Clinical Characteristics of Nail Unit Melanoma in Türkiye: The Experience of Two Tertiary Dermatology Centers

Background

The literature on the clinical presentations of nail unit melanoma (NUM) in different countries is limited.

Aims

To assess the specific clinical characteristics of NUM in Türkiye.

Study Design

A retrospective cross sectional study.

Methods

Patients with NUM in two centers were retrospectively evaluated for their clinicopathological features, including the location, laterality, destruction of the nail plate, erosion or ulceration, presence of longitudinal melanonychia (LM), Hutchinson's sign (HS), and the absence of pigmentation and Breslow thickness. These variables were compared in terms of the main location of the NUMs (fingernail versus toenail).

Results

A total of 37 patients (54.1% female) of mean age 61.9 ± 14.8 years were enrolled. In most cases, NUMs were located in the fingernails (62.2%), with the most common location being the thumbnails (45.9%), followed by the big toenails (32.4%). Five cases had in situ melanoma presenting with LM. The mean Breslow thickness of invasive NUM lesions (n = 26) was 4.7 ± 4.1 mm (median: 3). Although all in situ NUMs were located on the hands, no statistically significant difference was noted in the Breslow thickness of invasive NUMs on the toenails and fingernails. NUMs were hypomelanotic/amelanotic in 10 (27%) patients. LM was clinically evident in 40.5% of the patients and was significantly more frequently observed on fingernails. The HS of the nail folds was noted in 40.5% of the patients, with the proximal (73.3%) and distal (73.3%) nail folds being most commonly involved. Total or partial destruction of the nail plate was recorded in 24.3% and 51.4% of the patients, respectively. Erosion and/or ulceration on the surface of the NUM was clinically present in most (75.7%) cases. Invasive NUMs associated with LM (n = 10) displayed partial destruction of the nail plate (n = 9), erosion and/or ulceration on the tumor surface (n = 7), and HS (n = 6).

Conclusion

The clinical characteristics of patients with NUM, such as more common localization on the hands, a high rate of preference for thumbnail and big toe, and the ratio of HS, were similar to the studies reported from diverse countries. Partial destruction of the nail plate is an important clinical feature of NUM. Furthermore, LM is more frequently observed in NUMs on the fingernails.

Evaluation of Demographic and Clinical Characteristics of Turkish Patients With Primary Cutaneous Melanoma: A 5-Year Experience of a Tertiary Referral Center

INTRODUCTION

Data about the demographic and clinical characteristics of melanoma patients in Turkey is limited.

OBJECTIVES

Data about the demographic and clinical characteristics of melanoma patients in Turkey is limited. We aimed to review the features of patients with primary cutaneous melanoma (PCM) diagnosed and treated in a tertiary referral center.

METHODS

The medical records of melanoma patients followed up by the Departments of Dermatology and Medical Oncology were retrospectively reviewed.

RESULTS

Within a 5-year period, 180 patients had been diagnosed with melanoma. Of all, 158 (87.8%) had PCM, 9 (5%) had mucosal melanoma, 9 (5%) had unknown primary melanoma, and 4 (2.2%) had ocular melanoma. Of 146 patients with PCM, 32.9% had stage I, 28.8% had stage II, 17.8% had stage III, and 20.5% had stage IV disease. The most common subtype was superficial spreading melanoma (38.8%). A statistically significant correlation was found between the patients Breslow thickness and lymph node involvement, histopathological subtype, and tumor ulceration (P < 0.001). Among all PCM patients, those in stage IV had the lowest 5-year survival rate when compared to the other disease stages (P < 0.001).

CONCLUSIONS

Relatively younger age at melanoma diagnosis, frequent presence of thick (> 4 mm) tumor, and frequent acral lentiginous subtype are the most remarkable features that suggest the low awareness and knowledge of melanoma in our population.

Amelanotic nodular appearance within superficial spreading melanoma

Usual clinical types of malignant melanoma (MM) are lentigo maligna, superficial spreading, nodular, and acral lentiginous MMs. Rarer variants of MM are amelanotic, neurotropic, desmoplastic, metastatic, invisible, pedunculatedmelanoma (PM), or nodal melanoma (NM), which constitute less than 5% of cases. Recognition and discrimination of these variants are important to avoid misdiagnosis of MM. We report a 42-year-old Caucasian woman presented with a superficial spreading malignant melanoma (SSM) with an amelanotic nodular center. The lesion simulated a NM or PM clinically, but its histopathology showed an SSM. This misleading appearance of SSM has not been reported previously.

A retrospective study of malignant melanoma from a tertiary care centre in Saudi Arabia from 2004 to 2016

BACKGROUND

Malignant melanoma is a well-known and commonly lethal tumour yet there exists scarce published information available from Saudi Arabia.

MATERIALS AND METHODS

This study examined the demographic, clinical, and histopathological profile of melanoma in a sample of Saudi patients over a period of 13 years. Medical records of 98 patients from 2004 to 2016 were retrieved from the Department of Pathology and Laboratory Medicine at King Faisal Specialist Hospital (KFSH), Riyadh, Saudi Arabia.

RESULTS

Forty two males and fifty six females (median age of 58 years) were analysed. Most cases were diagnosed in patients aged 50 years or above. The most common sites of occurrence were the extremities, especially the feet, followed by the head and neck, and then mucosal regions. Most mucosal melanomas were located in the mouth. The most common histopathological form was nodular melanoma (38 cases) followed by acral lentiginous melanoma (27 cases). Most of the cases were diagnosed in late diagnostic stages III and IV (59 cases) and most had higher Clark's level and stage V Breslow thickness. The cases with preceding history of xeroderma pigmentosum and dysplastic nevi tended to be diagnosed earlier. The most common mode of treatment was surgical resection. Patients on palliative treatment were older. Only 27/40 patients were confirmed to be alive and the rest were lost to follow-up.

CONCLUSION

Our data contrast with previously published studies from other parts of the world. Further work is needed to confirm our findings of female preponderance, common histological subtypes of nodular and acral melanomas, and the high involvement of oral mucosa in our Saudi patients.

Perineural Invasion of the Orbit by Neurotropic Nondesmoplastic Melanoma

The authors report a case of neurotropic nondesmoplastic melanoma involving the ophthalmic division of the trigeminal nerve and the cavernous sinus in a patient with recurrent scalp melanoma. This case highlights the importance of earlier diagnosis of local recurrence of melanoma and the rare association of neurotropic melanoma and orbital metastasis.

An update on cutaneous melanoma in Turkey: evaluation of 19-year data in a single tertiary centre and review of the literature

BACKGROUND

Information on frequency of melanoma and its clinicopathological subtypes derived from dermatology clinics in Turkey is limited.

OBJECTIVE

As data about melanoma show clear differences due to geographic and ethnic distribution, we scrutinized the rich data of our dermatology centre in Istanbul.

METHODS

Consecutive patients diagnosed with melanoma in a tertiary dermatology clinic during the last 19 years were retrospectively investigated about the clinical presentation of the skin lesions during admission, frequency of subtypes and localization of the tumour.

RESULTS

There were 227 patients with melanoma showing five different clinical presentations: 200 of them had totally 207 primary cutaneous melanoma (PCM) lesions, nine had PCM lesions associated with metastatic skin lesions, three presented with local recurrence, eight with only skin metastases and seven with regressed skin melanoma following systemic melanoma metastases. Histologically, 23.19% of the PCM lesions were intraepidermal (in situ) and Breslow thickness was less than 1 mm in 30.9% of the patients with invasive melanoma. The most common subtype was superficial spreading melanoma (SSM) (37.19%), followed by lentigo malignant melanoma (LMM) (31.4%), acral lentiginous melanoma (ALM) (19.32%) and nodular melanoma (NM) (6.76%). Head and neck region was the most common (34.78%) localization of PCM lesions.

CONCLUSIONS

Different clinical presentations, including various types of cutaneous melanoma metastases, were seen. However, a great proportion of our patients were relatively early diagnosed, either having an in situ or an invasive PCM with a Breslow thickness ≤1 mm. Even though SSM was the most common subtype of PCM in our series, its rate was lower compared to many European countries. Furthermore, the rate of NM subtype was also low, while LMM and ALM rates were higher in comparison to studies originating from European countries. This striking discrepancy requires further studies to explain the probable causes.