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45. 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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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [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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46. 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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47. 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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48. 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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49. 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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50. 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


51. 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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52. 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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53. 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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5
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4. 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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  • [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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55. 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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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [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


56. 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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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [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


57. 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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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • 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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58. 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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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [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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59. 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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60. 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


61. 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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62. 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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  • [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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63. 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.
  • 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


65. 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


66. 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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67. 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.
  • 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


68. 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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69. 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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70. 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


71. 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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72. Chagpar RB, Ross MI, Reintgen DS, Edwards MJ, Scoggins CR, Martin RC 2nd, Noyes RD, Goydos JS, Beitsch PD, Urist MM, Ariyan S, Davidson BS, Sussman JJ, McMasters KM: Factors associated with improved survival among young adult melanoma patients despite a greater incidence of sentinel lymph node metastasis. J Surg Res; 2007 Nov;143(1):164-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Factors associated with improved survival among young adult melanoma patients despite a greater incidence of sentinel lymph node metastasis.
  • INTRODUCTION: We sought to evaluate the factors that affect sentinel lymph node (SLN) metastasis and survival among young melanoma patients (< or =30 y).
  • METHODS: The Sunbelt Melanoma Trial is a multi-institutional prospective randomized trial of patients aged 18 to 70 y.
  • On univariate analysis, younger patients were more often female (54.7% versus 40.9%, P < 0.0005), with tumors <4 mm thick (94.9% versus 89.4%, P = 0.001) without ulceration (80.3% versus 70.9%, P < 0.0005) or evidence of regression (93.8% versus 87.8%, P = 0.003), and were less likely to have lentigo maligna (0.0% versus 2.6%) or acral lentiginous (0.4% versus 3.1%, P < 0.0005) subtype.
  • [MeSH-major] Lymphatic Metastasis / diagnosis. Melanoma / diagnosis. Skin Neoplasms / diagnosis

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  • (PMID = 17950088.001).
  • [ISSN] 0022-4804
  • [Journal-full-title] The Journal of surgical research
  • [ISO-abbreviation] J. Surg. Res.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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73. 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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74. 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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  • [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


75. 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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76. Lens M: Current clinical overview of cutaneous melanoma. Br J Nurs; 2008 Mar 13-26;17(5):300-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [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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