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Liu J, Mei L, Yu J, Feng G, Zeng Y, Xu X, Wang X, Wang Y. Epidemiological characteristics and hospitalization burden analysis of pediatric inpatients with melanocytic nevi in China from 2016 to 2021: A nationwide retrospective study of 13,396 cases. J Plast Reconstr Aesthet Surg 2024; 95:62-72. [PMID: 38879936 DOI: 10.1016/j.bjps.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/20/2024] [Accepted: 04/05/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Melanocytic nevi typically appear in early childhood, and their removal is a common plastic surgery procedure performed on children. However, the epidemiological characteristics and hospitalization burden of children with melanocytic nevi have rarely been described in detail. METHODS Medical records of pediatric inpatients with melanocytic nevi from January 1, 2016, to December 31, 2021, were collected from the Futang Research Center of Pediatric Development database in China. We then extracted and statistically analyzed the relevant information, including demographic characteristics, clinical information, hospitalization burden, and other basic information for each inpatient. RESULTS Among the 13,396 inpatients with melanocytic nevi, the highest number of cases was found in East China, and most patients were residents of urban areas. Most hospitalized patients consisted of boys aged 7-12 years with melanocytic nevi. Lesion sites in the buttocks and lower limbs were most common among pediatric inpatients with melanocytic nevi. Compound nevi were the most common (38.50 %) histological subtype and the rate of conversion into melanoma was 1.02 % (137 inpatients) among pediatric inpatients with melanocytic nevi. The hospitalization burden for patients varied significantly based on factors such as the age of the patients undergoing surgery, year of hospitalization, site of the lesion, histological subtype, and surgical method. In general, if the patients' age was under 1 year, lesion site was located in face, and there was a need for excision combined with tissue expander can significantly increase the treatment fees for pediatric inpatients with melanocytic nevi. CONCLUSION Given the increasing number and relatively large hospitalization burden among children with melanocytic nevi hospitalized in China, the government needs to pay more attention to this group and provide corresponding economic and policy support.
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Affiliation(s)
- Jing Liu
- Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Lin Mei
- Department of Otolaryngology, Head and Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jing Yu
- Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Guoshuang Feng
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yueping Zeng
- Medical Record Management Office, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xin Xu
- Information Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xinyu Wang
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Yanni Wang
- Department of Burn and Plastic Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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2
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Chen J, Zhang G, Liu X, Tu P. The association of BRAF V600E gene mutation with proliferative activity and histopathological characteristics of congenital melanocytic nevi in children. An Bras Dermatol 2023:S0365-0596(23)00062-4. [PMID: 37156689 DOI: 10.1016/j.abd.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND A lot of congenital melanocytic nevi (CMN) carry the somatic mutation in the oncogene BRAF V600E. But the detailed histopathologic characteristics and the proliferative activity of CMN with BRAF V600E gene mutation have not been systematically documented. OBJECTIVE To identify the proliferative activity and histopathological features correlating them with BRAF V600E gene mutation status in CMN. METHODS CMN were retrospectively identified from the laboratory reporting system. Mutations were determined by Sanger sequencing. The CMN were divided into a mutant group and control group according to whether there was BRAF gene mutation and were strictly matched according to gender, age, nevus size, and location. Histopathological analysis, analysis of Ki67 expression by immunohistochemistry and laser confocal fluorescence microscopy were performed. RESULTS The differences in Ki67 index, the depth of nevus cell involvement and the number of nevus cell nests between the mutant group and the control group was statistically significant, with p-values of 0.041, 0.002 and 0.007, respectively. Compared with BRAF V600E negative nevi, BRAF V600E positive nevi often exhibited predominantly nested intraepidermal melanocytes, and larger junctional nests, but the difference in this data sets were not statistically significant. The number of nests (p = 0.001) was positively correlated with the proportion of Ki67 positive cells. STUDY LIMITATIONS A small sample of patients were included and there was no follow-up. CONCLUSIONS BRAF V600E gene mutations were associated with high proliferative activity and distinct histopathological features in congenital melanocytic nevi.
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Affiliation(s)
- Jianyou Chen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Gaolei Zhang
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Xiaoyan Liu
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.
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3
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Maher NG, Scolyer RA, Colebatch AJ. Biology and genetics of acquired and congenital melanocytic naevi. Pathology 2023; 55:169-177. [PMID: 36635156 DOI: 10.1016/j.pathol.2022.12.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
Acquired and congenital melanocytic naevi are common benign neoplasms. Understanding their biology and genetics will help clinicians and pathologists correctly diagnose melanocytic tumours, and generate insights into naevus aetiology and melanomagenesis. Genomic data from published studies analysing acquired and congenital melanocytic naevi, including oncogenic driver mutations, common melanoma associated mutations, copy number aberrations, somatic mutation signature patterns, methylation profile, and single nucleotide polymorphisms, were reviewed. Correlation of genomic changes to dermoscopic features, particular anatomic sites and total body naevus counts, was also performed. This review also highlights current scientific theories and evidence concerning naevi growth arrest. Acquired and congenital melanocytic naevi show simple genomes, typically characterised by mutually exclusive single oncogenic driver mutations in either BRAF or NRAS genes. Genomic differences exist between acquired and congenital naevi, common and dysplastic naevi, and by dermoscopic features. Acquired naevi show a higher rate of BRAF hotspot mutations and a lower rate of NRAS hotspot mutations compared to congenital naevi. Dysplastic naevi show upregulation of follicular keratinocyte-related genes compared to common naevi. Anatomical locations and DNA signatures of naevi implicates ultraviolet radiation and non-ultraviolet radiation pathways in naevogenesis. DNA driver point mutations in acquired and congenital melanocytic naevi have been well characterised. Future research is required to better understand transcriptional and epigenetic changes in naevi, as well as those regulating naevus growth arrest and cell environment signalling.
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Affiliation(s)
- Nigel G Maher
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Andrew J Colebatch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Massone C, Stanganelli I, Ingordo V, Ferrara G, Brunasso AMG, Siri G, Casazza S, Gnone M, Pizzichetta MA, Giovanni B, Chiodi S, Sola S. Clinicopathologic and Dermoscopic Features of 20 Cases of Spark's Nevus, a Dermoscopic Simulator of Melanoma. Am J Dermatopathol 2023; 45:153-162. [PMID: 36730758 DOI: 10.1097/dad.0000000000002323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023]
Abstract
ABSTRACT Spark's nevus is a particular type of melanocytic nevus, with histology that shows features of both Spitz and Clark nevus. Detailed dermoscopic features in a series of Spark nevi have not been described yet. We performed a monocentric retrospective observational study on 20 lesions of Spark nevus excised from 19 patients (M:F = 10:9; mean age: 37,6 years), reviewed by 5 experts in dermoscopy and 2 dermatopathologists. A histologic review confirmed that Spark nevi were mostly symmetric (80%), well circumscribed (100%), mainly compound (65%) melanocytic lesions with either epithelioid (55%) or spitzoid (45%) cell morphology and bridging of the nests (100%). Spark nevi were more frequently found on the trunk (85%) in patients with a history of sunburns in childhood (84%), with skin phototype III (79%), and with high nevus count (>100 nevi, 7 patients (36%)). On dermoscopy, we observed different general patterns: multicomponent (40%), reticular-globular-homogeneous (15%), globular homogeneous (15%), reticular (15%), reticular-globular (5%), homogeneous (5%), and globular (5%). Spark nevi showed frequently dermoscopic asymmetry (63%), brown color (90%) with areas of central hyperpigmentation (41%) and peripheral hypopigmentation (28%), atypical pigment network (48%), irregular globules (42%), irregular dots (31%), irregular blotches (16%), blue-whitish veil (13%), peripheral island (25%), irregular hyperpigmented areas (12%), and regression (33%). BRAF mutation was present in 7 of the 10 analyzed cases (70%); all these cases presented a history of evolution. In conclusion, Spark nevi occur on the trunk of young adults with high nevus count and history of sunburns; dermoscopic features are protean, often atypical and suspicious of melanoma.
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Affiliation(s)
- Cesare Massone
- Physician, Dermatology Unit, Galliera Hospital, Genova, Italy
| | - Ignazio Stanganelli
- Physician, Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) IRCCS, Meldola, Italy
- Physician, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vito Ingordo
- Physician, Department of Dermatology, Local Health Centre Taranto, Taranto, Italy
| | - Gerardo Ferrara
- Physician, Anatomic Pathology Unit, Hospital of Macerata, Macerata, Italy
| | | | - Giacomo Siri
- Physician, Dermatology Unit, Galliera Hospital, Genova, Italy
- Department of Mathematics, University of Genoa, Genoa, Italy
| | | | | | - Maria Antonietta Pizzichetta
- Physician, Department of Dermatology, University of Trieste, Trieste, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Biondo Giovanni
- Physician, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy; and
| | - Stefano Chiodi
- Physician, Plastic Surgery, Galliera Hospital, Genova, Italy
| | - Simona Sola
- Physician, Surgical Pathology, Galliera Hospital, Genoa, Italy
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5
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Moreno S, Maiques O, Barcelo C, Romero M, Santacana M, Gómez I, Cuevas D, Velasco A, Vea A, Macia A, Boix R, Valls J, Gatius S, Canti C, Matias-Guiu X, Soria X, Marti RM. Differential Immunoexpression of BRAF/V600E, Senescence Markers, PTEN, and T-type Calcium Channels in Acquired Naevi According to their Histopathological and Dermoscopic Classification. Acta Derm Venereol 2021; 101:adv00597. [PMID: 34643739 PMCID: PMC9455337 DOI: 10.2340/actadv.v101.361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BRAF/V600E mutation and other cell growth/growth-control mechanisms are involved in naevogenesis and melanomagenesis. Immunoexpression of BRAF/V600E and other molecules (p16, phosphatase and tensin homologue (PTEN), Ki67, hTERT and Cav3.1 and 3.2 calcium channels) were investigated in 80 histopathologically and dermoscopically classified acquired naevi. Regarding BRAF/V600E, dysplastic naevi showed lower immunostaining than common naevi, which was significant in comparison with intradermal naevi, which showed the highest BRAF/V600E histoscore. Junctional naevi showed the lowest BRAF/V600E levels. Globular/cobblestone and reticular dermoscopic patterns were consistently associated with high and low BRAF/V600E immunoexpression, respectively, but Zalaudek’s peripheral globule pattern (CR/PG) showed the highest BRAF/V600E immunoexpression. Among global patterns, the previously not investigated multicomponent pattern showed the lowest BRAF/V600E immunoexpression. Regarding the remaining biomarkers, new immunohistochemical features were found, in particular p16 and PTEN low expression in multicomponent pattern; and Ki67, hTERT and Cav.3.1 high expression in CR/PG. In conclusion, histopathology and dermoscopy provide complementary information regarding the biology of melanocytic naevi.
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Affiliation(s)
- Sara Moreno
- Department of Dermatology, Hospital Universitari Arnau de Vilanova, University of Lleida, IRBLleida, Avda Alcalde Rovira Roure 80, ES-25198 Lleida, Spain.
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Massone C, Hofman-Wellenhof R, Chiodi S, Sola S. Dermoscopic Criteria, Histopathological Correlates and Genetic Findings of Thin Melanoma on Non-Volar Skin. Genes (Basel) 2021; 12:1288. [PMID: 34440462 PMCID: PMC8391530 DOI: 10.3390/genes12081288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/23/2022] Open
Abstract
Dermoscopy is a non-invasive, in vivo technique that allows the visualization of subsurface skin structures in the epidermis, at the dermoepidermal junction, and in the upper dermis. Dermoscopy brought a new dimension in evaluating melanocytic skin neoplasms (MSN) also representing a link between clinical and pathologic examination of any MSN. However, histopathology remains the gold standard in diagnosing MSN. Dermoscopic-pathologic correlation enhances the level of quality of MSN diagnosis and increases the level of confidence of pathologists. Melanoma is one of the most genetically predisposed among all cancers in humans. The genetic landscape of melanoma has been described in the last years but is still a field in continuous evolution. Melanoma genetic markers play a role not only in melanoma susceptibility, initiation, and progression but also in prognosis and therapeutic decisions. Several studies described the dermoscopic specific criteria and predictors for melanoma and their histopathologic correlates, but only a few studies investigated the correlation among dermoscopy, pathology, and genetic of MSN. The aim of this work is to review the published data about dermoscopic features of melanoma, their histopathological correlates with regards also to genetic alterations. Particularly, this review will focus on low-CSD (cumulative sun damage) melanoma or superficial spreading melanoma, high-CSD melanoma, and nevus-associated melanoma.
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Affiliation(s)
| | | | | | - Simona Sola
- Surgical Pathology, Galliera Hospital, 16128 Genoa, Italy;
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7
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Ghanadan A, Yousefi T, Kamyab-Hesari K, Azhari V, Nasimi M. Prevalence and Main Determinants of BRAF V600E Mutation in Dysplastic and Congenital Nevi. IRANIAN JOURNAL OF PATHOLOGY 2020; 16:51-56. [PMID: 33391380 PMCID: PMC7691709 DOI: 10.30699/ijp.2020.130968.2451] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/23/2020] [Indexed: 01/19/2023]
Abstract
Background & Objective: Predicting the transformation of dysplastic or congenital nevi into malignant lesions results in a significant increase in the survival of patients. Some specific gene mutations have been reported to be very helpful in this regard. Therefore, this study aimed to evaluate the prevalence of BRAF V600E mutation in dysplastic and congenital nevi. Methods: This cross-sectional study was conducted on patients with congenital (n=30) or dysplastic (n=30) nevi. For genomic analysis, the BRAF gene mutation (V600E) was evaluated using the real-time polymerase chain reaction. Results: The prevalence of BRAF gene (V600E) mutation was found as 1 case (3.3%) in congenital and 8 cases (26.7%) in dysplastic nevi indicating the higher prevalence of this mutation in patients with dysplastic nevi (P=0.026). Moreover, in the dysplastic nevi group, the presence of BRAF gene mutation (V600E) showed a significant relationship with the severity of dysplasia as the mutation rate was 25% in mild cases, in comparison with 54.5% in moderate dysplasia cases (P=0.009). Conclusion: According to the results, 3.3% of the patients with congenital nevi and 26.7% of the subjects with dysplastic nevi were positive for BRAF V600E mutation. Furthermore, the severity of dysplasia could have a positive relationship with the presence of the mutation.
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Affiliation(s)
- Alierza Ghanadan
- Department of dermatopathology, Razi hospital, and pathology department of cancer institute, Imam Khomeini hospital complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Yousefi
- Department of Anatomical Pathology, Yas hospital complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Kamyab-Hesari
- Department of dermatopathology, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahidehsadat Azhari
- Department of dermatopathology, Razi hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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8
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Genes Determining Nevus Count and Dermoscopic Appearance in Australian Melanoma Cases and Controls. J Invest Dermatol 2019; 140:498-501.e17. [PMID: 31421127 DOI: 10.1016/j.jid.2019.05.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 11/21/2022]
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9
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Savoia P, Fava P, Casoni F, Cremona O. Targeting the ERK Signaling Pathway in Melanoma. Int J Mol Sci 2019; 20:ijms20061483. [PMID: 30934534 PMCID: PMC6472057 DOI: 10.3390/ijms20061483] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 12/24/2022] Open
Abstract
The discovery of the role of the RAS/RAF/MEK/ERK pathway in melanomagenesis and its progression have opened a new era in the treatment of this tumor. Vemurafenib was the first specific kinase inhibitor approved for therapy of advanced melanomas harboring BRAF-activating mutations, followed by dabrafenib and encorafenib. However, despite the excellent results of first-generation kinase inhibitors in terms of response rate, the average duration of the response was short, due to the onset of genetic and epigenetic resistance mechanisms. The combination therapy with MEK inhibitors is an excellent strategy to circumvent drug resistance, with the additional advantage of reducing side effects due to the paradoxical reactivation of the MAPK pathway. The recent development of RAS and extracellular signal-related kinases (ERK) inhibitors promises to add new players for the ultimate suppression of this signaling pathway and the control of pathway-related drug resistance. In this review, we analyze the pharmacological, preclinical, and clinical trial data of the various MAPK pathway inhibitors, with a keen interest for their clinical applicability in the management of advanced melanoma.
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Affiliation(s)
- Paola Savoia
- Department of Health Science, University of Eastern Piedmont, via Solaroli 17, 28100 Novara, Italy.
| | - Paolo Fava
- Section of Dermatology, Department of Medical Science, University of Turin, 10124 Turin, Italy.
| | - Filippo Casoni
- San Raffaele Scientific Institute, Division of Neuroscience, via Olgettina 58, 20132 Milano, Italy.
- Università Vita Salute San Raffaele, via Olgettina 58, 20132 Milano, Italy.
| | - Ottavio Cremona
- San Raffaele Scientific Institute, Division of Neuroscience, via Olgettina 58, 20132 Milano, Italy.
- Università Vita Salute San Raffaele, via Olgettina 58, 20132 Milano, Italy.
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10
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Tan JM, Tom LN, Soyer HP, Stark MS. Defining the Molecular Genetics of Dermoscopic Naevus Patterns. Dermatology 2018; 235:19-34. [PMID: 30332666 DOI: 10.1159/000493892] [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] [Received: 08/16/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
Melanocytic naevi are common melanocytic proliferations that may simulate the appearance of cutaneous melanoma. Naevi commonly harbour somatic mutations implicated in melanomagenesis but in most cases lack the necessary genomic alterations required for melanoma development. While the mitogen-activated protein kinase pathway and ultraviolet radiation strongly contribute to naevogenesis, the somatic mutational landscape of dermoscopic naevus subsets distinguishes some of the molecular hallmarks of naevi in relation to melanoma. We herein discuss the classification of naevi and theories of naevogenesis and review the current literature on the somatic alterations in naevi and melanoma. This review focusses on the clinical-dermoscopic-pathological and genomic correlation of naevi that shapes the current understanding of naevi.
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Affiliation(s)
- Jean-Marie Tan
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - Lisa N Tom
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mitchell S Stark
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland,
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Kiuru M, Tartar DM, Qi L, Chen D, Yu L, Konia T, McPherson JD, Murphy WJ, Fung MA. Improving classification of melanocytic nevi: Association of BRAF V600E expression with distinct histomorphologic features. J Am Acad Dermatol 2018; 79:221-229. [PMID: 29653212 DOI: 10.1016/j.jaad.2018.03.052] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/25/2018] [Accepted: 03/29/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND A subset of melanomas carrying a B-Raf proto-oncogene, serine/threonine kinase gene (BRAF) V600E mutation, which is the most common targetable mutation in melanoma, arise in association with a melanocytic nevus that is also harboring a BRAF V600E mutation. The detailed histomorphologic characteristics of nevi positive for BRAF V600E have not been systematically documented. OBJECTIVE To identify histomorphologic features correlating with BRAF V600E status in nevi. METHODS We retrospectively identified melanocytic nevi from our laboratory reporting system. We performed a histomorphologic analysis and analysis of BRAF V600E expression by immunohistochemistry. RESULTS Thirteen nevi (14.8%) were negative and 76 (86.4%) were positive for BRAF V600E. The nevi positive for BRAF V600E were predominantly dermal (predominantly dermal growth in 55.3% of nevi positive for BRAF V600E and 15.4% of nevi negative for BRAF V600E [P = .01]) and showed a congenital growth pattern (congenital growth pattern in 51.3% of nevi positive for BRAF V600E and 15.4% of nevi negative for BRAF V600E [P = .02]). Compared with nevi negative for BRAF V600E, those that were positive for BRAF V600E often exhibited predominantly nested intraepidermal melanocytes, larger junctional nests, abrupt lateral circumscription, and larger cell size. Architectural disorder and inflammatory infiltrates were seen more often in nevi negative for BRAF V600E. BRAF sequencing of a subset of nevi confirmed the immunohistochemical results. LIMITATIONS Limitations include the study's retrospective design and the small sample size of nevi negative for BRAF V600E. CONCLUSIONS BRAF V600E is associated with distinct histomorphologic features in nevi. These features may contribute to improving the accuracy of classification and diagnosis of melanocytic neoplasms.
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Affiliation(s)
- Maija Kiuru
- Department of Dermatology, University of California, Davis, Sacramento and Davis, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento and Davis, California.
| | - Danielle M Tartar
- Department of Dermatology, University of California, Davis, Sacramento and Davis, California
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, Sacramento and Davis, California
| | - Danyang Chen
- Department of Public Health Sciences, University of California, Davis, Sacramento and Davis, California
| | - Lan Yu
- Department of Dermatology, University of California, Davis, Sacramento and Davis, California
| | - Thomas Konia
- Department of Dermatology, University of California, Davis, Sacramento and Davis, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento and Davis, California
| | - John D McPherson
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Sacramento and Davis, California
| | - William J Murphy
- Department of Dermatology, University of California, Davis, Sacramento and Davis, California; Department of Internal Medicine, University of California, Davis, Sacramento and Davis, California
| | - Maxwell A Fung
- Department of Dermatology, University of California, Davis, Sacramento and Davis, California; Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento and Davis, California
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12
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Dermoscopic assessment of skin toxicities in patients with melanoma during treatment with vemurafenib. Postepy Dermatol Alergol 2018; 35:39-46. [PMID: 29599670 PMCID: PMC5872245 DOI: 10.5114/ada.2018.73163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/15/2017] [Indexed: 01/16/2023] Open
Abstract
Introduction The use of vemurafenib in melanoma has improved the survival of patients; however, it is associated with skin toxicities. Aim To assess skin toxicities by dermoscopy in patients treated with vemurafenib. Material and methods Eight patients with BRAF V600 mutation positive metastatic melanoma were examined dermoscopically during vemurafenib treatment. All skin lesions occurring during therapy were assessed clinically and dermoscopically using a hand-held dermoscope with polarised and non-polarised light. Skin lesions suspected for malignancy appearing during therapy were totally surgically excised with consecutive histopathological examination. Results All 8 examined patients developed skin toxicity. The majority of patients (7/8) presented G1 skin toxicity according to CTCAE version 4.3. Only 1 of them had G2 skin toxicity. The most common dermoscopy findings in our study were hyperkeratotic verrucas in 5 patients (5/8) with structureless pattern. In some of them we also observed central dots, exophytic proliferation, hairpin vessels and homogeneous haemorrhage. Other findings were hyperkeratosis of the nipples (5/8) with brownish to yellowish, angular clods with a tendency to be more confluent in dermoscopy. Palmar plantar erythrodysaesthesia (3/8) showed dermoscopically a yellowish, homogeneous pattern. Four melanocytic skin lesions in 2 patients were surgically excised due to suspected malignant transformation. In most of them we observed an atypical pigmented network (abrupt cut-off, big holes), atypical globules and a homogeneous blue pattern; however, histopathological diagnosis excluded any malignancy. Conclusions Dermoscopy seems to be an easily performed and valuable method for assessment of skin toxicities during oncological therapy, at any time of the treatment.
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Tan JM, Tom LN, Jagirdar K, Lambie D, Schaider H, Sturm RA, Soyer HP, Stark MS. The BRAF and NRAS mutation prevalence in dermoscopic subtypes of acquired naevi reveals constitutive mitogen-activated protein kinase pathway activation. Br J Dermatol 2017; 178:191-197. [PMID: 28714107 DOI: 10.1111/bjd.15809] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Acquired naevi can have unique dermoscopic patterns that correspond to distinct microanatomical growth patterns. Previous studies on acquired naevi stratified according to dermoscopic pattern focused on the frequency of somatic BRAF mutations, whereas NRAS mutations remained to be elucidated. OBJECTIVES To investigate the BRAF and NRAS mutation prevalence and activation of the mitogen-activated protein kinase (MAPK) pathway in distinct dermoscopic subtypes of acquired naevi. METHODS Common mutations present in BRAF and NRAS were assessed in 40 globular, reticular and peripheral rim of globules (PG) subtypes of acquired naevi from 27 participants (19 male, 8 female; mean age 46·7 years) selected from 1261 eligible volunteers. Mutations were determined using the highly sensitive and quantitative QX200 droplet digital™ polymerase chain reaction (ddPCR) system. RESULTS The BRAF V600E (c.1799T>A or c.1799_1800delTGinsA) and BRAF V600K mutations were detected in 85% (n = 34/40) of naevi. All BRAF wild-type naevi (15%; n = 6/40) harboured an NRAS codon 12/13 or 61 mutation. BRAF mutations were present in 92% (n = 12/13) of globular and 100% (n = 12/12) of PG naevi, whereas reticular naevi were 67% (n = 10/15) BRAF- and 33% (n = 5/15) NRAS-mutant (P = 0·037). CONCLUSIONS We discovered that 100% of the assessed acquired naevi had either a BRAF or NRAS mutation. Using sensitive techniques capable of single-cell mutation detection, it is likely that all acquired naevi will be mutated for BRAF or NRAS. Because both of these mutations are prevalent in distinct dermoscopic naevus subsets, our study supports the role of the MAPK pathway in the development of benign melanocytic proliferations, indicating that additional genomic events besides somatic mutations in BRAF or NRAS are required for melanoma development.
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Affiliation(s)
- J M Tan
- Dermatology Research Centre, The University of Queensland, UQ Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - L N Tom
- Dermatology Research Centre, The University of Queensland, UQ Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland, UQ Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - D Lambie
- IQ Pathology, Brisbane, QLD, Australia
| | - H Schaider
- Dermatology Research Centre, The University of Queensland, UQ Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland, UQ Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, UQ Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - M S Stark
- Dermatology Research Centre, The University of Queensland, UQ Diamantina Institute, Level 5, Translational Research Institute, 37 Kent Street, Woolloongabba, Brisbane, QLD, 4102, Australia
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14
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Urvanegia AC, Tavoloni Braga JC, Shitara D, Fregnani JH, Neves JI, Pinto CA, Marghoob AA, Duprat JP, Rezze GG. Reflectance confocal microscopy features of BRAF V600E mutated thin melanomas detected by immunohistochemistry. PLoS One 2017; 12:e0179745. [PMID: 28662062 PMCID: PMC5491027 DOI: 10.1371/journal.pone.0179745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/02/2017] [Indexed: 12/17/2022] Open
Abstract
The classification of melanoma into four histological subtypes has been questioned regarding its clinical validity in providing relevant information for treatment for metastatic tumors. Specific genetic alterations are associated with particular clinical and histopathological features, suggesting that these could be helpful in refining existing melanoma classification schemes. We analyzed BRAF V600E mutated melanomas to explore the Reflectance confocal microscopy (RCM) utility as a screening aid in the evaluation of the most appropriate patients for genetic testing. Thus, 32 melanomas were assessed regarding their BRAF V600E mutational status. Experts blinded to dermoscopic images and V600E immunohistochemistry results evaluated RCM images regarding previously described melanoma features. BRAF positive melanomas were related to younger age (p = 0.035), invasive melanomas (p = 0.03) and to the presence of hiporreflective cells (p = 0.02), epidermal nests (p = 0.02), dermal-epidermal junction nests (p = 0.05), edged papillae (p = 0.05), and bright dots (p = 0.05), and to absence of junctional thickening due to isolated cells (p = 0.01) and meshwork (p = 0.02). This study can not characterize other mutations in the BRAF, because the immunohistochemistry is specific to the type V600E. The findings should encourage the genetic evaluation of BRAF mutation. This study highlights the potential of RCM as a supplementary tool in the screening of BRAF-mutated melanomas.
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Affiliation(s)
| | | | | | | | | | | | - Ashfaq A. Marghoob
- Dermatology Service, Memorial Sloan Kettering Skin Cancer Center, New York, United States of America
| | | | - Gisele Gargantini Rezze
- Cutaneous Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
- Dermaimage Medical Associates, São Paulo, Brazil
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15
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Huang JM, Chikeka I, Hornyak TJ. Melanocytic Nevi and the Genetic and Epigenetic Control of Oncogene-Induced Senescence. Dermatol Clin 2017; 35:85-93. [PMID: 27890240 PMCID: PMC5391772 DOI: 10.1016/j.det.2016.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Melanocytic nevi represent benign clonal proliferations of the melanocytes in the skin that usually remain stable in size and behavior or disappear during life. Infrequently, melanocytic nevi undergo malignant transformation to melanoma. Understanding molecular and cellular mechanisms underlying oncogene-induced senescence should help identify pathways underlying melanoma development, leading to the development of new strategies for melanoma prevention and early detection.
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Affiliation(s)
- Jennifer M Huang
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene St., Baltimore, MD 21201, USA
| | - Ijeuru Chikeka
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene St., Baltimore, MD 21201, USA
| | - Thomas J Hornyak
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene St., Baltimore, MD 21201, USA; Research & Development Service, VA Maryland Health Care System, Baltimore, MD, 21201, USA; Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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16
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Roh MR, Eliades P, Gupta S, Tsao H. Genetics of melanocytic nevi. Pigment Cell Melanoma Res 2016; 28:661-72. [PMID: 26300491 DOI: 10.1111/pcmr.12412] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/19/2015] [Indexed: 01/05/2023]
Abstract
Melanocytic nevi are a benign clonal proliferation of cells expressing the melanocytic phenotype, with heterogeneous clinical and molecular characteristics. In this review, we discuss the genetics of nevi by salient nevi subtypes: congenital melanocytic nevi, acquired melanocytic nevi, blue nevi, and Spitz nevi. While the molecular etiology of nevi has been less thoroughly studied than melanoma, it is clear that nevi and melanoma share common driver mutations. Acquired melanocytic nevi harbor oncogenic mutations in BRAF, which is the predominant oncogene associated with melanoma. Congenital melanocytic nevi and blue nevi frequently harbor NRAS mutations and GNAQ mutations, respectively, while Spitz and atypical Spitz tumors often exhibit HRAS and kinase rearrangements. These initial 'driver' mutations are thought to trigger the establishment of benign nevi. After this initial phase of the cell proliferation, a senescence program is executed, causing termination of nevi growth. Only upon the emergence of additional tumorigenic alterations, which may provide an escape from oncogene-induced senescence, can malignant progression occur. Here, we review the current literature on the pathobiology and genetics of nevi in the hope that additional studies of nevi promise to inform our understanding of the transition from benign neoplasm to malignancy.
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Affiliation(s)
- Mi Ryung Roh
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Philip Eliades
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - Sameer Gupta
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hensin Tsao
- Wellman Center for Photomedicine, Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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17
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Scope A, Marchetti MA, Marghoob AA, Dusza SW, Geller AC, Satagopan JM, Weinstock MA, Berwick M, Halpern AC. The study of nevi in children: Principles learned and implications for melanoma diagnosis. J Am Acad Dermatol 2016; 75:813-823. [PMID: 27320410 PMCID: PMC5030195 DOI: 10.1016/j.jaad.2016.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
Abstract
Melanocytic nevi are a strong phenotypic marker of cutaneous melanoma risk. Changes in nevi during childhood and adolescence make these prime periods for studying nevogenesis. Insights gained by the study of nevi in childhood have implications for melanoma detection in both adults and children. A more comprehensive understanding of the morphologic characteristics of nevi in different anatomic locations, in association with the patient's age and pigmentary phenotype may aid in the identification of melanomas. When monitoring melanocytic lesions over time, it is essential to differentiate normal from abnormal change. This review summarizes the rapidly expanding body of literature relevant to nevus phenotype, particularly in the context of our experience with the Study of Nevi in Children (SONIC) Project.
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Affiliation(s)
- Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Dermatology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan C Geller
- Harvard School of Public Health, Social and Behavioral Sciences, Boston, Massachusetts
| | - Jaya M Satagopan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin A Weinstock
- Dermatoepidemiology Unit, Veteran's Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island
| | - Marianne Berwick
- Division of Epidemiology and Biostatistics, University of New Mexico, Albuquerque, New Mexico
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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18
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Bajaj S, Dusza SW, Marchetti MA, Wu X, Fonseca M, Kose K, Brito J, Carrera C, Martins de Silva VP, Malvehy J, Puig S, Yagerman S, Liebman TN, Scope A, Halpern AC, Marghoob AA. Growth-Curve Modeling of Nevi With a Peripheral Globular Pattern. JAMA Dermatol 2015; 151:1338-1345. [PMID: 26287475 DOI: 10.1001/jamadermatol.2015.2231] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Importance Although nevi with a peripheral rim of globules (peripheral globular nevi [PGN]) observed with dermoscopy are associated with enlarging melanocytic nevi, their actual growth dynamics remain unknown. Because change is a sensitive but nonspecific marker for melanoma, beginning to understand the growth patterns of nevi may improve the ability of physicians to differentiate normal from abnormal growth and reduce unnecessary biopsies. Objective To study the growth dynamics and morphologic evolution of PGN on dermoscopy. Design, Setting, and Participants A total of 84 participants with 121 PGN from September 1, 1999, through May 1, 2013, were identified retrospectively. Cohorts were recruited from the Memorial Sloan Kettering Cancer Center; Melanoma Unit of the Hospital Clinic, University of Barcelona; and Study of Nevi in Children. All 3 cohorts underwent longitudinal monitoring with serial dermoscopic imaging of their PGN. Data analysis was performed from May 1, 2014, through April 1, 2015. Main Outcomes and Measures Establishment of the natural growth curve of PGN. The secondary aim was to establish the median time to growth cessation in those PGN for which the size eventually stabilized and/or had begun to decrease during the study period. Results The median duration of follow-up was 25.1 (range, 2.0-114.4) months. Most of the nevi (116 [95.9%]) enlarged at some point during sequential monitoring. The rate of increase in the surface area of PGN varied among cohorts and ranged from -0.47 to 2.26 mm2/mo (mean rate, 0.25 [95% CI, 0.14-0.36] mm2/mo). The median time to growth cessation in the 26 PGN that stabilized or decreased in size (21.5%) was 58.6 months. All lesions changed in a symmetric manner and 91 (75.2%) displayed a decrease in the density of peripheral globules over time. Conclusions and Relevance Nevi displaying a peripheral globular pattern enlarged symmetrically with apparent growth cessation occurring during a span of 4 to 5 years. Our results reiterate the important concept that not all growth is associated with malignancy.
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Affiliation(s)
- Shirin Bajaj
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xinyuan Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maira Fonseca
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kivanc Kose
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Johanna Brito
- Melanoma Unit, Department of Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain3Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, B
| | - Cristina Carrera
- Melanoma Unit, Department of Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain3Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, B
| | - Vanessa P Martins de Silva
- Melanoma Unit, Department of Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain3Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, B
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain3Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, B
| | - Susana Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain3Centro de Investigación Biomédica en Red de Enfermedades Raras, Instituto de Salud Carlos III, B
| | - Sarah Yagerman
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tracey N Liebman
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alon Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York4Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Allan C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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19
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Fonseca M, Marchetti MA, Chung E, Dusza SW, Burnett ME, Marghoob AA, Geller AC, Bishop M, Scope A, Halpern AC. Cross-sectional analysis of the dermoscopic patterns and structures of melanocytic naevi on the back and legs of adolescents. Br J Dermatol 2015; 173:1486-1493. [PMID: 26189624 DOI: 10.1111/bjd.14035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 01/24/2023]
Abstract
BACKGROUND Junctional (flat) naevi predominate on the extremities, whereas dermal (raised) naevi are found primarily on the head, neck and trunk. Few studies have investigated the anatomical site prevalence of melanocytic naevi categorized using dermoscopy. OBJECTIVES To identify the prevalence of dermoscopic patterns and structures of naevi from the back and legs of adolescents. METHODS Dermoscopic images of acquired melanocytic naevi were obtained from the back and legs of students from a population-based cohort in Framingham, Massachusetts. Naevi were classified into reticular, globular, homogeneous or complex dermoscopic patterns. Multinomial logistic regression modelling assessed the associations between dermoscopic pattern and anatomical location. RESULTS In total 509 participants (mean age 14 years) contributed 2320 back naevi and 637 leg naevi. Compared with homogeneous naevi, globular and complex naevi were more commonly observed on the back than the legs [odds ratio (OR) 29·39, 95% confidence interval (CI) 9·53-90·65, P < 0·001 and OR 6·8, 95% CI 2·7-17·14, P < 0·001, respectively], whereas reticular lesions were less likely to be observed on the back than on the legs (OR 0·67, 95% CI 0·54-0·84, P = 0·001). Naevi containing any globules were more prevalent on the back than on the legs (25% vs. 3·6%, P < 0·001). Naevi containing any network were more prevalent on the legs than on the back (56% vs. 40·6%, P < 0·001). CONCLUSIONS These findings add to a robust body of literature suggesting that dermoscopically defined globular and reticular naevi represent biologically distinct naevus subsets that differ in histopathological growth pattern, age- and anatomical-site-related prevalence, molecular phenotype and aetiological pathways.
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Affiliation(s)
- M Fonseca
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - M A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - E Chung
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - S W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - M E Burnett
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - A A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - A C Geller
- Harvard School of Public Health, Social and Behavioral Sciences, Boston, MA, U.S.A
| | - M Bishop
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
| | - A Scope
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A.,Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 52621, Israel
| | - A C Halpern
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 E. 60 Street, New York, NY 10022, U.S.A
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Abstract
Use of dermoscopy has been proven to increase diagnostic accuracy for melanoma. It is frequently used by dermatologists and other healthcare providers during skin cancer screening and in the evaluation of concerning skin lesions. Studies have shown that it is useful in the diagnosis of many nononcologic cutaneous diseases as well as in the monitoring of disease progression and treatment response. Furthermore, dermoscopy has the potential to aid in pathology specimen sectioning, translational research and medical technology development. Its broad applications and ease of use will make it an increasingly influential tool in healthcare. In this article, we review the established uses of dermoscopy by different healthcare providers and its potential future applications.
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Affiliation(s)
- Xinyuan Wu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Abstract
A new or changing melanocytic nevus in a child or adolescent often leads to concern in parents and physicians. To avoid undue alarm and unnecessary procedures, dermatologists should be aware of the natural history and clinical spectrum of nevi in pediatric patients, as well as findings that are potentially worrisome in this age group. This review provides an update on melanocytic nevi in children, focusing on their dynamic evolution over time, molecular insights into nevogenesis, and phenotypic markers for increased risk of melanoma in adolescence and adulthood. Special considerations for Spitz nevi and nevi located in particular sites (eg, scalp, acral, genital) are highlighted. Current understanding of the risks associated with congenital melanocytic nevi of different sizes and strategies for the management of children with numerous acquired nevi, Spitz nevi, and congenital nevi are also discussed.
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22
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Kittler H. B-RAF, naevi and melanoma: a complex relationship. Br J Dermatol 2014; 171:931-2. [PMID: 25409993 DOI: 10.1111/bjd.13392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- H Kittler
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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