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Disponible online el 20 de septiembre de 2024
Mutational Study Through Massive Sequencing of 12 Desmoplastic Melanomas and Clinical and Histopathological Features
Estudio mutacional por secuenciación masiva de 12 melanomas desmoplásicos y características clínicas e histopatológicas
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A. Casanova-Esquembrea,
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avonasac.94@hotmail.com

Corresponding author.
, J. Lorca-Spröhnlea, J.Á. García-Garcíab, G. Pérez-Pastora
a Dermatology Department, Hospital General Universitario de Valencia, Spain
b Pathological Anatomy Department, Hospital General Universitario de Valencia, Spain
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A. Casanova-Esquembre, J. Lorca-Spröhnle, J.Á. García-García, G. Pérez-Pastor
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Table 1. Clinical and histopathological characteristics of patients diagnosed with DM.
Table 2. Subtype, Breslow thickness and mutations of DM tumors.
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To the Editor,

Desmoplastic melanoma (DM) is a rare subtype of melanoma that affects patients older than 70 years with intense sun damage. DM shows a good response to immunotherapy and is characterized by a high mutation rate.1–3

We studied a total of 12 cases of DM and analyzed the clinical and histopathological variables. Mutational studies were performed through massive sequencing of all tumours. DNA and RNA were amplified with the Oncomine Precision Panel – GX5 – Solid Tumour w2.6.0 DNA and Fusion Panel (Thermo Fisher Scientific), generating a library and including amplicons for the study of mutations and INDELs in the hotspot regions of 45 genes, copy number variations in 14 genes, and fusions in 18 genes. Sequencing was analyzed on the Genexus System platform.

A total of 12 patients (8♂:4♀) with a median age 70 years and diagnosed with DM were studied. The most common presentation was nodules on the scalp (5 cases, 41.6%), with other common presentations being nodules on the cheek, arms, nose and ear (Fig. 1). Histopathologically, eight pure and four mixed cases were found, being the median Breslow thickness, 7.3mm, with no significant differences being reported between pure and mixed cases. Only 25% of the cases (3 cases) were pigmented, 50% (6 cases) presented neurotropism, and all cases lymphoid aggregates. Patient staging (computed tomography) turned out negative in all patients at diagnosis except for one patient, 16% (2 cases) showed positive sentinel lymph nodes, all of which were of the mixed subtype, and 25% (3 cases) had local recurrences. A total of 75% (6 cases) of all pure DMs were stage IIB, and 25% (2 cases), stage IV. A total of 50% (2 cases) of all mixed DMs were stage IIB, and the remaining 50% (2 cases), stages III and IV. Systemic therapy with anti-PD-L1 and/or anti-CTLA4 was started in 41% of the patients (5 patients), with excellent responses in all them (Table 1). No patient has died due to melanoma to this date. Twenty-five mutations were found in 13 different genes – 21 were somatic mutations – and four copy number variations with amplifications. The most widely mutated gene was the TP53, found in 50% (6 cases) of all DMs. Mutations in the EGFR, IDH1 and RET genes were the next most widely found in 16% (2 cases) of all DMs reported. Other mutations found were in the ALK, MET, CTNNB1, CD274/PD-L1, FGFR 1 and 3 genes. Only one case of DM exhibited the mutated BRAF gene, while no mutated gene was ever found in three DMs (Table 2). Not differences were found in Breslow thickness or in pure or mixed DM cases with mutations in TP53 vs the remaining cases of DMs.

Figure 1.

Images of different forms of desmoplastic melanomas from our series showing clinical differences vs non-desmoplastic melanomas.

(0.45MB).
Table 1.

Clinical and histopathological characteristics of patients diagnosed with DM.

Case  Age/sex  Clinic  Pigmented  Neurotropism  Lymphoid aggregates  Extension study (CT)  Sentinel lymph node  Local recurrence  Inmunotherapy 
66Male  Scalp nodule  No  No  Yes  Negative  Negative  Yes  IpilimumabNivolumab 
64Male  Scalp nodule  No  No  Yes  Negative  Negative  No  No 
89Female  Cheek plaque  Yes  Yes  Yes  Negative  Negative  No  No 
27Female  Nose nodule  No  Yes  Yes  Negative  Negative  Yes  Nivolumab+Ipilimumab 
95Female  Cheek nodule  No  Yes  Yes  Negative  Negative  No  No 
70Male  Arm nodule  Yes  No  Yes  Negative  Positive  No  Nivolumab 
79Female  Scalp nodule  No  No  Yes  Negative  Positive  Yes  Nivolumab 
92Male  Scalp nodule  No  Yes  Yes  Negative  Negative  No  No 
87Male  Scalp nodule  No  No  Yes  Negative  Negative  No  No 
10  80Male  Cheek nodule  No  No  Yes  Negative  Negative  No  No 
11  42Male  Back nodule  Yes  Yes  Yes  Positive  Unrealized  No  Nivolumab 
12  68Male  Ear nodule  No  Yes  Yes  Negative  Negative  No  No 
Table 2.

Subtype, Breslow thickness and mutations of DM tumors.

Case  DM type  Breslow (mm)  Mutated gene  Type  Chr  Exon  Mutation: amino acid change  Ratio 
Pure  25  RET  Somatic  10    c.2428G>A; p.(Gly810Ser)   
2Pure5FGFR1  Somatic    c.1774G>A; p.(Val592Met)   
RET  Somatic  10    c.1894G>A; p.(Glu632Lys)   
TP53  Somatic  17  c.637C>T; p.(Arg213Ter)   
ALK  Copy number variation      Amplification: 1.29 
ERBB2  Copy number variation  17      Amplification: 1.23 
3Mixed3.7TP53  Somatic  17  c.842A>G; p.(Asp281Gly)   
MET  Somatic  17    c.2962C>T; p.(Arg988Cys)   
EGFR  Copy number variation      Amplification: 4.46 
Pure  1.5  None           
Pure  10  None           
6Mixed7BRAF  Somatic    c.1798_1799delGTinsAA; p.(V600K)   
IDH1  Somatic    c.394C>T; p.(R132C)   
CTNNB1  Somatic    c.109T>C; p.(S37P)   
Mixed  8.6  none           
8Mixed7.3FGFR3  Somatic    15  c.1922A>C; p.(Asp641Ala)   
ROS1  Somatic  36  c.5845C>T; p.(Leu1949Phe)   
TP53  Somatic  17  c.722C>T; p.(Ser241Phe)   
Pure  17  TP53  Somatic  17  c.733G>A; p.(Gly245Ser)   
10Pure15TP53  Somatic  17    c.809T>G; p.(Phe270Cys)   
TP53  Somatic  17  c.817C>T; p.(Arg273Cys)   
EGFR  Somatic  c.2305G>A; p.(Val769Met)   
11  Pure  13  IDH1  Somatic    c.394C>T; p.(Arg132Cys)   
12Mixed5.2TP53  Somatic  17  c.395A>T; p.(Lys132Met)   
CD274/PD-L1  Copy number variation      Amplification: 1.61 

RET: ret proto-oncogene; FGFR: fibroblast growth factor receptor; TP53: tumor protein p53; ALK: anaplastic lymphoma kinase; ERBB2: erythroblastic oncogene B2; MET: MET proto-oncogene, receptor tyrosine kinase; EGFR: epidermal growth factor receptor; BRAF: B-Raf proto-oncogene, serine/threonine kinase; IDH1: isocitrate dehydrogenase (NADP (+)) 1; CTNNB1: β-catenin 1; ROS1: ROS proto-oncogene 1, receptor tyrosine kinase; CD274/PD-L1: programmed cell death 1 ligand.

The diagnosis of DM can be complicated as they are usually nonspecific lesions. Frequent locations are photoexposed regions with sun damage, which happen to be strongly associated with UV radiation. Lymphoid aggregates and perineural invasion are common histopathological findings in DM,4,5 which is a subtype of melanoma with a high mutation rate. In our study, the most widely mutated gene was the TP53 without correlation with Breslow thickness or the DM subtype. The TP53 mutation is associated with cumulative sun damage. Similar results have been obtained in other studies, where the most common mutation found in DM was TP53. However, in other studies, the most widely identified mutation was in the NF1 gene.6 In our panel of studied genes, the NF1 gene was not included, which accounts for a limitation of our results. In contrast, the BRAF mutation is rare in this subtype of melanoma.7,8 DMs have a good response to immunotherapy (anti PD-L1/anti-CTLA4) and prognosis looks good.9,10

Conflict of interest

The authors declare that they have no conflict of interest.

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