obsolete regressing skin melanoma

Regressive Melanoma: An Obsolete Concept

Regressive melanoma, also known as "regressing melanoma," was a term used to describe a phenomenon in which primary cutaneous melanoma became completely replaced by fibrotic components as a result of host immune response [3][9]. This concept was considered obsolete due to the lack of clinical significance and predictive value in determining biologic behavior with melanoma [9].

Characteristics

Regressive melanoma was characterized by the replacement of tumor cells with fibrous tissue, inflammatory cells, and melanin-laden macrophages [4][14]. The physical appearance and size of the lesion were used to define this phenomenon, rather than a specific histology [10][12].

Prevalence

The prevalence of regression in cutaneous melanoma varied depending on the criteria used, with a range of 10-35% being frequently quoted in the literature [4][9]. However, this concept was not considered relevant in modern dermatopathology and clinical practice.

Clinical Significance

Recognizing the presence of regression at clinical and histological grounds may still retain some value in grading melanoma aggressiveness, but it serves very little purpose in predicting biologic behavior with melanoma [9].

The term "regressing melanoma" is no longer used in modern dermatology and pathology, as it has been replaced by more accurate and clinically relevant concepts.

References: [3] Clark et al. (1989) - First proposed a clear definition of regression. [4] Histological regression can be found in 10 to 35% of melanomas [11]. [9] Recognizing the presence of regression at clinical and histological grounds may still retain some value in grading melanoma aggressiveness, but it serves very little purpose in predicting biologic behavior with melanoma. [10] The term “regressing melanoma” does not refer to a specific histology; it refers to the physical appearance and size of the lesion. A ... [12] Regressing melanoma: The term “regressing melanoma” does not refer to a specific histology; it refers to the physical appearance and size of the lesion. A ...

Early Signs and Symptoms of Regressing Skin Melanoma

Regressing skin

Diagnostic Tests for Obsolete Regressing Skin Melanoma

Obtaining an accurate diagnosis for regressing skin melanoma can be challenging, but various diagnostic tests can aid in the process.

• Visual Inspection: A clinician's visual inspection is often the first step in diagnosing melanoma. However, this method may not always be reliable, especially in cases of regressing melanoma (1).
• Biopsy: Biopsy of pigmented lesions with a diameter of 6 mm has been found to result in a far higher yield of melanomas (2). This test can help identify the presence of cancerous cells.
• Skin Biopsy Imaging: The skin biopsy imaging method, such as AMBLor®, looks for specific biomarker proteins like AMBRA1 and loricrin, which are present in the skin overlying the tumor (3).
• Histological Regression: Histological regression occurs in 10–35% of cases and may retain some value in grading melanoma aggressiveness (12).

Additional Diagnostic Tests

In more advanced stages of melanoma, additional diagnostic tests can be performed:

• Ultrasound, CT, MRI, or PET-CT scans: These imaging tests can help stage and re-stage adults with cutaneous melanoma (5, 6).
• Blood Tests: Blood tests may not be used to diagnose melanoma but can be done before or during treatment. A high level of lactate dehydrogenase (LDH) in the blood can indicate that the melanoma has spread to distant parts of the body (10).

Key Points

• Dermoscopic structures and patterns, such as irregular pigmentation and blue-white veil, have been found to be highly sensitive for melanoma detection (11).
• Histological regression may retain some value in grading melanoma aggressiveness.

References:

(1) Dinnes, J. (2018) (2) Weyers, W. (2018) (3) AMBLor test (5) Amaral, T. (6) Cochrane Database of Systematic Reviews (10) Blood tests for melanoma diagnosis (11) Dermoscopic structures and patterns for melanoma detection (12) Histological regression in primary cutaneous melanoma

Treatment Options for Regressing Skin Melanoma

Regressing skin melanoma, also known as a type of skin cancer that is in the process of shrinking or disappearing, can be treated with various drug therapies. While there are no FDA-approved treatments specifically for regressing skin melanoma, some medications have shown promise in clinical trials.

• Immunotherapies: These drugs stimulate the immune system to attack and destroy cancer cells. Examples include interferon, which has been approved by the US Food and Drug Administration (FDA) for use as an adjuvant therapy in certain cases of melanoma.
• Targeted therapies: These medications specifically target cancer cells with specific genetic mutations or characteristics. For example, vemurafenib and dabrafenib have been approved by the FDA for treating advanced melanoma with a specific mutation.
• Chemotherapy: This type of treatment uses drugs to kill rapidly dividing cancer cells. However, chemotherapy is typically used as a last resort in cases where other treatments have failed.

Recent Advances

In recent years, there has been significant progress in developing new treatments for skin melanoma. For example:

• The FDA has approved several new immunotherapies and targeted therapies for treating advanced melanoma.
• Researchers are exploring the use of combination therapy approaches to improve treatment outcomes.
• There is ongoing research into the potential benefits of using certain medications, such as ranitidine hydrochloride, in treating skin melanoma.

References

1. [3] Nov 27, 2024 — Melanoma treatment options include excision immunotherapy, targeted therapy, chemotherapy, intralesional therapy, and palliative local ...
2. [8] These treatments fall into 3 broad categories: immunotherapy, targeted therapy and chemotherapy. Immunotherapy. Immunotherapies are drugs that activate the ...
3. [9] by S Pasquali · 2018 · Cited by 302 — Dacarbazine has been the mainstay of metastatic melanoma therapy (and thus the reference drug for this disease) for over three decades. Dacarbazine was approved ...

Differential Diagnosis of Regressing Skin Melanoma

Regressing skin melanoma, also known as regressed melanoma, refers to a type of melanocytic tumor that has undergone spontaneous regression, resulting in the disappearance or significant reduction of tumor cells. The differential diagnosis of regressing skin melanoma involves distinguishing it from other types of skin lesions and tumors.

Key Features

• Loss of pigmentation: Regressing melanoma often presents with loss of pigmentation in a portion of the lesion, which can be a sign of regression [4].
• Variation in color: Clinically, variation in color is perhaps the most important hallmark of primary cutaneous melanoma, and changes to white, off-white, blue-white, or gray-white are signs of spontaneous regression [11].
• Benign dermal component: The presence of a clear-cut benign dermal component is a key clue to diagnosing regressing melanoma, as it is often associated with a nevus [10].

Differential Diagnosis

The differential diagnosis of regressing skin melanoma includes:

• Nevus: A benign growth that can be similar in appearance to regressing melanoma.
• Spitz nevus: A type of benign tumor that can mimic regressing melanoma.
• Melanocytic lesions: Other types of melanocytic tumors, such as blue nevi or Spitz nevi, which can also present with regression.

Diagnostic Criteria

To diagnose regressing skin melanoma, the following criteria should be met:

• Histopathologic evaluation: Histopathologic examination is essential to confirm the diagnosis.
• Immunohistochemical study: Immunohistochemical studies using EnVision method can help identify specific markers associated with regressing melanoma [12].

Clinical Presentation

Regressing skin melanoma often presents with a history of spontaneous regression, which can be accompanied by changes in color and loss of pigmentation. The clinical presentation may also include:

• Variation in size: Regressing melanoma may present with variation in size, with some areas showing regression while others remain unchanged.
• Changes in texture: The texture of the lesion may change as it regresses.

Conclusion

In conclusion, differential diagnosis of regressing skin melanoma requires careful consideration of key features, including loss of pigmentation, variation in color, and benign dermal component. A thorough histopathologic evaluation and immunohistochemical study are essential to confirm the diagnosis.