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Kamata M, Minamisaka T, Imura J, Saitoh K, Shimomura A, Noguchi A. A Case of Dedifferentiated Melanoma With Lymph Node Metastasis Where Molecular Biological Tests Were Useful for Diagnosis. Cureus 2022; 14:e21644. [PMID: 35233321 PMCID: PMC8881242 DOI: 10.7759/cureus.21644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/05/2022] Open
Abstract
Malignant melanoma is known to have an altered phenotype and loss of differentiation markers for melanoma due to metastasis. Here, we report a case in which the expression of the immunohistochemical markers for melanoma was changed due to lymph node metastasis of primary cutaneous malignant melanoma. The patient, a male in his 60s, was diagnosed with malignant melanoma after undergoing excision of a skin mass. The additional excision specimen showed a small number of tumor cell clusters infiltrating the dermis. The biopsied lymph node showed completely different histological findings from those of the skin lesion and consisted of spindle-shaped tumor cells. An immunohistochemical study revealed no significant positive reactions in the lymph node tissue indicative of melanoma. The additional genetic study revealed BRAF V600e mutations in both the primary tumor and a lymph node. Together with the histological findings, the diagnosis was of metastasis of dedifferentiated melanoma to a lymph node. In summary, there is a risk of underestimation or misdiagnosis of melanoma as undifferentiated sarcoma or other tumors when melanoma metastasizes to lymph nodes and findings show a dedifferentiated or undifferentiated tumor. Therefore, as in this case, it is necessary to add a genetic study in order to make a comprehensive judgment.
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2
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Stridh MT, Hult J, Merdasa A, Albinsson J, Pekar-Lukacs A, Gesslein B, Dahlstrand U, Engelsberg K, Berggren J, Cinthio M, Sheikh R, Malmsjö M. Photoacoustic imaging of periorbital skin cancer ex vivo: unique spectral signatures of malignant melanoma, basal, and squamous cell carcinoma. BIOMEDICAL OPTICS EXPRESS 2022; 13:410-425. [PMID: 35154881 PMCID: PMC8803040 DOI: 10.1364/boe.443699] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/14/2023]
Abstract
Radical excision of periorbital skin tumors is difficult without sacrificing excessive healthy tissue. Photoacoustic (PA) imaging is an emerging non-invasive biomedical imagi--ng modality that has potential for intraoperative micrographic control of surgical margins. This is the first study to assess the feasibility of PA imaging for the detection of periocular skin cancer. Eleven patients underwent surgical excision of periocular skin cancer, one of which was a malignant melanoma (MM), eight were basal cell carcinomas (BCCs), and two squamous cell carcinomas (SCCs). Six tumors were located in the eyelid, and five in periocular skin. The excised samples, as well as healthy eyelid samples, were scanned with PA imaging postoperatively, using 59 wavelengths in the range 680-970 nm, to generate 3D multispectral images. Spectral unmixing was performed using endmember spectra for oxygenated and deoxygenated Hb, melanin, and collagen, to iden--tify the chromophore composition of tumors and healthy eyelid tissue. After PA scanning, the tumor samples were examined histopathologically using standard hematoxylin and eosin staining. The PA spectra of healthy eyelid tissue were dominated by melanin in the skin, oxygenated and deoxygenated hemoglobin in the orbicularis oculi muscle, and collagen in the tarsal plate. Multiwavelength 3D scanning provided spectral information on the three tumor types. The spectrum from the MM was primarily reconstructed by the endmember melanin, while the SCCs showed contributions primarily from melanin, but also HbR and collagen. BCCs showed contributions from all four endmembers with a predominance of HbO2 and HbR. PA imaging may be used to distinguish different kinds of periocular skin tumors, paving the way for future intraoperative micrographic control.
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Affiliation(s)
- Magne Tordengren Stridh
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - Jenny Hult
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - Aboma Merdasa
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - John Albinsson
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | | | - Bodil Gesslein
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - Ulf Dahlstrand
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - Karl Engelsberg
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - Johanna Berggren
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering,
Faculty of Engineering, Lund University,
Sweden
| | - Rafi Sheikh
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
| | - Malin Malmsjö
- Ophthalmology, Department of Clinical
Sciences Lund, Lund University, Skåne University
Hospital, Lund, Sweden
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Olla D, Tufaro AP, Neumeister MW. Extirpative Considerations of Melanoma of the Head and Neck. Clin Plast Surg 2021; 48:659-668. [PMID: 34503726 DOI: 10.1016/j.cps.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The incidence of melanoma is continuing to rise in the United States, and head and neck melanomas account for 25% of all cutaneous melanomas. The National Comprehensive Cancer Network guideline recommendations for surgical margins and sentinel lymph node biopsy in head and neck melanomas are the same as cutaneous melanoma located in other regions, but require special considerations when performing wide local excision, sentinel lymph node biopsy, and completion lymph node dissection and reconstruction taking into account the location of the melanoma and structures involved in and around the suggested margins.
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Affiliation(s)
- Danielle Olla
- Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA.
| | - Anthony P Tufaro
- University Hospitals Cleveland Medical Center, 11100 Euclid Aveune, Suite 5206, Cleveland, OH 44106, USA
| | - Michael W Neumeister
- Department of Surgery, The Elvin G Zook Endowed Chair - Institute for Plastic Surgery, Southern Illinois University, 747 North Rutledge Street #3, Springfield, IL 62702, USA
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Hult J, Merdasa A, Pekar-Lukacs A, Tordengren Stridh M, Khodaverdi A, Albinsson J, Gesslein B, Dahlstrand U, Engqvist L, Hamid Y, Larsson Albèr D, Persson B, Erlöv T, Sheikh R, Cinthio M, Malmsjö M. Comparison of photoacoustic imaging and histopathological examination in determining the dimensions of 52 human melanomas and nevi ex vivo. BIOMEDICAL OPTICS EXPRESS 2021; 12:4097-4114. [PMID: 34457401 PMCID: PMC8367235 DOI: 10.1364/boe.425524] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 05/21/2023]
Abstract
Surgical excision followed by histopathological examination is the gold standard for the diagnosis and staging of melanoma. Reoperations and unnecessary removal of healthy tissue could be reduced if non-invasive imaging techniques were available for presurgical tumor delineation. However, no technique has gained widespread clinical use to date due to shallow imaging depth or the absence of functional imaging capability. Photoacoustic (PA) imaging is a novel technology that combines the strengths of optical and ultrasound imaging to reveal the molecular composition of tissue at high resolution. Encouraging results have been obtained from previous animal and human studies on melanoma, but there is still a lack of clinical data. This is the largest study of its kind to date, including 52 melanomas and nevi. 3D multiwavelength PA scanning was performed ex vivo, using 59 excitation wavelengths from 680 nm to 970 nm. Spectral unmixing over this broad wavelength range, accounting for the absorption of several tissue chromophores, provided excellent contrast between healthy tissue and tumor. Combining the results of spectral analysis with spatially resolved information provided a map of the tumor borders in greater detail than previously reported. The tumor dimensions determined with PA imaging were strongly correlated with those determined by histopathological examination for both melanomas and nevi.
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Affiliation(s)
- Jenny Hult
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Aboma Merdasa
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | | | - Magne Tordengren Stridh
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Azin Khodaverdi
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - John Albinsson
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bodil Gesslein
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Ulf Dahlstrand
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Linn Engqvist
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Yousef Hamid
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Douglas Larsson Albèr
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bertil Persson
- Department of Dermatology, Skåne University Hospital, Lund, Sweden
| | - Tobias Erlöv
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
| | - Magnus Cinthio
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences Lund, Ophthalmology, Lund University and Skåne University Hospital, Lund, Sweden
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Mejbel HA, Arudra SKC, Pradhan D, Torres-Cabala CA, Nagarajan P, Tetzlaff MT, Curry JL, Ivan D, Duose DY, Luthra R, Prieto VG, Ballester LY, Aung PP. Immunohistochemical and Molecular Features of Melanomas Exhibiting Intratumor and Intertumor Histomorphologic Heterogeneity. Cancers (Basel) 2019; 11:E1714. [PMID: 31684113 PMCID: PMC6896082 DOI: 10.3390/cancers11111714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
Melanoma is a heterogeneous neoplasm at the histomorphologic, immunophenotypic, and molecular levels. Melanoma with extreme histomorphologic heterogeneity can pose a diagnostic challenge in which the diagnosis may predominantly rely on its immunophenotypic profile. However, tumor survival and response to therapy are linked to tumor genetic heterogeneity rather than tumor morphology. Therefore, understating the molecular characteristics of such melanomas become indispensable. In this study, DNA was extracted from 11 morphologically distinct regions in eight formalin-fixed, paraffin-embedded melanomas. In each region, mutations in 50 cancer-related genes were tested using next-generation sequencing (NGS). A tumor was considered genetically heterogeneous if at least one non-overlapping mutation was identified either between the histologically distinct regions of the same tumor (intratumor heterogeneity) or among the histologically distinct regions of the paired primary and metastatic tumors within the same patient (intertumor heterogeneity). Our results revealed that genetic heterogeneity existed in all tumors as non-overlapping mutations were detected in every tested tumor (n = 5, 100%; intratumor: n = 2, 40%; intertumor: n = 3, 60%). Conversely, overlapping mutations were also detected in all the tested regions (n = 11, 100%). Melanomas exhibiting histomorphologic heterogeneity are often associated with genetic heterogeneity, which might contribute to tumor survival and poor response to therapy.
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Affiliation(s)
- Haider A Mejbel
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Sri Krishna C Arudra
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Dinesh Pradhan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Dzifa Y Duose
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Raja Luthra
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| | - Leomar Y Ballester
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Metastatic Malignant Melanoma With Complete Loss of Differentiation Markers (Undifferentiated/Dedifferentiated Melanoma): Analysis of 14 Patients Emphasizing Phenotypic Plasticity and the Value of Molecular Testing as Surrogate Diagnostic Marker. Am J Surg Pathol 2016; 40:181-91. [PMID: 26448190 DOI: 10.1097/pas.0000000000000527] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Metastatic malignant melanoma is notorious for its phenotypic diversity and loss of differentiation markers. We herein summarized our experience with 14 metastatic melanomas showing complete loss of immunohistochemical melanocytic markers (with or without heterologous differentiation). Patients included 11 men and 3 women aged 24 to 78 years (median, 67 y). Thirteen patients had histologically confirmed primary skin melanoma, and 1 had metastatic melanoma of unknown primary. Undifferentiated metastasis was diagnosed synchronous to primary tumor (n=1), following skin melanoma by 3 months to 9 years (n=11) and preceding it by 1 year (n=1). Sites of undifferentiated metastases were axillary (3), inguinal (1), or submandibular (1) lymph nodes, digestive tract (2), bone/soft tissue (2), lung/pleura (2), and disseminated (n=3). Histology of metastases mimicked undifferentiated pleomorphic or spindle cell sarcoma with variable myxoid and giant cell areas (n=10) and cytokeratin-positive undifferentiated small cell sarcoma (n=1). Three cases showed heterologous dedifferentiation: pleomorphic rhabdomyosarcoma (n=1), teratocarcinosarcoma-like with prominent rhabdomyoblasts (n=1), and adenocarcinoma-like with metaplastic bone (n=1). All cases were negative for S100, melanoma cocktail, HMB45, Melan A, and SOX10. Other markers showed following results: smooth muscle actin (1/14), p16 (1/14), TP53 (2/12), pancytokeratin (4/14), desmin (5/14), h-caldesmon (0/9), and MDM2/CDK4 (0/5). SMARCB1 was intact in 8/8 cases. Genotyping showed BRAF(V600E) mutation (5/14), NRAS mutation (5/14), and BRAF/NRAS wild-type (4/14). In conclusion, undifferentiated/dedifferentiated metastatic melanoma is likely underrecognized and frequently mistaken for undifferentiated sarcoma or other neoplasms. Diagnosis of undifferentiated sarcoma at sites where melanoma metastasis are frequent (eg, inguinal and axillary region) should be made with great caution and warrants exploration of the remote history. Genotyping is a helpful surrogate marker in classifying such difficult cases. In the light of available targeted therapies, recognition of undifferentiated/dedifferentiated metastatic melanoma is mandatory for appropriate treatment.
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Abstract
Malignant melanoma (MM) of soft tissue, also called clear cell sarcoma (CCS) of tendons and aponeuroses, derives from the neural crest. CCS is similar morphologically to MM but has no precursor skin lesion, and instead, has a characteristic chromosomal translocation. Prognosis is related to the tumor size. Early recognition and initial radical surgery is the key to a favorable outcome. The tumor has to be differentiated from other benign and malignant lesions of the soft tissues, such as fibrosarcoma. The demonstration of melanin and a positive immunohistochemical reaction for S-100 protein and HMB-45 can assist in the differential diagnosis. We report the case of a 58-year-old woman with CCS arising from the soft tissue of her little finger.
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Affiliation(s)
- Pinar Ozuguz
- Department of Dermatology, Afyon Kocatepe University, Afyon, Turkey
| | - Mukadder Kocak
- Department of Dermatology, Kirikkale University, Kirikkale, Turkey
| | - Pinar Atasoy
- Department of Pathology, Kirikkale University, Kirikkale, Turkey
| | - Ibrahim Vargel
- Department of Plastic and Reconstructive Surgery, Kirikkale University, Kirikkale, Turkey
| | - Tarik Cavusoglu
- Department of Plastic and Reconstructive Surgery, Kirikkale University, Kirikkale, Turkey
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Rodríguez-Martín M, Sáez-Rodríguez M, Esquivel B, Gonzáalez RS, Cabrera AN, Herrera AM. Clear cell sarcoma: a case mimicking primary cutaneous malignant melanoma. Indian J Dermatol 2010; 54:168-72. [PMID: 20101313 PMCID: PMC2807157 DOI: 10.4103/0019-5154.53193] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Clear cell sarcoma (CCS) is a recently described variant of sarcoma characterized by prominent clear cells showing features similar to clear cell melanoma. This neoplasm was first described by Dr. Franz M. Erzinger. Primary CCS usually arises in deeper soft tissues, in association with fascia, tendons, or aponeuroses. Characteristic translocation t(12;22) (q13;q12) has been considered pathognomonic for CCS. Prognosis is related to tumor size. An early recognition and initial radical surgery is the key to a favourable outcome. We present a patient with an unusual neoplasm that resembled malignant melanoma.
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Affiliation(s)
- M Rodríguez-Martín
- Department of Dermatology, Hospital Universitario de Canarias, University of La Laguna, 38320 - La Laguna, Tenerife, Spain.
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