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M Santucci

Publications and source records attributed to M Santucci.

At least 37 records · Page 2Linked to original sources
PubMed2000

Accuracy, concordance, and reproducibility of histologic diagnosis in cutaneous T-cell lymphoma: an EORTC Cutaneous Lymphoma Project Group Study. European Organization for Research and Treatment of Cancer.

OBJECTIVE: To assess the level of observer variability in the histologic identification of cutaneous T-cell lymphoma (CTCL) and its discrimination from diseases with similar histologic features. DESIGN: Cutaneous T-cell lymphoma specimens and randomly mixed controls were evaluated twice by 3 examiners. SETTINGS: The European Organization for Research and Treatment of Cancer (EORTC) Cutaneous Lymphoma Project Group. PATIENTS: The study was conducted with histologic specimens from 32 patients with mycosis fungoides (MF). In addition, 13 specimens of spongiotic, lichenoid, or psoriasiform simulators of MF were blindly and randomly mixed with the CTCL specimens as controls. MAIN OUTCOME MEASURES: To evaluate the accuracy and concordance among and individual reproducibility of raters of histologic diagnoses. RESULTS: Overall, the concordance among raters was fair to moderate (range, 0.283-0.562; weighted overall kappa, 0.412). Individual reproducibility of examiners ranged from moderate to almost perfect (range, 0.473-0.896; weighted overall kappa, 0.709) and was not significantly different for the definite lymphoma (range, 0.551-0.921; overall kappa, 0.802) and nonlymphoma (range, 0.368-0.950; overall kappa, 0.793) categories. Accuracy was similarly variable among raters: sensitivity ranged from 49.3% to 78.1% (overall kappa, 0.654), and specificity (control series) ranged from 46.2% to 69.2% (overall kappa, 0.595). Adding the diagnoses of probable lymphoma to those of definite lymphoma, sensitivity ranged between 73.5% and 84.9%. Although for each examiner there was a trend toward a lower sensitivity in the detection of early lesions compared with later lesions, the difference in sensitivity between the 2 groups was not statistically significant. CONCLUSIONS: The levels of concordance and reproducibility found in this investigation were similar to those obtained with comparable studies in the most varied fields of pathology, confirming that the identification of CTCL for our observers did not cause particular problems. Our findings also revealed that pitfalls in CTCL identification are not only limited to early lymphomatous lesions, as commonly postulated.

Biopsy↗
PubMed2000

The skin-associated lymphoid tissue-related B-cell lymphomas.

Primary cutaneous B-cell lymphomas (CBCLs) should be clearly separated from non-Hodgkin's B-cell lymphomas with secondary cutaneous involvement and from cutaneous B-cell pseudolymphomas. The majority of CBCLs are characterized by a homogeneous clinical presentation and behavior, with good response to local radiotherapy, low tendency to extracutaneous spread, and excellent prognosis. According to the European Organization for Research on the Treatment of Cancer classification of primary cutaneous lymphomas, CBCLs with an indolent behavior are divided into 2 subgroups: follicular center cell lymphoma and immunocytoma/marginal zone lymphoma, due to putative histologic similarities with their purported nodal counterparts. In addition, a third subgroup with intermediate prognosis (large B-cell lymphoma of the leg) is identified. Conversely, the identification of distinct subgroups is disputable from a strictly histologic, immunophenotypic, and genotypic point of view, and has neither correlation with the clinical course nor the prognosis of the disease. Moreover, the majority of CBCLs show a uniform immunophenotype (CD5-, CD10-) and genotype (lack of bcl-1/bcl-2 and c-myc gene rearrangement) of neoplastic cells. Therefore, we favor the use of the term Skin-Associated Lymphoid Tissue (SALT)-related B-cell lymphomas, due to the close similarities between CBCLs and mucosa-associated lymphoid tissue (MALT) lymphomas, and the evidence for an acquired B-cell arm of SALT.

Diagnosis, Differential↗
PubMed2000

Angiokeratoma corporis diffusum (Anderson-Fabry's disease): a case report.

We report on a 14-year-old boy who presented with a 4-year history of acral pains and febrile episodes. On physical examination, numerous small reddish papules were present on his abdomen, located predominantly on the periumbelical region. Renal function was within normal limits. Ophthalmological examination revealed whorled opacities of the cornea (cornea verticillata) and dilated tortuous conjunctival vessels. Histopathological examination of one of the cutaneous papules showed several dilated blood vessels in the superficial dermis surrounded by collarettes of thickened rete ridges, consistent with a diagnosis of angiokeratoma. The electron-microscopic study of a skin specimen demonstrated the presence of dilated lysosomes with deposition of electron-dense bodies, some of which with laminated structure, in endothelial cells and fibroblasts. These findings were regarded as indicative of Fabry's disease. Subsequent biochemical analysis confirmed the presence of a alpha-galactosidase A deficiency in leukocytes. In conclusion, we described the clinical, histopathological and submicroscopic findings of a case of Fabry's disease, in which the combination of electron microscopic and biochemical approaches allowed the correct diagnosis.

Adolescent↗
PubMed2000

Efficacy of histologic criteria for diagnosing early mycosis fungoides: an EORTC cutaneous lymphoma study group investigation. European Organization for Research and Treatment of Cancer.

The correct classification of lymphoproliferative disorders provides valuable information regarding subsequent clinical evolution of the disease. The ability of pathologists to distinguish such lesions is generally low, especially when dealing with minimal lymphoid infiltrates. To improve the efficacy of histopathology in the diagnosis of early lesions of mycosis fungoides (MF), we reviewed 24 skin biopsies from 18 patients with patch stage lesions of MF early in the course of their disease and 13 slides of lichenoid, spongiotic, or psoriasiform simulators of MF as a control series. A series of cytoarchitectural features was assessed, and differences in the distribution of histopathologic parameters between the two groups (early MF lesions and MF simulators) were evaluated by the chi-square test and Fisher's exact test. For these parameters, sensitivity and specificity also were calculated. A multivariate log-linear analysis was performed to estimate which of the morphologic parameters yielded independent diagnostic information. We found that the most important feature for the diagnosis of lymphoma was the presence of lymphocytes with extremely convoluted, medium-large (7-9 microm in diameter) nuclei (medium-large cerebriform cells), singly or clustered in the epidermis and in small sheets in the dermis. Additional significant histologic features were epidermotropism as single cells lined up along the basal keratinocytes of the dermal-epidermal junction, absence of significant papillary dermis fibrosis, and absence of significant numbers of dermal blastlike cells. We conclude that the efficacy of single histopathologic features in the diagnosis of early MF is generally poor. Only the presence of medium-large cerebriform cells in the epidermis or in clusters in the dermis proved to be a highly reliable feature. However, the histopathologic diagnosis of early MF lesions and their discrimination from inflammatory simulators can be achieved using the constellation of cytoarchitectural parameters proposed.

Biopsy↗
PubMed2000

Thick cutaneous malignant melanoma: a reappraisal of prognostic factors.

The prognosis of patients with thick (>3 mm) cutaneous malignant melanomas is generally poor; however, some cases survive far longer than expected. Thus tumour thickness cannot serve as the only predictor of disease course in the individual patient. The aims of the current study were to evaluate the clinical outcome of patients with thick (>3 mm) cutaneous melanoma and test the prognostic value of a series of clinicopathological parameters on disease-free and cause-specific survival. We retrospectively evaluated 140 patients with stage I cutaneous melanoma >3 mm in thickness. Disease-free and cause-specific survival rates (Kaplan-Meier method) were compared using the log rank test. A multivariate analysis (Cox proportional hazards model) was used to determine the independent effect of each variable on prognosis. The overall 5-year and 10-year disease-free survival rates were 35.5% and 29.3%, respectively, whereas the overall 5-year and 10-year cause-specific survival rates were 55.3% and 47.7%, respectively. In the univariate analysis, the following factors were found to be significantly associated with the disease-free and cause-specific survival: tumour thickness, mitotic rate/mm2, type of invasive front, ulceration, thickness of the nodular component and predominant cell type. In addition, the presence of vascular invasion was significantly correlated with the risk of metastases but not with survival. In the multivariate analysis (Cox proportional hazards model), only tumour thickness (both as a continuous variable and >7.5 mm), infiltrating invasive front, presence of ulceration and mitotic rate/mm2 (both as a continuous variable and >10 mitoses/mm2) were significant independent predictors of poorer clinical outcome.

Adult↗
PubMed2000

Epileptic negative myoclonus and brief asymmetric tonic seizures. A supplementary sensorimotor area involvement for both negative and positive motor phenomena.

Epileptic negative myoclonus (ENM) is an epileptic motor dysfunction characterised by brief lapses of postural tone provoked by paroxysmal cortical discharges. We report the electrophysiological and video-polygraphic findings in a patient presenting with the unusual association of ENM and brief asymmetric tonic-postural seizures of cryptogenetic origin. Focal EMG silent periods in the left deltoid muscle (mean duration 81.2 +/- 16.4 ms), time-locked with vertex spikes were present. The time lag between spikes and ENM was 33.1 +/- 4.6 ms. We suggest the involvement of mesial frontal areas in the genesis of both negative and positive motor phenomena.

Adolescent↗
PubMed1999

CD30-CD30 ligand interaction in primary cutaneous CD30(+) T-cell lymphomas: A clue to the pathophysiology of clinical regression.

Primary CD30(+) cutaneous T-cell lymphomas (CTCLs) represent a spectrum of non-Hodgkin's lymphomas (NHLs) that have been well defined at the clinical, histologic, and immunologic level. This group, which includes 2 main entities (large cell lymphoma and lymphomatoid papulosis [LyP]) and borderline cases, is characterized by the expression of CD30 antigen by neoplastic large cells at presentation, possible spontaneous regression of the skin lesions, and generally favorable clinical course. Although the functional relevance of CD30 and its natural ligand (CD30L) expression in most cases of NHL is presently undefined, previous studies indicate that CD30L is likely to mediate reduction of proliferation in CD30(+) anaplastic large-cell NHL. No information is currently available concerning the expression of CD30L in primary CD30(+) CTCLs. In this study, we investigated the immunophenotypic and genotypic expression of CD30 and CD30L in different developmental phases of skin lesions (growing v spontaneously regressing). By immunohistochemistry, CD30L expression was detected in regressing lesions only; by molecular analysis, the expression of CD30L was clearly higher in regressing lesions than in growing ones. CD30L, while expressed by some small lymphocytes, was most often coexpressed by CD30(+) neoplastic large cells, as demonstrated by 2-color immunofluorescence and by immunohistochemistry on paraffin sections. Taken together, these data suggest that CD30-CD30L interaction may play a role in the pathobiology of primary cutaneous CD30(+) lymphoproliferative disorders. In particular, CD30L (over)expression might have a major role in the mechanism of self-regression of skin lesions, the most distinctive clinical feature of this cutaneous lymphoma subtype.

Adult↗
PubMed1999

Expression of CCR5 is increased in human monocyte-derived macrophages and alveolar macrophages in the course of in vivo and in vitro Mycobacterium tuberculosis infection.

Human immunodeficiency virus (HIV) replicates more efficiently in Mycobacterium tuberculosis (MTB)-infected macrophages than in uninfected controls. We investigated whether this may be partly explained by changes in expression of CCR5 in the course of mycobacterial infection, as this molecule has been shown to be a coreceptor for HIV entry. Since the lung is the preferential organ of HIV replication in the course of tuberculosis, we preliminarily analyzed beta-chemokine receptor expression in alveolar macrophages from patients with active tuberculosis, using flow cytometry based on an MIP-1alpha ligand-biotin/avidin-FITC detection system. Increased MIP-1alpha receptor (MIP-1alphaR) expression in alveolar macrophages from infected patients was observed whereas no detectable expression could be revealed in uninfected controls. Since MIP-la can also bind CCR1 and CCR4, the presence of CCR5 mRNA was investigated in bronchoalveolar lavage (BAL) cells and detected in alveolar macrophages from tuberculosis patients only. The study was then extended to in vitro MTB-infected macrophages. Monocyte-derived macrophages (MDMs) were left to differentiate for 7 days before MTB H37Rv infection, and CCR5 expression was monitored, by using a specific monoclonal antibody, on days 1, 6, and 11 after infection. Increased CCR5 expression in MTB-infected macrophages was observed, with a peak on day 6 (64% in MTB-infected versus 33% in control cultures) and a decrease by day 11 (25% in MTB infected versus 13% in control cultures). These results show that CCR5 expression is enhanced in the course of in vitro MTB infection and during active pulmonary tuberculosis.

Cells, Cultured↗
PubMed1999

Thin cutaneous malignant melanomas (< or =1.5 mm): identification of risk factors indicative of progression.

BACKGROUND: Although thin cutaneous melanomas generally have a favorable prognosis, in some cases they may undergo progression. The current study was undertaken to identify variables that may predict a more aggressive clinical outcome in these patients. In addition to classic clinicopathologic features, the authors tested the prognostic impact of three new morphometric quantitative parameters: 1) tumor thickness plus regression thickness (T+R), 2) percentage of skin thickness infiltrated by tumor cells (T/S ratio), and 3) percentage of skin thickness infiltrated by tumor cells and regression ([T+R]/S ratio). METHODS: The authors retrospectively evaluated 287 patients with invasive cutaneous melanoma < or = 1.5 mm in thickness. Disease free survival rates (Kaplan-Meier method) were compared by using the log rank test. A multivariate analysis (Cox proportional hazards model) was used to determine the independent effect of each variable on progression. Progression was defined as any documented cutaneous local and/or distant metastasis. RESULTS: Thirty-two of the 287 patients (11.1%) underwent disease progression. The overall 5-year and 10-year disease free survival rates were 89.3% and 84.6%, respectively. In the univariate analysis, the following factors were found to be significant predictors of progression: male gender (P = 0.01), acral-lentiginous histotype (P = 0.02), tumor thickness (P = 0.005), T+R (P = 0.001), T/S ratio > or = 50% (P = 0.03), (T+R)/S ratio > or = 50% (P = 0.006), vertical growth phase (P = 0.04), and absence of inflammatory response (P < 0.0001). Conversely, age, site, and Clark's level did not affect the risk of recurrences and/or metastases significantly. In the multivariate analysis, only T+R (P = 0.009) and inflammatory response (P < 0.0001) were found to be independent predictors of progression. Five-year disease free survival rates according to presence versus absence of inflammatory response were 93.4% and 63.8%, respectively (P < 0.0001). CONCLUSIONS: In the current study, peritumoral and intratumoral inflammatory infiltrate and T+R were found to be strong independent predictors of progression in thin cutaneous melanomas.

Adult↗
PubMed1999

Osteonectin expression correlates with clinical outcome in thin cutaneous malignant melanomas.

Osteonectin, also termed BM40 or SPARC (secreted protein, acidic and rich in cysteine) is a multifunctional glycoprotein involved in tissue mineralization, cell-extracellular matrix interactions as well as angiogenesis. It has been suggested that osteonectin may play a key role in the process of tumoral invasion and metastasis in certain malignancies. In this study, we reviewed the clinical records and the histopathologic slides of 188 thin cutaneous malignant melanomas (< or = 0.75 mm). Among them, 12 cases underwent progression and were selected for the study. Osteonectin expression was investigated by immunohistochemistry in these 12 patients and 24 matched controls who did not undergo progression. Osteonectin staining was correlated with clinical outcome and other clinicopathologic parameters. Progression-free and disease-specific survival rates were calculated with the Kaplan-Meier method and their differences were evaluated by the log rank test. Overall, immunoreactivity for osteonectin was found in 23 (63.8%) cases. Eighteen cases (50%) displayed staining in 1% to 50% of neoplastic cells whereas five cases (13.8%) showed a diffuse positivity in more than 50% of the tumor cells. Osteonectin expression was significantly correlated with risk of progression (P = .01), incidence of distant metastases (P = .005) and survival (P = .03). There was a higher incidence of osteonectin-positive tumors in cases that did experience regional lymph node metastases versus those cases that did not, but that difference did not reach statistical significance (P = .06). No significant correlation was found between osteonectin expression and other clinicopathologic features, including age, sex, site, histotype, Clark's level, presence of regression, presence of inflammatory response, and tumor growth phase. Our data showed that osteonectin expression is a predictor of clinical outcome in thin cutaneous melanomas.

Adult↗
PubMed1999

Clinical relevance of the histological classification of sinonasal intestinal-type adenocarcinomas.

To verify the prognostic value of the histological typing of intestinal-type adenocarcinoma (ITAC) of the sinonasal tract, 41 such lesions were separately classified by 2 pathologists both according to the World Health Organization (WHO) criteria for the histological typing of large intestine adenocarcinomas (well, moderately, poorly differentiated adenocarcinomas, and mucinous adenocarcinomas) and to the criteria of Kleinsasser and Schroeder (papillary-tubular cylinder cell type, alveolar-goblet cell type, signet-ring cell type, and transitional type). Using the WHO classification, 7 adenocarcinomas (17.1%) were well differentiated, 15 (36.6%) were moderately differentiated, and 6 (14.6%) were poorly differentiated; 13 cases (31.7%) were classified as mucinous adenocarcinoma. Following the Kleinsasser and Schroeder classification, 28 adenocarcinomas were of the papillary-tubular cylinder cell type (PTCC), 6 tumors (14.6%) were of the alveolar-goblet cell type (AGC), 1 (2.4%) was of the signet-ring cell (SRC) type, and 6 (14.6%) were of the transitional (TR) type. The interrater agreement in subtyping for both histological classifications was 92.6% (kappa, 0.89; P < .001). Kaplan-Meier analysis of cases stratified according to WHO classification showed that patients with mucinous and poorly differentiated adenocarcinomas had a significantly shorter disease-free interval and survival rate than patients with well and moderately differentiated adenocarcinomas (P = .02 and P < .001, respectively; log-rank test). Separate evaluation of survival for patients with AGC and TR adenocarcinomas did not show any statistically significant difference (P = .5). Clinical stage was advanced in most cases (92.6% of patients had T3 or T4 carcinomas) and had no prognostic relevance in the current series, as did treatment and occupational exposure. We conclude that the histological typing of ITACs is highly reproducible and appears to be related to the clinical outcome of the tumors. Adenocarcinomas with a prominent (>50%) mucinous component tend to have a similar clinical behavior, irrespective of their cyto-architectural features and the presence of an associated tubulopapillary component. Therefore, the separation into alveolar-goblet, signet-ring, and transitional forms has no prognostic impact.

Adenocarcinoma↗
PubMed1999

Cutaneous melanoma histologically associated with a nevus and melanoma de novo have a different profile of risk: results from a case-control study.

BACKGROUND: Histopathologic association between melanocytic nevus and melanoma has been reported in approximately 10% to more than 50% of melanoma cases. Whether melanomas in contiguity with a nevus have a different natural history and pathogenesis from melanomas without a nevus is still to be determined. OBJECTIVE: The present study was undertaken to clarify whether melanocytic nevus-associated melanomas (MN[+]) have a different risk factor profile from cases without histopathologic evidence of melanocytic nevus association (MN[-]). METHODS: The study population consisted of 131 invasive melanoma cases with a thickness of 4.00 mm or less and 174 control cases without melanomas. The whole series was evaluated for the following risk factors: phenotypic traits; the number of common, atypical, and congenital nevus-like nevi; and freckling and history of sunburns. Melanoma cases were revised for the presence of associated melanocytic nevi. The analysis of risk factors was performed by a case-control approach comparing cases, classified by histologic association with nevus, to the group of controls. Possible differences in risk factor distribution between MN(+) cases and MN(-) cases were evaluated with a polychotomous logistic regression model and a likelihood ratio test for heterogeneity. RESULTS: Histopathologic association between melanocytic nevus and melanoma was found in 27 cases (20.6%). Phenotypic traits were shown to be more powerful predictors of risk for MN(-) than for MN(+) cases (blond/red hair; odds ratio, 7.4 and 1.2, respectively; likelihood ratio test for heterogeneity, 4.13; P < .05). Conversely, history of frequent sunburn was a risk factor only in MN(+) cases (more than 5 sunburns; odds ratio, 6.7; 95% confidence interval, 1.3-33.7), but not in MN(-) cases (odds ratio, 1.2; 95% confidence interval, 0.3-4.0; likelihood ratio test for heterogeneity, 4.2; P < .05). Where melanocytic nevi are concerned, an increased number of common nevi was a predictor of melanoma risk in both MN(+) and MN(-) cases, but with a different magnitude of risk, higher for MN(+) cases (number of common nevi, 10-30; odds ratio, 14.4 and 4.7, respectively; likelihood ratio test for heterogeneity, 3.7; P = .055). CONCLUSION: This study showed that, although MN(+) and MN(-) melanomas share many risk factors, there is a different strength of association between the 2 groups. The effect of a history of sunburn as a predictor of risk was found only for nevus-associated melanomas, suggesting a possible role of sunburns in the neoplastic transformation of nevi.

Adult↗
PubMed1999

A glucose biosensor operating under non-isothermal conditions: the dynamic response.

The results obtained with a glucose biosensor operating under non-isothermal conditions are presented and discussed. Glucose oxidase, immobilized onto Nylon membranes, was used as biological element. An amperometric two electrodes system was employed to measure the anodic current produced by oxidation of hydrogen peroxide. Non-isothermal conditions were characterised in terms of the temperature difference, delta T = Tw - Tc, and of the average temperature of the system, Tav = (Tw + Tc)/2, Tw and Tc being the temperature in the warm and cold half-cells constituting the biosensor. Comparison between the functioning of the biosensor under isothermal and non-isothermal conditions was performed. It was found that, under non-isothermal conditions, the dynamic response and sensitivity increased, while the response times and the detection limit decreased, if comparison was done with the same parameters measured under isothermal conditions. The increase of the dynamic response was found to be proportional to the applied temperature gradient.

Biosensing Techniques↗
PubMed1999

Bilateral centrotemporal spikes triggered by blinking: an unusual form of sensory input with related cortical EEG activity.

OBJECTIVE: To investigate the morphology, scalp topography and temporal relationship with orbicularis oculi muscle contraction of bilateral blink related spikes (BRS) in a 7-year-old boy with chromosomopathy, mild mental retardation and left spontaneous centrotemporal spikes (SS). METHODS: The patient underwent video-polygraphic recordings with off-line analysis of SS and BRS by means of spike-averaging and orbicularis oculi contraction-locked averaging techniques respectively. EEG activity related to reflex blinking (evoked by glabellar tapping) was also studied. RESULTS: SS and BRS presented the same morphology, characterised by four peaks (P1, N1, P2, N2). SS were located over the left centroparietal regions, while BRS were placed over both left and right centrotemporoparietal regions and constantly followed the contraction of orbicularis oculi with overlapping peak latencies over C3 and C4 electrodes (P1 72 ms; N1 115 ms; P2 164 ms; N2 236 ms). Reflex blinking evoked a small waveform with the same features as BRS. CONCLUSIONS: Our findings suggest that both involuntary and reflex blinking can act as a form of sensory stimulation probably engaging similar nervous pathways and cortical sources in generating EEG abnormalities: the trigeminal system.

Action Potentials↗
PubMed1999

Reduced E-cadherin expression correlates with unfavorable prognosis in adenoid cystic carcinoma of salivary glands of the oral cavity.

Reduced expression of E-cadherin (E-cad), a transmembrane glycoprotein, is associated with loss of differentiation, acquisition of an invasive phenotype, and an unfavorable prognosis in carcinomas from several sites. We used immunohistochemistry to study the expression of E-cad in 50 adenoid cystic carcinomas (ACCs) in salivary glands to evaluate correlations with clinicopathologic parameters and patient survival. Absent or low E-cad expression was observed more frequently in solid than in cribriform or tubular carcinomas. E-cad expression also was significantly correlated with histologic grade and the growth pattern. In addition, ACCs showing low or absent E-cad expression were more frequently larger than 4 cm in diameter, and distant metastases developed more frequently. Reduced expression correlated with shorter disease-free intervals and actuarial survival rates. Univariate and multivariate analysis identified tumor stage and E-cad expression as the only 2 parameters predictive of the disease-free interval. E-cad expression and tumor stage, grade, and type of growth were significant prognostic factors for survival in univariate analysis, while tumor stage, type of growth, and E-cad expression were the only significant covariates in multivariate analysis. These findings indicate that the loss of E-cad has an important role in the natural history of ACC, as it is associated with loss of differentiation and development of metastases. We also provide evidence that E-cad expression is an independent indicator of clinical aggressiveness in patients with ACC, together with clinical stage and type of growth at the periphery of the tumor.

Adult↗
PubMed1999

Naevus-associated melanomas: cause or chance?

Controversies exist regarding the true incidence and significance of the histological association between melanocytic naevi and melanomas. The current study was undertaken to determine the incidence of melanocytic naevi histologically associated with melanomas, to compare the clinicopathological profiles of melanomas associated with a naevus (MN+) and melanomas not associated with a naevus (MN-), and to verify the interobserver reliability of classifying the naevus remnants as congenital or acquired. We evaluated 131 patients with invasive melanoma < or = 4 mm in thickness with a Clark's level < V. Histological evidence of an associated melanocytic naevus was found in 27 out of 131 melanoma cases (20.6%). MN+ were significantly more frequent among males compared with MN-(P = 0.002) and were predominantly located on the trunk (P =0.001). No significant differences between MN+ and MN- were found in the distribution of histotype, Clark's level and thickness. Among MN-, the naevus component showed acquired features in 14 cases (51.8%), whereas 12 cases (44.5%) had features of small superficial congenital naevi; in one case (3.7%) a confident distinction between congenital and acquired naevus could not be made. Overall, there was concordance among the three observers in the diagnosis of the type of naevus remnants in 81.4% of cases (kappa = 0.78; P<0.0001). We conclude that, although the majority of cutaneous melanomas arise de novo, in approximately 20% of cases an associated melanocytic naevus is found. Our observation that MN+ and MN- have different clinicopathological profiles suggests that, at least for some cases, a causal relationship between the two lesions may be present. However, when the naevus is histopathologically adjacent to the melanoma, the possibility of a collision event cannot be ruled out. Finally, we documented a significant concordance among examiners in the diagnosis of the congenital versus acquired nature of the associated naevus. This suggests that the histopathological criteria generally employed to distinguish between congenital and acquired naevi have good reproducibility.

Adult↗