Malignant melanoma and granulomatosis

Abstract

Sarcoidosis or granulomatous reactions have rarely been reported in association with malignant melanoma (MM). We describe seven patients who presented with both granulomatous disease and MM, and discuss the physiopathological and prognostic significance of this association. In three patients, the granulomatosis was diagnosed as true sarcoidosis and in one patient, as tumour-associated granuloma. In three cases, designated here as atypical tumour-associated granulomatoses, the presence of clear-cut pulmonary granulomatous nodules was typical neither for sarcoidosis nor for tumour-associated granuloma and was highly suggestive of melanoma metastases. Mediastinal lymphadenopathy was present in every patient. In all seven patients, the question of mediastinal or pulmonary involvement or relapse of the MM was raised, but could be confirmed in only one patient. MM can be associated with granulomatous disease. Knowledge of this association has implications in the management of patients with MM.

Inflammatory cells in the formation of tumor-related sarcoid reactions

“…This distinction, however, has been taken not absolute by same authors [5], whereas others regard it as not helpful because ECGs negative for B cells are also observed in sarcoid reactions [22]. We found a few B cells especially within multiple and confluent ECGs even in sarcoidosis, probably intermingled by chance when the inflammation spread in B-cell areas of the affected lymph nodes.…”

“…Because epithelioid cells are not selectively recognized by CD68 or any other current marker in routinely processed tissues, our findings concerning a well-working mAb to denatured human ACE [37] are important. High amounts of ACE in ECGs and epithelioid cells of sarcoidosis are known for long [23,38], and elevated serum levels of ACE have been clinically used as a criterion to distinguish sarcoidosis from sarcoid reactions [4,13,22]. ACE expression in ECGs other than sarcoidosis is controversial [23,38,39], although there are former reports on increased enzyme activities also in tuberculosis, leprosy, berylliosis, silicosis, and foreign body reaction [39][40][41][42].…”

“…Sarcoid reactions appear as a natural model of a similar immune response, because ECGs usually form as a result of the persistence of a nondegradable product or as the result of DTH responses [20]. However, only few controversial studies have addressed the lymphocyte subtypes in ECGs and their relationship to sarcoidosis [3,5,21,22]. Moreover, dendritic cells and the developmental stage of ECGs have not been regarded so far.…”

BRAF Inhibitor–Induced Antitumoral Granulomatous Dermatitis Eruption in Advanced Melanoma

“…Granulomatous reactions have rarely been reported in association with malignant melanoma. 9,10 In 1 of 7 cases reported by Robert et al, 9 and in the case reported by Tsunoda et al, 10 the granulomas were true tumor-associated reactions rather than sarcoidosis or suggestive of melanoma metastases. The sarcoid nodules disappeared with the treatment of the primary disease by surgery and chemotherapy in the case reported by Tsunoda et al 10 In addition, 2 cases of granulomatous reactions have been reported in the setting of targeted BRAF therapy.…”

Nodal Peripheral T-cell Lymphoma with Secondary Granulomatous Cutaneous Involvement

“…In addition to lymphoproliferative disorders, development of granulomatous reaction has been observed in lung and breast carcinoma (7), as well as in malignant melanoma (9). In the skin, both formation of granulomas representing a non-specific reaction pattern and true sarcoidosis -cutaneous or extracutaneous -have been rarely reported in association with Hodgkin's disease and non-Hodgkin extracutaneous lymphomas (10).…”