P2802Differences in cytokine levels in melanoma patients

Jacob Mashiah, MD, Tel Aviv-Sourasky Medical Center, Tel Aviv, Israel; JacobSchachter, MD, Ella Institute for Treatment and Research of Melanoma, ShebaMedical Center, Ramat Gan, Israel; Kobi Pessach, MD, Tel Aviv-Sourasky MedicalCenter, Tel Aviv, Israel; Sarah Brenner, MD, Tel Aviv-Sourasky Medical Center,Tel Aviv, Israel

Objective: In view of several studies concerning an observation of an erythematouseruption in the vicinity of or distant from the lesion in melanoma patients, weattempt to assess whether this phenomenon might be related to the blood level ofcytokines interleukin (IL)-6 and IL-8.

Methods: Sera specimens were obtained from 27 patients with melanoma, of which15 had erythematous eruptions and 12 did not, and were studied by immunohis-tochemistry for the expression of IL-6 and IL-8.

Results: IL-6 was detected in all melanoma patients in both groups. The mean level ofIL-6 in the redness group (2.41 pg/L) was significantly higher than in the groupwithout redness (1.25 pg/L). IL-8 was detected in all 27 melanoma patients in thetwo groups. However, the serum level was\5 pg/L in only one patient (6.7%) in theredness group, and in six patients (50%) in the group without redness, a statisticallysignificant difference.

Conclusions: At first glance it appears that the Brenner sign reflects a more advanceddisease and heralds a poor prognosis, according to its correlation to the IL-8 and IL-6blood level. However, in view of the biphasic effect of IL-8 level on tumorprogression, and IL-6’s ability to inhibit early stage melanoma, redness in melanomapatients, could serve as a sign of melanoma and has a place in the prognostic factorsof the disease.

AB132

cial support: None identified.

Commer

P2803Atypical melanosis of the foot, an early lesion of acral lentiginousmelanoma in situ: Specific dermatoscopy patterns may precede histo-pathologically recognizable changes

Hsiu-Hui Chiu, Department of Dermatology, Chia-Yi Christian Hospital, Chiayi,Taiwan; Shih-Tsung Cheng, MD, Department of Dermatology, Kaohsiung MedicalUniversity Hospital, Kaohsiung, Taiwan

We present a unique pigmented lesion (2.3 3 2.5 cm) on the third toe of the rightfoot of a 39-year-old Taiwanese female patient. Clinically, the lesion was character-ized by irregular borders and variegated pigmentation, mimicking acral lentiginousmelanoma (ALM). On dermatoscopy, features of melanoma on acral volar skin, suchas parallel ridge pattern (PRP), irregular diffuse pigmentation, peripheral dots, andabrupt edge were all noted. However, the histologic findings revealed onlymelanocytic hyperplasia with minimal cytologic atypia confined to the epidermis.Some melanocytes were present in the lower portion of spinous layer. Afterreviewing the literature, atypical melanosis of the foot (AMOF) was diagnosed.AMOF was first designated by Nogita et al in 1994. Clinically, these lesions are closelymimicking ALM in situ. However, the histologic findings revealed only focalmelanocytic hyperplasia with minimal cytologic atypia along the basal layer. Theysuggested that the potential for development of malignancy in these cases remainedundetermined. We believe that AMOF represented the early phase of acralmelanoma in situ by providing the following arguments. First, AMOF fulfill all theclinical criteria for ALM. Second, the dermatoscopic features of AMOF, such as PRPand irregular diffuse pigmentation, are highly specific for ALM. Third, the PRPappeared at a very early development phase of ALM, even chronologically precedingthe histopathologically recognizable changes. We suggest that dermatoscopy, whichprovides a radial overview of the lesion, is a powerful tool for detecting early lesionsof acral melanoma in radial growth phase. In certain cases, it could identify earlymalignant lesion of ALM in situ, not recognizable by vertically-oriented conventionalhistopathology. Among all of the dermatoscopic features, PRP is most specific andexists at a very early phase.

cial support: None identified.

Commer

J AM ACAD DERMATOL

P2804Acral lentiginous melanoma: Incidence and survival patterns in the UnitedStates, 1986-2004

Porcia Bradford, National Institutes of Health, Rockville, MD, United States; AlisaGoldstein, PhD, National Institutes of Health, Rockville, MD, United States;Margaret Tucker, MD, National Institutes of Health, Rockville, MD, United States;Mary McMaster, MD, National Institutes of Health, Rockville, MD, United States

Introduction: Acral lentiginous melanoma (ALM) is the most common type ofmelanoma found in people of color and is most often found on the palms and soles.Several small single-institution case series of ALM have been published, but havebeen limited by small sample sizes and have not been population-based. Hence, weconducted a population-based evaluation of ALM to examine its incidence andsurvival patterns.

Methods: Using the Surveillance, Epidemiology, and End Results (SEER) Program ofthe National Cancer Institute, we evaluated 1683 histologically confirmed cases ofALM reported to 17 cancer registries from 1986 to 2004. Age-adjusted (2000 USstandard) incidence and relative survival rates were calculated with SEER*statsoftware version 6.3.5 and analyzed with PROC FREQ of SAS and PROC LIFETEST ofSAS (version 9.1.3).

Results: The age-adjusted ALM incidence rate was 1.9 per 1,000,000. The annualpercentage change (APC) for ALM was 1.0, unlike CMM, where the incidence hasincreased over time with an APC of 3.1 (P\.05). The incidence rate for ALM amongracial groups was similar, with the exception of Asian/Pacific Islanders who had astatistically lower incidence rate of 1.4 (P ¼ .01). The proportion of ALM among allother melanoma subtypes was greatest in people of color, with blacks having thehighest percentage of 37%. Overall, ALM had 5- and 10-year relative survival rates of82.2% and 72.7%, respectively, which were significantly lower than for all CMM,with rates of 88.8% and 86.9% (P\.01). Five- and 10-year survival rates for ALM werehighest in non-Hispanic whites (84.9% and 74.1%) and lowest in Asian/PacificIslanders (70.5% and 56.9%). ALM thickness correlated with survival in differentracial groups. ALM was most frequently thin (0.01-1.00 mm) in non-Hispanic whites(45%). The highest percentage of thick ALM ([4.00 mm) was seen in Asian/PacificIslanders (25%).

Conclusions: ALM is the least frequent of the four major histologic subtypes of CMMoverall, but the most frequent subtype among people of color. The incidence of ALMin the United States has remained steady over time, unlike CMM overall, where theincidence has been steadily increasing. ALM is associated with a worse prognosisthan CMM overall. Asian/Pacific Islanders have worse survival rates than othergroups, and factors such as increased tumor thickness and more advanced stage atpresentation are the most likely explanations.

cial support: None identified.

Commer

P2805The use of imiquimod to minimize the surgical defect when excisinginvasive malignant melanoma surrounded by melanoma in situ, lentigi-nous type

Tricia A. Missall, MD, Saint Louis University School of Medicine, St Louis, MO,United States; Scott W. Fosko, MD, Saint Louis University School of Medicine,St Louis, MO, United States

Malignant melanoma in situ, lentiginous type or lentigo maligna (LM) is known tohave a protracted radial growth phase, which may eventually develop an invasivecomponent or lentigo maligna melanoma (LMM). For this reason, in most patientswith LMM, there is surrounding LM. For both LM and LMM, the recommended first-line treatment is surgical excision. Because LM lesions may become large and ill-defined and are often found on the head and neck, this treatment alone may causesignificant morbidity and mortality. There is the additional management challenge ofdiscerning the histopathologic extent and hence, the tumor-free margins of theselesions. Based on recent reports of successful treatment of LM with topicalimiquimod cream, we have managed selected patients who refused the recom-mended surgical therapy with a combination of treatment modalities to minimizetheir surgical defect and recovery time, but to ultimately attempt to provide a usefulmanagement approach. Two cases of extensive melanoma in situ, lentiginous typewith an identified focal area of invasive malignant melanoma were treated with acombination of initial surgical excision for the invasive component followed bytopical 5% imiquimod cream for the surrounding in situ disease. After initial surgeryand 62 to 65 days of imiquimod therapy, with posttreatment biopsies both patientsin this study have no histologic evidence of residual LM, with clinical follow-up of16 to 20 months. Imiquimod may be a useful adjunctive treatment for extensive LMin combination with surgical excision for an invasive component.

cial support: None identified.

Commer

MARCH 2009