Metastatic melanoma: Pathologic characterization, current treatment, and complications of therapy
Section snippets
Metastatic amelanotic melanoma—Differential diagnosis
When melanoma retains its ability to synthesize melanin in metastatic locations, its histopathologic recognition is typically straightforward. Nonetheless, many tumors lose that capacity in the VGP, and therefore secondary deposits of them are grossly and microscopically amelanotic. That scenario creates definite problems with regard to the morphological recognition of such neoplasms as melanocytic in nature. An additional compounding factor is the structural malleability of melanoma that
Staging of metastatic melanoma
Several strata exist in the scheme developed by the American Joint Committee on Cancer (AJCC) for the staging of melanoma.25 Stages III and IV include those patients with extracutaneous disease as follows:
Stage III denotes the presence of regional metastasis, and is subcategorized into three groups.
- (1)
N1: a single metastatically involved regional lymph node is present.
- (2)
N2: two to three regional lymph nodes are involved by tumor or regional cutaneous/in-transit metastasis exists.
- (3)
N3: four or more
Treatment for metastatic melanoma
Until the development of dacarbazine (imidazole carboximide and temozolomide) in the mid-1970s, no therapeutic agents existed with any real efficacy against metastatic melanoma. That drug did effect definable responses, and it is still used today. Another conventional chemotherapeutic choice with some activity against melanoma is that of vinblastine, but it is usually used in combination with dacarbazine.26 The overall response rate of patients with metastatic melanoma to those agents has
Prognostication of metastatic melanoma
Segura et al.107 have published an interesting study that focuses on gene sets governing the biological behavior of melanoma. In that analysis, RNA was extracted from formalin-fixed tissue from melanoma metastases and hybridized to microRNA (miRNA) arrays containing over 900 probes. RNA expression by the tumors was then correlated with post-recurrence survival. A signature of 18 miRNAs was identified, the overexpression of which was associated with survival for more than 18 months after tumor
Economic aspects of biological therapy for melanoma
Conceptually, the development of the therapeutic agents described above has been an awesome accomplishment. The expertise of clinicians, pharmacologists, immunologists, and many other investigators was required for this feat, no doubt incurring a substantial price for overall research and development. That fact, and the comparatively limited market for oncological drugs, have led the pharmaceutical companies who market them to assign a high price tag. For example, according to a publication by
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Metastases of malignant neoplasms: Historical, biological, & clinical considerations
2018, Seminars in Diagnostic PathologyCitation Excerpt :The operative genes in this category may be different from tumor to tumor, because they largely depend on the tissue in which the metastasis is attempting to grow.25,29,41,43 Well-known clinical examples of so-called “late-metastasizing” neoplasms include carcinomas of the breast and kidney, malignant testicular germ cell tumors, and cutaneous melanomas, among others.31,44–49 Several publications on those lesions have shown the emergence of distant metastases in various anatomic sites, 10 years of more after resection of the primary tumors.
Metastatic melanocarcinoma - Cytomorphological patterns
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