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Paolino G, Carugno A, Rongioletti F, Ponzoni M, Russo V, Sena P, Ardigò M, Costanzo A, Mercuri SR, Valenti M. Bone marrow metastases: a systematic review of a neglected involvement in malignant melanoma. Melanoma Res 2024; 34:31-37. [PMID: 37939076 DOI: 10.1097/cmr.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The occurrence of bone marrow metastases (BMM) in melanoma patients is often underestimated, with only 7% detected during in-vivo staging procedures but rising to 45% in autopsy cases. This systematic review aims to shed light on the clinical and laboratory features of BMM in melanoma by analyzing 73 studies selected from 2 482 initially retrieved from PubMed, Embase , and Cochrane CENTRAL databases. Our findings reveal a slight male predominance, with a median age at BMM diagnosis of 56 years. Primary melanoma sites included the skin (52%), mucosa (8.8%), uvea (20.5%) and unidentified (19%). BMM was preceded by lymph node involvement in 36.5% of cases, whereas 63% showed no nodal metastases, with direct BMM occurring in 22.5% and metastases to other sites in 41%. Common BMM symptoms included pain (60.7%), anemia (80%), thrombocytopenia, leukoerythroblastosis, pancytopenia and leukopenia, while disseminated intravascular coagulation was detected in 11% of cases. In 23.6% of cases, BMM was amelanotic. The prognosis for BMM is grim, with a median survival of only 2 months. Conventional therapies for BMM remain largely ineffective, emphasizing the importance of considering bone marrow as a potential metastatic site in melanoma patients.
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Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology, IRCCS Ospedale San Raffaele
- Unit of Dermatologic Clinic, Università Vita-Salute, San Raffaele, Milan
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo
- Ph.D. Program in Molecular and Translational Medicine (DIMET), University of Milan-Bicocca
| | - Franco Rongioletti
- Unit of Dermatology, IRCCS Ospedale San Raffaele
- Unit of Dermatologic Clinic, Università Vita-Salute, San Raffaele, Milan
| | - Maurilio Ponzoni
- Vita-Salute San Raffaele University
- Pathology Unit, IRCCS Ospedale San Raffaele
| | - Vincenzo Russo
- Unit of Immuno-Biotherapy of Melanoma and Solid Tumors, IRCCS Ospedale San Raffaele
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo
| | - Marco Ardigò
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Antonio Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Santo Raffaele Mercuri
- Unit of Dermatology, IRCCS Ospedale San Raffaele
- Unit of Dermatologic Clinic, Università Vita-Salute, San Raffaele, Milan
| | - Mario Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Effective Immunotherapy in Bone Marrow Metastatic Melanoma Presenting with Disseminated Intravascular Coagulopathy. Case Reports Immunol 2018; 2018:4520294. [PMID: 29796327 PMCID: PMC5896417 DOI: 10.1155/2018/4520294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/27/2017] [Indexed: 12/26/2022] Open
Abstract
Malignant melanoma is responsible for the majority of skin cancer deaths and is increasing in prevalence. Bone marrow (BM) involvement by melanoma is rare in the absence of widespread visceral disease. Here, we report the case of a 30-year-old female who presented to the hospital with back pain, low-grade fever, and easy bruising. She was found to be bicytopenic and in disseminated intravascular coagulopathy (DIC). Surprisingly, BM biopsy showed extensive involvement by metastatic malignant melanoma in the absence of visceral or brain metastasis. The unique presentation of this case and the challenge of management of a potentially treatable cancer in a critically ill patient are discussed, alongside a review of published cases of metastatic melanoma in the BM and an exploration of currently available treatment options. The excellent response of our patient to combined immune checkpoint inhibitors has yet to be paralleled in the available literature.
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Fernandez-Flores A, Díaz-Galvez FJ. S100 expression by atypical megakaryocytes: a previously unreported potential pitfall in dermatopathology. J Cutan Pathol 2014; 41:963-8. [PMID: 25371084 DOI: 10.1111/cup.12426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/27/2014] [Accepted: 10/12/2014] [Indexed: 11/28/2022]
Abstract
Several types of large atypical epithelioid cells can mimic tumoral melanocytes and can therefore be a source of misdiagnosis of melanoma. Megakaryocytes are one of these types, and are not frequently mentioned in the literature. In the current report, we present the case of a 76-year-old man presenting with acute panmyelosis with myelofibrosis. The bone marrow biopsy contained atypical megakaryocytes that expressed S100 in the cytoplasm. We discuss how such aberrant expression could be a source of some diagnostic problems in dermatopathology, including cutaneous melanoma, metastasis of melanoma in bone marrow and metastasis of melanoma in sentinel lymph nodes.
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Tran B, Fong C, Tong M, Hosking P, Schwarer AP, Parente P. Malignant melanoma mimicking acute leukemia. J Clin Oncol 2009; 27:e62-4. [PMID: 19487374 DOI: 10.1200/jco.2009.21.9956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ben Tran
- Department of Medical Oncology, Box Hill Hospital, Box Hill, Victoria, Australia
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Jain D, singh T, Kumar N, Daga MK. Metastatic malignant melanoma in bone marrow with occult primary site--a case report with review of literature. Diagn Pathol 2007; 2:38. [PMID: 17910749 PMCID: PMC2140052 DOI: 10.1186/1746-1596-2-38] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Accepted: 10/02/2007] [Indexed: 11/14/2022] Open
Abstract
Background Metastases of malignant melanoma to the bone marrow are very rare. A few case reports are published in the literature with a known primary site. Case presentation Herein we present a case of metastatic malignant melanoma in bone marrow with occult primary site in a 22- year-old-male. Diagnosis was confirmed by morphology and immunohistochemistry. A pertinent review of literature is also presented by using relevant articles indexed in PubMed (National Library of Medicine) database. The search was based on the following terms: metastasis or metastases, malignant melanoma and bone marrow. Conclusion In this report we discuss a rare case of metastatic malignant melanoma to the bone marrow with an unknown primary. Clinicians must be aware of the varied clinical manifestations of disseminated malignant melanoma even if the primary site is not evident.
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Affiliation(s)
- Deepali Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Tejindar singh
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Naresh Kumar
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | - Mradul K Daga
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
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Batsis JA, Barry MJ. Metastatic malignant melanoma presenting with hypercalcaemia and bone marrow involvement. J Eur Acad Dermatol Venereol 2006; 20:432-4. [PMID: 16643142 DOI: 10.1111/j.1468-3083.2006.01435.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a 75-year-old female patient with a background of malignant melanoma who presented with hypercalcaemia to our institution. She was aggressively treated but declined clinically. Computed tomography head and X-ray studies were suggestive of multiple myeloma, but bone marrow examination was significant for metastatic malignant melanoma. Very few patients with melanoma present with these features, and it further exemplifies the importance of close follow-up and the aggressive nature of this disease process.
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Affiliation(s)
- J A Batsis
- Department of Medicine, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, MN 55901, USA.
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Spiller SE, Hawkins DS, Finn LS, Sze RW, Sybert V. Metastatic malignant melanoma presenting as pancytopenia in a three-year-old boy. Pediatr Blood Cancer 2005; 45:60-3. [PMID: 15800910 DOI: 10.1002/pbc.20200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Malignant melanoma is rare in childhood and has never been reported to cause pancytopenia due to bone marrow metastases in a child. We report a 3-year-old boy with a large congenital melanocytic nevus who presented with bone pain and pancytopenia due to diffuse bone and bone marrow infiltration with metastatic melanoma without an identifiable primary site. Despite treatment with imatinib mesylate there was no response and the patient died with progressive disease. This case illustrates an unusual presentation of bone marrow failure secondary to malignant melanoma in a young child with symptomatic metastatic marrow infiltration, a rarely reported site of melanoma involvement in adults or children.
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Affiliation(s)
- Susan E Spiller
- Division of Hematology/Oncology, Children's Hospital and Regional Medical Center, Seattle, Washington 98105-0371, USA.
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Schadendorf D, Dorn-Beineke A, Borelli S, Riethmuller G, Pantel K. Limitations of the immunocytochemical detection of isolated tumor cells in frozen samples of bone marrow obtained from melanoma patients. Exp Dermatol 2003; 12:165-71. [PMID: 12702145 DOI: 10.1034/j.1600-0625.2003.120207.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report on a case of a 70-year-old woman with an ocular melanoma, which was diagnosed and treated 14 years ago. The patient was referred to the hospital with a suspected lymphoma. Cytological examination of bone marrow proved a marked infiltration with melanoma cells. Because detection of isolated tumor cells in the bone marrow of patients with various types of tumors was shown to be of prognostic significance and since current tumor-staging techniques are unable to detect single disseminated tumor cells or small aggregates of tumor cells, which might be the seed for subsequent metastatic relapse, we therefore evaluated the feasibility of immunocytochemical screening of bone marrow aspirates of 36 melanoma patients in different clinical stages using three monoclonal antibodies against melanoma-associated antigens in comparison with 43 non-melanoma control patients. Two of these antibodies (HMB45 and NKI-beteb) are directed against the melanoma antigen gp100/pmel17, whereas the third one (TA99) recognizes gp75/Tyrosinase-related protein 1 (TRP-1). None of the patients demonstrated a macroscopic bone marrow infiltration as was present in our patient with metastatic ocular melanoma. Seven (20.6%) of the 34 eligible melanoma patients presented with cells in the bone marrow positive for one or more of the above-mentioned melanosomal markers. Four of the positive patients were clinically free of tumors by the time of puncture, whereas the remaining 3 patients showed overt metastases in the subcutaneous fat (2 patients) and the brain (1 patient). On the other hand, 20 (66%) of the 29 patients with negative bone marrow findings also presented with clinical advanced disease with overt metastasis in the skin, lymph node, spleen, liver, lung, bone and brain. In conclusion, immunocytochemical screening of bone marrow samples is a feasible procedure that allows the detection of micrometastatic tumor cells in a subset of melanoma patients. Massive invasion of bone marrow with melanoma cells is a rare event even in far-advanced metastatic stages and no clear correlation between tumor load and bone marrow infiltration could be established.
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Affiliation(s)
- Dirk Schadendorf
- Klinische Kooperationseinheit für Dermatoonkologie, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany.
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