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Moysset I, Castrejon N, Garcia-Herrera A, Castillo P, Marginet M, Teixido C, Podlipnik S, Albero-Gonzalez R, Montironi C, Navarro J, Rovira C, Puig S, Carrera C, Alos L. Restrospective reappraisal of the prognostic classification of spitzoid melanocytic neoplasms after BRAF and NRAS mutation characterisation: a single institution experience. Histopathology 2024; 84:1154-1166. [PMID: 38409889 DOI: 10.1111/his.15160] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
AIMS The current WHO classification of melanocytic tumours excludes neoplasms showing BRAF or NRAS mutations from the Spitz category. This study aimed to review and reclassify atypical melanocytic tumours with spitzoid morphological features diagnosed between 2009 and 2021 in our hospital after expanding the molecular profile, including BRAF and NRAS mutations in all cases. METHODS AND RESULTS A total of 71 neoplasms showing spitzoid features (Spitz-like) and atypia were included. The risk of progression of tumours was first studied by integrating the morphology, immunohistochemistry (p16, Ki67, HMB45 and PRAME) and fluorescence in-situ hybridisation (FISH) results (melanoma multiprobe and 9p21). In a second step, after expanding the molecular study, including BRAF and NRAS mutational status, the neoplasms were finally classified into four subgroups: atypical Spitz tumour (AST, n = 45); BRAF-mutated naevus/low-grade melanocytoma with spitzoid morphology (BAMS, n = 2); Spitz melanoma (SM, n = 14); and BRAF or NRAS mutated melanoma with spitzoid features (MSF, n = 10). Follow-up of patients revealed uneventful results for AST and BAMS. Only one SM presented lymph node metastasis after 134 months. Conversely, patients with MSF showed an unfavourable outcome: three developed lymph node metastases after a mean time of 22 months, with one patient presenting distant metastasis and dying of the disease 64 months from diagnosis. The progression-free survival showed significant differences between the four groups of spitzoid tumours (P < 0.001) and between both melanoma subtypes (P = 0.012). CONCLUSIONS The classification and prognostication of atypical neoplasms with spitzoid features requires the integration of histomorphology with the molecular investigation of tumours, which should include BRAF and NRAS mutational status.
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Affiliation(s)
- Irene Moysset
- Department of Pathology, Consorci Sanitari Integral, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
| | - Natalia Castrejon
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Adriana Garcia-Herrera
- University of Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Paola Castillo
- University of Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marta Marginet
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Teixido
- University of Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Molecular Biology Core, Hospital Clinic Barcelona, Barcelona, Spain
| | | | - Raquel Albero-Gonzalez
- University of Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carla Montironi
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
- Molecular Biology Core, Hospital Clinic Barcelona, Barcelona, Spain
| | - Judit Navarro
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Carlota Rovira
- Department of Pathology, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Susana Puig
- University of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Dermatology, Hospital Clínic of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Carrera
- University of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Department of Dermatology, Hospital Clínic of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Llucia Alos
- University of Barcelona, Barcelona, Spain
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
- August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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de Gordoa KS, Alos L, Albero-González R. [[Translated article]]S100-Protein-Negative Mouth Lesion. Actas Dermosifiliogr 2024:S0001-7310(24)00343-0. [PMID: 38653366 DOI: 10.1016/j.ad.2024.04.003] [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: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 04/25/2024] Open
Affiliation(s)
- K Saez de Gordoa
- Servicio de Anatomía Patológica, CDB, Hospital Clínic, Barcelona, España.
| | - L Alos
- Servicio de Anatomía Patológica, CDB, Hospital Clínic, Barcelona, España
| | - R Albero-González
- Servicio de Anatomía Patológica, CDB, Hospital Clínic, Barcelona, España
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Alos L, Carrasco A, Teixidó C, Szumera-Ciećkiewicz A, Vicente A, Massi D, Carrera C. Melanoma on congenital melanocytic nevi. Pathol Res Pract 2024; 256:155262. [PMID: 38518732 DOI: 10.1016/j.prp.2024.155262] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Among nevus-associated melanomas, which overall account for 20%-30% of all melanomas, those arising specifically in congenital melanocytic nevi are infrequent, but can be disproportionately frequent in childhood and adolescence. Congenital melanocytic nevi (CMNi) are common benign melanocytic tumors that are present at birth or become apparent in early childhood. They are classified based on the projected adult size. Small and medium-sized CMNi are frequent, whereas large/giant CMNi (over 20 cm in diameter) are rare, but can be associated with high morbidity due to marked aesthetic impairment and the risk of neurocutaneous syndrome or melanoma development. In this setting, melanomas can appear in early childhood and are very aggressive, while the risk of small-medium CMNi of developing melanoma is low and similar to non-congenital melanocytic nevi. Histologically, most melanomas on CMNi initiate their growth at the epidermal-dermal junction, but in large/giant CMNi they can develop entirely in the dermis, in deeper tissues, or in extracutaneous sites (especially in the central nervous system). Most CMNi harbour an NRAS mutation, but other genes are rarely involved, and gene translocations have recently been described. However, no prognostic implications have been associated with the CMN genotype. Melanomas developed on CMNi harbour additional molecular alterations to which the aggressive clinical course of these tumors has been attributed. This review covers the distinctive clinical and pathological aspects of melanomas on CMNi, and includes the epidemiology, etiopathogenesis, clinical and dermoscopic presentation, histological and molecular characteristics, as well as tumour behaviour.
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Affiliation(s)
- Llucia Alos
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group
| | - Antonio Carrasco
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Cristina Teixidó
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Molecular Biology Core, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Anna Szumera-Ciećkiewicz
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Maria Sklodowska-Curie National Research Institute of Oncology, Department of Pathology, Warsaw, Poland
| | - Asunción Vicente
- Pediatric Dermatology Department, Hospital Sant Joan de Déu, Esplugues del Llobregat, Barcelona, Spain
| | - Daniela Massi
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Pathology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Carrera
- University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Dermatology, Hospital Clínic de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain.
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Castillo P, Castrejon N, Marginet M, Massi D, Alamon F, Teixido C, Montironi C, Garcia-Herrera A, Albero-Gonzalez R, Matas J, Puig S, Alos L. Combined WNT-activated deep-penetrating/plexiform melanocytoma: insights into clinicopathological and molecular characterization. Clin Exp Dermatol 2024; 49:356-363. [PMID: 37995304 DOI: 10.1093/ced/llad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/15/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND A combined deep-penetrating tumour redefined as WNT-activated deep-penetrating/plexiform melanocytoma (DPM), may pose challenging clinical and histological diagnoses. OBJECTIVES To review the clinicopathological characteristics of combined DPMs and characterize the molecular profile of atypical and malignant forms. METHODS The study included 51 patients with combined DPMs diagnosed at the Hospital Clinic of Barcelona and the University of Florence between 2012 and 2020. Clinical data, dermoscopy images (when available) and histological characteristics were reviewed. Immunohistochemistry for β-catenin, LEF1, HMB45, Ki67, p16 and PRAME (preferentially expressed antigen in melanoma) was performed. Atypical forms underwent next-generation sequencing (NGS) panel analysis, including driver genes implicated in DPMs, TERT-promoter (p) mutations and the investigation of the 9p21 locus via fluorescence in situ hybridization. RESULTS Among the 51 patients (32 females and 19 males, age range 4-74 years), 68% with available clinical data (15/22) were initially suspected of having melanoma. Except for one patient, complete excision resulted in no recurrences or metastases. One patient who had an incompletely excised combined DPM developed a lymph node melanoma metastasis 10 years later. In the 51 patients, 10 samples (20%) showed atypical histological features; 7 (14%) exhibited a significant loss of p16 expression; and 2 (4%) showed a high-proliferative index (Ki67 over 5%). NGS analysis in 11 patients revealed a double mutation BRAFV600E and exon 3 CTNNB1; no TERTp mutations were detected. CONCLUSIONS Clinical suspicion of melanoma is common in combined DPMs, but malignant progression is infrequent in tumours lacking high-grade atypia or proliferation. These findings are congruent with the consideration of these lesions as intermediate-grade tumours or melanocytomas.
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Affiliation(s)
- Paola Castillo
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Daniela Massi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence. Florence, Italy
- European Organisation for Research and Treatment of Cancer (EORTC), Melanoma Group
| | | | - Cristina Teixido
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Adriana Garcia-Herrera
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Jessica Matas
- Opthamology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Susana Puig
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- European Organisation for Research and Treatment of Cancer (EORTC), Melanoma Group
- Dermatology
| | - Llucia Alos
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- European Organisation for Research and Treatment of Cancer (EORTC), Melanoma Group
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Ewen T, Husain A, Stefanos N, Barrett P, Jones C, Ness T, Long A, Horswell S, Bosomworth H, Lowenstein J, Richardson G, Swan D, McConnell A, Rose A, Andrew T, Reynolds N, Malvehy J, Carrera C, Alos L, Mailer S, Helm T, Ding L, Bogner P, Podlipnik S, Puig S, McArthur GA, Paragh G, Labus M, Sloan P, Armstrong JL, Lovat PE. Validation of epidermal AMBRA1 and loricrin (AMBLor) as a prognostic biomarker for nonulcerated American Joint Committee on Cancer stage I/II cutaneous melanoma. Br J Dermatol 2024; 190:549-558. [PMID: 38006317 DOI: 10.1093/bjd/ljad459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/05/2023] [Accepted: 11/11/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Combined expression of the autophagy-regulatory protein AMBRA1 (activating molecule in Beclin1-regulated autophagy) and the terminal differentiation marker loricrin in the peritumoral epidermis of stage I melanomas can identify tumour subsets at low risk of -metastasis. OBJECTIVES To validate the combined expression of peritumoral AMBRA1 and loricrin (AMBLor) as a prognostic biomarker able to identify both stage I and II melanomas at low risk of tumour recurrence. METHODS Automated immunohistochemistry was used to analyse peritumoral AMBRA1 and loricrin expression in geographically distinct discovery (n = 540) and validation (n = 300) cohorts of nonulcerated American Joint Committee on Cancer (AJCC) stage I and II melanomas. AMBLor status was correlated with clinical outcomes in the discovery and validation cohorts separately and combined. RESULTS Analysis of AMBLor in the discovery cohort revealed a recurrence-free survival (RFS) rate of 95.5% in the AMBLor low-risk group vs. 81.7% in the AMBLor at-risk group (multivariate log-rank, P < 0.001) and a negative predictive value (NPV) of 96.0%. In the validation cohort, AMBLor analysis revealed a RFS rate of 97.6% in the AMBLor low-risk group vs. 78.3% in the at-risk group (multivariate log-rank, P < 0.001) and a NPV of 97.6%. In a multivariate model considering AMBLor, Breslow thickness, age and sex, analysis of the combined discovery and validation cohorts showed that the estimated effect of AMBLor was statistically significant, with a hazard ratio of 3.469 (95% confidence interval 1.403-8.580, P = 0.007) and an overall NPV of 96.5%. CONCLUSIONS These data provide further evidence validating AMBLor as a prognostic biomarker to identify nonulcerated AJCC stage I and II melanoma tumours at low risk of disease recurrence.
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Affiliation(s)
- Tom Ewen
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Niki Stefanos
- Pathology, Addenbrookes Hospital, Cambridge University NHS Trust, Cambridge, UK
| | - Paul Barrett
- Pathology, University Hospitals of North Durham, Durham, UK
| | | | - Tom Ness
- Novo Path and Cellular Pathology
| | | | - Stuart Horswell
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Francis Crick Institute, London, UK
| | - Helen Bosomworth
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Joe Lowenstein
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle upon Tyne, UK
| | - Grant Richardson
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle upon Tyne, UK
| | - David Swan
- AMLo Biosciences, Newcastle upon Tyne, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Ashleigh McConnell
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle upon Tyne, UK
| | - Aidan Rose
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tom Andrew
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nick Reynolds
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Dermatology and NIHR Newcastle Biomedical Research Centre, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Josep Malvehy
- Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Christina Carrera
- Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Llucia Alos
- Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Sonia Mailer
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Helm
- Division of Dermatology, Buffalo Medical Group, Williamsville, NY, USA
- Department of Dermatology, Penn State Hershey, Hershey, Pennsylvania, USA
| | - Liang Ding
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Paul Bogner
- Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Susana Puig
- Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain
| | - Grant A McArthur
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Gyorgy Paragh
- Department of Dermatology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Marie Labus
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle upon Tyne, UK
| | - Philip Sloan
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Novo Path and Cellular Pathology
- AMLo Biosciences, Newcastle upon Tyne, UK
| | - Jane L Armstrong
- AMLo Biosciences, Newcastle upon Tyne, UK
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Penny E Lovat
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- AMLo Biosciences, Newcastle upon Tyne, UK
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Laeijendecker AE, El Sharouni MA, Stathonikos N, Spoto CPE, van de Wiel BA, Eijken EJE, Mulder M, Mooyaart AL, Szumera-Cieckiewicz A, Mihic-Probst D, Massi D, Cook M, Koljenovic S, Alos L, van Diest PJ, van Akkooi ACJ, Blokx W. The difficulty with measuring the largest melanoma tumour diameter in sentinel lymph nodes. J Clin Pathol 2024:jcp-2023-209354. [PMID: 38378246 DOI: 10.1136/jcp-2023-209354] [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: 12/12/2023] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
Identification of sentinel node (SN) metastases can set the adjuvant systemic therapy indication for stage III melanoma patients. For stage IIIA patients, a 1.0 mm threshold for the largest SN tumour diameter is used. Therefore, uniform reproducible measurement of its size is crucial. At present, the number of deposits or their microanatomical sites are not part of the inclusion criteria for adjuvant treatment. The goal of the current study was to show examples of the difficulty of measuring SN melanoma tumour diameter and teach how it should be measured. Histopathological slides of SN-positive melanoma patients were retrieved using the Dutch Pathology Registry (PALGA). Fourteen samples with the largest SN metastasis around 1.0 mm were uploaded via tele-pathology and digitally measured by 12 pathologists to reflect current practice of measurements in challenging cases. Recommendations as educational examples were provided. Microanatomical location of melanoma metastases was 1 subcapsular, 2 parenchymal and 11 combined. The smallest and largest difference in measurements were 0.24 mm and 4.81 mm, respectively. 11/14 cases (78.6%) showed no agreement regarding the 1.0 mm cut-off. The median discrepancy for cases ≤5 deposits was 0.5 mm (range 0.24-0.60, n=3) and 2.51 mm (range 0.71-4.81, n=11) for cases with ≥6 deposits. Disconcordance in measuring SN tumour burden is correlated with the number of deposits. Awareness of this discordance in challenging cases, for example, cases with multiple small deposits, is important for clinical management. Illustrating cases to reduce differences in size measurement are provided.
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Affiliation(s)
- Annelien E Laeijendecker
- Department of Dermatology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mary-Ann El Sharouni
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, Victoria, Australia
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nikolaos Stathonikos
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Bart A van de Wiel
- Department of Pathology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Erik J E Eijken
- Laboratory for Pathology East Netherlands (LabPON), Hengelo, Netherlands
| | - Marijne Mulder
- Symbiant Pathology Expert Center, Hoorn/Zaandam, Netherlands
| | - Antien L Mooyaart
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Anna Szumera-Cieckiewicz
- Department of Pathology and Laboratory Diagnostics and Department of Diagnostic Hematology, Institute of Hematology and Transfusion Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Daniela Mihic-Probst
- Department of Surgical Pathology, University Hospital Zürich, Zurich, Switzerland
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Martin Cook
- Department of Histopathology, Royal Surrey County Hospital, Guildford, UK
| | - Senada Koljenovic
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Llucia Alos
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Willeke Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
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7
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Massi D, Szumera-Ciećkiewicz A, Alos L, Simi S, Ugolini F, Palmieri G, Stanganelli I, Cook MG, Mandalà M. Impact of second opinion pathology review in the diagnosis and management of atypical melanocytic lesions: A prospective study of the Italian Melanoma Intergroup (IMI) and EORTC Melanoma Group. Eur J Cancer 2023; 189:112921. [PMID: 37280145 DOI: 10.1016/j.ejca.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/07/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The clinical value of an expert pathological review in patients with an atypical melanocytic lesion diagnosis remains unclear. Herein, we evaluate its impact in a prospective clinical study. METHODS Patients with newly diagnosed or suspected atypical melanocytic proliferations and challenging skin tumours were reviewed prospectively by a specialised dermatopathologist through the nationwide 'Second Opinion Platform' of the Italian Melanoma Intergroup (IMI) network. The primary aim was the rate of major discrepancies that impacted patient management. Major discrepancies in diagnosis between referral and specialised review were blindly re-analysed by a panel of European Organisation for Research and Treatment (EORTC) Melanoma pathologists. RESULTS The samples submitted to central review included 254 lesions from 230 patients. The most frequent referral diagnoses were atypical melanocytic nevi of different subtypes (74/254, 29.2%), invasive melanomas (61/254, 24.0%), atypical melanocytic proliferations (37/254, 14.6%), AST (21/254, 8.3%) and in situ melanomas (17/254, 6.7%). There was disagreement between referral diagnosis and expert review in 90/254 cases (35.4%). Most importantly, 60/90 (66.7%) were major discordances with a change to the patient's clinical management. Among the 90 discordant cases, the most frequent new diagnosis occurred in World Health Organisation (WHO) Pathway I, followed by WHO Pathway IV (64/90 and 12/90, respectively). In total, 51/60 cases with major discrepancies were blindly re-evaluated by EORTC Melanoma pathologists with a final interobserver agreement in 90% of cases. CONCLUSION The study highlights that a second opinion for atypical melanocytic lesions affects clinical management in a minor, but still significant, proportion of cases. A central expert review supports pathologists and clinicians to limit the risk of both over- and under-treatment.
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Affiliation(s)
- Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Anna Szumera-Ciećkiewicz
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Pathology, Warsaw, Poland
| | - Llucia Alos
- Department of Pathology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sara Simi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Filippo Ugolini
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giuseppe Palmieri
- Immuno-Oncology & Targeted Cancer Biotherapies, Unit of Cancer Genetics, University of Sassari IRGB-CNR, Sassari, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, IRCCS Scientific Institute of Romagna for the Study of Cancer, IRCCS IRST, Meldola, Italy; Dermatology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Martin G Cook
- Unit of Pathology, Royal Surrey County Hospital, Guildford, UK
| | - Mario Mandalà
- University of Perugia, Unit of Medical Oncology, Santa Maria della Misericordia Hospital, Perugia, Italy
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Goldstein AM, Qin R, Chu EY, Elder DE, Massi D, Adams DJ, Harms PW, Robles-Espinoza CD, Newton-Bishop JA, Bishop DT, Harland M, Holland EA, Cust AE, Schmid H, Mann GJ, Puig S, Potrony M, Alos L, Nagore E, Millán-Esteban D, Hayward NK, Broit N, Palmer JM, Nathan V, Berry EG, Astiazaran-Symonds E, Yang XR, Tucker MA, Landi MT, Pfeiffer RM, Sargen MR. Association of germline variants in telomere maintenance genes ( POT1, TERF2IP, ACD, and TERT) with spitzoid morphology in familial melanoma: A multi-center case series. JAAD Int 2023; 11:43-51. [PMID: 36876055 PMCID: PMC9978843 DOI: 10.1016/j.jdin.2023.01.013] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/31/2023] Open
Abstract
Background Spitzoid morphology in familial melanoma has been associated with germline variants in POT1, a telomere maintenance gene (TMG), suggesting a link between telomere biology and spitzoid differentiation. Objective To assess if familial melanoma cases associated with germline variants in TMG (POT1, ACD, TERF2IP, and TERT) commonly exhibit spitzoid morphology. Methods In this case series, melanomas were classified as having spitzoid morphology if at least 3 of 4 dermatopathologists reported this finding in ≥25% of tumor cells. Logistic regression was used to calculate odds ratios (OR) of spitzoid morphology compared to familial melanomas from unmatched noncarriers that were previously reviewed by a National Cancer Institute dermatopathologist. Results Spitzoid morphology was observed in 77% (23 of 30), 75% (3 of 4), 50% (2 of 4), and 50% (1 of 2) of melanomas from individuals with germline variants in POT1, TERF2IP, ACD, and TERT, respectively. Compared to noncarriers (n = 139 melanomas), POT1 carriers (OR = 225.1, 95% confidence interval: 51.7-980.5; P < .001) and individuals with TERF2IP, ACD, and TERT variants (OR = 82.4, 95% confidence interval: 21.3-494.6; P < .001) had increased odds of spitzoid morphology. Limitations Findings may not be generalizable to nonfamilial melanoma cases. Conclusion Spitzoid morphology in familial melanoma could suggest germline alteration of TMG.
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Affiliation(s)
- Alisa M. Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Richard Qin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Emily Y. Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David E. Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniela Massi
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - David J. Adams
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, England
| | - Paul W. Harms
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Carla Daniela Robles-Espinoza
- Experimental Cancer Genetics, The Wellcome Trust Sanger Institute, Hinxton, England
- Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Campus Juriquilla, Santiago de Querétaro, Qro, Mexico
| | - Julia A. Newton-Bishop
- Division of Haematology and Immunology, Institute of Medical Research at St James’s, University of Leeds, Leeds, England
| | - D. Timothy Bishop
- Division of Haematology and Immunology, Institute of Medical Research at St James’s, University of Leeds, Leeds, England
| | - Mark Harland
- Division of Haematology and Immunology, Institute of Medical Research at St James’s, University of Leeds, Leeds, England
| | - Elizabeth A. Holland
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Sydney, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Sydney, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Helen Schmid
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council, NSW, Sydney, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Graham J. Mann
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clínic de Barcelona, IDIBAPS, Barcelona University, Barcelona, Spain
- Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Miriam Potrony
- Centre of Biomedical Research on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
- Melanoma Unit, Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, IDIBAPS, Barcelona University, Barcelona, Spain
| | - Llucia Alos
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eduardo Nagore
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain
- School of Medicine, Universidad Católica de València San Vicente Mártir, València, Spain
| | - David Millán-Esteban
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain
- School of Medicine, Universidad Católica de València San Vicente Mártir, València, Spain
| | | | - Natasa Broit
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Jane M. Palmer
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Vaishnavi Nathan
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Elizabeth G. Berry
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Xiaohong R. Yang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Margaret A. Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Maria Teresa Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Ruth M. Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Michael R. Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
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9
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Saez de Gordoa K, Alos L, Albero-González R. S100-Protein-Negative Mouth Lesion. Actas Dermosifiliogr 2022:S0001-7310(22)01046-8. [PMID: 36493896 DOI: 10.1016/j.ad.2022.09.022] [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: 08/29/2022] [Accepted: 09/04/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- K Saez de Gordoa
- Servicio de Anatomía Patológica, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic, Barcelona, España.
| | - L Alos
- Servicio de Anatomía Patológica, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic, Barcelona, España
| | - R Albero-González
- Servicio de Anatomía Patológica, Centro de Diagnóstico Biomédico (CDB), Hospital Clínic, Barcelona, España
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10
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Sun W, Zhao F, Hu T, Wu Z, Xu Y, Dong Y, Zheng B, Wang C, Yan W, Zhu X, Wu J, McKay MJ, Arozarena I, Alos L, Teixido C, Chen Y. Oncogenic alterations reveal key strategies for precision oncology in melanoma treatment. Ann Transl Med 2022; 10:1246. [PMID: 36544693 PMCID: PMC9761125 DOI: 10.21037/atm-22-5346] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022]
Abstract
Background Molecular profiling with next-generation sequencing (NGS) has been applied in multiple solid tumors, including melanomas, to identify potential drug targets. However, the association between clinical outcomes and the molecular alterations has not yet been fully clarified. Methods A total of 108 patients with melanoma were included in this study, 95 of whom had both sequencing data and clinical outcomes were collected. We analyzed the genetic alterations of 108 malignant melanoma patients using the OncoCare panel, which covers 559 genes. Results A model was also established to predict side effects through a combination analysis of clinical data and somatic variants, yielding an area under the receiver operating characteristic curve (AUROC) score of 0.8. We also identified epidermal growth factor receptor (EGFR) mutation was excellent predictor for progression-free survival (PFS) for patient who received immunotherapy (log-rank P=0.01), while tumor mutation burden (TMB) was found to not be significantly associated with PFS (log-rank P=0.87). Combining clinical features with genetic analysis, we found that patients carrying both DNA POLD1/ALOX12B or POLD1/PTPRT mutations had a significantly lower survival rate. Conclusions Overall, these results demonstrate the benefits of applying NGS clinical panels and shed light on future directions of personalized therapeutics for the treatment of melanoma.
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Affiliation(s)
- Wei Sun
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fang Zhao
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Tu Hu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiqiang Wu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yu Xu
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yan Dong
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Biqiang Zheng
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chunmeng Wang
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wangjun Yan
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiaoli Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China;,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Jian Wu
- MyGenostics Inc., Beijing, China
| | - Michael J. McKay
- Department of Radiation Oncology, Northern Cancer Service, Burnie, Australia
| | - Imanol Arozarena
- Navarrabiomed-Fundación Miguel Servet-Idisna, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Llucia Alos
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Cristina Teixido
- Department of Pathology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Yong Chen
- Department of Musculoskeletal Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Barragan-Estudillo Z, Brito J, Chavez-Bourgeois M, Alejo B, Alos L, García AP, Puig S, Malvehy J, Carrera C. Dermoscopy And Reflectance Confocal Microscopy To Estimate Breslow Index And Mitotic Rate In Primary Melanoma. Dermatol Pract Concept 2022; 12:e2022174. [DOI: 10.5826/dpc.1204a174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Non-invasive imaging techniques offer the possibility to optimize the first approach to melanoma. RCM has a promising role in predicting the main prognostic events in the dermoepidermal and papillary dermis.
Objectives: To identify pre-surgical criteria that can predict the main prognostic features of melanoma.
Methods: A retrospective cohort-study evaluated dermoscopic, confocal and histopathological characteristics of consecutively diagnosed sporadic melanomas. RCM-melanoma patterns classified into 1) dendritic-cell, 2) round-cell, 3) dermal nest and 4) combined type. Acral, facial and mucosal locations were excluded.
Results: 92 primary melanomas were included: 44 male and 48 female (mean age 60.4 years, SD 16.2) with a mean Breslow of 1.43mm (SD 1.6). The most frequent dermoscopic presentation was the multicomponent pattern, the predominant confocal pattern was dendritic-cell type (44.6%). The presence of pigmented network on dermoscopy was related to lower Breslow and mitotic rates (both p=0.002); in contrast to the presence of visible vessels, which was related to higher Breslow and mitotic indexes (both p=0.001). Confocal observation of dermal nests or atypical cells in the papillary dermis was related to a higher mitotic rate (p=0.006 and p=0.03, respectively). Similarly, diffuse inflammatory infiltrates visible in the superficial dermis was associated with higher Breslow (p=0.04) and mitotic index (p=0.04).
Conclusions: Dermoscopic and RCM in vivo findings on primary melanoma correlate with histopathologic Breslow index, mitotic rate and tumor infiltrating lymphocytes. The architecture and cytology of primary melanoma can be estimated by combining dermoscopy and RCM prior to excision.
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12
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Perez‐Anker J, Puig S, Alos L, García A, Alejo B, Cinotti E, Orte Cano C, Tognetti L, Lenoir C, Monnier J, Machuca N, Castillo P, Rosés Gibert P, Rubegni P, Suppa M, Perrot JL, del Marmol V, Malvehy J. Morphologic evaluation of melanocytic lesions with three‐dimensional line‐field confocal optical coherence tomography: correlation with histopathology and reflectance confocal microscopy. A pilot study. Clin Exp Dermatol 2022; 47:2222-2233. [DOI: 10.1111/ced.15383] [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] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Javiera Perez‐Anker
- Fundación Hospital Clinic Barcelona Spain
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona Barcelona Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona Barcelona Spain
- Centro de Investigación Biomédica en red de enfermedades raras, CIBERER, Instituto de Salud Carlos III Barcelona Spain
| | - Llucia Alos
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona Barcelona Spain
| | - Adriana García
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona Barcelona Spain
| | | | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences University of Siena Siena Italy
- Groupe d’Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie, (SFD), Paris France
| | - Carmen Orte Cano
- Department of Dermatology, Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
| | - Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences University of Siena Siena Italy
| | - Clement Lenoir
- Department of Dermatology, Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
| | - Jilliana Monnier
- Dermatology Department, AP‐HM, Aix‐Marseille University Marseille France
| | - Natalia Machuca
- Bioengineering Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès Barcelona Spain
| | - Paola Castillo
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona Barcelona Spain
| | - Pau Rosés Gibert
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona Barcelona Spain
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences University of Siena Siena Italy
| | - Mariano Suppa
- Groupe d’Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie, (SFD), Paris France
- Department of Dermatology, Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
- Department of Dermatology, Institut Jules Bordet Université Libre de Bruxelles Brussels Belgium
| | - Jean L. Perrot
- Department of Dermatology University Hospital of Saint‐Etienne Saint‐Etienne France
| | - Veronique del Marmol
- Department of Dermatology, Hôpital Erasme Université Libre de Bruxelles Brussels Belgium
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona Barcelona Spain
- Centro de Investigación Biomédica en red de enfermedades raras, CIBERER, Instituto de Salud Carlos III Barcelona Spain
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13
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Chavez-Bourgeois M, Ribero S, Barreiro A, Espinoza N, Carrera C, Garcia A, Alos L, Puig S, Malvehy J. Reflectance Confocal Microscopy and Electrical Impedance Spectroscopy in the Early Detection of Melanoma in Changing Lesions during Long-term Follow-up of Very High-risk Patients. Acta Derm Venereol 2022; 102:adv00751. [PMID: 35535641 PMCID: PMC9558334 DOI: 10.2340/actadv.v102.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Electrical impedance spectroscopy has clinical relevance in diagnosing malignancy in melanocytic lesions. Sixty-eight lesions with changes during digital follow-up of patients at very high risk of developing melanoma were prospectively included in this study from February to December 2016. Electrical impedance spectroscopy and reflectance confocal microscopy were performed to evaluate their performance in this subset of difficult lesions. Forty-six lesions were considered suspicious on reflectance confocal microscopy and were excised, of these, 19 were diagnosed as melanoma. Fifteen melanomas were detected by electrical impedance spectroscopy, while 4 received a score lower than 4, which suggested no malignancy. The addition of reflectance confocal microscopy improves accuracy while maintaining the same sensitivity. In the case of electrical impedance spectroscopy scores <4, lesions exhibiting changes in follow-up may need short-term monitoring or excision if dermoscopy shows criteria for melanoma. Results of electrical impedance spectroscopy in this subset of very early lesions should be carefully considered due to the risk of false negatives.
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Affiliation(s)
| | | | | | | | | | | | | | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Villarroel 170, ES-08036, Barcelona, Spain.
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14
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Moysset I, Fuster-Anglada C, Castillo P, Teixido C, Garcia-Herrera A, Marginet M, Lopez I, Costa D, Carrera C, Arance A, Alos L. Immunophenotype of tumor-infiltrating lymphocytes in atypical Spitzoid tumors according to the risk of progression. Ann Diagn Pathol 2022; 60:151985. [PMID: 35709617 DOI: 10.1016/j.anndiagpath.2022.151985] [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: 03/04/2022] [Revised: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 11/25/2022]
Abstract
The aims of the study were to investigate and compare the immunophenotype of tumor-infiltrating lymphocytes (TILs) and PD-L1 expression in a series of benign, intermediate and malignant Spitzoid lesions showing marked inflammatory lymphoid component, to find out its possible relation with the prognosis of these lesions. Six out of 97 Spitz nevus (SN) (6 %), five out of 26 atypical Spitz tumors (AST) (16 %) and seven out of 37 Spitzoid melanomas (SM) (19 %) showed diffuse, intense inflammatory component and were included in the study. The biological risk of the tumors was assessed in all AST through the melanoma 4 probe-FISH assay and the 9p21 locus exploration. TILs were quantitatively immunophenotyped using CD3, CD4, CD8, CD20, TIA1, FOXP3 and PD1 antibodies. PD-L1 was assessed in tumoral cells and inflammatory cells adjacent to the tumor. No significant differences of TILs immunophenotype were found between SN, AST and SM. However, the classification of tumors according to the biological risk showed that grouped SN plus low-risk AST had a significantly higher number of T-cells CD8+ and TIA-1+, as well as a lower CD4/CD8 relation and B- lymphocyte number than high-risk of progression tumors (grouped high-risk AST plus SM). Immunoregulatory T-cell markers PD1 and FOXP3 only correlated with each other and with PD-L1 expression. In conclusion, The TILs immunoprofile differences between low-risk and high-risk of progression Spitzoid tumors, especially regarding CD8 and the cytotoxic immune response, can add prognostic information about these challenging tumors and impact the clinical management of patients.
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Affiliation(s)
- Irene Moysset
- Department of Pathology, Consorci Sanitari Integral, Av. Josep Molins, 29, 08906, L'Hospitalet de Llobregat, Barcelona, Spain; University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Carla Fuster-Anglada
- Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain.
| | - Paola Castillo
- University of Barcelona, Villarroel 170, 08036, Barcelona, Spain; Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain.
| | - Cristina Teixido
- Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Casanova 143, 08036 Barcelona, Spain.
| | - Adriana Garcia-Herrera
- University of Barcelona, Villarroel 170, 08036, Barcelona, Spain; Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Casanova 143, 08036 Barcelona, Spain.
| | - Marta Marginet
- Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain.
| | - Ingrid Lopez
- Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain.
| | - Dolors Costa
- Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain.
| | - Cristina Carrera
- University of Barcelona, Villarroel 170, 08036, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Casanova 143, 08036 Barcelona, Spain; Department of Dermatology, Hospital Clínic of Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain.
| | - Ana Arance
- Department of Oncology, Hospital Clínic of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
| | - Llucia Alos
- University of Barcelona, Villarroel 170, 08036, Barcelona, Spain; Department of Pathology, Hospital Clinic of Barcelona, Villarroel 170, 08036, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Casanova 143, 08036 Barcelona, Spain.
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15
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Abstract
Melanoma develops as a result of several genetic alterations, with UV radiation often acting as a mutagenic risk factor. Deep knowledge of the molecular signaling pathways of different types of melanoma allows better characterization and provides tools for the development of therapies based on the intervention of signals promoted by these cascades. The latest World Health Organization classification acknowledged the specific genetic drivers leading to melanoma and classifies melanocytic lesions into nine distinct categories according to the associate cumulative sun damage (CSD), which correlates with the molecular alterations of tumors. The largest groups are melanomas associated with low-CSD or superficial spreading melanomas, characterized by frequent presentation of the BRAFV600 mutation. High-CSD melanomas include lentigo maligna type and desmoplastic melanomas, which often have a high mutation burden and can harbor NRAS, BRAFnon-V600E, or NF1 mutations. Non-CSD-associated melanomas encompass acral and mucosal melanomas that usually do not show BRAF, NRAS, or NF1 mutations (triple wild-type), but in a subset may have KIT or SF3B1 mutations. To improve survival, these driver alterations can be treated with targeted therapy achieving significant antitumor activity. In recent years, relevant improvement in the prognosis and survival of patients with melanoma has been achieved, since the introduction of BRAF/MEK tyrosine kinase inhibitors and immune checkpoint inhibitors. In this review, we describe the current knowledge of molecular pathways and discuss current and potential therapeutic targets in melanoma, focusing on their clinical relevance of development.
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Affiliation(s)
- Cristina Teixido
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; (P.C.); (L.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain;
| | - Paola Castillo
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; (P.C.); (L.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain;
| | - Clara Martinez-Vila
- Department of Medical Oncology, Hospital Clínic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain;
- Department of Medical Oncology, Althaia Xarxa Assistencial Universitària de Manresa, Dr. Joan Soler, 1–3, 08243 Manresa, Spain
| | - Ana Arance
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain;
- Department of Medical Oncology, Hospital Clínic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain;
| | - Llucia Alos
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain; (P.C.); (L.A.)
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Rosselló 149, 08036 Barcelona, Spain;
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16
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Manca A, Sini MC, Cesinaro AM, Portelli F, Urso C, Lentini M, Cardia R, Alos L, Cook M, Simi S, Paliogiannis P, De Giorgi V, Cossu A, Palmieri G, Massi D. NGS-Based Analysis of Atypical Deep Penetrating Nevi. Cancers (Basel) 2021; 13:cancers13123066. [PMID: 34205480 PMCID: PMC8234376 DOI: 10.3390/cancers13123066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary The recent WHO classification of melanocytic tumors requires the implementation of combined phenotypic–genotypic diagnostics. For rare tumors, such as atypical deep penetrating nevi, there is insufficient information regarding genetic status, and it is not yet clear whether the observed unusual morphological cyto-architectures reflect a distinct genomic profile or are associated with an increased metastatic potential and aggressive clinical behavior. We report herein a comprehensive next-generation sequencing (NGS) analysis of a series of atypical DPNs, showing their mutational profile with some specific signatures for these rare and diagnostically challenging tumors. Abstract Deep penetrating nevi (DPNs) are rare melanocytic neoplasms consisting of pigmented spindled or epithelioid melanocytes with a distinctive wedge-shaped configuration showing activation of the WNT pathway, with unusual cyto-architectural features. It is unclear whether they show a distinct genomic profile associated with a diverse metastatic potential. We describe herein a cohort of 21 atypical DPNs analyzed by next-generation sequencing using the Ion AmpliSeq™ Comprehensive Cancer Panel. We found that β-catenin exon 3 was mutated in 95% and MAP kinase pathway genes in 71% of the cases. Less frequent mutations were observed in HRAS (19%) and MAP2K1 (24%). Isocitrate dehydrogenases 1 (IDH1) mutations, including R132C, V178I, and S278L, were identified in 38% of cases and co-existed with BRAF/HRAS mutations. The only case with progressive nodal disease carried alterations in the β-catenin pathway and mutations in IDH1 and NRAS (codon 61). By a comprehensive mutation analysis, we found low genetic heterogeneity and a lack of significant associations between specific gene mutations and histopathological features, despite atypical features. Whether the acquisition of an NRAS or IDH1 mutation in an atypical DPN may represent a molecular evolution implying a pathway to melanoma progression should be confirmed in a larger series.
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Affiliation(s)
- Antonella Manca
- Institute of Genetic & Biomedical Research, National Research Council, 07100 Sassari, Italy;
| | - Maria Cristina Sini
- Istituto di Chimica Biomolecolare, Consiglio Nazionale delle Ricerche (CNR), 07100 Sassari, Italy;
| | | | - Francesca Portelli
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, 50121 Firenze, Italy; (F.P.); (S.S.)
| | - Carmelo Urso
- Dermatopathology Study Center of Florence, 50129 Florence, Italy;
| | - Maria Lentini
- Department of Human Pathology, University of Messina, 98122 Messina, Italy; (M.L.); (R.C.)
| | - Roberta Cardia
- Department of Human Pathology, University of Messina, 98122 Messina, Italy; (M.L.); (R.C.)
| | - Llucia Alos
- Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Martin Cook
- Division of Pathology, University of Surrey, Guildford GU2 7XH, UK;
| | - Sara Simi
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, 50121 Firenze, Italy; (F.P.); (S.S.)
| | - Panagiotis Paliogiannis
- Laboratory Quality Control Unit, University Hospital (AOU) of Sassari, 07100 Sassari, Italy;
| | | | - Antonio Cossu
- Department of Medical Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Giuseppe Palmieri
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Daniela Massi
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, 50121 Firenze, Italy; (F.P.); (S.S.)
- Correspondence:
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de la Fouchardiere A, Blokx W, van Kempen LC, Luzar B, Piperno-Neumann S, Puig S, Alos L, Calonje E, Massi D. ESP, EORTC, and EURACAN Expert Opinion: practical recommendations for the pathological diagnosis and clinical management of intermediate melanocytic tumors and rare related melanoma variants. Virchows Arch 2021; 479:3-11. [PMID: 33432480 DOI: 10.1007/s00428-020-03005-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/25/2020] [Revised: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 01/17/2023]
Abstract
The recent WHO classification of skin tumors has underscored the importance of acknowledging intermediate grade melanocytic proliferations. A multistep acquisition of oncogenic events drives the progressive transformation of nevi into melanomas. The various pathways described are modulated by the initial oncogenic drivers that define the common, blue, and Spitz nevi groups. Intermediate lesions are most often the result of a clonal evolution within such nevi. Based on this established classification, we have suggested for each pathway a practical diagnostic approach, benefiting from the recently developed molecular tools, both in the setting of general pathology labs and expert centers. Moreover, recommendations regarding the re-excision and clinical follow-up are given to support decision-making in multidisciplinary tumor boards.
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Affiliation(s)
| | - Willeke Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center, Utrecht, The Netherlands
| | - Léon C van Kempen
- Faculty of Medical Sciences, University Medical Center Groningen, Department of Pathology & Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Boštjan Luzar
- Institute of Pathology, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
| | - Sophie Piperno-Neumann
- Department of Medical Oncology, Institut Curie, 75005, Paris, France.,EURACAN network member (rare skin and eye melanoma domain), Leiden, The Netherlands
| | - Susana Puig
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Llucia Alos
- Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Department of Pathology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Eduardo Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
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Alos L, Fuster C, Castillo P, Jares P, Garcia-Herrera A, Marginet M, Agreda F, Arance A, Gonzalvo E, Garcia M, Puig S, Teixido C. TP53 mutation and tumoral PD-L1 expression are associated with depth of invasion in desmoplastic melanomas. Ann Transl Med 2020; 8:1218. [PMID: 33178750 PMCID: PMC7607103 DOI: 10.21037/atm-20-1846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Desmoplastic melanoma (DM) is a rare subtype of spindle cell malignant melanoma characterized by frequent local recurrences and hematogenous spread, but without molecular classification. The aim of the study was to investigate in a DM series the incidence of relevant gene alterations in cancer, the programmed death-ligand 1 (PD-L1) expression status and the association with clinicopathological features and melanoma progression. Methods A total of 38 patients were included. Clinical follow-up and the histopathological features of all cases were retrospectively collected. PD-L1 expression by immunohistochemistry (IHC) and BRAF genomic alterations by real-time PCR were determined in 34 samples. Additionally, a molecular analysis by next-generation sequencing was performed in 25 DMs. Results Tumors occurred predominantly in men (76%) and in the head and neck region (50%). Most tumors were pure DMs (66%), containing less than 10% of conventional melanoma. Overall, 48% of our cohort harbored TP53 mutations, most of them showing a molecular signature associated with ultraviolet (UV)-oncogenesis, and 29%, BRAF mutations. A positive correlation between TP53 with depth of invasion (P=0.005) and presence of elastosis (P=0.002) was found. High-expression of PD-L1 in tumor cells was observed in 38% of cases and correlated with depth of tumoral infiltration (P=0.003), TP53 (P=0.016), PD-1 (P<0.001) and tumor-infiltrating lymphocytes (TILS) (P<0.001). PD-L1 expression in immune cells correlated with PD-1 (P=0.006), tumoral PD-L1 expression (P=0.029) and TP53 mutation (P=0.002). Survival correlated with depth of invasion (P=0.003), stage of tumors (P=0.015), positive sentinel lymph node (P=0.004), lymph node metastasis (P=0.024) and distant metastasis (P<0.001). Conclusions Our results suggest that progressed DMs with deep tumoral infiltration frequently harbor TP53 mutations, PD-L1 expression and present a high inflammatory response, probably related to adaptive immune resistance in this tumor-type.
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Affiliation(s)
- Llucia Alos
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Carla Fuster
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Pedro Jares
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Adriana Garcia-Herrera
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marta Marginet
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Fernando Agreda
- Department of Urological Surgery, Hospital Trias I Pujol, Carretera de Canyet, Badalona, Spain
| | - Ana Arance
- Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Elena Gonzalvo
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Mireia Garcia
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Susana Puig
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Department of Dermatology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Cristina Teixido
- Department of Pathology, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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Sargen MR, Calista D, Elder DE, Massi D, Chu EY, Potrony M, Pfeiffer RM, Carrera C, Aguilera P, Alos L, Puig S, Elenitsas R, Yang XR, Tucker MA, Landi MT, Goldstein AM. Histologic features of melanoma associated with germline mutations of CDKN2A, CDK4, and POT1 in melanoma-prone families from the United States, Italy, and Spain. J Am Acad Dermatol 2020; 83:860-869. [PMID: 32283231 DOI: 10.1016/j.jaad.2020.03.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/12/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND CDKN2A, CDK4, and POT1 are well-established melanoma-susceptibility genes. OBJECTIVE We evaluated melanoma histopathology for individuals with germline mutations of CDKN2A, CDK4, and POT1. METHODS We assessed histopathology for melanomas diagnosed in melanoma-prone families (≥2 individuals with melanoma) from the United States, Italy, and Spain. Comparisons between mutation carriers and noncarriers (no mutation) were adjusted for age, sex, Breslow depth, and correlations among individuals within the same family. RESULTS Histologic slides were evaluated for 290 melanomas (139 from 132 noncarriers, 122 from 68 CDKN2A carriers, 10 from 6 CDK4 carriers, and 19 from 16 POT1 carriers). Superficial spreading was the predominant subtype for all groups. Spitzoid morphology (>25% of tumor) was observed in 10 of 15 invasive melanomas (67%) from POT1 carriers (P < .0001 vs noncarriers). This finding was independently confirmed by 3 expert melanoma dermatopathologists in 9 of 15 invasive melanomas (60%). In situ and invasive melanomas from CDKN2A and CDK4 carriers were histologically similar to melanomas from noncarriers. LIMITATIONS Limited sample sizes for rare melanoma-susceptibility syndromes (CDK4, POT1). CONCLUSION Spitzoid morphology was associated with POT1 mutations suggesting that telomere dysfunction (POT1 mutations) may contribute to spitzoid differentiation in melanocytic tumors.
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Affiliation(s)
- Michael R Sargen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland.
| | - Donato Calista
- Department of Dermatology, Maurizio Bufalini Hospital, Cesena, Italy
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniela Massi
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Emily Y Chu
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Míriam Potrony
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Paula Aguilera
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Llucia Alos
- Pathology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clínic de Barcelona, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Barcelona, Spain
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Xiaohong R Yang
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Margaret A Tucker
- Human Genetics Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Maria Teresa Landi
- Integrative Tumor Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Alisa M Goldstein
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Alos L, Rodriguez-Carunchio L, Brugués A, Fuster C, Pinyol M, Puig S. The Usefulness of Molecular Tools for the Diagnosis of a Challenging Nevoid Melanoma. Appl Immunohistochem Mol Morphol 2020; 28:e36-e37. [PMID: 29734246 DOI: 10.1097/pai.0000000000000670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Llucia Alos
- Departments of Pathology
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS)
| | | | | | | | - Magda Pinyol
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS)
| | - Susana Puig
- Dermatology, Hospital Clinic University of Barcelona
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS)
- Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras Barcelona, Spain
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Castillo P, Marginet M, Jares P, García M, Gonzalvo E, Arance A, García A, Alos L, Teixido C. Implementation of an NGS panel for clinical practice in paraffin-embedded tissue samples from locally advanced and metastatic melanoma patients. Exploration of Targeted Anti-tumor Therapy 2020; 1:101-108. [PMID: 36046072 PMCID: PMC9400780 DOI: 10.37349/etat.2020.00006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022] Open
Abstract
Aim: Single biomarker diagnostic test of BRAFV600 locus in metastatic melanoma is mandatory for treatment decision; however, multiple-gene based techniques, such as targeted next-generation sequencing (NGS) are being used to maximize the number of patients that can benefit from a targeted therapy. The main objective of this study is to investigate whether an NGS panel could be adopted in routine clinical care for advanced melanoma. Methods: Patients diagnosed with advanced melanoma at our center from 2017 to 2019 were included. Presence of genetic alterations was performed using two methods: real-time polymerase chain reaction-based Idylla test (Biocartis) and NGS with the oncomine solid tumor DNA kit (Thermo Fisher Scientific). Total genomic DNA was extracted from formalin-fixed and paraffin embedded samples for sequencing. Results: A total of 155 samples were evaluated for molecular analysis but 40 samples (25.8%) were inadequate for sequencing. The clinical utility of BRAFV600 real-time polymerase chain reaction and targeted-NGS was compared in 29 samples and a very good concordance was observed (Kappa = 0.89, 95% confidence interval 0.68 ± 1.05). An oncogenic mutation by NGS was found in 75 samples (65%)–53% of whom were candidates for personalized therapies. The most prevalent mutated genes were BRAF (39%), TP53 (23%), and NRAS (14%). Other genes identified at lower incidence (< 5%) were: PIK3CA, ERBB4, CTNNB1, STK11, FGFR1, SMAD4, KRAS, FGFR3, PTEN and AKT. Co-occurrence of oncogenic mutations was detected in 40% of the samples. Among the mutations identified, TP53 was significantly more prevalent in men (men 31.8% versus women 12.2%, P = 0.03) and NRAS in women (men 9.1% versus women 24.4%, P = 0.03). Conclusions: Targeted-NGS testing is a feasible technique to implement in the routine clinical practice. Based on our results, NGS has provided more information on target-genes than RT-PCR technique, maximizing the benefit for patients with advanced melanoma.
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Affiliation(s)
- Paola Castillo
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Marta Marginet
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Pedro Jares
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Mireia García
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Elena Gonzalvo
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Ana Arance
- Department of Medical Oncology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Adriana García
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Llucia Alos
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Cristina Teixido
- Department of Pathology, Hospital Clinic, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
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Pérez‐Anker J, Ribero S, Yélamos O, García‐Herrara A, Alos L, Alejo B, Combalia M, Moreno‐Ramírez D, Malvehy J, Puig S. A new type of microscopy to help scientists examine skin cancers. Br J Dermatol 2020. [DOI: 10.1111/bjd.18760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pérez‐Anker J, Ribero S, Yélamos O, García‐Herrara A, Alos L, Alejo B, Combalia M, Moreno‐Ramírez D, Malvehy J, Puig S. 一种可帮助科学家检查皮肤癌的新型显微镜检查. Br J Dermatol 2020. [DOI: 10.1111/bjd.18775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pérez-Anker J, Ribero S, Yélamos O, García-Herrera A, Alos L, Alejo B, Combalia M, Moreno-Ramírez D, Malvehy J, Puig S. Basal cell carcinoma characterization using fusion ex vivo confocal microscopy: a promising change in conventional skin histopathology. Br J Dermatol 2019; 182:468-476. [PMID: 31220341 DOI: 10.1111/bjd.18239] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Ex vivo confocal microscopy (CM) works under two modes, fluorescence and reflectance, allowing the visualization of different structures. Fluorescence CM (FCM) requires a contrast agent and has been used for the analysis of basal cell carcinomas (BCCs) during Mohs surgery. Conversely, reflectance CM (RCM) is mostly used for in vivo diagnosis of equivocal skin tumours. Recently, a new, faster ex vivo confocal microscope has been developed which simultaneously uses both lasers (fusion mode). OBJECTIVES To describe the BCC features identified on reflectance, fluorescence and fusion modes using this novel device. To determine the best mode to identify characteristic BCC features. To develop a new staining protocol to improve the visualization of BCC under the different modes. METHODS From September 2016 to June 2017, we prospectively included consecutive BCCs which were excised using Mohs surgery in our department. The lesions were evaluated using ex vivo CM after routine Mohs surgery. The specimens were first stained with acridine orange and then stained using both acetic acid and acridine orange. RESULTS We included 78 BCCs (35 infiltrative, 25 nodular, 12 micronodular, 6 superficial). Most features were better visualized with the fusion mode using the double staining. We also identified new CM ex vivo features, dendritic and plump cells, which have not been reported previously. CONCLUSIONS Our results suggest that nuclei characteristics are better visualized in FCM but cytoplasm and surrounding stroma are better visualized in RCM. Thus, the simultaneous evaluation of reflectance and fluorescence seems to be beneficial due to its complementary effect. What's already known about this topic? Ex vivo fluorescent confocal microscopy (FCM) is an imaging technique that allows histopathological analysis of fresh tissue. FCM is faster - at least one-third of the time - than conventional methods. FCM has a sensitivity of 88% and a specificity of 99% in detecting basal cell carcinomas (BCCs). What does this study add? Reflectance and fluorescence modes can be used simultaneously in a new ex vivo CM device. Each mode complements the other, resulting in an increase in the detection of BCC features in fusion mode. A combined staining using acetic acid and acridine orange enhances the visualization of tumour and stroma without damaging the tissue for further histopathological analysis.
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Affiliation(s)
- J Pérez-Anker
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - S Ribero
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - O Yélamos
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - A García-Herrera
- Department of Pathology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - L Alos
- Department of Pathology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - B Alejo
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - M Combalia
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - D Moreno-Ramírez
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - J Malvehy
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) de enfermedades raras, Madrid, Spain
| | - S Puig
- Department of Dermatology (Melanoma Unit), Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) de enfermedades raras, Madrid, Spain
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Oliva J, Larque A, Marti C, Bodalo‐Torruella M, Nonell L, Nadal A, Castillo P, Sieira R, Ferrer A, Garcia‐Diez E, Alos L. Oral premalignant lesions of smokers and non‐smokers show similar carcinogenic pathways and outcomes. A clinicopathological and molecular comparative analysis. J Oral Pathol Med 2019; 50:280-286. [DOI: 10.1111/jop.12864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/04/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Jorge Oliva
- Department of Pathology, Hospital Clínic, IDIBAPS University of Barcelona Barcelona Spain
| | - Ana‐Belen Larque
- Department of Pathology, Hospital Clínic, IDIBAPS University of Barcelona Barcelona Spain
| | - Carles Marti
- Department of Maxillofacial Surgery Hospital Clínic Barcelona Spain
| | - Marta Bodalo‐Torruella
- Microarray Analysis Service Institut Hospital del Mar d’InvestigacionsMèdiques (IMIM) Barcelona Spain
| | - Lara Nonell
- Microarray Analysis Service Institut Hospital del Mar d’InvestigacionsMèdiques (IMIM) Barcelona Spain
| | - Alfons Nadal
- Department of Pathology, Hospital Clínic, IDIBAPS University of Barcelona Barcelona Spain
| | - Paola Castillo
- Department of Pathology, Hospital Clínic, IDIBAPS University of Barcelona Barcelona Spain
| | - Ramón Sieira
- Department of Maxillofacial Surgery Hospital Clínic Barcelona Spain
| | - Ada Ferrer
- Department of Maxillofacial Surgery Hospital Clínic Barcelona Spain
| | - Eloy Garcia‐Diez
- Department of Maxillofacial Surgery Hospital Clínic Barcelona Spain
| | - Llucia Alos
- Department of Pathology, Hospital Clínic, IDIBAPS University of Barcelona Barcelona Spain
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Barreiro-Capurro A, Mascaró JM, Galindo BA, Giavedoni P, Carrera C, Alos L, Puig S, Malvehy J. Clinical and Dermoscopic Evaluation of Melanocytic Lesions in Patients with Chronic Graft Versus Host Disease. Acta Derm Venereol 2019; 99:777-782. [PMID: 30938827 DOI: 10.2340/00015555-3194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients treated with haematopoietic stem cell transplantation are at increased risk of cutaneous malignant neoplasms. There are no reports on the characteristics of melanocytic lesions in patients with chronic graft versus host disease and the value of recognizing these difficult lesions in high-risk patients. The objective of this study is to describe the clinical and dermoscopic characteristics of melanocytic lesions in patients with chronic graft versus host disease in order to understand their morphology. A prospective cross-sectional study was performed; 10 melanocytic lesions on the trunk and extremities were selected from each patient. A statistically significant association was found between regression and high total dermoscopic score and 7-point checklist score. Lesions were excised or included in short-term digital follow-up. Melanocytic lesions in patients with chronic graft versus host disease developing after allogeneic-haematopoietic stem cell transplantation exhibit marked structural and colour changes similar to melanoma. This is believed to result from the inflammatory process associated with graft versus host disease.
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Salazar-Villegas Á, Matas J, Palma-Carvajal F, González-Valdivia H, Alos L, Ortiz-Pérez S. Sebaceous carcinoma of the caruncle. J Fr Ophtalmol 2019; 42:925-927. [PMID: 31178073 DOI: 10.1016/j.jfo.2019.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/19/2019] [Accepted: 04/21/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Á Salazar-Villegas
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain.
| | - J Matas
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain
| | - F Palma-Carvajal
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain
| | - H González-Valdivia
- Oculoplastic Unit, Hospital Sant Joan de Déu, Passeig de Sant Joan de Déu, 2, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - L Alos
- Department of Pathology, Hospital Clínic, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - S Ortiz-Pérez
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, Carrer de Sabino Arana, 1, 08028 Barcelona, Spain
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28
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Monnier J, Bahadoran P, Barreiro A, Ferrandiz L, Carrera C, Alos L, Puig S, Malvehy J. Intérêt de l’imagerie cutanée non-invasive par reflectance confocale microscopy (microscopie confocale) pour les carcinomes spinocellulaires in situ pigmentés atypiques : une série de 7 cas. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Theillac C, Cinotti E, Malvehy J, Ronger Savle S, Balme B, Robinson P, Perrot JL, Douchet C, Biron Schneider AC, Alos L, Garcia A, Barreiro A, Labeille B, Duru G, Dalle S, Thomas L, Debarbieux S. Evaluation of large clinically atypical vulvar pigmentation with RCM: atypical melanosis or early melanoma? J Eur Acad Dermatol Venereol 2018; 33:84-92. [PMID: 29920797 DOI: 10.1111/jdv.15141] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vulvar melanosis can occasionally be clinically challenging by mimicking an early melanoma. OBJECTIVE To report our experience of initial evaluation and follow-up in this peculiar subset of vulvar melanosis using reflectance confocal microscopy (RCM). METHODS We retrospectively evaluated 18 consecutive cases referred for atypical vulvar pigmentation or for which melanoma was considered and that underwent both RCM examination and histopathological assessment. In 13 cases with available dermoscopic pictures, RCM classification was compared to dermoscopic diagnosis, and in all cases, the density of melanocytes was evaluated on biopsies using MelanA immunostaining. RESULTS Among the 18 atypical pigmented lesions, 17 vulvar melanosis and one melanoma were histologically determined. RCM concluded a benign vulvar melanosis in 10 of 17 cases, whereas dermoscopy did so in three of 12 cases. RCM identified the only early malignant lentiginous melanoma. In several cases of vulvar melanosis, RCM could identify foci of melanocytic hyperplasia in an otherwise benign pattern. CONCLUSIONS In this clinically and dermoscopically challenging subset of vulvar pigmentations, RCM appears relevant for initial extensive evaluation, especially to target initial biopsy sampling, and to perform non-invasive monitoring of foci of melanocytic hyperplasia.
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Affiliation(s)
- C Theillac
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - E Cinotti
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
| | - J Malvehy
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - S Ronger Savle
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - B Balme
- Pathology Department, Centre Hospitalier de Lyon Sud, Lyon, France
| | - P Robinson
- DRCI, Hospices Civils de Lyon, Lyon, France
| | - J L Perrot
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
| | - C Douchet
- Pathology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - A C Biron Schneider
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - L Alos
- Pathology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Garcia
- Pathology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Barreiro
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - B Labeille
- Dermatology Department, University Hospital of Saint-Etienne, Saint-Etienne, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
| | - G Duru
- Department of Biostatistics, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - S Dalle
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - L Thomas
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France
| | - S Debarbieux
- Dermatology Department, Centre Hospitalier de Lyon Sud, Hospices civils de Lyon, Université Claude Bernard Lyon 1, Pierre Bénite, France.,Pour le Groupe Imagerie Cutanée Non Invasive de la Société Française de Dermatologie, Paris, France
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30
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Barragan-Estudillo ZF, Jesus-Silva MA, Chavez-Bourgeois MM, Brito J, Alos L, Puig S, Malvehy J. Image Gallery: Transition pattern in acral melanoma. Br J Dermatol 2018; 178:e225. [PMID: 29595218 DOI: 10.1111/bjd.16233] [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: 11/27/2022]
Affiliation(s)
- Z F Barragan-Estudillo
- Dermatology and Pathology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - M A Jesus-Silva
- Dermatology and Pathology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - M M Chavez-Bourgeois
- Dermatology and Pathology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J Brito
- Dermatology and Pathology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - L Alos
- Dermatology and Pathology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - S Puig
- Dermatology and Pathology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
| | - J Malvehy
- Dermatology and Pathology Department, Melanoma Unit, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Barcelona, Spain
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31
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Prat A, Navarro A, Paré L, Reguart N, Galván P, Pascual T, Martínez A, Nuciforo P, Comerma L, Alos L, Pardo N, Cedrés S, Fan C, Parker JS, Gaba L, Victoria I, Viñolas N, Vivancos A, Arance A, Felip E. Immune-Related Gene Expression Profiling After PD-1 Blockade in Non-Small Cell Lung Carcinoma, Head and Neck Squamous Cell Carcinoma, and Melanoma. Cancer Res 2017; 77:3540-3550. [PMID: 28487385 DOI: 10.1158/0008-5472.can-16-3556] [Citation(s) in RCA: 278] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/02/2017] [Accepted: 05/02/2017] [Indexed: 11/16/2022]
Abstract
Antibody targeting of the immune checkpoint receptor PD1 produces therapeutic activity in a variety of solid tumors, but most patients exhibit partial or complete resistance to treatment for reasons that are unclear. In this study, we evaluated tumor specimens from 65 patients with melanoma, lung nonsquamous, squamous cell lung or head and neck cancers who were treated with the approved PD1-targeting antibodies pembrolizumab or nivolumab. Tumor RNA before anti-PD1 therapy was analyzed on the nCounter system using the PanCancer 730-Immune Panel, and we identified 23 immune-related genes or signatures linked to response and progression-free survival (PFS). In addition, we evaluated intra- and interbiopsy variability of PD1, PD-L1, CD8A, and CD4 mRNAs and their relationship with tumor-infiltrating lymphocytes (TIL) and PD-L1 IHC expression. Among the biomarkers examined, PD1 gene expression along with 12 signatures tracking CD8 and CD4 T-cell activation, natural killer cells, and IFN activation associated significantly with nonprogressive disease and PFS. These associations were independent of sample timing, drug used, or cancer type. TIL correlated moderately (∼0.50) with PD1 and CD8A mRNA levels and weakly (∼0.35) with CD4 and PD-L1. IHC expression of PD-L1 correlated strongly with PD-L1 (0.90), moderately with CD4 and CD8A, and weakly with PD1. Reproducibility of gene expression in intra- and interbiopsy specimens was very high (total SD <3%). Overall, our results support the hypothesis that identification of a preexisting and stable adaptive immune response as defined by mRNA expression pattern is reproducible and sufficient to predict clinical outcome, regardless of the type of cancer or the PD1 therapeutic antibody administered to patients. Cancer Res; 77(13); 3540-50. ©2017 AACR.
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Affiliation(s)
- Aleix Prat
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alejandro Navarro
- Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Laia Paré
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Noemí Reguart
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Patricia Galván
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain.,Translational Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Tomás Pascual
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Alex Martínez
- Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Laura Comerma
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Llucia Alos
- Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Nuria Pardo
- Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Susana Cedrés
- Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Cheng Fan
- Department of Bioinformatics, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Joel S Parker
- Department of Bioinformatics, Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Lydia Gaba
- Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Iván Victoria
- Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Nuria Viñolas
- Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ana Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ana Arance
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.,Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Enriqueta Felip
- Medical Oncology Department, Vall d'Hebron Hospital, Barcelona, Spain
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32
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Erfan G, Puig S, Carrera C, Arance A, Gaba L, Victoria I, Garcia-Herrera A, Alos L, Malvehy J. Development of Cutaneous Toxicities During Selective Anti-BRAF Therapies: Preventive Role of Combination with MEK Inhibitors. Acta Derm Venereol 2017; 97:258-260. [PMID: 27353949 DOI: 10.2340/00015555-2488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Basal Cell/chemically induced
- Carcinoma, Basal Cell/prevention & control
- Carcinoma, Squamous Cell/chemically induced
- Carcinoma, Squamous Cell/prevention & control
- Drug Eruptions/etiology
- Drug Eruptions/prevention & control
- Female
- Humans
- Imidazoles/administration & dosage
- Imidazoles/adverse effects
- Indoles/administration & dosage
- Indoles/adverse effects
- Keratoacanthoma/chemically induced
- Keratoacanthoma/prevention & control
- Keratoderma, Palmoplantar/chemically induced
- Keratoderma, Palmoplantar/prevention & control
- Keratosis, Actinic/chemically induced
- Keratosis, Actinic/prevention & control
- Keratosis, Seborrheic/chemically induced
- Keratosis, Seborrheic/prevention & control
- Male
- Melanoma/drug therapy
- Middle Aged
- Mitogen-Activated Protein Kinase Kinases/antagonists & inhibitors
- Oximes/administration & dosage
- Oximes/adverse effects
- Photosensitivity Disorders/chemically induced
- Photosensitivity Disorders/prevention & control
- Proto-Oncogene Proteins B-raf/antagonists & inhibitors
- Pyridones/administration & dosage
- Pyrimidinones/administration & dosage
- Skin Neoplasms/drug therapy
- Sulfonamides/administration & dosage
- Sulfonamides/adverse effects
- Vemurafenib
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Affiliation(s)
- Gamze Erfan
- Dermatology Department, Melanoma Unit, Hospital Clinic and IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Potrony M, Badenas C, Naerhuyzen B, Aguilera P, Puig-Butille JA, Tell-Marti G, Díaz A, Carrera C, Alos L, Delahaye N, Malvehy J, Puig S. Time and tumor type (primary or metastatic) do not influence the detection of BRAF/NRAS mutations in formalin fixed paraffin embedded samples from melanomas. Clin Chem Lab Med 2016; 54:1733-1738. [PMID: 27101548 DOI: 10.1515/cclm-2015-1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/10/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND BRAF and NRAS mutation detection is crucial for advanced melanoma treatment. Our aim was to evaluate how different characteristics from formalin-fixed paraffin-embedded (FFPE) samples, age of the block or DNA concentration could influence the success of BRAF and NRAS mutational screening. METHODS DNA was obtained from 144 FFPE samples (62 primary melanoma, 43 sentinel lymph nodes [SLN] and 39 metastasis). BRAF and NRAS were sequenced by Sanger sequencing. RESULTS Complete sequencing results were obtained from 75% (108/144) of the samples, and at least one gene was sequenced in 89% (128/144) of them. BRAF was mutated in 55% (29/53) and NRAS in 11% (5/45) of the primary melanomas sequenced. DNA concentration correlated with the tumor area used for DNA extraction (mm2) (adj p-value<0.01, r=0.73). The age of the block did not affect sequencing success. In 60% of samples kept for more than 10 years, both BRAF and NRAS were successfully sequenced. CONCLUSIONS Preserving sufficient tumor area in FFPE blocks is important. It is necessary to keep the FFPE blocks, no matter their age, as they are necessary to decide the best treatment for the melanoma patient.
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Meneses M, Chavez-Bourgeois M, Badenas C, Villablanca S, Aguilera P, Bennàssar A, Alos L, Puig S, Malvehy J, Carrera C. Atypical Clinical Presentation of Xeroderma Pigmentosum in a Patient Harboring a Novel Missense Mutation in the XPC Gene: The Importance of Clinical Suspicion. Dermatology 2015; 231:217-21. [PMID: 26278556 DOI: 10.1159/000433527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Xeroderma pigmentosum (XP) is a genodermatosis caused by abnormal DNA repair. XP complementation group C (XPC) is the most frequent type in Mediterranean countries. We describe a case with a novel mutation in the XPC gene. CASE A healthy Caucasian male patient was diagnosed with multiple primary melanomas. Digital follow-up and molecular studies were carried out. RESULTS During digital follow-up 8 more additional melanomas were diagnosed. Molecular studies did not identify mutations in CDKN2A, CDK4 or MITF genes. Two heterozygous mutations in the XPC gene were detected: c.2287delC (p.Leu763Cysfs*4) frameshift and c.2212A>G (p.Thr738Ala) missense mutations. CONCLUSION The p.Thr738Ala missense mutation has not been previously described. Missense mutations in the XPC gene may allow partial functionality that could explain this unusual late onset XP. Atypical clinical presentation of XPC could be misdiagnosed when genetic aberrations allow partial DNA repair capacity.
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Affiliation(s)
- Marina Meneses
- Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Alarcon I, Carrera C, Palou J, Alos L, Malvehy J, Puig S. Impact of in vivo reflectance confocal microscopy on the number needed to treat melanoma in doubtful lesions. Br J Dermatol 2015; 170:802-8. [PMID: 24124911 DOI: 10.1111/bjd.12678] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The number needed to treat (NNT) ratio is an effective method for measuring accuracy in melanoma detection. Dermoscopy reduces the number of false positives and subsequently unnecessary excisions. In vivo reflectance confocal microscopy (RCM) is a noninvasive technique that allows examination of the skin with cellular resolution. OBJECTIVES To assess the impact of RCM analysis on the number of equivocal lesions, assumed to be melanocytic, excised for every melanoma. METHODS Consecutive patients (n = 343) presenting with doubtful lesions were considered for enrolment. The lesions were analysed by dermoscopy and RCM, with histopathological assessment considered the reference standard. The main outcome was the NNT, calculated as the proportion of equivocal lesions excised for every melanoma. RESULTS Dermoscopy alone obtained a hypothetical NNT of 3·73; the combination of dermoscopy and RCM identified 264 equivocal lesions that qualified for excision, 92 of which were confirmed to be a melanoma, resulting in an NNT of 2·87, whereas the analysis of RCM images classified 103 lesions as melanoma, with a consequent NNT of 1·12. The difference in the reduction of this ratio was statistically significant between the three groups (P < 0·0001). There was no significant improvement in sensitivity when comparing the combination of dermoscopy and RCM with RCM alone (94·6% vs. 97·8%; P = 0·043). However, the differences between specificities were statistically significant (P < 1 × 10(-6) ), favouring RCM alone. CONCLUSION The addition of RCM analysis to dermoscopy reduces unnecessary excisions with a high diagnostic accuracy and could be a means for reducing the economic impact associated with the management of skin cancer.
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Affiliation(s)
- I Alarcon
- Dermatology Department, Melanoma Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Villarroel 170, Barcelona, 08036, Spain
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36
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González-Álvarez T, Carrera C, Bennassar A, Vilalta A, Rull R, Alos L, Palou J, Vidal-Sicart S, Malvehy J, Puig S. Dermoscopy structures as predictors of sentinel lymph node positivity in cutaneous melanoma. Br J Dermatol 2015; 172:1269-77. [PMID: 25418318 DOI: 10.1111/bjd.13552] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 01/29/2023]
Abstract
BACKGROUND Histological features such as Breslow thickness, ulceration and mitosis are the main criteria to guide sentinel lymph node biopsy (SLNB) in melanoma. Dermoscopy may add complementary information to these criteria. OBJECTIVES To evaluate the correlation between dermoscopy structures and SLNB positivity. METHODS Retrospective analysis of 123 consecutive melanomas with Breslow thickness > 0·75 mm, SLNB performed during follow-up and dermoscopic images. RESULTS Men were more likely to have a positive SLNB. The presence of ulceration and blotch and the absence of a pigmented network in dermoscopy correlated with positive SLNB. Histological ulceration also correlated with positive SLNB. A dermoscopy SCORE predicted SLN status with a sensitivity of 96·3% and a specificity of 30·2%. When sex and Breslow thickness were added (SCOREBRESEX), the sensitivity remained at 96·3% but the specificity increased to 52·1%. This study is limited by the number of patients and was performed in only one institution. CONCLUSIONS Dermoscopy allowed a more precise prediction of SLN status. If a combined SCOREBRESEX was used to select patients for SLNB, 41·5% of procedures might be avoided.
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Affiliation(s)
- T González-Álvarez
- Melanoma Unit, Dermatology Department, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Universidad CES, Medellín, Colombia
| | - C Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Barcelona, Spain
| | - A Bennassar
- Melanoma Unit, Dermatology Department, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - A Vilalta
- Melanoma Unit, Dermatology Department, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - R Rull
- Melanoma Unit, Surgery Service, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - L Alos
- Melanoma Unit, Pathology Service, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Medicine Department, Universitat de Barcelona, Barcelona, Spain
| | - J Palou
- Melanoma Unit, Dermatology Department, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - S Vidal-Sicart
- Melanoma Unit, Nuclear Medicine Service, Unit, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Barcelona, Spain
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Barcelona, Spain.,Medicine Department, Universitat de Barcelona, Barcelona, Spain
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37
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Larque AB, Conde L, Hakim S, Alos L, Jares P, Vilaseca I, Cardesa A, Nadal A. P16(INK⁴a) overexpression is associated with CDKN2A mutation and worse prognosis in HPV-negative laryngeal squamous cell carcinomas. Virchows Arch 2015; 466:375-82. [PMID: 25652585 DOI: 10.1007/s00428-015-1725-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/15/2014] [Accepted: 01/21/2015] [Indexed: 12/19/2022]
Abstract
We studied the expression of p16(INK4a) in a series of HPV-negative laryngeal squamous cell carcinomas and assessed its association with prognosis. Forty-five patients with laryngeal carcinoma were included in the study. Clinicopathological features and prognosis were reviewed. p16(INK4a) protein expression was analysed through immunohistochemistry. We analysed messenger RNA (mRNA) in 25 cases through quantitative reverse transcription polymerase chain reaction. HPV status was assessed by PCR using three different protocols based on MY09/11 and GP5/6 primers. Four out of 45 (9 %) cases overexpressed p16(INK4a) protein and showed a tendency to worse survival that was significant for stages I-III (log-rank p value = 0.001). Expression of p16(INK4a) mRNA was high in 12 out of 25 (48 %) cases using an arbitrary cut-off level. All tumours were HPV negative with all three detection methods. A CDKN2A mutation was found in eight cases. One case with a missense and one with a frameshift mutation showed p16(INK4a) protein expression by immunohistochemistry. Six out of seven (86 %) mutated but only 6 out of 18 (33 %) non-mutated cases presented p16(INK4a) mRNA overexpression (p = 0.03). Our findings suggest that p16(INK4a) overexpression, both at protein and mRNA levels, may reflect CDKN2A genetic alterations in HPV-negative laryngeal squamous cell carcinomas.
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Affiliation(s)
- Ana B Larque
- Department of Pathology, Hospital Clínic, Villarroel, 170, 08036, Barcelona, Spain
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Alarcon I, Brito J, Alos L, Malvehy J, Puig S. In vivo characterization of solitary angiokeratoma by reflectance confocal microscopy and high definition optical coherence tomography. J Am Acad Dermatol 2015; 72:S43-4. [DOI: 10.1016/j.jaad.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
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Diaz A, Puig-Butillé JA, Muñoz C, Costa D, Díez A, Garcia-Herrera A, Carrera C, Badenas C, Solé F, Malvehy J, Puig S, Alos L. TERT gene amplification is associated with poor outcome in acral lentiginous melanoma. J Am Acad Dermatol 2014; 71:839-41. [PMID: 25219713 DOI: 10.1016/j.jaad.2014.05.035] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 05/13/2014] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Alba Diaz
- Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Joan Anton Puig-Butillé
- Department of Biochemical and Molecular Genetics, Hospital Clínic, IDIBAPS, University of Barcelona, Spain; Centro Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Concha Muñoz
- Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Dolors Costa
- Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain
| | - Anna Díez
- Institute of Predictive and Personalized Medicine of Cancer (IMPPC), Badalona, Spain
| | | | - Cristina Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain; Centro Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Celia Badenas
- Department of Biochemical and Molecular Genetics, Hospital Clínic, IDIBAPS, University of Barcelona, Spain; Centro Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Francesc Solé
- Institut de Recerca contra la Leucèmia Josep Carreras, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain; Centro Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain; Centro Investigación Biomédica en Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Llucia Alos
- Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Spain.
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Pozzobon F, Puig‐Butillé J, González‐Alvarez T, Carrera C, Aguilera P, Alos L, Badenas C, Grichnik J, Malvehy J, Puig S. Dermoscopic criteria associated with
BRAF
and
NRAS
mutation status in primary cutaneous melanoma. Br J Dermatol 2014; 171:754-9. [DOI: 10.1111/bjd.13069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- F.C. Pozzobon
- Dermatology Department Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
- National University of Colombia Bogotá Colombia
| | - J.A. Puig‐Butillé
- Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER) ISCIII Barcelona Spain
- Biochemical and Molecular Genetics Service Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
| | - T. González‐Alvarez
- Dermatology Department Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
- Universidad CES Medellín Colombia
| | - C. Carrera
- Dermatology Department Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
- Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER) ISCIII Barcelona Spain
| | - P. Aguilera
- Dermatology Department Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
- Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER) ISCIII Barcelona Spain
| | - L. Alos
- Pathology Service Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
- Medicine Department Universitat de Barcelona Barcelona Spain
| | - C. Badenas
- Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER) ISCIII Barcelona Spain
- Biochemical and Molecular Genetics Service Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
| | - J.M. Grichnik
- Department of Dermatology and Cutaneous Surgery University of Miami Miller School of Medicine Miami FL U.S.A
| | - J. Malvehy
- Dermatology Department Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
- Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER) ISCIII Barcelona Spain
| | - S. Puig
- Dermatology Department Melanoma Unit Hospital Clinic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer) Barcelona Spain
- Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER) ISCIII Barcelona Spain
- Medicine Department Universitat de Barcelona Barcelona Spain
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Alarcon I, Carrera C, Alos L, Palou J, Malvehy J, Puig S. In vivo reflectance confocal microscopy to monitor the response of lentigo maligna to imiquimod. J Am Acad Dermatol 2014; 71:49-55. [PMID: 24725478 DOI: 10.1016/j.jaad.2014.02.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 11/11/2013] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Imiquimod has been used for treating lentigo maligna (LM) in selected cases when surgery is not an appropriate option because of functional or aesthetic impairment. Reflectance confocal microscopy (RCM) is a noninvasive method that has not been validated for monitoring the treatment of LM with imiquimod. OBJECTIVE We sought to evaluate the use of in vivo RCM to accurately monitor the response of LM to nonsurgical treatment with topical imiquimod. METHODS Twenty patients with confirmed facial LM, not amenable to surgical treatment or radiation therapy, were included prospectively. Clinical evaluation was performed by dermoscopy, RCM, and histopathology. Patients applied imiquimod 5% for 8 weeks. The affected area was assessed using the previously described LM score on RCM, and target sample biopsies were performed to confirm or discard RCM findings. RESULTS Fifteen of the 20 patients (75%) presented histologic tumor clearance. Confocal microscopy identified 70% of these responders with no false-negative results, and when compared with histopathology, there was no significant difference in evaluating the response to imiquimod. LIMITATIONS The impossibility of examining the entire lesion by means of histopathology is a limitation. CONCLUSION In vivo RCM evaluation was useful in accurately monitoring the response of LM to nonsurgical treatment with topical imiquimod in patients when surgery is contraindicated.
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Affiliation(s)
- Ivette Alarcon
- Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Carrera
- Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Llucia Alos
- Pathology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain
| | - Josep Palou
- Pathology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clinic of Barcelona, Barcelona, Spain; Institut de Recerca Biomédica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
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Armengot-Carbo M, Abrego A, Gonzalez T, Alarcon I, Alos L, Carrera C, Malvehy J, Puig S. Inverted follicular keratosis: dermoscopic and reflectance confocal microscopic features. Dermatology 2013; 227:62-6. [PMID: 23988627 DOI: 10.1159/000351715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 04/29/2013] [Indexed: 11/19/2022] Open
Abstract
Inverted follicular keratosis (IFK) is a rare benign tumor which usually appears as a firm papule on the face. The diagnosis is generally made by histopathology because the clinical appearance is difficult to differentiate from other lesions. Dermoscopic features of IFK have not been established to date. Herein we describe the dermoscopic findings of 4 cases of IFK. Radial peripheral hairpin vessels surrounded by a whitish halo arranged around a central white-yellowish amorphous area were observed in 3 cases, and glomerular vessels were present in the central area of one of them. The fourth case also presented a central white amorphous area but showed arborizing vessels. Reflectance confocal microscopy (available in 1 case) revealed a broadened honeycomb pattern, epidermal projections and hairpin and glomerular vessels. To our knowledge this is the first case series describing the dermoscopic features of inverted follicular keratosis and the first confocal microscopy description of this entity.
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Affiliation(s)
- M Armengot-Carbo
- Dermatology Department, Melanoma Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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Carrera C, Bennassar A, Ishioka P, Dalle S, Vilalta A, Fuertes I, Alos L, Thomas L, Puig S, Malvehy J. Desmoplastic melanoma on the nose: electrochemotherapy as an alternative treatment to local advanced disease. J Eur Acad Dermatol Venereol 2013; 28:424-32. [PMID: 23506474 DOI: 10.1111/jdv.12115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 01/17/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Desmoplastic malignant melanoma (DMM) is a rare and usually misdiagnosed type of melanoma. Delayed detection at complicated anatomical locations can lead to the necessity of alternative therapies. OBJECTIVE Characterization of DMM on the nose, which is the second more frequent type of MM. METHODS Review of case series of eight pathologically proven DMM on the nose from two referral centres with a mean follow-up of 69 ± 40.5 months. RESULTS According to a single centre experience, there is a more than 70-fold increased risk of having a DMM on the nose compared with a non-DMM (P < 0.0005, CI99% 16.3-317.3). Clinical and pathological misdiagnoses were frequent, only three of the eight cases were properly diagnosed and treated and indeed they did not experience relapses. Due to non-clinical suspicion and superficial biopsies, three cases were initially pathologically misdiagnosed as basal cell carcinomas and a nevus respectively. Atypical vessels and remnants of pigment on dermoscopy are indicative findings even in non-pigmented cases. Although not significant, the mean disease-free survival differed between cases with a correct initial management (four cases, 66.7 ± 57.3 months) in contrast to improper (four cases, 16.25 ± 18.9 months). Electrochemotherapy achieved a complete local control of disease in two cases unsuitable for surgery. CONCLUSIONS Use of dermoscopy and correctly selected biopsy of lesions on the face is mandatory to improve early diagnosis of DMM. Improper management of challenging cases implies a more complicated therapy and loco-regional invasion risk. Electrochemotherapy could be a promising therapy in local advanced tumours.
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Affiliation(s)
- C Carrera
- Dermatology Department, Melanoma Unit, IDIBAPS, Hospital Clinic de Barcelona, Barcelona, Spain; CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
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Parada D, Peña KB, Gil I, Queralt R, Garcia A, Alos L. Interdigitating dendritic cell sarcoma presenting in the nasal region. Pathol Res Pract 2012; 208:368-71. [DOI: 10.1016/j.prp.2012.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/26/2012] [Accepted: 02/06/2012] [Indexed: 12/21/2022]
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Yakirevich E, Sabo E, Klorin G, Alos L, Cardesa A, Ellis GL, Shumway BS, Gnepp DR. Primary mucin-producing tumours of the salivary glands: a clinicopathological and morphometric study. Histopathology 2010; 57:395-409. [PMID: 20738418 DOI: 10.1111/j.1365-2559.2010.03639.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine clinicopathological and morphometric features that discriminate between mucin-producing primary salivary gland carcinomas. MATERIALS AND RESULTS Fifteen mucin-producing tumours were stratified into five colloid carcinomas (CCs), four mucinous cystadenocarcinomas (MCAs), three mucin-rich salivary duct carcinomas (SDCs) and three mucin-rich mucoepidermoid carcinomas (MECs). The mean patient age was 70, 58, 43 and 63 years for CC, MCA, SDC and MEC, respectively. Eleven of 15 patients were female. The majority of CC cases originated from major salivary glands; MCA showed a predilection for the minor salivary glands. No disease-related mortality was observed in the CC group; one patient died in the MCA group, and one in the SDC group. Receiver-operating characteristic curve analysis revealed an optimal cut-off point of 17% of the tumour cells in contact with stroma that best distinguished between the CC and MCA. Histomorphometric measurements revealed that CC was best differentiated from MCA by smaller nuclear size and more regular chromatin. CONCLUSIONS Strict morphological criteria of CC coupled with assessment of the tumour cell/stroma relationship and the nuclear features facilitate discrimination between mucinous tumours of salivary gland.
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Affiliation(s)
- Evgeny Yakirevich
- Department of Pathology, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Lujan B, Hakim S, Moyano S, Nadal A, Caballero M, Diaz A, Valera A, Carrera M, Cardesa A, Alos L. Activation of the EGFR/ERK pathway in high-grade mucoepidermoid carcinomas of the salivary glands. Br J Cancer 2010; 103:510-6. [PMID: 20664595 PMCID: PMC2939786 DOI: 10.1038/sj.bjc.6605788] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Mucoepidermoid carcinoma (MEC) shows differences in biological behaviour depending mainly on its histological grade. High-grade tumours usually have an aggressive biological course and they require additional oncological treatment after surgery. Methods: In a series of 43 MECs of the salivary glands, we studied the epidermal growth factor receptor (EGFR) gene by using dual-colour chromogenic in situ hybridisation (CISH). Moreover, we assessed the protein expressions of the EGFR and the activated extracellular signal-regulated kinases (pERK1/2) by using immunohistochemistry. These results were correlated with the histological grade of the tumours and the outcome of the patients. Results: The CISH study demonstrated a high-EGFR gene copy number, with balanced chromosome 7 polysomy, in 8 out of 11 high-grade MECs (72.7%), whereas 27 low-grade and 15 intermediate-grade tumours had a normal EGFR gene copy number (P<0.001). The EGFR gene gains correlated with disease-free interval (P=0.003) and overall survival of the patients (P=0.019). The EGFR protein expression had a significant correlation with the histological grade of the tumours but not with the outcome of the patients. The pERK1/2 expression correlated with histological grade of tumours (P<0.001), disease-free interval (P=0.004) and overall survival (P=0.001). Conclusions: The EGFR/ERK pathway is activated in high-grade MECs with aggressive behaviour. Patients with these tumours who require oncological treatment in addition to surgery could benefit from EGFR and mitogen-activated protein kinase pathway inhibitors.
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Affiliation(s)
- B Lujan
- Department of Pathology, Hospital Clínic, IDIBAPS, University of Barcelona, Villarroel, 170, Barcelona 08036, Spain
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Grau JJ, Tagliapietra A, Verger E, Caballero M, Muñoz C, Alos L. Prognostic significance of epithelitis by concurrent cetuximab and radiotherapy (RT) for locally advanced head and neck squamous cell carcinoma (HNSCC) patients (Pts). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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McLemore MS, Haigentz M, Smith RV, Nuovo GJ, Alos L, Cardesa A, Brandwein-Gensler M. Head and neck squamous cell carcinomas in HIV-positive patients: a preliminary investigation of viral associations. Head Neck Pathol 2010; 4:97-105. [PMID: 20333562 PMCID: PMC2878620 DOI: 10.1007/s12105-010-0171-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
Abstract
Oncogenic human papillomaviruses (HPVs) are associated with oropharyngeal squamous cell carcinoma (SCC). Infection with human immunodeficiency virus (HIV) increases susceptibility to opportunistic infections and viral-promoted cancers. The prevalences of HPV, herpes simplex virus (HSV), Epstein-Barr virus (EBV), and human herpesvirus-8 (HHV-8) have not been established for head and neck squamous cell carcinoma in HIV-positive patients (HIV+ HNSCC). We have observed that HIV+ HNSCC tend to contain numerous multinucleated tumor giant cells, this finding has not been described previously. The goal of this study is to test for these oncogenic viruses in a small cohort of retrospectively identified patients with HIV infection, and to compare histologically these cancers to a control group of HNSCC patients. Tumors were reviewed histologically and compared to a control group of 102 patients with HNSCC (serologically untyped or HIV negative). Polymerase chain reaction (PCR) was performed on formalin-fixed, paraffin-embedded HIV+ HNSCC samples from combined 25 patients in two institutions. In situ hybridization was performed to identify EBV (EBER) and immunohistochemistry was performed to detect HSV-1, HSV-2, HHV-8, and HIV-related proteins (Nef, p24). The study sample consisted of 34 HIV+ patients with HNSCC from Montefiore Medical Center, and six HIV+ HNSCC patients from Hospital Clinic, University of Barcelona; 24 (60%) men and 16 (40%) women. The larynx was most commonly involved (65%, n = 26); followed by the oropharynx (22.5%, n = 9). Four carcinomas arose from the oral cavity (10%) and one from the nasal cavity (2.5%). Histologically, multinucleated tumor giant cells were more common in the HIV+ group (39/40, 97.5%) than the control group (27/102, 26%, p 0.001, chi-square). HPV was detected in 6 of 25 (24%) HNSCC tumors by PCR, five were typed as HPV 16 and one as HPV 26/69; five of these tumors (83%) were located in the oropharynx. EBV, HSV-1, HSV-2, and HHV-8 were detected only infrequently in tumor cells. Nef protein was detected in tumor cells in 7 of 21 (33.3%) cases; p24 was not detectable in 6 tumors studied. There were no significant associations between HPV positive tumors and co-infections with other viruses. This study is consistent with other reports that suggest an increased incidence of laryngeal carcinoma for HIV+ patients. HPV was detected in 24% of HIV+ HNSCC, however, the number of tumors with amplifiable DNA (n = 25) is too small to allow for conclusions. EBV, HSV-1, HSV-2, and HHV-8 are uncommon in HIV+ HNSCC; it is unlikely that these viruses have a promoting effect. MNTCG are significantly common in HIV+ HNSCC, but there is overlap in MNTCG counts with the control group and therefore this finding cannot be used as a biomarker of HIV infection.
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Affiliation(s)
| | - Missak Haigentz
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Richard V. Smith
- Department of Otorhinolaryngology, Head & Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY USA
| | - Gerard J. Nuovo
- Department of Pathology, Ohio State University College of Medicine, Columbus, OH USA
| | - Llucia Alos
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Margaret Brandwein-Gensler
- Department of Pathology, NP 3545, University of Alabama at Birmingham, 1802 6th Avenue South, Birmingham, AL 35249 USA
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Massi D, Franchi A, Alos L, Cook M, Di Palma S, Enguita AB, Ferrara G, Kazakov DV, Mentzel T, Michal M, Panelos J, Rodriguez-Peralto JL, Santucci M, Tragni G, Zioga A, Tos APD. Primary cutaneous leiomyosarcoma: clinicopathological analysis of 36 cases. Histopathology 2010; 56:251-62. [DOI: 10.1111/j.1365-2559.2009.03471.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Moyano S, Ordi J, Caballero M, Garcia F, Diaz A, de Sanjose S, Cardesa A, Alos L. Laryngeal squamous cell carcinoma in HIV-positive patients: lack of association with human papillomavirus infection. HIV Med 2009; 10:634-9. [DOI: 10.1111/j.1468-1293.2009.00737.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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