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The State of Melanoma: Emergent Challenges and Opportunities

UC San Francisco Previously Published Works (2021)

Five years ago, the Melanoma Research Foundation (MRF) conducted an assessment of the challenges and opportunities facing the melanoma research community and patients with melanoma. Since then, remarkable progress has been made on both the basic and clinical research fronts. However, the incidence, recurrence, and death rates for melanoma remain unacceptably high and significant challenges remain. Hence, the MRF Scientific Advisory Council and Breakthrough Consortium, a group that includes clinicians and scientists, reconvened to facilitate intensive discussions on thematic areas essential to melanoma researchers and patients alike, prevention, detection, diagnosis, metastatic dormancy and progression, response and resistance to targeted and immune-based therapy, and the clinical consequences of COVID-19 for patients with melanoma and providers. These extensive discussions helped to crystalize our understanding of the challenges and opportunities facing the broader melanoma community today. In this report, we discuss the progress made since the last MRF assessment, comment on what remains to be overcome, and offer recommendations for the best path forward.

Cover page: The State of Melanoma: Emergent Challenges and Opportunities

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Pedunculated polypoid melanoma. A case report of a rare spindle-cell variant of melanoma

Dermatology Online Journal, Volume 21, Issue 4 (2015)

We report an 89-year-old man who presented with a slowly growing pigmented pedunculated tumor. The nodule was diagnosed as a spindle cell pedunculated malignant melanoma (PMM), a rare variant of spindle-cell malignant melanoma. The clinical presentation of this tumor and its histological and immunohistological features are discussed.

Cover page: Pedunculated polypoid melanoma. A case report of a rare spindle-cell variant of melanoma

Creative Commons 'BY-NC-ND' version 4.0 license

Article
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Malignant Melanoma With Neural Differentiation

UCLA Previously Published Works (2014)

: The term neurotropic melanoma has been used to refer to malignant melanoma with associated infiltration of nerve or "neural differentiation"--that is, melanoma cells exhibiting cytological characteristics of nerve cells. Historically, neurotropic melanoma has generally been discussed within the context of desmoplastic melanoma. We report an exceptional case of melanoma notable for a very well-differentiated neural component that was contiguous with obvious overlying melanoma. After careful consideration of all pertinent histological features, the overall diagnostic impression was that of melanoma with associated "malignant neurotization." We have not encountered a previously reported case with such a well-differentiated neural component. The following article details our exceptional case of melanoma with "malignant neurotization" and presents a discussion of the differential diagnosis and brief review of the pertinent literature.

Cover page: Malignant Melanoma With Neural Differentiation

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Verrucous melanoma masquerading as a seborrheic keratosis

Dermatology Online Journal, Volume 25, Issue 2 (2019)

Seborrheic keratosis is a benign condition that can mimic many different non-melanoma and melanoma neoplasms. There have been several case reports of underlying squamous cell carcinomas or intraepidermal carcinomas appearing within lesions that look analogous to seborrheic keratoses. We present a patient with a verrucous melanoma that could be mistaken for a benign skin tumor like an inflamed seborrheic keratosis. In our patient's case, her verrucous plaque was initially clinically suggestive of a benign seborrheic keratosis. However, given the patient's complaint of pain associated with the lesion, a biopsy was performed and revealed a verrucous-keratotic malignant melanoma, which was subsequently removed through surgical excision. It is important to remain vigilant of this diagnosis, as treatment for inflamed seborrheic keratosis often includes a trial of cryotherapy, which potentially could lead to a delayed diagnosis of an underlying malignant lesion.

Cover page: Verrucous melanoma masquerading as a seborrheic keratosis

Article

Compliance with follow-up among patients with melanoma and non-melanoma skin cancers

Dermatology Online Journal, Volume 20, Issue 2 (2014)

Background: A history of cutaneous malignancies puts patients at an increased risk of developing additional skin cancers, but there is little data available regarding compliance with any recommended follow-up regimens.

Purpose: To report on compliance with physician recommended follow-up regimens among patients diagnosed with melanoma and non-melanoma skin cancers.

Methods: 105 patients with cutaneous melanoma and 1151 patients with non-melanoma skin cancers diagnosed between December 1996 and December 2001 were identified through biopsy records. The records of all identified patients were then retrospectively reviewed for compliance with physician recommended follow-up regimens over a 60-month period.

Results: At 60 months following initial diagnosis, 22.6% of melanoma patients and 19.3% of non-melanoma patients were still continuing follow-up examinations. However, only 10.5% of melanoma patients and 7.2% of non-melanoma patients were compliant with the recommended follow-up schedule. Among melanoma patients, Breslow thickness correlated positively with duration of follow-up (P = 0.03). The frequency of additional primary non-melanoma and melanoma skin cancers was positively correlated with duration of follow-up among patients with non-melanoma skin cancers (P ≤ 0.001).

Conclusions: Patient compliance with physician recommended follow-up regimens is generally poor; further research and intervention is necessary to identify and address the underlying causes.

Cover page: Compliance with follow-up among patients with melanoma and non-melanoma skin cancers

Article
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A pink enlarging plaque on the plantar foot: amelanotic acral lentiginous melanoma

Dermatology Online Journal, Volume 25, Issue 1 (2019)

Acral lentiginous melanomas account for less than 5% of all melanomas, whereas amelanotic melanomas account for around 2-8% of all melanomas. Amelanotic acral lentiginous melanomas are even less common and can often be mistaken for other clinical entities, including pyogenic granulomas, non-melanoma skin cancers, and warts. We describe a man in his 50s with a twenty-year history of a skin-colored plaque on the right plantar foot; after enlargement and failure of wart treatment, a shave biopsy revealed an amelanotic melanoma. A subsequent wide local excision and sentinel lymph node biopsy revealed melanoma in 4 lymph nodes and the patient underwent an abbreviated course of interferon-alpha therapy. The patient remained stable until 2 ? years after diagnosis, at which time he presented with in-transit metastases on the foot and right thigh; he has since been stable on nivolumab. This case represents the challenge of diagnosing amelanotic melanomas on acral surfaces and highlights the importance of considering a skin biopsy for diagnosis of any changing, atypical amelanotic lesions on the feet or hands.

Cover page: A pink enlarging plaque on the plantar foot: amelanotic acral lentiginous melanoma

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Polypoid amelanotic melanoma: a diagnostic challenge

Dermatology Online Journal, Volume 24, Issue 8 (2018)

Melanoma is a highly aggressive cutaneous malignancy with considerable risk for metastasis. These malignant tumors are typically pigmented given that they arise from melanocytes capable of producing melanin. Amelanotic melanomas are a rare variant and there is often a delay in diagnosis owing to lack of pigmentation. Although there are various presentations of amelanotic melanoma, a solitary polypoid nodule is unusual and warrants further reporting. Herein, we present a patient with a 3-year history of a tender firm, skin-to-pink colored polypoid nodule. Excisional biopsy and work up showed an aggressive amelanotic melanoma with depth of 20mm and nodal metastasis consistent with stage IIIC disease. This case highlights the necessity of recognition and prompt management of this rare subtype of melanoma.

Cover page: Polypoid amelanotic melanoma: a diagnostic challenge

Article

Melanoma patient notification and treatment timelines

Dermatology Online Journal, Volume 25, Issue 4 (2019)

Melanoma is an extremely aggressive cancer for which the American Academy of Dermatology currently does not have formal recommendations outlining a timeline from biopsy to definitive treatment. Our dermatology department investigated our treatment timeline for melanoma. Using the database from our electronic medical record, Epic, we evaluated patients over a one-year period; in total we identified 109 melanomas. We evaluated patient demographics, tumor characteristics, and timelines regarding diagnosis and treatments. There was a statistically significant difference in patient notification of diagnosis and treatment times between stage 1 and stages 2-4 combined (based on the American Joint Committee on Cancer staging system). We found that 84% of melanomas were treated within 4 weeks of diagnosis and 96% within 6 weeks. The lower the stage, the earlier the melanoma was definitively treated; higher stage melanomas had a longer delay to definitive treatment. Herein, we have presented our single institutional experience of the melanoma timeline from diagnosis to definitive treatment and have identified factors that impact timely definitive treatment.

Cover page: Melanoma patient notification and treatment timelines

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Metastatic malignant melanoma in an endometrial polyp

Dermatology Online Journal, Volume 27, Issue 4 (2021)

Melanocytic metastasis to gynecologic organs is rare with most metastases to the ovaries. Metastases to the uterus, or in this case report, a uterine polyp, is exceedingly rare with only 17 cases reported in the literature. Post-menopausal bleeding is the most common presentation of metastatic melanoma in the endometrium, followed by uterine bleeding or abnormal postnatal bleeding in the premenopausal population. We present an 81-year-old woman with metastatic melanoma confined to an endometrial polyp leading to the diagnosis of widespread dissemination of the patient's acral melanoma resected 6 years prior. Although rare, metastatic melanoma should be considered as a cause for abnormal bleeding, especially in the post-menopausal patient with a history of melanoma.

Cover page: Metastatic malignant melanoma in an endometrial polyp

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An amelanotic nail bed melanoma presenting as persistent onychodystrophy

Dermatology Online Journal, Volume 24, Issue 3 (2018)

Nail apparatus melanomas are rare and may present with a wide variety of clinical presentations. In particular, the amelanotic subtype can pose a diagnostic challenge, often leading to a poor prognosis related to a delayed diagnosis. We report a 69-year-old man with an unusual subungual amelanotic melanoma presenting as a persistent single nail dystrophy that was repeatedly treated as onychomycosis. Owing to the delayed diagnosis of the melanoma and to minimize recurrence risk, the patient underwent a partial amputation of his left thumb.

Cover page: An amelanotic nail bed melanoma presenting as persistent onychodystrophy