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Borges MI, Abreu JM, Ramalhosa F, Nogueira S, Corte Real A. Late-Onset Masseteric Metastasis of Malignant Melanoma in a Patient With Neurofibromatosis and Lipomatosis: A Diagnostic Challenge and Case Report. Cureus 2023; 15:e50847. [PMID: 38249267 PMCID: PMC10798650 DOI: 10.7759/cureus.50847] [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] [Accepted: 12/20/2023] [Indexed: 01/23/2024] Open
Abstract
Melanoma and neurofibromatosis (NF) are distinctly separate conditions, each characterized by unique pathophysiological processes. Nevertheless, their clinical presentations can share overlapping similarities. This report highlights a unique case involving a 68-year-old male with NF1 and lipomatosis, whose unwavering belief that a developing mass in the masseter region was benign and linked to the pre-existing diagnoses contributed to a significant delay in seeking healthcare. Consequently, this postponement resulted in the late diagnosis of disseminated malignant melanoma (stage IV, T4N0M1c). Given the patient's prognosis and poor general health, a palliative treatment plan was devised, entailing the complete excision of the masseteric mass and vertebral radiotherapy. Following a rapid and extensive progression of the cancerous lesions, the patient passed away in a palliative care infirmary four months after surgery. The significance of this case, justified not only by its uncommon presentation and atypical differential diagnosis, highlights the critical necessity of regular follow-up protocols for melanoma patients, particularly those prone to metastasis, while ensuring patient attendance. Furthermore, it underscores the necessity of patient education, particularly in recognizing early signs and symptoms, and timely intervention in cases with complex comorbidities.
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Affiliation(s)
- Maria Inês Borges
- Department of Stomatology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - João M Abreu
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
- Department of Stomatology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Fátima Ramalhosa
- Department of Pathology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Simão Nogueira
- Department of Stomatology, Clinical and Academic Centre of Coimbra, Coimbra, PRT
| | - Ana Corte Real
- Faculty of Medicine, Clinical and Academic Centre of Coimbra, Coimbra, PRT
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Ziemer M, Weidenthaler-Barth B, Gussek P, Pfeiffer M, Kleemann J, Bankov K, Wild PJ, Seibold S, Sureshkumar P, Nickel P, Strobel A, Werner M, Grabbe S. Analytical Validation of an Immunohistochemical 7-Biomarker Prognostic Assay (immunoprint ®) for Early-Stage Cutaneous Melanoma in Archival Tissue of Patients with AJCC v8 T2-T3 Disease. Diagnostics (Basel) 2023; 13:3096. [PMID: 37835839 PMCID: PMC10572486 DOI: 10.3390/diagnostics13193096] [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: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Selected patients with early-stage melanoma have a "hidden high risk" of poor oncologic outcomes. They might benefit from clinical trials, and ultimately, if warranted by trial results, judicious everyday use of adjuvant therapy. A promising tool to identify these individuals is the immunoprint® assay. This immunohistochemical 7-biomarker prognostic test was clinically validated in three independent cohorts (N = 762) to classify early-stage patients as high-risk or low-risk regarding melanoma recurrence and mortality. Using College of American Pathologists (CAP) recommendations, we analytically validated this assay in primary melanoma specimens (N = 20 patients). We assessed assay precision by determining consistency of risk classification under repeated identical conditions (repeatability) or across varying conditions (reproducibility), involving separate assay runs, operators (laboratory scientists), and/or observers (e.g., dermatopathologists). Reference classification was followed by five analytical validation phases: intra-run/intra-operator, intra-observer, inter-run, inter-operator, and inter-observer. Concordance of classifications in each phase was assessed via Fleiss' kappa (primary endpoint) and percent agreement (secondary endpoint). Seven-marker signature classification demonstrated high consistency across validation categories (Fleiss' kappa 0.864-1.000; overall percent agreement 95-100%), in 9/10 cases, exceeding, and in 1/10 cases, closely approaching, CAP's recommended 0.9 level. The 7-marker assay has now been verified to provide excellent repeatability, reproducibility, and precision, besides having been clinically validated.
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Affiliation(s)
- Mirjana Ziemer
- Department of Dermatology, Allergology and Venereology, University Medical Center, 04103 Leipzig, Germany;
| | - Beate Weidenthaler-Barth
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany; (B.W.-B.); (M.P.); (S.G.)
| | - Philipp Gussek
- Department of Dermatology, Allergology and Venereology, University Medical Center, 04103 Leipzig, Germany;
| | - Maja Pfeiffer
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany; (B.W.-B.); (M.P.); (S.G.)
| | - Johannes Kleemann
- Department of Dermatology, Venerology and Allergology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany;
| | - Katrin Bankov
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.B.); (P.J.W.)
| | - Peter J. Wild
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University, 60590 Frankfurt am Main, Germany; (K.B.); (P.J.W.)
- Frankfurt Institute for Advanced Studies, 60438 Frankfurt am Main, Germany
| | - Silke Seibold
- Synvie GmbH, 80992 Munich, Germany; (S.S.); (P.S.); (P.N.); (A.S.); (M.W.)
| | | | - Patricia Nickel
- Synvie GmbH, 80992 Munich, Germany; (S.S.); (P.S.); (P.N.); (A.S.); (M.W.)
| | - Anton Strobel
- Synvie GmbH, 80992 Munich, Germany; (S.S.); (P.S.); (P.N.); (A.S.); (M.W.)
| | - Markus Werner
- Synvie GmbH, 80992 Munich, Germany; (S.S.); (P.S.); (P.N.); (A.S.); (M.W.)
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, 55131 Mainz, Germany; (B.W.-B.); (M.P.); (S.G.)
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Stătescu L, Cojocaru E, Trandafir LM, Ţarcă E, Tîrnovanu MC, Heredea RE, Săveanu CI, Tarcău BM, Popescu IA, Botezat D. Catching Cancer Early: The Importance of Dermato-Oncology Screening. Cancers (Basel) 2023; 15:3066. [PMID: 37370677 DOI: 10.3390/cancers15123066] [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: 05/09/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
The European Society for Medical Oncology experts have identified the main components of the long-term management of oncological patients. These include early diagnosis through population screening and periodic control of already diagnosed patients to identify relapses, recurrences, and other associated neoplasms. There are no generally accepted international guidelines for the long-term monitoring of patients with skin neoplasms (nonmelanoma skin cancer, malignant melanoma, precancerous-high-risk skin lesions). Still, depending on the experience of the attending physician and based on the data from the literature, one can establish monitoring intervals to supervise these high-risk population groups, educate the patient and monitor the general population.
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Affiliation(s)
- Laura Stătescu
- Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- 'Saint Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Elena Cojocaru
- Department of Morphofunctional Sciences I-Pathology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Mihaela Trandafir
- Department of Mother and Child Medicine-Pediatrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Ţarcă
- Department of Surgery II-Pediatric Surgery, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mihaela Camelia Tîrnovanu
- Department of Mother and Child Medicine-Obstetrics, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Rodica Elena Heredea
- Department of Clinical Practical Skills, "Victor Babeş" University of Medicine and Pharmacy, 300041 Timişoara, Romania
| | - Cătălina Iulia Săveanu
- Surgical Department, Discipline of Preventive Dentistry, Faculty of Dental Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Bogdan Marian Tarcău
- Department of Dermatology, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- 'Saint Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | | | - Doru Botezat
- Department of Preventive Medicine and Interdisciplinarity-Behavioral Sciences, Faculty of Medicine, "Grigore. T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
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