Received: 22 August 2017
Accepted: 25 August 2017
LETTER TO THE EDITOR
Management of thin melanoma
Durham et al
performed a study on a cohort of 510 patients affected by
512 lesions with Breslow tickness comprised between 0.75 and 0.99 mm.
Their aim was to establish a correct treatment choice for the mentioned
lesions. The authors concluded that the sentinel lymph node biopsy
(SLNB) should be considered for patients of 45 years or less, with a
Breslow thickness ≥0.85 mm, rounded to 0.9 mm, according to the AJCC
a mitotic rate>1 mm, and/or lesion ulceration. Conversely,
they reported that thin melanomas (TMs) <0.85 mm thickness that are
without high-risk features may be treated with wide local excision (WLE).
Primary melanomas evolve through three tumor progression steps. A
typical melanocytes first proliferate above epidermal basement membrane,
then invade the papillary dermis (invasive radial growth phase [RGP]), and
subsequently develop the capacity to grow a tumor (vertical growth phase
[VGP]). Following these histogenetic concepts, Roncati et al
classified TMs into three subtypes correlated with therapeutic implications:
1. Nontumorigenic microinvasive RGP TM,
where the WLE is indicated:
in fact, very small cellular nests (three or four cells) may be present distantly
from the main lesion. These cells should be removed because they could
develop the capacity to grow as a tumor (VGP). Anyway, the SLNB is not
necessary, because the lesion is nontumorigenic itself; 2. Tumorigenic,
early VGP, TM: the lesion is associated with a statistical chance for distant
: thus, both WLE and SLNB must be performed; and 3.
Uncertain potentially tumorigenic TM, accompanied with a significant risk
for metastases due to the presence of extensive regression which could
contain a VGP clone. WLE and SLNB are recommended.
the presence of mitoses is conclusive for early VGP TM displaying the
capacity to develop metastases. Consequently, the SLNB should be always
performed according to the histogenesis of the lesion. In conclusion, the
guidelines to be followed for the management must be based only on the
TM histogenetic classification.
CONFLICTS OF INTEREST
None of the authors has a financial interest in any of the products,
devices, or drugs mentioned in this manuscript.
All authors had full access to all the data in the study and the accuracy
of the data analysis. TP contributed to the study concept and design,
and drafted the article. FP contributed to the acquisition of data. All
authors contributed to a critical revision of the article for important
intellectual content, and they grave final approval of the version to be
Teresa Pusiol http://orcid.org/0000-0001-8431-9702
Teresa Pusiol MD, PhD
Francesco Piscioli MD, PhD
Provincial Health Care Services, Institute of Pathology, Santa Maria
del Carmine Hospital, Rovereto (TN), Italy
Teresa Pusiol, MD, PhD, Provincial Health Care Services, Istitute of
Pathology, Santa Maria del Carmine Hospital, Rovereto (TN), Italy.
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