A case of melanoma concurrent with progressive systemic sclerosis

Why target the tumor stroma in melanoma?

Melanoma metastasis is fatal. Melanoma cells are often characterized by an activated extracellular signal-regulated kinase (ERK) pathway downstream of mutations in BRAF. Therapies targeting these BRAF mutations are useful for a while; however, patients ultimately develop resistance to these therapies. Recent evidence suggests that this resistance occurs when tumor cells leave their microenvironment and migrate on a stiff, activated tumor stroma; that is, this resistance is linked to the presence of an extracellular matrix reminiscent of a fibrotic micronvironment. These data suggest that agents targeting fibrosis might be used to treat melanoma. We therefore discuss what is known about the tumor stroma in melanoma. An emergent target, CCN2 (CTGF), that is required for fibrosis, may also be a good target for drug-resistant melanoma. Intriguingly, anti-CCN2 antibodies are currently under clinical development.

Paraneoplastic systemic sclerosis: About 3 cases and review of literature

OBJECTIVE

Association between cancer and systemic sclerosis (SSc) has been described. However, paraneoplastic SSc is not well known. The aim of this article is to describe cases of paraneoplastic systemic sclerosis and to compare them to other cases of the literature, to find characteristics that can make suspect a paraneoplastic mechanism when SSc is diagnosed.

METHODS

We retrospectively analyzed patients, in our department who, over the last 15 years, presented with Raynaud's phenomenon with a diagnosis of SSc (including cancer during the period of SSc). Treatment of cancer had to be concomitted with an improvement of sclerosis and/or negativation of antinuclear antibodies. Review analysis of other cases was made with Pubmed.

RESULTS

Three patients responded to the criteria. Two of them had an ovarian cancer with peritoneal carcinomatosis and a concomitted SSc. One had a colon cancer with an ovarian metastasis diagnosed 1 year before SSc. None of them had anti-ENA antibody. One had a normal capillaroscopy. After treatment of cancer, all of them had an improvement of sclerosis and a negativation of antinuclear antibodies.

CONCLUSION

We believe that physicians should be aware of paraneoplastic SSc when presentation of SSc is atypical: no anti-ENA (anti-SCl70 or anti-centromere) or normal capillaroscopy, in particular gynecologic cancer in women.

[Systemic sclerosis (scleroderma) and malignancy]

The association of malignancy with collagen diseases has been a focus of interest. Especially, relation between dermatomyositis and malignancy is well-recognized. I reviewed here about the coexistence of SSc and malignancy in literature. I would like to raise four points as characteristics of the relationship. (1) Special attention should be paid to the patients who is late-onset, with advanced skin sclerosis (ex. Barnett III type) and male. (2) There are three generalized mechanisms of the association. The first is the predisposition of the malignancy on the basis of organ fibrosis, such as pulmonary fibrosis and lung cancer. The second is the nature of paraneoplastic syndrome. Lastly, immunological derangement inherent to SSc might cause carcinogenesis. (3) It has been documented that the interval of the onsets of SSc and breast cancer is extremely short. (4) Longstanding reflux esophagitis and Barrett's esophagus with SSc is suspected to predispose to esophageal carcinoma.