Vulvar melanoma: a report of 20 cases and review of the literature

BACKGROUND: Vulvar melanoma is the second most common vulvar malignancy and represents a significant women's health issue. OBJECTIVE: To report experience with 21 cases of vulvar melanoma in 20 patients and to review the literature about the condition. METHODS: Parameters retrospectively reviewed included age at diagnosis, family history of melanoma, location on the vulva, atypical nevi, Breslow depth, ulceration status, histologic pattern, presenting signs and symptoms, and the results of sentinel lymph node biopsy. Molecular characterization of the melanocortin type 1 receptor was performed in 1 patient. RESULTS: A family history of cutaneous melanoma was present in 15% of cases. The mean Breslow depth was 2.8 mm (range, 0.0-11.0 mm). Ten patients successfully underwent sentinel lymph node biopsy, results of which were positive in 2 (20%). Reported for the first time is that one patient had a germline mutation in the melanocortin type 1 receptor. CONCLUSION: Vulvar and cutaneous melanoma behave similarly despite their unique pathogeneses. Sentinel lymph node biopsy can be performed successfully for vulvar melanoma.     

2例阴茎亲吻痣及相关文献复习

亲吻痣是一种奇怪的痣,第1次描述发生在上眼皮,很少在阴茎。我们报告2例阴茎亲吻痣并复习已经报告的病例。阴茎痣的亲吻病变特征性表现为相对于冠状沟的镜像对称。病理组织学检查,病变显示复合痣。     

Pulmonary carcinoid associated with melanoma: two cases and a review of the literature

To our knowledge, this is the first report in the British literature documenting the co-occurrence of melanoma and pulmonary carcinoid. The only other report is from America and documents pulmonary carcinoid in association with a parathyroid hormone-producing melanoma. We report two patients with melanoma who presented with nodules on chest X-ray. Both underwent resection of assumed lung metastasis which unexpectedly revealed primary pulmonary carcinoid. Evidence of an association between these two tumours which show striking biological and pathological similarities is discussed. The incidence of pulmonary carcinoid is increasing and with the improved power of radiological assessment we may see additional accounts of such an association in the near future.     

The triad of pruritus,xanthomas, and cholestasis: Two cases and a brief review of the literature

When encountered in children, xanthomas are most commonly associated with a group of disorders known as familial hyperlipidemias. Aside from cosmetic concerns, these xanthomas are typically asymptomatic, but when generalized pruritus is a prominent associated symptom, clinicians should consider a different set of diagnoses that includes cholestasis of the liver. In this article we present two illustrative cases of children with cholestatic disease, pruritus, and xanthomas and discuss other disorders that may include this triad.     

Desmoplastic malignant melanoma of the lip: a report of 6 cases and review of the literature

Desmoplastic malignant melanoma is a rare neoplasm consisting primarily of spindle-shaped melanoma cells embedded in a fibrous stroma, with approximately 6% of cases occurring in the lip. A literature search revealed that most reported cases occur in sun-exposed areas in older men. Few cases of desmoplastic malignant melanoma of the lip in young people (in their mid-twenties) have been described. We report 6 previously undocumented cases of labial desmoplastic malignant melanoma occurring in young individuals and review 20 cases from the literature. Physicians should consider the possibility of desmoplastic malignant melanoma in young people who present with atypical lip lesions, which on histopathologic analysis demonstrate spindle-cell hyperplasia. Although this diagnosis is rare and there have not been reports of such patients in the literature thus far, our findings should alert clinicians to the possibility of desmoplastic malignant melanoma as a diagnosis for lip lesions in young people.     

Clinical characteristics,differential diagnosis,and treatment outcome of subcutaneous panniculitis-like T-cell lymphoma: a literature review of published Japanese cases

Background

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare subtype of non-Hodgkin lymphoma that shows phenotypic features of cytotoxic T cells and preferentially involves subcutaneous tissue. SPTCL is believed to show an indolent clinical course, unless patients develop haemophagocytic syndrome. Various reported therapies include corticosteroids, immunosuppressive drugs, and chemotherapies. The use of chemotherapy as a first-line treatment remains controversial, and treatment approaches for SPTCL have not been established yet.

Objectives

To investigate the clinicopathological features, treatment modalities, and outcomes of Japanese patients with SPTCL.

Materials & methods

We performed a literature review of Japanese cases of SPTCL.

Results

Twenty-two cases have been reported in the English and Japanese literature. Six cases were excluded due to a lack of sufficient clinical and immunohistological data, and treatment modalities and outcome were available in 16 cases. Clinical characteristics of the Japanese cases were generally similar to those of Western countries. Approximately half of the Japanese patients were treated initially with corticosteroids. Among them, more than half subsequently received chemotherapies due to a lack of response or recurrence of the disease. Overall, chemotherapy was used for approximately 80% of reported cases as a primary or secondary therapy.

Conclusions

Our findings suggest that corticosteroids may be beneficial for some SPTCL patients, but most patients required chemotherapy during the course of their disease. Further investigations are needed to both establish appropriate treatment strategies for SPTCL and clarify predictive factors in order to identify patients who may benefit from corticosteroid therapy as a primary treatment.

     

Congenital and infantile melanoma: review of the literature and report of an uncommon variant,pigment-synthesizing melanoma

Congenital and infantile types of melanoma are uncommon conditions for which there are limited epidemiologic data. The number of reported cases is small with several ascribed etiologies. We review the literature and report the first documented case, to our knowledge, of pigment-synthesizing melanoma in an infant. Reported cases of congenital and infantile melanoma were identified and categorized on the basis of disease origin. Dermatopathologic specimens from an infant given a diagnosis of pigment-synthesizing melanoma are described. Disease arising from medium and large/giant congenital nevi was most common, whereas reports of de novo and transplacental disease were infrequent. Death of approximately 40% of patients was noted within 18 months of diagnosis. Male infants accounted for approximately 74% of cases. The most commonly affected anatomic sites were the head and neck. The prognosis for congenital and infantile melanoma is poor. The high incidence of head-and-neck involvement and male predominance for disease suggest dispositions for both anatomic disease localization and sex.     

Malignant melanoma arising in a radiotherapy field: report of two cases and review of the literature

We report 2 patients who developed melanoma or melanoma metastases in radiation fields 6 and 43 years after radiation therapy, respectively. One of the patients had received adjuvant hyperfractionated photon therapy for Ewing sarcoma, while the other patient had received X-ray therapy for a hemangioma. While postradiation secondary cancers with a long latency period are not uncommon, the development of melanoma is exceedingly rare.     

Malignant melanoma of the eyelid. A report of eight cases and a review of the literature.

BACKGROUND: Because of the relatively rare occurrence of malignant melanoma (MM) of the eyelid, prognostic factors in relation to survival in these patients have not been established. OBJECTIVE: Our purpose was to examine prognostic indicators in relation to survival in patients with MM of the eyelid. METHODS: All patients seen at UCLA Medical Center with MM of the eyelid as well as all cases reported in the literature were reviewed retrospectively. RESULTS: The data obtained from 47 total cases seen at UCLA Medical Center revealed a significant disadvantage in 5-year survival for those patients with MM involving the lid margins in comparison to those without lid margin involvement. CONCLUSION: Our review suggests that melanoma involving the eyelid margin and conjunctiva has a worse prognosis than melanomas of the eyelid that do not involve the conjunctiva. We can make no predictions in regard to the benefits of narrow versus wide surgical margins in the treatment of these patients.     

COVID-19 and cutaneous manifestations: A review of the published literature

Background

COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID-19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020.

Aim

Skin manifestations related to SARS-CoV-2 infection can be divided mainly into five groups: chilblainlike lesions (CBLLs), maculopapular eruptions, urticarial eruptions, vesicular eruptions, and livedo or necrosis. Other skin findings reported are erythema multiforme (EM)-like lesions and skin findings associated with multisystem inflammatory syndrome in children (MIS-C) and rarely with multisystem inflammatory syndrome in adults (MIS-A). Other manifestations such as pityriasis rosea or shingles are also reported.

Methods

A total of 60 articles including reviews, studies and case reports were selected for the evaluation in this review.

Results

The skin manifestations associated with COVID-19 infection are numerous and can vary widely. The major dermatological patterns of COVID-19 can be classified as inflammatory reactions (maculopapular/morbilliform, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo acemose-like pattern)

Conclusion

We believe that the dermatologist could play an important role in the response to the SARS-CoV-2 pandemic through early recognition of skin lesions suggestive of COVID-19, particularly in paucisymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis.     

Two cases of subungual melanoma in situ

Melanonychia, which is characterized by brown or black pigmentation within the nail plate, includes heterogeneous conditions such as pigmented nevus, subungual melanoma and lentigo. We treated two cases of subungual melanoma in situ. One case was a 58‐year‐old woman who suffered from a malignant melanoma in situ of the left third fingernail, who had also suffered from melanonychia of the fingers for more than 30 years. She had a past history of carcinoma of the uterine cervix. The other patient was a 42‐year‐old man, who suffered from a malignant melanoma in situ of the right fifth fingernail. He had a past history of carcinoma of the stomach for which he had undergone surgery 2 years earlier. Both cases were accompanied by Hutchinson's sign on the fingertip skin, and the presence of this sign led to the correct diagnosis of subungual melanoma in situ. Judging from previously reported cases, it is unlikely that patients with malignant melanoma have an increased risk of carcinoma of the uterine cervix or of the stomach.     

Cost‐of‐illness of melanoma in Europe – a systematic review of the published literature

Malignant melanoma accounts for the vast majority of skin cancer deaths. Primary prevention is used to increase knowledge about skin cancer and set incentives for a change in behaviour, which leads to a decrease in cases. Primary prevention may be cost‐effective or even cost saving. Cost‐of‐illness (COI) studies provide information on such potential savings. The purpose of this study is to give an overview on COI studies in European countries and to compare the COI in total and by cost categories. The results can be used to model potential cost savings from prevention. We conducted a systematic literature research in PubMed using the PRISMA checklist. All costs were converted into Euro and adjusted for the reference year 2012. For the ranking of countries according to their COI, all costs were adjusted for the purchasing power parity. All studies focusing on stage III–IV melanoma include information on hospital, hospice, and outpatient treatment. Costs for the treatment of advanced melanoma range between € 2972 in Italy and € 17 408 in Sweden after adjusting for purchasing power parity. Most studies on stage I–IV melanoma include costs of hospitalization, outpatient treatment and general practitioner consultation. Direct costs range from € 923 in Sweden to € 9829 in Denmark. Three articles also include information on indirect costs. Mortality costs vary between € 3511 in Sweden and € 20 408 in England, morbidity costs between € 103 in Sweden and € 4550 in England. We showed that costs for the treatment of skin cancer are moderately high in the included countries. Since after publication of the articles new costly drugs were approved in Europe, treatment costs of melanoma in Europe may be expected to have risen in the last few years, which means that there is a high expectable potential for prevention programmes to become cost‐effective or even cost saving.     

面部恶性雀斑样黑素瘤二例

例1女,37岁.右侧口角黑色斑片4年,多次手术切除仍复发就诊.患者于4年前无明显诱因右侧口角出现米粒大小黑色斑片,渐增大,当地医院行激光治疗,治疗后不久原皮损处又出现黑色斑片.此后1年中,黑色斑片进行性增大,无任何不适.3年前分3次手术切除该黑色斑,病理诊断为复合痣,皮脂腺痣.术后不久患处义出现褐色皮疹,渐增大至1 cm×1 cm大小.2年前再次切除,术后病理报告“交界痣”.     

Morphological analysis of nevoid melanoma: a study of 20 cases with a review of the literature

Nevoid melanoma is a rare variant of melanoma characterized by deceptive morphologic features reminiscent of a benign melanocytic nevus. Twenty (13 nodular, 7 verrucous) nevoid melanomas were reviewed with the goal of identifying the predominant architectural patterns, cytologic features, and prognostic indicators. Although at scanning magnification, many lesions showed a strong resemblance to banal compound or dermal nevi, careful inspection in all cases demonstrated subtle pleomorphism and impaired maturation with depth, invariably accompanied by multiple dermal mitoses. Four tumors recurred and three metastasized, with subsequent death of the patients. Follow-up information for a period of at least 3 years was available in eight cases. In this group, mortality was 37.5%, the metastasis rate was 37.5%, and the local recurrence rate was 75%, with an average tumor thickness of 2.5 mm. We conclude that nevoid melanoma may be distinguished from a benign melanocytic nevus by a high index of suspicion, a careful analysis of architecture, and attention to cytologic features. Our data and a review of the literature do not support the notion that nevoid melanoma has a better prognosis than ordinary melanoma.     

颅内转移性黑素瘤5例临床分析

目的：讨论颅内转移性黑素瘤的临床表现、影像学特征及治疗方法。方法：对本科近17年来治疗的5例颅内转移性黑素瘤，进行回顾性分析。结果：颅内转移性黑素瘤的临床表现不具有特征性。影像学上CT表现为高密度或混杂密度，增强扫描呈不同程度强化。核磁共振检查(MRI)表现为短T1短T2信号，也可以因顺磁性黑素含量不同和瘤内有无出血表现为高、低或混杂信号，注射二乙胺五乙酸钆(GD—DTPA)后出现不同程度的强化。5例患者中，3例手术全切，1例大部分切除，1例未手术。结论：颅内转移性黑素瘤的预后差，应在手术基础上进行包括放疗及化疗的综合治疗。     

Vulvar malignant melanoma associated with human papillomavirus DNA: report of two cases and review of literature

Oncogenic human papillomavirus (HPV) types such as HPV 16 are known to play a crucial role in the development of anogenital carcinomas. The etiology of anogenital malignant melanoma is unknown. We report two case of vulvar malignant melanoma in which multiple HPV types including HPV 16 and putative novel HPV types (alb-1, alb-2, alb-7, and alb-10) were identified by degenerated nested polymerase chain techniques (polymerase chain reaction) in both the malignant melanoma and surrounding skin. One melanoma was associated with lichen sclerosus, and the other, with melanoma in situ and pigmented vulvar squamous papillomatosis. These melanomas harbored HPV types alb-7, and HPV 16 as well as alb-1, respectively. HPV types 16, 20, 21, 36, alb-2, and AJ001060 were detected in vulvar skin affected by lichen sclerosus. Vulvar squamous papillomatosis harbored HPV types 28 and alb-10. HPV 16 was physically integrated into the host genome in lichen sclerosus skin and possibly in the melanoma associated with pigmented vulvar squamous papillomatosis. Twenty-two percent (4 of 18) of normal control specimens from skin tumor excisions were found to harbor HPV DNA (HPV types 3, 54, and alb-7); none of these control samples harbored multiple HPV DNA. These findings of multiple HPV DNA and integrated HPV 16 in skin associated with vulvar malignant melanoma indicate that HPV may play a role in the development of vulvar malignant melanoma. The role of HPV could be either direct through infection of melanocytes or indirect as a cofactor with free radicals in chronic fibroinflammatory vulvar disorders such as lichen sclerosus.     

Two cases of cutaneous apocrine ductal carcinoma of the axilla. Case report and review of the literature

We report 2 cases of cutaneous apocrine ductal carcinoma (CADC) of the axilla in a 64- and a 54-year-old male. Histological examination revealed 2 solid, ductal and glandular tumors with decapitation secretion. Tumor cells showed cellular and nuclear atypism, and infiltrative growth of tumor cell nests was also observed. Although there were no characteristic features of extramammary Paget's disease on the overlying skin, case 1 exhibited a typical Paget's phenomenon. We concluded that the Paget's phenomenon of case 1 was a result of upward extension of the tumor in the dermis. The neoplastic cells of both cases were immunohistochemically positive for gross cystic disease fluid protein, lysozyme, CD15 and carcinoembryonic antigen but negative for S-100 protein. Based on these findings, we concluded that these tumors were cutaneous apocrine ductal carcinomas. There was no evidence of tumor remnants in the axilla, and the patients have shown no signs of local recurrence or metastasis. We also reviewed the literature and summarize here the clinical features of CADC. Copyright (R) 2000 S. Karger AG, Basel