Do All Melanomas Come From “Moles”? A Study of the Histological Association Between Melanocytic Naevi and Melanoma

Marks, Robin; Dorevitch, A.P.; Mason, Graham

doi:10.1111/j.1440-0960.1990.tb00656.x

Cited by 112 publications

(66 citation statements)

References 13 publications

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“…These associations seemed to largely explain initially observed associations with N+ melanoma for male sex, younger age at diagnosis, thinner melanoma, and solar elastosis in adjacent tissue. Previous studies have found, as we did, that superficial spreading melanoma was more likely than other histologic subtypes of melanoma to be N+ (19,21). In addition, many studies have reported a lower probability of finding an associated nevus with thicker melanomas (5,15,21,(27)(28)(29).…”

Section: Discussionsupporting

confidence: 70%

“…A hypothesis of divergent pathways has been proposed: that high cumulative sun exposure is necessary for progression of some melanomas whereas for others ''pigment cell instability,'' manifested by a propensity to develop many nevi, is sufficient to drive progression (11,17). These findings are consistent with the observation that lentigo maligna melanomas (a subtype of melanoma commonly diagnosed at sun-damaged sites) and melanomas arising on habitually sun-exposed anatomic sites are less likely to have evidence of nevus remnants than other melanomas (13,15,(18)(19)(20)(21).…”

Section: Introductionsupporting

confidence: 67%

See 1 more Smart Citation

Etiologic and Other Factors Predicting Nevus-Associated Cutaneous Malignant Melanoma

Purdue

From²,

Armstrong³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Cutaneous malignant melanomas with histologic evidence of an associated nevus (N+) may have a different risk factor profile from that of melanomas without it (NÀ). To address this question, a case-only analysis of 932 people with cutaneous malignant melanoma was done to identify etiologic and other factors associated with N+ melanoma. Evidence of an associated nevus was found in 36% of melanomas. N+ melanomas were thinner (P trend = 0.0009) and more likely to be of the superficial spreading type than other types of melanoma. Subjects with N+ melanomas were younger (P trend < 0.0001) and reported a higher nevus density on their skin than subjects with NÀ melanomas [odds ratio (OR), 3.1; 95% confidence interval (CI), 1.6-6.0, for high nevus density versus no nevi]. Indicators of high accumulated sun exposure were less prevalent among subjects with N+ melanomas (OR, 0.3; 95% CI, 0.2-0.4, for melanoma location on the head and neck versus location on trunk; OR, 0.2; 95% CI, 0.1-0.4, for severe solar elastosis adjacent to the melanoma versus no elastosis; OR, 0.2; 95% CI, 0.1-0.4, for lentigo maligna melanoma subtype versus superficial spreading subtype). With the exception of solar elastosis and age, all of the aforementioned variables remained significantly associated with N+ melanomas in multivariate analyses. No associations with self-reported measures of sun exposure, sunburn, or pigmentation phenotype were apparent. Our findings provide some support for the hypothesis of etiologically separate pathways for melanoma, with N+ melanomas appearing less likely to develop in the presence of characteristics suggesting high accumulated sun exposure than NÀ melanomas. However, it is possible that high UV exposure causes involution of nevi, thus reducing the density of nevi in exposed skin and thereby the probability of N+ melanoma. (Cancer Epidemiol Biomarkers Prev 2005;14(8):2015 -22)

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Section: Discussionsupporting

confidence: 70%

Section: Introductionsupporting

confidence: 67%

Etiologic and Other Factors Predicting Nevus-Associated Cutaneous Malignant Melanoma

Purdue

From²,

Armstrong³

et al. 2005

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…Our observed prevalence of contiguous neval remnants in approximately half of all SSM but only 11% of LM/LMM is similar in magnitude to previously reported estimates. [10][11][12][13][14][15] Because of these marked differences by histologic type, we restricted further analyses to melanomas of the superficial spreading type. We found that SSM of the H & N was significantly less likely than SSM of the back to be associated with a contiguous nevus in accord with earlier descriptive studies of the anatomical distribution of nevusassociated melanoma.…”

Section: Discussionmentioning

confidence: 99%

“…10,12,16 This could be due to earlier excision of melanomas arising in a preexisting nevus or due to the neval remnants being obscured by the growing tumor. 12,13 In our series of mainly thin melanomas, there was no evidence that the prevalence of neval remnants decreased with increasing tumor thickness. Another study of predominantly thin melanomas 11 has reported very similar findings.…”

Section: Discussionmentioning

confidence: 99%

Sun exposure and host phenotype as predictors of cutaneous melanoma associated with neval remnants or dermal elastosis

Lee

Williamson

Watt

et al. 2006

Intl Journal of Cancer

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Recent research suggests that cutaneous melanomas may arise through 2 distinct pathways, characterized by chronic sun exposure on one hand and nevus-prone phenotype of the host on the other. Two histological characteristics of melanoma consistent with these divergent origins are dermal elastosis in adjacent skin and neval remnants contiguous with the tumor, respectively. To further explore causal heterogeneity in melanoma, we compared sun exposure histories and phenotypic characteristics among a population-based sample of patients newly diagnosed with cutaneous melanoma with and without contiguous neval remnants or dermal elastosis. Tissue blocks were obtained for 141 patients: 53 with superficial spreading melanoma (SSM) of the back, 42 with SSM of head and neck (H & N), and 39 and 7 with lentigo maligna/lentigo maligna melanoma (LM/LMM) of the H & N and back, respectively. Melanomas of the H & N were less likely than those on back to have neval remnants (adjusted OR 0.6, 95% CI 0.3-1.4), but were significantly more likely to have dermal elastosis (adjusted OR 9.3, 95% CI 3.5-25). In site-specific analyses, we found that H & N melanomas with neval remnants were more likely than those without neval remnants to arise in people with more than 60 nevi (adjusted OR 2.1, 95% CI 0.3-14.3), but were less likely to arise in those with more than 20 actinic keratoses. Less marked associations were observed for melanomas of the back. High levels of sun exposure strongly predicted dermal elastosis for H & N melanomas (OR 22.5, 95% CI 2.1-245), but not for melanomas of the back (OR 2.1, 95% CI 0.4-11). We conclude that melanomas with different histologic characteristics have different risk factor profiles, particularly on the head and neck. These data accord with the hypothesis that melanomas arise through different causal pathways. ' 2006 Wiley-Liss, Inc.

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“…8 However, the best evidence for this association is the histological recognition of dysplastic nevi in contiguity with a melanoma, which is observed in about 20-40% of cases in most studies. [12][13][14][15][16][17] Thus, the majority of melanomas do not arise in association with a demonstrable nevus. The prevalence of dysplastic nevi is vastly greater in populations than that of melanoma, indicating, consistent with clinical observations, 18 that most dysplastic nevi are stable and do not progress to melanoma.…”

Section: Dysplastic Nevimentioning

confidence: 99%

Precursors to melanoma and their mimics: nevi of special sites

2006

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Melanocytic nevi, which are benign tumors of melanocytes, may have occasional cosmetic significance but, for the most part, they are important only in relation to melanoma. Nevi are the most important simulants of melanoma, both clinically and histologically, and can usually be reliably distinguished from melanomas using published criteria. Some lesions are characterized by greater degrees of atypia and may be more difficult to diagnose. Dysplastic nevi are among the most important simulants of melanoma. Nevi may also be important as potential precursors of melanoma; however, most nevi are stable and will not progress to malignancy. Nevi are vastly more common than melanomas and the rate of progression of individual lesions is very low. Therefore, nevi are not as a rule managed by wholesale excision to prevent melanoma. Nevi are also important as risk markers, identifying individuals at greater risk of developing melanoma in the future. Dysplastic nevi and, to a lesser extent, common acquired and congenital nevi are among the most important melanoma risk markers. Nevi of special sites have been identified as nevi that may show atypical features suggestive of a dysplastic nevus or of a melanoma. However, they are not risk markers and they are not malignancies. Nevi of genital skin, acral skin, and flexural skin are among the most important 'nevi of special sites'. It is important, in considering the differential diagnosis of a lesion in a special site, to avoid overcalling such a lesion as a melanoma or a dysplastic nevus because this could lead to excessive treatment. Conversely, it is important to avoid undercalling a lesion that is a dysplastic nevus or a melanoma as a nevus of special sites, because in this circumstance a patient could lose the opportunity either for surveillance to recognize a developing melanoma at an early, curable stage, or for definitive treatment of an established malignancy. In this monograph, dysplastic nevi and nevi of special sites are compared and contrasted in relation to melanoma.

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Do All Melanomas Come From “Moles”? A Study of the Histological Association Between Melanocytic Naevi and Melanoma

Cited by 112 publications

References 13 publications

Etiologic and Other Factors Predicting Nevus-Associated Cutaneous Malignant Melanoma

Etiologic and Other Factors Predicting Nevus-Associated Cutaneous Malignant Melanoma

Sun exposure and host phenotype as predictors of cutaneous melanoma associated with neval remnants or dermal elastosis

Precursors to melanoma and their mimics: nevi of special sites

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