Welcome back to Dr. King! Dr. King and Dr. Phil Mitchell have been in Bulawayo, Zimbabwe for the past 2 weeks helping to kick start an advanced trauma training course for the nursing school. This course was established through a Global Grant with Rotary International, and the Rotary Clubs of Knoxville and the Rotary Clubs in Bulawayo Zimbabwe . Dr. King is the current president of the Rotary Club of Knoxville and his leadership this year has been critical to the success of many projects in Knoxville and abroad. Their efforts also helped establish a connection with the medical students in Zimbabwe, allowing for live video-conference lectures between the U.S. and Zimbabwe.
The International Collaboration on Cancer Reporting (ICCR) has released a paper in the American Journal of Surgical Pathology with recommendations to help establish more uniform reporting of invasive melanomas, so that the pathology reports that patients and clinicians receive have the elements that are clinically important.
The article can be freely downloaded at this link: http://journals.lww.com/ajsp/Fulltext/2013/12000/Data_Set_for_Pathology_Reporting_of_Cutaneous.3.aspx
One comment from this article refers to molecular pathology mutation testing for BRAF, NRAS, and KIT on primary melanomas:
“With the recent development and testing of new promising targeted therapies for patients with metastatic melanoma, molecular pathology mutation testing for BRAF, NRAS, KIT, and other mutations has become common in many melanoma treatment centers. At the present time, routine mutation testing is recommended only in patients with inoperable AJCC stage III or stage IV disease (and will therefore usually not be performed at the time of diagnosis of primary cutaneous melanoma), and mutation testing was not included in the current version of the ICCR melanoma pathology reporting protocol.”
Our dermatopathologists agree with this statement and, at this time, we consider it unnecessary to perform these tests routinely on all patients with a primary melanoma. It may not provide clinically relevant information to patients and clinicians regarding their primary melanoma, and results in an increased charge to the patient.
The article is an excellent read for those interested in pathology reporting of melanoma. If you have specific questions or concerns, please contact one of our Board Certified Dermatopathologists at 865-474-8866.
Patients with Muir-Torre Syndrome develop sebaceous neoplasms as well as one or more visceral malignancies. Our dermatopathologists screen sebaceous neoplasms using immunohistochemistry stains to evaluate for loss of expression of DNA mismatch repair proteins MLH1, MSH2, MSH6, and PMS2. Loss of expression of one or more of these markers has been reported in sebaceous neoplasms of patients with Muir-Torre Syndrome. Because the development of the sebaceous skin tumors can precede the presentation of the visceral malignancy, these studies may be an important first step in identifying patients with Muir-Torre Syndrome.
For an excellent review of sebaceous neoplasms and Muir-Torre syndrome, please visit the links to the articles below:
- Histopathology. 2010 January; 56(1): 133–147. Sebaceous neoplasia and the Muir–Torre syndrome: important connections with clinical implications. Sara C Shalin, Stephen Lyle,1 Eduardo Calonje,2 and Alexander J F Lazar3
- Am J Surg Pathol. 2009 Jun;33(6):934-44. Towards identification of hereditary DNA mismatch repair deficiency: sebaceous neoplasm warrants routine immunohistochemical screening regardless of patient’s age or other clinical characteristics. Orta L, Klimstra DS, Qin J, Mecca P, Tang LH, Busam KJ, Shia J.