Marija Buljan

Prognostic value of galectin-3 in primary cutaneous melanoma

Background  Galectin‐3, one of the β‐galactoside‐binding lectins, has been suggested as a marker of disease progression in melanoma patients because of its overexpression observed in recent studies. However, prognostic value of galectin‐3 in primary cutaneous melanoma (PCM) has not been clearly defined.

Prognostic value of microphthalmia-associated transcription factor and tyrosinase as markers for circulating tumor cells detection in patients with melanoma

The aim of this study was to analyze microphthalmia-associated transcription factor (MITF) as a marker for the detection of circulating melanoma cells, determine its prognostic value in melanoma patients, and compare it with tyrosinase. Blood samples from 201 melanoma patients in all stages of the disease and 40 healthy volunteers were analyzed. RNA was isolated from mononuclear cell fraction of the blood and assayed by reverse transcription-PCR for the expression of MITF and tyrosinase. All samples from healthy volunteers were negative for both MITF and tyrosinase. Out of 201 blood samples from melanoma patients 32 were positive for MITF, 20 for tyrosinase, and four for both MITF and tyrosinase. Analysis of MITF as an additional marker to tyrosinase allowed for detection of circulating melanoma cells in a larger number of melanoma patients in comparison to tyrosinase analysis alone (48 vs. 20 positive). A positive value of MITF was associated with shorter progression-free (P=0.005) and overall survival (P=0.042). A positive value of tyrosinase was associated with shorter overall survival (P=0.012), whereas there was no significant association between the value of tyrosinase and progression-free survival. The value of MITF was selected with multivariate analysis as the independent prognostic factor for progression-free survival, whereas the only independent prognostic factor for overall survival was the stage of disease. This study has shown that MITF is a specific marker for detection of circulating melanoma cells that has a prognostic value in melanoma patients. Determination of MITF in addition to tyrosinase improved the detection of circulating melanoma cells in melanoma patients.

Psychological burden of anogenital warts

Background  Human papillomavirus (HPV) is one of the most common sexually transmitted diseases in the world, and anogenital warts are one of its various clinical manifestations. It has been shown that anogenital warts influence psychological status.

Histomorphologic spectrum of BAP1 negative melanocytic neoplasms in a family with BAP1-associated cancer susceptibility syndrome

Multiple BAP1 negative melanocytic neoplasms are a hallmark of familial cancer susceptibility syndrome caused by BAP1 germline mutation. The syndrome is characterized by increased incidence of renal cell carcinoma, mesothelioma, cholangiocarcinoma, cutaneous and uveal melanoma and some other neoplasms.

Melanoma with second myxoid stromal changes after personally applied prolonged phototherapy

Most malignant melanomas are easily diagnosed; however, melanoma is also one of the lesions most frequently reported to mimic other tumors. One of the most difficult patterns to recognize is characterized by prominent myxoid matrix. A case is presented of primary cutaneous melanoma with abundant myxoid matrix in a patient who underwent prolonged phototherapy. Three years before, after getting sunburns, the patient noticed changes of a congenital nevus located in the area of sunburns. It became darker, started to blanch, and grew, with occasional bleeding. Without consulting a physician, the patient applied phototherapy onto the area for 30 months. He used a Bioptron lamp with polarized, polychromatic, incoherent light, at a wavelength from 480 to 3400 nm, without ultraviolet radiation. Clinically, the lesion was unevenly pigmented, ulcerated, covered with hemorrhagic crust, and measuring 3.5 cm in greatest dimension, with a satellite nodule. Multiple metastatic subcutaneous nodules were also found on the scalp and trunk. Histologically, the primary tumor and metastases were composed of nests and pseudotubular formations of polygonal, spindle, and stellate cells embedded in abundant myxoid stroma that comprised more than 80% of the tumor mass. Focally, in the epidermis and papillary dermis, nests of atypical melanocytes and numerous melanophages were observed. Chemotherapy and immunotherapy were administered as suggested by an oncologist. The patient died from distant metastases 6 months after the diagnosis. Although some authors believe that myxoid changes do not seem to alter the behavior of melanoma, it remains an important differential diagnosis issue.

Dermoscopy and reflectance confocal microscopy in cutaneous leishmaniasis on the face.

Leishmaniasis is a vector-borne intracellular parasitic infection that can present in two major forms, visceral and cutaneous. Cutaneous leishmaniasis (CL) is widely distributed, Spain and Croatia being hypoendemic regions. The disease usually presents as an asymptomatic reddish, mostly ulcerated, papule, often located on the face. The diagnosis is confirmed by histopathology and immunohistochemistry. Characteristic dermoscopic structures have been identified in CL in several studies. Reflectance confocal microscopy (RCM) is a technique that allows in vivo visualisation of skin structures at a nearly histological resolution. To the best of our knowledge, only one case of RCM of CL has been published until now.

Full manuscript title: Early subungual melanoma: A diagnostic and treatment challenge

Acral lentiginous melanoma accounts for less than 5% of all melanomas, and most often appears on palmar, plantar, subungual, and mucosal surfaces (Wolff, Goldsmith, Katz, Gilchrest, Paller, Leffell, 2008). Subungual melanoma (SM) is a rare type of acral lentiginous melanoma that represents only 0.7–3.5% of reported melanoma cases (Levit, Kagen, Scher, Grossman, & Altman, 2000). SM is often misdiagnosed and improperly treated as various benign conditions including onychomycosis, pigmented nevus, as well as drug induced or malnutrition induced hyperpigmentation. Therefore, most SMs are in advanced stages at the time of diagnosis, therefore, associated with a poor prognosis (Cochran, Buchanan, Bueno, & Neumeister, 2014). Early stage of SM is often difficult to differentiate from benign melanocytic lesions. However, making the correct diagnosis is crucial, as treatment and prognosis of these two entities significantly differ. Typically, SM initially present as melanonychia striata, often followed by development of the Hutchinson sign, which is the most significant clinical sign in differentiating SM from benign melanocytic lesions. In situ melanoma usually arises in the nail matrix, from where it can extend to the ventral part of the proximal nail fold or to the nail bed. Furthermore, in cases of in situ melanoma, single melanocytes predominate over nests in most fields, however rare small nests are occasionally present upon histopathologic evaluation. In these early lesions, the atypia is often focal and moderate, and displays pagetoid spread (Calonje, Brenn, & McKee, 2011).

Malignant Blue Nevus Arising in a Congenital Cellular Blue Nevus in a YoungWoman: Case Report and Review of Literature

Malignant blue nevus is a term related to melanoma arising in association with or that resembles blue nevus. Such lesions are extremely rare with occasional reports and a few small series of cases described in the literature; therefore, the biology and prognosis of such tumors is not well clarified. Due to lack of strictly defined histopathological criteria, such lesions may present a significant diagnostic challenge. We are presenting a case of a malignant blue nevus arising in a congenital cellular blue nevus, presenting as a slowly progressing and asymptomatic pigmented lesion on the buttock of a 21-year-old woman. Histopathological analysis showed presence of a cellular blue nevus as well as features characteristic for malignant blue nevus. The definitive diagnosis was reached only at the histopathological and immunohistochemical examination. The histological features and clinical course in our patient are also discussed in context and the review of the previous related literature.