Identification of Vertical Growth Phase in Malignant Melanoma: A Study of Interobserver Agreement

McDermott, N.; Hayes, D P; Al-Sader, Mohammed Hussain; Hogan, John M.; Walsh, Caitriona Barry; Kay, Elaine W.; Leader, M.

doi:10.1093/ajcp/110.6.753

Cited by 42 publications

(22 citation statements)

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“…The overall high reproducibility of growth phase assessment has been corroborated by other recent studies. 35,36 However, the clinical relevance of such determination is less clear, as shown by the 10 "nontumorigenic," yet metastasizing, cases in our series. Perhaps, we should resist from providing such categorical predictions that, in some instances, may not be more than an educated guess, yet with profound prognostic implications to the patient.…”

Section: Commentmentioning

confidence: 64%

Histological Characteristics of Metastasizing Thin Melanomas

et al. 2002

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Section: Commentmentioning

confidence: 64%

Histological Characteristics of Metastasizing Thin Melanomas

et al. 2002

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“…All necessary pathologic data, as listed in the first portion of this article, can still be obtained by examination of standard microscopic preparations of melanoma as stained with H&E, and recognition of the vertical growth phase is a key element of that procedure. Finally, it is important to note that the data of McDermott and coworkers 44 show that this process can be mastered by all pathologists. Despite the fatuous assertions of some attorneys who are involved in medicolegal actions, 88 one does not need "special board certification" in dermatopathology to interpret, and give counsel on, melanocytic lesions of the skin.…”

Section: Discussionmentioning

confidence: 90%

“…For example, cells in the basal epidermis in one VGM may be large and epithelioid, whereas those in the vertical growth clusters in the dermis have a small round cell configuration or vice versa, and the sizes of cell nests in these 2 microanatomic compartments differ as well. McDermott et al 44 micronodule of tumor cells in the corium in VGMs that appears to be "dominant"; it is larger than any single cluster at the DEJ or within the epidermis, and its constituent cells are monomorphic (ie, clonal). In addition, the dermal cell nests in VGMs that are cytologically disparate from those at the DEJ also show mitotic activity, which is often higher than that seen in epidermal tumor cells.…”

Section: Vertical Growthmentioning

confidence: 99%

“…40 The odds ratios for some of the truly useful and independent predictors of survival in melanoma cases have been summarized by Elder et al 6 Among all of the determinants just cited, perhaps the most important-but misunderstood and poorly recognizedis the phase of tumor growth. Proffered definitions of radial and vertical growth in melanomas are outlined in ITable II and described in the following text, both of which draw liberally from the cited work by Elder et al 6 In addition, they incorporate elements of a study by McDermott et al, 44 which is published in this issue of the Journal.…”

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confidence: 99%

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Prognostic Factors for Cutaneous Melanoma

Wick

1998

Am J Clin Pathol

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“…Many of these melanomas belong to the superficial spreading type. The scheme of melanoma progression suggested by Clark et al in 1989 (2), was externally validated (12,13), and it was demonstrated that growth phase and dermal mitosis are independent prognostic factors. Evidence suggests that ~45% of melanoma cases are entirely in an RGP, 10% have a VGP alone (thus classified as nodular or d'emblèe types, which are often amelanotic) (14), and the remaining 45% of cases present with a VGP tumor nodule surrounded by an RGP, in which they presumably arose (15).…”

Section: Discussionmentioning

confidence: 99%

An observational study regarding the rate of growth in vertical and radial growth phase superficial spreading melanomas

et al. 2016

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Abstract. The natural history of superficial spreading melanomas (SSMs) involves the progression from a radial growth phase (RGP) to a vertical growth phase (VGP). Currently, a patient's history represents the only method to estimate the rate of tumor growth. The present study aimed to verify whether the estimated rate of growth (ROG) of SSMs with a RGP or VGP exhibited any differences, and to evaluate the possible implications for the most important prognostic determinants. ROG was quantified as the ratio between Breslow's thickness in millimeters (mm) and the time of tumor growth in months, defined as the time between the date that the patient had first noticed the lesion in which melanoma subsequently developed and the date on which the patient first felt this lesion changed. A total of 105 patients (58 male and 47 female) were studied. Of these, 66 had VGP-SSMs, whilst 39 had RGP-only SSMs (RGP-SSMs). No significant differences in age and gender were observed between these groups. The mean Breslow's thickness in patients with VGP-SSMs was significantly greater than in patients with RGP-SSMs (0.78±0.68 vs. 0.48±0.22 mm, P=0.0096). Similarly, the ROG was observed to be higher in VGP-SSM vs. RGP-SSM patients (0.13±0.16 vs. 0.065±0.09 mm/month, P=0.0244). In patients with VGP-SSMs, Breslow's thickness and ROG were significantly higher for tumors with a mitotic rate of ≥1 mitosis/mm 2 compared with those with <1 mitosis/mm 2 (1.15±0.96 vs. 0.56±0.30 mm, P=0.0005; and 0.188±0.20 vs. 0.09±0.12 mm/month, P=0.0228, respectively). According to these results, two subsets of SSMs exist: The first is characterized by the presence of mitosis and a higher ROG, while the second exhibits a more indolent behavior and is characterized by an RGP only. Given the differences in the Breslow's thickness and ROG, clinicians must be aware of the possible diagnostic delay in these subsets of melanoma that, differently from true nodular melanomas, generally fulfill the classical ABCD clinical criteria. IntroductionSuperficial spreading melanoma (SSM) and nodular melanoma (NM) exhibit different growth patterns, being characterized by slower and faster growth, respectively. The radial growth phase (RGP), which is present in SSM and absent in NM, is of paramount importance in the classification of melanoma (1-3). The rapid growth of primary melanomas is associated with aggressive features and a negative effect on prognosis (4). According to the linear model of progression, malignant melanocytes in SSM spread radially prior to invading vertically. Clark et al (1) designated this invasion pattern the vertical growth phase (VGP), and defined it as the focal formation of a dermal nodule within the RGP. Melanomas with a VGP do not necessarily indicate NM.Patient interviews are a useful source of information about the growth phase of the tumor (5). The rate of growth (ROG), which is defined as the ratio between Breslow's thickness in millimetres and the duration of tumor growth in months, currently represents the only method to measure the grow...

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Identification of Vertical Growth Phase in Malignant Melanoma: A Study of Interobserver Agreement

Cited by 42 publications

References 0 publications

Histological Characteristics of Metastasizing Thin Melanomas

Histological Characteristics of Metastasizing Thin Melanomas

Prognostic Factors for Cutaneous Melanoma

An observational study regarding the rate of growth in vertical and radial growth phase superficial spreading melanomas

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