Dermoscopic features and management strategy of a 10-year history acral lentiginous melanoma in a 55-year-old Filipino

Introduction@#Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians that is not associated with ultraviolet radiation (UV) exposure. Dermoscopy enables clinicians to distinguish between benign and malignant acral melanocytic lesions, with some dermoscopic characteristics playing a role in staging and have prognostic implications, which allows for appropriate surgical intervention. The difficulty of making an early diagnosis of ALM is highlighted by this case. ALM’s destructive nature, alongside the patient’s lack of awareness and vigilance, and healthcare access inequality, influences its prognosis. @*Case Report@#This is a case of a long-standing acral lentiginous melanoma with no palpable lymphadenopathies in which it was not immediately detected through biopsy. Upon detection, wide excision with 2 cm margins and disarticulation of the 5th digit of the right foot reconstructed with a fasciocutaneous advancement flap with split thickness skin graft, grafted from the right anterior thigh was done.

Human leukocyte antigen Class II alleles associated with acral lentiginous melanoma in Mexican Mestizo patients: A case-control study

Background: Melanoma is an aggressive cutaneous cancer. Acral lentiginous melanoma is a melanoma subtype arising on palms, soles, and nail-units. The incidence, prevalence and prognosis differ among populations. The link between expression of major histocompatibility complex Class II alleles and melanoma progression is known. However, available studies report variable results regarding the association of melanoma with specific HLA Class II loci. Aims: The aim of the study was to determine HLA Class II allele frequencies in acral lentiginous melanoma patients and healthy Mexican Mestizo individuals. Methods: Eighteen patients with acral lentiginous melanoma and 99 healthy controls were recruited. HLA Class II typing was performed based on the sequence-specific oligonucleotide method. Results: Three alleles were associated with increased susceptibility to develop acral lentiginous melanoma, namely: HLA-DRB1*13:01; pC = 0.02, odds ratio = 6.1, IC95% = 1.4–25.5, HLA-DQA1*01:03; pC = 0.001, odds ratio = 9.3, IC95% = 2.7–31.3 and HLA-DQB1*02:02; pC = 0.01, odds ratio = 3.7, IC95% = 1.4–10.3. Limitations: The small sample size was a major limitation, although it included all acral lentiginous melanoma patients seen at the dermatology department of Dr. Manuel Gea González General Hospital during the study period. Conclusion: HLA-DRB1*13:01, HLA-DQB1*02:02 and HLA-DQA*01:03 alleles are associated with increased susceptibility to develop acral lentiginous melanoma in Mexican Mestizo patients.

Analysis of prognostic factors for acral lentiginous melanoma based on SEER database / 中华皮肤科杂志

Objective:To investigate prognostic factors for acral lentiginous melanoma (ALM) , and to construct a nomogram to verify the predictive value of these factors.Methods:Clinical data on 1 573 patients with ALM were collected from the Surveillance, Epidemiology, and End Results (SEER) database of National Cancer Institute in United States between 2004 and 2015. Data about patients′ age, gender, ulcer status, SEER staging, surgical protocols, T-, N- and M-staging, overall survival rates and disease-specific survival rates were extracted. Chi-square test was used to analyze the correlation of clinical characteristics with overall survival rates and melanoma-specific survival rates, and univariate and multivariate Cox proportional hazards regression models were used to investigate prognostic factors and establish predictive models.Results:Among the 1 537 patients with ALM, 714 were males, 823 were females, 818 were under 64 years of age, and 1 363 were Caucasian. Skin lesions occurred on the lower limbs and buttocks in 1 205 cases, and 974 cases had ulcers; according to the SEER staging, non-spread localized skin lesions were observed in 1 048 cases. There were significant differences in the mortality rate among patients of different ages at diagnosis, different gender, with different ulcer status, surgical status, and at different SEER stages, T-stages, N-stages and M-stages (all P < 0.001) . Univariate and multivariate Cox regression analysis showed that age ≥ 65 years, male, ulcers and distant lymph node metastasis in the SEER staging were associated with increased risk of death in the patients (all P < 0.05) , and the mortality rate was significantly higher in the patients with T2-, T3- or T4-stage ALM than in those with T1-stage ALM (all P < 0.05) , and higher in the patients with N1-, N2- and N3-stage ALM than in those with N0-stage ALM (all P < 0.05) . Conclusion:Age, gender, ulcer status, SEER stage, T-stage and N-stage are independent prognostic factors for overall survival rates and disease-specific survival rates of ALM.

Melanoma Lentiginoso Acral Revisión Narrativa de uno de los Melanomas más Frecuentes en América Latina / Acral lentiginous melanoma: Review of one of the most frequent melanomas in Latin America

Resumen El melanoma es el cáncer de piel con mayor tasa de mortalidad a nivel mundial. Se han descrito 4 subtipos principales de melanoma cutáneo: el melanoma de extensión superficial, el melanoma nodular, el léntigo maligno y el melanoma lentiginoso acral. Existen diferencias raciales y geográficas en la distribución y frecuencia de estos subtipos. En caucásicos, el riesgo es mayor para melanomas de piel expuesta a radiación UV, ya sea de forma crónica o intermitente. En contraste, en asiáticos, afroamericanos e hispanos, la tendencia es mayor en sitios anatómicos no expuestos (palmas y plantas), encabezando el melanoma lentiginoso acral en una proporción mayor. Usualmente, este melanoma se diagnostica de manera tardía y en estadios avanzados, por cual se asocia con un peor pronóstico. La presente revisión pretende brindar una visión general sobre el conocimiento del melanoma lentiginoso acral, describiendo aspectos como la epidemiología, los factores de riesgo asociados, las características genéticas y los factores pronósticos.

Abstract Melanoma is the cutaneous cancer with the highest mortality worldwide. Four main subtypes of cutaneous melanoma have been described: superficial spreading melanoma, nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. There are racial and geographical differences in the distribution and frequency of these subtypes. In Caucasians, the risk is higher to develop melanoma on skin exposed to UV radiation, either chronically or intermittently. In contrast, in Asians, African Americans, and Hispanics, there is a greater tendency towards unexposed anatomical sites (palms and soles), which is called acral lentiginous melanoma. This melanoma is usually diagnosed in advanced stages, and therefore has a worse prognosis. This review aims to provide an update on what is known about acral lentiginous melanoma, mainly describing its epidemiology, risk factors associated with genetic characteristics, and prognosis.

Increased Expression of Dickkopf-1 in Acral Lentiginous Melanoma / 대한피부과학회지

BACKGROUND: Dickkopf-1 (DKK-1), an inhibitor of the Wnt signaling pathway, is known as an inhibitor of melanocyte proliferation. In recent studies, the expression of DKK-1 gene is reduced in melanoma and they lose their preventive role during development or progression of melanoma. There are no available data regarding the changes in DKK-1 gene expression in acral lentiginous melanoma (ALM), which is common in Asians. OBJECTIVE: To analyze changes in DKK-1 expression in the development or progression of ALM in Koreans. METHODS: Immunohistochemical staining using DKK-1 antibody of 13 invasive ALM, six ALM in situ, nine acral nevi, and four benign non-related palmoplantar specimens as controls were evaluated by the semi-quantitative grading scale, which is divided into three distinctive grades according to the degree of cytoplasmic staining of DKK-1. RESULTS: Among the invasive ALM specimens, seven of 13 (53.8%) were graded as strongly positive (2+), and only one case (7.7%) was negative. In cases of ALM in situ, two specimens (33.3%) stained positive (1+) and the remaining four specimens (66.6%) were not stained. All specimens from both acral nevus and benign palmoplantar lesions, which were used as the control group, were also negative. CONCLUSION: In contrast with recent reports, DKK-1 expression showed a positive correlation with ALM progression or invasiveness. The role of DKK-1 as a potential predictor of ALM progression warrants further study.

Genética molecular del melanoma lentiginoso acral / Molecular genetics of acral lentiginous melanoma

En la última década se ha avanzado en la caracterización genética y mapeo molecular del melanoma cutáneo con el objetivo de identificar y comprender mejor los mecanismos patogénicos propios de cada subgrupo y así desarrollar tratamientos específicos. El melanoma lentiginoso acral (MLA) constituye un subtipo de melanoma con características clínicas, epidemiológicas, histopatológicas, pronósticas y terapéuticas distintivas y su perfil mutacional no es la excepción. A diferencia del melanoma ubicado en zonas fotoexpuestas, el MLA presenta una baja tasa de mutaciones BRAF (15%) y mayor frecuencia de amplificaciones y ganancias genéticas de KIT (15-30%), CCND1 (15-40%) y TERT (20%). En esta revisión se describen las características más relevantes del MLA con énfasis en el rol que cumplen los principales genes que participan en la patogenia del MLA.

Over the last decade, the genetic characterization and molecular mapping of cutaneous melanoma has been developed in order to identify and better understand the pathogenic mechanisms of each subgroup and to develop specific treatments. Acral lentiginous melanoma (ALM) is a melanoma subtype with distinctive clinical, epidemiological, histopathological, prognostic and therapeutic features and its mutational profile is not an exception. Unlike melanoma located in photoexposed areas, MLA has a low rate of BRAF mutations (15%) and a higher frequency of amplifications and genetic gains at KIT (15-30%), CCND1 (15-40%) and TERT (20%). In this review we will describe the most relevant characteristics of MLA with emphasis on the role of the main genes involved in its pathogenesis.

Acral Lentiginous Melanoma, Indolent Subtype Diagnosed by En Bloc Excision: A Case Report

Nail unit melanoma is a type of acral lentiginous melanoma and requires histopathologic examination for a confirmed diagnosis. However, inadequate biopsy techniques make definitive diagnosis difficult. A 61-year-old man presented with progressive nail pigmentation for 15 years, which was clinically highly suspicious for malignancy. Acral lentiginous melanoma was not detected in punch and longitudinal biopsy specimens, but en bloc excision tissue revealed melanoma. Acral lentiginous melanoma is known to have a heterogeneous pathologic manifestation depending on the pigmented region and the time it takes to progress. In this regard, en bloc excision can be considered as a first-line biopsy technique to diagnose acral lentiginous melanoma, indolent subtype.

Melanoma subungueal de la mano: reporte de un caso / Hand’s subungueal melanoma: A case report

El melanoma es considerado una neoplasia melanocítica maligna; la localización subungueal corresponde al 0.7-3.5% de todos los melanomas. Clínicamente se presenta como una melanoniquia en general asintomática. Comunicamos un paciente masculino de 67 años, que consulta por presentar melanoniquia estriada en el cuarto dedo de la mano izquierda. El estudio histopatológico de biopsia informa un melanoma acral, por lo que se procede a realizar resección completa de la lesión con amputación de la falange distal; el paciente evolucionó satisfactoriamente. Este melanoma se origina de la matriz ungular, aunque se ha propuesto la asociación con traumas, su etiología no está clara. Histológicamente, se caracteriza por una proliferación de melanocitos atípicos o fusiformes, con grados variables de invasión; algunas lesiones son pigmentadas y otras amelanóticas. Se debe establecer el diagnóstico diferencial con: hematomas, osteomielitis, onicomicosis, granuloma piógeno, paroniquia, enfermedad de Kaposi, carcinoma espinocelular, entre otras. Algunos factores pronósticos incluyen profundidad de invasión, índice mitótico, ulceración, índice de proliferación con Ki 67 para nombrar solo algunos factores del denominado “histopronóstico”. El retraso en el diagnóstico del melanoma subungueal condiciona un mal pronóstico. El tratamiento apunta hacia la intervención quirúrgica en estadios tempranos, con evaluación del ganglio centinela (esto varía según la escuela académica). Sin embargo, actualmente se hace referencia a nuevos fármacos, que modifican la respuesta inmune o que intervienen en el metabolismo celular, con lo que se dan los primeros pasos para modificar la historia natural de esta enfermedad.

Introduction: melanoma is considered a biologically aggressive neoplasm. It’s more common in the 6th decade. Subungual melanoma corresponding to 0.7-3.5% of all melanomas. The most common locations are hallux, thumb, index and ring. Clinically, it presents as an asymptomatic melanonychia. Case Report: male aged 67 who consulted for striated melanonychia fourth finger left hand. Biopsy histopathological study reports malignant melanoma. Complete resection of the lesion was performed with amputation of distal phalanx. Patient evolves satisfactorily. Discussion: this melanoma originates from the nail matrix. Although it has been proposed partnership with traumas, its etiology is unclear. Hasn’t been able to establish an association with race, skin type and sun exposure, as in other melanoma’s types. Histologically it is characterized by a proliferation of atypical melanocytes or fusiform with varying degrees of invasion. Some injuries are pigmented and others may be amelanotic. Should be established the differential diagnosis with hematomas, osteomyelitis, onychomycosis, pyogenic granuloma, paronychia, among other injuries. Some prognostic factors include depth of invasion, mitotic rat, ulceration, proliferation index among others. The delay in diagnosis of subungual melanoma determines a poor prognosis. The treatment aims to surgery in early stages, with evaluation of sentinel node. But now referred to new drugs that modify the immune response or that involve its cellular metabolism thus taking the first steps to modify the natural history of this disease.

Melanoma lentiginoso acral en una mujer suazí / Acral lentiginous melanoma in a suazi woman

Se presenta el caso clínico de una fémina de 58 años de edad, de raza negra, quien acudió a la consulta de Cirugía del Hospital Gubernamental de Mbabane en Suazilandia por presentar una lesión pigmentada y ulcerada en el talón del pie derecho, donde se le practicó una biopsia por escisión cuyo resultado fue un melanoma lentiginoso acral invasivo. Posteriormente fue evaluada en la consulta de Oncología y luego de realizarle los exámenes complementarios necesarios, la neoplasia se clasificó en estadio IIC. La paciente fue remitida a Sudáfrica para recibir tratamiento con citosinas inmunomoduladoras, factor estimulante de colonias de granulocitos y macrófagos o inhibidores del gen BRAF.

The case report of a 58 years black woman is presented. She went to the Surgery Service of Mbabane Government Hospital in Suaziland due to a pigmented and ulcerated injury in her right foot heel, where she had an excisional biopsy whose result was an invasive acral lentiginous melanoma. Later on she was evaluated in the Oncology Service and after carrying out the necessary complementary tests, the neoplasm was classified in stage IIC. The patient was referred to South Africa to receive treatment with immunomodulatory cytokines, stimulating factor of granulocytes and macrophages colonies or BRAF gene inhibitors.

Melanoma lentiginoso acral en una paciente adulta / Acral lentiginous melanoma in an adult patient

Se presenta el caso clínico de una paciente ecuatoriana de 58 años, blanca, con antecedentes de hernias discales en regiones cervical y lumbar, quien hace 2 años asistió a la Consulta de Dermatología por presentar cambio de coloración en la uña del tercer dedo de la mano derecha, síntomas que se correspondían con un lentigo simple. En esta ocasión acude con destrucción de la lámina ungueal y aumento de la coloración que se extiende a todo el pulpejo del dedo, por lo cual se le realizó otra biopsia y se confirmó el diagnóstico histológico de melanoma lentiginoso acral (in situ).

The case report of a 58 years white patient is presented with a history of disk herniation in cervical and lumbar regions, who 2 years ago attended the Dermatology Service due to a color change in the fingernail of the third finger of her right hand, symptoms that belonged to a lentigo simplex. In this occasion she presented destruction of the ungueal bed and increase of color which covers the whole fingertip, so another biopsy was carried out and the histological diagnosis of acral lentiginous melanoma (in situ) was confirmed.

Prognostic and Clinicopathologic Associations of BRAF Mutation in Primary Acral Lentiginous Melanoma in Korean Patients: A Preliminary Study

BACKGROUND: In the majority of melanomas, the RAS/RAF/MEK/ERK signaling pathway is constitutively activated, due to oncogenic mutations in the BRAF and NRAS genes. The BRAF mutation has been mainly described in Caucasian melanomas. However, there is a lack of study evaluating the status, and the clinical significance, of BRAF mutation in the Asian population. OBJECTIVE: This study was aimed to determine the frequency of BRAF mutation, and to evaluate the correlation of BRAF status with clinicopathologic features and outcomes, in Korean primary acral lentiginous melanoma (ALM) patients. METHODS: ALM samples (n=36) were analyzed for the BRAF V600E mutation, by dual-priming oligonucleotide (DPO) based real-time polymerase chain reaction. The clinicopathologic features and prognosis of the patients were analyzed with BRAF mutation status. RESULTS: The incidence of BRAF V600E mutation was 19.4% (7/36). The BRAF V600E mutations were not associated with clinicopathologic features, except for the age factor. All of the BRAF-mutant patients survived without recurrence or metastasis, and have a better clinical outcome than BRAF wild-type patients. CONCLUSION: In Korean primary ALM, a low frequency of BRAF mutation was shown; and BRAF mutation presented with a favorable prognosis. These results indicate that other distinctive genetic mechanisms may have more important roles in the development and progression of disease. Further multicenter study with large sample size is firmly needed, to confirm the results of our preliminary study.

Acral Lentiginous Melanoma Developing during Long-standing Atypical Melanosis: Usefulness of Dermoscopy for Detection of Early Acral Melanoma

Clinical guidelines suggest that suspicious pigmented lesions of the plantar or palmar area require biopsy for early detection of acral melanoma. We present here a case of acral lentiginous melanoma in which various melanocytic atypia was observed at each biopsy site, including focal melanocytic proliferation. We suggest that this atypical melanosis is part of a contiguous phase of invasive tumor growth, which is known as the very early stage of melanoma in situ. In addition, noninvasive dermoscopy has been effective for the early discovery of hidden lesions of acral melanoma.

Acral Lentiginous Melanoma in situ / 대한피부과학회지

Acral lentiginous melanoma (ALM) is the most common subtype of melanoma in Asian countries including Korea. ALM was considered more aggressive than other subtypes, but recent reports suggest that it was because of late detection or delayed diagnosis, rather than a true biological difference. Therefore, early diagnosis of ALM is important for a better prognosis but its diagnosis is not always easy. There are scarce reports upon ALM in situ, probably due to its rarity and diagnostic difficulty, which makes in depth understanding and proper management of ALM in situ complicated. Therefore, we have reviewed our experience for twenty years with acral pigmented lesions showing intraepidermal proliferation of melanocytes which was diagnosed or suspected as ALM in situ.

Progression from Acral Lentiginous Melanoma in situ to Invasive Acral Lentiginous Melanoma

Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians. The very early stage of ALM demonstrates only a proliferation of a few atypical melanocytes within the epidermis, and has been termed ALM in situ. A 74-year-old male patient presented with a pigmented lesion on the left great toe for 12 years, which had initially showed only a few scattered hyperplastic atypical melanocytes without dermal invasion upon biopsy 5 years ago. This time however, rebiopsy of the lesion confirmed a diagnosis of ALM, stage IIIB. It could be inferred that the lesion had slowly progressed from ALM in situ to invasive ALM over a period of 12 years. Herein we report a case of ALM in situ which progressed to invasive ALM over a long period of time. We expect this report may assist physicians in early recognition and proper management of future cases of ALM in situ.

Melanoma lentiginoso acral: una variante de melanoma maligno de especial interés en Colombia / Acral lentiginous melanoma: a variant of malignant melanoma of special interest in Colombia

El melanoma lentiginoso acral (MLA) es una variante rápidamente progresiva del melanoma maligno (MM). Constituye el 5-10% de los MM y se presenta con mayor frecuencia en pacientes de raza negra, asiáticos y latinoamericanos. En Colombia, la frecuencia de MM se encuentra en aumento y el MLA es una de las variantes más comunes (14,7% de todos los melanomas). La edad promedio de presentación es de 58 años, con una tasa de supervivencia menor para las personas de raza negra, asociada al diagnóstico tardío. EL MLA se localiza en las plantas, palmas y regiones subungueales y en su etiopatología se ha descrito la presencia de mutaciones en varios genes: 9p21 p16: (67%), 11q13 (CCND1) (47%), 22q11-q13 (40%) y 5p15 (20%). El diagnóstico de MLA se ha fundamentado clásicamente en la histopatología; sin embargo, otros métodos como la dermatoscopia, la evaluación del ganglio centinela y la detección de alteraciones en las proteínas del ciclo celular pueden contribuir al diagnóstico precoz y a mejorar el pronóstico tanto del MLA como del MM en general.

Acral lentiginous melanoma (ALM) is a rapidly progressive variant of malignant melanoma (MM). It constitutes 5-10% of all cases of MM and its prevalence is higher in blacks, Asians and Latin Americans. In Colombia, the incidence of MM is increasing and ALM is one of its most common variants (14.7% of all melanoma cases). The mean age at presentation of the disease is 58 years, and the survival rate is lower in black people, partly due to delayed diagnoses. ALM is located in the soles, palms and subungual regions. Mutations in several genes have been described in the pathogenesis of ALM, namely: 9p21 (p16: 67%), 11q13 (CCND1) (47%), 22q11-q13 (40%) and 5p15 (20%). The diagnosis of ALM has been traditionally based on histopathology; however, other diagnostic tools such as dermoscopy, evaluation of the sentinel lymph node and detection of alterations in proteins that control the cell cycle, may contribute to earlier diagnoses and, consequently, improve the prognosis of both ALM and MM.

Características clínicas e histopatológicas del melanoma maligno en el Hospital General Dr. Manuel Gea González / Clinical and histopathological characteristics of malignant melanoma cases seen at Dr. Manuel Gea González General Hospital

Antecedentes: El melanoma maligno es una neoplasia derivada de los melanocitos que suelen localizarse en la unión dermoepidérmica. A pesar de que su incidencia es baja, menor de 10%, 75% de las muertes por cáncer cutáneo se debe a esta neoplasia. Existen cuatro variantes: de extensión superficial, léntigo melanoma maligno, acral lentiginoso y nodular. En la población caucásica predomina el melanoma de extensión superficial; en series mexicanas se ha encontrado que prevalece el nodular. El objetivo de este estudio fue describir los casos de melanoma maligno del Hospital General “Dr. Manuel Gea González” para establecer la frecuencia de presentación y el subtipo clínico. Métodos: Se realizó estudio retrospectivo, descriptivo y transversal, de marzo de 1981 a diciembre del 2006, de los pacientes con melanoma; se registró sexo, edad, residencia, ocupación, evolución de la lesión, topografía y manifestaciones clínicas. Histológicamente se valoró el índice de Breslow y el nivel de Clark. Resultados: Se incluyeron 165 pacientes, de los cuales 112 fueron del sexo femenino y 53 del masculino. La localización más frecuente fue la extremidad inferior. El melanoma acral lentiginoso fue el que mostró mayor prevalencia. Conclusiones: En esta serie los subtipos con mayor prevalencia fueron el melanoma acral lentiginoso y el léntigo maligno melanoma, a diferencia de otras series donde se informa el nodular y el de extensión superficial. La proporción mujer:hombre fue de 2.1:1, mayor a la indicada en otras series.

BACKGROUND: Melanoma is a type of tumor that arises from melanocytes generally located in the dermoepidermal junction. Although melanoma is found in less than 10% of cases, mortality is high representing 75% of deaths attributed to cutaneous cancer. There are four major subtypes: Superficial spreading melanoma, lentigo malignant melanoma, acral lentiginous melanoma and nodular melanoma. Superficial spreading melanoma is the most common type among Caucasians. In a Mexican case series, the nodular type is the most common type reported. The aim of this study was to determine the most common type seen at our medical facility. METHODS: We analyzed patient's medical records from March 1981 to December 2006. Demographic data included sex, age, place of residence, occupation, tumor progression, location and clinical description. Histologically we evaluated tumor thickness using the Breslow scale; invasion was measured using the Clark scale. This is a descriptive, cross-sectional and retrospective study. RESULTS: 165 patients were studied, 112 were females and 53 males. The most common location was the lower limb. Acral lentiginous melanoma was the most common subtype. CONCLUSIONS: Our findings differ from the other series where they report nodular and superficial spreading melanoma as the most common types. The most common subtypes in our study were acral lentiginous melanoma and lentigo malignant melanoma among females, with a ratio of female-male of 2.1:1.

Surgical Management of Acral Lentiginous Melanoma on Extremities

The ALM(acral lentiginous melanoma) on extremities are less common and less well studied. The purpose of the study is to investigate the surgical management for 19 cases of ALM on extremities for last 10 years. When tumor depth was less than 1.5mm on thumb, the lesion was removed with distal periosteum and full skin through degloving procedure and the defect was covered with wrap around procedure. When tumor depth was more than 1.5mm, distal amputation of thumb was performed, and new thumb was reconstructed through bone graft and wrap-around procedure. The ALM on palm was treated with wide excision, and then reconstruction was performed with reversed radial island flap. Because heel was required for weight bearing, the defect of heel after wide tumor resection was reconstructed with volume rich free flap. During 3 years follow-up period, local recurrence and general metastasis was 0% respectively in cases of tumor depth below 1.5mm. In cases of tumor depth more than 1.5mm, local recurrence and general metastasis rate were 0% and 20% respectively. In terms of function, the reconstructed thumb could have ability of pinch and grasp, and the reconstructed heel could be achieved good contour and weight bearing function.

Immunohistochemical Study on Acral Lentiginous Melanoma / 대한피부과학회지

BACKGROUND: Although clinicopathologic characteristics of acral lentiginous melanoma (ALM) is well established, immunohistochemical study on ALM has rarely been reported. OBJECTIVE: Our purpose is to evaluate the usefulness of several immune markers in the diagnosis of ALM. METHODS: An immunohistochemical study was performed on paraffin sections of 20 ALMs using S-100 protein, HMB-45, vimentin, epithelial membrane antigen (EMA), and CAM 5.2. RESULTS: 1. Nineteen (95%) and 16 (80%) out of 20 ALM showed reactivity with S-100 protein and HMB-45, respectively. 2. Melanin bleaching was useful for diagnosing heavily pigmented ALM using both S-100 protein and HMB-45. 3. The immunoreactivity of S-100 protein and HMB-45 did not correlate with tumor thickness or level of invasion of ALM. The intensity of HMB-45 correlated well with the melanin content. 4. One and 2 out of 20 cases stained focally with EMA and CAM5.2 respectively, but these cases stained also with HMB-45 and/or S-100 protein. CONCLUSION: S-100 protein and HMB-45 were relatively sensitive markers for diagnosing ALM. Despite the occasional positivity for the epithelial markers in ALM, all epithelial marker-positive cases stained also with HMB-45 and/or S-100 protein. Therefore, S-100 protein and HMB-45 are very useful markers for diagnosing ALM.

Immunohistochemical Analysis for Basal Activation of NF-κB in Acral Lentiginous Melanoma

BACKGROUND: Spontaneous basal activation that might be related to survival mechanism of tumor cells by allowing them to escape from apoptosis has been proven in some tumor cells, but it has not been evaluated in malignant melanoma tissue. OBJECTIVE: The purpose of this study was to evaluate basal activation of NF-κB using immunohistochemical analysis and demonstrate its clinical significance in cutaneous malignant melanoma tissue. MATERIALS AND METHODS: Twenty-five cases of acral lentiginous melanoma(ALM) from 20 patients were selected. Immunohistochemical analysis was performed to detect nuclear localization of classic NF-κB heterodimer, p50 and p65 in the formalin-fixed, paraffin-embedded tissues. RESULTS: In about 50% of cases, nuclear expression of NF-κB heterdimer, p50 and p65 was detected, 12(48%) and 13(52%) of 25 cases of ALM, respectively. However, the nuclear ex-pressing of p50 and p65 was not significant for tumor thickness or level of invasion in ALM. CONCLUSION: We demonstrated basal NF-κB activation in malignant melanoma, but we need to research further to demonstrate its clinical significance.

A Case of Acral Lentiginous Melanoma / 대한피부과학회지

Acral lentiginous melanoma has a poor prognosis, because it has relatively short radial growth phase than lentigo maligna melanoma does. A 50 year-old female was presented with a 4X5cm-sized irregularly pigmented patch developed on the left palm. Initial punch biopsy examinations revealed atypical melanocytes only in the epidermis. But, after complete excision, melanoma cells were also observed in the upper dermis. We report an unusual case of acral lentiginous melanoma which showed vertical growth phase after twenty years of radial growth phase.