Malignant Melanoma Metastatic to a Basal Cell Carcinoma Simulating the Pattern of a Basomelanocytic Tumor
Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.American Journal of Surgical Pathology (Impact Factor: 5.15). 02/2006; 30(1):133-6. DOI: 10.1097/01.pas.0000179118.76904.02
We report a case of metastatic melanoma colliding with and colonizing a basal cell carcinoma (BCC) on the head of a 69-year-old man. The man had a prior history of multiple primary BCCs and melanomas. One of his primary melanomas, on the left scalp, recurred locally and resulted in the development of numerous in-transit metastases. A bluish nodule was noted on the postauricular area with clinical features consistent with a pigmented BCC. Dermoscopy showed some large gray-blue ovoid structures and blood vessels, features also consistent with BCC. However, the histologic features revealed that the nodule consisted of both metastatic melanoma as well as BCC. Melanoma was present adjacent to as well as within the epithelium of the BCC. The intimate association of melanoma cells within the nodules of BCC simulated the pattern of so-called "malignant basomelanocytic tumor," a recently proposed novel entity. To our knowledge, this is the first description of metastatic melanoma colonizing a BCC.
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- "These patterns can also been associated with cancers of gastric, pulmonary, prostatic, ovarian, laryngeal, palatine-tonsillar, pancreatic, colorectal, parotid, thyroid, or uterine origin and may suggest local treatments that work for melanoma may also work for other metastatic cutaneous malignancies. Tumors may even metastasize into other tumors, causing diagnostic conundrums. When metastases are suspected, punch or excisional biopsy is indicated for definitive diagnosis. "
ABSTRACT: Skin metastases are rare in the routine clinical practice of dermatology, but are of major clinical significance because they usually indicate advanced disease. We reviewed the literature on skin metastasis regarding recent trends in clinical presentation and diagnosis of the most common cutaneous lesions. An extensive literature review was conducted using PubMed from May 26, 2011 to July 16, 2013 relating cutaneous metastases. Articles chosen for reference were queried with the following prompts: "Cutaneous metastases", "clinical presentation", "histological features", and "immunohistochemistry". Further searches included "treatment" and "management" options for "metastatic breast", "metastatic colorectal", "metastatic melanoma", "metastatic lung", and "hematologic cancers." We also reviewed the literature on the current management of melanoma as a model for all cutaneous metastatic disease. Our own clinical findings are presented and compared to the literature. Additionally, we highlight the most useful immunohistochemical studies that aid in diagnoses. Several novel therapies and combination therapies such as electrochemotherapy, vemurafenib, and imiquimod will be discussed for palliative treatment of cancers that have been found to improve cutaneous lesions. We review these notable findings and developments regarding skin metastases for the general dermatologist.
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- "Another explanation is the biclonal occurrence of 2 separate but adjacent neoplasms as a result of exposure to certain carcinogenic stimuli, or as a result of paracrine factors released by one neoplasm affecting vulnerable cells in the adjacent environment.13 One further possibility was given by Busam et al. who described a patient with recurrent melanoma of the scalp who developed multiple satellite nodules and a BCC colonised by atypical melanocytes in close proximity to the primary lesion, and regarded the collision lesion as MM that had metastasised to the BCC.14 "
ABSTRACT: Although malignant melanoma (MM) and both basal cell carcinoma (BCC) and actinic keratosis (AK) are sun-induced lesions, the coexistence of these entities at the same anatomical site (collision tumour) is exceedingly rare. We report the case of a 54-year-old woman with a known history of xeroderma pigmentosum variant (XPV) who presented with 2 separate skin lesions over the middle and upper right forearm, respectively. The clinical impression was that of BCCs or squamous cell lesions. On histological examination, both specimens showed features of melanoma in situ (MIS). In the first lesion, MIS merged with and colonised a superficial and focally invasive BCC. In the second lesion, MIS merged with an AK. No separate invasive nests of malignant melanoma were seen in either specimen. The atypical melanocytes were highlighted by Melan-A and HMB-45 immunostaining, whereas the epithelial cells in both the BCC and AK stained with the pancytokeratin MNF-116. The patient had a previous history of multiple MMs and non-melanomatous skin cancers and finally developed widespread metastatic malignant melanoma, which proved fatal. The rare and interesting phenomenon of collision tumours may pose diagnostic difficulties. To our knowledge, this is the first reported simultaneous presentation of cytologically malignant collision tumours in a patient with XPV.
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ABSTRACT: The evolution of our concepts on the neural crest-derived cells and their tumors constitutes one of the most fascinating sagas in pathology. The story started in a rather modest fashion, with Kultschitsky13 detecting a chromaffin cell at the base of the normal crypts of Lieberkühn of the intestine, and Lubarsch and Oberndorfer18 describing a peculiar little tumor of the small bowel and appendix with the almost apologetic terms of small carcinoma and carcinoid tumor , respectively. It took the brilliant intuition of Masson11 to make the link between the two observations through his proposal that carcinoids of the appendix are "endocrine tumors," and the vision of Feyrter9 to advance the notion that the isolated cells described by Kultschitsky13 are part of a vast system of endocrine cells scattered throughout practically all organs endowed with an epithelial lining (his diffuse endocrine or paracrine system). The saga took a spectacular turn with the observation by A. G. E. Pearse20 that these cells share important biochemical pathways (symbolized acronimically as APUD) and his daring suggestion that this commonality of biological attributes derives from their common origin from the neural crest, a transient embryonal neural structure already known to be the progenitor of autonomic ganglia and plexuses, paraganglia, and melanocytes. The attractiveness of the theory was weakened by the questionable accuracy of the experimental methods offered in its support19 and undermined by more rigorous experiments done by other investigators, particularly the ingenious quail-chick chimeric model devised by the French embryologist Nicolle LeDouarin14 . These new data led to the abandonment of the neural crest theory and its replacement by the present dogma, according to which neural crest derivates include ganglia, paraganglia, melanocytes, and thyroid C cells, but none of the other neuroendocrine cells (NE) cells, now thought to derive from the same local epithelial stem cells that give rise to all other epithelial cell types of the particular mucosa in which those cells are located. The widely reproduced scheme by Cheng and Leblond6 provides the best pictorial demonstration of this interpretation as far as the small bowel mucosa is concerned. Predictably, this paradigm switch has led to a substantial change in terminology. Not only terms such as APUD, APUDoma and the awkward neurolophoma have been expunged from the literature, but the very notions of NE cell and NE tumor have been called into question. While some authors still retain the use of these terms to signify the presence of neural-like phenotypical and biological features regardless of embryologic derivation, others believe that the attribute neuro should not apply to cells of endodermal or other non neural derivation, and they refer to these cells as endocrine tumors. The pancreas is the best example of this approach, in that no tumor of this organ carries any longer the qualifier neuro in the WHO classification of neoplasms of this organ. I think it is fair to conclude that in current scientific language the prefix neuro has become objectionable when used in this context.5 Actually, one could carry this reasoning further by pointing out that legitimate questions are beginning to arise even about the thyroid C cells, the neural crest origin of which had thought to have been validated by the chick-quail model.10 If the C cell is of neural origin, the question has been asked, how does one explain the immunohistochemical demonstration of thyroid transcription factor-1 (TTF-1),12 the presence of the thyrotropin receptor gene trascript, and the existence of mixed follicular-C cell and papillary-C cell
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