1
|
Chang Y, Dai T, Song G, Wang S, Pei H, Shen G, Feng J. Metabolomic analysis reveals the biological characteristics of giant congenital melanocytic nevi. J Pharm Biomed Anal 2024; 242:116060. [PMID: 38382316 DOI: 10.1016/j.jpba.2024.116060] [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: 01/12/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
Giant congenital melanocytic nevi (GCMN) is a congenital cutaneous developmental deformity tumor that usually occurs at birth or in the first few weeks after birth, but its pathogenesis is still unclear. In this study, nuclear magnetic resonance-based metabolomics strategy was employed to evaluate the metabolic variations in serum and urine of the GCMN patients in order to understand its underlying biochemical mechanism and provide a potential intervention idea. Twenty-nine metabolites were observed to change significantly in serum and urine metabolomes, which are mainly involved in a variety of metabolic pathways including glyoxylate and dicarboxylate metabolism, TCA cycle and metabolisms of amino acids. The substantial cores of all the disturbed metabolic pathways are related to amino acid metabolism and carbohydrate metabolism and regulate the physiological state of the GCMN patients. Our results provide the physiological basis and physiological responses of GCMN and will be helpful for better understanding the molecular mechanisms of GCMN in future research.
Collapse
Affiliation(s)
- Yajie Chang
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Tao Dai
- Department of Wound Reconstructive Surgery, Tongji Hospital of Tongji University, Shanghai 200065, China.
| | - Ge Song
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China; Department of Plastic Surgery, First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China
| | - Sanxi Wang
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| | - Huile Pei
- Department of Dermatology, Second Affiliated Hospital Henan University of Science and Technology, Luoyang 471003, China
| | - Guiping Shen
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China.
| | - Jianghua Feng
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen 361005, China
| |
Collapse
|
2
|
Alos L, Carrasco A, Teixidó C, Szumera-Ciećkiewicz A, Vicente A, Massi D, Carrera C. Melanoma on congenital melanocytic nevi. Pathol Res Pract 2024; 256:155262. [PMID: 38518732 DOI: 10.1016/j.prp.2024.155262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Among nevus-associated melanomas, which overall account for 20%-30% of all melanomas, those arising specifically in congenital melanocytic nevi are infrequent, but can be disproportionately frequent in childhood and adolescence. Congenital melanocytic nevi (CMNi) are common benign melanocytic tumors that are present at birth or become apparent in early childhood. They are classified based on the projected adult size. Small and medium-sized CMNi are frequent, whereas large/giant CMNi (over 20 cm in diameter) are rare, but can be associated with high morbidity due to marked aesthetic impairment and the risk of neurocutaneous syndrome or melanoma development. In this setting, melanomas can appear in early childhood and are very aggressive, while the risk of small-medium CMNi of developing melanoma is low and similar to non-congenital melanocytic nevi. Histologically, most melanomas on CMNi initiate their growth at the epidermal-dermal junction, but in large/giant CMNi they can develop entirely in the dermis, in deeper tissues, or in extracutaneous sites (especially in the central nervous system). Most CMNi harbour an NRAS mutation, but other genes are rarely involved, and gene translocations have recently been described. However, no prognostic implications have been associated with the CMN genotype. Melanomas developed on CMNi harbour additional molecular alterations to which the aggressive clinical course of these tumors has been attributed. This review covers the distinctive clinical and pathological aspects of melanomas on CMNi, and includes the epidemiology, etiopathogenesis, clinical and dermoscopic presentation, histological and molecular characteristics, as well as tumour behaviour.
Collapse
Affiliation(s)
- Llucia Alos
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group
| | - Antonio Carrasco
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Cristina Teixidó
- Department of Pathology, Hospital Clinic de Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Molecular Biology Core, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Anna Szumera-Ciećkiewicz
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Maria Sklodowska-Curie National Research Institute of Oncology, Department of Pathology, Warsaw, Poland
| | - Asunción Vicente
- Pediatric Dermatology Department, Hospital Sant Joan de Déu, Esplugues del Llobregat, Barcelona, Spain
| | - Daniela Massi
- EORTC (European Organisation for Research and Treatment of Cancer) Melanoma Group; Pathology Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Carrera
- University of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Dermatology, Hospital Clínic de Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Spain.
| |
Collapse
|
3
|
Chen W, Jiang X, Chen N, Zhang Q, Cai W. Histopathological characteristics analysis of giant melanocytic naevi in children. J Cosmet Dermatol 2024; 23:978-985. [PMID: 37933518 DOI: 10.1111/jocd.16065] [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: 09/05/2023] [Revised: 10/16/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The major diagnostic criterion for the giant congenital melanocytic nevus (GCMN) is a size larger than 20 cm in diameter. However, the histopathological origin, pathogenesis, and GCMN progression are not yet completely clear. Unlike other medium or small superficial lesions, histomorphological evaluation is significant for GCMN pathological classification, malignant transformation assessment, and early detection of prognosis. AIMS This study aimed to investigate the pathological features of GCMN, including its satellite lesions. PATIENTS/METHODS Twenty-three giant naevi and seventeen "satellite lesions" were collected from children aged 1 to 10 in Shanghai Ninth People's Hospital from 2018 to 2020. A histological study was conducted to evaluate their histological appearance. All the data observed and recorded data were statistically analyzed. RESULTS In 23 cases of GCMN primary nevus, nevus cells were mainly distributed in the dermal region, with melanocyte proliferation and the presence of nevus nests at the dermal-epidermal junction. However, in satellite nevus, a junctional growth pattern was noted. Additionally, other histopathologic features, including epidermal contour, cell morphology, and architecture disorder also showed significant differences between primary nevus and satellite nevus. CONCLUSIONS We demonstrated that the congenital pattern of the main nevus is more obvious than one of the satellite nevus, suggesting that the satellite nevus and the main nevus may occur slightly later than the main nevus. "Satellite nevus" happens as a result of a separate genetic event.
Collapse
Affiliation(s)
- Wei Chen
- Department of Plastic Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Xuewei Jiang
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nan Chen
- The Affiliated Eye Hospital, Nanjing Medical University, Nanjing, China
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Wei Cai
- Department of Plastic Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Chen HC, Hsu TI, Chao TY, Yang ST. Neurocutaneous Melanosis with Meningeal Melanocytosis: A Rare Case of Intracranial Hypertension and Cutaneous Manifestations. Life (Basel) 2024; 14:139. [PMID: 38255754 PMCID: PMC10817463 DOI: 10.3390/life14010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
A 50-year-old male presented to the emergency room after experiencing sudden right upper limb facial numbness and dysphasia, followed by full recovery. A brain CT scan showed hyperdense lesions within the left hemispheric sulcus, which raised suspicion of spontaneous subarachnoid hemorrhage. A T1-weighted MRI showed multiple tiny leptomeningeal enhancements in the same area, and a digital subtraction angiography showed no signs of vascular abnormality. Cerebrospinal fluid cytology revealed atypical melanin-containing cells with minimal pleomorphism. One month later, the patient developed sixth nerve palsy, which was determined to be due to intracranial hypertension. Multiple giant nevi on the legs, trunk, and scalp were also observed. A skin biopsy showed well-defined and symmetrical proliferation of melanocytic nevus cell nests in the dermis. An open biopsy was performed due to the suspicious leptomeningeal lesions, which surprisingly revealed diffuse and thick black-colored tissue infiltration of the leptomeninges. Pathology confirmed the diagnosis of meningeal melanocytosis. A ventriculoperitoneal shunt was then placed, and the patient's neurological symptoms gradually improved. Based on the presence of multiple giant nevi on the patient's skin and the finding of diffuse meningeal melanocytosis during the open biopsy, the patient was diagnosed with neurocutaneous melanosis. The patient received 6 cycles triweekly of Ipilimumab and Nivolumab 8 months after initial diagnosis. Unfortunately, the disease progressed and the patient passed away 14 months after initial diagnosis.
Collapse
Affiliation(s)
- Hsien-Chung Chen
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei 110, Taiwan; (H.-C.C.); (T.-I.H.)
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
| | - Tsung-I Hsu
- Ph.D. Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University and National Health Research Institutes, Taipei 110, Taiwan; (H.-C.C.); (T.-I.H.)
- TMU Research Center of Neuroscience, Taipei Medical University, Taipei 110, Taiwan
- International Master Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
- TMU Research Center of Cancer Translational Medicine, Taipei 110, Taiwan
- Ph.D. Program in Drug Discovery and Development Industry, College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan
| | - Tsu-Yi Chao
- Cancer Center, Attending Physician, Division of Hematology-Oncology, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan;
| | - Shun-Tai Yang
- Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, Taipei 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei 110, Taiwan
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| |
Collapse
|
5
|
Tan S, Hu H, Xin X, Wu D. A clinical and biologic review of congenital melanocytic nevi. J Dermatol 2024; 51:12-22. [PMID: 37955315 DOI: 10.1111/1346-8138.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/14/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
Congenital melanocytic nevi (CMN) are the result of aberrations in the mitogen-activated protein kinase signal transduction pathway caused by postzygotic somatic mutations. The estimated incidence of newborns with CMN is 1%-2%. The main complications of CMN include proliferative nodules, melanomas, and neurocutaneous melanosis, and the latter two are the most troublesome issues to address. Treatments are primarily taken into account for aesthetic purposes and the reduction of melanoma risk. Due to the much lower incidence of malignant transformation observed in recent studies than in previous data, clinical management paradigms for CMN patients have gradually shifted towards conservative observation and close monitoring. Surgery and lasers are still the main treatments, and targeted therapy may be a promising strategy to help manage complications. With the increase in awareness of mental health, increasing focus has been placed on the quality of life (QoL) and psychological issues of both CMN patients and their parents. Recent studies have revealed that families coping with CMN might endure intense pressure, a major loss in QoL, and psychological problems after diagnosis and during treatment. Here, we sought to present an overview of genetic basis, complications, treatments, and psychological issues related to CMN and hope to provide better management for patients with CMN.
Collapse
Affiliation(s)
- Songtao Tan
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyue Hu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin Xin
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Di Wu
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
6
|
Raj S, Chouksey P, Shrivastava A, Mishra R, Tandon A, Prakash M, Agrawal A. Non-dysraphic extramedullary intradural spinal lipoma with neurocutaneous melanocytosis. Br J Neurosurg 2023; 37:1824-1828. [PMID: 34148439 DOI: 10.1080/02688697.2021.1937518] [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: 01/19/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intradural spinal lipomas are very rare and constitute less than 1% of all spinal tumors. Such tumors are usually associated with spinal dysraphism and occur mostly in the lumbosacral or cervical region. Intradural spinal lipomas tends to be intramedullary or subpial. Meningeal melanocytoma is further rarer cases that comprise less than 0.1% of cases. These usually occur in the fifth or fifth decade and chances of malignant transformation are high. CASE REPORT Here, we report an extremely rare case (first to the best of our knowledge) of a 9 years female child who presented to us with rapid progressing paraparesis. She was operated and found to have an intradural purely extramedullary spinal lipoma without spinal dysraphism. Moreover, she had melanin pigment deposits all over her meninges which is further rare. On presentation, the patient was bedridden but after surgery, the patient improved and could walk without support. CONCLUSIONS To the best of our knowledge, this is the first case of spinal cord lipoma in dorsal location along with melanin pigments in the meninges. We discuss the pathogenesis, presentation and management of intradural extramedullary spinal lipomas.
Collapse
Affiliation(s)
- Sumit Raj
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Pradeep Chouksey
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Rakesh Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Ashwani Tandon
- Department of Pathology, All India Institute of Medical Sciences, Bhopal, India
| | - Manas Prakash
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
| |
Collapse
|
7
|
Takiya M, Fushimi Y, Sakamoto M, Yoshida T, Ueno K, Nakajima S, Sakata A, Okuchi S, Otani S, Tagawa H, Morimoto N, Nakamoto Y. Incidence of neurocutaneous melanosis in Japanese pediatric patients with congenital melanocytic nevi. Sci Rep 2023; 13:16442. [PMID: 37777590 PMCID: PMC10542349 DOI: 10.1038/s41598-023-43829-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/28/2023] [Indexed: 10/02/2023] Open
Abstract
Neurocutaneous melanosis (NCM) is a rare, non-hereditary neurocutaneous disorder characterized by excessive melanocytic proliferation in the skin and central nervous system. As no major studies have covered the incidence of NCM among Japanese patients with congenital melanocytic nevi (CMN), we prospectively investigated the incidence of NCM among Japanese patients who underwent initial treatment for CMN. The relationship of CMN and NCM was also investigated. Japanese pediatric patients with CMN under 1 year of age were included between January 2020 and November 2022, and all patients underwent brain MRI to check for NCM in this study. NCM lesions were most frequently seen in the amygdala, followed by the cerebellum, brainstem, and cerebral hemispheres. NCM was diagnosed on brain MRI in 31.6% of the 38 patients with CMN and in 25.0% of patients with no prior examination or treatment. Distribution and size of CMN, number of satellite nevi, rugosity and nodules were strongly associated with the existence of NCM, and these findings may guide a future registry study with a large cohort of CMN patients.
Collapse
Affiliation(s)
- Miyuki Takiya
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan
| | - Yasutaka Fushimi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan.
| | - Michiharu Sakamoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Takeshi Yoshida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Kentaro Ueno
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Satoshi Nakajima
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan
| | - Sachi Okuchi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan
| | - Sayo Otani
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan
| | - Hiroshi Tagawa
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyoku, Kyoto, 6068507, Japan
| |
Collapse
|
8
|
Meyer SN, Simmons EM, McPherson JD, Awasthi S, Kiuru M. SCALP syndrome with a germline heterozygous DOCK6 mutation and somatic mosaic NRAS Q61R mutation. Pediatr Dermatol 2023; 40:523-527. [PMID: 36456540 PMCID: PMC10250009 DOI: 10.1111/pde.15184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/18/2022] [Indexed: 12/04/2022]
Abstract
We present a case of SCALP syndrome, which was diagnosed in a male infant with the characteristic findings of sebaceous nevi, central nervous system malformations, aplasia cutis congenita, limbal dermoid, and giant congenital melanocytic nevi, or pigmented nevi. We identified a germline compound heterozygous DOCK6 mutation and a somatic mosaic NRAS Q61R mutation in the giant congenital melanocytic nevus. This report will increase clinician awareness of SCALP syndrome and augment the literature in characterizing this rare syndrome, including its genetic background.
Collapse
Affiliation(s)
- Summer N. Meyer
- Department of Dermatology, University of California Davis, Sacramento California, USA
| | - Elanee M. Simmons
- Department of Dermatology, University of California Davis, Sacramento California, USA
| | - John D. McPherson
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento California, USA
| | - Smita Awasthi
- Department of Dermatology, University of California Davis, Sacramento California, USA
- Department of Pediatrics, University of California Davis, Sacramento California, USA
| | - Maija Kiuru
- Department of Dermatology, University of California Davis, Sacramento California, USA
- Department of Pathology & Laboratory Medicine, University of California Davis, Sacramento California, USA
| |
Collapse
|
9
|
Dung PTV, Son TT, Thuy TTH, Duy TT. Serial excision surgery for giant dorsal congenital melanocytic nevus: Case report. Int J Surg Case Rep 2023; 106:108152. [PMID: 37098292 PMCID: PMC10149246 DOI: 10.1016/j.ijscr.2023.108152] [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: 02/19/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Giant congenital melanocytic nevus increases the risk of melanoma and seriously affects the aesthetics and psychology of patients, influencing the personality development of children. CASE PRESENTATION A 7-year-old female child presented with a giant congenital melanocytic nevus on the back, which extended from the right anterior abdominal wall to the left flank Taking advantage of the elasticity of children's skin, we performed serial excision and obtained favourable results. The procedure included seven surgeries, and the average interval between the surgeries was 7 months. The nevus was partially resected from the periphery to the centre, and the direction of excision of the nevus depended on the mobilisation of the surrounding normal skin, including from the shoulder downward, lateral to medial, and from the bottom upward. After the seventh surgery at 11 years of age, the nevus was completely removed, and there were no complications. CLINICAL DISCUSSION Serial excision is a simple and less invasive surgical technique that can achieve both complete excision and a satisfactory aesthetic result for giant congenital melanocytic nevus. The giant nevus of the back can be removed completely after several procedures due to the very good elasticity of the skin and the great ability of natural expansion of healthy skin under a considerable stretching force in children. CONCLUSION Serial excision is an effective method for treating dorsal giant congenital melanocytic nevus in children because of excellent natural skin elasticity.
Collapse
Affiliation(s)
- Pham Thi Viet Dung
- Plastic Surgery Department, Hanoi Medical University, Hanoi, Viet Nam; Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam.
| | - Tran Thiet Son
- Plastic Surgery Department, Hanoi Medical University, Hanoi, Viet Nam; Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam.
| | - Ta Thi Hong Thuy
- Plastic Surgery Department, Hanoi Medical University, Hanoi, Viet Nam; Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam.
| | - Truong The Duy
- Plastic Reconstructive and Aesthetic Surgery Department, Bach Mai Hospital, Hanoi, Viet Nam
| |
Collapse
|
10
|
Gout HA, Fledderus AC, Lokhorst MM, Pasmans SGMA, Breugem CC, Lapid O, van der Horst CMAM. Safety and effectiveness of surgical excision of medium, large, and giant congenital melanocytic nevi: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 77:430-455. [PMID: 36652871 DOI: 10.1016/j.bjps.2022.10.048] [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: 11/08/2021] [Revised: 06/28/2022] [Accepted: 10/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Treatment indications of congenital melanocytic naevi (CMN) have shifted from the prevention of malignant transformation more towards the improvement of appearance and psychosocial health. Surgical excision is often preferred, but its safety and effectiveness remain unclear. OBJECTIVE To assess the outcomes of surgical excision of medium-to-giant CMN. PRIMARY OUTCOME safety (complications). SECONDARY OUTCOME effectiveness (satisfaction and CMN core outcomes). METHODS PubMed, EMBASE, and CENTRAL were searched for studies on the excision of medium-to-giant CMN and/or CMN requiring reconstruction or serial excision. Meta-analyses of safety per patient were conducted, and pooled outcomes of safety and effectiveness were presented in summary-of-findings tables. RESULTS A total of 1444 studies were found, of which 22 were included, evaluating 643 eligible patients. Study quality varied, and reporting of baseline characteristics and outcomes was heterogeneous. Pooled proportions were overall 9.8% for major wound-related complications, 1.2% for minor wound-related complications, 1.2% for scar-related complications, and 4.3% for anatomical deformities. For large/giant CMN, complication rates were, respectively, 23.1%, 2.9%, 12.9%, and 2.4%; and for CMN with eyelid involvement, 0.5%, 3.3%, 0.4%, and 54.2%. Patients rated their satisfaction with the cosmetic outcome as 24.4% excellent, 71.0% good, and 4.6% poor/moderate. Physicians rated this as 18.3% excellent, 70.1% good, and 11.7% poor/moderate. Thirty-five other outcomes of effectiveness were summarized. However, many were rarely reported. CONCLUSIONS Surgical excision of CMN appears to be safe and effective in many cases, depending on CMN size and location. Major wound-related complications and scar-related complications occurred more frequently with large/giant CMN, whereas anatomical deformities occurred with the majority of CMN with eyelid involvement.
Collapse
Affiliation(s)
- H Antoine Gout
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - Anne C Fledderus
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Department of Dermatology, Erasmus University Medical Center - Sophia Children's Hospital, Erasmus University Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Max M Lokhorst
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus University Medical Center - Sophia Children's Hospital, Erasmus University Rotterdam, Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| | - Chantal M A M van der Horst
- Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands
| |
Collapse
|
11
|
Measurement instruments for the core outcome set of congenital melanocytic naevi and an assessment of the measurement properties according to COSMIN: a systematic review. JPRAS Open 2022; 35:58-75. [PMID: 36691582 PMCID: PMC9860390 DOI: 10.1016/j.jpra.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background Congenital melanocytic naevi (CMN) can impact on patients' lives due to their appearance and the risk they carry of neurological complications or melanoma development. The development of a core outcome set (COS) will allow standardised reporting and enable comparison of outcomes. This will help to improve guidelines. In previous research, relevant stakeholders reached a consensus over which core outcomes should be measured in any future care or research. The next step of the COS development is to select the appropriate measurement instruments. Aim Step 1: to update a systematic review identifying all core outcomes and measurement instruments available for CMN. Step 2: to evaluate the measurement properties of the instruments for the core outcomes. Methods This study was registered in PROSPERO and performed according to the PRISMA checklist. Step 1 includes a literature search in EMBASE (Ovid), PubMed and the Cochrane Library to identify core outcomes and instruments previously used in research of CMN. Step 2 yields a systematic search for studies on the measurement properties of instruments that were either developed or validated for CMN, including a methodological quality assessment following the COSMIN methodology. Results Step 1 included twenty-nine studies. Step 2 yielded two studies, investigating two quality of life measurement instruments. Conclusion Step 1 provided an overview of outcomes and instruments used for CMN. Step 2 showed that additional research on measurement properties is needed to evaluate which instruments can be used for the COS of CMN. This study informs the instrument selection and/or development of new instruments.
Collapse
|
12
|
Fledderus AC, Widdershoven AL, Lapid O, Breugem CC, Pasmans SGMA, van der Horst CMAM, Engelen MM, Spuls PI. Neurological signs, symptoms and MRI abnormalities in patients with congenital melanocytic naevi and evaluation of routine MRI-screening: systematic review and meta-analysis. Orphanet J Rare Dis 2022; 17:95. [PMID: 35236387 PMCID: PMC8889704 DOI: 10.1186/s13023-022-02234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 02/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background A congenital melanocytic naevus (CMN) is a rare skin condition that can be associated with abnormalities of the central nervous system (CNS). These anomalies can sometimes cause severe complications, and rarely death. Adequate information about aetiology and management is therefore crucial. To identify how to monitor patients with CMN, we aimed to estimate the prevalence of neurological involvement in patients with CMN and to summarize what specific neurological signs and symptoms and MRI abnormalities are reported in the medical literature. In addition, we summarized and evaluated the recommendations regarding MRI-screening reported in the medical literature. Methods This review was registered in PROSPERO and reported according to the MOOSE checklist. A search was conducted in EMBASE (Ovid), PubMed, and the Cochrane Library. We included studies with 10 or more patients with CMN, reporting on neurological signs and symptoms or CNS MRI. Study selection, data extraction and methodological quality assessment were performed by two independent reviewers. A meta-analysis was used to assess the prevalence of neurological signs and symptoms. Results Out of 1287 studies, fourteen studies were eligible for inclusion of which eight were included in the meta-analysis. Neurological signs and symptoms prevalence was 7.04% (CI 95% 4.47–10.93%) in the meta-analysis group and 6.26% (95% CI 3.85–10%) in a subgroup of patients with a CMN > 6 cm, evaluated in seven studies. Neurodevelopmental delay and seizures were the most frequently reported signs and symptoms. CNS melanocytosis and hydrocephalus were the most frequently reported MRI abnormalities. It was not possible to estimate the increased risk of neurological involvement in patients with CMN due to low quality of evidence and clinical heterogeneity. Conclusion Standardization in CMN studies and a multi-centre prospective study are needed to evaluate neurological involvement. Based on current literature, it is not possible to make strong recommendations on routine MRI-screening. For now, every clinical centre should decide on its own policy and weigh the advantages and disadvantages of routine MRI. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02234-8.
Collapse
Affiliation(s)
- Anne C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location AMC, University of Amsterdam, 1100 DD, Amsterdam, The Netherlands.
| | - Anna Linn Widdershoven
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Oren Lapid
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Doctor Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Chantal M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marc M Engelen
- Department of Pediatric Neurology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Phyllis I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Kim JY, Jeon JH, Choi TH, Kim BJ. Risk of Malignant Transformation Arising From Giant Congenital Melanocytic Nevi: A 20-year Single-center Study. Dermatol Surg 2022; 48:171-175. [PMID: 34935754 DOI: 10.1097/dss.0000000000003341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although giant congenital melanocytic nevus (GCMN) is regarded as premalignant, the incidence and risk factors of malignant transformation are controversial. OBJECTIVE This study aimed to share the authors' surgical experience with GCMNs and provide data on their demographics, malignant transformation, and prognosis. METHODS This single-center, consecutive study included 152 patients with GCMN who visited this center from March 2000 to February 2020. Their medical documentation was reviewed retrospectively, and the nevi were classified according to the size as follows: Group 1, 10 to 19.9 cm (n = 45); Group 2, 20 to 39.9 cm (n = 62); and Group 3, ≥40 cm (n = 45). RESULTS Seven malignancies were found (4.6%; 4 melanomas, 2 rhabdomyosarcomas [RMS], and 1 malignant peripheral nerve sheath tumor [MPNST]). The risk increased according to the nevus size (2.2% in Group 1, 3.2% in Group 2, and 8.9% in Group 3) but the difference was not statistically significant (p = .3305). CONCLUSION Malignant transformation from GCMN cannot be ignored. It can include transformation into melanoma, RMS, and MPNST. Early surgical resection and regular follow-up should be performed in patients with nevi ≥10 cm.
Collapse
Affiliation(s)
- Ji-Young Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hui Jeon
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Choi
- The Nevus Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
14
|
Carmen Ceballos-Rodríguez M, Redondo P, Tomás-Velázquez A, Cieza-Díaz D, Carlos López-Gutiérrez J. Surgical outcomes and psychosocial impact of giant congenital melanocytic nevus surgery: A single-center case series of 136 patients. J Pediatr Surg 2021; 56:2113-2117. [PMID: 33461742 DOI: 10.1016/j.jpedsurg.2020.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/24/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the outcomes, complications and psychosocial impact of surgical treatment of giant congenital melanocytic nevus (GCMN). METHODS Patients with surgically treated GCMN who attended our clinic between May 2014 and May 2018 were included. Patient demographics and data on the characteristics of the nevus, surgical treatment, and the psychosocial impact (including C-DLQI/DLQI questionnaires) were collected. RESULTS One hundred thirty-six patients were included (median age 9 years). Mean age at first surgery was 34 (+/- 61.45) months; 5.53 (+/- 3.69) surgical interventions were necessary to completely excise the nevus. The expanded skin flap was the preferred surgical technique in most locations. Complications were common but not severe. Of the patients studied, 70.4% reported that the surgery had a minor impact on their quality of life (QoL). Patients and caregivers stated that surgical treatment should begin as soon as possible, even in cases where early treatment did not have an impact on their QoL nor on their satisfaction with the surgery (p < 0.05). The lower the patient age at first surgery, the higher the surgeon's satisfaction (p < 0.01). CONCLUSIONS Surgical treatment is a safe option for management of GCMN, and has a low impact on QoL. Patients, caregivers, and surgeons agree that the treatment should begin as soon as possible. This is the largest single-center study evaluating surgical treatment in GCMN patients and its psychosocial impact, and the first to take into account the patient, caregivers and dermatologists opinion of surgical results.
Collapse
Affiliation(s)
- María Carmen Ceballos-Rodríguez
- Department of Dermatology, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain.
| | - Pedro Redondo
- Department of Dermatology, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Navarra, Spain
| | - Alejandra Tomás-Velázquez
- Department of Dermatology, Clínica Universidad de Navarra, Avenida de Pío XII 36, 31008 Pamplona, Navarra, Spain
| | - Deysy Cieza-Díaz
- Department of Dermatology, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos 2, 28040 Madrid, Spain
| | - Juan Carlos López-Gutiérrez
- Department of Pediatric Surgery, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain
| |
Collapse
|
15
|
Müller CSL, Müller SG, Vogt T, Pföhler C. Current concepts of ectopic nodal inclusions with special emphasis on nodal nevi. J Dtsch Dermatol Ges 2021; 19:1145-1157. [PMID: 34390159 DOI: 10.1111/ddg.14521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
Nodal inclusions of ectopic tissue within lymph nodes are seen comparatively often in dermatopathology and general pathology. Glandular and nonglandular epithelium, as well as melanocytic nevi can be observed within lymph nodes and represent mostly incidental findings without any relevance. The main challenge in reporting these morphologic features is to differentiate such benign inclusions from metastatic settlements of distinct organ tumors. As sentinel node biopsy and lymph node dissection have become standard procedure in clinical oncology and have an immense clinical impact, the correct evaluation of these nodal inclusions is indispensable to avoid undertreatment or overtreatment of patients. In addition, the genesis of these inclusions has not yet been satisfactorily clarified. Two concepts have been laid out: the theory of benign metastases and the migration arrest theory. However, neither theory has so far been able to answer the following questions: Why do we find more nodal nevi in patients with melanoma who had a sentinel node biopsy than in patients without melanoma, and why do we not find nodal nevi in deep visceral lymph nodes? We present a comprehensive review of the current knowledge on nodal inclusions, proposing a concept for the pathogenesis of nodal nevi, to answer these questions.
Collapse
Affiliation(s)
- Cornelia Sigrid Lissi Müller
- Medical supply center for Histology, Cytology, and Molecular diagnostics Trier GmbH, Wissenschaftspark Trier, TRIER, Germany
| | - Stephan G Müller
- Department of General-, Visceral-, Vascular- and Pediatric Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thomas Vogt
- Department of Dermatology, Allergology, and Venerology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Claudia Pföhler
- Department of Dermatology, Allergology, and Venerology, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
16
|
Müller CSL, Müller SG, Vogt T, Pföhler C. Aktuelle Konzepte zu ektopen Lymphknoten‐Einschlüssen unter besonderer Berücksichtigung nodaler Nävi. J Dtsch Dermatol Ges 2021; 19:1145-1158. [PMID: 34390137 DOI: 10.1111/ddg.14521_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Stephan G Müller
- Klinik für allgemeine Chirurgie, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Thomas Vogt
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Claudia Pföhler
- Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum des Saarlandes, Homburg/Saar
| |
Collapse
|
17
|
Mormina E, Granata F, Vinci SL, Coglitore A, Caragliano AA, Agostino T, Longo M, Visalli C. Imaging and clinical features of neurocutaneous melanosis in the pediatric population. Curr Med Imaging 2021; 17:1391-1402. [PMID: 34047260 DOI: 10.2174/1573405617666210527091109] [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: 10/12/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurocutaneous melanosis (NCM) is a rare nonfamilial phakomatosis characterized by the presence of congenital melanocytic nevi and abnormal melanocytes infiltration of the leptomeninges. OBJECTIVE & METHODS This paper shows the importance of early diagnosis and the most important imaging features of the disease on CT and MR scans. PubMed database was searched from January 1972 to September 2020. Papers including imaging findings of NCM, clinical, follow-up, and treatment features were collected, selecting only 89 studies. DISCUSSION NCM is a term used for the first time by van Bogaert in 1948. It refers to a condition caused by an error during morphogenesis and migration leading to leptomeningeal melanocytic accumulation. Although histological findings are the gold standard for diagnosis confirmation, neuroimaging and clinical features strongly support the suspect of NCM. Localization and extension of the lesions are predictive of neurological manifestations related to increased intracranial pressure, mass lesions, or spinal cord compression. CT demonstrates sites of increased density in the anterior temporal lobe - mainly the amygdala - thalami, cerebellum, and frontal lobes base. However, MRI is the best imaging method to diagnose central nervous system lesions, often appearing as T1-short signal areas of the cerebral parenchyma, indicative of central nervous system melanosis. MRI can also reveal associated intracranial and intraspinal abnormalities. CONCLUSION Early imaging, when available, is helpful if NCM suspect is raised and may be of guidance in comparing later studies. NCM requires a multidisciplinary approach since it is a multisystem disease with a genetic component.
Collapse
Affiliation(s)
- Enricomaria Mormina
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Francesca Granata
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Alessandra Coglitore
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Antonio Armando Caragliano
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Tessitore Agostino
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Marcello Longo
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| | - Carmela Visalli
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, Italy
| |
Collapse
|
18
|
Fledderus AC, Pasmans SGMA, Wolkerstorfer A, Oei W, Etchevers HC, van Kessel MS, van der Horst CMAM, Spuls PI. Domains and outcomes of the core outcome set of congenital melanocytic naevi for clinical practice and research (the OCOMEN project): part 2. Br J Dermatol 2021; 185:970-977. [PMID: 33959942 PMCID: PMC9290785 DOI: 10.1111/bjd.20437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
Background Congenital melanocytic naevi (CMN) can have a great impact on patients’ lives owing to perceived stigmatization, and the risk of melanoma development and neurological complications. Development of a core outcome set (COS) for care and research in CMN will allow standard reporting of outcomes. This will enable comparison of outcomes, allowing professionals to offer advice about the best management options. In previous research, stakeholders (patients, parents and professionals) reached consensus on the core domains of the COS. To select the appropriate measurement instruments, the domains should be specified by outcomes. Objectives To reach consensus on the specific core outcomes describing the core domains pertaining to clinical care and research in CMN. Methods A list of provisional outcomes (obtained earlier) was critically reviewed by the Outcomes for COngenital MElanocytic Naevi (OCOMEN) research team and by relevant stakeholders through an online questionnaire, to refine this list and provide clear definitions for every outcome. When needed, discussion with individual participants was undertaken over the telephone or by email. During an online consensus meeting, stakeholders discussed the inclusion of potential outcomes. After the meeting, participants voted in two rounds for the inclusion of outcomes. Results Forty‐four stakeholders from 19 countries participated. Nine core outcomes were included in the COS relative to clinical care and 10 core outcomes for research. Conclusions These core outcomes will enable standard reporting in future care and research of CMN. This study facilitates the next step of COS development: selecting the appropriate measurement instruments for every outcome. What is already known about this topic?Congenital melanocytic naevi (CMN) can be associated with psychosocial burden and increased risk of melanoma and/or neurological complications. Outcomes measured for research and care in CMN are heterogeneous, impeding comparison. A core outcome set (COS) may enhance standardized use and reporting, and reduce selective reporting bias. In previous research, relevant stakeholders reached consensus on what domains should be included in the core domain set (CDS).
What does this study add?To select the appropriate measurement instruments for the domains included in the CDS, the domains should be further specified by outcomes. We reached consensus on what outcomes should describe the domains of the CDS of CMN care and research. Through a consensus procedure, including online discussions, online consensus meeting and voting, relevant stakeholders reached consensus on a limited number of core outcomes describing the core domains.
What are the clinical implications of this work?Development of a COS will allow standard reporting of outcomes in future care and research of CMN. This will enable pooling and comparison of outcomes, allowing guideline development of optimal management policy.
Linked Comment: M.V. Heppt et al. Br J Dermatol 2021; 185:881–882. Plain language summary available online
Collapse
Affiliation(s)
- A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands.,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - W Oei
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - H C Etchevers
- Aix Marseille Univ, INSERM, MMG, Faculté de Médecine AMU, 27 boulevard Jean Moulin, Marseille, 13005, France
| | - M S van Kessel
- Patient representative, Naevus International, the Netherlands
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| |
Collapse
|
19
|
Mormina E, Vinci SL, Coglitore A, Visalli C, Tessitore A, Cavallaro M, Galletta K, Granata F. Cerebellar amelanotic melanoma can mimic cerebellar abscess in a pediatric case of neurocutaneous melanosis. Clin Case Rep 2021; 9:1999-2006. [PMID: 33936629 PMCID: PMC8077441 DOI: 10.1002/ccr3.3926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 12/01/2022] Open
Abstract
Neurocutaneous melanosis (NCM) is a rare phakomatosis that may be associated with intracerebral masses. The differential diagnosis of intracerebral masses in NCM is often challenging and should include pigmented and nonpigmented lesions.
Collapse
Affiliation(s)
- Enricomaria Mormina
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Sergio Lucio Vinci
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Alessandra Coglitore
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Carmela Visalli
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Agostino Tessitore
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Marco Cavallaro
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Karol Galletta
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| | - Francesca Granata
- Department of Biomedical and Dental Sciences and of Morphofunctional ImagingUniversity of MessinaMessinaItaly
| |
Collapse
|
20
|
Cholesterol was identified as a biomarker in human melanocytic nevi using DESI and DESI/PI mass spectrometry imaging. Talanta 2021; 231:122380. [PMID: 33965043 DOI: 10.1016/j.talanta.2021.122380] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 01/16/2023]
Abstract
The rapid differentiation between diseased tissue and healthy normal tissue is of great importance for the intraoperative diagnosis. Herein, desorption electrospray ionization (DESI) and DESI/post-photoionization (DESI/PI) mass spectrometry imaging were combined to in situ visualize the distribution of biochemicals within the tissue regions of human melanocytic nevi under the ambient condition with a spatial resolution of around 200 μm. Plenty of polar and nonpolar lipids were found to be specifically distributed in melanocytic nevi with statistical significance and could be used to differentiate the healthy normal tissue and melanocytic nevi. Cholesterol was further confirmed to be a potential biomarker for melanocytic nevi diagnosis by multivariate statistical analysis and immunohistochemistry of 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) and translocator protein (TSPO) enzymes. This work provides a visual way for the diagnosis of human melanocytic nevi by lipid profiling, which benefits the understanding of the pathological mechanism of melanocytic nevi and provides a new insight to control melanin growth from the synthesis, transport, and metabolism of cholesterol.
Collapse
|
21
|
Neurocutaneous Melanocytosis and Leptomeningeal Melanoma. J Pediatr Hematol Oncol 2021; 43:e195-e197. [PMID: 31764519 DOI: 10.1097/mph.0000000000001680] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 11/26/2022]
Abstract
Neurocutaneous melanocytosis (NCM) is a disorder characterized by multiple or large congenital nevi and excessive proliferation of melanocytes in the leptomeninges and brain parenchyma. The majority of NCM is a result of somatic mosaicism due to a single postzygotic mutation in codon 61 of NRAS. Patients with NCM are at high risk of developing leptomeningeal melanoma. The prognosis for leptomeningeal melanoma is poor with no known effective treatment options. We describe the clinical features, treatment, and outcome of 4 children with NCM and leptomeningeal melanoma and discuss the latest molecular findings and treatment options for this rare condition.
Collapse
|
22
|
Oei W, Fledderus AC, Spuls PI, Eggen CAM, Kottner J, van der Horst CMAM, Wolkerstorfer A, van Kessel MS, Krengel S, Etchevers HC, Korfage IJ, Pasmans SGM. Development of an international core domain set for medium, large and giant congenital melanocytic naevi as a first step towards a core outcome set for clinical practice and research. Br J Dermatol 2021; 185:371-379. [PMID: 33237568 DOI: 10.1111/bjd.19694] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Medium, large and giant congenital melanocytic naevi (CMN) can impose a psychosocial burden on patients and families, and are associated with increased risk of developing melanoma or neurological symptoms. Lack of consensus on what outcomes to measure makes it difficult to advise patients and families about treatment and to set up best practice for CMN. OBJECTIVES Fostering consensus among patient representatives and professionals, we aim to develop a core outcome set, defined as the minimum set of outcomes to measure and report in care and all clinical trials of a specific health condition. We focused on the 'what to measure' aspect, the so-called core domain set (CDS), following the COMET and CS-COUSIN guidelines. METHODS We conducted a systematic review to identify outcomes reported in the literature. Focus groups with patient representatives identified patient-reported outcomes. All these outcomes were classified into domains. Through e-Delphi surveys, 144 stakeholders from 27 countries iteratively rated the importance of domains and outcomes. An online consensus meeting attended by seven patient representatives and seven professionals finalized the CDS. RESULTS We reached consensus on six domains, four of which were applied to both care and research: 'quality of life', 'neoplasms', 'nervous system' and 'anatomy of skin'. 'Adverse events' was specific to care and 'pathology' to research. CONCLUSIONS We have developed a CDS for medium-to-giant CMN. Its application in reporting care and research of CMN will facilitate treatment comparisons. The next step will be to reach consensus on the specific outcomes for each of the domains and what instruments should be used to measure these domains and outcomes.
Collapse
Affiliation(s)
- W Oei
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - A C Fledderus
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands.,Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - C A M Eggen
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - J Kottner
- Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, D-10117, Germany
| | - C M A M van der Horst
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Amsterdam Public Health, Amsterdam University Medical Center, Meibergdreef 9, Amsterdam, 1105 AZ, the Netherlands
| | - M S van Kessel
- President Naevus Global, Naevus International Patient Representative Working Group Leader, Utrecht, the Netherlands
| | - S Krengel
- Dermatological Group Practice, Lindenplatz 6, Lübeck, 23554, Germany
| | - H C Etchevers
- Aix Marseille University, INSERM, MMG, Faculté de Médecine, 27 Boulevard Jean Moulin, Marseille, 13005, France
| | - I J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - S G M Pasmans
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Sophia Children's Hospital, Doctor Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| |
Collapse
|
23
|
Farabi B, Akay BN, Goldust M, Wollina U, Atak MF, Rao B. Congenital melanocytic naevi: An up-to-date overview. Australas J Dermatol 2021; 62:e178-e191. [PMID: 33591589 DOI: 10.1111/ajd.13535] [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: 10/03/2020] [Revised: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
Congenital melanocytic naevi are hamartomas of the neuroectoderm caused by genetic mosaicism. Congenital melanocytic naevi are seen in 1-6% of all live births and commonly classified based on the projected size in adults. Congenital melanocytic naevi appear in different colours, shapes, and sizes, and occasionally present with complications. In this review, we sought to evaluate congenital melanocytic naevi, their clinical, dermatoscopic, and reflectance confocal microscopic features, behavioural pattern over time, new trends in classification, underlying genetic factors and their influence on clinical manifestations and management, associated risks, complications, magnetic resonance imaging findings and their management in the light of recent literature.
Collapse
Affiliation(s)
- Banu Farabi
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey.,Department of Dermatology, Robert Wood Johnson Medical Centre, Rutgers University, New Brunswick, New Jersey, USA
| | - Bengu Nisa Akay
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Mohamad Goldust
- Department of Dermatology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Mehmet Fatih Atak
- Dermatology and Venerology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Babar Rao
- Department of Dermatology, Robert Wood Johnson Medical Centre, Rutgers University, New Brunswick, New Jersey, USA
| |
Collapse
|
24
|
Molinelli A, Cozzani E, Burlando M, Santi P, Parodi A, Ventura F. Spastic quadriplegia following intradermal use of hydrogen peroxide in the tardive curettage procedure for the treatment of a giant congenital nevus. GIORN ITAL DERMAT V 2021; 155:780-782. [PMID: 33645938 DOI: 10.23736/s0392-0488.16.05231-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The possible transformation of a giant congenital melanocytic nevi (GCMN) in malignant melanoma estimated from 0.05% to 40% depend on the size of the lesions. Many are the surgical procedures proposed, including: full or partial-thickness excisions, dermabrasion, curettage in the first weeks of life and laser treatment. The curettage technique has been proposed in the literature for the treatment of GCMN in the first few weeks of life and defined as a relatively atraumatic surgery procedure without general complications. The authors report the first case in the literature of embolization due to use of subcutaneous peroxide infiltration before a tardive curettage procedure in a newborn case of GCMN resulting in spastic quadriplegia with dystonic reaction. Consequently, a lawsuit, due to this medical malpractice, has been opened.
Collapse
Affiliation(s)
- Andrea Molinelli
- Department of Legal Medicine, IRCCS San Martino University Hospital, Genoa, Italy
| | - Emanuele Cozzani
- Department of Dermatology, Di.S.Sal., IRCCS San Martino University Hospital, Genoa, Italy -
| | - Martina Burlando
- Department of Dermatology, Di.S.Sal., IRCCS San Martino University Hospital, Genoa, Italy
| | - Pierluigi Santi
- Department of Plastic Surgery, IRCCS San Martino University Hospital, Genoa, Italy
| | - Aurora Parodi
- Department of Dermatology, Di.S.Sal., IRCCS San Martino University Hospital, Genoa, Italy
| | - Francesco Ventura
- Department of Legal Medicine, IRCCS San Martino University Hospital, Genoa, Italy
| |
Collapse
|
25
|
Habibi Z, Ebrahimi H, Meybodi KT, Yaghmaei B, Nejat F. Clinical Follow-Up of Patients with Neurocutaneous Melanosis in a Tertiary Center; Proposed Modification in Diagnostic Criteria. World Neurosurg 2020; 146:e1063-e1070. [PMID: 33246180 DOI: 10.1016/j.wneu.2020.11.091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Neurocutaneous melanosis (NCM) is a rare congenital syndrome. Except for some retrospective studies, information on clinical follow-up and management of these patients are limited. This study aimed to review our experience on diagnostic protocol and clinical follow-up of patients with NCM in a referral children's hospital in Iran. METHODS Between 2012 and 2019, eight patients with NCM were consecutively managed in our center. Brain magnetic resonance imaging and cutaneous biopsy were done in all patients at diagnosis. Follow-up surveillance and characteristics of the disease are described. RESULTS The mean follow-up period was 25.75 ± 13.81 months, and 75% of patients were male. Most magnetic resonance imaging findings were hypersignal lesions in the temporal lobe (75%), cerebellum (62.5%), brainstem (50%), and thalamus (12.5%). Dandy-Walker syndrome was found in 4 patients (50%), and shunt-dependent hydrocephalus was found in 3 patients (37.5%). Cutaneous malignant melanoma and malignant involvement of the central nervous system were found in 2 (25%) and 3 cases (37.5%), respectively. The mortality rate was 37.5%. CONCLUSIONS There are no specific guidelines for management of NCM due to the rarity of the disease. This study proposed modifications in diagnostic criteria, as well as recommendations for follow-up surveillance.
Collapse
Affiliation(s)
- Zohreh Habibi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hannan Ebrahimi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Keyvan Tayebi Meybodi
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahareh Yaghmaei
- Department of Pediatric Intensive Care Medicine, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Nejat
- Department of Pediatric Neurosurgery, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
26
|
Ruggieri M, Polizzi A, Catanzaro S, Bianco ML, Praticò AD, Di Rocco C. Neurocutaneous melanocytosis (melanosis). Childs Nerv Syst 2020; 36:2571-2596. [PMID: 33048248 DOI: 10.1007/s00381-020-04770-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/23/2020] [Indexed: 02/03/2023]
Abstract
Neurocutaneous melanosis (NCM; MIM # 249400; ORPHA: 2481], first reported by the Bohemian pathologist Rokitansky in 1861, and now more precisely defined as neurocutaneous melanocytosis, is a rare, congenital syndrome characterised by the association of (1) congenital melanocytic nevi (CMN) of the skin with overlying hypertrichosis, presenting as (a) large (LCMN) or giant and/or multiple (MCMN) melanocytic lesions (or both; sometimes associated with smaller "satellite" nevi) or (b) as proliferative melanocytic nodules; and (2) melanocytosis (with infiltration) of the brain parenchyma and/or leptomeninges. CMN of the skin and leptomeningeal/nervous system infiltration are usually benign, more rarely may progress to melanoma or non-malignant melanosis of the brain. Approximately 12% of individuals with LCMN will develop NCM: wide extension and/or dorsal axial distribution of LCMN increases the risk of NCM. The CMN are recognised at birth and are distributed over the skin according to 6 or more patterns (6B patterns) in line with the archetypical patterns of distribution of mosaic skin disorders. Neurological manifestations can appear acutely in infancy, or more frequently later in childhood or adult life, and include signs/symptoms of intracranial hypertension, seizures/epilepsy, cranial nerve palsies, motor/sensory deficits, cognitive/behavioural abnormalities, sleep cycle anomalies, and eventually neurological deterioration. NMC patients may be symptomatic or asymptomatic, with or without evidence of the typical nervous system changes at MRI. Associated brain and spinal cord malformations include the Dandy-Walker malformation (DWM) complex, hemimegalencephaly, cortical dysplasia, arachnoid cysts, Chiari I and II malformations, syringomyelia, meningoceles, occult spinal dysraphism, and CNS lipoma/lipomatosis. There is no systemic involvement, or only rarely. Pathogenically, single postzygotic mutations in the NRAS (neuroblastoma RAS viral oncogene homologue; MIM # 164790; at 1p13.2) proto-oncogene explain the occurrence of single/multiple CMNs and melanocytic and non-melanocytic nervous system lesions in NCM: these disrupt the RAS/ERK/mTOR/PI3K/akt pathways. Diagnostic/surveillance work-ups require physical examination, ophthalmoscopy, brain/spinal cord magnetic resonance imaging (MRI) and angiography (MRA), positron emission tomography (PET), and video-EEG and IQ testing. Treatment strategies include laser therapy, chemical peeling, dermabrasion, and surgical removal/grafting for CMNs and shunt surgery and surgical removal/chemo/radiotherapy for CNS lesions. Biologically targeted therapies tailored (a) BRAF/MEK in NCM mice (MEK162) and GCMN (trametinib); (b) PI3K/mTOR (omipalisib/GSK2126458) in NMC cells; (c) RAS/MEK (vemurafenib and trametinib) in LCMNs cells; or created experimental NMC cells (YP-MEL).
Collapse
Affiliation(s)
- Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy.
| | - Agata Polizzi
- Chair of Pediatrics, Department of Educational Sciences, University of Catania, Catania, Italy
| | - Stefano Catanzaro
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
- Unit of Neonatology and Neonatal Intensive Care Unit (NICU), AOU "Policlinico", PO "San Marco", University of Catania, Catania, Italy
| | - Manuela Lo Bianco
- Postgraduate Programme in Pediatrics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea D Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| | - Concezio Di Rocco
- Pediatric Neurosurgery, International Neuroscience Institute (INI), Hannover, Germany
| |
Collapse
|
27
|
Braunberger TL, Adelman M, Shwayder TA, Clarke LE, Friedman BJ. Proliferative nodule resembling angiomatoid Spitz tumor with degenerative atypia arising within a giant congenital nevus. J Cutan Pathol 2020; 47:1200-1204. [PMID: 32776331 DOI: 10.1111/cup.13840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022]
Abstract
Proliferative nodules arising within congenital melanocytic nevi often present a diagnostic challenge given a close resemblance to melanoma. Several morphologic variants have been characterized. In difficult cases, ancillary molecular tests can be used to better exclude the possibility of malignant degeneration. Herein, we report a case of an unusual proliferative nodule with overlapping features of angiomatoid Spitz tumor and ancient melanocytic nevus, which demonstrated normal findings on both chromosomal microarray and a gene expression profiling assay.
Collapse
Affiliation(s)
| | - Madeline Adelman
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Tor A Shwayder
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Ben J Friedman
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA.,Department of Pathology and Laboratory Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| |
Collapse
|
28
|
A Unique Case of Lower Limb Soft Tissue Reconstruction with a Prefabricated Bipedicled Deep Inferior Epigastric Artery Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2976. [PMID: 32802668 PMCID: PMC7413782 DOI: 10.1097/gox.0000000000002976] [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: 01/07/2020] [Accepted: 05/22/2020] [Indexed: 11/25/2022]
Abstract
Aesthetic lower-extremity reconstruction is a secondary field in lower limb reconstructive surgery. Nevertheless, it plays an important role in the final stages of patient rehabilitation after traumatic events, treatment of deformations, and oncoplastic surgery, and in unique cases of purely aesthetic reconstruction. We present a clinical case of lower limb reconstruction with a prefabricated bipedicled deep inferior epigastric artery (DIEP) flap in a young patient who underwent a massive congenital circular pigmented nevus excision surgery. Due to the lack of sufficient donor site tissues anywhere on the body, a bilateral DIEP flap was prefabricated using tissue expansion. Two expanders were used to prepare the donor site. Six months after expansion, lower limb reconstruction was performed. A large (50 × 25cm2) surgical defect was covered by a prefabricated DIEP flap. Flap positioning was regarded with extra care due to importance of proper venous outflow in accordance with lower limb venous anatomy. Treatment results were above the satisfactory level both aesthetically and therapeutically. Aesthetic and therapeutic incentives were assessed before surgical treatment decision. Large defects of the lower limbs require significant amount of excess tissue in the donor site and may require prefabrication. In young patients with low BMI, flap transfer is nearly impossible without prior expansion. In this case, we successfully performed giant pigmented nevus excision, with immediate reconstruction with a prefabricated bilateral DIEP flap. Venous outflow was problematic due to the anatomical structure of lower limb veins. This required extra venous drainage and special regard to positioning of the flap.
Collapse
|
29
|
Fledderus A, Franke C, Eggen C, van Etten-Jamaludin F, van der Horst C, Brinkmann S, Spuls P. Outcomes and measurement instruments used in congenital melanocytic naevi research: A systematic review. J Plast Reconstr Aesthet Surg 2020; 73:703-715. [DOI: 10.1016/j.bjps.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022]
|
30
|
Sato TS, Handa A, Priya S, Watal P, Becker RM, Sato Y. Neurocristopathies: Enigmatic Appearances of Neural Crest Cell–derived Abnormalities. Radiographics 2019; 39:2085-2102. [DOI: 10.1148/rg.2019190086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- T. Shawn Sato
- From the Department of Radiology, Stead Family Children’s Hospital, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 3889 JPP, Iowa City, IA 52242
| | - Atsuhiko Handa
- From the Department of Radiology, Stead Family Children’s Hospital, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 3889 JPP, Iowa City, IA 52242
| | - Sarv Priya
- From the Department of Radiology, Stead Family Children’s Hospital, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 3889 JPP, Iowa City, IA 52242
| | - Pankaj Watal
- From the Department of Radiology, Stead Family Children’s Hospital, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 3889 JPP, Iowa City, IA 52242
| | - Robert M. Becker
- From the Department of Radiology, Stead Family Children’s Hospital, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 3889 JPP, Iowa City, IA 52242
| | - Yutaka Sato
- From the Department of Radiology, Stead Family Children’s Hospital, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 3889 JPP, Iowa City, IA 52242
| |
Collapse
|
31
|
Management of Congenital Melanocytic Nevus on Face Using Multiple Re-expansion Method: Aesthetic and Psychosocial Results. J Craniofac Surg 2019; 30:2385-2389. [PMID: 31609959 DOI: 10.1097/scs.0000000000006000] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Congenital giant melanocytic nevus on the face is a challenging condition, especially in the pediatric population. It can produce significant cosmetic deformity with negative psychosocial effects in pediatric patients even after treatment. The objective of this study was to report aesthetic and psychosocial results in the management of congenital melanocytic nevus on the face using multiple reexpansion. METHODS Data of 6 patients with congenital melanocytic nevus on the face who underwent excision and multiple reexpansion at our center from September 2004 to August 2017, were retrospectively reviewed. To evaluate aesthetic outcomes, preoperative and final photographs of each patient were reviewed by 3 other plastic surgeons and 4 laypersons. For comparison, 6 other patients who were treated with conventional surgery during the same period were reviewed. After final reconstruction surgery, the authors surveyed patients' satisfaction via telephone. RESULTS Six patients were followed up for an average of 87.66 months (range, 55-123 months). The mean number of tissue expander insertions was 3.33 and the mean number of total expanders inserted was 4.83. Complication associated with expander exposure occurred in 1 patient during the fifth expansion. The average score of aesthetic outcome in the multiple reexpansion group was superior to that of the conventional group (2.60 versus 2.10, P = 0.03). During the telephone survey, patients did not rate their appearance as positive, although they were comparatively satisfied with the surgical procedure. CONCLUSION Considering the low rate of malignancy involving congenital melanocytic nevus in childhood, multiple reexpansion is an attractive option to obtain better results compared with other reconstructive methods.
Collapse
|
32
|
Abstract
Melanoma accounts for 7% of all cancers in adolescents ages 15-19 years but is an unexpected malignancy in younger children. The prevalence of malignant melanoma is very rare in children ages 1-4 years, but certain non-modifiable risk factors such as xeroderma pigmentosum, congenital melanocytic nevus syndrome and other inherited traits increase the risk for its development in these young children. Recent genomic studies have identified characteristics of pediatric melanoma that differ from conventional melanoma seen in adults. In this review the authors inform on the types of melanoma seen in children and adolescents, discuss similarities and differences in melanoma between children and adults, and discuss the role of imaging in the care of these children.
Collapse
Affiliation(s)
- Sue C Kaste
- Departments of Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MSN 220, Memphis, TN, 38105-3678, USA.
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.
| |
Collapse
|
33
|
Funayama E, Yamamoto Y, Oyama A, Murao N, Hayashi T, Maeda T, Furukawa H, Osawa M. Combination laser therapy as a non-surgical method for treating congenital melanocytic nevi from cosmetically sensitive locations on the body. Lasers Med Sci 2019; 34:1925-1928. [PMID: 30820775 DOI: 10.1007/s10103-019-02753-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Emi Funayama
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Akihiko Oyama
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima, Japan
| | - Naoki Murao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masayuki Osawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan
| |
Collapse
|
34
|
Belysheva TS, Vishnevskaya YV, Nasedkina TV, Emelyanova MA, Abramov IS, Orlova KV, Lubchenko LN, Utyashev IA, Doroshenko MB, Demidov LV, Aliev MD. Melanoma arising in a Giant congenital melanocytic nevus: two case reports. Diagn Pathol 2019; 14:21. [PMID: 30782194 PMCID: PMC6381634 DOI: 10.1186/s13000-019-0797-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/10/2019] [Indexed: 12/22/2022] Open
Abstract
Background A giant congenital melanocytic nevus (GCMN) is found in 0.1% of live-born infants. If present, the lesion has a chance of about 6% to develop into malignant melanoma. Both children and adults can be affected by malignant melanoma arising in a giant congenital nevus. Up to 95% of GCMNs harbor NRAS mutations, and mutations in the BRAF, MC1R, TP53, and GNAQ genes have also been described. The individualization of therapy is required, but diagnostic and prognostic criteria remain controversial. Case presentations We report two cases: 1) melanoma arising in a giant congenital nevus during the first month of life complicated with neurocutaneous melanosis (NCM), and 2) melanoma arising in a giant congenital nevus during the first 6 months of life. Pathology, immunohistochemistry, and genetic analyses of tumor tissue were performed. The first case revealed only a non-pathogenic P72R polymorphism of the TP53 gene in the homozygote condition. For the second case, a Q61K mutation was detected in the NRAS gene. Conclusion Malignant melanoma associated with GCMN is rare and therefore poorly understood. Outcomes have been linked to the stage at diagnosis, but no additional pathological prognostic factors have been identified. The most frequent genetic event in giant CMNs is NRAS mutations, which was discovered in one of our cases. To accumulate evidence to improve disease prognosis and outcomes, children with congenital melanocytic nevus should be included in a systemic follow-up study from birth.
Collapse
Affiliation(s)
- Tatiana S Belysheva
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Yana V Vishnevskaya
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Tatiana V Nasedkina
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Marina A Emelyanova
- Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Ivan S Abramov
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.,Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russian Federation
| | - Kristina V Orlova
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation.
| | - Ludmila N Lubchenko
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Igor A Utyashev
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Marina B Doroshenko
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Lev V Demidov
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| | - Mamed D Aliev
- Federal State Budgetary Institution, "N.N. Blokhin Medical Research Center of Oncology" of the Ministry of Health of the Russian Federation, 115478 Kashirskoye shosse, 24, Moscow, Russian Federation
| |
Collapse
|
35
|
Bagnoni G, Fidanzi C, D'Erme AM, Viacava P, Leoni M, Strambi S, Calani C, Bertocchini A, Morganti R, Spinelli C. Melanoma in children, adolescents and young adults: anatomo-clinical features and prognostic study on 426 cases. Pediatr Surg Int 2019; 35:159-165. [PMID: 30411144 DOI: 10.1007/s00383-018-4388-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study was conducted to determine the difference in anatomo-pathological and prognostic features of cutaneous melanoma in children, adolescents and young adults. METHODS This is a retrospective review on 383 young patients ≤ 39 years of age with cutaneous melanoma, in a period from 2006 to 2016 in Area Vasta Nord Ovest, Tuscany, Italy. We subdivided patients in three groups (children ≤ 14 years, adolescents 15-21 years, young adults 22-39 years). We correlated all the anatomo-pathological parameters with age groups. RESULTS We identified a total of 426 cases of cutaneous melanoma on an overall total of 383 patients. Mean age at diagnosis for all the patients ≤ 39 years of age was 31.2 years: in group A was 11.2 years, in group B 19.2 years and in group C 32.5 years. Incidence, in the subjects between 0 and 14 years, is 14 cases per million inhabitants, between 15 and 21 years of 145, and between 22 and 39 years of 394. Global incidence was 1.6 case per million for group A, 8.9 cases per million for group B, 105 cases per million for group C. No statistically significative correlation could be described for clinical parameters and age groups. CONCLUSIONS Incidence of melanoma in our casuistry results as the highest in the world. These data open new study for this kind of cancer.
Collapse
Affiliation(s)
- Giovanni Bagnoni
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
| | - Cristian Fidanzi
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
| | - Angelo Massimiliano D'Erme
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
| | | | - Matteo Leoni
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Silvia Strambi
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Chiara Calani
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Alessia Bertocchini
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, Pisa, Italy
| | - Claudio Spinelli
- Pediatric, Adolescent and Young Adults Surgery Division, Department of Surgical, Medical, Pathological, Molecular and Critical Area, University of Pisa, Pisa, Italy.
| |
Collapse
|
36
|
Harvey NT, Wood BA. A Practical Approach to the Diagnosis of Melanocytic Lesions. Arch Pathol Lab Med 2018; 143:789-810. [PMID: 30059258 DOI: 10.5858/arpa.2017-0547-ra] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Melanocytic lesions are common in routine surgical pathology. Although the majority of these lesions can be confidently diagnosed using well-established morphologic criteria, there is a significant subset of lesions that can be diagnostically difficult. These can be a source of anxiety for patients, clinicians, and pathologists, and the potential consequences of a missed diagnosis of melanoma are serious. OBJECTIVE.— To provide a practical approach to the diagnosis of melanocytic lesions, including classic problem areas as well as suggestions for common challenges and appropriate incorporation of ancillary molecular techniques. DATA SOURCES.— Literature search using PubMed and Google Scholar, incorporating numerous search terms relevant to the particular section, combined with contemporaneous texts and lessons from personal experience. CONCLUSIONS.— Although a subset of melanocytic lesions can be diagnostically challenging, the combination of a methodical approach to histologic assessment, knowledge of potential diagnostic pitfalls, opinions from trusted colleagues, and judicious use of ancillary techniques can help the pathologist navigate this difficult area.
Collapse
Affiliation(s)
- Nathan T Harvey
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
| | - Benjamin A Wood
- From the Dermatopathology Group, Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Australia; and the Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Australia
| |
Collapse
|
37
|
Goil P, Jain A, Patil AN, Singh A, Chaudhary G. Surgical management of giant congenital melanocytic nevus of face in the adult—outcomes and experience. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-018-1425-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
38
|
Dolbashid AS, Mokhtar MS, Muhamad F, Ibrahim F. Potential applications of human artificial skin and electronic skin (e-skin): a review. BIOINSPIRED BIOMIMETIC AND NANOBIOMATERIALS 2018. [DOI: 10.1680/jbibn.17.00002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Asdani Saifullah Dolbashid
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Innovation in Medical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Mas Sahidayana Mokhtar
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Innovation in Medical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Farina Muhamad
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Fatimah Ibrahim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia; Centre for Innovation in Medical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
39
|
Goodarzi P, Falahzadeh K, Nematizadeh M, Farazandeh P, Payab M, Larijani B, Tayanloo Beik A, Arjmand B. Tissue Engineered Skin Substitutes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1107:143-188. [PMID: 29855826 DOI: 10.1007/5584_2018_226] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The fundamental skin role is to supply a supportive barrier to protect body against harmful agents and injuries. Three layers of skin including epidermis, dermis and hypodermis form a sophisticated tissue composed of extracellular matrix (ECM) mainly made of collagens and glycosaminoglycans (GAGs) as a scaffold, different cell types such as keratinocytes, fibroblasts and functional cells embedded in the ECM. When the skin is injured, depends on its severity, the majority of mentioned components are recruited to wound regeneration. Additionally, different growth factors like fibroblast growth factor (FGF), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF) are needed to orchestrated wound healing process. In case of large surface area wounds, natural wound repair seems inefficient. Inspired by nature, scientists in tissue engineering field attempt to engineered constructs mimicking natural healing process to promote skin restoration in untreatable injuries. There are three main types of commercially available engineered skin substitutes including epidermal, dermal, and dermoepidermal. Each of them could be composed of scaffold, desired cell types or growth factors. These substitutes could have autologous, allogeneic, or xenogeneic origin. Moreover, they may be cellular or acellular. They are used to accelerate wound healing and recover normal skin functions with pain relief. Although there are a wide variety of commercially available skin substitutes, almost none of them considered as an ideal equivalents required for proper wound healing.
Collapse
Affiliation(s)
- Parisa Goodarzi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Khadijeh Falahzadeh
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehran Nematizadeh
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parham Farazandeh
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Moloud Payab
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Tayanloo Beik
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
40
|
Is there still a place for skin graft in giant congenital melanocytic nevus? EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-017-1344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
41
|
Kinsler VA, O'Hare P, Bulstrode N, Calonje JE, Chong WK, Hargrave D, Jacques T, Lomas D, Sebire NJ, Slater O. Melanoma in congenital melanocytic naevi. Br J Dermatol 2017; 176:1131-1143. [PMID: 28078671 PMCID: PMC5484991 DOI: 10.1111/bjd.15301] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2016] [Indexed: 01/31/2023]
Abstract
Congenital melanocytic naevi (CMN) are a known risk factor for melanoma, with the greatest risk currently thought to be in childhood. There has been controversy over the years about the incidence of melanoma, and therefore over the clinical management of CMN, due partly to the difficulties of histological diagnosis and partly to publishing bias towards cases of malignancy. Large cohort studies have demonstrated that melanoma risk in childhood is related to the severity of the congenital phenotype. New understanding of the genetics of CMN offers the possibility of improvement in diagnosis of melanoma, identification of those at highest risk, and new treatment options. We review the world literature and our centre's experience over the last 25 years, including the molecular characteristics of melanoma in these patients and new melanoma incidence and outcome data from our prospective cohort. Management strategies are proposed for presentation of suspected melanoma of the skin and the central nervous system in patients with CMN, including use of oral mitogen-activated protein kinase kinase inhibitors in NRAS-mutated tumours.
Collapse
Affiliation(s)
- V A Kinsler
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K.,Genetics and Genomic Medicine, UCL Institute of Child Health, London, U.K
| | - P O'Hare
- Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - N Bulstrode
- Paediatric Plastic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - J E Calonje
- Dermatopathology Department, St John's Institute of Dermatology, Guy's and St Thomas' Hospital, London, U.K
| | - W K Chong
- Paediatric Neuroradiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - D Hargrave
- Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K.,Developmental Biology and Cancer Programme, UCL Institute of Child Health, London, U.K
| | - T Jacques
- Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K.,Developmental Biology and Cancer Programme, UCL Institute of Child Health, London, U.K
| | - D Lomas
- Paediatric Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - N J Sebire
- Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K.,Developmental Biology and Cancer Programme, UCL Institute of Child Health, London, U.K
| | - O Slater
- Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| |
Collapse
|
42
|
Simons EA, Huang JT, Schmidt B. Congenital melanocytic nevi in young children: Histopathologic features and clinical outcomes. J Am Acad Dermatol 2017; 76:941-947. [PMID: 28242090 DOI: 10.1016/j.jaad.2016.12.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 12/09/2016] [Accepted: 12/16/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although only large congenital melanocytic nevi (CMN) are associated with a significantly high risk for malignant transformation, CMN of all sizes are prone to changes in clinical appearance in early childhood and thus are often biopsied or excised. While CMNs typically exhibit benign behavior, atypical histopathologic findings might be common and may prompt additional unnecessary procedures. OBJECTIVE To assess the prevalence and associated clinical outcomes of atypical histopathologic features in CMN in children. METHODS A single center retrospective study was conducted with patients 0-35 months of age with CMN diagnosed by histopathology between 1993-2013. RESULTS One hundred seventy-nine patients with a total of 197 CMNs were identified. Cytologic atypia, architectural disorder, or pagetoid spread were present in 73% of CMN. With a mean follow up of 7.3 years, no cases of melanoma or CMN-related deaths were identified. LIMITATIONS Our findings were based on a largely Caucasian population and might not apply to darker skin types. Our findings might not apply to older children or adults with CMN. CONCLUSION Atypical histopathologic features of cytologic atypia, architectural disorder, and pagetoid spread are common in benign CMN of young children.
Collapse
Affiliation(s)
- Emily A Simons
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Jennifer T Huang
- Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Birgitta Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
43
|
Ma T, Fan K, Li L, Xie F, Li H, Chou H, Zhang Z. Tissue expansion in the treatment of giant congenital melanocytic nevi of the upper extremity. Medicine (Baltimore) 2017; 96:e6358. [PMID: 28353563 PMCID: PMC5380247 DOI: 10.1097/md.0000000000006358] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of our study was to use tissue expansion for the treatment of giant congenital melanocytic nevi of the upper extremity and examine potential advantages over traditional techniques.There were 3 stages in the treatment of giant congenital melanocytic nevi of the upper extremities using tissue expansion: first, the expander was inserted into the subcutaneous pocket; second, the expander was removed, lesions were excised, and the wound of the upper extremity was placed into the pocket to delay healing; third, the residual lesion was excised and the pedicle was removed. The pedicle flap was then unfolded to resurface the wound.During the period between June 2007 and December 2015, there were 11 patients with giant congenital melanocytic nevi of the upper extremities who underwent reconstruction at our department with skin expansion. Few complications were noted in each stage of treatment. The functional and aesthetic results were observed and discussed in this study.Optimal aesthetic and functional results were obtained using tissue expansion to reconstruct the upper extremities due to the giant congenital melanocytic nevi.
Collapse
Affiliation(s)
| | - Ke Fan
- Department of Operating Theater, Henan Provincial People's Hospital, Zhengzhou City, Henan Province, China
| | - Lei Li
- Department of Plastic Surgery
| | | | - Hao Li
- Department of Plastic Surgery
| | | | | |
Collapse
|
44
|
Viana ACL, Goulart EMA, Gontijo B, Bittencourt FV. A prospective study of patients with large congenital melanocytic nevi and the risk of melanoma. An Bras Dermatol 2017; 92:200-205. [PMID: 28538879 PMCID: PMC5429105 DOI: 10.1590/abd1806-4841.20175176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 04/02/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Large congenital melanocytic nevus (LCMN) is considered a risk factor for melanoma, although the magnitude of this risk is controversial. OBJECTIVE: To evaluate the risk of melanoma development in patients with LCMN seen at a dermatology referral center in Brazil during a twelve-year period. To the best of our knowledge, there are no published similar studies on large congenital melanocytic nevus in South America. METHODS: Our prospective cohort included only patients with congenital nevi ≥20cm. The cumulative risk of developing melanoma and the standardized morbidity ratio were calculated for patients followed up prospectively for at least 1 month. RESULTS: Sixty-three patients were enrolled in this study. One patient who developed melanoma prior to enrollment was excluded, and five were eliminated because of insufficient follow-up time. Mean follow-up for the remaining 57 patients was 5.5 years (median 5.2 years). Median age of entry into the study was 2.6 years. Most patients (75.4%) underwent only clinical observation. Melanomas occurred in 2 (3.5%) patients. Five-year cumulative risk for melanoma was 4.8% (95% CI: 1.9-11.5%). Standardized morbidity ratio was 1584 (95% CI: 266-5232, p<0.001). STUDY LIMITATIONS: The small sample size reduces the accuracy of risk estimates. CONCLUSIONS: This study analyzed prospectively for the first time data from South America demonstrating that patients with LCMN have a higher risk of developing melanoma than the general population (p<0.001).
Collapse
Affiliation(s)
- Ana Carolina Leite Viana
- Dermatology Unity – Hospital das Clinicas – Universidade Federal de
Minas Gerais (UFMG) – Belo Horizonte (MG), Brazil
| | - Eugênio Marcos Andrade Goulart
- Department of Pediatrics – School of Medicine, Universidade Federal
de Minas Gerais (UFMG) – Belo Horizonte (MG), Brazil
| | - Bernardo Gontijo
- Dermatology Unity – Hospital das Clinicas – Universidade Federal de
Minas Gerais (UFMG) – Belo Horizonte (MG), Brazil
| | - Flávia Vasques Bittencourt
- Dermatology Unity – Hospital das Clinicas – Universidade Federal de
Minas Gerais (UFMG) – Belo Horizonte (MG), Brazil
| |
Collapse
|
45
|
Expanded bi-pedicled “sleeve” flap for reconstruction of the upper extremity after large circumferential nevus excision in children. J Plast Reconstr Aesthet Surg 2016; 69:1676-1682. [DOI: 10.1016/j.bjps.2016.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022]
|
46
|
Dégardin N, Jaloux C, Mallet S, Hesse S, Bardot J. [Skin tumors in children]. ANN CHIR PLAST ESTH 2016; 61:498-512. [PMID: 27374221 DOI: 10.1016/j.anplas.2016.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 05/30/2016] [Indexed: 11/28/2022]
Abstract
The presence of a congenital or acquired cutaneous lesion is a frequent reason for consultation in pediatric plastic surgery unit. The management of these lesions requires a good knowledge of specific diagnoses in children. This step is sometimes difficult because of the multiplicity of possible diagnosis. Some skin tumors may be the external sign of a general disease or an underlying malformation; those can change the overall prognosis and management and require to be properly identified. The decision of surgical excision depends on various criteria, including diagnosis but also the reconstruction possibilities. The timing of surgical treatment depends on the medical emergency of the tumor resection (benign tumor, spontaneously regressive tumor, risk of degeneration into malignancy), on the cosmetic and psychological impact but also on the growth or learning steps in child life. This article first provides an aid in the diagnosis of the most common or more characteristic skin tumors. The algorithm is principally based on the pigmentation aspect of the tumor. The age and conditions of the surgical management are specified for each type of tumor. Cutaneous hemangiomas and vascular malformations, and congenital cysts and fistulas are not reported in this article.
Collapse
Affiliation(s)
- N Dégardin
- Service de chirurgie plastique pédiatrique, hôpital Timone-Enfants, CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| | - C Jaloux
- Service de chirurgie plastique pédiatrique, hôpital Timone-Enfants, CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - S Mallet
- Unité de dermatologie pédiatrique, hôpital Timone CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - S Hesse
- Unité de dermatologie pédiatrique, hôpital Timone CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - J Bardot
- Service de chirurgie plastique pédiatrique, hôpital Timone-Enfants, CHU de Marseille, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| |
Collapse
|
47
|
Jalalabadi F, Trost JG, Cox JA, Lee EI, Pourciau CY. Common Pediatric Skin Lesions: A Comprehensive Review of the Current Literature. Semin Plast Surg 2016; 30:91-7. [PMID: 27478417 PMCID: PMC4961505 DOI: 10.1055/s-0036-1584822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The timely diagnosis and treatment of dermatologic disease in the pediatric population can be challenging. A basic, yet comprehensive knowledge of common lesions is essential for a successful practice in plastic surgery. In this article, the authors describe vascular, cystic, and pigmented cutaneous lesions that are commonly encountered in the pediatric population. Epidemiology, pathogenesis, clinical course, and management options are discussed for each.
Collapse
Affiliation(s)
- Faryan Jalalabadi
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Jeffrey G. Trost
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Joshua A. Cox
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | - Edward I. Lee
- Division of Plastic and Reconstructive Surgery, Baylor College of Medicine, Houston, Texas
| | | |
Collapse
|
48
|
Bekiesińska-Figatowska M, Sawicka E, Żak K, Szczygielski O. Age related changes in brain MR appearance in the course of neurocutaneous melanosis. Eur J Radiol 2016; 85:1427-31. [DOI: 10.1016/j.ejrad.2016.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/15/2016] [Accepted: 05/24/2016] [Indexed: 12/17/2022]
|
49
|
Telomerase Expression by Aberrant Methylation of the TERT Promoter in Melanoma Arising in Giant Congenital Nevi. J Invest Dermatol 2016; 136:339-342. [PMID: 26763461 PMCID: PMC4731027 DOI: 10.1038/jid.2015.374] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 11/30/2022]
|
50
|
Markovic I, Milenkovic Z, Jovanović M, Jakubi BJ, Sekulovic-Stefanovic L. Early diagnosis of asymptomatic neurocutaneous melanosis (60 month follow-up). Pediatr Int 2016; 58:403-405. [PMID: 26762599 DOI: 10.1111/ped.12826] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 07/12/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
Abstract
Neurocutaneous melanosis (NCM) is a rare, sporadic, congenital neuroectodermal dysplasia. Large congenital melanocytic nevi (CMN) can evolve in a certain percentage of patients to NCM. Meningeal deposits are benign, but can be prone to malignant transformation in some cases. We describe the case of an infant with asymptomatic NCM, and typical magnetic resonance imaging (MRI) findings. The diagnosis was established shortly after delivery, and the patient was followed for 60 months. At that time, the girl did not have any neurologic symptoms; she reached normal developmental milestones and did not show mental retardation and did not develop malignant melanoma; further follow-up will be needed, although there are no reliable guidelines as to the time range of follow up of asymptomatic NCM in the literature. We report the typical MRI signal abnormalities of the brain, and present a review of the literature regarding this rare and mysterious congenital disorder.
Collapse
Affiliation(s)
- Ivana Markovic
- Institute of Radiology, Clinical Center Nis, Serbia, Nis, Serbia
| | | | - Marina Jovanović
- Al Adan Hospital, Pediatric Department, Neurology Unit, Hadya, Kuwait
| | | | | |
Collapse
|