Is melanocyte density our last hope? Comparison of histologic features of photodamaged skin and melanoma in situ after staged surgical excision with concurrent scouting biopsies.
atypical junctional melanocytic hyperplasia
lentigo maligna
melanoma in situ
scouting biopsy
slow Mohs
staged excision
Journal
Journal of cutaneous pathology
ISSN: 1600-0560
Titre abrégé: J Cutan Pathol
Pays: United States
ID NLM: 0425124
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
18
06
2018
revised:
01
03
2019
accepted:
08
03
2019
pubmed:
25
3
2019
medline:
14
2
2020
entrez:
24
3
2019
Statut:
ppublish
Résumé
Differentiating melanocytic hyperplasia (MH) on photodamaged skin from junctional lentiginous melanocytic proliferations (JLMP), early evolving melanoma in situ (MIS), or the periphery of a lesion of MIS on staged excision can be challenging. Although previous cross-sectional studies have elucidated important criteria for distinguishing MH on photodamaged skin from more concerning lesions, this study highlights a technique to treat JLMP and MIS with staged mapped excision and baseline scouting biopsies of adjacent nonlesional photodamaged skin to assist in determination of surgical margin clearance. Additionally, we compare the lesional and photodamaged control biopsies from the same patient to evaluate relevant histologic criteria that may be used to distinguish MH in photodamaged skin from JLMP/MIS, while minimizing confounding factors. There was a statistically significant difference (P ≤ 0.05) found for melanocyte density, irregular melanocyte distribution, melanocyte clustering, follicular infundibulum involvement, and nesting. However, criteria such as nesting, epithelioid cells and melanocyte clustering were seen in both photodamaged skin and MIS. These findings underscore the fact that histologic features of photodamaged skin can overlap with the histopathological features of MIS. Of all of the criteria evaluated, melanocytic density was the most objective histologic criterion and did not show overlap between the sun-damaged and JLMP/MIS groups.
Types de publication
Clinical Trial
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
555-562Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
Tzellos T, Kyrgidis A, Mocellin S, Chan AW, Pilati P, Apalla Z. Interventions for melanoma in situ, including lentigo maligna. Cochrane Database Syst Rev. 2014;12:CD010308. https://doi.org/10.1002/14651858.CD010308.pub2.
Hendi A, Wada DA, Jacobs MA, et al. Melanocytes in nonlesional sun-exposed skin: a multicenter comparative study. J Am Acad Dermatol. 2011;65(6):1186-1193.
Bowen AR, Thacker BN, Goldgar DE, Bowen GM. Immunohistochemical staining with Melan-a of uninvolved sun-damaged skin shows features characteristic of lentigo maligna. Dermatol Surg. 2011;37(5):657-663.
Kamino H, Ackerman AB. Malignant melanoma in situ: the evolution of malignant melanoma within the epidermis. In: Ackerman AB, ed. Pathology of Malignant Melanoma. New York, NY: Masson; 1981:59-91.
Nosrati A, Berlinger JG, Goel S, et al. Outcomes of melanoma in situ treated with Mohs micrographic surgery compared with wide local excision. JAMA Dermatol. 2017;153(5):436-441. https://doi.org/10.1001/jamadermatol.2016.6138.
Abdelmalek M, Loosemore MP, Hurt MA, Hruza G. Geometric staged excision for the treatment of lentigo maligna and lentigo maligna melanoma: a long-term experience with literature review. Arch Dermatol. 2012;148(5):599-604. https://doi.org/10.1001/archdermatol.2011.2155.
Moyer JS, Rudy S, Boonstra PS, et al. Efficacy of staged excision with permanent section margin control for cutaneous head and neck melanoma. JAMA Dermatol. 2017;153(3):282-288. https://doi.org/10.1001/jamadermatol.2016.4603.
Shoo BA, Sagebiel RW, Kashani-Sabet M. Discordance in the histopathologic diagnosis of melanoma at a melanoma referral center. J Am Acad Dermatol. 2010;62(5):751-756. https://doi.org/10.1016/j.jaad.2009.09.043.
Gerami P, Busam K, Cochran A, et al. Histomorphologic assessment and interobserver diagnostic reproducibility of atypical spitzoid melanocytic neoplasms with long-term follow-up. Am J Surg Pathol. 2014;38(7):934-940. https://doi.org/10.1097/PAS.0000000000000198.
Duncan LM, Berwick M, Bruijn JA, Byers HR, Mihm MC, Barnhill RL. Histopathologic recognition and grading of dysplastic melanocytic nevi: an interobserver agreement study. J Invest Dermatol. 1993;100(3):S318-S321.
Nobre AB, Piñeiro-Maceira J, Luiz RR. Analysis of interobserver reproducibility in grading histological patterns of dysplastic nevi. An Bras Dermatol. 2013;88(1):23-31. https://doi.org/10.1590/S0365-05962013000100002.
Welch HG, Woloshin S, Schwartz LM. Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ. 2005;331(7515):481. https://doi.org/10.1136/bmj.38516.649537.E0.
Swerlick RA, Chen S. The melanoma epidemic. Is increased surveillance the solution or the problem? Arch Dermatol. 1996;132(8):881-884. https://doi.org/10.1001/archderm.1996.03890320029004.
Ackerman AB, Briggs PL, Bravo F. Differential Diagnosis in Dermatopathology III. Philadelphia, PA: Lea & Febiger; 1993:166-169.
Smolle J, Soyer HP, Juettner FM, Hoedl S, Kerl H. Nuclear parameters in the superficial and deep portion of melanocytic lesions: a morphometrical investigation. Pathol Res Pract. 1988;183(3):266-270.
Boivin C, Thomine E, Menard JF, Bigorgne C, Hemet J. Morphometric analysis of melanocytic tumors. A study of nuclear area and density. Am J Dermatopathol. 1994;16(2):145-149.
Björnhagen V, Bonfoco E, Brahme EM, Lincoln J, Auer G. Morphometric, DNA, and proliferating cell nuclear antigen measurements in benign melanocytic lesions and cutaneous malignant melanoma. Am J Dermatopathol. 1994;16(6):615-623.
Smolle J, Soyer HP, Kerl H. Proliferative activity of cutaneous melanocytic tumors defined by Ki-67 monoclonal antibody. A quantitative immunohistochemical study. Am J Dermatopathol. 1989;11(4):301-307. https://doi.org/10.1097/00000372-198908000-00002.
Fogt F, Vortmeyer AO, Tahan SR. Nucleolar organizer regions (AgNOR) and Ki-67 immunoreactivity in cutaneous melanocytic lesions. Am J Dermatopathol. 1995;17(1):12-17.
Tokuda Y, Mukai K, Matsuno Y, et al. Proliferative activity of cutaneous melanocytic neoplasms defined by a proliferative cell nuclear labelling index. Arch Dermatol Res. 1992;284(6):319-323.
Robinson JK. Margin control for lentigo maligna. J Am Acad Dermatol. 1994;31(1):79-85.
Weyers W, Bonczkowitz M, Weyers I, Bittinger A, Schill WB. Melanoma in situ versus melanocytic hyperplasia in sun-damaged skin. Assessment of the significance of histopathologic criteria for differential diagnosis. Am J Dermatopathol. 1996;18(6):560-566.
Hendi A, Brodland DG, Zitelli JA. Melanocytes in long-standing sun-exposed skin: quantitative analysis using the MART-1 immunostain. Arch Dermatol. 2006;142(7):871-876.
Black WH, Thareja SK, Blake BP, Chen R, Cherpelis BS, Glass LF. Distinction of melanoma in situ from solar lentigo on sun-damaged skin using morphometrics and MiTF immunohistochemistry. Am J Dermatopathol. 2011;33(6):573-578.
Christensen KN, Hochwalt PC, Hocker TL, et al. Comparison of MiTF and Melan-A immunohistochemistry during Mohs surgery for lentigo maligna-type melanoma in situ and lentigo maligna melanoma. Dermatol Surg. 2016;42(2):167-175.
Beltraminelli H, Shabrawi-Caelen LE, Kerl H, Cerroni L. Melan-A-positive "pseudomelanocytic nests": a pitfall in the histopathologic and immunohistochemical diagnosis of pigmented lesions on sun-damaged skin. Am J Dermatopathol. 2009;31(3):305-308.
Ordóñez NG. Value of SOX10 immunostaining in tumor diagnosis. Adv Anat Pathol. 2013;20(4):275-283.
Mutasim D. What is atypical junctional melanocytic hyperplasia? Practical Skin Pathology. Switzerland: Springer International Publishing; 2015:3-6.
Gilchrest BA, Blog FB, Szabo G. Effects of aging and chronic sun exposure on melanocytes in human skin. J Invest Dermatol. 1979;73(2):141-143.
Botella-Estrada R, Sanmartín O, Sevila A, Escudero A, Guillén C. Melanotic pigmentation in excision scars of melanocytic and non-melanocytic skin tumors. J Cutan Pathol. 1999;26(3):137-144.
Barlow JO, Maize JSr, Lang PG. The density and distribution of melanocytes adjacent to melanoma and nonmelanoma skin cancers. Dermatol Surg. 2007;33(2):199-207.
Bricca GM, Brodland DG, Zitelli JA. Immunostaining melanoma frozen sections: the 1-hour protocol. Dermatol Surg. 2004;30(3):403-408.
Weinstein D, Leininger J, Hamby C, Safai B. Diagnostic and prognostic biomarkers in melanoma. J Clin Aesthet Dermatol. 2014;7:13-24.
Maize JC, JSJr R, Shapiro PE, McCalmont TH, LeBoit PE. Ducking stray “magic bullets”: a Melan-A alert. Am J Dermatopathol. 2003;25:162-165.
Nybakken GE, Sargen M, Abraham R, Zhang PJ, Ming M, Xu X. MiTF accurately highlights epidermal melanocytes in atypical intraepidermal melanocytic proliferations. Am J Dermatopathol. 2013;35(1):25-29.
North JP, Kageshita T, Pinkel D, LeBoit PE, Bastian BC. Distribution and significance of occult intraepidermal tumor cells surrounding primary melanoma. J Invest Dermatol. 2008;128(8):2024-2030.
Gorman M, Khan MA, Johnson PC, Hart A, Mathew B. A model for lentigo maligna recurrence using melanocyte count as a predictive marker based upon logistic regression analysis of a blinded retrospective review. J Plast Reconstr Aesthet Surg. 2014;67(10):1322-1332.
Flores S, Luby NJ, Bowen GM. Comparison of melanocyte density counts in topical imiquimod-treated skin surrounding lentigo maligna vs control biopsy specimens. JAMA Dermatol. 2018;154(4):482-484.
Katz SK, Guitart J. Starburst giant cells in benign nevomelanocytic lesions. J Am Acad Dermatol. 1998;38(2 Pt 1):283.
Madden K, Forman SB, Elston D. Quantification of melanocytes in sun-damaged skin. J Am Acad Dermatol. 2011;64(3):548-552.