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Clinicopathologic, misdiagnosis, and survival differences between clinically amelanotic melanomas and pigmented melanomas - 12/04/19

Doi : 10.1016/j.jaad.2019.01.012 
Lauren C. Strazzulla, BA a, Xiaoxue Li, PhD b, c, Kathleen Zhu, BA d, Jean-Phillip Okhovat, MD, MPH e, Sandra J. Lee, ScD b, c, Caroline C. Kim, MD f,
a Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York 
b Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts 
c Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts 
d University of Massachusetts Medical School, Worcester, Massachusetts 
e Department of Dermatology, Stanford University Medical Center, Stanford University School of Medicine, Palo Alto, California 
f Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 

Correspondence to: Caroline C. Kim, MD, Beth Israel Deaconess Medical Center, Department of Dermatology, 330 Brookline Ave, Shapiro 2, Boston, MA 02215.Beth Israel Deaconess Medical CenterDepartment of Dermatology330 Brookline Ave, Shapiro 2BostonMA02215

Abstract

Background

Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined.

Objective

To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM).

Methods

A cross-sectional retrospective medical record review at a tertiary academic medical center.

Results

A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]).

Limitations

Retrospective study design, single-institutional study.

Conclusion

Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.

Le texte complet de cet article est disponible en PDF.

Key words : amelanotic, MC1R, melanoma, red hair, risk factors

Abbreviations used : AMM, CI, DN, FH, NMSC, OR, PMM, UV


Plan


 Funding sources: Supported in part by a grant from the National Cancer Institute of the National Institutes of Health (R21CA182241) (to Dr Li, Dr Lee, and Dr Kim).
 Conflicts of interest: None disclosed.
 Reprints not available from the authors.


© 2019  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 80 - N° 5

P. 1292-1298 - mai 2019 Retour au numéro
Article précédent Article précédent
  • Cutaneous nevi and risk of melanoma death in women and men: A prospective study
  • Wen-Qing Li, Eunyoung Cho, Martin A. Weinstock, Suyun Li, Meir J. Stampfer, Abrar A. Qureshi
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