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Principe P, Cazares U, Dao H, Elsensohn A, Ibraheim MK. The divisive dysplastic nevus: Searching for concordance in discord. J Cutan Pathol 2024; 51:230-231. [PMID: 38018249 DOI: 10.1111/cup.14562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Affiliation(s)
| | - Ulysses Cazares
- University of California, Riverside, School of Medicine, Riverside, California, USA
| | - Harry Dao
- Department of Dermatology, Loma Linda University, Loma Linda, California, USA
| | - Ashley Elsensohn
- Department of Dermatology, Loma Linda University, Loma Linda, California, USA
- Department of Pathology, Loma Linda University, Loma Linda, California, USA
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Taibo A, Paradela S, Suanzes-Hernández J, Balboa-Barreiro V, Amado-Bouza J, Fonseca E. Prognosis of CDKN2A germline mutation in patients with familial melanoma: a systematic review and meta-analysis. Melanoma Res 2024; 34:9-15. [PMID: 37924530 DOI: 10.1097/cmr.0000000000000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Familial melanoma is defined as melanoma occurring in two or more first-degree relatives by the WHO. Germline mutations are isolated in a subset of them. It is well known that CDKN2A is the most frequently mutated high-risk gene in familial melanoma, however, the prognosis it confers to patients who carry its mutations is still controversial. This review aims to assess whether germline mutations imply a worse prognosis in patients with familial melanoma. A systematic review and meta-analysis were conducted by searching the electronic databases PubMed/MEDLINE, EMBASE, and Cochrane Library. Data from 3 independent populations were eventually included in the meta-analysis, involving 291 cases and 57 416 controls. The results of this systematic review and meta-analysis suggest that there is a tendency for patients with germline mutations in the CDKN2A gene to have a worse overall survival (HR = 1.30, 95% CI = 0.99-1.69, P = 0.05) and melanoma-specific survival (HR = 1.5, 95% CI = 0.97-2.31, P = 0.07). Carrier patients would not only have more incidence of melanoma and a higher risk of a second melanoma, but they also seem to have a worse prognosis. The inclusion of gene panel testing in clinical practice and the collaboration within consortia are needed to provide further evidence on the prognosis of these patients.
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Affiliation(s)
- Ana Taibo
- Department of Dermatology, University Hospital of A Coruña
| | | | - Jorge Suanzes-Hernández
- Research Support Unit, University Hospital of A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Vanesa Balboa-Barreiro
- Research Support Unit, University Hospital of A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - Javier Amado-Bouza
- Research Support Unit, University Hospital of A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
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3
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Green AR, Moshiri A, Hippe DS, Raymundo C, Piepkorn M, Shinohara MM. Differences in nomenclature usage and preference among dermatopathologists for "dysplastic" nevi: A national survey. J Cutan Pathol 2023; 50:530-535. [PMID: 36239041 DOI: 10.1111/cup.14341] [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: 09/05/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ongoing controversy exists regarding terminology used to describe atypical melanocytic nevi. Efforts to standardize nomenclature, including the 1992 NIH consensus conference, have been largely unsuccessful. Significant advances have revealed an increasingly detailed genetic picture of melanocytic neoplasms, including strong evidence for the existence of those with "intermediate" behavior. METHODS We sent an electronic survey to dermatopathologists (n = 846) to assess trends in nomenclature usage and attitudes toward developing new consensus nomenclature for atypical melanocytic nevi. RESULTS There were 229 complete responses (27.1% response rate). The most used/preferred nomenclature was "dysplastic nevus" (43%/39%, respectively), followed by the NIH-recommended terminology (28%/26%). Three-tier grading systems were most heavily used/preferred (79%/63%). Dermatopathologists based in New England were most likely to use the NIH terminology; on the other hand, "dysplastic nevus" or "other" were most used elsewhere (p = 0.029). Most (76%) expressed at least "moderate" enthusiasm for developing consensus nomenclature, with 47% "very" or "extremely" enthusiastic. CONCLUSION Little has changed with the wide variation in terminology for atypical melanocytic nevi. There continues to be no one dominant terminology in use. However, there is enthusiasm for standardization. A new attempt at updated consensus nomenclature may be fruitful.
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Affiliation(s)
- Austin R Green
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Ata Moshiri
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Daniel S Hippe
- Cancer Research Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Caroline Raymundo
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | | | - Michi M Shinohara
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
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Gillstedt M, Segerholm K, Mannius L, Paoli J, Polesie S. How Does a Convolutional Neural Network Trained to Differentiate between Invasive Melanoma and Melanoma In situ Generalize when Assessing Dysplastic Naevi? Acta Derm Venereol 2023; 103:adv00891. [PMID: 36916955 PMCID: PMC10026012 DOI: 10.2340/actadv.v103.4822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/20/2023] [Indexed: 03/16/2023] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
- Martin Gillstedt
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Klara Segerholm
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ludwig Mannius
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - John Paoli
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden
| | - Sam Polesie
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden.
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5
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Zakria D, Brownstone N, Han J, Owji S, Dirr M, Rigel D. Electrical impedance spectroscopy significantly enhances correct biopsy choice for pigmented skin lesions beyond clinical evaluation and dermoscopy. Melanoma Res 2023; 33:80-83. [PMID: 36223289 DOI: 10.1097/cmr.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to investigate whether EIS technology can further improve correct biopsy choices beyond clinical and dermoscopic evaluation for melanoma (MM), severe dysplastic nevi (SDN) and benign PSLs. Images of 49 MMs, SDNs and benign PSLs were randomly selected from a prior study and were provided in a reader-type survey study to dermatologists to evaluate for biopsy. A total of 33,957 biopsy decisions were analyzed. Respondents significantly improved on the correct biopsy choice with the addition of dermoscopy versus clinical image alone for melanoma and severely dysplastic nevi. Respondents also showed a statistically significant improvement in correct biopsy choice beyond their dermoscopic evaluation when integrating the EIS score versus dermoscopy with clinical images for MM, SDN and benign lesions. Respondents also made fewer incorrect biopsy choices with the addition of the EIS score versus dermoscopy and clinical image for MM and benign lesions. Sub-analyses of biopsy choices were also conducted based on experience and practice type. The findings from this study demonstrate that the integration of EIS technology into PSL biopsy decisions has the potential to significantly improve the accuracy of lesion selection for biopsy beyond clinical and dermoscopic evaluation alone.
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Affiliation(s)
- Danny Zakria
- National Society for Cutaneous Medicine, New York
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicholas Brownstone
- Department of Dermatology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Joseph Han
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shayan Owji
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - McKenzie Dirr
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Darrell Rigel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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6
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Du J, Yu WJ, Guo RP, Su J. [Application of immunohistochemical staining of PRAME in differential diagnosis between melanoma and melanocytic nevus]. Zhonghua Bing Li Xue Za Zhi 2022; 51:621-626. [PMID: 35785832 DOI: 10.3760/cma.j.cn112151-20211116-00835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To investigate the diagnostic value of preferentially expressed antigen in melanoma (PRAME) in differential diagnosis of benign and malignant cutaneous melanocytic lesions. Methods: Fifty-nine cases of melanoma (50 cases of skin primary melanoma, and 9 cases of metastatic melanoma) and 48 cases of melanocytic nevus (40 cases of common nevus and 8 cases of dysplastic nevus) were subject to PRAME immunohistochemistry staining.The difference of PRAME expression between melanoma and melanocytic nevus was analyzed. Results: Among the 50 patients with primary cutaneous melanoma, there were 23 males and 27 females ranging in age from 33 to 87 years (average age 62.4 years, median age 64.5 years). Among the 9 metastatic melanoma there were 7 males and 2 females ranging in age from 40 to 82 years (average age 64 years, median age 65 years). Twenty-six cases (26/50, 52.0%) of cutaneous primary melanoma and 4 cases (4/9) of metastatic melanoma showed diffuse positive PRAME staining. 40 cases (40/40, 100%) of common nevus and 8 (8/8) cases of dysplastic nevus were PRAME negative. Compared with melanocytic nevus group, the melanoma group included more cases with diffuse positive PRAME staining (P<0.05). The sensitivity and specificity of using PRAME to differentiate primary cutaneous melanoma from melanocytic nevus in the cohort is 52.0% and 100%. Conclusions: There is a significant difference in the expression of PRAME between melanoma and melanocytic nevus.Thus, PRAME can be used as an auxiliary diagnostic tool for differentiating benign from malignant cutaneous lesions.
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Affiliation(s)
- J Du
- Department of Pathology, Peking University Third Hospital; Department of Pathology, School of Basic Medical Science, Peking University, Beijing 100191, China
| | - W J Yu
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - R P Guo
- Department of Pathology, Peking University Third Hospital; Department of Pathology, School of Basic Medical Science, Peking University, Beijing 100191, China
| | - J Su
- Department of Pathology, Peking University Third Hospital; Department of Pathology, School of Basic Medical Science, Peking University, Beijing 100191, China
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Eijmael MJPM, Janmaat CJ, Briët-Schipper EMN. [The risks of tanning with the Barbie drug]. Ned Tijdschr Geneeskd 2022; 166:D6578. [PMID: 35736369] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Melanotan II, also known as 'Barbie drugs', can be purchased over the internet and in gyms to facilitate sunless tanning. The purchased product is a alpha-melanocyte-stimulating hormone (α-MSH) analogue, which stimulates the production of eumelanin to get skin pigmentation. However, previous research showed that Melanotan supports the development of new pigmented and dysplastic naevi. CASE REPORT We report a case of a 27 year old male, with no relevant medical history, who presented at the emergency department two hours after subcutaneous self-administration of Melanotan II. He suffered from sympathomimetic symptoms and was treated with lorazepam, supplemental potassium and intravenous fluid resuscitation. CONCLUSION This case reports underlines self-administration of Melanotan II is not without potential side effects, although Melanotan II is easily available on the internet and in gyms.
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Affiliation(s)
- M J P Marjella Eijmael
- Groene Hart Ziekenhuis, afd. Interne Geneeskunde, Gouda
- Contact: M. J.P.(Marjella) Eijmael
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8
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Bruner P, Bashline B. Skin Cancer: Precancers. FP Essent 2019; 481:23-27. [PMID: 31188549] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Actinic keratoses (AKs) are common skin lesions caused by cumulative sun exposure. Rates of lesion progression to squamous cell carcinoma (SCC) have been reported to be between 0.025% and 16%, some lesions may regress. Atypical moles are melanocytic nevi that indicate a higher risk of melanoma and, on rare occasions, transform into malignant melanoma, particularly in patients with dysplastic nevus syndrome or familial atypical multiple mole-melanoma syndrome. Precancerous lesions can be identified by physical examination; diagnostic accuracy is enhanced by dermatoscopy. Biopsy is indicated when definitive diagnosis is deemed necessary for suspicious lesions. AKs can be managed with surgical methods, topical chemotherapeutic drugs, or photodynamic therapy. Complications of AKs include itching, pain, cosmetic concerns, and progression to SCC. Management of dysplastic nevi depends on the degree of atypia present. Lesions may be observed in cases of mild atypia with positive histologic margins but negative clinical margins. Dysplastic nevi with a high degree of atypia should be surgically excised or the patient should be referred to a dermatology subspecialist. Complications of atypical nevi include cosmetic concerns, recurrence, and rare progression to melanoma. Surveillance of precancerous lesions should include patient self-examination and regular follow-up skin examinations performed by the physician.
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Affiliation(s)
- Paul Bruner
- Firelands Regional Medical Center Family Medicine Residency, 1111 Hayes Ave, Sandusky, OH 44870
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Saida T. [Ⅳ.What Is Dysplastic Nevus ?-Problems of Its Definition in the WHO Blue Book 2018]. Gan To Kagaku Ryoho 2019; 46:650-654. [PMID: 31164503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Helm TN, Chung CG, Helm KF. Note to dermatopathologists: When it comes to moderately atypical nevi, leave the treatment plan to clinicians. J Am Acad Dermatol 2019; 80:e169. [PMID: 30654073 DOI: 10.1016/j.jaad.2018.12.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas N Helm
- Department of Dermatology, Buffalo Medical Group, Buffalo, New York.
| | - Catherine G Chung
- Department of Dermatology, Wexner Medical Center, The Ohio State University, Columbus, Ohio; Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Klaus F Helm
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania; Department of Pathology, Penn State Hershey Medical Center, Hershey, Pennsylvania
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11
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Hiscox B, Hardin MR, Orengo IF, Rosen T, Mir M, Diwan AH. Reply: Do moderately dysplastic nevi with positive histologic margins need to be reexcised? J Am Acad Dermatol 2017; 77:e85. [PMID: 28807129 DOI: 10.1016/j.jaad.2017.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 05/13/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Bryan Hiscox
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Melissa R Hardin
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Ida F Orengo
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Theodore Rosen
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Mohsin Mir
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | - Abdul Hafeez Diwan
- Department of Dermatology, Baylor College of Medicine, Houston, Texas; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas.
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12
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Affiliation(s)
- Dirk Elston
- Ackerman Academy of Dermatopathology, New York, New York 10016, USA.
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13
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14
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Keller DL. Dysplastic nevi. N Engl J Med 2004; 350:1258-9; author reply 1258-9. [PMID: 15031863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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16
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Brandberg Y, Sjödén PO, Rosdahl I. Assessment of sun-related behaviour in individuals with dysplastic naevus syndrome: a comparison between diary recordings and questionnaire responses. Melanoma Res 1997; 7:347-51. [PMID: 9293486 DOI: 10.1097/00008390-199708000-00011] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [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: 02/05/2023]
Abstract
In Sweden, individuals with dysplastic naevus syndrome (DNS-D2), a high risk group for malignant melanoma, are regularly screened and informed about self-examination and sun protection. During the summer of 1994, 54 out of 65 consecutive patients completed 1 month of daily self-recordings of sun-related behaviour. The diary report was compared with questionnaire responses obtained 6 months later concerning sun-related behaviour, both habitual and during the month of self-recording. The correspondence between the sun-related behaviour recorded in the diary and given in response to the questionnaire was fairly high, but 48% underestimated and 29% overestimated their actual number of sunbathing occasions in the questionnaire. Few patients indicated habitual high frequencies of sunbathing, although some of them recorded six or more occasions during 1 month in the diary. Those who recorded multiple sunburns reported the highest number of sunburns in the questionnaire. Patients who scored high on sunbed use also recorded high numbers of sunbathing occasions. Diaries should be used when detailed information about the magnitude of sun-related behaviour is essential, whereas questionnaires should be sufficient in studies aiming to differentiate between high and low frequencies of such behaviour.
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Affiliation(s)
- Y Brandberg
- Department of Oncology, Karolinska Hospital, Stockholm, Sweden
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Tucker MA, Halpern A, Holly EA, Hartge P, Elder DE, Sagebiel RW, Guerry D, Clark WH. Clinically recognized dysplastic nevi. A central risk factor for cutaneous melanoma. JAMA 1997; 277:1439-44. [PMID: 9145715] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the relationship of number and type of nevi to the development of melanoma. DESIGN Case-control study. SETTING Outpatient clinics in referral hospitals. PATIENTS Cases were 716 consecutive patients with newly diagnosed melanoma identified at 2 melanoma centers between January 1, 1991, and December 31, 1992. Stratified random sampling of patients from outpatient clinics was used to identify 1014 participating controls of the same age, sex, race, and geographic distribution as the melanoma cases. All study subjects underwent an interview, a complete skin examination, photography of the most atypical nevi, and, if the patient was willing, a biopsy of the most atypical nevus. MAIN OUTCOME MEASURES Number and type of nevi on the entire body were systematically reported. All diagnoses of clinically dysplastic nevi were confirmed by expert examiners. RESULTS Risk for melanoma was strongly related to number of small nevi, large nondysplastic nevi, and clinically dysplastic nevi. In the absence of dysplastic nevi, increased numbers of small nevi were associated with an approximately 2-fold risk, and increased numbers of both small and large nondysplastic nevi were associated with a 4-fold risk. One clinically dysplastic nevus was associated with a 2-fold risk (95% confidence interval, 1.4-3.6), while 10 or more conferred a 12-fold increased risk (95% confidence interval, 4.4-31). Congenital nevi were not associated with increased risk of melanoma. CONCLUSIONS Although nondysplastic nevi confer a small risk, clinically dysplastic nevi confer substantial risk for melanoma. On the basis of nevus number and type, clinicians can identify a population at high risk of this epidemic cancer for screening and intervention.
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Affiliation(s)
- M A Tucker
- Genetic Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Md, 20892-7372, USA.
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Brandberg Y, Jonell R, Broberg M, Sjödén PO, Rosdahl I. Sun-related behaviour in individuals with dysplastic naevus syndrome. Acta Derm Venereol 1996; 76:381-4. [PMID: 8891013 DOI: 10.2340/0001555576381384] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
In Sweden, individuals with dysplastic naevus syndrome are regularly screened and informed about self-examination and sun-protection at special clinics. This study describes sun-related behaviour in this group. A total of 54/65 consecutive patients with dysplastic naevus syndrome (28 women and 26 men) completed diary recordings of sun-related behaviour during 1 month in 1994. A majority (81%) reported sunbathing with the intention to get a tan, mean number of occasions 9.2, range 1-24 occasions, during the month of recordings. Out of these, 61% reported sunburns, some of them repeatedly up to 7 times. Sunbathing occurred mainly in bathing suits during midday in sunny weather, with a mean duration of 2.5 h per occasion. Such a hazardous behaviour in the sun in a melanoma high risk group is alarming. New models for intervention to support a more sun protective life style in this group of patient have to be elaborated.
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Affiliation(s)
- Y Brandberg
- Department of Oncology, Karolinska Hospital, Stockholm, Sweden
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Abadir MC, Marghoob AA, Slade J, Salopek TG, Yadav S, Kopf AW. Case-control study of melanocytic nevi on the buttocks in atypical mole syndrome: role of solar radiation in the pathogenesis of atypical moles. J Am Acad Dermatol 1995; 33:31-6. [PMID: 7601943 DOI: 10.1016/0190-9622(95)90006-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND It is not known why melanocytic nevi (MN) become dysmorphic (atypical) in patients with the atypical mole syndrome (AMS). A complex origin for acquired MN has been postulated. Genetic predisposition, solar radiation, and/or the formation of a sun-induced circulating mitogenic factor may contribute to the formation of MN. OBJECTIVE This study was undertaken to help elucidate the pathogenesis of atypical MN in patients with AMS. METHODS The number of common and atypical MN was determined for a defined sun-protected area on the buttocks in 150 patients with AMS (cases) and 150 control subjects without AMS. Patients and control subjects were matched for age and sex and were classified into risk groups for the development of malignant melanoma according to the Rigel classification. RESULTS MN on the buttocks were found in 23% of patients with AMS and 9% of control subjects (p < 0.003). In patients versus control subjects the mean number (1.3 vs 1.2, respectively) and mean diameter (5.7 vs 5.9 mm, respectively) of MN on the buttocks did not differ significantly. The MN in both patients and control subjects were not atypical clinically. The odds ratio for having AMS if MN were present on the buttocks was calculated to be 1.56 (95% confidence interval, 1.25 to 1.95). CONCLUSION Although the patients were 2.6 times more likely to have MN on their buttocks than the control subjects, clinically the MN did not differ significantly in number or appearance from those found on the buttocks of control subjects. It is hypothesized that the formation of some atypical MN requires direct solar radiation for their phenotypic expression.
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Affiliation(s)
- M C Abadir
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, NY 10016, USA
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Brown MD. Identifying and managing early melanoma. Contemp Intern Med 1994; 6:19-26. [PMID: 10150303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- M D Brown
- Division of Dermatologic Surgery, Oncology, and Mohs Surgery, University of Rochester Medical Center, NY, USA
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Abstract
Expression of the tumour suppressor protein, p53, was determined in 77 cutaneous melanocytic lesions, and in five lymph node metastases from malignant melanoma, in an immunohistochemical study employing CM-1, an antiserum raised against recombinant human p53 protein. Because wild-type p53 protein is rapidly degraded in normal cells, p53 immunoreactivity suggests the presence of an abnormally stable p53 protein. This may occur through either post-translational mechanisms or gene mutation. A highly significant correlation was found between p53 immunoreactivity and malignancy in melanocytic lesions (P < 0.0001). Overall, p53 immunoreactivity was observed in 63% of tumour specimens examined, but not in benign melanocytic naevi, although occasional foci of weak nuclear p53 immunoreactivity were observed in a minority of dysplastic naevi and a solitary Spitz naevus. A significant correlation was also found between strong p53 immunoreactivity and malignant melanomas associated with a poor prognosis (P = 0.008). These data suggest an important role for p53 tumour suppressor protein in the biology of human cutaneous malignant melanoma.
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Affiliation(s)
- J M McGregor
- Department of Dermatology, Guy's Hospital, London, U.K
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Taylor RM. Early melanoma: diagnosis and treatment. A synopsis of conference findings with relevant literature citations. Md Med J 1993; 42:511-4. [PMID: 8336538] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In summary, 13 panelists and 23 featured speakers convened in late January 1992 in an attempt to define early melanoma clinically and histologically; develop treatment guidelines including follow-up for early melanoma; wrestle with the controversial issues of dysplastic nevus and dysplasia; formulate plans, present and future, for public education and screening of early melanoma; and list future directions for research and primary prevention in early melanoma. The panel accomplished its goals all within the incredibly short time of three days (January 27-29, 1992). While criticism has been raised with regard to the panel's findings, the medical community owes a debt of gratitude to the participants for the selfless giving of time, energy and expertise.
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Affiliation(s)
- R M Taylor
- Johns Hopkins University School of Medicine
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Abstract
The question of whether definite precursors to melanoma exist is answered in the affirmative. Three cutaneous lesions likely to be such precursors are described and discussed as to their clinical and histologic appearance and incidence. Additionally, a type of conjunctival melanosis that has been associated with malignant melanoma of the conjunctiva is discussed and an attempt is made to define it; a proposed classification of this entity is reviewed. Basic approaches to management and analysis of precursor lesions are elaborated.
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Affiliation(s)
- M C Mihm
- Dermatopathology Division, Massachusetts General Hospital/Harvard Medical School, Boston 02114
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25
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Abstract
BACKGROUND Development of multiple primary cutaneous melanomas is a well-recognized phenomenon. As with single primary melanoma, personal and family histories of melanoma and dysplastic nevi (DN) are considered important risk factors. The natural history and impact of regular follow-up evaluation of this entity were examined. METHOD Through a search of the computerized data bank of the Pathology Department and the Melanoma Registry of the Pigmented Lesion Clinic at Massachusetts General Hospital, 41 patients with multiple cutaneous melanomas were identified. RESULTS Mean (+/- standard error) age at first diagnosis was 49 +/- 2 years (range, 21-75 years). The male to female ratio was 2:1. The median number of primary melanomas was two (88%). Three patients had three and one had five. Melanoma types included superficial spreading (70%), nodular (8%), lentigo maligna (2%), and unclassified (10%), and in 7% the type was unknown. Nineteen (46%) patients had histologic and/or clinical evidence of DN. For the group with DN, the mean age at first diagnosis (44 +/- 3 years) was significantly less than that of patients without DN (54 +/- 3 years) (P less than 0.05). Family history of melanoma was found in 10 patients (24%). Multiple melanomas were diagnosed concurrently in 16 patients (39%), whereas in 25 (61%) diagnosis was sequential. For the latter group, the mean tumor thickness from the first (1.21 +/- 0.28 mm) to the second melanoma (0.51 +/- 0.08 mm) decreased significantly (P less than 0.05); the median time interval was 36 months (range, 2-372 months). CONCLUSION These data confirm the need for complete skin examination for patients with newly diagnosed melanoma; and, with subsequent melanomas appearing as long as 31 years after the first melanoma, continued follow-up with complete skin examinations seems prudent.
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Affiliation(s)
- S Kang
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
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26
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Abstract
Melanocytic nevi are common in children and adolescents, and the preponderance of these lesions are benign. Congenital melanocytic nevi, dysplastic nevi, and large numbers of common acquired nevi, however, may indicate an increased risk of malignant melanoma. With the exception, possibly, of giant congenital nevi, melanoma associated with these lesions generally occurs in adulthood. Nonetheless, some patients can be identified as being at increased risk for the development of melanoma during childhood. The poor prognosis associated with advanced melanoma and the curability of early lesions underscore the importance of prompt recognition of melanoma when it does occur in children. Furthermore, physicians who care for children are in a key position to decrease risk of melanoma throughout the lifespan by encouraging avoidance of excessive sun exposure during childhood.
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Affiliation(s)
- M E Roth
- Division of Dermatology, Brown University, Providence, Rhode Island
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27
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Kleeberg UR. Etiology and risk factors of melanoma. Ann Ital Chir 1989; 60:231-6. [PMID: 2699706] [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: 01/02/2023]
Abstract
Epidemiologic and etiological research about the pathogenesis of melanoma remains a controversial issue. The dominant cause appears to rest on the relation between the genetically determined susceptibility of the host and ultraviolet radiation (UVR). Basic to the understanding however is the knowledge about the clinical and histopathological, the genotypical and phenotypical heterogeneity of this tumor entity. In terms of the multistage concept of carcinogenesis, melanocytes, atypical or normal, are exposed to a mutagenic event, predominantly UVR, initiating malignant growth in a genetically altered and susceptible genome. The initiation could also occur spontaneously or as the result of other insults such as chemical carcinogens, viral infections, ionizing radiation etc. Promotion through the stage of melanocytic dysplasia or de novo from an altered skin, follows additional exposure to UVR or cocarcinogens and is likely to be modulated by ethnic, dietary, endocrine but also protective factors and concomitant disease. In terms of descriptive epidemiology, melanoma may be caused by exposure to intermittent and intense sunlight on unacclimatized skin. The mechanism of this association such as the wavelength responsible, effects of total dose, intensity of dose rate, latency period between exposure and the clinical incidence of disease finally the stage of carcinogenesis affected by UVR and other initiating factors and the impact of any specific modulation for the pathogenesis and clinical course of the disease remain to be elucidated.
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28
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29
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Coverman MH. Total-body photographs of dysplastic nevi: who pays? Arch Dermatol 1989; 125:565-6. [PMID: 2930216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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30
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