DNA was extracted from 52 thick primary melanomas and mutations sought in exon 15 of the BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene using denaturing high performance liquid chromatograph (dHPLC) fragme...DNA was extracted from 52 thick primary melanomas and mutations sought in exon 15 of the BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene using denaturing high performance liquid chromatograph (dHPLC) fragment analysis, sequencing, and allele-specific PCR. Exon 15 BRAF mutations were found in 13 of 52 (25% ) primary melanomas. These comprised five of 17 (29% ) superficial spreading melanomas, three of 11 (27% ) nodular melanomas, two of 13 (15% ) acral lentiginous melanomas, one of one (100% ) mucosal melanoma and two of 10 (20% ) lentigo maligna melanomas. In common with other groups, our findings show a relative concentration of the exon 15 BRAF mutation in superficial spreading and nodular melanomas, but add further evidence that this mutation not necessary for malignant transformation of the melanocyte.展开更多
An acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians. However, it is unusual to encounter a patient showing only the histologic features of an ALM in situ. Here we describe clini...An acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians. However, it is unusual to encounter a patient showing only the histologic features of an ALM in situ. Here we describe clinical and histologic features of nine cases of ALM in situ including immunohistochemical staining with anti-S 100 protein and HMB-45. All the patients had a long clinical history. Clinically, the lesions were characterized by a longitudinal pigmented streak in the nail plates, black pigmentation on the proximal or lateral nail fold, and an irregular border and variegated pigmentation on the sole or thumb. Total resections of the lesions were performed in all patients. All lesions, in both biopsy and excisional specimens demonstrated more melanocytes generally located in the basal layer of the epidermis. There was no dermal invasion. No recurrence of the disease had occurred in any patient after a follow-up period of between 6 months to 12 years after surgery. These results suggest that ALM can evolve slowly over many years.展开更多
Lentigo maligna (LM) is a melanocytic lesion which is a potential precursor to melanoma and often has a prolonged intraepidermal growth phase before evolving into lentigo ma-ligna melanoma (LMM). LM is also noted for ...Lentigo maligna (LM) is a melanocytic lesion which is a potential precursor to melanoma and often has a prolonged intraepidermal growth phase before evolving into lentigo ma-ligna melanoma (LMM). LM is also noted for its tendency to locally recur after treatment. We present a patient who had a persistent LM on her left cheek which, despite multiple excisions, persisted and transformed into a partially amelanotic LMM roughly three decades later. Our patient’s course was also notable for this melanoma recurring at the edge of, and subsequently migrating into, a previously placed skin graft.展开更多
Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evalua...Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evaluation of lesions located on the face may require a different approach, as a histopathological diagnosis of malignancy is not uncommon in clinically trivial lesions (i.e. lesions lacking the ABCD criteria for clinical suspicion). Moreover, at this site dermoscopy reveals specific criteria according to the particular histological architecture shown by sun- damaged skin. We report four cases of lentigo maligna (LM) of the face whose identification depended on dermoscopic examination which was performed routinely on all faciallesions,as the lesions did not show ABCD clinical criteria for malignancy. In our experience, the identification of early signs of malignancy by dermoscopy may indicate the excision of LM at an early phase, before the lesion is associated with the ABCD signs of melanoma. Dermatologists should avoid the mistake of immediately excluding a diagnosis of malignancy when examining an ABCD- negative pigmented skin lesion of the face.展开更多
Background.Traditionally melanoma has been considered as a radioresistant tumor.However,recent observations regarding radiobiology and clinical response of melanoma have prompted physicians to re-evaluate the role of ...Background.Traditionally melanoma has been considered as a radioresistant tumor.However,recent observations regarding radiobiology and clinical response of melanoma have prompted physicians to re-evaluate the role of radiotherapy in the management of melanoma.Indeed,radiotherapy is frequently used in the treatment of metastatic melanoma but the role of this therapeutic approach in the primary tumor management is unclear.We report 4 cases of thick primary melanoma treated by interstitial brachytherapy.Case reports.Four patients(3 men,1 woman;age:73,74,79,84 years),three with lentigo maligna melanoma and one with nodular melanoma,were treated exclusively by interstitial brachytherapy.The thickness of the 4 tumors was more than 3 mm.This treatment was chosen either because of the impossibility of conservative surgery or because of a contraindication for general anesthesia.Median follow-up was 48 months [18 to 65 months] and we did not observe any local tumor relapse.The cosmetic and functional results of this therapy were excellent.Discussion.These four cases illustrate the possibility of obtaining good local control of thick primary melanoma by interstitial brachy therapy where surgery is impossible,although without challenging the standard surgical therapy for primary melanoma.Before our study,this treatment was used only in one study to treat melanoma patients.In this case however,interstitial brachy therapy was accompanied by surgery.Therefore,the findings reported here are the first to demonstrate the efficacy of this treatment when used as the sole treatment for primary melanoma.In conclusion,where surgery is difficult or impossible,interstitial brachytherapymay be used to treat primary melanoma with excellent local tumor control and a good cosmetic outcome.展开更多
文摘DNA was extracted from 52 thick primary melanomas and mutations sought in exon 15 of the BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene using denaturing high performance liquid chromatograph (dHPLC) fragment analysis, sequencing, and allele-specific PCR. Exon 15 BRAF mutations were found in 13 of 52 (25% ) primary melanomas. These comprised five of 17 (29% ) superficial spreading melanomas, three of 11 (27% ) nodular melanomas, two of 13 (15% ) acral lentiginous melanomas, one of one (100% ) mucosal melanoma and two of 10 (20% ) lentigo maligna melanomas. In common with other groups, our findings show a relative concentration of the exon 15 BRAF mutation in superficial spreading and nodular melanomas, but add further evidence that this mutation not necessary for malignant transformation of the melanocyte.
文摘An acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians. However, it is unusual to encounter a patient showing only the histologic features of an ALM in situ. Here we describe clinical and histologic features of nine cases of ALM in situ including immunohistochemical staining with anti-S 100 protein and HMB-45. All the patients had a long clinical history. Clinically, the lesions were characterized by a longitudinal pigmented streak in the nail plates, black pigmentation on the proximal or lateral nail fold, and an irregular border and variegated pigmentation on the sole or thumb. Total resections of the lesions were performed in all patients. All lesions, in both biopsy and excisional specimens demonstrated more melanocytes generally located in the basal layer of the epidermis. There was no dermal invasion. No recurrence of the disease had occurred in any patient after a follow-up period of between 6 months to 12 years after surgery. These results suggest that ALM can evolve slowly over many years.
文摘Lentigo maligna (LM) is a melanocytic lesion which is a potential precursor to melanoma and often has a prolonged intraepidermal growth phase before evolving into lentigo ma-ligna melanoma (LMM). LM is also noted for its tendency to locally recur after treatment. We present a patient who had a persistent LM on her left cheek which, despite multiple excisions, persisted and transformed into a partially amelanotic LMM roughly three decades later. Our patient’s course was also notable for this melanoma recurring at the edge of, and subsequently migrating into, a previously placed skin graft.
文摘Up until now, only lesions selected on the basis of their clinical atypia or which appear equivocal on naked eye examination have been shown to benefit from the use of dermoscopy. In our experience, dermoscopic evaluation of lesions located on the face may require a different approach, as a histopathological diagnosis of malignancy is not uncommon in clinically trivial lesions (i.e. lesions lacking the ABCD criteria for clinical suspicion). Moreover, at this site dermoscopy reveals specific criteria according to the particular histological architecture shown by sun- damaged skin. We report four cases of lentigo maligna (LM) of the face whose identification depended on dermoscopic examination which was performed routinely on all faciallesions,as the lesions did not show ABCD clinical criteria for malignancy. In our experience, the identification of early signs of malignancy by dermoscopy may indicate the excision of LM at an early phase, before the lesion is associated with the ABCD signs of melanoma. Dermatologists should avoid the mistake of immediately excluding a diagnosis of malignancy when examining an ABCD- negative pigmented skin lesion of the face.
文摘Background.Traditionally melanoma has been considered as a radioresistant tumor.However,recent observations regarding radiobiology and clinical response of melanoma have prompted physicians to re-evaluate the role of radiotherapy in the management of melanoma.Indeed,radiotherapy is frequently used in the treatment of metastatic melanoma but the role of this therapeutic approach in the primary tumor management is unclear.We report 4 cases of thick primary melanoma treated by interstitial brachytherapy.Case reports.Four patients(3 men,1 woman;age:73,74,79,84 years),three with lentigo maligna melanoma and one with nodular melanoma,were treated exclusively by interstitial brachytherapy.The thickness of the 4 tumors was more than 3 mm.This treatment was chosen either because of the impossibility of conservative surgery or because of a contraindication for general anesthesia.Median follow-up was 48 months [18 to 65 months] and we did not observe any local tumor relapse.The cosmetic and functional results of this therapy were excellent.Discussion.These four cases illustrate the possibility of obtaining good local control of thick primary melanoma by interstitial brachy therapy where surgery is impossible,although without challenging the standard surgical therapy for primary melanoma.Before our study,this treatment was used only in one study to treat melanoma patients.In this case however,interstitial brachy therapy was accompanied by surgery.Therefore,the findings reported here are the first to demonstrate the efficacy of this treatment when used as the sole treatment for primary melanoma.In conclusion,where surgery is difficult or impossible,interstitial brachytherapymay be used to treat primary melanoma with excellent local tumor control and a good cosmetic outcome.
