Skin Cancer
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Skin cancer is the most common type of cancer and accounts for half of all new cancers in Western populations. It occurs more often in people with light coloured skin who have had a high exposure to sunlight. The two most frequent types of skin cancer are Basal Cell Carcinomas and Squamous Cell Carcinoma (often grouped under "non-melanoma skin cancer"). The third most frequent skin cancer is Melanoma, this is a malignancy of the cells which give the skin it's colour (melanocytes). In addition there are a number of other, less common cancers starting in the skin including Merkel cell tumours, cutaneous lymphomas, and sarcomas (see the pages on sarcoma and lymphoma in this guide).

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Information for Patients and the Public
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Latest Research Publications
Prevention of Skin Cancer
Non Melanoma Skin Cancer
-- Basal Cell Carcinoma
-- Squamous Cell Carcinoma
Cutaneous T-cell Lymphoma
Dermatofibrosarcoma Protuberans
Merkel Cell Cancer

Information Patients and the Public (10 links)

Information for Health Professionals / Researchers (6 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Youlden DR, Youl PH, Soyer HP, et al.
Distribution of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma Queensland, Australia, 1982-2010.
JAMA Dermatol. 2014; 150(5):526-34 [PubMed] Related Publications
IMPORTANCE: Melanoma survivors are known to have a highly elevated risk of subsequent primary melanomas.
OBJECTIVE: To determine the relative risk of subsequent primary invasive melanomas following a first primary invasive or in situ melanoma, with a focus on body site.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using population-based administrative data for melanoma diagnoses collected by the Queensland Cancer Registry, Queensland, Australia. Deidentified records of all cases of melanoma among Queensland residents during the period 1982-2005 were obtained and reviewed to December 31, 2010. There were 39,668 eligible cases of first primary invasive melanoma and 22,845 cases of first primary in situ melanoma.
MAIN OUTCOMES AND MEASURES: Standardized incidence ratios (SIRs), a proxy measure for relative risk, were calculated by dividing the observed number of subsequent primary invasive melanomas by the product of the strata-specific incidence rates that occurred in the general population and the cumulative time at risk for the cohort. Synchronous subsequent melanomas (diagnosed within 60 days of the first primary melanoma) were excluded. Differences between SIRs were assessed using multivariate negative binomial regression adjusted for sex, age group, time to second diagnosis, and body site and expressed in terms of adjusted SIR ratios with corresponding 95% CIs.
RESULTS: There were 5358 subsequent primary invasive melanomas diagnosed, resulting in SIRs of 5.42 (95% CI, 5.23-5.61) and 4.59 (4.37-4.82) for persons with a first primary invasive or in situ melanoma, respectively. The SIRs remained elevated throughout the follow-up period. In general, subsequent primary invasive melanomas were more likely to occur at the same body site as the initial invasive or in situ melanoma. The largest relative risk was for females with a first primary invasive melanoma on the head followed by a subsequent primary invasive melanoma also on the head (SIR, 13.32; 95% CI, 10.28-16.98).
CONCLUSIONS AND RELEVANCE: Melanoma survivors require ongoing surveillance, with particular attention required for the body site of the initial lesion. Clinical practice guidelines have recognized the importance of monitoring for people with invasive melanoma; the results of the present study highlight the need for similar levels of supervision for those with a diagnosis of in situ melanoma.

Related: Melanoma

Tchernev G, Guarneri C, Bevelacqua V, Wollina U
Carcinoma cuniculatum in course of etanercept: blocking autoimmunity but propagation of carcinogenesis?
Int J Immunopathol Pharmacol. 2014 Apr-Jun; 27(2):261-6 [PubMed] Related Publications
Carcinoma cuniculatum (CC) or verrucous squamous cell carcinoma is a rare variant of squamous cell carcinoma with low incidence of metastasis. It mainly affects men during the fifth-sixth decade of life, arising mostly on the weight-bearing surface of the foot, but it can also be found in other body areas. The favorable effects on the psoriatic, rheumatoid, juvenile polyarthritis as well as the ankylosing spondylitis after the application of Tumour Necrosis Factor (TNF)-alpha inhibitors, like etanercept, presume the availability of similarity between the etiopathogenetic mechanisms which are responsible for the generation of the inflammatory cascade. According to the latest studies, the sensitivity of the patients to TNF-alpha inhibitors could be genetically determined and may also be due to certain genetic polymorphisms of the NLP3 and CARD8 zones of the inflammasome. The blocking of the inflammatory reaction within the borderlines of the psoriatic arthritis could also be accepted as something of a double edged sword. There is a growing volume of literary data which informs us of the clinical manifestation, not only of skin, but also of other types of tumors after the application of TNF-alpha inhibitors. This inevitably generates the hypothesis that within a certain group of patients the TNF-alpha inhibitors have some additional, and currently obscure, effects on presumably key regulatory proteins of the so-called extrinsic apoptotic pathway. Other proteins of the human inflammasome could be also implicated in the regulation of the programmed cell death and the carcinogenesis - there are speculations, that the adapter protein, ASC/TMS1, could be one of these. The present study describes the case of a patient who developed a rare form of skin tumor - epithelioma cuniculatum - whilst undergoing etanercept therapy for psoriatic arthritis. Under discussion are the possible critical connections in the complex regulatory networks of the inflammatory processes, the programmed cell death (apoptosis) and the carcinogenesis which, in the near or distant future, could become the objects of a targeted therapy.

Related: Apoptosis

Mendivil AA, Micha JP, Stallman JM, Goldstein BH
A very rare case of vaginal angiokeratoma.
Eur J Gynaecol Oncol. 2014; 35(3):313-5 [PubMed] Related Publications
Angiokeratomas are benign, vascular lesions that are very rarely identified in the vagina. A patient originally presented with endometrial cancer in 1993 and was cured following surgery and adjuvant radiotherapy. However, in 2007, she developed multiple, erythematous, vaginal nodules that were eventually diagnosed as angiokeratoma of the vagina. The diagnosis of vaginal angiokeratoma may not be initially suspected. Therefore, physicians should perform a histologic examination to verify the condition and accordingly, provide relevant clinical management.

Sheets N, Powers J, Richmond B
Cutaneous metastasis of colon cancer: case report and literature review.
W V Med J. 2014 May-Jun; 110(3):22-4 [PubMed] Related Publications
Cutaneous metastases arising from an internal malignancy are a rare phenomenon, occurring in 0.001% of all skin biopsies performed. Of these, 6.5% originate from the a primary colon cancer. Colon cancer, when metastatic to the skin, typically appears as a painless flesh-colored nodule or as a mass with occasional ulceration. We report a case of a large cutaneous metastasis to the suprascapular region as the initial presenting symptom of an underlying colon cancer.

Holderfield M, Deuker MM, McCormick F, McMahon M
Targeting RAF kinases for cancer therapy: BRAF-mutated melanoma and beyond.
Nat Rev Cancer. 2014; 14(7):455-67 [PubMed] Related Publications
The identification of mutationally activated BRAF in many cancers altered our conception of the part played by the RAF family of protein kinases in oncogenesis. In this Review, we describe the development of BRAF inhibitors and the results that have emerged from their analysis in both the laboratory and the clinic. We discuss the spectrum of RAF mutations in human cancer and the complex interplay between the tissue of origin and the response to RAF inhibition. Finally, we enumerate mechanisms of resistance to BRAF inhibition that have been characterized and postulate how strategies of RAF pathway inhibition may be extended in scope to benefit not only the thousands of patients who are diagnosed annually with BRAF-mutated metastatic melanoma but also the larger patient population with malignancies harbouring mutationally activated RAF genes that are ineffectively treated with the current generation of BRAF kinase inhibitors.

Related: Melanoma BRAF gene

Faries MB, Leung A, Morton DL, et al.
A 20-year experience of hepatic resection for melanoma: is there an expanding role?
J Am Coll Surg. 2014; 219(1):62-8 [PubMed] Related Publications
BACKGROUND: Melanoma liver metastasis is most often fatal, with a 4- to 6-month median overall survival (OS). Over the past 20 years, surgical techniques have improved in parallel with more effective systemic therapies. We reviewed our institutional experience of hepatic melanoma metastases.
STUDY DESIGN: Overall and disease-specific survivals were calculated from hepatic metastasis diagnosis. Potential prognostic factors including primary tumor type, depth, medical treatment response, location, and surgical approach were evaluated.
RESULTS: Among 1,078 patients with melanoma liver metastases treated at our institution since 1991, 58 (5.4%) received surgical therapy (resection with or without ablation). Median and 5-year OS were 8 months and 6.6 %, respectively, for 1,016 nonsurgical patients vs 24.8 months and 30%, respectively, for surgical patients (p < 0.001). Median OS was similar among patients undergoing ablation (with or without resection) relative to those undergoing surgery alone. On multivariate analysis of surgical patients, completeness of surgical therapy (hazard ratio [HR] 3.4, 95% CI 1.4 to 8.1, p = 0.007) and stabilization of melanoma on therapy before surgery (HR 0.38, 95% CI 0.19 to 0.78, p = 0.008) predicted OS.
CONCLUSIONS: In this largest single-institution experience, patients selected for surgical therapy experienced markedly improved survival relative to those receiving only medical therapy. Patients whose disease stabilized on medical therapy enjoyed particularly favorable results, regardless of the number or size of their metastases. The advent of more effective systemic therapy in melanoma may substantially increase the fraction of patients who are eligible for surgical intervention, and this combination of treatment modalities should be considered whenever it is feasible in the context of a multidisciplinary team.

von der Lippe C, Roscher I, Nordgarden H, et al.
Man with macrocephaly, learning disability and multiple basal cell carcinomas.
Tidsskr Nor Laegeforen. 2014; 134(11):1151-4 [PubMed] Related Publications
Gorlin syndrome is a rare genetic condition in which patients may develop medulloblastomas, jaw cysts and basal cell carcinomas and show congenital skeletal malformations. If left undiagnosed, Gorlin syndrome can have a number of negative consequences. Early diagnosis and good follow-up is important for all patients with rare disorders. We wish to make doctors and dentists aware of Gorlin syndrome so that, whenever the syndrome is suspected or a patient has been diagnosed, the patient is referred for assessment, treatment and follow-up by specialists who know the disorder well. Dermatology departments at university hospitals and departments of medical genetics have a key role to play in assessment and follow-up. A national support group for Gorlin syndrome has been established, consisting of a dermatologist, oncologist, geneticist, paediatrician, specialist dentist, ophthalmologist, orthopaedic surgeon, plastic surgeon, oral and maxillofacial surgeon and counsellors. Patients, relatives and health professionals can contact the Centre for Rare Disorders directly for information about Gorlin syndrome, or to be put in touch with members of the group.

Parsons M, Moore L
Nurses lead the way for "safe in the sun" play!
NASN Sch Nurse. 2014; 29(3):134-9 [PubMed] Related Publications
Skin cancer prevention is of great importance as it is the most common type of cancer in the United States. Much skin damage occurs early in life. Adolescents are a vulnerable population, as they strive to fit in with their peers, and they neglect sun safety habits. Since a substantial portion of adolescents' time is spent at school, school nurses are in an ideal position to develop and lead a sun safety action plan, using guidelines from the Centers for Disease Control and Prevention and evidence-based sun safety internet resources. It is hoped that incorporating a culture of skin health promotion and disease prevention among teens will lead to improved health outcomes in the future.

Wiznia LE, Shanley KM, Federman DG
Advanced, neglected basal cell carcinoma.
South Med J. 2014; 107(4):242-5 [PubMed] Related Publications
Although basal cell carcinoma (BCC) rarely metastasizes and has a cure rate >95% when diagnosed early in its course, BCC causes significant morbidity and presents an enormous burden to the healthcare system worldwide. Patients who present late in the course of their disease are particularly challenging in that their treatment can be more complicated and less likely to be effective than had they presented earlier. Given the high prevalence of this malignancy and the morbidity associated with a late presentation, healthcare professionals should be familiar with the consequences of neglected BCCs, as well as their management after presentation. Knowledge of patient risk characteristics may allow earlier engagement and diagnosis of patients, before more significant morbidity occurs.

Related: Basal Cell Carcinoma

Canty KM, Horii KA, Ahmad H, et al.
Multiple cutaneous and hepatic hemangiomas in infants.
South Med J. 2014; 107(3):159-64 [PubMed] Related Publications
OBJECTIVES: The objectives of the study were to determine the rate of hepatic hemangiomas in infants with cutaneous infantile hemangiomas that were screened by abdominal ultrasound; identify morphological subtypes and number of cutaneous infantile hemangiomas that are likely to suggest the presence of hepatic hemangiomas; and identify clinical history, physical findings, or laboratory abnormalities that may predict hepatic involvement.
METHODS: A retrospective study was conducted between 2000 and 2007 on 37 infants with cutaneous hemangiomas who underwent abdominal ultrasound for hepatic hemangiomas. Infants were classified into subgroups based upon the morphology of their cutaneous hemangioma(s). Data collected included clinical history, physical examination findings, sonographic findings, laboratory results, treatment(s) rendered, and clinical outcome.
RESULTS: Eight of 37 infants (22%) had hepatic hemangiomas. Infants with miliary (30-100 pinpoint/small cutaneous hemangiomas), six or more small cutaneous hemangiomas, and one large with one or more small cutaneous hemangiomas were more likely to have concurrent hepatic hemangiomas. No other clinical findings were associated with hepatic involvement.
CONCLUSIONS: Similar to other studies, our study found clinically asymptomatic hepatic hemangiomas in 22% of infants with multiple cutaneous infantile hemangiomas. No clinical findings studied were predictive of hepatic involvement.

Related: Liver Cancer

Minokadeh A, Wulkan AJ, Beer K, Waibel JS
Merkel cell carcinoma.
Skinmed. 2014 Mar-Apr; 12(2):120-1 [PubMed] Related Publications
A 92-year-old man presented for evaluation with a 1-month history of a rapidly growing asymptomatic pink nodule on his forearm. Biopsy results of the lesion demonstrated pathology consistent with Merkel cell carcinoma (MCC). Immunohistochemical studies displayed positive cytoplasmic staining for cytokeratin AE1/AE3, positive dot-like perinuclear staining for cytokeratin-20, diffuse cytoplasmic staining for neuron specific enolase, and no significant staining for S-100. Subsequent positron emission tomography did not reveal evidence of metastatic disease. Wide excision of the lesion was performed along with a sentinel node biopsy of his left axilla. The sentinel nodes were negative for MCC. Adjuvant radiation treatment of the tumor site was provided because the pathologist noted MCC within 2 mm of the deep margin.

Related: Merkel Cell Carcinoma

Carvajal RD, Wong MK, Thompson JA, et al.
A phase 2 randomised study of ramucirumab (IMC-1121B) with or without dacarbazine in patients with metastatic melanoma.
Eur J Cancer. 2014; 50(12):2099-107 [PubMed] Related Publications
BACKGROUND: To evaluate the efficacy and safety of ramucirumab (IMC-1121B; LY3009806), a fully human monoclonal antibody targeting the vascular endothelial growth factor receptor-2, alone and in combination with dacarbazine in chemotherapy-naïve patients with metastatic melanoma (MM).
METHODS: Eligible patients received ramucirumab (10mg/kg) + dacarbazine (1000 mg/m(2)) (Arm A) or ramucirumab only (10mg/kg) (Arm B) every 3 weeks. The primary end-point was progression-free survival (PFS); secondary end-points included overall survival (OS), overall response and safety.
FINDINGS: Of 106 randomised patients, 102 received study treatment (Arm A, N=52; Arm B, N=50). Baseline characteristics were similar in both arms. Median PFS was 2.6 months (Arm A) and 1.7 months (Arm B); median 6-month PFS rates were 30.7% and 17.9% and 12-month PFS rates were 23.7% and 15.6%, respectively. In Arm A, 9 (17.3%) patients had partial response (PR) and 19 (36.5%), stable disease (SD); PR and SD in Arm B were 2 (4.0%) and 21 (42.0%), respectively. Median OS was 8.7 months in Arm A and 11.1 months in Arm B. Patients in both arms tolerated the treatment with limited Grade 3/4 toxicities.
INTERPRETATION: Ramucirumab alone or in combination with dacarbazine was associated with an acceptable safety profile in patients with MM. Although the study was not powered for comparison between treatment arms, PFS appeared greater with combination therapy. Sustained disease control was observed on both study arm.

Related: Monoclonal Antibodies Dacarbazine

Wiener M, Uren RF, Thompson JF
Lymphatic drainage patterns from primary cutaneous tumours of the forehead: refining the recommendations for selective neck dissection.
J Plast Reconstr Aesthet Surg. 2014; 67(8):1038-44 [PubMed] Related Publications
BACKGROUND: Recommended selective neck dissections for primary cutaneous tumours on the head and neck are based largely on clinical recurrence data acquired prior to the era of lymphatic mapping and sentinel lymph node (SLN) biopsy. This study aimed to examine lymphatic drainage patterns from the forehead in order to provide evidence upon which to base recommendations regarding the extent of neck dissection.
METHODS: Data were collected prospectively from all patients undergoing lymphoscintigraphy following diagnosis of a primary cutaneous tumour on the forehead. The site of injection of radioisotope was documented using a co-ordinate-based mapping system. The forehead was divided into glabellar, supra-orbital and anterior temple zones. The location of all SLNs was recorded and drainage patterns were analysed.
RESULTS: Between 1994 and 2006, 152 patients underwent lymphoscintigraphy for primary cutaneous tumours on the forehead. Drainage was to 3.0 SLNs in 2.1 lymph node fields (mean values). Drainage was to ipsilateral SLNs in 85% of cases. Between zones there were significant differences in drainage patterns and the frequency of bilateral drainage. From the glabellar zone, drainage was more frequently to a higher number of SLNs and SLN fields, and to level I nodes.
CONCLUSIONS: The forehead can be divided into zones with patterns of lymphatic drainage that vary significantly in terms of number of SLNs, number of SLN sites, likelihood of drainage to contralateral SLNs and predictability of drainage pattern. Drainage to level 1 nodes from the anterior temple is rare, suggesting that it may be safe to exclude this level when performing a selective neck dissection for tumours in this zone.

Related: Merkel Cell Carcinoma Melanoma

Alvino E, Passarelli F, Cannavò E, et al.
High expression of the mismatch repair protein MSH6 is associated with poor patient survival in melanoma.
Am J Clin Pathol. 2014; 142(1):121-32 [PubMed] Related Publications
OBJECTIVES: The outcome of patients with primary melanoma (PM) cannot be completely explained based on currently adopted clinical-histopathologic criteria. In this study, we evaluated the potential prognostic value of mismatch repair protein expression in PMs.
METHODS: We examined the immunohistochemical staining of mismatch repair proteins in 18 benign nevi and 101 stage I to III PMs and investigated their association with tumor clinicopathologic variables and melanoma mortality.
RESULTS: Expression of MSH2, MLH1, and PMS2 was high in benign nevi and reduced in a subset of PMs. Conversely, MSH6 expression was absent or extremely low in benign nevi and increased in a subset of PMs. In the multivariate analysis, including sex, age, Breslow thickness, and ulceration, high MSH6 expression in PMs (ie, immunostaining in >20% of tumor cells) was significantly associated with an increased risk of melanoma mortality (relative risk, 3.76; 95% confidence interval, 1.12-12.70).
CONCLUSIONS: MSH6 protein expression can be a valuable marker to improve prognosis assessment in PMs.

Related: Melanoma MSH6 MSH2

Di Domizio J, Demaria O, Gilliet M
Plasmacytoid dendritic cells in melanoma: can we revert bad into good?
J Invest Dermatol. 2014; 134(7):1797-800 [PubMed] Related Publications
Tumor-infiltrating plasmacytoid dendritic cells (pDCs) promote an immunosuppressive milieu that drives tumor growth in melanoma. This phenomenon typically results from the lack of appropriate pDC activation signals in the tumor microenvironment, but it is also actively controlled by tumor cells, which have evolved strategies to inhibit type I IFN production by pDCs. In this issue, Camisaschi et al. identify a new mechanism in which tumors avoid type I IFN production by triggering LAG-3-dependent activation of pDCs. Combination therapies that restore pDC functionality and trigger innate activation to produce type I IFN should be envisaged to induce effective antitumor immunity.

Related: Melanoma

Gipponi M, Solari N, Giovinazzo D, et al.
The role of sentinel lymph node biopsy in patients with local recurrence or in-transit metastasis of melanoma.
Anticancer Res. 2014; 34(6):3197-203 [PubMed] Related Publications
From January 2003 to March 2010, a prospective study was undertaken at the National Cancer Research Institute of Genoa in 15 patients with melanoma who had local recurrence (LR) or a few (≤ 3) in-transit metastases and clinically-negative regional lymph nodes with the aim of defining: i) the feasibility of sentinel node re-staging (r-sN) of the regional nodal basin; ii) the prognostic value of sentinel node status, and iii) the potential benefit in terms of disease-free survival and overall survival in patients with an histologically-positive sentinel node undergoing therapeutic regional lymph node dissection. Preoperative lymphoscintigraphy was performed to identify the r-sN: the radiotracer was intra-dermally injected around the LR or in-transit metastasis. Moreover, 10 min prior to the operative procedure, 0.5 ml intradermal injection of Patent-Blue-V dye was given around each LR or in-transit metastasis site, so that r-sN identification was achieved by both visualization of the nodal blue dye staining and the information supplied by gamma-detection probe. At least one sentinel node was intra-operatively identified in each patient, and a tumor-positive r-sN was required in four out of fifteen patients. The interval between the diagnosis of primary melanoma and the onset of recurrence was longer, although not significantly, in patients with tumor-negative r-sN, a compared to tumor-positive r-sN (49 ± 47 months vs. 25 ± 19 months, p=0.342). There was a trend toward an improved 1-, 3-, and 5-year disease-free survival and overall survival in patients with tumor-negative r-sN a compared to tumor-positive r-sN. Hence, the r-sN proved to be a feasible and accurate staging procedure even in patients with a few localizations of LR or in-transit metastases (≤ 3). r-sN identified those with a more favorable prognosis, supporting an aggressive therapeutic approach in the natural history of their disease; moreover, an unnecessary regional lymph node dissection was safely avoided in 11 out of 15 73.3% patients because they had a tumor-negative r-sN.

Related: Melanoma

Brożyna AA, Jóźwicki W, Slominski AT
Decreased VDR expression in cutaneous melanomas as marker of tumor progression: new data and analyses.
Anticancer Res. 2014; 34(6):2735-43 [PubMed] Related Publications
BACKGROUND: Vitamin D3, acting via vitamin D receptor (VDR) affects a wide range of biological activities, including inhibition of proliferation and angiogenesis, with net antitumor effects. VDR expression is disturbed in many tumors, including melanomas.
AIM: To find correlation between VDR expression in melanomas and prognostic biomarkers.
MATERIALS AND METHODS: VDR was analyzed immunohistochemically in 69 cutaneous melanomas in relation to prognostic factors.
RESULTS: Less advanced melanomas showed significantly higher VDR expression than the advanced stages. The presence of other markers such as ulceration and lack or non-brisk tumor infiltrating lymphocytes (TILs) was accompanied by significantly lower VDR expression. VDR expression also affected overall survival (OS) with most noticeable effect in the cases without ulceration.
CONCLUSION: High VDR expression determines a less malignant phenotype and is related to better prognosis. Loss of VDR expression affects melanoma tumor behavior, allowing for progression of disease. VDR expression can also serve as a prognostic marker in routine histopathology evaluation.

Related: Melanoma

Dumych T, Lutsyk M, Banski M, et al.
Visualization of melanoma tumor with lectin-conjugated rare-earth doped fluoride nanocrystals.
Croat Med J. 2014; 55(3):186-94 [PubMed] Free Access to Full Article Related Publications
AIM: To develop specific fluorescent markers for melanoma tumor visualization, which would provide high selectivity and reversible binding pattern, by the use of carbohydrate-recognizing proteins, lectins, combined with the physical ability for imaging deep in the living tissues by utilizing red and near infrared fluorescent properties of specific rare-earth doped nanocrystals (NC).
METHODS: B10F16 melanoma cells were inoculated to C57BL/6 mice for inducing experimental melanoma tumor. Tumors were removed and analyzed by lectin-histochemistry using LABA, PFA, PNA, HPA, SNA, GNA, and NPL lectins and stained with hematoxylin and eosin. NPL lectin was conjugated to fluorescent NaGdF4:Eu(3+)-COOH nanoparticles (5 nm) via zero length cross-linking reaction, and the conjugates were purified from unbound substances and then used for further visualization of histological samples. Fluorescent microscopy was used to visualize NPL-NaGdF4:Eu(3+) with the fluorescent emission at 600-720 nm range.
RESULTS: NPL lectin selectively recognized regions of undifferentiated melanoblasts surrounding neoangiogenic foci inside melanoma tumor, PNA lectin recognized differentiated melanoblasts, and LCA and WGA were bound to tumor stroma regions. NPL-NaGdF4:Eu(3+) conjugated NC were efficiently detecting newly formed regions of melanoma tumor, confirmed by fluorescent microscopy in visible and near infrared mode. These conjugates possessed high photostability and were compatible with convenient xylene-based mounting systems and preserved intensive fluorescent signal at samples storage for at least 6 months.
CONCLUSION: NPL lectin-NaGdF4:Eu(3+) conjugated NC permitted distinct identification of contours of the melanoma tissue on histological sections using red excitation at 590-610 nm and near infrared emission of 700-720 nm. These data are of potential practical significance for development of glycans-conjugated nanoparticles to be used for in vivo visualization of melanoma tumor.

Coyette M, Elajmi A, Bayet B, Lengelé B
Hydrosurgery, a new therapeutic perspective in early care of giant congenital nevi: a preliminary series of four cases.
J Plast Reconstr Aesthet Surg. 2014; 67(8):1063-9 [PubMed] Related Publications
BACKGROUND: Congenital melanocytic nevi are present at birth or may appear in the first weeks of life. Small and medium-size lesions are relatively common, affecting approximately 1% of newborns; large or giant melanocytic nevi occur in 1/20,000-1/500,000 births. The main concern raised by these lesions is their potential risk of degeneration which is strongly size-dependent and estimated in the literature between 0% and 40% over a lifetime. Although multiple treatment modalities have been described, to date there is no consensus regarding their optimal management.
PATIENTS AND METHODS: Four neonates (three females and one male) presenting giant congenital nevi with a mean age 12 days (7-24 days) were referred to our Plastic Surgery department for treatment from 2012 to 2013. All patients underwent an alternative dermabrasion procedure with the innovative use of hydrosurgery. All procedures were performed under general anaesthesia by the same senior operator (Dr. B.Bayet).
RESULTS: The mean operating time was significantly reduced compared to conventional techniques. No complications were observed in the postoperative course. Good final results were obtained in three patients after a mean follow-up of respectively 11, 8 and 4 months. The first operated neonate showed a complete recurrence of pigmentation of the treated areas after 6 months.
CONCLUSIONS: The need for early treatment in giant congenital nevi is admitted by all. Hydrosurgery is easy to use and allows to achieve a selective and symmetric resection with an obvious cleavage plane and clean-cut borders. Furthermore, this procedure has convinced us with its speed of use, ensuring significant time saving, and therefore less morbidity for the neonate. Aesthetic results as well as recurrence rate may be comparable to conventional techniques. However, regular follow-up to detect any malignancy is necessary.

Kraft S, Granter SR
Molecular pathology of skin neoplasms of the head and neck.
Arch Pathol Lab Med. 2014; 138(6):759-87 [PubMed] Related Publications
CONTEXT: Skin neoplasms include the most common malignancies affecting humans. Many show an ultraviolet (UV)-induced pathogenesis and often affect the head and neck region.
OBJECTIVE: To review literature on cutaneous neoplasms that show a predilection for the head and neck region and that are associated with molecular alterations.
DATA SOURCES: Literature review.
CONCLUSIONS: Common nonmelanoma skin cancers, such as basal and squamous cell carcinomas, show a UV-induced pathogenesis. Basal cell carcinomas are characterized by molecular alterations of the Hedgehog pathway, affecting patched and smoothened genes. While squamous cell carcinomas show UV-induced mutations in several genes, driver mutations are only beginning to be identified. In addition, certain adnexal neoplasms also predominantly affect the head and neck region and show interesting, recently discovered molecular abnormalities, or are associated with hereditary conditions whose molecular genetic pathogenesis is well understood. Furthermore, recent advances have led to an increased understanding of the molecular pathogenesis of melanoma. Certain melanoma subtypes, such as lentigo maligna melanoma and desmoplastic melanoma, which are more often seen on the chronically sun-damaged skin of the head and neck, show differences in their molecular signature when compared to the other more common subtypes, such as superficial spreading melanoma, which are more prone to occur at sites with acute intermittent sun damage. In summary, molecular alterations in cutaneous neoplasms of the head and neck are often related to UV exposure. Their molecular footprint often reflects the histologic tumor type, and familiarity with these changes will be increasingly necessary for diagnostic and therapeutic considerations.

Related: Basal Cell Carcinoma Merkel Cell Carcinoma Head and Neck Cancers Head and Neck Cancers - Molecular Biology Melanoma Signal Transduction

Vogel RI, Ahmed RL, Nelson HH, et al.
Exposure to indoor tanning without burning and melanoma risk by sunburn history.
J Natl Cancer Inst. 2014; 106(6):dju112 [PubMed] Article available free on PMC after 01/06/2015 Related Publications
Indoor tanning is carcinogenic to humans. Individuals report that they tan indoors before planning to be in the sun to prevent sunburns, but whether skin cancer is subsequently reduced is unknown. Using a population-based case-control study, we calculated the association between melanoma and indoor tanning after excluding exposed participants reporting indoor tanning-related burns, stratified by their number of lifetime sunburns (0, 1-2, 3-5, >5). Confounding was addressed using propensity score analysis methods. All statistical tests were two-sided. We observed increased risk of melanoma across all sunburn categories for participants who had tanned indoors without burning compared with those who never tanned indoors, including those who reported zero lifetime sunburns (odds ratio = 3.87; 95% confidence interval = 1.68 to 8.91; P = .002). These data provide evidence that indoor tanning is a risk factor for melanoma even among persons who reported never experiencing burns from indoor tanning or outdoor sun exposure.

Related: Melanoma USA

Kaiser S, Vassell R, Pinckney RG, et al.
Clinical impact of biopsy method on the quality of surgical management in melanoma.
J Surg Oncol. 2014; 109(8):775-9 [PubMed] Related Publications
BACKGROUND AND OBJECTIVES: Though guidelines recommend excisional biopsy for diagnosing melanoma, partial biopsy techniques are commonly performed, risking underestimation of Breslow depth and altering surgical management. Biopsy choice patterns by specialty and subsequent impact on surgical management was examined.
METHODS: Retrospective review of the University of Vermont Cancer Registry. All patients with a single, primary cutaneous melanoma from 1/02 to 6/12 analyzed.
RESULTS: Among 853 lesions analyzed, 606 had Breslow depth <1 mm. Dermatologists perform 62.6% of biopsies, favoring shave biopsies; surgeons favor excisional biopsies (48%), and primary care doctors favor punch biopsies (44.8%), (P < 0.001). Final Breslow depth was upstaged in 107 (12.5%); however, only 23 of 488 partial biopsies (4.7%) displayed a discrepancy great enough to change surgical recommendations (P < 0.001). There was no statistically significant relationship with presence of ulceration, regression, high Clark level, or high mitotic index.
CONCLUSIONS: Partial biopsy techniques are commonly performed in diagnosing melanoma; especially among dermatologists, who perform the majority of biopsies. Though partial biopsies were less accurate in determining Breslow thickness; they rarely alter recommendations for surgical management. Predictive features could not be determined to identify the few cases where a Breslow discrepancy was clinically relevant.

Related: Melanoma

Frankel TL, Bamboat ZM, Ariyan C, et al.
Predicting the development of brain metastases in patients with local/regional melanoma.
J Surg Oncol. 2014; 109(8):770-4 [PubMed] Related Publications
BACKGROUND: The brain is a common site of recurrence in melanoma patients. Brain recurrence may present as a seizure, hemorrhage, or death. We sought to determine predictors of brain metastases in patients with primary and regional melanoma in order to facilitate targeted screening.
METHODS: Prospectively maintained databases were used to identify patients treated for local or regional melanoma who developed stage IV melanoma with and without brain metastasis at initial recurrence. One hundred twenty patients were identified with brain relapse and compared to 487 patients without brain recurrence.
RESULTS: On univariate analysis, patients with brain metastases were younger (55 vs. 59yrs, P = 0.04) but did not differ in primary site (head and neck 23% vs. 21%, P = 0.20). Brain metastasis patients had thinner primaries (mean 3.4 vs. 4.5 mm, P = 0.01). There were no other pathologic differences including ulceration (55% vs. 53%, P = 0.75), mitoses (7 vs.7.5, P = 0.61) or histologic subtype. Younger age and decreased Breslow thickness were independently associated with brain metastases at stage IV recurrence (OR = 1.10 P = 0.01 and OR = 1.02 P = 0.02, respectively).
CONCLUSIONS: Our analysis, the largest to date, demonstrates that thinner Breslow depth and younger age were associated with brain recurrence at first presentation with Stage IV disease.

Bradish JR, Cheng L
Molecular pathology of malignant melanoma: changing the clinical practice paradigm toward a personalized approach.
Hum Pathol. 2014; 45(7):1315-26 [PubMed] Related Publications
Melanocytic proliferations are notoriously difficult lesions to evaluate histologically, even among experts, as there is a lack of objective, highly reproducible criteria, which can be broadly applied to the wide range of melanocytic lesions encountered in daily practice. These difficult diagnoses are undeniably further compounded by the substantial medicolegal risks of an "erroneous" diagnosis. Molecular information and classification of melanocytic lesions is already vast and constantly expanding. The application of molecular techniques for the diagnosis of benignity or malignancy is, at times, confusing and limits its utility if not used properly. In addition, current and future therapies will necessitate molecular classification of melanoma into one of several distinct subtypes for appropriate patient-specific therapy. An understanding of what different molecular markers can and cannot predict is of the utmost importance. We discuss both mutational analysis and chromosomal gains/losses to help clarify this continually developing and confusing facet of pathology.

Related: Melanoma

Ellis H
Edward Cock: Cock's 'peculiar tumour'.
J Perioper Pract. 2014; 24(4):87-8 [PubMed] Related Publications
I must first apologise to my readers for including in this series a condition which I have never personally seen in 40 years of general surgery, nor, I believe, have any of the readers of this article. My excuse is that the condition has such a charming name and that the surgeon, Edward Cock, was such an interesting character.

Findley A, Lee K, Jellinek NJ
Nail surgery among Mohs surgeons: prevalence, safety, and practice patterns.
Dermatol Surg. 2014; 40(6):691-5 [PubMed] Related Publications
BACKGROUND: Among US dermatologists, Mohs surgeons perform most of the nail surgeries. The specific practice patterns and safety precautions have not been formally studied.
OBJECTIVE: To study the practice patterns, safety precautions, and complications of this group when performing nail surgery.
METHODS: A survey was sent electronically to all members of the American College of Mohs Surgery Listserv. The survey evaluated the demographics of the surgeons, the types of surgery performed, the techniques for obtaining a bloodless field, and complications.
RESULTS: Those surgeons who performed more procedures in training tended to continue that practice and performed more surgeries when in practice, as did surgeons with greater time since completing fellowship. Complications were rare.
CONCLUSION: The data herein support that nail surgeries performed by Mohs surgeons are safe, with minimal complications, despite a broad range of approaches to obtaining a bloodless field and with a variety of procedures performed.

Related: USA

Lee KC, Higgins HW, Linden O, Cruz AP
Gender differences in tumor and patient characteristics in those undergoing Mohs surgery.
Dermatol Surg. 2014; 40(6):686-90 [PubMed] Related Publications
BACKGROUND: Nonmelanoma skin cancer is the most common cancer in the United States, and when indicated, Mohs micrographic surgery (MMS) is an effective method for tumor removal. Few studies have focused on gender-specific characteristics among those undergoing MMS.
OBJECTIVE: To elucidate patient- and tumor-specific characteristics in female MMS patients.
MATERIALS AND METHODS: We performed a retrospective chart review of 12,344 consecutive patients undergoing MMS from 2005 to 2012.
RESULTS: There was a 1.5:1 male predominance in the presentation of basal cell carcinoma (BCC) for MMS. However, BCC comprised 72% of tumors in women compared with 63% in men. Presenting tumor sizes of BCCs were smaller in women (0.9 vs 1.2 cm, p < .01). Superficial BCCs were more common in women (p < .001). Women had fewer squamous cell carcinoma (p < .01) and squamous cell carcinoma in situ (p < .01). They were more likely to present with tumors on their legs and central facial areas, whereas men had more tumors on their scalps and ears. Plastic surgery referral was over twice as common in the female population (p < .01).
CONCLUSION: In our data set, significant gender-specific differences were found in women compared with men undergoing MMS. These findings may be the result of discrepancies in sun exposure, protective behavior, and cosmetic concern.

Related: Basal Cell Carcinoma USA

Larson RJ, Aylward J
Evaluation and management of hypertension in the perioperative period of Mohs micrographic surgery: a review.
Dermatol Surg. 2014; 40(6):603-9 [PubMed] Related Publications
BACKGROUND: While patients' hypertensive problems are usually actively and effectively managed by their primary physician, the dermatologic surgeon can still be affected by hypertension where the condition is unrecognized or uncontrolled. Hypertension is an important contributor to both bleeding and hematoma formation during and after surgery, ultimately affecting functional and cosmetic outcomes.
OBJECTIVE: To extensively review the literature on perioperative management of the hypertensive patient as relates to the dermatologic surgeon.
MATERIALS AND METHODS: An updated and comprehensive literature review, focusing on current diagnostic guidelines, practice by specific dermatologic surgery groups and management recommendations, was conducted.
RESULTS: Review of the literature does support generalized guidelines for the management of hypertensive patients in the Mohs Micrographic Surgery (MMS) setting; however data on implementation and outcomes by specific dermatologic surgery groups is variable and lacking.
CONCLUSIONS: The treatment of nonmelanoma skin cancers with MMS is now routine, and fortunately can be performed quite safely. There are still improvements to be made however, in managing perioperative hypertension-both in making patients aware of their condition and in treating it effectively. Practicing these measures can promote patients' overall health and the efficiency of the dermatologic surgeon's practice.

Dubravcić ID, Brozić JM, Aljinović A, Sindik J
Quality of life in Croatian metastatic melanoma patients.
Coll Antropol. 2014; 38(1):69-74 [PubMed] Related Publications
The aim of this study was to examine the quality of life (QoL) in 40 Croatian metastatic melanoma patients who had completed at least first-line treatment and to see if there was a correlation between QoL parameters and serum lactate dehydrogenase (LDH). LDH levels were measured and all patients clinically examined between April and September 2013. Two QoL questionnaires were used for patient self-evaluation: the European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC QLQ-C30) and the Dartmouth Primary Care Cooperative Research Network and the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians (COOP/WONCA) charts. The average EORTC QLQ-C30 score for global health status (GHS) was 41.204. The average scores for functional scales were high, with the exception of emotional functioning (65.02). Blood LDH levels positively correlated with the Eastern Cooperative Oncology Group (ECOG) status (r = 0.415; p < 0.01) and pain (r = 0.345; p < 0.05), but not with any functional or COOP/WONCA scores. Global health status (GHS) positively correlated with patient age at the time of evaluation (r = 0.386; p < 0.05) and age at the time when metastatic disease had been diagnosed (r = 0.366; p < 0.05). Quality of life for the studied group of metastatic melanoma patients in Croatia can be considered generally good, with the exception of emotional functioning and symptoms of fatigue, dispnoea, insomnia, and financial difficulties.

Agarwal AK, Gude RP, Kalraiya RD
Regulation of melanoma metastasis to lungs by cell surface Lysosome Associated Membrane Protein-1 (LAMP1) via galectin-3.
Biochem Biophys Res Commun. 2014; 449(3):332-7 [PubMed] Related Publications
Lysosome Associated Membrane Protein-1 (LAMP1), which lines the lysosomes, is often found to be expressed on surface of metastatic cells. We previously demonstrated that its surface expression on B16 melanoma variants correlates with metastatic potential. To establish the role of cell surface LAMP1 in metastasis and to understand the possible mechanism by which it facilitates lung colonization, LAMP1 was downregulated in high metastatic B16F10 cells using shRNAs cloned in a doxycycline inducible vector. This also resulted in significantly decreased LAMP1 on the cell surface. Being a major carrier of poly-N-acetyllactosamine (polyLacNAc) substituted β1,6 branched N-oligosaccharides, the high affinity ligands for galectin-3, LAMP1 down regulation also resulted in appreciably decreased binding of galectin-3 to the cell surface. LAMP1 has been shown to bind to Extracellular Matrix (ECM), Basement Membrane (BM) components and also to galectin-3 (via carbohydrates) which is known to get incorporated into the ECM and BM. Although, LAMP1 downregulation had a marginal effect on cellular spreading and motility on fibronectin and matrigel, it significantly altered the same on galectin-3, and ultimately leading to notably reduced lung metastasis. The results thus for the first time provide direct evidence that cell surface LAMP1 facilitates lung metastasis by providing ligands for galectin-3 which has been shown to be expressed in highest amounts on lungs and constitutively on its vascular endothelium.

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