Metastatic melanoma mimicking primary bronchial melanoma

Primary malignant melanoma of the bronchus is an extremely rare neoplasm. The criteria required to establish a bronchial origin include junctional change and invasion of intact bronchial mucosa by melanoma cells. A case of metastatic melanoma demonstrating such changes is described, so casting doubt on the validity of these criteria.     

Immunodiagnosis of melanoma using chimpanzee antihuman melanoma antiserum.

Three cases of metastatic malignant lesions are presented. By conventional pathologic examination these lesions were diagnosed as undifferentiated carcinomas. They were studied using a chimpanzee antiserum specific for human melanoma-associated antigens. In each case, cells from the tumor were reactive with the anti-melanoma antiserum. The tumors were also studied using the DOPA test. All three tumors were positive in the DOPA test, suggesting the presence of tyrosinase within the tumor cells. The results suggest that serologic identification of melanoma may provide a rapid, inexpensive means for tumor diagnosis.     

Melanoma markers-negative primary melanoma with melanoma markers-positive metastasis

Concordant loss of all 3 commonly used melanocytic markers (ie, S-100, HMB-45, and Melan-A) in a primary malignant melanoma with expression of the same in the metastatic lesion is very rare. To the best of the authors' knowledge, they documented the second case of this unusual and rare phenomenon.     

Malignant melanoma

CONTEXT: The rapidly developing fields of melanoma research are revolutionizing the current concepts on melanoma etiology and pathogenesis and are introducing newer diagnostic techniques and potential therapeutic approaches. OBJECTIVES: To present the most current concepts on the etiology and pathogenesis of melanoma and to introduce the recent diagnostic techniques and the potential therapeutic approaches. METHODS: Data sources were reports on melanoma published in the English language literature and observations made using specimens available at Harvard University, Johns Hopkins Medical Center, Albany Medical College, Loyola University Medical Center, and University of Tennessee Health Science Center. RESULTS: Studies on melanoma containing chromosomal or genetic evaluation were selected for further analysis. Current clinical and pathologic categories with the reported genetic abnormalities were related to the latest information on pigment biology. The data extracted were used to develop a conceptual framework on the pathogenesis of melanoma; the generated model was then evaluated and used to suggest potential therapeutic approaches. CONCLUSIONS: (1) Melanoma is not genetically homogeneous, and the existing differences between the pathologic categories, particularly in areas such as type of growth phase (radial vs vertical growth), total vertical dimension, ulceration of primary tumor, and metastatic process, have profound prognostic and therapeutic implications. (2) Chromosomal aberrations and gene mutations are found in sporadic and familial melanomas; among the most important are those affecting the 9p21, which contains the p16 locus, a site known to be critical for normal progression of the cell cycle. Aberrant p16 expression is associated with more aggressive behavior. (3) Melanoma cells possess a remarkable repertoire of biosynthetic capacities represented by the production of hormones, growth factors, and their receptors that may sustain and accelerate tumor development and progression. For example, expression of the tumoral products alpha-melanocyte-stimulating hormone and adrenocorticotropic hormone is regulated in vitro by ultraviolet light, a known carcinogen. (4) Melanomas differ from other tumors in their intrinsic capability to express melanogenic enzymes with the corresponding structural proteins to actually synthesize melanin. Melanogenesis-related proteins are rapidly entering the clinical arena, being used not only as diagnostic markers, but also as potential targets for melanoma therapy.     

Desmoplastic melanoma

Desmoplastic melanoma is a rare tumour of which a limited number of cases have been described. The clinical and histopathological features of desmoplastic melanoma and its variants may give rise to perplexing diagnostic and therapeutic dilemmas. In the past decades, some insight has been gained into the histogenesis of these lesions and discriminating clinical and morphological features are now recognized. Review of the literature reveals an extensive list of differential diagnoses. Adequate surgical excision and close follow-up of these radioresistant, frequently-recurring tumours is strongly advocated.     

Osteogenic melanoma

A case of osteogenic melanoma arising in the sole of the foot of a 75-year-old male is described. The patient had a history of cutaneous malignant melanoma of the left sole from 15 years previously with local recurrence 5 years previously. A second recurrence presented as an unencapsulated, poorly circumscribed mass measuring 7.5x6x3 cm, located in the dermis, subcutis and muscle, and composed of a lobular growth of malignant osteocartilaginous elements with foci of epithelioid cells. The tumor was strongly positive for HMB45 and S-100 protein. No conventional melanoma was found in the skin. The patient had no evidence of recurrence or metastasis 10 months after surgery. Pathologists and clinicians should be aware of the existence of osteogenic melanoma and should differentiate it from mimics.     

Acral melanoma

Basing on 18 observations, histological features of malignant melanomas on the soles and the terminal phalanges of the toes were revealed and described in detail. A specific character of melanomas with such localization is evident from the histological pattern and clinical manifestations. It is suggested to distinguish the described acral lentiginous melanoma as a separate clinico-morphologic form of melanoma.     

Iris melanoma

The iris is the least common site of primary uveal melanoma. The prognosis of iris melanoma is better than that of melanoma of the ciliary body and choroid, but the reason for this difference is unclear. One possible explanation is that iris melanoma is smaller than its posterior segment counterparts at the time of diagnosis. Most iris melanomas are spindle cell types, according to a modified Callender classification system. There is evidence that the proliferation of melanocytes of the anterior iris surface (iris plaque) and diffuse stromal invasion may be risk factors for local recurrence and metastasis, respectively.     

Prevalence of variations in melanoma susceptibility genes among Slovenian melanoma families

Background  

Two high-risk genes have been implicated in the development of CM (cutaneous melanoma). Germline mutations of the CDKN2A gene are found in < 25% of melanoma-prone families and there are only seven families with mutation of the CDK4 gene reported to date. Beside those high penetrance genes, certain allelic variants of the MC1R gene modify the risk of developing the disease.     

Current immunotherapy of melanoma

The immunotherapy of patients with metastatic melanoma is currently at a crossroads. Indeed, recent results from vaccine strategies worldwide have revealed a strikingly low overall response rate in patients with stage IV melanoma. Although disappointing, we have gained valuable insight and knowledge about how vaccines interact with the host immune response and to melanoma. However, although an immunological response to therapy is often reported from various clinical trials, it does not contribute to a patient's long term survival. It has been proven time and again that an immunological response to therapy does not necessarily translate into a meaningful clinical response. This frustrating dichotomy of response continues to vex investigators, providing a glaring example of our poor understanding of the immunologic response to cancer. Thus, we remain at the crossroads of understanding and treatment. On the one hand, we have dramatically advanced the field of tumor immunology/immunotherapy over the last 20 years. On the other hand, we have made little headway in truly developing effective treatment options for patients with stage IV disease. We must realize our previous shortcomings and failures in order to learn from them and develop improved therapies. The future of immunotherapy remains a bright ray of hope for everyone, with the road to success paved with the previous hard work of thousands of clinicians and researchers everywhere. Towards this end, this review hopes to provide the reader with the current state of affairs for the immunotherapy of melanoma as well as a primer of where we might be heading in the future.