Management of Early-Stage Melanoma.

Melanoma is a potentially aggressive skin cancer with a steadily rising incidence. Most melanomas are diagnosed at an early stage and associated with an excellent prognosis when treated appropriately. Primary treatment for melanoma is surgical. Wider surgical margins and a variety of techniques for comprehensive histologic margin assessment may be considered for lentigo maligna type melanoma on the head and neck, due to characteristic broad subclinical extension. For invasive melanoma, sentinel lymph node biopsy may be indicated for staging, and to guide further management and follow-up. Appropriate treatment guidelines for early-stage melanoma are reviewed and discussed.

Intracellular degradation of elastin by cathepsin K in skin fibroblasts--a possible role in photoaging.

Solar elastosis is observed in the dermis of photoaged skin and is characterized by an accumulation of abnormal elastin in the extracellular space. Several proteases that degrade elastin in the extracellular space have been implicated in its formation. The lysosomal protease cathepsin K (catK) has recently been described to be highly expressed in skin fibroblasts under certain pathologic conditions. As cat K is one of the most potent mammalian elastases, we hypothesized that catK-mediated intracellular elastin degradation may play a role in the formation of solar elastosis. Immunostaining of cultured skin fibroblasts incubated with labeled elastin demonstrated internalization of extracellular elastin to lysosomes and its degradation by catK. Induction of catK expression in fibroblasts was observed both in vitro and in vivo after exposure to longwave UVA. In contrast to fibroblasts from young donors, cells from old donors failed to activate catK in response to UVA. These data suggest a role of intracellular elastin degradation by catK in the formation of solar elastosis. We propose that an age-related decline in catK activity, in particular after UV exposure, may promote the formation of actinic elastosis through a decline of orderly intracellular elastin degradation and subsequent accumulation of elastin in the extracellular space.

Expression and regulation of cathepsin K in skin fibroblasts.

Cathepsin K (catK) is a lysosomal cysteine protease with strong collagenolytic activity well known to mediate bone resorption in osteoclasts. Recently, catK has also been reported to be expressed in other tissues. In the dermis, it is expressed only under certain circumstances such as scarring or inflammation. We therefore investigated the expression and regulation of this protease in dermal fibroblasts using immunoblotting and immunostaining. Cultured skin fibroblasts were found to strongly express catK in lysosomes. Internalization of collagen I and IV to lysosomes of fibroblasts indicates a role of catK in intracellular collagen degradation after endocytosis, a process that is different from the metalloproteinase-mediated collagen degradation in the extracellular space. In fibroblasts, interleukin-1alpha and cellular confluence upregulate catK expression and transforming growth factor-beta1 inhibits confluence-induced catK upregulation in skin fibroblasts. RANKL (ligand of receptor activator of NF-kappaB) did not alter catK expression. These regulators of catK expression are likely to play a role in the as-needed upregulation in certain skin conditions, where the prominent matrix-degrading properties of catK are thought to require tight regulation to maintain the homeostasis of the extracellular matrix.

Cathepsin K in melanoma invasion.

Cathepsin K (catK) is a lysosomal cysteine protease with strong collagenolytic activity that mediates bone resorption in osteoclasts. Recently, catK expression has been reported in skin and lung fibroblasts, which suggests a role in maintaining homeostasis of the extracellular matrix outside of bone. Matrix degradation is a pivotal step in tumor invasion and metastasis. As other proteases, in particular matrix metalloproteinases and some cathepsins, but not catK, have been described to mediate melanoma invasion, we studied catK in melanoma. Immunostaining revealed strong catK expression in most primary melanomas and all cutaneous melanoma metastases. Melanocytic nevi also demonstrated catK expression, but it was less intense than in melanomas. Melanoma lines express both the pro- and the active form of catK and internalize extracellular collagen into lysosomes. Inhibition of catK greatly reduced melanoma cell invasion through Matrigel basement membrane matrix and increased detection of internalized collagen. We suggest that catK may play an important role in melanoma invasion and metastasis by mediating intracellular degradation of matrix proteins after phagocytosis. Clinical use of catK inhibitors, a class of medication currently in clinical trials for the treatment of osteoporosis, may be a promising avenue for the treatment of melanoma.