Melanoma of the foot

NewsBot · Jun 15, 2023

Establishment of a prognostic model for melanoma based on necroptosis-related genes
Xiaohui Sui et al
Funct Integr Genomics. 2023 Jun 14;23(3):202

In this study, the clinical implications and potential functions of necroptosis-related genes (NRGs) in melanoma were systematically characterized. A novel NRG signature was then constructed to analyze the immune status and prognosis of patients with melanoma. The NRG signatures for melanoma prognosis were searched using the Cancer Genome Atlas (TCGA) dataset and followed by stepwise Cox regression analysis. Patients with melanoma were divided into two groups, and survival analysis, receiver operating characteristic (ROC), and univariate and multivariate analyses were subsequently performed. The correlation of risk score (RS) with tumor immunity and RT-polymerase chain reaction (PCR) was analyzed to further verify the gene signatures. Data on tumor mutational burden (TMB) and chromosomal copy number variation (CNV) were analyzed. Three NRGs were identified as prognostic risk signatures and were significantly related to overall survival (OS) in melanoma. The signatures had better diagnostic accuracy. Furthermore, analysis of mutations in the NRGs and the incidence of chromosomal CNV helped to reveal the relationship between mutations and melanoma occurrence. A nomogram was established based on RSs. The risk characteristics were significantly associated with immunity and high risk is closely correlated with melanoma development. In vitro experiments revealed that necrostatin-1 (Nec-1) promoted cell viability and repressed the expression levels of interleukin (IL)12A and proprotein convertase subtilisin/kexin type (PCSK)1. Additionally, the expression levels of IL12A, CXCL10, and PCSK1 decreased in tumor tissues of melanoma patients. NRGs exert vital roles in immunity and might be applied as a prognostic factor of melanoma.
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NewsBot · Sep 12, 2023

Metastatic melanoma to the proximal ureter
Matthew DeSanto et al
Urol Case Rep. 2023 Aug 24;

We present an exceptionally rare scenario of obstructive uropathy secondary to a ureteral mass. This case details a 68-year-old female with metastatic stage IIID melanoma of the right heel found to have a two cm right proximal ureteral mass with associated hydronephrosis. Pathology from ureteroscopic biopsy revealed metastatic melanoma to the ureter, creating a unique treatment quandary.
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NewsBot · Feb 24, 2024

The Value of Anterolateral Thigh Free Flap for the Reconstruction of Malignant Melanoma of the Sole of the Foot
Yong Chan Bae, Joo Hyoung Kim, Changryul Claud Yi
Ann Plast Surg. 2024 Jan 9

Background: Wide excision of malignant melanoma on the foot usually results in an extensive function-destroying defect, and the reconstruction of foot defects remains challenging for reconstructive surgeons. We propose using anterolateral thigh perforator (ALT) free flaps for the reconstruction of widespread defects caused by malignant melanoma in the sole.

Methods: This retrospective study included 34 patients who underwent reconstruction of sole defects caused by malignant melanoma resection with 35 ALT perforator free flaps between August 2005 and July 2021.

Results: In total, 18 male patients and 16 female patients were included (mean age at surgery, 65.4 years). The mean size of the flaps was 100.4 cm2. Thirty-three of the 35 flaps survived. Hematoma, seroma, and chronic ulceration were not identified in any cases. All patients achieved independent ambulation within the follow-up period, except 1 patient with gait discomfort. The 5-year overall and disease-free survival rates of patients were 64.4% and 56.6%, respectively.

Conclusions: The ALT flap is a versatile surgical option that should be considered for reconstruction of the sole after malignant melanoma resection, considering its various surgical advantages and the functional aspects of independent ambulation, the aesthetic aspects of wearing conventional footwear, and the anatomical aspects of the sole.
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NewsBot · May 22, 2024

High prevalence of dermatophytosis of the feet in acral melanoma of the foot
Yuma Waki et al
J Dermatol. 2024 May 6

The clinical characteristics and pathogenesis of acral melanoma of the foot (AMF) have not been sufficiently elucidated. Clinical or subclinical persistent inflammation of the feet is caused by dermatophytosis of the feet (DPF). Persistent inflammation is potentially associated with oncogenesis. Moreover, diabetes has been reported to be associated with the development of dermatophytosis and cancer. The present study aimed to elucidate the clinical association between DPF and AMF, with consideration of diabetes. The medical records of 114 Japanese patients were retrospectively examined and divided into an AMF group (n = 30) and a control group consisting of patients with foot diseases other than melanoma (n = 84). Microscopic DPF screening was performed on all patients who reported symptoms in the foot, with or without AMF. Patients underwent a microscopic test to detect the presence of dermatophytes, and the diagnosis of DPF was made based on a positive result. In the AMF group, 18 (60.0%) and eight (26.7%) patients had DPF and diabetes, respectively. Four patients (13.3%) had both DPF and diabetes. In the control group, 25 (29.8%) and 11 (13.1%) patients had DPF and diabetes, respectively. Five patients (6.0%) had both DPF and diabetes. Univariate analyses showed a significantly higher prevalence of DPF in the AMF group than in the control group (odds ratio, 3.540; p = 0.003, Pearson χ2 test). Furthermore, multivariate analyses of sex, body mass index, DPF, and diabetes revealed DPF as a significant factor associated with AMF (odds ratio, 4.285; p = 0.002, logistic regression analysis). The hyperkeratotic type of DPF was more frequently observed in patients with AMF than in control patients (odds ratio, 11.083; p < 0.001, Pearson χ2 test). In conclusion, the present study found a significantly higher prevalence of DPF, especially its hyperkeratotic type, in patients with AMF. DPF may be associated with AMF pathogenesis.
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NewsBot · May 26, 2024

Misdiagnosis and Clinical Insights into Acral Amelanotic Melanoma-A Systematic Review
Fortunato Cassalia et al
J Pers Med. 2024 May 13;14(5):518

Background: Acral amelanotic melanomas (AAMs), a rare subset of melanomas located on acral sites such as the palms, soles, and subungual areas, are diagnostically challenging due to their lack of typical pigmentation and often benign clinical appearance. Misdiagnosis is common, leading to delays in treatment and potentially worse outcomes. This systematic review aims to synthesise evidence on cases of AAM initially misdiagnosed as other conditions, to better understand their clinical and epidemiological characteristics, diagnostic pitfalls, and management strategies.

Methods: A comprehensive search of the MEDLINE/PubMed, EMBASE, and SCOPUS databases was conducted up to March 2024. Case reports and small case series of AAMs initially misdiagnosed as other conditions were included. Data on patient demographics, clinical presentation, and diagnostic methods were collected and analyzed.

Results: Of the 152 records identified, 26 cases from 23 articles met the inclusion criteria. A demographic analysis revealed that the gender distribution appears to be perfectly balanced, with an age range of 38 to 91 years. Misdiagnoses included non-healing ulcers or traumatic lesions (37.5%), benign proliferative lesions (29.2%) and infectious lesions (20.8%). The foot was the most affected site (53.8%). Notably, a histological evaluation was performed in 50% of cases involving the upper extremities, in contrast to only 7.1% of cases involving the foot and 0% of cases of the heel. This discrepancy suggests a reluctance to perform biopsies in the lower extremities, which may contribute to a higher misdiagnosis rate in these areas.

Conclusions: The underutilization of biopsy in the diagnosis of lower extremity lesions contributes significantly to the misdiagnosis and delay in treatment of AAMs. Especially when the clinical assessment and dermoscopy are inconclusive, biopsies of suspicious lesions are essential. Immunohistochemistry and markers such as PRAME are critical in differentiating melanoma from other malignancies such as clear cell sarcoma. This review highlights the need for increased vigilance and a proactive diagnostic approach to increase early detection rates and improve prognostic outcomes.
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NewsBot · May 28, 2024

Study of risk factors for the presence of interdigital nevi of the feet
V Sánchez-García et al
Actas Dermosifiliogr. 2024 May 20:

Background and objectives: No studies focused on counting the interdigital acquired melanocytic nevi (AMN) of the foot (IDNf) have ever been conducted. Therefore, our objective was to study the relationship between the presence of IDNf and the total number of AMN in the feet and the rest of the body, the racial phenotypic characteristics, and other risk factors for melanoma.

Material and methods: We conducted a cross-sectional observational study with 255 patients ≥18 years old who attended our Dermatology Unit from September 2020 through February 2021, and included all AMN ≥ 1 mm from the feet and ≥ 2 mm from the rest of the bod. The association between the variables was studied using univariate and multivariate logistic regression models.

Results: The presence of IDNf was significantly and independently associated with the presence of plantar AMN and body counts ≥ 50 AMN. However, no significant differences were observed regarding sex, age, personal history of melanoma, presence of nevi on the dorsum of the foot, history of sunburn or UV rays, or racial phenotypic characteristics.

Conclusions: The presence of IDNf is associated with a higher count of plantar nevi and total AMN in the body, meaning that interdigital spaces of the foot-anatomical expansions of the sole and other possibly genetic causes-could be responsible for the number of AMN found in this location, as these regions are not photoexposed.
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NewsBot · Jun 29, 2024

Pattern Analysis of Benign and Malignant Atypical Melanocytic Skin Lesions of Palms and Soles: Variations of Dermoscopic Features According to Anatomic Site and Personal Experience
Linda Tognetti et al
Life (Basel). 2024 May 22;14(6):659

Background: The differential diagnosis of atypical melanocytic skin lesions localized on palms and soles represents a diagnostic challenge: indeed, this spectrum encompasses atypical nevi (AN) and early-stage melanomas (EN) displaying overlapping clinical and dermoscopic features. This often generates unnecessary excisions or delayed diagnosis. Investigations to date were mostly carried out in specific populations, focusing either on acrolentiginous melanomas or morphologically typical acquired nevi. Aims: To investigate the dermoscopic features of atypical melanocytic palmoplantar skin lesions (aMPPLs) as evaluated by variously skilled dermatologists and assess their concordance; to investigate the variations in dermoscopic appearance according to precise location on palms and soles; to detect the features with the strongest association with malignancy/benignity in each specific site. Methods: A dataset of 471 aMPPLs-excised in the suspect of malignancy-was collected from 10 European Centers, including a standardized dermoscopic picture (17×) and lesion/patient metadata. An anatomical classification into 17 subareas was considered, along with an anatomo-functional classification considering pressure/friction, (4 macroareas). A total of 156 participants (95 with less than 5 years of experience in dermoscopy and 61 with ≥than 5 years) from 17 countries performed a blinded tele-dermoscopic pattern analysis over 20 cases through a specifically realized web platform. Results: A total of 37,440 dermoscopic evaluations were obtained over 94 (20%) EM and 377 (80%) AN. The areas with the highest density of EM compared to AN were the heel (40.3% EM/aMPPLs) of the sole and the "fingers area" (33%EM/aMPPLs) of the palm, both characterized by intense/chronic traumatism/friction. Globally, the recognition rates of 12 dermoscopic patterns were non statistically different between 95 dermatology residents and 61 specialists: aMPPLs in the plantar arch appeared to be the most "difficult" to diagnose, the parallel ridge pattern was poorly recognized and irregular/regular fibrillar patterns often misinterpreted. Regarding the aMPPL of the "heel area", the parallel furrow pattern (p = 0.014) and lattice-like pattern (p = 0.001) significantly discriminated benign cases, while asymmetry of colors (p = 0.002) and regression structures (p = 0.025) malignant ones. In aMPPLs of the "plantar arch", the lattice-like pattern (p = 0.012) was significant for benignity and asymmetry of structures, asymmetry of colors, regression structures, or blue-white veil for malignancy. In palmar lesions, no data were significant in the discrimination between malignant and benign aMPPLs. Conclusions: This study highlights that (i) the pattern analysis of aMPPLs is challenging for both experienced and novice dermoscopists; (ii) the histological distribution varies according to the anatomo-functional classification; and (iii) different dermoscopic patterns are able to discriminate malignant from benign aMPPLs within specific plantar and palmar areas.
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NewsBot · Jun 30, 2024

NEWS RELEASE 27-JUN-2024
The mechanism behind melanoma resistance to treatment
In many cases of malignant melanoma, the effect of targeted treatment is lost over time. A research team from UZH and USZ has now discovered that a factor secreted by tumor cells is responsible for the resistance. These findings could pave the way for more effective therapies.

Malignant melanoma is one of the most aggressive types of cancer. Despite recent progress in effective therapies, the tumors of many patients are either resistant from the outset or become so during the course of treatment.

“It is therefore crucial to understand the mechanism behind resistance development in melanoma,” says Lukas Sommer, professor of stem cell biology at the Institute of Anatomy at the University of Zurich (UZH). A study under his lead has now identified a mechanism that impedes the effectiveness of therapies. The result provides new ideas for treatments to suppress the development of resistance. The project was carried out in collaboration with Mitch Levesque and Reinhard Dummer from the University Hospital Zurich (USZ).

Comparing resistant and non-resistant tumor cells

For the study, the team utilized an innovative fine-needle biopsy to sample tumor cells before and during therapy. This allowed the researchers to analyze each cell individually. The patients providing the samples were undergoing targeted cancer therapy for malignant melanoma, which inhibits signalling pathways for tumor formation.

“It was important that some of the tumors responded to the therapy, while others showed resistance,” says Sommer. This allowed the team to compare the metabolism and environment of resistant and non-resistant tumor cells and look for significant differences.

Interaction between tumor factor and immune cells

One of the most relevant findings concerned the POSTN gene: it codes for a secreted factor that plays an important role in resistant tumors. In fact, the tumors of patients with rapidly progressing disease despite treatment showed increased POSTN levels. In addition, the microenvironment of these tumors contained a larger number of a certain type of macrophage – a subtype of immune cell that promotes the development of cancer.

Through a series of further experiments – both with human cancer cells and with mice – the research team was able to show how the interaction of increased POSTN levels and this type of macrophage triggers resistance: the POSTN factor binds to receptors on the surface of the macrophages and polarizes them to protect melanoma cells from cell death. “This is why the targeted therapy no longer works,” says Sommer.

No resistance without cancer-promoting macrophages

The team considers this mechanism a promising starting point. “The study highlights the potential of targeting specific types of macrophages within the tumor microenvironment to overcome resistance,” says Sommer. “In combination with already known therapies, this could significantly improve the success of treatment for patients with malignant melanoma.”

NewsBot · Nov 8, 2024

Misdiagnosis and Clinical Insights into Acral Amelanotic Melanoma—A Systematic Review
Fortunato Cassalia et al
J. Pers. Med. 2024, 14(5), 518; https://doi.org/10.3390/jpm14050518

Background: Acral amelanotic melanomas (AAMs), a rare subset of melanomas located on acral sites such as the palms, soles, and subungual areas, are diagnostically challenging due to their lack of typical pigmentation and often benign clinical appearance. Misdiagnosis is common, leading to delays in treatment and potentially worse outcomes. This systematic review aims to synthesise evidence on cases of AAM initially misdiagnosed as other conditions, to better understand their clinical and epidemiological characteristics, diagnostic pitfalls, and management strategies. Methods: A comprehensive search of the MEDLINE/PubMed, EMBASE, and SCOPUS databases was conducted up to March 2024. Case reports and small case series of AAMs initially misdiagnosed as other conditions were included. Data on patient demographics, clinical presentation, and diagnostic methods were collected and analyzed. Results: Of the 152 records identified, 26 cases from 23 articles met the inclusion criteria. A demographic analysis revealed that the gender distribution appears to be perfectly balanced, with an age range of 38 to 91 years. Misdiagnoses included non-healing ulcers or traumatic lesions (37.5%), benign proliferative lesions (29.2%) and infectious lesions (20.8%). The foot was the most affected site (53.8%). Notably, a histological evaluation was performed in 50% of cases involving the upper extremities, in contrast to only 7.1% of cases involving the foot and 0% of cases of the heel. This discrepancy suggests a reluctance to perform biopsies in the lower extremities, which may contribute to a higher misdiagnosis rate in these areas. Conclusions: The underutilization of biopsy in the diagnosis of lower extremity lesions contributes significantly to the misdiagnosis and delay in treatment of AAMs. Especially when the clinical assessment and dermoscopy are inconclusive, biopsies of suspicious lesions are essential. Immunohistochemistry and markers such as PRAME are critical in differentiating melanoma from other malignancies such as clear cell sarcoma. This review highlights the need for increased vigilance and a proactive diagnostic approach to increase early detection rates and improve prognostic outcomes.
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NewsBot · Dec 8, 2024 at 11:28 PM

Dermoscopic Examination of Tinea Nigra on the Plantar Foot Unveils a Parallel Ridge Pattern Mimicking Acral-Lentiginous Melanoma
Mako Saikawa et al
Med Mycol J. 2024;65(4):103-106

A man in his thirties patient visited his previous physician with the chief complaint of a pigmented macule on the sole of his left foot that had steadily grown over the past two years. A dermoscopic examination of the lesion showed a parallel ridge pattern (PRP); therefore, acral-lentiginous melanoma (ALM) was suspected, and the patient was referred to our hospital for a more detailed examination. On closer inspection, PRP had a well-defined and irregular border with no variation in color, which is atypical for ALM which is characterized by asymmetrical structure and variation in colors. Therefore, a skin biopsy was performed for a definite diagnosis, and the histopathological findings showed mycelia in the horny layers. Fungal culture revealed Hortaea werneckii, and the patient was diagnosed with tinea nigra (TN). Although TN is a rare fungal infection in Japan, we emphasize that this fungal infection should be noted as a mimic of ALM and should be considered when PRP is detected on the palms and soles by dermoscopic examination.
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Melanoma of the foot

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Malignant Melanoma Misdiagnosed as a Diabetic Foot Ulcer

Dermoscopy as a technique for the early identification of foot melanoma

Amelanotic melanoma misdiagnosed as a diabetic foot ulcer

Melanoma

Liability in the context of misdiagnosis of melanoma as a plantar wart

Subungual/ feet Melanoma Mortality rates in Australia

bpac NZ Journal for Primary Healthcare and article Melanoma

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Melanoma of the foot

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Malignant Melanoma Misdiagnosed as a Diabetic Foot Ulcer

Dermoscopy as a technique for the early identification of foot melanoma

Amelanotic melanoma misdiagnosed as a diabetic foot ulcer

Melanoma

Liability in the context of misdiagnosis of melanoma as a plantar wart

Subungual/ feet Melanoma Mortality rates in Australia

bpac NZ Journal for Primary Healthcare and article Melanoma

Share This Page

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