Eyelid Melanoma Marchalik, Rachel J; Venna, Suraj
The New England journal of medicine,
07/2016, Letnik:
375, Številka:
1
Journal Article
Recenzirano
An 87-year-old man presented with a stye on his left upper eyelid. Despite conservative interventions, the stye had persisted and the skin had become noticeably darker over several weeks. His risk ...factors included a history of prolonged sun exposure while working as a lifeguard.
An 87-year-old man presented for treatment of a stye on his left upper eyelid. Despite conservative interventions, the stye had persisted and the skin had become noticeably darker over several weeks (Panels A and B). He reported itching but no pain or bleeding. His risk factors for skin cancer included a history of prolonged sun exposure while working as a lifeguard. A biopsy specimen from the margin of the left upper eyelid was obtained and on examination revealed invasive lentigo maligna melanoma, with a Breslow thickness of 0.35 mm, no ulceration, and no mitogenesis (Panel C, Melan-A stain). The patient . . .
Background A minority of patients with T1 melanoma will have a positive sentinel lymph node (SLN) biopsy (SLNB) finding. Identifying who will develop metastatic disease is important in determining ...prognosis and treatment. Objective We sought to identify clinical and histologic features predictive of a positive SLNB result and determine its prognostic significance in patients with T1 melanoma. Methods Clinical and histologic parameters were evaluated in 484 patients with T1 melanoma for their ability to predict a positive SLNB result. The impact of various factors on SLN positivity was evaluated. SLN status was examined as a predictor of overall survival. Results In all, 34 patients had a positive SLNB finding. Four factors predicted a higher risk of SLN positivity: age 43 years or younger, Breslow depth 0.8 mm or greater, tumors on the lower extremity and trunk, and tumor-infiltrating lymphocyte level. By multivariate analysis, low tumor-infiltrating lymphocytes ( P = .0015) and decreasing age ( P = .0058) independently predicted SLN positivity. If 0 to 2 of these factors were present, the rate of a positive SLNB result was 3%; this increased to 15% with 3 factors present and to 30% if all 4 factors were present ( P < .002). SLN-positive patients had significantly decreased survival ( P = .003), and SLN status was the most powerful predictor of survival ( P = .009). Limitations Our data analysis includes patients from 1994 to 2007 and therefore information on mitotic rate, a recently defined T1b criterion, is not recorded for all patients. Conclusions Combining clinical and histologic prognostic factors may help identify subgroups of T1 patients at higher risk of SLN positivity. SLN status has significant prognostic impact in patients with thin melanomas.
Melanoma is usually apparent on the skin and readily detected by trained medical providers using a routine total body skin examination, yet this malignancy is responsible for the majority of skin ...cancer-related deaths. Currently, there is no national consensus on skin cancer screening in the USA, but dermatologists and primary care providers are routinely confronted with making the decision about when to recommend total body skin examinations and at what interval. The objectives of this paper are: to propose rational, risk-based, data-driven guidelines commensurate with the US Preventive Services Task Force screening guidelines for other disorders; to compare our proposed guidelines to recommendations made by other national and international organizations; and to review the US Preventive Services Task Force's 2016 Draft Recommendation Statement on skin cancer screening.
IMPORTANCE: The management of clinically atypical nevi/dysplastic nevi (CAN/DN) is controversial, with few data to guide the process. Management recommendations for DN with positive histologic ...margins were developed by the Delphi method to achieve consensus among members of the Pigmented Lesion Subcommittee (PLS) of the Melanoma Prevention Working Group (MPWG) after reviewing the current evidence. OBJECTIVES: To outline key issues related to the management of CAN/DN: (1) biopsies of CAN and how positive margins arise, (2) whether incompletely excised DN evolve into melanoma, (3) current data on the outcomes of DN with positive histologic margins, (4) consensus recommendations, and (5) a proposal for future studies, including a large-scale study to help guide the management of DN with positive margins. EVIDENCE REVIEW: The literature, including recent studies examining management and outcomes of DN with positive margins between 2009 to 2014, was reviewed. FINDINGS: A consensus statement by the PLS of the MPWG following review of the literature, group discussions, and a structured Delphi method consensus. CONCLUSIONS AND RELEVANCE: This consensus statement reviews the complexities of management of CAN/DN. A review of the literature and 2 rounds of a structured Delphi consensus resulted in the following recommendations: (1) mildly and moderately DN with clear margins do not need to be reexcised, (2) mildly DN biopsied with positive histologic margins without clinical residual pigmentation may be safely observed rather than reexcised, and (3) observation may be a reasonable option for management of moderately DN with positive histologic margins without clinically apparent residual pigmentation; however, more data are needed to make definitive recommendations in this clinical scenario.
Optimal treatment of skin cancer before it metastasizes critically depends on early diagnosis and treatment. Imaging spectroscopy and polarized remittance have been utilized in the past for ...diagnostic purposes, but valuable information can be also obtained from the analysis of skin roughness. For this purpose, we have developed an out-of-plane hemispherical Stokes imaging polarimeter designed to monitor potential skin neoplasia based on a roughness assessment of the epidermis. The system was utilized to study the rough surface scattering for wax samples and human skin. The scattering by rough skin-simulating phantoms showed behavior that is reasonably described by a facet scattering model. Clinical tests were conducted on patients grouped as follows: benign nevi, melanocytic nevus, melanoma, and normal skin. Images were captured and analyzed, and polarization properties are presented in terms of the principal angle of the polarization ellipse and the degree of polarization. In the former case, there is separation between different groups of patients for some incidence azimuth angles. In the latter, separation between different skin samples for various incidence azimuth angles is observed.
The cause is unknown, but it has been suggested that they are a trauma-induced hyperplasia of the nerve fibers.3 Excision is typically curative.4 The most common form of basal cell carcinoma presents ...as a dome-shaped papule or nodule that may ulcerate and bleed. The raised, rolled, pearly borders can be accentuated by applying traction to the surrounding skin.5 Telangiectasia forms an arboreal pattern on dermoscopy.6 An epidermal inclusion cyst usually presents as a 1- to 4-cm, solitary, firm, mobile, subcutaneous nodule on the trunk, neck, or face. Summary Table Condition Characteristics Basal cell carcinoma Dome-shaped papule or nodule that may ulcerate or bleed; raised, pearly, rolled borders; telangiectasia forms an arboreal pattern on dermoscopy Epidermal inclusion cyst 1- to 4-cm, solitary, firm, mobile, subcutaneous nodule; surface punctum that may express accumulated keratin debris Intradermal melanocytic nevus Soft with smooth edges and preservation of skin markings; brown pigment, comma-shaped vessels, and hair are often noted on dermoscopy Neurofibroma Soft sessile or pedunculated papule, usually on the trunk, that invaginates with pressure (“buttonholing”) Palisaded encapsulated neuroma Small, asymptomatic, skin-colored, firm, dome-shaped papule; usually no hair on the surface and minimal or absent telangiectasia Author disclosure:
Purpose: To determine the prognostic significance of a multimarker assay incorporating expression levels of three molecular markers
in primary cutaneous melanoma.
Experimental Design: We assessed ...expression levels of NCOA3, SPP1, and RGS1 using immunohistochemical analysis in a tissue microarray cohort of
395 patients. For each marker, we identified optimal cut-points for expression intensity to predict disease-specific survival
(DSS) and, as a secondary endpoint, sentinel lymph node (SLN) status. The cumulative overexpression of all three markers was
embodied in a multimarker index, and its prognostic effect on DSS and SLN status was assessed using Cox regression, Kaplan-Meier
analysis, and logistic regression. The prognostic effect of this multimarker assay on DSS was assessed in an independent cohort
of 141 patients, in which marker expression levels were scored using immunohistochemical analysis of stained tissue sections.
Results: Increasing multimarker index scores were significantly predictive of reduced DSS and increased SLN metastasis in the 395-patient
cohort. Multivariate logistic regression analysis revealed multimarker expression scores as an independent predictor of SLN
status ( P = 0.001). Multivariate Cox regression analysis showed the independent effect of the multimarker index on DSS ( P < 0.001). The multimarker index was the most significant factor predicting DSS when compared with other clinical and histologic
factors, including SLN status ( P = 0.002). Multimarker expression scores were also the most significantly predictive of DSS in the independent cohort ( P = 0.01).
Conclusions: These results describe a multimarker assay with independent prognostic effect on the prediction of survival associated with
melanoma in two distinct cohorts. (Clin Cancer Res 2009;15(22):6987–92)
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