Case Letter
Tumoral melanosis without metastasis: a report after three years of follow-up
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melanosis without metastasis: a report after three years of follow-up" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "797" "paginaFinal" => "798" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Anna Carolina Miola, Ana Claudia Cavalcante Esposito, Hamilton Ometto Stolf, Helio Amante Miot" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Anna Carolina" "apellidos" => "Miola" "email" => array:1 [ 0 => "anna.c.miola@unesp.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana Claudia Cavalcante" "apellidos" => "Esposito" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Hamilton Ometto" "apellidos" => "Stolf" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Helio Amante" "apellidos" => "Miot" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Dermatology Discipline, Universidade Estadual de Campinas, Campinas, SP, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] ] "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" => 567 "Ancho" => 755 "Tamanyo" => 147063 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presence of macrophages full of melanin pigment (melanophages), better seen in H&E after counterstaining with Giemsa.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tumoral melanosis is a rare clinical manifestation of a completely regressed melanoma, usually represented by a pigmented lesion clinically suspected of invasive melanoma. The histopathological examination shows a dense dermal melanophage infiltrate but no atypical melanocytes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The prognosis for this unusual entity is uncertain, but metastases have been described during follow-up or even at the diagnosis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This is the report of a white female patient, aged 56 years, with no previous history of sunburns and with a dark pigmented lesion on the back, measuring 1.2 cm in diameter and showing a hypopigmented halo, which was detected during medical consultation and without a history of growth. Dermoscopy disclosed areas of peppering in the periphery, irregular edges, and a bluish-gray veil (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No hardened or enlarged lymph nodes were found during palpation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">An excisional biopsy with a 2-mm margin was performed, considering the hypothesis of melanoma, and the histopathological examination revealed multiple aggregates of melanophages in the reticular dermis (Clark III), better observed after counterstaining with Giemsa (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>). The diagnosis of tumoral melanosis was established and a choice was made for enlargement with margins measuring 2 cm in diameter. Clinical examination and total body computed tomography did not disclose metastatic lesions. An abdominal and lymph node ultrasonography was performed, which did not disclose the presence of enlargement or signs of metastasis. The patient was maintained under clinical follow-up every three months, for three consecutive years, with no signs of local recurrence of the lesion or metastasis, confirmed by clinical and ultrasonographic examination.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Regression is a common occurrence in melanocytic neoplasias and is expected to occur in approximately 30% of cases. It usually occurs focally and seems to have little or no effect on the prognosis of an excised melanoma. However, extensive areas of regression are associated with a worse prognosis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Since tumoral melanosis represents complete regression of atypical melanocytic cells, they can also be found in lymph nodes with clinical signs of metastasis. Tumoral melanosis has also been reported following treatment of metastatic melanoma with monoclonal antibodies (e.g., dabrafenib/trametinib).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Conflicting data have been reported in the literature on the prognostic effect of regression on melanoma. It is suggested that partial regression in less than 50%–75% of tumor cells does not affect prognosis, whereas complete or extensive regression above this percentage of tumor tissue is associated with metastatic disease.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The level of melanophage infiltrate is commonly correlated with the invasiveness of the previous lesion, in addition to other histopathological signs, such as solar elastosis in tumoral melanosis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In the present case, although the melanophages are located in the dermis – without contact with the epidermis, which makes it difficult to state that it was a primary lesion – it is believed that the patient had a thin melanoma that progressed into complete regression, explaining the follow-up without recurrence or metastasis for a period of three years.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The present case highlights the importance of knowing the unusual histopathology of this lesion and calls attention for the necessity of a close follow-up, even in cases with an apparent good evolution.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0040" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Anna Carolina Miola: Approval of the final version of the manuscript; drafting and editing of the manuscript; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Ana Claudia Cavalcante Esposito: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Hamilton Ometto Stolf: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Helio Amante Miot: Approval of the final version of the manuscript; drafting and editing of the manuscript; critical review of the literature; critical review of the manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-12-18" "fechaAceptado" => "2020-04-28" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Miola AC, Esposito ACC, Stolf HO, Miot AA. Tumoral melanosis without metastasis: a report after three years of follow-up. An Bras Dermatol. 2021;96:797–8.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital das Clínicas, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil.</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" => 1133 "Ancho" => 755 "Tamanyo" => 153595 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Blackish lesion, measuring 1.2 cm in diameter, with a hypopigmented halo; dermoscopy shows irregular borders and a bluish-gray veil.</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" => 567 "Ancho" => 755 "Tamanyo" => 168709 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Close-up of the heavy melanophage infiltrate in the dermis (Hematoxylin & eosin, ×100).</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" => 567 "Ancho" => 755 "Tamanyo" => 147063 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presence of macrophages full of melanin pigment (melanophages), better seen in H&E after counterstaining with Giemsa.</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" => "The many faces of completely regressed malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "RJ Barr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pathology" "fecha" => "1994" "volumen" => "2" "paginaInicial" => "359" "paginaFinal" => "370" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9420907" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumoral melanosis involving the sentinel lymph nodes: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 3 | 9 |
| 2024 October | 103 | 75 | 178 |
| 2024 September | 172 | 81 | 253 |
| 2024 August | 173 | 101 | 274 |
| 2024 July | 157 | 124 | 281 |
| 2024 June | 111 | 76 | 187 |
| 2024 May | 117 | 83 | 200 |
| 2024 April | 102 | 103 | 205 |
| 2024 March | 105 | 80 | 185 |
| 2024 February | 91 | 79 | 170 |
| 2024 January | 96 | 45 | 141 |
| 2023 December | 90 | 68 | 158 |
| 2023 November | 66 | 78 | 144 |
| 2023 October | 60 | 76 | 136 |
| 2023 September | 104 | 87 | 191 |
| 2023 August | 57 | 28 | 85 |
| 2023 July | 125 | 32 | 157 |
| 2023 June | 78 | 40 | 118 |
| 2023 May | 65 | 26 | 91 |
| 2023 April | 70 | 16 | 86 |
| 2023 March | 90 | 49 | 139 |
| 2023 February | 72 | 39 | 111 |
| 2023 January | 54 | 48 | 102 |
| 2022 December | 75 | 41 | 116 |
| 2022 November | 124 | 58 | 182 |
| 2022 October | 158 | 71 | 229 |
| 2022 September | 65 | 67 | 132 |
| 2022 August | 54 | 65 | 119 |
| 2022 July | 46 | 51 | 97 |
| 2022 June | 71 | 52 | 123 |
| 2022 May | 48 | 56 | 104 |
| 2022 April | 59 | 50 | 109 |
| 2022 March | 65 | 72 | 137 |
| 2022 February | 44 | 41 | 85 |
| 2022 January | 111 | 107 | 218 |
| 2021 December | 168 | 97 | 265 |
| 2021 November | 107 | 73 | 180 |
| 2021 October | 43 | 55 | 98 |
| 2021 September | 3 | 9 | 12 |
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