Journal of Clinical Oncology, Vol 20, Issue 5
(March), 2002: 1411-1412
© 2002 American Society for Clinical Oncology
Skin Lesions in Melanoma and Kaposi’s Sarcoma
Case 1. Detection of Circulating Malignant Cells by RT-PCR in a Case of Cutaneous Melanoma in Complete Regression
Daniele Santini,
Giuseppe Tonini,
Bruno Vincenzi,
Raffaele Murace,
Giulio Ferranti,
Alfonso Baldi
Università Campus Bio-Medico, Centro Diagnostico, and Istituto Dermopatico dell’Immacolata, Rome, and Seconda Università di Napoli, Naples, Italy
A healthy 37-year-old woman with a familial history of cutaneous melanoma and a recent history (6 months) of atypical nevus was seen in consultation by a dermatologist. Complete skin mapping revealed only an oval, 6 x 4-mm pigmented lesion on her upper left arm that had a history of rapid growth and a variegated chromatic pattern (Fig 1A). In vivo digital epiluminescence microscopy showed digitated radial streaming, grayish-blue reticular patterns, opaque gypseous alabaster lacunas, brown-black dots on a blue-gray background, pseudopodia at the periphery, blue-in-pink areas, and a blue-gray velum (Fig 1B). Surprisingly, histologic examination of the excised lesion (Fig 1C and 1D) displayed all the typical pathologic features of completely regressed melanocytic lesion and led to a diagnosis of atypical pigmented lesion in regression and a suspicion of melanoma (uninvolved flattened epidermis, fibrosis parallel to the epidermis together with many melanophages, and chronic inflammatory cell infiltration consisting mainly of lymphocytes). Although partial regression in malignant cutaneous melanoma occurred in 10% to 58% in several large series, spontaneous complete regression of primary melanomas are rarely described in the literature.1,2 The present case did not meet all the stringent criteria for the diagnosis of spontaneous complete regression of primary melanoma because of the absence of clinically tumor-involved lymph nodes draining the area where the regressed pigmented lesion was localized. Because of the diagnostic dilemma, 3 months after surgical excision we performed a reverse transcriptase–polymerase chain reaction (RT-PCR)–based assessment of malignant melanoma cells in three sequential peripheral-blood samplings.3-5 Tyrosinase-positive circulating cells (Fig 1E) were detected in all the samples (lanes 1, 2, and 3: peripheral blood from the patient obtained in three sequential samplings at different time points; lane 4: peripheral blood from a healthy donor; lane 5: A375M melanoma cell line).
A skin and systemic search for an occult primary melanoma and systemic staging with axillary ultrasonography, total-body computed tomography, and total-bone scintigraphy were negative. On the basis of these data, a diagnosis of complete spontaneous regression of cutaneous malignant melanoma was suggested and a local surgical resection was performed. Results of an RT-PCR assay for tyrosinase from peripheral blood continued to be positive 10 months after the diagnosis in the absence of any other sign of systemic disease or atypical skin lesions. To the best of our knowledge, this is the first report of a diagnosis of a completely regressed primary cutaneous melanoma formulated with the help of RT-PCR tyrosinase detection.
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