This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (8)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Dermatologic Disorders  • Neoplasms  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

Distinct Immunohistochemical Findings and Clinical Outcome Compared With Nodular and Metastatic Melanoma

David S. Cassarino, MD, PhD; Erik S. Cabral, BS; Reena V. Kartha, PhD; Susan M. Swetter, MD

Arch Dermatol. 2008;144(1):49-56.

Objective  To provide an updated and expanded analysis of clinical outcome and immunohistochemical (IHC) findings unique to primary dermal melanoma (PDM) that may be used to differentiate this entity from primary nodular melanoma (PNM) and cutaneous metastatic melanoma (MM).

Design  Cohort analysis and extensive IHC panel comparing PDM with PNM and cutaneous MM.

Setting  Melanoma clinics and pathology departments of academic and VA medical centers.

Patients  Thirteen patients with a solitary dermal or subcutaneous nodule of histologically proven melanoma, prospectively followed through April 30, 2007.

Interventions  Clinical, pathologic, and IHC assessment of patients diagnosed as having PDM.

Main Outcome Measures  Long-term clinical outcome and determination of unique clinical and IHC features in the study cohort compared with other melanoma subtypes.

Results  Histologically, there was no evidence of an overlying in situ component, ulceration, or regression, and there was no associated nevus in any cases. Clinical history and findings from workup, including imaging studies, skin examination, and sentinel lymph node biopsy, were negative for evidence of melanoma elsewhere. The mean Breslow depth was 9.6 mm. Two patients developed satellite or in-transit recurrences, 1 developed pulmonary metastasis, and another died of liver metastases. Overall, the cohort showed a 92% melanoma-specific survival rate at a mean duration of follow-up of 44 months. The IHC findings showed that PDM exhibited lower levels of staining for the antigens p53 (P = .02), Ki-67 (Mib-1) (P = .002), cyclin D1 (P = .001), and podoplanin (recognized by D2-40 antibody) lymphovascular staining (P <.001) compared with MM and PNM. All other markers were comparable.

Conclusions  Patients with PDM have remarkably prolonged survival compared with patients with MM or PNM of similar thickness. Preliminary results suggest that PDM may be characterized by lower levels of p53, Ki-67, cyclin D1, and D2-40 compared with histologically similar MM and PNM.

Author Affiliations: Departments of Pathology (Drs Cassarino and Kartha and Mr Cabral) and Dermatology (Drs Cassarino and Swetter), Stanford University Medical Center, Stanford, California; and Dermatology Service, Veterans Affairs Palo Alto Health Care System (Dr Swetter), Palo Alto, California. Dr Cassarino is now with the Department of Pathology, University of California, Los Angeles.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Immunohistochemical Studies of Atypical Conjunctival Melanocytic Nevi
Jakobiec et al.
Arch Ophthalmol 2009;127:970-980.
ABSTRACT | FULL TEXT  

Three Roots of Melanoma
Zalaudek et al.
Arch Dermatol 2008;144:1375-1379.
FULL TEXT  

More Evidence for a New Melanoma Paradigm
Helm and Helm
Arch Dermatol 2008;144:946-947.
FULL TEXT