Sarcomatoid Dedifferentiated Melanoma: The Diagnostic Role of Next-Generation Sequencing.

ABSTRACT: Sarcomatoid dedifferentiated melanoma (SDDM) represents a diagnostic challenge as this cutaneous spindle cell melanoma lacks expression of classic melanocytic markers including S100, SOX10, Melan-A, HMB45, and MITF. The expression of the emerging melanoma marker preferentially expressed antigen in melanoma (PRAME) in SDDM is largely unknown. In this article, a case of SDDM arising in association with a nodular melanoma is highlighted. A 65-year-old man presented with a several week history of an ulcerated lesion on the right medial knee. A shave biopsy of the lesion revealed a biphasic neoplasm, which consisted of a centrally located poorly differentiated spindle cell component and an adjacent nodular component consisting of atypical melanocytes arranged in nests and fascicles. While the nodular component stained for S100, SOX10, and Melan-A, the spindle cell component failed to stain for these conventional melanocytic markers, only staining diffusely for CD10 and faintly for CD68. Both components stained for PRAME diffusely albeit less intensely within the spindle cell component. Next-generation DNA sequencing assay of the microdissected biphasic components revealed a shared mutation of NRAS. The results of the PRAME immunohistochemical stain and next-generation DNA sequencing assay facilitated in establishing the diagnosis of SDDM in association with nodular melanoma.

Human-papillomavirus-related disease in pediatrics.

PURPOSE OF REVIEW: Human papillomaviruses (HPVs) account for a number of distinct disease entities in pediatrics, ranging from common warts to the stigmatizing condyloma acuminata to life-threatening respiratory papillomatosis. Although there is still a lack of consensus on treatment for each of these HPV-related diseases, scientific investigation continues to progress. Increasing prevention of HPV-related disease with further vaccination and development of new vaccines continues to be the best medical strategy. RECENT FINDINGS: Although high-quality evidence for treatment of HPV-related disease is still lacking, several new studies have been published in recent years that have refined opinions on therapy. Novel treatments continue to be developed, including new vaccines to further coverage for other strains. SUMMARY: HPV-related disease in pediatrics is associated with societal stigmatization and a high level of morbidity. Greater understanding of the distinct diseases and high-quality research is necessary to enhance treatment selection in the coming future.

Computer-assisted diagnosis of melanoma.

The computer-assisted diagnosis of melanoma is an exciting area of research where imaging techniques are combined with diagnostic algorithms in an attempt to improve detection and outcomes for patients with skin lesions suspicious for malignancy. Once an image has been acquired, it undergoes a processing pathway which includes preprocessing, enhancement, segmentation, feature extraction, feature selection, change detection, and ultimately classification. Practicality for everyday clinical use remains a vital question. A successful model must obtain results that are on par or outperform experienced dermatologists, keep costs at a minimum, be user-friendly, and be time efficient with high sensitivity and specificity.

Necrolytic migratory erythema associated with fatty liver disease and the psuedoglucagonoma syndrome.

We report a 48-year-old woman with a past medical history of psoriasis, nonalcoholic steatohepatitis (NASH), and type II diabetes mellitus, who presented to the emergency department with a 1 week history of erosive annular plaques with associated atrophy and telangiectasias on her legs bilaterally, thighs and buttock, histopathologically consistent with necrolytic migratory erythema. Although classically associated with a pancreatic glucagonoma, this patient experienced this figurate erythema in the setting of fatty liver disease with no glucagonoma. The rarity of pseudoglucagonoma syndrome, or necrolytic migratory erythema occurring in the absence of a glucagonoma, warranted the discussion of this case.

Perioperative survival of elderly head and neck squamous cell carcinoma patients.

OBJECTIVES/HYPOTHESIS: To evaluate the survival benefit of surgery for elderly head and neck cancer (HNC) patients. STUDY DESIGN: Retrospective national database cohort study of HNC patients. METHODS: The study is a retrospective cohort review of the Surveillance, Epidemiology, and End-Results (SEER) database from 2004 to 2009. We developed an estimated perioperative window, based on the institutional database at a tertiary academic center. The average time to surgery among HNC patients at this center correlated with SEER's 3-month post diagnosis. From this estimate, we calculated postoperative (3 months), 2-year, and 5-year overall survival (OS) for patients receiving HNC surgery from 2004 to 2009 in the SEER database. Patients were matched for sex, tumor grade/stage, primary location, and radiation treatment status. RESULTS: Overall, after matching we found a statistically significant decrease in 3-month OS for the elderly patients versus younger controls who received surgery (P < .05). However, a matched analysis of elderly patients alone found a significant increase in OS for elderly patients who received surgery compared to those who did not (P < .05). CONCLUSIONS: Surgery appears to offer overall benefit to elderly HNC patients. These patients have a significantly worse postoperative OS than their younger counterparts, but the clinical significance appears to be limited. The improved survival among elderly patients who receive surgery compared to those who do not suggests that surgery should be offered to properly selected patients regardless of age.