Nodular Melanoma Research Articles

A Review of Melanoma Subtypes: Genetic and Treatment Considerations.

Melanoma affects over one million people in the United States. This review explores genetic mutations and markers of all seven subtypes. Current treatment options and prognosis of each subtype are also discussed. For lentigo maligna, spitzoid, and nodular subtypes, BRAF was the most common mutation reported. For superficial spreading, TP53 was the most common. Acral lentiginous demonstrated CCDN1 and desmoplastic NF1 most frequently. No mutations have been identified in the nevoid subtype. Nodular melanoma is the deadliest subtype. Evidence suggests that the subtypes differ in regard to genetic markers/mutations, treatment and prognosis. Therefore, subtype should be considered when treating a melanoma patient.

Goldfinger: A case of metal tattooing mimicking recurrent melanoma.

Metal tattooing can be a clinical mimic of melanoma of which dermatologists should be aware. Metal tattoos can vary in size and shape depending on the causative injury, usually they are blue, grey or black in colour. We report the case of a 73-year-old patient diagnosed with a nodular subungal melanoma on his middle left finger. Six months following his amputation he attended dermatology follow-up and was noted to have multiple blue-grey cutaneous macules measuring 1-2mm in size proximal to the amputation scar. While a careful occupational history, in this case, suggested the source of the dermal blue grey deposits around the scar, it remains important to confirm histologically especially in patients at high risk of recurrent melanoma.

Multiple, non-syndromic and non-metastatic pigmented basal cell carcinoma mimicking nodular melanoma: a rare presentation in Indian patient

Basal cell carcinoma is most common cutaneous malignancy having exposure to ultraviolet radiation as the most important predisposing factor. It could be solitary or multiple, in which case they can be associated with variety of syndromes. Out of various clinical types of BCC pigmented bcc can mimic sometimes malignant melanoma and in which case dermoscopy and skin biopsy can be helpful to differentiate. Metastasis of BCC is a rare phenomenon and it depends on various factors like tumour size, site, depth, histological type etc. Here we describe an interesting case of primary, non-syndromic, multifocal BCC which was initially diagnosed as melanoma but later on based on dermoscopy and histology diagnosed and successfully treated as BCC.

Development of a prognostic model for patients with nodular melanoma of the lower extremities: a study based on the SEER database.

Lower extremity nodular melanoma (NM) is a common malignant tumor with a poor prognosis. We aims to identify the prognostic factors and develop a nomogram model to predict overall survival (OS) in patients with lower extremity NM. A total of 746 patients with lower extremity NM were selected and randomly divided into a training set (522 cases) and a validation set (224 cases) from the Surveillance, Epidemiology, and End Results(SEER) database. The training set underwent univariate and multivariate Cox regression analyses to identify independent prognostic factors associated with patient outcomes, and to develop a nomogram model. The effectiveness of the nomogram was subsequently validated using the validation set. Multivariable Cox regression analysis of the training set indicated that age, ulceration, radiotherapy, chemotherapy, primary site of first malignant tumor, and Breslow thickness were independent variables associated with OS. In the training set, the area under the curve (AUC) of the nomogram for predicting 3-year and 5-year OS was 0.796 and 0.811, respectively. In the validation set, the AUC for predicting 3-year and 5-year OS was 0.694 and 0.702, respectively. The Harrell's C-index for the training set and validation set were 0.754 (95% CI: 0.721-0.787) and 0.670 (95% CI: 0.607-0.733), respectively. Calibration curves for both training and validation sets showed good agreement. In this study, we develop and validate a nomogram to predict OS in patients with lower extremity NM. The nomogram demonstrated reasonable reliability and clinical applicability. Nomograms are important tools assessing prognosis and aiding clinical decision-making.

Artificial intelligence-assisted metastasis and prognosis model for patients with nodular melanoma.

The objective of this study was to identify the risk factors that influence metastasis and prognosis in patients with nodular melanoma (NM), as well as to develop and validate a prognostic model using artificial intelligence (AI) algorithms. The Surveillance, Epidemiology, and End Results (SEER) database was queried for 4,727 patients with NM based on the inclusion/exclusion criteria. Their clinicopathological characteristics were retrospectively reviewed, and logistic regression analysis was utilized to identify risk factors for metastasis. This was followed by employing Multilayer Perceptron (MLP), Adaptive Boosting (AB), Bagging (BAG), logistic regression (LR), Gradient Boosting Machine (GBM), and eXtreme Gradient Boosting (XGB) algorithms to develop metastasis models. The performance of the six models was evaluated and compared, leading to the selection and visualization of the optimal model. Through integrating the prognostic factors of Cox regression analysis with the optimal models, the prognostic prediction model was constructed, validated, and assessed. Logistic regression analyses identified that marital status, gender, primary site, surgery, radiation, chemotherapy, system management, and N stage were all independent risk factors for NM metastasis. MLP emerged as the optimal model among the six models (AUC = 0.932, F1 = 0.855, Accuracy = 0.856, Sensitivity = 0.878), and the corresponding network calculator (https://shimunana-nm-distant-m-nm-m-distant-8z8k54.streamlit.app/) was developed. The following were examined as independent prognostic factors: MLP, age, marital status, sequence number, laterality, surgery, radiation, chemotherapy, system management, T stage, and N stage. System management and surgery emerged as protective factors (HR < 1). To predict 1-, 3-, and 5-year overall survival (OS), a nomogram was created. The validation results demonstrated that the model exhibited good discrimination and consistency, as well as high clinical usefulness. The developed prediction model more effectively reflects the prognosis of patients with NM and differentiates between the risk level of patients, serving as a useful supplement to the classical American Joint Committee on Cancer (AJCC) staging system and offering a reference for clinically stratified individualized treatment and prognosis prediction. Furthermore, the model enables clinicians to quantify the risk of metastasis in NM patients, assess patient survival, and administer precise treatments.

Vertical Ex Vivo Dermoscopy in Assessment of Malignant Skin Lesions.

The role of vertical ex vivo dermoscopy relevant to clinical diagnosis has not been investigated yet. Study objectives were defining, describing, and determining the importance of the structures visible using vertical ex vivo dermoscopy in the diagnosis of malignant skin lesions, as well as determining their accuracy in the assessment of tumor margins. A prospective, descriptive study was conducted in two University centers. Digital images of completely excised skin lesions, fixed in formalin, before histopathological diagnosis were used for analysis. BCCs had the most diverse dermoscopic presentation on the vertical section, while SCCs showed a similar presentation in most cases. Vertical dermoscopy of thin melanomas was almost identical, unlike nodular melanomas. Thickness accuracy assessed by dermatologist was 0.753 for BCC, 0.810 for SCC, and 0.800 for melanomas, whereas assessment by pathologist was 0.654, 0.752, and 0.833, respectively. The accuracy of tumor width assessment was 0.819 for BCCs, 0.867 for SCCs and 1.000 for melanoma as estimated by a Dermatologist. Interobserver agreement was 0.71 for BCC, 0.799 for SCC and 0.832 for melanomas. Vertical ex vivo dermoscopy may contribute to the distinction between BCCs, SCCs, and melanomas. Moreover, regardless of the doctor's specialty, it enables a good assessment of the tumor's margins.

Persistent poverty impacts survival and National Comprehensive Cancer Network guideline-concordant care for patients with melanoma.

1598 Background: Based on guidelines from the National Comprehensive Cancer Network (NCCN), sentinel lymph node biopsy (SLNB) should be offered to patients with high-risk stage IB or stage II melanoma and adjuvant systemic therapy is recommended for patients with stage III disease. Persistent poverty census tracts are defined as areas where at least20% of residents were poor as measured by each of the 1980, 1990, 2000 censuses and 2007 American Community Survey 5-year average. The aim of this study was to describe the association between persistent poverty and adherence to NCCN guidelines and cancer-specific survival in patients with cutaneous melanoma. Methods: Patients diagnosed with melanoma from 2006-2018 were identified in Survival, Epidemiology, and End Results (SEER) Program registries. The analytic cohort was restricted to patients with superficial spreading melanoma, nodular melanoma, malignant melanoma with regression, lentigo malignant melanoma, and acral lentiginous melanoma. Patient demographics such as age, race, and ethnicity and tumor characteristics associated with stage at diagnosis were analyzed using adjusted regression analyses for patients of all melanoma stages. Demographics and tumor characteristics associated with receipt of SLNB were analyzed amongst pathologic stage IB and II cases, and demographics and tumor characteristics associated with receipt of adjuvant systemic therapy were analyzed amongst stage III cases. Kaplan-Meier curves and adjusted accelerated failure time models were used to examine disparities in cancer-specific survival. Results: Of 127,308 total patients, 3.13% (n=3994) lived in census tracts with persistent poverty. In adjusted analyses, persistent poverty was an independent predictor of later pathologic stage at diagnosis (OR 1.32 [95% CI 1.21-1.44] p&lt;0.001). Persistent poverty was also associated with lower likelihood of receiving SLNB according to NCCN guidelines (OR 0.717 [SE 0.072] p&lt;0.01) and with worse cancer-specific survival (HR 1.25 [1.06-1.47], p=0.008) when controlling for age, race, ethnicity, pathologic stage at diagnosis, and histology. In univariable models persistent poverty was associated with increased odds of receiving systemic therapy, but this relationship was not significant on multivariable analysis. Conclusions: Patients from areas with persistent poverty had a later pathologic stage at diagnosis, were less likely to receive a SLNB according to NCCN guidelines, and had worse cancer-specific survival. Efforts to better define and resolve disparities in the treatment and survival of patients with melanoma are warranted.

Identifying the high risk group in stage pT1bN0 cutaneous melanoma.

9583 Background: In recent years, there has been a substantial improvement in prognosis for patients diagnosed with stage II or III melanoma due to the advent of adjuvant and neoadjuvant therapy. At the same time, significant percentage of melanoma deaths are caused by prevalent cases of thin melanoma. In this work, we aimed to identify the stage pT1bN0 melanoma subgroup with the worst prognosis. Methods: All cases of stage pT1b melanoma (with negative sentinel node biopsy) treated between 1998 and 2022 in high-throughput reference center were analyzed. Patients were followed for ten years or up to lost to follow-up or death. Patients alive at 10 year mark were censored. The patients were divided into groups with BOTH pT1b features (i.e., Breslow thickness &gt; 0.8mm AND ulceration) vs those with just ONE of those features. Additionally, patients’ sex, the tumor’s pathological subtype, and mitotic index were analyzed. The Kaplan-Meier and the Cox proportional model were used in statistical analysis. Results: There were 665 cases identified. 63% of patients were female, median age was 49 (IQR: 38-60). 70% of patients were classified as pT1b due to Breslow thickness, 21% due to ulceration and 9% due to BOTH features. 48% of patients had superficially spreading melanoma, 3% - acral, 9% - nodular while other patients had other/unspecified subtype. The median mitotic index was 1/mm2, but this feature was missing in 46% of cases. Overall, 61 patients died during the follow-up. The 10-year overall survival (OS) rate for the whole group was 86% (95% CI: 83-90%). In a multivariable model, patients with BOTH IB features (HR 2.1, 95%CI:1.1-4.2), nodular or acral melanoma (HR 2.2, 95%CI:1.2-4.1) and males (HR 2.6, 95%CI:1.6-4.4) had worse prognosis; the mitotic index was not predictive for OS in this model. In patients with BOTH pT1b features the 10 year survival rate was 75% (95%CI: 62-89) and 87% (95%CI: 84-91%) in case of just one feature (log-rank p=0.008). Conclusions: There is a specific subgroup of patients diagnosed with stage IB who have a relatively bad prognosis. Focusing on perioperative treatment or on a more strict follow-up schedule in this group may prove beneficial.

Characteristics and variations in young adults with cutaneous melanoma: A national cancer database analysis.

Many cancers in young adulthood differ in terms of biology, histologic variation, and prognosis compared to cancer in other older age groups. Differences in cutaneous melanoma among young adults compared to other older age groups, as well as between sexes in young adults are not well studied. The National Cancer Database was queried for patients diagnosed with cutaneous melanoma between 2004 and 2017. Patient characteristics, disease factors, and treatment were stratified by age-based cohorts and compared using standard univariate statistics. The Kaplan-Meier method and log-rank tests were used to evaluate overall survival (OS) between age-based cohorts and young adult sexes. Of the 329 765 patients identified, 10.5% were between 18 and 39 years of age at diagnosis. Compared with other older age groups, young adult patients were more likely to be female and uninsured with higher proportions of superficial spreading melanoma, melanoma of the trunk and extremities, and earlier-stage disease. Young adults had improved OS compared to other older age groups. Young male patients had a greater proportion of no insurance, nodular melanoma, higher-stage disease, and decreased OS compared to young female patients. Additionally, while the 5-year OS difference was statistically significant across all stages of disease between young males and females, the clinical significance is likely limited to later stages. Age and sex-specific differences in cutaneous melanoma highlight distinct patterns and characteristics, emphasizing the need for tailored approaches to screening, diagnosis, and treatment.

Cutaneous Melanoma: A Case Report of a Nodular Melanoma, One of the Most Aggressive Presentations and with the Worst Prognosis

Melanoma is a malignant melanocytic tumor that constitutes the sixth most frequent cancer in the general population and has a high capacity to produce metastasis [1]. Cutaneous melanoma is the most common subtype, accounting for 91% cases. Even though it is reported less frequently than basal cell carcinoma or squamous cell carcinoma, it accounts for 70% mortality due to cutaneous neoplasms [5]. Diagnosis begins with a complete skin examination. Dermoscopy is an excellent support tool that suggests the diagnosis of melanoma [2].

Incidence Rates and Outcomes of Nodular and Superficial Spreading Melanoma along the Rural-Urban Continuum in Kentucky and Their Relationship to Provider Care Access.

This study compared incidence rates, stage at presentation, and cause-specific mortality of nodular and superficial spreading melanoma along the rural-urban continuum in Kentucky. We compared resulting patterns in our data with sample demographic and other potential factors, including population by county and primary care provider rate. Retrospective patient data were extracted from the Surveillance, Epidemiology, and End Results database from 2010 through 2017. These data were supplemented by environmental, demographic, and socioeconomic data derived from publicly accessible databases. Correlation and χ2 analyses were used to test for significant differences in outcome variables by US Department of Agriculture Rural-Urban Continuum Code (RUCC) categories and other potential predictor variables. Incidence rates by Kentucky county were not associated with RUCC or population; likewise, there was no relationship between stage at presentation and RUCC category. There was, however, a highly significant association between cause-specific mortality and RUCC; patients from rural areas were significantly more likely to die from melanoma than those in urban areas. This overall difference was due to differences in mortality for superficial spreading melanoma. Our results suggest that a disparity in patients' ability or tendency to access primary care and/or specialist providers postdiagnosis may be critical factors in determining the ultimate outcome of a melanoma diagnosis. Further studies should explore the availability of dermatologists and/or treatment options for melanoma in rural areas. Our data also provide additional support for inclusion of melanoma subtype in the American Joint Committee on Cancer guidelines.

Association of miR-146a-5p and miR-21-5p with Prognostic Features in Melanomas.

Cutaneous melanoma (CM) is one of the most lethal tumors among skin cancers and its incidence is rising worldwide. Recent data support the role of microRNAs (miRNAs) in melanoma carcinogenesis and their potential use as disease biomarkers. We quantified the expression of miR-146a-5p and miR-21-5p in 170 formalin-fixed paraffin embedded (FFPE) samples of CM, namely 116 superficial spreading melanoma (SSM), 26 nodular melanoma (NM), and 28 lentigo maligna melanoma (LMM). We correlated miRNA expression with specific histopathologic features including Breslow thickness (BT), histological subtype, ulceration and regression status, and mitotic index. miR-146a-5p and miR-21-5p were significantly higher in NM compared to SSM and LMM. The positive correlation between miR-146a-5p and miR-21-5p expression and BT was confirmed for both miRNAs in SSM. Considering the ulceration status, we assessed that individual miR-21-5p expression was significantly higher in ulcerated CMs. The increased combined expression of the two miRNAs was strongly associated with ulceration (p = 0.0093) and higher mitotic rate (≥1/mm2) (p = 0.0005). We demonstrated that the combination of two-miRNA expression and prognostic features (BT and ulceration) can better differentiate cutaneous melanoma prognostic groups, considering overall survival and time-to-relapse clinical outcomes. Specifically, miRNA expression can further stratify prognostic groups among patients with BT ≥ 0.8 mm but without ulceration. Our findings provide further insights into the characterization of CM with specific prognostic features. The graphical abstract was created with BioRender.com.

A Prognostic Model for Cancer-Specific Survival Among Patients with Nodular Melanoma in Head and Neck.

This study aims to evaluate the correlation between risk factors and treatment methods affecting nodular melanoma (NM) in the head and neck, as well as cancer-specific survival (CSS), and provide personalized predictive tools for clinical physicians. The retrospective study data of 1848 patients were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. All variables were included in the correlation analysis using the Spearman method. Significant prognostic factors were extracted and integrated through Cox risk regression analysis to construct a nomogram. To assess the performance of the nomogram, Harrell's concordance index (C-index) and a receiver operating characteristic (ROC) curve analysis were employed. Spearman's correlation analysis revealed a positive correlation between radiotherapy and lymph node metastasis, whereas chemotherapy showed a stronger association with distant metastasis. However, Cox risk regression analysis demonstrated that Mohs surgery and wide excision with margins exceeding 1 cm yielded substantial therapeutic advantages. Five independent risk prognostic factors (Breslow thickness, ulceration, N classification, M classification, and surgery type) were employed to construct a nomogram. The C-index for this nomogram was 0.713 for the training set and 0.720 for the validation set. In the training set, the 3-, 5-, and 8-year areas under the curve (AUCs) for CSS were 0.752, 0.723, and 0.720, whereas the validation set's AUCs were 0.754, 0.763, and 0.760, respectively. Calibration curves indicated the nomogram's strong discriminative ability for predicting CSS. In this study, we identified independent prognostic factors for patients with NM in head and neck and developed a relatively accurate model to predict the survival probability of them, which could contribute to the tumor assessment and clinical decision-making. 3 Laryngoscope, 134:3611-3619, 2024.

Preliminary analysis of the melanoma multimedia educational program for general practitioners on behalf of the Italian Melanoma Intergroup.

According to the National Oncological Plan 2023-2027 on the importance of multidisciplinary and interactive e-learning training, the Italian Melanoma Intergroup (IMI) has developed MelaMEd (Melanoma Multimedia Education), a national project for general practitioners (GPs) on the prevention and detection of cutaneous melanoma through an online platform and an online course. MelaMEd enables participants to i) recognize skin lesions that require specialist dermatological assessment, ii) select patients at high risk of melanoma and iii) be informed of the diagnosis and treatment pathway of patients with melanoma. A free online platform and online course were developed and launched in June 2022. Before starting the course, enrolled participants fill out a pre-training questionnaire concerning the basic knowledge of the disease and the recognition and management of suspicious lesions. After the course, participants will fill out the same questionnaire again. The online course will end in December 2023. Here we present a preliminary analysis of the pre-training results (January 2023-July 2023). The data have been analyzed descriptively. So far, five healthcare centers have participated in the project for a total of 1320 participants. Of these, 298 compiled the pre-training questionnaire. Forty-seven percent of them were aged <40 years. Respondents were almost divided between GPs (47%) and resident GPs (48%). Among the theoretical questions, the ABCDE rule and ugly duckling sign are well known (96% and 91% of correct answers, respectively), but a lower percentage (68%) of respondents knows the EFG rule for the recognition of nodular melanomas and the statement of Breslow thickness (29%). Regarding the series of clinical images of pigmented skin lesions and their management, the percentages rate of accuracy varied from 33% to 87%: melanoma (5 cases) ranges from 36% to 71%, melanocytic nevi (3 cases) from 33% to 84%, whereas the percentages rate of referral for dermatological evaluation varied from 44% to 99%. Melanoma cases referred to dermatologist ranges from 67% to 99%. This preliminary analysis on pre-train-ing questionnaire mainly showed a lack of knowledge of the two major points of melanoma diagnosis (EFG) and management (Breslow thickness), as well as a low rate of participants. We will compare the proportions of correct answers to the questionnaires before and after the course once available.

Nodular Malignant Melanoma on the Abdomen of a Lactating Lady

AbstractMalignant melanoma is an uncommon condition in Indian and dark-skinned individuals. Additionally, it is associated with lifetime recurrences and poor prognosis. Its presence on the trunk poses a diagnostic challenge as it can simulate various skin lesions. Furthermore, it raises diagnostic and therapeutic challenges in pregnancy and lactation. Early recognition and appropriate treatment can reduce adverse events in the mother and the baby. Here, we are reporting a case of a 33-year-old lactating mother who presented with a solitary, rapidly growing nodule on the abdomen. Nodular malignant melanoma was diagnosed on further evaluation with histopathology and immunohistochemistry.

Comparative Quantitative Proteomic Analysis of Melanoma Subtypes, Nevus-Associated Melanoma, and Corresponding Nevi

A substantial part of cutaneous malignant melanomas develops from benign nevi. However, the precise molecular events driving the transformation from benign to malignant melanoma are not well understood. We used laser microdissection and mass spectrometry to analyze the proteomes of melanoma subtypes, including superficial spreading melanomas (SSM, n=17), nodular melanomas (NM, n=17), and acral melanomas (AM, n=15). Furthermore, we compared the proteomes of nevi cells and melanoma cells within the same specimens (nevus-associated melanoma (NAM, n=14)). In total, we quantified 7,935 proteins.Despite the genomic and clinical differences of the melanoma subtypes, our analysis revealed relatively similar proteomes, except for the upregulation of proteins involved in immune activation in NM vs AM. Examining NAM versus nevi, we found 1,725 differentially expressed proteins (FDR < 0.05). Among these proteins were 140 that overlapped with cancer hallmarks, tumor suppressors, and regulators of metabolism and cell cycle. Pathway analysis indicated aberrant activation of the PI3K-AKT-mTOR pathways and the Hippo-YAP pathway. Using a classifier, we identified six proteins capable of distinguishing melanoma from nevi samples. Our study represents a comprehensive comparative analysis of the proteome in melanoma subtypes and associated nevi, offering, to our knowledge, previously unreported insights into the biological behavior of these distinct entities.

Preoperative bimodal imaging evaluation in finding histological correlations of in situ, superficial spreading and nodular melanoma.

The aim of this study is to correlate the diagnostic criteria described in dermoscopy, ultrasonography (US), and histology of the most common types of cutaneous melanoma (CM). We conducted a prospective study including 40 CM cases, which were analyzed by dermoscopy using the Delta 30 dermatoscope and Vidix 4.0 videodermoscope, by ultrasound (US) using a high-resolution 20 MHz linear probe, along with histopathological analysis. The study involved 40 patients with histopathologically confirmed CM, comprising 10 nodular melanomas (NM), 21 superficial spreading melanomas (SSM), and nine in situ melanomas (MIS). US measurements of tumor thickness exhibited strong correlations with the histopathological Breslow index (BI), particularly in the NM and SSM groups. A notable correlation was observed between the presence of ulceration in histopathology and ultrasonography. Dermoscopic analysis revealed significant associations between specific features and CM types. For instance, the presence of an atypical network, irregular globules, irregular dots, prominent skin margins, angulated lines/polygons, dotted and short linear vessels, and negative network correlated with a median BI ≤ 0.5 mm. Conversely, the presence of blue-white veil, atypical vessels, blue-black color, and milky red color were associated with a median BI ≥ 2.3 mm. Furthermore, regression observed in histopathology correlated with regression identified in dermoscopy, we also found statistical correlations between the presence of vascularization at US with the high Clark level, and the presence of prominent skin markings at dermoscopy. The presence of histopathological regression was more frequently associated with tumors that had precise margins, absent vascularization and with those that did not have ulceration on US. The high mitotic rate was associated with tumors that presented imprecise margins, increased vascularization and US detectable ulceration. Innovative CM diagnosis using non-invasive methods like dermoscopy and ultrasound may enhance accuracy and treatment guidance by assessing lesion characteristics.

High charge of cerebroid nests in nodular melanomas predicts tumor aggressiveness and high mutational tumoral burden: a pilot study.

Even today, melanoma is a highly aggressive neoplasm with a high mortality rate. The nodular type is very aggressive and has cerebroid nests of melanocytes (CNMs) at the growth edge, morphologically similar to the poorly differentiated neoplastic epithelial cell clusters described in colorectal, breast, and endometrioid endometrial cancers. We selected 25 nodular melanomas (NMs) with known molecular profiles, of which the entire paraffin-embedded lesion was available. We counted CNMs under a microscopic at a magnification of 20x (i.e., a microscopic field with a major axis of 1mm). Based on the number of CNMs in the area, melanomas were classified into three groups: G1 (CNMs ranging from 0 to 4), G2 (CNMs ranging from 5 to 9), and G3 (CNMs ≥ 10). The presence of CNMs and their counts were compared with molecular and histopathological data. Seventeen (NMs) were grouped as G1 (68%), 5 as G2 (20%), and 3 as G3 (12%) based on CNMs count. The presence of CNMs correlated with epithelioid cell morphology (p < 0.05), Clark IV and V levels (p < 0.05), vascular invasion (p < 0.05), and biological mutants (p < 0.05). Melanomas with ≥ 10 CNMs more frequently show ulceration (p < 0.02) and the BRAF V600E mutation (p < 0.02). CNMs count has a predictive role regardless of tumor size; their association with the BRAF V600E mutation suggests their predictive significance in response to biologics. However, further investigations are needed to strengthen this hypothesis.

Subtypes of Melanomas Associated with Different Degrees of Actinic Elastosis in Conventional Histology, Irrespective of Age and Body Site, Suggesting Chronic Ultraviolet Light Exposure as Driver for Lentigo Maligna Melanoma and Nodular Melanoma.

(1) Background: Ultraviolet (UV) radiation and sunburns are associated with an increased incidence of acquired nevi and melanomas. However, the data are controversial as to whether chronic UV exposure or high intermittent UV exposure is the major carcinogenic factor in melanocytic tumors. In this study, we compared the degree of actinic elastosis (AE) as a surrogate for lifetime UV exposure in nevi and different clinical melanoma subtypes (i.e., superficial spreading melanoma (SSM), nodular malignant melanoma (NMM), acral lentiginous melanoma (ALM), and lentigo maligna melanoma (LMM)) with respect to clinical variables (age, sex, and body site). (2) Methods: We defined a semi-quantitative score for the degree of AE ranging from 0 = none to 3 = total loss of elastic fibers (basophilic degeneration) and multiplied it by the perilesional vertical extent (depth), measured histometrically (tumor-associated elastosis grade (TEG)). We matched the TEG of n = 595 melanocytic lesions from 559 patients with their clinical variables. (3) Results: The TEG was correlated with age and UV-exposed body sites. Furthermore, the TEG was significantly higher in LMM than in all other types of melanomas and the TEG in NMM was higher than in SSM, irrespective of patient age and tumor site. (4) Conclusions: High cumulative UV exposure is more strongly associated with LMM and NMM than with other melanoma subtypes.

Descriptive Epidemiology of Melanoma Diagnosed between 2010 and 2014 in a Colombian Cancer Registry and a Call for Improving Available Data on Melanoma in Latin America.

We aimed to improve the available information on morphology and stage for cutaneous melanoma in the population-based cancer registry of the Bucaramanga Metropolitan Area in Colombia. The incidence and survival rates and the distribution of melanoma patients by age, gender, anatomical subsite, and histological subtype were calculated. All 113 melanoma patients (median age 61) were followed up (median time 7.4 years). This exercise (filling in missing information in the registry by manual search of patient clinical record and other available information) yielded more identified invasive melanomas and cases with complete information on anatomical localization and stage. Age-standardized incidence and mortality rates were 1.86 and 1.08, being slightly higher for males. Most melanomas were localized on the lower limbs, followed by the trunk. For 35% of all melanomas, the morphological subtype remained unknown. Most of the remaining melanomas were nodular and acral lentiginous melanomas. Overall global and relative 5-year survival was 61.6% and 71.3%, respectively, with poorer survival for males than females. Melanomas on the head and neck and unspecified anatomical sites had the worst survival. Patients without stage information in their medical files had excellent survival, unlike patients for whom medical files were no longer available. This study shows the possibility of improving data availability and the importance of good quality population-based data.