Case Letter
Malignant melanoma after treatment for Merkel cell carcinoma
Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "662" "paginaFinal" => "664" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Masato Ishikawa, Toshiyuki Yamamoto" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Masato" "apellidos" => "Ishikawa" "email" => array:1 [ 0 => "ishimasa@fmu.ac.jp" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Toshiyuki" "apellidos" => "Yamamoto" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Dermatology, Fukushima Medical University, Fukushima, Japan" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 685 "Ancho" => 905 "Tamanyo" => 154620 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological examination showed many atypical cells infiltrating irregularly from the epidermis to the dermis (Hematoxylin & eosin, ×200).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 98-year-old male was referred complaining of a mass on his left cheek. He had never received immunosuppressive therapy. Physical examination showed a solid, dome-shaped, reddish tumor, 35 mm in diameter, on his left cheek. Microscopic examination of a biopsy specimen revealed an infiltrative tumor in the dermis. The tumor was composed of sheets and trabeculae of atypical cells with scant cytoplasm, and round nuclei with stippled chromatin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Immunohistochemistry results revealed that the tumor cells stained positive for cytokeratin 20 and neuron specific enolase. The patient underwent total resection of the tumor. However, because of the patient’s advanced age, neither the patient nor his family wished further treatment, including radiotherapy, choosing follow-up visits only. Two years later, he presented again with erosion of the right hallux. Physical examination showed widespread erosion of his right hallux, which in part had a reddish nodule. The nail had completely disappeared (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Histological examination revealed many atypical cells infiltrating irregularly from the epidermis to the dermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). These atypical cells were immunoreactive for MART-1 and HMB-45. For the same reason as before, the patient and his family wanted only local symptomatic treatments at a nearby hospital.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine cancer that is known to be a highly aggressive malignancy with frequent metastasis and a high mortality rate. A previous review article revealed increased risk of a second primary cancer after the diagnosis of MCC, and cutaneous malignant melanoma (MM) is one of the most common cancers after MCC.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Miller and Rabkin reported that occurrences of MM and MCC were similarly increased with sun exposure and immunosuppression.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Considering that ultra violet (UV) rays attenuate systemic immune responses <span class="elsevierStyleItalic">via</span> the induction of regulatory T-cells, systemic immunosuppression may be an essential factor in the development of both conditions in a patient.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the present case, MCC occurred on the left cheek, and MM occurred on the right hallux. In Japan, the majority of MM cases occur on the edges of limbs that are not directly affected by UV rays, and external irritation has been considered one of the risk factors.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However, systemic immunosuppression associated with aging and/or UV irradiation may be a common cause of both conditions in the present case. According to previous articles, several cases in which MCC and MM developed in a patient have been reported from countries other than Japan; however, to the best of the authors’ knowledge, this is the first report of its type from Japan. Interestingly, there was a report of a case of MCC that developed in a patient during treatment with immune checkpoint inhibitors for MM.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> Given the increase of immune checkpoint inhibitors used to treat MM, the number of cases in which both MCC and MM develop in a patient may increase in Japan, as well as around the world.</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Financial support</span><p id="par0025" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors' contributions</span><p id="par0015" class="elsevierStylePara elsevierViewall">Masato Ishikawa: Drafting and editing of the manuscript; collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Toshiyuki Yamamoto: Approval of the final version of the manuscript; conception and planning of the study; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-12-12" "fechaAceptado" => "2020-02-12" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Ishikawa M, Yamamoto T. Malignant melanoma after treatment for Merkel cell carcinoma. An Bras Dermatol. 2020; 95. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.abd.2020.02.013">https://doi.org/10.1016/j.abd.2020.02.013</span>.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Fukushima Medical University, Fukushima, Japan.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 684 "Ancho" => 905 "Tamanyo" => 224242 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Microscopic examination of a biopsy specimen from a mass on patient’s left cheek. There was an infiltrative tumor in the dermis. The tumor was composed of sheets and trabeculae of atypical cells with scant cytoplasm, and round nuclei with stippled chromatin (Hematoxylin & eosin, ×200).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1022 "Ancho" => 899 "Tamanyo" => 96065 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Physical examination revealed widespread erosion of the right hallux, which in part had a reddish nodule. The nail had completely disappeared.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 685 "Ancho" => 905 "Tamanyo" => 154620 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological examination showed many atypical cells infiltrating irregularly from the epidermis to the dermis (Hematoxylin & eosin, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of second cancers in Merkel cell carcinoma: a meta-analysis of population based cohort studies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Saxena" 1 => "M. Rubens" 2 => "V. Ramamoorthy" 3 => "H. Khan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Skin Cancer." "fecha" => "2014" "volumen" => "2014" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Merkel cell carcinoma and melanoma etiological similarities and differences" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.W. Miller" 1 => "C.S. Rabkin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cancer Epidemiol Biomarkers Prev." "fecha" => "1999" "volumen" => "8" "paginaInicial" => "153" "paginaFinal" => "158" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of ultraviolet light on human serum 25-hydroxyvitamin D and systemic immune function" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.V. Milliken" 1 => "H. Wassall" 2 => "B.J. Lewis" 3 => "J. Logie" 4 => "R.N. Barker" 5 => "H. Macdonald" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Allergy Clin Immunol." "fecha" => "2012" "volumen" => "129" "paginaInicial" => "1554" "paginaFinal" => "1561" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis and Statistical Investigation Committee of the Japanese Skin Cancer Society. Statistical profiles of malignant melanoma and other skin cancers in Japan: 2007 update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Ishihara" 1 => "T. Saida" 2 => "F. Otsuka" 3 => "N. Yamazaki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Clin Oncol" "fecha" => "2008" "volumen" => "13" "paginaInicial" => "33" "paginaFinal" => "41" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of Merkel cell carcinoma and squamous cell carcinoma during treatment with pembrolizumab for metastatic mucosal melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T. Hajar" 1 => "E.E. Hill" 2 => "J.J. Leitenberger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Dermatol Surg." "fecha" => "2019" "volumen" => "1" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009500000005/v2_202011080908/S0365059620301884/v2_202011080908/en/main.assets" "Apartado" => array:4 [ "identificador" => "82769" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Letter" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009500000005/v2_202011080908/S0365059620301884/v2_202011080908/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059620301884?idApp=UINPBA00008Z" ]
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| 2021 December | 35 | 46 | 81 |
| 2021 November | 29 | 55 | 84 |
| 2021 October | 44 | 79 | 123 |
| 2021 September | 23 | 45 | 68 |
| 2021 August | 33 | 50 | 83 |
| 2021 July | 30 | 33 | 63 |
| 2021 June | 26 | 47 | 73 |
| 2021 May | 49 | 96 | 145 |
| 2021 April | 130 | 229 | 359 |
| 2021 March | 52 | 65 | 117 |
| 2021 February | 25 | 18 | 43 |
| 2021 January | 19 | 22 | 41 |
| 2020 December | 19 | 19 | 38 |
| 2020 November | 27 | 14 | 41 |
| 2020 October | 18 | 10 | 28 |
| 2020 September | 14 | 7 | 21 |
| 2020 August | 10 | 11 | 21 |
| 2020 July | 4 | 5 | 9 |
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