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Green AC, Mundra PA, Grant M, Marais R, Cook MG. Frequency of naevus cells in lymph nodes of melanoma and breast cancer patients. Pathol Res Pract 2024; 254:155106. [PMID: 38271783 DOI: 10.1016/j.prp.2024.155106] [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: 10/25/2023] [Revised: 12/19/2023] [Accepted: 01/06/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION We aimed to study the frequency (prevalence) and histology of benign melanocytic naevus cells in regional lymph nodes in relation to age and sex and nodal location. MATERIAL AND METHODS Histopathology reports of sentinel lymph node (SLN) biopsies from melanoma patients, 2002 - 2014, and from breast cancer patients, 2010- 2019, were obtained from records of a single hospital in England. All sections were similarly processed and examined. For standardisation, presence of naevus cells was assessed in a single node per patient: the first SLN biopsied (melanoma) or the node nearest the first SLN (breast cancer). RESULTS Associations were tested using Fisher's exact test. Naevus cells were found in 10% (60/585) of melanoma patients' index SLNs. Frequency varied significantly by anatomic region: 13% in axillary to 0% cervical SLNs (p = 0.03), but not by sex or age. Within nodes, naevus cells were present in capsular or pericapsular tissue (93%), or trabeculae (7%). In breast cancer patients' index axillary nodes, 6% (11/196) contained naevus cells, all intracapsular. In the predominant 40-69 years age-group, prevalence was similar in breast cancer (7%) and female melanoma (9%) patients, but in those aged 70-100, prevalence was lower in breast cancer (2%) than in female melanoma (15%) patients (p = 0.05). CONCLUSIONS Standard methods of assessment yielded no clear pattern of naevus cell frequency in lymph nodes by age or sex, but confirmed naevus cell location as mostly intracapsular.
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Affiliation(s)
- Adele C Green
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia; Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK.
| | - Piyushkumar A Mundra
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Megan Grant
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Richard Marais
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Martin G Cook
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK; Histopathology, Royal Surrey Hospital, Guildford, UK; Division of Clinical Medicine, University of Surrey, Guildford, Surrey, UK; Member of European Organisation for Research and Treatment of Cancer (EORTC) Melanoma Group, Brussels, Belgium
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Cook MG, Grant M, Sylvestre Y, Akhras V, Khosrotehrani K, Hughes MCB, Malt M, Smithers BM, Massi D, De Giorgi V, Marais R, Green AC. Prognosis of naevoid melanomas. Pathol Res Pract 2023; 251:154881. [PMID: 37832354 DOI: 10.1016/j.prp.2023.154881] [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: 07/26/2023] [Revised: 10/03/2023] [Accepted: 10/07/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION There appear to be several variants of naevoid melanoma suspected as having different outcomes, but follow-up studies have been few. We aimed to assess the prognosis of naevoid melanomas in a multi-centre study. MATERIAL AND METHODS From histopathology records we ascertained patients in the UK, Australia and Italy diagnosed with maturing naevoid melanoma (n = 65; 14; 7 respectively) and nodular/papillomatous naevoid melanoma (12; 6; 0), and patients with superficial spreading melanoma (SSM) from UK (73) and Australia (26). Melanoma deaths in UK patients were obtained from NHS Digital; in Australia, via the National Death Index and cancer registry; and in Italy, through clinical records. For maturing naevoid vs. SSM, we used Cox-proportional hazard regression models to compare survival adjusted for age, sex, tumour thickness, and ulceration, and additionally Fine-Gray regression analysis, to calculate sub-hazard ratios (SHR) in the UK cohort, accounting for competing causes of death. RESULTS Among UK patients, there was a non-significantly lower risk of melanoma death in maturing naevoid vs SSM, including after accounting for competing causes of death (SHR 0.40, 95% confidence interval (CI) 0.12-1.31), while among nodular/papillomatous naevoid melanoma patients, there were no melanoma deaths on follow-up. Two melanoma deaths occurred in Australian SSM patients, and none in maturing or nodular/papillomatous naevoid melanoma patients, after 5 years' minimum follow-up. None of the 7 Italian patients with maturing naevoid melanoma died of melanoma after nearly 12 years' average follow-up. CONCLUSIONS There was no significant difference in risk of death from melanomas with naevoid features, and SSM. Nodular/ papillomatous naevoid melanoma patients did not carry higher risk of death than SSM patients though the very few cases of the papillomatous naevoid variant limited our assessment.
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Affiliation(s)
- Martin G Cook
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK; Royal Surrey NHS Foundation Trust, Guildford, UK; Division of Clinical Medicine, University of Surrey, Guildford, Surrey, UK; Members of EORTC Melanoma Pathology Working Group, Belgium
| | - Megan Grant
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK
| | - Yvonne Sylvestre
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, UK
| | | | - Kiarash Khosrotehrani
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; The University of Queensland, Frazer Institute, Brisbane, Queensland, Australia
| | | | - Maryrose Malt
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Australia
| | - Daniela Massi
- Members of EORTC Melanoma Pathology Working Group, Belgium; Section of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, Italy
| | - Richard Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK
| | - Adele C Green
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Macclesfield SK10 4TG, UK; QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
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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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Shakeel M, Jiyad Z, Grant M, Cook MG, Oudit D, Green AC. Melanoma predilection for the lower limbs of women compared with men. Arch Dermatol Res 2023; 315:633-636. [PMID: 36104631 DOI: 10.1007/s00403-022-02375-7] [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] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/05/2022] [Accepted: 08/01/2022] [Indexed: 11/02/2022]
Abstract
The lower limb is a common site for melanoma in women, but the reason for this is not fully understood. To investigate this phenomenon in more detail, we assessed the specific subsites of primary melanoma occurring on the lower limbs of females compared with males across age groups. In a records-based study at an oncology hospital in north-west of England, among an unselected sample of patients with primary invasive melanoma treated between 2002-2015, information was collected on patient age at diagnosis, sex, and co-morbidities, and the tumor thickness and anatomical subsite (thigh, lower leg, foot for lower limb). Of a total sample of 1,522 patients, 316 (227, 72% female) had lower limb melanoma. The most common subsite was lower leg (142 cases with F:M ratio =3.74), followed by thigh (55 cases with F:M = 1.83) and feet (30 cases with F:M = 1.15). At ages <40 years the odds of thigh to foot melanoma was 20 times higher in females than in males (OR 20.0, 95% CI 2.6-152.6) and 7.5 times higher on the lower limb (OR 7.5, 95% CI 1.1-49.2). For ages 40+ years, the odds of females developing thigh melanoma compared to foot melanoma was similar in males versus females (OR 0.8), while the corresponding odds of lower leg melanoma in females versus males remained significantly increased at ages 40-59 and 60+ (OR 4.2 and 2.8 respectively). Our study demonstrates the female predilection for lower limb melanoma persists over most but not all subsites.However, there is heterogeneity in the female to male occurence of lower limb melanoma across subsites and at different ages, which may be linked to relative influence of genetic and environmental risk factors.
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Affiliation(s)
- M Shakeel
- Northern Care Alliance NHS Group, Mayo Building, Salford Royal, Stott Lane, Salford, M6 8HD, UK
| | - Z Jiyad
- Department of Dermatology, St George's Hospital, London, UK
| | - M Grant
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Alderley Park, Macclesfield, SK10 4TG, Cheshire, UK
| | - M G Cook
- Department of Dermatology, St George's Hospital, London, UK
- Department of Histopathology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK
- Division of Clinical Medicine, University of Surrey, Guildford, UK
- Member of EORTC Melanoma Group, Brussels, Belgium
| | - D Oudit
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, UK
| | - A C Green
- Department of Dermatology, St George's Hospital, London, UK.
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
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Barnhill RL, Elder DE, Piepkorn MW, Knezevich SR, Reisch LM, Eguchi MM, Bastian BC, Blokx W, Bosenberg M, Busam KJ, Carr R, Cochran A, Cook MG, Duncan LM, Elenitsas R, de la Fouchardière A, Gerami P, Johansson I, Ko J, Landman G, Lazar AJ, Lowe L, Massi D, Messina J, Mihic-Probst D, Parker DC, Schmidt B, Shea CR, Scolyer RA, Tetzlaff M, Xu X, Yeh I, Zembowicz A, Elmore JG. Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement. JAMA Netw Open 2023; 6:e2250613. [PMID: 36630138 PMCID: PMC10375511 DOI: 10.1001/jamanetworkopen.2022.50613] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose. OBJECTIVE To revise the MPATH-Dx version 1.0 classification tool, using feedback from dermatopathologists participating in the National Institutes of Health-funded Reducing Errors in Melanocytic Interpretations (REMI) Study and from members of the International Melanoma Pathology Study Group (IMPSG). EVIDENCE REVIEW Practicing dermatopathologists recruited from 40 US states participated in the 2-year REMI study and provided feedback on the MPATH-Dx version 1.0 tool. Independently, member dermatopathologists participating in an IMPSG workshop dedicated to the MPATH-Dx schema provided additional input for refining the MPATH-Dx tool. A reference panel of 3 dermatopathologists, the original authors of the MPATH-Dx version 1.0 tool, integrated all feedback into an updated and refined MPATH-Dx version 2.0. FINDINGS The new MPATH-Dx version 2.0 schema simplifies the original 5-class hierarchy into 4 classes to improve diagnostic concordance and to provide more explicit guidance in the treatment of patients. This new version also has clearly defined histopathological criteria for classification of classes I and II lesions; has specific provisions for the most frequently encountered low-cumulative sun damage pathway of melanoma progression, as well as other, less common World Health Organization pathways to melanoma; provides guidance for classifying intermediate class II tumors vs melanoma; and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as neoplasms lacking criteria for melanoma. CONCLUSIONS AND RELEVANCE The implementation of the newly revised MPATH-Dx version 2.0 schema into clinical practice is anticipated to provide a robust tool and adjunct for standardized diagnostic reporting of melanocytic lesions and management of patients to the benefit of both health care practitioners and patients.
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Affiliation(s)
- Raymond L Barnhill
- Department of Translational Research, Institut Curie, Unit of Formation and Research of Medicine University of Paris, Paris, France
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle
- Dermatopathology Northwest, Bellevue, Washington
| | | | - Lisa M Reisch
- Department of Biostatistics, University of Washington School of Medicine, Seattle
| | - Megan M Eguchi
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Boris C Bastian
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Willeke Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcus Bosenberg
- Departments of Dermatology, Pathology, and Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Carr
- Cellular Pathology, South Warwickshire NHS Trust, Warwick, United Kingdom
| | - Alistair Cochran
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Martin G Cook
- Department of Histopathology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Arnaud de la Fouchardière
- Department of Biopathology, Centre Léon Bérard, Lyon, France
- University of Lyon, Université Claude Bernard Lyon 1, National Center for Scientific Research, Mixed Research Unit 5286, National Institute of Health and Medical Research U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Iva Johansson
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Lori Lowe
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Jane Messina
- Departments of Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Birgitta Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher R Shea
- Department of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Richard A Scolyer
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Michael Tetzlaff
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Iwei Yeh
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Artur Zembowicz
- Tufts University, Boston, Massachusetts
- Lahey Clinic, Burlington, Massachusetts
- Dermatopathology Consultations, Needham, Massachusetts
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
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Cook MG, Powell BWEM, Grant ME, Green AC. Evolution of superficial spreading melanoma to resemble desmoplastic melanoma: case report. Virchows Arch 2022; 480:945-947. [PMID: 34286349 PMCID: PMC9023384 DOI: 10.1007/s00428-021-03127-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/29/2021] [Accepted: 05/02/2021] [Indexed: 12/03/2022]
Abstract
Desmoplastic melanoma commonly occurs on the head and neck in a pure form, but occasionally, it occurs in a mixed tumor with another type, usually superficial spreading melanoma (SSM), and rarely as a metastasis from a primary SSM. We report here a primary SSM on the leg of a 32-year-old male which metastasised to lymph nodes, and 10 years later recurred at the primary site initially with mixed features but evolving to resemble a uniformly desmoplastic, deeply invasive melanoma. This unusual case has implications for clinical management and is additionally notable for its reversal in behavior, from metastatic to local infiltrative type, correlating with the change in morphology.
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Affiliation(s)
- Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK.
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK.
- Division of Clinical Medicine, University of Surrey, Guildford, GU2 7XH, Surrey, UK.
| | - Barry W E M Powell
- Department of Plastic and Reconstructive Surgery, St. George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Megan E Grant
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
| | - Adele C Green
- Molecular Oncology Group, Cancer Research UK Manchester Institute, University of Manchester, Wilmslow Road, Manchester, M20 4BX, UK
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4006, Australia
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Cook MG, Massi D, Szumera-Ciećkiewicz A, Van den Oord J, Blokx W, van Kempen LC, Balamurugan T, Bosisio F, Koljenović S, Portelli F, van Akkooi AC. An updated European Organisation for Research and Treatment of Cancer (EORTC) protocol for pathological evaluation of sentinel lymph nodes for melanoma. Eur J Cancer 2019; 114:1-7. [DOI: 10.1016/j.ejca.2019.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/13/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022]
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Sturm B, Creytens D, Cook MG, Smits J, van Dijk MCRF, Eijken E, Kurpershoek E, Küsters-Vandevelde HVN, Ooms AHAG, Wauters C, Blokx WAM, van der Laak JAWM. Validation of Whole-slide Digitally Imaged Melanocytic Lesions: Does Z-Stack Scanning Improve Diagnostic Accuracy? J Pathol Inform 2019; 10:6. [PMID: 30972225 PMCID: PMC6415522 DOI: 10.4103/jpi.jpi_46_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/17/2018] [Indexed: 01/21/2023] Open
Abstract
Background Accurate diagnosis of melanocytic lesions is challenging, even for expert pathologists. Nowadays, whole-slide imaging (WSI) is used for routine clinical pathology diagnosis in several laboratories. One of the limitations of WSI, as it is most often used, is the lack of a multiplanar focusing option. In this study, we aim to establish the diagnostic accuracy of WSI for melanocytic lesions and investigate the potential accuracy increase of z-stack scanning. Z-stack enables pathologists to use a software focus adjustment, comparable to the fine-focus knob of a conventional light microscope. Materials and Methods Melanocytic lesions (n = 102) were selected from our pathology archives: 35 nevi, 5 spitzoid tumors of unknown malignant potential, and 62 malignant melanomas, including 10 nevoid melanomas. All slides were scanned at a magnification comparable to use of a ×40 objective, in z-stack mode. A ground truth diagnosis was established on the glass slides by four academic dermatopathologists with a special interest in the diagnosis of melanoma. Six nonacademic surgical pathologists subspecialized in dermatopathology examined the cases by WSI. Results An expert consensus diagnosis was achieved in 99 (97%) of cases. Concordance rates between surgical pathologists and the ground truth varied between 75% and 90%, excluding nevoid melanoma cases. Concordance rates of nevoid melanoma varied between 10% and 80%. Pathologists used the software focusing option in 7%-28% of cases, which in 1 case of nevoid melanoma resulted in correcting a misdiagnosis after finding a dermal mitosis. Conclusion Diagnostic accuracy of melanocytic lesions based on glass slides and WSI is comparable with previous publications. A large variability in diagnostic accuracy of nevoid melanoma does exist. Our results show that z-stack scanning, in general, does not increase the diagnostic accuracy of melanocytic.
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Affiliation(s)
- Bart Sturm
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Creytens
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Jan Smits
- Pathan B.V., Rotterdam, The Netherlands
| | | | - Erik Eijken
- Laboratory for Pathology East Netherlands (LabPON), Hengelo, The Netherlands
| | | | | | | | - Carla Wauters
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
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Affiliation(s)
- Adèle C Green
- Cancer and Population Studies Group, QIMR Berghofer Medical Research Institute, Locked Bag 2000 Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia.
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10
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Cook MG, Massi D, Blokx WAM, Van den Oord J, Koljenović S, De Giorgi V, Kissin E, Grant M, Mandal A, Gremel G, Gaudy C, Viros A, Dhomen N, Khosrotehrani K, Marais R, Green AC, Mihm MC. New insights into naevoid melanomas: a clinicopathological reassessment. Histopathology 2017; 71:943-950. [PMID: 28741688 DOI: 10.1111/his.13317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 02/08/2017] [Accepted: 07/19/2017] [Indexed: 11/27/2022]
Abstract
AIMS Because the term 'naevoid melanoma' has variable clinical and pathological interpretations, we aimed to clarify the features of melanomas referred to as naevoid. METHODS AND RESULTS A review was undertaken of 102 melanomas diagnosed histopathologically as naevoid melanomas and ascertained by European Organization for Research and Treatment of Cancer Melanoma Group Subcommittee pathologists from their records. We found these could be classified morphologically into three groups. Thirteen melanomas were overlying genuine naevi and were therefore excluded. Of the 89 melanomas considered to be naevoid, 11 presented clinically as exophytic papillomatous nodules with little junctional component and composed of small atypical cells showing numerous mitoses and no change with depth; we termed these 'papillomatous naevoid' melanomas. The other 78 were flat or only slightly raised, and had a superficial spreading melanoma-like component with maturation to a small cell, but still an atypical, dermal component; we termed these 'maturing naevoid' melanomas. We showed that papillomatous and maturing naevoid melanomas also have differing immunochemical profiles. Preliminary clinical follow-up suggested different outcomes for these two naevoid melanoma types. CONCLUSIONS Melanomas that have been classified as naevoid melanomas comprise two types with distinct clinical, histopathological and immunohistochemical features that may also be prognostically significant.
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Affiliation(s)
- Martin G Cook
- Histopathology, Royal Surrey County Hospital, Guildford, UK
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
- Division of Clinical Medicine, University of Surrey, Guildford, Surrey, UK
- Members of EORTC Melanoma Group Pathology Working Group, Florence, Italy
| | - Daniela Massi
- Members of EORTC Melanoma Group Pathology Working Group, Florence, Italy
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Willeke A M Blokx
- Members of EORTC Melanoma Group Pathology Working Group, Florence, Italy
- Department of Pathology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joost Van den Oord
- Members of EORTC Melanoma Group Pathology Working Group, Florence, Italy
- Translational Cell and Tissue Research, Department of Imaging and Pathology, University of Leuven (KU Leuven), Leuven, Belgium
| | - Senada Koljenović
- Members of EORTC Melanoma Group Pathology Working Group, Florence, Italy
- Department of Pathology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | - Eleanor Kissin
- Eleanor Kissin, Department of Plastic Surgery, St George's Hospital, London, UK
| | - Megan Grant
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Amit Mandal
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Gabriela Gremel
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Caroline Gaudy
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Amaya Viros
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Nathalie Dhomen
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Kiarash Khosrotehrani
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- The University of Queensland, UQ Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - Richard Marais
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - Adele C Green
- Molecular Oncology Group, CRUK Manchester Institute, University of Manchester, Manchester, UK
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Martin C Mihm
- Members of EORTC Melanoma Group Pathology Working Group, Florence, Italy
- Brigham and Women's Hospital, Boston, MA, USA
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11
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Lott JP, Elmore JG, Zhao GA, Knezevich SR, Frederick PD, Reisch LM, Chu EY, Cook MG, Duncan LM, Elenitsas R, Gerami P, Landman G, Lowe L, Messina JL, Mihm MC, van den Oord JJ, Rabkin MS, Schmidt B, Shea CR, Yun SJ, Xu GX, Piepkorn MW, Elder DE, Barnhill RL. Evaluation of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) classification scheme for diagnosis of cutaneous melanocytic neoplasms: Results from the International Melanoma Pathology Study Group. J Am Acad Dermatol 2016; 75:356-63. [PMID: 27189823 DOI: 10.1016/j.jaad.2016.04.052] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 10/28/2015] [Revised: 04/05/2016] [Accepted: 04/13/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pathologists use diverse terminology when interpreting melanocytic neoplasms, potentially compromising quality of care. OBJECTIVE We sought to evaluate the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) scheme, a 5-category classification system for melanocytic lesions. METHODS Participants (n = 16) of the 2013 International Melanoma Pathology Study Group Workshop provided independent case-level diagnoses and treatment suggestions for 48 melanocytic lesions. Individual diagnoses (including, when necessary, least and most severe diagnoses) were mapped to corresponding MPATH-Dx classes. Interrater agreement and correlation between MPATH-Dx categorization and treatment suggestions were evaluated. RESULTS Most participants were board-certified dermatopathologists (n = 15), age 50 years or older (n = 12), male (n = 9), based in the United States (n = 11), and primary academic faculty (n = 14). Overall, participants generated 634 case-level diagnoses with treatment suggestions. Mean weighted kappa coefficients for diagnostic agreement after MPATH-Dx mapping (assuming least and most severe diagnoses, when necessary) were 0.70 (95% confidence interval 0.68-0.71) and 0.72 (95% confidence interval 0.71-0.73), respectively, whereas correlation between MPATH-Dx categorization and treatment suggestions was 0.91. LIMITATIONS This was a small sample size of experienced pathologists in a testing situation. CONCLUSION Varying diagnostic nomenclature can be classified into a concise hierarchy using the MPATH-Dx scheme. Further research is needed to determine whether this classification system can facilitate diagnostic concordance in general pathology practice and improve patient care.
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Affiliation(s)
- Jason P Lott
- Cornell Scott-Hill Health Center, New Haven, Connecticut
| | - Joann G Elmore
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Ge A Zhao
- Division of Dermatology, University of Washington School of Medicine, Seattle, Washington
| | | | - Paul D Frederick
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Lisa M Reisch
- Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Emily Y Chu
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Martin G Cook
- University of Surrey Division of Clinical Medicine, Surrey, United Kingdom
| | - Lyn M Duncan
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rosalie Elenitsas
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gilles Landman
- Department of Pathology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Lori Lowe
- Department of Pathology and Dermatology, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan
| | - Jane L Messina
- Departments of Anatomic Pathology and Cutaneous Oncology, Moffitt Center, and Department of Pathology and Cell Biology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Martin C Mihm
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joost J van den Oord
- Department of Pathology, University Hospitals Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Birgitta Schmidt
- Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christopher R Shea
- Section of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University School of Medicine, Gwangju, Korea
| | - George X Xu
- Department of Pathology and Lab Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michael W Piepkorn
- Division of Dermatology, University of Washington School of Medicine, Seattle, Washington
| | - David E Elder
- Department of Pathology and Lab Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Raymond L Barnhill
- Department of Pathology, Institut Curie and Faculty of Medicine, University of Paris Descartes, Paris, France
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12
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Akhras V, Ramakrishnan R, Stanton AWB, Levick JR, Cook MG, Chong H, Mortimer PS. Quantitative Imaging In Vivo of Functioning Lymphatic Vessels Around Human Melanoma and Benign Nevi. Microcirculation 2015; 22:454-63. [PMID: 26094869 DOI: 10.1111/micc.12216] [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: 03/26/2015] [Accepted: 06/08/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The density of functioning human lymphatics in vivo and of immunohistochemically defined lymphatics was quantified around melanomas, benign nevi, and matched normal skin, to assess the current lymphangiogenesis paradigm. We investigated whether histological and functioning density increased around melanomas compared with benign nevi or matched skin; whether functioning and histological density increased similarly; and whether larger increases occurred around metastatic melanomas. METHODS Functioning density was quantified in vivo as the total amount of human dermal microlymphatics taking up fluorescent marker injected at the lesion margin. After tissue excision, perilesion histological density was quantified using podoplanin marker D2-40. RESULTS Histological density was raised similarly around metastasising and non-metastasising melanomas compared with normal skin (+71%, p < 0.0001, n = 32); but was also raised significantly around benign nevi (+17%, p = 0.03, n = 20). In contrast, functioning lymphatic density was substantially reduced around the margins of melanomas (both metastasising and non-metastasising) compared with benign nevi (by 65%, p = 0.02) or normal skin (by 53%, p = 0.0014). CONCLUSIONS Raised perilesion histological lymphatic density is not unique to melanoma but occurs also around benign nevi. The findings indicated that the number of functioning lateral lymphatics around human melanomas in vivo but not benign nevi is reduced, despite histologically increased numbers of lymphatics.
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Affiliation(s)
- Victoria Akhras
- Cardiovascular and Cell Sciences (Dermatology), St George's Hospital, University of London, London, UK
| | | | - Anthony W B Stanton
- Cardiovascular and Cell Sciences (Dermatology), St George's Hospital, University of London, London, UK
| | - John R Levick
- Basic Medical Sciences (Physiology), St George's Hospital, University of London, London, UK
| | - Martin G Cook
- Histopathology Department, Royal Surrey County Hospital and Division of Clinical Medicine, University of Surrey, Guildford, UK
| | - Heung Chong
- Histopathology Department, St George's Hospital, London, UK
| | - Peter S Mortimer
- Cardiovascular and Cell Sciences (Dermatology), St George's Hospital, University of London, London, UK
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13
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Jewell R, Elliott F, Laye J, Nsengimana J, Davies J, Walker C, Conway C, Mitra A, Harland M, Cook MG, Boon A, Storr S, Safuan S, Martin SG, Jirström K, Olsson H, Ingvar C, Lauss M, Bishop T, Jönsson G, Newton-Bishop J. The clinicopathological and gene expression patterns associated with ulceration of primary melanoma. Pigment Cell Melanoma Res 2015; 28:94-104. [PMID: 25220403 PMCID: PMC4276506 DOI: 10.1111/pcmr.12315] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 03/05/2014] [Accepted: 09/08/2014] [Indexed: 02/07/2023]
Abstract
Ulceration of primary melanomas is associated with poor prognosis yet is reported to predict benefit from adjuvant interferon. To better understand the biological processes involved, clinicopathological factors associated with ulceration were determined in 1804 patients. From this cohort, 348 primary tumor blocks were sampled to generate gene expression data using a 502-gene cancer panel and 195 blocks were used for immunohistochemistry to detect macrophage infiltration and vessel density. Gene expression results were validated using a whole genome array in two independent sample sets. Ulceration of primary melanomas was associated with more proliferative tumors, tumor vessel invasion, and increased microvessel density. Infiltration of tumors with greater number of macrophages and gene expression pathways associated with wound healing and up-regulation of pro-inflammatory cytokines suggests that ulceration is associated with tumor-related inflammation. The relative benefit from interferon reported in patients with ulcerated tumors may reflect modification of signaling pathways involved in inflammation.
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Affiliation(s)
- Rosalyn Jewell
- Section of Epidemiology and Biostatistics, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
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14
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Godechal Q, Ghanem GE, Cook MG, Gallez B. Electron Paramagnetic Resonance Spectrometry and Imaging in Melanomas: Comparison between Pigmented and Nonpigmented Human Malignant Melanomas. Mol Imaging 2013. [DOI: 10.2310/7290.2012.00037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Quentin Godechal
- From the Biomedical Magnetic Resonance Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium; Laboratoire d'Oncologie et de Chirurgie Expérimentale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; and Department of Histopathology, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Ghanem E. Ghanem
- From the Biomedical Magnetic Resonance Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium; Laboratoire d'Oncologie et de Chirurgie Expérimentale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; and Department of Histopathology, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Martin G. Cook
- From the Biomedical Magnetic Resonance Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium; Laboratoire d'Oncologie et de Chirurgie Expérimentale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; and Department of Histopathology, Royal Surrey County Hospital, Guildford, Surrey, UK
| | - Bernard Gallez
- From the Biomedical Magnetic Resonance Research Group, Louvain Drug Research Institute, Université Catholique de Louvain, Brussels, Belgium; Laboratoire d'Oncologie et de Chirurgie Expérimentale, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; and Department of Histopathology, Royal Surrey County Hospital, Guildford, Surrey, UK
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15
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Godechal Q, Ghanem GE, Cook MG, Gallez B. Electron paramagnetic resonance spectrometry and imaging in melanomas: comparison between pigmented and nonpigmented human malignant melanomas. Mol Imaging 2013; 12:218-223. [PMID: 23651499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
It has been known for a long time that the melanin pigments present in normal skin, hair, and most of malignant melanomas can be detected by electron paramagnetic resonance (EPR) spectrometry. In this study, we used EPR imaging as a tool to map the concentration of melanin inside ex vivo human pigmented and nonpigmented melanomas and correlated this cartography with anatomopathology. We obtained accurate mappings of the melanin inside pigmented human melanoma samples. The signal intensity observed on the EPR images correlated with the concentration of melanin within the tumors, visible on the histologic sections. In contrast, no EPR signal coming from melanin was observed from nonpigmented melanomas, therefore demonstrating the absence of EPR-detectable pigments inside these particular cases of skin cancer and the importance of pigmentation for further EPR imaging studies on melanoma.
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16
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MacKenzie Ross AD, Cook MG, Chong H, Hossain M, Pandha HS, Bennett DC. Senescence evasion in melanoma progression: uncoupling of DNA-damage signaling from p53 activation and p21 expression. Pigment Cell Melanoma Res 2013; 26:226-35. [PMID: 23253087 PMCID: PMC3963476 DOI: 10.1111/pcmr.12060] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 12/15/2012] [Indexed: 01/07/2023]
Abstract
The best-established function of the melanoma-suppressor p16 is mediation of cell senescence, a permanent arrest following cell proliferation or certain stresses. The importance of p16 in melanoma suggests indolence of the other major senescence pathway through p53. Little or no p53 is expressed in senescent normal human melanocytes, but p16-deficient melanocytes can undergo p53-mediated senescence. As p16 expression occurs in nevi but falls with progression toward melanoma, we here investigated whether p53-dependent senescence occurs at some stage and, if not, what defects were detectable in this pathway, using immunohistochemistry. Phosphorylated checkpoint kinase 2 (CHEK2) can mediate DNA-damage signaling, and under some conditions senescence, by phosphorylating and activating p53. Remarkably, we detected no prevalent p53-mediated senescence in any of six classes of lesions. Two separate defects in p53 signaling appeared common: in nevi, lack of p53 phosphorylation by activated CHEK2, and in melanomas, defective p21 upregulation by p53 even when phosphorylated.
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Affiliation(s)
- Alastair D MacKenzie Ross
- Biomedical Sciences Research Centre (Box J2A), St George's, University of LondonCranmer Terrace, London, SW17 0RE, UK
| | - Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital and Division of Clinical Medicine, University of SurreyGuildford, UK
| | - Heung Chong
- Cellular Pathology, Division of Biomedical Sciences, St George's, University of LondonLondon, UK
| | - Mehnaz Hossain
- Biomedical Sciences Research Centre (Box J2A), St George's, University of LondonCranmer Terrace, London, SW17 0RE, UK
| | - Hardev S Pandha
- Postgraduate Medical School, University of SurreyGuildford, UK
| | - Dorothy C Bennett
- Biomedical Sciences Research Centre (Box J2A), St George's, University of LondonCranmer Terrace, London, SW17 0RE, UK
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17
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Jewell R, Chambers P, Harland M, Laye J, Conway C, Mitra A, Elliott F, Cook MG, Boon A, Newton-Bishop J. Clinicopathologic features of V600E and V600K melanoma--letter. Clin Cancer Res 2012; 18:6792; author's reply p. 6793. [PMID: 23169438 DOI: 10.1158/1078-0432.ccr-12-2974] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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van Akkooi AC, Cook MG, Eggermont AM. Increased sampling will lead to an increase in detection, but is it clinically relevant? Eur J Cancer 2012; 48:2488-9; author reply 2486-7. [DOI: 10.1016/j.ejca.2012.02.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 02/29/2012] [Indexed: 11/25/2022]
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Abstract
AIM Some views on sentinel nodes for melanoma seem to cast doubt on the relevance of micrometastases in the sentinel nodes of patients with melanoma, suggesting that small metastases or isolated tumour cells can be ignored. Tumour dormancy has been proposed for their postulated lack of progression. The implication of the argument seems to be that minute metastases are inactive and therefore non-threatening, whereas larger ones are proliferative and therefore have aggressive potential. METHODS 54 sentinel lymph nodes were studied with histologically identified micrometastatic melanoma using the protocol accepted by the European Organisation for Research and Treatment of Cancer melanoma group. These were studied with respect to metastasis size and by use of immunohistochemical markers of proliferation (MIB-1) and dormancy (p16). RESULTS The authors have demonstrated no correlation between the size of metastases and their proliferative activity. Very small metastases may not show proliferative activity, but this may be a reflection of the small number of assessable cells rather than a genuine reflection of the tumoural characteristics. Furthermore, the minute size of some of these metastases resulted in no residual tumour being present in adjacent sections. Where further sections did show more tumour, these small metastases were invariably p16 negative, suggesting dormancy was not the explanation for the lack of measurable proliferation. Occasionally, larger metastases, clearly not clinically insignificant, showed no proliferative activity presumably, considering their size, a transient phenomenon. CONCLUSION These findings suggest that variable phases in proliferation occur in metastases, and no conclusion of clinical insignificance can be made on the basis of small size.
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20
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Broekaert SMC, Roy R, Okamoto I, van den Oord J, Bauer J, Garbe C, Barnhill RL, Busam KJ, Cochran AJ, Cook MG, Elder DE, McCarthy SW, Mihm MC, Schadendorf D, Scolyer RA, Spatz A, Bastian BC. Genetic and morphologic features for melanoma classification. Pigment Cell Melanoma Res 2011; 23:763-70. [PMID: 20874733 DOI: 10.1111/j.1755-148x.2010.00778.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Melanoma is comprised of biologically distinct subtypes. The defining clinical, histomorphologic, and molecular features are not fully established. This study sought to validate the association between genetic and histomorphologic features previously described and to determine their reproducibility and association with important clinical variables. Detailed clinical and histomorphologic features of 365 primary cutaneous melanomas were assessed by 11 pathologists and correlated with mutation status of BRAF and NRAS. There was substantial agreement in the quantitative assessment of histomorphologic features showing similar or better interobserver reproducibility than the established World Health Organization classification scheme. We confirmed that melanomas with BRAF mutations showed characteristic morphologic features (P < 0.0001) and metastasized more frequently to regional lymph nodes (P = 0.046). Importantly, melanomas without mutations were a heterogeneous group, with a subset having very similar clinical and morphological features as those with BRAF mutation raising the possibility that they are biologically related. Our study confirms an association between histomorphologic features, mutation status, and pattern of metastasis, providing criteria for a refined melanoma classification aimed at defining biologically homogeneous disease subgroups.
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Affiliation(s)
- Sigrid M C Broekaert
- Department of Dermatology, University of California San Francisco, 1701 Divisadero St, San Francisco, CA 94115, USA
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21
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Batistatou A, Gököz O, Cook MG, Massi D. Melanoma histopathology report: proposal for a standardized terminology. Virchows Arch 2010; 458:359-61. [PMID: 21193926 DOI: 10.1007/s00428-010-1027-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 12/07/2010] [Indexed: 11/25/2022]
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22
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Emmett MS, Symonds KE, Rigby H, Cook MG, Price R, Metcalfe C, Orlando A, Bates DO. Prediction of melanoma metastasis by the Shields index based on lymphatic vessel density. BMC Cancer 2010; 10:208. [PMID: 20478045 PMCID: PMC2891632 DOI: 10.1186/1471-2407-10-208] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [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: 08/26/2009] [Accepted: 05/17/2010] [Indexed: 02/05/2023] Open
Abstract
Background Melanoma usually presents as an initial skin lesion without evidence of metastasis. A significant proportion of patients develop subsequent local, regional or distant metastasis, sometimes many years after the initial lesion was removed. The current most effective staging method to identify early regional metastasis is sentinel lymph node biopsy (SLNB), which is invasive, not without morbidity and, while improving staging, may not improve overall survival. Lymphatic density, Breslow's thickness and the presence or absence of lymphatic invasion combined has been proposed to be a prognostic index of metastasis, by Shields et al in a patient group. Methods Here we undertook a retrospective analysis of 102 malignant melanomas from patients with more than five years follow-up to evaluate the Shields' index and compare with existing indicators. Results The Shields' index accurately predicted outcome in 90% of patients with metastases and 84% without metastases. For these, the Shields index was more predictive than thickness or lymphatic density. Alternate lymphatic measurement (hot spot analysis) was also effective when combined into the Shields index in a cohort of 24 patients. Conclusions These results show the Shields index, a non-invasive analysis based on immunohistochemistry of lymphatics surrounding primary lesions that can accurately predict outcome, is a simple, useful prognostic tool in malignant melanoma.
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Affiliation(s)
- Maxine S Emmett
- Microvascular Research Laboratories, Bristol Heart Institute, Department of Physiology and Pharmacology, University of Bristol, Bristol, UK.
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23
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Chakera AH, Hesse B, Burak Z, Ballinger JR, Britten A, Caracò C, Cochran AJ, Cook MG, Drzewiecki KT, Essner R, Even-Sapir E, Eggermont AMM, Stopar TG, Ingvar C, Mihm MC, McCarthy SW, Mozzillo N, Nieweg OE, Scolyer RA, Starz H, Thompson JF, Trifirò G, Viale G, Vidal-Sicart S, Uren R, Waddington W, Chiti A, Spatz A, Testori A. EANM-EORTC general recommendations for sentinel node diagnostics in melanoma. Eur J Nucl Med Mol Imaging 2009; 36:1713-42. [PMID: 19714329 DOI: 10.1007/s00259-009-1228-4] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The accurate diagnosis of a sentinel node in melanoma includes a sequence of procedures from different medical specialities (nuclear medicine, surgery, oncology, and pathology). The items covered are presented in 11 sections and a reference list: (1) definition of a sentinel node, (2) clinical indications, (3) radiopharmaceuticals and activity injected, (4) dosimetry, (5) injection technique, (6) image acquisition and interpretation, (7) report and display, (8) use of dye, (9) gamma probe detection, (10) surgical techniques in sentinel node biopsy, and (11) pathological evaluation of melanoma-draining sentinel lymph nodes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "general consensus" and similar expressions. The recommendations are designed to assist in the practice of referral to, performance, interpretation and reporting of all steps of the sentinel node procedure in the hope of setting state-of-the-art standards for good-quality evaluation of possible spread to the lymphatic system in intermediate-to-high risk melanoma without clinical signs of dissemination.
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Affiliation(s)
- Annette H Chakera
- Department of Plastic Surgery and Burns Unit, Rigshospitalet, Copenhagen, Denmark.
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24
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Murali R, Cochran AJ, Cook MG, Hillman JD, Karim RZ, Moncrieff M, Starz H, Thompson JF, Scolyer RA. Interobserver reproducibility of histologic parameters of melanoma deposits in sentinel lymph nodes: implications for management of patients with melanoma. Cancer 2009; 115:5026-37. [PMID: 19658180 DOI: 10.1002/cncr.24298] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND : Histologic parameters of melanoma deposits in sentinel lymph nodes (SLNs) have been shown to be predictive of clinical outcome and the presence or absence of tumor in non-SLNs, but assessment of these parameters is prone to interobserver variation. METHODS : Histologic sections of 44 SLNs containing metastatic melanoma were examined by 7 pathologists. Parameters assessed included cross-sectional area of tumor deposits, cross-sectional area of SLNs, percentage of SLN area involved by tumor calculated from the 2 previous parameters, estimated percentage of SLN area involved by tumor, tumor penetrative depth, location of tumor within the SLN, and presence of extracapsular spread. Levels of interobserver agreement were measured by using intraclass correlation coefficients (ICC). RESULTS : There was good to excellent interobserver agreement on measurement of quantitative parameters: maximal size of largest tumor deposits, calculated area of 3 largest tumor deposits, percentage of the area of SLN involved by tumor, and tumor penetrative depth (ICC, 0.88, 0.73, 0.68, and 0.83, respectively). There was moderate agreement on the evaluation of subcapsular versus nonsubcapsular location of tumor deposits (ICC = 0.50). Agreement on assessment of extracapsular spread was fair (ICC = 0.39). CONCLUSIONS : Assessment of some of the quantitative parameters was highly reproducible between pathologists. However, evaluation of the location of tumor deposits within SLNs and assessment of extracapsular spread was less reproducible. Clearer definitions and training can be expected to improve the reproducibility of assessment. These results have important implications for reliability and reproducibility of these parameters in staging, prediction of outcome, and clinical management of melanoma patients. Cancer 2009. (c) 2009 American Cancer Society.
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Affiliation(s)
- Rajmohan Murali
- Department of Anatomical Pathology, Royal Prince Alfred Hospital, Sydney, Australia.
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van Akkooi ACJ, Spatz A, Eggermont AMM, Mihm M, Cook MG. Expert opinion in melanoma: the sentinel node; EORTC Melanoma Group recommendations on practical methodology of the measurement of the microanatomic location of metastases and metastatic tumour burden. Eur J Cancer 2009; 45:2736-42. [PMID: 19767199 DOI: 10.1016/j.ejca.2009.08.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Accepted: 08/20/2009] [Indexed: 11/30/2022]
Abstract
The sentinel node (SN) status has been recognised to be the most important prognostic factor in melanoma. Many studies have investigated additional factors to further predict survival/lymph node involvement. The EORTC Melanoma Group (MG) has formulated the following question: How should we report the microanatomic location and SN tumour burden? The EORTC MG recommends the following: the EORTC MG SN pathology protocol or a similarly extensive protocol, which has also been proven to be accurate, should be used. Only measure what you can see not what you presume. Cumulative measurements decrease the accuracy and reproducibility of measuring. The most reproducible measure is a single measurement of the maximum diameter of the largest lesion in any direction (1-D). If there is any infiltration into the parenchyma, this lesion can no longer be considered solely subcapsular. Reporting of the microanatomic location of metastases should be an assessment of the entire sentinel node, not only of the largest lesion. Multifocality reflects a scattered metastatic pattern, not to be confused with multiple cohesive foci, which fall under the regular location system. A subcapsular metastasis should have a smooth usually curved outline, not ragged or irregular. We recommend all pathologists to report the following items per positive SN for melanoma patients: the microanatomic location of the metastases according to Dewar et al. for the entire node, the SN Tumour Burden according to the Rotterdam Criteria for the maximum diameter of the largest metastasis expressed as an absolute number, and the SN Tumour Burden stratified per category; <0.1mm or 0.1-1.0mm or >1.0mm.
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Affiliation(s)
- Alexander C J van Akkooi
- Erasmus University Medical Centre - Daniel den Hoed Cancer Centre, Department of Surgical Oncology, Groene Hilledijk 301 - Kamer A1-41, 3075 EA Rotterdam, The Netherlands.
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Kaur C, Thomas RJ, Desai N, Green MA, Lovell D, Powell BWEM, Cook MG. The correlation of regression in primary melanoma with sentinel lymph node status. J Clin Pathol 2007; 61:297-300. [PMID: 17675538 DOI: 10.1136/jcp.2007.049411] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The significance of regression in primary melanoma has been disputed for many years. Some have suggested regression as a marker for poor prognosis while others have reported a negligible or even a favourable effect, on prognosis. AIM To understand the significance of regression in melanoma and provide further information on whether patients should be subjected to sentinel lymph node biopsy (SLNB) on the basis of regression. METHODS 146 melanoma cases who had undergone SLNB were included in the study. The histological criteria for offering SLNB were melanoma >1 mm in thickness, Clark's level IV or those with regression. RESULTS A statistically significant greater proportion of individuals without regression showed sentinel lymph node (SLN) positivity (p = 0.028) compared with those which do show regression. Metastatic disease correlated with growth phase of the primary lesion. All the node positive cases were in the vertical growth phase; none of the cases in radial growth phase and showing regression were associated with nodal metastasis (p = 0.029). 62 cases had melanomas with thickness <1 mm and were in radial growth phase, yet were offered SLNB because of regression. Of these, 44 showed features of regression and all were node negative. The remaining 16 cases of thin melanomas did not show regression; 2 of these had sentinel node metastasis. CONCLUSION Results suggest that regression is usually a favourable process, particularly in thin melanomas and that metastasis in "thin melanomas showing regression" is real but rare. Variant vertical growth phase, mitoses and other prognostically significant variables may be more important predictors of metastatic potential in thin melanomas.
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Affiliation(s)
- C Kaur
- Department of Histopathology, Royal Surrey County Hospital, Guildford, UK
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McArthur GJ, Banwell ME, Cook MG, Powell BW. The role of sentinel node biopsy in the management of melanocytic lesions of uncertain malignant potential (MUMP). J Plast Reconstr Aesthet Surg 2007; 60:952-4. [PMID: 17616368 DOI: 10.1016/j.bjps.2006.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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: 01/20/2006] [Accepted: 04/05/2006] [Indexed: 10/24/2022]
Abstract
Melanocytic lesions of uncertain malignant potential (MUMP) is a term which is useful in identifying melanocytic tumours where the distinction between benign and malignant is a histological problem. Sentinel node biopsy is recognised to provide unmatched prognostic information in melanoma patients, but has recently been advocated for diagnostic purposes in MUMP. We present the case of a seven-year-old girl who presented with a six-month history of a changing pigmented lesion on her left upper arm. Excision biopsy not only showed a melanocytic lesion with some spitzoid features but also marked atypia making it appropriate to use the term MUMP. Sentinel node biopsy was undertaken. This case demonstrates that sentinel node biopsy can be performed safely in children. Given the low morbidity of the procedure we advocate that this technique should be considered in this difficult diagnostic situation to further the management of these patients.
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Affiliation(s)
- G J McArthur
- Department of Plastic and Reconstructive Surgery, St. George's Hospital NHS Trust, Blackshaw Road, Tooting London SW17 0QT, United Kingdom.
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Di Palma S, Collins N, Faulkes C, Ping B, Ferns G, Haagsma B, Layer G, Kissin MW, Cook MG. Chromogenic in situ hybridisation (CISH) should be an accepted method in the routine diagnostic evaluation of HER2 status in breast cancer. J Clin Pathol 2007; 60:1067-8. [PMID: 17293390 PMCID: PMC1972421 DOI: 10.1136/jcp.2006.043356] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antineoplastic Agents/therapeutic use
- Breast Neoplasms/diagnosis
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Chromogenic Compounds
- Female
- Genes, erbB-2
- Humans
- In Situ Hybridization/methods
- Patient Selection
- Trastuzumab
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Affiliation(s)
- S Di Palma
- Histopathology, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK.
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Abstract
Review of problematic melanocytic consultation cases has enabled identification of the most common variants of benign melanocytic proliferations which can be confused with melanoma. Apart from Spitz naevus, the most common in this group of lesions are pigmented spindle cell naevus and atypical dermal nodule. Potentially the most problematic but less common are pseudomelanoma following incomplete removal of a naevus and 'activated' benign naevus cells in sentinel lymph nodes. By considering the overall architecture and the degree of nuclear atypia of the lesions, all of these problems can usually be resolved. Nuclear or architectural abnormalities by themselves are insufficient and must be assessed together. In addition, the combinations of pattern and cytological change in most of the lesions described here are distinctive and have become recognised as known variations of benign entities.
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Affiliation(s)
- Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital, Postgraduate Medical School University of Surrey, Guildford, UK.
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Elliott B, Cook MG, John RJ, Powell BW, Pandha H, Dalgleish AG. Erratum to “Successful live cell harvest from bisected sentinel lymph nodes research report” [J. Immunol. Methods 291 (2004) 71–78]. J Immunol Methods 2004. [DOI: 10.1016/j.jim.2004.04.029] [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: 11/26/2022]
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Elliott B, Cook MG, John RJ, Powell BWEM, Pandha H, Dalgleish AG. Successful live cell harvest from bisected sentinel lymph nodes research report. J Immunol Methods 2004; 291:71-8. [PMID: 15345306 DOI: 10.1016/j.jim.2004.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 02/05/2004] [Revised: 04/26/2004] [Accepted: 04/30/2004] [Indexed: 10/26/2022]
Abstract
Sentinel lymph nodes provide an excellent opportunity to study early immune responses to cancer. However, harvesting live cells has not previously been possible, because it conflicts with the need to preserve tissue for histological interpretation. This study used scrape cytology on 26 sentinel and 8 non-sentinel nodes, harvested from 17 stage I/II melanoma patients undergoing sentinel node biopsy. Numbers of viable cells harvested before and after cryopreservation were measured and the effect on subsequent histology assessed. The mean number of cells harvested from 26 sentinel nodes was 7.06 x 10(6) (range 0.1-32.2), with a mean viability of 99.5% (range 87-100, lower 95% CI 98.5%). Furthermore, counts and viabilities were well maintained after cryopreservation. Flow cytometry confirmed CD3+, CD20+ and lineage-1-/HLA-DR+ subpopulations, consistent with T-lymphocytes, B-lymphocytes and dendritic cells, respectively. Importantly, there was no discernible change in histological detail and the proportion of positive sentinel nodes remained unchanged. This technique will allow more functional and quantitative approaches to sentinel lymph node research.
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Affiliation(s)
- Bruce Elliott
- Oncology Department, St. George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom.
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Ramakrishnan R, Young R, Powell B, Cook MG. Features of sentinel lymph nodes for melanoma may lead to re-diagnosis of the cutaneous primary: an unusual case and review of literature. Virchows Arch 2004; 445:527-30. [PMID: 15365832 DOI: 10.1007/s00428-004-1100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 02/18/2004] [Accepted: 06/14/2004] [Indexed: 10/26/2022]
Abstract
Although sentinel lymph-node biopsy is accepted as a reliable method of staging of melanoma, it is not without problems to the pathologist. It has been re-emphasised that aggregates of benign naevus cells are not uncommon. Usually these are easily identified by a combination of their benign cytology and location in the fibrous skeleton of lymph nodes. This case represents a combination of an unusual pseudo-malignant pattern in the primary lesion with unusual morphology of the sentinel lymph node. The latter prompted reassessment of the cutaneous lesion as a benign naevus. Confirmation of the diagnosis as cutaneous melanoma by a positive sentinel-node biopsy was averted only by a careful comparison of unusual features of the putative primary and the sentinel lymph node. This case illustrates the need for a rigorous protocol for pathological assessment of sentinel lymph nodes for melanomas to assure detection of all metastases but also to avoid misdiagnosis and over-treatment. It also supports "benign metastases" as the mechanism underlying at least some melanocytes in regional lymph nodes.
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Affiliation(s)
- Rathi Ramakrishnan
- Department of Histopathology, The Royal Surrey County Hospital, Egerton Road, GU2 5XX, Guildford, Surrey, UK
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Dewar DJ, Newell B, Green MA, Topping AP, Powell BWEM, Cook MG. The microanatomic location of metastatic melanoma in sentinel lymph nodes predicts nonsentinel lymph node involvement. J Clin Oncol 2004; 22:3345-9. [PMID: 15310779 DOI: 10.1200/jco.2004.12.177] [Citation(s) in RCA: 197] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Sentinel node biopsy is now widely accepted as the most accurate prognostic indicator in melanoma, and is important in guiding management of patients with clinical stage I or II disease. Patients with a positive sentinel node have conventionally undergone completion lymphadenectomy (CLND) of the involved basin, but only 20% have involvement beyond the sentinel node, suggesting that CLND may be unnecessary for the other 80% of patients. This study seeks to identify criteria that might be used to be more restrictive in selecting those who should undergo CLND. METHODS A total of 146 patients were identified who had had a positive sentinel node biopsy for malignant melanoma. Their sentinel nodes and lymphadenectomy specimens were re-evaluated pathologically. The metastatic melanoma in each sentinel node was assessed according to its microanatomic location within the node (subcapsular, combined subcapsular and parenchymal, parenchymal, multifocal, or extensive), and this was correlated with the presence of involved nonsentinel nodes in the CLND. The depth of the metastases from the sentinel node capsule was also recorded. RESULTS The metastatic deposits in the sentinel node were subcapsular in 26.0% of patients. None of these patients had any nonsentinel nodes involved on CLND. In the patients whose sentinel node metastases had a different microanatomic location, the rate of nonsentinel node involvement was 22.2% overall. CONCLUSION The microanatomic location of metastases within sentinel nodes predicts nonsentinel lymph node involvement. In patients with only subcapsular deposits in the sentinel node, it is possible that CLND could safely be avoided.
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Affiliation(s)
- D J Dewar
- Department of Plastic and Reconstructive Surgery, St George's Hosptial, London, United Kingdom.
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Essapen S, Thomas H, Green M, De Vries C, Cook MG, Marks C, Topham C, Modjtahedi H. The expression and prognostic significance of HER-2 in colorectal cancer and its relationship with clinicopathological parameters. Int J Oncol 2004; 24:241-8. [PMID: 14719098] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
The prognostic role of HER-2 has been established in breast cancer but remains controversial in colorectal cancer. In this study, 170 archival specimens of Dukes' B and C colorectal cancer were analysed immunohisto-chemically, using an anti-HER-2 monoclonal antibody HM64.13. Immunostaining was classified as cytoplasmic or membranous, and the intensity of the immunostaining was graded negative, weak or strong. The association between these scores and survival was estimated using Cox survival analyses. Overall, 87% of cases showed cytoplasmic HER-2 staining, with 54% exhibiting strong intensity cytoplasmic immunostaining. Membranous HER-2 was seen in 41% of cases, with most of these being of strong intensity. No correlation with clinical outcome was seen with membranous HER-2. Positive cytoplasmic immunostaining was found to be associated with a significantly better overall survival (HR 0.46, CI95 0.24-0.87) in the Dukes C cancers, but no survival benefit was seen in the Dukes' B cancers. Tumour grade, depth of tumour invasion and positive apical node were also found to be independent prognostic factors in Dukes' C cancers. We conclude that HER-2 over-expression occurs in a significant number of colorectal cancers. Since cytoplasmic HER-2 is incapable of transmitting the strong mitogenic signal via heterodimerization with other members of the Epidermal Growth Factor Receptor (EGFR) family, this may partly explain the correlation between cytoplasmic HER-2 over-expression and a better prognosis in the Dukes' C colorectal cancers. In addition, high levels of membraneous HER-2 in colorectal cancer could make HER-2 a good target for monoclonal antibody-based immunotherapy.
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Affiliation(s)
- Sharadah Essapen
- Division of Oncology, Postgraduate Medical School, University of Surrey, Guildford, Surrey GU2 7XH, UK.
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Abstract
In the recently revised melanoma staging system proposed by the American Joint Committee on Cancer (AJCC), ulceration assessment by the pathologist is a pivotal parameter. Patients upstaged because of ulceration might be included in adjuvant trials conducted in AJCC stage II melanoma patients. Therefore, accuracy based on interobserver reproducibility for melanoma ulceration assessment is crucial for proper clinical management. In some cases, it is extremely difficult, even for an experienced pathologist, to distinguish between trauma-induced ulceration, artifact and tumoral ulceration. Whether this difficulty may be resolved by the use of a more precise definition of ulceration has not been evaluated. Therefore, we have proposed a refined definition of melanoma ulceration and we tested whether this definition might improve the interobserver interpretative reproducibility of ulceration in primary cutaneous melanomas. The results of this study support the need for a more precise definition of melanoma ulceration that rules out biopsy trauma or processing artifact and could be incorporated into a standardised pathology worksheet for reporting primary melanomas.
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Affiliation(s)
- A Spatz
- Institut Gustave-Roussy, Villejuif, France.
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Cook MG, Green MA, Anderson B, Eggermont AMM, Ruiter DJ, Spatz A, Kissin MW, Powell BWEM. The development of optimal pathological assessment of sentinel lymph nodes for melanoma. J Pathol 2003; 200:314-9. [PMID: 12845627 DOI: 10.1002/path.1365] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
1158 sentinel lymph nodes (SLNs), excised from patients with primary cutaneous melanoma, were assessed pathologically using histology with immunohistochemistry (IHC) on all nodes, and RT-PCR for Mart-1 and tyrosinase on 55 nodes. RT-PCR was compared with the histology and IHC assessed on the same nodes. The evaluation of progressively more detailed protocols for histology and IHC modulated by the RT-PCR results led to a procedure that consistently detects metastases in 34% of patients submitted to SLN biopsy for cutaneous melanomas with a vertical growth phase and a mean thickness of 2.02 mm (range 0.25, with regression, to 19 mm). As this technique is virtually free of false positives and produces only a marginally lower detection rate than RT-PCR, which was subject to false positives of 7% in our study, it is suggested that this extended protocol should be the basis on which further evaluation of the place of RT-PCR in SLN assessment takes place. The evolved protocol described here has been adopted by the EORTC as the standard procedure for pathological handling of sentinel lymph nodes for melanoma when SLN status is a criterion in their clinical trials or studies.
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Affiliation(s)
- Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital, Guildford, UK
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Cook MG, Spatz A, Brocker EB, Ruiter DJ. Authors' reply. J Pathol 2003. [DOI: 10.1002/path.1268] [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: 11/10/2022]
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Abstract
It is generally felt that a halo naevus is benign, and patients can be reassured. The lesion is frequently left alone. We present a case where the clinician felt reassured, but at the patient's insistence the lesion was excised. The histology result was not anticipated.
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Affiliation(s)
- M R Mandalia
- Department of Plastic Surgery, St George's Hospital, London, UK
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Abstract
The American Joint Committee on Cancer (AJCC) recently launched a new staging system for cutaneous melanoma that was based on clinical experience with a large number of patients treated in major centers worldwide. As this system includes various histopathologic parameters of the primary melanoma and of melanoma metastasis, including micrometastases in the sentinel lymph node (SLN), they are discussed here. Special attention is given to ulceration of the primary tumor, because it remains a dominant prognostic parameter in addition to tumor thickness. Molecular markers that may reflect aggressive behavior of the primary melanoma also are described. Finally, pathologic examination of SLNs is addressed with emphasis on the efficacy of various microstaging approaches.
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Affiliation(s)
- Dirk J Ruiter
- Department of Pathology, University Medical Center St Radboud, Nijmegen, The Netherland
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42
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Cook MG. Ed R. Cerio: Dermatopathology. Virchows Arch 2002. [DOI: 10.1007/s00428-001-0599-0] [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: 11/28/2022]
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Cook MG, Spatz A, Bröcker EB, Ruiter DJ. Identification of histological features associated with metastatic potential in thin (<1.0 mm) cutaneous melanoma with metastases. A study on behalf of the EORTC Melanoma Group. J Pathol 2002; 197:188-93. [PMID: 12015742 DOI: 10.1002/path.1093] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Contrary to expectations, a small number of thin (<1 mm) melanomas do metastasize. This collaborative study was performed in an attempt to identify the morphological basis of such aggressive behaviour. Regression was expected to be the explanation for the lack of thickness in some cases. Whether a vertical growth phase (VGP) was present in the remainder was carefully assessed. A pilot study had identified two other patterns associated with metastasis in thin melanomas. These were termed 'junctional expansion nodules' and 'melanomatous follicular invasion'. Both were seen in the absence of other dermal invasion. These two patterns were included in the study, which comprised 54 cases and 56 controls, which were thin melanomas which had not metastasized 5 years after excision. Regression was present in 50% of test cases (30.4% in controls, p=0.036) and VGP was present in 59.3% of cases and 48.2% of controls. The thinnest metastasizing melanoma without regression was 0.27 mm. Eight (14.8%) cases, however, had metastasized but showed neither regression nor VGP; seven of these showed a junctional expansion nodule, present in only three controls (p=0.016). Five of these seven also showed melanomatous follicular invasion. One of these five showed this follicular involvement without a junctional nodule. Melanomatous follicular invasion was not seen in the control cases (p=0.012). Mitoses were seen in the VGP of both test and control cases, but high counts (>3 per mm(2)) were much more common in the metastasizing lesions (p=0.007). These findings support the idea that in most cases, regression and/or a VGP are required for metastasis to occur. However, a small number of thin melanomas without these features, as conventionally described, still metastasize. This implies that VGP may require redefinition and that junctional expansion nodules and melanomatous follicular invasion may be variants of VGP.
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Affiliation(s)
- Martin G Cook
- Department of Histopathology, Royal Surrey County Hospital, Guildford, UK.
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Abstract
Recent papers have addressed critical issues regarding the microstaging of cutaneous melanoma. They concern the new staging proposal by the American Joint Committee on Cancer (AJCC), the presentation of new prognostic models than seem applicable in daily practice, and new immunohistochemical findings than demonstrate prognostic information independently of the conventional major factors. These issues are commented on by the Pathology Committee of the EORTC Melanoma Group.
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Hettiaratchy SP, Kang N, O'Toole G, Allan R, Cook MG, Powell BW. Sentinel lymph node biopsy in malignant melanoma: a series of 100 consecutive patients. Br J Plast Surg 2000; 53:559-62. [PMID: 11000070 DOI: 10.1054/bjps.2000.3409] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A consecutive cohort of 100 patients who had undergone sentinel lymph node biopsy (SLNB) was analysed retrospectively. Three areas were studied: success in finding the sentinel node(s); complications of the procedure; and extra costs incurred by SLNB. The sentinel node(s) were successfully identified in 98% of the lymph node basins biopsied. The overall complication rate was 33%. The additional cost of the procedure was estimated at 1420 pounds sterling per patient. SLNB can reliably identify the sentinel node. However there is a significant complication rate of the technique and considerable additional costs. SLNB requires further critical evaluation before it can be accepted as a standard treatment for patients with malignant melanoma.
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Affiliation(s)
- S P Hettiaratchy
- Department of Plastic and Reconstructive Surgery, St George's Hospital, London, UK
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46
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Affiliation(s)
- S Cliff
- St George's Hospital, London, England
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Bataille V, Sasieni P, Curley RK, Cook MG, Marsden RA. Melanoma yield, number of biopsies and missed melanomas in a British teaching hospital pigmented lesion clinic: a 9-year retrospective study. Br J Dermatol 1999; 140:243-8. [PMID: 10233216 DOI: 10.1046/j.1365-2133.1999.02656.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The demand for pigmented lesion clinics (PLCs) is increasing in view of improved skin cancer awareness following public health education campaigns. These clinics offer an effective way of screening a large number of patients. However, there is no evidence, as yet, that they have an impact on mortality due to malignant melanoma. With the lack of follow-up inherent to these busy screening clinics, there is some concern that melanomas may be missed. This study reports on 7874 patient visits to a PLC in a teaching hospital between 1985 and 1994. In total, 1705 biopsies were performed over the 9-year period. Lesions were more likely to be biopsied in men compared with women. The yield for picking melanomas was one in 36 patient visits. The mean age of patients attending the PLC was 10 years less than the mean age for population-based melanomas. Melanoma thickness did not significantly change over the 9-year period. Only 0.2% of patients (14 cases) re-presented to the PLC for a second or third visit with a final diagnosis of melanoma, but for five of these patients, the interval between the two visits was over 2 years. Most of these 're-attending' melanomas were early lesions. PLCs offer a fast, safe and efficient service for the screening of pigmented lesions but their role in reducing mortality due to malignant melanoma remains to be established. It is likely that these clinics have an important role in terms of public health education regarding sun avoidance and early recognition of skin cancer.
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Affiliation(s)
- V Bataille
- Department of Dermatology, Queen Mary and Westfield College, Royal London Hospital, London E1 2AT, U.K
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48
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Abstract
We describe a 19-year-old girl with a painful naevoid eccrine spiradenoma affecting the right side of the body. This represents an extremely rare variant of this benign eccrine sweat gland tumour, and is the most extensive lesion described in the U.K. to date.
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Affiliation(s)
- A J Bedlow
- Department of Dermatology, St Helier Hospital, Carshalton, SM5 1AA, U.K
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49
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Carter RL, Cook MG. An assessment of the operation of an external quality assessment (EQA) scheme in histopathology in the South Thames (West) region: 1995-1998. J Clin Pathol 1998; 51:910-3. [PMID: 10070332 PMCID: PMC501026 DOI: 10.1136/jcp.51.12.910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To describe the design and organisation of a voluntary regional external quality assessment (EQA) scheme in histopathology, and to record the results obtained over a three year period. METHODS A protocol is presented in which circulation of EQA slides alternated with teaching sessions. Procedures for the choice of suitable cases, evaluation of submitted diagnoses, and feedback of results to participants are described. The use of teaching sessions, complementary to the slide circulations, and dealing with current diagnostic problems is also outlined. RESULTS Participation rates in the nine slide circulations varied between 66% and 89%, mean 85%. Overall scores were predictably high but 4% of returns, from 10 pathologists, were unsatisfactory. These low scores were typically isolated or intermittent and none of the participants fulfilled agreed criteria for chronic poor performers. CONCLUSIONS This scheme has been well supported and overall performances have been satisfactory. The design was sufficiently discriminatory to reveal a few low scores which are analysed in detail. Prompt feedback of results to participants with identification of all "incomplete" and "wrong" diagnoses is essential. Involvement of local histopathologists in designing, running, and monitoring such schemes is important.
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Affiliation(s)
- R L Carter
- Department of Histopathology, Royal Surrey County Hospital, Surrey, UK
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