Malignant melanoma arising in a blue nevus with features of pilar neurocristic hamartoma

Pathy, Arun L.; Helm, Thomas N.; Elston, Dirk M.; Bergfeld, Wilma F.; Tuthill, Ralph J.

doi:10.1111/j.1600-0560.1993.tb00672.x

Cited by 85 publications

(56 citation statements)

References 21 publications

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“…Overall, there is a slight male preponderance described in the literature (56 lesions in males compared with 51 women)-in contrast to our findings (9 men to 15 women). The most common anatomic site for these lesions is the head and neck region in 52 cases, 4,5,7,11,13,[15][16][17][18][19][20][21]23,24,27,28,31,33,36,39,42,[46][47][48]51,53 followed by the trunk in 28 cases, 4,5,7,[11][12][13]16,18,25,32,34,35,38,43,45,50,52 the lower extremity in 11 cases, 4,7,13,14,26,30,33...…”

Section: Discussionmentioning

confidence: 99%

“…Regarding pathologic findings, the reported cases (in order of frequency) included malignant melanocytic proliferations mimicking a cellular blue nevus but lacking an identifiable benign component (in 38% of cases) 5,11,[13][14][15]18,20,25,28,30,33,36,47,49 or melanomas arising in association with a distinctive blue nevus component, including (a) cellular blue nevus (26%), 4,5,11,16,18,29,40,46,50,51,53 (b) common blue nevus (21%), 5,13,22,24,27,31,32,34,37,39,41,43,52 (c) both cellular and common blue nevus (13%), 12,16,21,23,35,38,44,45,48 (d) neurocristic hamartoma (1%) 42 and (e) nevus of Ota (1%). 17 In contrast, all of the cases in our series consisted of distinctly biphenotypic melanocytic proliferations (melanoma together with a benign blue nevus component).…”

Section: Discussionmentioning

confidence: 99%

“…Not every parameter is provided for each reported case in the literature and therefore, the figures represent cases for which the specific respective parameters were reported. (a) Provides a breakdown of the associated nevus component for our cases as well as those reported in the literature (n ¼ 108) 4,5,7, (b) Age (n ¼ 111), 4,5,7,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] (c) gender (n ¼ 131) 4,5,7,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] and (d) anatomic distribution (n ¼ 135) 4,5,7, for all cases.…”

Section: Discussionmentioning

confidence: 99%

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Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

et al. 2014

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Melanomas arising in association with blue nevi or mimicking cellular blue nevi comprise a relatively rare and heterogeneous group of melanomas. It remains controversial which prognostic indicators predictive of outcome in conventional cutaneous melanomas are applicable to this type of melanoma. Here, we describe the clinical and histopathologic features of 24 melanomas arising in association with blue nevi and correlate these with clinical outcome. The mean patient age was 49 years (range: 23-85) with a slight female predominance (15 females:9 males). The most common anatomic locations included the head and neck region (50%), the trunk (21%), and the buttock/sacrococcygeum (17%). Histologically, the tumors were typically situated in the mid to deep dermis with variable involvement of the subcutis, but uniformly lacked a prominent intraepithelial component. The mean tumor thickness (defined as either the standard Breslow thickness or, if not available due to the lack of orientation or lack of epidermis, the largest tumor dimension) was 20.9 mm (range: 0.6-130 mm). The mean mitotic figure count was 6.5/mm 2 (range: 1-30/mm 2 ). Perineural invasion was common (38%). Followup was available for 21 cases (median 2.1 years). The median overall survival, recurrence-free survival, time to local recurrence, and time to distant recurrence were 5.2, 0.7, 2.6, and 1.6 years, respectively. Logistic regression analyses demonstrated a significant association between tumor thickness and recurrence-free survival (hazard ratio ¼ 1.02 per mm; P ¼ 0.04) and reduced time to distant metastasis (hazard ratio ¼ 1.03 per mm; P ¼ 0.02) with a similar trend toward reduced time to local recurrence (hazard ratio ¼ 1.02 per mm; P ¼ 0.07). No other parameters (age, anatomic location, mitotic figures, lymphovascular or perineural invasion, or type of associated blue nevus) emerged as significant. In addition, we provide a comprehensive review of 109 cases of melanoma blue nevus type described in the English literature and summarize our findings in this context.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

et al. 2014

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“…71 There is one case report where metastasis to a regional lymph node occurred without widespread dissemination, another case report describing a local cutaneous metastasis 1 year after excision, 65 and a third case report of a patient who developed widespread metastatic disease. 73 Animal-type melanoma manifests a common theme, namely, a tumorous proliferation of melanocytes with striking pigment synthesis. The differential diagnosis encompasses benign cellular pigment-synthesizing melanocytic tumors, but there is sufficient distinctiveness to the histomorphology and to the biological behavior to preclude other diagnoses such as cellular blue nevus or deeppenetrating nevus.…”

Section: Introductionmentioning

confidence: 99%

Unusual variants of malignant melanoma

2006

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A potential diagnostic pitfall in the histologic assessment of melanoma is the inability to recognize unusual melanoma variants. Of these, the more treacherous examples include the desmoplastic melanoma, the nevoid melanoma, the so-called 'minimal-deviation melanoma,' melanoma with prominent pigment synthesis or 'animal-type melanoma,' and the malignant blue nevus. Also problematic are the unusual phenotypic profiles seen in vertical growth phase melanomas; these include those tumors whose morphological peculiarities mimic cancers of nonmelanocytic lineage and those melanomas that express aberrant antigenic profiles not commonly associated with a melanocytic histogenesis. Metaplastic change in melanoma, balloon cell melanoma, signet-ring cell melanoma, myxoid melanoma, small cell melanoma and rhabdoid melanoma all have the potential to mimic metastatic and primary neoplasms of different lineage derivations. Abnormal immunohistochemical expression of CD 34, cytokeratins, epithelial membrane antigen, and smooth muscle markers as well as the deficient expression of S100 protein and melanocyte lineage-specific markers such as GP100 protein (ie HMB-45 antibody) and A103 (ie Melan-A) also present confusing diagnostic challenges. In this review, we will discuss in some detail certain of these novel clinicopathologic types of melanoma, as well as the abnormal phenotypic expressions seen in vertical growth phase melanoma. Modern Pathology (2006) 19, S41-S70. doi:10.1038/modpathol.3800516Keywords: melanoma; variants; phenotype; immunohistochemistry; morphology Desmoplastic melanoma Introduction and Clinical FeaturesDemoplastic melanoma is a rare variant of malignant melanoma first recognized in 1971.1 Desmoplastic and neurotropic melanoma may be mistaken clinically for a scar, a fibroma, a basal cell carcinoma, or a fibromatosis. Sometimes there is pronounced mucin deposition that imparts a boggy quality to the lesion. 2,3 The clinical clue to the diagnosis, when present, is cutaneous or mucosal pigmentation overlying a palpable dermal or submucosal nodule. That said, only half of desmoplastic melanomas are clinically pigmented. 3 Desmoplastic melanomas tend to occur in the head and neck area and the upper back [4][5][6][7] but are also seen in mucosal sites such as the vulva or gingiva 8 and in acral locations. Typically, they occur in older patients, with mean ages in the larger series falling into the sixth to eighth decades of life. 4,6,[9][10][11][12][13][14][15] Larger series show a male preponderance of 1.75 to 1. 15 Although any given desmoplastic melanoma can be deeply invasive, when matched for depth of invasion, they are associated with a lesser risk of metastatic disease than conventional melanomas of similar depth. The classical clinical finding is that of a pale or fleshy firm nodule reminiscent of a scar, which tends to delay clinical diagnosis and biopsy. Carlson et al,6 who reported an equal distribution in men and women, found most tumors to be located in the head and neck area (75%) and to be nonpigment...

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“…124 On occasion, these lesions give rise to a melanoma. 125,126 Histopathology The pilar neurocristic hamartoma manifests sheets of germinitive cells admixed with pigmented cells, with dendritic processes similar to the critical cell of the blue nevus of the dermal melanocytoses. Ultrastructurally, these can be shown to represent melanocytes, while other cells manifest Schwann cell features.…”

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confidence: 99%

Malignant adnexal neoplasms

2006

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Malignant cutaneous adnexal neoplasms are one of the most challenging areas of dermatopathology. Tumors of the pilosebaceous apparatus can occur as single-lineage neoplasms or may manifest as complex proliferations with multilineal differentiation patterns including not only the germinative component of the hair bulb, the inner or outer root sheath epithelium and the sebaceous gland and duct, but also the sweat duct components that relate to the apocrine secretory apparatus which empties into the follicle near the follicular bulge. Eccrine and apocrine neoplasms present a bewildering array of morphologies, which often defy precise classification. The purpose of this review is to discuss in detail the malignant neoplasms of the cutaneous adnexae and their benign and prognostically indeterminate mimics. Modern Pathology (2006) 19, S93-S126. doi:10.1038/modpathol.3800511Keywords: eccrine carcinoma; sebaceous neoplasia Malignant tumors of the pilosebaceous apparatus, their mimics and precursors IntroductionTumors of the pilosebaceous unit can occur in isolation or in combination with complex proliferations showing multilineal differentiation patterns encompassing those of sweat ducts, epidermis and stroma with its varied components. In this review, we will focus upon the malignant adnexal proliferations, considering benign entities mainly insofar as they impact the diagnostic approach to adnexal carcinoma. We will first turn to the malignant sebaceous neoplasms, their precursors and their mimics. Sebaceous adenoma Clinical FeaturesThe sebaceous adenoma is a benign neoplasm that manifests clinically as a pale yellow nodular lesion, typically of the face, that expresses itself clinically after the age of 50. Tumors range in size from o1 to 45 cm. [1][2][3][4][5][6] These lesions are associated with the Muir-Torre syndrome, comprising the coexpression of cutaneous neoplasms, including those of sebaceous type with well-differentiated squamous epithelial neoplasms, and visceral malignancies, including carcinomas of the breast, ovary, gastrointestinal tract and larynx. [7][8][9][10][11][12][13][14] An occasional patient may manifest a malignant lymphoma of nodal or extranodal type. 10,12,14 Sebaceous neoplasms in the setting of Muir-Torre syndrome are often difficult to classify, showing overlap features between all of the prototypic forms of sebaceous neoplasm ranging from hyperplasia to carcinoma. 13 HistologyThe prototypic sebaceous adenoma manifests 1-2 layers of germinitive cells which mature to form central sebocytes, and have an architecture comprising a sharply circumscribed sebaceous lobule surrounded by a compressed pseudocapsule of dermal stroma ( Figure 1a). The overlying epidermis may be attenuated, but sometimes forms a collarette around the peripheral aspect of the neoplasm. Unlike sebaceous hyperplasia, occasional mitoses may be seen in the lobules of a sebaceous adenoma and in concert with this nucleoli may be somewhat prominent, but the pleomorphism, hyperchromasia and individual cell necrosis of the se...

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Malignant melanoma arising in a blue nevus with features of pilar neurocristic hamartoma

Cited by 85 publications

References 21 publications

Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

Melanoma arising in association with blue nevus: a clinical and pathologic study of 24 cases and comprehensive review of the literature

Unusual variants of malignant melanoma

Malignant adnexal neoplasms

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