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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Vázquez-Osorio, M. Espasandín-Arias, J. García-Gavín, V. Fernández-Redondo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Vázquez-Osorio" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Espasandín-Arias" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "García-Gavín" ] 3 => array:2 [ "nombre" => "V." "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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| 2020 Mayo | 19 | 19 | 38 |
| 2020 Abril | 29 | 8 | 37 |
| 2020 Marzo | 30 | 15 | 45 |
| 2020 Febrero | 4 | 5 | 9 |
| 2020 Enero | 4 | 4 | 8 |
| 2019 Diciembre | 4 | 1 | 5 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 0 | 4 |
| 2019 Agosto | 4 | 8 | 12 |
| 2019 Julio | 2 | 3 | 5 |
| 2019 Junio | 4 | 14 | 18 |
| 2019 Mayo | 1 | 7 | 8 |
| 2019 Abril | 0 | 4 | 4 |
| 2019 Marzo | 0 | 7 | 7 |
| 2019 Febrero | 0 | 3 | 3 |
| 2019 Enero | 0 | 3 | 3 |
| 2018 Diciembre | 0 | 7 | 7 |
| 2018 Noviembre | 2 | 0 | 2 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Marzo | 1 | 0 | 1 |
| 2018 Febrero | 31 | 2 | 33 |
| 2018 Enero | 38 | 6 | 44 |
| 2017 Diciembre | 33 | 6 | 39 |
| 2017 Noviembre | 29 | 3 | 32 |
| 2017 Octubre | 20 | 1 | 21 |
| 2017 Septiembre | 34 | 11 | 45 |
| 2017 Agosto | 46 | 7 | 53 |
| 2017 Julio | 53 | 14 | 67 |
| 2017 Junio | 52 | 18 | 70 |
| 2017 Mayo | 40 | 7 | 47 |
| 2017 Abril | 33 | 9 | 42 |
| 2017 Marzo | 30 | 21 | 51 |
| 2017 Febrero | 16 | 9 | 25 |
| 2017 Enero | 14 | 5 | 19 |
| 2016 Diciembre | 34 | 8 | 42 |
| 2016 Noviembre | 42 | 2 | 44 |
| 2016 Octubre | 39 | 11 | 50 |
| 2016 Septiembre | 35 | 11 | 46 |
| 2016 Agosto | 35 | 6 | 41 |
| 2016 Julio | 21 | 4 | 25 |
| 2016 Junio | 13 | 3 | 16 |
| 2016 Mayo | 9 | 3 | 12 |
| 2016 Abril | 4 | 6 | 10 |
| 2016 Marzo | 6 | 19 | 25 |
| 2016 Febrero | 12 | 10 | 22 |
| 2016 Enero | 5 | 10 | 15 |
| 2015 Diciembre | 5 | 9 | 14 |
| 2015 Noviembre | 4 | 10 | 14 |
| 2015 Octubre | 3 | 6 | 9 |
| 2015 Septiembre | 7 | 1 | 8 |
| 2015 Agosto | 8 | 5 | 13 |
| 2015 Julio | 27 | 1 | 28 |
| 2015 Junio | 22 | 5 | 27 |
| 2015 Mayo | 32 | 21 | 53 |
| 2015 Abril | 21 | 9 | 30 |
| 2015 Marzo | 15 | 3 | 18 |
| 2015 Febrero | 15 | 3 | 18 |
| 2015 Enero | 10 | 3 | 13 |
| 2014 Diciembre | 14 | 7 | 21 |
| 2014 Noviembre | 14 | 12 | 26 |
| 2014 Octubre | 16 | 13 | 29 |
| 2014 Septiembre | 10 | 9 | 19 |
| 2014 Agosto | 6 | 7 | 13 |
| 2014 Julio | 4 | 8 | 12 |
| 2014 Junio | 12 | 5 | 17 |
| 2014 Mayo | 10 | 6 | 16 |
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