scholarly journals Clark Level Finding

2020 ◽  
Author(s):  
Keyword(s):  
Clark Level

Clark Level IV

2020 ◽  
Author(s):  
Keyword(s):  
Clark Level

Metastasierendes malignes Melanom nach Laserung eines Pigmentmals

2021 ◽  
Author(s):  
P. Elsner
Keyword(s):  
Malignes Melanom ◽  
Sich Eine ◽  
Clark Level

ZusammenfassungEine 21-jährige Patientin hatte seit Jahren ein pigmentiertes „Muttermal“ an der Schulter, das sie von einem Dermatologen mit einem Laser entfernen ließ. Ein Jahr später bildete sich erneut eine Pigmentierung an der gelaserten Stelle. Unter dem Verdacht auf ein malignes Melanom wurde die Läsion exzidiert; die Dermatohistologie bestätigte ein ulzeriertes malignes Melanom, Clark-Level IV, max. Tumordicke nach Breslow 2,4 mm. Nachdem eine Sentinel-Lymphnode-Biopsie der Axilla zunächst unauffällig war, stellte sich die Patientin nach wenigen Monaten wegen Kieferschmerzen vor, wobei sich eine osteolytische Metastase in der Mandibula zeigte. Das weitere Staging ergab multiple pulmonale, hepatische, mediastinale und weitere ossäre Metastasen. Unter einer Therapie mit Dabrafenib und Trametinib kam es nach kurzzeitiger Besserung zu einem nicht beherrschbaren Hirnödem mit Exitus letalis.In Anbetracht des tragischen Krankheitsverlaufes stellt sich die Frage nach der Vereinbarkeit der primären Lasertherapie von Pigmentmalen mit dem dermatologischen Facharztstandard. Risiken durch die Lasertherapie melanozytärer Naevuszellnaevi betreffen die mögliche Fehldiagnose eines malignen Melanoms als Naevus, welches nach Lasertherapie aufgrund des destruierenden Verfahrens nicht dermatohistologisch untersucht werden kann, die möglicherweise unvollständige Entfernung von Naevuszellen, die im Folgenden maligne entarten können, und Schwierigkeiten der klinischen Nachbeobachtung einer Läsion nach Laserung. Dysplastische Naevi sollten daher keinesfalls destruierend mit einer Lasertherapie entfernt werden; Leitlinien raten auch von einer Laserbehandlung melanozytärer Naevi ab und empfehlen, sollte einem entsprechenden Patientenwunsch doch gefolgt werden, zumindest eine Stanzbiopsie zur Diagnosesicherung durchzuführen. Ein Verzicht auf diese empfohlene diagnostische Absicherung könnte einen Befunderhebungsfehler mit der möglichen Folge einer Beweislastumkehr darstellen.

scholarly journals E-Cadherin Expression in Canine Melanocytic Tumors: Histological, Immunohistochemical, and Survival Analysis

2020 ◽  
Vol 57 (5) ◽  
pp. 608-619 ◽  
Author(s):  
Serenella Silvestri ◽  
Ilaria Porcellato ◽  
Luca Mechelli ◽  
Laura Menchetti ◽  
Selina Iussich ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Epithelial Mesenchymal Transition ◽  
Tumor Thickness ◽  
Mesenchymal Transition ◽  
Clark Level ◽  
Melanocytic Tumors ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Favorable Clinical Outcome ◽  
E Cadherin

E-cadherin, a glycoprotein involved in cell-cell adhesion, has a pivotal role in epithelial-mesenchymal transition, a process through which neoplastic epithelial cells develop an invasive phenotype. In human cutaneous melanomas, decreased E-cadherin expression is associated with shorter survival and increased Breslow thickness, whereas in the dog its role is poorly understood. Tumor thickness and modified Clark level were recently proposed as useful features to assess canine melanocytic tumors, but no studies investigated their association with E-cadherin expression. We performed immunohistochemistry on 77 formalin-fixed, paraffin-embedded primary canine melanocytic tumors. A 3-tier and a 2-tier classification system for assessing E-cadherin expression were tested, with the latter being more informative for the assessment of canine melanocytic tumors. E-cadherin expression was lower in cutaneous melanomas than melanocytomas, as well as in amelanotic tumors compared to pigmented tumors. In amelanotic melanomas, absent E-cadherin expression was associated with an unfavorable outcome, suggesting a potential use of this marker in defining the prognosis of amelanotic melanomas. E-cadherin expression was lower in tumors with greater tumor thickness and modified Clark level ≥IV, suggesting its possible utility in identifying the most invasive tumors. The expression of E-cadherin in oral melanomas was heterogeneous, but was associated with pigmentation and clinical outcome; thus, E-cadherin evaluation could be advantageous to detect the most aggressive neoplasms. However, cutaneous melanomas without E-cadherin expression frequently had a favorable clinical outcome. Hence, its importance as prognostic factor should be carefully considered depending on the tumor origin.

scholarly journals Immunohistochemical Analysis of BRAF (V600E) Mutation and P16 Expression in Malignant Melanoma in Lagos, Nigeria: A 10-Year Retrospective Study

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
O. Obadofin ◽  
K. Badmos ◽  
N. Orsi ◽  
M. Bipin ◽  
O. Rotimi ◽  
...  
Keyword(s):  
Malignant Melanoma ◽  
Protein Expression ◽  
Immunohistochemical Analysis ◽  
Braf V600e Mutation ◽  
Breslow Thickness ◽  
University Teaching ◽  
Braf V600e ◽  
Clark Level ◽  
P16 Protein ◽  
P16 Expression

Background. In Blacks, malignant melanoma (MM) is associated with greater morbidity and mortality compared to Caucasians. MMs with BRAF V600E mutation as well as those with loss of p16 protein expression are associated with aggressive behavior and worse prognosis. Objectives. We determined BRAF (V600E) mutation status and loss of p16 expression in MM cases in Lagos, Nigeria, and correlated these with histopathologic parameters and patients’ age. Methods. Forty-five cases of MM received between January 2005 and December 2014 in the Anatomic and Molecular Pathology Department of Lagos University Teaching Hospital were subjected to immunohistochemical studies to determine BRAF V600E mutation and p16 protein expression. These included cutaneous (n=37), musosal (n=3), and ocular MM (n=2) as well as lymph node metastatases (n=3). Results. BRAF (V600E) mutations were detected in 5/45 (11%) while 31/45 (69%) of the cases had loss of p16 expression. No statistically significant association was found between the BRAF (V600E) mutation, loss of p16 expression, and histologic parameters such as histologic variant, Clark level, Breslow thickness, and ulceration. Conclusion. BRAF (V600E) mutation was detected only in a small proportion of cases while loss of p16 expression occurred in most cases which also had high Clark level, high Breslow thickness, and ulceration.

Trends in Invasive Cutaneous Melanoma in Saskatchewan 1970–1999

2003 ◽  
Vol 7 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Marcie J. Ulmer ◽  
Jon M. Tonita ◽  
Peter R. Hull
Keyword(s):  
Prognostic Factors ◽  
Cutaneous Melanoma ◽  
Excess Mortality ◽  
Tumor Thickness ◽  
Tumor Characteristics ◽  
Anatomic Site ◽  
Clark Level ◽  
Melanoma Incidence ◽  
Number Of Patients ◽  
And Gender

Background: Melanoma incidence rates have increased dramatically in white populations worldwide during the past several decades. A more modest increase has been observed for melanoma-related mortality. Cause-specific and disease-free survivals are related to tumor characteristics, gender, age, and possibly anatomic site. It is difficult to accurately assess these trends without information on tumor thickness that is often unavailable. Objective: This study determines trends in melanoma incidence, mortality, and survival in Saskatchewan for a 30-year period, incorporating analysis of tumor thickness. Methods: Information about cases of primary cutaneous melanoma for the 30-year period 1970–1999 was obtained from the population-based Saskatchewan Cancer Registry. A 50% random sample of charts was reviewed to collect information about Breslow depth, Clark level, and other demographic data not available from the Registry. Multivariate regression analysis was used to determine the significance of prognostic factors on incidence and five-year relative survival rates. Results: The number of patients registered increased dramatically during the study period. The increase was greatest for thin lesions in all age groups. Anatomic site varied by gender. Head and neck tumors showed continual increase in risk with increasing age. Mortality rates in females have been stable over time but increased for males in the 1990s. The prognostic factors that predicted excess mortality at five years were tumor thickness, Clark level, and gender. Conclusion: The observed increase in melanoma appears to be real and not the result of increased surveillance or screening. Tumor characteristics (Breslow depth, Clark level) and gender were significant prognostic indicators of five-year excess mortality.

Multivariate analysis of the relationship between survival and the microstage of primary melanoma by clark level and breslow thickness

Cancer ◽  
1993 ◽  
Vol 71 (11) ◽  
pp. 3737-3743 ◽  
Author(s):  
Donald L. Morton ◽  
David G. Davtyan ◽  
Leslie A. Wanek ◽  
Leland J. Foshag ◽  
Alistar J. Cochran
Keyword(s):  
Multivariate Analysis ◽  
Primary Melanoma ◽  
Breslow Thickness ◽  
Clark Level ◽  
The Relationship

scholarly journals Breslow thickness and Clark level in melanoma

Cancer ◽  
2000 ◽  
Vol 88 (3) ◽  
pp. 589-595 ◽  
Author(s):  
Ashfaq A. Marghoob ◽  
Karen Koenig ◽  
Flavia V. Bittencourt ◽  
Alfred W. Kopf ◽  
Robert S. Bart
Keyword(s):  
Breslow Thickness ◽  
Clark Level

Prognostic significance of children with cutaneous melanoma: Implications for treatment

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8021-8021
Author(s):  
M. A. Kavanagh ◽  
R. Essner ◽  
S. L. Chen ◽  
L. A. Wanek ◽  
R. P. Scheri ◽  
...  
Keyword(s):  
Overall Survival ◽  
Cutaneous Melanoma ◽  
Pediatric Patients ◽  
Prognostic Significance ◽  
Initial Diagnosis ◽  
Adult Patients ◽  
Breslow Thickness ◽  
Superficial Spreading ◽  
Clark Level ◽  
Melanoma Patients

8021 Background: The incidence of melanoma in pediatric patients, particularly teenagers, is increasing. Treatment strategies employed for adult patients with melanoma have been applied to pediatric populations with minimal data to support similar efficacy. We performed a matched-paired analysis to compare the prognosis of pediatric (≤19 yrs old) and adult melanoma patients. Methods: Single institution, prospectively obtained melanoma database containing >14,000 records was queried for children ages 1–19 years treated for cutaneous melanoma. We identified 197 pediatric patients seen at our institute over the last 35 years. After excluding patients not seen within 4 months of initial diagnosis, 115 pediatric patients were matched to adults (age 20–70 years) chosen from the database by gender, stage, primary site and tumor characteristics (Clark level, Breslow thickness, and ulceration). Overall survival was compared between cohorts by the Kaplan-Meier method. Results: For the pediatric patients, median age at diagnosis was 17.7 years (range 7–19 years). Patients were almost equally distributed between girls (47%) and boys. AJCC stage I and II disease at presentation was most common (73%), with stage III and IV occurring much less frequently (25% and 2%). Most pediatric patients had Clark level IV (37%) lesions; Clark level II (25%), III (25%), V (4%), and I (2%) lesions were less common. Breslow thickness ranged between <1.0mm (38%), 1.1–2.0mm (20%), 2.1–4.0mm (17%), and >4.1mm (12%). The two predominant histologic types were superficial spreading (52%) and nodular (22%) melanoma. 14% of the primary lesions were ulcerated. Rates of disease-free and overall survival were 75%± 4% and 84%± 4% at 5 years and 74%± 4% and 77%± 5% at 10 years, respectively, with a median follow up of 5.1 years (range 1–30 years). Matched pediatric and adult patients showed no difference in survival from time of initial diagnosis and stage of presentation (log rank p=0.24). Conclusions: Stage-specific survival in pediatric and adult melanoma patients is similar. In the absence of specific pediatric trials, standard treatment for children with melanoma should be consistent with that for adults. No significant financial relationships to disclose.

Second primary melanoma: Risk factors, histopathologic features, and survival

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9073-9073
Author(s):  
H. F. Schoellhammer ◽  
H. Torisu-Itakura ◽  
Y. Huynh ◽  
M. Sim ◽  
M. B. Faries ◽  
...  
Keyword(s):  
Primary Melanoma ◽  
Breslow Thickness ◽  
Second Primary ◽  
Clark Level ◽  
Ajcc Stage ◽  
Melanoma Patients ◽  
Level I ◽  
Second Primaries

9073 Background: Melanoma incidence in the United States is expected to be 4.3% of all cancers in 2008. Cutaneous melanoma patients are at risk for second primary melanoma development. Our goal was to characterize the histopathologic features, risk factors, and patient survival for second primary melanoma. Methods: A review of the melanoma database established in 1971 at John Wayne Cancer Institute was conducted identifying patients with American Joint Committee on Cancer (AJCC) stage I and II cutaneous melanoma who later developed a second primary melanoma. Patients were grouped by Breslow thickness, Clark level, and histopathologic subtype (superficial spreading [SSM], nodular, acral lentiginous, lentigo maligna, and in situ). Multivariate analysis involving age, gender, Breslow thickness, Clark level, and ulceration status was performed to determine an effect on development of second primary. Kaplan-Meier survival curves were plotted for single primary and second primary melanoma patients. Results: Second primary melanoma was identified in 411 (3.7%) of 10,968 patients with AJCC stage I-II melanoma. The most common first primary subtype was SSM, and 93% of these patients had in situ or SSM as the second primary. Sixty-five percent of first primaries had a Breslow thickness of ≤1 mm, and 75% of second primaries had a thickness ≤1 mm. Forty-nine percent of first primaries had Clark level I or II, but 68% of second primaries had Clark level I or II. In multivariate analysis, only increasing age was significantly associated with the likelihood of second primary melanoma (p<0.0001). With increasing follow-up time the hazard ratio of second primary melanoma was 1.31 for every decade. Overall survival for second primary melanoma patients was better than for single primary patients (p<0.0001). Conclusions: Most second primary melanoma patients will have SSM or in situ, with a decreased Clark level and Breslow thickness. Contrary to expectations, patients developing second primary melanoma did not exhibit decreased overall survival. Increased follow-up time after first primary melanoma is a significant risk factor for second primary development, thus illustrating the importance of lifelong patient follow-up. No significant financial relationships to disclose.

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