Desmoplastic malignant melanoma associated with pigmented ocular tumor: second documented problematic case from the board of “adcrstr-association for dermatohistopathologic control, re-evaluation and subsequent therapeutic recommendations”.

Malignant melanoma is the most malignant skin tumor, whose incidence is rising gradually. It usually occurs in pre-existing lesions in photo-exposed areas of the skin, and, despite its occurrence across a broad age range, its appearance prevails among the elderly. It has a tendency to metastasize rapidly. Secondary lesions are often located on mucous membranes including the conjunctiva, which in turn leads to higher mortality. Despite significant achievements in tumor diagnostics, explicit verification of a possible malignant melanoma is achieved by surgical removal of the lesion and its subsequent detailed histopathology. The prognosis for patients is determined by the stage of the primary tumor, tumor thickness and the presence or absence of additional risk factors, respectively. We present the case of a 39-year old female patient who was diagnosed with malignant melanoma of the left shoulder with a tumor thickness of 1 mm. No further microscopic prognostic criteria were described in the histological report. The lack of additional histopathological criteria in the pathologist’s report, such as mitotic activity and angio-lymphatic invasion from a lesion with this sort of tumor thickness, is followed almost always by risky or inadequate diagnostic and therapeutic decisions that may have fatal consequences for patients. The newly created Association for Dermatohistopathologic Control, Reevaluation and Subsequent Therapeutic Reccomendation in Sofia, Bulgaria aims to focus attention on these errors, in order to promote a unified histopathologic assessment of skin tumors in accordance with generally accepted European and World standards. This should ultimately help the clinician by increasing the efficiency of subsequent diagnostic and therapeutic decisions.

Giant congenital melanocytic nevus localized in the axillary area: serial excisions as optimal treatment option.

Congenital melanocytic nevi are relatively rare lesions (1-6%). Their size and location can cause cosmetic and functional disorders of varying degrees of severity, but in addition they can also undergo transformation to malignant melanoma. Different types of treatments have been described as being effective for these lesions, the choice of the most appropriate method depending on the size and the location of the nevi as well as the patient’s age. While locally destructive methods for superficial treatment could successfully reduce the pigmentation, recurrences are not rare and incomplete elimination of the melanocytic nevus would not exclude the possible development of subsequent malignancy. Surgical excision is the only reliable method allowing for complete removal of the lesion and the provision of material for subsequent histological examination. Complete surgical excision is a good option for prevention of future malignant transformation, but it is not always possible to carry out, especially in the case of large melanocytic nevi. In such cases, serial or staged surgical excisions represent an optimal therapeutic approach with the greatest assurance of total removal of the lesion, even large. We present the case of a female patient with a congenital melanocytic nevus located in the axillary area that had increased significantly in size during her pregnancy. The lesion was successfully treated through a series of surgical excisions with excellent aesthetic results in Onkoderma-Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria.

Dysplastic nevi, melanoma and pregnancy- where is the relationship?

Dysplastic nevus is a precursor and a risk factor for the development of malignant melanoma, which explains the scientific interest in this field. Its etiology includes various of endogenous and exogenous factors, as we are considering the influence of hormonal status on the possible malignancy of congenital nevi in particular. The occurrence of some typical melanocytic lesions such as chloasma during pregnancy, where the hormone effect is demonstrated, as well as the more frequent changes of the dysplastic nevi namely within the pregnancy, leads to the idea for the endocrine dependence of the malignant transformation of some melanocytic lesions. We present a case of 37-year-old female patient whom consulted with the dermatologist due to occurrence of pigmented lesions on her left breast. The lesion changed significantly during both her pregnancies with a pause in growth between them and without any signs of regression after the births. During pregnancy, all pigmented skin lesions should be observed with caution because of the increased risk of malignant transformation. Lesions with any suspected changes are required to be immediately removed surgically with appropriate anaesthesia, without waiting to give birth.

[MALIGNANT MELANOMA--THE INFLUENCE OF HORMONAL FACTORS ON THE PROGRESSION AND PROGNOSIS. COMPARATIVE ANALYSIS BASED ON TWO CLINICAL CASES].

Malignant melanoma is the most aggressive form of skin cancer showing extremely high metastatic rate and leading to high levels of lethality. The continually growing incidence of malignant melanoma in the world and his difficult early diagnosis are the occasion for numerous studies. The individual risk for malignant transformation of melanocytes is determined by a number of etiologic factors--endogenous and exogenous. Ultraviolet radiation has a leading role in the group of exogenous factors. Within the group of endogenous factors, besides the well-known photo type skin, as well as genes mutations, are added and the sex hormones, with their significant prognostic importance. The differences, which are observed in the progression and prognosis of malignant melanoma in pre- and postmenopausal women, and men, have defined this cutaneous neoplasma as hormone-dependent tumor. We present two seemingly similar clinical cases of 52 year old woman and 53-year-old man diagnosed with malignant melanomas, developed on the basis of pigmented lesions located on the upper back, as we attempt a comparative analysis on etiopathogenetic factors led to radically different course and prognosis of the disease in these two patients.

[CONGENITAL MELANOCYTIC NEVUS OF THE SHOULDER WITH RAPID GROWTH PROGRESSION DURING PREGNANCY. SUCCESSFUL SURGICAL APPROACH].

Congenital melanocytic nevi are common subject of scientific debates nowadays, because of their possibility for transformation in malignant melanoma, although relatively rare. The diagnosis is difficult, due to their non-specific clinical and histological presentation, while the therapeutic methods are varied, depending on their size and localization. Surgical excision, however, is the most secure among them, because a complete removal of the lesion could be achieved, which, firstly provides a prevention of a possible malignant transformation, as well as this approach provides material for histological examination. We present a case of a 23-year-old female patient with congenital melanocytic nevus, located on the upper back, which increased significantly its size during her pregnancy, successfully treated by single surgical excision, with excellent aesthetic results.

[MALIGNANT MELANOMA--THE INFLUENCE OF HORMONAL FACTORS ON THE PROGRESSION AND PROGNOSIS. COMPARATIVE ANALYSIS BASED ON TWO CLINICAL CASES].

Malignant melanoma is the most aggressive form of skin cancer showing extremely high metastatic rate and leading to high levels of lethality. The continually growing incidence of malignant melanoma in the world and his difficult early diagnosis are the occasion for numerous studies. The individual risk for malignant transformation of melanocytes is determined by a number of etiologic factors--endogenous and exogenous. Ultraviolet radiation has a leading role in the group of exogenous factors. Within the group of endogenous factors, besides the well-known photo type skin, as well as genes mutations, are added and the sex hormones, with their significant prognostic importance. The differences, which are observed in the progression and prognosis of malignant melanoma in pre- and postmenopausal women, and men, have defined this cutaneous neoplasma as hormone-dependent tumor. We present two seemingly similar clinical cases of 52 year old woman and 53-year-old man diagnosed with malignant melanomas, developed on the basis of pigmented lesions located on the upper back, as we attempt a comparative analysis on etiopathogenetic factors led to radically different course and prognosis of the disease in these two patients.