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1. Bradford PT, Goldstein AM, McMaster ML, Tucker MA: Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986-2005. Arch Dermatol; 2009 Apr;145(4):427-34
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  • [Title] Acral lentiginous melanoma: incidence and survival patterns in the United States, 1986-2005.
  • OBJECTIVE: To examine incidence and survival patterns of acral lentiginous melanoma (ALM) in the United States.
  • PARTICIPANTS: A total 1413 subjects with histologically confirmed cases of ALM.
  • Main Outcome Measure Incidence and survival patterns of patients with ALM.
  • RESULTS: The age-adjusted incidence rate of ALM overall was 1.8 per million person-years.
  • The proportion of ALM among all melanoma subtypes was greatest in blacks (36%).
  • Acral lentiginous melanoma had 5- and 10-year melanoma-specific survival rates of 80.3% and 67.5%, respectively, which were less than those for all cutaneous malignant melanomas overall (91.3% and 87.5%, respectively; P < .001).
  • The ALM 5- and 10-year melanoma-specific survival rates were highest in non-Hispanic whites (82.6% and 69.4%), intermediate in blacks (77.2% and 71.5%), and lowest in Hispanic whites (72.8% and 57.3%) and Asian/Pacific Islanders (70.2% and 54.1%).
  • Acral lentiginous melanoma thickness and stage correlated with survival according to sex and in the different racial groups.
  • CONCLUSIONS: Population-based data showed that ALM is a rare melanoma subtype, although its proportion among all melanomas is higher in people of color.
  • It is associated with a worse prognosis than cutaneous malignant melanoma overall.
  • [MeSH-major] Hutchinson's Melanotic Freckle / epidemiology. Melanoma / epidemiology. Skin Neoplasms / epidemiology

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  • (PMID = 19380664.001).
  • [ISSN] 1538-3652
  • [Journal-full-title] Archives of dermatology
  • [ISO-abbreviation] Arch Dermatol
  • [Language] eng
  • [Grant] United States / Intramural NIH HHS / / Z01 CP004410-31
  • [Publication-type] Journal Article; Research Support, N.I.H., Intramural
  • [Publication-country] United States
  • [Other-IDs] NLM/ NIHMS107338; NLM/ PMC2735055
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2. Nishi H, Inoue Y, Kageshita T, Takata M, Ihn H: The expression of human high molecular weight melanoma-associated antigen in acral lentiginous melanoma. Biosci Trends; 2010 Apr;4(2):86-9
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  • [Title] The expression of human high molecular weight melanoma-associated antigen in acral lentiginous melanoma.
  • The high molecular weight melanoma-associated antigen (HMW-MAA) is a membrane-bound chondroitin sulphate proteoglycan that is highly expressed on the surface of melanoma cells.
  • It represents an attractive target for immunotherapy of malignant melanoma.
  • Previously, it was reported that HMW-MAA was detected in about 20-30% of primary acral lentiginous melanoma (ALM) lesions by immunohistochemical staining (IHC) of frozen sections with monoclonal antibodies (mAbs).
  • In the present study, we examined the expression of HMW-MAA in 95 paraffin-embedded, primary ALM lesions and 13 primary superficial spreading melanoma (SSM) lesions.
  • A total of 51 primary ALM lesions (53.6%) were positive for HMW-MAA.
  • Our data showed that the staining intensity of HMW-MAA ALM lesions was weaker than that of SSM.
  • Furthermore, the percentage of HMW-MAA positive staining in ALM lesions was higher than previously reported.
  • [MeSH-major] Antigens, Neoplasm / metabolism. Melanoma / metabolism. Skin Neoplasms / metabolism

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  • (PMID = 20448346.001).
  • [ISSN] 1881-7823
  • [Journal-full-title] Bioscience trends
  • [ISO-abbreviation] Biosci Trends
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Antibodies, Monoclonal; 0 / Antigens, Neoplasm; 0 / HMW-MAA
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3. Bristow IR, Acland K: Acral lentiginous melanoma of the foot and ankle: A case series and review of the literature. J Foot Ankle Res; 2008;1(1):11

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  • [Title] Acral lentiginous melanoma of the foot and ankle: A case series and review of the literature.
  • BACKGROUND: Acral lentiginous melanoma (ALM) is an uncommon, cutaneous malignant tumour which may arise on the foot.
  • METHODS: At a tertiary skin tumour centre, a retrospective review was undertaken of all patients diagnosed with the tumour at the level of ankle or below.
  • CONCLUSION: Earlier diagnosis of ALM requires education at both a patient and practitioner level.

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  • (PMID = 18822168.001).
  • [ISSN] 1757-1146
  • [Journal-full-title] Journal of foot and ankle research
  • [ISO-abbreviation] J Foot Ankle Res
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC2553782
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4. Lang J, MacKie RM: Prevalence of exon 15 BRAF mutations in primary melanoma of the superficial spreading, nodular, acral, and lentigo maligna subtypes. J Invest Dermatol; 2005 Sep;125(3):575-9
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  • [Title] Prevalence of exon 15 BRAF mutations in primary melanoma of the superficial spreading, nodular, acral, and lentigo maligna subtypes.
  • DNA was extracted from 52 thick primary melanomas and mutations sought in exon 15 of the BRAF (v-raf murine sarcoma viral oncogene homolog B1) gene using denaturing high performance liquid chromatograph (dHPLC) fragment analysis, sequencing, and allele-specific PCR.
  • Exon 15 BRAF mutations were found in 13 of 52 (25%) primary melanomas.
  • These comprised five of 17 (29%) superficial spreading melanomas, three of 11 (27%) nodular melanomas, two of 13 (15%) acral lentiginous melanomas, one of one (100%) mucosal melanoma and two of 10 (20%) lentigo maligna melanomas.
  • In common with other groups, our findings show a relative concentration of the exon 15 BRAF mutation in superficial spreading and nodular melanomas, but add further evidence that this mutation not necessary for malignant transformation of the melanocyte.
  • [MeSH-major] Hutchinson's Melanotic Freckle / genetics. Melanoma / genetics. Mutation. Proto-Oncogene Proteins B-raf / genetics. Skin Neoplasms / genetics


5. Sundersingh S, Majhi U, Murhekar K, Krishnamurthy R: Malignant melanoma with osteocartilaginous differentiation. Indian J Pathol Microbiol; 2010 Jan-Mar;53(1):130-2
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  • [Title] Malignant melanoma with osteocartilaginous differentiation.
  • We report a case of acral lentiginous melanoma on the plantar aspect of foot in a 50-year-old male that exhibited a prominent osteo-cartilaginous differentiation in the metastatic inguinal lymph node.
  • The ability of melanomas to undergo multidirectional differentiation leads to a variety of histological appearances that can be misleading.
  • Although the true nature of the tumor is most often recognized at the primary cutaneous site, metastatic tumors may closely mimic other malignant mesenchymal or neuro-ectodermal tumors.
  • Hence awareness of this unusual phenomenon occurring in malignant melanoma is essential to avoid misdiagnosis.
  • [MeSH-major] Foot Diseases / pathology. Melanoma / diagnosis. Melanoma / pathology

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  • (PMID = 20090243.001).
  • [ISSN] 0974-5130
  • [Journal-full-title] Indian journal of pathology & microbiology
  • [ISO-abbreviation] Indian J Pathol Microbiol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] India
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6. Chang JW: Cutaneous melanoma: Taiwan experience and literature review. Chang Gung Med J; 2010 Nov-Dec;33(6):602-12
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Cutaneous melanoma: Taiwan experience and literature review.
  • Malignant melanoma is a rare disease in Taiwan with an incidence rate of 0.65/100,000.
  • Excessive exposure to ultraviolet radiation is not associated with most Taiwanese melanoma cases.
  • Acral lentiginous melanoma comprises 58% of cutaneous melanoma.
  • Surgery, including resection of the primary melanoma, sentinel lymph nodes that may harbor microscopic metastasis, clinically abnormal lymph nodes, and selected distant metastases, is the most important treatment.
  • Recently biochemotherapy has been more commonly utilized to treat patients with metastatic melanoma.
  • [MeSH-major] Melanoma. Skin Neoplasms

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  • (PMID = 21199605.001).
  • [ISSN] 2309-835X
  • [Journal-full-title] Chang Gung medical journal
  • [ISO-abbreviation] Chang Gung Med J
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] China (Republic : 1949- )
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7. Saldanha G, Potter L, Daforno P, Pringle JH: Cutaneous melanoma subtypes show different BRAF and NRAS mutation frequencies. Clin Cancer Res; 2006 Aug 1;12(15):4499-505
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  • [Title] Cutaneous melanoma subtypes show different BRAF and NRAS mutation frequencies.
  • PURPOSE: BRAF mutations are present in two thirds of cutaneous melanomas and many of the rest have NRAS mutations.
  • However, cutaneous melanoma is a heterogeneous disease with many clinicopathologic subtypes.
  • Of these, the majority fits into four categories: superficial spreading, nodular, lentigo maligna, and acral lentiginous melanoma (ALM).
  • Thus far, there is very limited data combining BRAF and NRAS mutation analysis to explore differences between cutaneous melanoma subtypes.
  • EXPERIMENTAL DESIGN: The frequency of BRAF and NRAS hotspot mutations, in exons 15 and 2, respectively, was assessed in 59 cutaneous melanomas comprising superficial spreading, nodular, lentigo maligna, and ALM using single-strand conformational polymorphism and RFLP-PCR analysis.
  • RESULTS: Only 2 of 21 (9.5%) ALM showed BRAF exon 15 mutation compared with 9 of 14 (64.3%) superficial spreading malignant melanomas, 4 of 11 (36.4%) nodular melanomas, and 7 of 13 (53.4%) lentigo maligna melanomas (P < 0.01).
  • In particular, 9 of 19 (47.4%) ALM without BRAF exon 15 mutation had an NRAS exon 2 mutation.
  • CONCLUSIONS: We show that the overall BRAF/NRAS frequency in mutation hotspots is not significantly different among cutaneous melanoma subtypes.
  • These data show that mitogen-activated protein kinase pathway activation may be important in all major subtypes of cutaneous melanoma, although the mechanism by which this is achieved varies.
  • [MeSH-major] Genes, ras / genetics. Melanoma / classification. Melanoma / genetics. Proto-Oncogene Proteins B-raf / genetics. Skin Neoplasms / classification. Skin Neoplasms / genetics

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  • (PMID = 16899595.001).
  • [ISSN] 1078-0432
  • [Journal-full-title] Clinical cancer research : an official journal of the American Association for Cancer Research
  • [ISO-abbreviation] Clin. Cancer Res.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] EC 2.7.11.1 / BRAF protein, human; EC 2.7.11.1 / Proto-Oncogene Proteins B-raf
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8. Káram-Orantes M, Toussaint-Caire S, Domínguez-Cherit J, Veja-Memije E: [Clinical and histopathological characteristics of malignant melanoma cases seen at "Dr. Manuel Gea González" General Hospital]. Gac Med Mex; 2008 May-Jun;144(3):219-23
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  • [Title] [Clinical and histopathological characteristics of malignant melanoma cases seen at "Dr. Manuel Gea González" General Hospital].
  • [Transliterated title] Características clínicas e histopatológicas del melanoma maligno en el Hospital General "Dr. Manuel Gea González".
  • BACKGROUND: Melanoma is a type of tumor that arises from melanocytes generally located in the dermoepidermal junction.
  • Although melanoma is found in less than 10% of cases, mortality is high representing 75% of deaths attributed to cutaneous cancer.
  • There are four major subtypes: Superficial spreading melanoma, lentigo malignant melanoma, acral lentiginous melanoma and nodular melanoma.
  • Superficial spreading melanoma is the most common type among Caucasians.
  • Acral lentiginous melanoma was the most common subtype.
  • CONCLUSIONS: Our findings differ from the other series where they report nodular and superficial spreading melanoma as the most common types.
  • The most common subtypes in our study were acral lentiginous melanoma and lentigo malignant melanoma among females, with a ratio of female-male of 2.1:1.
  • [MeSH-major] Melanoma / pathology. Skin Neoplasms / pathology

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  • (PMID = 18714590.001).
  • [ISSN] 0016-3813
  • [Journal-full-title] Gaceta médica de México
  • [ISO-abbreviation] Gac Med Mex
  • [Language] spa
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Mexico
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9. Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L: Acral lentiginous melanoma: histopathological prognostic features of 121 cases. Br J Dermatol; 2007 Aug;157(2):311-8
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  • [Title] Acral lentiginous melanoma: histopathological prognostic features of 121 cases.
  • BACKGROUND: Acral lentiginous melanoma (ALM) is the fourth histopathological subtype of malignant melanoma, accounting for < 10% of all melanomas in white-skinned populations.
  • It is characterized by a lentiginous pattern of proliferation of the intraepidermal component of the tumour.
  • OBJECTIVES: To characterize better ALM from a pathological point of view and to assess the prognostic value of all histopathological features of ALM.
  • METHODS: We performed a review of all cases of ALM followed from 1996 to 2004 at the University Hospital Department of Dermatology, Lyon, France.
  • Several pathological parameters of interest in melanoma were evaluated for disease-free and specific survival with the Kaplan-Meier method and the Cox proportional hazards regression model.
  • Remnants of pre-existing naevus were found in four (3%) melanomas.
  • Only the presence of microsatellites (P = 0.02) and a high mitotic rate (P < 0.01) were independently correlated with specific survival in ALM.
  • CONCLUSIONS: This is a detailed pathological study of a large cohort with ALM, an uncommon subtype of melanoma.
  • Mitotic activity appears to be of particular importance in predicting the outcome of ALM.
  • [MeSH-major] Melanoma / pathology. Skin Neoplasms / pathology

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  • (PMID = 17596173.001).
  • [ISSN] 0007-0963
  • [Journal-full-title] The British journal of dermatology
  • [ISO-abbreviation] Br. J. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
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10. Sharquie KE, Al-Meshhadani SA, Al-Nuaimy AA: Acral lentiginous melanoma versus lentigo maligna melanoma among Iraqi patients. Saudi Med J; 2007 Jan;28(1):105-7
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  • [Title] Acral lentiginous melanoma versus lentigo maligna melanoma among Iraqi patients.
  • OBJECTIVE: To report the different clinical aspects of malignant melanoma and their varieties in Iraqi patients.
  • Eighteen patients with malignant melanoma were enrolled in this work.
  • The duration of acral lentiginous melanoma was 0.5-4 years (2.16 +/- 1.36 years) and in nodular type was 0.5-3 years (1.28 +/- 0.90 years), while in lentigo maligna melanoma was 1.5-5 years (3.37 +/- 1.49 years).
  • Regarding the location and gender of the patients affected, 6 cases (all females) were on the acral parts of the body (4 on the feet, and 2 on the hands), 5 patients (all females) on the face, 5 cases (4 females and one male) on the lower legs, while the remaining 2 male cases, was on the interscapular region and the other one on the elbow area.
  • CONCLUSION: We conclude that malignant melanoma in Iraqi patients is a disease of younger females, which presented mainly as acral lentiginous melanoma, nodular melanoma and lentigo maligna melanoma and superficial spreading melanoma.
  • [MeSH-major] Melanoma / diagnosis. Skin Neoplasms / diagnosis


11. Hsieh R, Firmiano A, Sotto MN: Expression of p16 protein in acral lentiginous melanoma. Int J Dermatol; 2009 Dec;48(12):1303-7
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  • [Title] Expression of p16 protein in acral lentiginous melanoma.
  • BACKGROUND: Acral lentiginous melanoma (ALM) is a clinicopathologic subtype of cutaneous malignant melanoma.
  • ALM is the most common type of melanoma amongst Asians, Africans, and patients with mixed ancestry.
  • In Brazil, ALM comprises 10% of cutaneous melanoma.
  • ALM develops on palmar, plantar, and subungual skin, and its biology is different from that of other cutaneous melanomas, where sunlight is the major known environmental determinant.
  • Alterations and inactivation of the p16INK4 gene that encodes a specific inhibitor of cyclin-dependent kinase have been related to melanoma genesis and progression.
  • Few studies, however, have addressed p16 expression in ALM.
  • METHODS: In order to verify and compare p16 protein expression, 32 paraffin-embedded ALM specimens were subjected to a immunohistochemical technique using a monoclonal anti-p16 antibody.
  • CONCLUSION: The data obtained suggest that p16 protein expression per se may not represent a marker of retinoblastoma protein (pRb) pathway disturbance in ALM tumorigenesis.
  • [MeSH-major] Melanoma / metabolism. Neoplasm Proteins / metabolism. Skin Neoplasms / metabolism

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  • (PMID = 20415670.001).
  • [ISSN] 1365-4632
  • [Journal-full-title] International journal of dermatology
  • [ISO-abbreviation] Int. J. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Cyclin-Dependent Kinase Inhibitor p16; 0 / Neoplasm Proteins; 0 / P16 protein, human; 0 / Retinoblastoma Protein
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12. Rosen T: Acral lentiginous melanoma misdiagnosed as verruca plantaris: a case report. Dermatol Online J; 2006;12(4):3
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  • [Title] Acral lentiginous melanoma misdiagnosed as verruca plantaris: a case report.
  • The ratio of acral lentiginous melanoma (ALM) to all melanomas among Caucasians is small, although this type of malignant melanocytic neoplasm comprises the majority of melanomas among those who have darker skin tone.
  • Because of frequently atypical clinical morphology, and as a consequence of their relative rarity, ALM is often misdiagnosed.
  • This case demonstrates the disastrous consequences of prolonged treatment of an ALM presumed to be a plantar wart.
  • [MeSH-major] Diagnostic Errors. Foot Diseases / diagnosis. Melanoma / diagnosis. Warts / diagnosis


13. Merrill RM, Pace ND, Elison AN: Cutaneous malignant melanoma among white Hispanics and non-Hispanics in the United States. Ethn Dis; 2010;20(4):353-8
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  • [Title] Cutaneous malignant melanoma among white Hispanics and non-Hispanics in the United States.
  • AIM: To explore whether disparities exist in melanoma incidence and prognosis between White Hispanics and White non-Hispanics.
  • METHODS: Analyses were based on 42,770 patients with malignant melanoma in the United States, 2004 through 2006.
  • RESULTS: Hispanics were significantly less likely to be diagnosed with superficial spreading melanoma or Hutchinson's melanotic freckle, but significantly more likely to be diagnosed with nodular melanoma or acral lentiginous melanoma.
  • Approximately 7.3% of Hispanic patients and 4.8% of non-Hispanic patients died specifically from melanoma.
  • Later stage at diagnosis was the primary explanation for the difference in death from melanoma between Hispanic and non-Hispanic Whites.
  • CONCLUSIONS: Hispanic melanoma patients experience significantly poorer prognostic findings at diagnosis.
  • The disparity in melanoma stage, tumor depth, and ulcerated tumors at diagnosis emphasizes the need for greater secondary prevention efforts among this group.
  • [MeSH-major] European Continental Ancestry Group / statistics & numerical data. Health Status Disparities. Hispanic Americans / statistics & numerical data. Melanoma / ethnology. Skin Neoplasms / ethnology


14. Forman SB, Ferringer TC, Peckham SJ, Dalton SR, Sasaki GT, Libow LF, Elston DM: Is superficial spreading melanoma still the most common form of malignant melanoma? J Am Acad Dermatol; 2008 Jun;58(6):1013-20
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  • [Title] Is superficial spreading melanoma still the most common form of malignant melanoma?
  • BACKGROUND: Most epidemiological studies suggest that superficial spreading melanoma is the most common histological subtype of malignant melanoma, but past data may not reflect current patterns of sun exposure or other risk factors.
  • OBJECTIVE: We sought to determine the prevalence of melanoma subtypes among recent specimens in a South Texas dermatopathology practice.
  • RESULTS: Lentigo maligna was the most common subtype of melanoma among the cases studied.
  • Of 771 cases of melanoma reviewed, lentigo maligna and lentigo maligna melanoma accounted for 429 (56%).
  • There were 220 cases of pagetoid (superficial spreading) melanoma (29%).
  • Nodular melanoma with no apparent radial growth phase accounted for 27 cases (4%), and there were 23 cases of acral lentiginous melanoma (3%).
  • The remaining 72 specimens (9%) included cutaneous metastases, spitzoid melanoma, melanoma in situ arising within a nevus, nevoid melanoma, desmoplastic melanoma, and patterns that could not be classified.
  • We were not able to perform subgroup analysis based on ethnicity or skin type as such data were not typically submitted with the specimens.
  • CONCLUSION: Our results challenge the notion that pagetoid (superficial spreading) melanoma is the most common subtype of malignant melanoma, at least in patients with extensive sun exposure.
  • Changing patterns of sun exposure or environmental factors may contribute to the changing epidemiology of malignant melanoma.
  • The current prevalence of subtypes of melanoma should be studied in other populations.
  • [MeSH-major] Melanoma / epidemiology. Melanoma / pathology. Skin Neoplasms / epidemiology. Skin Neoplasms / pathology

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  • [CommentIn] J Am Acad Dermatol. 2008 Jun;58(6):1059-60 [18485988.001]
  • [CommentIn] J Am Acad Dermatol. 2009 May;60(5):876 [19389532.001]
  • [ErratumIn] J Am Acad Dermatol. 2009 Sep;61(3):507
  • (PMID = 18485983.001).
  • [ISSN] 1097-6787
  • [Journal-full-title] Journal of the American Academy of Dermatology
  • [ISO-abbreviation] J. Am. Acad. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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15. Homolak D, Vucetić B, Puljiz Z, Blajć I, Vurnek Zivković M, Situm M: Our experience of melanoma thickness as a predictor of outcome of sentinel node biopsy. Coll Antropol; 2008 Oct;32 Suppl 2:57-60
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  • [Title] Our experience of melanoma thickness as a predictor of outcome of sentinel node biopsy.
  • All follow up protocols for patients with malignant melanoma (MM) are oriented to early detection of metastases.
  • This method provides valuable prognostic information, facilitates early therapeutical lymphadenectomy and so provides good base for identification of those patients who are candidates for different adjuvant modalities of treatment. (In 2001 American Joint Committee on Cancer introduced new staging system for melanoma patients which presents good frame for prognosis and therapeutical approach.
  • Metastatic lymph nodes were founded in all acral-lentiginous melanoma patients, followed by nodular melanoma--55.6% and superficial spreading melanoma--14.1%.
  • [MeSH-major] Melanoma / pathology. Neoplasm Staging / methods. Patient Selection. Sentinel Lymph Node Biopsy. Skin Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Child. Early Diagnosis. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Predictive Value of Tests. Retrospective Studies

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  • (PMID = 19138008.001).
  • [ISSN] 0350-6134
  • [Journal-full-title] Collegium antropologicum
  • [ISO-abbreviation] Coll Antropol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Croatia
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16. Boyd AS, Wu H, Shyr Y: Monster cells in malignant melanoma. Am J Dermatopathol; 2005 Jun;27(3):208-10
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  • [Title] Monster cells in malignant melanoma.
  • They have not been previously described in cutaneous melanomas.
  • We sought to determine the prevalence of monster cells in otherwise conventional biopsies of primary cutaneous melanomas and its association with other histopathologic features of this malignancy.
  • Ninety-nine superficial spreading melanomas, nodular melanomas, and acral lentiginous melanomas/lentigo malignas were retrospectively evaluated for the presence of monster cells, multinucleated giant cells, ulceration, inflammation, and depth of invasion (Breslow level).
  • Thirteen cases of melanoma containing monster cells were found.
  • A statistically significant association was noted between the presence of these cells, the histologic subtype of nodular melanoma (P = 0.0125), ulceration (P = 0.0127), the depth of invasion (P = 0.0103), and the presence of multinucleated giant cells (P = 0.0016).
  • The finding of monster cells is not an uncommon occurrence and is seen more often in nodular melanomas.
  • [MeSH-major] Melanoma / pathology. Skin Neoplasms / pathology

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  • [CommentIn] Am J Dermatopathol. 2006 Oct;28(5):462-3; author reply 463 [17012927.001]
  • (PMID = 15900123.001).
  • [ISSN] 0193-1091
  • [Journal-full-title] The American Journal of dermatopathology
  • [ISO-abbreviation] Am J Dermatopathol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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17. Wang YC, Lee ST: Brain metastases of malignant melanoma in Chinese: report of 23 cases. Chin Med J (Engl); 2007 Jun 20;120(12):1058-62
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  • [Title] Brain metastases of malignant melanoma in Chinese: report of 23 cases.
  • BACKGROUND: Patients with melanoma metastasized to the central nervous system have a poor prognosis.
  • Because the incidence of malignant melanoma in the Oriental is lower than that in the Caucasian population, brain metastases of malignant melanoma are rarely reported in Asia.
  • Here we present our experience of brain metastasis of melanoma in an Asian perspective.
  • METHODS: From 1990 to 2003, 369 patients with melanoma were treated in our hospital, 26 of them were diagnosed as having central nervous system involvement.
  • RESULTS: Among the 369 patients with melanoma, 45% (167/369) developed lower extremity melanoma, and 27.1% (100/369) had acral lentiginous melanoma (ALM); while in the 23 patients with brain metastases, 34.7% (8/23) had lower extremity melanoma, and 34.7% (8/23) had ALM.
  • CONCLUSIONS: Compared with the Caucasian, Chinese patients with melanoma have a different proportion of melanoma subtype and higher incidence rates of lower extremities melanoma and ALM.
  • [MeSH-major] Brain Neoplasms / secondary. Melanoma / pathology. Skin Neoplasms / pathology

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  • (PMID = 17637222.001).
  • [ISSN] 0366-6999
  • [Journal-full-title] Chinese medical journal
  • [ISO-abbreviation] Chin. Med. J.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] China
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18. Nakajima K, Nakano H, Takiyoshi N, Rokunohe A, Ikenaga S, Aizu T, Kaneko T, Mitsuhashi Y, Sawamura D: Papillon-Lefèvre syndrome and malignant melanoma. A high incidence of melanoma development in Japanese palmoplantar keratoderma patients. Dermatology; 2008;217(1):58-62
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  • [Title] Papillon-Lefèvre syndrome and malignant melanoma. A high incidence of melanoma development in Japanese palmoplantar keratoderma patients.
  • The development of malignant cutaneous neoplasms within the hyperkeratotic lesions of the syndrome is quite rare.
  • Here, we report on a 51-year-old Japanese woman with PLS associated with recurrent malignant melanoma (MM).
  • Including our case, 4 families have been described as having PLS with MM, 3 of which are Japanese, implying a high incidence of melanoma development in Japanese PLS patients.
  • This tendency might be attributable to the high frequency of acral lentiginous melanoma in Japanese subjects, in contrast to a lower frequency of this subtype in Caucasians.
  • [MeSH-major] Genetic Predisposition to Disease / ethnology. Keratoderma, Palmoplantar / complications. Melanoma / etiology. Papillon-Lefevre Disease / ethnology. Skin Neoplasms / etiology

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  • [Copyright] Copyright 2008 S. Karger AG, Basel.
  • [CommentIn] Dermatology. 2009;219(2):187-8 [19506350.001]
  • (PMID = 18401176.001).
  • [ISSN] 1421-9832
  • [Journal-full-title] Dermatology (Basel, Switzerland)
  • [ISO-abbreviation] Dermatology (Basel)
  • [Language] eng
  • [Databank-accession-numbers] OMIM/ 245000
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] Switzerland
  • [Chemical-registry-number] EC 3.4.14.1 / Cathepsin C
  • [Number-of-references] 28
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19. Höiom V, Tuominen R, Käller M, Lindén D, Ahmadian A, Månsson-Brahme E, Egyhazi S, Sjöberg K, Lundeberg J, Hansson J: MC1R variation and melanoma risk in the Swedish population in relation to clinical and pathological parameters. Pigment Cell Melanoma Res; 2009 Apr;22(2):196-204
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  • [Title] MC1R variation and melanoma risk in the Swedish population in relation to clinical and pathological parameters.
  • The genetic background of cutaneous malignant melanoma (CMM) includes both germ line aberrations in high-penetrance genes, like CDKN2A, and allelic variation in low-penetrance genes like the melanocortin-1 receptor gene, MC1R.
  • Red-hair colour associated MC1R alleles (RHC) have been associated with red hair, fair skin and risk of CMM.
  • The study cohort consisted of sporadic primary melanoma patients, familial melanoma patients and a control group.
  • An allele-dose dependent increase in melanoma risk for carriers of variant MC1R alleles (after adjusting for phenotype), with an elevated risk among familial CMM patients, was observed.
  • MC1R variation was found to be less frequent among acral lentiginous melanomas (ALM) and dependent on tumour localisation.
  • No association was found between CDKN2A gene variants and general melanoma risk.
  • [MeSH-major] European Continental Ancestry Group / genetics. Genetic Predisposition to Disease. Melanoma / genetics. Melanoma / pathology. Mutation / genetics. Receptor, Melanocortin, Type 1 / genetics

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  • (PMID = 19077144.001).
  • [ISSN] 1755-1471
  • [Journal-full-title] Pigment cell & melanoma research
  • [ISO-abbreviation] Pigment Cell Melanoma Res
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Receptor, Melanocortin, Type 1; 0 / Tumor Suppressor Protein p14ARF
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20. Rahnama Z, Meymandi SS, Nasiri N: Cutaneous melanoma in a desert climate zone: a retrospective study of 125 cases. Int J Dermatol; 2010 Apr;49(4):406-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Cutaneous melanoma in a desert climate zone: a retrospective study of 125 cases.
  • BACKGROUND: With increasing incidence over the last few decades, cutaneous malignant melanoma (CM) represents 3% of all skin tumors, and accounts for 75% of all deaths because of cutaneous malignancies.
  • Little is known about the nature and epidemiology of CM in individuals with pigmented skin.
  • Skin biopsies with a diagnosis of CM were reevaluated to confirm the diagnosis of CM.
  • The mean age at the time of diagnosis was 58.9 years; with a peak in the seventh decade of life.
  • Acral-lentiginous melanoma (ALM) represented 28.8% and; nodular melanoma occurred in 20% of cases.
  • There was a significant correlation between age and ALM (P = 0.007) and also between gender and melanoma types (P = 0.024).
  • [MeSH-major] Desert Climate. Melanoma / epidemiology. Skin Neoplasms / epidemiology

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  • (PMID = 20465695.001).
  • [ISSN] 1365-4632
  • [Journal-full-title] International journal of dermatology
  • [ISO-abbreviation] Int. J. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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21. dos Santos Gon A, Minelli L: Melanoma in a long-standing lesion of chromoblastomycosis. Int J Dermatol; 2006 Nov;45(11):1331-3
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  • [Title] Melanoma in a long-standing lesion of chromoblastomycosis.
  • BACKGROUND: Chromoblastomycosis is a chronic cutaneous fungal infection where the presence of fibrous scars and continuous inflammation might be the propitious condition for the development of malignant neoplasms.
  • METHODS: We report a case of cutaneous melanoma arising on a leg of a man that had been affected by extensive chromoblastomycosis for more than 30 years.
  • Histological examination showed an acral lentiginous melanoma, Clark level IV, thickness of 2.3 mm.
  • [MeSH-major] Chromoblastomycosis / complications. Melanoma / etiology. Skin Neoplasms / etiology

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  • (PMID = 17076718.001).
  • [ISSN] 0011-9059
  • [Journal-full-title] International journal of dermatology
  • [ISO-abbreviation] Int. J. Dermatol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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22. Togawa Y, Nakamura Y, Kamada N, Kambe N, Takahashi Y, Matsue H: Melanoma in association with acquired melanocytic nevus in Japan: a review of cases in the literature. Int J Dermatol; 2010 Dec;49(12):1362-7
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  • [Title] Melanoma in association with acquired melanocytic nevus in Japan: a review of cases in the literature.
  • BACKGROUND: Malignant melanomas clinically and/or histologically associated with melanocytic nevi have been reported worldwide.
  • Approximately 20% of malignant melanomas in Caucasians, most of which are found on the trunk and proximal extremities, develop in association with pre-existing melanocytic nevi.
  • In Japan, however, over half of all melanomas are acral lentiginous melanomas (ALMs) on the hands and feet; melanomas on sun-exposed areas are seen less frequently in Japanese people than in Caucasians.
  • As ALMs are not usually accompanied by melanocytic nevi and there have been no reviews of the literature or statistical data regarding Japanese cases of melanomas with melanocytic nevi, dermatologists in Japan have few opportunities to see melanomas associated with pre-existing melanocytic nevi.
  • METHODS: Here we report a case of a superficial spreading melanoma that was formed on a melanocytic nevus on the trunk, and we review for the first time the case reports from the Japanese literature.
  • RESULTS AND CONCLUSIONS: With regard to the reported cases, melanomas associated with melanocytic nevi were mainly superficial spreading melanomas and nodular melanomas on the trunk or extremities; ALMs were rarely associated with nevi, indicating a trend similar to that observed in Caucasians.
  • These findings suggest that the low frequency of associations between melanomas and melanocytic nevi in Japan reflects racial differences in the frequencies of each type of melanoma.
  • [MeSH-major] Melanoma / complications. Melanoma / pathology. Nevus, Pigmented / complications. Skin Neoplasms / complications. Skin Neoplasms / pathology

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  • (PMID = 21155082.001).
  • [ISSN] 1365-4632
  • [Journal-full-title] International journal of dermatology
  • [ISO-abbreviation] Int. J. Dermatol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] United States
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23. Rex J, Paradelo C, Mangas C, Hilari JM, Fernández-Figueras MT, Ferrándiz C: Management of primary cutaneous melanoma of the hands and feet: a clinicoprognostic study. Dermatol Surg; 2009 Oct;35(10):1505-13
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Management of primary cutaneous melanoma of the hands and feet: a clinicoprognostic study.
  • BACKGROUND: Although acral lentiginous melanoma is the most common subtype of malignant melanoma in acral locations, the term acral melanoma (AM) has to be differentiated from the histopathologic description.
  • OBJECTIVES: To characterize the clinical and pathologic features of patients with a primary AM and to elucidate whether the prognosis of patients with AM differs from that of those with melanoma at other sites (nonacral melanoma; NAM).
  • PATIENTS AND METHOD: Over a 20-year period, a series of 822 consecutive patients with melanoma were recorded in the database.
  • Clinical and follow-up data were retrieved from the melanoma register and prospectively analyzed.
  • RESULTS: Eighty-nine patients had a malignant melanoma located on the acral sites of extremities.
  • CONCLUSION: Survival differences between patients with AM and NAM are due to differences in already known prognostic factors, probably as a consequence of a delay in the diagnosis in these locations.
  • [MeSH-major] Melanoma / pathology. Skin Neoplasms / pathology

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  • (PMID = 19686364.001).
  • [ISSN] 1524-4725
  • [Journal-full-title] Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
  • [ISO-abbreviation] Dermatol Surg
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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24. Gray RJ, Pockaj BA, Vega ML, Connolly SM, DiCaudo DJ, Kile TA, Buchel EW: Diagnosis and treatment of malignant melanoma of the foot. Foot Ankle Int; 2006 Sep;27(9):696-705
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  • [Title] Diagnosis and treatment of malignant melanoma of the foot.
  • BACKGROUND: Patients diagnosed with melanoma of the foot have been reported to have a poor prognosis.
  • We reviewed our experience at a tertiary-care medical clinic to determine the disease course in patients diagnosed with melanoma of the foot.
  • METHODS: A retrospective review was performed of 38 patients with a diagnosis of primary or locally recurrent melanoma of the foot treated between January, 1988, and July, 2004.
  • The main outcome measures included methods of diagnosis, clinical and histopathologic features, and patterns of recurrence.
  • RESULTS: The mean age at diagnosis was 61 years; most were women (58%) and Caucasian (95%).
  • The average time to diagnosis was 17 months.
  • Initial clinical diagnosis had been considered benign in 12 (32%).
  • The median Breslow thickness was 1.75 mm, T1 lesions were the most common, and acral lentiginous melanoma accounted for 42%.
  • Surgical complications occurred in 12 patients, usually after skin graft or soft-tissue flap reconstruction.
  • CONCLUSIONS: Most patients were elderly Caucasian women and most presented with early-stage disease, but diagnosis can be difficult and a subgroup presented with thick melanomas.
  • Stage of cancer at diagnosis was associated with systemic metastases.
  • [MeSH-major] Foot Diseases / diagnosis. Foot Diseases / surgery. Melanoma / diagnosis. Melanoma / surgery

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  • (PMID = 17038281.001).
  • [ISSN] 1071-1007
  • [Journal-full-title] Foot & ankle international
  • [ISO-abbreviation] Foot Ankle Int
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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25. Huang KY, Wang CR, Yang RS: Rare clinical experiences for surgical treatment of melanoma with osseous metastases in Taiwan. BMC Musculoskelet Disord; 2007;8:70
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  • [Title] Rare clinical experiences for surgical treatment of melanoma with osseous metastases in Taiwan.
  • BACKGROUND: Malignant melanoma occurs infrequently in Taiwan.
  • METHODS: To improve our understanding of the rare clinical experiences, we retrospectively investigated clinical characteristics, radiological findings, treatment modalities, survival outcomes and prognoses of 11 Taiwanese patients with osseous metastasis of melanoma treated surgically at two national medical centers, National Taiwan University Hospital and National Cheng Kung University Hospital from January 1983 to December 2006.
  • RESULTS: Six patients suffered from acral-lentiginous melanoma.
  • The interval from the initial diagnosis of melanoma to the clinical detection of osseous metastases varied from 0-37.8 months (mean 9.75 months).
  • Metastatic melanoma was invariably fatal; the mean survival time from bone metastases to death was 5.67 months.
  • CONCLUSION: Due to the high morbidity and poor survival of Taiwanese patients with osseous metastases of melanoma, surgical treatment should be directed towards pain relief and the prevention of skeletal debilitation in order to maintain their quality of life.
  • [MeSH-major] Bone Neoplasms / secondary. Bone Neoplasms / surgery. Melanoma / surgery. Rare Diseases / surgery. Skin Neoplasms / surgery

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  • (PMID = 17650346.001).
  • [ISSN] 1471-2474
  • [Journal-full-title] BMC musculoskeletal disorders
  • [ISO-abbreviation] BMC Musculoskelet Disord
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC1945025
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26. Uehara J, Ito Y, Takahashi I, Honma M, Ishida-Yamamoto A, Matsuo S, Iizuka H: Sequential acral lentiginous melanomas of the foot. Case Rep Dermatol; 2010;2(3):201-6
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  • [Title] Sequential acral lentiginous melanomas of the foot.
  • She received surgical excision following a diagnosis of acral lentiginous melanoma (ALM), which was confirmed histopathologically.
  • One month after the operation, a second melanoma lesion was noticed adjacent to the grafted site.
  • The unique occurrence of a sequential lesion of a primary melanoma might be caused by stimulated subclinical field cells during the wound healing process following the initial operation.
  • This case warrants further investigation to establish the appropriate surgical margin of ALM lesions.

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  • [Cites] Cytokine. 2000 Jun;12(6):547-54 [10843728.001]
  • [Cites] Oncogene. 2003 May 19;22(20):3081-6 [12789284.001]
  • [Cites] Int J Clin Oncol. 2008 Feb;13(1):33-41 [18307017.001]
  • [Cites] J Invest Dermatol. 2008 Aug;128(8):2024-30 [18323782.001]
  • [Cites] Wound Repair Regen. 2008 Sep-Oct;16(5):585-601 [19128254.001]
  • (PMID = 21537371.001).
  • [ISSN] 1662-6567
  • [Journal-full-title] Case reports in dermatology
  • [ISO-abbreviation] Case Rep Dermatol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Switzerland
  • [Other-IDs] NLM/ PMC3085035
  • [Keywords] NOTNLM ; Acral lentiginous melanoma / Cyclin D1 / Field cell model / Melanoma spread / Primary melanoma / Surgical margins
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27. Richards HW, Medrano EE: Epigenetic marks in melanoma. Pigment Cell Melanoma Res; 2009 Feb;22(1):14-29
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  • [Title] Epigenetic marks in melanoma.
  • Melanoma is a highly heterogeneous cancer that comes in different flavors (lentigo maligna melanoma, superficial spreading melanoma, nodular melanoma, acral lentiginous/mucosal melanoma and other less common subtypes including malignant cellular blue nevus, desmoplastic melanoma, nevoid melanoma, and animal-type melanoma) and colors (black/bluish or unpigmented).
  • Pathologists have known for many years that melanoma displays notable changes in the nuclear architecture including thick chromatic rims, presence of mitosis, nuclear grooves, and more.
  • Here, we review the current data on epigenetic research in melanoma skin cancers, discuss ways to modify the epigenetic landscape of melanoma for inhibiting its growth, and propose strategies for identifying novel melanoma markers.
  • [MeSH-major] Epigenesis, Genetic. Melanoma / genetics

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  • [ErratumIn] Pigment Cell Melanoma Res. 2009 Apr;22(2):242
  • (PMID = 19040501.001).
  • [ISSN] 1755-1471
  • [Journal-full-title] Pigment cell & melanoma research
  • [ISO-abbreviation] Pigment Cell Melanoma Res
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / 2R01 CA84282; United States / NIA NIH HHS / AG / R01 AG032135
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] England
  • [Number-of-references] 160
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28. Koelemij R, Wille J: [Diagnostic image (378). A woman with a subungual pigmentation of the left hallux]. Ned Tijdschr Geneeskd; 2008 Jun 21;152(25):1418
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  • [Transliterated title] Diagnose in beeld (378). Een vrouw met een subunguale pigmentatie aan de linker hallux.
  • An 81-year-old woman presented with a subungual pigmented lesion of the left hallux, caused by a malignant acral-lentiginous melanoma.
  • [MeSH-major] Melanoma / diagnosis. Skin / pathology. Skin Neoplasms / diagnosis. Toes / pathology. Toes / surgery
  • [MeSH-minor] Aged, 80 and over. Amputation. Diagnosis, Differential. Female. Humans. Nails

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  • (PMID = 18624004.001).
  • [ISSN] 0028-2162
  • [Journal-full-title] Nederlands tijdschrift voor geneeskunde
  • [ISO-abbreviation] Ned Tijdschr Geneeskd
  • [Language] dut
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Netherlands
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29. Liao YH, Hsu SM, Huang PH: ARMS depletion facilitates UV irradiation induced apoptotic cell death in melanoma. Cancer Res; 2007 Dec 15;67(24):11547-56
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  • [Title] ARMS depletion facilitates UV irradiation induced apoptotic cell death in melanoma.
  • Here, we report that ankyrin repeat-rich membrane spanning (ARMS), a transmembrane protein abundant in the developing and adult neural tissues, is overexpressed in melanoma, a tumor ontogenetically originating from neural crest.
  • Immunohistochemical study of 79 melanocytic lesions showed significantly increased expression of ARMS in primary malignant melanomas (92.9%) and metastatic melanoma (60.0%) in comparison with benign nevocellular nevi (26.7%).
  • To investigate the role of ARMS in melanoma formation, murine B16F0 melanoma cells with stable knockdown of ARMS were established by RNA interference.
  • Down-regulation of ARMS resulted in significant inhibition of anchorage-independent growth in soft agar and restrictive growth of melanoma in severe combined immunodeficient mice.
  • Importantly, depletion of ARMS facilitated UVB-induced apoptosis in melanoma cells through inactivation of mitogen-activated protein kinase/extracellular signal-regulated kinase (ERK) kinase (MEK)/ERK.
  • Addition of MEK inhibitor PD98059 further sensitized ARMS-depleted melanoma cells to UVB-induced apoptosis, whereas constitutively active MEK rescued ARMS-depleted cells from apoptosis.
  • We further showed that BRAF, a downstream signaling molecule of ARMS in ERK pathway, is not mutated as a constitutively active form in acral lentiginous melanoma; in contrast, BRAF(T1799A) mutation, which leads to constitutive activation of ERK signaling, was detected in 57.1% of superficial spreading melanoma.
  • Our study suggests that overexpression of ARMS per se serves as one mechanism to promote melanoma formation by preventing stress-induced apoptotic death mediated by the MEK/ERK signaling pathway, especially in acral lentiginous melanoma, most of which does not harbor BRAF mutation.
  • [MeSH-major] Melanoma / physiopathology. Membrane Proteins / physiology. Nerve Tissue Proteins / physiology

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  • (PMID = 18089783.001).
  • [ISSN] 1538-7445
  • [Journal-full-title] Cancer research
  • [ISO-abbreviation] Cancer Res.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / KIDINS220 protein, human; 0 / Membrane Proteins; 0 / Nerve Tissue Proteins; EC 2.7.11.1 / BRAF protein, human; EC 2.7.11.1 / Proto-Oncogene Proteins B-raf
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30. Lens M: Current clinical overview of cutaneous melanoma. Br J Nurs; 2008 Mar 13-26;17(5):300-5
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  • [Title] Current clinical overview of cutaneous melanoma.
  • This article reviews current evidence on epidemiology, diagnosis and management of cutaneous melanoma.
  • Incidence of cutaneous melanoma is rising in all Caucasian populations across the world; thus, melanoma represents a significant public health burden.
  • Although, incidence of melanoma is in continuous increase, a decrease of mortality and improved survival has been observed in most western European populations.
  • Clinical characteristics of four major types of melanoma (superficial spreading, nodular, lentigo maligna melanoma and acral lentiginous melanoma) have been described.
  • Surgical removal of melanoma remains the standard care in all primary melanomas.
  • Wider margins may be necessary in patients with thicker melanomas with higher risk for local recurrence.
  • Currently there is no standard adjuvant therapy for melanoma although interferon-alpha has been the most widely used treatment in the adjuvant setting.
  • Chemotherapeutic agents have a limited activity in patients with metastatic melanoma with response rates up to 25%.
  • Although different vaccines have been tested in melanoma patients their role still remain to be established in phase III trials.
  • Progresses in molecular biology and genetics of melanoma may lead to the development of novel melanoma therapies.
  • [MeSH-major] Melanoma. Skin Neoplasms
  • [MeSH-minor] Cancer Vaccines. Causality. Diagnosis, Differential. Early Diagnosis. Europe / epidemiology. European Continental Ancestry Group / statistics & numerical data. Humans. Lymph Node Excision. Mohs Surgery. Neoplasm Staging. Prognosis. Sentinel Lymph Node Biopsy. Survival Rate. Treatment Outcome

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  • (PMID = 18414292.001).
  • [ISSN] 0966-0461
  • [Journal-full-title] British journal of nursing (Mark Allen Publishing)
  • [ISO-abbreviation] Br J Nurs
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Cancer Vaccines
  • [Number-of-references] 47
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31. Ishihara K, Saida T, Otsuka F, Yamazaki N, Prognosis and Statistical Investigation Committee of the Japanese Skin Cancer Society: Statistical profiles of malignant melanoma and other skin cancers in Japan: 2007 update. Int J Clin Oncol; 2008 Feb;13(1):33-41
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  • [Title] Statistical profiles of malignant melanoma and other skin cancers in Japan: 2007 update.
  • BACKGROUND: In the previous report of the Prognosis and Statistical Investigation Committee of the Japanese Skin Cancer Society, we tabulated data on patients with malignant melanoma who had been registered at major medical institutions (22 institutions on average) in Japan over 5-year periods from 1987 to 1991 (group A) and from 1992 to 1996 (group B).
  • METHODS: The numbers of melanoma patients registered were: 545 in group A (1987-1991), 699 in group B (1992-1996), and 821 in group C (1997-2001).
  • Because the International Union Against Cancer (UICC) TNM and stage classifications for malignant melanoma were changed substantially in 2002, analyses in the present investigation were performed according to the new classifications.
  • In addition, the numbers of patients with various kinds of skin malignancies, including not only malignant melanoma but also basal cell carcinoma, squamous cell carcinoma, mycosis fungoides, actinic keratosis, Bowen's disease, and Paget's disease, registered at approximately 100 medical institutions in Japan from 1987 to 2001, were also investigated and data were tabulated.
  • RESULTS: The nationwide survey of Japanese patients with malignant skin tumors from 1987 to 2001 showed that the most prevalent skin tumor was basal cell carcinoma, which increased year by year, followed by squamous cell carcinoma, and then by malignant melanoma.
  • The following results were obtained from the data for melanoma patients registered at major institutions from 1987 to 2001. (1) The overall 10-year survival rates for melanoma patients in each chronological group were ranked as: group C > B > A, although only the difference between groups C and A was statistically significant. (2) The male-to-female ratio ranged from 1: 0.97 to 1: 1.14, and the survival rate of female patients was higher than that of male patients (the 140-month survival rate was 70.6% in females and 60% in males). (3) Assessment of the age distribution showed that the number of patients increased rapidly from ages 40-49 years and reached a peak at around 60 years in all three groups. (4) The sole of the foot was the most common site of melanoma in both males and females, while melanomas on the lower limbs were also prevalent in females. (5) Acral lentiginous melanoma (ALM) was the most common type in all three groups, accounting for nearly 50% of the patients in each group.
  • The number of patients with superficial spreading melanoma (SSM) increased steadily over time and exceeded the number of patients with nodular melanoma (NM) in group C.
  • In group C, the overall survival rate of stage IV patients with a normal serum lactic dehydrogenase (LDH) level was higher than that of patients with elevated LDH values. (9) Evaluation of the effects of some therapeutic procedures (prophylactic lymph node dissection and chemotherapy with and without interferon-beta) on the survivals of patients with melanoma was inconclusive and suggested the need for more studies in this area.
  • CONCLUSION: In Japan, the number of patients with malignant skin tumors has increased year by year.
  • The prognosis of patients with advanced malignant melanoma remains extremely poor, but that of patients in stage III has shown an improvement.
  • [MeSH-major] Melanoma / epidemiology. Skin Neoplasms / epidemiology

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  • [Cites] Int J Epidemiol. 1995 Oct;24(5):897-907 [8557445.001]
  • [Cites] Int J Clin Oncol. 2003 Jun;8(3):139-50 [12851837.001]
  • [Cites] Int J Clin Oncol. 2001 Jun;6(3):109-16 [11706778.001]
  • [Cites] Cancer. 2000 Mar 15;88(6):1484-91 [10717634.001]
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  • [Cites] Harefuah. 1995 Jun 15;128(12):745-51, 824 [7557679.001]
  • (PMID = 18307017.001).
  • [ISSN] 1341-9625
  • [Journal-full-title] International journal of clinical oncology
  • [ISO-abbreviation] Int. J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Japan
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32. Gajanin V, Krivokuća Z, Kostić K, Gajanin R, Sladojević I: Significance of vascular endothelial growth factor expression in skin melanoma. Vojnosanit Pregl; 2010 Sep;67(9):747-54
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Significance of vascular endothelial growth factor expression in skin melanoma.
  • BACKGROUND/AIM: Melanoma is a heterogeneous disease of skin and mucous membranes which shows significant increase in incidence worldwide in the past decades.
  • The aim of this research was to determine the level of VEGF expression in skin melanoma in different body regions and in different primary stages of the disease.
  • METHODS: The research was conducted on bioptic materials of skin in 39 patients.
  • RESULTS: Analysis confirmed that 61.54% of skin melanoma showed a high VEGF expression.
  • Nodular and acral lentiginous melanomas showed more frequently a high level of VEGF expression, while superficial spreading melanoma showed a lower level of VEGF expression (p = 0.032, p < 0.05).
  • A higher level of expression was present in thicker melanomas (higher in the Breslow stage; p = 0.011, p < 0.05).
  • The width of the lesion did not have an influence on the level of VEGF expression in melanoma (U =142.000, p = 0.273).
  • CONCLUSION: Melanomas show a higher level of VEGF expression.
  • Nodular and acral lentiginous types of melanoma show a high level of VEGF expression, while superficial spreading melanoma shows a lower level of VEGF expression.
  • Melanomas in higher-stage disease (Breslow, Clark, pTNM) show a higher level of VEGF expression.
  • [MeSH-major] Melanoma / metabolism. Skin Neoplasms / metabolism. Vascular Endothelial Growth Factor A / metabolism
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Female. Humans. Male. Middle Aged. Skin / metabolism. Young Adult

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  • (PMID = 20949875.001).
  • [ISSN] 0042-8450
  • [Journal-full-title] Vojnosanitetski pregled
  • [ISO-abbreviation] Vojnosanit Pregl
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Serbia
  • [Chemical-registry-number] 0 / Vascular Endothelial Growth Factor A
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33. Kleinerman R, Kriegel D, Amir I, Emanuel PO, Markinson BC: Osteoinvasive subungual melanoma: a case and review. J Drugs Dermatol; 2010 Feb;9(2):159-63
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Osteoinvasive subungual melanoma: a case and review.
  • Subungual melanoma is a relatively rare variant of melanoma, accounting for 0.7-3.5% of all melanoma cases in the Caucasian population.
  • Curiously, it occurs in 8-33% of cases in black, Asian, Native American and Hispanic populations, which generally face a substantially lower risk of melanoma.
  • Herein the authors report the case of a 69-year-old Hispanic female with a subungual melanoma of the acral lentiginous type that directly invaded the periosteum, cortex and medulla of the distal phalanx.
  • In addition, we review published reports of acral lentiginous melanoma with osseous invasion and discuss the evidence, on a molecular level, for this entity's aggressive pattern of invasion.
  • [MeSH-major] Bone Neoplasms / secondary. Melanoma / pathology. Skin Neoplasms / pathology. Toe Phalanges / pathology

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  • (PMID = 20214180.001).
  • [ISSN] 1545-9616
  • [Journal-full-title] Journal of drugs in dermatology : JDD
  • [ISO-abbreviation] J Drugs Dermatol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 32
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34. Hutcheson AC, McGowan JW 4th, Maize JC Jr, Cook J: Multiple primary acral melanomas in African-Americans: a case series and review of the literature. Dermatol Surg; 2007 Jan;33(1):1-10
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Multiple primary acral melanomas in African-Americans: a case series and review of the literature.
  • BACKGROUND: Although melanoma accounts for only 4% to 5% of all skin cancers in the United States, it causes most skin cancer-related deaths.
  • We describe a unique group of African-American patients with multiple primary acral lentiginous melanomas (ALMs).
  • OBJECTIVE: The purpose of this study was to review the case histories and management of a cohort of patients in the Mohs practice of our dermatologic surgeon with multiple primary ALM.
  • METHODS: This is a case series of patients with multiple ALM identified by chart review from 2000 to 2005.
  • RESULTS: Four patients, all African-American, were identified with multiple ALM.
  • None of the patients with ALM had melanomas at nonacral sites or other types of skin cancer.
  • Several had acral melanosis.
  • Information in the literature on patients with multiple primary acral melanomas was insufficient.
  • CONCLUSION: Patients with multiple acral melanomas have not, to our knowledge, been reported thus far.
  • It can be extrapolated from current literature, however, that appropriate management of these patients, including staging work and surgical intervention, is to be determined by the individual characteristics of the melanoma and the patient's concomitant risk factors, if any.
  • [MeSH-major] African Americans. Foot Diseases / ethnology. Foot Diseases / pathology. Melanoma / ethnology. Melanoma / pathology. Skin Neoplasms / ethnology. Skin Neoplasms / pathology

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  • (PMID = 17214672.001).
  • [ISSN] 1076-0512
  • [Journal-full-title] Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
  • [ISO-abbreviation] Dermatol Surg
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 81
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35. Bickle K, Smithberger E, Lien MH, Fenske NA: Unilateral lichen planus pigmentosus mimicking acral lentiginous melanoma. J Drugs Dermatol; 2010 Jul;9(7):841-3
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  • [Title] Unilateral lichen planus pigmentosus mimicking acral lentiginous melanoma.
  • The authors report a case of a Latin American woman who developed progressive pigmentation primarily involving two digits of her right hand.
  • She was scheduled for amputation based on a presumptive histologic diagnosis of melanoma with regression.
  • Dermatology consultation with repeat biopsies disclosed a lichenoid tissue reaction with marked pigment incontinence and no evidence of melanoma.
  • This report should prompt physicians to include lichen planus pigmentosus in the differential diagnosis of acral lentiginous melanoma.
  • [MeSH-major] Hyperpigmentation / diagnosis. Lichen Planus / diagnosis. Melanoma / diagnosis. Skin Neoplasms / diagnosis
  • [MeSH-minor] Diagnosis, Differential. Erythema / diagnosis. Female. Humans. Middle Aged


36. Demirkan NC, Kesen Z, Akdag B, Larue L, Delmas V: The effect of the sun on expression of beta-catenin, p16 and cyclin d1 proteins in melanocytic lesions. Clin Exp Dermatol; 2007 Nov;32(6):733-9
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  • BACKGROUND: The tumour suppressor gene product, p16, is often inactivated during melanoma malignant progression.
  • Although the importance of p16 in melanomas is well documented, its relationship with cyclin D1, beta-catenin and ultraviolet radiation (UVR) remains unclear.
  • METHODS: We used immunohistochemistry to examine 28 melanocytic naevi (MN; 9 congenital and 19 acquired types) and 24 primary cutaneous malignant melanomas (CMM; 19 nodular melanomas, 3 lentigo maligna melanomas, 1 acral lentiginous melanoma and 1 superficial spreading melanoma) for the presence of p16, cyclin D1 and beta-catenin.
  • [MeSH-major] Cell Cycle Proteins / biosynthesis. Melanoma / metabolism. Neoplasm Proteins / biosynthesis. Nevus, Pigmented / metabolism. Skin Neoplasms / metabolism. Sunlight

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  • (PMID = 17868395.001).
  • [ISSN] 0307-6938
  • [Journal-full-title] Clinical and experimental dermatology
  • [ISO-abbreviation] Clin. Exp. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Cell Cycle Proteins; 0 / Cyclin-Dependent Kinase Inhibitor p16; 0 / Neoplasm Proteins; 0 / beta Catenin; 136601-57-5 / Cyclin D1
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37. Kogushi-Nishi H, Kawasaki J, Kageshita T, Ishihara T, Ihn H: The prevalence of melanocytic nevi on the soles in the Japanese population. J Am Acad Dermatol; 2009 May;60(5):767-71
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • BACKGROUND: Acral lentiginous melanoma (ALM) is the most common type of melanoma in Japan.
  • The association between ALM and acral nevus has not been elucidated.
  • OBJECTIVE: To investigate the prevalence and dermatoscopic patterns of plantar melanocytic nevi on the soles in the Japanese and to evaluate the relationship between acral nevi and ALM.
  • METHODS: All outpatients (N = 1697) and melanoma patients (N = 104) were included.
  • The prevalence of nevi in patients with ALM and melanoma in situ on the soles was 8.6% and that of patients with melanoma on other sites was 14.5%.
  • CONCLUSION: The number, size, and dermatoscopic patterns of nevi on the soles of patients with ALM and melanoma in situ on the soles did not differ from those of the control group.
  • [MeSH-major] Foot Diseases / epidemiology. Nevus, Pigmented / epidemiology. Skin Neoplasms / epidemiology
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Child. Child, Preschool. Female. Humans. Infant. Infant, Newborn. Japan / epidemiology. Male. Melanoma / epidemiology. Melanoma / pathology. Middle Aged. Prevalence

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  • (PMID = 19389519.001).
  • [ISSN] 1097-6787
  • [Journal-full-title] Journal of the American Academy of Dermatology
  • [ISO-abbreviation] J. Am. Acad. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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38. Bae JM, Kim HO, Park YM: Progression from Acral Lentiginous Melanoma in situ to Invasive Acral Lentiginous Melanoma. Ann Dermatol; 2009 May;21(2):185-8

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Progression from Acral Lentiginous Melanoma in situ to Invasive Acral Lentiginous Melanoma.
  • Acral lentiginous melanoma (ALM) is the most common type of cutaneous melanoma in Asians.
  • The very early stage of ALM demonstrates only a proliferation of a few atypical melanocytes within the epidermis, and has been termed ALM in situ.
  • This time however, rebiopsy of the lesion confirmed a diagnosis of ALM, stage IIIB.
  • It could be inferred that the lesion had slowly progressed from ALM in situ to invasive ALM over a period of 12 years.
  • Herein we report a case of ALM in situ which progressed to invasive ALM over a long period of time.
  • We expect this report may assist physicians in early recognition and proper management of future cases of ALM in situ.

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  • [Cites] Clin Exp Dermatol. 1991 Nov;16(6):451-4 [1806322.001]
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  • (PMID = 20523783.001).
  • [ISSN] 2005-3894
  • [Journal-full-title] Annals of dermatology
  • [ISO-abbreviation] Ann Dermatol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Korea (South)
  • [Other-IDs] NLM/ PMC2861213
  • [Keywords] NOTNLM ; Acral lentiginous melanoma in situ
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39. Park HS, Cho KH: Acral lentiginous melanoma in situ: a diagnostic and management challenge. Cancers (Basel); 2010;2(2):642-52

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Acral lentiginous melanoma in situ: a diagnostic and management challenge.
  • Early stage recognition of acral lentiginous melanoma (ALM) is important for a better prognosis, but in-depth understanding and proper management of ALM in situ is complicated, because there are only a few reports, probably due to its rarity and diagnostic difficulty.
  • We have reviewed our experience with seven patients who were diagnosed as having ALM in situ and discuss how to accurately diagnose and properly manage these rare lesions.
  • All the lesions showed a diffuse lentiginous pattern of melanocytic proliferation with variable level of atypism along the dermoepidermal junction.
  • Confrontation of clinical and histopathologic findings was observed in three, and the lesions were not recognized or diagnosed as ALM in situ in the first place.
  • Recurrence was observed in three patients and one developed invasive ALM and lymph node metastasis.
  • Integration of all available information concerning the clinical presentation, histopathology, and dermoscopic findings is very important and can lead to the best classification for correct diagnosis.
  • Lack of knowledge upon clinical course and optimal margin to control ALM in situ provokes the need for further studies with longer follow up and larger number of cases.

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  • (PMID = 24281086.001).
  • [ISSN] 2072-6694
  • [Journal-full-title] Cancers
  • [ISO-abbreviation] Cancers (Basel)
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Switzerland
  • [Other-IDs] NLM/ PMC3835096
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40. Nagore E, Pereda C, Botella-Estrada R, Requena C, Guillén C: Acral lentiginous melanoma presents distinct clinical profile with high cancer susceptibility. Cancer Causes Control; 2009 Feb;20(1):115-9
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Acral lentiginous melanoma presents distinct clinical profile with high cancer susceptibility.
  • BACKGROUND: Acral lentiginous melanoma (ALM) is a distinct histological variant of cutaneous melanoma that presents a genomic profile different from the other variants.
  • Our aim was to explore the distinctive clinical, pathological, and epidemiological characteristics of ALM.
  • PATIENTS AND METHODS: A series of 978 patients with primary cutaneous melanoma was selected from a single referral center.
  • Among these, 79 were located on acral sites and 46 presented an ALM.
  • This group was compared with a group composed of 932 patients with the remaining three most frequent cutaneous melanoma variants.
  • RESULTS: The ALM differed significantly from other variants: in an older age at diagnosis (65.52 vs. 51.79 years), a lower number of common (88.2 vs. 55.8%) and atypical nevi (95.0 vs. 80.2%), a predisposing genetic trait to cancer (22.2 vs. 7.1% had a personal history of other non-cutaneous malignancies and 58.1 vs. 36.4% had at least one first degree relative with non-cutaneous neoplasia) and lower number of sunburns (88.2 vs. 47.4% remembered none).
  • CONCLUSIONS: Our results, from a clinical and epidemiological point of view, support recent data on genetic characterization of melanomas.
  • In comparison with the other frequent variants we have shown that ALM has some important differences which emphasize that it is a distinct entity more probably related to certain cancer susceptibility but unrelated to familial melanoma, tendency to developing nevus or sun exposure.
  • [MeSH-major] Melanoma / diagnosis. Skin Neoplasms / diagnosis

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  • (PMID = 18758972.001).
  • [ISSN] 1573-7225
  • [Journal-full-title] Cancer causes & control : CCC
  • [ISO-abbreviation] Cancer Causes Control
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Netherlands
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41. Lichte V, Breuninger H, Metzler G, Haefner HM, Moehrle M: Acral lentiginous melanoma: conventional histology vs. three-dimensional histology. Br J Dermatol; 2009 Mar;160(3):591-9
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  • [Title] Acral lentiginous melanoma: conventional histology vs. three-dimensional histology.
  • BACKGROUND: Patients with acral lentiginous melanoma (ALM) seem to have a poor prognosis.
  • ALMs represent 4-10% of cutaneous melanomas in white populations.
  • OBJECTIVES: Clinical parameters and surgical strategies influencing the prognosis of patients with ALM were evaluated.
  • METHODS: Two hundred and forty-one patients (44% male, 56% female) with stage I/II ALM were recorded during 1980-2006.
  • CONCLUSIONS: Clinical and surgical risk factors seem to have different influences on the outcome of ALM.
  • [MeSH-major] Melanoma / pathology. Mohs Surgery / methods. Skin Neoplasms / pathology

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  • (PMID = 19067697.001).
  • [ISSN] 1365-2133
  • [Journal-full-title] The British journal of dermatology
  • [ISO-abbreviation] Br. J. Dermatol.
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article
  • [Publication-country] England
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42. Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L: Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol; 2006 Sep;155(3):561-9
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  • [Title] Acral lentiginous melanoma: a clinicoprognostic study of 126 cases.
  • BACKGROUND: Although the histopathological subtype of melanoma has not been clearly proven to carry independent prognostic significance, acral lentiginous melanoma (ALM) seems to confer a poorer prognosis mainly because disease is often more advanced at the time of diagnosis.
  • OBJECTIVES: To investigate the distinctive epidemiological and clinical characteristics of ALM, a peculiar histological entity, and to identify prognostic factors.
  • ALM-specific and disease-free survival were estimated using the KaplanMeier method and compared using the log-rank test.
  • RESULTS: One hundred and twenty-six patients were identified as having histopathology-proven ALM in our melanoma patient register from 1996 to 2004.
  • There were 46 (37%) subungual ALM and 80 (63%) ALM on soles, palms and nonvolar sites.
  • The mean age at diagnosis was 63 years.
  • Thirty-four ALM (28%) were unpigmented.
  • The median ALM-specific and disease-free survival were 13.5 and 10.1 years, respectively.
  • Multivariate analysis identified tumour thickness, male gender and amelanosis as independent clinical prognostic factors for both ALM-specific and disease-free survival.
  • CONCLUSIONS: Our study provides specific information on the clinical characteristics and outcome of this uncommon histological subtype of melanoma.
  • [MeSH-major] Foot Diseases / diagnosis. Hand. Melanoma / diagnosis. Nail Diseases / diagnosis. Skin Neoplasms / diagnosis
  • [MeSH-minor] Adult. Age Distribution. Aged. Aged, 80 and over. Epidemiologic Methods. Female. France / epidemiology. Genetic Predisposition to Disease. Humans. Male. Middle Aged. Motivation. Patient Acceptance of Health Care. Prognosis. Sex Distribution. Skin / injuries. Ultraviolet Rays / adverse effects


43. Cormier JN, Xing Y, Ding M, Lee JE, Mansfield PF, Gershenwald JE, Ross MI, Du XL: Ethnic differences among patients with cutaneous melanoma. Arch Intern Med; 2006 Sep 25;166(17):1907-14
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  • [Title] Ethnic differences among patients with cutaneous melanoma.
  • BACKGROUND: Melanoma incidence continues to increase in whites, but little is known about melanoma in minority populations.
  • Surveillance, Epidemiology, and End Results (SEER) data were used to examine the incidence, manifestations, and survival in patients with melanoma with respect to race/ethnicity.
  • METHODS: A SEER search (1992-2002) for primary invasive cutaneous melanoma cases identified 48 143 whites, 932 Hispanics, 394 Asian/Pacific islanders, 251 African Americans, and 52 American Indians.
  • RESULTS: Based on our cohort of patients, the average annual age-adjusted melanoma incidence per 100 000 persons was 18.4 for whites compared with 2.3, 0.8, 1.6, and 1.0 for Hispanics, African Americans, American Indians, and Asians, respectively.
  • Lower extremity and acral lentiginous melanomas were more common among minorities.
  • In addition, Hispanics (odds ratio [OR], 3.6), African Americans (OR, 4.2), American Indians (OR, 3.4), and Asians (OR, 2.4) were more likely to present with stage IV melanoma than were whites.
  • CONCLUSIONS: Melanoma is a public health concern for all ethnic populations.
  • Understanding melanoma in minority populations may lead to early detection and ultimately save lives.
  • [MeSH-major] Melanoma / ethnology. Skin Neoplasms / ethnology

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  • (PMID = 17000949.001).
  • [ISSN] 0003-9926
  • [Journal-full-title] Archives of internal medicine
  • [ISO-abbreviation] Arch. Intern. Med.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / 5-K12-CA088084
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural
  • [Publication-country] United States
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44. Soudry E, Gutman H, Feinmesser M, Gutman R, Schachter J: "Gloves-and-socks" melanoma: does histology make a difference? Dermatol Surg; 2008 Oct;34(10):1372-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] "Gloves-and-socks" melanoma: does histology make a difference?
  • BACKGROUND: Acral lentiginous melanoma (ALM) is associated with low survival.
  • OBJECTIVE: The aim of the study was to compare the clinical course of ALM, non-ALM hand and foot melanoma, and melanoma of the extremities in nonacral locations.
  • METHODS: Data on 168 patients operated on for cutaneous melanoma of the extremities from 1993 to 2005 were examined.
  • Twenty-nine had ALM, 16 non-ALM, and 123 other-extremity melanoma.
  • All known melanoma prognosticators were analyzed for their impact on survival at a median of 53 months' follow-up.
  • RESULTS: The ALM group was significantly older (p=.015).
  • No differences between the ALM and non-ALM groups were noted in tumor characteristics, lymph node status, and survival.
  • However, the other-extremity melanoma group presented with significantly thinner lesions, fewer positive sentinel lymph nodes, and lower tumor stage and, consequently, had significantly better disease-specific and disease-free survival (p=.006, p=.0001).
  • The acral lesions were nearly free of peritumoral lymphocytic infiltration.
  • CONCLUSION: Cutaneous melanomas in acral sites, regardless of histology, tend to be diagnosed at an advanced stage probably owing to older patient age, difficult-to-see sites, and biologic factors, leading to reduced patient survival.
  • [MeSH-major] Melanoma / pathology. Skin Neoplasms / pathology

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  • (PMID = 18616532.001).
  • [ISSN] 1524-4725
  • [Journal-full-title] Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
  • [ISO-abbreviation] Dermatol Surg
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
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45. Jung SM, Hsu YY, Chuang CC, Chang CN, Hsueh C, Kuo TT: A man in his mid-70s with a sellar mass. Brain Pathol; 2007 Jan;17(1):115-6, 121
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  • Metastatic melanoma to a pituitary oncocytoma is a very rare condition.
  • He had a subungual acral lentiginous melanoma (T3N1M0) with gangrenous change of left big toe, treated by amputation 15 months ago.
  • Microscopically, the tumor revealed an admixture of pituitary adenoma and invasive metastatic melanoma with fragments containing both populations in juxtaposition.
  • The adenoma was negative for melanoma markers and pituitary hormone markers.
  • The melanoma was positive for S-100 protein and BMB-45.
  • The diagnosis was metastatic melanoma to a pituitary oncocytoma.
  • [MeSH-major] Adenoma, Oxyphilic / pathology. Melanoma / secondary. Pituitary Neoplasms / secondary. Sella Turcica / pathology. Skin Neoplasms / pathology

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  • (PMID = 17493045.001).
  • [ISSN] 1015-6305
  • [Journal-full-title] Brain pathology (Zurich, Switzerland)
  • [ISO-abbreviation] Brain Pathol.
  • [Language] eng
  • [Publication-type] Case Reports; Letter
  • [Publication-country] Switzerland
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46. Robertson SJ, Leonard J, Chamberlain AJ: PlayStation purpura. Australas J Dermatol; 2010 Aug;51(3):220-2
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  • Although the parallel ridge pattern is typically the hallmark for early acral lentiginous melanoma, it may be observed in a limited number of benign entities, including subcorneal haematoma.

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  • (PMID = 20695869.001).
  • [ISSN] 1440-0960
  • [Journal-full-title] The Australasian journal of dermatology
  • [ISO-abbreviation] Australas. J. Dermatol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Australia
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47. Kramkimel N, Maubec E, Boitier F, Cavalcanti A, Beldi M, Mamelle G, Kolb F, Duvillard P, Avril MF: [Tumour regression is not predictive for higher risk of sentinel node involvement in thin melanomas (Breslow thickness &lt; or = 1 mm)]. Ann Dermatol Venereol; 2010 Apr;137(4):276-80
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] [Tumour regression is not predictive for higher risk of sentinel node involvement in thin melanomas (Breslow thickness < or = 1 mm)].
  • [Transliterated title] La régression tumorale n'est pas un facteur de risque d'atteinte du ganglion sentinelle dans les mélanomes fins (indice de Breslow < or = 1 mm).
  • BACKGROUND: Thin melanomas (Breslow thickness < or = 1 mm) are considered highly curable.
  • The aim of this study was to evaluate the correlation between histological tumour regression and sentinel lymph node (SLN) involvement in thin melanomas.
  • PATIENTS AND METHODS: This was a retrospective single-centre study of 34 patients with thin melanomas undergoing SLN biopsy between April 1998 and January 2005.
  • Melanomas were located on the neck (n=3), soles (n=4), trunk (n=13) and extremities (n=14).
  • Pathological examination showed 25 SSM, four acral lentiginous melanomas, three in situ melanomas, one nodular melanoma and one unclassified melanoma with a mean Breslow thickness of 0.57 mm.
  • CONCLUSION: The results of the present study and the analysis of the literature show that histological regression of the primary tumour does not seem predictive of higher risk of SLN involvement in thin melanomas.
  • This suggests that screening for SLN is not indicated in thin melanomas, even those with histological regression.
  • [MeSH-major] Lymphatic Metastasis. Melanoma / secondary. Melanoma / ultrastructure. Sentinel Lymph Node Biopsy. Skin Neoplasms / ultrastructure

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  • [Copyright] 2010 Elsevier Masson SAS. All rights reserved.
  • (PMID = 20417360.001).
  • [ISSN] 0151-9638
  • [Journal-full-title] Annales de dermatologie et de vénéréologie
  • [ISO-abbreviation] Ann Dermatol Venereol
  • [Language] fre
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] France
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48. Kim KB, Eton O, Davis DW, Frazier ML, McConkey DJ, Diwan AH, Papadopoulos NE, Bedikian AY, Camacho LH, Ross MI, Cormier JN, Gershenwald JE, Lee JE, Mansfield PF, Billings LA, Ng CS, Charnsangavej C, Bar-Eli M, Johnson MM, Murgo AJ, Prieto VG: Phase II trial of imatinib mesylate in patients with metastatic melanoma. Br J Cancer; 2008 Sep 2;99(5):734-40
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  • [Title] Phase II trial of imatinib mesylate in patients with metastatic melanoma.
  • Metastatic melanoma cells express a number of protein tyrosine kinases (PTKs) that are considered to be targets for imatinib.
  • We conducted a phase II trial of imatinib in patients with metastatic melanoma expressing at least one of these PTKs.
  • One patient with metastatic acral lentiginous melanoma, containing the highest c-kit expression among all patients, had dramatic improvement on positron emission tomographic scan at 6 weeks and had a partial response lasting 12.8 months.
  • Imatinib at the studied dose had minimal clinical efficacy as a single-agent therapy for metastatic melanoma.
  • However, based on the characteristics of the responding tumour in our study, clinical activity of imatinib, specifically in patients with melanoma with certain c-kit aberrations, should be examined.

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  • (PMID = 18728664.001).
  • [ISSN] 1532-1827
  • [Journal-full-title] British journal of cancer
  • [ISO-abbreviation] Br. J. Cancer
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / P30 CA016672; United States / NCI NIH HHS / CA / CA16672; United States / NCI NIH HHS / CM / N01 CM-17003
  • [Publication-type] Clinical Trial, Phase II; Journal Article; Research Support, N.I.H., Extramural
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Benzamides; 0 / DNA Primers; 0 / Piperazines; 0 / Pyrimidines; 8A1O1M485B / Imatinib Mesylate
  • [Other-IDs] NLM/ PMC2528157
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49. Ferrari Júnior NM, Muller H, Ribeiro M, Maia M, Sanches Júnior JA: Cutaneous melanoma: descriptive epidemiological study. Sao Paulo Med J; 2008 Jan 2;126(1):41-7
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  • [Title] Cutaneous melanoma: descriptive epidemiological study.
  • CONTEXT AND OBJECTIVE: Cutaneous melanoma represents around 3% of all skin tumors.
  • DESIGN AND SETTING: Retrospective, descriptive, epidemiological study at the Melanoma Unit, Dermatological Clinic, Irmandade da Santa Casa de Misericórdia, São Paulo.
  • The prevalent anatomical sites for cutaneous melanoma were the trunk and feet, for both men and women.
  • Acral lentiginous melanoma represented 22.3% of the cohort.
  • In situ primary lesions were observed in few cases and a high percentage of thick cutaneous melanoma was detected.
  • CONCLUSIONS: The cohort mostly presented thick and ulcerated tumors, denoting late diagnosis and bad prognosis.
  • Also, the sample was characterized by considerable prevalence of female patients, nonwhite patients, limb lesions and acral lentiginous melanoma.
  • [MeSH-major] Melanoma / pathology. Skin Neoplasms / pathology

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  • (PMID = 18425286.001).
  • [ISSN] 1516-3180
  • [Journal-full-title] São Paulo medical journal = Revista paulista de medicina
  • [ISO-abbreviation] Sao Paulo Med J
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Brazil
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50. Phan A, Dalle S, Touzet S, Ronger-Savlé S, Balme B, Thomas L: Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population. Br J Dermatol; 2010 Apr;162(4):765-71
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  • [Title] Dermoscopic features of acral lentiginous melanoma in a large series of 110 cases in a white population.
  • BACKGROUND: Acral lentiginous melanoma (ALM) is a rare but distinctive subtype of melanoma.
  • The diagnosis is often delayed and misdiagnosis is common, due to frequently unusual clinical presentation and a higher rate of amelanosis than in other melanoma subtypes.
  • OBJECTIVES: We aimed to investigate the dermoscopic features of a large series of ALM in a white-skinned population, in order to emphasize their diagnostic value.
  • METHODS: All recorded dermoscopic photographs of ALM, including nail unit variants, were collected from the files of the University Hospital Department of Dermatology (Lyons, France) and reviewed.
  • RESULTS: In total 110 lesions, including 66 (60%) palmoplantar ALM and 44 (40%) ALM of the nail apparatus, were analysed for dermoscopic characteristics.
  • In volar skin melanomas, the two most prevalent patterns were irregular diffuse pigmentation (60%) and the parallel-ridge pattern (53%).
  • Both corresponded to early ungual ALM.
  • The study included 37 (34%) amelanotic melanomas.
  • CONCLUSIONS: The presence of a parallel-ridge pattern and/or irregular diffuse pigmentation within the lesion is highly indicative of melanoma on volar skin.
  • An irregular lines pattern is the most prominent dermoscopic feature of pigmented ALM of the nail apparatus.
  • Amelanotic ALM either in volar skin or in nail apparatus is characterized by remnants of pigmentation and a polymorphic vascular pattern.
  • [MeSH-major] Dermoscopy / methods. Foot Diseases / pathology. Melanoma / pathology. Nail Diseases / pathology. Skin Neoplasms / pathology
  • [MeSH-minor] Diagnosis, Differential. European Continental Ancestry Group. Extremities. Humans. Predictive Value of Tests


51. Mátrai Z, Plotár V, Liszkay G, Fejos Z, Vámosi A, Dubóczky Z, Rényi Vámos F, Vámosi Nagy I, Köves I, Bartal A, Schmidt E, Tóth L: [Recurrent acral lentigous melanoma successfully treated with Mohs' micrographic surgery. Case report and review of the literature]. Orv Hetil; 2009 Jun 7;150(23):1071-82
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  • [Title] [Recurrent acral lentigous melanoma successfully treated with Mohs' micrographic surgery. Case report and review of the literature].
  • [Transliterated title] Recidív acralis lentiginosus melanoma sikeres eltávolítása Mohs-féle mikrográfikus sebészi technikával. Esetismertetés és irodalmi áttekintés.
  • Mohs' micrographic surgery is an approach to selected skin cancer removal that aims to achieve the best prospect of total tumor excision simultaneously with maximal functional and cosmetic preservation.
  • Mohs' micrographic surgery is the method of choice for removal of large, recurrent or incompletely excised skin cancers or for tumors located in functional and aesthetic relevant anatomic regions.
  • The authors present a case of a 75-year-old man with a second time recurrent plantar invasive malignant melanoma successfully treated with Mohs' micrographic surgery technique and an immediate reconstruction using split-thickness skin graft.
  • [MeSH-major] Melanoma / pathology. Melanoma / surgery. Mohs Surgery / methods. Neoplasm Recurrence, Local / surgery. Skin Neoplasms / pathology. Skin Neoplasms / surgery
  • [MeSH-minor] Aged. Carcinoma, Basal Cell / surgery. Carcinoma, Squamous Cell / surgery. Frozen Sections. Humans. Male. Skin Transplantation. Transplantation, Autologous. Treatment Outcome

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  • (PMID = 19470423.001).
  • [ISSN] 0030-6002
  • [Journal-full-title] Orvosi hetilap
  • [ISO-abbreviation] Orv Hetil
  • [Language] hun
  • [Publication-type] Case Reports; English Abstract; Journal Article; Review
  • [Publication-country] Hungary
  • [Number-of-references] 46
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52. Albreski D, Sloan SB: Melanoma of the feet: misdiagnosed and misunderstood. Clin Dermatol; 2009 Nov-Dec;27(6):556-63
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  • [Title] Melanoma of the feet: misdiagnosed and misunderstood.
  • Acral lentiginous melanoma of the foot is a relatively rare but often very aggressive variant of melanoma.
  • More commonly identified in patients with darker skin, diagnosis of the lesions is often delayed because the area is not routinely examined by patients or primary care physicians.
  • [MeSH-major] Diagnostic Errors. Foot / pathology. Foot Diseases / diagnosis. Melanoma / diagnosis. Skin Neoplasms / diagnosis
  • [MeSH-minor] Biopsy, Needle. Combined Modality Therapy. Diagnosis, Differential. Disease Progression. Female. Humans. Immunohistochemistry. Male. Neoplasm Invasiveness / pathology. Neoplasm Staging. Prognosis. Rare Diseases. Risk Assessment. Survival Analysis

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  • (PMID = 19880043.001).
  • [ISSN] 1879-1131
  • [Journal-full-title] Clinics in dermatology
  • [ISO-abbreviation] Clin. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 46
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53. Choi TY, Sohn KC, Kim JH, Kim SM, Kim CH, Hwang JS, Lee JH, Kim CD, Yoon TJ: Impact of NAD(P)H:quinone oxidoreductase-1 on pigmentation. J Invest Dermatol; 2010 Mar;130(3):784-92
ZFIN. ZFIN .

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  • We obtained metastasized melanoma tissue from a primary acral lentiginous melanoma (ALM) patient and established a melanoma cell line named primary culture of melanoma cell derived from lymph node (PML)-1.
  • To identify genes differentially regulated in PML-1 melanoma cells, we performed DNA microarray and two-dimensional matrix-assisted laser desorption ionization-time of flight mass spectrometry analyses.
  • Reverse transcription-PCR and western blot analyses showed that NQO1 was markedly decreased in PML-1 cells and in several amelanotic melanoma cell lines.
  • [MeSH-major] NAD(P)H Dehydrogenase (Quinone) / genetics. NAD(P)H Dehydrogenase (Quinone) / metabolism. Skin Pigmentation / genetics
  • [MeSH-minor] Adenoviridae / genetics. Alkaloids / biosynthesis. Animals. Biomarkers, Tumor / metabolism. Cell Line, Tumor. Gene Expression / physiology. Humans. Lymph Nodes / cytology. Melanins / biosynthesis. Melanocytes / cytology. Melanocytes / physiology. Melanoma / metabolism. Melanoma / physiopathology. Monophenol Monooxygenase / metabolism. Recombinant Proteins / genetics. Recombinant Proteins / metabolism. Skin Neoplasms / metabolism. Skin Neoplasms / physiopathology. Zebrafish

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  • [CommentIn] J Invest Dermatol. 2010 Mar;130(3):645-7 [20145642.001]
  • (PMID = 19759547.001).
  • [ISSN] 1523-1747
  • [Journal-full-title] The Journal of investigative dermatology
  • [ISO-abbreviation] J. Invest. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Alkaloids; 0 / Biomarkers, Tumor; 0 / Melanins; 0 / Recombinant Proteins; 6801-22-5 / melinonine F; EC 1.14.18.1 / Monophenol Monooxygenase; EC 1.6.5.2 / NAD(P)H Dehydrogenase (Quinone); EC 1.6.5.2 / NQO1 protein, human
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54. Yamaguchi Y, Hearing VJ, Maeda A, Morita A: NADPH:quinone oxidoreductase-1 as a new regulatory enzyme that increases melanin synthesis. J Invest Dermatol; 2010 Mar;130(3):645-7
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  • Because NQO1 was identified by comparing normally pigmented melanocytes with hypopigmented acral lentiginous melanoma cells, these results suggest various hypotheses regarding the carcinogenic origin of the latter.
  • [MeSH-major] Melanins / biosynthesis. Melanoma / metabolism. NAD(P)H Dehydrogenase (Quinone) / genetics. NAD(P)H Dehydrogenase (Quinone) / metabolism. Skin Neoplasms / metabolism

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  • [CommentOn] J Invest Dermatol. 2010 Mar;130(3):784-92 [19759547.001]
  • (PMID = 20145642.001).
  • [ISSN] 1523-1747
  • [Journal-full-title] The Journal of investigative dermatology
  • [ISO-abbreviation] J. Invest. Dermatol.
  • [Language] eng
  • [Publication-type] Comment; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Melanins; EC 1.14.18.1 / Monophenol Monooxygenase; EC 1.6.5.2 / NAD(P)H Dehydrogenase (Quinone); EC 1.6.5.2 / NQO1 protein, human
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55. Tejera-Vaquerizo A, Mendiola-Fernández M, Fernández-Orland A, Herrera-Ceballos E: Thick melanoma: the problem continues. J Eur Acad Dermatol Venereol; 2008 May;22(5):575-9
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  • [Title] Thick melanoma: the problem continues.
  • BACKGROUND: The incidence of melanoma and its associated mortality has stabilized over the recent years, due in part to efforts directed at better prevention and detection of these lesions.
  • We analysed the trends in the distribution of melanomas, mainly according to their thickness.
  • METHODS: Data from the Dermatology Service of 'Virgen de la Victoria' University Hospital in Malaga (Spain) showed a total of 459 cases of melanoma between 1990 and 2005, both inclusive.
  • The lesions were stratified according to year of diagnosis (1990-96 and 1997-2005), sex, age (0-49, > or = 50), thickness (0-0.99, 1.00-1.99, and > or = 2 mm) and the histological subtype [lentigo maligna melanoma (LMM), superficial spreading melanoma (SSM), nodular melanoma (NM) and acral lentiginous melanoma (ALM)].
  • However, the number of new cases of thick melanoma remained almost constant over the two periods, being associated with persons over 50 years of age (65.1% vs. 64.3%), with men having half the cases (48.4% vs. 47%).
  • The proportion of nodular melanomas within the group of thick melanomas was high in both periods (36.5% and 39.3%, respectively).
  • CONCLUSIONS: This study shows that despite the large increase in new melanomas, the diagnosis of thick melanomas has remained constant, mainly in persons over the age 50 years, with a relative increase in men.
  • [MeSH-major] Melanoma / epidemiology. Skin Neoplasms / epidemiology

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  • (PMID = 18081751.001).
  • [ISSN] 1468-3083
  • [Journal-full-title] Journal of the European Academy of Dermatology and Venereology : JEADV
  • [ISO-abbreviation] J Eur Acad Dermatol Venereol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Netherlands
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56. Puzanov I, Flaherty KT: Targeted molecular therapy in melanoma. Semin Cutan Med Surg; 2010 Sep;29(3):196-201
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  • [Title] Targeted molecular therapy in melanoma.
  • Immunotherapy and chemotherapy benefit few patients with metastatic melanoma, and even fewer experience durable survival benefit.
  • These poor results may come from treating all melanomas as though they are biologically homogeneous.
  • Recently, it has been shown that targeting specific activated tyrosine kinases (oncogenes) can have striking clinical benefits in patients with melanoma.
  • In 2002, a V600E mutation of the BRAF serine/threonine kinase was described as present in more than 50% of all melanomas.
  • The mutation appeared to confer a dependency by the melanoma cancer cell on activated signaling through mitogen-activated protein kinase pathway.
  • The frequency and focality of this mutation (>95% of all BRAF mutations being at V600 position) suggested its importance in melanoma pathophysiology and potential as a target for therapy.
  • The recent results of a phase 1 study with PLX4032/RG7204, a small molecule RAF inhibitor, confirm this hypothesis.
  • Mucosal and acral-lentiginous melanomas, comprising 3% of all melanomas, frequently harbor activating mutations of c-kit and drugs targeting this mutation seem to confer similar benefits for these types of tumors.
  • Here we provide an overview of the targeted therapy development in melanoma with emphasis on BRAF inhibition because of its prevalence and possibility of transforming the care of many melanoma patients.
  • [MeSH-major] Antineoplastic Agents / therapeutic use. Melanoma / drug therapy. Molecular Targeted Therapy. Skin Neoplasms / drug therapy


57. Kundu RV, Kamaria M, Ortiz S, West DP, Rademaker AW, Robinson JK: Effectiveness of a knowledge-based intervention for melanoma among those with ethnic skin. J Am Acad Dermatol; 2010 May;62(5):777-84
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  • [Title] Effectiveness of a knowledge-based intervention for melanoma among those with ethnic skin.
  • BACKGROUND: Among patients with melanoma, ethnic minorities are 1.96 to 3.01 times as likely to die from melanoma as Caucasians of the same age and sex.
  • OBJECTIVE: We sought to assess the effectiveness of a melanoma early detection educational intervention among those with ethnic skin.
  • METHODS: A consecutive convenience sample of patients received instruction on the ABCDEs of melanoma and skin self-examination.
  • RESULTS: Among the 71 participants, 21% reported a skin phenotype with at least sometimes burning.
  • Knowledge that melanoma is a skin cancer and of the warning signs of melanoma significantly increased after the intervention and was retained at 3 months.
  • The perception of being at risk to develop a melanoma significantly increased after the intervention and was retained at 3 months (P < .001).
  • Monthly checking of the skin, especially acral sites (palms, soles, periungual), increased significantly immediately after the intervention.
  • LIMITATIONS: A limitation is accrual from dermatology patients, who may be more inclined to perform skin self-examination compared with the general minority population.
  • CONCLUSIONS: People of color benefit from specific physician recommendations explaining their risk to develop melanoma and which anatomic sites to check.
  • Acral lentiginous melanoma among ethnic minorities tends to present in non-sun-exposed but visible areas, particularly volar and subungual sites; therefore, skin self-examination educational materials for minority populations should incorporate these anatomic sites.
  • [MeSH-major] Ethnic Groups. Health Knowledge, Attitudes, Practice. Melanoma / diagnosis. Skin Neoplasms / diagnosis
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Early Diagnosis. European Continental Ancestry Group. Female. Humans. Male. Middle Aged. Patient Education as Topic. Self-Examination. Sunburn / complications

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  • [Copyright] Copyright 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
  • (PMID = 20219266.001).
  • [ISSN] 1097-6787
  • [Journal-full-title] Journal of the American Academy of Dermatology
  • [ISO-abbreviation] J. Am. Acad. Dermatol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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58. Roh MR, Kim J, Chung KY: Treatment and outcomes of melanoma in acral location in Korean patients. Yonsei Med J; 2010 Jul;51(4):562-8
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  • [Title] Treatment and outcomes of melanoma in acral location in Korean patients.
  • PURPOSE: A retrospective study was conducted to review the treatment and outcomes of mainly melanomas in acral location in a single institution in Korea, and to evaluate the prognostic significance of anatomic locations of the tumor.
  • RESULTS: Forty melanoma patients were identified and analyzed.
  • Of these, 18 were male and 22 were female patients and the mean age at the time of diagnosis was 55.9 years.
  • Of the tumors, 65% were located on the hands and feet with acral lentiginous melanoma being the most common histological subtype.
  • Univariate analysis for the overall melanoma survival revealed that the thickness of the tumor and the clinical stage have prognostic significances.
  • Acral melanomas did not show statistically significant differences in the age at diagnosis, thickness of the tumor, stage, ulceration, and survival rates compared to non-acral melanomas.
  • There was also no significant difference in the survival rate between the patients treated by amputation versus wide local excision in acral melanomas.
  • CONCLUSION: In Korean melanoma patients, thickness and advanced stages are significant factors for poorer prognosis.
  • However, the location of melanoma did not have a significant prognostic value.
  • In treating the melanomas in acral location, local wide excisions resulted in a similar prognosis compared to amputations.
  • [MeSH-major] Melanoma / therapy. Skin Neoplasms / therapy

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  • (PMID = 20499423.001).
  • [ISSN] 1976-2437
  • [Journal-full-title] Yonsei medical journal
  • [ISO-abbreviation] Yonsei Med. J.
  • [Language] eng
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59. Ng JC, Swain S, Dowling JP, Wolfe R, Simpson P, Kelly JW: The impact of partial biopsy on histopathologic diagnosis of cutaneous melanoma: experience of an Australian tertiary referral service. Arch Dermatol; 2010 Mar;146(3):234-9
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  • [Title] The impact of partial biopsy on histopathologic diagnosis of cutaneous melanoma: experience of an Australian tertiary referral service.
  • OBJECTIVE: To compare partial and excisional biopsy techniques in the accuracy of histopathologic diagnosis and microstaging of cutaneous melanoma.
  • Other factors considered were anatomic site, physician type at initial management, hypomelanosis, melanoma subtype, biopsy sample size, multiple biopsies, and tumor thickness.
  • MAIN OUTCOME MEASURES: Histopathologic diagnosis (false-negative misdiagnosis-overall or with an adverse outcome-and false-positive misdiagnosis) and microstaging accuracy.
  • Other factors associated with increased odds of misdiagnosis included acral lentiginous melanoma (OR, 5.1; 95% CI, 2-13) (P < .001), desmoplastic melanoma (OR, 3.8; 95% CI, 1.1-13.0) (P = .03), and nevoid melanoma (OR, 28.4; 95% CI, 7-115) (P < .001).
  • CONCLUSIONS: Among melanoma seen at a tertiary referral center, histopathologic misdiagnosis is more common for melanomas that have been assessed with punch and shave biopsy than with excisional biopsy.
  • [MeSH-major] Biopsy / methods. Melanoma / pathology. Referral and Consultation. Skin Neoplasms / pathology
  • [MeSH-minor] Confidence Intervals. Diagnosis, Differential. Diagnostic Errors. Follow-Up Studies. Humans. Neoplasm Staging. Odds Ratio. Prevalence. Prospective Studies. Reproducibility of Results. Victoria / epidemiology

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  • [CommentIn] Arch Dermatol. 2010 Mar;146(3):325-8 [20231507.001]
  • (PMID = 20231492.001).
  • [ISSN] 1538-3652
  • [Journal-full-title] Archives of dermatology
  • [ISO-abbreviation] Arch Dermatol
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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60. Byrd-Miles K, Toombs EL, Peck GL: Skin cancer in individuals of African, Asian, Latin-American, and American-Indian descent: differences in incidence, clinical presentation, and survival compared to Caucasians. J Drugs Dermatol; 2007 Jan;6(1):10-6
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  • [Title] Skin cancer in individuals of African, Asian, Latin-American, and American-Indian descent: differences in incidence, clinical presentation, and survival compared to Caucasians.
  • Skin cancer most commonly affects Caucasians and rarely affects individuals of African, Asian, Latin-American, and American-Indian descent.
  • Although skin cancer is rare in these groups, the diagnosis may be associated with significant morbidity and mortality.
  • Skin cancers in these groups may have atypical presentations.
  • Melanoma usually involves areas not exposed to the sun, including palmoplantar skin and mucosal surfaces with the acral lentiginous melanoma being the most common histologic subtype.
  • Because of the low index of suspicion in both the medical community and the ethnic groups, diagnosis is often delayed resulting in an advanced presentation and a worse prognosis.
  • [MeSH-major] African Continental Ancestry Group / statistics & numerical data. Asian Americans / statistics & numerical data. European Continental Ancestry Group / statistics & numerical data. Hispanic Americans / statistics & numerical data. Indians, North American / statistics & numerical data. Skin Neoplasms / ethnology


61. Woodman SE, Davies MA: Targeting KIT in melanoma: a paradigm of molecular medicine and targeted therapeutics. Biochem Pharmacol; 2010 Sep 1;80(5):568-74
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  • [Title] Targeting KIT in melanoma: a paradigm of molecular medicine and targeted therapeutics.
  • Despite multiple clinical trials utilizing a spectrum of therapeutic modalities, melanoma remains a disease with dismal outcomes in patients with advanced disease.
  • However, it is now clear that melanoma is not a single entity, but can be molecularly divided into subtypes that generally correspond to the anatomical location of the primary melanoma.
  • Melanomas from acral lentiginous, mucosal, and chronic sun-damaged sites frequently harbor activating mutations and/or increased copy number in the KIT tyrosine kinase receptor gene, which are very rare in the more common cutaneous tumors.
  • Multiple case reports and early observations from clinical trials suggest that targeting mutant KIT with tyrosine kinase inhibitors is efficacious in KIT mutant melanoma.
  • This review recounts what is known about the role of KIT in melanocyte maturation, our current understanding of KIT genetic aberrations in melanoma, and how this knowledge is being translated into clinical oncology.

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  • [Copyright] Copyright 2010 Elsevier Inc. All rights reserved.
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  • (PMID = 20457136.001).
  • [ISSN] 1873-2968
  • [Journal-full-title] Biochemical pharmacology
  • [ISO-abbreviation] Biochem. Pharmacol.
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / K12 CA088084; United States / NCI NIH HHS / CA / P30 CA016672; United States / NCI NIH HHS / CA / P50 CA093459; United States / NCI NIH HHS / CA / P50 CA93459
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; EC 2.7.10.1 / Proto-Oncogene Proteins c-kit
  • [Number-of-references] 43
  • [Other-IDs] NLM/ NIHMS224261; NLM/ PMC3935736
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62. Sneyd MJ, Cox B: Melanoma in Maori, Asian, and Pacific peoples in New Zealand. Cancer Epidemiol Biomarkers Prev; 2009 Jun;18(6):1706-13
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  • [Title] Melanoma in Maori, Asian, and Pacific peoples in New Zealand.
  • New Zealand Maori, Pacific, and Asian people develop melanoma less frequently than New Zealand Europeans, but little is known about melanomas that develop in these people.
  • We examined the characteristics of melanoma in these minority ethnic groups in New Zealand.
  • In 2007, all first primary melanomas diagnosed from January 1996 to December 2006 were extracted from the New Zealand Cancer Registry database.
  • Melanoma was more commonly diagnosed in Maori than Asian or Pacific peoples.
  • Nodular melanoma occurred more often in Maori (15.9%) and Pacific peoples (17.1%) compared with Asians (8.7%) and New Zealand Europeans (10.5%).
  • In Pacific peoples, acral lentiginous melanoma (22.9%) was the most common subtype.
  • The median thickness of melanoma was 0.78 mm in New Zealand Europeans, 1.2 mm in Maori, 2.5 mm in Pacific peoples, and 0.73 mm in Asians (P < 0.001, difference in medians).
  • Thirty-seven percent of melanomas in Pacific peoples were >4 mm thick compared with 7.9% in New Zealand Europeans.
  • About 13% of Asians and 11% of Pacific peoples, compared with 4% of New Zealand Europeans with melanoma, were diagnosed by histology of metastases rather than the primary lesion.
  • Minority ethnicities in New Zealand have a higher than expected risk of thick and more advanced melanoma, with poorer prognosis.
  • Melanoma campaigns should include messages that incorporate the unique features of melanoma in minorities.
  • [MeSH-major] Melanoma / epidemiology. Skin Neoplasms / epidemiology

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  • [CommentIn] Cancer Epidemiol Biomarkers Prev. 2009 Jun;18(6):1674-5 [19505898.001]
  • (PMID = 19505903.001).
  • [ISSN] 1538-7755
  • [Journal-full-title] Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
  • [ISO-abbreviation] Cancer Epidemiol. Biomarkers Prev.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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63. Gerami P, Mafee M, Lurtsbarapa T, Guitart J, Haghighat Z, Newman M: Sensitivity of fluorescence in situ hybridization for melanoma diagnosis using RREB1, MYB, Cep6, and 11q13 probes in melanoma subtypes. Arch Dermatol; 2010 Mar;146(3):273-8
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  • [Title] Sensitivity of fluorescence in situ hybridization for melanoma diagnosis using RREB1, MYB, Cep6, and 11q13 probes in melanoma subtypes.
  • OBJECTIVE: To evaluate the diagnostic sensitivity of fluorescence in situ hybridization (FISH) using probes targeting 6p25, 6q23, 11q13, and Cep6 in melanoma subtypes.
  • DESIGN: Blinded comparison of chromosomal copy number changes detected using FISH targeting 6p25, 6q23, 11q13, and Cep6 in benign nevi and melanoma subtypes.
  • PARTICIPANTS: One hundred ten individuals with benign nevi and 123 with melanoma (70 superficial spreading, 28 lentigo maligna, 22 nodular, and 3 acral lentiginous melanomas).
  • MAIN OUTCOME MEASURES: Sensitivity of previously developed criteria using FISH using probes targeting 6p25, 6q23, 11q13, and Cep6 in the melanoma subtypes.
  • The assay was most sensitive in the subgroups of nodular and acral melanomas and least sensitive in the superficial spreading subtype.
  • The 11q13 gain was more commonly seen in chronically sun-damaged skin and infrequently in non-chronically sun-damaged skin.
  • CONCLUSIONS: Heterogeneous changes in melanoma occur at the molecular level, and the changes are different among melanoma subtypes.
  • Clonal abnormalities in chromosome 6 with increased copies of the short arm relative to the long arm are common in all melanoma subtypes, suggesting that isochromosome 6 is common in all variants of cutaneous melanoma subtypes.
  • An increase in copy number of 11q13 is most frequent in chronically sun-damaged melanomas.
  • [MeSH-major] Cyclin D1 / genetics. DNA, Neoplasm / analysis. DNA-Binding Proteins / genetics. In Situ Hybridization, Fluorescence / methods. Melanoma / diagnosis. Proto-Oncogene Proteins c-myb / genetics. Skin Neoplasms / diagnosis. Transcription Factors / genetics
  • [MeSH-minor] Aged. Chromosome Aberrations. Chromosomes, Human, Pair 11. Chromosomes, Human, Pair 6. DNA Probes. Diagnosis, Differential. Female. Genetic Predisposition to Disease. Humans. Male. Middle Aged. Sensitivity and Specificity. Zinc Fingers

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  • (PMID = 20231497.001).
  • [ISSN] 1538-3652
  • [Journal-full-title] Archives of dermatology
  • [ISO-abbreviation] Arch Dermatol
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / DNA Probes; 0 / DNA, Neoplasm; 0 / DNA-Binding Proteins; 0 / Proto-Oncogene Proteins c-myb; 0 / RREB1 protein, human; 0 / Transcription Factors; 136601-57-5 / Cyclin D1
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64. van der Meijden WA, van Bruchem-Visser RL, Thio HB, van der Cammen TJ: [Melanomas more serious in the elderly]. Ned Tijdschr Geneeskd; 2010;154:A1535
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  • [Title] [Melanomas more serious in the elderly].
  • Two patients, a 96-year-old woman and a 94-year-old man, were diagnosed with metastatic cutaneous melanoma.
  • The second patient presented with neurological symptoms caused by a metastatic melanoma; the primary tumour had recently been resected.
  • Both patients died within three weeks of the diagnosis.
  • Cutaneous melanomas have a high metastatic rate.
  • The incidence of melanoma increases with age.
  • Older patients more often present with more serious histological characteristics and more aggressive types of melanoma.
  • Nodular melanoma, lentigo maligna or acral lentiginous melanoma are observed more frequently in this group of patients.
  • Early diagnosis improves the prognosis, also in the elderly.
  • [MeSH-major] Aging / pathology. Melanoma / pathology. Skin Neoplasms / pathology

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  • (PMID = 20482904.001).
  • [ISSN] 1876-8784
  • [Journal-full-title] Nederlands tijdschrift voor geneeskunde
  • [ISO-abbreviation] Ned Tijdschr Geneeskd
  • [Language] dut
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Netherlands
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65. Duarte AF, Correia O, Barros AM, Azevedo R, Haneke E: Nail matrix melanoma in situ: conservative surgical management. Dermatology; 2010;220(2):173-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Nail matrix melanoma in situ: conservative surgical management.
  • BACKGROUND: Nail unit melanoma (NUM) is a rare variant of acral lentiginous melanoma.
  • The differential diagnosis is wide but an acquired brown streak in the nail of a fair-skinned person must be considered a potential melanoma.
  • METHODS: We report the case of a 61-year-old Caucasian woman with melanonychia occupying the central portion of the right thumbnail plate with 1 year of evolution.
  • An excisional biopsy was performed, and pathological examination revealed melanoma in situ.
  • For safety reasons, the nail unit was totally removed down to the phalangeal bone 3 weeks later, and a full-thickness skin graft taken from the arm was used for reconstruction.
  • Wide excision with phalanx amputation is not satisfactory for patients with in situ and early invasive melanoma.
  • Full-thickness skin grafting after total nail unit excision is a simple procedure providing a good functional and cosmetic outcome.
  • [MeSH-major] Melanoma / surgery. Nail Diseases / surgery. Skin Neoplasms / surgery. Skin Transplantation / methods
  • [MeSH-minor] Dermoscopy. Diagnosis, Differential. Esthetics. Female. Humans. Middle Aged. Reconstructive Surgical Procedures. Risk Factors

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  • [CommentIn] Dermatology. 2011;223(2):122-3 [21846959.001]
  • (PMID = 20016126.001).
  • [ISSN] 1421-9832
  • [Journal-full-title] Dermatology (Basel, Switzerland)
  • [ISO-abbreviation] Dermatology (Basel)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Switzerland
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66. Tichý M, Ditrichová D, Brychtová S, Tichá V, Urbánek J: Double skin tumors with an atypical clinical picture. Acta Dermatovenerol Alp Pannonica Adriat; 2007 Jun;16(2):63-6
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  • [Title] Double skin tumors with an atypical clinical picture.
  • The authors present a rare case of double skin tumors: acral lentiginous melanoma and metatypical carcinoma.
  • The skin biopsies showed advanced acral lentiginous melanoma on the sole and metatypical carcinoma of the lower leg.
  • Soon after the diagnosis was made, the melanoma generalized.
  • The article discusses the differential diagnosis of both leg ulcerations, correct diagnostic procedures, and characteristic features of both tumors that are important questions for general practitioners, dermatologists, and surgeons.
  • [MeSH-major] Carcinoma / diagnosis. Leg Ulcer / etiology. Melanoma / diagnosis. Neoplasms, Multiple Primary / diagnosis. Skin Neoplasms / diagnosis
  • [MeSH-minor] Aged. Diagnosis, Differential. Foot Ulcer / etiology. Humans. Male

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  • (PMID = 17992460.001).
  • [ISSN] 1318-4458
  • [Journal-full-title] Acta dermatovenerologica Alpina, Pannonica, et Adriatica
  • [ISO-abbreviation] Acta Dermatovenerol Alp Pannonica Adriat
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Slovenia
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67. Chiu HH, Hu SC, Ke CL, Cheng ST: Dermoscopy identifies histopathologically indiscernible malignant lesion of atypical melanosis of the foot, an early lesion of acral lentiginous melanoma in situ. Dermatol Surg; 2008 Jul;34(7):979-83
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  • [Title] Dermoscopy identifies histopathologically indiscernible malignant lesion of atypical melanosis of the foot, an early lesion of acral lentiginous melanoma in situ.
  • [MeSH-major] Carcinoma in Situ / diagnosis. Dermoscopy. Melanoma / diagnosis. Skin Neoplasms / diagnosis
  • [MeSH-minor] Adult. Female. Humans. Melanosis / diagnosis. Toes

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  • (PMID = 18384603.001).
  • [ISSN] 1524-4725
  • [Journal-full-title] Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.]
  • [ISO-abbreviation] Dermatol Surg
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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68. Seaman SM, Melhorn JM: Case of the month. Pigmented acral-lentiginous melanoma (ALM). JAAPA; 2006 Feb;19(2):72
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Case of the month. Pigmented acral-lentiginous melanoma (ALM).
  • [MeSH-major] Amputation. Melanoma / surgery. Nail Diseases / surgery. Thumb / surgery

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  • (PMID = 16483079.001).
  • [ISSN] 1547-1896
  • [Journal-full-title] JAAPA : official journal of the American Academy of Physician Assistants
  • [ISO-abbreviation] JAAPA
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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69. Sohl S, Simon JC, Wetzig T: [Finger stall technique skin graft for reconstruction of fingers after extensive excisions of acral lentiginous Melanomas]. J Dtsch Dermatol Ges; 2007 Jun;5(6):525-6
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  • [Title] [Finger stall technique skin graft for reconstruction of fingers after extensive excisions of acral lentiginous Melanomas].
  • [MeSH-major] Fingers / surgery. Hutchinson's Melanotic Freckle / surgery. Reconstructive Surgical Procedures / methods. Skin Neoplasms / surgery. Skin Transplantation / methods

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  • (PMID = 17537047.001).
  • [ISSN] 1610-0387
  • [Journal-full-title] Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG
  • [ISO-abbreviation] J Dtsch Dermatol Ges
  • [Language] ger
  • [Publication-type] Journal Article
  • [Publication-country] Germany
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70. Burd A: Sun and melanoma: What about acral lentiginous melanoma? BMJ; 2008;337:a1133
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Sun and melanoma: What about acral lentiginous melanoma?
  • [MeSH-major] Hutchinson's Melanotic Freckle / etiology. Skin Neoplasms / etiology. Sunlight / adverse effects

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  • [CommentOn] BMJ. 2008;337:a764 [18647766.001]
  • [CommentOn] BMJ. 2008;337:a763 [18647765.001]
  • (PMID = 18684760.001).
  • [ISSN] 1756-1833
  • [Journal-full-title] BMJ (Clinical research ed.)
  • [ISO-abbreviation] BMJ
  • [Language] eng
  • [Publication-type] Comment; Letter
  • [Publication-country] England
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71. Pereyra-Rodríguez JJ, Pulpillo A, Zulueta-Dorado T, Conejo-Mir J: [Acral lentiginous melanoma mimicking pyogenic granuloma]. Med Clin (Barc); 2010 Jul 3;135(4):193
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  • [Title] [Acral lentiginous melanoma mimicking pyogenic granuloma].
  • [Transliterated title] Melanoma acral que simula un granuloma piógeno.
  • [MeSH-major] Fingers. Granuloma, Pyogenic / pathology. Melanoma / pathology. Skin Diseases / pathology. Skin Neoplasms / pathology
  • [MeSH-minor] Diagnosis, Differential. Female. Humans. Middle Aged


72. Seidl H, Weger W, Wolf P, Kerl H, Schaider H: Lack of oncogenic mutations in the c-Met catalytic tyrosine kinase domain in acral lentiginous melanoma. Int J Dermatol; 2008 Dec;47(12):1327-9
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  • [Title] Lack of oncogenic mutations in the c-Met catalytic tyrosine kinase domain in acral lentiginous melanoma.
  • [MeSH-major] Melanoma / genetics. Mutation. Proto-Oncogene Proteins c-met / genetics. Skin Neoplasms / genetics


73. Muchemwa FC, Ma D, Inoue Y, Curtin JA, Bastian BC, Ihn H, Kageshita T: Constitutive activation of the phosphatidyl inositol 3 kinase signalling pathway in acral lentiginous melanoma. Br J Dermatol; 2008 Feb;158(2):411-3
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  • [Title] Constitutive activation of the phosphatidyl inositol 3 kinase signalling pathway in acral lentiginous melanoma.
  • [MeSH-major] Melanoma / metabolism. Phosphatidylinositol 3-Kinases / metabolism. Skin Neoplasms / metabolism

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  • (PMID = 17999703.001).
  • [ISSN] 0007-0963
  • [Journal-full-title] The British journal of dermatology
  • [ISO-abbreviation] Br. J. Dermatol.
  • [Language] eng
  • [Publication-type] Letter
  • [Publication-country] England
  • [Chemical-registry-number] EC 2.7.1.- / Phosphatidylinositol 3-Kinases; EC 2.7.11.1 / Proto-Oncogene Proteins B-raf; EC 2.7.11.24 / Mitogen-Activated Protein Kinases
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74. Cellier M, Sirvain S, Fraisse T: [Acral lentiginous melanoma: a slow growing tumor of the second finger]. Presse Med; 2010 Oct;39(10):1100-2
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] [Acral lentiginous melanoma: a slow growing tumor of the second finger].
  • [Transliterated title] Mélanome acral lentigineux: une volumineuse tumeur de l'index d'évolution lente.
  • [MeSH-major] Fingers. Lentigo / pathology. Melanoma / pathology. Skin Neoplasms / pathology
  • [MeSH-minor] Aged, 80 and over. Antigens, Neoplasm / blood. Biomarkers, Tumor / blood. Female. Humans. Melanoma-Specific Antigens. Neoplasm Proteins / blood. Neoplasm Staging. S100 Proteins / blood

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  • (PMID = 20630700.001).
  • [ISSN] 2213-0276
  • [Journal-full-title] Presse medicale (Paris, France : 1983)
  • [ISO-abbreviation] Presse Med
  • [Language] fre
  • [Publication-type] Case Reports; Letter
  • [Publication-country] France
  • [Chemical-registry-number] 0 / Antigens, Neoplasm; 0 / Biomarkers, Tumor; 0 / Melanoma-Specific Antigens; 0 / Neoplasm Proteins; 0 / S100 Proteins
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75. Martorell A, Millan-Parrilla F, Gimeno-Carpio E: Cutaneous involvement in multiple myeloma mimicking acral-lentiginous melanoma. J Am Acad Dermatol; 2010 Jun;62(6):1076-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Cutaneous involvement in multiple myeloma mimicking acral-lentiginous melanoma.
  • [MeSH-major] Melanoma / diagnosis. Multiple Myeloma / pathology. Skin Neoplasms / diagnosis. Skin Neoplasms / secondary
  • [MeSH-minor] Diagnosis, Differential. Female. Humans. Middle Aged






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