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Longitudinal nevus: A distinctive type of nevus on the sole
P8716
P7771
Localization of melanoma depends of sun exposure and preventive behavior Barbara Borkowska, MD, Department of Dermatology CSK MSW, Warsaw, Poland; Agnieszka Kardynal, MD, Department of Dermatology CSK MSW, Warsaw, Poland; Anna Stepien, Department of Dermatology CSK MSW, Warsaw, Poland; Lidia Rudnicka, MD, PhD, Department of Dermatology CSK MSW and Medical University of Warsaw, Warszawa, Poland; Monika Slowinska, MD, PhD, Department of Dermatology CSK MSW, Warsaw, Poland Anatomic location of melanoma is considered a significant prognostic factor. However, factors, which determine the location of melanoma have not been established. The aim of the study was to characterize patients with melanoma in different anatomic locations. The study included 273 consecutive patients with cutaneous melanoma (65.2 % women and 34.8 % men). The most frequent location of melanoma was the lower extremity. The most common site of melanoma of the lower extremity was the lower leg (62%), while melanoma arising on the upper extremities was most commonly localized on the upper arm (64%). The front of the abdomen was more commonly affected compared to the back (82% and 18%, respectively). The chest was the most common site of melanoma in patients, who reported multiple short episodes of UV exposure, did not use sunscreens, and had a small number of nevi (\10). In this group of patients, the average time from appearance of the suspicious lesion on the skin to first dermatology check-up was 2.8 years. Patients with melanomas localized on extremities were less commonly exposed to short, intense sunlight, were more commonly aware of the necessity of sun protection, used sunscreens according to current guidelines (UVB SPF $ 30, UVA protection, application every 2 hours) and their average time from appearance of a suspicious lesion to first dermatology check-up was 1.3 years. Head and neck localization (usually lentigo maligna melanoma) was most commonly associated with higher age, but showed no statistically significant association with sun protection. No specific anatomic location of melanoma was observed in outdoor workers, even though melanoma demonstrated a dependence of distribution based on recreational UV exposure. In conclusion, our observation indicates that melanoma localized on the chest is more commonly associated with excessive, recreational sun exposure compared to melanoma in other locations.
LPA chemotaxis: A key driver of melanoma invasion Andrew Muinonen-Martin, MBChB, Beatson Institute for Cancer Research, Glasgow, United Kingdom; David Knecht, University of Connecticut, Storrs, CT, United States; Dorothy Bennett, Biomedical Sciences Research Centre St. George’s, London, United Kingdom; Laura Machesky, Beatson Institute for Cancer Research, Glasgow, United Kingdom; Michael Wakelam, Babraham Institute, Cambridge, United Kingdom; Robert Herd, Western Infirmary, Glasgow, United Kingdom; Robert Insall, Beatson Institute for Cancer Research, Glasgow, United Kingdom Melanoma is notoriously resistant to immunotherapies and even targeted chemotherapeutic strategies despite recent advances in drug development. The overall mortality of melanoma correlates with its ability to metastasize. Breslow thickness remains the most useful prognostic indicator, thereby linking the ability of the cells to invade with their propensity to metastasize. Invasion occurs early during tumor development, but the factors driving this process remain poorly understood. There is a growing appreciation that chemotaxis plays an important role in driving the migration and invasion of melanoma cells, but the key stimuli are not known. To investigate this process, we developed a 2-dimensional chemotaxis chamber assay capable of tracking melanoma cell migration up to 24 hours, which is essential for analyzing the migration of these relatively slow moving cells. Using this technique, we identified the inflammatory signal LPA as the key driver of melanoma migration and chemotaxis in a density-dependent manner. We demonstrate that cells almost completely fail to perform chemotaxis without the presence of LPA. Conversely, inhibiting LPA signaling in the presence of serum produces the same result both in the chamber and organotypic assays. Sampling across the margins of melanomas in vivo, we reproducibly identified gradients of LPA that are capable of driving chemotaxis that are not present in normal skin. To the best of our knowledge, this is the first in-depth study addressing the key stimuli that drive melanoma chemotaxis, and we have identified LPA as a key driver of this process. We have clarified important novel roles for growth factors that were previously considered to play essential roles in driving directed migration, but instead facilitate LPA chemotaxis. The fact that gradients of LPA exist in vivo and that melanoma cells perform chemotaxis in a density dependent manner provides a clear explanation for the increased risk of metastasis with depth of invasion. In addition to practical clinical implications that will be discussed, the LPA signaling pathway potentially represents an important prognostic and therapeutic target for patients with melanoma.
Commercial support: None identified.
Supported mainly by a Wellcome Trust Research Training Fellowship and partially by a Cancer Research UK Core Funded Fellowship.
P7887 Longitudinal nevus: A distinctive type of nevus on the sole Laura Frances, MD, Hospital General Universitario de Alicante, Alicante, Spain; Angelica Maria Bouret, MD, Hospital General Universitario de Alicante, Alicante, Spain; Irene Marin, MD, Hospital General Universitario de Alicante, Alicante, Spain; Jose Ba~ nuls, MD, Hospital General Universitario de Alicante, Alicante, Spain; Maria Leiva-Salinas, MD, Hospital General Universitario de Alicante, Alicante, Spain Introduction: The shape of acquired melanocytic nevus is usually oval or round in all the body skin surface. Despite this morphology being the most frequent on the sole, we have observed a new group of very elongated lesions in this location. Report of case series: In total, 10 patients with 10 pigmented lesions were evaluated by dermoscopy with a handheld (Dermlite) and a digital dermatoscope (MoleMax II). Melanocytic lesions with atypical clinical or dermoscopic features were excised and histopathologically evaluated and cases without evidence of malignancy were followed up. Results: The average nevus length was 14.7 mm, while the average width was only 2.3 mm. The length of the nevus was not related to the dermoscopy pattern, and the lesions were observed in combination with all different types of acral benign dermoscopic patterns. Melanoma was detected in only 1 of the 10 patients. Discussion: It is well known that clinical morphology and histology of melanocytic nevus are conditioned by their anatomic0 location. The pressure supported by plantar skin determines the expression of particular clinical and histologic features, making the diagnosis difficult. We have found a new subgroup of patients with large lesions located on soles with a clear disproportion between length and width. This ‘‘longitudinal or linear micropattern’’ is not usually observed elsewhere in the body skin except for the nail. On the other hand, the greatest diameter of plantar nevi reported in the literature ranged from 0.8 to 7.0 mm (1.0-10.0 mm in black patients), and our lesions reach twice the average length described. Despite their large size (diameter [7 mm is considered a dermoscopic criteria of malignancy) and its asymmetry, we have observed that most nevus with this morphology are benign lesions. We hypothesized that this peculiar presentation can be explained (such as the dermoscopic fibrillar pattern in dermoscopy), by mechanical pressure from the bodyweight that forces melanocytes to adopt this artifactual linear expression.
P7903
Conclusion: To the best of our knowledge, this is the first reported serie of cases of ‘‘longitudinal/linear nevus’’ on soles. We emphasize the importance of knowing this special presentation of acral melanocytic nevus, as a clinical and dermoscopical particular variant in this location. Although this new ‘‘micropattern’’ should not alarm the physician, we recommend dermoscopic follow-up to ensure the stable character of these lesions.
Melanoma in children, adolescents, and young adults: A clinicopathologic study in a Brazilian population Aliene Noda, MD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Cyro Neto, PhD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Dilcilea Franco, MD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Martin Sang€ ueza, MD, Surgical Pathology Department, Hospital Obrero, La Paz, Bolivia; Paula Sanchez, MD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Silvia Lourenc¸o, PhD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil Malignant melanoma in children, adolescents, and young adults is unusual, especially before puberty. In children (ages 0-14 years), most primary lesions are thick and atypical (amelanotic, simulating pyogenic granuloma). In the population of adolescents and young adults (ages 15-39 years), melanoma is the third most common cancer, only behind lymphoma and breast cancer. Our study investigated the records of 89 patients diagnosed with cutaneous melanoma at age 0-39 years at Hospital das Clınicas, Medical School, University of S~ao Paulo. They were divided in group A (0-14 years of age) and group B (15-39 years of age). The histopathology of all cases was reexamined. Statistical analysis of the data presented was performed and the obtained data were compared with the literature. The frequency of melanoma in the group aged 15-39 years was higher in women and the most affected site was the trunk. In addition, melanomas were more frequent at an earlier age in patients with family history of melanoma (P ¼ .014). Most cases were diagnosed, at histopathology, as superficial spreading melanoma. Thick nodular melanomas with Breslow values [2 mm were associated with lymph node metastasis (P \.05). Our study revealed that melanoma in children, adolescents, and young adults may present peculiar behavior and outcome, which might reflect the genetic and yet not fully unraveled pathogenesis of this complex disease.
Commercial support: None identified.
Commercial support: None identified.
AB128
J AM ACAD DERMATOL
MAY 2014
P7771
Localization of melanoma depends of sun exposure and preventive behavior Barbara Borkowska, MD, Department of Dermatology CSK MSW, Warsaw, Poland; Agnieszka Kardynal, MD, Department of Dermatology CSK MSW, Warsaw, Poland; Anna Stepien, Department of Dermatology CSK MSW, Warsaw, Poland; Lidia Rudnicka, MD, PhD, Department of Dermatology CSK MSW and Medical University of Warsaw, Warszawa, Poland; Monika Slowinska, MD, PhD, Department of Dermatology CSK MSW, Warsaw, Poland Anatomic location of melanoma is considered a significant prognostic factor. However, factors, which determine the location of melanoma have not been established. The aim of the study was to characterize patients with melanoma in different anatomic locations. The study included 273 consecutive patients with cutaneous melanoma (65.2 % women and 34.8 % men). The most frequent location of melanoma was the lower extremity. The most common site of melanoma of the lower extremity was the lower leg (62%), while melanoma arising on the upper extremities was most commonly localized on the upper arm (64%). The front of the abdomen was more commonly affected compared to the back (82% and 18%, respectively). The chest was the most common site of melanoma in patients, who reported multiple short episodes of UV exposure, did not use sunscreens, and had a small number of nevi (\10). In this group of patients, the average time from appearance of the suspicious lesion on the skin to first dermatology check-up was 2.8 years. Patients with melanomas localized on extremities were less commonly exposed to short, intense sunlight, were more commonly aware of the necessity of sun protection, used sunscreens according to current guidelines (UVB SPF $ 30, UVA protection, application every 2 hours) and their average time from appearance of a suspicious lesion to first dermatology check-up was 1.3 years. Head and neck localization (usually lentigo maligna melanoma) was most commonly associated with higher age, but showed no statistically significant association with sun protection. No specific anatomic location of melanoma was observed in outdoor workers, even though melanoma demonstrated a dependence of distribution based on recreational UV exposure. In conclusion, our observation indicates that melanoma localized on the chest is more commonly associated with excessive, recreational sun exposure compared to melanoma in other locations.
LPA chemotaxis: A key driver of melanoma invasion Andrew Muinonen-Martin, MBChB, Beatson Institute for Cancer Research, Glasgow, United Kingdom; David Knecht, University of Connecticut, Storrs, CT, United States; Dorothy Bennett, Biomedical Sciences Research Centre St. George’s, London, United Kingdom; Laura Machesky, Beatson Institute for Cancer Research, Glasgow, United Kingdom; Michael Wakelam, Babraham Institute, Cambridge, United Kingdom; Robert Herd, Western Infirmary, Glasgow, United Kingdom; Robert Insall, Beatson Institute for Cancer Research, Glasgow, United Kingdom Melanoma is notoriously resistant to immunotherapies and even targeted chemotherapeutic strategies despite recent advances in drug development. The overall mortality of melanoma correlates with its ability to metastasize. Breslow thickness remains the most useful prognostic indicator, thereby linking the ability of the cells to invade with their propensity to metastasize. Invasion occurs early during tumor development, but the factors driving this process remain poorly understood. There is a growing appreciation that chemotaxis plays an important role in driving the migration and invasion of melanoma cells, but the key stimuli are not known. To investigate this process, we developed a 2-dimensional chemotaxis chamber assay capable of tracking melanoma cell migration up to 24 hours, which is essential for analyzing the migration of these relatively slow moving cells. Using this technique, we identified the inflammatory signal LPA as the key driver of melanoma migration and chemotaxis in a density-dependent manner. We demonstrate that cells almost completely fail to perform chemotaxis without the presence of LPA. Conversely, inhibiting LPA signaling in the presence of serum produces the same result both in the chamber and organotypic assays. Sampling across the margins of melanomas in vivo, we reproducibly identified gradients of LPA that are capable of driving chemotaxis that are not present in normal skin. To the best of our knowledge, this is the first in-depth study addressing the key stimuli that drive melanoma chemotaxis, and we have identified LPA as a key driver of this process. We have clarified important novel roles for growth factors that were previously considered to play essential roles in driving directed migration, but instead facilitate LPA chemotaxis. The fact that gradients of LPA exist in vivo and that melanoma cells perform chemotaxis in a density dependent manner provides a clear explanation for the increased risk of metastasis with depth of invasion. In addition to practical clinical implications that will be discussed, the LPA signaling pathway potentially represents an important prognostic and therapeutic target for patients with melanoma.
Commercial support: None identified.
Supported mainly by a Wellcome Trust Research Training Fellowship and partially by a Cancer Research UK Core Funded Fellowship.
P7887 Longitudinal nevus: A distinctive type of nevus on the sole Laura Frances, MD, Hospital General Universitario de Alicante, Alicante, Spain; Angelica Maria Bouret, MD, Hospital General Universitario de Alicante, Alicante, Spain; Irene Marin, MD, Hospital General Universitario de Alicante, Alicante, Spain; Jose Ba~ nuls, MD, Hospital General Universitario de Alicante, Alicante, Spain; Maria Leiva-Salinas, MD, Hospital General Universitario de Alicante, Alicante, Spain Introduction: The shape of acquired melanocytic nevus is usually oval or round in all the body skin surface. Despite this morphology being the most frequent on the sole, we have observed a new group of very elongated lesions in this location. Report of case series: In total, 10 patients with 10 pigmented lesions were evaluated by dermoscopy with a handheld (Dermlite) and a digital dermatoscope (MoleMax II). Melanocytic lesions with atypical clinical or dermoscopic features were excised and histopathologically evaluated and cases without evidence of malignancy were followed up. Results: The average nevus length was 14.7 mm, while the average width was only 2.3 mm. The length of the nevus was not related to the dermoscopy pattern, and the lesions were observed in combination with all different types of acral benign dermoscopic patterns. Melanoma was detected in only 1 of the 10 patients. Discussion: It is well known that clinical morphology and histology of melanocytic nevus are conditioned by their anatomic0 location. The pressure supported by plantar skin determines the expression of particular clinical and histologic features, making the diagnosis difficult. We have found a new subgroup of patients with large lesions located on soles with a clear disproportion between length and width. This ‘‘longitudinal or linear micropattern’’ is not usually observed elsewhere in the body skin except for the nail. On the other hand, the greatest diameter of plantar nevi reported in the literature ranged from 0.8 to 7.0 mm (1.0-10.0 mm in black patients), and our lesions reach twice the average length described. Despite their large size (diameter [7 mm is considered a dermoscopic criteria of malignancy) and its asymmetry, we have observed that most nevus with this morphology are benign lesions. We hypothesized that this peculiar presentation can be explained (such as the dermoscopic fibrillar pattern in dermoscopy), by mechanical pressure from the bodyweight that forces melanocytes to adopt this artifactual linear expression.
P7903
Conclusion: To the best of our knowledge, this is the first reported serie of cases of ‘‘longitudinal/linear nevus’’ on soles. We emphasize the importance of knowing this special presentation of acral melanocytic nevus, as a clinical and dermoscopical particular variant in this location. Although this new ‘‘micropattern’’ should not alarm the physician, we recommend dermoscopic follow-up to ensure the stable character of these lesions.
Melanoma in children, adolescents, and young adults: A clinicopathologic study in a Brazilian population Aliene Noda, MD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Cyro Neto, PhD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Dilcilea Franco, MD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Martin Sang€ ueza, MD, Surgical Pathology Department, Hospital Obrero, La Paz, Bolivia; Paula Sanchez, MD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil; Silvia Lourenc¸o, PhD, Hospital das Clınicas da Faculdade de Medicina da Universidade de S~ao Paulo, S~ao Paulo, Brazil Malignant melanoma in children, adolescents, and young adults is unusual, especially before puberty. In children (ages 0-14 years), most primary lesions are thick and atypical (amelanotic, simulating pyogenic granuloma). In the population of adolescents and young adults (ages 15-39 years), melanoma is the third most common cancer, only behind lymphoma and breast cancer. Our study investigated the records of 89 patients diagnosed with cutaneous melanoma at age 0-39 years at Hospital das Clınicas, Medical School, University of S~ao Paulo. They were divided in group A (0-14 years of age) and group B (15-39 years of age). The histopathology of all cases was reexamined. Statistical analysis of the data presented was performed and the obtained data were compared with the literature. The frequency of melanoma in the group aged 15-39 years was higher in women and the most affected site was the trunk. In addition, melanomas were more frequent at an earlier age in patients with family history of melanoma (P ¼ .014). Most cases were diagnosed, at histopathology, as superficial spreading melanoma. Thick nodular melanomas with Breslow values [2 mm were associated with lymph node metastasis (P \.05). Our study revealed that melanoma in children, adolescents, and young adults may present peculiar behavior and outcome, which might reflect the genetic and yet not fully unraveled pathogenesis of this complex disease.
Commercial support: None identified.
Commercial support: None identified.
AB128
J AM ACAD DERMATOL
MAY 2014