatology, University of Michigan Health System, Ann Arbor2Dermatology, Sanford Health, Sioux Falls, South Dakota
| | - Kent A Griffith
- Center for Cancer Biostatistics, University of Michigan Health System, Ann Arbor
| | - Kelly L Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor
| | - James A Hayman
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor
| | - Douglas R Fullen
- Department of Pathology, University of Michigan Health System, Ann Arbor
| | - Christine C Nelson
- Department of Ophthalmology and Visual Science, University of Michigan Health System, Ann Arbor
| | - Sandra L Wong
- Department of Surgery, University of Michigan Health System, Ann Arbor
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13
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Wang L, Harms PW, Palanisamy N, Carskadon S, Cao X, Siddiqui J, Patel RM, Zelenka-Wang S, Durham AB, Fullen DR, Harms KL, Su F, Shukla S, Mehra R, Chinnaiyan AM. Age and Gender Associations of Virus Positivity in Merkel Cell Carcinoma Characterized Using a Novel RNA In Situ Hybridization Assay. Clin Cancer Res 2017; 23:5622-5630. [PMID: 28606924 PMCID: PMC5600832 DOI: 10.1158/1078-0432.ccr-17-0299] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/28/2017] [Accepted: 06/05/2017] [Indexed: 12/14/2022]
Abstract
Purpose: Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine tumor of the skin. Merkel cell polyomavirus (MCPyV) plays an oncogenic role in the majority of MCCs. Detection of MCPyV in MCCs has diagnostic utility and prognostic potential. We investigated whether RNAscope, an RNA in situ hybridization (ISH) assay for detection of RNA transcripts in tissues, is useful for MCPyV detection.Experimental Design: We applied an RNAscope probe targeting MCPyV T antigen transcripts on tissue microarrays (TMA) and whole-tissue sections encompassing 87 MCCs from 75 patients, 14 carcinomas of other types, and benign tissues. For comparison, qPCR was performed on 57 cases of MCC from 52 patients.Results: RNA-ISH demonstrated the presence of MCPyV in 37 of 75 cases (49.3%). Notably, tumors from younger patients (<73 years) had a significantly higher virus positivity than those from elderly patients (≥73 years; 64.9% vs. 34.2%, P = 0.011). Female patients had a higher positive rate of MCPyV than male patients (66.7% vs. 39.6%, P = 0.032). Data from both RNA-ISH and qPCR were available for 57 samples. Considering MCPyV qPCR as the gold standard for determining MCPyV status, RNAscope had 100% sensitivity and 100% specificity. There was a strong correlation between qPCR copy number and RNA-ISH product score (Spearman correlation coefficient R2 = 0.932, P < 0.0001).Conclusions: RNA-ISH is comparably sensitive to qPCR for detection of MCPyV and allows for correlation with tissue morphology. This study also reveals a significant association between age, gender, and MCPyV positivity. Clin Cancer Res; 23(18); 5622-30. ©2017 AACR.
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Affiliation(s)
- Lisha Wang
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Paul W Harms
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Nallasivam Palanisamy
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Urology, Henry Ford Health System, Detroit, Michigan
| | | | - Xuhong Cao
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Howard Hughes Medical Institute, Ann Arbor, Michigan
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Rajiv M Patel
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Sylvia Zelenka-Wang
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Alison B Durham
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Douglas R Fullen
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Kelly L Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Fengyun Su
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Sudhanshu Shukla
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
| | - Rohit Mehra
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Arul M Chinnaiyan
- Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor, Michigan.
- Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan
- Howard Hughes Medical Institute, Ann Arbor, Michigan
- Comprehensive Cancer Center, University of Michigan Health System, Ann Arbor, Michigan
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan
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14
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Affiliation(s)
- Kelly L Harms
- 1 Department of Dermatology, University of Michigan Health Systems, Ann Arbor
| | - Lori Lowe
- 1 Department of Dermatology, University of Michigan Health Systems, Ann Arbor.,2 Department of Pathology, University of Michigan Health Systems, Ann Arbor
| | - Douglas R Fullen
- 1 Department of Dermatology, University of Michigan Health Systems, Ann Arbor.,2 Department of Pathology, University of Michigan Health Systems, Ann Arbor
| | - Paul W Harms
- 1 Department of Dermatology, University of Michigan Health Systems, Ann Arbor.,2 Department of Pathology, University of Michigan Health Systems, Ann Arbor
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15
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Harms PW, Hocker TL, Zhao L, Chan MP, Andea AA, Wang M, Harms KL, Wang ML, Carskadon S, Palanisamy N, Fullen DR. Loss of p16 expression and copy number changes of CDKN2A in a spectrum of spitzoid melanocytic lesions. Hum Pathol 2016; 58:152-160. [DOI: 10.1016/j.humpath.2016.07.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/20/2016] [Accepted: 07/28/2016] [Indexed: 12/14/2022]
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16
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Harms KL, Healy MA, Nghiem P, Sober AJ, Johnson TM, Bichakjian CK, Wong SL. Analysis of Prognostic Factors from 9387 Merkel Cell Carcinoma Cases Forms the Basis for the New 8th Edition AJCC Staging System. Ann Surg Oncol 2016; 23:3564-3571. [PMID: 27198511 DOI: 10.1245/s10434-016-5266-4] [Citation(s) in RCA: 325] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The first consensus Merkel cell carcinoma (MCC) staging system was published in 2010. New information on the clinical course prompts review of MCC staging. METHODS A total of 9387 MCC cases from the National Cancer Data Base Participant User File with follow-up and staging data (1998-2012) were analyzed. Prognostic differences based on clinical and pathological staging were evaluated. Survival estimates were compared by disease extent. RESULTS Sixty-five percent of cases presented with local disease, whereas 26 and 8 % presented with nodal and distant disease. Disease extent at presentation was predictive of 5-year overall survival (OS) with estimates of 51, 35, and 14 % for local, nodal, and distant disease. Tumor burden at the regional nodal basin was predictive of 5-year OS with estimates of 40 and 27 % for clinically occult and clinically detected nodal disease. For local disease, we confirm improved prognosis when the regional nodal basin was negative by pathological compared with clinical staging. We identified 336 cases with clinically detected nodal disease and unknown primary tumor and showed improved prognosis over cases presenting with concurrent primary tumor (OS estimates of 42 vs. 27 %). CONCLUSIONS Analysis of a national dataset of MCC cases validates the predictive value of disease extent at presentation. Separation of clinical and pathological stage groups and regrouping of unknown primary tumors are supported by the analysis. The revised staging system provides more accurate prognostication and has been formally accepted by the AJCC staging committee for inclusion in the 8th edition.
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Affiliation(s)
- Kelly L Harms
- Department of Dermatology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.
| | - Mark A Healy
- Department of Surgery, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA
| | - Paul Nghiem
- Department of Medicine/Dermatology, University of Washington, Seattle, WA, USA.,Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Department of Surgery, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Department of Otolaryngology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System and Medical School, Ann Arbor, MI, USA
| | - Sandra L Wong
- Department of Surgery, University of Michigan Health System and Medical School, Ann Arbor, MI, USA.,Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.,Department of Surgery, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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17
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Abstract
Spitzoid melanocytic lesions encompass a spectrum from benign Spitz nevi to malignant spitzoid melanomas. Spitzoid melanocytic neoplasms have significant morphologic and molecular differences from conventional melanocytic lesions, and prediction of biologic behavior and metastatic risk may be difficult. Most challenging is the atypical Spitz tumor, a borderline spitzoid melanocytic lesion of uncertain malignant potential that has overlapping histologic features with conventional Spitz nevus and spitzoid melanoma. Atypical Spitz tumors involve the sentinel lymph nodes at a greater frequency than conventional melanoma and frequently harbor chromosomal copy number changes, yet most cases follow an indolent course. Herein we review the clinical, microscopic, and molecular features of atypical Spitz tumors, including recent molecular advances, including the potential prognostic significance of chromosomal abnormalities, such as homozygous CDKN2A loss.
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Affiliation(s)
- Kelly L Harms
- From the Department of Dermatology (Drs K. L. Harms, Lowe, Fullen, and P. W. Harms), the Comprehensive Cancer Center (Dr K. L. Harms), and the Department of Dermatology and Pathology (Drs Lowe, Fullen, and P. W. Harms), University of Michigan Medical School, Ann Arbor
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18
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Affiliation(s)
| | - Kelly L. Harms
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Jennifer L. Schwartz
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
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19
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Harms KL, Harms PW, Anderson T, Betz BL, Ross CW, Fullen DR, Hristov AC. Mycosis fungoides with CD20 expression: report of two cases and review of the literature. J Cutan Pathol 2014; 41:494-503. [DOI: 10.1111/cup.12299] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 01/14/2014] [Accepted: 01/25/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kelly L. Harms
- Department of Dermatology; University of Michigan; Ann Arbor MI USA,
| | - Paul W. Harms
- Department of Dermatology; University of Michigan; Ann Arbor MI USA,
- Department of Pathology; University of Michigan; Ann Arbor MI USA
| | - Thomas Anderson
- Department of Dermatology; University of Michigan; Ann Arbor MI USA,
| | - Bryan L. Betz
- Department of Pathology; University of Michigan; Ann Arbor MI USA
| | - Charles W. Ross
- Department of Pathology; University of Michigan; Ann Arbor MI USA
| | - Douglas R. Fullen
- Department of Dermatology; University of Michigan; Ann Arbor MI USA,
- Department of Pathology; University of Michigan; Ann Arbor MI USA
| | - Alexandra C. Hristov
- Department of Dermatology; University of Michigan; Ann Arbor MI USA,
- Department of Pathology; University of Michigan; Ann Arbor MI USA
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20
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21
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Affiliation(s)
- K L Harms
- Department of Cell Biology, University of Alabama at Birmingham, MCLM 660, 1918 University Blvd., Birmingham, AL 35294, USA
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22
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Vanderpool HE, Friis EA, Smith BS, Harms KL. Prevalence of carpal tunnel syndrome and other work-related musculoskeletal problems in cardiac sonographers. J Occup Med 1993; 35:604-10. [PMID: 8331442 DOI: 10.1097/00043764-199306000-00018] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cardiac sonographers at a regional medical center have experienced carpal tunnel syndrome symptoms and other work-related musculoskeletal injuries. The nationwide incidence of these problems was not known. A questionnaire pertaining to possible causes of work-related injuries was developed and distributed to 225 cardiac sonographers. A 47% response rate was achieved with 72% female respondents. Eighty-six percent reported one or more physical symptoms. Only 3% of respondents had been diagnosed with carpal tunnel syndrome. Posture correlated significantly with other work-related musculoskeletal injuries. High-pressure hand grip correlated significantly with carpal tunnel syndrome symptoms. No other strong relations with physical symptoms were found. The contribution of specific factors to musculoskeletal problems experienced by cardiac sonographers was difficult to determine.
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Affiliation(s)
- H E Vanderpool
- Department of Physical Therapy, Wichita State University, Kans
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