Chonnam Med J.  2016 Sep;52(3):185-193. 10.4068/cmj.2016.52.3.185.

Cutaneous Melanoma in Asians

Affiliations
  • 1Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea. sjyun@chonnam.ac.kr

Abstract

Malignant melanoma is a rare disease in Asians but potentially the most aggressive form of skin cancer worldwide. It can occur in any melanocyte-containing anatomic site. Four main cutaneous melanoma subtypes are recognized: lentigo maligna melanoma, superficial spreading melanoma, acral lentiginous melanoma (ALM), and nodular melanoma. Generally, excessive exposure to ultraviolet (UV) radiation increases the risk of melanoma. The exception is ALM, which is the most common melanoma subtype in Asians and is not associated with UV radiation. ALM presents as dark brownish to black, irregular maculopatches, nodules, or ulcers on the palms, soles, and nails. The lesions may be misdiagnosed as more benign lesions, such as warts, ulcers, hematomas, foreign bodies, or fungal infections, especially in amelanotic acral melanomas where black pigments are absent. The aim of this brief review is to improve understanding and the rate of early detection thereby reducing mortality, especially regarding cutaneous melanoma in Asians.

Keyword

Melanoma, Cutaneous Malignant; Hutchinson's Melanotic Freckle; Nails; Melanoma

MeSH Terms

Asian Continental Ancestry Group*
Foreign Bodies
Hematoma
Humans
Hutchinson's Melanotic Freckle
Melanoma*
Mortality
Rare Diseases
Skin Neoplasms
Ulcer
Warts

Figure

  • FIG. 1 Histopathologic features of cutaneous melanoma. Lentigo maligna melanoma is characterized by (A) lentiginous proliferation of atypical cells along the basal layer of flattened epidermis and marked solar elastosis in the dermis (H&E, ×100), and (B) proliferated along the hair follicles (H&E, ×100). (C) Superficial spreading melanoma show many pagetoid spread of epithelioid cells in the epidermis (H&E, ×100). (D) Nodular melanoma reveal deep nodular vertical growth of melanoma cells in the dermis without radial growth phase (H&E, ×40).

  • FIG. 2 Acral lentiginous melanoma. (A) Black irregular large patch on the left sole. (B) Brownish to black irregular patch on the left forefoot.

  • FIG. 3 Hutchinson's nail sign. Black pigmented patch spreading onto the skin beyond the nail folds on the left great toenail.

  • FIG. 4 Histopathologic findings of acral lentiginous melanoma. (A) In the very early stages of melanoma in situ, there are only scattered single cell proliferation of hyperchromatic cells surrounded by a clear halo along the basal layer (H&E, ×100). (B) Over time, melanoma cells are continuously proliferated along the dermo-epidermal junction and invade into the dermis (H&E, ×100). (C) HMB45 immunostain reveals spindle cells with prominent dendrites in melanoma in situ (original magnification, ×100). (D) There are invading mixed cell types of heavily pigmented epithelioid and spindle cells (H&E, ×40).

  • FIG. 5 Amelanotic acral melanoma. (A) Ulcerative patch without black pigment on the left heel. (B) Subungual erythematous nodule without black pigment on the left thumbnail.

  • FIG. 6 Dermoscopic features of acral melanocytic lesions. Acral melanoma showing (A) small black papule on the right sole, and (B) parallel ridge pattern on dermoscopy. Acral melanocytic nevus showing (C) small black macule on the left palm, and (D) parallel furrow pattern on dermoscopy.


Cited by  4 articles

Clinicopathologic Features and Prognostic Factors of Primary Cutaneous Melanoma: a Multicenter Study in Korea
Jung Eun Kim, Bo Young Chung, Chang Yoon Sim, A Young Park, Jong Suk Lee, Kyu Uang Whang, Young Lip Park, Hye One Kim, Chun Wook Park, Sung Yul Lee
J Korean Med Sci. 2019;34(16):.    doi: 10.3346/jkms.2019.34.e126.

Clinical Application of the Unifying Concept of Cutaneous Melanoma
Luca Roncati, Francesco Piscioli, Teresa Pusiol
Chonnam Med J. 2017;53(1):78-80.    doi: 10.4068/cmj.2017.53.1.78.

Pathogenesis and prevention of skin cancer
Byung-Ho Oh
J Korean Med Assoc. 2018;61(11):644-648.    doi: 10.5124/jkma.2018.61.11.644.

Sensitivity and Usefulness of VE1 Immunohistochemical Staining in Acral Melanomas with BRAF Mutation
Min Song Suh, Yoo Duk Choi, Jee-Bum Lee, Seung-Chul Lee, Young Ho Won, Sook Jung Yun
Ann Dermatol. 2018;30(5):556-561.    doi: 10.5021/ad.2018.30.5.556.


Reference

1. Curado MP, Edwards B, Shin HR, Storm H, Ferlay J, Heanue M, et al. Cancer incidence in five continents. Vol. IX. Lyon: IARC Scientific Pubulications;2007.
2. Sneyd M, Cox B. The control of melanoma in New Zealand. N Z Med J. 2006; 119:U2169.
3. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014; 64:9–29.
Article
4. Shoo BA, Kashani-Sabet M. Melanoma arising in African-, Asian-, Latino- and Native-American populations. Semin Cutan Med Surg. 2009; 28:96–102.
Article
5. Bellew S, Del Rosso JQ, Kim GK. Skin cancer in asians: part 2: melanoma. J Clin Aesthet Dermatol. 2009; 2:34–36.
6. Elder DE, Elenitasas R, Murphy GF, Xu X. Benign pigmented lesions and malignant melanoma. In : Elder DE, Elenitasas R, Rosenbach M, Murphy GF, Rubin AI, Xu X, editors. Lever's Histo-Pathology of the Skin. 11th ed. Philadelphia: Wolters Kluwer;2014. p. 853–968.
7. Reed RJ. New concepts in surgical pathology of the skin. New York: Wiley;1976. p. 89–90.
8. Lee MW, Koh JK, Kwon KS, Kim NI, Kim SW, Kim SN, et al. Clinical and histopathological study of cutaneous melanoma in Korea. Korean J Dermatol. 2003; 41:43–47.
9. Jung HJ, Kweon SS, Lee JB, Lee SC, Yun SJ. A clinicopathologic analysis of 177 acral melanomas in Koreans: relevance of spreading pattern and physical stress. JAMA Dermatol. 2013; 149:1281–1288.
Article
10. Yun SJ, Kim SJ. Images in clinical medicine. Hutchinson's nail sign. N Engl J Med. 2011; 364:e38.
11. Soon SL, Solomon AR Jr, Papadopoulos D, Murray DR, McAlpine B, Washington CV. Acral lentiginous melanoma mimicking benign disease: the Emory experience. J Am Acad Dermatol. 2003; 48:183–188.
Article
12. Choi YD, Chun SM, Jin SA, Lee JB, Yun SJ. Amelanotic acral melanomas: clinicopathological, BRAF mutation, and KIT aberration analyses. J Am Acad Dermatol. 2013; 69:700–707.
Article
13. Park SL, Le Marchand L, Wilkens LR, Kolonel LN, Henderson BE, Zhang ZF, et al. Risk factors for malignant melanoma in white and non-white/non-African American populations: the multiethnic cohort. Cancer Prev Res (Phila). 2012; 5:423–434.
Article
14. Yun SJ, Kwon OS, Han JH, Kweon SS, Lee MW, Lee DY, et al. Clinical characteristics and risk of melanoma development from giant congenital melanocytic naevi in Korea: a nationwide retrospective study. Br J Dermatol. 2012; 166:115–123.
Article
15. Elwood JM, Jopson J. Melanoma and sun exposure: an overview of published studies. Int J Cancer. 1997; 73:198–203.
Article
16. Tadokoro T, Kobayashi N, Zmudzka BZ, Ito S, Wakamatsu K, Yamaguchi Y, et al. UV-induced DNA damage and melanin content in human skin differing in racial/ethnic origin. FASEB J. 2003; 17:1177–1179.
Article
17. Sheehan JM, Cragg N, Chadwick CA, Potten CS, Young AR. Repeated ultraviolet exposure affords the same protection against DNA photodamage and erythema in human skin types II and IV but is associated with faster DNA repair in skin type IV. J Invest Dermatol. 2002; 118:825–829.
Article
18. Eide MJ, Weinstock MA. Association of UV index, latitude, and melanoma incidence in nonwhite populations--US Surveillance, Epidemiology, and End Results (SEER) Program, 1992 to 2001. Arch Dermatol. 2005; 141:477–481.
Article
19. Veierød MB, Weiderpass E, Thörn M, Hansson J, Lund E, Armstrong B, et al. A prospective study of pigmentation, sun exposure, and risk of cutaneous malignant melanoma in women. J Natl Cancer Inst. 2003; 95:1530–1538.
Article
20. Holly EA, Aston DA, Cress RD, Ahn DK, Kristiansen JJ. Cutaneous melanoma in women. II. Phenotypic characteristics and other host-related factors. Am J Epidemiol. 1995; 141:934–942.
Article
21. Garbe C, Büttner P, Weiss J, Soyer HP, Stocker U, Krüger S, et al. Associated factors in the prevalence of more than 50 common melanocytic nevi, atypical melanocytic nevi, and actinic lentigines: multicenter case-control study of the Central Malignant Melanoma Registry of the German Dermatological Society. J Invest Dermatol. 1994; 102:700–705.
Article
22. Tucker MA, Halpern A, Holly EA, Hartge P, Elder DE, Sagebiel RW, et al. Clinically recognized dysplastic nevi. A central risk factor for cutaneous melanoma. JAMA. 1997; 277:1439–1444.
Article
23. Curtin JA, Fridlyand J, Kageshita T, Patel HN, Busam KJ, Kutzner H, et al. Distinct sets of genetic alterations in melanoma. N Engl J Med. 2005; 353:2135–2147.
Article
24. Curtin JA, Busam K, Pinkel D, Bastian BC. Somatic activation of KIT in distinct subtypes of melanoma. J Clin Oncol. 2006; 24:4340–4346.
Article
25. Kong Y, Si L, Zhu Y, Xu X, Corless CL, Flaherty KT, et al. Large-scale analysis of KIT aberrations in Chinese patients with melanoma. Clin Cancer Res. 2011; 17:1684–1691.
Article
26. Ashida A, Takata M, Murata H, Kido K, Saida T. Pathological activation of KIT in metastatic tumors of acral and mucosal melanomas. Int J Cancer. 2009; 124:862–868.
Article
27. Jin SA, Chun SM, Choi YD, Kweon SS, Jung ST, Shim HJ, et al. BRAF mutations and KIT aberrations and their clinicopathological correlation in 202 Korean melanomas. J Invest Dermatol. 2013; 133:579–582.
Article
28. Nagore E, Oliver V, Moreno-Picot S, Fortea JM. Primary cutaneous melanoma in hidden sites is associated with thicker tumours - a study of 829 patients. Eur J Cancer. 2001; 37:79–82.
Article
29. Weinstock MA. Cutaneous melanoma: public health approach to early detection. Dermatol Ther. 2006; 19:26–31.
Article
30. Saida T, Koga H, Uhara H. Key points in dermoscopic differentiation between early acral melanoma and acral nevus. J Dermatol. 2011; 38:25–34.
Article
31. Kim YC, Lee MG, Choe SW, Lee MC, Chung HG, Cho SH. Acral lentiginous melanoma: an immunohistochemical study of 20 cases. Int J Dermatol. 2003; 42:123–129.
Article
32. Balch CM, Gershenwald JE, Soong SJ, Thompson JF, Atkins MB, Byrd DR, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009; 27:6199–6206.
Article
33. Tsao H, Atkins MB, Sober AJ. Management of cutaneous melanoma. N Engl J Med. 2004; 351:998–1012.
Article
34. Khayat D, Rixe O, Martin G, Soubrane C, Banzet M, Bazex JA, et al. Surgical margins in cutaneous melanoma (2 cm versus 5 cm for lesions measuring less than 2.1-mm thick). Cancer. 2003; 97:1941–1946.
Article
35. Krown SE, Chapman PB. Defining adequate surgery for primary melanoma. N Engl J Med. 2004; 350:823–825.
Article
36. Veronesi U, Cascinelli N. Narrow excision (1-cm margin). A safe procedure for thin cutaneous melanoma. Arch Surg. 1991; 126:438–441.
37. Morton DL, Cochran AJ, Thompson JF, Elashoff R, Essner R, Glass EC, et al. Sentinel node biopsy for early-stage melanoma: accuracy and morbidity in MSLT-I, an international multicenter trial. Ann Surg. 2005; 242:302–311. discussion 311-3.
38. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Elashoff R, Essner R, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med. 2006; 355:1307–1317.
Article
39. Sabel MS, Griffith K, Sondak VK, Lowe L, Schwartz JL, Cimmino VM, et al. Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma. J Am Coll Surg. 2005; 201:37–47.
Article
40. Chang AE, Karnell LH, Menck HR. The National Cancer Data Base report on cutaneous and noncutaneous melanoma: a summary of 84,836 cases from the past decade. The American College of Surgeons Commission on Cancer and the American Cancer Society. Cancer. 1998; 83:1664–1678.
Article
41. Chang JW, Yeh KY, Wang CH, Yang TS, Chiang HF, Wei FC, et al. Malignant melanoma in Taiwan: a prognostic study of 181 cases. Melanoma Res. 2004; 14:537–541.
Article
42. Kirkwood JM, Ibrahim JG, Sondak VK, Richards J, Flaherty LE, Ernstoff MS, et al. High- and low-dose interferon alfa-2b in high-risk melanoma: first analysis of intergroup trial E1690/S9111/C9190. J Clin Oncol. 2000; 18:2444–2458.
Article
43. Acquavella N, Kluger H, Rhee J, Farber L, Tara H, Ariyan S, et al. Toxicity and activity of a twice daily high-dose bolus interleukin 2 regimen in patients with metastatic melanoma and metastatic renal cell cancer. J Immunother. 2008; 31:569–576.
Article
44. Kilbridge KL, Weeks JC, Sober AJ, Haluska FG, Slingluff CL, Atkins MB, et al. Patient preferences for adjuvant interferon alfa-2b treatment. J Clin Oncol. 2001; 19:812–823.
Article
45. Treisman J, Garlie N. Systemic therapy for cutaneous melanoma. Clin Plast Surg. 2010; 37:127–146.
46. Del Prete SA, Maurer LH, O'Donnell J, Forcier RJ, LeMarbre P. Combination chemotherapy with cisplatin, carmustine, dacarbazine, and tamoxifen in metastatic melanoma. Cancer Treat Rep. 1984; 68:1403–1405.
47. Legha SS, Ring S, Papadopoulos N, Plager C, Chawla S, Benjamin R. A prospective evaluation of a triple-drug regimen containing cisplatin, vinblastine, and dacarbazine (CVD) for metastatic melanoma. Cancer. 1989; 64:2024–2029.
Article
48. Hofmann M, Kiecker F, Wurm R, Schlenger L, Budach V, Sterry W, et al. Temozolomide with or without radiotherapy in melanoma with unresectable brain metastases. J Neurooncol. 2006; 76:59–64.
Article
49. Carvajal RD, Antonescu CR, Wolchok JD, Chapman PB, Roman RA, Teitcher J, et al. KIT as a therapeutic target in metastatic melanoma. JAMA. 2011; 305:2327–2334.
Article
50. Niezgoda A, Niezgoda P, Czajkowski R. Novel approaches to treatment of advanced melanoma: a review on targeted therapy and immunotherapy. Biomed Res Int. 2015; 2015:851387.
Article
Full Text Links
  • CMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr