Cutaneous Malignant Melanoma

Mortality from cutaneous malignant melanoma (CMM) increased in the past, but trends have been favorable in more recent years in many high-income countries. However, incidence has been increasing in several countries. We provided an up-to-date overview of mortality trends from CMM. We analyzed death certification data from the WHO in selected countries worldwide from 1980 to the most recent available calendar years. We also reported incidence data derived from Cancer Incidence in Five Continents from 1990 to 2012. Separate analyses were performed for young adults aged 20-44 and middle-aged adults aged 45-64 years. Mortality from CMM in all age groups showed a favorable pattern in the majority of the countries considered. Mortality trends declined by 40 to 50% in Australia over the last decades, confirming the importance of prevention measures. Considering young adults aged 20-44, Australia, New Zealand and Northern Europe reported the highest death rates for both sexes (>0.90/100 000 in men and >0.60/100 000 in women) while Japan, the Philippines, and Latin America the lowest ones (<0.50/100 000 and <0.35/100 000 in men and women, respectively). Incidence trends were stable or upward in most countries, with higher rates among women. Our study highlights a global reduction of CMM mortality over the last three decades. The increasing awareness of risk factors, mainly related to UV exposure, along with early diagnosis and progress in treatment for advanced disease played pivotal roles in reducing CMM mortality, particularly in Australia.

BackgroundThe accuracy of melanoma diagnosis continues to challenge the pathology community, even today with sophisticated histopathologic techniques. Melanocytic lesions exhibit significant morphological heterogeneity. While the majority of biopsies can be classified as benign (nevus) or malignant (melanoma) using well-established histopathologic criteria, there exists a cohort for which the prediction of clinical behaviour and invasive or metastatic potential is difficult if not impossible to ascertain on the basis of morphological features alone. Multiple studies have shown that there is significant disagreement between pathologists and even expert dermatopathologists in the diagnosis of this subgroup of difficult melanocytic lesions.MethodsA four probe FISH assay was utilized to analyse a cohort of 500 samples including 157 nevus, 176 dysplastic nevus and 167 melanoma specimens.ResultsReview of the lesions determined the assay identified genetic abnormalities in a total of 83.8% of melanomas, and 1.9% of nevus without atypia, while genetic abnormalities were identified in 6.3%, 6.7%, and 10.3% of nevus identified with mild, moderate and severe atypia, respectively.ConclusionsBased on this study, inheritable genetic damage/instability identified by FISH testing is a hallmark of a progressive malignant process, and a valuable diagnostic tool for the identification of high risk lesions.

Cutaneous malignant melanoma is a severe and sometimes life-threatening cancer. The molecular mechanism of melanomagenesis is incompletely understood. Deregulation of apoptosis is probably one of the key factors contributing to the progression of melanoma. The inhibitor of growth (ING) family proteins are candidate tumour suppressors which play important roles in apoptosis. Downregulated expression of ING proteins have been reported in several tumour types, including the loss of nuclear expression of p33ING1b in melanoma. As ING2 exhibits 58.9% homology with p33ING1b, we hypothesized that the aberrant expression of ING2 may be involved in melanomagenesis. Here, we used tissue microarray technology and immunohistochemistry to examine ING2 expression in human nevi and melanoma biopsies. Our data showed that nuclear ING2 expression was significantly reduced in radial growth phase (RGP), vertical growth phase (VGP), and metastatic melanomas compared with dysplastic nevi (P 0.05). Taken together, our results suggest that nuclear ING2 expression is significantly reduced in human melanomas and that reduced ING2 may be an important molecular event in the initiation of melanoma development.

BackgroundMelanoma of the foot and nail unit carries a worse prognosis than cutaneous melanoma elsewhere because lesions are frequently hidden, misdiagnosed, and therefore diagnosed at more advanced stages. Traditional ABCDE criteria are often insufficient for foot and nail presentations; the CUBED recognition tool was developed to improve detection of atypical plantar and subungual lesions.AimTo evaluate four consecutive cases of foot melanoma seen in a single NHS community podiatry department, compare case characteristics against ABCDE and CUBED recognition tools, and describe service responses that aimed to improve early detection.MethodsA retrospective case series of four patients diagnosed with foot melanoma between 2019 and 2022 in one community podiatry service. Clinical features, referral timelines, diagnostic pathways, treatments, and outcomes were extracted and mapped against ABCDE and CUBED criteria. Shared-learning interventions developed by the department following these cases are described.ResultsAll four cases were toe-based melanomas (one lentigo maligna, one nail-bed malignant melanoma, two acral melanomas). Presentations commonly included irregular colour, bleeding or ulceration, delayed healing, diagnostic uncertainty, and lesion enlargement. CUBED criteria more consistently identified concerning features across the series than ABCDE criteria, prompting urgent dermatology referral in each case. Outcomes varied: one patient remains disease-free after excision, one developed distant metastasis and died, two underwent toe amputation and received systemic treatment. Departmental responses included case-based teaching and a poster campaign promoting CUBED and ABCDE recognition across local clinical networks.ConclusionPodiatrists are pivotal in early detection of foot melanoma. The CUBED tool demonstrated greater sensitivity for atypical foot and nail lesions in this series. Wider education and adoption of CUBED alongside ABCDE may reduce misdiagnosis, shorten diagnostic delay, and improve clinical outcomes.