Cutaneous malignancy

Early diagnosis of skin cancer is the key to improved prognosis. Diagnostic accuracy and clinical skills are two essential factors in the appropriate management of skin cancer. On presentation to a clinician s office, patients may offer a history of a new growth or an area of irritation. Conversely, the skin cancer may have been present for years undetected by the patient. The definitive diagnosis of any suspected cutaneous malignancy should be confirmed by a biopsy prior to treatment. 

Bittner, M., et al., "Molecular Classification of Cutaneous Malignant Melanoma by Gene Expression Profiling," Nature, 406, 536-540 (2000). 

Hieken TJ, Ronan SG, Farolan M, et al. Beta 1 integrin expression a marker of lymphatic metastases in cutaneous malignant melanoma. Anticancer Res 1996 16(4B) 2321-2324. 

MM = multiple myeloma ATL = adult T-cell leukemia ALL = acute lymphoblastic leukemia CLL = chronic lymphocytic leukemia FCC = follicular center cell lymphoma DLC = diffuse large cell lymphoma TRB = T-cell rich B-cell lymphoma ALCL = anaplastic large cell lymphoma MALT = mucosa-associated lymphoid tissue-type lymphoma LC = lung cancer CMM = cutaneous malignant melanoma TCC = transitional cell carcinoma CSCC = cutaneous squamous cell carcinoma. 

FIGURE 1.5. Unusual prominent vasculature at the base of a primary cutaneous malignant melanoma. Courtesy of G. E. Pierard. For a color representation of this figure, see Plate 1A facing this page. 

Gollnick, H.P.M. and Orfanos, C.E., Theoretical aspects of the use of retinoids as anticancer agents, Retinoids in Cutaneous Malignancy, Marks, R., Ed., Blackwell Scientific Publications, Oxford, 1991, p. 41. 

Holman CDJ Armstrong BK (1984) Cutaneous malignant melanoma and indicators of total accumulated exposure to the sun An analysis separating histogenetic types. J Natl Cancer Inst, 73 75-82. 

Ameen M, Russell-Jones R. Seizures associated with interferon-alpha treatment of cutaneous malignancies. Br J Dermatol 1999 141(2) 386-7. 

Mineral oils, including the older preparations of fog oil, can produce cutaneous malignant neoplasms because of the presence of PAHs. In view of this, the military (army) altered the specification for screening smoke fog oil, requiring that it be solvent-treated or hydrotreated to remove potential carcinogenic hydrocarbons and analyzed to confirm the absence of such materials (NRC, 1997). 

Squamous cell carcinoma (SCC) is a cutaneous malignancy with estimates of approximately 200,000 cases in the United States in 2001. SCC seems to be more common in advanced age, and twice as common in men as in women. Because of their susceptibility to the negative effects of long-term sun exposure, patients of Celtic ancestry and those with blue or green eyes, red hair, and fair complexion are at the greatest risk of developing SCC. Other risk factors include precursor lesions such as AKs, long-term immunosuppression, and ultraviolet radiation. SCC can appear in many areas, but mainly occurs... 

Clear cell sarcoma (CCS) was formerly thought to represent a primary soft tissue counterpart of cutaneous malignant melanoma. Nonetheless, it is now known that CCS exhibits a consistent and characteristic t(12 22) chromosomal translocation that is not shared by mela-nocytic lesions of the skin. This neoplasm is typified by an epithelioid and/or spindle cell constituency, with a delicate fibrovascular stroma and clear or lightly eosinophilic cytoplasm. Melanin pigmentation may or may not be observed. 

Fernando SS, Johnson S, Bate J. Immunohistochemical analysis of cutaneous malignant melanoma comparison of SlOO protein, HMB-45 monoclonal antibody, and NKI/C3 monoclonal antibody. Pathology. 1994 26 16-19. 

Reed JA, Finnerty B, Albino AP. Divergent cellular differentiation pathways during the invasive stage of cutaneous malignant melanoma progression. Am J Pathol. 1999 155 549-555. 

Henrique R, Azevedo R, Bento MJ, et al. Prognostic value of Ki-67 expression in localized cutaneous malignant melanoma. J Am Acad Dermatol. 2000 43 991-1000. 

PSA has been found to stain scattered tumor cells from cutaneous malignant melanoma and its metas-tases." This should not create a diagnostic dilemma because prostate cancers are strongly and diffusely positive with LMW keratin antibodies such as CAM5.2, which is another illustration of the necessity of examining tumors with a panel of antibodies. 

Kondapalli L, Soltani K, Lacoumre ME. The promise of molecular targeted therapies protein kinase inhibitors in the treatment of cutaneous malignancies. J Am Acad Dermatol. 2005 53 291-302. 

Monteagudo C, Martin JM, Jorda E, Llombart-Bosch A. CXCR3 chemokine receptor immunoreactivity in primary cutaneous malignant melanoma correlation with clinico-pathologic prognostic factors. J. Clin. Pathol. 60 596-9, 2007. 

So far, attempts to treat cutaneous malignant melanomas by PDT have not been successful (Fritsch et al., 1998 Kalka et al., 2000 Morton et al., 2002), supposedly... 

Mechlorethamine hydrochloride (Mustargen) and carmustine (bischloronitrosourea, BCNU, BICNU) are used topically to treat cutaneous T-cell lymphoma. Both can be applied as a solution or in ointment form. It is important to monitor complete blood counts and liver function tests because systemic absorption can cause bone marrow suppression and hepatitis. Other side effects include allergic contact dermatitis, irritant dermatitis, secondary cutaneous malignancies, and pigmentary changes. Carmustine also can cause erythema and posttreatment telangiectasias. 

The relationship between UV-B radiation and skin cancer is by now well documented and accepted. The US EPA has estimated that each 1 % decrease in stratospheric ozone concentration will result world wide in a 2% rise in cutaneous malignant melanoma. Among the Asian and Pacific region, people of many countries, such as Australia, New Zealand, South Pacific Islands, Indonesia, Malaysia, Philippines, Thailand, etc, are the most vulnerable to the exposure of UV-B radiation. For example, between 1980 and 1991, when the growth of CFCs production was the maximum, melanoma cancer registration rates in New Zealand increased by 22% (ESC AP, 1995). 

C., Glatfelter, A., Pollock, P, Carpten, J., Gillanders, E., Leja, D., Dietrich, K., Beaudry, C., Berens, M., Alberts, D., Sondak, V., Hayward, N., and Trent, J. M. (2000). Molecular classification of cutaneous malignant melanoma by gene expression profiling. Nature 406, 536-540. 

Walter SD, Marrett LD, Shannon HS, From L, Hertzman C (1992) The association of cutaneous malignant melanoma and florescent light exposure. Am J Epidemol 135 749-762 Weinberg RA (1991) Tumor suppressor genes. Science 254 1138-1146... 

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