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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Prevention of Skin Cancer
Melanoma
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).

Ho AM, Avery R, Krupinski EA, et al.
Predictive role of imaging in sentinel lymph node dissection for melanoma.
Lymphology. 2014; 47(3):134-41 [PubMed] Related Publications
A retrospective study of 67 patients with metastatic melanoma was performed to evaluate if imaging from lymphoscintigraphy could predict a higher miss rate if only the most radioactive node were removed. Following protocol for sentinel node biopsy, the surgeon resected all lymph nodes containing radioactivity > 10% of the most radioactive node. A correlation was performed between the radioactive counts of the lymph nodes and the presence of metastases. The percentage of cases in which the most radioactive node was negative for metastasis on pathology was calculated. Two nuclear medicine physicians read the images from lymphoscintigraphy specifically to determine if the first lymph node visualized became less intense than other nodes on later images. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. In 13 of 67 (19%) patients, the most radioactive lymph node was negative for metastasis while a less radioactive node contained metastatic disease. Consensus reading by the nuclear medicine physicians determined that in 9 cases, the first lymph node visualized became less intense than another lymph node on later images. Of the 9 cases, 4 were true positive and 5 were false positive when correlated with intraoperative count rate and pathology. Of the cases where the most radioactive node was not positive on histopathology (n = 13), the consensus reading by the nuclear medicine physicians reported 4 of them (31%). Imaging by lymphoscintigram had a sensitivity 31%, specificity 91%, positive predictive value 44%, and negative predictive value 85% for predicting whether the most radioactive lymph node at surgery would be negative for metastasis at pathology. We conclude that in patients with melanoma, lymphoscintigraphy has high specificity and negative predictive value but modest sensitivity and positive predictive value for detecting when the sentinel node will not be the most radioactive lymph node during sentinel lymph node dissection. These findings support that dynamic imaging by lymphoscintigraphy has a role in surgical planning but that the imaging protocol could benefit from further optimization.


Lo JA, Fisher DE
The melanoma revolution: from UV carcinogenesis to a new era in therapeutics.
Science. 2014; 346(6212):945-9 [PubMed] Related Publications
Melanoma, the deadliest form of skin cancer, is an aggressive disease that is rising in incidence. Although melanoma is a historically treatment-resistant malignancy, in recent years unprecedented breakthroughs in targeted therapies and immunotherapies have revolutionized the standard of care for patients with advanced disease. Here, we provide an overview of recent developments in our understanding of melanoma risk factors, genomics, and molecular pathogenesis and how these insights have driven advances in melanoma treatment. In addition, we review benefits and limitations of current therapies and look ahead to continued progress in melanoma prevention and therapy. Remarkable achievements in the field have already produced a paradigm shift in melanoma treatment: Metastatic melanoma, once considered incurable, can now be treated with potentially curative rather than palliative intent.

Related: Melanoma


Snyder A, Makarov V, Merghoub T, et al.
Genetic basis for clinical response to CTLA-4 blockade in melanoma.
N Engl J Med. 2014; 371(23):2189-99 [PubMed] Related Publications
BACKGROUND: Immune checkpoint inhibitors are effective cancer treatments, but molecular determinants of clinical benefit are unknown. Ipilimumab and tremelimumab are antibodies against cytotoxic T-lymphocyte antigen 4 (CTLA-4). Anti-CTLA-4 treatment prolongs overall survival in patients with melanoma. CTLA-4 blockade activates T cells and enables them to destroy tumor cells.
METHODS: We obtained tumor tissue from patients with melanoma who were treated with ipilimumab or tremelimumab. Whole-exome sequencing was performed on tumors and matched blood samples. Somatic mutations and candidate neoantigens generated from these mutations were characterized. Neoantigen peptides were tested for the ability to activate lymphocytes from ipilimumab-treated patients.
RESULTS: Malignant melanoma exomes from 64 patients treated with CTLA-4 blockade were characterized with the use of massively parallel sequencing. A discovery set consisted of 11 patients who derived a long-term clinical benefit and 14 patients who derived a minimal benefit or no benefit. Mutational load was associated with the degree of clinical benefit (P=0.01) but alone was not sufficient to predict benefit. Using genomewide somatic neoepitope analysis and patient-specific HLA typing, we identified candidate tumor neoantigens for each patient. We elucidated a neoantigen landscape that is specifically present in tumors with a strong response to CTLA-4 blockade. We validated this signature in a second set of 39 patients with melanoma who were treated with anti-CTLA-4 antibodies. Predicted neoantigens activated T cells from the patients treated with ipilimumab.
CONCLUSIONS: These findings define a genetic basis for benefit from CTLA-4 blockade in melanoma and provide a rationale for examining exomes of patients for whom anti-CTLA-4 agents are being considered. (Funded by the Frederick Adler Fund and others.).

Related: Monoclonal Antibodies Ipilimumab (Yervoy)


Robert C, Karaszewska B, Schachter J, et al.
Improved overall survival in melanoma with combined dabrafenib and trametinib.
N Engl J Med. 2015; 372(1):30-9 [PubMed] Related Publications
BACKGROUND: The BRAF inhibitors vemurafenib and dabrafenib have shown efficacy as monotherapies in patients with previously untreated metastatic melanoma with BRAF V600E or V600K mutations. Combining dabrafenib and the MEK inhibitor trametinib, as compared with dabrafenib alone, enhanced antitumor activity in this population of patients.
METHODS: In this open-label, phase 3 trial, we randomly assigned 704 patients with metastatic melanoma with a BRAF V600 mutation to receive either a combination of dabrafenib (150 mg twice daily) and trametinib (2 mg once daily) or vemurafenib (960 mg twice daily) orally as first-line therapy. The primary end point was overall survival.
RESULTS: At the preplanned interim overall survival analysis, which was performed after 77% of the total number of expected events occurred, the overall survival rate at 12 months was 72% (95% confidence interval [CI], 67 to 77) in the combination-therapy group and 65% (95% CI, 59 to 70) in the vemurafenib group (hazard ratio for death in the combination-therapy group, 0.69; 95% CI, 0.53 to 0.89; P=0.005). The prespecified interim stopping boundary was crossed, and the study was stopped for efficacy in July 2014. Median progression-free survival was 11.4 months in the combination-therapy group and 7.3 months in the vemurafenib group (hazard ratio, 0.56; 95% CI, 0.46 to 0.69; P<0.001). The objective response rate was 64% in the combination-therapy group and 51% in the vemurafenib group (P<0.001). Rates of severe adverse events and study-drug discontinuations were similar in the two groups. Cutaneous squamous-cell carcinoma and keratoacanthoma occurred in 1% of patients in the combination-therapy group and 18% of those in the vemurafenib group.
CONCLUSIONS: Dabrafenib plus trametinib, as compared with vemurafenib monotherapy, significantly improved overall survival in previously untreated patients with metastatic melanoma with BRAF V600E or V600K mutations, without increased overall toxicity. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT01597908.).

Related: BRAF gene Vemurafenib (Zelboraf)


Murakami I, Takata K, Matsushita M, et al.
Immunoglobulin expressions are only associated with MCPyV-positive Merkel cell carcinomas but not with MCPyV-negative ones: comparison of prognosis.
Am J Surg Pathol. 2014; 38(12):1627-35 [PubMed] Related Publications
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine skin cancer, often associated with Merkel cell polyomavirus (MCPyV). Recently, immunoglobulin (Ig) expression was reported in MCC, thereby suggesting that B cells might be their cellular ancestors. We tested 30 MCCs (20 MCPyV-positive and 10 MCPyV-negative) using immunohistochemistry for the expressions of IgG, IgA, IgM, Igκ, Igλ, terminal desoxynucleotidyl transferase, paired box gene 5 (PAX5), octamer transcription factor-2 (Oct-2), and sex-determining region Y-box 11 (SOX11). We performed in situ hybridization for Igκ-mRNA or Igλ-mRNA and Ig heavy chain (IgH) gene rearrangement (IgH-R) analyses. The expressions of PAX5, TdT, Oct-2, and SOX11 were not significantly different between MCPyV-positive and MCPyV-negative MCCs. At least 1 of IgG, IgA, IgM, or Igκ was expressed in MCPyV-positive (14/20, 70%) and none in MCPyV-negative MCCs (P=0.0003). There was a higher tendency for Igκ-mRNA expression (7/19, using in situ hybridization) and IgH-R (10/20, using polymerase chain reaction) in MCPyV-positive than in MCPyV-negative MCCs (0/10 and 2/10, respectively), thus suggesting a different Ig production pattern and pathogenesis between the 2 types of MCC. Ig expression or IgH-R in MCPyV-positive MCCs might be associated with MCPyV gene integration or expression in cancer cells but do not necessarily suggest a B-cell origin for MCCs. IgH expression or IgH-R nonsignificantly correlated with improved prognosis. However, these might be important factors that influence the survival of neoplastic cells and might allow the development of novel therapies for patients with MCPyV-positive MCCs.

Related: Merkel Cell Carcinoma Merkel Cell Polyomavirus


Bønnelykke-Behrndtz ML, Schmidt H, Christensen IJ, et al.
Prognostic stratification of ulcerated melanoma: not only the extent matters.
Am J Clin Pathol. 2014; 142(6):845-56 [PubMed] Related Publications
OBJECTIVES: For patients with melanoma, ulceration is an important prognostic marker and interestingly also a predictive marker for the response of adjuvant interferon. A consensual definition and accurate assessment of ulceration are therefore crucial for proper staging and clinical management. We evaluated the prognostic impact of the extent and type of ulceration and the epidermal involvement theoretically preceding it (consumption of epidermis and cleft formation) or seen subsequent to the inflammation (reepithelialization and reactive epidermal hyperplasia), aiming for better prognostic stratification of ulcerated lesions.
METHODS: From H&E-stained sections, the status (presence vs absence), extent (percentage of the total tumor length), and type (infiltrative vs attenuative) of ulceration and epidermal involvement were evaluated from 385 patients with cutaneous melanoma.
RESULTS: The presence of ulceration (hazard ratio [HR], 1.83), an attenuative type of ulceration (HR, 3.02), and excessive ulceration (HR, 3.57) were independent predictors of poor melanoma-specific survival. Further subdivision of minimal/moderate ulceration showed independent prognostic value only for lesions with epidermal involvement of the surrounding epidermis (HR, 1.78).
CONCLUSION: The extent and type of ulceration and involvement of the surrounding epidermis provided more accurate prognostic information than the mere absence or presence and may be useful markers allowing better stratification of ulcerated lesions.

Related: Melanoma


Hodi FS, Lee S, McDermott DF, et al.
Ipilimumab plus sargramostim vs ipilimumab alone for treatment of metastatic melanoma: a randomized clinical trial.
JAMA. 2014; 312(17):1744-53 [PubMed] Related Publications
IMPORTANCE: Cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) blockade with ipilimumab prolongs survival in patients with metastatic melanoma. CTLA-4 blockade and granulocyte-macrophage colony-stimulating factor (GM-CSF)-secreting tumor vaccine combinations demonstrate therapeutic synergy in preclinical models. A key unanswered question is whether systemic GM-CSF (sargramostim) enhances CTLA-4 blockade.
OBJECTIVE: To compare the effect of ipilimumab plus sargramostim vs ipilimumab alone on overall survival (OS) in patients with metastatic melanoma.
DESIGN, SETTING, AND PARTICIPANTS: The Eastern Cooperative Oncology Group (ECOG) conducted a US-based phase 2 randomized clinical trial from December 28, 2010, until July 28, 2011, of patients (N = 245) with unresectable stage III or IV melanoma, at least 1 prior therapy, no central nervous system metastases, and ECOG performance status of 0 or 1.
INTERVENTIONS: Patients were randomized to receive ipilimumab, 10 mg/kg, intravenously on day 1 plus sargramostim, 250 μg subcutaneously, on days 1 to 14 of a 21-day cycle (n = 123) vs ipilimumab alone (n = 122). Ipilimumab treatment included induction for 4 cycles followed by maintenance every fourth cycle.
MAIN OUTCOMES AND MEASURES: Primary end point: comparison of length of OS. Secondary end point: progression-free survival (PFS), response rate, safety, and tolerability.
RESULTS: Median follow-up was 13.3 months (range, 0.03-19.9). Median OS as of December 2012 for ipilimumab plus sargramostim was 17.5 months (95% CI, 14.9-not reached) vs 12.7 months (95% CI, 10.0-not reached) for ipilimumab. The 1-year survival rate for ipilimumab plus sargramostim was 68.9% (95% CI, 60.6%-85.5%) compared to 52.9% (95% CI, 43.6%-62.2%) for ipilimumab alone (stratified log-rank 1-sided P = .01; mortality hazard ratio 0.64 [1-sided 90% repeated CI, not applicable-0.90]). A planned interim analysis was conducted at 69.8% of expected events (104 observed with 149 expected deaths). Planned interim analysis using the O'Brien-Fleming boundary was crossed for improvement in OS. There was no difference in PFS. Median PFS for ipilimumab plus sargramostim was 3.1 months (95% CI, 2.9-4.6) vs 3.1 months (95% CI, 2.9-4.0) for ipilimumab alone. Grade 3 to 5 adverse events occurred in 44.9% (95% CI; 35.8%-54.4%) of patients in the ipilimumab plus sargramostim group vs 58.3% (95% CI, 49.0%-67.2%) of patients in the ipilimumab-alone group (2-sided P = .04).
CONCLUSION AND RELEVANCE: Among patients with unresectable stage III or IV melanoma, treatment with ipilimumab plus sargramostim vs ipilimumab alone resulted in longer OS and lower toxicity, but no difference in PFS. These findings require confirmation in larger studies with longer follow-up.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01134614.

Related: Monoclonal Antibodies Melanoma Ipilimumab (Yervoy)


Hau HM, Tautenhahn HM, Schoenberg MB, et al.
Liver resection in multimodal concepts improves survival of metastatic melanoma: a single-centre case-matched control study.
Anticancer Res. 2014; 34(11):6633-9 [PubMed] Related Publications
BACKGROUND/AIM: The aim of the present study was to define prognostic factors and to evaluate liver resection as an additive tool in metastatic melanoma.
PATIENTS AND METHODS: In a case-control study, 32 patients with hepatic melanoma metastasis were analyzed between 1998-2012. Sixteen patients who underwent liver resection (6 patients with multimodal therapy) were matched to 16 patients scheduled for non-surgical approaches. Univariate and multivariate analyses were performed.
RESULTS: Following primary resection and liver resection, respectively, survival was better for patients who underwent surgery in addition to multimodal therapy with 219 and 28 months, when compared to patients scheduled for non-surgical approaches with 64 (p=0.04) and 8 months (p=0.6). Following primary resection, primary tumor site, metastatic time <70 months, combination of multimodal therapy and surgery were of prognostic value (p<0.05).
CONCLUSION: Liver resection should be considered a suitable additive tool in multimodal therapy of resectable metastatic melanoma.

Related: Cisplatin Dacarbazine Interleukin 2 (Aldesleukin) Melanoma


Sessums MT, Ward KM, Brodell R
Cutaneous eruption on chest and back.
J Fam Pract. 2014; 63(8):467-8 [PubMed] Related Publications
The cause of this "dirty" rash was fairly obvious to us, but only because we'd encountered this rare skin disorder before.


Solovăstru LG, Vâţă D, Stătescu L, Andrese E
Pachydermodactyly--role of local corticotherapy.
Rev Med Chir Soc Med Nat Iasi. 2014 Jul-Sep; 118(3):643-8 [PubMed] Related Publications
Pachydermodactyly is a rare skin disease, defined as a benign form of digital fibromatosis. It is clinically characterized by painless hypertrophy of the skin around the proximal interphalangeal joints of the fingers, more common in males. This rare condition can affect both hands and is often associated with mechanical injury of the skin. Although there is no specific therapy, cessation of mechanical trauma associated with topical corticosteroid therapy can lead to satisfactory results. We present 3 sporadic cases of classical pachydermodactyly, anatomopathologically confirmed by the presence hyperkeratosis and acanthosis, which responded favorably to topically applied corticosteroids under occlusive dressings.


Rangwala S, Duvic M
Antinuclear antibody seropositivity in men with cutaneous B-cell lymphoma of the scalp.
Skinmed. 2014 Jul-Aug; 12(4):244-8 [PubMed] Related Publications
Patient 1: A 65-year-old Caucasian man presented with a 2-month history of large erythematous patches of the right temporal scalp. The patient was otherwise in good health and taking no medications. He denied a family history oflymphomas or autoimmune diseases. No hepatosplenomegaly or lymphadenopathy was appreciated. A complete blood cell count, serum protein electrophoresis, peripheral blood flow cytometric analysis, bone marrow biopsy, Helicobacter pylori titers, and Borrelia burgdorferi titers were within normal range. The antinuclear antibody titer was positive at 1:640 and showed a homogenous pattern. Rheumatoid factor, SSA (Ro), and SSB (La) antibody titers were negative. Computed tomography scans of the chest, abdomen, and pelvis were unremarkable. Two punch biopsies from different time points demonstrated an atypical lymphocytic infiltrate forming clusters in the dermal and subcutaneous tissue. These cells had a (14;18) translocation and were mostly positive for CD20 and bcl-6, but not bcl-2. The patient was diagnosed with low-grade primary cutaneous follicle center lymphoma based on clinicopathological evidence, and achieved complete remission after local radiation and 6 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. The patient has had no evidence of recurrence for 6 years.


Bogo F, Romero J, Peserico E, Black MJ
Automated detection of new or evolving melanocytic lesions using a 3D body model.
Med Image Comput Comput Assist Interv. 2014; 17(Pt 1):593-600 [PubMed] Related Publications
Detection of new or rapidly evolving melanocytic lesions is crucial for early diagnosis and treatment of melanoma. We propose a fully automated pre-screening system for detecting new lesions or changes in existing ones, on the order of 2 - 3mm, over almost the entire body surface. Our solution is based on a multi-camera 3D stereo system. The system captures 3D textured scans of a subject at different times and then brings these scans into correspondence by aligning them with a learned, parametric, non-rigid 3D body model. This means that captured skin textures are in accurate alignment across scans, facilitating the detection of new or changing lesions. The integration of lesion segmentation with a deformable 3D body model is a key contribution that makes our approach robust to changes in illumination and subject pose.

Related: Melanoma


Madooei A, Drew MS
A probabilistic approach to quantification of melanin and hemoglobin content in dermoscopy images.
Med Image Comput Comput Assist Interv. 2014; 17(Pt 1):49-56 [PubMed] Related Publications
We describe a technique that employs the stochastic Latent Topic Models framework to allow quantification of melanin and hemoglobin content in dermoscopy images. Such information bears useful implications for analysis of skin hyperpigmentation, and for classification of skin diseases. The proposed method outperforms existing approaches while allowing for more stringent and probabilistic modeling than previously.


Ming M, Han W, Zhao B, et al.
SIRT6 promotes COX-2 expression and acts as an oncogene in skin cancer.
Cancer Res. 2014; 74(20):5925-33 [PubMed] Article available free on PMC after 15/10/2015 Related Publications
SIRT6 is a SIR2 family member that regulates multiple molecular pathways involved in metabolism, genomic stability, and aging. It has been proposed previously that SIRT6 is a tumor suppressor in cancer. Here, we challenge this concept by presenting evidence that skin-specific deletion of SIRT6 in the mouse inhibits skin tumorigenesis. SIRT6 promoted expression of COX-2 by repressing AMPK signaling, thereby increasing cell proliferation and survival in the skin epidermis. SIRT6 expression in skin keratinocytes was increased by exposure to UVB light through activation of the AKT pathway. Clinically, we found that SIRT6 was upregulated in human skin squamous cell carcinoma. Taken together, our results provide evidence that SIRT6 functions as an oncogene in the epidermis and suggest greater complexity to its role in epithelial carcinogenesis.

Related: COX2 (PTGS2) AKT1


Kempf W, Keller K, John H, Dommann-Scherrer C
Benign atypical intravascular CD30+ T-cell proliferation: a recently described reactive lymphoproliferative process and simulator of intravascular lymphoma: report of a case associated with lichen sclerosus and review of the literature.
Am J Clin Pathol. 2014; 142(5):694-9 [PubMed] Related Publications
OBJECTIVES: Intravascular accumulations of atypical large lymphoid cells are a rare finding in skin biopsy specimens and raise the suspicion for intravascular lymphoma. The intravascular accumulation of atypical large CD30+ T cells, however, as a reactive process is very uncommon in the skin, with only four cases documented so far in the literature. This condition, referred to as benign intravascular atypical CD30+ T-cell proliferation, has been associated with chronic inflammation after trauma.
METHODS: We report on a case of atypical intravascular CD30+ T-cell proliferation in a patient with ulcerated lichen sclerosus on the foreskin, discuss the differential diagnoses, propose diagnostic criteria, and review the literature on this uncommon reactive intralymphatic CD30+ T-cell lymphoproliferation.
RESULTS: The atypical intravascular CD30+ T-cell proliferation is characterized by the accumulation of large CD30+ polyclonal T cells within lymphatics in close vicinity to ulceration or an inflammatory skin disease. There is no association with Epstein-Barr virus infection.
CONCLUSIONS: This benign cutaneous lymphoproliferation needs to be distinguished from intravascular T-cell lymphoma, particularly from the intravascular variant of anaplastic large cell lymphoma. Obstruction of lymphatics due to lichen sclerosus with disrupted immune cell trafficking may result in the accumulation of activated CD30+ lymphocytes.


Hsi AC, Robirds DH, Luo J, et al.
T-cell prolymphocytic leukemia frequently shows cutaneous involvement and is associated with gains of MYC, loss of ATM, and TCL1A rearrangement.
Am J Surg Pathol. 2014; 38(11):1468-83 [PubMed] Related Publications
T-cell prolymphocytic leukemia (T-PLL) is a rare aggressive mature T-cell leukemia with frequent cutaneous presentation, which has not been well characterized. Among the 25 T-PLLs diagnosed between 1990 and 2013 at our institution, 32% (8/25) showed cutaneous manifestations, presenting as rash, purpura, papules, and ulcers. The skin biopsies showed leukemia cutis with perivascular and periadnexal irregular, small to medium-sized lymphoid infiltrates without epidermotropism. The lymphoid infiltrates were composed of mature CD4+ T cells expressing other T-cell antigens, and a subset (48%) showed dual CD4+/CD8+ coexpression. Higher median absolute peripheral blood lymphocyte count (43.0 vs. 13.0 k/mm; P=0.031) and elevated lactate dehydrogenase levels (P=0.00018) at the time of diagnosis were significantly associated with T-PLLs with skin involvement compared with those without. The extent of bone marrow involvement (P=0.849) and overall survival (P=0.144) was similar in the 2 groups. Fluorescence in situ hybridization or karyotype revealed frequent gains of MYC (67%; n=9), loss of ATM (64%; n=11), and TCL1A rearrangement or inversion 14q (75%; n=12). Gains of TCL1A was also seen (78%; n=9), including in some cases that had concurrent TCL1A rearrangement, whereas TP53 loss was less common (30%; n=10). No correlation was seen between the immunophenotype and morphology versus the presence or absence of skin involvement. These data suggest that cutaneous involvement by T-PLL is relatively common and often associated with significant peripheral blood involvement. The frequent MYC, ATM, and TCL1A alterations identified support that these genes are integral to the pathogenesis of T-PLL.

Related: FISH MYC gene TCL1A gene ATM


Trinh N, Novice K, Lekakh O, et al.
Use of a brief educational video administered by a portable video device to improve skin cancer knowledge in the outpatient transplant population.
Dermatol Surg. 2014; 40(11):1233-9 [PubMed] Related Publications
BACKGROUND: The considerably high risk of skin cancer development among transplant recipients warrants effective and efficient patient education on sun-protective behaviors.
OBJECTIVE: To evaluate the effectiveness and patient satisfaction of a brief educational video on skin cancer risks and sun-protective behaviors in the transplant population during a routine posttransplant follow-up visit, as compared with an educational handout.
MATERIALS AND METHODS: One hundred posttransplant patients were randomized to receive either video or pamphlet education about skin cancer. The primary outcome measure was knowledge acquisition, which was assessed using a 10-criterion grading instrument before and after the assigned educational intervention. The secondary outcome measure was patient satisfaction with the particular educational intervention received.
RESULTS: Comparison between the 2 treatment groups demonstrated that the video group had significantly greater improvement in knowledge scores (3.96 ± 1.69) as compared with the pamphlet group (1.76 ± 1.42, p < .01). Moreover, subjects in the video group rated the educational material as more useful and appealing than did subjects in the pamphlet group.
CONCLUSION: These findings suggest an inherent appeal for audio-visual presentation and point its potential to improve patients' knowledge of their increased risk of skin cancer and preventive skin cancer measures.


Pérez Ramírez S, Parra V, Avilés Izquierdo JA, et al.
Metastatic melanoma with spontaneous regression, psoriasis and HLA-Cw6: case report and a hypothesis to explore.
Tumori. 2014 Jul-Aug; 100(4):144e-7e [PubMed] Related Publications
Spontaneous regressions of metastatic melanoma are rare, but several cases have been described in the literature. Although the mechanism of the phenomenon is not well understood, it is postulated that an activation of the immune system is behind it. Here we report the case of a patient with metastatic melanoma that, without any treatment, regressed spontaneously. The patient presented psoriasis (a disease of the skin related with autoimmunity) linked with HLA-Cw6. We review the literature and hypothesize with the possible relationship between psoriasis, HLA-Cw6 and the spontaneous regression.


den Uil SH, Thomassen I, Vermeulen EG, et al.
Small bowel perforation caused by advanced melanoma.
Tumori. 2014 Jul-Aug; 100(4):140e-3e [PubMed] Related Publications
The incidence of melanoma has been increasing over the years and it remains, despite the heterogeneous survival for different stages, a disease with high mortality. Dissemination occurs primarily by the lymphatic route, followed by the hematogenous route. Gastrointestinal metastases do occur, but they are mainly intraluminal mucosal melanomas. Peritoneal or primary mucosal melanomas are rare. Only a few cases have been described of patients presenting with acute abdominal pain due to a melanoma. In this report we present a young patient with no prior health problems. Due to silent progression of disease at first, and secondarily avoidance of medical consultation, she finally presented to our emergency department with signs of intestinal perforation. In the operating theater a massive metastasis in the intestines with perforation was seen, as well as many smaller intra-abdominal and cutaneous lesions. Approximately 35 cm of jejunum had to be resected. Furthermore, the primary melanoma on the left forearm was excised and turned out to be in almost complete regression. Although initial recovery after surgery was good, the patient died only one month after presentation due to the advanced nature of her disease, which points to the devastating effect of undiagnosed melanoma and gastrointestinal metastasis. Since the melanoma incidence is rising, similar cases may present in the near future. This emphasizes the importance of proper full physical examination in patients with atypical abdominal symptoms.


Ross M, Hadzikadic Gusic L, Dabbs DJ, et al.
Simultaneous breast and axillary recurrence in a patient with a history of breast cancer and ipsilateral upper extremity melanoma: challenges in diagnosis and management.
Tumori. 2014 Jul-Aug; 100(4):136e-9e [PubMed] Related Publications
BACKGROUND: Nodal patterns of spread for breast cancer and melanoma have been extensively studied in the literature. The phenomenon of upper extremity melanoma and ipsilateral breast cancer has been previously reported. We describe a rare case of a simultaneous locoregional recurrence of both malignancies.
CASE REPORT: A patient with a previous diagnosis of stage 1A melanoma of the left upper extremity at age 29 developed left breast invasive ductal carcinoma 1 year later. The patient underwent a wide local excision with negative margins for the melanoma and a partial mastectomy with axillary dissection followed by chemotherapy and radiation therapy for her breast cancer. Five years later she was diagnosed with a dual recurrence while 36 weeks pregnant.
CONCLUSIONS: Regular follow-up according to the NCCN guidelines is critical in diagnosing a recurrence of malignancy. Pathologic analysis is paramount in dictating management strategies in rare cases of dual recurrence.

Related: Breast Cancer Fluorouracil Breast cancer in pregnancy Capecitabine Trastuzumab (Herceptin)


La Rosa F, Liso A, Bianconi F, et al.
Seasonal variation in the month of birth in patients with skin cancer.
Br J Cancer. 2014; 111(9):1810-3 [PubMed] Related Publications
BACKGROUND: Month of birth influences the risk of developing several diseases. We investigated the influence of date of birth on melanoma skin cancer (MSC) and non-melanoma skin cancer (NMSC) incidence.
METHODS: Enhanced cancer registry data were analysed including 1751 MSC and 15 200 NMSC.
RESULTS: People born in February to April showed significantly elevated risks of NMSC compared with those born in summertime.
CONCLUSIONS: We demonstrated seasonality by date of birth for skin cancer incidence. Neonatal UV exposure may explain this finding.

Related: Basal Cell Carcinoma Melanoma


Falivene S, Giugliano FM, Grimaldi AM, et al.
Tomotherapy concomitant with cetuximab, followed by cetuximab as single-agent therapy for unresectable squamous cell carcinoma of the skin: a case report.
BMC Dermatol. 2014; 14:15 [PubMed] Article available free on PMC after 15/10/2015 Related Publications
BACKGROUND: Cutaneous squamous cell carcinoma (SCC) is the second most frequency of all skin tumors. Incidence of SCC has risen significantly due to an increased sun exposure and the number of immunodeficient patients. Cutaneous SCC is characterized by high Epidermal growth factor receptor (EGFR) expression with low frequency of RAS mutations. Generally, locoregional surgery is curative and systemic therapy is not indicated. We evaluated the activity and toxicity profile of tomotherapy concomitant with Cetuximab, followed by Cetuximab as single agent therapy in a patient affected by unresectable, locally advanced cutaneous SCC.
CASE PRESENTATION: At our institution, on March 2012 we treated a 45 years-old patient affected by locally advanced, unresectable G1 SCC of the lumbar region. At our first observation, the patient was asthenic, with severe pain and functional limitations. There was also a superinfection due to Pseudomonas Aeruginosa resistant to antibiotics, and a G3 anemia secondary to the bleeding lesion. ECOG Performance Status was 2. Tomotherapy has been performed concomitant with the Cetuximab (400 mg/m2, followed by weekly doses of 250 mg/m2) at the total dose of 60 Gy (2 Gy/fx), followed by Cetuximab monotherapy.The lesion reduced progressively until disappear even after the suspension of the treatment and the patient achieved complete response. Toxicity resulted in G1 cutaneous rash and G2 toxicity to the nails, appeared after 5 months of treatment, typical toxicity profile of the anti-EGFR therapies. After one month of therapy the Pseudomonas Aeruginosa superinfection totally disappeared. Quality of life resulted significantly improved with reduction until discontinuation of the anti-pain drugs, and progressive increase of the hemoglobin levels. At follow up of 15 months there was no evidence of active disease and the ECOG Performance Status was 0 (zero).
CONCLUSION: The treatment was effective and feasible. Considering these excellent results, further studies about concomitant tomotherapy with Cetuximab for advanced/inoperable SCC of the skin are needed.

Related: Cetuximab (Erbitux)


Sligh JE
New therapeutic options for actinic keratosis and basal cell carcinoma.
Semin Cutan Med Surg. 2014; 33(4 Suppl):S76-80 [PubMed] Related Publications
Actinic keratosis (AK) is a common premalignant skin lesion that is frequently treated by cryosurgery. Basal cell carcinoma is the most common malignancy of man, and early-stage lesions are usually cured via surgery. Advanced basal cell carcinoma may require more extensive surgery resulting in deformity, and many advanced lesions cannot be treated surgically. Several recent developments have improved therapeutic options for both conditions. Cryosurgery is still a mainstay of treatment for AK, but the introduction of effective topical agents, imiquimod cream and ingenol mebutate, has provided alternatives to cryosurgery. For advanced basal cell carcinoma, the small-molecule inhibitor vismodegib has proven to be an effective therapy for lesions that are not amenable to surgery and has demonstrated ability to achieve dramatic improvement in advanced, potentially disfiguring cancer.

Related: Basal Cell Carcinoma


Pletneva MA, Andea A, Palanisamy N, et al.
Clear cell melanoma: a cutaneous clear cell malignancy.
Arch Pathol Lab Med. 2014; 138(10):1328-36 [PubMed] Related Publications
Clear cell melanoma is a rare clear cell malignancy. Accurate diagnosis of clear cell melanoma requires integration of immunohistochemical and morphologic findings, with molecular studies to rule out clear cell sarcoma. The differential diagnosis includes melanoma, carcinoma, perivascular epithelioid cell tumor, and epidermotropic clear cell sarcoma. We use a case of a lesion on the helix of an 86-year-old man as an example. Histologic examination revealed an ulcerated clear cell malignant tumor. Tumor cell cytoplasm contained periodic acid-Schiff-positive, diastase-sensitive glycogen. Tumor cells showed positive labeling for S100, HMB-45, and Melan-A, and negative labeling for cytokeratins, p63, and smooth muscle actin. Molecular studies demonstrated BRAF V600E mutation, copy gains at the 6p25 (RREB1) and 11q13 (CCND1) loci, and absence of EWSR1-ATF1 fusion. These findings supported a diagnosis of clear cell melanoma. The rare pure clear cell morphology occurs due to accumulation of intracytoplasmic glycogen. We review the differential diagnosis of clear cell melanoma and describe the utility of immunohistochemical and molecular studies in confirming this diagnosis.

Related: Melanoma BRAF gene BCL1 Gene (CCND1)


Lan TT, Brown NA, Hristov AC
Controversies and considerations in the diagnosis of primary cutaneous CD4⁺ small/medium T-cell lymphoma.
Arch Pathol Lab Med. 2014; 138(10):1307-18 [PubMed] Related Publications
CONTEXT: Primary cutaneous CD4⁺ small/medium T-cell lymphoma is a provisional and controversial entity with a broad differential diagnosis. Despite being an uncommon lymphoma, it is a frequent diagnostic consideration in cutaneous biopsies with a dense lymphoid infiltrate because it shows overlapping features with reactive lymphoid hyperplasia (pseudolymphoma) and a variety of other primary cutaneous and systemic lymphomas. However, proper classification of this process is important for determining patient prognosis and treatment options.
OBJECTIVE: To review the clinical, morphologic, immunophenotypic, and genetic features of primary cutaneous CD4⁺ small/medium T-cell lymphoma and contrast those features with entities in the differential diagnosis.
DATA SOURCES: Applicable literature will be reviewed with emphasis on current controversies and distinguishing characteristics.
CONCLUSIONS: Although many consider primary cutaneous CD4⁺ small/medium T-cell lymphoma to be indistinguishable from reactive lymphoid hyperplasia/pseudolymphoma, it can be differentiated from other primary cutaneous and systemic lymphomas. Patients with solitary lesions of primary cutaneous CD4⁺ small/medium T-cell lymphoma generally have an excellent prognosis. Nevertheless, a subset of patients who have been reported to meet criteria for this lymphoma have followed a more-aggressive course; however, those patients show some differing clinical, morphologic, and immunophenotypic features.

Related: MALT Lymphoma Cutaneous T-cell lymphoma


Esmer O, Karadag R, Bayramlar H, et al.
Bilateral lower eyelid basosquamous cell carcinoma: a rare case.
J Pak Med Assoc. 2014; 64(7):837-9 [PubMed] Related Publications
Basosquamous cell carcinoma is a subtype of basal cell cancer. It is known to be more aggressive than basal cell cancer. A 70-year-old male patient was admitted to our clinic for evaluation of cosmetic problems caused by masses on both lower eyelids for at least two years. The mass excision from and reconstruction of lower eyelids were performed. Histopathological examination of the resected masses was consistent with basosquamous cell carcinoma. We present a case of basosquamous cell carcinoma involving bilateral lower eyelids with a different clinical appearance. To the best of our knowledge, this is the first report of bilateral basosquamous cell carcinoma in a patient.


Mancebo SE, Wang SQ
Skin cancer: role of ultraviolet radiation in carcinogenesis.
Rev Environ Health. 2014; 29(3):265-73 [PubMed] Related Publications
UV radiation is a carcinogen known to play a role in the development of non-melanoma and melanoma skin cancers. Acute and chronic exposure to UV radiation causes clinical and biological effects that promote the unregulated proliferation of skin cells. In recent decades, changes in climate and increased air pollution have led to environmental changes that increase UV light transmission. In this chapter, we discuss sources of UV radiation that are relevant to human health, as well as the acute and chronic effects that result from UV radiation exposure.


Stubblefield J, Kelly B
Melanoma in non-caucasian populations.
Surg Clin North Am. 2014; 94(5):1115-26, ix [PubMed] Related Publications
Melanoma is the most dangerous form of skin cancer and the sixth leading cause of malignancy in the United States. Non-Caucasians have a decreased overall incidence of melanoma, but African Americans and other ethnic groups often have more advanced disease at initial diagnosis and higher mortality rates than Caucasian populations. Patients with more darkly pigmented skin have a higher percentage of acral lentiginous melanoma, which presents on the palms, soles, and subungual sites and carries specific genetic alterations. Increased awareness of melanoma presentation in pigmented skin may help reduce disparities between ethnic groups.

Related: Cancer Screening and Early Detection Melanoma


Cheriyan J, Wernberg J, Urquhart A
Head and neck melanoma.
Surg Clin North Am. 2014; 94(5):1091-113, ix [PubMed] Related Publications
Wide local excision is the mainstay in the treatment of the primary lesion with consideration given to specific anatomic constraints in head and neck melanoma. Sentinel lymph node biopsy is considered in all lesions with ulceration, mitoses greater than or equal to 1/mm(2), stage1B or higher, and in all high-risk nonmetastatic melanoma. Reconstructive strategy must be considered in multidisciplinary teams with reconstructive surgeons for large head and neck defects.

Related: Cancer Screening and Early Detection Head and Neck Cancers Head and Neck Cancers - Molecular Biology Melanoma


Wei IH, Healy MA, Wong SL
Surgical treatment options for stage IV melanoma.
Surg Clin North Am. 2014; 94(5):1075-89, ix [PubMed] Related Publications
Melanomas have unique tumor biology and unpredictable patterns of metastasis. Metastatic melanoma is classified based on the location of metastasis. Surgical resection of metastatic melanoma may be performed for curative or palliative intent. In carefully selected patients, there is a survival benefit to metastasectomy. Candidates for surgical resection generally have favorable prognostic factors. Targeted biologic therapies and immunomodulatory therapies are promising new treatments associated with improved progression-free and overall survival. In the setting of new, effective medical therapies, further study is needed to determine how best to combine nonsurgical and surgical treatments for stage IV melanoma.


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