Publications by authors named "Celia Requena"

118 Publications

Association between melanoma thickness and clinical and demographic characteristics.

Eur J Dermatol 2021 Aug 26. Epub 2021 Aug 26.

Dermatology Department. Instituto Valenciano de Oncología. València, Spain, School of Medicine. Universidad Católica de Valencia San Vicente Mártir, València, Spain.

The large-scale implementation of primary and secondary skin cancer prevention strategies in recent decades has led to an increase in the diagnosis of thin melanomas and a decrease in the mean thickness of tumours diagnosed. The number of newly diagnosed thick melanomas, however, has remained stable. To investigate associations between melanoma thickness, clinical presentation and demographic and phenotypic characteristics. The study is based on a cross-sectional study of 1,459 patients with melanoma from a dermatology department at a tertiary hospital in Spain between 2000 and 2017. We analysed associations between median Breslow thickness and demographic, phenotypic, and clinical characteristics, including the method of melanoma detection. Age ≥ 70 years (regression coefficient [RC] =  1.2, 95% CI: 1.1-1.3; p  <  0.001), male sex (RC  =  0.9, 95% CI: 0.8-0.9; p  <  0.001), symptom-based detection (RC  =  1.3, 95% CI: 1.1-1.4; p  <  0.001), and a history of sunburn at the melanoma site (RC  =  0.9, 95% CI: 0.8-0.9; p  =  0.04) were all associated with thicker tumours. Melanomas on the lower extremities, by contrast, were significantly thinner (RC  =  0.9, 95% CI: 0.8-0.9; p = 0.04). Thick melanomas occur preferentially in older men and show changes such as bleeding or an increase in volume or colour. This information should be incorporated into health training and education programs to design better prevention strategies and minimize diagnostic delays.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/ejd.2021.4096DOI Listing
August 2021

Stewart-Treves Syndrome.

JAMA Dermatol 2021 Jun;157(6):721

Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamadermatol.2021.0341DOI Listing
June 2021

Longitudinal study of prognostic factors for localized cutaneous melanoma in patients who have been disease-free for five years.

Eur J Dermatol 2021 Apr;31(2):192-198

Department of Dermatology, Instituto Valenciano de Oncología, València, Spain, School of Medicine, Universidad Católica de Valencia, Spain.

Most relapses in melanoma patients occur during the first five years after diagnosis. Identifying characteristics associated with recurrence after this period could help delineate guidelines, specifically for follow-up protocols. Objectives: The aim of this study was to identify the prognostic factors for relapse and death caused by melanoma in patients who have been disease-free for five years. We designed a longitudinal retrospective cohort to study Stage I/II cutaneous melanoma patients who have been free of disease for more than five years (late relapse cohort). Prognostic factors for disease-free and melanoma-specific survival were evaluated using the Kaplan-Meier method and Cox regression models. A series of 746 patients who had Stage I-II cutaneous melanoma and were free of disease for five years was selected. After a median follow-up of 64 months (124 months since melanoma diagnosis), 51 (6.8%) patients relapsed and 18 (2.4%) died from melanoma. Acral location and presence of ulceration, as well as intermediate growth rate (0.11-0.50 mm/month), were significantly associated with relapse or death due to melanoma. The initial recurrence site was associated with distant metastasis in 48% of the cases. In this study, we have identified melanoma characteristics in patients who have been disease-free for five years that may allow us to establish groups at increased risk of relapse or death due to melanoma, which could be helpful for melanoma management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/ejd.2021.4022DOI Listing
April 2021

Localized Injection-site Toxic Erythema of Chemotherapy: An Under-recognized Acquaintance Revisited.

Acta Derm Venereol 2021 Apr 12;101(4):adv00429. Epub 2021 Apr 12.

Department of Dermatology, Instituto Valenciano de Oncología, ES-46009 Valencia, Spain. E-mail:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2340/00015555-3791DOI Listing
April 2021

Distribution and clinical role of KIT gene mutations in melanoma according to subtype: a study of 492 Spanish patients.

Eur J Dermatol 2021 Mar 1. Epub 2021 Mar 1.

Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain, School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain.

Background: KIT mutations are primarily associated with acral and mucosal melanoma, and have been reported to show higher prevalence in chronic sun-damaged (CSD) than non-CSD melanomas.

Objectives: To investigate the prevalence of KIT mutations in melanoma according to subtype, and determine the clinical role of such mutations.

Material & Methods: We present results from a study of a Spanish population of 492 melanomas, classified according to the latest World Health Organization (WHO) guidelines. We analysed the mutational status of KIT and correlated with different clinical variables related to sun exposure and family history.

Results: KIT mutations were significantly more frequent in acral (3/36; 8.3%) and mucosal (4/8; 50%) melanomas than non-acral cutaneous melanomas. No significant difference was observed in KIT mutational status between CSD and non-CSD melanomas.

Conclusion: Our results suggest that KIT mutations in melanoma tumours are unrelated to the development of nevi or chronic sun damage, but their presence is associated with aggressive melanomas which show ulceration, vascular invasiveness, and increased Breslow thickness. These findings are consistent with those reported by The Cancer Genome Atlas network.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/ejd.2021.3971DOI Listing
March 2021

Adherence to Primary Prevention and Skin Self-Examination Practices by Spanish Melanoma Patients.

Dermatology 2021 Jan 19:1-7. Epub 2021 Jan 19.

Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain,

Background: The incidence of cutaneous melanoma, an important global public health problem, has been increasing over the last several decades.

Objectives: In order to decrease melanoma-related mortality, ways to communicate and implement the correct methods for conducting primary and secondary prevention measures (such as early detection via self-examination) should be investigated.

Materials And Methods: An observational, cross-sectional, retrospective study consisting of 409 patients diagnosed with cutaneous melanoma was conducted. An online questionnaire was created to evaluate knowledge levels, attitudes, and adherence to primary preventive measures and to skin self-examination practices.

Results: The results revealed that even when 43% of the patients perform cutaneous self-examinations, only half of them fully followed the recommendations. Patients aged <45 years, female, with a I-II phototype, with an intermediate/high level of education, and with a history of NMSC were more likely to have an adequate degree of knowledge. Moreover, patients aged <45 years and with an adequate degree of knowledge more frequently showed an adequate adherence to the primary prevention measures. Finally, patients aged 45-60 years and with an adequate degree of knowledge presented a good adherence to the self-skin examination measures.

Limitations: Possible limitations of this study were memory bias through the influence of age within the study population, and bias due to a greater proportion of subjects with a high education level.

Conclusion: Within the population of patients with melanoma, a high percentage of patients do not rigorously follow the recommended prevention measures. Our study highlights the need to implement awareness in this population to improve the prevention of cutaneous cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000512887DOI Listing
January 2021

[Protocol for the histologic diagnosis of cutaneous melanoma: consensus statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry].

Rev Esp Patol 2021 Jan-Mar;54(1):29-40. Epub 2020 Dec 13.

Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España.

This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.patol.2020.10.004DOI Listing
December 2020

Usefulness of ultrasound in dermatofibrosarcoma protuberans and correlation with histopathological findings: A series of 30 cases.

Skin Res Technol 2021 Sep 17;27(5):701-708. Epub 2021 Jan 17.

Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.

Background: Small series of ultrasound findings in dermatofibrosarcoma protuberans (DFSP) have been published, but the usefulness of this technique as a preoperative planning tool for tumor resection has not been studied.

Materials And Methods: We retrospectively reviewed patients with DFSP at our hospital that underwent ultrasound examination. Depth of invasion was evaluated by ultrasound and histopathology. Accuracy of ultrasound for assessing depth of tumor invasion was estimated.

Results: Thirty histopathologically confirmed DFSPs were studied. Classic finger-like projections were observed in 73.3% of cases. A posterior hyperechoic area extending deep into the subcutaneous tissue correlated with the honeycomb DFSP pattern and was observed in 53.3% of patients. Concordance between ultrasound and histopathologic depth measurements was excellent. Lateral tumor extension and Doppler activity were not evaluated in our series.

Conclusion: Ultrasound showed excellent prediction of depth of invasion. Further studies are required to define the usefulness of ultrasound for determining lateral tumor extension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/srt.13003DOI Listing
September 2021

Differences in cutaneous melanoma survival between the 7th and 8th edition of the American Joint Committee on Cancer (AJCC). A multicentric population-based study.

Eur J Cancer 2021 03 5;145:29-37. Epub 2021 Jan 5.

Department of Dermatology, Hospital Clínic de Barcelona, Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona University, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain. Electronic address:

Background: The 8th edition of the AJCC manual for melanoma includes many changes leading to major substage migrations, which could lead to important clinical reassessments.

Objectives: To evaluate the differences and prognostic value of the 8th AJCC classification in comparison with the 7th edition.

Methods: Clinical and histopathological data were retrieved from five melanoma referral centers including 7815 melanoma patients diagnosed between January 1998 and December 2018. All patients were reclassified and compared using the 7th and 8th classifications of the AJCC. Sankey plots were used to evaluate the migration of patients between the different versions. The primary outcome was overall survival (OS), and curves based on the Kaplan-Meier method were used to investigate survival differences between the 7th and 8th editions.

Results: The number of patients classified as stages IB, IIIA, and IIIB decreased while the patients classified as stages IA and IIIC increased notably. Migration analysis showed that many patients in group I were understaged whereas a significant percentage of patients in group III were upstaged. Indirect OS analysis showed a loss in the linearity in the AJCC 8th edition and the groups tended to overlap. Direct OS analysis between groups and versions of the AJCC showed a better prognosis within the new stage III patients, with no effect on those in stages I and II.

Conclusion: The 8th AJCC edition represents an important change in the classification of patients. We observe that the main migratory changes occur in stage I and III, that severity linearity is lost and groups overlap, and that a more advanced stage does not mean a worse prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejca.2020.11.036DOI Listing
March 2021

Prognostic Role of Non-Identification of Sentinel Lymph Node in Cutaneous Melanoma Patients: An Observational Retrospective Study.

Cancers (Basel) 2020 Oct 27;12(11). Epub 2020 Oct 27.

Department of Dermatology, Instituto Valenciano de Oncología, 46001 València, Spain.

: Sentinel lymph node (SLN) status is recognized as the most important prognostic factor for patients with cutaneous melanoma. However, sometimes it is not possible to identify SLN. The phenomenon of non-identification of SLN and its prognostic role have not been thoroughly evaluated in melanoma literature. The objective of this study was to identify which patient or tumor variables may be associated to non-identification of SLN and to evaluate the prognostic role of non-identification of SLN. : Observational retrospective study of 834 cutaneous melanoma patients who underwent SLN biopsy at Instituto Valenciano de Oncología. : Forty-two patients (5%) presented non-identification of SLN. Patients with age at diagnosis of ≥ 64 years, obesity (BMI ≥ 30), and head and neck localization were at higher risk of non-identification of SLN. Non-identified SLN patients had worse nodal disease-free survival with respect to negative SLN patients, but not worse melanoma-specific survival. : Our findings suggest a need to follow-up patients with non-identified SLN in the same way as patients with positive SLN.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/cancers12113151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692392PMC
October 2020

Pleomorphic dermal sarcoma: a retrospective study of 16 cases in a dermato-oncology centre and a review of the literature.

Eur J Dermatol 2020 Oct;30(5):545-553

Department of Dermatology, Instituto Valenciano de Oncología. Valencia, Spain.

Background: Relatively little is known about the true aggressive potential of pleomorphic dermal sarcoma (PDS) or optimal management strategies.

Objective: To describe the outcomes of 16 cases of PDS treated at our hospital (14 with modified Mohs micrographic surgery [M-MMS] and two with conventional surgery) and establish an adequate plan for management.

Materials & Methods: We reviewed 16 PDS cases treated at our hospital between October 2007 and June 2019 and compared our results with the available evidence.

Results: In total, 69% of cases had recurred after initial conventional surgery, M-MMS led to local disease control in 83% of cases, and 19% of patients developed metastasis. Combining all published PDS cases with ours, we calculated an overall metastasis rate of 12%, and an overall recurrence rate of 35% after conventional surgery and 17% after M-MMS.

Conclusion: PDS is more aggressive than previously estimated, with an overall metastatic rate of 12%. Despite high recurrence rates with previous conventional surgery (69%), M-MMS achieved a good rate of local disease control (83%). Given the potential aggressivity of PDS and the importance of clear surgical margins, M-MMS appears to be more adequate than conventional excision. Staging studies and close monitoring are warranted in PDS patients, for which we propose a management algorithm.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1684/ejd.2020.3875DOI Listing
October 2020

Locoregional Lymph Node Recurrence of Trunk Melanoma in Non-sentinel Lymph Node Basins: An Observational Retrospective Study.

Acta Derm Venereol 2020 Oct 6;100(17):adv00284. Epub 2020 Oct 6.

Doctorate School, Universidad Católica de Valencia San Vicente Mártir, València, Spain.

Locoregional lymph node recurrences of primary trunk melanoma can occur in basins not identified during sentinel lymph node biopsy. However, the factors associated with recurrences in non-sentinel lymph node basins are unknown. To evaluate these factors, this observational retrospective study examined the patterns of first lymph node recurrence and the factors associated with recurrence in non-sentinel lymph node basins. A total of 305 patients with primary trunk melanoma who had undergone sentinel lymph node biopsy from 2000 to 2015 were evaluated. Twenty-three patients presented locoregional lymph node recurrence; 8 of which (34.8%) were in non-sentinel lymph node basins. Non-sentinel lymph node recurrences were more frequent in patients with positive sentinel lymph nodes and in those patients whose number of tumour-involved nodes was > 3. These results suggest that clinical examination and ultrasound surveillance should be performed on all potential lymph node drainage basins of trunk melanomas.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2340/00015555-3635DOI Listing
October 2020

Angiosarcomas: histology, immunohistochemistry and molecular insights with implications for differential diagnosis.

Histol Histopathol 2021 Jan 4;36(1):3-18. Epub 2020 Sep 4.

Pathology Department, University of Valencia, Valencia, Spain.

Angiosarcomas (AS) represent a heterogenous group of tumors with variable clinical presentation. AS share an important morphologic and immunohistochemical overlap with other sarcomas, hence the differential diagnosis is challenging, especially in poorly-differentiated tumors. Although molecular studies provide significant clues, especially in the differential diagnosis with other vascular neoplasms, a thorough hematoxylin and eosin analysis remains an essential tool in AS diagnosis. In this review, we discuss pathological and molecular insights with emphasis on implications for differential diagnosis in cutaneous, breast, soft tissue and visceral AS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14670/HH-18-246DOI Listing
January 2021

Intralesional Methotrexate for the Treatment of Advanced Keratinocytic Tumors: A Multi-Center Retrospective Study.

Dermatol Ther (Heidelb) 2020 Aug 13;10(4):769-777. Epub 2020 Jun 13.

Department of Medicine and Aging Science, Dermatologic Clinic, University G. D'Annunzio, Chieti Pescara, Italy.

Introduction: Keratinocyte tumors (KT) are frequently observed. Surgery is the treatment gold standard. In some cases, a surgical approach might not be the best option. Radiotherapy (RT) and systemic treatments can frequently cause side effects or be contraindicated. Intralesional methotrexate (MTX) can be a conservative yet effective alternative. We decided to evaluate the effectiveness and safety of intralesional chemotherapy with MTX for the treatment of squamous cell carcinoma (SCC), keratoacanthoma (KA), and basal cell carcinoma (BCC).

Methods: All patients had a histologically confirmed diagnosis of BCC, SCC, or KA and no indication to surgery or RT. MTX was injected subcutaneously proceeding from the periphery of the lesion toward the center. Different protocols in terms of dose, frequency, and length of treatment were used to compare them. Treatment efficacy was evaluated in terms of tumor size reduction. Patients were divided into three groups: responders (improvement of more than 50%), partial responders (< 50%), and non-responders (no improvement or worsening). All data were analyzed using the chi-squared test (χ).

Results: Thirty-five patients were included. Twenty-one patients suffered from SCC, 12 from KA, and 2 from BCC. KA showed a higher response rate than SCC and BCC. For AK, 92% of patients had a complete resolution; 8% were partial responders. For SCC, 47.6% of cases were responders and 14.3% partial responders, while 38% non-responders. All BCCs showed no improvement. A treatment protocol of weekly injections, performed for 4 to 6 weeks, was the most efficient. Doses of 25 mg/ml per session seemed to be most effective. About one third of our patients developed side effects with mild anemia being the most frequent.

Conclusions: For selected cases, intralesional MTX can be a safe and effective option for the treatment of KT, especially in case of KA and, to a lesser extent, SCC.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13555-020-00400-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7367996PMC
August 2020

A unilateral zosteriform cutaneous eruption on the lower extremity.

Int J Dermatol 2021 Apr 4;60(4):e137-e139. Epub 2020 Jun 4.

Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ijd.14980DOI Listing
April 2021

Coding and noncoding somatic mutations in candidate genes in basal cell carcinoma.

Sci Rep 2020 05 14;10(1):8005. Epub 2020 May 14.

Division of Functional Genome Analysis, German Cancer Research Center, Heidelberg, Germany.

Basal cell carcinoma (BCC) represents the most commonly diagnosed human cancer among persons of European ancestry with etiology mainly attributed to sun-exposure. In this study we investigated mutations in coding and flanking regions of PTCH1 and TP53 and noncoding alterations in the TERT and DPH3 promoters in 191 BCC tumors. In addition, we measured CpG methylation within the TERT hypermethylated oncological region (THOR) and transcription levels of the reverse transcriptase subunit. We observed mutations in PTCH1 in 58.6% and TP53 in 31.4% of the tumors. Noncoding mutations in TERT and DPH3 promoters were detected in 59.2% and 38.2% of the tumors, respectively. We observed a statistically significant co-occurrence of mutations at the four investigated loci. While PTCH1 mutations tended to associate with decreased patient age at diagnosis; TP53 mutations were associated with light skin color and increased number of nevi; TERT and DPH3 promoter with history of cutaneous neoplasms in BCC patients. Increased reverse transcriptase subunit expression was observed in tumors with TERT promoter mutations and not with THOR methylation. Our study signifies, in addition to the protein altering mutations in the PTCH1 and TP53 genes, the importance of noncoding mutations in BCC, particularly functional alterations in the TERT promoter.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-65057-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224188PMC
May 2020

Cutaneous intralymphatic histiocytosis associated with breast and orthopedic surgery.

J Cutan Pathol 2021 Jun 20;48(6):725-729. Epub 2021 Jan 20.

Department of Dermatology, Fundación Instituto Valenciano de Oncología, Valencia, Spain.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cup.13740DOI Listing
June 2021

Genome-wide association meta-analyses combining multiple risk phenotypes provide insights into the genetic architecture of cutaneous melanoma susceptibility.

Nat Genet 2020 05 27;52(5):494-504. Epub 2020 Apr 27.

Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.

Most genetic susceptibility to cutaneous melanoma remains to be discovered. Meta-analysis genome-wide association study (GWAS) of 36,760 cases of melanoma (67% newly genotyped) and 375,188 controls identified 54 significant (P < 5 × 10) loci with 68 independent single nucleotide polymorphisms. Analysis of risk estimates across geographical regions and host factors suggests the acral melanoma subtype is uniquely unrelated to pigmentation. Combining this meta-analysis with GWAS of nevus count and hair color, and transcriptome association approaches, uncovered 31 potential secondary loci for a total of 85 cutaneous melanoma susceptibility loci. These findings provide insights into cutaneous melanoma genetic architecture, reinforcing the importance of nevogenesis, pigmentation and telomere maintenance, together with identifying potential new pathways for cutaneous melanoma pathogenesis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41588-020-0611-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255059PMC
May 2020

Mutation Signatures in Melanocytic Nevi Reveal Characteristics of Defective DNA Repair.

J Invest Dermatol 2020 10 6;140(10):2093-2096.e2. Epub 2020 Mar 6.

Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany; Division of Functional Genome Analysis, German Cancer Research Center (DKFZ), Heidelberg, Germany.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jid.2020.02.021DOI Listing
October 2020

Factors associated with sentinel lymph node status and prognostic role of completion lymph node dissection for thick melanoma.

Eur J Surg Oncol 2020 02 2;46(2):263-271. Epub 2019 Oct 2.

Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain.

Introduction: Sentinel lymph node (SLN) biopsy is useful for the prognostic stratification of patients with thick melanoma. Identifying which variables are associated with SLN involvement and establishing risk in different subgroups of patients could be useful for guiding the indication of SLN biopsy. The value of complete lymph node dissection (CLND) in patients with a positive SLN biopsy is currently under debate.

Materials And Methods: To identify factors associated with SLN involvement in thick melanoma we performed a multicentric retrospective cohort study involving 660 patients with thick melanoma who had undergone SLN biopsy. To analyze the role of CLND in thick melanoma patients with a positive SLN biopsy, we built a multivariate Cox proportional hazards model for melanoma-specific survival (MSS) and disease-free survival (DFS) and compared 217 patients who had undergone CLND with 44 who had not.

Results: The logistic regression analysis showed that age, histologic subtype, ulceration, microscopic satellitosis, and lymphovascular invasion were associated with nodal disease. The CHAID (Chi-squared Automatic Interaction Detection) decision tree showed ulceration to be the most important predictor of lymphatic involvement. For nonulcerated melanomas, the histologic subtype lentigo maligna melanoma was associated with a low rate of SLN involvement (4.3%). No significant differences were observed for DFS and MSS between the CLND performed and not-performed groups. Nodal status on CLND was associated with differences in DFS and MSS rates.

Conclusion: We identified subgroups of thick melanoma patients with a low likelihood of SLN involvement. CLND does not offer survival benefit, but provides prognostic information.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejso.2019.09.189DOI Listing
February 2020

Decreased vitamin D serum levels at melanoma diagnosis are associated with tumor ulceration and high tumor mitotic rate.

Melanoma Res 2019 12;29(6):664-667

Dermatology Department.

The aim of this study is to evaluate the relation between 25-hydroxyvitamin D levels at diagnosis and pathological characteristics in primary invasive melanoma. A cross-sectional study was designed based on a series of 204 consecutive patients diagnosed of invasive melanomas in the 2013-2017 period at a single institution. 25-hydroxyvitamin D serum levels at diagnosis were assessed, and three groups were defined by vitamin D status: deficiency, insufficiency, and sufficiency. Clinical and pathological characteristics were compared between the groups by Chi-square test. Logistic regression models were performed to evaluate the association between vitamin D status and Breslow thickness, ulceration, and tumor mitotic rate. A significant association between vitamin D levels at diagnosis and location, tumor mitotic rate, and ulceration was found; and a borderline association with Breslow thickness and BMI. Deficient levels were found in 7.8% of patients and increased the risk of presenting ulcerated tumors [odds ratio: 6.8 (95% confidence interval: 1.5-29.7; P = 0.012)] and with a tumor mitotic rate greater than 1 mitosis/mm [odds ratio: 6.0 (95% confidence interval: 1.4-25.1; P = 0.014)]. A marginal increased risk of tumor thickness greater than 1 mm was also observed [odds ratio: 3.7 (95% confidence interval: 1.0-13.9; P = 0.057)]. Our study suggests a role of vitamin D levels in melanoma aggressiveness and raises the question as to whether vitamin D levels should be monitored, or even supplemented, in people with low yearly sun exposure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/CMR.0000000000000638DOI Listing
December 2019

Solid Microcystic Adnexal Carcinoma on the Thigh: An Unusual Location.

Am J Dermatopathol 2020 Feb;42(2):122-124

Department of Dermatology, Instituto Valenciano de Oncología, Valencia, Spain.

Solid carcinoma, probably the solid variant of microcystic adnexal carcinoma, is an apocrine adnexal tumor first described in 1998. The authors report an additional new case of the tumor at an unusual localization. A 78-year-old man presented with an asymptomatic firm plaque on his right thigh that had been present for 15 years. A biopsy was taken, and then, the lesion was removed. A pathological study showed a huge number of islands made up of aggregations of neoplastic epithelial cells. The epithelial islands showed variable sizes and shapes at scanning magnification, arranged columns, cords, and strands at the basis of the tumor. The neoplastic cells were embedded within a fibrotic stroma. Ductal differentiation, cystic structures, and neurotropism were also observed. Immunohistochemically, the neoplastic cells expressed high-molecular-weight keratin (cytokeratin 5/6), broad-spectrum keratin (AE1/AE3), p40, and p63. No immunoreactivity was found for BerEP4, cytokeratin 7, cytokeratin 19, cytokeratin 20, chromogranin A, carcinoembryonic antigen, and S-100. The lesion was completely removed with slow-Mohs micrographic surgery. Two stages and previous debulking were necessary to obtain free margins. The second stage included the muscular fascia. The patient remains free of tumor after a year of follow-up. Solid microcystic adnexal carcinoma is a rare skin tumor that seems to occur more frequently in the scalp than in the face, but no area of the body can be excluded, as reported in our case. Differential diagnosis should include sclerosing and clear-cell basal cell carcinoma, clear-cell dermal duct tumor, or desmoplastic trichoepithelioma. Mohs micrographic surgery is the treatment of choice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/DAD.0000000000001466DOI Listing
February 2020

The proportion of nevus-associated invasive melanoma differs with Breslow thickness: A cross-sectional study of 1087 cutaneous melanomas.

J Am Acad Dermatol 2019 09;81(3):852-854

Department of Dermatology, Instituto Valenciano de Oncología, Spain; School of Medicine, Universidad Católica de Valencia "San Vicente Mártir", Spain. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaad.2019.04.043DOI Listing
September 2019

Survival analysis and sentinel lymph node status in thin cutaneous melanoma: A multicenter observational study.

Cancer Med 2019 08 18;8(9):4235-4244. Epub 2019 Jun 18.

Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain.

Mitotic rate is no longer considered a staging criterion for thin melanoma in the 8th edition of the American Joint Committee on Cancer Staging Manual. The aim of this observational study was to identify prognostic factors for thin melanoma and predictors and prognostic significance of sentinel lymph node (SLN) involvement in a large multicenter cohort of patients with melanoma from nine tertiary care hospitals. A total of 4249 consecutive patients with thin melanoma diagnosed from January 1, 1998 to December 31, 2016 were included. The main outcomes were disease-free interval and melanoma-specific survival for the overall population and predictors of SLN metastasis (n = 1083). Associations between survival and SLN status and different clinical and pathologic variables (sex, age, tumor location, mitosis, ulceration, regression, lymphovascular invasion, histologic subtype, Clark level, and Breslow thickness) were analyzed by Cox proportional hazards regression and logistic regression. SLN status was the most important prognostic factor for melanoma-specific survival (hazard ratio, 13.8; 95% CI, 6.1-31.2; P < 0.001), followed by sex, ulceration, and Clark level for patients who underwent SLNB. A mitotic rate of >2 mitoses/mm was the only factor associated with a positive SLN biopsy (odds ratio, 2.9; 95% CI, 1.22-7; P = 0.01. SLN status is the most important prognostic factor in thin melanoma. A high mitotic rate is associated with metastatic SLN involvement. SLN biopsy should be discussed and recommended in patients with thin melanoma and a high mitotic rate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/cam4.2358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675713PMC
August 2019

Histologic Features Associated With an Invasive Component in Lentigo Maligna Lesions.

JAMA Dermatol 2019 07;155(7):782-788

School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain.

Importance: Lentigo maligna (LM) presents an invasive component in up to 20% of biopsied cases, but to date the histologic features useful in detecting this invasive component have not been described. Some histologic characteristics are hypothesized to contribute to the progression of LM invasion.

Objective: To identify the histologic characteristics associated with lentigo maligna melanoma (LMM) in patients with LM diagnosed by a partial diagnostic biopsy.

Design, Setting, And Participants: A retrospective cross-sectional study of patients treated between January 1, 2000, and December 31, 2017, was conducted in a referral oncology center in València, Spain. Data and specimens of patients (n = 96) with a diagnosis of primary cutaneous melanoma in the form of either LM or LMM who had undergone surgical treatment, a complete histologic examination of the whole tumor, and an initial diagnostic partial biopsy of LM were included in the study. Histologic assessment was blinded to the presence of an invasive component.

Interventions: All biopsy specimens were evaluated for the presence of certain histologic characteristics.

Main Outcomes And Measures: Comparisons between invasive samples and samples without an invasive component were performed. The differences in the distribution of variables between the groups were assessed using the χ2 and Fisher exact tests, and the degree of association of the relevant variables was quantified by logistic regression models. A classification and regression tree analysis was performed to rank the variables by importance.

Results: In total, 96 patients had sufficient histologic material that could be evaluated. The patients were predominantly male (56 [58.3%]) and had a mean (SD) age at diagnosis of 72 (12) years. Of these patients, 63 (65.6%) had an LM diagnosis and 33 (34.4%) had an LMM diagnosis (an invasive component). The histologic variables associated with the presence of an invasive component were melanocytes forming rows (odds ratio [OR], 11.5; 95% CI, 1.4-94.1; P = .02), subepidermal clefts (OR, 2.8; 95% CI, 1.0-7.9; P = .049), nests (OR, 3.0; 95% CI, 1.1-8.6; P = .04), and a lesser degree of solar elastosis (OR, 0.4; 95% CI, 0.1-1.1; P = .07). A classification and regression tree analysis of the relevant histologic features was able to accurately identify lentigo maligna with an invasive component (LMM) in more than 60% of patients.

Conclusions And Relevance: These findings may be useful in classifying early LM specimens at higher risk of invasion, which may eventually be relevant in identifying the most appropriate management for LM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1001/jamadermatol.2019.0467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506897PMC
July 2019

Multiple facial plaque variant of trichoblastoma.

J Cutan Pathol 2019 Apr 7;46(4):285-289. Epub 2019 Feb 7.

Departments of Dermatology and Pathology, Instituto Valenciano de Oncología, Valencia, Spain.

Background: The plaque variant of trichoblastoma has been described as a solitary tumor with diffuse infiltration of the lower dermis and hypodermis, with poorly defined borders. Herein, we report a new variant of multiple centrofacial trichoblastoma.

Object: To describe clinical and pathological features of a new multiple kind of plaque variant of centrofacial trichoblastoma.

Methods: Case series of patients with a multiple-plaque variant of centrofacial trichoblastoma treated in our department between 2005 and 2017. We identified eight patients with the centrofacial plaque variant of trichoblastoma treated in our department from 2005 to 2017.

Results: The final study sample comprised 13 trichoblastomas from four patients. All patients also developed at least one basal cell carcinoma. Mohs surgery was the method of treatment in the majority of the cases of trichoblastoma and in all the cases of basal cell carcinoma. We needed between 2 and 6 stages to obtain free margins in our cases of facial plaque trichoblastomas treated by Mohs surgery.

Conclusion: To the best of our knowledge, a multiple-plaque variant of trichoblastoma has not been described in the literature. We suggest a genetic origin of this variant of trichoblastoma and describe its remarkable infiltrative nature, with poorly defined surgical margins.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cup.13416DOI Listing
April 2019

Correction: Cutaneous melanoma primary site is linked to nevus density.

Oncotarget 2018 12 4;9(95):36816. Epub 2018 Dec 4.

Department of Dermatology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain.

[This corrects the article DOI: 10.18632/oncotarget.22016.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18632/oncotarget.26445DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298408PMC
December 2018
-->