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1.
N Z Med J ; 134(1530): 30-37, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33651775

RESUMO

AIM: To investigate the outcomes and effect of a multidisciplinary 'see and treat' pigmented lesion clinic, run jointly by dermatology and general surgery, on the diagnosis and treatment of melanoma at Auckland District Health Board (DHB). METHOD: All patients attending the newly established Pigmented Lesion Clinic (PLC) between 1 March 2019 and 31 August 2019 were included in the study. They were compared against a retrospective cohort of patients seen for suspected or biopsy-proven melanomas during the same corresponding period in 2016. RESULTS: 251 new patients attended the PLC, compared to 148 new patients seen at Auckland DHB in 2016. There was a significant reduction in proportion of pigmented lesions requiring biopsy (35.2% vs 64.3%, p<0.001), with a benign-to-malignant ratio of 2.4:1. Fifty-three melanomas were treated through the PLC, with a significant reduction in mean waiting time from referral to first specialist assessment (22.6 vs 35.1 days, p=0.038), and from referral to wide local excision (50.6 vs 99.1 days, p<0.001). 86.5% of patients received full skin check, from which additional skin malignancies were detected in 1-per-5.3 patients. CONCLUSION: The novel PLC model has led to reduction in unnecessary excisional biopsies of benign pigmented lesions, while streamlining and improving timely access to specialist review and surgical treatment for patients with melanomas.


Assuntos
Melanoma/diagnóstico , Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial , Dermatologia/métodos , Erros de Diagnóstico , Feminino , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Modelos Estatísticos , Invasividade Neoplásica , Nova Zelândia , Valor Preditivo dos Testes , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , Adulto Jovem
2.
Anticancer Res ; 41(2): 895-903, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517295

RESUMO

BACKGROUND/AIM: This study analysed the prevalence of the characteristics evaluated in dermatoscopy for melanocytic infiltrations of the conjunctiva with various degrees of malignancy. PATIENTS AND METHODS: A total of 160 conjunctival pigmented lesions were studied. Each lesion was scored using dermatoscopic patterns and the characteristics of malignancy described by Kittler. Also, the Authors' own clues were added to the evaluation. RESULTS: In melanomas, the following characteristics were identified: asymmetry of the pattern and colour, larger average number of colours, the presence of grey colour, structureless area, polymorphic vessels and feeder vessels. A pattern of black dots and a black colour was typical of malignant lesions and pre-cancerous (premalignant) lesions - primary acquired melanosis (PAM) with atypia. Cysts were observed only in the group of naevi. CONCLUSION: The patterns evaluated with dermatoscopy are present in pigmented lesions of the conjunctiva. There are, however, some characteristics which allow differentiation between melanoma and pigmented naevus and melanosis and also between PAM.


Assuntos
Neoplasias da Túnica Conjuntiva/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Nevo Pigmentado/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Neoplasias da Túnica Conjuntiva/patologia , Dermoscopia , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adulto Jovem
3.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(6): 299-305, nov.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197924

RESUMO

INTRODUCCIÓN: El nevo de Ota y el nevo de Ito son melanocitosis dérmicas hiperpigmentarias que surgen como consecuencia de alteraciones o fallas en la migración de los melanocitos desde la cresta neural hacia la epidermis, tienen una etiopatogenia poco conocida y pueden ser congénitas o adquiridas. CASO CLÍNICO: Se trata de un paciente con diagnóstico simultáneo de nevo de Ota y nevo de Ito desde el nacimiento que acude al Servicio de Neurocirugía del hospital Carlos Andrade Marín de la ciudad de Quito y consulta por presentar cefalea súbita de gran intensidad asociada a hemiparesia braquiocrural izquierda. Evolución: Por medio de exámenes complementarios es diagnosticado de dos lesiones ocupantes intracraneales extraaxiales, una parasagital frontoparietal derecha y otra localizada en polo temporal derecho. Se planificó una resección quirúrgica de la lesión parasagital cuyo diagnóstico histopatológico fue melanocitosis meníngea. La lesión de polo temporal fue derivada para tratamiento con Gamma Knife(R). CONCLUSIÓN: Los tumores melanocíticos primarios son extremadamente raros, existe evidencia de su asociación con las melanocitosis dérmicas y en especial con el nevo de Ota. El caso presentado describe la coexistencia de dos melanocitosis dérmicas poco frecuentes (nevo de Ota - nevo de Ito) y un tumor melanocítico primario en el mismo paciente, un caso muy fuera de lo común


BACKGROUND: Nevus of Ota and nevus of Ito are hyperpigmentary dermal melanocytoses which develop as a consequence of disturbances or failures during migration of melanocytes from the neural crest towards the epidermis; they have a relatively unknown aetiopathogenesis and may be congenital or acquired. CASE REPORT: This case involves a male patient with a simultaneous diagnosis of nevus of Ota and nevus of Ito at birth. He attended the Neurosurgery department at Carlos Andrade Marín hospital (Quito) with sudden severe headache associated with left brachio-crural hemiparesis. PROGRESS: Investigations revealed two extra-axial space-occupying lesions, one parasagittal at the right frontal and parietal lobes and the other located at the right temporal lobe pole. A surgical resection was planned for the parasagittal lesion and the histopathological diagnosis was meningeal melanocytosis. The temporal pole lesion was referred for treatment with Gamma Knife(R). CONCLUSION: Primary melanocytic neoplasms are extremely rare. There is evidence of their association with dermal melanocytosis and, in particular, with nevus of Ota. This highly unusual case describes the coexistence of two very rare dermal melanocytoses (nevus of Ota and nevus of Ito) and a primary melanocytic neoplasms in the same patient


Assuntos
Humanos , Masculino , Adulto , Nevo de Ota/cirurgia , Neoplasias Cutâneas/cirurgia , Melanócitos/patologia , Nevo Pigmentado/cirurgia , Neoplasias Meníngeas/cirurgia , Nevo de Ota/patologia , Neoplasias Cutâneas/diagnóstico , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patologia , Cefaleia/etiologia , Paresia/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/cirurgia , Biópsia
4.
Medicine (Baltimore) ; 99(30): e21350, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791736

RESUMO

RATIONALE: Optic disc melanocytoma is an ophthalmic tumor that arises from melanocytes, and is a variant of the melanocytic nevus. Here we report 2 cases of optic disc melanocytoma in Asian patient: one associated with normal tension glaucoma (NTG), and the other associated with angle closure glaucoma (ACG). PATIENT CONCERNS: Case 1 is a 57-year-old Asian female presented to our department for a general ophthalmic examination. Incidentally, brownish pigmented lesion was found on dilated fundus examination of her right eye. The fundus examination and optical coherence tomography (OCT) examination revealed a mass within optic disc, and superotemporal retinal nerve fiber layer (RNFL) thinning. The Humphrey visual field test showed corresponding visual field defect. Fluorescein angiography showed no leakage around the lesion. Case 2 is a 78-year-old Asian woman presented with complaints of acute bilateral ocular pain. The initial examination revealed shallow anterior chamber. Under the impression of intermittent angle closure attack, prophylactic laser peripheral iridotomy were performed. On dilated fundus examination, black pigmented lesion was found at superior sector of optic disc. Further examination revealed bilateral superotemporal, inferotemporal RNFL thinning on OCT, and spatially corresponding visual field defects. DIAGNOSES: Clinical diagnosis of NTG was made for case 1 patient. Although it was a little distant from typical glaucomatous changes, nevertheless she had RNFL defect compatible with visual field defects. Considering her normal IOP and angle structures, we believe NTG was a probable diagnosis for the patient. In case 2, we made diagnosis of ACG presenting as intermittent angle closure attack because of her presenting symptoms, narrowing of anterior chamber and angle structures found on gonioscopic and slit lamp examinations. INTERVENTIONS: In Case 1, we prescribe 0.005% latanoprost ophthalmic solution. In Case 2, at first prophylactic laser peripheral iridotomy was performed. Then, topical eyedrops administration was started, and the patient was examined periodically. OUTCOMES: In Case 1, at 6 months' follow-up, OCT and visual field test showed no progression. In Case 2, to this date, the optic disc melanocytoma remains stable for over a 6-year-follow-up period. LESSONS: The fact that NTG and ACG can coexist in patients with melanocytoma of optic disc should be recognized, and the possibility of such should appropriately be evaluated.


Assuntos
Glaucoma de Ângulo Fechado/complicações , Glaucoma de Baixa Tensão/complicações , Nevo Pigmentado/patologia , Disco Óptico/patologia , Neoplasias do Nervo Óptico/patologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nevo Pigmentado/etiologia , Neoplasias do Nervo Óptico/etiologia
5.
Am J Surg Pathol ; 44(10): 1398-1405, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32732488

RESUMO

We report a series of 6 melanocytic proliferations harboring both NRAS and IDH1 hotspot mutations. Clinically, there was no specific sex-ratio, ages ranged from 18 to 85 years, and the trunk and limbs were the most affected localizations. In half of the cases, progressive modification of a pre-existing nevus was reported. Morphologically, all tumors were predominantly based in the dermis and the most striking pathologic finding was the presence of a background architecture of congenital-type nevi with a superimposed biphasic pattern formed by dendritic pigmented melanocytes surrounding areas of nevoid melanocytes. This finding was further underscored by HMB45 staining, which was positive in the dendritic cells and negative in the nevoid melanocytes. Four cases displayed increased cellularity and 1 case showed increased dermal mitotic activity. DNA and RNA sequencing revealed NRAS and IDH1 comutations in all 6 cases, with homogenous expression data according to unsupervised clustering analysis. Array-comparative genomic hybridization revealed no copy number alteration for the 2 most cellular and mitogenic cases. All were surgically excised, available follow-up for 2 patients showed no relapse nor metastases. We hypothesize that the IDH1 mutation is a secondary event in a pre-existing NRAS-mutated nevus and could be in part responsible for the emergence of a pigmented dendritic dermal component. So far, such comutations have been reported in one benign melanocytic nevus and several melanomas. This combination could represent a new subgroup of intermediate prognosis (melanocytoma) with a distinctive morphology. Further acquisition of genomic anomalies could progressively lead to malignant transformation.


Assuntos
GTP Fosfo-Hidrolases/genética , Isocitrato Desidrogenase/genética , Melanócitos/patologia , Proteínas de Membrana/genética , Nevo Pigmentado/genética , Neoplasias Cutâneas/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transformação Celular Neoplásica/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adulto Jovem
6.
Sci Rep ; 10(1): 8594, 2020 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-32451385

RESUMO

Malignant melanoma is a rare neoplasm in the pediatric age group. One of the main risks factors is represented by the presence of a high number of melanocytic nevi. Sun exposure in pediatric age represents a predictor of melanocytic nevi number in the adult age and there is a direct correlation between the presence of melanocytic moles in early childhood and the development of many nevi in adults, suggesting that a high number of nevi in childhood should be considered as a predictor of melanoma development during adult life. The predominance of dermoscopic types of melanocytic nevi varies according to the individual's age and depends on endogenous or exogenous signaling, suggesting different pathways of nevogenesis. We evaluated the total amount of melanocytic nevi of pediatric patients and their prevalent dermoscopic pattern. We investigated the reasons for dermatological examination, pointing out the role of older parents' populations in the decision to refer to a dermatological consultant. We performed a prospective observational study on 295 pediatric outpatients consecutively enrolled from July 2018 to July 2019. Descriptive and inferential statistical analyses were performed using logistic and linear regression. 49% of children were characterized by less than 10 nevi, 45% of children by a number of nevi between 10 and 30, whilst 17 patients (5%) had a number of nevi between 30 and 50. The most prevalent dermoscopic pattern was the globular one. An older parenting age was correlated with an autonomous reason for referral and a later first visit. Our data agreed with previous suggestions demonstrating a strong influence of latitude, sun exposure and ethnic background in the development of the number of nevi. To our knowledge, this is the first study, which evaluated the reasons for dermatological examination and the role of older parents' populations in the decision to refer to a dermatological consultant.


Assuntos
Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adolescente , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Humanos , Lactente , Itália/epidemiologia , Modelos Lineares , Modelos Logísticos , Masculino , Nevo Pigmentado/epidemiologia , Prevalência , Estudos Prospectivos , Neoplasias Cutâneas/epidemiologia
7.
Virchows Arch ; 477(1): 121-130, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32388720

RESUMO

Overlapping histological features between benign and malignant lesions and a lack of firm diagnostic criteria for malignancy result in high rates of inter-observer variation in the diagnosis of melanocytic lesions. We aimed to investigate the differential expression of five miRNAs (21, 200c, 204, 205, and 211) in benign naevi (n = 42), dysplastic naevi (n = 41), melanoma in situ (n = 42), and melanoma (n = 42) and evaluate their potential as diagnostic biomarkers of melanocytic lesions. Real-time PCR showed differential miRNA expression profiles between benign naevi; dysplastic naevi and melanoma in situ; and invasive melanoma. We applied a random forest machine learning algorithm to classify cases based on their miRNA expression profiles, which resulted in a ROC curve analysis of 0.99 for malignant melanoma and greater than 0.9 for all other groups. This indicates an overall very high accuracy of our panel of miRNAs as a diagnostic biomarker of benign, dysplastic, and malignant melanocytic lesions. However, the impact of variable lesion percentage and spatial expression patterns of miRNAs on these real-time PCR results was also considered. In situ hybridisation confirmed the expression of miRNA 21 and 211 in melanocytes, while demonstrating expression of miRNA 205 only in keratinocytes, thus calling into question its value as a biomarker of melanocytic lesions. In conclusion, we have validated some miRNAs, including miRNA 21 and 211, as potential diagnostic biomarkers of benign, dysplastic, and malignant melanocytic lesions. However, we also highlight the crucial importance of considering tissue morphology and spatial expression patterns when using molecular techniques for the discovery and validation of new biomarkers.


Assuntos
Biomarcadores/análise , Síndrome do Nevo Displásico/patologia , Hiperplasia/patologia , Melanoma/genética , MicroRNAs/genética , Neoplasias Cutâneas/genética , Diagnóstico Diferencial , Síndrome do Nevo Displásico/diagnóstico , Síndrome do Nevo Displásico/metabolismo , Humanos , Hiperplasia/diagnóstico , Hiperplasia/metabolismo , Melanócitos/metabolismo , Melanócitos/patologia , Melanoma/patologia , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia
8.
Am J Surg Pathol ; 44(7): 893-900, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32317605

RESUMO

PRAME (PReferentially expressed Antigen in MElanoma) is a melanoma-associated antigen. Although diffuse immunoreactivity for PRAME is found in most primary cutaneous melanomas, melanocytic nevi express PRAME usually only in a subpopulation of tumor cells or not at all. Hence, testing for PRAME expression has the potential to provide useful information for the assessment for diagnostically ambiguous melanocytic neoplasms. Many of the latter tumors are currently studied by cytogenetic methods for ancillary evidence in support of or against a diagnosis of melanoma. In this study we analyzed 110 diagnostically problematic melanocytic tumors comparing results for PRAME immunohistochemistry (IHC) with those from fluorescence in situ hybridization and/or single nucleotide polymorphism-array, and each with the final diagnostic interpretation. In 90% of cases there was concordance between PRAME IHC and cytogenetic tests results, and in 92.7% concordance between PRAME IHC and the final diagnosis. The high concordance between PRAME IHC and cytogenetic test results as well as the final diagnosis supports the use of PRAME IHC as an ancillary test in the evaluation of ambiguous primary cutaneous melanocytic neoplasms, especially given its practical advantage of lower cost and faster turnaround over cytogenetic or gene expression studies. However, our results indicate that PRAME IHC and cytogenetic tests for melanocytic tumors are not entirely interchangeable and on occasion each type of test may yield false-negative or false-positive results.


Assuntos
Antígenos de Neoplasias , Biomarcadores Tumorais , Análise Citogenética , Imuno-Histoquímica , Melanoma/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígenos de Neoplasias/genética , Antígenos de Neoplasias/metabolismo , Biomarcadores Tumorais/genética , Biomarcadores Tumorais/metabolismo , Criança , Pré-Escolar , Diagnóstico Diferencial , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Hibridização in Situ Fluorescente , Masculino , Melanoma/genética , Melanoma/metabolismo , Melanoma/patologia , Pessoa de Meia-Idade , Nevo Pigmentado/genética , Nevo Pigmentado/metabolismo , Nevo Pigmentado/patologia , Análise de Sequência com Séries de Oligonucleotídeos , Polimorfismo de Nucleotídeo Único , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologia , Adulto Jovem
9.
Orv Hetil ; 161(15): 563-574, 2020 04 01.
Artigo em Húngaro | MEDLINE | ID: mdl-32320191

RESUMO

Our purpose is to summarize the actual knowledge about melanocytic lesions of the ocular surface (conjunctival nevus, primary acquired melanosis and conjunctival melanoma),especially their clinical appearance, differential diagnosis and treatment. Conjunctival nevus is the most common benign, conjunctival melanocytic lesion. Primary acquired melanosis mainly presents in middle-aged or elderly individuals, characterized by proliferation of melanocytes of the conjunctival epithelial layer. Conjunctival melanoma is a rare tumor, it is the second most common malignant ocular surface tumor after ocular surface squamous neoplasia and the third most common ocular malignancy following choroideal malignant melanoma and ocular surface squamous neoplasia. Early recognition and proper management of conjunctival melanoma is indispensable due to its high malignant and metastatic potential. Due to frequent recurrences, the knowledge and use of intra- and postoperative adjuvant treatment modalities, and regular follow-up are necessary. Orv Hetil. 2020; 161(15): 563­574.


Assuntos
Neoplasias da Túnica Conjuntiva/patologia , Melanócitos/patologia , Melanoma/patologia , Nevo Pigmentado/patologia , Nevo/patologia , Neoplasias Cutâneas/patologia , Idoso , Diagnóstico Diferencial , Humanos , Pessoa de Meia-Idade
11.
An Bras Dermatol ; 95(3): 351-354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32265056

RESUMO

Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.


Assuntos
Doenças Ósseas Metabólicas/patologia , Nevo Intradérmico/patologia , Nevo Pigmentado/patologia , Ossificação Heterotópica/patologia , Dermatoses do Couro Cabeludo/patologia , Dermatopatias Genéticas/patologia , Neoplasias Cutâneas/patologia , Adulto , Doenças Ósseas Metabólicas/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Melanócitos/patologia , Nevo Intradérmico/cirurgia , Nevo Pigmentado/cirurgia , Ossificação Heterotópica/cirurgia , Dermatoses do Couro Cabeludo/cirurgia , Dermatopatias Genéticas/cirurgia , Neoplasias Cutâneas/cirurgia
14.
In Vivo ; 34(1): 441-445, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882511

RESUMO

A 59-year-old woman, undergoing treatment with encorafenib for metastatic BRAF mutated colorectal cancer, developed during the first two months of therapy multiple eruptive nevi and changes in pre-existing nevi. Development of eruptive nevi has increasingly been reported in association with medications, most frequently conventional immunosuppressants and biologics. Some drugs are associated with eruptive nevi through an indirect effect of their mechanism of action, whereas other drugs are directly implicated in melanocyte proliferation. In this regard, BRAF inhibitors have been demonstrated to activate the MAPK pathway, and to promote cellular proliferation and survival, therefore leading to the development of new melanocytic nevi and to an increase in the size and hyperpigmentation of pre-existing nevi. A dermatological assessment and follow-up should be recommended in all patients presenting with eruptive nevi, regardless of the pathogenesis, because a high number of acquired melanocytic nevi may represent an adjunctive risk factor for melanoma.


Assuntos
Carbamatos/efeitos adversos , Neoplasias Colorretais/tratamento farmacológico , Melanoma/induzido quimicamente , Nevo Pigmentado/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Proteínas Proto-Oncogênicas B-raf/genética , Neoplasias Cutâneas/induzido quimicamente , Sulfonamidas/efeitos adversos , Neoplasias Colorretais/secundário , Feminino , Humanos , Melanoma/patologia , Pessoa de Meia-Idade , Mutação , Nevo Pigmentado/patologia , Prognóstico , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Neoplasias Cutâneas/patologia
15.
Dermatology ; 236(3): 241-247, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31707398

RESUMO

BACKGROUND: The head and neck are considered one single anatomical unit. No data on clinical, dermoscopic and confocal aspects of neck melanoma are currently available. OBJECTIVES: To identify clinical, dermoscopic and confocal diagnostic features of neck melanomas. METHODS: Consecutive malignant (cases) and benign (controls) melanocytic skin lesions located on the neck, excised as suspected of being melanoma from March 2011 to February 2018, were retrospectively retrieved. Dermoscopic criteria of the 7-point checklist, integrated by other melanoma features (such as grey colour and irregular hyperpigmented areas) were assessed. Reflectance confocal microscopy (RCM) images were examined when available. RESULTS: 282 lesions located to the head and neck area were biopsied to rule out melanoma. Thirty-one out of 282 (11%) lesions were located on the neck: 21 melanomas and 10 naevi. Melanoma patients were older than patients with naevi (mean age: 60.4 vs. 37.9 years, p < 0.001). Neck melanomas were more frequently located on sun-damaged skin compared to naevi (76.2 vs. 30%, p = 0.02). Dermoscopically, neck melanomas were characterized by irregular dots/globules, grey colour and regression (76.2, 81 and 46.7% of cases) and showed criteria of lentigo maligna melanoma (LMM) in 52.4% of cases. Regression, grey colour, irregular hyperpigmented areas and criteria of LMM typified melanomas on sun-damaged skin, whereas tumours located on non-sun-damaged areas were often characterized by irregular pigmentation (blotches). RCM, implemented to dermoscopy, correctly diagnosed 10/12 melanomas and 3/5 naevi. CONCLUSION: Neck melanoma has peculiar clinical and dermoscopic aspects that could help clinicians to distinguish it from naevi and to diagnose melanoma earlier.


Assuntos
Melanoma/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Idoso , Biópsia , Dermoscopia , Feminino , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Sarda Melanótica de Hutchinson/diagnóstico , Sarda Melanótica de Hutchinson/diagnóstico por imagem , Masculino , Melanoma/diagnóstico por imagem , Melanoma/patologia , Microscopia Confocal , Pessoa de Meia-Idade , Pescoço , Nevo Pigmentado/diagnóstico por imagem , Nevo Pigmentado/patologia , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia
17.
Am J Dermatopathol ; 42(1): 11-15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31145105

RESUMO

Our understanding of melanoma precursors and progression to melanoma has developed as a result of advances in the field of molecular diagnostics. We now better understand the potential for genetic heterogeneity within a single lesion. Combined tumors can pose a diagnostic challenge when deciding the line between benign and malignant, which in turn has direct implications for patient management. Primary cilia (PC) are ubiquitous sensory organelles that have essential functions in cellular proliferation, differentiation, and development. The ciliation index (percentage of ciliated melanocytes) has been shown to reliably differentiate melanoma, which fail to ciliate, from melanocytic nevi, which retain PC. We therefore analyzed the potential for using the ciliation index to differentiate benign and malignant components in combined melanocytic lesions. We collected patient samples (n = 10) of unequivocal combined lesions with both melanoma and associated nevus components. Melanocytes were highlighted with SOX10 and costained with gamma-Tubulin and acetylated alpha-Tubulin to highlight the basal body and cilium, respectively. The number of melanocytes retaining cilia under high-power microscopy was examined. The melanoma component had average of 4% ciliation (SD: 7%), whereas the associated nevus component was significantly higher with 59% ciliation (SD: 17%). These data show that PC may be a reliable means of distinguishing benign from malignant components within a single tumor. The ciliation index may be a helpful tool in distinguishing challenging cases of combined lesions of melanoma in situ with a dermal nevus component from invasive melanoma, thus promoting improved staging and clinical management.


Assuntos
Cílios/patologia , Melanoma/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Feminino , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Cutâneas/diagnóstico
18.
Arch Pathol Lab Med ; 144(4): 457-465, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31469587

RESUMO

CONTEXT.­: Granular cell change in melanocytic nevus is underrepresented in the literature with only 4 well-documented cases, 1 described in the conjunctiva. Unfamiliarity with the clinical and pathologic features of these lesions contributes to the diagnostic difficulty. OBJECTIVE.­: To delineate the clinical and histopathologic features of conjunctival nevi with granular cell change. DESIGN.­: In a retrospective observational case series, the medical records of all patients with conjunctival nevi and granular cell change diagnosed between December 2016 and October 2018 were reviewed. Data collected included age, sex, clinical presentation, pathologic findings, and follow-up. RESULTS.­: Twelve patients, 6 males and 6 females, with a median age of 14 years (range, 8-82 years) were identified. The nevus manifested as a pigmented, well-circumscribed nodule (7 of 9; 78%) or patch (2 of 9; 22%) in the bulbar and limbal conjunctiva (7 of 9; 78%) or in the plica semilunaris/caruncle (2 of 9; 22%). Cysts were noted in 7 of 9 lesions (78%). Features prompting surgical excision included atypical pigmentation (8 of 9; 89%), growth (7 of 9; 78%), and atypical vascularity (4 of 9; 44%). Microscopically, all lesions comprised a conventional melanocytic nevus with focal granular cell change and immunoreactivity for Melan-A, SOX10, and HMB-45, with Ki-67 proliferative index of less than 2%. Of the 9 lesions with follow-up information, there were no recurrences over mean follow-up of 11.2 months (range, 1-23 months). CONCLUSIONS.­: Granular cell change in melanocytic nevi is an underrecognized finding that can simulate melanoma clinically and histopathologically. Young age at diagnosis, lack of associated conjunctival melanosis, bulbar location, cysts, and the absence of mitotic figures with a low Ki-67 proliferative index are helpful clinical and pathologic diagnostic clues.


Assuntos
Neoplasias da Túnica Conjuntiva/patologia , Nevo Pigmentado/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
Sci Rep ; 9(1): 18204, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31796811

RESUMO

To evaluate histopathological characteristics of conjunctival pigmented lesions and analyze clinical features related to histologic classification in Asian population, we analyzed medical records, anterior segment photographs, and histological specimen of 85 eyes who had undergone biopsy for pigmented conjunctival lesions at Seoul National University Hospital between 1999 and 2018. Compound nevus was the most common type of conjunctival pigmented lesions (67.1%), followed by conjunctival melanocytic intraepithelial neoplasia (primary acquired melanosis)(11.8%), subepithelial nevus (8.2%), and malignant melanoma (MM)(7.1%). Patients with compound nevus were younger than those with non-compound nevus (22.1 ± 17.0 vs 39.9 ± 18.8 years, p < 0.001), while patients with MM were older than those without melanoma (55.7 ± 18.2 vs 25.8 ± 18.0 years, p = 0.001). The lesion in compound nevus tended to be more frequently located on the temporal conjunctiva than that in the non-compound nevus group (54.4% vs 32.1%, p = 0.053), and feeder vessels were associated with most of compound nevus (98.2% vs 78.6% of non-compound nevus, p = 0.005). The lesion in MM was larger, involved multiple quadrants, and had extrabulbar location than lesions without melanoma (p < 0.001, p < 0.001, and p = 0.002, respectively). Together, the results would help clinicians to distinguish benign conjunctival pigmentations from malignant counterparts in clinical practice without biopsy.


Assuntos
Túnica Conjuntiva/patologia , Neoplasias da Túnica Conjuntiva/epidemiologia , Melanoma/epidemiologia , Nevo Pigmentado/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Túnica Conjuntiva/diagnóstico por imagem , Neoplasias da Túnica Conjuntiva/diagnóstico , Neoplasias da Túnica Conjuntiva/patologia , Feminino , Humanos , Lactente , Masculino , Melanoma/diagnóstico , Melanoma/patologia , Pessoa de Meia-Idade , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patologia , Fotografação , Prevalência , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
20.
Bol Med Hosp Infant Mex ; 76(6): 251-258, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31769436

RESUMO

Giant congenital melanocytic nevi (GCMN) are melanocytic lesions secondary to the abnormal migration of melanoblasts during the embryogenesis, affecting approximately one in 20,000 live births. They are usually present since birth and are distinguished by changing their morphological characteristics within time, and increasing their size parallel to the growth of the child, reaching a diameter ≥ 20 cm in adulthood. The importance of the GCMN lies in the complications associated to them; mainly the development of melanoma or neurocutaneous melanosis, in addition to the psychological or social impact that generates in most of the cases. Therefore, individuals with GCMN will require a multidisciplinary long-term follow-up. Currently, the management of children with GCMN is still controversial since there is no treatment of choice. Consequently, the treatment must be individualized according to the characteristics of the nevus and the specific needs of each patient.


Assuntos
Nevo Pigmentado , Neoplasias Cutâneas , Continuidade da Assistência ao Paciente , Humanos , Nevo Pigmentado/complicações , Nevo Pigmentado/genética , Nevo Pigmentado/patologia , Nevo Pigmentado/terapia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia
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