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Picciotto F, Lesca A, Mastorino L, Califaretti E, Conti L, Quaglino P, Ribero S, Caliendo V, Deandreis D. SPECT/CT-Guided Surgical Removal of a Positive External Iliac Sentinel Node in Primary Umbilical Melanoma: Report of a Case, and Up-to-Date Review of the Literature. Front Oncol 2022; 11:772771. [PMID: 35111668 PMCID: PMC8801450 DOI: 10.3389/fonc.2021.772771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Primary umbilical melanoma is rare tumor, representing about 5% of all umbilical malignancies.The lymphatic drainage from the tumor is challenging and can be to inguinal, axillary and retroperitoneal nodes. Dynamic and static lymphoscintigraphy with single-photon emission tomography/computed tomography (SPECT/CT) and sentinel lymph node biopsy (SLNB) is a widely validated technique in patients with clinically localized melanoma to search for and quantify nodal spread of cutaneous melanoma. Moreover, it offers the surgeon the preoperative information about the number and location of the sentinel lymph nodes (SLNs), which makes SLNB easier and quicker. This is the first report of an ulcerated thick melanoma of the umbilicus metastasizing only to an external iliac lymph-node without involvement of superficial inguinal SLNs. The preoperative high-resolution ultrasound (HR-US) examination of the regional lymph node field had been normal. This case-report shows how addition of SPECT/CT to planar imaging in a patient with clinically localized umbilical melanoma can help avoid incomplete SLNB when a deep SLN is not removed. A literature review of umbilical melanoma is also provided.
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Affiliation(s)
- Franco Picciotto
- Dermatologic Surgery Section, Department of Surgery, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Adriana Lesca
- Division of Nuclear Medicine, Medical Sciences Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Luca Mastorino
- Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy
| | - Elena Califaretti
- Division of Nuclear Medicine, Medical Sciences Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Luca Conti
- Surgical Pathology Section, Oncology Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy
| | - Virginia Caliendo
- Dermatologic Surgery Section, Department of Surgery, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Désirée Deandreis
- Division of Nuclear Medicine, Medical Sciences Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
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Abstract
BACKGROUND Primary cutaneous umbilical melanoma is rare. Thorough information regarding its characteristics and treatment, including use of sentinel lymph node biopsy (SLNB) staging, is difficult to obtain. The unique anatomy of the umbilicus adds to the complexity of diagnosing and treating melanoma at this site. OBJECTIVE To improve understanding of diagnosis and treatment of primary cutaneous umbilical melanoma through presenting 7 new cases and reviewing 39 cases in the literature. MATERIALS AND METHODS The University of Michigan melanoma database query and review of the literature regarding reported cases of primary umbilical melanoma. RESULTS In 7 new and 39 previously reported cases of primary cutaneous umbilical melanoma, we describe signs and symptoms, histopathologic features, differential diagnosis, relevant anatomical considerations, and definitive treatment including SLNB when applicable. CONCLUSION Our series, combined with a thorough literature review and compilation of findings, provides a better understanding and appreciation of melanoma in the unique anatomical site of the umbilicus, with a reminder to carefully examine the umbilicus during a full skin examination in patients at risk of melanoma. Primary umbilical melanoma presents and can be appropriately treated similarly to cutaneous melanoma in other sites, with attention to relevant anatomy.
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Yan L, Sethi S, Bitterman P, Reddy V, Gattuso P. Umbilical Lesions: Clinicopathologic Features of 99 Tumors. Int J Surg Pathol 2018; 26:417-422. [DOI: 10.1177/1066896918758916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background. Umbilical lesions are rare, and can be benign or malignant. This retrospective study was conducted to assess the epidemiological, clinical, and histologic characteristics of umbilical masses. Methods. Cases of umbilical masses from January 1994 to August 2016 were retrieved from our institution’s pathology databases, and their clinicopathological features were reviewed. Results. There were a total of 99 cases of umbilical masses, 78 women (78.8%) and 21 men (21.2%). Of these, 59 were malignant (59.6%) and 40 were benign (40.4%). Among the malignant cases, 48 were women with a mean age of 65 years and 11 were men with a mean age of 66 years. All malignant lesions were secondary tumors. Twenty-five patients (42.3%) had a metastatic tumor to the umbilicus with an average of 7 months from the original diagnosis (12 gynecological, 8 pancreatic/gastrointestinal, 2 lymphomas, and a case each of breast, prostate, and melanoma). Of the patients with a benign diagnosis, 30 were women (75%) with a mean age of 52 years and 10 were men (25%) with a mean age of 43 years. The benign lesions included epidermal inclusion cysts (15/40), endometriosis (11/40), lipomas (3/40), neurofibromas (3/40), fibromas (3/40), abscesses (2/40), and 1 case each of tubular apocrine adenoma, serous cystadenoma, and calcified nodule. Conclusion. The most common metastatic tumors to the umbilicus are from the adjacent organs with the gynecologic tract as the most frequent primary followed by the gastrointestinal system. Primary malignant tumors of the umbilical region are rarely identified in clinical practice.
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Affiliation(s)
- Lei Yan
- Rush University Medical Center, Chicago, IL, USA
| | - Shenon Sethi
- Rush University Medical Center, Chicago, IL, USA
| | | | - Vijaya Reddy
- Rush University Medical Center, Chicago, IL, USA
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Di Monta G, Caracò C, Marone U, Grimaldi AM, Anniciello AM, Di Marzo M, Simeone E, Mori S. Clinicopathologic features and surgical management of primary umbilical melanoma: a case series. BMC Res Notes 2015; 8:147. [PMID: 25890364 PMCID: PMC4404075 DOI: 10.1186/s13104-015-1096-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/25/2015] [Indexed: 11/26/2022] Open
Abstract
Background Primary umbilical melanoma is an uncommon tumor that is poorly described in the medical literature. The umbilical region is a particular anatomic site owing to the presence of embryonal remnants, which can be a potential metastatic pathway, as well as the braided lymphatic network drainage. Hence, primary malignant neoplasms affecting the umbilicus require a different and more radical surgical approach compared with other melanomas. Case presentation In this report, we describe a series of three patients of Caucasian ethnicity who presented with primary umbilical melanoma at the National Cancer Institute of Naples, Italy. All patients underwent wide excision of the tumor including the underlying peritoneum. No surgical complications, either immediate or delayed, were observed in any of the patients. Sentinel lymph node biopsy was negative in two cases. Two of the patients developed metastatic disease and died after systemic medical therapy. The other patient is currently in follow-up, and remains disease-free after 21 months. Conclusions The umbilicus has vascular and embryological connections with the underlying peritoneum, so that early visceral involvement is more likely to occur with primary umbilical melanomas. As such, tumor resection including the underlying peritoneum is required to avoid local relapse, whilst sentinel lymph node biopsy appears to be of poor diagnostic value.
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Affiliation(s)
- Gianluca Di Monta
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Corrado Caracò
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Ugo Marone
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, National Cancer Institute "G. Pascale", 80131, Naples, Italy.
| | - Anna Maria Anniciello
- Department of Pathology, National Cancer Institute "G. Pascale", 80131, Naples, Italy.
| | - Massimiliano Di Marzo
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, National Cancer Institute "G. Pascale", 80131, Naples, Italy.
| | - Stefano Mori
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
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Nakamura Y, Teramoto Y, Tanaka R, Nakamura Y, Maruyama H, Fujisawa Y, Sato S, Fujimoto M, Yamamoto A. Surgical management of umbilical basal cell carcinoma: Published work review and the optimal depth of surgical excision. J Dermatol 2014; 41:992-5. [DOI: 10.1111/1346-8138.12640] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 08/25/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology; Saitama Medical University International Medical Center; Hidaka Japan
| | - Yukiko Teramoto
- Department of Skin Oncology/Dermatology; Saitama Medical University International Medical Center; Hidaka Japan
| | - Ryota Tanaka
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yoshiyuki Nakamura
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Hiroshi Maruyama
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Yasuhiro Fujisawa
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Sayuri Sato
- Department of Skin Oncology/Dermatology; Saitama Medical University International Medical Center; Hidaka Japan
| | - Manabu Fujimoto
- Department of Dermatology; Faculty of Medicine; University of Tsukuba; Tsukuba Japan
| | - Akifumi Yamamoto
- Department of Skin Oncology/Dermatology; Saitama Medical University International Medical Center; Hidaka Japan
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Kluger N. Dermatoses ombilicales et péri-ombilicales. Ann Dermatol Venereol 2014; 141:224-35; quiz 223, 236. [DOI: 10.1016/j.annder.2013.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022]
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Song Y, Xu D, Sun L, Ding K, Hu Y, Yuan Y. Diagnosis and management of primary umbilical melanoma with omphalitis features. Case Rep Oncol 2013; 6:154-7. [PMID: 23626553 PMCID: PMC3636959 DOI: 10.1159/000350421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report on a 62-year-old Chinese male patient who presented with a pigmented lesion in the umbilical area and who was treated for omphalitis in a local hospital for 1 month. Biopsy pathological examination revealed that the lesion was a melanoma. The Breslow depth was estimated at 3 mm, and Clark's level was IV. Ultrasonography showed no suspicious pathological lymph nodes, and no metastases were detected in the lung, liver or brain through CT scans. Reexcision was performed with lateral marginsd >2 cm from the original scar down to the peritoneum, including the umbilicus, round ligament of the liver and urachus. No adjuvant therapy was suggested, and the patient was still alive without recurrences or metastases after 36 months.
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Affiliation(s)
- Y Song
- Department of Surgical Oncology, The Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
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Primary adenocarcinoma of the navel: an uncommon entity. Cir Esp 2012; 92:436-8. [PMID: 23031719 DOI: 10.1016/j.ciresp.2012.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 11/23/2022]
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An Infrequent Case of Neoplasm With Fibroepithelioma of Pinkus and Hidradenomatous Features Arising at the Umbilicus: A Rare Finding. Am J Dermatopathol 2011; 33:750-2. [DOI: 10.1097/dad.0b013e31820978cf] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Papalas JA, Selim MA. Metastatic vs primary malignant neoplasms affecting the umbilicus: clinicopathologic features of 77 tumors. Ann Diagn Pathol 2011; 15:237-42. [DOI: 10.1016/j.anndiagpath.2010.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 12/10/2010] [Indexed: 11/16/2022]
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Alver O, Ersoy YE, Dogusoy G, Erguney S. Primary Umbilical Adenocarcinoma: Case Report and Review of the Literature. Am Surg 2007. [DOI: 10.1177/000313480707300921] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary adenocarcinoma arising at the umbilicus is a very rare condition. The umbilicus has been found to show a wide variety of tumors and is predisposed to metastases from visceral tumors because of its relationships and generous vascular and embryologic connections. Herein, we describe a case of a primary umbilical adenocarcinoma with short time survival related to local recurrence and multiple hepatic metastases 6 months after her surgical treatment.
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Affiliation(s)
- Olcay Alver
- Departments of General Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Gulen Dogusoy
- Departments of Pathology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Sabri Erguney
- Departments of General Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Campos-Muñoz L, Quesada-Cortés A, Ruiz E, Casado M, Pizarro A. Primary melanoma of the umbilicus appearing as omphalitis. Clin Exp Dermatol 2007; 32:322-4. [PMID: 17335551 DOI: 10.1111/j.1365-2230.2007.02366.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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