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1.
Med. oral patol. oral cir. bucal (Internet) ; 25(6): e728-e731, nov. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-197179

RESUMO

BACKGROUND: Oral melanomas have some histopathological resemblance with its cutaneous counterpart; howev-er, an aggressive behavior is more common in tumors that occur in the oral cavity. Several markers have been suggested as indicative of tumoral progression and aggressiveness, such as cyclooxygenase 2 (COX-2) and Ki67. MATERIAL AND METHODS: In this study, we have compared the expression of COX-2 and Ki67 in a series of amelanotic (n = 7) and melanotic oral melanomas (n = 22). The cases were selected from 4 pathology laboratories and sub-mitted to the immunohistochemical (IHC) reactions. We analyzed the IHC staining based on a qualitative - using visual scores; and a computer-assisted method (quantitative) using scanned slides and software for digital analysis. RESULTS: COX-2 was expressed in all oral melanomas; however, its intensity was significantly higher in the amelanotic ones (P < 0.001). Similarly, a high Ki67-positivity index was observed in the amelanotic than melanotic ones (P < 0.001). CONCLUSIONS: Based on these results, we suggest that amelanotic oral melanomas have marked pro-inflammatory and high-proliferative phenotype, justifying their more aggressive behavior compared with the melanotic ones


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Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Melanoma/patologia , Neoplasias Bucais/patologia , Ciclo-Oxigenase 2/análise , Antígeno Ki-67/análise , Imuno-Histoquímica , Inclusão em Parafina , Carga Tumoral , Melanoma Amelanótico/patologia
2.
Dermatol Online J ; 26(5)2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621707

RESUMO

Oculocutaneous albinism is a genetically heterogeneous, autosomal recessive group of disorders characterized by a generalized decreased or absence of melanin pigment in the eyes, hair, and skin. These patients have a greater sensitivity to UV radiation and a predisposition to skin tumors, mainly squamous cell carcinoma and basal cell carcinomas, and to a lesser extent malignant melanomas. Melanoma can be one of the most challenging cancers to diagnose in patients with albinism. We report an uncommon clinical presentation of melanoma, an amelanotic melanoma in the right supraciliar region in a patient with oculocutaneous albinism. The clinical presentation was an erythematous, scaly and ill-defined plaque. The skin biopsy revealed a lentigo maligna melanoma. Amelanotic melanomas are one of the two most difficult to diagnose subtypes of melanoma, together with the nevoid type. Melanoma in oculocutaneous albinism patients are often amelanotic, which makes their clinical diagnosis very difficult. These patients should be examined in the dermatology department at least once a year and it is recommended to have a high index of suspicion.


Assuntos
Albinismo Oculocutâneo/complicações , Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Dermoscopia , Feminino , Humanos , Lactente , Masculino , Melanoma Amelanótico/complicações , Melanoma Amelanótico/diagnóstico , Pessoa de Meia-Idade , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico
4.
Br J Ophthalmol ; 104(2): 194-201, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31023712

RESUMO

PURPOSE: To investigate demographics and clinical features of patients with amelanotic choroidal tumours. DESIGN: Retrospective analysis. METHODS: Comparison of demographic and clinical features of various amelanotic choroidal tumours based on stratification by patient age, sex and tumour diameter. Included were all patients with amelanotic choroidal tumours evaluated on the Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA, over a 45-year time period. RESULTS: A total of 5586 amelanotic choroidal tumours in 4638 eyes of 4441 patients were included with a mean age at presentation of 58 years (median 60, range 0.1-100 years). Most patients were white (95%), female (56%) and with unilateral lesion (96%). By comparison, amelanotic melanoma presented at a younger mean age (57 years) compared with metastasis (60 years, p<0.001), nevus (61 years, p<0.001), lymphoma (65 years, p<0.001), sclerochoroidal calcification (70 years, p<0.001) and peripheral exudative haemorrhagic chorioretinopathy (80 years, p<0.001). Melanoma presented at an older mean age compared with osteoma (30 years, p<0.001), granuloma (42 years, p<0.001), haemangioma (49 years, p<0.001) and inflammatory choroidal lesions (49 years, p<0.001). Differences in race and sex were also seen between the various amelanotic choroidal lesions. With few exceptions, amelanotic melanoma had significantly larger basal diameter, greater thickness, more frequent association with subretinal fluid and more often ultrasonographically hollow, compared with other amelanotic choroidal lesions. CONCLUSION: Understanding the demographic and clinical features of amelanotic choroidal melanoma and other amelanotic lesions could lead to an earlier and more accurate diagnosis.


Assuntos
Neoplasias da Coroide/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Corioide/patologia , Feminino , Granuloma/patologia , Hemangioma/patologia , Humanos , Lactente , Linfoma/patologia , Melanoma Amelanótico/patologia , Pessoa de Meia-Idade , Nevo/patologia , Osteoma/patologia , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
6.
Int Wound J ; 16(6): 1445-1449, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31531925

RESUMO

Amelanotic melanoma is a rare melanoma subtype, and it is even more rare when it occurs at an acral site. We here present a case of a nodular amelanotic acral melanoma (NAAM) occurring on the heel of an 83-year old female. It presented as an ulcerated pink nodular growth on the heel, which clinically mimicked other nodular non-pigmented lesions, causing a delay in diagnosis until it was biopsied. This case is a demonstration of the critical importance to include NAAM in the differential diagnosis of nodular non-pigmented skin lesions as to avoid delay in diagnosis and disease progression, in which early detection can provide the most modifiable prognostic factor.


Assuntos
Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Tecido Adiposo/patologia , Idoso de 80 Anos ou mais , Diagnóstico Tardio , Feminino , Calcanhar , Humanos , Invasividade Neoplásica
10.
An Bras Dermatol ; 94(1): 86-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726470

RESUMO

We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.


Assuntos
Dermatoses do Pé/patologia , Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Verrugas/patologia , Adulto , Biópsia , Diagnóstico Tardio , Dermoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Dermatoses do Pé/diagnóstico , Humanos , Metástase Linfática , Melanoma Amelanótico/diagnóstico , Neoplasias Cutâneas/diagnóstico , Verrugas/diagnóstico
11.
Dermatol Online J ; 25(1)2019 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-30710904

RESUMO

Acral lentiginous melanomas account for less than 5% of all melanomas, whereas amelanotic melanomas account for around 2-8% of all melanomas. Amelanotic acral lentiginous melanomas are even less common and can often be mistaken for other clinical entities, including pyogenic granulomas, non-melanoma skin cancers, and warts. We describe a man in his 50s with a twenty-year history of a skin-colored plaque on the right plantar foot; after enlargement and failure of wart treatment, a shave biopsy revealed an amelanotic melanoma. A subsequent wide local excision and sentinel lymph node biopsy revealed melanoma in 4 lymph nodes and the patient underwent an abbreviated course of interferon-alpha therapy. The patient remained stable until 2 ? years after diagnosis, at which time he presented with in-transit metastases on the foot and right thigh; he has since been stable on nivolumab. This case represents the challenge of diagnosing amelanotic melanomas on acral surfaces and highlights the importance of considering a skin biopsy for diagnosis of any changing, atypical amelanotic lesions on the feet or hands.


Assuntos
Doenças do Pé/patologia , Melanoma Amelanótico/patologia , Neoplasias Cutâneas/patologia , Antineoplásicos Imunológicos/uso terapêutico , Procedimentos Cirúrgicos Dermatológicos , Doenças do Pé/diagnóstico , Doenças do Pé/terapia , Humanos , Fatores Imunológicos/uso terapêutico , Interferon-alfa/uso terapêutico , Masculino , Melanoma Amelanótico/diagnóstico , Melanoma Amelanótico/terapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Nivolumabe/uso terapêutico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia
12.
An. bras. dermatol ; 94(1): 86-88, Jan.-Feb. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-983745

RESUMO

Abstract: We report a case of amelanotic acral melanoma in a 42-year-old Chinese woman. Ten months previously the patient found a 2-cm asymmetric erythematous macular plaque on her left sole. The lesion was diagnosed as verruca plantaris by every physician the patient consulted. One month ago, an enlarged lymph node was detected in the left groin, which biopsy reported as metastatic melanoma. Dermoscopy suggested verruca plantaris, and positron emission tomography (PET) revealed increased glucose metabolism in the macular plaque. Finally, biopsy of the plaque revealed amelanotic melanoma. Misdiagnosis and diagnostic delay are usually associated with poorer patient outcomes. Awareness of atypical presentations of acral melanoma is thus important for decreasing misdiagnosis rates and improving patient outcomes.


Assuntos
Humanos , Feminino , Adulto , Neoplasias Cutâneas/patologia , Verrugas/patologia , Melanoma Amelanótico/patologia , Dermatoses do Pé/patologia , Neoplasias Cutâneas/diagnóstico , Biópsia , Verrugas/diagnóstico , Melanoma Amelanótico/diagnóstico , Dermoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Diagnóstico Tardio , Dermatoses do Pé/diagnóstico , Metástase Linfática
13.
J Cell Physiol ; 234(8): 13510-13524, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30613977

RESUMO

Interferon ß (IFN-ß) is considered a signaling molecule with important therapeutic potential in cancer since IFN-ß-induced gene transcription mediates antiproliferation and cell death induction. Whereas, TNF-related apoptosis inducing ligand/Apo2 ligand (TRAIL/Apo2L) has emerged as a promising anticancer agent because it induces apoptosis specifically in cancer cells. In this study, we elucidated that IFN-ß augments TRAIL-induced apoptosis synergistically using five human malignant melanoma cells. All of these cells were induced apoptosis by TRAIL. Whereas, the response against IFN-ß was different in amelanotic cells (A375 and CRL1579) and melanotic cells (G361, SK-MEL-28, and MeWo). The responsibility of amelanotic cells against IFN-ß was higher than those of melanotic cells. The synergism of IFN-ß and TRAIL were correlated with the responsibilities of the cells against IFN-ß. The synergistic interaction was confirmed by a combination index based on the Chou-Talalay method. The upregulation of apoptosis in amelanotic cells was caused by very low doses of IFN-ß (over 0.1 IU/ml). Both of p53-mediated intrinsic pathway and Fas-related extrinsic pathway were activated by IFN-ß alone and combination with TRAIL. Further, TRAIL death receptors (DR4 and DR5) were upregulated by a low-dose IFN-ß (over 0.1 IU/ml) and the expression was more promoted by the combination with TRAIL. It was clarified that the upregulation of DR5 is associated with the declination of viability.


Assuntos
Interferon beta/administração & dosagem , Melanoma/tratamento farmacológico , Ligante Indutor de Apoptose Relacionado a TNF/administração & dosagem , Apoptose/efeitos dos fármacos , Caspases/metabolismo , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Sinergismo Farmacológico , Expressão Gênica/efeitos dos fármacos , Humanos , Melanoma/metabolismo , Melanoma/patologia , Melanoma Amelanótico/tratamento farmacológico , Melanoma Amelanótico/metabolismo , Melanoma Amelanótico/patologia , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Receptores do Ligante Indutor de Apoptose Relacionado a TNF/genética , Proteínas Recombinantes/administração & dosagem
14.
Melanoma Res ; 29(3): 221-230, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30672881

RESUMO

Cutaneous amelanotic melanoma (AM) is a rare amelanotic or a hypomelanotic subtype of melanoma, comprising only 0.4-27.5% of all melanoma cases. The mean age of the patients is over 50 years, and the male/female ratio varies from 0.5 to 4. Patients with red hair, type I skin, freckles, lack of nevi on the back, a sun-sensitive phenotype, or previous AM history are more likely to develop AMs. As AMs lack pigmentation, their appearances vary and can mimic many benign and malignant conditions, thus presenting a diagnostic challenge. AMs are composed of greater proportions of nodular melanoma, acral lentiginous melanoma, and desmoplastic melanoma than pigmented melanomas. They also present with thicker Breslow thickness, higher mitotic rate, more frequent ulceration, higher tumor stage, and lower survival than pigmented melanomas.


Assuntos
Melanoma Amelanótico/epidemiologia , Melanoma Amelanótico/patologia , Humanos , Melanoma Amelanótico/terapia , Prognóstico
15.
J Am Acad Dermatol ; 80(5): 1292-1298, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30654075

RESUMO

BACKGROUND: Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined. OBJECTIVE: To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM). METHODS: A cross-sectional retrospective medical record review at a tertiary academic medical center. RESULTS: A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]). LIMITATIONS: Retrospective study design, single-institutional study. CONCLUSION: Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Melanoma Amelanótico/patologia , Segunda Neoplasia Primária/patologia , Nevo/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Erros de Diagnóstico , Feminino , Cor de Cabelo , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Masculino , Melanoma Amelanótico/diagnóstico , Pessoa de Meia-Idade , Índice Mitótico , Segunda Neoplasia Primária/diagnóstico , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Úlcera Cutânea/etiologia , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
17.
Arch Soc Esp Oftalmol ; 94(2): 81-84, 2019 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30342820

RESUMO

We report an unusual case of an amelanotic melanoma in a 7 year old hispanic child with subclinical globe perforation. Uveal melanoma rarely occurs in children. Young affected patients are mostly light-colored eye Caucasian adolescents. Since they are not common, these tumors are usually not recognized and misdiagnosed. Differential diagnoses and therapeutic options are outlined.


Assuntos
Perfuração da Córnea/etiologia , Neoplasias da Íris/complicações , Melanoma Amelanótico/complicações , Criança , Diagnóstico Diferencial , Enucleação Ocular , Hemorragia Ocular/etiologia , Humanos , Neoplasias da Íris/diagnóstico , Neoplasias da Íris/patologia , Neoplasias da Íris/cirurgia , Masculino , Melanoma Amelanótico/diagnóstico , Melanoma Amelanótico/patologia , Melanoma Amelanótico/cirurgia
19.
World Neurosurg ; 122: 229-239, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30404049

RESUMO

BACKGROUND: Meningeal melanoma is a rare tumor of the central nervous system, whose amelanotic variant is called "amelanotic meningeal melanoma" (AMM). AMM does not produce melanin and therefore does not exhibit typical short T1 and short T2 signal on magnetic resonance imaging and thus can be easily misdiagnosed and be inappropriately managed. To date, only 4 AMM cases have been reported in the English literature. Here, we report the fifth case. CASE DESCRIPTION: A 26-year-old female patient presented with a 4-month history of progressive headache and nausea, the conventional magnetic resonance imaging demonstrated a posterior fossa mass accompanied by diffuse leptomeningeal dissemination. Repeated cerebrospinal fluid cytology screening showed negative results. The functional magnetic resonance examinations, including diffusion-weighted imaging, proton magnetic resonance spectroscopy, and dynamic susceptibility contrast perfusion-weighted imaging, provided complementary information. The final diagnosis of AMM was made by immunohistochemistry. Despite gross total excision of the tumor, the disease progressed, and the patient died 10 months after diagnosis. CONCLUSIONS: Our experience with this case demonstrated that meningeal melanoma should be included in the differential diagnosis when an intracranial mass is accompanied by leptomeningeal dissemination, and especially when proton magnetic resonance spectroscopy and dynamic susceptibility contrast perfusion-weighted imaging indicate a malignant tumor whereas diffusion-weighted imaging does not. And the loss of a typical melanin signal should not server as an excluding criterion for meningeal melanoma.


Assuntos
Melanoma Amelanótico/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meninges/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Melanoma Amelanótico/patologia , Melanoma Amelanótico/cirurgia , Neoplasias Meníngeas/patologia , Neoplasias Meníngeas/cirurgia , Meninges/patologia , Meninges/cirurgia , Metástase Neoplásica/diagnóstico por imagem
20.
Diagn Cytopathol ; 47(3): 230-233, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30478998

RESUMO

Vaginal mucosa represents a rare site for primary melanoma. These neoplasms more commonly occur in the postmenopausal period, usually presenting with vaginal discharge, bleeding, or palpable mass. We report a case of an 89-year-old woman presenting with vaginal bleeding and a non-pigmented lesion in the lower third of the vagina at the gynaecological examination. A PAP smear and tissue incisional biopsy were concurrently performed. The cytological sample showed a subpopulation of non-cohesive, atypical epithelioid cells suggestive for malignancy. The histological examination showed the same morphological characteristics in the neoplastic population widely underlying the vaginal epithelium, with scattered intraepithelial nests and single elements. In both samples, there was no evidence of melanin pigment within the malignant cells. Immunohistochemical analysis performed on the tissue biopsy demonstrated a strong and diffuse positivity for melanocytic markers (HMB-45, S-100, Melan-A), confirming the diagnosis of primary amelanotic vaginal melanoma.


Assuntos
Melanoma Amelanótico/patologia , Neoplasias Vaginais/patologia , Idoso de 80 Anos ou mais , Feminino , Humanos
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