Amelanotic Lentigo Maligna Melanoma: Mohs Surgery as the Definitive Treatment of an Invisible Tumour

2017 ◽  
Vol 22 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Marisa Grace Ponzo ◽  
Richard Ian Crawford ◽  
Irèn Kossintseva

Amelanotic lentigo maligna melanoma represents <2% of melanomas. Diagnosis is delayed owing to the lack of lesion pigmentation and advanced disease at presentation. Excision with appropriate margins is the treatment standard, but the starting point for such margins is often unclear. We describe 2 patients with amelanotic melanoma treated by Mohs micrographic surgery (MMS) that would not have been cleared by wide local excision alone and provide an extensive review of the literature. Both patients presented with histologic diagnoses of malignant melanoma, one with a barely perceptible biopsy site scar on the left infraorbital cheek/lower eyelid (Breslow 1.8 mm) and the second with an amelanotic tumour on the right helix (Breslow 10 mm). Due to location, aggressive histology, amelanotic appearance, and no apparent surrounding skin surface changes, MMS was elected to maximise margin control. For patient 1, invasive and in situ tumour was found at the American Joint Committee on Cancer–recommended margin of 1.5 cm, and the final defect measured 8.5 × 4.8 cm. Patient 2 had a significant invasive and amelanotic lentigo maligna component, resulting in a 9.0 × 6.5-cm defect. MMS allows for immediate histologic feedback on tumour margins of a clinically invisible tumour and thus offers the most definitive treatment.

2021 ◽  
Vol 5 (5) ◽  
pp. 530-532
Author(s):  
Gabrielle Brody ◽  
Katerina Yale ◽  
Alora Nguyen ◽  
Margit Juhasz ◽  
Linda Doan ◽  
...  

Background: Melanoma has been described to have preferential left-sided laterality on the human body. The distribution and invasion patterns of lentigo maligna (LM) and lentigo maligna melanoma (LMM) have not been well described. Methods: This was a cross-sectional, retrospective study at a single, academic center. LM and LMM cases from 2008-2018 in the dermatopathology registry were analyzed. Results: A total of 392 cases were included (241 LM and 151 LMM). There was no laterality preference overall. The only exception were neoplasms located on the head/neck, which showed a left-sided laterality. LM and LMM had the highest incidence on the head/neck, followed by upper extremities, trunk, then lower extremities. Men had a higher incidence on the head/neck and trunk, while women had a higher incidence on the extremities. Interestingly, the upper extremities and the right side of the female body had a higher propensity for invasive lesions. Conclusion: While melanomas demonstrate preferential left-sided laterality, LM and LMM only share this pattern in respect to the head/neck region. Our results complement previous study findings which characterize LM and LMM as a head/neck and upper extremity pathology. Finally, our study suggests that certain body sites and laterality have an increased propensity for invasion.


2019 ◽  
Author(s):  
Valentina Escotet Espinoza

UNSTRUCTURED Over half of Americans report looking up health-related questions on the internet, including questions regarding their own ailments. The internet, in its vastness of information, provides a platform for patients to understand how to seek help and understand their condition. In most cases, this search for knowledge serves as a starting point to gather evidence that leads to a doctor’s appointment. However, in some cases, the person looking for information ends up tangled in an information web that perpetuates anxiety and further searches, without leading to a doctor’s appointment. The Internet can provide helpful and useful information; however, it can also be a tool for self-misdiagnosis. Said person craves the instant gratification the Internet provides when ‘googling’ – something one does not receive when having to wait for a doctor’s appointment or test results. Nevertheless, the Internet gives that instant response we demand in those moments of desperation. Cyberchondria, a term that has entered the medical lexicon in the 21st century after the advent of the internet, refers to the unfounded escalation of people’s concerns about their symptomatology based on search results and literature online. ‘Cyberchondriacs’ experience mistrust of medical experts, compulsion, reassurance seeking, and excessiveness. Their excessive online research about health can also be associated with unnecessary medical expenses, which primarily arise from anxiety, increased psychological distress, and worry. This vicious cycle of searching information and trying to explain current ailments derives into a quest for associating symptoms to diseases and further experiencing the other symptoms of said disease. This psychiatric disorder, known as somatization, was first introduced to the DSM-III in the 1980s. Somatization is a psycho-biological disorder where physical symptoms occur without any palpable organic cause. It is a disorder that has been renamed, discounted, and misdiagnosed from the beginning of the DSMs. Somatization triggers span many mental, emotional, and cultural aspects of human life. Our environment and social experiences can lay the blueprint for disorders to develop over time; an idea that is widely accepted for underlying psychiatric disorders such as depression and anxiety. The research is going in the right direction by exploring brain regions but needs to be expanded on from a sociocultural perspective. In this work, we explore the relationship between somatization disorder and the condition known as cyberchondria. First, we provide a background on each of the disorders, including their history and psychological perspective. Second, we proceed to explain the relationship between the two disorders, followed by a discussion on how this relationship has been studied in the scientific literature. Thirdly, we explain the problem that the relationship between these two disorders creates in society. Lastly, we propose a set of intervention aids and helpful resource prototypes that aim at resolving the problem. The proposed solutions ranged from a site-specific clinic teaching about cyberchondria to a digital design-coded chrome extension available to the public.


2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Cosphiadi Irawan ◽  
Rahmat Cahyanur ◽  
Reyhan Eddy Yunus

Nasopharyngeal cancer (NPC) is the most common cancer among head and neck cancer that usually presented with unilateral neck mass. Unusual symptoms of NPC can lead us to diagnosis misleading and delayed definitive treatment. We present a case of NPC with bone metastasis in the shoulder. A 33-year-old female presented with right shoulder mass caused by undifferentiated carcinoma of unknown primary, based on biopsy of shoulder mass. After four months, she was complaining painless neck swelling, headache, and hearing impairment in the left ear. Bone MRI showed malignant bone tumour in the right humerus. Neck CT scan showed mass in the nasopharyngeal and bilateral lymphadenopathy. Biopsy in nasopharyngeal revealed undifferentiated carcinoma of nasopharyngeal cancer (WHO-3 type A). The patient was diagnosed as NPC stage IVb and thus was treated with palliative chemotherapy. After three cycles of cisplatin docetaxel, patient condition improved.


2021 ◽  
pp. 136843102098713
Author(s):  
David Martínez ◽  
Alexander Elliott

According to David Miller, immigration is not a human right. Conversely, Kieran Oberman makes a case for immigration as a human right. We agree with the latter view, but we show that its starting point is mistaken. Indeed, both Miller and Oberman discuss the right to immigration within the liberal paradigm: it is a right or not depending on the correct balance between the interests of the citizens of a given national state and the interests of the immigrants. Instead, we claim that public justification can underpin immigration as a human right. That said, the public justification of the right to immigration has several counterarguments to rebut. Before we deal with that issue, relying on Jürgen Habermas’s social theory, we examine the legal structures that could support the right to immigration in practice. To be sure, this does not provide the normative justification needed, instead it shows the framework that allows the institutional realization of this right. Then, through a combination of civic and cosmopolitan forms of solidarity, the article discusses the formation of a public sphere, which could provide the justification of the right to immigration.


2007 ◽  
Vol 14 (4) ◽  
pp. 313-319
Author(s):  
Benedikt Buchner

AbstractIndustry-sponsored medical education is a much disputed issue. So far, there has been no regulatory framework which provides clear and definite rules as to whether and under what circumstances the sponsorship of medical education is acceptable. State regulation does not exist, or confines itself to a very general principle. Professional regulation, even though applied frequently, is rather vague and indefinite, raising the general question as to whether self-regulation is the right approach at all. Certainly, self-regulation by industry cannot and should not replace other regulatory approaches. Ultimately, advertising law in general and the European Directive 2001/83/EC specifically, might be a good starting point in providing legal certainty and ensuring the independence of medical education. Swiss advertising law illustrates how the principles of the European Directive could be implemented clearly and unambiguously.


1993 ◽  
Vol 30 (3) ◽  
pp. 280-286 ◽  
Author(s):  
K. Yoshitomi ◽  
G. A. Boorman

Spontaneous amelanotic melanomas in the eyelids of F344 rats were found in one of 1/926 (0.11 %) male and 5/925 (0.54%) female F344 rats that were used as control and treated animals in five different carcinogenicity studies conducted by the National Toxicology Program (Research Triangle Park, NC). These melanomas were grossly recognized as single, tan or white, well-circumscribed masses of the right or left eyelid. These melanomas primarily occurred in the dermis of the skin of the eyelids and consisted of poorly differentiated spindle cells characteristically arranged in interlacing fascicles. Rarely, epithelioid tumor cells were also observed, and these tumor cells showed a negative histochemical reaction for melanin. The epidermis and dermal–epidermal junction were usually uninvolved. The diagnosis of amelanotic melanoma could only be established by electron microscopic examination. The most striking ultrastructural feature of the tumor cells was a large number of intracytoplasmic premelanosomes (stage II melanosomes without melanin), which nearly filled the cytoplasm of most tumor cells. Giant premelanosomes and melanophagosomes were also seen. The tumor cells did not possess the ultrastructural features characteristic of Schwann cells (thin, long cell processes and pericytoplasmic basal laminae). The histologic and ultrastructural features of these palpebral tumors were similar to those of cutaneous amelanotic melanomas of the pinna in F344 rats.


Legal Studies ◽  
1995 ◽  
Vol 15 (2) ◽  
pp. 219-235 ◽  
Author(s):  
Peter Luther

When the topic of severance of a beneficial joint tenancy is discussed, most judges and academics start with the case of Williams v Hensman. The judgment of Sir William Page Wood V-C is the ‘locus classicus’, the ‘starting point for any discussion of the modem law’. One paragraph of Page Wood's judgment is quoted in case after case:‘A joint tenancy may be severed in three ways: in the first place, an act of one of the persons interested operating on his own share may create a severance as to that share. The right of each joint tenant is a right by survivorship only in the event of no severance having taken place of the share which is claimed under the jus accrescendi. Each one is at liberty to dispose of his own interest in such a manner as to sever it from the joint fund - losing, of course, at the same time, his own right of survivorship.


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