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Homer NA, Rieger KE. Melanocytoma of the eyelid: Case report and introduction of new nomenclature. Am J Ophthalmol Case Rep 2024; 34:102059. [PMID: 38690089 PMCID: PMC11059469 DOI: 10.1016/j.ajoc.2024.102059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/17/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
Purpose The term melanocytoma was recently proposed for intermediate-stage melanocytic lesions with specific histopathologic and molecular genetic features. Prior studies have demonstrated a heightened potential for these intermediate lesions to spread to regional lymph nodes, with decreased likelihood for distant spread, when compared to melanomas. Observations Herein we present a case of a 28-year-old male who presented with a recurrent right lower eyelid margin combined cutaneous and palpebral conjunctival pigmented lesion, ultimately classified as a melanocytoma, to highlight this new nomenclature, characteristic histopathologic and genetic findings, and prognostic implications. Conclusions Ophthalmologists should be aware of this new cutaneous histopathologic classification system and apply to the periorbital region to improve melanocytic lesion management and surveillance.
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Affiliation(s)
| | - Kerri E. Rieger
- Departments of Dermatology and Pathology, Stanford University, Palo Alto, CA, USA
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2
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Leblebici C, Mod BN, Cin M, Özcan B. Perineural differentiation in neurotized nevi. Pathol Res Pract 2024; 255:155184. [PMID: 38324967 DOI: 10.1016/j.prp.2024.155184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Perineuriomatous melanocytic nevi are rare and this may indicate the similar embryological source of melanocytes and peripheral nerves in the neural crest. Neurotized melanocytic nevi may resemble nerve sheath tumors histologically, and show schwannian differentiation. However, literature on whether neurotized nevi differentiate into perineural cells is controversial. We examined our cases of neurotized nevi for evidence of perineural differentiation. MATERIALS AND METHODS A total of 100 benign nevi with large neurotized component (microscopically involved a low power field 4.2 mm in diameter) were prospectively evaluated in excisional biopsy samples. Immunohistochemical stainings for EMA, Claudin1, Glut1 and neurofilament were performed. RESULTS Perineural differentiation was immunohistochemically detected in the neurotized component of the nevi in 61% of the cases with EMA and in all the cases with Glut1 and Claudin1. Axonal differentiation was not detected with neurofilament. The expression pattern, especially with Glut1, was usually in form of partial or complete staining surrounding the Meissner's corpuscle-like structure (MCLS). Also, a linear/curvilinear staining pattern was observed particularly with Claudin1. A diffuse staining pattern with EMA, Glut1 and Claudin1 was detected in a case with a microscopically distinct whorl structure, and in which spindle cells are separated from the superficial epithelioid melanocytes with an abrupt transition histologically. These findings of the case are compatible with previous reports of perineuromatous nevus. CONCLUSION Perineural differentiation is not uncommon and immunohistochemically observed in all nevi with a relatively large component of neurotization. To prevent misdiagnosing desmoplastic melanoma and overtreating patients, it is crucial to be aware of perineuromatous nevi.
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Affiliation(s)
- Cem Leblebici
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey.
| | - Beste Noyan Mod
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Merve Cin
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Burcu Özcan
- Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey
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3
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Socorro Castro C, Hernández Delgado S, García Palacios R. [Histopathological interpretation of biopsies for melanocytic tumours in unusual locations]. Rev Esp Patol 2024; 57:48-52. [PMID: 38246710 DOI: 10.1016/j.patol.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/19/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION AND OBJECTIVE Melanoma is the leading cause of death from skin cancer in the world. Despite the advances in molecular diagnosis, the differential diagnosis between melanoma and benign melanocytic tumors relies on histopathology. However, not all of the criteria for the microscopy of a biopsy of a melanocytic tumor are applicable to all locations. PATIENTS We highlight these difficulties in the presentation of 2cases of melanocytic tumors in unusual locations which were diagnostically challenging. RESULTS After analyzing the relevant literature, the atypical histopathological characteristics of melanocytic tumors could be specified for unusual anatomical sites.
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Affiliation(s)
- Caridad Socorro Castro
- Departamento de Anatomía Patológica, Hospital General Universitario Dr. Gustavo Aldereguía Lima, Cienfuegos, Cuba.
| | - Susana Hernández Delgado
- Departamento de Anatomía Patológica, Hospital General Universitario Dr. Gustavo Aldereguía Lima, Cienfuegos, Cuba
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4
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Wakefield C, O'Keefe L, Heffron CCBB. Refining the application of PRAME-a useful marker in high CSD and acral melanoma subtypes. Virchows Arch 2023; 483:847-854. [PMID: 37723345 DOI: 10.1007/s00428-023-03648-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/14/2023] [Accepted: 09/10/2023] [Indexed: 09/20/2023]
Abstract
Pathologic discordance affecting patient management may approach 20% in melanocytic cases following specialist review. The diagnostic utility of PRAME has been highlighted in several studies but interpretative challenges exist including its use in severely dysplastic compound nevi showing progression to melanoma in situ, nevoid melanoma, and coexisting nevi with melanoma. We examine the PRAME status of a broad spectrum of melanocytic lesions including challenging, dysplastic nevi with severe atypia from a large Irish patient cohort. Retrospective review of the dermatopathology database was conducted to evaluate the PRAME staining characteristics of two hundred and twenty-one melanocytic lesions using a commercially available PRAME antibody (EPR20330). The proportion of nuclear labeling and intensity of staining was recorded. The sensitivity and specificity of PRAME for in situ and malignant melanocytic lesions was 77% and 100%, respectively. Virtually all of our melanoma in situ from high-cumulative sun damaged (CSD) skin (22/23) and all acral lentiginous melanoma (5/5) were PRAME positive while 80% (8/10) of our lentigo maligna melanoma showed diffuse expression. None of our benign subgroup showed diffuse immunoexpression (0/82), including thirty-seven moderate or severely dysplastic nevi. In all cases of melanoma in situ arising in association with a dysplastic compound nevus (0/10), no immunoexpression was observed in the nevic component while in five cases of melanoma in situ with coexistent, intradermal nevus immunostaining was confined to the in situ component. A total of 100% (2/2) of desmoplastic melanomas and 50% (4/8) of nodular melanomas were PRAME positive. PRAME is a sensitive and highly specific immunostain in the diagnosis of in situ and invasive melanoma and we emphasize its application in the evaluation of high CSD and acral melanoma subtypes as well as in challenging threshold cases.
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Affiliation(s)
- Craig Wakefield
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland.
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Laura O'Keefe
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
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5
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Gudiu AV, Stoicu-Tivadar L. Challenges in Early Diagnosis of Melanoma Using Tele-Dermatology. Stud Health Technol Inform 2023; 309:53-57. [PMID: 37869805 DOI: 10.3233/shti230738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Numerous classification systems have been developed over the years, systems which not only provide assistance to dermatologists, but also enable individuals, especially those living in areas with low medical access, to get a diagnosis. In this paper, a Machine Learning model, which performs a binary classification, and, which for the remainder of this paper will be abbreviated as ML model, is trained and tested, so as to evaluate its effectiveness in giving the right diagnosis, as well as to point out the limitations of the given method, which include, but are not limited to, the quality of smartphone images, and the lack of FAIR image datasets for model training. The results indicate that there are many measures to be taken and improvements to be made, if such a system were to become a reliable tool in real-life circumstances.
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Montazer F, Heshmati SM, Asgari S, Mollazadehghomi S. Conjunctival Melanoma: A Case Presentation. Iran J Pathol 2023; 18:488-491. [PMID: 38024555 PMCID: PMC10646746 DOI: 10.30699/ijp.2023.557981.2941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/15/2023] [Indexed: 12/01/2023]
Abstract
Conjunctival melanoma is an uncommon tumor that is likely to recur and carries an overall mortality rate of approximately 30%. Melanoma arises from melanocytes, most often in sun-exposed skin. Less commonly, melanoma originates from other tissues such as the uvea, rectum, mouth, respiratory tract, and conjunctiva. Conjunctival melanoma represents only 1.6% of all noncutaneous melanoma. Herein, we reported a case of conjunctival melanoma followed by reviewing the literature to provide an optimal diagnostic approach.
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Affiliation(s)
| | - Seyed Mohammad Heshmati
- Department of Pathology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Campos-Muñoz L, Belmar Madrid C, Conde-Taboada A, Iglesias Puzas A, Gonzalez Guerra E, López-Bran E. Quality of life in children with skin disease: A Spanish sample. An Pediatr (Barc) 2023; 99:170-175. [PMID: 37658021 DOI: 10.1016/j.anpede.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/18/2023] [Indexed: 09/03/2023] Open
Abstract
INTRODUCTION The impact of skin diseases on quality of life varies widely, and some can have an impact similar to that of asthma or cystic fibrosis. MATERIAL AND METHODS We conducted a cross-sectional, observational and descriptive study with the aim of describing the degree to which quality of life was affected in paediatric patients managed in a dermatology clinic by means of the Children's Dermatology Life Quality Index (CDLQI). RESULTS In our study, the skin disease with the greatest impact on quality of life was atopic dermatitis, chiefly on account of symptoms like pruritus and insomnia. It was followed by acne, mainly due to the associated negative feelings (shame, sadness, etc.). Quality of life in patients with viral warts and molluscum contagiosum was mostly affected by the treatment, chiefly based on cryotherapy. Most patients with nevi or café-au-lait spots did not have a decreased quality of life, although up to one third of them had negative feelings in relation to their skin disease. DISCUSSION Atopic dermatitis was the common skin disease that caused the greatest impairment in quality of life in our sample, although other diseases also had an impact on different dimensions of quality of life. We ought to underscore the recommendation to use less painful treatments than cryotherapy for viral warts and molluscum contagiosum, as the impairment in quality of life in paediatric patients with these conditions was mainly due to the treatment.
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8
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Chen J, Zhang G, Liu X, Tu P. The association of BRAF V600E gene mutation with proliferative activity and histopathological characteristics of congenital melanocytic nevi in children. An Bras Dermatol 2023:S0365-0596(23)00062-4. [PMID: 37156689 DOI: 10.1016/j.abd.2022.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND A lot of congenital melanocytic nevi (CMN) carry the somatic mutation in the oncogene BRAF V600E. But the detailed histopathologic characteristics and the proliferative activity of CMN with BRAF V600E gene mutation have not been systematically documented. OBJECTIVE To identify the proliferative activity and histopathological features correlating them with BRAF V600E gene mutation status in CMN. METHODS CMN were retrospectively identified from the laboratory reporting system. Mutations were determined by Sanger sequencing. The CMN were divided into a mutant group and control group according to whether there was BRAF gene mutation and were strictly matched according to gender, age, nevus size, and location. Histopathological analysis, analysis of Ki67 expression by immunohistochemistry and laser confocal fluorescence microscopy were performed. RESULTS The differences in Ki67 index, the depth of nevus cell involvement and the number of nevus cell nests between the mutant group and the control group was statistically significant, with p-values of 0.041, 0.002 and 0.007, respectively. Compared with BRAF V600E negative nevi, BRAF V600E positive nevi often exhibited predominantly nested intraepidermal melanocytes, and larger junctional nests, but the difference in this data sets were not statistically significant. The number of nests (p = 0.001) was positively correlated with the proportion of Ki67 positive cells. STUDY LIMITATIONS A small sample of patients were included and there was no follow-up. CONCLUSIONS BRAF V600E gene mutations were associated with high proliferative activity and distinct histopathological features in congenital melanocytic nevi.
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Affiliation(s)
- Jianyou Chen
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China; Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Gaolei Zhang
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Xiaoyan Liu
- Department of Dermatology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Ping Tu
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China.
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9
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Kim JW, Shin JW, Huh CH. Primary Cutaneous Apocrine Carcinoma and Syringocystadenoma Papilliferum Arising in Nevus Sebaceus: A Case Report and Review of the Literature. Ann Dermatol 2023; 35:S4-S9. [PMID: 37853855 PMCID: PMC10608364 DOI: 10.5021/ad.21.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/11/2021] [Accepted: 04/15/2021] [Indexed: 10/20/2023] Open
Abstract
Nevus sebaceus is a hamartomatous lesion characterized by epidermal, follicular, sebaceus, and apocrine gland abnormalities. Approximately 25% of affected individuals may develop benign or malignant secondary neoplasms within the preceding nevus sebaceus. Primary cutaneous apocrine carcinoma (PCAC) is a rare malignant skin tumor affecting elderly adults in their sixth decade of life. Histologically, PCAC appears as a dermal tumor displaying apocrine differentiation with decapitation secretion and malignant features. Secondary malignancy arising from nevus sebaceus is a rare complication, especially for apocrine carcinoma. To date, approximately 200 cases of PCAC have been reported in the literature, and only a few cases have developed PCAC on the scalp. Very few cases (approximately only 12) of PCACs developing in nevus sebaceus have been reported. Here, we report an extremely rare case of the coexistence of PCAC and syringocystadenoma papilliferum arising within nevus sebaceus of the scalp.
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Affiliation(s)
- Jee Woo Kim
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Won Shin
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hun Huh
- Department of Dermatology, Seoul National University Bundang Hospital, Seongnam, Korea.
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10
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Gupta A, Daigavane S. A rare case of conjunctival nevi involving the cornea. Pan Afr Med J 2023; 44:167. [PMID: 37455881 PMCID: PMC10349616 DOI: 10.11604/pamj.2023.44.167.39067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/25/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Ankit Gupta
- Department of Ophthalmology, Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (M), Wardha, India
| | - Sachin Daigavane
- Department of Ophthalmology, Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Datta Meghe Institute of Higher Education and Research, Sawangi (M), Wardha, India
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11
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Soares K, Assmann T, Kremer A, Mang R. [Self-administration of a "mole removal pen"]. Dermatologie (Heidelb) 2023; 74:191-4. [PMID: 36282290 DOI: 10.1007/s00105-022-05067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
A 31-year-old woman used a "mole removal pen" purchased from the internet for cosmetic reasons to remove numerous pigmentary moles. After self-application there was multiple scarring. Sequential videodermatoscopic documentation was performed. The purchase of medical-cosmetic products, their use, and the possible risks are discussed.
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12
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Varde MA, Heindl LM, Kakkassery V. [Diagnosis and treatment of benign eyelid tumors]. Ophthalmologie 2023; 120:240-251. [PMID: 36763162 DOI: 10.1007/s00347-022-01798-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Benign tumors of the eyelids are frequent entities. They are often cause for cosmetic concern or can lead to irritation of the ocular surface. The differentiation from premalignant or malignant eyelid tumors is particularly important. In most cases this can be done clinically; however, in some cases histological evaluation is warranted. OBJECTIVE The aim of this article is to characterize the most important benign tumors of the eyelid and to ascertain when a histological examination is necessary. Furthermore, fundamental treatment procedures are discussed. METHODS This narrative review was prepared based on a selective literature search. The characteristics of some eyelid tumors are underlined with illustrations from clinical cases. RESULTS Most benign eyelid tumors are treated because of cosmetic or functional concerns. Some of them, including actinic keratosis, keratoacanthoma, cutaneous horn, trichofolliculoma, resemble malignant lid tumors or precancerous lesions and are thus excised in oder to obtain a diagnosis. Dermoid cysts can cause complications and congenital melanocytic naevi can exhibit malignant transformation and may need treatment. Inflammatory tumors can be treated conservatively in most cases but might require surgery in certain cases. Systemic associations exist with some of the benign lid tumors and should not be overlooked as they can be crucial for overall patient morbidity. CONCLUSION Benign tumors of the eyelids are frequent and can be found at any age depending on the diagnosis. This article describes the lesions most commonly encountered in the clinical routine and helps at making a plan for further management.
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Affiliation(s)
- M A Varde
- Augenklinik, Kantonsspital St. Gallen, Rohrschacherstr. 95, 9007, St. Gallen, Schweiz. .,Augenklinik, Universitätsspital Zürich, Zürich, Schweiz.
| | - L M Heindl
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universitätsklinikum Köln, Universität zu Köln, Köln, Deutschland.,Centrum für Integrierte Onkologie (CIO) Aachen-Bonn-Köln-Düsseldorf, Köln, Deutschland
| | - V Kakkassery
- Klinik für Augenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
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Algarra-Sahuquillo J, Ramos-Rodríguez D, Santos-e-Silva Caldeira-Marques ML, Mercader-Salvans J, Rodríguez-Rodríguez RN, Hernández-León CN, Guimerá Martin-Neda F. Short Brown Parallel Lines on the Proximal Nail Fold. Clinical-Dermoscopic-Histologic Correlation of a Melanocytic Nevus of the Eponychium. Skin Appendage Disord 2023; 9:147-150. [PMID: 36937164 PMCID: PMC10015647 DOI: 10.1159/000528884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/24/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Although Hutchinson's sign can appear associated with benign conditions, dermoscopic findings of non-melanoma eponychium pigmentation have not yet been described in the literature. We report for the first time to our knowledge the dermoscopic findings of an acral nevus located in the proximal nail fold as well as its clinical-dermoscopic-histologic correlation. Case Report A twenty-year-old patient presented with a homogeneous longitudinal melanonychia on the left-hand thumb, with benign dermoscopic pattern, and an irregular, 6-mm, dark-brown hyperpigmented macule on the adjacent eponychium (Hutchinson's sign). The eponychium lesion showed on dermoscopy two irregular brown-black pigmented blotches, with superimposed parallel brown lines on a brushy distribution, with a thicker terminal end. The histopathologic examination of the proximal nail fold was performed, revealing scattered nevus cells in the epidermal basal layer and dermal-epidermal junction thecae, without any atypia or mitosis. These features were consistent with nevus of the proximal nail fold. Discussion Previous descriptions of benign hyponychium's pigmentations, despite the malignant appearance of the overlying melanonychia, were reported to have a similar dermoscopic pattern, known as longitudinal brushy pigmentation. This newly described dermoscopic sign on the eponychium may help distinguish Hutchinson's sign related to subungual melanoma to non-melanoma Hutchinson's sign.
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14
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Han HS, Hong JK, Yoo KH, Seo SJ. Combination of Non-Ablative Fractional Laser with Q-Switched Laser for the Treatment of Becker's Nevus: Efficacy and Limitations. Ann Dermatol 2023; 35:56-60. [PMID: 36750459 PMCID: PMC9905864 DOI: 10.5021/ad.20.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/18/2020] [Accepted: 12/19/2020] [Indexed: 01/31/2023] Open
Abstract
Becker's nevus (BN) is a benign hamartoma that may present as a distressing cosmetic problem. The treatment of BN poses a significant challenge as current therapeutic modalities are suboptimal and have an increased risk of adverse effects, such as scarring and dyspigmentation. We present the use of non-ablative fractional laser therapy combined with Q-switched Nd:YAG laser as a possible therapeutic option for BN treatment and review relevant literature to discuss its efficacy and limitations.
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Affiliation(s)
- Hye Sung Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jun Ki Hong
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kwang Ho Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, Korea.
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15
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Qazi SS, Shah SMI, Baqai MWS, Enam SA. Primary leptomeningeal melanoma in association with neurocutaneous melanosis: A case report. Surg Neurol Int 2022; 13:547. [PMID: 36600756 PMCID: PMC9805607 DOI: 10.25259/sni_856_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Primary melanocytic tumors of the central nervous system accounts for approximately 1% of all melanoma with a peak incidence in the fourth decade. The tumor originates from leptomeningeal melanocytes with a variable degree of belligerence. The proliferation of these melanocytes in large amounts in the dermis and nervous system can raise suspicion of neurocutaneous melanosis (NCM), which is an association between malignant melanoma and the presence of a giant intradermal nevus. Case Description We present a case of a 62-year-old South Asian male with a large congenital melanocytic nevus (>20 cm in size) in the left hemifacial, and head region who presented with complaints of a single episode of grand-mal seizure followed by neuropsychiatric symptoms. The patient was thoroughly evaluated both clinically and surgically leading to a rare diagnosis of primary leptomeningeal melanoma of the left temporal lobe. The patient subsequently underwent a neuronavigation guided left temporal craniotomy with gross total resection of the lesion. Conclusion Primary leptomeningeal melanoma with a clinical association with NCM is rarely ever reported within the literature. To date, our case is one of the very few instances where such an association is being reported in this age group along with rare neuropsychiatric symptoms.
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Affiliation(s)
- Saba Saleem Qazi
- Department of Neurosurgery, Ziauddin Medical University, Karachi, Pakistan
| | | | - Muhammad Waqas Saeed Baqai
- Department of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan.,Corresponding author: Muhammad Waqas Saeed Baqai, Department of Neurosurgery, The Aga Khan University Hospital, Karachi, Pakistan.
| | - Syed Ather Enam
- Department of Neurosurgery, Aga Khan University, Karachi, Pakistan
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16
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Heppt MV, Heinzerling L. [Pigmented lesions of the mucosa]. Dermatologie (Heidelb) 2022; 73:682-691. [PMID: 35997969 DOI: 10.1007/s00105-022-05039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pigmented lesions of the mucosa are a common reason to consult a dermatologist. They have heterogeneous etiologies and comprise a wide range of differential diagnoses. Both practitioners and patients are often uncertain about the malignancy of the lesions. MATERIALS AND METHODS Review and demonstration of the most common pigmentation disorders of the mucous membranes, including discussion of clinical findings and underlying causes. RESULTS Pigmented mucosal lesions can be classified as either focal or multifocal-diffuse. Focal hyperpigmentation encompasses melanotic macules, nevi, deposition of exogenous materials or pigments, and oral melanoacanthoma. They are mostly benign but must be discerned from mucosal melanoma with an aggressive course and poor prognosis. Multifocal or diffuse hyperpigmentation may be drug-induced or indicative of an underlying medical condition. Importantly, as part of hereditary syndromes further diagnostic work-up is required. CONCLUSION Specific knowledge of the distribution and causes of pigmented mucosal lesions helps in clinical assessment between benign findings and those requiring further work-up and histologic clarification.
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Affiliation(s)
- Markus V Heppt
- Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Deutschland.,Comprehensive Cancer Center Erlangen, Europäische Metropolregion Nürnberg, Erlangen, Deutschland
| | - Lucie Heinzerling
- Hautklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, Deutschland. .,Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Frauenlobstr. 9-11, 80337, München, Deutschland.
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17
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Maron RC, Hekler A, Haggenmüller S, von Kalle C, Utikal JS, Müller V, Gaiser M, Meier F, Hobelsberger S, Gellrich FF, Sergon M, Hauschild A, French LE, Heinzerling L, Schlager JG, Ghoreschi K, Schlaak M, Hilke FJ, Poch G, Korsing S, Berking C, Heppt MV, Erdmann M, Haferkamp S, Schadendorf D, Sondermann W, Goebeler M, Schilling B, Kather JN, Fröhling S, Lipka DB, Krieghoff-Henning E, Brinker TJ. Model soups improve performance of dermoscopic skin cancer classifiers. Eur J Cancer 2022; 173:307-316. [PMID: 35973360 DOI: 10.1016/j.ejca.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/04/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Image-based cancer classifiers suffer from a variety of problems which negatively affect their performance. For example, variation in image brightness or different cameras can already suffice to diminish performance. Ensemble solutions, where multiple model predictions are combined into one, can improve these problems. However, ensembles are computationally intensive and less transparent to practitioners than single model solutions. Constructing model soups, by averaging the weights of multiple models into a single model, could circumvent these limitations while still improving performance. OBJECTIVE To investigate the performance of model soups for a dermoscopic melanoma-nevus skin cancer classification task with respect to (1) generalisation to images from other clinics, (2) robustness against small image changes and (3) calibration such that the confidences correspond closely to the actual predictive uncertainties. METHODS We construct model soups by fine-tuning pre-trained models on seven different image resolutions and subsequently averaging their weights. Performance is evaluated on a multi-source dataset including holdout and external components. RESULTS We find that model soups improve generalisation and calibration on the external component while maintaining performance on the holdout component. For robustness, we observe performance improvements for pertubated test images, while the performance on corrupted test images remains on par. CONCLUSIONS Overall, souping for skin cancer classifiers has a positive effect on generalisation, robustness and calibration. It is easy for practitioners to implement and by combining multiple models into a single model, complexity is reduced. This could be an important factor in achieving clinical applicability, as less complexity generally means more transparency.
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Affiliation(s)
- Roman C Maron
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sarah Haggenmüller
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christof von Kalle
- Department of Clinical-Translational Sciences, Charité University Medicine and Berlin Institute of Health (BIH), Berlin, Germany
| | - Jochen S Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Verena Müller
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Maria Gaiser
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
| | - Friedegund Meier
- Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases Dresden, Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Sarah Hobelsberger
- Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases Dresden, Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Frank F Gellrich
- Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases Dresden, Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Mildred Sergon
- Skin Cancer Center at the University Cancer Center and National Center for Tumor Diseases Dresden, Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany; Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Lucie Heinzerling
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Justin G Schlager
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Max Schlaak
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Franz J Hilke
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gabriela Poch
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sören Korsing
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg, CCC Alliance WERA, Erlangen, Germany
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg, CCC Alliance WERA, Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, University Hospital Erlangen, Comprehensive Cancer Center Erlangen - European Metropolitan Region Nürnberg, CCC Alliance WERA, Erlangen, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Jakob N Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel B Lipka
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Krieghoff-Henning
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany.
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18
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Xavier-Junior JCC, Ocanha-Xavier JP. Dysplastic melanocytic nevus: Are molecular findings the key to the diagnosis? Ann Diagn Pathol 2022; 60:152006. [PMID: 35839551 DOI: 10.1016/j.anndiagpath.2022.152006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/13/2022]
Abstract
The primary differential diagnosis of melanoma is dysplastic nevus. Until now, the final diagnosis is based on histological findings. With modern techniques, pathologists receive very early melanocytic lesions, which do not fit all malignant criteria. In those cases, even the concurrence between specialists and intraobserver agreement is not good. A molecular test could be developed to improve the accuracy of melanocytic lesions diagnosis and help in challenging lesions. The objective of this study is to provide a literary review looking for molecular markers that characterize dysplastic nevi and could help surgical pathologists differentiate them from melanoma. Articles from PubMed presenting case series of dysplastic nevi and melanoma genomic analyses were considered. The search was conducted in PubMed looking for papers written in English, published in the ten years preceding April 2020. This review confirmed the absence of a pathognomonic molecular marker of dysplastic nevi. This is a heterogeneous group of lesions with an uncertain risk to become a melanoma. The molecular heterogeneity of dysplastic nevi, the variation of histological diagnostic criteria among services, and the diverse molecular techniques applied are challenging features that might hamper definitive diagnoses. However, currently, there appears to be limited value for molecular testing in the diagnosis of dysplastic nevi.
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Affiliation(s)
- José Cândido Caldeira Xavier-Junior
- Pathology Institute of Araçatuba, Araçatuba, SP, Brazil; School of Medicine, Centro Universitário Católico Salesiano Auxilium (Unisalesiano), Araçatuba, SP, Brazil; School of Medicine, Paulista State University, Botucatu, SP, Brazil.
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19
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Chandra SR, Singu S, Foster J. Principles of Surgery in Head and Neck Cutaneous Melanoma. Oral Maxillofac Surg Clin North Am 2022; 34:251-262. [PMID: 35428503 DOI: 10.1016/j.coms.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Surgical management of head and neck melanoma starts from the primary biopsy of the cutaneous site by a narrow excision with a 1 to 3 mm margins. The margin should include the whole breadth and sufficient depth of the lesion. The key is not to transect the lesion. With the advent of molecular testing, gene expression profiling, and immunotherapies, the surgical management of advanced melanoma has changed. Sentinel lymph node biopsy is an essential armamentarium for T2a and higher staging/greater than 1 mm thick and advance stage disease. Molecular pathogenesis and cancer immunology are recognized in the recent treatment protocols along with surgery in advanced stages of melanoma.
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Affiliation(s)
- Srinivasa Rama Chandra
- Oral and Maxillofacial Surgery, Oregon Health & Sciences University, 3181 SW Sam Jackson Park, Portland, OR 97239, USA.
| | - Sravani Singu
- University of Nebaraska Medical Center, College of Medicine, Omaha, NE 68198, USA
| | - Jason Foster
- Division of Surgical Oncology, University of Nebraska Medical Center, 986345 Nebraska Medical Center, Omaha, NE 68198-6345, USA
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20
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Zabor EC, Raval V, Luo S, Pelayes DE, Singh AD. A Prediction Model to Discriminate Small Choroidal Melanoma from Choroidal Nevus. Ocul Oncol Pathol 2022; 8:71-78. [PMID: 35356604 PMCID: PMC8914269 DOI: 10.1159/000521541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/16/2021] [Indexed: 02/03/2023] Open
Abstract
Objective This study aimed to develop a validated machine learning model to diagnose small choroidal melanoma. Design This is a cohort study. Subjects Participants and/or Controls The training data included 123 patients diagnosed as small choroidal melanocytic tumor (5.0-16.0 mm in largest basal diameter and 1.0 mm-2.5 mm in height; Collaborative Ocular Melanoma Study criteria). Those diagnosed as melanoma (n = 61) had either documented growth or pathologic confirmation. Sixty-two patients with stable lesions classified as choroidal nevus were used as negative controls. The external validation dataset included 240 patients managed at a different tertiary clinic, also with small choroidal melanocytic tumor, observed for malignant growth. Methods In the training data, lasso logistic regression was used to select variables for inclusion in the final model for the association with melanoma versus choroidal nevus. Internal and external validation was performed to assess model performance. Main Outcome Measures The main outcome measure is the predicted probability of small choroidal melanoma. Results Distance to optic disc ≥3 mm and drusen were associated with decreased odds of melanoma, whereas male versus female sex, increased height, subretinal fluid, and orange pigment were associated with increased odds of choroidal melanoma. The area under the receiver operating characteristic "discrimination value" for this model was 0.880. The top four variables that were most frequently selected for inclusion in the model on internal validation, implying their importance as predictors of melanoma, were subretinal fluid, height, distance to optic disc, and orange pigment. When tested against the validation data, the prediction model could distinguish between choroidal nevus and melanoma with a high discrimination of 0.861. The final prediction model was converted into an online calculator to generate predicted probability of melanoma. Conclusions To minimize diagnostic uncertainty, a machine learning-based diagnostic prediction calculator can be readily applied for decision-making and counseling patients with small choroidal melanoma.
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Affiliation(s)
- Emily C. Zabor
- Taussig Cancer Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vishal Raval
- Cole Eye Institute, Ophthalmic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shiming Luo
- Cole Eye Institute, Ophthalmic Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - David E. Pelayes
- Department of Ophthalmology, Buenos Aires University and Maimonides University, Buenos Aires, Argentina
| | - Arun D. Singh
- Cole Eye Institute, Ophthalmic Oncology, Cleveland Clinic, Cleveland, Ohio, USA,*Arun D. Singh,
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21
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Hu J, Cai X, Lv JJ, Wan XC, Zeng XY, Feng ML, Dai B, Kong YY. Preferentially expressed antigen in melanoma immunohistochemistry as an adjunct for differential diagnosis in acral lentiginous melanoma and acral nevi. Hum Pathol 2022; 120:9-17. [PMID: 34800527 DOI: 10.1016/j.humpath.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/30/2021] [Accepted: 11/03/2021] [Indexed: 12/12/2022]
Abstract
Preferentially expressed antigen in melanoma (PRAME) has shown promising utility in distinguishing benign melanocytic lesions from melanomas, but knowledge of its expression pattern in acral lentiginous melanoma (ALM) and acral nevi (ANs) is limited. Immunohistochemical expression of PRAME was examined in 75 ALMs and 34 ANs. The clinical and histopathologic characteristics of patients with ALM were collected. PRAME was immunoreactive in 89.3% (67/75) of ALMs, but entirely negative in 94.1% (32/34) of ANs. When staining at least 50% of lesional melanocytes was determined as positivity, the sensitivity and specificity of PRAME for distinguishing ALM from ANs were 69.3% and 100%, respectively. Seventy-one cases of ALMs had tumor cells in the epidermis; 71.8% (51/71) of them showed positive for PRAME. By contrast, 61 ALMs had tumor cells in the dermis; 65.6% (40/61) exhibited positive expression. Twenty-nine of 39 (74.4%) epithelioid cell ALMs were observed to be positive for PRAME. By comparison, 63.8% (23/36) of ALMs with spindle tumor cells were positive for PRAME. However, PRAME positive expression was not associated with any clinical and histopathologic characteristics of patients with ALM, including Breslow thickness, ulcer, cytomorphology, lymph node metastasis, or tumor-infiltrated lymphocytes (TILs). Nevertheless, we observed that 82.6% (19/23) of ALMs with lymph node involvement at diagnosis expressed PRAME, compared with 57.6% (20/35) of those without. In summary, PRAME immunohistochemistry can serve as a helpful adjunct in the differential diagnosis of ALMs and ANs with good sensitivity and high specificity. Additionally, PRAME tends to have a higher positive rate in epidermal melanocytes than in the dermis and is inclined to express in epithelioid cells than in spindle cells of ALMs.
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Affiliation(s)
- Jue Hu
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xu Cai
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jiao-Jie Lv
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xiao-Chun Wan
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Xue-Ying Zeng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Ming-Li Feng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China
| | - Bo Dai
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China; Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China.
| | - Yun-Yi Kong
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, People's Republic of China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
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22
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Saleem A, Narala S, Raghavan SS. Immunohistochemistry in melanocytic lesions: Updates with a practical review for pathologists. Semin Diagn Pathol 2022; 39:239-247. [PMID: 35016807 DOI: 10.1053/j.semdp.2021.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023]
Abstract
This review provides a summary of the immunohistochemical markers pertinent to the diagnosis of melanocytic lesions. There is considerable morphologic overlap between benign and malignant melanocytic lesions, and given the significant differences in clinical management, the diagnostic workup becomes crucial. Immunohistochemistry aids in the distinction between various melanocytic proliferations and recent contributions to the literature have furthered our optimization of panels in the diagnostic workup. In recent years, SOX10 has been considered as the optimal marker for melanocytic lesions given the similar sensitivity but higher specificity than S100. HMB-45 is less sensitive than S100 but demonstrates utility in confirmation of deceptively banal small cell and nevoid melanoma variants where deep nests of melanocytes are highlighted. Melan-A (MART-1) and MiTF show similar sensitivity to S100 however there is a lack of expression in spindle cell and desmoplastic melanomas.
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Affiliation(s)
- Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Saisindhu Narala
- Department of Pathology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Shyam S Raghavan
- Department of Pathology, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA 22903, USA.
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23
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Prieto Herman Reinehr C, Marchiori Bakos R. Dermoscopic Nevus Patterns Associated with Melanoma Patients. Dermatology 2021; 238:670-676. [PMID: 34903683 DOI: 10.1159/000520164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/10/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The quantitative and qualitative presence of melanocytic nevi is considered a significant risk factor for melanoma. Little is known whether patients showing any of the recognized global dermoscopic nevus patterns might also be considered at increased risk for the disease. OBJECTIVES We aimed to investigate the frequency of global dermoscopic patterns of common nevi among melanoma patients and compare them to controls, as well as the dermoscopic patterns of atypical nevi between the groups. METHODS We included consecutive melanoma patients and age- and sex-matched controls who presented to our Department with at least 10 melanocytic nevi. Total body examination was performed, and all nevi had their dermoscopic pattern described. Global dermoscopic patterns of nevi were compared between groups, as well as atypical nevus patterns. Finally, nevus patterns were stratified by their location and also compared between groups. RESULTS We included 120 melanoma patients and 120 controls. Melanoma patients presented a larger number of common (p = 0.002) and atypical melanocytic nevi (p < 0.001) and more variability of dermoscopic nevus patterns (p < 0.001). No difference in the global dermatoscopic pattern of common nevi was observed between groups. The complex pattern of atypical nevi was associated with melanoma (OR = 2.87). Melanoma patients also showed more common nevi with a reticular pattern on the back (p = 0.014) and lower limbs (p = 0.041) as well as atypical nevi on the back with reticular pattern (p = 0.01), with reticular-homogeneous pattern (p = 0.001), and with reticular-globular pattern (p = 0.048) than controls. Nevi with multifocal pigmentation were also more frequent among melanoma patients (OR = 2.61). CONCLUSION Melanoma patients tend to present a higher number of common reticular nevi on the back and lower limbs, as well as atypical nevi with a complex pattern, especially reticular, reticular-homogeneous, and reticular-globular on the back.
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Affiliation(s)
| | - Renato Marchiori Bakos
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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24
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Winkler JK, Tschandl P, Toberer F, Sies K, Fink C, Enk A, Kittler H, Haenssle HA. Monitoring patients at risk for melanoma: May convolutional neural networks replace the strategy of sequential digital dermoscopy? Eur J Cancer 2021; 160:180-188. [PMID: 34840028 DOI: 10.1016/j.ejca.2021.10.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/06/2021] [Accepted: 10/25/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Sequential digital dermoscopy (SDD) is applied for early melanoma detection by uncovering dynamic changes of monitored lesions. Convolutional neural networks (CNN) are capable of high diagnostic accuracies similar to trained dermatologists. OBJECTIVES To investigate the capability of CNN to correctly classify melanomas originally diagnosed by mere dynamic changes during SDD. METHODS A retrospective cross-sectional study using image quartets of 59 high-risk patients each containing one melanoma diagnosed by dynamic changes during SDD and three nevi (236 lesions). Two validated CNN classified quartets at baseline or after SDD follow-up at the time of melanoma diagnosis. Moreover, baseline quartets were rated by 26 dermatologists. The main outcome was the number of quartets with correct classifications. RESULTS CNN-1 correctly classified 9 (15.3%) and CNN-2 8 (13.6%) of 59 baseline quartets. In baseline images, CNN-1 attained a sensitivity of 25.4% (16.1%-37.8%) and specificity of 92.7% (87.8%-95.7%), whereas CNN-2 of 28.8% (18.8%-41.4%) and 75.7% (68.9%-81.4%). Expectedly, after SDD follow-up CNN more readily detected melanomas resulting in improved sensitivities (CNN-1: 44.1% [32.2%-56.7%]; CNN-2: 49.2% [36.8%-61.6%]). Dermatologists were told that each baseline quartet contained one melanoma, and on average, correctly classified 24 (22-27) of 59 quartets. Correspondingly, accepting a baseline quartet to be appropriately classified whenever the highest malignancy score was assigned to the melanoma within, CNN-1 and CNN-2 correctly classified 28 (47.5%) and 22 (37.3%) of 59 quartets, respectively. CONCLUSIONS The tested CNN could not replace the strategy of SDD. There is a need for CNN capable of integrating information on dynamic changes into analyses.
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Affiliation(s)
- Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Philipp Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Katharina Sies
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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25
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Lohman ME, McCalmont TH, Cordoro KM. An Evidence-Based Approach to Pediatric Melanonychia. Dermatol Clin 2022; 40:37-49. [PMID: 34799034 DOI: 10.1016/j.det.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Melanonychia including melanonychia striata in children poses a diagnostic dilemma. Atypical clinical features often raise the possibility of malignancy, and a nail unit biopsy may be recommended. Commensurate with atypical clinical features, the histopathology may also appear alarming. However, accumulating data illustrate that most cases of melanonychia striata are benign and suggest that an alternate approach is often warranted for pediatric patients. Herein, we review the existing data regarding pediatric melanonychia striata and offer an evidence-based approach to its evaluation and management.
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26
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Clemens AC, Loeffler KU, Holz FG, Herwig-Carl MC. Clinico-pathological correlation of lacrimal caruncle tumors: a retrospective analysis over 22 years at the University Eye Hospital Bonn. Graefes Arch Clin Exp Ophthalmol 2021. [PMID: 34709452 DOI: 10.1007/s00417-021-05464-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/28/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Purpose The lacrimal caruncle is composed of numerous structures including different glands as well as hair follicles. Accordingly, the spectrum of benign and malignant lesions is broad, and the clinical diagnosis is often challenging. Here we systematically analyzed excised caruncular tumors over the past 22 years with special emphasis on the clinico-pathological correlation to provide a guidance for clinicians. Methods Retrospective evaluation with clinico-pathologic correlation of surgically removed caruncular tumors between 1998 and 2020 at a tertiary referral center. Results Eighty-two caruncular tumors were identified in the respective period. The patients were between 11 and 85 years of age (mean, 46.8 years; median, 49 years). Nevi (n = 35), cystic lesions (n = 14), oncocytoma (n = 9), papilloma (n = 8), sebaceous gland hyperplasia (n = 8), and reactive lymphoid hyperplasia (n = 4) were observed most frequently. Besides, we are the first reporting herniated orbital fat accompanied by a pyogenic granuloma. 2.4% (n = 2) were malignant tumors (sebaceous gland carcinoma, conjunctival intraepithelial neoplasia with pyogenic granuloma). Conclusion Caruncular tumors show a broad spectrum of mostly benign tumors. They can occur in patients of any age. However, 8/9 oncocytomas and both malignant lesions were detected in patients older than 60 years. Although the clinical diagnosis was confirmed in only 68.3% by the histopathological analysis, the two malignant lesions were identified as such already clinically. Caruncular lesions with a history of growth or other signs of malignancy should be excised followed by detailed histopathological examination to allow a final diagnosis and exclude rare malignant tumors with lethal potential. ![]() Supplementary Information The online version contains supplementary material available at 10.1007/s00417-021-05464-x.
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de Albuquerque ML, Correa Z, Messias A, Jorge R. Decreased Retinal Sensitivity Overlying Choroidal Nevi. Ocul Oncol Pathol 2021; 7:287-293. [PMID: 34604202 DOI: 10.1159/000515561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/28/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To report retinal function findings on the choroidal nevus. Methods Prospective descriptive case series of 7 patients (n = 7 eyes) presenting a melanocytic choroidal lesion consistent with choroidal nevus and no other ocular disease. Baseline evaluation included measurement of best-corrected visual acuity (BCVA), color and near-infrared fundus pictures, and spectral-domain OCT (Heidelberg Engineering). Retinal function was tested with microperimetry (MAIA; CenterVUE, Padova) using a standard grid (µP1) and a linear grid (µP2) that distribute test points on retinal areas that overlaid the choroidal lesion as well as lesion-free areas equidistantly to the fovea in 3 parallel lines. mfERG was performed following the International Society for Clinical Electrophysiology of Vision (ISCEV) recommendation using a 61-hexyagon protocol. Results BCVA was 20/25 (0.1 logMAR) or better in all 7 eyes. Microperimetry showed central stable fixation on all eyes, with mean ± SE sensitivity threshold significantly decreased on retinal areas overlaying the lesions (µP1): 21.8 ± 0.6 dB versus 25.2 ± 0.9 dB on nonaffected retinal areas (p < 0.001). Sensitivity was also decreased on µP2: 23.7 ± 0.2 dB for areas overlying the nevi and 25.7 ± 0.3 dB for the nonaffected retina (p < 0.001). mfERG responses showed no focal amplitude or implicit-time changes on the retina in the topographical region corresponding to the nevus for all patients. Conclusion Our results indicate that choroidal nevi may cause significant retinal sensitivity impairment, as shown by microperimetry, but preserved mfERG response indicates that the retinal function may be only partially impaired.
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Affiliation(s)
- Marina L de Albuquerque
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Zelia Correa
- Bascom Palmer Eye Institute, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - André Messias
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rodrigo Jorge
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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Lozano-Masdemont B, Pérez-Tato B, Zamora-Martínez E, Rodríguez-Lomba E. Regressing eruptive disseminated pigmented Spitz (Reed) nevi in a young adult. An Bras Dermatol 2021; 96:768-770. [PMID: 34579962 PMCID: PMC8790198 DOI: 10.1016/j.abd.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022] Open
Abstract
Eruptive disseminated Spitz nevi is a rare clinical presentation that features an abrupt widespread eruption of Spitz nevi. Spontaneous regression of these nevi has been rarely reported in previous literature. The authors of the present study report the case of a 30-year-old man who presented eruptive disseminated Spitz nevi that appeared within a week and started regression in the following years.
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Affiliation(s)
| | - Berta Pérez-Tato
- Department of Dermatology, Hospital Universitario de Móstoles, Madrid, Spain
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Komulainen J, Siiskonen H, Harvima IT. Association of Elevated Serum Tryptase with Cutaneous Photodamage and Skin Cancers. Int Arch Allergy Immunol 2021; 182:1135-1142. [PMID: 34455412 DOI: 10.1159/000517287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mast cells and their major protein, the serine proteinase tryptase, can be involved in cutaneous photodamage and carcinogenesis. The serum test of tryptase (S-tryptase) measures total tryptase protein (active tryptase and inactive protryptases), and S-tryptase is elevated in a variety of diseases, for example, in mastocytosis and α-tryptasemia. OBJECTIVES The objective of this study is to study whether S-tryptase is a marker of cutaneous photodamage and carcinogenesis. METHODS Adult subjects (n = 399, aged 21-79) evaluated to be at risk for skin cancers were recruited at the dermatological policlinic and examined for photodamage severity, mole count, actinic keratoses (AKs), skin cancers, and immunosuppression (IS). A blood sample was analyzed for S-tryptase using the ImmunoCAP® Tryptase fluoroenzymeimmunoassay. RESULTS There was no difference in S-tryptase between non-IS (n = 321) and IS (n = 78) subjects or between genders. S-tryptase correlated slightly to photodamage and AKs in 321 non-IS subjects, and this association can be related, in part, to the age of subjects. In 34 subjects, S-tryptase was elevated (≥13.5 ng/mL), and in 20 males, but not in 14 females, the photodamage level was significantly (p = 0.031) more severe than in 179 males with normal S-tryptase. In contrast, there were more frequently subjects (n = 12) with past or present skin cancer (basal or squamous cell carcinoma or melanoma) in 14 females with elevated S-tryptase than in 186 female controls. So far, no explanation has been found for the elevated S-tryptase. CONCLUSION There are significant associations between elevated S-tryptase and skin carcinogenesis, but the molecular mechanisms are unclear and gender differences can exist.
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Affiliation(s)
- Jenni Komulainen
- Department of Dermatology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Hanna Siiskonen
- Department of Dermatology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Ilkka T Harvima
- Department of Dermatology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
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Maron RC, Schlager JG, Haggenmüller S, von Kalle C, Utikal JS, Meier F, Gellrich FF, Hobelsberger S, Hauschild A, French L, Heinzerling L, Schlaak M, Ghoreschi K, Hilke FJ, Poch G, Heppt MV, Berking C, Haferkamp S, Sondermann W, Schadendorf D, Schilling B, Goebeler M, Krieghoff-Henning E, Hekler A, Fröhling S, Lipka DB, Kather JN, Brinker TJ. A benchmark for neural network robustness in skin cancer classification. Eur J Cancer 2021; 155:191-9. [PMID: 34388516 DOI: 10.1016/j.ejca.2021.06.047] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND One prominent application for deep learning-based classifiers is skin cancer classification on dermoscopic images. However, classifier evaluation is often limited to holdout data which can mask common shortcomings such as susceptibility to confounding factors. To increase clinical applicability, it is necessary to thoroughly evaluate such classifiers on out-of-distribution (OOD) data. OBJECTIVE The objective of the study was to establish a dermoscopic skin cancer benchmark in which classifier robustness to OOD data can be measured. METHODS Using a proprietary dermoscopic image database and a set of image transformations, we create an OOD robustness benchmark and evaluate the robustness of four different convolutional neural network (CNN) architectures on it. RESULTS The benchmark contains three data sets-Skin Archive Munich (SAM), SAM-corrupted (SAM-C) and SAM-perturbed (SAM-P)-and is publicly available for download. To maintain the benchmark's OOD status, ground truth labels are not provided and test results should be sent to us for assessment. The SAM data set contains 319 unmodified and biopsy-verified dermoscopic melanoma (n = 194) and nevus (n = 125) images. SAM-C and SAM-P contain images from SAM which were artificially modified to test a classifier against low-quality inputs and to measure its prediction stability over small image changes, respectively. All four CNNs showed susceptibility to corruptions and perturbations. CONCLUSIONS This benchmark provides three data sets which allow for OOD testing of binary skin cancer classifiers. Our classifier performance confirms the shortcomings of CNNs and provides a frame of reference. Altogether, this benchmark should facilitate a more thorough evaluation process and thereby enable the development of more robust skin cancer classifiers.
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Ba W, Wang R, Yin G, Song Z, Zou J, Zhong C, Yang J, Yu G, Yang H, Zhang L, Li C. Diagnostic assessment of deep learning for melanocytic lesions using whole-slide pathological images. Transl Oncol 2021; 14:101161. [PMID: 34192650 PMCID: PMC8254118 DOI: 10.1016/j.tranon.2021.101161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/25/2021] [Accepted: 06/20/2021] [Indexed: 11/05/2022] Open
Abstract
The performance of the deep learning algorithm was on par with that of 7 expert pathologists in discriminating melanoma from nevus using whole-slide pathological images (WSIs). Deep learning algorithm might function as a supplemental tool to assist pathologist by automatically pre-screening and highlighting interest regions prior to review.
Background Deep learning has the potential to improve diagnostic accuracy and efficiency in medical image recognition. In the current study, we developed a deep learning algorithm and assessed its performance in discriminating melanoma from nevus using whole-slide pathological images (WSIs). Methods The deep learning algorithm was trained and validated using a set of 781 WSIs (86 melanomas, 695 nevi) from PLA General Hospital. The diagnostic performance of the algorithm was tested on an independent test set of 104 WSIs (29 melanomas, 75 nevi) from Tianjin Chang Zheng Hospital. The same test set was also diagnostically classified by 7 expert dermatopathologists. Results The deep learning algorithm receiver operating characteristic (ROC) curve achieved a sensitivity 100% at the specificity of 94.7% in the classification of melanoma and nevus on the test set. The area under ROC curve was 0.99. Dermatopathologists achieved a mean sensitivity and specificity of 95.1% (95% confidence interval [CI]: 92.0%-98.2%) and 96.0% (95% CI: 94.2%-97.8%), respectively. At the operating point of sensitivity of 95.1%, the algorithm revealed a comparable specificity with 7 dermatopathologists (97.3% vs. 96.0%, P = 0.11). At the operating point of specificity of 96.0%, the algorithm also achieved a comparable sensitivity with 7 dermatopathologists (96.5% vs. 95.1%, P = 0.30). A more transparent and interpretable diagnosis could be generated by highlighting the regions of interest recognized by the algorithm in WSIs. Conclusion The performance of the deep learning algorithm was on par with that of 7 expert dermatopathologists in interpreting WSIs with melanocytic lesions. By pre-screening the suspicious melanoma regions, it might serve as a supplemental diagnostic tool to improve working efficiency of pathologists.
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Affiliation(s)
- Wei Ba
- Department of Dermatology, Chinese PLA General Hospital & Medical School, No. 28 Fuxing Road, Beijing 100853, China
| | - Rui Wang
- Department of Dermatology, Chinese PLA General Hospital & Medical School, No. 28 Fuxing Road, Beijing 100853, China
| | - Guang Yin
- Department of Dermatology, Chinese PLA General Hospital & Medical School, No. 28 Fuxing Road, Beijing 100853, China
| | - Zhigang Song
- Department of Pathology, Chinese PLA General Hospital & Medical School, Beijing, China
| | - Jinyi Zou
- Artificial Intelligence (AI) Lab, Lenovo Research, Beijing, China
| | - Cheng Zhong
- Artificial Intelligence (AI) Lab, Lenovo Research, Beijing, China
| | - Jingrun Yang
- Department of Dermatology, Chinese PLA General Hospital & Medical School, No. 28 Fuxing Road, Beijing 100853, China
| | - Guanzhen Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan, China
| | - Hongyu Yang
- St Vincent Evansville medical center, Washington, United States
| | - Litao Zhang
- Department of Dermatology, Tianjin Chang Zheng Hospital, Tianjin, China
| | - Chengxin Li
- Department of Dermatology, Chinese PLA General Hospital & Medical School, No. 28 Fuxing Road, Beijing 100853, China.
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Tai F, Pereira VM, Babak S, Radovanovic I, Sade S, Teshima TL. Malignant Melanoma within a Cellular Blue Nevi Presenting as a Vascular Malformation and the Connection to Sporadic KRAS Mutations. Case Rep Dermatol 2021; 13:310-316. [PMID: 34248538 PMCID: PMC8255697 DOI: 10.1159/000517202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/16/2021] [Indexed: 11/25/2022] Open
Abstract
We present a case of malignant melanoma (MM) developing within a vascular malformation showing features of cellular blue nevi. A 47-year-old male presented with acute symptoms of a temporal and zygomatic mass, which were both previously asymptomatic upon development 30 years ago. These masses were diagnosed as vascular malformations upon imaging and were treated with sclerotherapy. Embolization and surgical excision were performed 3 years later due to symptomatic growth. Final pathology reports showed MM with congenital blue nevi. We hypothesize a possible linkage to a sporadic KRAS mutation, linking both presentations of vascular malformation, MM, and cellular blue nevi. A literature search for similar cases is also reported.
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Affiliation(s)
- Felicia Tai
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vitor M Pereira
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sam Babak
- Medical Oncology, Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Shachar Sade
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tara Lynn Teshima
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Markham Stouffville Hospital, Markham, Ontario, Canada
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Mejia O, Vazquez T, Alexis J. CD63 expression in metastatic melanoma and melanocytic nevi in lymph nodes. Pathol Res Pract 2021; 223:153464. [PMID: 34051511 DOI: 10.1016/j.prp.2021.153464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 10/21/2022]
Abstract
Lymph node status remains one of the most important determinants for prognosis in patients with invasive malignant melanoma. Immunohistochemical stains are routinely employed in the histopathologic evaluation of sentinel lymph nodes removed for staging in patients with melanoma. Histologic analysis may reveal the presence of incidental benign melanocytic nevus cell inclusions (BMNCI), which are critical to distinguish from metastatic melanoma (MM). Our study assesses the utility of NK1 C3 (CD63) immunohistochemical staining in distinguishing between MM and BMNCI in sentinel lymph nodes. We found no difference in staining of MM and BMNCI, precluding its usefulness in differentiating between benign and malignant melanocytes. Thus CD63 lacks specificity when facing challenging cases requiring distinction between benign and malignant melanocytic cells; however, in combination with other immunohistochemical antibodies, CD63 may be useful in supporting melanocytic differentiation. Distinguishing MM and BMNCI continues to be a diagnostic challenge at times. Further research is needed to identify potentially useful markers to provide better diagnostic utility when evaluating lymph node biopsies in patients with melanoma.
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Affiliation(s)
- Odille Mejia
- Arkadi M. Rywlin M.D. Department of Pathology, Mount Sinai Medical Center, Miami Beach, FL, USA.
| | - Thomas Vazquez
- Florida International University Wertheim College of Medicine, Miami, FL, USA
| | - John Alexis
- Arkadi M. Rywlin M.D. Department of Pathology, Mount Sinai Medical Center, Miami Beach, FL, USA
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Abstract
PRAME (PReferentially expressed Antigen in MElanoma) is a melanoma-associated antigen expressed in cutaneous and ocular melanomas and some other malignant neoplasms, while its expression in normal tissue and benign tumors is limited. Detection of PRAME protein expression by immunohistochemistry in a cohort of 400 melanocytic tumors showed diffuse nuclear immunoreactivity for PRAME in most metastatic and primary melanomas. In contrast, most nevi were negative for PRAME or showed nondiffuse immunoreactivity. The difference in the extent of immunoreactivity for PRAME in unambiguous melanocytic tumors prompted the study of PRAME as an ancillary tool for evaluating melanocytic lesions in more challenging scenarios.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Achim A Jungbluth
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Fernandez JP, Haider AA, Materin MA. Choroidal nevus with retinal invasion, clinical and imaging features. Am J Ophthalmol Case Rep 2021; 22:101059. [PMID: 33778181 DOI: 10.1016/j.ajoc.2021.101059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/18/2020] [Accepted: 02/21/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To report a clinically challenging case of a choroidal nevus with retinal invasion with accompanying ancillary testing. Observations A 60-year-old Caucasian female was referred for a suspicious melanocytic choroidal lesion in her left eye. Ophthalmoscopic examination revealed a melanocytic choroidal lesion, measuring 10 mm × 10 mm in basal diameter. The lesion had a clinically evident area of retinal invasion seen as a protruding choroidal mass at its center, darker in appearance compared to the rest of the lesion, obscuring retinal vessels. The choroidal nevus had associated chronic retinal changes and the absence of overlying orange pigment or subretinal fluid. On fundus autofluorescence, there was a hypoautofluorescent area showing the site of retinal invasion. Fluorescein angiography at the lesion site exhibited central blocked perfusion corresponding to the area of retinal invasion. Ultrasonography showed a dome-shaped choroidal lesion that was optically dense with a medium-high internal reflectivity measuring 3.3mm in thickness. The optical coherence tomography showed a choroidal mass extruding through a break in Bruch's membrane with inner retinal invasion. A watchful waiting strategy was adopted, and at 28 months follow-up, the choroidal lesion did not show growth or presence of new suspicious features of malignant transformation. Conclusion and importance This case highlights the importance of recognizing the key features of choroidal nevi with retinal invasion, which can prevent the treatment of a benign condition and assist in the arrival of a correct diagnosis. These lesions should be monitored for long-term.
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Greene AK, Sudduth CL, Taghinia AH. Lower Extremity Reconstruction in the Pediatric Population. Clin Plast Surg 2021; 48:341-347. [PMID: 33674055 DOI: 10.1016/j.cps.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Indications for lower extremity reconstruction in children are unique because most result from congenital conditions (eg, constriction ring, lymphedema, syndactyly, nevi, vascular anomalies). Like adults, pediatric patients also suffer from effects following extirpation and trauma. Principles of reconstruction are based on the condition and type of deformity. The pediatric population typically has fewer comorbidities than adults that can negatively affect outcomes (eg, diabetes, peripheral vascular disease), although children can be less compliant with postoperative care. Growth, development, appearance, and postoperative compliance are variables that especially influence operative management of children.
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Affiliation(s)
- Arin K Greene
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Christopher L Sudduth
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Amir H Taghinia
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Winkler JK, Sies K, Fink C, Toberer F, Enk A, Abassi MS, Fuchs T, Haenssle HA. Association between different scale bars in dermoscopic images and diagnostic performance of a market-approved deep learning convolutional neural network for melanoma recognition. Eur J Cancer 2021; 145:146-154. [PMID: 33465706 DOI: 10.1016/j.ejca.2020.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies systematically unravelling possible causes for false diagnoses of deep learning convolutional neural networks (CNNs) are scarce, yet needed before broader application. OBJECTIVES The objective of the study was to investigate whether scale bars in dermoscopic images are associated with the diagnostic accuracy of a market-approved CNN. METHODS This cross-sectional analysis applied a CNN trained with more than 150,000 images (Moleanalyzer-pro®, FotoFinder Systems Inc., Bad Birnbach, Germany) to investigate seven dermoscopic image sets depicting the same 130 melanocytic lesions (107 nevi, 23 melanomas) without or with digitally superimposed scale bars of different manufacturers. Sensitivity, specificity and area under the curve (AUC) of receiver operating characteristics (ROC) for the CNN's binary classification of images with or without superimposed scale bars were assessed. RESULTS Six dermoscopic image sets with different scale bars and one control set without scale bars (overall 910 images) were submitted to CNN analysis. In images without scale bars, the CNN attained a sensitivity [95% confidence interval] of 87.0% [67.9%-95.5%] and a specificity of 87.9% [80.3%-92.8%]. ROC AUC was 0.953 [0.914-0.992]. Scale bars were not associated with significant changes in sensitivity (range 87%-95.7%, all p ≥ 1.0). However, four scale bars induced a decrease of the CNN's specificity (range 0%-43.9%, all p < 0.001). Moreover, ROC AUC was significantly reduced by two scale bars (range 0.520-0.848, both p ≤ 0.042). CONCLUSIONS Superimposed scale bars in dermoscopic images may impair the CNN's diagnostic accuracy, mostly by increasing the rate of the false-positive diagnoses. We recommend avoiding scale bars in images intended for CNN analysis unless specific measures counteracting effects are implemented. CLINICAL TRIAL NUMBER This study was registered at the German Clinical Trial Register (DRKS-Study-ID: DRKS00013570; URL: https://www.drks.de/drks_web/).
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Affiliation(s)
- Julia K Winkler
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Katharina Sies
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Mohamed S Abassi
- Department of Research and Development, FotoFinder Systems GmbH, Bad Birnbach, Germany
| | - Tobias Fuchs
- Department of Research and Development, FotoFinder Systems GmbH, Bad Birnbach, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany.
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Han JW, Sun H, Kim JW, Yun JY, Chung EH, Oh MJ. A novel subdermal anchoring technique for the effective treatment of congenital melanocytic nevus using de-epithelialized dermal flaps. Arch Plast Surg 2021; 48:55-60. [PMID: 33503745 DOI: 10.5999/aps.2020.00458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022] Open
Abstract
Background In patients with congenital melanocytic nevus (CMN), single-stage removal of large lesions can be difficult because the high tension created by excising and repairing a large lesion may result in scar widening. Herein, we introduce a method to effectively excise lesions while minimizing scarring and compare its outcomes to those of existing surgical methods. Methods We compared patients who underwent surgery using the anchoring technique (n=42) or the conventional elliptical technique (n=36). One side of the lesion was removed via en bloc resection up to the superficial fascia. The other side of the lesion was removed via de-epithelialization. The de-epithelialized dermal flap was then fixed by suturing it to the superficial fascia on the opposite side. The length of the lesion’s long axis and amount of scar widening were measured immediately after surgery and at 2, 6, and 12 months postoperatively. At 12 months, patients were assessed using the Patient and Observer Scar Assessment Scale. Results The lesion locations included the face, arms, legs, back, and abdomen. The anchoring method resulted in shorter and smaller scars than the conventional method. There were no cases of postoperative hematoma or wound dehiscence. Significant differences in postoperative scar widening were found in the arm and leg areas (P<0.05). Conclusions The anchoring method introduced in this study can provide much better outcomes than the conventional method. The anchoring method is particularly useful for the removal of CMN around the joints or extremities, where the surgical site is subjected to high tension.
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Maron RC, Haggenmüller S, von Kalle C, Utikal JS, Meier F, Gellrich FF, Hauschild A, French LE, Schlaak M, Ghoreschi K, Kutzner H, Heppt MV, Haferkamp S, Sondermann W, Schadendorf D, Schilling B, Hekler A, Krieghoff-Henning E, Kather JN, Fröhling S, Lipka DB, Brinker TJ. Robustness of convolutional neural networks in recognition of pigmented skin lesions. Eur J Cancer 2021; 145:81-91. [PMID: 33423009 DOI: 10.1016/j.ejca.2020.11.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/06/2020] [Accepted: 11/15/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND A basic requirement for artificial intelligence (AI)-based image analysis systems, which are to be integrated into clinical practice, is a high robustness. Minor changes in how those images are acquired, for example, during routine skin cancer screening, should not change the diagnosis of such assistance systems. OBJECTIVE To quantify to what extent minor image perturbations affect the convolutional neural network (CNN)-mediated skin lesion classification and to evaluate three possible solutions for this problem (additional data augmentation, test-time augmentation, anti-aliasing). METHODS We trained three commonly used CNN architectures to differentiate between dermoscopic melanoma and nevus images. Subsequently, their performance and susceptibility to minor changes ('brittleness') was tested on two distinct test sets with multiple images per lesion. For the first set, image changes, such as rotations or zooms, were generated artificially. The second set contained natural changes that stemmed from multiple photographs taken of the same lesions. RESULTS All architectures exhibited brittleness on the artificial and natural test set. The three reviewed methods were able to decrease brittleness to varying degrees while still maintaining performance. The observed improvement was greater for the artificial than for the natural test set, where enhancements were minor. CONCLUSIONS Minor image changes, relatively inconspicuous for humans, can have an effect on the robustness of CNNs differentiating skin lesions. By the methods tested here, this effect can be reduced, but not fully eliminated. Thus, further research to sustain the performance of AI classifiers is needed to facilitate the translation of such systems into the clinic.
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Grajewski RS, Rokohl AC, Becker M, Paulsen F, Heindl LM. Malignancy going viral: ACE2 and TMPRSS2 expression in conjunctival neoplastic diseases. Ann Anat 2021; 234:151661. [PMID: 33340650 DOI: 10.1016/j.aanat.2020.151661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/03/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
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Abstract
Secondary neoplasms in nevus sebaceous can develop during adolescence and adulthood. Trichoblastoma and syringocystadenoma papilliferum are the most common benign neoplasms, but poroma is rarely reported. A 28-year-old female presented with an asymptomatic mass on the scalp. She has had a hairless lesion on the scalp since birth. A soft mass developed on that lesion four years prior. Physical examination revealed a localized 1 cm×2.5 cm-sized brownish, verrucous-surfaced plaque with a 1 cm×1 cm-sized pedunculated erythematous tumor on the scalp. We performed skin biopsy on both the plaque and tumor lesions. The histopathological findings demonstrated the plaque lesion consistent with nevus sebaceous and the tumor lesion consistent with eccrine poroma. Surgical mass excision was performed. The patient was eventually diagnosed with eccrine poroma arising within nevus sebaceous. To the best of our knowledge, there are only six reported cases on poroma arising within nevus sebaceous. Although rarely documented in the literature, it should be considered as a secondary neoplasm within nevus sebaceous.
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Affiliation(s)
- Jong-Kil Seo
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Min Kyung Shin
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Ki-Heon Jeong
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Mu-Hyoung Lee
- Department of Dermatology, School of Medicine, Kyung Hee University, Seoul, Korea
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Dehavay F, Goettmann S, Zaraa I, Moulonguet I, André J, Caucanas M, Baran R, Richert B. Nail Unit Blue Nevi: A 11-Case Series and Review of the Literature. Skin Appendage Disord 2020; 6:287-295. [PMID: 33088814 DOI: 10.1159/000509204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022] Open
Abstract
Background Blue nevus of the nail apparatus is a rare entity and only isolated cases are reported in the literature. Objective The aim of this study was to better characterize blue nevus at the nail unit. Methods Retrospective analysis of all nail unit blue nevi from the Nail Group of the French Society of Dermatology was compared to the literature. Results Eleven cases were retrieved from 2002 to 2019 with an average age of 45 years. The majority were women (9/11) and acquired (10/11). Hands were more frequently involved (9/11) with a predilection for the thumb and 2 cases were located on the hallux. Nail unit blue nevus mostly presented as a well-delimited blue spot of the lunula (9/11) and histologically was of the common type (10/11). There was no malignancy. Conclusion Nail unit blue nevus is a rare asymptomatic benign entity, mostly acquired on the thumb or the hallux of women. The most frequent presentation is a painless blue spot on the lunula. Congenital blue nevi seem to only affect the paronychium. Main differential diagnosis is melanoma and histopathological examination is mandatory.
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Affiliation(s)
- Florence Dehavay
- St Pierre, Brugmann and Children's University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Sophie Goettmann
- Department of Dermatology, Hôpital Bichat - Claude Bernard, Paris, France
| | - Ines Zaraa
- Dermatology Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Josette André
- St Pierre, Brugmann and Children's University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
| | | | | | - Bertrand Richert
- St Pierre, Brugmann and Children's University Hospitals, Université Libre de Bruxelles, Bruxelles, Belgium
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Abstract
Recent research has revealed that ion channels and transporters can be important players in tumor development, progression, and therapy resistance in melanoma. For example, members of the ABC family were shown to support cancer stemness-like features in melanoma cells, while several members of the TRP channel family were reported to act as tumor suppressors.Also, many transporter proteins support tumor cell viability and thus suppress apoptosis induction by anticancer therapy. Due to the high number of ion channels and transporters and the resulting high complexity of the field, progress in understanding is often focused on single molecules and is in total rather slow. In this review, we aim at giving an overview about a broad subset of ion transporters, also illustrating some aspects of the field, which have not been addressed in detail in melanoma. In context with the other chapters in this special issue on "Transportome Malfunctions in the Cancer Spectrum," a comparison between melanoma and these tumors will be possible.
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Affiliation(s)
- Ines Böhme
- Institute of Biochemistry, Emil Fischer Center, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Schönherr
- Institute of Biochemistry and Biophysics, Friedrich Schiller University Jena and Jena University Hospital, Jena, Germany
| | - Jürgen Eberle
- Department of Dermatology, Venerology and Allergology, Skin Cancer Center Charité, University Medical Center Charité, Berlin, Germany
| | - Anja Katrin Bosserhoff
- Institute of Biochemistry, Emil Fischer Center, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany. .,Comprehensive Cancer Center (CCC) Erlangen-EMN, Erlangen, Germany.
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Rishi P, Trivedi M, Sreelakshmi K. Choroidal Nevus and Melanoma in Patients with Oculocutaneous Albinism. Ocul Oncol Pathol 2020; 6:31-34. [PMID: 32002402 DOI: 10.1159/000500784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/05/2019] [Indexed: 11/19/2022] Open
Abstract
Background There are limited reports of uveal "melanocytic" lesions in patients with oculocutaneous albinism, with no reports from Asia. Objectives In this study, we report 3 eyes with uveal "melanocytic" lesions in Asian patients with oculocutaneous albinism. Methods Retrospective small case series. Three eyes of 2 Asian patients with oculocutaneous albinism were included. Case 1 was a 54-year-old female who presented with juxtapapillary choroidal melanoma and underwent enucleation. Case 2 was a 39-year-old male with pigmented choroidal nevus in the right eye and suspicious nevus/choroidal variegation in the left eye. Results For case 1, metastatic workup including ultrasound of the abdomen, liver function test, and chest X-ray was unremarkable. Magnetic resonance imaging of the cranium ruled out extraocular extension. The left eye was enucleated due to the large tumor size and poor visual potential, and histopathological examination confirmed the diagnosis of choroidal melanoma with mixed cell type. At the last follow-up 6 months after enucleation, there was no evidence of metastasis. Case 2 was observed. Conclusion Pigmented choroidal nevus and melanoma are rarely observed in patients with oculocutaneous albinism.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
| | - Mihir Trivedi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, India
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Affiliation(s)
| | - Saxon D Smith
- Royal North Shore Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | - Deshan F Sebaratnam
- Liverpool Hospital, Sydney, NSW.,Sydney Children's Hospitals Network, Sydney, NSW
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Abstract
Spitz nevus is a benign melanocytic lesion, which presents in several ways: solitary, agminated, or disseminated. The disseminated variant is uncommon; it may have a rapid evolution (the eruptive form) and be difficult to manage. This report presents the case of a 24-year-old patient with multiple papules on his limbs, which had appeared four years previously. On physical examination, 120 pink and skin-colored papules were seen, which under dermoscopy were observed to be homogeneous, pink vascular lesions. Histopathologic study revealed epithelioid cells arranged in groups or singly in the dermis and dermo-epidermal junction. They were HMB-45 positive in the superficial dermis, and Ki-67 < 1%. Given these findings, a diagnosis of eruptive disseminated Spitz nevi was made.
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Affiliation(s)
- Pablo Vargas
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile.
| | | | - Roberto Cullen
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Andrés Figueroa
- Dermatology Service, University of Chile Clinical Hospital, University of Chile, Santiago, Chile
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Abstract
Background Wide-field imaging plays an increasingly important role in ocular oncology clinics. The purpose of this review is to describe the commonly used wide-field imaging devices and review conditions seen in ocular oncology clinic that underwent wide-field imaging as part of the multimodal evaluation. Summary of review Wide-field or wide-angle imaging is defined as greater than 50° field of view. Modern devices can reach far beyond this reporting fields of view up to 267°, when utilizing montage features, with increasingly impressive resolution. Wide-field imaging modalities include fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine angiography (ICG), spectral domain optical coherence tomography (SD-OCT), and recently wide-field OCT Angiography (OCTA). These imaging modalities are increasingly prevalent in practice. The wide-field systems include laser, optical, and lens based systems that are contact or non-contact lens systems each with its own benefits and drawbacks. The purpose of this review is to discuss commonly used wide-field imaging modalities for retinal and choroidal tumors and demonstrate the use of various widefield imaging modalities in select ocular oncology cases. Conclusions Clinical examination remains the gold standard for the evaluation of choroidal and retinal tumors. Wide-field imaging plays an important role in ocular oncology for initial documentation, surgical planning, determining the relationship of the tumor to adjacent ocular structures, following tumor size after treatment, and monitoring for recurrence.
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Affiliation(s)
- Natalia F Callaway
- Department of Ophthalmology, Stanford University Byers Eye Institute, 2452 Watson Court MC 5353, Palo Alto, CA 94303 USA
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Stanford University Byers Eye Institute, 2452 Watson Court MC 5353, Palo Alto, CA 94303 USA
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Maillard M, Stucki L, Kaya G. A Case of Compound Nevus with Intradermal Pseudoglandular Features: A Rare Variant and Possible Pitfall. Dermatopathology (Basel) 2019; 6:41-44. [PMID: 31700842 PMCID: PMC6827545 DOI: 10.1159/000500400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 11/19/2022] Open
Abstract
Melanocytic nevi are frequent cutaneous lesions with a large variation of morphological features, including pseudoglandular formation, which has rarely been described in the literature and remains of uncertain biological and clinical significance. We report a case of benign compound melanocytic nevus, with a dermal component showing an epithelioid proliferation arranged in small nests with central lumen-like structures mimicking glands. Immunohistochemical staining was necessary to determine the exact nature of the proliferation, since the tubular differentiation can be seen in benign and malignant epithelial neoplasms and has to be clearly identified to avoid misdiagnosis.
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Affiliation(s)
- Marie Maillard
- Departments of Dermatology and Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Listette Stucki
- Specialist in Dermatology and Venereology, Vésenaz, Switzerland
| | - Gürkan Kaya
- Departments of Dermatology and Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
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Abstract
Background The incidence of pediatric melanoma is very rare. Dermoscopic features help to distinguish pediatric melanoma and common nevi. Objective To study the evolution of dermoscopic findings in benign nevi in childhood through serial observation and photography. Methods We examined 504 melanocytic lesions in 100 patients. From each participant, dermoscopic images of the nevi from 4-year dermoscopic follow-up were obtained, including randomly selected nevi. Results The most common dermoscopic patterns were homogeneous (193 nevi; 38.3%), globular (92 nevi; 18.3%), and reticular (86 nevi; 17.1%). Dermoscopic pattern changes were detected in 27% of patients aged 2~10 years and in 20% of patients aged 11~16 years. The main pattern changes consisted of the transition from homogeneous to globular-homogeneous (16%), from homogeneous to reticular-homogeneous (12%) and from globular to globular-homogeneous (10%). Although 257 of the 504 nevi (51.0%) have stable duration without size changes, 169 of the 504 nevi (33.5%) were enlarged, and 78 of the 504 nevi (15.5%) had become smaller. Conclusion These results contrast with the prevailing view that dermoscopic patterns in pediatric nevi are usually characterized by globular patterns and that melanocytic nevi generally undergo a characteristic transition from a globular pattern to a reticular pattern. Fifty one percent of patients did not exhibit a size change. While 33% of patients had symmetrical enlargement, 15% of patients had involution. Therefore, enlargement is a common dermoscopic change in pediatric nevi, and is not a specific sign of pediatric melanoma.
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Affiliation(s)
- Fatma Pelin Cengiz
- Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yaren Yılmaz
- Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Nazan Emiroglu
- Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey
| | - Nahide Onsun
- Department of Dermatoveneorology, Bezmialem Vakif University, Istanbul, Turkey
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Weiss SJ, Stathopoulos C, Shields CL. Choroidal Nevus with Retinal Invasion in 8 Cases. Ocul Oncol Pathol 2019; 5:369-378. [PMID: 31559248 DOI: 10.1159/000495841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 11/23/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose Choroidal nevus can cause overlying chronic retinal pigment epithelium (RPE) degenerative features, but frank retinal invasion is exquisitely rare. Procedures This is a retrospective review of 8 cases of choroidal nevus with retinal invasion with evaluation of clinical and imaging features. Results At the time of diagnosis of choroidal nevus with retinal invasion, mean patient age was 65 years. Mean tumor basal diameter was 7 mm, and mean thickness was 2.3 mm. Retinal invasion was ophthalmoscopically visible in all eyes. Related features included drusen (n = 4/8) and RPE fibrous metaplasia (n = 2/8). Overlying lipofuscin, subretinal fluid, RPE detachment, and retinal edema were absent. On B-scan ultrasonography, the lesion was dome-shaped (n = 7/7) and echo-dense (n = 6/7). Optical coherence tomography demonstrated outer retinal invasion (n = 8/8) with additional inner retinal invasion (n = 3/8). The tissue was hypoautofluorescent at the site of invasion (n = 6/7). Over a mean follow-up of 40 months, tumor enlargement was detected in 2 eyes and managed with observation (< 1 mm enlargement) or plaque radiotherapy (5 mm enlargement). Nevus hypoautofluorescence was correlated with nevus stability (p = 0.035). Conclusion Retinal invasion of the choroidal nevus is rare. In this series of 8 cases, only 1 demonstrated transformation to melanoma over a mean interval of 40 months. Long-term monitoring of such lesions is warranted.
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Affiliation(s)
- Stephanie J Weiss
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Retina Service, Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Christina Stathopoulos
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, University of Lausanne, Lausanne, Switzerland
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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