TET2-mutant undifferentiated pleomorphic sarcoma metastatic to lung and brain.

Sarcomas constitute approximately 1% of adult cancers and 8%-10% of paediatric cancers. Undifferentiated pleomorphic sarcoma (UPS) is a type of soft-tissue sarcoma (STS) characterised by dedifferentiated cancer cells. The most common sites of metastasis for UPS include the lungs, liver, bones and regional lymph nodes. Brain metastasis is rare, affecting only 1%-8% of STS patients. This report presents a unique case of a woman in her 80s with a TET2-mutant UPS metastatic to the lung and brain.

The metabolism of melanin synthesis-From melanocytes to melanoma.

Melanin synthesis involves the successful coordination of metabolic pathways across multiple intracellular compartments including the melanosome, mitochondria, ER/Golgi, and cytoplasm. While pigment production offers a communal protection from UV damage, the process also requires anabolic and redox demands that must be carefully managed by melanocytes. In this report we provide an updated review on melanin metabolism, including recent data leveraging new techniques, and technologies in the field of metabolism. We also discuss the many aspects of melanin synthesis that intersect with metabolic pathways known to impact melanoma phenotypes and behavior. By reviewing the metabolism of melanin synthesis, we hope to highlight outstanding questions and opportunities for future research that could improve patient outcomes in pigmentary and oncologic disease settings.

Clinical Features and Outcomes of Black Patients With Melanoma.

Importance: Melanoma in Black individuals has an annual incidence of approximately 1 in 100 000 people. Most studies of melanoma in Black patients have used population databases, which lack important, precise clinical details. Objective: To identify patient-level and tumor-level characteristics of melanoma in Black patients. Design, Setting, and Participants: This case series included Black patients with melanoma at 2 tertiary care centers (University of Texas Southwestern [UTSW] Medical Center and Parkland Health), affiliated with a single institution, UTSW in Dallas, Texas. Self-reported Black patients with a histopathologic diagnosis of melanoma were identified between January 2006 and October 2022. Main Outcomes and Measures: The main variables were demographics, clinical characteristics, personal and family medical history, immunosuppression history, comorbidities, histopathology reports, molecular/genetic studies, imaging reports, melanoma treatments and responses, time to progression, metastatic sites, and survival rates. Results: A total of 48 Black patients with melanoma (median [range] age at diagnosis, 62 [23-86] years; 30 [63%] female) were included in the study. Of 40 primary cutaneous melanomas, 30 (75%) were located on acral skin, despite only 10 of 30 (33%) being histologically classified as acral lentiginous melanomas. Compared with those with acral disease, patients with nonacral cutaneous melanomas were more likely to be immunocompromised (4 of 10 [40%] vs 2 of 30 [7%]) or have a personal history of cancer (6 of 10 [60%] vs 5 of 30 [17%]), with all 3 patients with superficial spreading melanoma having a history of both. No patients had more than 1 confirmed primary melanoma. Overall, 13 Black patients (27%) with melanoma developed stage IV disease, of whom 12 died because of disease progression. Those diagnosed with advanced acral melanoma, mucosal/ocular melanoma, or melanoma of unknown primary lacked actionable sequence variations, were nonresponsive to immunotherapy, and had the poorest outcomes. No patients with nonacral cutaneous melanomas developed distant metastases or died of melanoma. Conclusions and Relevance: This single-institution case series highlights several features of melanoma in Black patients that have not been captured in existing population-level registries, including precise anatomic sites, immune status, family and personal cancer history, and genetics. Multi-institutional registries would improve understanding of melanoma in Black patients.

COVID-19 and the acceleration toward remote cancer care.

The disruption caused by the COVID-19 pandemic has disproportionately affected cancer patients' access to care. As a result, many specialists in the United States, including oncologists, have adopted telemedicine-a transition largely made possible by reforms to insurer reimbursement schemes. Years after the COVID-19 crisis, there will continue to be a steady demand for remote outpatient visits, particularly in oncology. However, in a health system heavily influenced by reimbursements, strategies to optimize remote oncology care will not be embraced without appropriate incentives. Here we propose that restructuring financial incentives in three areas of cancer care-anticancer drug delivery, wearable health monitoring, and digital data-sharing tools-has the potential to improve patient outcomes, reduce overall costs, and expand clinical trial access for patients in underresourced areas. As with telemedicine, it is time for policymakers to recognize this need and adjust the incentives, both for routine care and for clinical trials, to make it possible.

Multiplex protein detection on circulating tumor cells from liquid biopsies using imaging mass cytometry.

Molecular analysis of circulating and disseminated tumor cells (CTCs/DTCs) has great potential as a means for continuous evaluation of prognosis and treatment efficacy in near-real time through minimally invasive liquid biopsies. To realize this potential, however, methods for molecular analysis of these rare cells must be developed and validated. Here, we describe the integration of imaging mass cytometry (IMC) using metal-labeled antibodies as implemented on the Fluidigm Hyperion Imaging System into the workflow of the previously established High Definition Single Cell Analysis (HD-SCA) assay for liquid biopsies, along with methods for image analysis and signal normalization. Using liquid biopsies from a metastatic prostate cancer case, we demonstrate that IMC can extend the reach of CTC characterization to include dozens of protein biomarkers, with the potential to understand a range of biological properties that could affect therapeutic response, metastasis and immune surveillance when coupled with simultaneous phenotyping of thousands of leukocytes.