EARLY DETECTION AND MANAGEMENT OF MELANOMA: A CASE REPORT
Keywords:
superficial spreading melanoma; dermoscopy; immunohistochemistry; early detection.
Abstract
Melanoma stands as the most lethal variant of skin malignancies. During its incipient stages, surgical intervention alone can yield successful treatment outcomes, resulting in high survival rates. However, once metastasis occurs, the survival rates substantially decline. In this case study, we present the journey of a 42-year-old woman with thalassemia minor and a benign breast nodule, highlighting the critical role of early detection and specialized medical care in securing the most favorable prognosis for patients. Upon presentation to the Dermatology department, a thorough evaluation unveiled a unique tumor formation on the patient’s skin, approximately 2.5 cm in diameter, with irregular margins. Importantly, the dermatoscopic examination showed a polymorphic appearance with atypical pigment network and central regression, findings that immediately raised concerns. Subsequent surgical excision, coupled with histopathological and immunohistochemical assessments, confirmed a superficial spreading melanoma with a Clark level IV invasion. The development of this malignancy has occurred concurrently with a preexisting intradermal melanocytic nevus. This study underscores the value of early detection and specialized medical intervention in melanoma cases, showcasing the transformative impact of timely medical attention on treatment outcomes and patient well-being.
References
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[2] H. Sung et al., "Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwde for 36 Cancers in 185 Countries," CA Cancer J Clin, vol. 71, no. 3, pp. 209-249, 2021. doi: 10.3322/caac.21660.
[3] U. Leiter and C. Garbe, "Epidemiology of melanoma and nonmelanoma skin cancer--the role of sunlight," Adv Exp Med Biol, vol. 624, pp. 89-103, 2008. doi: 10.1007/978-0-387-77574-6_8.
[4] D. S. Rigel, "Cutaneous ultraviolet exposure and its relationship to the development of skin cancer," J Am Acad Dermatol, vol. 58, no. 5 Suppl 2, pp. S129-32, 2008.
[5] H. Kittler et al., "Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy," J Am Acad Dermatol, vol. 74, no. 6, pp. 1093-1106, 2016. doi: 10.1016/j.jaad.2015.12.038.
[6] D. E. Elder et al., "The 2018 World Health Organization Classification of Cutaneous, Mucosal, and Uveal Melanoma: Detailed Analysis of 9 Distinct Subtypes Defined by Their Evolutionary Pathway," Arch Pathol Lab Med, vol. 144, no. 4, pp. 500-522, 2020. doi: 10.5858/arpa.2019-0561-RA.
[7] J. R. Marsden et al., "Revised U.K. guidelines for the management of cutaneous melanoma 2010," Br J Dermatol, vol. 163, no. 2, pp. 238-256, 2010. doi: 10.1111/j.1365-2133.2010.09883.x.
[8] M. A. Bobonich and M. E. Nolen, Dermatology for Advanced Practice Clinicians. LWW, 2015, pp. 94-112.
[9] U. Leiter, U. Keim, and C. Garbe, "Epidemiology of Skin Cancer: Update 2019," Adv Exp Med Biol, vol. 1268, pp. 123-139, 2020. doi: 10.1007/978-3-030-46227-7_6. PMID: 32918216.
[10] M. Bobos, "Histopathologic classification and prognostic factors of melanoma: a 2021 update," Ital J Dermatol Venerol, vol. 156, no. 3, pp. 300-321, 2021. doi: 10.23736/S2784-8671.21.06958-3.
[11] J. U. Bertrand et al., "Melanoma Risk and Melanocyte Biology," Acta Derm Venereol, vol. 100, no. 11, p. adv00139, Jun. 3, 2020. doi: 10.2340/00015555-3494.
[12] R. Darp and C. Ceol, "Making a melanoma: Molecular and cellular changes underlying melanoma initiation," Pigment Cell Melanoma Res, vol. 34, no. 2, pp. 280-287, 2021. doi: 10.1111/pcmr.12950.
[13] F. Tas and K. Erturk, "Acral Lentiginous Melanoma Is Associated with Certain Poor Prognostic Histopathological Factors but May Not be Correlated with Nodal Involvement, Recurrence, and a Worse Survival," Pathobiology, vol. 85, no. 4, pp. 227-231, 2018. doi: 10.1159/000488457.
[14] S. S. Bernardes et al., "More than just acral melanoma: the controversies of defining the disease," J Pathol Clin Res, vol. 7, no. 6, pp. 531-541, 2021. doi: 10.1002/cjp2.233.
[15] S. Kang et al., Fitzpatrick's Dermatology, 9th ed. McGraw Hill, 2019, pp. 1982-2017.
[16] N. G. Marghoob, K. Liopyris, and N. Jaimes, "Dermoscopy: A Review of the Structures That Facilitate Melanoma Detection," J Am Osteopath Assoc, vol. 119, no. 6, pp. 380-390, 2019. doi: 10.7556/jaoa.2019.067.
[17] D. S. Cassarino et al., Diagnostic Pathology: Neoplastic Dermatopathology, 2nd ed. Elsevier, 2016.
[18] D. C. Whiteman et al., "Melanocytic nevi, solar keratoses, and divergent pathways to cutaneous melanoma," J Natl Cancer Inst, vol. 95, no. 11, pp. 806-812, 2003. doi: 10.1093/jnci/95.11.806.
[19] A. H. Shain et al., "The Genetic Evolution of Melanoma from Precursor Lesions," N Engl J Med, vol. 373, no. 20, pp. 1926-1936, 2015. doi: 10.1056/NEJMoa1502583.
[20] S. E. Rose, G. Argenziano, and A. A. Marghoob, "Melanomas difficult to diagnose via dermoscopy," G Ital Dermatol Venereol, vol. 145, no. 1, pp. 111-126, 2010.
[21] G. Ferrara, "The Histopathological Gray Zone," in Cutaneous Melanoma: A Pocket Guide for Diagnosis and Management, A. Argenziano, A. Lallas, C. Longo, E. Moscarella, A. Kyrgidis, and G. Ferrara, Eds. London, UK: Academic Press, 2017.
[22] A. Breslow, "Thickness, cross-sectional areas and depth of invasion in the prognosis of cutaneous melanoma," Ann Surg, vol. 172, no. 5, pp. 902-908, 1970. doi: 10.1097/00000658-197011000-00017.
[23] M. B. Amin et al., Eds., AJCC Cancer Staging Manual, 8th ed. Springer, 2017.
24. J. E. Gershenwald et al., "Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual," CA Cancer J Clin, vol. 67, no. 6, pp. 472-492, 2017. doi: 10.3322/caac.21409.
[25] W. H. Clark Jr. et al., "The histogenesis and biologic behavior of primary human malignant melanomas of the skin," Cancer Res, vol. 29, no. 3, pp. 705-727, 1969.
[26] S. S. Koh and D. S. Cassarino, "Immunohistochemical Expression of p16 in Melanocytic Lesions: An Updated Review and Meta-analysis," Arch Pathol Lab Med, vol. 142, no. 7, pp. 815-828, 2018. doi: 10.5858/arpa.2017-0435-RA.
[27] C. Lezcano et al., "PRAME Expression in Melanocytic Tumors," Am J Surg Pathol, vol. 42, no. 11, pp. 1456-1465, 2018. doi: 10.1097/PAS.0000000000001134.
[28] G. Cazzato, "Histopathological Diagnosis of Malignant Melanoma at the Dawn of 2023: Knowledge Gained and New Challenges," Dermatopathology, vol. 10, no. 1, pp. 91-92, 2023. https://doi.org/10.3390/dermatopathology10010013.
[29] L. Ha, G. Merlino, and E. V. Sviderskaya, "Melanomagenesis: overcoming the barrier of melanocyte senescence," Cell Cycle, vol. 7, no. 13, pp. 1944-1948, 2008. doi: 10.4161/cc.7.13.6230.
[30] C. Fung, G. M. Pupo, R. A. Scolyer, R. F. Kefford, and H. Rizos, "p16(INK) (4a) deficiency promotes DNA hyper-replication and genetic instability in melanocytes," Pigment Cell Melanoma Res, vol. 26, no. 2, pp. 236-246, 2013. doi: 10.1111/pcmr.12062.
[31] A. Mohamed, R. S. Gonzalez, D. Lawson, J. Wang, and C. Cohen, "SOX10 expression in malignant melanoma, carcinoma, and normal tissues," Appl Immunohistochem Mol Morphol, vol. 21, no. 6, pp. 506-510, 2013. doi: 10.1097/PAI.0b013e318279bc0a.
[32] T. Ferringer, "Immunohistochemistry in dermatopathology," Arch Pathol Lab Med, vol. 139, no. 1, pp. 83-105, 2015. doi: 10.5858/arpa.2014-0075-RA.
[33] B. C. Willis, G. Johnson, J. Wang, and C. Cohen, "SOX10: a useful marker for identifying metastatic melanoma in sentinel lymph nodes," Appl Immunohistochem Mol Morphol, vol. 23, no. 2, pp. 109-112, 2015. doi: 10.1097/PAI.0000000000000097.
[34] N. Emiroglu, F. Pelin Cengiz, and R. Hofmann-Wellenhof, "Dermoscopic and clinical features of trunk melanomas," Postepy Dermatol Alergol, vol. 31, no. 6, pp. 362-367, 2014. doi: 10.5114/pdia.2014.47119.
[35] R. Dummer, A. Hauschild, M. Guggenheim, L. Jost, and G. Pentheroudakis; ESMO Guidelines Working Group, "Melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up," Ann Oncol, vol. 21, Suppl 5, pp. v194-v197, 2010. doi: 10.1093/annonc/mdq188.
[36] W. W. Dzwierzynski, "Managing malignant melanoma," Plast Reconstr Surg, vol. 132, no. 3, pp. 446e-460e, 2013. doi: 10.1097/PRS.0b013e31829ad411.
[37] D. M. Bello and M. B. Faries, "The Landmark Series: MSLT-1, MSLT-2 and DeCOG (Management of Lymph Nodes)," Ann Surg Oncol, vol. 27, no. 1, pp. 15-21, 2020. doi: 10.1245/s10434-019-07830-w.
[38] L. Kretschmer et al., "The sentinel node invasion level (SNIL) as a prognostic parameter in melanoma," Mod Pathol, vol. 34, no. 10, pp. 1839-1849, 2021. doi: 10.1038/s41379-021-00835-5.
[39] F. Sandru, R. C. Petca, M. Costescu, M. C. Dumitrașcu, A. Popa, A. Petca, and R. G. Miulescu, "Cutaneous Mastocytosis in Childhood-Update from the Literature," J Clin Med, vol. 10, no. 7, p. 1474, 2021. doi: 10.3390/jcm10071474.
[40] C. M. Balch, S. J. Soong, J. E. Gershenwald, et al., "Prognostic factors analysis of 17,600 melanoma patients: validation of the American Joint Committee on Cancer melanoma staging system," J Clin Oncol, vol. 19, no.16, pp. 3622-3634, 2001. doi: 10.1200/JCO.2001.19.16.3622.
Published
2024-01-21
How to Cite
Sandru, F., Petrescu, B., Dumitrascu, M., Petca, R., Radu, A., & Petca, A. (2024). EARLY DETECTION AND MANAGEMENT OF MELANOMA: A CASE REPORT. Romanian Journal of Clinical Research, 7(1). https://doi.org/10.33695/rjcr.v7i1.207
Section
Articles
