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Castillo P, Castrejon N, Marginet M, Massi D, Alamon F, Teixido C, Montironi C, Garcia-Herrera A, Albero-Gonzalez R, Matas J, Puig S, Alos L. Combined WNT-activated deep-penetrating/plexiform melanocytoma: insights into clinicopathological and molecular characterization. Clin Exp Dermatol 2024; 49:356-363. [PMID: 37995304 DOI: 10.1093/ced/llad405] [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: 06/24/2023] [Revised: 08/15/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND A combined deep-penetrating tumour redefined as WNT-activated deep-penetrating/plexiform melanocytoma (DPM), may pose challenging clinical and histological diagnoses. OBJECTIVES To review the clinicopathological characteristics of combined DPMs and characterize the molecular profile of atypical and malignant forms. METHODS The study included 51 patients with combined DPMs diagnosed at the Hospital Clinic of Barcelona and the University of Florence between 2012 and 2020. Clinical data, dermoscopy images (when available) and histological characteristics were reviewed. Immunohistochemistry for β-catenin, LEF1, HMB45, Ki67, p16 and PRAME (preferentially expressed antigen in melanoma) was performed. Atypical forms underwent next-generation sequencing (NGS) panel analysis, including driver genes implicated in DPMs, TERT-promoter (p) mutations and the investigation of the 9p21 locus via fluorescence in situ hybridization. RESULTS Among the 51 patients (32 females and 19 males, age range 4-74 years), 68% with available clinical data (15/22) were initially suspected of having melanoma. Except for one patient, complete excision resulted in no recurrences or metastases. One patient who had an incompletely excised combined DPM developed a lymph node melanoma metastasis 10 years later. In the 51 patients, 10 samples (20%) showed atypical histological features; 7 (14%) exhibited a significant loss of p16 expression; and 2 (4%) showed a high-proliferative index (Ki67 over 5%). NGS analysis in 11 patients revealed a double mutation BRAFV600E and exon 3 CTNNB1; no TERTp mutations were detected. CONCLUSIONS Clinical suspicion of melanoma is common in combined DPMs, but malignant progression is infrequent in tumours lacking high-grade atypia or proliferation. These findings are congruent with the consideration of these lesions as intermediate-grade tumours or melanocytomas.
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Affiliation(s)
- Paola Castillo
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | | | - Daniela Massi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence. Florence, Italy
- European Organisation for Research and Treatment of Cancer (EORTC), Melanoma Group
| | | | - Cristina Teixido
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Adriana Garcia-Herrera
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | | | - Jessica Matas
- Opthamology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Susana Puig
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- European Organisation for Research and Treatment of Cancer (EORTC), Melanoma Group
- Dermatology
| | - Llucia Alos
- Departments of Pathology
- University of Barcelona. Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- European Organisation for Research and Treatment of Cancer (EORTC), Melanoma Group
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Zaballos P, Álvarez-Salafranca M, Llambrich À, Malvehy J, Taberner R, Medina C, Argenziano G, Thomas L, Pizarro Á, Del Pozo LJ, Avilés JA, Martin JM, Karaarslan I, Guionnet N, Bañuls J. Dermoscopy of haemosiderotic/aneurysmal dermatofibroma: A morphological study of 110 cases. J Eur Acad Dermatol Venereol 2023; 37:317-327. [PMID: 36251407 DOI: 10.1111/jdv.18664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/21/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Haemosiderotic and aneurysmal dermatofibromas are uncommon and frequently misdiagnosed lesions, which can be considered as different histopathological stages of the same tumour. A dermoscopic diagnosis testing accuracy has not been performed for these tumours to date. OBJECTIVES To determine the diagnostic significance of dermoscopic structures and patterns associated with haemosiderotic/ aneurysmal dermatofibromas in a large series. METHODS Dermoscopic images of histopathologically proven cases of 110 haemosiderotic/ aneurysmal dermatofibromas and 501 other tumours were collected. The frequency, sensitivity, specificity, positive predictive value and negative predictive value of the dermoscopic structures and patterns associated with these lesions were calculated. RESULTS Haemosiderotic/ aneurysmal dermatofibromas are mostly symmetric lesions (86.5%), and a prominent homogeneous area was present in 100% of them. The presence of vascular structures was very common (86.4%), and dotted vessels were predominant (58.2%). Shiny white structures were seen in 85.5% of lesions, while a peripheral delicate pigment network was present in 69.1%. The most significant pattern was the one composed of a prominent homogeneous area and peripheral delicate pigment network, which showed a specificity of 100% with a relatively good sensitivity (69.1%). All the patterns containing a peripheral delicate pigment network showed very good specificities, positive predictive values and negative predictive values. Those patterns without a peripheral delicate pigment network showed the highest sensitivities, but they showed a significant overlap with other tumours, mainly with melanoma. CONCLUSIONS Dermoscopy is helpful in improving the diagnostic accuracy of haemosiderotic/ aneurysmal dermatofibromas. However, there is a considerable dermoscopic overlap between these tumours and melanoma, specifically when the peripheral delicate pigment network is absent.
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Affiliation(s)
- Pedro Zaballos
- Dermatology Department, Hospital Sant Pau i Santa Tecla, Tarragona, Spain
| | | | - Àlex Llambrich
- Dermatology Department, Hospital Universitari Son Llatzer, Palma de Mallorca, Spain
| | - Josep Malvehy
- Dermatology Department, Hospital Clínic, Barcelona, Spain
| | - Rosa Taberner
- Dermatology Department, Hospital Universitari Son Llatzer, Palma de Mallorca, Spain
| | - Carolina Medina
- Dermatology Department, Hospital Universitario de Gran Canaria "Doctor Negrín", Gran Canaria, Spain
| | | | - Luc Thomas
- Department of Dermatology, Centre Hospitalier Lyon Sud, Lyon, France.,Lyon 1 University, Lyon, France.,Lyons Cancer Research Center UMR INSERM U1052 - CNRS5286 - UCBL1, Lyon, France
| | - Ángel Pizarro
- Dermatology Department, Clínica Dermatológica Internacional, Madrid, Spain
| | - Luis Javier Del Pozo
- Dermatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Jose Antonio Avilés
- Dermatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Jose María Martin
- Dermatology Department, Hospital Clínico Universitario, Valencia, Spain
| | - Isil Karaarslan
- Dermatology Department, Medical University of Ege, Izmir, Turkey
| | - Neus Guionnet
- Pathology Department, Hospital de Sant Pau I Santa Tecla, Tarragona, Spain
| | - José Bañuls
- Dermatology Department, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
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Lesion- and Patient-Related Variables May Provide Additional Clues during Dermoscopic Assessment of Blue Nevi—A Retrospective Cohort Study. Cancers (Basel) 2022; 14:cancers14081920. [PMID: 35454827 PMCID: PMC9024686 DOI: 10.3390/cancers14081920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Blue nevi (BN) are dermal dendritic melanocytic proliferations which may be congenital or acquired. Due to wide clinical and dermoscopic presentation, their diagnosis may sometimes be difficult, especially if the history of lesion occurrence is unknown. Little is known about the correlation between lesion- and patient-related variables and dermoscopic features of blue nevi. The aim of the study was to analyze dermoscopic features of blue nevi, with particular regard to structures whose prevalence has not been previously reported, and to investigate the possible influence of selected clinical variables on dermoscopic presentation. Our findings provide new insights into the dermoscopic structures observed in blue nevi and their variability according to patient’s phototype and lesion size/localization. Abstract Background: Little is known about the correlation between lesion- and patient-related variables and the dermoscopic features of blue nevi. The aim of the study was dermoscopic analysis of blue nevi in association with patient- and lesion-related variables, with a special interest in structures whose prevalence has not been previously reported. Methods: This was a double-center, retrospective study, which included the analysis of histopathologically confirmed blue nevi (n = 93). Results: There was no difference in the frequency of the observed dermoscopic features according to patients’ gender and age. Pink structureless areas were more common in patients with I/II Fitzpatrick skin phototypes as well as in the patients with photodamaged skin, while blue prominent skin markings over brownish/blue-gray background occurred exclusively in patients with phototype III. Structures of previously unreported prevalence in blue nevi were skin-colored circles (present in 32.3%), gray circles (2.2%), follicular ostia with no pigmentation (18.4%; present exclusively on the face), blue skin markings over brownish background (present in 18.2%; detected only on the limbs) and dark brown polygons (one lesion located on the lower extremity). Conclusion: Dermoscopic presentation of blue nevi may vary according to the patient’s phototype and lesion size/localization rather than gender and age.
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