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Home All Specialties Dermatology

Amelanotic melanoma linked with advanced stage at diagnosis

byShirin BajajandAdam Whittington
August 31, 2014
in Dermatology, Oncology
Reading Time: 3 mins read
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1. Amelanotic melanoma was typically diagnosed at a later AJCC tumor stage than pigmented melanoma.                                           

2. After having accounted for Breslow depth, amelanotic melanoma was independently associated with histologic features that were suggestive of increased growth rate.

Evidence Rating Level: 2 (Good)

Study Rundown: Amelanotic melanoma poses a distinct challenge in diagnosis, as lack of pigment makes these tumors difficult to identify at early stages. Previous studies have indicated that poorer survival rate of amelanotic melanoma as compared to pigmented melanoma is due to advanced stage at diagnosis; however these studies had several limitations including limited number of cases and lack of centralized pathologic review. These authors sought to establish clinicopathologic features and survival of amelanotic vs. melanotic melanomas. Results corroborated that amelanotic melanoma was associated with advanced tumor stage at diagnosis, and increased mitoses on histology. The study was the only international study with an expansive cohort that utilized definition of tumor pigmentation by histopathology rather than clinical definition. Despite employing central pathologic review, the study was limited by the retrospective design and by moderate inter-rater agreement for histopathologic pigment. Future studies are needed to identify barriers to timely diagnosis and to improve diagnostic methods for these types of melanomas.

Click to read the study in JAMA Dermatology

Relevant Reading: Amelanotic melanoma: a detailed morphologic analysis with clinicopathologic correlation

In-Depth [case-control study]: 2995 patients with a total of 3486 primary cutaneous melanomas from Australia, USA, Italy and Canada were selected from the Genes, Environment, and Melanoma Study Group. 8% of melanomas were amelanotic and the median follow-up time was 7.6 years. Melanomas with increased AJCC tumor stage were more likely to be amelanotic; the OR for stage T4b as compared to T1a was 29.1 (95% CI 15.5-54.9, P value <.001). Although there were increased death from melanoma in amelanotic melanoma as compared to pigmented melanomas (HR 2.0, 95% CI: 1.4-3.0), this difference was mitigated once AJCC tumor stage was accounted for. Other features associated with amelanotic melanoma were female sex, nodular subtype, increased Breslow thickness, presence of mitoses, solar elastosis, and lack of co-existing nevi (p<0.05). The independently aggressive histologic features associated with amelanotic melanoma suggest that apart from merely the challenge of early-diagnosis, amelanotic melanomas may also be more rapidly growing tumors.

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More from this author: Tech-aided surveillance of patients at high risk for melanoma aids early diagnosis, Indoor tanning linked to high skin cancer risk in US and abroad, Free drug samples may alter prescription habits of dermatologists, Atopic dermatitis may be more persistent than previously understood,

Image: PD

©2012-2014 2minutemedicine.com. All rights reserved. No works may be reproduced without expressed written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors, editors, staff or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. 

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