Observational cross-sectional study comparing Breslow thickness of melanoma arising from naevi and melanomade novo

Abstract

mosaic layer can be visualized by the confocal microscope. In light microscopy, diagnostic difficulties are compensated by refocusing during the assessment and by evaluating additional paraffin sections.BCCs located in areas with sebaceous glands were more complicated to diagnose because sebaceous glands and nodular BCC showed similar structures in black-and-white images. One approach to this problem could be the staining of BCC cells with fluorophores as reported recently. 6,7,10 Technical problems are still time consuming and further investigation in the field of CLSM for micrographic surgery is certainly necessary. A larger field-of-view and matching stitch is required to accelerate the scanning of a complete specimen. In recent studies, some advances in instrumentation have been reported but have not yet been clinically validated. [5][6][7] To our knowledge, our study represents the largest CLSM series combined with micrographic surgery published to date. Our results showed a still unreliable association between histological and CLSM images. Further investigations are needed to apply this technology in routine micrographic surgery. However, large-area and high-quality mosaicing might revolutionize micrographic surgery of BCCs, as CLSM might provide a rapid way to analyse tumour excision margins. References1 Breuninger H, Schaumburg-Lever G. Control of excisional margins by conventional histopathological techniques in the treatment of skin tumours. An alternative to Mohs' technique. J Pathol 1988; 154:167-71. 2 Moehrle M, Dietz K, Garbe C et al. Conventional histology vs. three-dimensional histology in lentigo maligna melanoma. Br J Dermatol 2006; 154:453-9. 3 Moehrle M, Breuninger H, Rocken M. A confusing world: what to call histology of three-dimensional tumour margins? J Eur Acad Dermatol Venereol 2007; 21:591-5. 4 Möhrle M, Breuninger H. The Muffin technique -an alternative to Mohs' micrographic surgery. J Dtsch Dermatol Ges 2006; 4:1080-4. 5 Patel YG, Nehal KS, Aranda I et al. Confocal reflectance mosaicing of basal cell carcinomas in Mohs surgical skin excisions. J Biomed Opt 2007; 12:034027. 6 Gareau DS, Li Y, Huang B et al. Confocal mosaicing microscopy in Mohs skin excisions: feasibility of rapid surgical pathology. J Biomed Opt 2008; 13:054001. 7 Gareau DS, Patel YG, Li Y et al. Confocal mosaicing microscopy in skin excisions: a demonstration of rapid surgical pathology. J Microsc 2009; 233:149-59. 8 Chung VQ, Dwyer PJ, Nehal KS et al. Use of ex vivo confocal scanning laser microscopy during Mohs surgery for nonmelanoma skin cancers. Dermatol Surg 2004; 30:1470-8. 9 Horn M, Gerger A, Koller S et al. The use of confocal laser-scanning microscopy in microsurgery for invasive squamous cell carcinoma. Br J Dermatol 2007; 156:81-4. 10 Al-Arashi MY, Salomatina E, Yaroslavsky AN. Multimodal confocal microscopy for diagnosing nonmelanoma skin cancers. Lasers Surg Med 2007; 39:696-705. 6 Weatherhead SC, Haniffa M, Lawrence CM. Melanomas arising from naevi and de novo melanomas-does origin matter? Br J Dermato...

Observational study on the mitotic rate and other prognostic factors in cutaneous primary melanoma arising from naevi and from melanoma de novo

“…4,6 When the anamnestic record was used, a thicker Breslow's thickness in MA-N was observed, 2 but another report using the same method stated no significant differences in thickness between MN-A and M de novo. 17 Our observations confirmed the assumption that it is not possible to define a better or a worse prognosis for MN-A based on Breslow's index. The most recent AJCC guidelines included MR and then ulceration as a significant predictors of prognosis, 9 especially in patients with thinner melanomas.…”

“…Using the histologic evidence of a pre‐existing naevus, different reports claimed an association with a better prognosis . When the anamnestic record was used, a thicker Breslow's thickness in MA‐N was observed, but another report using the same method stated no significant differences in thickness between MN‐A and M de novo . Our observations confirmed the assumption that it is not possible to define a better or a worse prognosis for MN‐A based on Breslow's index.…”

Modelling melanoma in mice

“…It estimated that about 25–50% of melanomas arise from pre‐existing naevi (Bevona et al., 2003; Garcia‐Cruz et al., 2009), depending upon whether this is determined histopathologically (naeval remnants associated with lesions), by following the lesion in vivo over time dermoscopically or through the patient’s own recall of a pre‐existing lesion (not to be heavily relied on as the pre‐existing lesion may already been a melanoma). Most melanoma subtypes can arise from naevi, although rarely in the case of lentigo and acral melanoma (Garcia‐Cruz et al., 2009). However, the majority of melanomas probably arise de novo from normal skin.…”

Melanoma Arising in a Pre-Existent Nevus

“…6). In the literature, remnants of a nevus are found in sections from a melanoma in a very broad range, from 4.7 to 50% (Garcia-Cruz et al 2009). We will discuss the diffi culties involved in evaluating this in the section on histopathology.…”