Dysplastic nevus natural history, complications and prognosis: Difference between revisions

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{{Dysplastic nevus}}
{{Dysplastic nevus}}
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{{CMG}} ; {{AE}} {{ADG}}


==Overview==
==Overview==
Dysplastic nevus can progress to melanoma if it is not treated adequately. Complications of dysplastic nevi include melanoma and metastasis.
If left untreated, [[melanoma]] progression occurs horizontally (radial growth plate) and vertically (vertical growth plate) and is then followed by [[Dermis|dermal]] invasion and distant [[metastasis]]. [[Melanoma]] is an aggressive [[tumor]] characterized by early [[metastasis]]. Common sites of [[metastasis]] include [[Bone|bones]], [[brain]], [[Kidney|kidneys]], [[Lung|lungs]], [[liver]] and [[skin]] ([[secondary]] distant site). [[Complication (medicine)|Complications]] of [[melanoma]] are usually related to the site of [[metastasis]]. The 5-year relative survival of [[Patient|patients]] with [[melanoma]] is approximately 93%. Features associated with worse [[prognosis]] are [[tumor]] thickness ([[Breslow's depth|Breslow thickness]]), depth related to [[skin]] structures (Clark level), type of [[melanoma]], presence of [[Ulcer|ulceration]], presence of [[Lymphatic system|lymphatic]]/[[Perineurium|perineural]] invasion, location of [[lesion]], presence of [[Satellite (biology)|satellite]] [[Lesion|lesions]], and the presence of regional or distant [[metastasis]].


==Natural History, Complications, and Prognosis==
==Natural History==
* Dysplastic nevus can progress to melanoma if it is not treated adequately.  
*If left untreated, [[Melanocyte|melanocytes]] first [[Cell growth|proliferate]] randomly with an aberrant growth within an existing [[nevus]].
* Atypical nevi usually first appear during puberty and may develop throughout life.
*More advanced stages are characterized by a radial growth phase with [[Epidermis (skin)|intraepidermal]] growth and penetration into the papillary [[dermis]].
* Atypical nevi are dynamic in their clinical appearance.  
*Final stages demonstrate a vertical growth phase with [[Dermis|dermal]] invasion and widening of the papillary [[dermis]] before [[Cancer|cancerous]] [[Cell (biology)|cells]] finally [[Metastasis|metastasize]] to other parts of the [[skin]] and other [[Organ (anatomy)|organs]].
* The presence of atypical nevi is a strong risk factor for melanoma, approximately half of melanomas arising in patients with atypical nevi develop de novo and do not evolve from a precursor atypical nevus.
 
==Complications==
[[Complication (medicine)|Complications]] of [[melanoma]] are usually due to distant [[metastasis]]. Common sites of [[metastasis]] are shown below:
*[[Bone]]
*[[Brain]]
*[[Liver]]
*[[Kidney]]
*[[Skin]] (secondary distant site)
*Lungs<ref name="pmid25032021">{{cite journal |vauthors=Brant JM |title=Breathlessness with pulmonary metastases: a multimodal approach |journal=J Adv Pract Oncol |volume=4 |issue=6 |pages=415–22 |date=November 2013 |pmid=25032021 |pmc=4093448 |doi= |url=}}</ref>
 
==Prognosis==
===Determinants of Prognosis===
*Features that affect [[prognosis]] include:<ref>{{cite journal | author = Homsi J, Kashani-Sabet M, Messina J, Daud A | title = Cutaneous melanoma: prognostic factors. | journal = Cancer Control | volume = 12 | issue = 4 | pages = 223-9 | year = 2005 | id = PMID 16258493}}''[https://www.moffitt.usf.edu/pubs/ccj/v12n4/pdf/223.pdf Full text (PDF)]''</ref>
 
:*[[Tumor]] thickness in millimeters ([[Breslow's depth]])
:*Depth related to [[skin]] structures (Clark level)
:*Type of [[melanoma]]
:*Presence of [[Ulcer|ulceration]]
:*Presence of [[Lymphatic system|lymphatic]]/[[Perineurium|perineural]] invasion
:*Presence of [[tumor]] infiltrating [[lymphocyte]]s (if present, [[prognosis]] is better)
:*Location of [[lesion]]
:*Presence of [[Satellite (biology)|satellite]] [[Lesion|lesions]]
:*Presence of regional or distant [[metastasis]]
 
===TNM Staging===
*The [[TNM]] staging classification summarizes most of the above mentioned findings. Using the [[TNM|TNM classification]], [[prognosis]] can be determined based on the stage of the [[disease]] as follows:
:*'''Stage 0''': [[Melanoma]] [[in situ]], 100% Survival
:*'''Stage I''': Invasive [[Melanoma]], 85-95% Survival
:*'''Stage II''': High Risk [[Melanoma]], 40-85% Survival
:*'''Stage III''': Regional [[Metastasis]], 25-60% Survival
:*'''Stage IV''': Distant [[Metastasis]], 9-15% Survival
 
'''''Please check the [[Melanoma staging|staging]] page for more details about the staging scheme and the [[TNM|TNM classification]].'''''
 
===Breslow's Depth===
*The [[Breslow's depth]] is independent of other features of the [[tumor]] and has been demonstrated to be associated with 5-year survival:
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Breslow's Depth'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''5-year survival'''}}
|-
| < 0.76 mm||95% to 100%
|-
| 0.76-1.5 mm||80% to 96%
|-
| 1.5-4 mm||60% to 75%
|-
| > 4 mm||37% to 50%
|}
 
===Micro-metastasis vs. Macro-metastasis===
*Extent of [[Cancer|malignancy]] within a [[Lymph node|node]] is also important; micro-[[Metastasis|metastases]] in which [[Cancer|malignancy]] is only [[microscopic]] have a more favorable [[prognosis]] than macro-[[Metastasis|metastases]]. 
*In some cases, micro-[[Metastasis|metastases]] may only be detected by special [[staining]], and if [[Cancer|malignancy]] is only detectable [[polymerase chain reaction|polymerase chain reaction (PCR)]], the [[prognosis]] is better.  
*Macro-[[Metastasis|metastases]] in which [[Cancer|malignancy]] is clinically apparent (in some cases [[cancer]] completely replaces a node) have a far worse [[prognosis]], and if [[Lymph nodew|nodes]] are matted or if there is [[Lymph node capsule|extra-capsular]] extension, the [[prognosis]] is still worse.
 
===5-Year Survival===
* Between 2004 and 2010, the 5-year relative survival of [[Patient|patients]] with [[melanoma]] was 92.9%.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
* When stratified by age, the 5-year relative survival of [[Patient|patients]] with [[melanoma]] was 92.7% and 88.2% for [[Patient|patients]] <65 and ≥ 65 years of age respectively.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
*When there is distant [[metastasis]], the cancer is generally considered [[Cure|incurable]]. The five year survival rate is less than 10%.<ref name="AJCC">{{cite journal | author = Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J | title = Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma. | journal = J Clin Oncol | volume = 19 | issue = 16 | pages = 3635-48 | year = 2001 | id = PMID 11504745}}''[http://www.jco.org/cgi/content/full/19/16/3635 Full text]''</ref>
 
* The survival of [[Patient|patients]] with [[melanoma]] varies with the [[Cancer staging|stage]] of the [[disease]].  Shown below is a table depicting the 5-year relative survival by the [[Cancer staging|stage]] of [[melanoma]]:<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
{| {{table}} cellpadding="4" cellspacing="0" style="border:#c9c9c9 1px solid; margin: 1em 1em 1em 0; border-collapse: collapse;"
! style="background: #4479BA;" | {{fontcolor|#FFF|'''Stage'''}}
! style="background: #4479BA;" | {{fontcolor|#FFF|'''5-year relative survival (%), 2004-2010'''}}
|-
| '''All stages'''|| 91.3%
|-
| '''Localized'''|| 98.1%
|-
| '''Regional'''|| 62.6%
|-
| '''Distant'''|| 16.1%
|-
| '''Unstaged'''|| 78.4%
|}
 
* Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the [[Cohort study|cohort]] has already survived 0, 1, 3 years) between 1998 and 2010 of [[melanoma]] by [[Cancer staging|stage]] at [[diagnosis]] according to [[SEER]]. These graphs are adapted from [[SEER]]: The Surveillance, [[Epidemiology]], and End Results Program of the National [[Cancer]] Institute.<ref name="SEER">Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.</ref>
 
[[Image:5 year survival in melanoma in USA.png|5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of melanoma by stage at diagnosis according to SEER]]


=== Complications ===
* Complications of dysplastic nevi include melanoma and metastasis.


==References==
==References==

Revision as of 05:19, 4 June 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

If left untreated, melanoma progression occurs horizontally (radial growth plate) and vertically (vertical growth plate) and is then followed by dermal invasion and distant metastasis. Melanoma is an aggressive tumor characterized by early metastasis. Common sites of metastasis include bones, brain, kidneys, lungs, liver and skin (secondary distant site). Complications of melanoma are usually related to the site of metastasis. The 5-year relative survival of patients with melanoma is approximately 93%. Features associated with worse prognosis are tumor thickness (Breslow thickness), depth related to skin structures (Clark level), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, location of lesion, presence of satellite lesions, and the presence of regional or distant metastasis.

Natural History

Complications

Complications of melanoma are usually due to distant metastasis. Common sites of metastasis are shown below:

Prognosis

Determinants of Prognosis

TNM Staging

Please check the staging page for more details about the staging scheme and the TNM classification.

Breslow's Depth

  • The Breslow's depth is independent of other features of the tumor and has been demonstrated to be associated with 5-year survival:
Breslow's Depth 5-year survival
< 0.76 mm 95% to 100%
0.76-1.5 mm 80% to 96%
1.5-4 mm 60% to 75%
> 4 mm 37% to 50%

Micro-metastasis vs. Macro-metastasis

5-Year Survival

  • When stratified by age, the 5-year relative survival of patients with melanoma was 92.7% and 88.2% for patients <65 and ≥ 65 years of age respectively.[3]
  • When there is distant metastasis, the cancer is generally considered incurable. The five year survival rate is less than 10%.[4]
Stage 5-year relative survival (%), 2004-2010
All stages 91.3%
Localized 98.1%
Regional 62.6%
Distant 16.1%
Unstaged 78.4%
  • Shown below is an image depicting the 5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of melanoma by stage at diagnosis according to SEER. These graphs are adapted from SEER: The Surveillance, Epidemiology, and End Results Program of the National Cancer Institute.[3]

5-year conditional relative survival (probability of surviving in the next 5-years given the cohort has already survived 0, 1, 3 years) between 1998 and 2010 of melanoma by stage at diagnosis according to SEER


References

  1. ↑ Brant JM (November 2013). "Breathlessness with pulmonary metastases: a multimodal approach". J Adv Pract Oncol. 4 (6): 415–22. PMC 4093448. PMID 25032021.
  2. ↑ Homsi J, Kashani-Sabet M, Messina J, Daud A (2005). "Cutaneous melanoma: prognostic factors". Cancer Control. 12 (4): 223–9. PMID 16258493.Full text (PDF)
  3. ↑ 3.0 3.1 3.2 3.3 Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z,Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2011/, based on November 2013 SEER data submission, posted to the SEER web site, April 2014.
  4. ↑ Balch C, Buzaid A, Soong S, Atkins M, Cascinelli N, Coit D, Fleming I, Gershenwald J, Houghton A, Kirkwood J, McMasters K, Mihm M, Morton D, Reintgen D, Ross M, Sober A, Thompson J, Thompson J (2001). "Final version of the American Joint Committee on Cancer staging system for cutaneous melanoma". J Clin Oncol. 19 (16): 3635–48. PMID 11504745.Full text

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