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Arvia R, Tanturli M, Ugolini F, Vannucchi M, Massi D, Zakrzewska K. Molecular investigation of some DNA viruses in mucosal melanoma: Case-control study. J Med Virol 2023; 95:e29269. [PMID: 38009623 DOI: 10.1002/jmv.29269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/12/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
The association between viral infections and both cutaneous and mucosal melanoma (MM) has not been fully investigated. Here, we assessed the prevalence of the DNA of a broad range of viruses in 31 MMs and 15 biopsies of healthy mucosa (HM) using molecular methods. The parvoviruses CuV and B19V, herpesviruses HSV1, HSV2, EBV, HHV6, and HHV8, polyomavirus MCPyV, and α-HPVs were not detected, or rarely found, in MMs, and in HM, of the digestive, respiratory, and female genital tract. The overall prevalence of β-HPV in MMs was not significantly higher compared to that in HM (70.9% and 53.3% respectively; p = 0.514). However, the number of MMs positive for β-HPV types belonging to Species 3 and 5 and for some viral types belonging to Species 1, 2, 3, and 5 were significantly higher compared with HM (p < 0.05). Moreover, compared to HM, the MM samples contained a significantly higher number of β-HPV types, mainly belonging to Species 1, 3, and 5 (p < 0.05). Our data, although suggesting a role for certain β-HPV types in MM oncogenesis, require additional investigation in larger populations to support this hypothesis.
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Affiliation(s)
- Rosaria Arvia
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Tanturli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Filippo Ugolini
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Margherita Vannucchi
- Department of Medical Biotechnology, Section of Pathology, University of Siena, Siena, Italy
| | - Daniela Massi
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Krystyna Zakrzewska
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Ciccarese G, Drago F, Broccolo F, Pastorino A, Pizzatti L, Atzori L, Pilloni L, Santinelli D, Urbani A, Parodi A, Tomasini C, Rongioletti F. Oncoviruses and melanomas: A retrospective study and literature review. J Med Virol 2023; 95:e27924. [PMID: 35695214 PMCID: PMC9796782 DOI: 10.1002/jmv.27924] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/28/2022] [Accepted: 06/06/2022] [Indexed: 01/11/2023]
Abstract
The role of human oncoviruses in melanoma has been poorly investigated. The aim of this study was to investigate the association between oncoviruses and melanomas searching for human papillomavirus (HPV), Epstein Barr virus (EBV), and human herpesvirus 8DNA in melanoma specimens. Formalin-fixed and paraffin-embedded tissue specimens of cutaneous, mucosal, and ocular melanomas (OM) were selected from the Pathology Departments of the Galliera Hospital (Genoa) and the University Hospitals of Turin and Cagliari. Cutaneous and mucosal nevi have been collected as controls. The oncoviruses search has been performed with different polymerase chain reaction reagent kits. Fifty-four melanomas (25 mucosal, 12 ocular, and 17 cutaneous) and 26 nevi (15 cutaneous and 11 mucosal) specimens were selected. The detection rate for one of the investigated oncoviruses was 17% in mucosal, 20% in ocular, and 0% in cutaneous melanomas (CMs). Despite the differences between groups seeming remarkable, there was no statistical significance (p > 0.5). Our data do not support a primary role of oncoviruses in melanoma carcinogenesis; however, the finding of HPV and EBV DNA in a considerable fraction of mucosal and OMs suggests that these viruses may act as cofactors in the development of extra-CMs.
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Affiliation(s)
- Giulia Ciccarese
- Dermatology Unit, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Francesco Drago
- Dermatology Unit, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Francesco Broccolo
- Department of Medicine and Surgery, School of MedicineUniversity of Milano‐BicoccaMonzaItaly,Laboratory Cerba HealthCareMilanoItaly
| | | | - Laura Pizzatti
- Dermatology Unit, Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Laura Atzori
- Dermatology Unit, Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | - Luca Pilloni
- Pathology Service, Department of Medical Sciences and Public HealthUniversity of CagliariCagliariItaly
| | | | | | - Aurora Parodi
- Dermatology Unit, IRCCS Ospedale Policlinico San MartinoGenoaItaly
| | - Carlo Tomasini
- Dermatology Clinic, Fondazione IRCCS Policlinico San MatteoPaviaItaly,Department of Clinical‐Surgical, Diagnostic and Pediatric SciencesUniversity of PaviaPaviaItaly
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Primary Malignant Melanoma of the Cervix: A Case Report and a Review of the Literature. Case Rep Oncol Med 2020; 2020:7206786. [PMID: 33628550 PMCID: PMC7898279 DOI: 10.1155/2020/7206786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 07/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background Gynecologic melanomas are extremely rare malignancies, and primary malignant melanoma of the cervix (PMMC) is the rarest among them all, with less than 100 cases reported so far. Although some conditions have been correlated with the pathogenesis of this entity, no specific risk factor has been yet identified, with vaginal bleeding being the most common symptoms. The diagnosis is based on physical examination with speculum assessment and cytologic and histopathologic findings accompanied with immunohistochemical staining of lesion's biopsies. Case Presentation. We report a case of PMMC in a 34-year-old para-2 patient, among the youngest cases of PMMC reported, that presented to our clinic for routine examination. Gynecologic examination demonstrated a dark, heavily fully pigmented cervical growth completely covering the entire external cervical os. Biopsy obtained and showed malignant melanoma. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The pathological diagnosis was FIGO stage IB1 PMMC. Despite 2 courses of anti-PD-1 antibody (Nivolumab) treatment, the patient passed away 13 months after diagnosis (12 months after surgery). Conclusions Early diagnosis and subsequently early treatment are of high importance regarding patients' prognosis and survival. No standardized protocols or treatment guidelines specific for this rare cancer have been issued; thus, clinicians are called to assess each case individually. Current treatment options are based on surgical excision mostly with radical hysterectomy, but in advanced or recurrent state of the disease, other treatment modalities, such as chemotherapy, radiotherapy, and immunotherapy, can be employed. Prognosis for these patients is very poor, and survival rate remains extremely low, with the median OS reported being less than 2 years. Reporting and publishing of such cases are both of paramount importance for the better understanding of this uncommon cervical malignancy, and further biological and clinical investigations are required for more suitable and effective therapies to be determined. A new staging system, specific to PMMC, could be of great use for the better correlation of the disease's stage and prognosis of these patients.
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Lopez S, Guerrisi R, Brusadelli C, Bogani G, Ditto A, Raspagliesi F. The role of sentinel lymph node mapping in lower genital tract melanoma. ACTA ACUST UNITED AC 2020; 72:384-390. [PMID: 32744452 DOI: 10.23736/s0026-4784.20.04628-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Vulvar and vaginal melanomas are rare cancers of the female genital tract and account for 1% to 3% of all melanomas diagnosed in women. Due to the rarity of the disease, few data are available on the clinical and pathologic features of these cancers. Furthermore, treatment options are generally based on extrapolations of the information available for the more common cutaneous counterparts. Surgery represents the mainstay of treatment for lower genital tract melanoma. Moreover, the role of sentinel lymph node (SLN) assessment is controversial because no prospective data are available. EVIDENCE ACQUISITION Data were collected from Medline, Embase, Web of Sciences and Scopus databases. On July 10, 2020, we used the search comprising the terms "vulvar melanoma," "genital melanoma" and "vulvovaginal melanoma" including only studies in which SLN biopsy was performed. EVIDENCE SYNTHESIS Ten retrospective studies have been found. No randomized trials have been reported. The studies included 132 patients while only 63 (47%) undergone SLN. 99mTC with or without blue dye followed by ultrastaging was highly accurate and is currently the gold standard. Mean detection rate was 98.3%. No clear evidence supported the execution of back lymphadenectomy (after SLN mapping), in fact, extrapolating data from cutaneous melanomas of other sites, completion of lymphadenectomy does not confer a melanoma-specific survival advantage. CONCLUSIONS Although the small amount of available data, sentinel lymph node procedure is feasible and capable of identifying patients who have occult lymph node metastases. However, the potential role of the sentinel lymph node procedure as an alternative method of lymph node staging in patients with vulvar or vaginal melanoma needs further investigation.
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Affiliation(s)
- Salvatore Lopez
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy - .,Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy -
| | - Rocco Guerrisi
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Claudia Brusadelli
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Giorgio Bogani
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
| | - Antonino Ditto
- Unit of Gynecological Oncology, National Cancer Institute of Milan, Milan, Italy
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Srivastava P, Rath S, Hadi R, Husain N. Primary amelanotic malignant melanoma of cervix masquerading as squamous cell carcinoma presenting with extensive metastases. BMJ Case Rep 2018; 2018:bcr-2018-224723. [PMID: 30131413 DOI: 10.1136/bcr-2018-224723] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Amelanotic melanoma of cervix is a rare and aggressive neoplasm and only few cases have been reported in the literature. We report a rare case of an amelanotic melanoma of the uterine cervix with extensive metastases and multiple subcutaneous nodules. Due to the unusual site and amelanotic nature of the lesion, chances of misdiagnosis are high and immunohistochemical markers for melanoma help establish the diagnosis. The possibility of metastasis from a primary malignant melanoma of the skin needs to be ruled out. The present case was initially misdiagnosed and treated on the regimen for squamous cell carcinoma, but progressed despite chemotherapy. After a thorough re-evaluation and applying extensive panel of immunohistochemistry, the diagnosis of an amelanotic malignant melanoma of uterine cervix was established.
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Affiliation(s)
- Pallavi Srivastava
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Satyajeet Rath
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rahat Hadi
- Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Nuzhat Husain
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Melanoma of the lower genital tract: Prognostic factors and treatment modalities. Gynecol Oncol 2018; 150:180-189. [PMID: 29728261 DOI: 10.1016/j.ygyno.2018.04.562] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 12/13/2022]
Abstract
Primary melanomas originating from the gynecological tract are rare and aggressive cancers. The vulva is the most frequent site (70%), followed by vagina and more rarely by cervix. The clinical outcome of patients with female genital tract melanoma is very poor, with a 5-year overall survival (OS) of 37-50% for vulvar, 13-32% for vaginal, and approximately 10% for cervical melanoma. In this systematic review, we analyzed the pathogenesis and the different factors influencing the prognosis of melanomas of the lower genital tract, with particular emphasis on biologic variables that may influence new therapeutic approaches. We evaluated the different treatment modalities described in the literature, in order to offer a possible algorithm that may help the clinicians in diagnosing and treating patients with these uncommon malignancies.
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Zemelman VB, Valenzuela CY, Sazunic I, Araya I. Malignant melanoma in Chile: different site distribution between private and state patients. Biol Res 2015; 47:34. [PMID: 25204018 PMCID: PMC4125693 DOI: 10.1186/0717-6287-47-34] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The body site location of primary Malignant Melanoma (MM) has been correlated with prognosis and survival. Ethnic, genetics, sun exposure factors are related to the anatomical distribution of MM. Low and high socioeconomic strata in Chile differ in ethnic, genetic and cultural conditions. The purpose of this study was to analyze the anatomical MM distribution in the Chilean population in both strata searching for differences due to their ethno-genetic-cultural differences. Records of 1148 MM, 575cases from state hospitals (Low Socioeconomic Strata, LSS) and 573 cases from private clinics (High Socioeconomic Strata, HSS) were analyzed by body site. Results Females from LSS showed a higher number of MM in soles, cheeks, and around the eye area. Females from the HSS showed a higher number of MM in dorsal feet and dorsal hands. Males from LSS showed a higher number of MM in soles, around the eye area, and cheeks. However, males from HSS showed a higher number of MM in the trunk, and in the arms. Acral MM was significantly higher in LSS than in the HSS in both sexes. The Chilean population from the HSS and LSS showed differences in the distribution of MM by site. Furthermore, gender differences in the proportion of MM analyzed by anatomical site are observed in both strata. Conclusions Results show evidence that differential genetics factors, sun exposure, or other environmental or cultural factors of both strata may account for these differences.
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Murzaku EC, Penn LA, Hale CS, Pomeranz MK, Polsky D. Vulvar nevi, melanosis, and melanoma: An epidemiologic, clinical, and histopathologic review. J Am Acad Dermatol 2014; 71:1241-9. [DOI: 10.1016/j.jaad.2014.08.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 08/01/2014] [Accepted: 08/13/2014] [Indexed: 02/03/2023]
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10
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Paradisi A, Abeni D. Clustering of cutaneous melanoma in health care workers of a dermatological day hospital unit. Dermatology 2014; 228:281-4. [PMID: 24603034 DOI: 10.1159/000356179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 10/06/2013] [Indexed: 12/16/2023] Open
Abstract
BACKGROUND The incidence of cutaneous melanoma is increasing but in most countries is still below 20/100,000 per year. Despite such a low frequency of occurrence, recently the authors have had notice of several new melanoma cases among colleagues. We carried out a survey of melanoma occurrence among the personnel, and their close relatives, of a dermatological clinic. The self-reported figures were compared with data from cancer registries. OBSERVATIONS Thirty-eight doctors and nurses were surveyed. Three responders reported having had a diagnosis of melanoma (7.9%, 95% CI 1.7-21.4%). The respondents reported having 617 'relatives who are alive today and would have come to them if they had a melanoma': 12 had known diagnoses of melanoma (1.9%, 95% CI 1.0-3.4%). The relative risks were 26.3 (95% CI 8.9-78.0) and 4.1 (95% CI 1.2-13.8) for doctors and nurses compared to the general population and to their relatives, respectively, and 6.5 (95% CI 3.7-11.4) for relatives compared to the general population. CONCLUSIONS Two nonmutually exclusive hypotheses may be formulated to explain these findings: (a) most cutaneous melanomas regress spontaneously; (b) an infectious agent is involved in the causal pathway of cutaneous melanoma. Further studies may be warranted to confirm our observations and test such hypotheses.
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Affiliation(s)
- Andrea Paradisi
- Health Services Research Unit, Istituto Dermopatico dell'Immacolata, IRCCS, Rome, Italy
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11
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Bennani A, el Fatemi H, Erraghay S, Mobakir H, Ameurtess H, Souuaf I, Moumna K, Idrissi K, Zriouel A, Squalli N, Banani A, Amarti A. [The primary melanoma of the female genital tract: report of three cases and review of literature]. Pan Afr Med J 2013; 16:58. [PMID: 24672629 PMCID: PMC3964009 DOI: 10.11604/pamj.2013.16.58.2404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 06/24/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- Amal Bennani
- Service d'anatomie pathologique CHU Hassan II Fès, Maroc
| | | | | | - Hind Mobakir
- Service de gynécologie obstétrique CHU Hassan II Fès
| | | | - Ihsane Souuaf
- Service d'anatomie pathologique CHU Hassan II Fès, Maroc
| | - Kaoutar Moumna
- Service d'anatomie pathologique CHU Hassan II Fès, Maroc
| | - Karima Idrissi
- Service d'anatomie pathologique CHU Hassan II Fès, Maroc
| | | | | | | | - Affaf Amarti
- Service d'anatomie pathologique CHU Hassan II Fès, Maroc
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Coexisting malignant melanoma and blue nevus of the uterine cervix: an unusual combination. Case Rep Pathol 2012; 2012:986542. [PMID: 23024873 PMCID: PMC3457599 DOI: 10.1155/2012/986542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/26/2012] [Indexed: 02/03/2023] Open
Abstract
Malignant melanoma (MM) and blue nevi of the uterine cervix are an extremely rare neoplasm, probably derived from embryologic migration of melanocytes from the neural crest. MM displays aggressive behavior with a poor prognosis. We report the case of a 76-year-old postmenopausal woman abnormal vaginal bleeding. She underwent a hysterectomy and bilateral salpingo-oophorectomy with paraaortic-iliac lymphadenectomy. Histopathological and immunohistochemical studies were consistent with the diagnosis of MM and blue nevi in the uterine cervix. Although it is extremely rare, this case suggests that MM of the uterine cervix should be considered in the differential diagnosis of undifferentiated neoplasm. Early diagnosis is essential in order to warrant a better prognosis, although there are no cases of cure described.
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Linos K, Slominski A, Ross JS, Carlson JA. Melanoma update: diagnostic and prognostic factors that can effectively shape and personalize management. Biomark Med 2011; 5:333-60. [PMID: 21657842 DOI: 10.2217/bmm.11.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Routine light microscopy remains a powerful tool to diagnose, stage and prognose melanoma. Although it is very economical and efficient, it requires a significant level of expertise and, in difficult cases the final diagnosis is affected by subjective interpretation. Fortunately, new insights into the genomic aberrations characteristic of melanoma, coupled with ancillary studies, are further refining evaluation and management allowing for more confident diagnosis, more accurate staging and the selection of targeted therapy. In this article, we review the standard of care and new updates including four probe FISH, the 2009 American Joint Commission on Cancer staging of melanoma and mutant testing of melanoma, which will be crucial for targeted therapy of metastatic melanoma.
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Pusceddu S, Bajetta E, Carcangiu ML, Formisano B, Ducceschi M, Buzzoni R. A literature overview of primary cervical malignant melanoma: an exceedingly rare cancer. Crit Rev Oncol Hematol 2011; 81:185-95. [PMID: 21515070 DOI: 10.1016/j.critrevonc.2011.03.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/03/2011] [Accepted: 03/24/2011] [Indexed: 11/25/2022] Open
Abstract
Primary malignant melanoma (MM) of the uterine cervix is an extremely rare neoplasm, with about 78 cases described in the literature. Since traces of melanocytes in normal cervical epithelium were found in 3.5% of cases primary origin of melanoma at this site cannot be ruled out. It occurs mainly in the sixth decade of life, and it is five time less common than primary vaginal or vulvar MM. Clinical history usually includes abnormal genital bleeding; and physical examination frequently reveals a pigmented, exophytic cervical mass. Diagnosis is confirmed by immuno-histochemical methods and by exclusion of any other primary site of melanoma. Treatment of this condition is not yet standardized, and the overall prognosis is very poor. Diagnostic approaches and therapeutic procedures on primary MM of the uterine cervix are discussed following a review of the literature encompassing more than one century.
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Affiliation(s)
- Sara Pusceddu
- Medical Oncology Unit 2, Department of Pathology, Anatomic Pathology A Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori", Via G. Venezian 1, 20133 Milan, Italy
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Ragnarsson-Olding BK. Spatial density of primary malignant melanoma in sun-shielded body sites: A potential guide to melanoma genesis. Acta Oncol 2011; 50:323-8. [PMID: 21299449 DOI: 10.3109/0284186x.2010.535846] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
UNLABELLED UV radiation is a major factor in melanoma genesis, but non-UV linked factors are also operational, since primary malignant melanomas can emerge in body sites that never see the sun. The scarcity of melanomas in sun-shielded body sites reflects only the absolute number of melanomas, not the number of tumours per square unit of the surface in which they emerge. Studies on melanoma density conducted by us and others are here briefly reviewed. The access to reliable numbers along with measurable anatomical areas directed our choice of melanomas at the sun-shielded locations described here. Melanomas at the body surface. Calculations of surface areas bearing melanomas relative to the total body surface included sites on the vulva, subungual tissues, volar and palmar skin, and, for comparison melanomas of the face during the same period of time. The density of vulvar melanomas was identical to that in chronically sun-exposed facial skin. Subungual melanomas were almost nine times denser than expected whereas melanomas of palms and soles showed a lower density than expected. Melanomas beneath the body surface. The densities of melanomas in the vagina, anal canal and uvea, were calculated separately and compared to the average density of cutaneous melanomas (CMMs) during the same period of time. Melanomas of the anal canal displayed a density almost twice the average for CMMs, whereas the vaginal melanomas were similar in density to CMMs. In contrast, the density of the uveal melanomas was calculated as 50 and 41 times (men and women, respectively) the average density of CMMs. CONCLUSION The high density of some melanomas in sun-shielded body areas indicates the presence of factors underlying the origins of these tumours that seem to be equivalent in strength to UV radiation and also implies that specific anatomical sites favour the emergence and proliferation of melanomas, independent of UV radiation.
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Affiliation(s)
- Boel K Ragnarsson-Olding
- Department of Oncology and Pathology, Karolinska Institutet and Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden.
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Ruer JB, Pépin L, Gheit T, Vidal C, Kantelip B, Tommasino M, Prétet JL, Mougin C, Aubin F. Detection of alpha- and beta-human papillomavirus (HPV) in cutaneous melanoma: a matched and controlled study using specific multiplex PCR combined with DNA microarray primer extension. Exp Dermatol 2009; 18:857-62. [DOI: 10.1111/j.1600-0625.2009.00866.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Melanoma of the vulva: a pigmented lesion is also significant in a non-sun-exposed area. Arch Gynecol Obstet 2009; 280:831-4. [PMID: 19255768 DOI: 10.1007/s00404-009-1011-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 02/12/2009] [Indexed: 10/21/2022]
Abstract
PURPOSE The foremost important aetiological factor for malignant melanoma is considered to be sunlight exposure. However, primary lesions are also seen in non-sun-exposed areas. Vulvar melanoma is rare and associated with impaired outcome. Herein, we attempt to increase physicians' awareness for early diagnosis in order to improve prognosis. CASE REPORT A 64-year-old female presented with pruritus and irritation at her external genitalia. At examination a pigmented lesion of the vulva 3 cm in diameter was seen. Incisional biopsy revealed melanoma. Clinical examination and imaging studies did not show evidence for metastatic disease. She underwent wide excision of the melanoma with primary wound closure and biopsy of sentinel lymph nodes, which were free of disease. After a follow-up period of 43 months, she remains free of disease. CONCLUSIONS Literature review shows that prognosis is poorer than at other sites, most probably due more advanced disease at diagnosis. This case demonstrates that early diagnosis by physicians aware of this malignancy at this relatively rare site is of crucial importance since it may result in improved outcome, similar to that of melanoma at more common sites.
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Abstract
The differential diagnosis of perineal biopsies can include squamous intraepithelial lesions, extramammary Paget's disease, and melanoma. Less frequently two of these lesions coexist. BD ProEx C is a recently developed immunoassay that targets expression of two genes shown to be associated with cervical cancer. Immunostaining for ProEx C has been validated in cervical cytology and positive staining has also been shown to be strongly associated with human papilloma virus (HPV)-induced cervical and anal intraepithelial neoplasia in biopsies. We observed positive staining for ProEx C in Paget cells in all of 26 cases of Paget's disease irrespective of tissue site (extramammary, mammary) and in melanoma cells in all of 12 cases of primary perineal melanoma with immunostaining in >50% of malignant cells in 73% of Paget disease cases and 43% of perineal melanoma cases. Positive staining was heterogeneous and exclusively nuclear in all cases. In situ hybridization was negative for low-risk and high-risk HPV subtypes in all Paget and melanoma cases that were tested. Currently neither of these lesions is known to be HPV related although according to the literature the possibility of a role for HPV in melanoma is still unsettled. Relevant literature is reviewed.
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Incidental epidermodysplasia verruciformis human papillomavirus infection (EV acanthoma): evidence for ‘field cancerization’ and a putative cofactor in seborrheic keratosis. J Cutan Pathol 2008; 35:1151-5. [DOI: 10.1111/j.1600-0560.2007.00920.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Carlson JA, Cribier B, Nuovo G, Rohwedder A. Epidermodysplasia verruciformis-associated and genital-mucosal high-risk human papillomavirus DNA are prevalent in nevus sebaceus of Jadassohn. J Am Acad Dermatol 2008; 59:279-94. [PMID: 18638629 DOI: 10.1016/j.jaad.2008.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 02/17/2008] [Accepted: 03/10/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND The hamartoma nevus sebaceus (NS) presents at birth or early childhood as a yellowish plaque characterized histologically by variable acanthosis, papillomatosis, sebaceus hyperplasia, and proliferations of adnexal structures. Clinically apparent human papillomavirus (HPV) infection is also recognized by acanthosis and papillomatosis. OBJECTIVE We sought to determine the prevalence and physical state of HPV DNA in NS. METHODS DNA was retrieved from 44 formalin-fixed, paraffin-embedded samples of NS (22 with secondary tumors [eg, trichoblastoma, verruca, syringocystadenoma papilliferum] and two epidermal nevi [EN]). Nested polymerase chain reaction with multiple degenerate consensus and type-specific primers and direct sequencing of polymerase chain reaction products was performed. For selected cases, in situ hybridization using probes specific for HPV 5 and 8 and for high-risk genital-mucosal HPV types was performed. RESULTS HPV DNA was detected in 82% of NS and both EN, and consisted of genital-mucosal HPV types in 52% (HPV 6, 16, and 33) and a diverse variety of epidermodysplasia verruciformis-associated HPV types in 61%, including well-known epidermodysplasia verruciformis HPV types (5, 8, 15, 20, 22, 24, 36, 37, 38, and 80) and putatively novel epidermodysplasia verruciformis HPV types (DL285, DL287, DL436, and alb-1, -2, -3, -5, -6, -7, -8, -10, -11, -12, and -13). HPV coinfection was frequent, found in 48% (two HPV genotypes in 35% and 3 in 13%). Of NS and EN, 42% had HPV genotypes associated with cancer (ie, HPV 5, 8, 16, 20, 33, and 38); the two most commonly identified HPV types where HPV 16 (39%) and HPV 38 (18%). No differences were detected comparing frequency of HPV DNA detected with respect to age or presence of a secondary tumor. Histologically, all NS and EN showed HPV-associated cytopathic effects (ie, perinuclear halos, altered keratohyaline granules). By in situ hybridization, 64% (18/28) were positive, showing a low-intensity, punctate nuclear signal in epidermal and adnexal keratinocytes, indicating viral integration and low viral genome copy number. LIMITATIONS Absence of adjacent, uninvolved normal-appearing skin control samples. CONCLUSION HPV DNA is prevalent in NS, and HPV 16, the most frequently detected genotype, appears to be integrated into the host genome. Whether HPV represents a commensal infection caused by localized cutaneous predisposition, or is an essential factor in the pathogenesis of NS is unknown. The high frequency of oncogenic HPV types implicates maternal transmission of HPV and infection of an ectodermal stem cell leading to an epigenetic mosaic and altered skin development manifested along Blaschko's lines.
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Affiliation(s)
- J Andrew Carlson
- Department of Pathology, Division of Dermatopathology, Albany Medical College, Albany, New York 12208, USA.
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Abstract
Despite its low incidence, vulvar melanoma carries a poor prognosis and shows a high tendency to metastasize because the diagnosis is often delayed. Although it is very well known that ultraviolet radiation is an important aetiological factor for cutaneous melanomas in adults, this cannot be considered true for vulvar melanoma. Chronic inflammatory disease, viral infections, irritant agents are the main factors suspected to induce mucosal melanoma. We report 10 cases of vulvar malignant melanoma observed in our institute from 1990 to 2005 and a review of the literature.
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Lin MT, Rohwedder A, Mysliborski J, Leopold K, Wilson VL, Carlson JA. ‘HPV vulvitis’ revisited: frequent and persistent detection of novel epidermodysplasia verruciformis-associated HPV genotypes. J Cutan Pathol 2008; 35:259-72. [DOI: 10.1111/j.1600-0560.2007.00805.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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24
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Dainichi T, Kobayashi C, Fujita S, Shiramizu K, Ishiko T, Kiryu H, Urabe K, Tsuneyoshi M, Furue M. Interdigital amelanotic spindle-cell melanoma mimicking an inflammatory process due to dermatophytosis. J Dermatol 2007; 34:716-9. [PMID: 17908146 DOI: 10.1111/j.1346-8138.2007.00367.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Herein, we report a rare case of amelanotic spindle-cell melanoma on the interdigit of the left fifth toe of an 83-year-old woman. She also had tinea pedis on the same part for more than 2 years, and the part in which the tumor developed had been macerated and colonized with both Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus. Histopathologically, the biopsy specimen was indistinguishable from that of nonspecific inflammatory granulation. Two biopsies could not lead us to the correct diagnosis until the totally excised specimen was evaluated with immunohistochemical analysis including S-100 and other melanocyte markers. The patient died with multiple metastases of the tumor 18 months after her first visit. This case suggests that refractory interdigital dermatophytoses should be treated by considering the possibility of concomitant malignant neoplasms, and immunohistochemical analysis is indispensable for differential diagnosis of malignant neoplasms suggesting nonspecific granulation.
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Affiliation(s)
- Teruki Dainichi
- Department of Dermatology, Nakatsushima Hospital, Tsushima, Nagasaki, Japan.
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25
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Tapp RA, Feng J, Jones JW, Carlson JA, Wilson VL. Single base instability is promoted in vulvar lichen sclerosus. J Invest Dermatol 2007; 127:2563-76. [PMID: 17554370 DOI: 10.1038/sj.jid.5700889] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Single base substitution mutations in codons 248 and 273 of TP53 and codon 12 Kirsten-ras (KRAS) are commonly found in human carcinomas. To determine whether these mutations also occur in normal and inflamed tissues from which carcinomas arise, we utilized the ultra-sensitive polymerase chain reaction/restriction endonuclease/ligase chain reaction mutation assay. Ninety samples of genital skin, including lichen sclerosus (LS) affected skin, adjacent normal and non-adjacent normal, were assayed. Mutations were detected in 103 of 349 assays and consisted of KRAS G34A, G34T, G35A, and TP53 C742T, G818C, C817T, and G818A mutations. Mutant prevalence varied from 1 to 20 per 10(6) wild-type cells. Mutations occurred significantly more frequently in LS (78/224 (35%)) than adjacent normal (20/88 (23%)) and non-adjacent normal genital skin (5/38 (13%)). KRAS G34A mutation was relatively common to all classes of specimen, whereas TP53 gene C742T and G818C mutations were significantly more frequent in LS than normal genital skin. In matched samples, immunohistochemistry evaluation of p53 protein expression revealed the presence of epidermal p53 clones in LS whose presence and number significantly correlated with the presence of TP53 C742T and G818C mutations. Based on these results, it appears oncogenic point mutations occur in normal genital skin, and are selected for in LS.
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Affiliation(s)
- Ronald A Tapp
- Department of Veterinary Comparative Biomedical Sciences, Louisiana State University, Baton Rouge, Louisiana, USA
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26
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Ambretti S, Venturoli S, Mirasoli M, La Placa M, Bonvicini F, Cricca M, Zerbini M, Roda A, Musiani M. Assessment of the presence of mucosal human papillomaviruses in malignant melanomas using combined fluorescent in situ hybridization and chemiluminescent immunohistochemistry. Br J Dermatol 2007; 156:38-44. [PMID: 17199564 DOI: 10.1111/j.1365-2133.2006.07541.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The vast majority of studies aimed at detecting human papillomavirus (HPV) DNA in skin cancer have used sensitive polymerase chain reaction (PCR) methods but the PCR technique, despite its high sensitivity, is not suitable to ascertain whether (i) the presence of HPV can be related only to few cells harbouring the virus, (ii) the presence of HPV is due to a tumour surface contamination and (iii) the presence of HPV is localized in cancer cells, rather than in normal keratinocytes present in the tumour biopsy. In a recent work we have found mucosal high-risk (HR) HPV genotypes in primary melanoma by PCR. OBJECTIVES To localize mucosal HR-HPV nucleic acids and tumoural melanocytic marker in the same sections of primary melanoma samples in order to understand the relationship between HPVs and melanoma cells. METHODS We have developed a very sensitive method that combines an enzyme-amplified fluorescent in situ hybridization (ISH) for the detection of HPV nucleic acids (types 16 and 18) with a chemiluminescent immunohistochemistry (IHC) method for the detection of the tumoural melanocytic marker HMB-45 sequentially in the same section. Digital images of fluorescent ISH and chemiluminescent IHC were separately recorded, assigned different colours and merged using specific software for image analysis. RESULTS The combined fluorescent ISH and chemiluminescent IHC demonstrated a sharp colocalization (in the range 60-80%) of HPV nucleic acids and melanoma marker inside the same sections of melanoma biopsies, with a strong specificity and sensitivity. CONCLUSIONS The strong colocalization of mucosal HR-HPV nucleic acids and HMB-45 melanocytic marker emphasized that viral nucleic acids were specifically present in melanoma cells and supported a possible active role of HPV in malignant melanoma.
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Affiliation(s)
- S Ambretti
- Section of Microbiology, Department of Clinical and Experimental Medicine, University of Bologna, Bologna, Italy
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27
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Rohwedder A, Slominski A, Wolff M, Kredentser D, Carlson JA. Epidermodysplasia Verruciformis and Cutaneous Human Papillomavirus DNA, but Not Genital Human Papillomavirus DNAs, Are Frequently Detected in Vulvar and Vaginal Melanoma. Am J Dermatopathol 2007; 29:13-7. [PMID: 17284956 DOI: 10.1097/01.dad.0000245202.59762.09] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Vulvovaginal melanomas are rare and their etiology is unknown. Genital mucosal human papillomavirus (HPV) 16 has been identified in both cutaneous and mucosal melanoma, suggesting that it might play a role in the pathogenesis or progression of melanoma. In this study, we investigated the prevalence of HPV DNA by using a broad spectrum of degenerate and type-specific primers for genital-mucosal, epidermodysplasia verruciformis-associated (EV), and cutaneous HPV types in 6 vulvar and 3 vaginal melanomas. The patients were mostly postmenopausal women (8/9), had a mean age of 67 years (range, 44-85 years), and had mucosal lentiginous (7) or nodular (2) melanomas. In the adjacent skin/mucosa, mucosal melanosis was found in 5, lichen sclerosus or a lichenoid mucositis in 4, and blue nevi in 2 women. With nested polymerase chain reaction techniques followed by direct sequencing, HPV DNA was identified in 6 of 9 (67%) melanomas; these were either cutaneous (HPV 3) (4/9) or epidermodysplasia verruciformis-associated types (HPV 38, Z95969, AJ00151) (4/9). Epidermodysplasia verruciformis-associated HPV (type 15) was found solely in 1/10 (10%) normal vulvar controls. Genital-mucosal HPV types were not detected either by degenerate nested polymerase chain reaction or type-specific probes for HPV 16. We propose that the above findings are not coincidental but may represent a molecular record of HPV involvement in pathogenesis or progression of melanoma, which is consistent with the strong but poorly defined association of cutaneous HPV types with nonmelanoma skin cancers. The theory that HPV may act as a cofactor in melanoma development deserves further clinical and experimental investigations.
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28
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Kunthur A, Wiernik PH, Dutcher JP. Renal parenchymal tumors and lymphoma in the same patient: case series and review of the literature. Am J Hematol 2006; 81:271-80. [PMID: 16550521 DOI: 10.1002/ajh.20533] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We reviewed the incidence of diagnosis of renal cell carcinoma and lymphoma in the same patient and analyzed the characteristics of this association. Nine patients in 4 years had the diagnosis of renal cell carcinoma (RCC) and lymphoma, including 2 with Hodgkin disease, 1 with chronic lymphocytic leukemia (CLL), and 3 each with low-grade follicular and intermediate-grade non-Hodgkin lymphoma (NHL). In SEER data, the observed/expected (O/E) ratio of NHL and RCC is 1.86 to 2.07. In our series, 2 patients were diagnosed with NHL after the diagnosis of RCC, 1 was diagnosed concurrently, and in the other 6, lymphoma preceded diagnosis of RCC. In reviews of second malignancies following treatment of Hodgkin disease, RCC is less common (O/E 1.5, with 1/3 being transitional cell carcinoma and 2/3 being adenocarcinoma). We report 2 cases with Hodgkin disease preceding RCC, and in both, Hodgkin disease occurred as an adult. There is a male predominance for patients with both diagnoses, which is greater than the male predominance for either RCC or NHL alone (2.2 vs. 2.0 vs. 1.2). There is an increased likelihood of the lymphoma being extranodal. There is an increased association of RCC and NHL more often among male patients, and often with extranodal lymphoma. Potential common etiological factors include prior treatment for malignancy, genetic predisposition, environmental factors, including a search for viral sequences, and possible immune dysregulation generating the lymphoma and subsequently leading to solid tumors such as RCC or melanoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/etiology
- Carcinoma, Renal Cell/therapy
- Environmental Exposure
- Genetic Predisposition to Disease
- Humans
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/etiology
- Kidney Neoplasms/therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/therapy
- Lymphoma/diagnosis
- Lymphoma/etiology
- Lymphoma/therapy
- Male
- Middle Aged
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/therapy
- Sex Factors
- Treatment Outcome
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Affiliation(s)
- Anuradha Kunthur
- Comprehensive Cancer Center, Our Lady of Mercy Medical Center, New York Medical College, Bronx, New York 10466, USA
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29
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Boukamp P. UV-induced Skin Cancer: Similarities - Variations. Durch UV-Strahlung induzierte Hauttumore: Gemeinsamkeiten - Unterschiede. J Dtsch Dermatol Ges 2005; 3:493-503. [PMID: 15967008 DOI: 10.1111/j.1610-0387.2005.05037.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Skin cancer, the most common cancer world wide, encompasses different tumor entities, the keratinocyte-derived basal cell carcinoma (BCC), and squamous cell carcinoma (SCC) as well as the neuroectodermal malignant melanoma (MM) and the neuroendocrine Merkel cell carcinomas (MCC). While knowledge is significantly increasing about genetic changes contributing to BCCs and MMs, our understanding for the development and progression of SCCs and MCCs is still fragmentary. This review, thus, aims, on the one hand to summarize the present knowledge without claiming completeness and, on the other hand, to provide information on the HaCaT in vitro skin carcinogenesis model that is used to evaluate the functional consequence of genetic aberrations believed to play a role in skin cancer development and progression.
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Affiliation(s)
- Petra Boukamp
- Division of Genetics of Skin Carcinogenesis, German Cancer Research Center Heidelberg, Germany.
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30
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La Placa M, Ambretti S, Bonvicini F, Venturoli S, Bianchi T, Varotti C, Zerbini M, Musiani M. Presence of high-risk mucosal human papillomavirus genotypes in primary melanoma and in acquired dysplastic melanocytic naevi. Br J Dermatol 2005; 152:909-14. [PMID: 15888145 DOI: 10.1111/j.1365-2133.2005.06344.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Some studies have shown that cutaneous and mucosal melanoma biopsy specimens harbour human papillomavirus (HPV), suggesting that this virus may play a role in development and progression of the tumour. OBJECTIVES To investigate the presence of HPV DNA and the prevalence of different high-risk mucosal HPV genotypes in primary melanoma (PM) and in acquired dysplastic melanocytic naevi (ADMN). METHODS Fifty-one PMs from 18 men and 33 women (median age 55.5 years), 33 ADMN from 15 men and 18 women (median age 35.1 years) and 20 control skin samples from nine men and 11 women (median age 43.5 years) were studied. All diagnoses were made after histological analysis. HPV DNA analysis was made using two different polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA) methods, namely MY-PCR and GP-PCR. RESULTS Using GP-PCR, mucosal HPVs were detected in 14 PMs (27%; P = 0.0166) and eight ADMN (24%; P = 0.0367), while with MY-PCR, mucosal HPVs were found in 11 PMs (22%; P = 0.04) and five ADMN (15%; P not significant). All control skin samples were negative for mucosal HPVs with both DNA amplification procedures. CONCLUSIONS Using our PCR-ELISA methods, the detection of mucosal high-risk HPV genotypes in 24% of precursor lesions (ADMN) and in 27% of PMs adds to the body of evidence indicating a colocalization of mucosal HPV and tumoral melanocytic pathologies.
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Affiliation(s)
- M La Placa
- Sections of Dermatology and Microbiology, Department of Clinical and Experimental Medicine, University of Bologna, Bologna, Italy.
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31
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Abstract
Second malignancies occur with increased frequency in patients with chronic lymphocytic leukemia (CLL) regardless of treatment, but they may be more frequent and more aggressive after nucleoside analog therapy of CLL. In as many as 33% of patients with CLL who develop a second malignancy, a spontaneous remission of CLL precedes the diagnosis of the second malignancy by months or years. Richter's syndrome, whether manifested by anaplastic large cell lymphoma or Hodgkin's disease, is not truly a second malignancy because the CLL clone appears to be involved. However, all other malignancies developing in patients with CLL appear to be derived from a different clone. CLL and the second malignancy may have a common viral etiology. Second malignancies in patients with CLL should be treated as they would be in patients without CLL.
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Affiliation(s)
- Peter H Wiernik
- Our Lady of Mercy Cancer Center, 600 East 233rd Street, Bronx, NY 10466, USA.
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32
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Alexander A, Harris RM, Grossman D, Bruggers CS, Leachman SA. Vulvar melanoma: diffuse melanosis and metastasis to the placenta. J Am Acad Dermatol 2004; 50:293-8. [PMID: 14726891 DOI: 10.1016/j.jaad.2003.07.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mucocutaneous melanoma, including vulvar melanoma, is rare and has a worse prognosis and higher recurrence rate than traditional cutaneous melanoma. Diffuse cutaneous melanosis is another rare clinical presentation of metastatic melanoma. It is essential for dermatologists to be alerted to rare presentations of melanoma, to facilitate early detection. We present the first case to our knowledge of metastatic vulvar melanoma with diffuse cutaneous melanosis in a pregnant young woman. Despite the occurrence of placental metastasis, a healthy, unaffected baby was born. This case exemplifies the aggressiveness of vulvar melanoma. The genitalia should be included in routine total body skin examinations. Pregnant women with generalized melanosis may be at increased risk for placental metastasis of melanoma. Pregnancy does not alter the incidence or prognosis of melanoma; however, patients with a poor prognosis or high recurrence risk should be informed of potential pregnancy complications associated with melanoma recurrence or metastasis.
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Affiliation(s)
- April Alexander
- Department of Dermatology, University of Utah, Salt Lake City, Utah 84112-5550, USA
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33
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Schaller J, Rohwedder A, Burgdorf WHC, Itin PH, Lautenschlager S. Identification of human papillomavirus DNA in cutaneous lesions of Cowden syndrome. Dermatology 2004; 207:134-40. [PMID: 12920361 DOI: 10.1159/000071782] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2002] [Accepted: 11/22/2002] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cowden syndrome (CS) or multiple hamartoma syndrome is a cancer-associated genodermatosis inherited in an autosomal dominant pattern. One of the diagnostic criteria is facial papules which are felt to be trichilemmomas, benign hair follicle tumors, which some consider to be induced by human papillomavirus (HPV). OBJECTIVE To search for HPV in skin tumors, especially trichilemmomas, from patients with CS. METHODS Skin lesions from patients with CS were classified histologically. Each tumor was then analyzed for HPV DNA by polymerase chain reaction with different primer sets; positive amplicons were typed by direct sequencing. RESULTS Twenty-nine biopsies from 7 patients with CS were investigated. Only 2 of 29 tumors clinically suspected of being trichilemmomas were confirmed histologically. In addition, 3 sclerotic fibromas, also typical of CS, were found, as well as 1 sebaceous hyperplasia. The other 23 lesions showed histological features of HPV- induced tumors in various stages of development. HPV DNA was found in 19 of 29 cutaneous lesions. Tumors without any histological signs of HPV induction were negative for HPV DNA. Two tumors which were histologically classified as common warts contained HPV types 27 and 28. All the 17 other HPV types belong to the group of epidermodysplasia-verruciformis-associated types. CONCLUSIONS The majority of cutaneous lesions in CS contain HPV DNA. They may have a variety of histological patterns. Trichilemmomas are not clinically distinctive and can be difficult to identify in CS patients.
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Affiliation(s)
- Jörg Schaller
- Department of Dermatology, Dermatohistological Unit, St. Barbara Hospital, Duisburg, Germany.
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34
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Abstract
Lichen sclerosus is a chronic disorder of the skin and mucosal surfaces, and is most commonly seen on the female genital skin. It also occurs on other areas of the body. Any age group may be affected, although it is seen more often in elderly women. The exact cause of lichen sclerosus is unknown. There have been reports of family members with lichen sclerosus; thus it may have a genetic link. There is also the possibility of an autoimmune connection. Currently, ultra-potent topical corticosteroids are the medical treatment of choice. Other treatments that have been utilized for this condition include testosterone, progesterone, tacrolimus, surgery, and phototherapy. Surgery should be reserved for symptomatic patients who fail to respond to multiple medical treatments, as there is a high recurrence rate following surgery. The risk of developing squamous cell carcinoma of the vulva approaches 5% in women with vulvar lichen sclerosus, and therefore close surveillance by the healthcare provider and patient is needed. This review discusses the history, clinical features, pathophysiology, and treatment of lichen sclerosus of the vulva, as well as pregnancy issues and sexual function in patients with this condition. In addition, problems specific to children with lichen sclerosus are reviewed.
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Affiliation(s)
- Yolanda R Smith
- Department of Obstetrics and Gynecology, The University of Michigan Hospitals Health Systems, Ann Arbor, Michigan 48109-0276, USA.
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35
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Norgauer J, Rohwedder A, Schaller J. Human papillomavirus and Grzybowski's generalized eruptive keratoacanthoma. J Am Acad Dermatol 2003; 49:771-2. [PMID: 14512942 DOI: 10.1067/s0190-9622(03)01676-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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36
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Tobin E, Rohwedder A, Holland SM, Philips B, Carlson JA. Recurrent 'sterile' verrucous cyst abscesses and epidermodysplasia verruciformis-like eruption associated with idiopathic CD4 lymphopenia. Br J Dermatol 2003; 149:627-33. [PMID: 14511000 DOI: 10.1046/j.1365-2133.2003.05543.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Rupture of follicular (epidermoid) cysts is believed to be the consequence of bacterial infection. We report a 24-year-old man with idiopathic CD4 lymphopenia and chronic Mycobacterium avium intracellulare infection who developed multiple, recurring painful abscesses over the distal extremities that increased in number and severity when systemic steroid and interferon-gamma treatment was instituted for interstitial lung disease. Cultures were consistently negative for microorganisms, but pathological examination revealed ruptured epidermoid cyst walls with human papillomavirus (HPV) viropathic changes (keratinocytes with perinuclear halos and abundant basophilic keratohyaline granules). Cutaneous examination showed numerous, widespread flat-topped papules and achromic macules over the extremities, head and neck. Nested polymerase chain reaction analysis for HPV DNA revealed that the abscess-related cyst walls harboured epidermodysplasia verruciformis (EV)-associated HPV types 20, 24, alb-7 (AY013872) and 80. His cutaneous lesions harboured HPV types 3, 8 and 80. Similar to past reports, our patient developed an EV-like eruption in the setting of immunodeficiency. In this instance, EV-associated HPV infection of the follicular infundibular epithelium or pre-existing cysts in the setting of immunodeficiency may have led to cystic growth, rupture and subsequent painful inflammation.
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Affiliation(s)
- E Tobin
- Upstate Infectious Disease, 567 New Scotland Ave., Albany, NY 12208, USA
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37
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Rohwedder A, Murphy M, Carlson FA. Multiple human papillomavirus DNA identified in verruciform xanthoma by nested polymerase chain reaction with degenerate consensus primers. J Cutan Pathol 2003; 30:344-6; author reply 347. [PMID: 12753178 DOI: 10.1034/j.1600-0560.2003.00074.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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