Acceso abierto

Sclerosing melanocytic lesions (sclerosing melanomas with nevoid features and sclerosing nevi with pseudomelanomatous features) – an analysis of 90 lesions

Biljana Grcar-Kuzmanov
Biljana Grcar-Kuzmanov
, 
Emanuela Bostjancic
Emanuela Bostjancic
, 
Juan Antonio Contreras Bandres
Juan Antonio Contreras Bandres
 y 
Joze Pizem
Joze Pizem
   | 24 ene 2018
Radiology and Oncology's Cover Image
Acerca de este artículo
Artículo anterior
Artículo siguiente
Cite
Article Category: Research Article
Publicado en línea: 24 ene 2018
Páginas: 220 - 228
Recibido: 17 oct 2017
Aceptado: 20 dic 2017
DOI: https://doi.org/10.2478/raon-2018-0003
© 2018 Biljana Grcar-Kuzmanov, Emanuela Bostjancic, Juan Antonio Contreras Bandres, Joze Pizem, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Sclerosing melanocytic nevus from the abdomen of a 22-year-old woman, with negative FISH assay. (A) There is a trizonal pattern, maturation and an atypical intraepidermal component above the sclerosis, which does not extend beyond the sclerosis. (B) HMB-45 stain shows maturation in the dermal component.
Sclerosing melanocytic nevus from the abdomen of a 22-year-old woman, with negative FISH assay. (A) There is a trizonal pattern, maturation and an atypical intraepidermal component above the sclerosis, which does not extend beyond the sclerosis. (B) HMB-45 stain shows maturation in the dermal component.

Figure 2

Sclerosing melanocytic nevus from the abdomen of a 53-year-old man, with negative the FISH assay. (A), (B) There is lamellar-type sclerosis involving the entire dermal component.
Sclerosing melanocytic nevus from the abdomen of a 53-year-old man, with negative the FISH assay. (A), (B) There is lamellar-type sclerosis involving the entire dermal component.

Figure 3

Sclerosing melanoma from the abdomen of a 67-year-old man. (A) There are remnants of a nevus below the melanoma (arrow) and a trizonal pattern. (B) Some melanocytes are in the epithelium of an eccrine duct (arrow). (C) Melanocytes within sclerosis are atypical, with prominent nucleoli. (D) There is a mitotic figure (arrow). (E) HMB-45 staining is irregular diffuse in the sclerotic dermal component (melanoma) but negative in the nevus below (arrow). There is prominent pagetoid spread in the epidermis. (F) The FISH assay was positive, showing loss of MYB (gold) relative to CEP6 (aqua) in 57% of tumor cell nuclei.
Sclerosing melanoma from the abdomen of a 67-year-old man. (A) There are remnants of a nevus below the melanoma (arrow) and a trizonal pattern. (B) Some melanocytes are in the epithelium of an eccrine duct (arrow). (C) Melanocytes within sclerosis are atypical, with prominent nucleoli. (D) There is a mitotic figure (arrow). (E) HMB-45 staining is irregular diffuse in the sclerotic dermal component (melanoma) but negative in the nevus below (arrow). There is prominent pagetoid spread in the epidermis. (F) The FISH assay was positive, showing loss of MYB (gold) relative to CEP6 (aqua) in 57% of tumor cell nuclei.

Figure 4

Sclerosing melanoma from the back of a 70-year-old female. (A) There are remnants of a nevus below sclerosis (arrow). (B) Melanocytes in the sclerosis do not show maturation and (C) are larger with irregular nuclei and prominent nucleoli compared to melanocytes in the adjacent nevus (left). (D) HMB-45 stain shows pagetoid spread in the epidermis, but is completely negative in the dermis. (E) Ki67 (brown)/melan A (red) shows no proliferative activity in the melanocytes in the deepest aspect of the sclerotic component; note less intense melan A positivity in the nevus below the melanoma (arrow). (F) The FISH assay was positive, showing gain in RREB1 (red) in 30% of tumor cell nuclei.
Sclerosing melanoma from the back of a 70-year-old female. (A) There are remnants of a nevus below sclerosis (arrow). (B) Melanocytes in the sclerosis do not show maturation and (C) are larger with irregular nuclei and prominent nucleoli compared to melanocytes in the adjacent nevus (left). (D) HMB-45 stain shows pagetoid spread in the epidermis, but is completely negative in the dermis. (E) Ki67 (brown)/melan A (red) shows no proliferative activity in the melanocytes in the deepest aspect of the sclerotic component; note less intense melan A positivity in the nevus below the melanoma (arrow). (F) The FISH assay was positive, showing gain in RREB1 (red) in 30% of tumor cell nuclei.

Clinical and histopathologic parameters in relation to morphological diagnostic categories

Parameter, n (%) All Nevus Melanoma Melanoma with nevus P -value
N (%) 90 26 (29) 19 (21) 45 (50)
Age of the patients (years) (median; range) 48; 21-89 38; 22-53 60; 21-89 51; 26-85 < 0.001
Maximum diameter

available for 81 lesions

 (mm) (median; range)		 9; 2-29 7; 2-14 8; 3-29 11; 4-25 0.014
Location 0.076
Back 46 (51) 9 (35) 9 (47) 28 (62)
Other 44 (49) 17 (65) 10 (53) 17 (38)
Extension along eccrine ducts

no eccrine ducts were identified within or adjacent to sclerotic dermal component in 13 lesions

 49/77 (64) 5/21 (24) 14/17 (82) 30/39 (77) < 0.001
Evidence of regression 29 (32) 1 (4) 12 (63) 16 (36) /
Lamellar sclerosis 8 (9) 6 (23) 0 2 (4) /
Marked inflammation in the sclerosis 27 (30) 2 (8) 6 (32) 19 (42) /
Maturation in the sclerosis 50 (56) 25 (96) 8 (42) 17 (38) /
Dermal mitoses present 18 (20) 1 (4) 4 (21) 13 (29) /
Prominent nucleoli in the sclerosis 52 (58) 5 (19) 16 (84) 31 (69) /
Intraepidermal component adjacent to the sclerosis /
Not atypical 18 (20) 17 (65) 1 (5) 0
Atypical 17 (19) 9 (35) 1 (5) 7 (16)
Melanoma in situ 55 (61) 0 17 (89) 38 (84)
Severe cytological atypia in the epidermis above the sclerosis 68 (76) 9 (35) 19 (100) 40 (89) /
Lentiginous growth above the sclerosis 82 (91) 19 (73) 19 (100) 44 (98) /
Upward migration in the epidermis above the sclerosis /
No 12 (13) 9 (35) 1 (5) 2 (4)
Lower half 11 (12) 7 (27) 1 (5) 3 (7)
Focally in the upper half 23 (26) 9 (35) 5 (26) 9 (20)
Prominent full thickness 44 (48) 1 (4) 12 (63) 31 (69)
HMB-45 in the sclerotic component 60 19 11 30 /
Patchy, irregular 37 (62) 6 (32) 10 (91) 21 (70)
Maturation or completely absent 23 (38) 13 (68) 1 (9) 9 (30)
Ki67 in the sclerotic component 66 19 13 34
No positivity in the lower half 51 (77) 19 (100) 8 (62) 24 (71) /
Some positive melanocytes in the lower half, <5% overall 13 (20) 0 4 (31) 9 (26)
>5%, no gradient with the depth 2 (3) 0 1 (7) 1 (3)
Four-probe FISH in the sclerotic component 41 16 7 18 0.001
Positive 14 (34) 0 3 (43) 11 (61)
Negative 27 (66) 16 (100) 4 (57) 7 (39)

Clinical and histopathologic parameters in relation to FISH results in 41 lesions with FISH analysis of the sclerotic component

Parameter, n (%) All FISH-positive FISH-negative P -value
N (%) 41 14 27
Age of the patients (years) (median; range) 48; 22-89 51; 42-89 48; 22-77 0.196
Thickness of sclerosis (mm) (mean; range) 0.85; 0.5-1.5 1.0; 0.7-1.5 0.8; 0.5-1.3 0.002
Location 0.096
Back 25 (61) 11 (79) 14 (52)
Other 16 (39) 3 (21) 13 (48)
Extension along eccrine ducts 21/38 (55) 11/14 (71) 10/24 (42) 0.026
Evidence of regression 8 (20) 4 (29) 4 (15) 0.411
Maturation in the sclerosis 29 (71) 7 (50) 22 (81) 0.068
Dermal mitoses present 10 (24) 5 (36) 5 (19) 0.267
Prominent nucleoli in the sclerosis 20 (49) 11 (79) 9 (33) 0.009
Melanoma in situ adjacent to the sclerosis 23 (56) 13 (93) 10 (39) 0.001
Severe cytological atypia in the epidermis above the sclerosis 27 (66) 12 (86) 15 (56) 0.053
Prominent full thickness upward migration in the epidermis above the sclerosis 19 (22) 10 (71) 9 (33) 0.026
Patchy irregular HMB-45 in the sclerotic component 22/38 (58) 11/13 (85) 11/25 (44) 0.016
No Ki67 positivity in the lower half of the sclerotic component 28/39 (72) 7/14 (50) 21/25 (84) 0.033
eISSN:
1581-3207
Idioma:
Inglés
Calendario de la edición:
4 veces al año
Temas de la revista:
Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
RSS Feed de revista