1
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Chen A, Sharma N, Patel P, Olivares S, Bahrami A, Barnhill RL, Blokx WAM, Bosenberg M, Busam KJ, de La Fouchardière A, Duncan LM, Elder DE, Ko JS, Landman G, Lazar AJ, Lezcano C, Lowe L, Maher N, Massi D, Messina J, Mihic-Probst D, Parker DC, Redpath M, Scolyer RA, Shea CR, Spatz A, Tron V, Xu X, Yeh I, Jung Yun S, Zembowicz A, Gerami P. The Impact of Next-generation Sequencing on Interobserver Agreement and Diagnostic Accuracy of Desmoplastic Melanocytic Neoplasms. Am J Surg Pathol 2024; 48:708-718. [PMID: 38590014 DOI: 10.1097/pas.0000000000002226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Next-generation sequencing (NGS) is increasingly being utilized as an ancillary tool for diagnostically challenging melanocytic neoplasms. It is incumbent upon the pathology community to perform studies assessing the benefits and limitations of these tools in specific diagnostic scenarios. One of the most challenging diagnostic scenarios faced by skin pathologists involves accurate diagnosis of desmoplastic melanocytic neoplasms (DMNs). In this study, 20 expert melanoma pathologists rendered a diagnosis on 47 DMNs based on hematoxylin and eosin sections with demographic information. After submitting their diagnosis, the experts were given the same cases, but this time with comprehensive genomic sequencing results, and asked to render a diagnosis again. Identification of desmoplastic melanoma (DM) improved by 7%, and this difference was statistically significant ( P <0.05). In addition, among the 15 melanoma cases, in the pregenomic assessment, only 12 were favored to be DM by the experts, while after genomics, this improved to 14 of the cases being favored to be DM. In fact, some cases resulting in metastatic disease had a substantial increase in the number of experts recognizing them as DM after genomics. The impact of the genomic findings was less dramatic among benign and intermediate-grade desmoplastic tumors (BIDTs). Interobserver agreement also improved, with the Fleiss multirater Kappa being 0.36 before genomics to 0.4 after genomics. NGS has the potential to improve diagnostic accuracy in the assessment of desmoplastic melanocytic tumors. The degree of improvement will be most substantial among pathologists with some background and experience in bioinformatics and melanoma genetics.
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Affiliation(s)
- Alice Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Natasha Sharma
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pragi Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Armita Bahrami
- Department of Pathology, Emory University School of Medicine, Atlanta, GA
| | - Raymond L Barnhill
- Department of Translational Research, Institut Curie, Paris Sciences and Lettres Research University, and UFR of Medicine, University of Paris Cité, Paris
| | - Willeke A M Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, The Netherlands
| | | | - Klaus J Busam
- Department of Pathology, Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | - Lyn M Duncan
- Department of Dermatopathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, Hospital of the University of Pennsylvania
| | - Jennifer S Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cecilia Lezcano
- Department of Pathology, Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Lori Lowe
- Departments of Dermatology and Pathology, University of Michigan Medical School, Ann Arbor, MI
| | - Nigel Maher
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, and NSW Health Pathology, Sydney, NSW, Australia
- Faculty of Medicine and Health
- Melanoma Institute Australia
| | - Daniela Massi
- Department of Health Sciences, Section of Anatomic Pathology, University of Florence, Florence, Italy
| | - Jane Messina
- Departments of Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL
| | - Daniela Mihic-Probst
- Institute for Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, GA
| | | | - Richard A Scolyer
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, and NSW Health Pathology, Sydney, NSW, Australia
- Faculty of Medicine and Health
- Melanoma Institute Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Christopher R Shea
- Department of Medicine, Section of Dermatology, University of Chicago, Chicago, IL
| | - Alan Spatz
- Department of Pathology, McGill University, Montreal, QC
| | - Victor Tron
- Department of Dermatopathology, University of Toronto, Toronto, ON, Canada
| | - Xiaowei Xu
- Departments of Pathology and Dermatology, University of Pennsylvania, Philadelphia, PA
| | - Iwei Yeh
- Departments of Dermatology and Pathology, University of California, San Francisco, San Francisco, CA
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Artur Zembowicz
- Dermatopathology Consultations LLC, Lahey Clinic and Tufts Medical School, Boston, MA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Gerami P, Chen A, Sharma N, Patel P, Hagstrom M, Kancherla P, Geraminejad T, Olivares S, Biswas A, Bosenberg M, Busam KJ, de La Fouchardière A, Duncan LM, Elder DE, Ko J, Landman G, Lazar AJ, Lowe L, Massi D, Mihic-Probst D, Parker DC, Scolyer RA, Shea CR, Zembowicz A, Yun SJ, Blokx WAM, Barnhill RL. BRAF Mutated and Morphologically Spitzoid Tumors, a Subgroup of Melanocytic Neoplasms Difficult to Distinguish From True Spitz Neoplasms. Am J Surg Pathol 2024; 48:538-545. [PMID: 38525831 DOI: 10.1097/pas.0000000000002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Drivers of Spitz neoplasms include activating point mutations in HRAS and Spitz-associated genomic fusions. It has become evident that some BRAF -mutated melanocytic neoplasms can morphologically mimic Spitz tumors (STs). These have been termed BRAF mutated and morphologically spitzoid (BAMS). In this study, 17 experts from the International Melanoma Pathology Study Group assessed 54 cases which included 40 BAMS and 14 true STs. The participants reviewed the cases blinded to the genomic data and selected among several diagnostic options, including BAMS, ST, melanoma, and other. A total of 38% of all diagnostic selections in the BAMS cases were for BAMS, whereas 32% were for ST. In 22 of the BAMS cases, the favored diagnosis was BAMS, whereas in 17 of the BAMS cases, the favored diagnosis was ST. Among the 20 cases in the total group of 54 with the highest number of votes for ST, half were BAMS. Of BAMS, 75% had a number of votes for ST that was within the SD of votes for ST seen among true ST cases. There was poor interobserver agreement for the precise diagnosis of the BAMS (kappa = 0.16) but good agreement that these cases were not melanoma (kappa = 0.7). BAMS nevi/tumors can closely mimic Spitz neoplasms. Expert melanoma pathologists in this study favored a diagnosis of ST in nearly half of the BAMS cases. There are BAMS cases that even experts cannot morphologically distinguish from true Spitz neoplasms.
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Affiliation(s)
- Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Alice Chen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Natasha Sharma
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Pragi Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Pranav Kancherla
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Tara Geraminejad
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University
| | - Asok Biswas
- Department of Pathology, Western General Hospital, Edinburgh, UK
| | | | - Klaus J Busam
- Department of Pathology, Dermatopathology Service, Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | - Lyn M Duncan
- Department of Dermatopathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Division of Anatomic Pathology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Department of Pathology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Lori Lowe
- Department of Dermatology and Pathology, University of Michigan Medical School, Ann Arbor, MI
| | - Daniela Massi
- Department of Health Sciences, Section of Anatomic Pathology, University of Florence, Florence, Italy
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, GA
| | - Richard A Scolyer
- Department of Tissue Pathology, Royal Prince Alfred Hospital, and NSW Health Pathology, North Sydney, NSW, Australia
- Department of Dermatopathology, The University of Sydney, Sydney, NSW, Australia
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - Christopher R Shea
- Department of Medicine, Section of Dermatology, University of Chicago, Chicago, IL
| | - Artur Zembowicz
- Department of Anatomic and Clinical Pathology, Tufts Medical School, Boston, MA
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Willeke A M Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, The Netherlands
| | - Raymond L Barnhill
- Department of Translational Research, Curie Institute, Paris Sciences & Letters University, and UFR of Medicine, University of Paris Cité, Paris, France
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Patel P, Hagstrom M, Sharma N, Chen A, Dhillon S, Fumero-Velázquez M, Olivares S, Gerami P. Clinical, Morphologic, and Molecular Features of MAP3K8 Rearranged Spitz Neoplasms: A Retrospective Study Documenting That Bonafide Spitz Melanomas Are Rare. Am J Surg Pathol 2024; 48:437-446. [PMID: 38233731 DOI: 10.1097/pas.0000000000002179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Previous studies regarding the clinical behavior of Spitz neoplasms lack genomic characterization. We aim to assess our hypothesis that most MAP3K8 Spitz neoplasms are indolent despite MAP3K8 being the single most common driver of Spitz melanoma. Further, we aim to identify genomic features associated with aggressive behavior and to better characterize the morphology of these cases. We analyzed the outcomes of MAP3K8 Spitz neoplasms. We also performed a meta-analysis of the outcomes of MAP3K8 Spitz from the literature. Morphologic features were compared with other variants of Spitz using a Student t test and χ 2 test. Two of 35 cases resulted in local recurrence and one of these cases had local regional metastasis; all other cases had no evidence of recurrence (mean follow-up time: 33 mo). MAP3K8 Spitz only rarely results in aggressive behavior. Metastatic cases have genomic mutations associated with tumor progression. Morphologically, MAP3K8 Spitz neoplasms frequently showed nodular silhouette, large cell size, epithelioid morphology, and severe nuclear atypia resulting in more frequent diagnosis as Spitz melanoma. Most MAP3K8 Spitz neoplasms have excellent prognoses, apart from rare cases harboring additional genomic abnormalities associated with tumor progression.
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Affiliation(s)
- Pragi Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Khazaeli M, Maruthi VK, See S, Ondracek T, Gerami P. Melanocyte colonization and pigmentation of breast carcinoma: A case report. J Cutan Pathol 2024; 51:280-283. [PMID: 38114301 DOI: 10.1111/cup.14564] [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: 08/12/2023] [Revised: 11/13/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023]
Abstract
Pigmented mammary Paget disease is a rare variant of mammary Paget disease that is often clinically misdiagnosed as a melanocytic lesion of the skin or nipple-areolar complex. Careful morphological assessment, along with the performance of adequate immunohistochemical stains, will help in achieving the right diagnosis and avoiding misdiagnosis of the entity as malignant melanoma. We report a rare case of pigmented mammary Paget disease with concomitant colonization of the underlying invasive ductal carcinoma by melanocytes mimicking melanoma.
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Affiliation(s)
- Mahyar Khazaeli
- Department of Pathology, University at Buffalo, Buffalo, New York, USA
| | | | - Sharlene See
- Department of Dermatology, Section of Dermatopathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Theodore Ondracek
- Department of Pathology, University at Buffalo, Buffalo, New York, USA
| | - Pedram Gerami
- Department of Dermatology, Section of Dermatopathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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5
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Hawryluk EB, Moustafa D, Barry KK, Bahrani E, Reusch DB, Brahmbhatt M, Chen L, Coughlin CC, Gerami P, Haddock E, Hook K, Humphrey SR, Kao PC, Kruse LL, Lawley LP, Mansour D, Marghoob AA, Nguyen J, Phung TL, Pope E, Raisanen T, Robinson S, Rogers T, Schmidt B, Tran G, Travis K, Wolner Z, London WB, Eichenfield LF, Huang J. Risk factors and outcomes of melanoma in children and adolescents: A retrospective multicenter study. J Am Acad Dermatol 2024; 90:716-726. [PMID: 38040338 DOI: 10.1016/j.jaad.2023.10.067] [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: 09/28/2022] [Revised: 10/04/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Pediatric melanoma presents with distinct clinical features compared to adult disease. OBJECTIVE Characterize risk factors and negative outcomes in pediatric melanoma. METHODS Multicenter retrospective study of patients under 20 years diagnosed with melanoma between January 1, 1995 and June 30, 2015 from 11 academic medical centers. RESULTS Melanoma was diagnosed in 317 patients, 73% of whom were diagnosed in adolescence (age ≥11). Spitzoid (31%) and superficial spreading (26%) subtypes were most common and 11% of cases arose from congenital nevi. Sentinel lymph node biopsy was performed in 68% of cases and positive in 46%. Fatality was observed in 7% of cases. Adolescent patients with melanoma were more likely to have family history of melanoma (P = .046) compared to controls. LIMITATIONS Retrospective nature, cohort size, control selection, and potential referral bias. CONCLUSION Pediatric melanoma has diverse clinical presentations. Better understanding of these cases and outcomes may facilitate improved risk stratification of pediatric melanoma.
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Affiliation(s)
- Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Danna Moustafa
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kelly K Barry
- Tufts University School of Medicine, Boston, Massachusetts
| | - Eman Bahrani
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Diana B Reusch
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Meera Brahmbhatt
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Lily Chen
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Carrie C Coughlin
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ellen Haddock
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Kristen Hook
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Stephen R Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pei-Chi Kao
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lacey L Kruse
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Danny Mansour
- Division of Pediatric Dermatology, The Hospital for Sick Children, Toronto, Canada; Temerity Faculty of Medicine and University of Toronto, Toronto, Canada
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Nguyen
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Thuy L Phung
- Department of Pathology, University of South Alabama, Mobile, Alabama
| | - Elena Pope
- Division of Pediatric Dermatology, The Hospital for Sick Children, Toronto, Canada; Temerity Faculty of Medicine and University of Toronto, Toronto, Canada
| | - Tom Raisanen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Sarah Robinson
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Tova Rogers
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Birgitta Schmidt
- Harvard Medical School, Boston, Massachusetts; Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Gary Tran
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kate Travis
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Zachary Wolner
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Wendy B London
- Harvard Medical School, Boston, Massachusetts; Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California; Departments of Dermatology and Pediatrics, University of California, San Diego, San Diego, California
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Vest BE, Berrebi KG, Stone MS, Sargen MR, Gerami P. CRTC1::TRIM11 cutaneous tumor: An update with local recurrence and lung metastasis in a pediatric patient. J Cutan Pathol 2024; 51:181-183. [PMID: 37944913 DOI: 10.1111/cup.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Blake E Vest
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Kristen G Berrebi
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Mary S Stone
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Michael R Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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7
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Perkins IU, Tan SY, McCalmont TH, Chou PM, Mully TW, Gerami P, Pomerantz JH, Reyes-Múgica M, Balkin DM, Kruse LL, Huang B, Reichek JL, Gangopadhyay N, Chiosea S, Green JR, Chamlin SL, Frieden IJ, Bastian BC, Yeh I. Melanoma in infants, caused by a gene fusion involving the anaplastic lymphoma kinase (ALK). Pigment Cell Melanoma Res 2024; 37:6-14. [PMID: 37475109 DOI: 10.1111/pcmr.13115] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
We describe the first cases of pediatric melanoma with ALK fusion gene arising within giant congenital melanocytic nevi. Two newborn boys presented with large pigmented nodular plaques and numerous smaller satellite nevi. Additional expansile nodules developed within both nevi and invasive melanomas were diagnosed before 10 months of age in both boys. Oncogenic driver mutations in NRAS and BRAF were absent in both cases. Instead, oncogenic ZEB2::ALK fusion genes were identified in both the nevus and melanoma developing within the nevus. In both cases, tumors were noted by ultrasound in utero, demonstrated significant nodularity at birth, and progressed to melanoma in the first year of life suggesting that congenital nevi with ALK fusion genes may behave more aggressively than those with other mutations. As ALK kinase inhibitors are effective against a range of tumors with similar ALK fusion kinases, identifying ALK fusion genes in congenital melanocytic nevi may provide an opportunity for targeted therapy.
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Affiliation(s)
- Ifeoma U Perkins
- Department of Pathology, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Serena Y Tan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, California, USA
- GS Dermatology Associates, Walnut Creek, California, USA
| | - Pauline M Chou
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Thaddeus W Mully
- Department of Dermatology, University of California, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, California, USA
| | - Pedram Gerami
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jason H Pomerantz
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, California, USA
- Department of Orofacial Sciences, Program in Craniofacial Biology, Eli and Edythe Broad Center of Regeneration Medicine, University of California, San Francisco, California, USA
| | - Miguel Reyes-Múgica
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daniel M Balkin
- Department of Plastic & Oral Surgery, Boston's Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Lacey L Kruse
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Benjamin Huang
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Jennifer L Reichek
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Noopur Gangopadhyay
- Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Simon Chiosea
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jared R Green
- Envision Radiology Associates of Hollywood, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Sarah L Chamlin
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ilona J Frieden
- Department of Dermatology, University of California, San Francisco, California, USA
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Boris C Bastian
- Department of Dermatology, University of California, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, California, USA
| | - Iwei Yeh
- Department of Dermatology, University of California, San Francisco, California, USA
- Department of Pathology, University of California, San Francisco, California, USA
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8
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Donati M, Mansour B, Hagstrom M, Gerami P, Kazakov DV. Clinical, Morphological and Molecular Features of Spitz tumors. Cesk Patol 2024; 60:35-48. [PMID: 38697826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Spitz tumors represent a heterogeneous group of challenging melanocytic neoplasms, displaying a range of biological behaviors, spanning from benign lesions, Spitz nevi (SN) to Spitz melanomas (SM), with intermediate lesions in between known as atypical Spitz tumors (AST). They are histologically characterized by large epithelioid and/or spindled melanocytes arranged in fascicles or nests, often associated with characteristic epidermal hyperplasia and fibrovascular stromal changes. In the last decade, the detection of mutually exclusive structural rearrangements involving receptor tyrosine kinases ROS1, ALK, NTRK1, NTRK2, NTRK3, RET, MET, serine threonine kinases BRAF and MAP3K8, or HRAS mutation, led to a clinical, morphological and molecular based classification of Spitz tumors. The recognition of some reproducible histological features can help dermatopathologist in assessing these lesions and can provide clues to predict the underlying molecular driver. In this review, we will focus on clinical and morphological findings in molecular Spitz tumor subgroups.
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Fumero-Velázquez M, Hagstrom M, Dhillon S, Geraminejad T, Olivares S, Donati M, Nosek D, Waldenbäck P, Kazakov D, Sheffield BS, Tron VA, Gerami P. Clinical, Morphologic, and Molecular Features of Benign and Intermediate-grade Melanocytic Tumors With Activating Mutations in MAP2K1. Am J Surg Pathol 2023; 47:1438-1448. [PMID: 37773074 DOI: 10.1097/pas.0000000000002131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Activating mutations in MAP2K1 can be seen in benign and intermediate-grade melanocytic neoplasms with spitzoid morphology. We analyzed the clinical, histopathologic, and genetic features for 16 cases of benign and intermediate-grade melanocytic tumors harboring activating MAP2K1 mutations. We compared them to Spitz neoplasms with characteristic Spitz fusions or HRAS mutation. We also compared the mutational pattern of benign and intermediate-grade MAP2K1 -mutated neoplasms and melanomas with activating MAP2K1 mutations. Among the 16 cases, the favored morphologic diagnosis was Spitz nevus (8/16), atypical Spitz tumors (6/16), and deep penetrating nevus (2/16). The 2 most common architectural patterns seen included a plaque-like silhouette with fibroplasia around the rete reminiscent of a dysplastic nevus (n=7) or a wedge-shaped or nodular pattern with the plexiform arrangement of the nests aggregating around the adnexa or neurovascular bundle (n=8). The cases with dysplastic architecture and spitzoid cytology resembled dysplastic Spitz nevi. Compared with true Spitz neoplasms, MAP2K1 -mutated neoplasms occurred in older age groups and had more frequent pagetosis and a lower average mitotic count. The most common type of mutation in the benign and intermediate-grade cases in the literature involves an in-frame deletion, while, in melanomas, missense mutations are predominant. Benign and intermediate-grade melanocytic neoplasms with activating mutations in MAP2K1 can have morphologic overlap with Spitz neoplasms. A significant proportion of melanomas also have activating MAP2K1 mutations. In-frame deletions are predominantly seen in the benign and intermediate-grade cases, and missense mutations are predominantly seen in melanomas.
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Affiliation(s)
- Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Tara Geraminejad
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michele Donati
- Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
| | - Daniel Nosek
- Department of Pathology, Umeå University, Umeå, Sweden
| | | | - Dmitry Kazakov
- Institute for Dermatohistopathology, Pathology Institute Enge, Zürich, Switzerland
| | | | - Victor A Tron
- Department of Laboratory Medicine and Pathology, University of Toronto
- Department of Laboratory Medicine, Lifelabs LP, Toronto, ON, Canada
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Donati M, Nosek D, Olivares S, Lemahieu J, Loontiens S, Mansour B, Gerami P, Kazakov DV. Spitz tumor with RAF1 fusion: A report of 3 cases. Ann Diagn Pathol 2023; 67:152215. [PMID: 37856952 DOI: 10.1016/j.anndiagpath.2023.152215] [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: 08/21/2023] [Revised: 10/03/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Spitz tumors are melanocytic neoplasms morphologically characterized by spindled and/or epithelioid cells and specific stromal and epidermal changes associated with mutually exclusive fusion kinases involving ALK, ROS1, NTRK1, NTRK2, NTRK3, MET and RET, BRAF and MAP3K8 genes or, less commonly, HRAS mutation. RAF1 fusions have been recently detected in cutaneous melanocytic neoplasms, including conventional melanoma, congenital nevus and BAP-1 inactivated tumors. We report herewith three Spitz neoplasms with a RAF1 fusion, including a previously reported CTDSPL::RAF1 fusion and two novel PPAP2B::RAF1 and ATP2B4::RAF1 fusions. Two cases were classified as Spitz nevus, while the remaining neoplasm was classified as Spitz melanoma at the time of the diagnosis, given 9p21 homozygous deletion and positive sentinel lymph node biopsy. We suggest that RAF1 fused melanocytic neoplasms can represent a novel subgroup of Spitz tumors, with a RAF1 fusion representing an oncogenic driver.
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Affiliation(s)
- Michele Donati
- Department of Pathology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - Daniel Nosek
- Department of Pathology, Umeå University, Umeå, Sweden
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Siebe Loontiens
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium; Molecular Diagnostics Ghent University Hospital (MDG), Ghent, Belgium; CRIG, Cancer Research Institute Ghent, Ghent University Hospital, Ghent, Belgium
| | - Boulos Mansour
- Department of Pathology, Ospedale Israelitico di Roma, Rome, Italy
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Switzerland
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11
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Hagstrom M, Dhillon S, Fumero-Velázquez M, Olivares S, Gerami P. A reappraisal of the epidemiology of Spitz neoplasms in the molecular era: A retrospective cohort study. J Am Acad Dermatol 2023; 89:1185-1191. [PMID: 37567480 DOI: 10.1016/j.jaad.2023.08.005] [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: 04/28/2023] [Revised: 05/31/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Previous studies suggest that Spitz neoplasms occur primarily in younger patients, leading pathologists to shy away from diagnosing a benign Spitz neoplasm in the elderly. With the advent of genomic sequencing, there is a need for reappraisal of the epidemiology of Spitz neoplasms in the modern molecular era. OBJECTIVE We aim to reassess the epidemiology of Spitz neoplasms incorporating next-generation sequencing. METHODS We looked at 53,814 non-Spitz neoplasms and 1260 Spitz neoplasms including 286 Spitz neoplasms with next-generation sequencing testing and collected various epidemiologic data. RESULTS In our general pool of cases, the proportion of Spitz neoplasm cases occurring is relatively the same in each of the first 4 decades of life with a precipitous drop in the fifth decade. In assessing a group of genomically verified cases of Spitz neoplasms, the drop was much less significant and up to 20% of all Spitz neoplasm cases occurred in patients over 50 years of age. LIMITATIONS Limitations included the number of genetically verified Spitz neoplasm cases available and a possible bias as to which cases undergo genomic testing. CONCLUSION Genomic verification may allow more confident diagnosis of Spitz neoplasms in patients over 50 years of age and avoid melanoma overdiagnosis.
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Affiliation(s)
- Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
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12
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Busam KJ, Gerami P, Scolyer RA. Perspectives and Strategies to Minimize Harm From Melanoma Diagnosis. JAMA Dermatol 2023; 159:1307-1309. [PMID: 37938819 DOI: 10.1001/jamadermatol.2023.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
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Dhillon S, Duarte-Bateman D, Fowler G, Hagstrom MNE, Lampley N, Olivares S, Fumero-Velázquez MS, Vu K, Wayne JD, Gastman BR, Vetto J, Gerami P. Correction: Routine imaging guided by a 31‑gene expression profile assay results in earlier detection of melanoma with decreased metastatic tumor burden compared to patients without surveillance imaging studies. Arch Dermatol Res 2023; 316:6. [PMID: 38006425 PMCID: PMC10676301 DOI: 10.1007/s00403-023-02733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Affiliation(s)
- Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Daniela Duarte-Bateman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Graham Fowler
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Michael Norman Eun Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Mónica Stella Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Kathryn Vu
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Jeffery D Wayne
- Division of Surgical Oncology, Northwestern University, Chicago, IL, USA
| | - Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - John Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA.
- Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Burks HE, Pokorny JL, Koetsier JL, Roth-Carter QR, Arnette CR, Gerami P, Seykora JT, Johnson JL, Ren Z, Green KJ. Melanoma cells repress Desmoglein 1 in keratinocytes to promote tumor cell migration. J Cell Biol 2023; 222:e202212031. [PMID: 37733372 PMCID: PMC10512973 DOI: 10.1083/jcb.202212031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/25/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Melanoma is an aggressive cancer typically arising from transformation of melanocytes residing in the basal layer of the epidermis, where they are in direct contact with surrounding keratinocytes. The role of keratinocytes in shaping the melanoma tumor microenvironment remains understudied. We previously showed that temporary loss of the keratinocyte-specific cadherin, Desmoglein 1 (Dsg1), controls paracrine signaling between normal melanocytes and keratinocytes to stimulate the protective tanning response. Here, we provide evidence that melanoma cells hijack this intercellular communication by secreting factors that keep Dsg1 expression low in the surrounding keratinocytes, which in turn generate their own paracrine signals that enhance melanoma spread through CXCL1/CXCR2 signaling. Evidence suggests a model whereby paracrine signaling from melanoma cells increases levels of the transcriptional repressor Slug, and consequently decreases expression of the Dsg1 transcriptional activator Grhl1. Together, these data support the idea that paracrine crosstalk between melanoma cells and keratinocytes resulting in chronic keratinocyte Dsg1 reduction contributes to melanoma cell movement associated with tumor progression.
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Affiliation(s)
- Hope E. Burks
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jenny L. Pokorny
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jennifer L. Koetsier
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Quinn R. Roth-Carter
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Christopher R. Arnette
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - John T. Seykora
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jodi L. Johnson
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ziyou Ren
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - Kathleen J. Green
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
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15
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See SHC, Olivares S, Kulkarni M, Dhillon SK, Fumero-Velazquez MS, Hagstrom MNE, Gerami P. NONO::TFE3 fusion cutaneous epithelioid and spindle cell tumor: A case series. J Cutan Pathol 2023; 50:956-962. [PMID: 37606377 DOI: 10.1111/cup.14518] [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: 04/22/2023] [Revised: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
The NONO::TFE3 fusion has been described in MiT family translocation renal cell carcinomas as well as extracutaneous perivascular epithelioid cell tumors (PEComas). PEComas are known to express myogenic and melanocytic markers but SOX10 and p63 positivity has never been reported. We report two primary cutaneous tumors that morphologically and molecularly fit PEComas, both harboring the NONO::TFE3 fusion, but with an unusual immunophenotype of SOX10 and p63 positivity. One case was on an 80-year-old male's finger, and the other one was on a 72-year-old female's thigh. Both were well-circumscribed multinodular dermal tumors composed of nests of monotonous epithelioid to spindled cells with pale to vacuolated cytoplasm, some of which were arranged around blood vessels. Both tumors were positive for SOX10, S100, and p63, focally positive for Melan-A, and negative for myogenic markers. There are very little data regarding the molecular findings of primary cutaneous PEComas. While the NONO::TFE3 fusion has been identified in extracutaneous PEComas, it has never been reported in primary cutaneous cases. We believe these cases represent a previously undescribed subtype of cutaneous tumor which shows some immunophenotypic expression of melanocytic markers and we named these cases NONO::TFE3 fusion cutaneous epithelioid and spindle cell tumor. Further, we raise the question of whether this tumor should fall under the rubric of PEComa because of its morphology, partial expression of melanocytic markers, and the presence of the NONO::TFE3 fusion, or whether these tumors represent a separate novel class of tumors since the immunophenotypic expression of SOX10 and p63 is unusual for PEComas.
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Affiliation(s)
- Sharlene Helene C See
- Department of Dermatology, Section of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shantel Olivares
- Department of Dermatology, Section of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maansi Kulkarni
- Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
| | - Soneet K Dhillon
- Department of Dermatology, Section of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Monica Stella Fumero-Velazquez
- Department of Dermatology, Section of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Norman E Hagstrom
- Department of Dermatology, Section of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology, Section of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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16
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Thompson LJ, Furmanchuk A, Liszewski W, Kho A, West DP, Liebovitz DM, Nardone B, Gerami P. Machine learning identification of patient clusters for cutaneous melanoma. Ital J Dermatol Venerol 2023; 158:388-394. [PMID: 37750845 DOI: 10.23736/s2784-8671.23.07631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Cutaneous melanoma is a cancer arising in melanocyte skin cells and is the deadliest form of skin cancer worldwide. Although some risk factors are known, accurate prediction of disease progression and probability for metastasis are difficult to ascertain, given the complexity of the disease and the absence of reliable predictive markers. Since early detection and treatment are essential to enhance survival, this study utilizing machine learning (ML) aims to further delineate additional risk factors associated with cutaneous melanoma. METHODS A Bayesian Gaussian Mixture ML model was created with data from 2056 patients diagnosed with cutaneous melanoma and then used to group the patients into six Clusters based on a Silhouette Score analysis. A t-distributed stochastic neighbor embedding (t-SNE) model was used to visualize the six Clusters. RESULTS Statistical analysis revealed that Cluster 4 showed a significantly higher rate of metastatic disease, as well as higher Breslow depth at diagnosis, compared to the other five Clusters. Compared to the other five Clusters, patients represented in Cluster 4 also had lower healthcare utilization, fewer dermatology clinic visits, fewer primary care providers, and less frequent colonoscopies and mammograms, and were more likely to smoke and less likely to have a prior diagnosis of basal cell carcinoma. CONCLUSIONS This study uncovers gaps in healthcare utilization of services among patient groups with cutaneous melanoma as well as possible implications for management of disease progression. Data-driven analyses emphasize the importance of routine clinic visits to dermatologists and/or primary care physicians (PCPs) for early detection and management of cutaneous melanoma. The findings from this study demonstrate that unsupervised ML methodology may serve to define the best candidate patients to benefit from enhanced dermatology/primary care which, in turn, is expected to improve outcomes for cutaneous melanoma.
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Affiliation(s)
- Leo J Thompson
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Augmented Intelligence in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Al'ona Furmanchuk
- Department of Medicine (General Internal Medicine), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Walter Liszewski
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Abel Kho
- Institute for Augmented Intelligence in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medicine (General Internal Medicine), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David M Liebovitz
- Institute for Augmented Intelligence in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medicine (General Internal Medicine), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Beatrice Nardone
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA -
- Institute for Augmented Intelligence in Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Department of Medicine (General Internal Medicine), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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17
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Dhillon S, Duarte-Bateman D, Fowler G, Hagstrom MNE, Lampley N, Olivares S, Fumero-Velázquez MS, Vu K, Wayne JD, Gastman BR, Vetto J, Gerami P. Correction to: Routine imaging guided by a 31‑gene expression profile assay results in earlier detection of melanoma with decreased metastatic tumor burden compared to patients without surveillance imaging studies. Arch Dermatol Res 2023; 315:2303. [PMID: 37043011 DOI: 10.1007/s00403-023-02622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Daniela Duarte-Bateman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Graham Fowler
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Michael Norman Eun Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Mónica Stella Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Kathryn Vu
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Jeffrey D Wayne
- Division of Surgical Oncology, Northwestern University, Chicago, IL, USA
| | - Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - John Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA.
- Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Dhillon S, Duarte-Bateman D, Fowler G, Hagstrom MNE, Lampley N, Olivares S, Fumero-Velázquez MS, Vu K, Wayne JD, Gastman BR, Vetto J, Gerami P. Routine imaging guided by a 31-gene expression profile assay results in earlier detection of melanoma with decreased metastatic tumor burden compared to patients without surveillance imaging studies. Arch Dermatol Res 2023; 315:2295-2302. [PMID: 36977840 PMCID: PMC10676305 DOI: 10.1007/s00403-023-02613-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
Patients with early-stage disease typically have a good prognosis, but still have a risk of recurrence, even with negative sentinel lymph node biopsy (SLNB). This study explores the utility of routine imaging to detect metastases in patients with negative SLNB but high-risk 31 gene expression profile (31-GEP) scores. We retrospectively identified melanoma patients with negative SLNBs. Patients with high-risk GEP results were placed in the experimental group and patients without GEP testing were placed in the control group. Among both cohorts, recurrent melanoma groups were identified. The tumor burden at the time of recurrence and the time to recurrence were compared between experimental group patients with routine imaging and control group patients without imaging schedules. We identified 327 control patients and 307 experimental patients, of which 14.1% versus 20.5% had melanoma recurrence, respectively. Of the patients with recurrent melanoma, those in the experimental group were older (65.75 versus 59.20), had higher Breslow depths (3.72 mm versus 3.31 mm), and had advanced tumor staging (89.5% versus 71.4% of patients presenting clinical stage ≥ II) compared to the control group at primary diagnosis. However, melanoma recurrence was detected earlier (25.50 months versus 35.35 months) in the experimental group at a lower overall tumor burden (73.10 mm versus 27.60 mm). A higher percentage of experimental patients started immunotherapy when offered (76.3% and 67.9%). Patients who received routine imaging after high-risk GEP test scores had an earlier recurrence diagnosis with lower tumor burden, leading to better clinical outcomes.
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Affiliation(s)
- Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Daniela Duarte-Bateman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Graham Fowler
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Michael Norman Eun Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Mónica Stella Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Kathryn Vu
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Jeffrey D Wayne
- Division of Surgical Oncology, Northwestern University, Chicago, IL, USA
| | - Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - John Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Beaverton, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA.
- Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Fumero-Velázquez M, Hagstrom M, Dhillon S, Olivares S, Jennings LJ, Dittman D, Sukhanova M, Arva NC, Goldstein SD, Theos A, Pavlidakey P, Carr Z, Gerami P. Agminated presentation of fusion-driven melanocytic neoplasms. J Cutan Pathol 2023; 50:913-921. [PMID: 37407520 DOI: 10.1111/cup.14482] [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: 02/09/2023] [Revised: 05/09/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The conventionally understood pathogenesis of agminated Spitz nevi includes a mosaic HRAS mutation followed by copy number gains in 11p. However, we have recently observed agminated presentations of fusion-driven melanocytic neoplasms. METHODS We retrieved cases from our database of benign fusion-induced melanocytic neoplasms with an agminated presentation. Both the primary lesion and the secondary lesion were sequenced. TERT-promoter mutational testing and the melanoma fluorescence in situ hybridization assay were also performed. RESULTS Three cases were included. Two had a PRKCA fusion (partners ATP2B4 and MPZL1) and one had a ZCCHC8::ROS1 fusion. None of the cases met morphologic or molecular criteria for malignancy. There was no evidence of tumor progression in secondary lesions. The same fusion was identified in the primary and secondary lesions. None of the patients developed evidence of nodal or systemic metastasis. CONCLUSIONS We present accumulating evidence that fusion-driven melanocytic neoplasms can present with an agminated presentation. The differential diagnosis of an agminated presentation versus a locally recurrent or potentially locally metastatic tumor is critical, and accurate diagnosis has significant prognostic and therapeutic consequences for the patient. As with HRAS mutations, fusion-driven melanocytic tumors may have an agminated presentation.
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Affiliation(s)
- Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lawrence J Jennings
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - David Dittman
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Madina Sukhanova
- Division of Molecular Pathology, Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Nicoleta C Arva
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Seth D Goldstein
- Department of Surgery, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amy Theos
- Department of Dermatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Pavlidakey
- Department of Dermatology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zachary Carr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Boutko A, Hagstrom M, Lampley N, Roth A, Olivares S, Dhillon S, Fumero-Velázquez M, Benton S, Zhao J, Zhang B, Dittmann D, Asadbeigi S, Busam KJ, Gerami P. PRAME Immunohistochemical Expression and TERT Promoter Mutational Analysis as Ancillary Diagnostic Tools for Differentiating Proliferative Nodules From Melanoma Arising in Congenital Nevi. Am J Dermatopathol 2023; 45:437-447. [PMID: 37338065 DOI: 10.1097/dad.0000000000002357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
ABSTRACT Proliferative nodules (PNs) are benign melanocytic proliferations that typically develop within congenital melanocytic nevi. These tumors have overlapping histological features with melanoma. Ancillary immunohistochemistry and genomic sequencing are often used in diagnostically challenging cases. To assess the utility of preferentially expressed antigen in melanoma (PRAME) immunoreactivity and telomerase reverse transcriptase (TERT) promoter mutation analysis in distinguishing PNs from melanoma arising in congenital nevi cases. Twenty-one PNs and 2 melanomas arising in congenital nevi were immunohistochemically stained with PRAME. Cases with adequate tissue were also assessed for TERT promoter mutations through sequencing studies. The positivity rates in the PN cases were compared with those of the melanomas. Two of 21 PN cases were diffusely positive for PRAME (≥75% of the tumor cells positive). Two of 2 melanomas arising in congenital nevus cases were also diffusely PRAME positive. The difference was statistically significant using a Fisher exact test. None of the tumors harbored TERT promoter mutations. PRAME immunohistochemical marker may have diagnostic value in distinguishing diagnostically challenging PNs from melanoma, but diffuse expression is not specific for melanoma.
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Affiliation(s)
- Anastasiya Boutko
- Research Fellow, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Michael Hagstrom
- Research Fellow, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nathaniel Lampley
- Research Fellow, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrew Roth
- Research Fellow, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shantel Olivares
- Research Technologist, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Soneet Dhillon
- Research Technologist, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mónica Fumero-Velázquez
- Research Technologist, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sarah Benton
- Research Technologist, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jeffrey Zhao
- Research Technologist, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bin Zhang
- Research Technologist, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - David Dittmann
- Developmental Coordinator, Department of Molecular Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sepideh Asadbeigi
- Dermatopathology Fellow, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Klaus J Busam
- Director of Dermatopathology, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY; and
| | - Pedram Gerami
- Professor of Dermatology and Pathology, Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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21
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Boutko A, Asadbeigi S, Roth A, Lampley N, Olivares S, Dittmann D, Dittmann D, Jennings L, Gerami P. TERT Promoter Mutational Analysis as an Ancillary Diagnostic Tool for Diagnostically Challenging Melanocytic Neoplasms. Am J Dermatopathol 2023; 45:289-299. [PMID: 36898007 DOI: 10.1097/dad.0000000000002366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/14/2022] [Indexed: 03/12/2023]
Abstract
ABSTRACT Telomerase reverse transcriptase promoter mutations (TPMs) have been shown to be common in melanoma and uncommon in benign nevi. To assess the use of TPMs as an ancillary diagnostic tool, we report the concordance of the TPM status with the final diagnosis in clinical cases with distinct differential diagnostic scenarios: dysplastic nevus versus melanoma, atypical Spitz nevus versus melanoma, atypical deep penetrating nevus (DPN) versus melanoma, and atypical blue nevus versus malignant blue nevus. In a control cohort, we found a positive TPM in 51/70 (73%) of the total melanomas with the highest frequency in vertical growth phase melanoma cases. Conversely, only 2/35 (6%) dysplastic nevi in our control cases were TPM-positive and b were severely atypical dysplastic nevi. Our clinical cohort of 257 cases had a positive TPM in 24% of cases diagnosed as melanoma and in 1% of cases with a benign diagnosis. The overall concordance of the TPM status with the final diagnosis was 86%. The TPM status had the greatest concordance (95%) with the final diagnosis in the atypical DPN versus melanoma group, with the rest of the groups ranging between 50% and 88%. Overall, our results suggest that TPMs are most useful in the differential diagnosis of atypical DPN versus melanoma. It also has some value in the differential diagnosis of atypical Spitz tumor versus melanoma and dysplastic nevus versus melanoma, whereas in our cohort, it did not contribute meaningfully to differentiating malignant blue nevus and atypical blue nevus.
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Affiliation(s)
- Anastasiya Boutko
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Sepideh Asadbeigi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Andrew Roth
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - David Dittmann
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
| | - David Dittmann
- Department of Molecular Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Lawrence Jennings
- Department of Molecular Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL; and
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22
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Shi K, Zhang B, Kong BY, Zhang Y, Igartua C, Mohan LS, Quan VL, Panah E, Isales MC, Beaubier N, Taxter TJ, White KP, Zou L, Gerami P. Distinct genomic features in a retrospective cohort of mucosal, acral, and vulvovaginal melanomas. J Am Acad Dermatol 2023; 88:1051-1059. [PMID: 31306728 DOI: 10.1016/j.jaad.2019.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [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: 04/08/2019] [Revised: 06/21/2019] [Accepted: 07/03/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compared with sun-exposed melanomas, less is known regarding the pathogenesis of sun-protected melanomas. Sun-protected melanomas share many epidemiologic factors, but their genetic heterogeneity is not well studied. OBJECTIVE We investigated the genomic profile of acral, mucosal, and vulvovaginal melanomas. We hypothesize that mucosal melanomas, recognized for their uniquely aggressive clinical behavior, have distinct genomic features. METHODS We performed whole transcriptome messenger RNA and DNA (1711 genes) sequencing, messenger RNA expression profiling, tumor mutational burden, ultraviolet signature, and copy number variants analysis on 29 volar/digital acral, 7 mucosal, and 6 vulvovaginal melanomas. RESULTS There was significant genetic heterogeneity, particularly in acral melanomas, with 36% having BRAF alterations, whereas other melanomas had none (P = .0159). Nonzero ultraviolet signatures were more frequent in acral melanomas, suggesting greater ultraviolet involvement. Mucosal melanomas formed a distinct group with increased expression of cell cycle and proliferation genes. Various targetable aberrations were identified, such as AURKA and ERBB2, in mucosal and acral melanomas, respectively. LIMITATIONS The sample size was a small. CONCLUSION There is significant genetic heterogeneity among sun-protected melanomas. Mucosal melanomas have upregulation in cell cycle and proliferation genes, which may explain their aggressive behavior. Ultraviolet radiation plays some role in a subset of acral but not other melanomas.
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Affiliation(s)
- Katherine Shi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Betty Y Kong
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yongzhan Zhang
- Department of Chemical and Biological Engineering, McCormick School of Engineering, Northwestern University, Evanston, Illinois
| | | | - Lauren S Mohan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor L Quan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elnaz Panah
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Maria Cristina Isales
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | | | - Lihua Zou
- Department of Biochemistry and Molecular Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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23
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Roth A, Boutko A, Lampley N, Olivares S, Gerami P. Indoor tanning is associated with an increased risk of multiple primary melanomas: A case-control study. J Am Acad Dermatol 2023; 88:867-868. [PMID: 36400324 DOI: 10.1016/j.jaad.2022.09.038] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/09/2022] [Accepted: 09/17/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Andrew Roth
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anastasiya Boutko
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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24
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Lezcano C, Berwick M, Luo L, Barnhill R, Duncan LM, Gerami P, Lowe L, Messina JL, Scolyer RA, Wood B, Yeh I, Zembowicz A, Busam KJ. Interobserver agreement in the histopathological classification of desmoplastic melanomas. Pathology 2023; 55:223-226. [PMID: 36653238 PMCID: PMC9974895 DOI: 10.1016/j.pathol.2022.12.347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 01/03/2023]
Abstract
Desmoplastic melanoma is a subtype of melanoma characterised by amelanotic fusiform melanocytes dispersed in a collagenous stroma. Cell-poor and fibrous stroma-rich 'pure' variants have been distinguished from 'mixed' variants with areas of higher cell density and/or less desmoplastic stroma. This distinction is relevant because patients whose tumours display a pure phenotype have a lower risk for regional lymph node metastasis and distant recurrence. However, little is known about interobserver agreement among pathologists in the subclassification of desmoplastic melanoma. To address this issue, we conducted a study in which eleven dermatopathologists independently evaluated whole slide scanned images of excisions from 30 desmoplastic melanomas. The participating pathologists were asked to classify the tumours as pure or mixed. They were also asked to record the presence or absence of neurotropism and angiotropism. We found substantial interobserver agreement between the 11 dermatopathologists in the classification of tumours as pure versus mixed desmoplastic melanoma (kappa=0.64; p<0.0001). There was fair agreement between the 11 dermatopathologists in the evaluation of presence versus absence of neurotropism (kappa=0.26; p<0.0001), and slight agreement in the assessment of angiotropism (kappa=0.13; p<0.0001). The level of concordance in the subclassification of desmoplastic melanomas is encouraging for the acceptance of this prognostic parameter in the real-world practice of melanoma pathology.
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Affiliation(s)
- Cecilia Lezcano
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA.
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Li Luo
- Department of Internal Medicine, University of New Mexico Comprehensive Cancer Center, University of New Mexico, Albuquerque, NM, USA
| | - Raymond Barnhill
- Department of Translational Research, Institut Curie, Université de Paris UFR de Médecine, Paris, France
| | - Lyn M Duncan
- Pathology Service, Dermatopathology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lori Lowe
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Benjamin Wood
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, WA, Australia
| | - Iwei Yeh
- Departments of Dermatology and Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Artur Zembowicz
- Dermatopathology Consultations LLC, Lahey Clinic and Tufts Medical School, Boston, MA, USA
| | - Klaus J Busam
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer, New York, NY, USA
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25
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Roth A, Boutko A, Lampley N, Dhillon S, Hagstrom M, Olivares S, Dittman D, Jennings L, Santana Dos Santos L, Busam K, Gerami P. Next-generation Sequencing as a Potential Diagnostic Adjunct in Distinguishing Between Desmoplastic Melanocytic Neoplasms. Am J Surg Pathol 2023; 47:318-325. [PMID: 36383901 DOI: 10.1097/pas.0000000000001999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Desmoplastic melanomas (DMs) are often challenging to diagnose and ancillary tests, such as immunohistochemistry, have limitations. One challenge is distinguishing DM from benign desmoplastic melanocytic neoplasms. In this study, we explored the utility of next-generation sequencing data in the diagnosis of DMs versus desmoplastic Spitz nevi (DSN) and desmoplastic nevi (DN). We sequenced 47 cases and retrieved 12 additional previously sequenced clinical cases from our dermatopathology database. The 59 total cases were comprised of 21 DMs, 25 DSN, and 13 DN. The DMs had the highest tumor mutation burden at 22 mutations/megabase (m/Mb) versus the DSN (6 m/Mb) and DN (8 m/Mb). Truncating mutations in NF1 resulting in a loss-of-function were exclusive to the DM cohort, identified in 8/21 (38%) cases. Importantly, missense mutations in NF1 were nonspecific and seen with similar frequency in the different cohorts. Other mutations exclusive to the DMs included truncating mutations in TP53 , CDKN2A , and ARID2 . Among the DSN, 17/25 (68%) had an HRAS mutation or receptor tyrosine kinase fusion consistent with other Spitz tumors. Two cases in the DN cohort had missense mutations in BRAF without additional progression mutations and 2 other cases had mutations in GNAQ , supporting a diagnosis of a sclerosing blue nevus. The remainder of the DN had nonspecific mutations in various signaling pathways with few progression mutations. Overall, our study provides preliminary data that next-generation sequencing data may have the potential to serve as an ancillary diagnostic tool to help differentiate malignant and benign desmoplastic melanocytic neoplasms.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Klaus Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Pedram Gerami
- Departments of Dermatology
- Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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26
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Hagstrom M, Fumero-Velázquez M, Dhillon S, Olivares S, Gerami P. An update on genomic aberrations in Spitz naevi and tumours. Pathology 2023; 55:196-205. [PMID: 36631338 DOI: 10.1016/j.pathol.2022.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/30/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Spitz neoplasms continue to be a diagnostic challenge for dermatopathologists and are defined by distinctive morphological and genetic features. With the recent advancements in genomic sequencing, the classification, diagnosis, and prognostication of these tumours have greatly improved. Several subtypes of Spitz neoplasms have been identified based on their specific genomic aberrations, which often correlate with distinctive morphologies and biological behaviour. These genetic driver events can be classified into four major groups, including: (1) mutations [HRAS mutations (with or without 11p amplification) and 6q23 deletions]; (2) tyrosine kinase fusions (ROS1, ALK, NTRK1-3, MET and RET); (3) serine/threonine kinase fusions and mutations (BRAF, MAP3K8, and MAP2K1); and (4) other rare genomic aberrations. These driver genomic events are hypothesised to enable the initial proliferation of melanocytes and are often accompanied by additional genomic aberrations that affect biological behaviour. The discovery of theses genomic fusions has allowed for a more objective definition of a Spitz neoplasm. Further studies have shown that the majority of morphologically Spitzoid appearing melanocytic neoplasms with aggressive behaviour are in fact BRAF or NRAS mutated tumours mimicking Spitz. Truly malignant fusion driven Spitz neoplasms may occur but are relatively uncommon, and biomarkers such as homozygous 9p21 (CDKN2A) deletions or TERT-p mutations can have some prognostic value in such cases. In this review, we discuss the importance and various methods of identifying Spitz associated genomic fusions to help provide more definitive classification. We also discuss characteristic features of the various fusion subtypes as well as prognostic biomarkers.
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Affiliation(s)
- Michael Hagstrom
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mónica Fumero-Velázquez
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Soneet Dhillon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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27
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Barnhill RL, Elder DE, Piepkorn MW, Knezevich SR, Reisch LM, Eguchi MM, Bastian BC, Blokx W, Bosenberg M, Busam KJ, Carr R, Cochran A, Cook MG, Duncan LM, Elenitsas R, de la Fouchardière A, Gerami P, Johansson I, Ko J, Landman G, Lazar AJ, Lowe L, Massi D, Messina J, Mihic-Probst D, Parker DC, Schmidt B, Shea CR, Scolyer RA, Tetzlaff M, Xu X, Yeh I, Zembowicz A, Elmore JG. Revision of the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis Classification Schema for Melanocytic Lesions: A Consensus Statement. JAMA Netw Open 2023; 6:e2250613. [PMID: 36630138 PMCID: PMC10375511 DOI: 10.1001/jamanetworkopen.2022.50613] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE A standardized pathology classification system for melanocytic lesions is needed to aid both pathologists and clinicians in cataloging currently existing diverse terminologies and in the diagnosis and treatment of patients. The Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx) has been developed for this purpose. OBJECTIVE To revise the MPATH-Dx version 1.0 classification tool, using feedback from dermatopathologists participating in the National Institutes of Health-funded Reducing Errors in Melanocytic Interpretations (REMI) Study and from members of the International Melanoma Pathology Study Group (IMPSG). EVIDENCE REVIEW Practicing dermatopathologists recruited from 40 US states participated in the 2-year REMI study and provided feedback on the MPATH-Dx version 1.0 tool. Independently, member dermatopathologists participating in an IMPSG workshop dedicated to the MPATH-Dx schema provided additional input for refining the MPATH-Dx tool. A reference panel of 3 dermatopathologists, the original authors of the MPATH-Dx version 1.0 tool, integrated all feedback into an updated and refined MPATH-Dx version 2.0. FINDINGS The new MPATH-Dx version 2.0 schema simplifies the original 5-class hierarchy into 4 classes to improve diagnostic concordance and to provide more explicit guidance in the treatment of patients. This new version also has clearly defined histopathological criteria for classification of classes I and II lesions; has specific provisions for the most frequently encountered low-cumulative sun damage pathway of melanoma progression, as well as other, less common World Health Organization pathways to melanoma; provides guidance for classifying intermediate class II tumors vs melanoma; and recognizes a subset of pT1a melanomas with very low risk and possible eventual reclassification as neoplasms lacking criteria for melanoma. CONCLUSIONS AND RELEVANCE The implementation of the newly revised MPATH-Dx version 2.0 schema into clinical practice is anticipated to provide a robust tool and adjunct for standardized diagnostic reporting of melanocytic lesions and management of patients to the benefit of both health care practitioners and patients.
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Affiliation(s)
- Raymond L Barnhill
- Department of Translational Research, Institut Curie, Unit of Formation and Research of Medicine University of Paris, Paris, France
| | - David E Elder
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Michael W Piepkorn
- Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle
- Dermatopathology Northwest, Bellevue, Washington
| | | | - Lisa M Reisch
- Department of Biostatistics, University of Washington School of Medicine, Seattle
| | - Megan M Eguchi
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Boris C Bastian
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Willeke Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcus Bosenberg
- Departments of Dermatology, Pathology, and Immunobiology, Yale School of Medicine, New Haven, Connecticut
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard Carr
- Cellular Pathology, South Warwickshire NHS Trust, Warwick, United Kingdom
| | - Alistair Cochran
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Martin G Cook
- Department of Histopathology, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Lyn M Duncan
- Pathology Service, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rosalie Elenitsas
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Arnaud de la Fouchardière
- Department of Biopathology, Centre Léon Bérard, Lyon, France
- University of Lyon, Université Claude Bernard Lyon 1, National Center for Scientific Research, Mixed Research Unit 5286, National Institute of Health and Medical Research U1052, Cancer Research Centre of Lyon, Lyon, France
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Iva Johansson
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jennifer Ko
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Gilles Landman
- Department of Pathology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alexander J Lazar
- Departments of Pathology, Dermatology, and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Lori Lowe
- Departments of Pathology and Dermatology, University of Michigan, Ann Arbor
| | - Daniela Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Jane Messina
- Departments of Pathology and Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Douglas C Parker
- Departments of Pathology and Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Birgitta Schmidt
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher R Shea
- Department of Dermatology, University of Chicago Medicine, Chicago, Illinois
| | - Richard A Scolyer
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Michael Tetzlaff
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Iwei Yeh
- Departments of Pathology and Dermatology, University of California, San Francisco
| | - Artur Zembowicz
- Tufts University, Boston, Massachusetts
- Lahey Clinic, Burlington, Massachusetts
- Dermatopathology Consultations, Needham, Massachusetts
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
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Roy SF, Gerami P, Busam KJ. Malignant melanoma test results by a commercial 35-gene expression test are enriched for benign or atypical Spitz tumors. J Cutan Pathol 2022; 49:1009-1011. [PMID: 35949056 DOI: 10.1111/cup.14312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/28/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Simon F Roy
- Département de Pathologie et Biologie Cellulaire, Université de Montréal, Montréal, Quebec, Canada
| | - Pedram Gerami
- Department of Dermatology, Pathology and Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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29
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Daftary K, Fiessinger L, Gerami P, Nardone B, Liszewski W. Differences in the demographics, incidence, and survival of palmar and plantar acral melanoma: a population-based study. Arch Dermatol Res 2022; 315:957-961. [PMID: 36418602 DOI: 10.1007/s00403-022-02445-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
Acral melanoma (AM) has the worst prognosis of all cutaneous malignant melanomas (CMM). Differences between palmar and plantar tumors have not been well characterized at the population level. The objective of this study was to investigate the differences in demographics, incidence, and survival between palmar and plantar AM. The 2004-2016 National Cancer Database (NCDB) and 2000-2018 Surveillance, Epidemiology, and Results (SEER) databases were used to evaluate differences between palmar and plantar AM. Data were analyzed using Chi-square test, Fisher's exact, T-test, or likelihood ratio test. A total of 5002 participants were included in the study. A greater percentage of tumors occurred on the plantar surface (82.0%) than the palmar surface (18.0%). The incidence of plantar tumors is four times greater than palmar tumors (1.7 vs 0.4 cases per 1,000,000 people per year). Palmar melanomas were more likely to occur in Whites (84.6% vs 76.8%, p < 0.001) and be treated with amputation (28.1% vs 12.9%, p < 0.001) compared to plantar melanomas. Disease-specific five-year survival was similar for all palmar (80.8%) and plantar tumors (78.2%). While subtle differences do exist between palmar and plantar tumors, they behave similarly overall and should be treated as one entity.
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Affiliation(s)
- Karishma Daftary
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60610, USA
| | - Lori Fiessinger
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60610, USA
| | - Beatrice Nardone
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60610, USA
| | - Walter Liszewski
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 1600, Chicago, IL, 60610, USA.
- Department of Preventative Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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30
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Roth A, Lampley N, Boutko A, Zhao J, Benton S, Olivares S, Zembowicz A, Gerami P. Next-generation sequencing improves agreement and accuracy in the diagnosis of Spitz and spitzoid melanocytic lesions. J Cutan Pathol 2022; 49:868-874. [PMID: 35793166 PMCID: PMC9796257 DOI: 10.1111/cup.14291] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Spitzoid melanocytic neoplasms can be challenging to diagnose on histopathology alone. Next-generation sequencing (NGS) offers promise as a valuable aid in the diagnosis. Recently, one study reported increased inter-rater agreement in the diagnosis of spitzoid melanocytic neoplasms among 20 expert melanoma pathologists after incorporating NGS data. We hypothesized that NGS would carry a similar utility in a broader group of dermatopathologists and general pathologists. METHODS Sixty-three participants of a live online (www.Dermpedia.org) CME course rendered a diagnosis on 70 cases composed of melanocytic neoplasms with spitzoid features. In Survey 1, cases included H&E slides and demographic information only, while Survey 2 included NGS data. RESULTS With NGS information, inter-rater agreement significantly improved from "fair" to "almost perfect" and from "fair" to "substantial" for categorizing lesions as Spitz versus non-Spitz and conventional melanoma versus not, respectively. There was also an increase in diagnostic accuracy, evidenced by improved recognition of three metastatic tumors as being conventional melanomas. CONCLUSION The study supports the adoption of NGS as a valuable diagnostic adjunct for both expert and broader dermatopathologists in their assessments of spitzoid neoplasms.
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Affiliation(s)
- Andrew Roth
- Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Anastasiya Boutko
- Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Sarah Benton
- Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Artur Zembowicz
- Department of Pathology and Laboratory MedicineTufts Medical SchoolBostonMassachusettsUSA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA,Robert H. Lurie Cancer Center, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
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Gerami P, Benton S, Zhao J, Zhang B, Lampley N, Roth A, Boutko A, Olivares S, Busam KJ. PRAME Expression Correlates With Genomic Aberration and Malignant Diagnosis of Spitzoid Melanocytic Neoplasms. Am J Dermatopathol 2022; 44:575-580. [PMID: 35503885 PMCID: PMC11010723 DOI: 10.1097/dad.0000000000002208] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Spitzoid melanocytic neoplasms are a diagnostically challenging class of lesions in dermatopathology. Recently, molecular assays and immunohistochemical markers have been explored as ancillary methods to assist in the diagnostic workup. Specifically, preferentially expressed antigen in melanoma (PRAME) immunohistochemistry is a nuclear stain commonly positive in melanomas, but not in nevi. This study investigates PRAME immunoreactivity (≥75% positive nuclear staining in tumor cells) in a set of 59 spitzoid melanocytic neoplasms with known clinical outcomes. We compared PRAME status with (1) the clinical outcomes, (2) the morphologic diagnoses, and (3) the status of TERT promoter mutation. Regarding clinical outcomes, 3 cases developed metastatic disease, of which 2 expressed diffusely positive PRAME staining. Of the 56 cases that did not show evidence of metastasis, 6 expressed diffusely positive PRAME staining. Morphologically, diffusely positive PRAME staining was seen in 7 of 21 cases (33.3%) diagnosed as melanoma and only 1 benign tumor 1 of 38 (2.6%). There were 4 of 8 cases with a TERT promoter mutation which were diffusely PRAME-positive compared with 4 of 51 cases without TERT promoter mutation ( P = 0.001). Our results show a statistically significant correlation between PRAME expression and the diagnosis, outcome, and TERT promoter mutation status of atypical spitzoid melanocytic neoplasms, suggesting immunohistochemistry for PRAME can help support a suspected diagnosis. However, because of occasional false-positive and negative test results, correlation with the clinical and histologic findings as well as results from other tests is needed for the interpretation of diagnostically challenging spitzoid melanocytic neoplasms.
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Affiliation(s)
- Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Nathaniel Lampley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Andrew Roth
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anastasiya Boutko
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shantel Olivares
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Klaus J Busam
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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32
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Vest BE, Harview CL, Liu V, Swick BL, Berrebi KG, Olivares S, Stone MS, Sargen MR, Gerami P. Cutaneous melanocytic tumor with CRTC1::TRIM11 fusion and prominent epidermal involvement: A case report. J Cutan Pathol 2022; 49:1025-1030. [PMID: 35751643 PMCID: PMC10086857 DOI: 10.1111/cup.14287] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/13/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022]
Abstract
Cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMCT) is a recently described entity with only 13 cases reported in the literature. Histopathologically, the neoplasm consists of atypical epithelioid to spindled cells that form a well-circumscribed nodule confined to the dermis and subcutis with cytological features including large vesicular nuclei with prominent nucleoli and abundant eosinophilic cytoplasm. Immunohistochemistry shows variable expressivity of melanocytic markers. Currently, there is limited data regarding long-term outcomes of this newly described entity. Most cases have done well, but there is one case reported with an adverse event. Hence, further studies are needed to accurately classify this tumor. Definitive diagnosis is made by laboratory evidence of CRTC1::TRIM11 fusion. Herein, we report the first case of CMCT with epidermal involvement in the youngest patient known to be affected to date.
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Affiliation(s)
- Blake E Vest
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Christina L Harview
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Vincent Liu
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Brian L Swick
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kristen G Berrebi
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Shantel Olivares
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Mary S Stone
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Michael R Sargen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Burks HE, Arnette C, Koetsier J, Broussard J, Roth-Carter Q, Gerami P, Johnson J, Green K. Abstract 3186: Keratinocyte desmosomal cadherin Desmoglein 1 as a mediator and target of paracrine signaling in the melanoma niche. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-3186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Melanoma is an aggressive cancer arising from the transformation of melanocytes residing in the basal layer of the epidermis, where they are in direct contact with surrounding keratinocytes. The role of keratinocytes in shaping the melanoma tumor microenvironment, however, remains understudied. We previously showed that the keratinocyte-specific desmosomal cadherin, desmoglein 1 (Dsg1) is reduced in response to acute UV exposure. Here, we show that Dsg1 protein is reduced in keratinocytes surrounding melanoma lesions but is unchanged in keratinocytes adjacent to benign nevi. As Dsg1 reduction by UV exposure is transient, we hypothesized that the persistent loss of Dsg1 observed in the melanoma tumor niche is due to melanoma-keratinocyte paracrine crosstalk. To address this idea, keratinocytes were cultured in conditioned media from melanocytes or melanoma cells. Melanoma conditioned media reduced keratinocyte Dsg1 mRNA and protein levels, suggesting that Dsg1 downregulation in keratinocytes is maintained by melanoma cells post-transformation. Keratinocytes in melanoma conditioned media exhibited reduced Grhl1 (Grainyhead like 1), a transcriptional activator of Dsg1, and increased Snai2, a repressor of Grhl1 expression and epidermal differentiation. These data support the idea that increased Snai2 stimulated by factors secreted by melanoma cells reduces keratinocyte Dsg1 mRNA expression by repressing Grhl1. To determine the impact of keratinocyte Dsg1 loss on melanoma cell behavior, melanoma cells were grown in conditioned media from control or Dsg1-deficient keratinocytes. Melanoma cell migration increased in a trans-well assay when melanoma cells were grown in conditioned media from Dsg1-deficient keratinocytes compared to from control keratinocytes. Supporting the in vivo importance of this finding, we found a significant, negative correlation between keratinocyte Dsg1 expression and melanoma cell movement within the melanoma tumor niche in patient samples. Downregulation of keratinocyte Dsg1 by melanoma cell conditioned media increased Erk1/2 signaling upstream of pro-migratory CXCL1 production, while pharmacological inhibition of keratinocyte Erk1/2 abrogated this effect. Furthermore, inhibition of the CXCL1 receptor, CXCR2 on melanoma cells decreased migration in melanoma cells grown in Dsg1-depleted keratinocyte conditioned media. Together, these data support the idea that paracrine crosstalk between melanoma cells and keratinocytes resulting in chronic keratinocyte Dsg1 reduction is important for melanoma progression and melanoma cell movement in the early stages of metastasis.
Citation Format: Hope E. Burks, Christopher Arnette, Jennifer Koetsier, Joshua Broussard, Quinn Roth-Carter, Pedram Gerami, Jodi Johnson, Kathleen Green. Keratinocyte desmosomal cadherin Desmoglein 1 as a mediator and target of paracrine signaling in the melanoma niche [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3186.
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Affiliation(s)
| | | | | | | | | | - Pedram Gerami
- 2Northwestern University, Lurie Comprehensive Cancer Center, Chicago, IL
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34
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Zhao J, Benton S, Zhang B, Olivares S, Asadbeigi S, Busam K, Gerami P. Benign and Intermediate-grade Melanocytic Tumors With BRAF Mutations and Spitzoid Morphology: A Subset of Melanocytic Neoplasms Distinct From Melanoma. Am J Surg Pathol 2022; 46:476-485. [PMID: 34753863 DOI: 10.1097/pas.0000000000001831] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The current classification of Spitz neoplasms in the World Health Organization (WHO), Fourth Edition defines Spitz neoplasms as melanocytic proliferations with characteristic Spitz morphology and a Spitz-associated genomic fusion or HRAS mutation. In contrast, melanocytic neoplasms with BRAF mutations are considered typical of common acquired nevi, dysplastic nevi, and melanomas from intermittent sun-damaged skin. However, increased utilization of ancillary testing methods such as BRAFV600E immunohistochemistry and sequencing studies have made apparent a subgroup of benign-grade and intermediate-grade melanocytic neoplasms with Spitzoid morphology that harbor BRAFV600E mutations. We refer to these cases as BRAF mutated and morphologically Spitzoid (BAMS) nevi and tumors. Two experienced dermatopathologists reviewed a series of 36 BAMS nevi/tumors. Cases in which a diagnosis of melanoma was favored were excluded. The histomorphologic, clinical, and molecular findings were assessed by immunohistochemistry, fluorescence in situ hybridization, and next-generation sequencing using validated gene panels. Characteristics of BAMS nevi/tumors were compared with a control set of Spitz tumors with previously reported fusion proteins. BAMS nevi/tumors had a decreased proportion of Kamino bodies (P=0.03) and a higher proportion of cytoplasmic pigmentation (P<0.00001). There were no differences in other morphologic features such as the silhouette, epidermal hyperplasia, pagetosis, and cytologic atypia compared with fusion-induced Spitz tumors. In 6/17 cases where next-generation sequencing studies were available, recurrent mutations in the KMT gene family were seen. This was higher than the proportion of such mutations seen in fusion Spitz tumors and lower than the frequency in cutaneous melanoma.
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Affiliation(s)
| | | | | | | | | | - Klaus Busam
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Pedram Gerami
- Department of Dermatology
- Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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35
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Benton S, Roth A, Khan AU, Zhao J, Kim D, Compres EV, Wagner AM, Kruse LL, Zhang B, Gerami P. Risk factors for the development of Spitz neoplasms. Pediatr Dermatol 2022; 39:220-225. [PMID: 35187702 PMCID: PMC9306590 DOI: 10.1111/pde.14957] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 01/28/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES The principal environmental risk factor for conventional nevi and melanomas is ultraviolet exposure. However, little is known about genetic or environmental risk factors for developing Spitz tumors. This study investigates risk factors associated with Spitz neoplasms. METHODS Patients with Spitz tumors seen at Northwestern Memorial Hospital and Lurie Children's Hospital were surveyed with a 16-item questionnaire about environmental and inherited factors. Spitz tumor patients were compared to a pediatric control cohort from a similar clinical setting. This was supplemented with a meta-analysis of genetic and environmental causes of Spitz neoplasms. RESULTS One hundred and six Spitz and 58 control surveys were obtained and no statistically significant differences in genetic or environmental risk factors were found between Spitz and control groups. CONCLUSION Our data and meta-analysis suggest that typical risk factors associated with melanoma are not significantly associated with Spitz tumors. Identification of relevant genetic or environmental risk factors will likely require larger and population-based studies.
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Affiliation(s)
- Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Andrew Roth
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ayesha U Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elsy V Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Annette M Wagner
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Lacey L Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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36
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Labadie JG, Compres E, Sunshine JC, Alam M, Gerami P, Harikumar V, Poon E, Arndt KA, Dover JS. Actinic Keratosis Color and Its Associations: A Retrospective Photographic, Dermoscopic, and Histologic Evaluation. Dermatol Surg 2022; 48:57-60. [PMID: 34812188 DOI: 10.1097/dss.0000000000003281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Actinic keratoses (AKs) have been described with varying color and morphology; however, no reports have demonstrated associations between color, vasculature, and inflammation. In this retrospective study, we analyze the clinical, dermoscopic, and histopathologic features of AKs to elucidate this relationship. METHODS A retrospective search for patients diagnosed with AK between January 2018 and October 2019 was performed. Clinical and dermoscopic photographs and pathology slides for all included subjects were reviewed. RESULTS Forty-nine images and histopathology slides were analyzed. Dermoscopy of white AKs demonstrated scale and absence of erythema with corresponding absence of inflammation on histopathology. Dermoscopy of brown AKs revealed pseudonetwork, absent scale, and a variable vessel pattern with pigment incontinence and absence of inflammation on histopathology. Red AKs had a distinct polymorphous vessel pattern and presence of erythema on dermoscopy. On histopathology, about half of samples showed increased vascularity and variable inflammation. Pink AK dermoscopy revealed a presence of erythema with corresponding presence of inflammation on histopathology. CONCLUSION This report adds to our understanding of AKs and confirms that, in general, the pinker or redder the AK, the more prominent the inflammatory infiltrate and vasculature, respectively. Dermatologists should continue to use their diagnostic skills to successfully diagnose and triage AKs.
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Affiliation(s)
- Jessica G Labadie
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elsy Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Joel C Sunshine
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Dermatopathology, Northwestern University, Chicago, Illinois
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Dermatopathology, Northwestern University, Chicago, Illinois
| | - Vishnu Harikumar
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kenneth A Arndt
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jeffrey S Dover
- SkinCare Physicians, Chestnut Hill, Massachusetts
- Yale University School of Medicine, New Haven, Connecticut
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Yousif R, Boull C, Gerami P, Nardone B, Vivar KL, Liszewski W. THE demographics and trends in pediatric melanoma in the United States: An analysis of the National Cancer Database. Pediatr Dermatol 2021; 38:1191-1197. [PMID: 34250622 DOI: 10.1111/pde.14672] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/04/2021] [Accepted: 05/23/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND/OBJECTIVE Relative to adults, rates of melanoma are lower in children. Due to its rarity, it is difficult to assess the incidence, trends, and outcomes of this malignancy. Much of our understanding comes from single institution or regional cancer registries which may not be large enough to detect subtleties in the burden of pediatric melanoma. METHODS Data from the 2004 to 2016 National Cancer Database were analyzed; this database captures approximately 70% of all cancer diagnoses in the United States. RESULTS Our analysis consisted of 1903 cases. A majority were White (89.8%), the mean age was 12.4 years, and the ratio of females: males was 1.2:1.0. The most common anatomic location was the trunk (31.1%). Between 2004 and 2016, a decreasing trend in the number of new melanoma cases was observed. Comparing histologic subtype by age, there was an increased percentage of nodular and epithelioid and spindle cell tumors in the pre-teen children and a greater percentage of superficial spreading tumors in teenagers. Overall, a majority of cases were stage 0 or I (56.9%), with relatively few stage IV cases (2.0%). A 5-year all-cause survival of greater than 90% was observed for stage I-III tumors, with stage IV tumors having a 5-year all-cause survival of 34.4%. CONCLUSION Comparable to previous studies, pediatric melanoma occurred most often in Whites, females, and adolescents. However, we detected a decreasing trend in new cases, noted differences between histologic subtype and age, and observed a 5-year all-cause survival rate of greater than 90% for stage I-III tumors.
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Affiliation(s)
- Rame Yousif
- University of Toledo College of Medicine, Toledo, OH, USA
| | - Christina Boull
- Department of Dermatology, Division of Pediatric Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Dermatopathology, Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Beatrice Nardone
- Department of Dermatology, Northwestern University, Chicago, IL, USA
| | - Karina L Vivar
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Pediatric Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, IL, USA.,Division of Cancer Epidemiology and Prevention, Department of Preventative Medicine, Northwestern University, Chicago, IL, USA
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38
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See SHC, Tan TL, Kurtzer TA, Gerami P, Guitart J, Yazdan P. Vulvar Elastosis: A Novel Diagnostic Entity. Am J Dermatopathol 2021; 43:418-422. [PMID: 33298708 DOI: 10.1097/dad.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In vulvar biopsies, we have observed histopathologic abnormalities of elastic fibers identical to solar elastosis, with thick, curled, and irregular pale grey fibers in the dermis. In severe cases, changes resemble nodular solar elastosis. We retrospectively evaluated 238 vulvar biopsies with the goal of defining and characterizing changes of vulvar elastosis. Of 238 vulvar biopsies reviewed, 107 (45%) exhibited vulvar elastosis. Patients with vulvar elastosis were older (mean = 65 years old) compared to those without (mean = 44 years old). Sixty-six (62%) were graded as mild, 27 (25%) moderate, and 14 (13%) severe. Vulvar elastosis was significantly more common in women ≥45 years old (P-value < 0.001). There was moderate correlation between age and severity (correlation coefficient = 0.55, P-value < 0.001). Vulvar elastosis was observed in a variety of inflammatory and non-inflammatory pathologies. In 5 cases, the sole pathology was vulvar elastosis presenting clinically as either a pruritic or painful white to white-yellow papule or plaque, or vulvar pain or burning without a clinical lesion. Vulvar elastosis is a novel diagnostic entity occurring in a sun-protected site and its pathogenesis may be a degenerative phenomenon possibly related to advancing age and/or hormonal changes.
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Affiliation(s)
- Sharlene Helene C See
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Timothy L Tan
- Department of Dermatology, Division of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, IL; and
| | - Traci A Kurtzer
- Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, IL
| | - Pedram Gerami
- Department of Dermatology, Division of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, IL; and
| | - Joan Guitart
- Department of Dermatology, Division of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, IL; and
| | - Pedram Yazdan
- Department of Dermatology, Division of Dermatopathology, Northwestern University Feinberg School of Medicine, Chicago, IL; and
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Burks H, Arnette C, Koetsier J, Broussard J, Roth-Carter Q, Gerami P, Johnson J, Green K. 532 Keratinocyte desmoglein 1 as a target and mediator of paracrine signaling in the melanoma niche. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Pigmented epithelioid melanocytoma (PEM) was originally described based on keen morphologic analysis identifying a group of melanocytic tumors sharing heavily pigmented epithelioid melanocytes. It is defined as heavily pigmented epithelioid, spindled, and dendritic melanocytes with characteristic vesicular nuclei, prominent nucleoli, and melanophages. PEM often involves regional lymph nodes. Recent advances in molecular analysis have allowed for subclassification of PEM into more specific subsets of melanocytic tumors. The most common subsets include PRKCA fusions, which result in pure PEMs with sheets of monomorphic epithelioid melanocytes, and PEMs with combined pattern and mutations in both PRKAR1A and BRAF.
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Affiliation(s)
- Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Sepideh Asadbeigi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 1765, Chicago, IL 60611, USA.
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Kim D, Chu S, Khan AU, Compres EV, Zhang H, Gerami P, Wayne JD. Risk factors and patterns of recurrence after sentinel lymph node biopsy for thin melanoma. Arch Dermatol Res 2021; 314:285-292. [PMID: 33884478 DOI: 10.1007/s00403-021-02229-8] [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: 10/14/2020] [Revised: 03/07/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
While having a thin melanoma (defined as AJCC 8 T1 stage tumor ≤ 1.0 mm) with negative sentinel lymph node biopsy (SLNB) provides an excellent prognosis, some patients still develop recurrence and die. To determine risk factors for any recurrence (local/in-transit, nodal, distant) in thin melanoma patients with negative SLNB and assess survival outcomes. Retrospective review of thin melanomas with negative SLNB from 1999 to 2018 was performed. Two hundred and nine patients were identified. Clinicopathologic characteristics of the primary melanoma were collected. Patterns of recurrence for local/in-transit, nodal or distant recurrence and survival outcomes were analyzed. Eighteen patients (8.6%) developed recurrence: 3 (1.9%) local/in-transit, 4 (2.9%) regional/nodal, and 11 (5.3%) distant recurrence during a median follow-up time of 62 months. A multivariate Cox regression model showed that head and neck site (HR 3.52), ulceration (HR 10.8), and mitotic rate (HR 1.39) were significant risk factors for recurrence. Median time to first recurrence was 49 months. Patients with recurrence had a significantly worse 5 year overall survival than those without recurrence (82.2 vs 99.2%). A retrospective single center study and limited sample size. Did not factor in possible false negative SLNBs when calculating hazard ratios. For thin melanoma patients with negative SLNB, heightened surveillance is warranted for those with ulceration, primary tumor location on the head or neck, and elevated mitotic rate.
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Affiliation(s)
- Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Stanley Chu
- Division of Surgical Oncology, Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes 650, Chicago, IL, 60611, USA
| | - Ayesha U Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elsy V Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Hui Zhang
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jeffrey D Wayne
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Division of Surgical Oncology, Department of Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Arkes 650, Chicago, IL, 60611, USA. .,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Panah E, Tan TL, Yazdan P, Compres E, Khan A, Kim D, Benton S, Zhao J, Gerami P. Parakeratosis and pagetoid melanocytosis in the evaluation of dysplastic nevi and melanoma. Arch Dermatol Res 2021; 314:159-165. [PMID: 33733299 DOI: 10.1007/s00403-021-02203-4] [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: 09/22/2020] [Revised: 01/11/2021] [Accepted: 02/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is our experience that parakeratosis with pagetosis is common in early melanoma when there is no history of trauma in the anatomical site. In lesions where the differential diagnosis includes dysplastic nevus (DN) and melanoma, we hypothesize that parakeratosis may be a marker for cases in which immunohistochemistry (IHC) may identify occult pagetosis. METHODS We performed a retrospective case-control study on cases with a histologic differential diagnosis of DN versus melanoma, including 423 cases with parakeratosis and 125 cases without parakeratosis. IHC staining (Mart-1 and/or Sox-10) was performed in all cases. The frequency of pagetosis and diagnostic upgrades in the cases versus the controls was calculated. RESULTS The presence of parakeratosis was significantly associated with pagetosis (p < 0.0001). Diagnostic upgrades were more frequent in the cases with parakeratosis versus controls without parakeratosis (p = 0.0029). In the favored moderate DN group, 56% of cases were upgraded compared to 30% of the controls (p = 0.0017). In the favored mild DN and severe DN groups, there were more case upgrades compared to the controls (p = 0.1386, p = 0.2738). CONCLUSIONS Parakeratosis may be a useful marker to identify lesions with occult pagetosis for which IHC would be appropriate and may result in a diagnostic upgrade.
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Affiliation(s)
- Elnaz Panah
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Timothy L Tan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Pedram Yazdan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Elsy Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Ayesha Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Sarah Benton
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Jeffrey Zhao
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 1765, Chicago, IL, 60611, USA.
- Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Schwab G, Gerami P, Fiessinger L, Nardone B, Liszewski W. A comparison of the Breslow depth and all-cause survival of male and female genital melanomas. J Am Acad Dermatol 2021; 86:197-199. [PMID: 33516772 DOI: 10.1016/j.jaad.2021.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Gabrielle Schwab
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Lori Fiessinger
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Beatrice Nardone
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Walter Liszewski
- Department of Dermatology, Northwestern University, Chicago, Illinois; Division of Cancer Epidemiology and Prevention, Department of Preventative Medicine, Northwestern University, Chicago, Illinois.
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Kim D, Khan AU, Compres EV, Shi K, Shi - Bin Zhang K, Quan VL, Panah E, Yazdan P, Gerami P. 18715 A retrospective cohort: Genomic differences between pigmented spindle cell nevus of reed and reed-like melanomas. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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45
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Khan AU, Kim D, Compres EV, Shi K, Mohan LS, Wagner A, Kruse L, Zhang B, Gerami P. 15572 Risk factors for Spitz neoplasms. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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Kelm RC, Ali Y, Orrell K, Rangel SM, Kruse L, Wagner AM, Gerami P, West DP, Nardone B. Age and sex differences for malignant melanoma in the pediatric population-childhood versus adolescence: analysis of current nationwide data from the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) program. J Am Acad Dermatol 2020; 84:862-864. [PMID: 33478777 DOI: 10.1016/j.jaad.2020.10.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/06/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ryan C Kelm
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Yasmeen Ali
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Kelsey Orrell
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Stephanie M Rangel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Lacey Kruse
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Annette M Wagner
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois; Department of Pediatrics, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois
| | - Beatrice Nardone
- Department of Dermatology, Feinberg School of Medicine, Northwestern University Chicago, Chicago, Illinois.
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Burks HE, Arnette CR, Koetsier JL, Broussard JA, Ogwo V, Roth-Carter QR, Gerami P, Johnson JL, Green KJ. Abstract PR07: The role of keratinocyte desmoglein 1 in shaping the melanoma tumor niche. Cancer Res 2020. [DOI: 10.1158/1538-7445.mel2019-pr07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Melanoma is an aggressive cancer arising from transformation of melanocytes residing in the basal layer of the epidermis, where they are in direct contact with surrounding keratinocytes. Keratinocytes and melanocytes communicate through both contact and paracrine signaling, a niche called the pigmentary unit. Ultraviolet (UV) radiation-induced melanocyte mutations drive melanoma formation and progression, but the role of keratinocytes and an altered microenvironment in melanomagenesis is understudied. We showed that the keratinocyte-specific desmosomal cadherin, desmoglein 1 (Dsg1), is reduced in response to acute UV exposure. Here, we show that Dsg1 is progressively reduced in regions surrounding human dysplastic nevi, melanoma in situ, and stage I/II melanomas, preceding loss of E-cadherin that occurs in later stages. Since we previously showed that Dsg1 suppresses EGFR/Erk1/2 signaling and regulates keratinocyte cytokine profiles, we hypothesized that altered keratinocyte Dsg1 expression governs melanocyte behavior and transformation through paracrine signaling. Dsg1 knockdown via shRNA elevated phospho-EGFR, phospho-Stat3, phospho-ERK and nuclear NFκB, accompanied by increases in IL-1α, IL-1β, IL-6, and IL-8, and CXCL1 proinflammatory cytokine mRNAs and secretion of IL6, IL8, and CXCL1. Melanocytes grown in conditioned media from Dsg1-deficient keratinocytes increased MITF transcription, while AXL transcript levels remained unchanged, a signature associated with early-stage melanoma. Consistent with increased MITF, melanocytes cultured in conditioned media from Dsg1-depleted keratinocytes increased pigment secretion, reversible by inhibiting the melanocortin 1 receptor. Melanocytes incorporated into Dsg1-deficient 3D human skin equivalents mis-localized to suprabasal layers, similar to pagetoid behavior in early melanoma. This, combined with the loss of keratinocyte Dsg1 surrounding human melanoma lesions, led us to examine mechanisms of sustained Dsg1 loss in the tumor niche. Keratinocytes cultured in melanoma cell-conditioned media reduced Dsg1 expression, suggesting that Dsg1 downregulation is maintained by melanoma cells post-transformation. We postulate that keratinocyte Dsg1 downregulation may initially be part of the skin’s protective response against UV exposure through its role in increasing pigmentation. However, chronic Dsg1 loss may contribute to melanoma initiation and be important for the maintenance of the promelanoma tumor niche.
This abstract is also being presented as Poster A02.
Note: This abstract was not presented at the conference.
Citation Format: Hope E. Burks, Christopher R. Arnette, Jennifer L. Koetsier, Joshua A. Broussard, Valarie Ogwo, Quinn R. Roth-Carter, Pedram Gerami, Jodi L. Johnson, Kathleen J. Green. The role of keratinocyte desmoglein 1 in shaping the melanoma tumor niche [abstract]. In: Proceedings of the AACR Special Conference on Melanoma: From Biology to Target; 2019 Jan 15-18; Houston, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(19 Suppl):Abstract nr PR07.
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Affiliation(s)
- Hope E. Burks
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | | | | | - Valarie Ogwo
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | | | - Pedram Gerami
- Northwestern University, Feinberg School of Medicine, Chicago, IL
| | - Jodi L. Johnson
- Northwestern University, Feinberg School of Medicine, Chicago, IL
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Kim D, Khan AU, Compres EV, Zhang B, Sunshine JC, Quan VL, Gerami P. BRAF fusion Spitz neoplasms; clinical morphological, and genomic findings in six cases. J Cutan Pathol 2020; 47:1132-1142. [PMID: 32776349 DOI: 10.1111/cup.13842] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/10/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Fusions involving the BRAF gene are responsible for 5% of Spitz neoplasms. To better characterize them, we report the clinical, morphological, and genomic findings of six BRAF fusion Spitz tumors. METHODS The morphological, clinical, and molecular findings of six BRAF fusion Spitz neoplasms assessed by next generation sequencing (NGS) were compared to a control set of Spitz without BRAF fusions. RESULTS BRAF fusion Spitz tumors had frequent predominance of epithelioid morphology (4/6 cases), frequent high-grade nuclear atypia and pleomorphism (5/6 cases), and a frequent desmoplastic base (3/6 cases). Five of six cases were diagnosed as atypical Spitz tumor and one as Spitz nevus. All cases had uneventful clinical follow-up. There were five different fusion partners, with CLIP2 being the most frequent. Secondary pathogenic mutations were frequent and chromosomal copy number changes were seen in three of six cases by an NGS platform. CONCLUSIONS BRAF fusions Spitz usually have epithelioid morphology, high-grade nuclear atypia, and desmoplasia. Chromosomal copy number changes are not infrequent. While our cases had uneventful follow-up, a meta-analysis of the literature suggests that among the fusion subtypes associated with Spitz tumors, they are among the subgroups more likely to develop distant metastasis.
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Affiliation(s)
- Daniel Kim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ayesha U Khan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elsy V Compres
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bin Zhang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Joel C Sunshine
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Victor L Quan
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Chappell AG, Doe SC, Worley B, Yoo SS, Gerami P, Alam M, Buck DW, Kim JYS, Wayne JD. Multidisciplinary surgical treatment approach for dermatofibrosarcoma protuberans: an update. Arch Dermatol Res 2020; 313:367-372. [PMID: 32770258 DOI: 10.1007/s00403-020-02124-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/11/2020] [Revised: 07/13/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a cutaneous sarcoma that has remained a challenge for oncologic and reconstructive surgeons due to a high rate of local recurrence. The objective of this study is to investigate the oncologic and reconstructive benefits of employing a multidisciplinary two-step approach to the treatment of DFSP. A retrospective review was conducted using a prospectively collected database of all patients who underwent resection and reconstruction of large DFSPs by a multidisciplinary team, including a Mohs micrographic surgeon, surgical oncologist, dermatopathologist, and plastic and reconstructive surgeon, at one academic institution from 1998-2018. Each patient underwent Mohs micrographic surgery for peripheral margin clearance (Step 1) followed by wide local excision (WLE) of the deep margin by surgical oncology and immediate reconstruction by plastic surgery (Step 2). 57 patients met inclusion criteria. Average defect size after WLE (Step 2): 87.3 cm2 (range 8.5-1073.5 cm2). Mean follow-up time was 37 months (range 0-138 months). There were no cases of recurrence. A two-step multidisciplinary surgical treatment approach for DFSP minimizes risk of recurrence, decreases patient discomfort, and allows immediate reconstruction after deep margin clearance.
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Affiliation(s)
- Ava G Chappell
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Sydney C Doe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Brandon Worley
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Simon S Yoo
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Murad Alam
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA
| | - Donald W Buck
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University- St. Louis School of Medicine, St. Louis, MO, USA
| | - John Y S Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey D Wayne
- Department of Dermatology, Northwestern Feinberg School of Medicine, Arkes Pavilion, Suite 650, 676 N St Clair Street, Chicago, IL, 60611, USA. .,Division of Surgical Oncology, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
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Gerami P, Liszewski W. Risk assessment of outpatient dermatology practice in the setting of the COVID-19 pandemic. J Am Acad Dermatol 2020; 83:1538-1539. [PMID: 32682892 PMCID: PMC7365088 DOI: 10.1016/j.jaad.2020.07.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/07/2020] [Accepted: 07/14/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Walter Liszewski
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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