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Calculated Tumor Area and Breslow Density: Two New Prognostic Features in the Staging of Melanoma
FR -Área tumoral calculada y densidad de Breslow, dos nuevos parámetros pronósticos en la evaluación histológica del melanoma
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B)<span class="elsevierStyleHsp" style=""></span>Área tumoral calculada (ATC). En la zona de medición del IB se proyecta una caja que incluya la totalidad del melanoma invasor y se estima el porcentaje ocupado por células invasoras. Luego se mide la altura y el ancho de la caja (mm) a partir del diámetro de las lentes del objetivo del microscopio. Se calcula la ATC mediante la fórmula: altura ×<span class="elsevierStyleHsp" style=""></span>ancho ×<span class="elsevierStyleHsp" style=""></span>proporción. Por ejemplo, si el objetivo mide 5<span class="elsevierStyleHsp" style=""></span>mm y la caja (como en la figura) mide 3 objetivos de alto y 4 objetivos de ancho, y la proporción del área ocupada por células tumorales es del 20%, la ATC sería: 15 ×<span class="elsevierStyleHsp" style=""></span>20 ×<span class="elsevierStyleHsp" style=""></span>20/100<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>60<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>. C)<span class="elsevierStyleHsp" style=""></span>Densidad de Breslow. Con el aumento ×10 se proyecta una ventana en la zona de medición del IB; límite inferior: célula de melanoma más profunda, límite superior: membrana basal, y ancho dado por el campo de aumento ×10; mover horizontalmente la ventana hasta encontrar el área de mayor densidad del melanoma dérmico sin perder la célula más profunda; calcular el porcentaje del estroma dérmico ocupado por células de melanoma con una precisión del 5% (en puntuaciones <<span class="elsevierStyleHsp" style=""></span>5% o ><span class="elsevierStyleHsp" style=""></span>95% calcular el área con una precisión del 1%).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "X. Bosch-Amate, P. Vargas-Mora, D. Morgado-Carrasco" "autores" => array:3 [ 0 => array:2 [ "nombre" => "X." "apellidos" => "Bosch-Amate" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Vargas-Mora" ] 2 => array:2 [ "nombre" => "D." 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Bosch-Amate, P. Vargas-Mora, D. Morgado-Carrasco" "autores" => array:3 [ 0 => array:3 [ "nombre" => "X." "apellidos" => "Bosch-Amate" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "P." "apellidos" => "Vargas-Mora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "D." "apellidos" => "Morgado-Carrasco" "email" => array:1 [ 0 => "danielmorgado@yahoo.com.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Dermatología, Facultad de Medicina, Universidad de Chile, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "FR -Área tumoral calculada y densidad de Breslow, dos nuevos parámetros pronósticos en la evaluación histológica del melanoma" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 425 "Ancho" => 1500 "Tamanyo" => 79827 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of Breslow thickness, calculated tumor area, and Breslow density din melanoma.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Breslow thickness, mm. B, Calculated tumor area (CTA). To calculate CTA, construct a box in the Breslow thickness measurement area that includes the entire invasive melanoma and estimate the percentage of the area occupied by invasive cells. Measure the height and width of the box (mm) using the microscope objective lens diameter. The formula for calculating CTA is height × width × proportion. For example, if the objective measures 5 mm, the box (as shown in the Fig.) measures 3 lenses high and 4 lenses wide, and the area occupied by tumor cells is 20%, the CTA would be 15 × 20 × 20/100 = 60 mm<span class="elsevierStyleSup">2</span>. C, Breslow density. To calculate Breslow density, at the ×10 magnification, construct a window in the Breslow measurement area, the bottom of which is limited by the deepest melanoma cell and the top of which is limited by the basement membrane. The width is determined by the width of the magnification field. Horizontally move the window to the area of the dermis with the highest density of melanoma, whilst keeping the deepest melanoma cell within the window. The proportion of the dermis occupied by melanoma cells is expressed with a precision of 5% (for scores < 5% or > 95%, use a precision of 1%).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Breslow thickness (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) is one of the main prognostic factors in cutaneous melanoma and forms the basis of the American Joint Committee on Cancer (AJCC) TNM staging system. Although newly developed molecular assays are available for establishing prognosis in melanoma, their use is limited by their high cost. Histology thus remains the cornerstone for prognostic assessment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">It has been proposed that tumor volume may have greater prognostic relevance than Breslow thickness in melanoma.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In a recent publication, Saldanha et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> described the results of a retrospective study of 1239 patients with primary cutaneous melanoma (median Breslow thickness, 0.9  mm; interquartile range, 0.5-2 mm) and analyzed the prognostic value of calculated tumor area (CTA). CTA is a 2-dimensional measurement of the area occupied by melanoma in the area of maximum invasion (where Breslow thickness is measured) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The measurements were obtained using conventional hematoxylin-eosin–stained sections and took less than 1 minute in most cases. Interobserver agreement (intraclass correlation coefficient) was 0.99, indicating almost perfect agreement. Cox proportional hazards regression showed superior prognostic performance for CTA compared with Breslow thickness (hazard ratio, 1.70; 95% CI, 1.43-2.03; <span class="elsevierStyleItalic">P</span> < .001) after adjusting for Breslow thickness, ulceration, age, mitotic count, and microscopic satellites. Melanomas stratified by CTA showed a wider separation of survival curves than those stratified by Breslow thickness based on the criteria in the 8th edition of the AJCC Cancer Staging Manual (AJCC-8). In addition, significant heterogeneity was observed for CTA in lesions with the same T classification, suggesting that CTA subgrouping might result in improved prognostic accuracy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Saldanha et al.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> had previously assessed the prognostic value of Breslow density in melanoma. In a retrospective series of 970 cases of melanoma with a median Breslow thickness of 0.9 mm, they used conventional histologic sections to estimate the proportion of the dermis occupied by tumor cells in a 2-mm area in which Breslow thickness had been measured (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). Median Breslow density was 60% (interquartile range, 15%-85%). After adjusting for conventional prognostic factors, the authors found that Breslow density was a significant predictor of overall survival, metastasis-free survival, and melanoma-specific survival. It also explained melanoma-specific survival better than Breslow thickness, and its explanatory capacity was even higher when Breslow thickness and density were combined. High Breslow density (> 65%) upstaged the AJCC-8 T category from “a” to “b” in 27% of cases, showing its potential as an additional staging factor.</p><p id="par0020" class="elsevierStylePara elsevierViewall">CTA and Breslow density are noteworthy for their simplicity and reproducibility. They may be potentially useful as risk markers in thin melanomas, and could even help select optimal candidates for sentinel lymph node biopsy, although further research is needed. It will be difficult to depart from the paradigm of Breslow thickness, although it is reasonable to assume that 2-dimensional measurements probably provide a better measure of tumor burden and metastatic potential. Digital pathology will soon occupy a prominent place in melanoma staging and could further simplify measurement of CTA and Breslow density.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "xpalclavsec1437806" "titulo" => "Palabras clave" ] 1 => array:2 [ "identificador" => "xpalclavsec1437805" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1437805" "palabras" => array:6 [ 0 => "Melanoma" 1 => "Breslow thickness" 2 => "Biomarker" 3 => "Breslow density" 4 => "Tumor area" 5 => "Prognostic factors" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bosch-Amate X, Vargas-Mora P, Morgado-Carrasco D. FR -Área tumoral calculada y densidad de Breslow, dos nuevos parámetros pronósticos en la evaluación histológica del melanoma. Actas Dermosifiliogr. 2021;112:922–923.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 425 "Ancho" => 1500 "Tamanyo" => 79827 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of Breslow thickness, calculated tumor area, and Breslow density din melanoma.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Breslow thickness, mm. B, Calculated tumor area (CTA). To calculate CTA, construct a box in the Breslow thickness measurement area that includes the entire invasive melanoma and estimate the percentage of the area occupied by invasive cells. Measure the height and width of the box (mm) using the microscope objective lens diameter. The formula for calculating CTA is height × width × proportion. For example, if the objective measures 5 mm, the box (as shown in the Fig.) measures 3 lenses high and 4 lenses wide, and the area occupied by tumor cells is 20%, the CTA would be 15 × 20 × 20/100 = 60 mm<span class="elsevierStyleSup">2</span>. C, Breslow density. To calculate Breslow density, at the ×10 magnification, construct a window in the Breslow measurement area, the bottom of which is limited by the deepest melanoma cell and the top of which is limited by the basement membrane. The width is determined by the width of the magnification field. Horizontally move the window to the area of the dermis with the highest density of melanoma, whilst keeping the deepest melanoma cell within the window. The proportion of the dermis occupied by melanoma cells is expressed with a precision of 5% (for scores < 5% or > 95%, use a precision of 1%).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor volume as a prognostic factor in resectable malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Voss" 1 => "S. Wilop" 2 => "S. Jonas" 3 => "M.H.M. el-Komy" 4 => "J. Schaller" 5 => "V. von Felbert" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Dermatology (Basel)" "fecha" => "2014" "volumen" => "228" "paginaInicial" => "66" "paginaFinal" => "70" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development and initial validation of calculated tumor area as a prognostic tool in cutaneous malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Saldanha" 1 => "J. Yarrow" 2 => "S. Elsheikh" 3 => "M. O’Riordan" 4 => "H. Uraiby" 5 => "M. Bamford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamadermatol.2019.0621" "Revista" => array:6 [ "tituloSerie" => "JAMA Dermatol" "fecha" => "2019" "volumen" => "155" "paginaInicial" => "890" "paginaFinal" => "898" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31241720" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Breslow density is a novel prognostic feature in cutaneous malignant melanoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Rashed" 1 => "K. Flatman" 2 => "M. Bamford" 3 => "K.W. Teo" 4 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 4 | 11 |
| 2024 October | 120 | 58 | 178 |
| 2024 September | 118 | 40 | 158 |
| 2024 August | 129 | 69 | 198 |
| 2024 July | 158 | 32 | 190 |
| 2024 June | 105 | 58 | 163 |
| 2024 May | 103 | 30 | 133 |
| 2024 April | 104 | 42 | 146 |
| 2024 March | 115 | 37 | 152 |
| 2024 February | 91 | 41 | 132 |
| 2024 January | 91 | 43 | 134 |
| 2023 December | 91 | 40 | 131 |
| 2023 November | 104 | 44 | 148 |
| 2023 October | 88 | 34 | 122 |
| 2023 September | 75 | 36 | 111 |
| 2023 August | 82 | 15 | 97 |
| 2023 July | 114 | 37 | 151 |
| 2023 June | 85 | 28 | 113 |
| 2023 May | 136 | 26 | 162 |
| 2023 April | 83 | 31 | 114 |
| 2023 March | 83 | 39 | 122 |
| 2023 February | 60 | 26 | 86 |
| 2023 January | 77 | 27 | 104 |
| 2022 December | 79 | 48 | 127 |
| 2022 November | 50 | 39 | 89 |
| 2022 October | 48 | 21 | 69 |
| 2022 September | 47 | 59 | 106 |
| 2022 August | 42 | 46 | 88 |
| 2022 July | 41 | 32 | 73 |
| 2022 June | 35 | 33 | 68 |
| 2022 May | 80 | 52 | 132 |
| 2022 April | 97 | 47 | 144 |
| 2022 March | 110 | 70 | 180 |
| 2022 February | 71 | 41 | 112 |
| 2022 January | 91 | 62 | 153 |
| 2021 December | 77 | 54 | 131 |
| 2021 November | 100 | 57 | 157 |
| 2021 October | 89 | 67 | 156 |
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