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Journal of the American Academy of Dermatology
Volume 71, n° 6
pages 1083-1092 (décembre 2014)
Doi : 10.1016/j.jaad.2014.07.051
accepted : 29 July 2014
Original Articles

Primary dermal melanoma: A unique subtype of melanoma to be distinguished from cutaneous metastatic melanoma : A clinical, histologic, and gene expression–profiling study
 

Michael Sidiropoulos, MD, MS a, Roxana Obregon, BA a, Chelsea Cooper, BA a, Lauren Meldi Sholl, MS a, Joan Guitart, MD a, b, Pedram Gerami, MD a, b,
a Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 
b Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 

Reprint requests: Pedram Gerami, MD, Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair St, Suite 1765, Chicago, IL 60611.
Abstract
Background

Primary dermal melanoma (PDM) is a subtype of melanoma confined to the dermis that may be morphologically impossible to distinguish from cutaneous metastatic melanoma (CMM).

Objective

We sought to better characterize PDM by describing the clinical, histologic, and molecular features of 49 cases of PDM and determine whether a gene expression–profiling test could help distinguish PDM from CMM.

Methods

We describe 49 cases of PDM and determined whether any clinical or histopathologic features had a statistically significant relationship with outcome. Secondly, we performed a melanoma gene expression–profiling test on a subset of the PDM and CMM cases.

Results

Overall recurrence was infrequent and seen in 9 of 49 cases. Six patients had locoregional recurrences and 3 patients had distant metastasis. None of the clinical or histologic parameters showed a statistically significant relationship with recurrence. There was a statistically significant association of a class I signature by DecisionDx-Melanoma assay (Castle Biosciences Inc, Friendswood, TX) for PDM whereas CMM were more frequently class II (P value = .023).

Limitations

The mean follow-up time was 26 months.

Conclusions

Most conventional staging parameters used for prognosis in cutaneous melanoma have limited applicability to PDM. The melanoma prognostic assay may be a useful tool for distinguishing PDM from CMM.

The full text of this article is available in PDF format.

Key words : American Joint Committee on Cancer, cutaneous metastatic melanoma, fluorescence in situ hybridization, gene expression profile, melanoma, primary dermal melanoma

Abbreviations used : CGH, CMM, FISH, GEP, IDN, IHC, NOS, PDM, SLNB



 Supported by the Irene D. Pritzker Foundation and partially supported by Castle Biosciences Inc.
 Disclosure: Dr Gerami has served as a consultant to Castle Biosciences Inc, Myriad Genetics, and DermTech Inc, receiving honoraria. Dr Guitart has served as a consultant to Castle Biosciences Inc, receiving honoraria. The other authors declared no conflicts of interest.
 Dr Sidiropoulos and Ms Obregon contributed equally to this article.



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