Malignant melanoma appearing in a post‐mastectomy lymphedematous arm: A novel association of double primary tumors

Bartal, Arie H.; Pinsky, Carl M.

doi:10.1002/jso.2930300106

Cited by 31 publications

(12 citation statements)

References 8 publications

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“…Breast cancer and skin cancer. Twelve cases of tumors involving the skin and the breast in the same person have been described (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21); in particular, only two cases (11,12) presented the coexistence of squamous cell carcinoma and breast cancer, similarly to our case, which turns out to be the third case report documented since 1980. As discussed by Pastore et al (12), our patient presented a synchronism of a wide squamous cell carcinoma of the right breast synchronous to a right breast cancer.…”

Section: Review Of the Literaturesupporting

confidence: 72%

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Breast Cancer and Multiple Primary Malignant Tumors: Case Report and Review of the Literature

Luca

Frusone

Vergine

et al. 2019

In Vivo

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Multiple primary malignant neoplasms are multiple tumors with different pathogenetic origin. They may be synchronous or metachronous. The management of these conditions represents an interesting clinical scenario. A crucial aspect is the decision regarding which tumor to treat initially, and how to schedule further treatments according to individual tumor risk. This process involves a multidisciplinary physician team to ensure favorable outcomes. We describe a case report of a female patient affected by primary synchronous tumors of the breast and pectoral skin, which raised a series of diagnostic, etiological and therapeutic issues persuading us to carry out a critical review of the literature. Multiple primary malignant neoplasms (MPMNs), or multiple primary cancers, are defined as multiple tumors with different pathogenetic origin. The phenomenon of MPMN was first described by Billroth at the end of the 19th century (1) and since then several cases of double or even triple primary malignant neoplasms have been reported (1-3). Neoplasms can be synchronous or metachronous and may appear in a single organ or in multiple organs concurrently. According to Moertel (2), synchronous neoplasms are defined as those that occur within 6 months from the diagnosis of a previous malignant tumor, and metachronous neoplasms are defined as neoplasms that appear 6 months after the first diagnosed tumor (2). Despite many changes in the definition have been proposed, the diagnosis of MPMNs that is widely accepted is based on the criteria described by Warren and Gates (3). These criteria require that: (i) each tumor must have a clear picture and histological confirmation of malignancy; (ii) each tumor must be topographically distinct and separated by healthy mucosa (at least 2 cm of normal mucosa between two tumors of the same region); (iii) the lesions must be not metastases of each other (3). In this report, we describe our recent observation and treatment of a female patient affected by primary synchronous tumors of the breast and pectoral skin. This combination, to the best of our knowledge, has never been previously reported in the literature, and it raised a series of diagnostic, etiological and therapeutic issues persuading us to carry out a critical review of the literature.

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Section: Review Of the Literaturesupporting

confidence: 72%

“…Between 1980 and 2018 only 12 cases of MPMNs involving the breast gland or the skin have been described (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). Among these, only two (11,12) cases report the coexistence of breast and cutaneous squamous cell cancers (Table I).…”

Section: Discussionmentioning

confidence: 99%

Breast Cancer and Multiple Primary Malignant Tumors: Case Report and Review of the Literature

Luca

Frusone

Vergine

et al. 2019

In Vivo

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“…Since the lymphatic system controls important immunological functions, it is clear that, whatever the cause, inadequate lymph drainage of a given region makes it an immunologically vulnerable area, 1,2 i.e. a privileged site for a subsequent development of immunocompetencerelated diseases, such as tumours, infections, and immune disorders [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 2).…”

Section: Regional Chronic Lymphoedemamentioning

confidence: 99%

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

Ruocco¹,

Brunetti

Puca

et al. 2009

Acad Dermatol Venereol

206

275

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Systemic immunodeficiency is known to facilitate the onset of opportunistic infections, tumours and immune disorders in any district of the body. There are clinical events, such as chronic lymphoedema, herpetic infections, vaccinations and heterogeneous physical injuries which can selectively damage and immunologically mark the cutaneous district they act upon. After the causing event has disappeared, the affected district may appear clinically normal, but its immune behaviour is often compromised forever. An immunocompromised district becomes a site which is particularly susceptible to subsequent outbreaks of opportunistic infections, tumours and immune disorders confined to the district itself. In this review, there is an ample case-report collection of opportunistic disorders (infectious, neoplastic, immune) which appeared in immunocompromised districts. The cases have been grouped according to the clinical settings responsible for the local immune imbalance: regional chronic lymphoedema; herpes-infected sites, which feature the well-known Wolf's isotopic response; and otherwise damaged areas, comprising sites of vaccination, ionizing or UV radiation, thermal burns and traumas. Whatever the immunocompromising factor, a common denominator which facilitates the occurrence of tumours, infections and dysimmune reactions in an immunocompromised district may reside in locally hampered lymph drainage and/or locally altered neuromediator signalling. In fact, any obstacle to the normal trafficking of immunocompetent cells through lymphatic channels or any interference with the signals that the neuropeptides and neurotransmitters released by peripheral nerves send to cell membrane receptors of immunocompetent cells, can significantly alter the local immune response, thus paving the way for heterogeneous opportunistic disorders in the immunocompromised district.

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“…[1][2][3][4] In addition to drainage, lymphatics are an important pathway for immune cell trafficking (eg, lymphocytes, Langerhans cells, and macrophages), antigen delivery to the lymph node, and clearance of foreign antigens. 5,6 Complications of lymphedema include impaired limb function due to increased size, weight, and stiffness 2 ; recurrent bouts of cellulitis, 7 which exacerbate lymphedema and accelerate skin changes (elephantiasis) 4,8 ; and malignancies such as lymphangiosarcoma (Stewart-Treves Syndrome), 9 basal cell carcinoma, [10][11][12][13] squamous cell carcinoma, 13,14 lymphoma, 15,16 melanoma, 17,18 and Kaposi sarcoma. [19][20][21] The occurrence of multiple infections or malignancy in the setting of lymphedema is the suspected consequence of impaired local immune surveillance due to the disruption of trafficking of immunocompetent cells in the lymphedematous region.…”

Section: Introductionmentioning

confidence: 99%

Lymphangiectases Are Common Underlying Warts and in Normal Peritumoral Skin: Histologic Evidence of Decreased Immune Surveillance

Paul

2011

The American Journal of Dermatopathology

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Malignant melanoma appearing in a post‐mastectomy lymphedematous arm: A novel association of double primary tumors

Cited by 31 publications

References 8 publications

Breast Cancer and Multiple Primary Malignant Tumors: Case Report and Review of the Literature

Breast Cancer and Multiple Primary Malignant Tumors: Case Report and Review of the Literature

The immunocompromised district: a unifying concept for lymphoedematous, herpes‐infected and otherwise damaged sites

Lymphangiectases Are Common Underlying Warts and in Normal Peritumoral Skin: Histologic Evidence of Decreased Immune Surveillance

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