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CD10 and p63 expression in a sarcomatoid undifferentiated melanoma: A cautionary (and molecularly annotated) tale.

Abstract

Undifferentiated melanoma should be considered in the differential diagnosis of sarcomatoid cutaneous malignancies to ensure that patients receive the correct treatment. Dermatopathologists should recognize the pitfalls of relying too heavily on immunohistochemistry to establish this diagnosis and consider ancillary tests, including single-nucleotide polymorphism (SNP) copy number arrays and targeted next-generation sequencing (NGS), when a definitive diagnosis cannot be rendered on a primary or metastatic tumor. This technology can also help to exclude a collision of melanoma and sarcoma when both differentiated and undifferentiated components are juxtaposed. We describe an exceedingly rare, illustrative example of undifferentiated sarcomatoid melanoma presenting as a pedunculated nodule. The clinical context and presence of a small differentiated component helped to establish the diagnosis; however, the transition from differentiated to undifferentiated melanoma was accompanied by an abrupt loss of S100, Sox10, MITF, MelanA, and HMB45 with gain of CD10 and p63 staining. SNP copy number array and NGS revealed shared chromosomal copy number changes and overlapping mutations with additional aberrances detected exclusively in the sarcomatoid component, thereby excluding a collision tumor and confirming our putative impression of melanoma with progression to an undifferentiated sarcomatoid phenotype.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.Department of Surgery, Section of Surgical Oncology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31943331

Citation

Lefferts, Joel A., et al. "CD10 and P63 Expression in a Sarcomatoid Undifferentiated Melanoma: a Cautionary (and Molecularly Annotated) Tale." Journal of Cutaneous Pathology, 2020.
Lefferts JA, Loehrer AP, Yan S, et al. CD10 and p63 expression in a sarcomatoid undifferentiated melanoma: A cautionary (and molecularly annotated) tale. J Cutan Pathol. 2020.
Lefferts, J. A., Loehrer, A. P., Yan, S., Green, D. C., Deharvengt, S. J., & LeBlanc, R. E. (2020). CD10 and p63 expression in a sarcomatoid undifferentiated melanoma: A cautionary (and molecularly annotated) tale. Journal of Cutaneous Pathology, doi:10.1111/cup.13646.
Lefferts JA, et al. CD10 and P63 Expression in a Sarcomatoid Undifferentiated Melanoma: a Cautionary (and Molecularly Annotated) Tale. J Cutan Pathol. 2020 Jan 14; PubMed PMID: 31943331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CD10 and p63 expression in a sarcomatoid undifferentiated melanoma: A cautionary (and molecularly annotated) tale. AU - Lefferts,Joel A, AU - Loehrer,Andrew P, AU - Yan,Shaofeng, AU - Green,Donald C, AU - Deharvengt,Sophie J, AU - LeBlanc,Robert E, Y1 - 2020/01/14/ PY - 2019/10/31/received PY - 2020/01/07/revised PY - 2020/01/08/accepted PY - 2020/1/17/pubmed PY - 2020/1/17/medline PY - 2020/1/17/entrez KW - atypical fibroxanthoma KW - high-risk skin cancer KW - immunohistochemistry KW - melanoma KW - molecular pathology KW - pleomorphic dermal sarcoma JF - Journal of cutaneous pathology JO - J. Cutan. Pathol. N2 - Undifferentiated melanoma should be considered in the differential diagnosis of sarcomatoid cutaneous malignancies to ensure that patients receive the correct treatment. Dermatopathologists should recognize the pitfalls of relying too heavily on immunohistochemistry to establish this diagnosis and consider ancillary tests, including single-nucleotide polymorphism (SNP) copy number arrays and targeted next-generation sequencing (NGS), when a definitive diagnosis cannot be rendered on a primary or metastatic tumor. This technology can also help to exclude a collision of melanoma and sarcoma when both differentiated and undifferentiated components are juxtaposed. We describe an exceedingly rare, illustrative example of undifferentiated sarcomatoid melanoma presenting as a pedunculated nodule. The clinical context and presence of a small differentiated component helped to establish the diagnosis; however, the transition from differentiated to undifferentiated melanoma was accompanied by an abrupt loss of S100, Sox10, MITF, MelanA, and HMB45 with gain of CD10 and p63 staining. SNP copy number array and NGS revealed shared chromosomal copy number changes and overlapping mutations with additional aberrances detected exclusively in the sarcomatoid component, thereby excluding a collision tumor and confirming our putative impression of melanoma with progression to an undifferentiated sarcomatoid phenotype. SN - 1600-0560 UR - https://www.unboundmedicine.com/medline/citation/31943331/CD10_and_P63_Expression_in_a_Sarcomatoid_Undifferentiated_Melanoma:_A_Cautionary_(and_Molecularly_Annotated)_Tale L2 - https://doi.org/10.1111/cup.13646 DB - PRIME DP - Unbound Medicine ER -