What predicts severe histological dysplasia/early melanoma in excised atypical melanocytic lesions

For me this is a useless study that probably would not apply in Australia. They apparently did not use dermatoscopy to assess the degree of atypia but only looked at clinical factors. The older you are the more likely the excised pigmented lesion is to show atypia. Marvellous!

A retrospective study addressed to understanding what predicts severe histological dysplasia/early melanoma in excised atypical melanocytic lesions.Strauss RM, Elliott F, Affleck P, Boon AP, Newton-Bishop JA.
Department of Dermatology, Leeds General Infirmary and St James’s University Hospital, Leeds LS9 7TF, U.K.

Background Atypical naevi are common benign skin lesions but are also recognized both as precursors of and risk factors for melanoma. It is therefore imperative to excise those lesions that are either likely to progress or are already progressing to melanoma. Clinically, however, it may be difficult to distinguish these from benign atypical naevi with bland histology. Objectives To analyse the clinical characteristics of excised melanocytic lesions and to identify the predictors of severe histological atypia/melanoma in situ and invasive melanoma. Methods The case notes of 434 patients who had melanocytic lesions removed at a pigmented lesion clinic were studied retrospectively. A single pathologist reviewed the excised lesions and clinical characteristics predictive of malignancy were identified. Results The best predictors of melanoma were older age, history of change and site on an extremity, but only older age was predictive of severe histological atypia/melanoma in situ as opposed to mild to moderate atypical histology. Conclusions These results confirm the difficulty of differentiating accurately between benign atypical naevi and borderline lesions or early melanoma in a clinical setting. It is therefore necessary to have a sufficiently low threshold for excision to avoid missing early melanomas, particularly in older patients presenting with lesions on the extremities.

NM23 protein in primary cutaneous melanoma

This is an interesting article with a presumably simple test that inversely correlates with adverse prognostic factors in melanoma.

Dermatopathological indicators of poor melanoma prognosis are significantly inversely correlated with the expression of NM23 protein in primary cutaneous melanoma
Authors: Ferrari, Donata; Lombardi, Mara1; Ricci, Roberto2; Michiara, Maria3; Santini, Marcello1; De Panfilis, Giuseppe1

Source: Journal of Cutaneous Pathology, Volume 34, Number 9, September 2007 , pp. 705-712(8)
Abstract:

Background: 

Some dermatopathological parameters are recognized as dominant indicators of high metastatic potential in melanoma, especially Breslow thickness, ulceration, Clark's level of invasion and mitotic rate. Because NM23 protein is the product of a melanoma metastasis suppressor gene, the aim of this study was to compare such dermatopathological indicators of melanoma prognosis with NM23 protein expression in primary cutaneous melanoma. Methods: 

The immunohistochemical NM23 expression was semiquantitatively assessed in 30 primary cutaneous melanomas. Ten dermatopathological parameters were evaluated and compared with NM23 expression. Results: 

A significant inverse correlation was found for NM23 expression in comparison with Breslow thickness (p < 0.01), ulceration (p < 0.05), Clark's level (p < 0.01), mitotic rate (p < 0.05), and vertical growth phase (p < 0.05). By contrast, no significant correlation was found for NM23 expression in comparison with cell morphology, presence of adjacent nevus, pigmentation, tumor-infiltrating lymphocytes, and regression was impossible to evaluate.
Conclusions: 

The expression of NM23 protein in primary cutaneous melanoma is significantly inversely correlated with dermatopathological parameters currently recognized as powerful indicators of melanoma prognosis. NM23 may be therefore considered in the dermatopathological evaluation of primary cutaneous melanoma.

Dermatoscopy of Dermatofibromas

Conventional and Polarized Dermoscopy Features of Dermatofibroma
Anna Liza C. Agero, MD; Salvatore Taliercio; Stephen W. Dusza, MPH; Cristina Salaro, MD; Paul Chu, MD; Ashfaq A. Marghoob, MD


Arch Dermatol. 2006;142:1431-1437.

Objective To evaluate dermoscopic features and patterns of dermatofibromas using conventional and polarized light dermoscopy.

Design Dermatofibromas were imaged using conventional nonpolarized contact dermoscopy (NPD), polarized contact dermoscopy (PCD), and polarized noncontact dermoscopy, followed by evaluation and comparison of dermoscopic features of the lesions.

Setting Dermatology clinic specializing in pigmented lesions.

Patients Fifty patients with dermatofibromas.

Results The most common features of dermatofibromas observed with NPD and PCD were central white scarlike patches (37 [74%] and 42 [84%], respectively), brown globulelike structures (21 [42%] and 22 [44%]), vascular structures (24 [48%] and 22 [44%]), and a peripheral fine pigmented network (36 [72%] for both). A newly described feature observed with PCD was a central white patch characterized by shiny white streaks. With polarized noncontact dermoscopy, the most characteristic feature was a central pink hue or "vascular blush" (44 [88%]) and visibility of blood vessels (41 [82%]). The most common pattern identified with NPD and PCD was the combination of a peripheral pigmented network and a central white patch in 28 (56%) and 31 (62%) of lesions, respectively. With polarized noncontact dermoscopy, the most common pattern was a central pink hue with a peripheral pigmented network (23 [46%]). There was good to excellent agreement when comparing NPD with PCD images, but there was a variable level of agreement when polarized noncontact dermoscopy images were compared with NPD and PCD images.

Conclusions Conventional and polarized light dermoscopy are not equivalent but may be complementary. This study highlights some salient differences. We were able to identify new dermoscopic features and patterns not previously described with conventional dermoscopy. These new criteria can aid in the diagnosis of dermatofibroma.


Author Affiliations: Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York (Drs Agero, Salaro, and Marghoob and Mr Dusza); Albany Medical College, Albany (Mr Taliercio); and Pathology Associates, Port Chester (Dr Chu), NY.







THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES


Differences Between Polarized Light Dermoscopy and Immersion Contact Dermoscopy for the Evaluation of Skin Lesions
Benvenuto-Andrade et al.
Arch Dermatol 2007;143:329-338.
ABSTRACT | FULL TEXT

Combined malignant melanoma and basal cell carcinoma

J Cutan Pathol. 2007 Sep;34(9):731-5. Links
Combined malignant melanoma and basal cell carcinoma tumor of the intermingled type.Braun-Falco M.
Department of Dermatology, University Medical Center Freiburg, Freiburg, Germany.

Background: The combination of malignant melanoma (MM) and basal cell carcinoma (BCC) within a single tumor is an unusual finding. Case report: An 84-year-old white man with a pigmented tumor on the back showing a combination of MM and BCC. Results: A 1.5 x 1.5-cm irregular brown lesion on the back was clinically suggestive of MM. Histopathologically, the lesions turned out to be a combined tumor consisting of a superficial BCC and a regressive MM with a tumor thickness of 1.25 mm. The conglomerates of the BCC lay within the MM and were admixed with a high number of Melan-A-positive melanocytic cells. Conclusion: By reviewing the low number of published cases, we found that a combined MM-BCC tumor exists in two variants: a collision type in which components of each cell type are clearly demarcated and an intermingled type in which both cell types grow intimately together. Although both types occur as a mere incidence, in particular, the intermingled type may be diagnostically challenging and the evaluation of its dignity may be questionable.

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Malignant melanoma of the anal region

Malignant melanoma of the anal region
Authors: Heyn, J.; Placzek, M.1; Ozimek, A.; Baumgaertner, A. K.2; Siebeck, M.; Volkenandt, M.1

Source: Clinical & Experimental Dermatology, Volume 32, Number 5, September 2007 , pp. 603-607(5)

Publisher: Blackwell Publishing
Abstract:

Summary

Malignant melanoma (MM) of the anal region is an uncommon disease. In many cases, the disease is undetected or mistaken for a benign polyp or haemorrhoids until it reaches an advanced state. Owing to delayed diagnosis and early metastases, the prognosis is often poor. In contrast to melanomas of the skin, a history of sun exposure does not seem to have an impact in development of MM in this region. Anorectal melanomas (AM) are most common in the rectum, followed by the anal canal and anal verge. Ras mutations, especially in codon 61 of the N-ras oncogene, are common in CM and rare in melanomas of the vulva and anorectum. The diagnosis of an AM is usually made using a biopsy. Histopathological examinations show spindle-shaped and pleomorphic cells. Adjuvant immunohistological markers are the calcium-binding protein S-100, the melanoma antigen HMB-45, the melanoma-expressed protein Melan A, and microphthalmia-associated transcription factor (MiTF). To date, there are few published guidelines for the correct management of AM, and surgery remains the mainstay of treatment. We report on a 39-year old man who presented with a 5-week history of recurrent prolapse of an anal tumour. The tumour was histologically confirmed to be malignant melanoma.

How Does Inflammation Cause Skin Cancers?

How Does Inflammation Cause Skin Cancers?
Observations and controlled animal studies suggest that chronic inflammation induces SCCs; we may now know a bit more about how.

Chemokines are cytokines that attract lymphocytes. In skin, the CC class of chemokines may be especially important. Antigen-experienced T cells express CC-type receptors (CCRs); indeed, CCR4 mediates homing of cutaneous T cells. A novel chemokine receptor, D6, soaks up these CC chemokines and, in normal circumstances, helps shut off inflammation by making the chemokines unavailable.

Now, a group of researchers reports that D6-deficient mice show greatly increased susceptibility to developing papillomas induced by the inflammation-producing carcinogen phorbol ester. In contrast, transgenic mice with lots of D6 are resistant to tumor formation. Without D6 receptors, CC chemokine ligand-3 (CCL3) continues to attract aberrantly (in excess, and for a longer time) CD3+ T cells and dermal mast cells.

Comment: Infiltration of CD3+ T cells and dermal mast cells has previously been associated with development of skin cancer. The resultant excess in cytokines and cells leads to epidermal hyperproliferation and ras-driven tumor formation. The chronic presence of T cells and mast cells and persisting inflammation also increase the tendency for squamous cell carcinomas to invade and metastasize.

Chronic inflammation in human oral mucosa — from tobacco carcinogens, human papillomavirus, or chronic allergic stomatitis — may cause chronic overproduction of CC chemokines. Perhaps these abundant CC chemokines saturate all D6 receptors, allowing the overflow to bind to active CCRs and induce cancers. Many SCCs of the oral mucosa are driven by ras mutations, so ras-driven proliferation of squamous cells by chemokines has potential clinical relevance, including for possible interventions. Most SCCs in skin are based on mutations of p53 rather than ras. We don’t know yet if excessive tissue chemokine levels foster gain-of-function mutations of p53.

— Mark V. Dahl, MD

Eccrine Porocarcinoma

Eccrine porocarcinoma: Clinical and pathological studies of 12 cases Authors: SHIOHARA, Junko; KOGA, Hiroshi; UHARA, Hisashi; TAKATA, Minoru; SAIDA, Toshiaki

Source: Journal of Dermatology, Volume 34, Number 8, August 2007 , pp. 516-522(7)

Publisher: Blackwell


Abstract:


Twelve cases of eccrine porocarcinoma have been reported at our facility in the past 10 years. All of them were Japanese; half had lymph node metastases; and one-third died of this disease. Lymph node metastasis was correlated with pathological lymphovascular invasion. Death was correlated with a pathological growth pattern and clinical lymph node metastasis. Sentinel lymph node biopsy was performed usefully in two patients.