Lauren C Strazzulla1, Xiaoxue Li2, Kathleen Zhu3, Jean-Phillip Okhovat4, Sandra J Lee2, Caroline C Kim5. 1. Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York. 2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 3. University of Massachusetts Medical School, Worcester, Massachusetts. 4. Department of Dermatology, Stanford University Medical Center, Stanford University School of Medicine, Palo Alto, California. 5. Pigmented Lesion Clinic and Cutaneous Oncology Program, Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: ckim3@bidmc.harvard.edu.
Abstract
BACKGROUND: Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined. OBJECTIVE: To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM). METHODS: A cross-sectional retrospective medical record review at a tertiary academic medical center. RESULTS: A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]). LIMITATIONS: Retrospective study design, single-institutional study. CONCLUSION: Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.
BACKGROUND: Amelanotic malignant melanoma (AMM) is challenging to diagnose. Clinical risk factors for AMM are not well defined. OBJECTIVE: To investigate clinicopathologic, misdiagnosis, and survival differences between patients with AMM and those with pigmented malignant melanoma (PMM). METHODS: A cross-sectional retrospective medical record review at a tertiary academic medical center. RESULTS: A total of 933 patients with melanoma with known presenting tumor color were identified (342 with AMM vs 591 with PMM). AMM was associated with older age, history of nonmelanoma skin cancer, and red hair, whereas AMM was inversely associated with a family history of melanoma, more than 50 nevi, and a history of dysplastic nevi. Compared with PMM, AMM was more likely to be located on the head and/or neck, had more aggressive pathologic features (greater Breslow depth and/or mitoses, ulceration, nodular subtype), and was less likely to be associated with a precursor nevus or regression. Finally, patients with AMM were more likely to be misdiagnosed than were patients with PMM (25% vs 12% clinically and 12% vs 7% pathologically), and they had poorer melanoma-specific survival (5-year overall survival rate, 0.77 [95% confidence interval, 0.72-0.82] vs 0.84 [95% confidence interval, 0.80-0.87]). LIMITATIONS: Retrospective study design, single-institutional study. CONCLUSION: Greater clinician awareness, lower biopsy thresholds, and increased patient education may be useful to enhance AMM detection in patients with certain characteristics.
Authors: Zachary H Hopkins; Ryan P Carlisle; Zachary E Frost; Julia A Curtis; Laura K Ferris; Aaron M Secrest Journal: J Clin Aesthet Dermatol Date: 2021-12
Authors: Joon Min Jung; Chang Jin Jung; Chong Hyun Won; Sung Eun Chang; Mi Woo Lee; Jee Ho Choi; Woo Jin Lee Journal: Indian J Dermatol Venereol Leprol Date: 2021 [SEASON] Impact factor: 2.545