Malignant melanoma in East Anglia, England

A series of 137 patients with primary malignant melanoma of skin occurring in the Cambridge area in 1961–71 is reviewed. The histological material has been classified into lentigo maligna melanoma, superficial spreading melanoma and nodular melanoma, using the criteria of Clark et al. (1969). Consideration of type, site and incidence of melanoma when compared with previously reported series from Boston and Sydney supports the hypothesis that sunlight induces malignant melanoma in unexposed skin.     

Number of nevi at a specific anatomical site and its relation to cutaneous malignant melanoma

The risk of cutaneous malignant melanoma (CMM) is strongly associated with total number of nevi. Scanty information is available on the association between CMM at a specific anatomical site and number of nevi at the same site. We analyzed data from a case-control study conducted in Italy between 1992 and 1994, on 542 cases of CMM and 538 hospital controls. Cases and controls were examined by trained dermatologists who counted the number of melanocytic nevi. We derived multivariate odds ratios (ORs) and 95% confidence intervals (95% CIs) of site-specific risk of CMM for high versus low number of nevi at the corresponding site. The ORs of CMM for the highest versus the lowest tertile of number of nevi at the corresponding site was 1.4 (95% CIs: 0.7-2.8) at face and neck, 2.3 (95% CIs: 1.1-4.9) at anterior trunk, 4.9 (95% CIs: 2.9-8.4) at posterior trunk, 2.9 (95% CIs: 1.2-6.6) at upper limbs and 5.0 (95% CIs: 2.9-8.5) at lower limbs. In a case-case analysis, comparing CMM cases at a specific site and CMM cases at all other sites, the only excess risk was found for the posterior trunk, the ORs being 2.1 (95% CIs: 1.2-3.6) for the highest versus the lowest tertile of number of nevi. Our data do not support the hypothesis of a specific effect of nevi at each single anatomical site.     

Increased mast cell density in invasive melanoma

Mast cell participation in immune responses, tumor progression, and vascularization has been studied extensively in vitro . In situ investigation of mast cells in routinely processed tissues is hampered by difficulty in reliable detection of mast cells. We studied the tissue density of mast cells using a morphometric point-counting technique in 1 μm-thick, Giemsa-stained, tissue sections from epon-embedded samples of skin biopsies. This technique has been demonstrated to be an accurate and reproducible method for determining mast cell density.
Mast cell density in 15 cases of invasive melanoma was compared to that of 9 cases of benign melanocytic nevi and 4 cases of melanoma in situ . Mast cell density was greatest in invasive melanoma (mean density = 0.61 vol.%). The mean density of mast cells in nevi and in situ melanoma was 0.33 and 0.5 respectively. Six of 15 cases of melanoma had mast cell densities > 0.6, whereas mast cell density did not exceed 0.6 in any cases of melanoma in situ or benign melanocytic nevi (p < 0.02). Our findings confirm an increase in mast cell tissue density in some cases of invasive melanoma when compared to mast cell density in benign nevi and in situ melanoma.     

Diverging Racial Trends in Neonatal Infantile Hemangioma Diagnoses, 1979–2006

Nationally representative historical trends in neonatal infantile hemangioma (IH) diagnosis have not been previously assessed. Using the National Hospital Discharge Survey (NHDS), trends in IH diagnoses were assessed according to race and sex. Findings confirmed prior research that female and white newborns are more likely to be diagnosed with IH, and a statistically significant increase in IH diagnoses was observed in white, but not in nonwhite, infants.     

Screening, early detection, and trends for melanoma: current status (2000-2006) and future directions

In the past 5 years, there have been notable strides toward the earlier recognition and discovery of melanoma, including new technologies to complement and augment the clinical examination and new insights to help clinicians recognize early melanoma. However, incidence and mortality rates throughout most of the developed world have risen over the past 25 years, while education and screening, potentially the best means for reducing the disease, continue to be severely underutilized. Much progress needs to be made to reach middle-aged and older men and persons of lower socioeconomic status who suffer a disproportionate burden of death from melanoma. Worldwide melanoma control must also be a priority, and comprehensive educational and screening programs should be directed to Northern Ireland and a number of Eastern European nations, whose 5-year survival rates range between 53% and 60%, mirroring those of the United States and Australia more than 40 years ago. LEARNING OBJECTIVE: After completing this learning activity, participants should be aware of the most recent melanoma epidemiologic data, both in the United States and internationally; worldwide early detection and screening programs; clinical strategies to recognize and improve the detection of early melanoma; the latest technologies for early detection of melanoma; and public and professional education programs designed to enhance early detection.     

Ten-year audit of melanoma in a central England population

The incidence of melanoma in the North Staffordshire region has more than doubled over the last 10 years, and nearly tripled in the "thin" melanoma group (≤ 1 mm). A retrospective audit was performed to investigate the overall management of melanoma, with a focus on thin melanomas. A total of 507 patients was identified between 1999 and 2009. The incidence of melanoma is increasing in the older age groups (> 50 years), although the thin melanomas were diagnosed at a significantly younger age than the cohort as a whole (p < 0.001). The anatomical distribution was similar in both groups. More females were affected by thin melanomas (65%) compared with all melanomas (55%). This audit provides a unique insight into the incidence and characteristics of melanoma in a Central England population. The incidence of melanoma is increasing, but more so in the thin group. Thick (> 4 mm) and intermediate (1.01-4 mm) melanomas are increasing at a slower rate.     

Immunoreactivity of CD99 in invasive malignant melanoma

BACKGROUND: CD99, also known as p30/32, is a glycoprotein product of the MIC2 gene. It was originally utilized in immunohistochemistry as a unique marker for Ewing sarcoma, other primitive neuroectodermal tumors, and subsequently in other tumors. Its expression in malignant melanoma (MM) has not been well documented, with just two isolated cases of MM recently reported. Recent studies have documented CD99 expression in a significant percentage of atypical fibroxanthomas (AFX), posing potential diagnostic problems in differentiating these two entities. As mistaking MM for AFX based on immunohistochemical staining pattern has significant consequences, we sought to determine the percentage of invasive MM in our archives that have this staining pattern. METHODS: Seventy-eight cases of invasive melanoma were retrieved from our files. Each case was stained with mouse anti-human CD99 and evaluated for membranous expression. RESULTS: Our evaluation revealed that 47 of 78 MM cases (60%) stain positive for CD99. CONCLUSION: This study is the first to demonstrate, in a large series, the prevalence of CD99 expression in primary cutaneous melanoma. Additionally, this introduces in the histologic differential diagnosis of CD99 expressing dermal spindle cell lesions.     

Rapid HMB-45 staining in Mohs micrographic surgery for melanoma in situ and invasive melanoma

BACKGROUND: Accurate interpretation of frozen sections in the treatment of melanoma by Mohs micrographic surgery may be difficult. OBJECTIVE: Our purpose was to review the literature on the role of Mohs micrographic surgery in the treatment of melanoma and to demonstrate the added benefits of using rapid HMB-45 staining in Mohs micrographic surgery for the treatment of melanoma. METHODS: Twenty cases of melanoma were included in our study. Histologic diagnosis in each case was made by means of excisional biopsy specimens and permanent sections. Mohs micrographic surgery was performed with 3-mm margins used for each stage. Each Mohs frozen section was stained with HMB-45. In addition, routine frozen sections stained with hematoxylin-eosin were also prepared for comparison. All tissues were also sent for permanent sections. These permanent sections were cut similarly to Mohs-oriented sections because they were sectioned horizontally. Since they were serving as the standard, no staining with HMB-45 was performed on these permanent sections. Further stages with 3-mm margins were taken until tissues stained negative. Frozen sections were compared with permanent sections at each stage of resection. RESULTS: Eleven of the 20 cases stained positive with HMB-45 antibody on the first Mohs stage. These results were consistent with findings on permanent sections. Ten of the 11 cases were cleared by the first stage. One of the 11 cases required 3 stages because margins were not cleared and the specimens stained HMB-45 positive. However, permanent sections in this case revealed no tumor in the second stage. Nine of 20 cases did not stain with HMB-45 on the first layer of Mohs excision. This was consistent with findings on permanent sections. CONCLUSION: HMB-45 staining serves as a rapid technique to aid in the interpretation of frozen sections during Mohs micrographic surgery in the treatment of melanoma.     

Dermatoscopic finding of white circles in an invasive pigmented melanoma

Dermatoscopic white circles, seen with both non-polarized and polarized dermatoscopy, are a known clue to actinic keratosis in a flat lesion and invasive squamous cell carcinoma in a raised lesion. We have not discovered a previous published example of this clue in a melanoma. We present a case report of a 70-year-old Australian male with a pigmented superficial spreading melanoma on the face, Breslow thickness 1 mm, with dermatoscopic white circles displayed with both polarized and non-polarized dermatoscopy, and with dermatopathological correlation.     

Fibroblasts enhance the invasive capacity of melanoma cells in vitro

In previous experiments we have shown an enhanced expression of matrix metalloproteinase-1 (MMP-1) in fibroblasts obtained from the border of invasive melanoma in comparison to fibroblasts more distant from the tumour. In the study reported here we sought to determine whether melanoma-derived soluble factors are responsible for the stimulation of MMP-1 expression in fibroblasts. By real-time PCR and enzyme-linked immunosorbent assays, we demonstrated that the stimulation of fibroblasts with melanoma cell conditioned medium led to an increased expression of MMP-1 mRNA as well as MMP-1 protein, whereas melanoma cells themselves did not produce detectable amounts of MMP-1 protein. Basic fibroblast growth factor (bFGF) was detected as an important factor responsible for the enhanced expression of MMP-1 by fibroblasts after stimulation with melanoma cell conditioned medium. In a three-dimensional in vitro invasion assay, we demonstrated that fibroblasts are essential for melanoma cell invasion into a collagen I matrix. These findings support the hypothesis that stromal fibroblasts assist the invasion of melanoma cells through the extracellular matrix by producing elevated amounts of proteolytic enzymes after interaction with soluble factors (e.g. bFGF).     

Natural history of invasive cutaneous melanoma in Styria,Austria 2001–2003

Background: Rising melanoma incidences have created the need of assessment of epidemiological and clinical data. Patients and methods: We investigated the natural history of invasive cutaneous melanoma in Styria, a province of Austria, in the years 2001–2003. 1082 patients, 511 men and 571 women, mean age 58.2 ± 16.7 years, were collected. Besides basic melanoma data, special histologic features such as regression structures, ulceration, microsatellites and vascular invasion were investigated. Furthermore, lymph node pathology in case of sentinel node biopsy and/or lymph node dissection was recorded. Results: Mean annual incidence (crude rate) was 28.6 per 100,000 inhabitants, age standardized rate 24.5 per 100,000 (95 % CI 22.4–26.6). Cumulative risk (0– 74 years) was 1.92, lifetime risk 1 in 52. Superficial spreading melanoma was the most common type in both sexes, men on the trunk and women on the extremities. Only 11 % of all melanomas were in easily visible areas. Median tumor thickness was 0.75 mm, ranging between 0.2 and 50.0 mm. Sentinel node biopsy was performed in 158 melanomas (14.6 %),and was positive in 22 %.Primary therapeutic lymph node dissection was performed in 19 patients, showing metastases in 18 patients. Conclusions: The investigation revealed an unclear high melanoma incidence for invasive melanomas in our province, requiring further investigation.