- Email: [email protected]
Pulmonary carcinoid associated with melanoma
P2203
P2205
Quality of life and cancer anxiety impact of total body digital photography in patients with atypical mole syndrome Zakiya Pressley, MD, Emory University, Atlanta, GA, United States; Laura DeLong, MD, MPH, Emory University, Atlanta, GA, United States; Clara CurielLewandrowski, MD, Arizona University, Tuscon, AR, United States; Suephy Chen, MD, MS, Emory University, Atlanta, GA, United States Background: Total body digital photography (TBDP) is increasingly utilized by dermatologists in following patients with atypical mole syndrome (AMS). Currently, there are no data confirming the impact of this tool. Our objective was to assess whether TBDP has an impact on quality of life (QOL) and cancer anxiety in AMS patients.
Bilateral segmental lentiginosis associated with malignant melanomas Gonza´lez-Sixto Beatriz, MD, Complejo Hospitalario Pontevedra, Pontevedra, Spain; Flo´rez Angeles, MD, Complejo Hospitalario de Pontevedra, Pontevedra, Spain; De la Torre Carlos, MD, Complejo Hospitalario de Pontevedra, Pontevedra, Spain; Cruces Manuel, MD, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
Methods: Between June 2005 and June 2006, patients with AMS ([ 50 atypical nevi) with or without a history of melanoma seen in the pigmented lesion clinics at Emory and Arizona University were given survey instruments at 0 months and 3-6 months that measured QOL and anxiety. TBDP was obtained after initial baseline instruments. The instruments administered included: 1) SKINDEX-16, a skin-specific QOL scale, 2) Revised Impact of Events Scale (RIES) I and II, measuring subjective distress in response to life events, and 3) Breast Cancer Worry Scale, modified to be melanoma-specific (MWS), measuring worry about cancer. For all scales, lower scores indicated less of the measured construct. Analyses were completed with STATA Version 8.0 and Wilcoxon matched pairs signed-rank test calculated statistical significance between matched pairs. Results: A total of 30 patients were enrolled and 53% (n = 16) were female. The mean SKINDEX-16 total score for all patients was 18.6 6 15.8, (range, 0-65). The mean RIES I total score was13.3 6 15.9, (range, 0-57) and the mean MWS total score was 9.4 6 3.4, (range, 0-17). At this time, 13 patients have completed follow-up instruments. For these patients, the mean SKINDEX-16 total, REIS I, MWS at baseline in comparison to follow-up was 22.7 6 13.4 to 17.7 6 8.9 (p = 0.16), 15.5 6 16.5 to 13.3 6 14.9 (p = 0.97), and 10.8 6 3.0 to 9.6 6 2.6 (p = 0.048), respectively. Lastly, 60% (n = 18) of patients had a previous diagnosis of melanoma; 6 them had complete follow-up. In this group, the mean SKINDEX-16 total, REIS I, REIS II, MWS at baseline in comparison to follow-up was 32 6 8.8 to 21 6 9.4, 21.2 6 14.5 to 14.4 6 12.5, 25.5 6 11.3 to 15.7 6 16.1, and 12.4 6 2.2 to 10.6 6 2.4, respectively. Conclusion: This is the first study that has investigated TBDP impact on QOL in AMS patients. For all patients with follow-up, there was an improvement in all the instruments with statistical significance in the MWS, suggesting that TBDP may have a positive impact on QOL. Further studies with control groups may prove beneficial in targeting TBDP specific impact and a larger number of patients may strengthen statistical significance for the other instruments.
Introduction: Partial unilateral lentiginosis (PUL) is a rare pigmentary disorder characterized by multiple lentigines within an area of normal skin, usually limited to one side of the body. Bilateral cases are extremely rare. Several cutaneous and systemic disorders have been reported in patients with PUL, but malignant transformation has not been documented so far. We report a case of bilateral segmental lentiginosis with 2 malignant melanomas arising from lentigines. Case Report: An 86-year-old woman was referred to our department for evaluation of an asymptomatic lesion on the left preauricular region. Physical examination revealed a nonpigmented plaque (2 3 1.8 cm diameter) on the left preauricular area. Multiple small lentigines were found on the left side of the face, right side of the trunk, and left leg. These were present since childhood. A sudden stoppage at the midline was patent. In addition, an asymmetric, hyperpigmented macule (5 3 5 mm diameter) was observed on the left leg over the lentiginous area. There was no evidence of neurofibromas, cafe´-au-lait macules or axillary freckling. Both suspicious lesions were excised with 5 mm surgical margin. Histologic examination of the left preauricular lesion revealed features of superficially spreading melanoma (0.7 mm Breslow). The atypical macule located on the leg was a melanoma in situ. Discussion: PUL consists of small pigmented macules that are grouped on otherwise normal skin. The distribution of lentigines is generally unilateral with a sharp interruption at the midline, and it often corresponds to one or more dermatomes. Two cases of bilateral involvement have been described. Lentigines are present at birth or appear during childhood. Mental retardation, focal epilepsy, and segmental neurofibromatosis, among others, have been reported in association with PUL, although this association may be casual. Long-term prognosis is unknown and malignant transformation has not been previously reported. We present a case of extensive bilateral lentiginosis with 2 malignant melanomas arising out of lentiginous areas. To our knowledge this association has not been reported so far. References: Kim HS, Kim SY, Kim GM. Extensive partial unilateral lentiginosis. J Eur Acad Dermatol Venereol 2006;20:469-70. Trattner A, Metzker A. Partial unilateral lentiginosis. J Am Acad Dermatol 1993; 29:693-5. Commercial support: None identified.
Commercial support: None identified.
P2206
P2204 The dermoscopic pattern of truncal nevi may mirror the surrounding skin pigment pattern Jocelyn Lieb, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Christiane Benvenuto-Andrade, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Anna Liza Agero, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States Several different dermoscopic patterns have been recognized in pigmented skin lesions including globular, reticular, homogeneous, and combinations of these. It has been suggested that most nevi in a given individual retains a predominant dermoscopic pattern. Factors thought to contribute to pigment structure include age, sun exposure, and skin phototype. In facial and acral areas, pigment patterns have been correlated with skin structures such as pseudonetworks surrounding dilated adnexal structures on the face and the parallel patterns due to ridges and furrows on palms and soles. Such structural correlations have never been made regarding pigmented lesions of the trunk. We reviewed a series of dermoscopic images of acquired nevi from a dermoscopic database obtained from SONIC (Study of Nevi in Children) to assess whether the pigment network of surrounding skin has an association with the dermoscopic pattern of the lesions. We present several lesions whose pigment morphology mirrors that of the background architecture. These 12 examples include 4 nevi with an evident reticular pattern superimposed on a reticular background, 4 nevi with a globular pattern superimposed on a globular background, and 4 nevi with a globular-reticular pattern on a corresponding globular-reticular background. Each of these cases illustrates that the pigment morphology of acquired melanocytic nevi may indeed be influenced by the background pigment architecture. These associations appear to be more readily apparent in lesions with reticular patterning and in patients with darker skin phototypes (III-V). Further investigation into pigment architecture of normal skin and acquired melanocytic nevi may provide knowledge into the structural development of benign and malignant pigmented lesions. Commercial support: None identified.
AB144
J AM ACAD DERMATOL
Pulmonary carcinoid associated with melanoma Rajaratnam Ratna, MBChB, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom; Jerry Marsden, MBChB, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom To our knowledge, this is the first report in British literature documenting the cooccurrence of melanoma and pulmonary carcinoid. The only other report is from New York and documents pulmonary carcinoid in association with a parathormone producing melanoma (Wagner RF, et al. Pulmonary carcinoid associated with a parathormone producing melanoma. J Dermatol Surg Oncol 1983 Jul;9(7):562-6). Cases: A 46-year-old female presented in 1998 with a superficial spreading melanoma 1 mm, T2a/b N0M0 stage 1B. Two years later, a chest X-ray (CXR) detected an opacity in the left lung. Clinical examination was normal and computed tomograph (CT) imaging showed no other abnormality. The patient proceeded to a lobectomy. Unexpectedly, histology showed a primary pulmonary carcinoid. A 61year-old male had a nodular melanoma excised from the skin of his chest in 1997. The lesion was 8 mm thick, T4a/b N0M0 stage 2B. He remained well until 2005. A CXR detected an opacity in the left lung. CT imaging showed a further nodule in the right lung. Clinical examination was normal and imaging showed no other abnormality. Both lesions were excised and histologically showed bilateral pulmonary carcinoid. Discussion: To our knowledge, this is the second report documenting this association. Evidence is discussed in support of a possible association between melanoma and carcinoid, both of which fall under the APUD (amine precursor uptake and decarboxylation) classification. (Pearse AG. Common cytochemical and ultrastructural characteristics of cells producing polypeptide hormones and their relevance to the thyroid and ultimobronchial C cells and calcitonin. Proc R Soc Lond 1968;170:71-80.) Pearse first applied this term to cells which could produce amines or hormones. Melanoma and carcinoid were classified as APUD tumours. Pearse also hypothesised that they shared a common embryological origin. While the melanoblast’s origin from the neural crest has been verified, proving the neural crest origin of other APUD tumours is less clear. There is further similarity. Carcinoids have been shown to contain melanosomes and melanin in addition to neurosecretory granules suggesting a common origin. There are also reports of melanomas showing neuroendocrine differentiation. This report does not exclude the possibility of a chance association and additional reports will be required to strengthen the association. Commercial support: None identified.
FEBRUARY 2007
P2205
Quality of life and cancer anxiety impact of total body digital photography in patients with atypical mole syndrome Zakiya Pressley, MD, Emory University, Atlanta, GA, United States; Laura DeLong, MD, MPH, Emory University, Atlanta, GA, United States; Clara CurielLewandrowski, MD, Arizona University, Tuscon, AR, United States; Suephy Chen, MD, MS, Emory University, Atlanta, GA, United States Background: Total body digital photography (TBDP) is increasingly utilized by dermatologists in following patients with atypical mole syndrome (AMS). Currently, there are no data confirming the impact of this tool. Our objective was to assess whether TBDP has an impact on quality of life (QOL) and cancer anxiety in AMS patients.
Bilateral segmental lentiginosis associated with malignant melanomas Gonza´lez-Sixto Beatriz, MD, Complejo Hospitalario Pontevedra, Pontevedra, Spain; Flo´rez Angeles, MD, Complejo Hospitalario de Pontevedra, Pontevedra, Spain; De la Torre Carlos, MD, Complejo Hospitalario de Pontevedra, Pontevedra, Spain; Cruces Manuel, MD, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
Methods: Between June 2005 and June 2006, patients with AMS ([ 50 atypical nevi) with or without a history of melanoma seen in the pigmented lesion clinics at Emory and Arizona University were given survey instruments at 0 months and 3-6 months that measured QOL and anxiety. TBDP was obtained after initial baseline instruments. The instruments administered included: 1) SKINDEX-16, a skin-specific QOL scale, 2) Revised Impact of Events Scale (RIES) I and II, measuring subjective distress in response to life events, and 3) Breast Cancer Worry Scale, modified to be melanoma-specific (MWS), measuring worry about cancer. For all scales, lower scores indicated less of the measured construct. Analyses were completed with STATA Version 8.0 and Wilcoxon matched pairs signed-rank test calculated statistical significance between matched pairs. Results: A total of 30 patients were enrolled and 53% (n = 16) were female. The mean SKINDEX-16 total score for all patients was 18.6 6 15.8, (range, 0-65). The mean RIES I total score was13.3 6 15.9, (range, 0-57) and the mean MWS total score was 9.4 6 3.4, (range, 0-17). At this time, 13 patients have completed follow-up instruments. For these patients, the mean SKINDEX-16 total, REIS I, MWS at baseline in comparison to follow-up was 22.7 6 13.4 to 17.7 6 8.9 (p = 0.16), 15.5 6 16.5 to 13.3 6 14.9 (p = 0.97), and 10.8 6 3.0 to 9.6 6 2.6 (p = 0.048), respectively. Lastly, 60% (n = 18) of patients had a previous diagnosis of melanoma; 6 them had complete follow-up. In this group, the mean SKINDEX-16 total, REIS I, REIS II, MWS at baseline in comparison to follow-up was 32 6 8.8 to 21 6 9.4, 21.2 6 14.5 to 14.4 6 12.5, 25.5 6 11.3 to 15.7 6 16.1, and 12.4 6 2.2 to 10.6 6 2.4, respectively. Conclusion: This is the first study that has investigated TBDP impact on QOL in AMS patients. For all patients with follow-up, there was an improvement in all the instruments with statistical significance in the MWS, suggesting that TBDP may have a positive impact on QOL. Further studies with control groups may prove beneficial in targeting TBDP specific impact and a larger number of patients may strengthen statistical significance for the other instruments.
Introduction: Partial unilateral lentiginosis (PUL) is a rare pigmentary disorder characterized by multiple lentigines within an area of normal skin, usually limited to one side of the body. Bilateral cases are extremely rare. Several cutaneous and systemic disorders have been reported in patients with PUL, but malignant transformation has not been documented so far. We report a case of bilateral segmental lentiginosis with 2 malignant melanomas arising from lentigines. Case Report: An 86-year-old woman was referred to our department for evaluation of an asymptomatic lesion on the left preauricular region. Physical examination revealed a nonpigmented plaque (2 3 1.8 cm diameter) on the left preauricular area. Multiple small lentigines were found on the left side of the face, right side of the trunk, and left leg. These were present since childhood. A sudden stoppage at the midline was patent. In addition, an asymmetric, hyperpigmented macule (5 3 5 mm diameter) was observed on the left leg over the lentiginous area. There was no evidence of neurofibromas, cafe´-au-lait macules or axillary freckling. Both suspicious lesions were excised with 5 mm surgical margin. Histologic examination of the left preauricular lesion revealed features of superficially spreading melanoma (0.7 mm Breslow). The atypical macule located on the leg was a melanoma in situ. Discussion: PUL consists of small pigmented macules that are grouped on otherwise normal skin. The distribution of lentigines is generally unilateral with a sharp interruption at the midline, and it often corresponds to one or more dermatomes. Two cases of bilateral involvement have been described. Lentigines are present at birth or appear during childhood. Mental retardation, focal epilepsy, and segmental neurofibromatosis, among others, have been reported in association with PUL, although this association may be casual. Long-term prognosis is unknown and malignant transformation has not been previously reported. We present a case of extensive bilateral lentiginosis with 2 malignant melanomas arising out of lentiginous areas. To our knowledge this association has not been reported so far. References: Kim HS, Kim SY, Kim GM. Extensive partial unilateral lentiginosis. J Eur Acad Dermatol Venereol 2006;20:469-70. Trattner A, Metzker A. Partial unilateral lentiginosis. J Am Acad Dermatol 1993; 29:693-5. Commercial support: None identified.
Commercial support: None identified.
P2206
P2204 The dermoscopic pattern of truncal nevi may mirror the surrounding skin pigment pattern Jocelyn Lieb, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Christiane Benvenuto-Andrade, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States; Anna Liza Agero, MD, Memorial Sloan-Kettering Cancer Center, New York, NY, United States Several different dermoscopic patterns have been recognized in pigmented skin lesions including globular, reticular, homogeneous, and combinations of these. It has been suggested that most nevi in a given individual retains a predominant dermoscopic pattern. Factors thought to contribute to pigment structure include age, sun exposure, and skin phototype. In facial and acral areas, pigment patterns have been correlated with skin structures such as pseudonetworks surrounding dilated adnexal structures on the face and the parallel patterns due to ridges and furrows on palms and soles. Such structural correlations have never been made regarding pigmented lesions of the trunk. We reviewed a series of dermoscopic images of acquired nevi from a dermoscopic database obtained from SONIC (Study of Nevi in Children) to assess whether the pigment network of surrounding skin has an association with the dermoscopic pattern of the lesions. We present several lesions whose pigment morphology mirrors that of the background architecture. These 12 examples include 4 nevi with an evident reticular pattern superimposed on a reticular background, 4 nevi with a globular pattern superimposed on a globular background, and 4 nevi with a globular-reticular pattern on a corresponding globular-reticular background. Each of these cases illustrates that the pigment morphology of acquired melanocytic nevi may indeed be influenced by the background pigment architecture. These associations appear to be more readily apparent in lesions with reticular patterning and in patients with darker skin phototypes (III-V). Further investigation into pigment architecture of normal skin and acquired melanocytic nevi may provide knowledge into the structural development of benign and malignant pigmented lesions. Commercial support: None identified.
AB144
J AM ACAD DERMATOL
Pulmonary carcinoid associated with melanoma Rajaratnam Ratna, MBChB, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom; Jerry Marsden, MBChB, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom To our knowledge, this is the first report in British literature documenting the cooccurrence of melanoma and pulmonary carcinoid. The only other report is from New York and documents pulmonary carcinoid in association with a parathormone producing melanoma (Wagner RF, et al. Pulmonary carcinoid associated with a parathormone producing melanoma. J Dermatol Surg Oncol 1983 Jul;9(7):562-6). Cases: A 46-year-old female presented in 1998 with a superficial spreading melanoma 1 mm, T2a/b N0M0 stage 1B. Two years later, a chest X-ray (CXR) detected an opacity in the left lung. Clinical examination was normal and computed tomograph (CT) imaging showed no other abnormality. The patient proceeded to a lobectomy. Unexpectedly, histology showed a primary pulmonary carcinoid. A 61year-old male had a nodular melanoma excised from the skin of his chest in 1997. The lesion was 8 mm thick, T4a/b N0M0 stage 2B. He remained well until 2005. A CXR detected an opacity in the left lung. CT imaging showed a further nodule in the right lung. Clinical examination was normal and imaging showed no other abnormality. Both lesions were excised and histologically showed bilateral pulmonary carcinoid. Discussion: To our knowledge, this is the second report documenting this association. Evidence is discussed in support of a possible association between melanoma and carcinoid, both of which fall under the APUD (amine precursor uptake and decarboxylation) classification. (Pearse AG. Common cytochemical and ultrastructural characteristics of cells producing polypeptide hormones and their relevance to the thyroid and ultimobronchial C cells and calcitonin. Proc R Soc Lond 1968;170:71-80.) Pearse first applied this term to cells which could produce amines or hormones. Melanoma and carcinoid were classified as APUD tumours. Pearse also hypothesised that they shared a common embryological origin. While the melanoblast’s origin from the neural crest has been verified, proving the neural crest origin of other APUD tumours is less clear. There is further similarity. Carcinoids have been shown to contain melanosomes and melanin in addition to neurosecretory granules suggesting a common origin. There are also reports of melanomas showing neuroendocrine differentiation. This report does not exclude the possibility of a chance association and additional reports will be required to strengthen the association. Commercial support: None identified.
FEBRUARY 2007