1
|
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.
Collapse
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.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Yang CM, Li JM, Wang R, Lu LG. Malignant peripheral nerve sheath tumor in an elderly patient with superficial spreading melanoma: A case report. World J Clin Cases 2021; 9:6457-6463. [PMID: 34435012 PMCID: PMC8362584 DOI: 10.12998/wjcc.v9.i22.6457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malignant peripheral nerve sheath tumor (MPNST) is a type of spindle cell sarcoma originating from the peripheral nerve, which usually results in the corresponding nerve sign on magnetic resonance imaging (MRI). Patients with MPNST may also have neurofibromatosis type 1.
CASE SUMMARY A 78-year-old male was admitted to the hospital due to a tumor in his left knee. He had a previous history of superficial spreading melanoma on the left thigh. Color Doppler ultrasonography showed a hypoechoic mass in the subcutaneous soft tissues of the medial left knee with an abundant rich blood flow. Computed tomography scanning did not show obvious signs of bone destruction, but the skin adjacent to the tumor was slightly thickened. MRI examination revealed that the hypervascular lesion was well-circumscribed, lobulated, invaded the surrounding soft tissues and demonstrated heterogeneous enhancement but lacked an entering and exiting nerve sign. The MRI result indicated the invasiveness of the tumor. The patient underwent a left knee joint mass expanded resection and the first histopathological examination showed a MPNST with positive surgical margins. Therefore, the second extended resection was performed, and the patient had a good outcome in the short term.
CONCLUSION MRI is a useful technique for revealing the biological characteristics of MPNST and provides clinical support for evaluation of the surgical area before operation.
Collapse
Affiliation(s)
- Chong-Miao Yang
- Department of Medical Imaging, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People’s Hospital, Zhuhai 519000, Guangdong Province, China
- Zhuhai Hospital Affiliated with Jinan University, Jinan University, Guangzhou 510000, Guangdong Province, China
| | - Jia-Min Li
- Department of Medical Imaging, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People’s Hospital, Zhuhai 519000, Guangdong Province, China
- Zhuhai Hospital Affiliated with Jinan University, Jinan University, Guangzhou 510000, Guangdong Province, China
| | - Rui Wang
- Department of Pathology, Zhuhai Hospital Affiliated with Jinan University, Zhuhai People’s Hospital, Zhuhai 519000, Guangdong Province, China
| | - Li-Gong Lu
- Zhuhai Interventional Medical Center, Zhuhai Precision Medical Center, Zhuhai People’s Hospital of Jinan University, Zhuhai 519000, Guangdong Province, China
| |
Collapse
|
4
|
Susok L, Gambichler T. Caucasians with acral lentiginous melanoma have the same outcome as patients with stage- and limb-matched superficial spreading melanoma. J Cancer Res Clin Oncol 2021; 148:497-502. [PMID: 33856527 PMCID: PMC8800911 DOI: 10.1007/s00432-021-03630-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Acral lentiginous melanoma (ALM), a relatively rare subtype of cutaneous melanoma, has been reported to have a worse prognosis than other melanomas. We aimed to assess clinical findings in Caucasian ALM patients and compare the data with a matched cohort of superficial spreading melanoma (SSM) patients. METHODS We studied 63 patients with ALM and 63 randomly stage- and limb-matched patients with SSM (non-ALM). In both cohorts, guideline-adjusted diagnosis, treatment and follow-up were performed. RESULTS We did not observe differences in prognostic factors (e.g., tumor thickness, ulceration) between the two cohorts. Both in ALM and non-ALM patients positive sentinel lymph node was a significant independent predictor for disease relapse and melanoma-specific death. However, disease relapse and melanoma-specific death rates did not significantly differ between ALM and non-ALM patients. An overall 5-year melanoma-specific survival of 82.5% and 81% was observed in ALM and non-ALM patients, respectively. CONCLUSIONS Our data confirm that patients with ALM have no worse outcome than non-ALM patients when correcting for significant prognostic factors. Hence, the reportedly high rates of fatal ALM cases should not be ascribed to pathobiological differences between ALM and non-ALM but are most likely are a consequence of a delay in diagnosis and thus advanced stage of ALM.
Collapse
Affiliation(s)
- Laura Susok
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| |
Collapse
|
5
|
Coroiu A, Moran C, Davine JA, Brophy K, Bergeron C, Tsao H, Körner A, Swetter SM, Geller AC. Patient-identified early clinical warning signs of nodular melanoma: a qualitative study. BMC Cancer 2021; 21:371. [PMID: 33827477 PMCID: PMC8028760 DOI: 10.1186/s12885-021-08072-4] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nodular (NM) and superficial spreading melanoma (SSM) show different disease trajectories, with more rapid development in NM and fewer opportunities for early detection often resulting in worse outcomes. Our study described the patient-identified early signs of thin NM via comparisons to thin (≤ 2 mm) SSM and thick (> 2 mm) NM. METHODS We conducted semi-structured interviews with NM and SSM patients and analyzed the data using thematic analysis. RESULTS We enrolled 34 NM and 32 SSM patients. Melanoma early signs uniquely identified by patients with thin NM included white, blue or black coloration, "dot-like" size, fast changes in shape and color observed over 2 weeks, elevation and texture or "puffiness" over 6-12 months, and the sensation that the mole "did not feel right". Early signs reported by both thin NM and thin SSM patients included round or oblong shape, "jagged" border, pink/red, brown/reddish or dark coloration, "elevated like a pimple" or "tiny bump", fast color darkening, diameter growth, and border irregularity, and mole feeling "really itchy". CONCLUSIONS We found evidence that early signs of NM can be self-identified, which has important implications for the earlier detection of this most aggressive type of melanoma by both health professionals and patients.
Collapse
Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA.
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
| | - Kyla Brophy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Hensin Tsao
- Harvard Medical School, Boston, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, USA
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Stanford, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
| |
Collapse
|
6
|
Susok L, Stücker M, Bechara FG, Stockfleth E, Gambichler T. Multivariate analysis of prognostic factors in patients with nodular melanoma. J Cancer Res Clin Oncol 2021; 147:2759-2764. [PMID: 33630139 PMCID: PMC8310843 DOI: 10.1007/s00432-021-03562-1] [Citation(s) in RCA: 3] [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: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Nodular melanoma (NM) is associated with worse disease outcome when compared to superficial spreading melanoma (SSM). We aimed to perform a single-center analysis of prognostic factors in patients with NM and compare the data with SSM patients. METHODS We studied 228 patients with NN and 396 patients with SSM. Patients with in situ melanomas or stage IV at diagnosis were not included in the study. Data were analyzed using the Mann-Whitney test, Chi-square test, Kaplan-Meier curves including the log-rank test, and logistic regression model. RESULTS When compared to patients with SSM, patients with NM had less likely lower Clark level, higher tumor thickness, less likely tumor regression, more often ulcerated tumors, and less likely a history of precursor lesions such as a nevus. Within a 5-year follow-up we observed significantly more disease relapses and deaths in NM patients than in SSM patients. On multivariate analysis, disease relapse in NM patients was independently predicted by tumor thickness and positive SLNB, whereas melanoma-specific death of NM patients was independently predicted by male sex and tumor thickness. Histologic regression also remained in the logistic regression model as a significant independent negative predictor of NM death. CONCLUSIONS We did not observe that NM subtype was per se a significant independent predictor for disease relapse or melanoma-specific death. Among the well-known prognostic factors such as tumor thickness and male sex, NM is also associated with other unfavorable factors such as absence of regression.
Collapse
Affiliation(s)
- L Susok
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Stücker
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
| |
Collapse
|
7
|
Pizzichetta MA, Massi D, Mandalà M, Queirolo P, Stanganelli I, De Giorgi V, Ghigliotti G, Cavicchini S, Quaglino P, Corradin MT, Rubegni P, Alaibac M, Astorino S, Ayala F, Magi S, Mazzoni L, Manganoni MA, Talamini R, Serraino D, Palmieri G. Clinicopathological predictors of recurrence in nodular and superficial spreading cutaneous melanoma: a multivariate analysis of 214 cases. J Transl Med 2017; 15:227. [PMID: 29115977 PMCID: PMC5688807 DOI: 10.1186/s12967-017-1332-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nodular melanoma (NM) accounts for most thick melanomas and because of their frequent association with ulceration, fast growth rate and high mitotic rate, contribute substantially to melanoma-related mortality. In a multicentric series of 214 primary melanomas including 96 NM and 118 superficial spreading melanoma (SSM), histopathological features were examined with the aim to identify clinicopathological predictors of recurrence. METHODS All consecutive cases of histopathologically diagnosed primary invasive SSM and NM during the period 2005-2010, were retrieved from the 12 participating Italian Melanoma Intergroup (IMI) centers. Each center provided clinico-pathological data such as gender, age at diagnosis, anatomical site, histopathological conventional parameters, date of excision and first melanoma recurrence. RESULTS Results showed that NM subtype was significantly associated with Breslow thickness (BT) at multivariate analysis: [BT 1.01-2 mm (OR 7.22; 95% CI 2.73-19.05), BT 2.01-4 mm (OR 7.04; 95% CI 2.54-19.56), and BT > 4 mm (OR 51.78; 95% CI 5.65-474.86) (p < 0.0001)]. Furthermore, mitotic rate (MR) was significantly correlated with NM histotype: [(MR 3-5 mitoses/mm2 (OR 2.62; 95% CI 1.01-6.83) and MR > 5 mitoses/mm2 (OR 4.87; 95% CI 1.77-13.40) (p = 0.002)]. The risk of recurrence was not significantly associated with NM histotype while BT [BT 1.01-2.00 mm (HR 1.55; 95% CI 0.51-4.71), BT 2.01-4.00 mm (HR 2.42; 95% CI 0.89-6.54), BT > 4.00 mm. (HR 3.13; 95% CI 0.95-10.28) (p = 0.05)], mitotic rate [MR > 2 mitoses/mm2 (HR 2.34; 95% CI, 1.11-4.97) (p = 0.03)] and the positivity of lymph node sentinel biopsy (SNLB) (HR 2.60; 95% CI 1.19-5.68) (p = 0.007) were significantly associated with an increased risk of recurrence at multivariate analysis. CONCLUSIONS We found that NM subtype was significantly associated with higher BT and MR but it was not a prognostic factor since it did not significantly correlate with melanoma recurrence rate. Conversely, increased BT and MR as well as SNLB positivity were significantly associated with a higher risk of melanoma recurrence.
Collapse
Affiliation(s)
- Maria A. Pizzichetta
- Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano, Italy
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Mario Mandalà
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Queirolo
- Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | | | | | - Stefano Cavicchini
- Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Dept Medical Sciences, University of Torino, Turin, Italy
| | | | - Pietro Rubegni
- Department of Dermatology, University of Siena, Siena, Italy
| | - Mauro Alaibac
- Department of Dermatology, University of Padova, Padua, Italy
| | | | - Fabrizio Ayala
- National Cancer Institute, “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | | | - Renato Talamini
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Diego Serraino
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy
| | - on behalf of the Italian Melanoma Intergroup (IMI)
- Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano, Italy
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Florence, Florence, Italy
- Clinic of Dermatology, IRCCS San Martino-IST, Genoa, Italy
- Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
- Dermatologic Clinic, Dept Medical Sciences, University of Torino, Turin, Italy
- Division of Dermatology, Pordenone Hospital, Pordenone, Italy
- Department of Dermatology, University of Siena, Siena, Italy
- Department of Dermatology, University of Padova, Padua, Italy
- Division of Dermatology, Celio Hospital, Rome, Italy
- National Cancer Institute, “Fondazione G. Pascale”-IRCCS, Naples, Italy
- Department of Dermatology, ASST degli Spedali Civili di Brescia, Brescia, Italy
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| |
Collapse
|
8
|
Sadayasu A, Tanaka M, Maumi Y, Ikeda E, Sawada M, Ishizaki S, Murakami Y, Fujibayashi M. Abrupt Intralesional Color Change on Dermoscopy as a New Indicator of Early Superficial Spreading Melanoma in a Japanese Woman. Case Rep Dermatol 2015; 7:123-8. [PMID: 26269701 PMCID: PMC4519594 DOI: 10.1159/000432391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Indexed: 11/19/2022] Open
Abstract
Diagnosis of superficial spreading melanoma in the early stage is often difficult, even with dermoscopy. We report the case of a 37-year-old Japanese woman with superficial spreading melanoma in her left buttock. The lesion developed 20 years before becoming visible and gradually enlarged over the past few years without any symptoms. Physical examination showed a well-demarcated dark-brown macule 10 mm in diameter. Dermoscopy demonstrated a central dark area with a blue-grey structureless area, a milky-red area with irregular blue-grey dots or globules suggestive of regression structures, and multifocal black pigmentation with whitish scaly areas. An abrupt intralesional change in color from a central dark area to a peripheral light-brown area was also seen. The peripheral area showed an atypical pigment network with an obscure mesh and holes. Histopathologic examination of the lesion showed acanthosis with melanocytic proliferation and nuclear atypia, a band-like lymphocytic infiltrate, melanophages and a few nests of melanocytes just beneath the epidermis. The epidermal melanocytes were positive for S-100, Melan-A and HMB-45, but the dermal nests of melanocytes were negative for HMB-45 and positive for S-100 and Melan-A. A diagnosis of superficial spreading melanoma with a tumor thickness of 0.4 mm (pT1aN0M0, stage 1A) was established based on the clinical, dermoscopic and histopathologic findings. This case suggests that dermoscopy is useful in the diagnosis of this condition. An abrupt intralesional change of color might be a new indicator of early superficial spreading melanoma.
Collapse
Affiliation(s)
- Anna Sadayasu
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Masaru Tanaka
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoshifumi Maumi
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Eriko Ikeda
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Mizuki Sawada
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Sumiko Ishizaki
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | | | - Mariko Fujibayashi
- Department of Pathology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| |
Collapse
|
9
|
Egger ME, Stepp LO, Callender GG, Quillo AR, Martin RCG, Scoggins CR, Stromberg AJ, McMasters KM. Outcomes and prognostic factors in superficial spreading melanoma. Am J Surg 2013; 206:861-7; discussion 867-8. [PMID: 24124662 DOI: 10.1016/j.amjsurg.2013.09.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 03/15/2013] [Revised: 09/04/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prognostic factors and risk factors for positive sentinel lymph node (SLN) biopsy results are important to identify in superficial spreading melanoma (SSM). METHODS A single-center database and a prospective clinical trial database were reviewed for all patients with diagnoses of SSM. Logistic regression, Kaplan-Meier survival analysis, and univariate and multivariate Cox models were used. RESULTS A total of 1,643 patients with SSM were identified. Independent risk factors for positive SLN biopsy results were Breslow thickness (BT) ≥2.0 mm, age <60 years, and presence of ulceration. BT ≥2.0 mm, ulceration, lymphovascular invasion, and positive SLN and positive non-SLN biopsy results were independent risk factors for worse disease-free survival. Independent overall survival risk factors included BT ≥2.0 mm, age ≥60 years, ulceration, nonextremity tumor location, lymphovascular invasion, and positive SLN biopsy results. CONCLUSIONS BT, ulceration, lymphovascular invasion, and SLN and non-SLN status are important risk factors for SSM.
Collapse
Affiliation(s)
- Michael E Egger
- Hiram C. Polk Jr MD Department of Surgery, University of Louisville, 550 South Jackson Street, Louisville, KY 40202, USA
| | | | | | | | | | | | | | | |
Collapse
|