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JAAD Case Reports Feb 2023
PubMed: 36620496
DOI: 10.1016/j.jdcr.2022.11.032 -
Cureus May 2024Vulvar melanoma (VM) is a rare and aggressive malignancy presenting unique challenges in diagnosis and management. This report presents the case of a 61-year-old female...
Vulvar melanoma (VM) is a rare and aggressive malignancy presenting unique challenges in diagnosis and management. This report presents the case of a 61-year-old female patient and explores the clinical characteristics, diagnostic modalities, treatment strategies, and prognosis associated with VM. The patient presented with a painless mass on the labia majora, which turned out to be an undifferentiated malignant tumor process consistent with melanoma on examination. Immunohistochemical analysis confirmed the diagnosis and subsequent imaging revealed metastatic disease necessitating palliative chemotherapy following radiotherapy. VM is a rare and aggressive form of melanoma. While surgery is the standard of care for early stages, advanced stages require a combination of immunotherapy and targeted treatments. Clinical trials are vital to improve our understanding of this condition and the various aspects of its care. Collaboration among experts is essential to achieve progress in managing these patients.
PubMed: 38872659
DOI: 10.7759/cureus.60257 -
Dermatology Practical & Conceptual Jan 2024Pigmentation of lip and/or genitalia is mainly due to the development of benign melanotic macules, with a less occurrence of melanocytic and other non-melanocytic...
INTRODUCTION
Pigmentation of lip and/or genitalia is mainly due to the development of benign melanotic macules, with a less occurrence of melanocytic and other non-melanocytic lesions. Mucosal melanoma has worse prognosis compared with cutaneous counterpart, hence identification of atypical features for an early diagnosis is crucial.
OBJECTIVES
The aim of this study was to report further data of confocal features characterizing pigmented mucosal lesions of genital area and of the lips and test the diagnostic role of the reflectance confocal microscopy (RCM)lip score.
METHODS
Clinical, dermoscopic and RCM images of histologically proven pigmented lesions, involving the genital area (vulva or glans penis) and lip, were retrospectively reviewed. RCM images were evaluated for malignant criteria, and statistical analysis was conducted for categorical variables.
RESULTS
Seventy pigmented lesions were included in the study and divided into two groups based on the body area location: lip (17) and genital area (53). Architectural disarray (P = 0.002), dendritic (P = 0.031) and roundish cells in epidermis (P < 0.0001), interpapillary dendritic cells (P = 0.039) and junctional atypical cells (P = 0.002) were associated to genital melanoma. Melanoma involving the lip was characterized by roundish cells in epidermis, a criterion found in one labial benign lesion, only (P = 0.005). Main limitations of the study are the inclusion of low melanomas and the presence of epidermal dendritic cells in melanosis and melanoma, as a confusing factor in imaging.
CONCLUSIONS
Dermatologists should consider confocal microscopy as an adjunctive tool to dermoscopy in the differential diagnosis of pigmented mucosal lesions, especially in presence of clinical and dermoscopic findings suspicious for malignancy.
PubMed: 38364417
DOI: 10.5826/dpc.1401a28 -
PLoS Biology Feb 2022Cell invasion is an initiating event during tumor cell metastasis and an essential process during development. A screen of C. elegans orthologs of genes overexpressed in...
Cell invasion is an initiating event during tumor cell metastasis and an essential process during development. A screen of C. elegans orthologs of genes overexpressed in invasive human melanoma cells has identified several components of the conserved DNA pre-replication complex (pre-RC) as positive regulators of anchor cell (AC) invasion. The pre-RC genes function cell-autonomously in the G1-arrested AC to promote invasion, independently of their role in licensing DNA replication origins in proliferating cells. While the helicase activity of the pre-RC is necessary for AC invasion, the downstream acting DNA replication initiation factors are not required. The pre-RC promotes the invasive fate by regulating the expression of extracellular matrix genes and components of the PI3K signaling pathway. Increasing PI3K pathway activity partially suppressed the AC invasion defects caused by pre-RC depletion, suggesting that the PI3K pathway is one critical pre-RC target. We propose that the pre-RC, or a part of it, acts in the postmitotic AC as a transcriptional regulator that facilitates the switch to an invasive phenotype.
Topics: Animals; Animals, Genetically Modified; Caenorhabditis elegans; Caenorhabditis elegans Proteins; Cell Cycle; Cell Movement; DNA Replication; Female; Gene Expression Profiling; Gene Ontology; Larva; Phosphatidylinositol 3-Kinases; Replication Origin; Signal Transduction; Vulva
PubMed: 35192608
DOI: 10.1371/journal.pbio.3001317 -
JAAD Case Reports Aug 2023
PubMed: 37600735
DOI: 10.1016/j.jdcr.2023.05.037 -
Oncology Letters Dec 2022Melanoma is known to be insensitive to radiotherapy; however, the present study reports the case of a patient with vulvar malignant melanoma in which near complete...
Melanoma is known to be insensitive to radiotherapy; however, the present study reports the case of a patient with vulvar malignant melanoma in which near complete remission of the target area was observed after implementing immune checkpoint inhibitors (ICIs) and hypo-fractionated radiotherapy (HFRT). The patient was treated with an intensity-modulated radiation therapy technique that delivered a hypo-fractionated dose of 3,000 cGy in six fractions. After 3 days, the patient underwent immunotherapy with two cycles of 240 mg triprizumab every 2 weeks. Tumors that underwent radiotherapy had markedly decreased in size and a near complete remission of the melanoma was observed 4 months after radiotherapy. However, the metastases in the liver and lungs continued to grow, new metastases appeared in the abdominal subcutaneous tissue and enlarged lymph nodes were observed in the pelvic area. The results of the present study indicated that ICIs and HFRT exert a marked local effect, but no abscopal effect.
PubMed: 36380876
DOI: 10.3892/ol.2022.13578 -
Nuklearmedizin. Nuclear Medicine May 2024The authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma, in breast cancer, in penile and vulva tumors, in...
The authors present a procedure guideline for scintigraphic detection of sentinel lymph nodes in malignant melanoma, in breast cancer, in penile and vulva tumors, in head and neck cancer, and in prostate carcinoma. Important goals of sentinel lymph node scintigraphy comprise reduction of the extent of surgery, lower postoperative morbidity and optimization of histopathological examination focussing on relevant lymph nodes. Sentinel lymph node scintigraphy itself does not diagnose tumorous lymph node involvement and is not indicated when lymph node or distant metastases have been definitely diagnosed before sentinel lymph node scintigraphy. Procedures are compiled with the aim to reliably localise sentinel lymph nodes with a high detection rate typically in early tumour stages. New aspects in this guideline are new radiopharmaceuticals such as tilmanocept and Tc-99m-PSMA and SPECT/CT allowing an easier anatomical orientation. Initial dynamic lymphoscintigraphy in breast cancer is of little significance nowadays. Radiation exposure is low so that pregnancy is not a contraindication for sentinel lymph node scintigraphy. A one-day protocol should preferentially be used. Even with high volumes of scintigraphic sentinel lymph node procedures surgeons, theatre staff and pathologists receive a radiation exposure < 1 mSv/year so that they do not require occupational radiation surveillance. Aspects of quality control were included (scintigraphy, quality control of gamma probe, 6 h SLN course for surgeons, certified breast centers, medical surveillance center).
PubMed: 38788776
DOI: 10.1055/a-2319-8306 -
The Pan African Medical Journal 2021Malignant melanoma of the vulva is a rare and aggressive tumour with dismal prognosis. It tends to recur and metastasize early. Surgical excision with or without...
Malignant melanoma of the vulva is a rare and aggressive tumour with dismal prognosis. It tends to recur and metastasize early. Surgical excision with or without regional lymph node dissection is still the treatment of choice with adjuvant therapy decided on a case by case. Furthermore, HIV infection has been associated with more aggressive disease. Herein we present a 45-year-old HIV-infected female patient on antiretroviral therapy who presented with vulval ulcer for one year. On examination, she had ulcerated nodule on the labia majora. Radiology showed vulvovaginal tumour without involvement of the adjacent organs. Malignant melanoma was confirmed on both the incisional biopsy and vulvectomy. She responded poorly to radiotherapy. Furthermore, she presented with recurrence and metastatic disease a month after surgery. She was lost to follow-up clinic.
Topics: Anti-HIV Agents; Biopsy; Combined Modality Therapy; Female; HIV Infections; Humans; Melanoma; Middle Aged; Vulvar Neoplasms
PubMed: 33912285
DOI: 10.11604/pamj.2021.38.115.25864 -
Indian Journal of Surgical Oncology Sep 2019This retrospective study compared the immediate post-operative short-term outcomes of Lateral Approach-Video Endoscopic Inguinal Lymphadenectomy (L-VEIL) and open...
This retrospective study compared the immediate post-operative short-term outcomes of Lateral Approach-Video Endoscopic Inguinal Lymphadenectomy (L-VEIL) and open surgery approach in patients with TNM stage N0 and N1 tumors. Inguinal lymphadenectomies performed for various TNM stage N0 and N1 cancers between January 2011 and December 2015 at a single center were analyzed by collecting data from operation theater records and case files. Mean blood loss, operative time, drain output, nodal yield, nodal positivity, and complications were analyzed as post-procedural outcomes. Among the 116 surgeries performed, 92 were open surgery and 24 were L-VEIL. Compared with open surgery, L-VEIL led to significantly lower blood loss (64.8 mL vs. 23.3 mL; = 0.002), mean nodal yield (11.04 vs. 8.38; = 0.001), and mean hospital stay (3.08 vs. 8 days; < 0.001). However, the operative time was similar for both the groups (94.5 vs. 68.1 min; = 0.08). Complications that were significantly low in L-VEIL were flap necrosis [RR 1.29; 95% CI (1.03-1.72); < 0.001], wound dehiscence [RR 1.25; 95% CI (1.19-1.51); = 0.005), wound infection [RR 1.34; 95% CI (1.19-1.51); = 0.003], readmission [RR 1.3; 95% CI (1.17-1.44); = 0.005], and re-surgery [ = 0.014]. Occurrence of complications such as lymphocele [RR 1.25; 95% CI (0.33-4.78); = 0.5], lymphorrhea [RR 1.27; 95% CI (1.15-1.40); = 0.5], and pedal edema [ = 0.2] were similar for both the approaches. L-VEIL was effective and safe compared with open inguinal block dissection in treatment of various TNM stage N0 and N1 urogenital and skin cancers.
PubMed: 31496610
DOI: 10.1007/s13193-019-00951-4 -
Dermatology Practical & Conceptual May 2022
PubMed: 35646426
DOI: 10.5826/dpc.1202a50