RESUMEN
BACKGROUND: Acral melanoma is a subtype with worse outcomes. The Breslow micrometric measurement is the most critical parameter in planning treatment and predicting outcomes. However, for acral lentiginous melanoma, the value of the Breslow thickness is a matter of debate. Depth of Invasion (DOI) is a well-established measure for staging oral squamous cell carcinoma. OBJECTIVE: This study compared DOI and Breslow thickness for predicting acral melanoma outcomes. METHODS: We performed a retrospective cross-sectional study of 71 acral melanoma lesions subjected to sentinel lymph node biopsy at one Brazilian referral center. RESULTS: Cox model univariate analysis showed that both DOI and Breslow thickness predicted melanoma specific survival (HR 1.12; p = 0.0255 and HR 1.144; p = 0.0006, respectively), although Kaplan Meier curve was only significant for Breslow (χ2 = 5.792; p = 0.0161) and not for DOI (χ2 = 0.2556; p = 0.6132). Sentinel lymph node status and presence or absence of ulceration also predicted specific survival in patients with acral melanoma (χ2 = 6.3514; p = 0.0117 and χ2 = 4.2793; p = 0.0386, respectively). Multivariate analysis, however, demonstrated that Breslow depth was the only independent parameter for predicting acral melanoma specific survival (HR 1.144; p = 0.0006). CONCLUSION: Even though Breslow thickness remains the main predictor for survival in acral melanoma, it is not a perfect parameter. The introduction of DOI in this context opens new perspectives for predicting acral melanoma outcomes.
Asunto(s)
Melanoma , Invasividad Neoplásica , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas , Humanos , Melanoma/patología , Melanoma/mortalidad , Femenino , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/mortalidad , Estudios Transversales , Anciano , Biopsia del Ganglio Linfático Centinela/métodos , Adulto , Estadificación de Neoplasias/métodos , Pronóstico , Anciano de 80 o más Años , Brasil/epidemiología , Estimación de Kaplan-MeierRESUMEN
BACKGROUND: Cutaneous melanoma is a neoplasm with a high mortality rate and risk of metastases to distant organs. The Breslow micrometric measurement is considered the most important factor for evaluating prognosis and management, measured from the granular layer to the deepest portion of the neoplasm. Despite its widespread use, the Breslow thickness measurement has some inaccuracies, such as not considering variations in the thickness of the epidermis in different body locations or when there is ulceration. OBJECTIVE: To evaluate the applicability of a modified Breslow measurement, measured from the basal membrane instead of from the granular layer, in an attempt to predict sentinel lymph node examination outcome and survival of patients with melanoma. METHODS: A retrospective and cross-sectional analysis was carried out based on the evaluation of slides stained with hematoxylin & eosin from 275 cases of melanoma that underwent sentinel lymph node biopsy from 2008 to 2021 at a reference center in Brazil. RESULTS: Analysis of the Cox model to evaluate the impact of the Breslow measurement and the modified Breslow measurement on survival showed that both methods are statistically significant. Logistic regression revealed a significant association between both measurements and the presence of metastasis in sentinel lymph nodes. CONCLUSION: Measuring melanoma depth from the basal membrane (modified Breslow measurement) is capable of predicting survival time and sentinel lymph node outcome, as well as the conventional Breslow measurement.
Asunto(s)
Melanoma , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas , Humanos , Melanoma/patología , Melanoma/mortalidad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/mortalidad , Estudios Retrospectivos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Adulto , Estudios Transversales , Metástasis Linfática/patología , Pronóstico , Ganglio Linfático Centinela/patología , Anciano de 80 o más Años , Melanoma Cutáneo Maligno , Adulto Joven , Valor Predictivo de las Pruebas , Estadificación de NeoplasiasRESUMEN
Abstract Background Cutaneous melanoma is a neoplasm with a high mortality rate and risk of metastases to distant organs. The Breslow micrometric measurement is considered the most important factor for evaluating prognosis and management, measured from the granular layer to the deepest portion of the neoplasm. Despite its widespread use, the Breslow thickness measurement has some inaccuracies, such as not considering variations in the thickness of the epidermis in different body locations or when there is ulceration. Objective To evaluate the applicability of a modified Breslow measurement, measured from the basal membrane instead of from the granular layer, in an attempt to predict sentinel lymph node examination outcome and survival of patients with melanoma. Methods A retrospective and cross-sectional analysis was carried out based on the evaluation of slides stained with hematoxylin & eosin from 275 cases of melanoma that underwent sentinel lymph node biopsy from 2008 to 2021 at a reference center in Brazil. Results Analysis of the Cox model to evaluate the impact of the Breslow measurement and the modified Breslow measurement on survival showed that both methods are statistically significant. Logistic regression revealed a significant association between both measurements and the presence of metastasis in sentinel lymph nodes. Conclusion Measuring melanoma depth from the basal membrane (modified Breslow measurement) is capable of predicting survival time and sentinel lymph node outcome, as well as the conventional Breslow measurement.
RESUMEN
ABSTRACT: Vitamin D receptor (VDR) exerts its biological effects when it heterodimerizes to a nuclear receptor of the retinoid family called retinoid X receptor α (RXRα), stimulating or inhibiting DNA transcription. VDR stimulation by vitamin D analogs led to in vitro antiproliferative effects, and experimental RXRα knockout led to loss of proliferation control in melanoma cells. The aim of this study was to determine VDR and RXRα positivity in melanocytic lesions, compared with normal skin species. By immunohistochemistry assays, nuclear VDR, cytoplasmic VDR, and RXRα and RXRα in keratinocytes surrounding melanocytes were evaluated in 77 controls, 92 intradermal nevi, 54 dysplastic nevi, and 83 melanomas in this retrospective cross-sectional study. Nuclear VDR, cytoplasmic VDR, and RXRα were less expressed in exposed areas ( P < 0.001, P = 0.0006, and P < 0.001, respectively) than covered areas. All melanocytic lesions had loss of VDR and RXRα comparing with the control group. In the melanoma group, nuclear VDR tended to inversely correlate with the Breslow index (r = -0.11, P = 0.29) but directly correlated with histological regression ( P = 0.0293). RXRα inversely correlated with mitosis (r = -0.245; P = 0.0263). We can suggest that sun exposure affected VDR and RXRα immunopositivity. Nuclear VDR tendency of inverse correlation with the Breslow index showed that worse melanomas have a greater loss of VDR. RXRα inversely correlated with mitosis, indicating that RXRα can have a role in proliferation control. VDR and RXRα may participate in the development of melanocytic lesions and be a future target of new studies and directed therapies.
Asunto(s)
Melanoma , Receptores de Calcitriol , Humanos , Receptores de Calcitriol/genética , Receptor alfa X Retinoide/genética , Estudios Retrospectivos , Estudios Transversales , Melanoma/patología , Melanocitos/patologíaRESUMEN
The primary differential diagnosis of melanoma is dysplastic nevus. Until now, the final diagnosis is based on histological findings. With modern techniques, pathologists receive very early melanocytic lesions, which do not fit all malignant criteria. In those cases, even the concurrence between specialists and intraobserver agreement is not good. A molecular test could be developed to improve the accuracy of melanocytic lesions diagnosis and help in challenging lesions. The objective of this study is to provide a literary review looking for molecular markers that characterize dysplastic nevi and could help surgical pathologists differentiate them from melanoma. Articles from PubMed presenting case series of dysplastic nevi and melanoma genomic analyses were considered. The search was conducted in PubMed looking for papers written in English, published in the ten years preceding April 2020. This review confirmed the absence of a pathognomonic molecular marker of dysplastic nevi. This is a heterogeneous group of lesions with an uncertain risk to become a melanoma. The molecular heterogeneity of dysplastic nevi, the variation of histological diagnostic criteria among services, and the diverse molecular techniques applied are challenging features that might hamper definitive diagnoses. However, currently, there appears to be limited value for molecular testing in the diagnosis of dysplastic nevi.
Asunto(s)
Síndrome del Nevo Displásico , Melanoma , Nevo Pigmentado , Nevo , Neoplasias Cutáneas , Diagnóstico Diferencial , Síndrome del Nevo Displásico/diagnóstico , Síndrome del Nevo Displásico/genética , Síndrome del Nevo Displásico/patología , Humanos , Melanocitos/patología , Melanoma/diagnóstico , Melanoma/genética , Melanoma/patología , Nevo/patología , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/genética , Nevo Pigmentado/patología , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/genética , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: Leprosy is one of the main health problems in developing countries. It can show many different clinical presentations. CASE REPORT: A 37-yr-old woman with multiple reddish-brown papules on the lower and upper limbs, including the palms. The initial clinical impression was pityriasis lichenoides chronica. Biopsies were taken. The specimen from the left shin showed classical histological features of lepromatous leprosy. The specimen from the left thigh was similar to lipidized dermatofibroma showing epidermal hyperplasia with basal layer hyperpigmentation, a narrow Grenz zone, and spindle xanthomatous cells among dermal fibers. Fite-Faraco staining revealed many bacilli. DISCUSSION: No matter the clinical presentation, in the presence of lipidized macrophages, Fite-Faraco staining (an inexpensive method available worldwide) should be performed to rule out leprosy, even in nonendemic areas or associated with a tumor.
Asunto(s)
Histiocitoma Fibroso Benigno , Lepra Lepromatosa , Lepra , Biopsia , Epidermis/patología , Femenino , Humanos , Lepra/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patologíaRESUMEN
Primary oral melanoma (POM) is a rare entity that is often asymptomatic and is associated with a poor prognosis. Following the example of the ABCDE acronym for the clinical diagnosis of early cutaneous melanoma, we would like to introduce another acronym, AEIOU, to identify lesions that are clinically suspicious for POM. The letter "A" means age older than 50; "E" means ethnicity in reference to the higher occurrence among Asians, Hispanics, and Africans; "I" means irregularity in reference to irregular borders or color; "O" means oral palate, the most frequent site of POM; and "U" means ulceration. To the best of our knowledge, this paper is the first to describe an acronym AEIOU as a diagnostic aid for POM among health practitioners and the general population. Future studies should test the acronym's sensitivity and specificity for POM diagnosis in clinical practice.
Asunto(s)
Melanoma , Neoplasias de la Boca , Neoplasias Cutáneas , Humanos , Melanoma/diagnóstico , Melanoma/patología , Neoplasias de la Boca/diagnóstico , Sensibilidad y Especificidad , Neoplasias Cutáneas/patologíaAsunto(s)
Dermatitis/patología , Erupciones Liquenoides/diagnóstico , Enfermedades Linfáticas/patología , Trastornos de la Pigmentación/patología , Seudolinfoma/diagnóstico , Púrpura/patología , Adulto , Antígenos CD7/metabolismo , Biopsia/métodos , Dermoscopía/métodos , Diagnóstico Diferencial , Femenino , Hemosiderina/metabolismo , Humanos , Inmunohistoquímica/métodos , Erupciones Liquenoides/patología , Micosis Fungoide/diagnóstico , Micosis Fungoide/metabolismo , Patología Clínica , Linfocitos T/metabolismoRESUMEN
Since the first description of parapsoriasis more than 100 years ago, parapsoriasis has been a questionable condition and occasionally considered a precursor of cutaneous lymphoma. The name "parapsoriasis" is related to a heterogenous group of diseases that show a distinct clinical presentation; however, the histopathological criteria are not strongly specific. Pathologists do not consider parapsoriasis as a possible histopathological diagnosis, but dermatologists use the term as clinical hypothesis. We aim to provide an historical review of parapsoriasis focusing on histopathological criteria, considering its possible relation with cutaneous skin lymphoma, based on articles from PubMed and standard dermatopathological books. Parapsoriasis does not have well-defined histopathological criteria, so its use should be avoided. Being aware of parapsoriasis complexity, a consensus meeting can help to create a guideline regarding this topic.
Asunto(s)
Dermatología/normas , Micosis Fungoide/patología , Parapsoriasis/patología , Neoplasias Cutáneas/patología , Evolución Clonal/genética , Consenso , Historia del Siglo XX , Humanos , Linfoma Cutáneo de Células T/diagnóstico , Micosis Fungoide/diagnóstico , Parapsoriasis/diagnóstico , Parapsoriasis/historia , Patólogos/estadística & datos numéricos , VocabularioAsunto(s)
Síndrome del Nevo Displásico/patología , Nevo Pigmentado/patología , Nevo/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Axila/patología , Brasil/epidemiología , Mama/patología , Errores Diagnósticos/prevención & control , Femenino , Genitales/patología , Humanos , Rodilla/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Nevo/ultraestructura , Nevo Pigmentado/ultraestructura , Cuero Cabelludo/patología , Neoplasias Cutáneas/clasificación , Neoplasias Cutáneas/ultraestructura , Ombligo/patología , Organización Mundial de la Salud/organización & administraciónRESUMEN
Abstract: Recently, the World Health Organization published the revised 4th edition of its classification of tumors of hematopoietic and lymphoid tissues. The present paper is a concise comparative review of the main primary cutaneous T-cell hematopoietic tumors, with emphasis on their immunohistochemical profiles.
Asunto(s)
Humanos , Organización Mundial de la Salud , Linfoma Cutáneo de Células T/clasificación , Inmunohistoquímica , Linfoma Cutáneo de Células T/diagnóstico , Diagnóstico DiferencialRESUMEN
Recently, the World Health Organization published the revised 4th edition of its classification of tumors of hematopoietic and lymphoid tissues. The present paper is a concise comparative review of the main primary cutaneous T-cell hematopoietic tumors, with emphasis on their immunohistochemical profiles.
Asunto(s)
Linfoma Cutáneo de Células T/clasificación , Organización Mundial de la Salud , Diagnóstico Diferencial , Humanos , Inmunohistoquímica , Linfoma Cutáneo de Células T/diagnósticoRESUMEN
BACKGROUND: The incidence of melanoma has been increasing in Brazil and all over the world. Despite improvements in diagnosis and treatment, mortality remains unchanged. OBJECTIVE: To associate clinical and histopathological aspects with the evolution of 136 cases of cutaneous melanoma. METHODS: Retrospective cohort study that analyzed all patients diagnosed with melanoma during the period from 2003 to 2011, with at least 4 years follow up. Archived slides were analyzed to study histopathological variables (Breslow, ulceration, mitoses and histological regression). Medical records were used to retrieve clinical variables (age, sex, localization, time of appearance, diameter) and progression (metastases or death). Association measures were assessed by statistical analysis. RESULTS: There was no statistically significant difference between groups according to age. Superficial spreading subtype showed lower Breslow (0.5mm) than acral lentiginous and nodular subtypes (2 and 4.6mm respectively), less ulceration and metastases (9.4% against 50 and 70.6%). Nodular subtype had higher mitoses' median (5.0/mm2) than superficial spreading and lentigo maligna (0.0/mm2, for both). Regression was more frequent in superficial spreading and lentigo maligna subtypes. There were only deaths by melanoma in the acral group, however, there were deaths for other reasons in groups superficial spreading one, acral lentiginous one and lentigo maligna two. STUDY LIMITATIONS: Use of medical records as a source of data to the study. CONCLUSIONS: Superficial spreading subtype presents better prognosis indicators. Histological subtype should be considered in follow-up and treatment protocols of patients with cutaneous melanoma.
Asunto(s)
Peca Melanótica de Hutchinson/patología , Melanoma/patología , Neoplasias Cutáneas/patología , Anciano , Brasil/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Peca Melanótica de Hutchinson/mortalidad , Masculino , Melanoma/mortalidad , Persona de Mediana Edad , Invasividad Neoplásica/patología , Pronóstico , Estudios Retrospectivos , Neoplasias Cutáneas/mortalidad , Tasa de SupervivenciaRESUMEN
Abstract: BACKGROUND: The incidence of melanoma has been increasing in Brazil and all over the world. Despite improvements in diagnosis and treatment, mortality remains unchanged. OBJECTIVE: To associate clinical and histopathological aspects with the evolution of 136 cases of cutaneous melanoma. METHODS: Retrospective cohort study that analyzed all patients diagnosed with melanoma during the period from 2003 to 2011, with at least 4 years follow up. Archived slides were analyzed to study histopathological variables (Breslow, ulceration, mitoses and histological regression). Medical records were used to retrieve clinical variables (age, sex, localization, time of appearance, diameter) and progression (metastases or death). Association measures were assessed by statistical analysis. RESULTS: There was no statistically significant difference between groups according to age. Superficial spreading subtype showed lower Breslow (0.5mm) than acral lentiginous and nodular subtypes (2 and 4.6mm respectively), less ulceration and metastases (9.4% against 50 and 70.6%). Nodular subtype had higher mitoses' median (5.0/mm2) than superficial spreading and lentigo maligna (0.0/mm2, for both). Regression was more frequent in superficial spreading and lentigo maligna subtypes. There were only deaths by melanoma in the acral group, however, there were deaths for other reasons in groups superficial spreading one, acral lentiginous one and lentigo maligna two. STUDY LIMITATIONS: Use of medical records as a source of data to the study. CONCLUSIONS: Superficial spreading subtype presents better prognosis indicators. Histological subtype should be considered in follow-up and treatment protocols of patients with cutaneous melanoma.