Letter to the Editor
Stage IIIC Solitary Dermal Melanoma
Melanoma dérmico solitario y estadio IIIC
E. Piqué-Duran
Sección de Dermatología, Hospital Doctor José Molina Orosa, Arrecife, Lanzarote, Las Palmas, Spain
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"apellidos" => "Fernández-Redondo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0001731013002597" "doi" => "10.1016/j.ad.2013.04.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731013002597?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014001061?idApp=UINPBA000044" "url" => "/15782190/0000010500000004/v1_201404301027/S1578219014001061/v1_201404301027/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Stage IIIC Solitary Dermal Melanoma" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor</span>:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "434" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "E. Piqué-Duran" "autores" => array:1 [ 0 => array:3 [ "nombre" => "E." "apellidos" => "Piqué-Duran" "email" => array:1 [ 0 => "epiqued@medynet.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Dermatología, Hospital Doctor José Molina Orosa, Arrecife, Lanzarote, Las Palmas, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Melanoma dérmico solitario y estadio IIIC" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I read with interest the excellent article about primary dermal melanoma that was recently published in your journal.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While the authors did not specify the stage of the melanoma case they reported, they seemed to imply that it was stage IV.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The pathogenesis of tumors such as the one described, however, is not clear. There are several mutually nonexclusive hypotheses that can explain the presence of a single melanoma nodule in the dermis. Because not all the hypotheses involve a primary dermal origin, a more correct term for such a nodule would be <span class="elsevierStyleItalic">solitary dermal melanoma</span> (SDM).</p><p id="par0015" class="elsevierStylePara elsevierViewall">SDM could originate from a primary tumor with a completely regressed junctional component, an intradermal melanocytic nevus,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> or a dermal melanocytosis.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It might also be derived from a melanocytic cell that was trapped in the dermis during embryogenesis, or from melanocytes associated with appendageal structures.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In all these cases, the tumor would be considered localized melanoma (T1-4). The nodule, however, could also be a metastasis, in which case it would be classified as M1a if it were a distant metastasis or as N2c if it were an in-transit metastasis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The above reflections simply mean that different stages will be assigned depending on how the tumor is considered (presuming that staging studies have not detected disease at other sites). In the cases of localized melanoma described above (T1-4a, as SDM will never be ulcerated), the tumor could be assigned a stage as high as IIB if it exceeds a depth of 4<span class="elsevierStyleHsp" style=""></span>mm, while it would be categorized as stage IV or stage IIIB if it were considered a distant or in-transit metastasis, respectively. Clearly, as shown by the literature, the assignment of one stage or another has a very important bearing on treatment, which can range from excision of the melanoma<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> to chemotherapy.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless, the above reflections are not what prompted me to write this letter, but rather the fact that the Final Version of the 2009 American Joint Committee on Cancer Melanoma Staging and Classification<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> specifies that single dermal nodules should be considered regional. In other words, they should be classified as N2c (stage IIIB). According to this classification, a stage III melanoma with T1-4 N2c M0 would have a 5-year survival rate of 69%, which is similar to the rate of 66% reported by Lee et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in the largest series of SDM published to date.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although what I propose is probably not the best solution, until we have a better understanding of the pathogenesis of SDM or are able to identify the origin of each tumor, I think that single melanoma nodules in the dermis should be considered regional, classified as N2c, and called SDM.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Piqué-Duran E. Melanoma dérmico solitario y estadio IIIC. Actas Dermosifiliogr. 2014;105:433–434.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Melanoma dérmico primario: presentación de un caso y revisión de la literatura" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. González-de Arriba" 1 => "M.T. Bordel-Gómez" 2 => "J.C. Solera" 3 => "J. 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| 2019 September | 4 | 0 | 4 |
| 2019 August | 4 | 8 | 12 |
| 2019 July | 2 | 3 | 5 |
| 2019 June | 4 | 14 | 18 |
| 2019 May | 1 | 7 | 8 |
| 2019 April | 0 | 4 | 4 |
| 2019 March | 0 | 7 | 7 |
| 2019 February | 0 | 3 | 3 |
| 2019 January | 0 | 3 | 3 |
| 2018 December | 0 | 7 | 7 |
| 2018 November | 2 | 0 | 2 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 2 | 0 | 2 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 31 | 2 | 33 |
| 2018 January | 38 | 6 | 44 |
| 2017 December | 33 | 6 | 39 |
| 2017 November | 29 | 3 | 32 |
| 2017 October | 20 | 1 | 21 |
| 2017 September | 34 | 11 | 45 |
| 2017 August | 46 | 7 | 53 |
| 2017 July | 53 | 14 | 67 |
| 2017 June | 52 | 18 | 70 |
| 2017 May | 40 | 7 | 47 |
| 2017 April | 33 | 9 | 42 |
| 2017 March | 30 | 21 | 51 |
| 2017 February | 16 | 9 | 25 |
| 2017 January | 14 | 5 | 19 |
| 2016 December | 34 | 8 | 42 |
| 2016 November | 42 | 2 | 44 |
| 2016 October | 39 | 11 | 50 |
| 2016 September | 35 | 11 | 46 |
| 2016 August | 35 | 6 | 41 |
| 2016 July | 21 | 4 | 25 |
| 2016 June | 13 | 3 | 16 |
| 2016 May | 9 | 3 | 12 |
| 2016 April | 4 | 6 | 10 |
| 2016 March | 6 | 19 | 25 |
| 2016 February | 12 | 10 | 22 |
| 2016 January | 5 | 10 | 15 |
| 2015 December | 5 | 9 | 14 |
| 2015 November | 4 | 10 | 14 |
| 2015 October | 3 | 6 | 9 |
| 2015 September | 7 | 1 | 8 |
| 2015 August | 8 | 5 | 13 |
| 2015 July | 27 | 1 | 28 |
| 2015 June | 22 | 5 | 27 |
| 2015 May | 32 | 21 | 53 |
| 2015 April | 21 | 9 | 30 |
| 2015 March | 15 | 3 | 18 |
| 2015 February | 15 | 3 | 18 |
| 2015 January | 10 | 3 | 13 |
| 2014 December | 14 | 7 | 21 |
| 2014 November | 14 | 12 | 26 |
| 2014 October | 16 | 13 | 29 |
| 2014 September | 10 | 9 | 19 |
| 2014 August | 6 | 7 | 13 |
| 2014 July | 4 | 8 | 12 |
| 2014 June | 12 | 5 | 17 |
| 2014 May | 10 | 6 | 16 |
Show all
