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
Information for Health Professionals / Researchers
Latest Research Publications
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).

Morton DL, Thompson JF, Cochran AJ, et al.
Final trial report of sentinel-node biopsy versus nodal observation in melanoma.
N Engl J Med. 2014; 370(7):599-609 [PubMed] Related Publications
BACKGROUND: Sentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase 3 trial.
METHODS: We evaluated outcomes in 2001 patients with primary cutaneous melanomas randomly assigned to undergo wide excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or wide excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group). Results No significant treatment-related difference in the 10-year melanoma-specific survival rate was seen in the overall study population (20.8% with and 79.2% without nodal metastases). Mean (± SE) 10-year disease-free survival rates were significantly improved in the biopsy group, as compared with the observation group, among patients with intermediate-thickness melanomas, defined as 1.20 to 3.50 mm (71.3 ± 1.8% vs. 64.7 ± 2.3%; hazard ratio for recurrence or metastasis, 0.76; P=0.01), and those with thick melanomas, defined as >3.50 mm (50.7 ± 4.0% vs. 40.5 ± 4.7%; hazard ratio, 0.70; P=0.03). Among patients with intermediate-thickness melanomas, the 10-year melanoma-specific survival rate was 62.1 ± 4.8% among those with metastasis versus 85.1 ± 1.5% for those without metastasis (hazard ratio for death from melanoma, 3.09; P<0.001); among patients with thick melanomas, the respective rates were 48.0 ± 7.0% and 64.6 ± 4.9% (hazard ratio, 1.75; P=0.03). Biopsy-based management improved the 10-year rate of distant disease-free survival (hazard ratio for distant metastasis, 0.62; P=0.02) and the 10-year rate of melanoma-specific survival (hazard ratio for death from melanoma, 0.56; P=0.006) for patients with intermediate-thickness melanomas and nodal metastases. Accelerated-failure-time latent-subgroup analysis was performed to account for the fact that nodal status was initially known only in the biopsy group, and a significant treatment benefit persisted.
CONCLUSIONS: Biopsy-based staging of intermediate-thickness or thick primary melanomas provides important prognostic information and identifies patients with nodal metastases who may benefit from immediate complete lymphadenectomy. Biopsy-based management prolongs disease-free survival for all patients and prolongs distant disease-free survival and melanoma-specific survival for patients with nodal metastases from intermediate-thickness melanomas. (Funded by the National Cancer Institute, National Institutes of Health, and the Australia and New Zealand Melanoma Trials Group; ClinicalTrials.gov number, NCT00275496.).

Related: Melanoma


Hocar O, Sab IA, Akhdari N, et al.
Recurrent infantile myofibromatosis in a 19-month-old boy presenting as ulcerated plaque.
Skinmed. 2013 Nov-Dec; 11(6):371-3 [PubMed] Related Publications
A 19-month-old boy presented to our department with ulcerated plaque on the right lumbar region. The lesion was known to have been growing for about 5 months. At another center 9 months prior to presenting to our department, the patient's parents reported a history of cutaneous nodules from the same lumbar region. Their total excision was performed, and the pathology report stated that it was infantile calcifying fibromatosis or nodular fasciitis. The patient was healthy with a nonsignificant, medical history including no use of medications, no known drug allergies, and no significant family history of disease.


Bronsnick T, Kirkorian AY, Khan I, et al.
From mole to scar: the unintended consequence of treatment with an over-the-counter mole removal cream.
Skinmed. 2013 Nov-Dec; 11(6):364-6 [PubMed] Related Publications
A 26-year-old man presented with a scar at the site of a pigmented lesion treated with DermaTend (Solace Interntational, Inc., Reno, NV), an over-the-counter mole removal cream. According to the patient, the pigmented lesion had been present since childhood, was asymptomatic, and had not changed in appearance. It remained cosmetically displeasing to him. In an effort to remove the lesion, he had applied DermaTend on a daily basis for several weeks, at which point he noticed a scar at the site of treatment.


Madooei A, Drew MS, Sadeghi M, Atkins MS
Automatic detection of blue-white veil by discrete colour matching in dermoscopy images.
Med Image Comput Comput Assist Interv. 2013; 16(Pt 3):453-60 [PubMed] Related Publications
Skin lesions are often comprised of various colours. The presence of multiple colours with an irregular distribution can signal malignancy. Among common colours under dermoscopy, blue-grey (blue-white veil) is a strong indicator of malignant melanoma. Since it is not always easy to visually identify and recognize this feature, a computerised automatic colour analysis method can provide the clinician with an objective second opinion. In this paper, we put forward an innovative method, through colour analysis and computer vision techniques, to automatically detect and segment blue-white veil areas in dermoscopy images. The proposed method is an attempt to mimic the human perception of lesion colours, and improves and outperforms the state-of-the-art as shown in our experiments.

Related: Melanoma


Sehli Attafi S, Jones M, Fazaa B, et al.
Pinkus tumour: an unusual case.
Pathologica. 2013; 105(4):140-1 [PubMed] Related Publications
Fibroepithelioma of Pinkus is a rare cutaneous tumour. Its classification is controversial and is considered as a variant of either basal cell carcinoma or trichoblastoma. Its presentation as a multiple tumour is rare. We are reporting such a case occurring in a 55-year-old man presenting with multiple seborrheic keratosis-like lesions corresponding histologically to Pinkus tumours. The clinical diagnosis of Pinkus tumour represents a challenge. Histological examination is extremely useful in aiding in the diagnosis of difficult cases.


Vollmer RT
A probabilistic analysis of mitotic counts in melanoma.
Am J Clin Pathol. 2014; 141(2):213-8 [PubMed] Related Publications
OBJECTIVES: Mitotic counts in melanoma are important and have now become part of the staging of this tumor. Yet, this change was largely based on studies that evaluated the mitotic counts in a limited fashion. Because counts of things with a microscope are often distributed as a Poisson random variable, the major goal of this study was to uncover the probabilistic nature of mitotic counts in melanoma.
METHODS: Specifically, a general double Poisson model was applied to mitotic counts in 53 cutaneous melanomas representing both thin and thick tumors.
RESULTS: The general double Poisson probability model fit the data well. A single Poisson function was sufficient for 46 of the 53 study cases, and two Poisson functions were required for seven cases because of tissue heterogeneity. Furthermore, the success of the model implied that there is a high probability for false-negative mitotic counts, especially in thin melanomas, and that the "hot" spot methodology introduces bias.
CONCLUSIONS: Mitotic counts in melanomas are a probabilistic phenomenon closely related to the Poisson probability distribution, and this factor needs to be considered when using mitotic counts for staging and prognosis in melanoma.

Related: Melanoma


Kohen D, Dross P
Angiosarcoma of the scalp.
Del Med J. 2013; 85(9):269-72 [PubMed] Related Publications
Cutaneous angiosarcoma of the scalp is a rare malignant neoplasm of endothelial cells which occurs predominantly in elderly Caucasian males. The etiology is unknown; however the most common association is prior radiation exposure. The diagnosis is often delayed due to misinterpretation for other lesions, including trauma-related bruising and infectious processes such as abscess. Radiologic imaging is non-diagnostic but can be helpful in defining the extent of local disease, as well as distant metastases. Prognosis is poor with a five-year survival rate of less than 30 percent. Treatment guidelines are not well established; however the mainstay is surgical resection with wide margins followed by adjuvant radiation therapy. Prognosis remains poor with a local recurrence rate of greater than 80 percent. Adjuvant chemotherapy is also controversial but may play a role in short term palliation of metastatic or locally advanced disease. Current investigations using molecular targeted therapy are underway with the goal of eliminating systemic side effects.

Related: Head and Neck Cancers Head and Neck Cancers - Molecular Biology


Ravo V, Falivene S, De Chiara A, et al.
Treatment of cutaneous angiosarcoma of the face: efficacy of combined chemotherapy and radiotherapy.
Tumori. 2013 Sep-Oct; 99(5):e211-5 [PubMed] Related Publications
INTRODUCTION: Cutaneous angiosarcoma (AS) is a rare form of soft tissue sarcoma. It is aggressive and has a poor prognosis. The aim of our report is to show that with combined chemotherapy and radiotherapy it is possible to obtain good results in terms of local control, complete response, and aesthetic outcome.
CASE REPORT: We present the case of a 60-year-old man affected by AS covering the entire surface of the nose. Surgery, although indicated, was excluded because it was considered mutilating and would give a poor cosmetic result. The patient was treated with chemotherapy consisting of paclitaxel 80 mg/m2 for 6 cycles followed by radiotherapy at a dose of 50 Gy. Then 3 additional cycles of chemotherapy were administered according to the same scheme. A complete response was obtained. At 40 months after treatment, the patient did not show any signs of late toxicity, all lesions had disappeared, and all laboratory tests were negative.
CONCLUSIONS: Our experience shows that concomitant chemoradiotherapy can be delivered safely and can be tolerated with low toxicity and good results in terms of local control and complete response. We obtained an excellent aesthetic result with improvement of the patient's quality of life.

Related: Paclitaxel


Famenini S, Young LC
Aspirin use and melanoma risk: a review of the literature.
J Am Acad Dermatol. 2014; 70(1):187-91 [PubMed] Related Publications
In view of the increasing incidence of melanoma, it is critical to find effective preventive approaches. Contradictory evidence has been reported with regard to the possible association of aspirin use and the risk of melanoma. We review these studies and seek to elucidate the mechanism by which aspirin may produce a chemoprotective effect against melanoma.

Related: Melanoma


Roider EM, Fisher DE
The impact of MITF on melanoma development: news from bench and bedside.
J Invest Dermatol. 2014; 134(1):16-7 [PubMed] Article available free on PMC after 01/07/2014 Related Publications
In the current issue, two articles highlight the impact of melanocyte transcription factor (MITF) on melanoma development. In the first, Lister et al. reveal in vivo proof of MITF directly regulating tumor development in BRAF(V600E) melanomas. In the second, Sturm et al. present a clinical trial that emphasizes the importance of the recently discovered E318K MITF germline mutation in patients with multiple primary melanomas.

Related: Melanoma


Sanchez IM, Aplin AE
Hippo: hungry, hungry for melanoma invasion.
J Invest Dermatol. 2014; 134(1):14-6 [PubMed] Article available free on PMC after 01/07/2014 Related Publications
The acquisition of invasive properties in melanoma is associated with a high proclivity for metastasis, but the underlying pathways are poorly characterized. The Hippo pathway has an important role in organ size control and is dysregulated in some type of tumors. The present study, "Pro-invasive activity of the Hippo pathway effectors YAP and TAZ in cutaneous melanoma" by Nallet-Staub et al., 2013, provides the first in-depth analysis of expression of the Hippo pathway effectors YAP (yes-associated protein) and TAZ (Tafazzin) in human melanocytic lesions. Importantly, results from this study demonstrate a causal relationship between YAP/TAZ levels and melanoma cell tumorigenicity and invasiveness.

Related: Melanoma


Diaz JH, Diaz JH
Updates for responsible sun exposure behavior and photoprotection in the south.
J La State Med Soc. 2013 Sep-Oct; 165(5):277-82 [PubMed] Related Publications
In Louisiana, the "Sportsman's Paradise," and throughout the Southern United States (US), outdoor pursuits are among the most popular physical activities, despite well-documented associations between excessive solar ultraviolet (UV) radiation and skin cancer. Although there have been recent advances in broad-spectru m sunscreens, photoprotective clothing, and photoprotective sunglasses, few peer-reviewed publications have focused specifically on recommendations for responsible sun behavior and photoprotection for residents of the South. In response, the objectives of this review will be (1) to describe the adverse health effects of excessive UV radiation exposures; (2) to review recent cohort studies of public perceptions regarding sun behavior and photoprotection; (3) to identify special populations at increased risks of UV-associated skin cancers; and (4) to recommend responsible sun behavior and photoprotection strategies. Internet search engines were queried with the key words as search terms to examine the latest references on photoprotection and the epidemiology of UV-associated skin cancers and other adverse effects of UV-radiation exposures. Observational studies have demonstrated that the public knows little about proper sunscreen selection and UV protection, and cohort studies have identified populations at increased risks of UV-associated skin cancers. Southerners should avoid intense sunlight, wear photoprotective clothing, wear sunglasses, and select the right sunscreen for their skin type. Physicians should counsel their patients about responsible sun behavior and photoprotection and encourage them to take advantage of recent advances in the development of more effective broad-spectrum sunscreens and photoprotective clothing and sunglasses for themselves and their children.


Piris A, Peng Y, Boussahmain C, et al.
Cutaneous and mammary apocrine carcinomas have different immunoprofiles.
Hum Pathol. 2014; 45(2):320-6 [PubMed] Related Publications
Often the distinction of cutaneous apocrine carcinoma from metastatic mammary apocrine carcinoma to the skin can be a diagnostic dilemma because both tumors share similar histologic features and have overlapping immunohistochemical profile. We compared the expression of adipophilin, cytokeratin 5/6, p63, GATA3, mammaglobin, androgen receptor, estrogen receptor, progesterone receptor, and HER2 by immunohistochemistry in 14 cutaneous apocrine carcinomas (11 primary tumors, 3 metastases) and 26 primary apocrine carcinomas of the breast. Whereas focal adipophilin staining was seen in 36% (5/14) of cutaneous apocrine carcinoma, strong and diffuse adipophilin staining was seen in 88% (22/25) of mammary apocrine carcinoma (P = .0013). Differences in estrogen receptor and progesterone receptor expression were also statistically significant (P = .018 and .043). Androgen receptor was strongly positive in all cutaneous and mammary cases. Although there was no significant difference in the frequency of expression of cytokeratin 5/6, p63, HER2, GATA3, and mammaglobin in cutaneous apocrine carcinoma versus mammary apocrine carcinoma, strong and diffuse cytokeratin 5/6 and/or mammaglobin expression were seen only in cutaneous apocrine carcinoma. In conclusion, cutaneous apocrine carcinoma is likely adipophilin- ER+ PR+/- HER2- and can exhibit strong and diffuse cytokeratin 5/6 and/or mammaglobin expression. On the contrary, a mammary apocrine carcinoma is likely adipophilin+ ER- PR- and often exhibit 3+ HER2 with corresponding HER2 gene amplification. A panel of adipophilin, ER, PR, HER2, cytokeratin 5/6, and mammaglobin may be helpful in distinguishing cutaneous apocrine carcinoma from mammary apocrine carcinoma.

Related: Breast Cancer GATA3 gene AR: androgen receptor ESR1


Chow C, Gharavi NM, Smart CN, et al.
An unusual presentation and distribution of generalized eruptive syringomas.
Skinmed. 2013 Sep-Oct; 11(5):311-2 [PubMed] Related Publications
A 19-year-old Caucasian man presented with numerous erythematous to flesh-colored papules that appeared in crops on his neck, axillae, buttocks, and lower back. The lesions started on his anterior neck at age 12. At 18 years, new crops of papules appeared on his axillae, back, and buttocks over several months. He reported pruritus in the lesions following exercise and perspiration. He denied any family history of similar lesions. His primary care physician treated him with topical triamcinolone 0.1% cream, which made the lesions smaller, less erythematous, and less pruritic; however, the papules never fully resolved. After discontinuation of the steroids, these erythematous pruritic papules gradually recurred in the same areas of his body. The patient denied any other medical complaints.


Sadeghian G, Ziaei H
Multiple giant vulvar syringoma: an extraordinary report.
Skinmed. 2013 Sep-Oct; 11(5):305-6 [PubMed] Related Publications
A 26 year-old woman presented with asymptomatic multiple skin-colored eruptions affecting the vulva. She claimed that the lesions had started at the age of 15. The eruptions have been increasing in size and extent since her presentation. There was a family history of similar eruptions around the eyes of one of her sisters. Examination of the skin surface was marked by the presence of multiple, 2- to 3-cm firm, skin-colored, nodules on the labia majora (Figure 1). They were bilateral and symmetrical. One of the lesions was excised, and histopathologic serial sections were prepared and stained with hematoxylin and eosin. Sections showed clusters of small comma-shaped ducts lined by 2 cell-thick epithelium surrounded by a fibrotic stroma. Solid strands of basophilic epithelial cells independent of ducts were documented in the dermis (Figure 2). Accordingly, a diagnosis of syrangoma was made.

Related: Vulva Cancer


White AC, Khuu JK, Dang CY, et al.
Stem cell quiescence acts as a tumour suppressor in squamous tumours.
Nat Cell Biol. 2014; 16(1):99-107 [PubMed] Article available free on PMC after 01/07/2014 Related Publications
In some organs, adult stem cells are uniquely poised to serve as cancer cells of origin. It is unclear, however, whether tumorigenesis is influenced by the activation state of the adult stem cell. Hair follicle stem cells (HFSCs) act as cancer cells of origin for cutaneous squamous cell carcinoma and undergo defined cycles of quiescence and activation. The data presented here show that HFSCs are unable to initiate tumours during the quiescent phase of the hair cycle, indicating that the mechanisms that keep HFSCs dormant are dominant over the gain of oncogenes (such as Ras) or the loss of tumour suppressors (such as p53). Furthermore, Pten activity is necessary for quiescence-based tumour suppression, as its deletion alleviates tumour suppression without affecting proliferation. These data demonstrate that stem cell quiescence is a form of tumour suppression in HFSCs, and that Pten plays a role in maintaining quiescence in the presence of tumorigenic stimuli.

Related: PTEN Signal Transduction TP53 KRAS gene


Kiuru M, McDermott G, Coit DC, et al.
Basal cell carcinosarcoma with PTCH1 mutations in both epithelial and sarcomatoid primary tumor components and in the sarcomatoid metastasis.
Am J Surg Pathol. 2014; 38(1):138-42 [PubMed] Related Publications
Basal cell carcinosarcoma is a rare biphenotypic malignant skin tumor, in which one tumor component has light microscopic features of basal cell carcinoma, whereas the other has features of sarcoma. Clinical experience with this tumor is limited, and associated molecular genetic alterations are unknown. Herein, we report a unique case of metastatic basal cell carcinosarcoma, in which we analyzed the 2 components of the primary tumor as well as the metastasis by next-generation sequencing. The patient was a 72-year-old man who presented with a 7-year history of a large tumor of the left forearm. The tumor showed mixed features of basal cell carcinoma and undifferentiated sarcoma. The patient underwent a wide local excision and sentinel lymph node biopsy, which revealed microscopic subcapsular deposits of metastatic sarcomatoid tumor. One year later, intra-abdominal metastatic tumor was detected and resected. It had sarcomatoid features by light microscopy and failed to stain for epithelial markers by immunohistochemistry. DNA was extracted separately from the epithelial and sarcomatoid component of the primary tumor, intra-abdominal metastasis, and normal tissue. All exons of 230 cancer-associated genes were sequenced to an average read depth of >500-fold. This revealed multiple identical mutations in epithelial and sarcomatoid tumor compartments. Both compartments harbored 2 identical mutations, a truncating and a missense mutation, in the patched gene (PTCH1). This finding is not only of interest for a shared heritage of different subpopulations in a biphenotypic tumor, but also relevant clinically. It provides a rationale for the clinical use of hedgehog pathway inhibitors for treatment of patients affected by this tumor. Unfortunately, the patient reported herein died of metastatic disease before targeted therapy could be initiated.


Bath-Hextall F, Ozolins M, Armstrong SJ, et al.
Surgical excision versus imiquimod 5% cream for nodular and superficial basal-cell carcinoma (SINS): a multicentre, non-inferiority, randomised controlled trial.
Lancet Oncol. 2014; 15(1):96-105 [PubMed] Related Publications
BACKGROUND: Basal-cell carcinoma is the most common form of skin cancer and its incidence is increasing worldwide. We aimed to assess the effectiveness of imiquimod cream versus surgical excision in patients with low-risk basal-cell carcinoma.
METHODS: We did a multicentre, parallel-group, pragmatic, non-inferiority, randomised controlled trial at 12 centres in the UK, in which patients were recruited between June 19, 2003, and Feb 22, 2007, with 3 year follow-up from June 26, 2006, to May 26, 2010. Participants of any age were eligible if they had histologically confirmed primary nodular or superficial basal-cell carcinoma at low-risk sites. We excluded patients with morphoeic or recurrent basal-cell carcinoma and those with Gorlin syndrome. Participants were randomly assigned (1:1) via computer-generated blocked randomisation, stratified by centre and tumour type, to receive either imiquimod 5% cream once daily for 6 weeks (superficial) or 12 weeks (nodular), or surgical excision with a 4 mm margin. The randomisation sequence was concealed from study investigators. Because of the nature of the interventions, masking of participants was not possible and masking of outcome assessors was only partly possible. The trial statistician was masked to allocation until all analyses had been done. The primary outcome was the proportion of participants with clinical success, defined as absence of initial treatment failure or signs of recurrence at 3 years from start of treatment. We used a prespecified non-inferiority margin of a relative risk (RR) of 0.87. Analysis was by a modified intention-to-treat population and per protocol. This study is registered as an International Standard Randomised Controlled Trial (ISRCTN48755084), and with ClinicalTrials.gov, number NCT00066872.
FINDINGS: 501 participants were randomly assigned to the imiquimod group (n=254) or the surgical excision group (n=247). At year 3, 401 (80%) patients were included in the modified intention-to-treat group. At 3 years, 178 (84%) of 213 participants in the imiquimod group were treated successfully compared with 185 (98%) of 188 participants in the surgery group (RR 0.84, 98% CI 0.78-0.91; p<0.0001). No clear difference was noted between groups in patient-assessed cosmetic outcomes. The most common adverse events were itching (211 patients in the imiquimod group vs 129 in the surgery group) and weeping (160 vs 81). We recorded serious adverse events in 99 (40%) of 249 participants in the imiquimod group and 97 (42%) of 229 in the surgery group had serious adverse events, but none were regarded as related to treatment. 12 (5%) participants in the imiquimod group withdrew because of adverse events compared with four (2%) in the surgery group.
INTERPRETATION: Imiquimod was inferior to surgery according to our predefined non-inferiority criterion. Although excisional surgery remains the best treatment for low-risk basal-cell carcinoma, imiquimod cream might still be a useful treatment option for small low-risk superficial or nodular basal-cell carcinoma dependent on factors such as patient preference, size and site of the lesion, and whether the patient has more than one lesion.
FUNDING: Cancer Research UK.

Related: Basal Cell Carcinoma


Burton AL, Egger ME, Quillo AR, et al.
Prognostic factors in young women with cutaneous melanoma.
Am J Surg. 2014; 207(1):102-8 [PubMed] Related Publications
BACKGROUND: Gender is an established prognostic factor in cutaneous melanoma; women as a group have a better overall prognosis than men. However, the investigators hypothesized that melanoma in young women may have distinct clinicopathologic features and biologic behavior compared with melanoma in older women, possibly related to tanning bed use and excessive acute episodes of sun exposure.
METHODS: A retrospective analysis was performed of a large multicenter study that accrued patients between 1996 and 2003 and included patients aged 18 to 70 years with cutaneous melanoma ≥1 mm Breslow thickness and no evidence of regional or distant metastatic disease. All women with follow-up data were included. Univariate and multivariate analyses as well as Kaplan-Meier (KM) analysis were performed to test for differences in clinicopathologic variables, disease-free survival (DFS), and overall survival (OS) between female patients ≤40 and >40 years of age.
RESULTS: A total of 1,056 female patients were divided into 2 groups: those >40 years of age (n = 757 [71.7%]) and those ≤40 years of age (n = 299 [28.3%]). Overall, there were no differences in Breslow thickness, ulceration, or sentinel lymph node status between groups. Compared with older women, younger women were more likely to have truncal melanomas (39.5% vs 29.5%, P = .0017) and less likely to have regression of the primary tumor (6.4% vs 11.5%, P = .0208). The mean number of sentinel lymph nodes removed was 2.82 for younger women and 2.29 for older women (P < .0001). Multivariate analysis revealed that Breslow thickness, ulceration, and tumor-positive sentinel lymph node were associated with worse DFS in both the younger and older groups; truncal location was associated with worse DFS in the younger group only. The same factors were predictive of OS in both groups, except that ulceration was not significant in the younger patient group. In the younger patient group, the 5-year KM DFS rates were 78.1% for truncal melanomas and 92.5% for nontruncal melanoma locations (P = .0009); the corresponding 5-year KM OS rates were 76.6% and 93.9% (P = .0003). In the older patient group, the 5-year KM DFS rates were 84.1% for truncal and 82.8% for nontruncal melanomas (P = NS), and the corresponding 5-year KM OS rates were 81.6% and 87.5% (P = .0049).
CONCLUSIONS: Although women with cutaneous melanoma tend to have a better prognosis than men, women ≤40 years of age with primary melanoma of the trunk may represent a subgroup at higher risk for disease recurrence and metastasis.

Related: Melanoma


Howle JR, Veness MJ
Outcome of patients with microscopic and macroscopic metastatic nodal Merkel cell carcinoma: an Australian experience.
Dermatol Surg. 2014; 40(1):46-51 [PubMed] Related Publications
BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive cutaneous malignancy with a high rate of nodal metastasis. The American Joint Committee on Cancer staging system subclassifies nodal disease into microscopic and macroscopic groups based on prognosis.
OBJECTIVE: To compare the outcome of patients with microscopic and macroscopic nodal metastases.
MATERIALS AND METHODS: Patients were identified from a database of 180 patients with MCC who presented to Westmead Hospital, Sydney, Australia, from 1980 to 2013. Disease-free survival (DFS), overall survival (OS), and follow-up were calculated using Kaplan-Meier curves and compared using the log-rank (Mantel-Cox) test.
RESULTS: Forty-one patients were diagnosed with node-positive MCC; 11 patients had microscopic nodal metastases, with five (45%) relapsing, and 30 had macroscopic disease, with 17 (57%) relapsing. There was no significant difference in DFS (p = .93) or OS (p = .63) between the two groups.
CONCLUSION: The nonsignificant difference in DFS and OS suggest that even microscopic nodal metastases can predict a poor outcome. Because more than half of patients subsequently relapse, often at a distant site, there is a need to develop an effective systemic treatment.


Huang J, Cunliffe R
Medical image. An unusual case of melaena.
N Z Med J. 2013; 126(1386):111-3 [PubMed] Related Publications
Metastatic melanoma can present with non-cutaneous symptoms even after several years of remission. Although poor prognosis, surgical resection and arterial embolisation can provide effective symptom palliation.


Paul J, Sbicca JA, Hirano SA, et al.
Changing age distribution of melanoma patients: a 22-year, single-site perspective.
South Med J. 2013; 106(12):667-72 [PubMed] Related Publications
OBJECTIVES: To investigate possible changes in the demographics of patients with melanoma during a period of 22 years in one dermatopathology practice.
METHODS: We performed a retrospective review of 1835 cases of in situ and invasive melanomas histologically diagnosed between 1989 and 2010 in a private dermatopathology laboratory in Norfolk, Virginia. The age and sex of patients with in situ and invasive melanomas were recorded and compared with similar data for patients from whom any histopathologic specimen was received during the same interval. These data were then compared with those in the national Surveillance, Epidemiology, and End Results (SEER) registry between 1989 and 2009.
RESULTS: The number of melanomas diagnosed in the laboratory increased during the 22 study years, but the proportion of submitted specimens diagnosed as melanoma remained somewhat stable. Patient ages ranged from the teens to the ninth decade of life. The proportion of melanomas in the in situ stage gradually increased. Mean patient age rose from 52.4 years in 1989 to 60.7 years in 2010. Men and women aged 60 years and older made up an increasing proportion of melanoma cases. There also was a relative increase in the proportion of women in the 40- to 50-year-old age group and a slight increase among those aged 20 to 30 years, particularly for invasive lesions. In general, the trends were similar for in situ and invasive melanomas. Our data were consistent with the SEER data in showing a trend for decreasing proportion of melanomas in younger individuals, with a corresponding increase in the middle-age and older adult populations. Some differences between the two datasets emerged for men aged 70 to 80, women aged 60 to 70, and all patients aged 70 to 80.
CONCLUSIONS: An increasing proportion of melanomas were diagnosed in older individuals. There also was a relative increase in women aged 40 to 50 years and a lesser increase in those aged 20 to 30 years. Our findings were consistent with the national trends observed in the SEER dataset.

Related: Melanoma


Freeman SR, Gibbs BB, Brodland DG, Zitelli JA
Prognostic value of sentinel lymph node biopsy compared with that of Breslow thickness: implications for informed consent in patients with invasive melanoma.
Dermatol Surg. 2013; 39(12):1800-12 [PubMed] Related Publications
BACKGROUND: Sentinel lymph node (SLN) status is reportedly a powerful prognosticator of survival. Breslow thickness alone provides significant prognostic information.
OBJECTIVE: To assess overall survival (OS) according to tumor depth based on SLN status.
MATERIALS AND METHODS: MEDLINE, EMBASE, and the Cochrane Central Database were searched for studies. Included studies evaluated overall survival according to SLNB results and were stratified according to Breslow thickness. Meta-analysis was performed if appropriate in each category for which three or more studies reported risk estimates and variability measurement.
RESULTS: Twenty-nine articles met inclusion criteria. Six met the criteria for meta-analysis. In individuals with thin melanoma (<1 mm), SLN-negative status conferred no survival advantage (sign test, p > .99). Few studies were available for intermediate depths, and most reported worse survival in SLN-positive patients, although the difference was not statistically significant (p > .05). For thick melanoma (>4 mm), SLN positivity was related to worse prognosis (sign test, p = .004). Based on the pooled results of six studies of patients with tumors 4 mm thick or thicker, SLN-positive patients had a greater likelihood of dying (hazard ratio = 2.42, 95% confidence interval = 2.00-2.92).
CONCLUSIONS: Sentinel lymph node biopsy may not provide more-accurate prognostic information than Breslow thickness for most melanomas.

Related: Melanoma


Jeon SY, Kim KH, Song KH
Efficacy of photodynamic diagnosis-guided Mohs micrographic surgery in primary squamous cell carcinoma.
Dermatol Surg. 2013; 39(12):1774-83 [PubMed] Related Publications
BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) usually has ill-defined margins because of its irregular invasive patterns.
OBJECTIVE: To evaluate the surgical efficacy of photodynamic diagnosis (PDD) in primary cSCC treated using Mohs micrographic surgery (MMS).
METHODS & MATERIALS: We examined 67 cases of biopsy-proven primary facial cSCC treated with MMS. The 67 SCC were divided into the two groups depending on PDD application: PDD group (n = 38, 56.7%) and non-PDD group (n = 29, 43.3%). We analyzed the differences in surgical features between the PDD and non-PDD groups.
RESULTS: The PDD group required fewer Mohs stages (1.37 vs 1.83, p = .02) and smaller surgical margins (8.03 vs 11.24 mm, p = .03). PDD showed additional benefits in terms of surgical margin and Mohs stage, especially in low-risk SCC, including thin (≤4 mm), small (≤20 mm), well-differentiated, and nonulcerative tumors (p < .05) but did not show beneficial effects in high-risk SCC (p > .05) during MMS.
CONCLUSION: PDD can increase surgical efficacy of primary cSCC during MMS. These benefits are more pronounced in low-risk SCC. We recommend PDD as a simple and useful technique for delineating the margins of low-risk SCC before MMS.


Bogusławska J, Małecki M
siRNA preparations in gene therapy of melanoma.
Med Wieku Rozwoj. 2013 Jul-Sep; 17(3):196-201 [PubMed] Related Publications
Melanoma is a type of malignant skin cancer, characterized by a steadily increasing rate of morbidity, making it a continuous challenge for modern oncology. In recent years there has been a significant increase in developing gene therapy approaches for the treatment of cancer. The phenomenon of RNA interference initiated studies on the inhibition of the expression of selected genes by small interfering RNA (siRNA) in cells. The use of siRNA preparations for the treatment of patients depends on the transfection efficiency and the level of silencing the targeted genes. Currently, preclinical and clinical studies are being conducted in order to test the effectiveness and safety of siRNA preparations.

Related: Melanoma


Menon SK
An incidental finding.
J Fam Pract. 2013; 62(11):655-9 [PubMed] Related Publications
Pruritic patches on the patient's trunk and extremities prompted his visit, but it was the "birthmark" on his back that was far more worrisome.

Related: Monoclonal Antibodies Melanoma BRAF gene Vemurafenib (Zelboraf) Ipilimumab (Yervoy)


Iorio ML, Ter Louw RP, Kauffman CL, Davison SP
Evidence-based medicine: facial skin malignancy.
Plast Reconstr Surg. 2013; 132(6):1631-43 [PubMed] Related Publications
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Identify common precancerous and malignant cutaneous growths of the head and neck. 2. Recommend surgical treatment, including margins, based on consensus guidelines. 3. Counsel patients as to available evidence for expected recurrence, follow-up, and morbidity.
SUMMARY: Skin lesion excision is the most common procedure performed by plastic surgeons. Because of the cumulative risk factors of sun and carcinogen exposure, the head and neck are the most frequently affected regions of the body. Timely diagnosis and treatment are critical for preventing continued spread and metastasis, and it is incumbent on the treating physician to make the appropriate recommendations for surgical margin and the possibility of adjuvant therapy to prevent recurrence and optimize long-term survival. As clinical guidelines are developed from ongoing outcome studies, new generations of treatment recommendations are continuously in development. Therefore, a systematic review of the most relevant guidelines and clinically rigorous studies was performed with a summarization of treatment recommendations for the following: actinic keratosis, Bowen disease (squamous cell in situ), basal cell carcinoma, squamous cell carcinoma, malignant melanoma, and Merkel cell carcinoma of the head and neck.

Related: Basal Cell Carcinoma Merkel Cell Carcinoma Melanoma


McKenna G, Ziada H, Allen PF
Prosthodontic rehabilitation of a patient using a swing-lock lower denture after segmental mandibulectomy.
Eur J Prosthodont Restor Dent. 2013; 21(3):141-4 [PubMed] Related Publications
A swing-lock denture is useful in partially dentate patients where the configuration of the remaining teeth means that either the retention or stability available for a conventional removable partial denture is compromised. Such removable prostheses can also prove to be extremely useful when providing prosthodontic rehabilitation following surgical resection of oral cancer. A 20 year-old patient was referred to the Restorative Department of Cork University Dental Hospital following segmental mandibulectomy to treat a calicifying epithelial odontogenic tumour (Pindborg Tumour). Initial treatment using a conventional lower partial denture failed. This paper outlines the successfully rehabilitation using a lower Cobalt-Chromium swing-lock partial denture.


Avitan-Hersh E, Tatur S, Indelman M, et al.
Postzygotic HRAS mutation causing both keratinocytic epidermal nevus and thymoma and associated with bone dysplasia and hypophosphatemia due to elevated FGF23.
J Clin Endocrinol Metab. 2014; 99(1):E132-6 [PubMed] Related Publications
INTRODUCTION: Epidermal nevus syndrome is a rare group of disorders characterized by the combination of congenital epidermal nevi and extracutaneous features, including skeletal, neurological, ocular, and other systemic findings. We report a case of keratinocytic epidermal nevus syndrome that includes a thymoma, bone dysplasia, and hypophosphatemia with elevated fibroblast growth factor 23 (FGF23) levels associated with postzygotic HRAS mutation.
CASE REPORT: A 14-year-old boy was admitted due to recent limping. The physical examination revealed multiple right-sided linear epidermal nevi along Blaschko's lines. Magnetic resonance imaging showed cystic lesions in cervical bones and thymoma, and x-ray examination showed cystic lesions in the hands. Biochemical studies demonstrated severe hypophosphatemia, normocalcemia, high normal PTH, low 25-hydroxyvitamin D and low 1,25-dihydroxyvitamin D levels. The serum FGF23 C-terminal level was normal, but the intact FGF23 level was found to be elevated. Genetic evaluation revealed a heterozygote mutation in the HRAS gene in both the keratinocytic epidermal nevus and thymoma but not in DNA extracted from blood lymphocytes, thus establishing the mutation as postzygotic.
DISCUSSION: Postzygotic mutations in HRAS lead to elevation of FGF23 levels, as found in mutated PHEX, FGF23, DMP1, and ENPP1 genes, which lead to hypophosphatemia.
CONCLUSION: An identical postzygotic HRAS mutation was shown to be present in both keratinocytic epidermal nevus and thymoma and to be associated with bone lesions and hypophosphatemia due to elevated FGF23 levels. These may all be related to the HRAS mutation.

Related: Thymoma and Thymic Carcinoma


Nakayama-Takeda R, Sakakibara S, Kurokawa M, et al.
Comparison of malignant skin tumor thickness and relative depth of invasion estimates from preoperative MR-microscopy and pathological evaluation.
Dermatol Surg. 2013; 39(12):1767-73 [PubMed] Related Publications
BACKGROUND: Tumor thickness and relative depth of invasion are prognostic parameters considered when developing treatment plans for malignant skin tumors. Although conventional magnetic resonance (MR) imaging techniques cannot identify small tumors, use of microscopy coils considerably improves spatial resolution. Some studies have shown that this technique is efficacious in preoperative assessment of relative depth of invasion; however, its ability to provide accurate measurements of tumor thickness remains unconfirmed.
OBJECTIVE: The purpose of this pilot study was to evaluate the usefulness of preoperative MR-microscopy in determining tumor thickness and relative depth of invasion of malignant skin tumors.
METHODS AND MATERIALS: Magnetic resonance images of malignant skin tumors in seven female patients (six with basal cell carcinoma and one with malignant melanoma) were obtained using a 1.5 T system and a 47-mm or 23-mm microscopy coil. Tumors were then excised, fixed, dehydrated, embedded, and stained with hematoxylin and eosin. We then compared MR-microscopy and pathology values for thickness and relative depth of invasion of each tumor.
RESULTS: Both techniques produced similar measurements of tumor thickness and relative depth of invasion.
CONCLUSIONS: MR-microscopy is very useful for accurate preoperative estimation of not only relative depth of invasion, but also thickness of malignant skin tumors.

Related: Basal Cell Carcinoma Melanoma


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