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Antúnez-Lay A, Podlipnik S, Carrera C, Potrony M, Tell-Martí G, Badenas C, Puig-Butille JA, Espinosa N, Puig S, Malvehy J. Synchronous primary cutaneous melanomas: a descriptive study of their clinical features, histology, genetic background of the patients and clinical outcomes. J Eur Acad Dermatol Venereol 2022; 36:2364-2372. [PMID: 35882522 DOI: 10.1111/jdv.18467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Around 0.5% cutaneous melanoma (CM) patients will present with synchronous melanomas when first seen. Moreover, 26%-40% of patients with multiple primary melanomas present with synchronous lesions. OBJECTIVES To assess the prevalence, clinical and histopathological characteristics, germline mutations and outcome in patients with synchronous melanoma. METHODS Clinical and histopathological data from 4703 melanoma patients were included. Clinical, histological and genetic mutational status information was analyzed. Kaplan-Meier curves were used to investigate survival outcomes. RESULTS A total of 144 patients (3.06%) presented simultaneously with 2 or more primary melanomas. During follow-up, 25.7% of patients with synchronous melanoma developed a new primary melanoma compared to 8.6% of patients diagnosed with single melanoma (p < 0.001). Germinal CDKN2A mutations were identified in 10.7% of patients with synchronous melanomas and genetic variants in MC1R in 72%. No significant differences in all survival outcomes between patients with synchronous melanomas and single melanomas were found. CONCLUSION Synchronous melanomas are more frequent than previously reported and are more frequent in older patients compared to single melanomas. Moreover, these patients have a higher risk of developing a new primary melanoma during follow-up and have higher rates of germline susceptibility variants. Nevertheless, these findings were not associated with worse outcomes.
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Affiliation(s)
- A Antúnez-Lay
- Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain
| | - S Podlipnik
- Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain
| | - C Carrera
- Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - M Potrony
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Spain
| | - G Tell-Martí
- Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - C Badenas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Spain
| | - J A Puig-Butille
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain.,Molecular Biology CORE. Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain
| | - N Espinosa
- Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain
| | - S Puig
- Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - J Malvehy
- Department of Dermatology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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2
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Ingordo V, Feci L, Cazzaniga S, Naldi L, Ingordo I, Sirna R. Measuring the horizontal and vertical growth rates of superficial spreading melanoma: a pilot study with sequential digital dermoscopy. Ital J Dermatol Venerol 2020; 156:473-478. [PMID: 32129054 DOI: 10.23736/s2784-8671.19.06489-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Some authors have hypothesized that the initial kinetics of the primary melanoma (MM) growth could reflect its biologic aggressiveness. The aim of this study was to pilot a measure of the horizontal vs. vertical growth of superficial spreading melanomas (SSM). METHODS The dermoscopic images of twenty-three consecutive MMs (17 SSMs and 6 MMs in situ), excised after digital sequential dermoscopy, were reviewed. We built up two indexes: 1) dROG (digital Rate of Growth) defined as Breslow thickness/(t1-tR), where t1 was the reported time of the first dermoscopic image acquisition and tR was the reported time of the acquisition before the lesion excision; 2) lHGR (linear Horizontal Growth Rate) took into account the greater axis of the lesion at two time points, at the time (t1) of the first image acquisition (D1) and before (tR) lesion excision (DR). The index was computed as (DR-D1)/(t1-tR). We built up the Composite Rate of Growth index (cROG) calculated as dROG/lHRG. If the value of cROG is <1 the superficial growth is prevalent on the vertical growth, and if the value is >1 the vertical growth is prevalent on the superficial growth. RESULTS In 82.6% of lesions the horizontal growth was prevalent on the vertical growth, and in 17.4% of cases the vertical growth was equal or prevalent on the superficial growth. CONCLUSIONS A small proportion of SSMs with a slow horizontal growth could have a precocious vertical growth. Other larger studies are needed to confirm this observation.
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Affiliation(s)
- Vito Ingordo
- Outpatients' Department of Dermatology, Local Health Center Taranto - District 6, Taranto, Italy - .,Centro Studi GISED, Bergamo, Italy -
| | - Luca Feci
- Department of Dermatology, Local Health Center 9, Misericordia Hospital, Grosseto, Italy
| | - Simone Cazzaniga
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Luigi Naldi
- Centro Studi GISED, Bergamo, Italy.,Department of Dermatology, Local Health Center 8 Berica, San Bortolo Hospital, Vicenza, Italy
| | | | - Riccardo Sirna
- Department of Dermatology, Local Health Center 9, Misericordia Hospital, Grosseto, Italy
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Betti R, Agape E, Vergani R, Moneghini L, Cerri A. An observational study regarding the rate of growth in vertical and radial growth phase superficial spreading melanomas. Oncol Lett 2016; 12:2099-2102. [PMID: 27602146 DOI: 10.3892/ol.2016.4813] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 12/04/2015] [Indexed: 11/06/2022] Open
Abstract
The natural history of superficial spreading melanomas (SSMs) involves the progression from a radial growth phase (RGP) to a vertical growth phase (VGP). Currently, a patient's history represents the only method to estimate the rate of tumor growth. The present study aimed to verify whether the estimated rate of growth (ROG) of SSMs with a RGP or VGP exhibited any differences, and to evaluate the possible implications for the most important prognostic determinants. ROG was quantified as the ratio between Breslow's thickness in millimeters (mm) and the time of tumor growth in months, defined as the time between the date that the patient had first noticed the lesion in which melanoma subsequently developed and the date on which the patient first felt this lesion changed. A total of 105 patients (58 male and 47 female) were studied. Of these, 66 had VGP-SSMs, whilst 39 had RGP-only SSMs (RGP-SSMs). No significant differences in age and gender were observed between these groups. The mean Breslow's thickness in patients with VGP-SSMs was significantly greater than in patients with RGP-SSMs (0.78±0.68 vs. 0.48±0.22 mm, P=0.0096). Similarly, the ROG was observed to be higher in VGP-SSM vs. RGP-SSM patients (0.13±0.16 vs. 0.065±0.09 mm/month, P=0.0244). In patients with VGP-SSMs, Breslow's thickness and ROG were significantly higher for tumors with a mitotic rate of ≥1 mitosis/mm2 compared with those with <1 mitosis/mm2 (1.15±0.96 vs. 0.56±0.30 mm, P=0.0005; and 0.188±0.20 vs. 0.09±0.12 mm/month, P=0.0228, respectively). According to these results, two subsets of SSMs exist: The first is characterized by the presence of mitosis and a higher ROG, while the second exhibits a more indolent behavior and is characterized by an RGP only. Given the differences in the Breslow's thickness and ROG, clinicians must be aware of the possible diagnostic delay in these subsets of melanoma that, differently from true nodular melanomas, generally fulfill the classical ABCD clinical criteria.
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Affiliation(s)
- Roberto Betti
- Dermatology Clinic, Department of Health Sciences, University of Milan, Hospital San Paolo, 20142 Milan, Italy
| | - Elena Agape
- Dermatology Clinic, Department of Health Sciences, University of Milan, Hospital San Paolo, 20142 Milan, Italy
| | - Raffaella Vergani
- Dermatology Clinic, Department of Health Sciences, University of Milan, Hospital San Paolo, 20142 Milan, Italy
| | - Laura Moneghini
- Division of Pathology, Department of Health Sciences, University of Milan, Hospital San Paolo, 20142 Milan, Italy
| | - Amilcare Cerri
- Dermatology Clinic, Department of Health Sciences, University of Milan, Hospital San Paolo, 20142 Milan, Italy
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Tschandl P, Berghoff AS, Preusser M, Pammer J, Pehamberger H, Kittler H. Impact of oncogenic BRAF mutations and p16 expression on the growth rate of early melanomas and naevi in vivo. Br J Dermatol 2016; 174:364-70. [PMID: 26613644 DOI: 10.1111/bjd.14323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is important to know what drives and arrests melanocytic growth in vivo but observations linking oncogenic mutations to growth rates of melanocytic neoplasms in vivo are sparse. OBJECTIVES To clarify the relationship between BRAF(V) (600E) mutations and p16 expression and the growth rate of melanocytic neoplasms in vivo. METHODS We measured the growth rate of 54 melanocytic lesions (26 melanomas, 28 naevi) in vivo with digital dermatoscopy and correlated it with BRAF(V) (600E) and p16 expression, and with dermatoscopic and histological patterns. RESULTS Melanomas grew faster than naevi (mean 2·7 vs. 0·8 mm(2) /year; P < 0·001) and the growth rate was faster in lesions with more nests (> 25% nests: 2·0 mm(2) /year vs. < 25% nests: 1·0 mm(2) /year; P = 0·036). Melanomas with the BRAF(V) (600E) mutation grew significantly faster than melanomas without the mutation (mean 3·36 vs. 1·60 mm(2) /year, P = 0·018). This effect of the BRAF(V) (600E) mutation on the growth rate was not observed in melanocytic naevi (mean 1·01 vs. 0·47 mm(2) /year, P = 0·274). Histopathologically, extensive nesting, larger nests and larger cell sizes were more common in melanocytic neoplasms with the BRAF(V) (600E) mutation than in those without the mutation. Melanomas expressing p16 had a slower growth rate than melanomas without p16 expression (2·27 vs. 4·34 mm(2) /year, P = 0·047). This effect was not observed in naevi (0·81 vs. 0·68 mm(2) /year, P = 0·836). CONCLUSIONS The expression of BRAF(V) (600E) and the loss of p16 accelerate the growth rate of early melanomas in vivo but not in melanocytic naevi. In comparison to melanocytic proliferations that lack the mutation, the epidermal melanocytes in lesions that harbour BRAF(V) (600E) mutations are larger and more frequently arranged in large nests.
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Affiliation(s)
- P Tschandl
- Department of Dermatology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria
| | - A S Berghoff
- Institute of Neurology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria.,Department of Internal Medicine I, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria
| | - M Preusser
- Institute of Neurology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria
| | - J Pammer
- Department of Pathology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria
| | - H Pehamberger
- Department of Dermatology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria
| | - H Kittler
- Department of Dermatology, Medical University of Vienna, Währinger Güurtel 18-20, 1090, Vienna, Austria
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Tejera-Vaquerizo A, Arias-Santiago S, Nagore E, Martín-Cuevas P, Orgaz-Molina J, Traves V, Herrera-Acosta E, Naranjo-Sintes R, Guillén C, Herrera-Ceballos E. Defining the dermoscopic characteristics of fast-growing cutaneous melanomas. Melanoma Res 2015; 25:269-72. [PMID: 25919929 DOI: 10.1097/cmr.0000000000000157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A high growth rate in melanomas has been associated with a more aggressive phenotype and worse survival. The aim of this study was to define the dermoscopic characteristics associated with this type of cutaneous melanoma. We carried out a retrospective study of 132 cutaneous melanomas, analyzing certain clinical characteristics and the most important dermoscopic variables related to the melanomas. Fast-growing melanomas were considered to be those with a growth rate of more than 0.5 mm per month. Fast-growing melanomas more often lacked an atypical network, were symmetrical, presented ulceration, and were hypopigmented. The dermoscopic vascular pattern often showed atypical irregular vessels and milky-red areas. The association of these two is a specific characteristic. Fast-growing melanomas have a characteristic phenotype and dermoscopy can be useful for their identification.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- aUnidad de Gestión Clínica de Dermatología, Instituto de Biomedicina de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria/Universidad de Málaga, Málaga bServicio de Dermatología, Hospital Universitario San Cecilio cServicio de Dermatología dServicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, Spain
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An objective measure of growth rate using partial biopsy specimens of melanomas that were initially misdiagnosed. J Am Acad Dermatol 2014; 71:691-7. [DOI: 10.1016/j.jaad.2014.04.068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/13/2014] [Accepted: 04/29/2014] [Indexed: 11/23/2022]
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