WE ARE AWARE OF RECURRENT NEVI IN THE SKIN OCCURRING AFTER A PIGMENTED LESION HAS BEEN SHAVED AND THE PROBLEMS THIS POSES FOR BOTH THE DERATOSCOPIST AND THE PATHOLOGIST. THIS ARTICLE LOOKS AT HISTOLOGICAL CHANGES AFTER NON SURGICAL TRAUMA TO A MELANOCYTIC NEVUS. NOTE THE COMMENTS ON PAGETOID SPREAD.
Melanocytic Nevi With Nonsurgical Trauma: A Histopathologic Study.
Original Article
American Journal of Dermatopathology. 29(2):134-136, April 2007.
Selim, Maria Angelica MD *; Vollmer, Robin T MS, MD *+; Herman, Christopher M MD ++; Pham, Teresa TN MD *; Turner, John W MD *
Abstract:
There is a belief among dermatopathologists that benign melanocytic nevi (BMN) may display atypical histologic characteristics when traumatized. However, to our knowledge, a systematic study of nonsurgically traumatized melanocytic nevi (TMN) has not been published. We studied a series of 92 TMN. Cases were analyzed for histologic evidence of architectural and cytologic criteria associated with atypia. Of the patients, 54 were female and 37 were male. The mean age was 38 years old (range 8-74 years old). Nevi were present, in order of frequency, on the extremities, trunk, and head/neck, but there were no acral sites. Histologic findings of trauma were as follows: parakeratosis (92%), dermal telangiectasias (61%), ulceration (51%), dermal inflammation (49%), melanin within stratum corneum (24%), and dermal fibrosis (25%). Pagetoid spread of melanocytes was limited to the site of trauma in 20% of cases and was identified away from areas of trauma in 8% of cases. Melanocytic atypia was seen in three cases. Dermal mitoses were rare (one mitotic figure in three cases).Pagetoid spread under a traumatized epidermis was relatively frequent and, in isolation, is compatible with a benign TMN. Any traumatized melanocytic lesion that displays cytologic atypia, pagetoid spread outside of the area of the traumatized epidermis, or dermal mitoses should be treated with caution because these findings were rarely seen in TMN.
Saturday, March 31, 2007
Wednesday, March 28, 2007
Seborrhoeic keratosis like melanoma with folliculotropism
Arch Dermatol. 2007;143:373-376.
ABSTRACT
Background Seborrheic keratosislike melanoma could be one of the most problematic melanoma simulators, and it may be incorrectly treated by electrocautery or cryotherapy. Dermoscopic examination of pigmented tumors improves the diagnostic accuracy in these challenging lesions. In these tumors, numerous comedolike openings are present.
Observations A 34-year-old man was seen for a conspicuous pigmented lesion on his back that clinically resembled a seborrheic keratosis because of the presence of multiple comedolike openings. Findings from dermoscopic examination showed distinct melanoma criteria (atypical pigmented network, asymmetric globules and dots, and a blue-whitish veil), in addition to multiple comedolike openings. Histopathological examination confirmed a peculiar melanoma variant characterized by prominent folliculotropism and minimal radial spreading. This tumor was not associated with chronic sun-damaged skin.
Conclusion Dermoscopy was useful in identifying a particular case of seborrheic keratosislike melanoma with folliculotropism, thus avoiding incorrect treatment.
Friday, March 9, 2007
Volar intradermal nevus causing a parallel ridge pattern
This article simply shows that intradermal nevi on volar surfaces can present with a parallel ridge pattern just like acral melanoma
Dermoscopy of a Plantar Combined Blue Nevus: A Simulator of Melanoma
V. Panasitia, V. Devirgiliisa, R.G. Borronia, M. Mancinia, M. Rossia, M. Curzioa, B. Mastrecchiaa, U. Bottonib, D. Innocenzia, S. Calvieria
aDepartment of Dermatology, University of Rome 'La Sapienza', Rome, and
bDepartment of Dermatology and Oncology, University of Catanzaro 'Magna Graecia', Catanzaro, Italy
Address of Corresponding Author
Dermatology 2007;214:174-176 (DOI: 10.1159/00009
Abstract
Dermoscopy allows early detection of melanoma also on acral volar skin. The majority of melanocytic nevi on palms and soles may show three major dermoscopic patterns: the parallel-furrow pattern, the lattice-like pattern, and the fibrillar pattern. Melanomas at these sites are characterized by the parallel ridge pattern. We present the case of a 59-year-old woman who had an oval papule of bluish color, measuring 0.6 × 0.9 cm, localized on her left sole, that had been present, unchanged, for more than 10 years. Dermoscopy showed a parallel ridge pattern. The histopathological examination revealed a combined blue nevus. We present this case to underline that on acral volar skin also intradermal nevi, such as combined blue nevi, may dermoscopically exhibit a parallel ridge pattern, simulating melanoma.
Copyright © 2007 S. Karger AG, Basel
--------------------------------------------------------------------------------
Author Contacts
Vincenzo Panasiti, MD
Department of Dermatology, University of Rome 'La Sapienza'
Viale del Policlinico, 155
IT-00161 Rome (Italy)
Tel. +39 06 4997 6941, Fax +39 06 446 2104, E-Mail ilcapo75@gmx.net
Dermoscopy of a Plantar Combined Blue Nevus: A Simulator of Melanoma
V. Panasitia, V. Devirgiliisa, R.G. Borronia, M. Mancinia, M. Rossia, M. Curzioa, B. Mastrecchiaa, U. Bottonib, D. Innocenzia, S. Calvieria
aDepartment of Dermatology, University of Rome 'La Sapienza', Rome, and
bDepartment of Dermatology and Oncology, University of Catanzaro 'Magna Graecia', Catanzaro, Italy
Address of Corresponding Author
Dermatology 2007;214:174-176 (DOI: 10.1159/00009
Abstract
Dermoscopy allows early detection of melanoma also on acral volar skin. The majority of melanocytic nevi on palms and soles may show three major dermoscopic patterns: the parallel-furrow pattern, the lattice-like pattern, and the fibrillar pattern. Melanomas at these sites are characterized by the parallel ridge pattern. We present the case of a 59-year-old woman who had an oval papule of bluish color, measuring 0.6 × 0.9 cm, localized on her left sole, that had been present, unchanged, for more than 10 years. Dermoscopy showed a parallel ridge pattern. The histopathological examination revealed a combined blue nevus. We present this case to underline that on acral volar skin also intradermal nevi, such as combined blue nevi, may dermoscopically exhibit a parallel ridge pattern, simulating melanoma.
Copyright © 2007 S. Karger AG, Basel
--------------------------------------------------------------------------------
Author Contacts
Vincenzo Panasiti, MD
Department of Dermatology, University of Rome 'La Sapienza'
Viale del Policlinico, 155
IT-00161 Rome (Italy)
Tel. +39 06 4997 6941, Fax +39 06 446 2104, E-Mail ilcapo75@gmx.net
Thursday, March 8, 2007
Gene probes and melanocytic lesions
This is a good reference on the developing possibilities of applying gene research to separate out benign from malignant pigmented lesions. It applies to our discussion on Cliff Rosendahl's Mrs Brown on 7th March 2007.
1: Oncogene. 2003 May 19;22(20):3081-6.
Understanding the progression of melanocytic neoplasia using genomic analysis: from fields to cancer.Bastian BC.
Departments of Dermatology and Pathology, UCSF Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94115, USA. bastian@cc.ucsf.edu
Analysis of DNA copy number changes using comparative genomic hybridization in melanocytic neoplasms has revealed distinct patterns of chromosomal aberrations between benign melanocytic nevi and melanoma\. Whereas the vast majority of melanoma expresses chromosomal aberrations, blue nevi, congenital nevi, and most Spitz nevi typically show no aberrations\. A subset of Spitz nevi shows an isolated gain of chromosome 11p, an aberration pattern not observed in melanoma\. These Spitz nevi frequently harbor mutations in the HRAS gene located on this chromosomal arm\. Comparisons among melanoma types showed that melanomas of the palms, soles, and subungual sites can be distinguished by the presence of multiple gene amplifications that arise very early in their progression\. About 50% of these amplifications are found at the cyclin D1 locus\. By contrast, amplifications are significantly less frequent in other cutaneous melanoma types and if present arise late in progression\. The frequent amplifications in melanomas on acral sites allowed the detection of single basal melanocytes with gene amplifications in the histologically normal appearing skin immediately adjacent to a melanoma\. These "field cells" represent subtle melanoma in situ and are likely to represent minimal residual disease that can lead to local recurrences if not excised with safety margins\. The high frequency of chromosomal aberrations in melanomas and their relative absence in nevi could indicate that melanocytes of melanomas went through telomeric crisis, whereas melanocytes in nevi did not\. Such a scenario would suggest that replicative senescence is a tumor-suppressive mechanism in melanocytic neoplasia\. It might also explain part of the phenomenon of regression commonly seen in melanoma.Genomic analysis is a powerful tool to obtain insight in the progression of melanocytic neoplasms with potential clinical applications for classification and detection of minimal residual melanoma.
PMID: 12789284 [PubMed - indexed for MEDLINE]
1: Oncogene. 2003 May 19;22(20):3081-6.
Understanding the progression of melanocytic neoplasia using genomic analysis: from fields to cancer.Bastian BC.
Departments of Dermatology and Pathology, UCSF Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94115, USA. bastian@cc.ucsf.edu
Analysis of DNA copy number changes using comparative genomic hybridization in melanocytic neoplasms has revealed distinct patterns of chromosomal aberrations between benign melanocytic nevi and melanoma\. Whereas the vast majority of melanoma expresses chromosomal aberrations, blue nevi, congenital nevi, and most Spitz nevi typically show no aberrations\. A subset of Spitz nevi shows an isolated gain of chromosome 11p, an aberration pattern not observed in melanoma\. These Spitz nevi frequently harbor mutations in the HRAS gene located on this chromosomal arm\. Comparisons among melanoma types showed that melanomas of the palms, soles, and subungual sites can be distinguished by the presence of multiple gene amplifications that arise very early in their progression\. About 50% of these amplifications are found at the cyclin D1 locus\. By contrast, amplifications are significantly less frequent in other cutaneous melanoma types and if present arise late in progression\. The frequent amplifications in melanomas on acral sites allowed the detection of single basal melanocytes with gene amplifications in the histologically normal appearing skin immediately adjacent to a melanoma\. These "field cells" represent subtle melanoma in situ and are likely to represent minimal residual disease that can lead to local recurrences if not excised with safety margins\. The high frequency of chromosomal aberrations in melanomas and their relative absence in nevi could indicate that melanocytes of melanomas went through telomeric crisis, whereas melanocytes in nevi did not\. Such a scenario would suggest that replicative senescence is a tumor-suppressive mechanism in melanocytic neoplasia\. It might also explain part of the phenomenon of regression commonly seen in melanoma.Genomic analysis is a powerful tool to obtain insight in the progression of melanocytic neoplasms with potential clinical applications for classification and detection of minimal residual melanoma.
PMID: 12789284 [PubMed - indexed for MEDLINE]
Wednesday, March 7, 2007
Dermoscopic Features of Difficult Melanoma
This article does not give you positive features to look for but merely rates the significance of absent positive features you would hope to find! It emphasises the importance ofhe ugly duckling sign and the history of recent change.(IMCC)
Dermoscopic Features of Difficult Melanoma
MARIA A. PIZZICHETTA, MD**Centro di Riferimento Oncologico, CRO, Aviano, Italy; , IGNAZIO STANGANELLI, MDSkin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; , RICCARDO BONO, MDIstituto Dermopatico dell'Immacolata, IRCCS, Roma, Italy; , H. PETER SOYER, MD§§Department of Dermatology, Medical University of Graz, Graz, Austria, SERENA MAGI, SCDSkin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; , VINCENZO CANZONIERI, MD**Centro di Riferimento Oncologico, CRO, Aviano, Italy; , GIUSEPPE LANZANOVA, MDSkin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; , GIORGIO ANNESSI, MDIstituto Dermopatico dell'Immacolata, IRCCS, Roma, Italy; , CESARE MASSONE, MD§§Department of Dermatology, Medical University of Graz, Graz, Austria, LORENZO CERRONI, MD§§Department of Dermatology, Medical University of Graz, Graz, Austria, AND RENATO TALAMINI, SCD**Centro di Riferimento Oncologico, CRO, Aviano, Italy; , ON BEHALF OF THE ITALIAN MELANOMA INTERGROUP (IMI)*Centro di Riferimento Oncologico, CRO, Aviano, Italy; Skin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; Istituto Dermopatico dell'Immacolata, IRCCS, Roma, Italy; §Department of Dermatology, Medical University of Graz, Graz, Austria
Address correspondence and reprint requests to: Maria Antonietta Pizzichetta, MD, Division of Medical Oncology C–Preventive Oncology, Centro di Riferimento Oncologico, Via Pedemontana Occidentale 12, 33081 Aviano, Italy, or e-mail: pizzichetta@cro.it
The authors have indicated no significant interest with commercial supporters.
Abstract
BACKGROUND
The dermoscopic diagnosis of cutaneous melanoma (CM) may be difficult because some CM lack specific dermoscopic features for melanoma diagnosis.
OBJECTIVE
To evaluate whether a diagnosis of CM could be achieved using the classic dermoscopic melanoma-specific criteria, we conducted a retrospective multicenter study of 508 CM samples.
METHODS
All the dermoscopic images were analyzed to identify the dermoscopic criteria found in dermoscopically difficult melanomas (DDM) and to examine the possible relation of dermoscopic diagnosis with respect to the difficulty of the dermoscopic diagnosis and the melanoma thickness.
RESULTS
A significant percentage of melanomas, 89 of 508 (17.5%), were DDM. The criteria leading to a significant increased risk of DDM were presence of streaks [odds ratio (OR), 2.26; 95% confidence interval (CI), 1.15–4.47), absence or presence of regular pigmentation (OR, 3.41; 95% CI, 1.70–6.85), absence of a blue-whitish veil (OR, 4.04; 95% CI, 2.33–6.99), absence of regression structures (OR, 4.31; 95% CI, 2.42–7.66), and the presence of hypopigmentation (OR, 2.61; 95% CI, 1.49–4.58).
CONCLUSION
A significant number of melanomas defy even dermoscopic diagnosis. Only a meticulous comparative and interactive process based on an assessment of all the individual's other nevi ("ugly ducking" sign) and a knowledge about recent changes can lead to the recognition of DDM.
Dermoscopic Features of Difficult Melanoma
MARIA A. PIZZICHETTA, MD**Centro di Riferimento Oncologico, CRO, Aviano, Italy; , IGNAZIO STANGANELLI, MDSkin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; , RICCARDO BONO, MDIstituto Dermopatico dell'Immacolata, IRCCS, Roma, Italy; , H. PETER SOYER, MD§§Department of Dermatology, Medical University of Graz, Graz, Austria, SERENA MAGI, SCDSkin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; , VINCENZO CANZONIERI, MD**Centro di Riferimento Oncologico, CRO, Aviano, Italy; , GIUSEPPE LANZANOVA, MDSkin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; , GIORGIO ANNESSI, MDIstituto Dermopatico dell'Immacolata, IRCCS, Roma, Italy; , CESARE MASSONE, MD§§Department of Dermatology, Medical University of Graz, Graz, Austria, LORENZO CERRONI, MD§§Department of Dermatology, Medical University of Graz, Graz, Austria, AND RENATO TALAMINI, SCD**Centro di Riferimento Oncologico, CRO, Aviano, Italy; , ON BEHALF OF THE ITALIAN MELANOMA INTERGROUP (IMI)*Centro di Riferimento Oncologico, CRO, Aviano, Italy; Skin Cancer Unit, Ravenna-Niguarda Hospital, Milan, Italy; Istituto Dermopatico dell'Immacolata, IRCCS, Roma, Italy; §Department of Dermatology, Medical University of Graz, Graz, Austria
Address correspondence and reprint requests to: Maria Antonietta Pizzichetta, MD, Division of Medical Oncology C–Preventive Oncology, Centro di Riferimento Oncologico, Via Pedemontana Occidentale 12, 33081 Aviano, Italy, or e-mail: pizzichetta@cro.it
The authors have indicated no significant interest with commercial supporters.
Abstract
BACKGROUND
The dermoscopic diagnosis of cutaneous melanoma (CM) may be difficult because some CM lack specific dermoscopic features for melanoma diagnosis.
OBJECTIVE
To evaluate whether a diagnosis of CM could be achieved using the classic dermoscopic melanoma-specific criteria, we conducted a retrospective multicenter study of 508 CM samples.
METHODS
All the dermoscopic images were analyzed to identify the dermoscopic criteria found in dermoscopically difficult melanomas (DDM) and to examine the possible relation of dermoscopic diagnosis with respect to the difficulty of the dermoscopic diagnosis and the melanoma thickness.
RESULTS
A significant percentage of melanomas, 89 of 508 (17.5%), were DDM. The criteria leading to a significant increased risk of DDM were presence of streaks [odds ratio (OR), 2.26; 95% confidence interval (CI), 1.15–4.47), absence or presence of regular pigmentation (OR, 3.41; 95% CI, 1.70–6.85), absence of a blue-whitish veil (OR, 4.04; 95% CI, 2.33–6.99), absence of regression structures (OR, 4.31; 95% CI, 2.42–7.66), and the presence of hypopigmentation (OR, 2.61; 95% CI, 1.49–4.58).
CONCLUSION
A significant number of melanomas defy even dermoscopic diagnosis. Only a meticulous comparative and interactive process based on an assessment of all the individual's other nevi ("ugly ducking" sign) and a knowledge about recent changes can lead to the recognition of DDM.
BCC on the trunk and sun exposure
Bcc differs from Scc in that many lesions arise often in non sun exposed areas. It does not correlate as well with total sun exposure as Scc and solar keratoses.These authors point out that the frequency of Bcc on the trunk does correlate with excessive sun exposure. They looked at the different frequency of these superficial variants on the head and neck and the trunk.
Journal of the American Academy of Dermatology
Volume 56, Issue 3 , March 2007, Pages 380-386
Basal cell carcinoma on the trunk is associated with excessive sun exposure
Rachel E. Neale PhDa, Marcia Davis MPHb, Nirmala Pandeya MMedScib, David C. Whiteman PhDb and Adele C. Green PhDb
aFrom the Queensland Cancer Fund
bQueensland Institute of Medical Research
Accepted 20 August 2006. Spring Hill, Queensland, Australia. Available online 13 October 2006.
Background and Objective
Basal cell carcinoma (BCC) is the most common of all cancers. Ultraviolet radiation is the major etiologic agent in the pathogenesis of BCC, but there is not a straightforward relationship between cumulative exposure and risk. A high proportion of lesions arise on the trunk, which is generally much less exposed to the sun than the head, the major site affected. We tested the hypothesis that the phenotypic determinants and patterns of sun exposure that give rise to BCC on the head and trunk vary in a way that explains the anomalous site distribution.
Methods
The study was set in the context of the Nambour Skin Cancer Study, a community-based follow-up study among 1621 participants with virtually complete ascertainment of BCCs between 1992 and 2004. We compared phenotypic and sun exposure characteristics of participants who developed a first BCC of the head or trunk with those of participants who had no diagnosis of BCC.
Results
BCCs of the trunk were more likely to occur in men; they also occurred at a younger age than BCCs of the head. There was a positive association between sun sensitivity and BCC of the head that was absent for BCC of the trunk. A high number of solar keratoses conferred a greater than 3-fold risk for BCCs of both the head and the trunk. BCCs of the trunk had a particularly strong association with the number of reported sunburns and solar lentigines on the trunk, whereas many lentigines conferred a greater than 3-fold risk of truncal BCC compared with a 50% increased risk of BCC of the head.
Limitations
The relatively small numbers of tumors may have limited our ability to detect statistically significant differences.
Conclusions
BCCs of the trunk are the result of overexposure of the sensitive basal cells of the epidermis to ultraviolet radiation. This may result from acute intense exposures sufficient to cause sunburn among people whose ability to tan makes the skin of their face generally less susceptible to the carcinogenic effects of ultraviolet radiation.
Journal of the American Academy of Dermatology
Volume 56, Issue 3 , March 2007, Pages 380-386
Basal cell carcinoma on the trunk is associated with excessive sun exposure
Rachel E. Neale PhDa, Marcia Davis MPHb, Nirmala Pandeya MMedScib, David C. Whiteman PhDb and Adele C. Green PhDb
aFrom the Queensland Cancer Fund
bQueensland Institute of Medical Research
Accepted 20 August 2006. Spring Hill, Queensland, Australia. Available online 13 October 2006.
Background and Objective
Basal cell carcinoma (BCC) is the most common of all cancers. Ultraviolet radiation is the major etiologic agent in the pathogenesis of BCC, but there is not a straightforward relationship between cumulative exposure and risk. A high proportion of lesions arise on the trunk, which is generally much less exposed to the sun than the head, the major site affected. We tested the hypothesis that the phenotypic determinants and patterns of sun exposure that give rise to BCC on the head and trunk vary in a way that explains the anomalous site distribution.
Methods
The study was set in the context of the Nambour Skin Cancer Study, a community-based follow-up study among 1621 participants with virtually complete ascertainment of BCCs between 1992 and 2004. We compared phenotypic and sun exposure characteristics of participants who developed a first BCC of the head or trunk with those of participants who had no diagnosis of BCC.
Results
BCCs of the trunk were more likely to occur in men; they also occurred at a younger age than BCCs of the head. There was a positive association between sun sensitivity and BCC of the head that was absent for BCC of the trunk. A high number of solar keratoses conferred a greater than 3-fold risk for BCCs of both the head and the trunk. BCCs of the trunk had a particularly strong association with the number of reported sunburns and solar lentigines on the trunk, whereas many lentigines conferred a greater than 3-fold risk of truncal BCC compared with a 50% increased risk of BCC of the head.
Limitations
The relatively small numbers of tumors may have limited our ability to detect statistically significant differences.
Conclusions
BCCs of the trunk are the result of overexposure of the sensitive basal cells of the epidermis to ultraviolet radiation. This may result from acute intense exposures sufficient to cause sunburn among people whose ability to tan makes the skin of their face generally less susceptible to the carcinogenic effects of ultraviolet radiation.
Tuesday, March 6, 2007
Distinguishing primary skin carcinomas from metastatic adenocarcinoma.
You may think this is an esoteric topic but recently I had a patient sent to me who had a small nodule biopsied and after extensive tests reported as a metastatic adenocarcinoma to the skin by a locum histopathologist. The patient then had two weeks of mental torture being tested with every known scan to find the primary bfore the other pathologist came back and reviewed the slides and did other tests to change the diagnosis back to a poorly differentiated Scc. This test could have helped early on.
Podoplanin is a Highly Sensitive and Specific Marker to Distinguish Primary Skin Adnexal Carcinomas From Adenocarcinomas Metastatic to Skin.
Original Articles
American Journal of Surgical Pathology. 31(2):304-310, February 2007.
Liang, Haohai MD *; Wu, Hong MD, PhD +; Giorgadze, Tamar A. MD, PhD ++; Sariya, Dinesh MD +; Bellucci, Kirsten S.W. MD *; Veerappan, Ranjitha MD ++; Liegl, Bernadette MD [S]; Acs, Geza MD, PhD *; Elenitsas, Rosalie MD [//]; Shukla, Shruti MD ++; Youngberg, George A. MD [P]; Coogan, Philip S. MD ++; Pasha, Theresa *; Zhang, Paul J. MD *; Xu, Xiaowei MD, PhD *
Abstract:
Distinction of primary skin adnexal carcinomas from cutaneous metastasis of adenocarcinomas is challenging. In this study, we evaluated podoplanin immunoreactivity in a series of primary skin adnexal tumors and adenocarcinomas metastatic to skin using a D2-40 antibody. The initial test series were composed of a total of 93 cases including 32 primary skin adnexal carcinomas, 46 benign primary adnexal tumors, and 15 cutaneous metastatic adenocarcinomas. We found that variable D2-40 reactivity was seen in all of the primary cutaneous carcinomas including sebaceous carcinomas (10/10), squamous cell carcinomas (10/10), porocarcinomas (4/4), trichilemmal carcinomas (4/4), skin adnexal carcinomas not otherwise specified (4/4), and in the majority of benign skin adnexal tumors. In contrast, no podoplanin immunoreactivity was seen in any of the 15 (0/15) cutaneous metastases. To confirm the initial findings and to further explore the utility of podoplanin reactivity in the distinction of these tumors, we also examined a test set of 35 unknown cases, including 21 adenocarcinomas metastatic to skin and 14 primary adnexal tumors, in a blinded fashion. In this test set of cases, podoplanin was negative in 22 cases and positive in 13 cases. Of the 22 podoplanin negative cases, 20 were proven to be metastatic adenocarcinoma. Of the 13 D2-40 positive cases, 12 were proven to be primary adnexal tumors. Our results suggest that podoplanin can be a useful tool to distinguish primary skin adnexal carcinomas form adenocarcinomas metastatic to skin with high sensitivity (94.5%) and specificity (97.2%).
(C) 2007 Lippincott Williams & Wilkins, Inc.
Podoplanin is a Highly Sensitive and Specific Marker to Distinguish Primary Skin Adnexal Carcinomas From Adenocarcinomas Metastatic to Skin.
Original Articles
American Journal of Surgical Pathology. 31(2):304-310, February 2007.
Liang, Haohai MD *; Wu, Hong MD, PhD +; Giorgadze, Tamar A. MD, PhD ++; Sariya, Dinesh MD +; Bellucci, Kirsten S.W. MD *; Veerappan, Ranjitha MD ++; Liegl, Bernadette MD [S]; Acs, Geza MD, PhD *; Elenitsas, Rosalie MD [//]; Shukla, Shruti MD ++; Youngberg, George A. MD [P]; Coogan, Philip S. MD ++; Pasha, Theresa *; Zhang, Paul J. MD *; Xu, Xiaowei MD, PhD *
Abstract:
Distinction of primary skin adnexal carcinomas from cutaneous metastasis of adenocarcinomas is challenging. In this study, we evaluated podoplanin immunoreactivity in a series of primary skin adnexal tumors and adenocarcinomas metastatic to skin using a D2-40 antibody. The initial test series were composed of a total of 93 cases including 32 primary skin adnexal carcinomas, 46 benign primary adnexal tumors, and 15 cutaneous metastatic adenocarcinomas. We found that variable D2-40 reactivity was seen in all of the primary cutaneous carcinomas including sebaceous carcinomas (10/10), squamous cell carcinomas (10/10), porocarcinomas (4/4), trichilemmal carcinomas (4/4), skin adnexal carcinomas not otherwise specified (4/4), and in the majority of benign skin adnexal tumors. In contrast, no podoplanin immunoreactivity was seen in any of the 15 (0/15) cutaneous metastases. To confirm the initial findings and to further explore the utility of podoplanin reactivity in the distinction of these tumors, we also examined a test set of 35 unknown cases, including 21 adenocarcinomas metastatic to skin and 14 primary adnexal tumors, in a blinded fashion. In this test set of cases, podoplanin was negative in 22 cases and positive in 13 cases. Of the 22 podoplanin negative cases, 20 were proven to be metastatic adenocarcinoma. Of the 13 D2-40 positive cases, 12 were proven to be primary adnexal tumors. Our results suggest that podoplanin can be a useful tool to distinguish primary skin adnexal carcinomas form adenocarcinomas metastatic to skin with high sensitivity (94.5%) and specificity (97.2%).
(C) 2007 Lippincott Williams & Wilkins, Inc.
Tumour infiltrating lymphocytes and melanoma
Journal of Clinical Oncology, Vol 25, No 7 (March 1), 2007: pp. 869-875
© 2007 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2006.08.9755
Lack of Tumor-Infiltrating Lymphocytes Predict Sentinel Lymph Node Positivity in Patients With Cutaneous Melanoma
Rebecca C. Taylor, Ami Patel, Katherine S. Panageas, Klaus J. Busam, Mary S. Brady
From the Departments of Surgery, Biostatistics, and Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
Address reprint requests to Mary S. Brady, MD, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, H1212, New York, NY 10021; e-mail: bradym@mskcc.org
Purpose: Tumor-infiltrating lymphocytes (TILs) are considered a manifestation of the host immune response to tumor, but the influence of TILs on outcome remains controversial. Studies evaluating the prognostic significance of TILs were published before routine examination of draining lymph nodes by sentinel lymph node (SLN) biopsy, the most important predictor of survival in patients with melanoma. The prognostic implications of TILs were re-evaluated in a large group of patients undergoing SLN biopsy at our institution.
Patients and Methods: All patients who underwent SLN mapping for primary cutaneous melanoma between January 1996 and July 2005 were evaluated. Univariate and multivariate analyses were performed to assess factors that predict SLN positivity and survival. Factors analyzed included Breslow thickness, ulceration, anatomic site, sex, Clark level, age, mitotic rate, and the presence (brisk or nonbrisk) or absence of TIL.
Results: Eight hundred eighty-seven patients underwent SLN mapping, and a SLN was identified in 875 patients (98.8%). The SLN was positive for tumor in 156 patients (17.6%). Multivariate analysis revealed that only Breslow thickness (P < .0001), ulceration (P = .0004), male sex (P = .03), and absent TILs (P = .0003) were independently predictive of the presence of SLN metastases. In melanomas with a brisk TIL infiltrate, the probability of a positive SLN was 3.9% as compared with 26.2% for melanomas in which TILs were absent. TILs were not an independent predictive factor for survival.
Conclusion: The absence of TILs, together with increasing Breslow thickness, presence of ulceration and male sex, predicts SLN metastasis in patients undergoing SLN biopsy for primary cutaneous melanoma.
© 2007 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2006.08.9755
Lack of Tumor-Infiltrating Lymphocytes Predict Sentinel Lymph Node Positivity in Patients With Cutaneous Melanoma
Rebecca C. Taylor, Ami Patel, Katherine S. Panageas, Klaus J. Busam, Mary S. Brady
From the Departments of Surgery, Biostatistics, and Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
Address reprint requests to Mary S. Brady, MD, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, H1212, New York, NY 10021; e-mail: bradym@mskcc.org
Purpose: Tumor-infiltrating lymphocytes (TILs) are considered a manifestation of the host immune response to tumor, but the influence of TILs on outcome remains controversial. Studies evaluating the prognostic significance of TILs were published before routine examination of draining lymph nodes by sentinel lymph node (SLN) biopsy, the most important predictor of survival in patients with melanoma. The prognostic implications of TILs were re-evaluated in a large group of patients undergoing SLN biopsy at our institution.
Patients and Methods: All patients who underwent SLN mapping for primary cutaneous melanoma between January 1996 and July 2005 were evaluated. Univariate and multivariate analyses were performed to assess factors that predict SLN positivity and survival. Factors analyzed included Breslow thickness, ulceration, anatomic site, sex, Clark level, age, mitotic rate, and the presence (brisk or nonbrisk) or absence of TIL.
Results: Eight hundred eighty-seven patients underwent SLN mapping, and a SLN was identified in 875 patients (98.8%). The SLN was positive for tumor in 156 patients (17.6%). Multivariate analysis revealed that only Breslow thickness (P < .0001), ulceration (P = .0004), male sex (P = .03), and absent TILs (P = .0003) were independently predictive of the presence of SLN metastases. In melanomas with a brisk TIL infiltrate, the probability of a positive SLN was 3.9% as compared with 26.2% for melanomas in which TILs were absent. TILs were not an independent predictive factor for survival.
Conclusion: The absence of TILs, together with increasing Breslow thickness, presence of ulceration and male sex, predicts SLN metastasis in patients undergoing SLN biopsy for primary cutaneous melanoma.
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