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Eye (London, England) Apr 2023To provide evidence for long-term outcomes for margin-controlled excision of eyelid melanoma. (Observational Study)
Observational Study
OBJECTIVES
To provide evidence for long-term outcomes for margin-controlled excision of eyelid melanoma.
METHODS
Retrospective single-centre observational case series of patients treated for eyelid melanoma between 2007 and 2016, with a minimum of 5-year follow-up. Tumour excision involved rush-paraffin en face horizontal sections and delayed repair (Slow Mohs; SM).
RESULTS
Twenty-two cases were seen with a survival of 91% (two deaths from nodular and lentigo maligna melanoma) and seven with melanoma in situ (MIS). Invasive melanoma includes eight lentigo maligna melanoma, four nodular, two amelanotic and one desmoplastic. Mean Breslow thickness was 6 mm for invasive (range 0.5-26). Mean excision margin for MIS was 3 mm (range 2-5 mm) and for invasive was 5 mm (range 2-10). Further excisions were performed in nine (41%); two went on to recur. Local recurrence was 36%; six invasive (27%) at a mean of 24 months (range 1.5-5 years) and two for MIS at a mean of 15 months (range 1-1.5 years). Imaging occurred for suspected advanced disease. Sentinel node biopsy was not performed. Advanced melanoma therapy was performed in two cases. No vitamin D testing occurred.
CONCLUSIONS
Survival rates are in line with 90% overall survival in the UK. Prescriptive excision margins are not applicable in the periocular region and margin-controlled excision with a delayed repair is recommended, but patients need to know further excision may be needed to obtain clearance. Evidence recommending vitamin D therapy needs to be put into clinical practice. In addition, upstaging of MIS occurred advocating excision rather than observation of MIS. More studies are needed to determine the best management of eyelid melanoma.
Topics: Humans; Eyelid Neoplasms; Eyelids; Hutchinson's Melanotic Freckle; Melanoma; Neoplasm Recurrence, Local; Retrospective Studies; Skin Neoplasms; Melanoma, Cutaneous Malignant
PubMed: 36828958
DOI: 10.1038/s41433-023-02428-9 -
Frontiers in Oncology 2022Melanoma is a form of skin cancer that can rapidly invade distant organs. A distinctive feature of melanomas is their pigmentation status, as melanin is present in most...
Melanoma is a form of skin cancer that can rapidly invade distant organs. A distinctive feature of melanomas is their pigmentation status, as melanin is present in most skin melanomas, whilst many metastatic tumors could become amelanotic. Besides the obvious malfunction of the key genes of the melanin pathway, the amelanotic tumors could bear a characteristic molecular signature accounting for their aggressivity. Using mass spectrometry-based proteomics we report here a distinctive panel of biomarkers for amelanotic aggressive melanoma that differ from the less invasive pigmented cells. The developed method allows the label-free quantification of proteins identified by LC-MS/MS analysis. We found a set of proteins comprising AHNAK, MYOF, ANXA1, CAPN2, ASPH, EPHA2, THBS1, TGM2, ACTN4 along with proteins involved in cell adhesion/migration (integrins, PLEC, FSCN1, FN1) that are highly expressed in amelanotic melanoma. Accompanying the down regulation of pigmentation specific proteins such as tyrosinase and TYRP1, these biomarkers are highly specific for a type of highly invasive melanoma. Interestingly, the LC-MS/MS proteomics analysis in hypoxia revealed that the abundance of this specific set of proteins found in normoxia was rather unaltered in these conditions. These biomarkers could therefore predict a metastatic behaviour for the amelanotic cells in the early stages of the tumor development and thus serve in melanoma prognostic. Applying this algorithm to related databases including melanoma samples published by independent laboratories/public databases we confirm the specificity of the newly found signatures. Overall, we begin to unravel the molecular alterations in the amelanotic melanoma and how basic proteomics offers insights into how to assess the clinical, pathological and misdiagnosis differences between the main subtypes of melanoma.
PubMed: 36776379
DOI: 10.3389/fonc.2022.1061832 -
International Journal of Molecular... Jan 2023Melanoma is one of the fastest-growing cancers worldwide. Treatment of advanced melanoma is very difficult; therefore, there is growing interest in the identification of...
Melanoma is one of the fastest-growing cancers worldwide. Treatment of advanced melanoma is very difficult; therefore, there is growing interest in the identification of new therapeutic agents. Pterostilbene is a natural stilbene that has been found to have several pharmacological activities. The aim of this study was to evaluate the influence of pterostilbene on the proliferation and apoptosis of human melanoma cells. Proliferation of pterostilbene-treated amelanotic (C32) and melanotic (A2058) melanoma cells was determined by BRDU assay. Flow cytometric analyses were used to determine cell cycle progression, and further molecular investigations were performed using real-time RT-qPCR. The expression of the p21 protein and the DNA fragmentation assay were determined by the ELISA method. The results revealed that pterostilbene reduced the proliferation of both amelanotic and melanotic melanoma cells. Pterostilbene induced apoptosis in amelanotic C32 melanoma cells, and this effect was mediated by an increase in the expression of the , , and genes; induction of caspase 3 activity; and DNA degradation. Pterostilbene did not affect the activation of apoptosis in the A2058 cell line. It may be concluded that pterostilbene has anticancer potential against human melanoma cells; however, more studies are still needed to fully elucidate the effects of pterostilbene on amelanotic and melanotic melanoma cells.
Topics: Humans; Skin Neoplasms; Stilbenes; Melanoma, Amelanotic; Apoptosis; Cell Proliferation; Cell Line, Tumor; Melanoma, Cutaneous Malignant
PubMed: 36674631
DOI: 10.3390/ijms24021115 -
Pathology Mar 2023Desmoplastic melanoma is a subtype of melanoma characterised by amelanotic fusiform melanocytes dispersed in a collagenous stroma. Cell-poor and fibrous stroma-rich...
Desmoplastic melanoma is a subtype of melanoma characterised by amelanotic fusiform melanocytes dispersed in a collagenous stroma. Cell-poor and fibrous stroma-rich 'pure' variants have been distinguished from 'mixed' variants with areas of higher cell density and/or less desmoplastic stroma. This distinction is relevant because patients whose tumours display a pure phenotype have a lower risk for regional lymph node metastasis and distant recurrence. However, little is known about interobserver agreement among pathologists in the subclassification of desmoplastic melanoma. To address this issue, we conducted a study in which eleven dermatopathologists independently evaluated whole slide scanned images of excisions from 30 desmoplastic melanomas. The participating pathologists were asked to classify the tumours as pure or mixed. They were also asked to record the presence or absence of neurotropism and angiotropism. We found substantial interobserver agreement between the 11 dermatopathologists in the classification of tumours as pure versus mixed desmoplastic melanoma (kappa=0.64; p<0.0001). There was fair agreement between the 11 dermatopathologists in the evaluation of presence versus absence of neurotropism (kappa=0.26; p<0.0001), and slight agreement in the assessment of angiotropism (kappa=0.13; p<0.0001). The level of concordance in the subclassification of desmoplastic melanomas is encouraging for the acceptance of this prognostic parameter in the real-world practice of melanoma pathology.
Topics: Humans; Skin Neoplasms; Observer Variation; Melanoma; Prognosis
PubMed: 36653238
DOI: 10.1016/j.pathol.2022.12.347 -
Biotechnologia 2022Juglone is an allelopathin secreted by black walnut tree of the Juglandaceae family and is used as an active ingredient in many herbal preparations and as a commercial...
Juglone is an allelopathin secreted by black walnut tree of the Juglandaceae family and is used as an active ingredient in many herbal preparations and as a commercial dye. It is considered as an important phytochemical with wide therapeutic potential. Black walnut extract has long been used in folk medicine to treat various types of cancers. It demonstrates antiviral, antibacterial, antifungal, and antitumor activities. The present study aimed to analyze the effect of juglone on the viability and proliferation of melanoma cells of C-32 (amelanotic melanoma) and COLO 829 (melanotic melanoma) cell lines and on the mRNA expression of genes encoding the proapoptotic BAX protein and caspase 3 and the gene encoding antiapoptotic BCL2 protein. The results showed a dose-dependent effect of juglone on the viability, proliferation, and death induction in C-32 and COLO 829 melanoma cells and in HFF-1 normal dermal fibroblasts in cultures, but melanoma cells were more sensitive to juglone. Our findings revealed different mRNA expression patterns for all the studied genes in melanoma and normal cells treated with juglone in cultures.
PubMed: 36605377
DOI: 10.5114/bta.2022.113913 -
Polish Journal of Pathology : Official... 2023Anorectal melanoma is an exceptionally rare and aggressive form of cancer. One per cent of anorectal malignant tumours are anorectal malignant melanomas, which are...
Anorectal melanoma is an exceptionally rare and aggressive form of cancer. One per cent of anorectal malignant tumours are anorectal malignant melanomas, which are exceedingly uncommon. We report a case of a 47-year-old woman who experienced painless rectal bleeding. On examination, an irregular lump was seen in the posterior rectal wall, measuring 4 × 3.7 cm. Biopsies were obtained under endoscopic guidance for histomorphology and immunohistochemistry. The biopsy examination showed nests of tumour mass in the lamina and muscularis mucosae. The tumour mass was composed of round to oval cells having enlarged nuclei, conspicuous nucleoli, and a scant amount of cytoplasm. No melanin pigmentation was noted in the tumour cells. HMB-45, S-100, and vimentin were all detected by immunohistochemistry. A definitive diagnosis of amelanotic malignant melanoma was rendered. The patient underwent abdominoperineal resection with a hysterectomy and bilateral salpingo-oophorectomy. Anorectal melanoma presents with bleeding per rectum and is often misdiagnosed as internal haemorrhoids or adenocarcinoma clinically. Amelanotic melanoma, which lacks melanin pigment, is difficult to diagnose. Patients who appear with rectal bleeding should have a malignant melanoma evaluation as a possible differential diagnosis, and suitable diagnostic procedures, such as a colonoscopy and a biopsy with immunohistochemistry, should be carried out to arrive at a conclusive diagnosis.
Topics: Female; Humans; Middle Aged; Melanoma, Amelanotic; Rectal Neoplasms; Skin Neoplasms; Immunohistochemistry; Biopsy
PubMed: 38477093
DOI: 10.5114/pjp.2023.133846 -
American Journal of Ophthalmology Case... Mar 2023Malignant melanomas of the conjunctiva are extremely rare in children. In this case report we present a conjunctival melanoma of a child.
PURPOSE
Malignant melanomas of the conjunctiva are extremely rare in children. In this case report we present a conjunctival melanoma of a child.
OBSERVATIONS
We report a case of a 7 years old boy who presented with a rapidly growing reddish lesion measuring 8mm in base × 2.5 mm in thickness on the nasal conjunctiva in his right eye. The patient underwent resection of the lesion (with 4 mm margins of the surrounding clinically normal conjunctiva) and cryotherapy to the adjacent conjunctival margins. Histopathology confirmed the diagnosis of conjunctival melanoma. Pathology also can be challenging; a review of pathology is advisable as happened in this case. Systemic workup was negative for metastatic disease. On 73 months of follow up, the patient was stable without local recurrence or secondary systemic disease.
CONCLUSIONS AND IMPORTANCE
Malignant melanoma can present de novo as an amelanotic rapidly growing conjunctival lesion in children. This case should raise the awareness of the variable clinical presentations, the challenging diagnosis, treatment and follow up of pediatric conjunctival melanoma.
PubMed: 36582844
DOI: 10.1016/j.ajoc.2022.101735 -
Journal of Family & Reproductive Health Sep 2022Primary malignant urethral melanoma is a rare condition, concerning less than 1% of melanomas and 4% of all urethral cancers. The early treatment of urethral melanoma...
Primary malignant urethral melanoma is a rare condition, concerning less than 1% of melanomas and 4% of all urethral cancers. The early treatment of urethral melanoma is extremely important due to the tendency to early metastasis. 88-year-old Caucasian lady presented vaginal bleeding. At first Gynaecological examination an urethral caruncle with otherwise normal trans-vaginal ultrasound was diagnosed. The patient not reassured asked for a second consultation opting to remove the reddish fleshy polypoid lesion protruding from the urethra. Histology revealed a urethral amelanotic melanoma. The patient underwent an excission of the urethral lesion. Urologist, oncologist and gynaecologist at tumor board meeting, considering patient's age and negative PET, decided for conservative management with close clinical and imaging follow-up.7 months after, vaginal bleeding recurred and a nodule on the anterior vaginal wall was detected and biopsied and resulted a pigmented melanoma. The patient underwent a wide margin excision. At 10 months follow-up there were no evidence of recurrence nor distant metastasis. She started a prophylactic immunotherapy with Nivolumab; at her third administration she presented only asthenia as side effect. It is importanto to keep in mind the urethral amelanotic melanoma to allow an early removal or biopsy, preventing diagnostic delay/misdiagnosis and aiding either in better patient management or outcome.
PubMed: 36569257
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Nov 2022: Dermoscopy is a useful tool for the early and non-invasive diagnosis of skin malignancies. Besides many progresses, heavily pigmented and amelanotic skin tumors remain...
: Dermoscopy is a useful tool for the early and non-invasive diagnosis of skin malignancies. Besides many progresses, heavily pigmented and amelanotic skin tumors remain still a challenge. We aimed to investigate by dermoscopy if distinctive morphologic characteristics of vessels may help the diagnosis of equivocal nodular lesions. A collage of 16 challenging clinical and dermoscopic images of 8 amelanotic and 8 heavily pigmented nodular melanomas and basal cell carcinomas was sent via e-mail to 8 expert dermoscopists. Dermoscopy improved diagnostic accuracy in 40 cases. Vessels were considered the best clue in 71 cases. Focusing on the diameter of vessels improved diagnosis in 5 cases. vascular diameter in addition to morphology and arrangement may be a useful dermoscopic clue for the differential diagnosis of clinically equivocal nodular malignant tumors.
Topics: Humans; Skin Neoplasms; Melanoma; Carcinoma, Basal Cell; Diagnosis, Differential; Melanoma, Cutaneous Malignant
PubMed: 36556965
DOI: 10.3390/medicina58121761 -
Dermatology Reports Nov 2022Although described as early as 1975 as a distinct, rare form of cancer with diverse localization, primary cutaneous adenoid cystic carcinoma (PCACC) remains a mystery...
Although described as early as 1975 as a distinct, rare form of cancer with diverse localization, primary cutaneous adenoid cystic carcinoma (PCACC) remains a mystery and challenge for both clinicians and pathologists. The clinical presentation cannot be clearly distinguished from amelanotic melanoma or intradermal nevus, Merkel cell carcinoma, trichofolliculoma, trichoepithelioma or other rare tumors of the adnexa, or dermatofibrosarcoma protuberans. The histopathological diagnosis requires not only careful evaluation of standard hematoxylin/eosin preparations, but also immunohistochemical staining with a number of markers such as epithelial membrane antigen (EMA), S-100, SOX-10, Ki- 67, CD-117 (c-kit), Vimentin, carcinoembryonic antigen (CEA), Ber-EP4 and many others. The surgical approach should consist of excision with margins between 1 and 2 cm, with the choice of margins depending upon the histopathological findings in the primary excisional specimen. We present a 31-year-old patient with an enlarging, amelanotic, plaque-like tumor of the scalp with a duration of no more than 18-24 months. Surgical treatment was performed within two surgical sessions with a total resection field of 1.3 cm. A good cosmetic result was achieved.
PubMed: 36483235
DOI: 10.4081/dr.2022.9505