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      Metástasis de melanoma sobre zona donante de injerto. Caso clínico Translated title: Melanoma metastases on skin graft donor site. Case report

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          Abstract

          Resumen Las metástasis cutáneas de melanoma en el área de donde se extrae la piel para cubrir el defecto de la extirpación de la lesión inicial son raras, existiendo pocas publicaciones al respecto. Presentamos el caso inusual de un paciente de 60 años de edad con diagnóstico de melanoma en región supraescapular izquierda, al que se realizó cirugía de ampliación de márgenes y reconstrucción con injerto de piel parcial, apareciendo posteriormente múltiples lesiones metastásicas de aspecto papular, gris-azuladas, en las zonas receptora y donante del injerto. El hallazgo coincidió con la detección de metástasis hepáticas, pulmonares, retroperitoneales y cerebrales, sugestivas de enfermedad diseminada.

          Translated abstract

          Abstract Cutaneous melanoma metastases in the area where the skin is removed to cover the defect of the initial lesion removal are rare, and there are few publications about it. We present the unusual case of a 60-year-old patient with a diagnosis of melanoma in the left suprascapular region, who underwent a wide local excision surgery and was reconstructed with a partial thickness skin graft, subsequently appearing multiple metastatic lesions of gray-blue papular appearance in the graft recipient and donor areas. This clinical finding coincided with the detection of liver, lung, retroperitoneal, and brain metastases, that lead us to suspect disseminated disease.

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          Metastatic pathways and time courses in the orderly progression of cutaneous melanoma.

          B Schittek, F. Meier, S Will … (2002)
          It is known that two-thirds of patients who develop clinical metastases following treatment of a primary cutaneous melanoma initially present with locoregional metastases and one-third initially present with distant metastases. However, few reports in the literature give detailed figures on different metastatic pathways in cutaneous melanoma. The aim of the present study was to perform a detailed analysis of the different metastatic pathways, the time course of the development of metastases and the factors influencing them. In a series of 3001 patients with primary cutaneous melanoma at first presentation, 466 subsequently developed metastasis and were followed-up over the long term at the University of Tuebingen, Germany between 1976 and 1996. Different pathways of metastatic spread were traced. Associated risk factors for the different pathways were assessed. Differences in survival probabilities were calculated by the Kaplan-Meier method and evaluated by the log-rank test. In 50.2% of the patients the first metastasis after treatment of the primary tumour developed in the regional lymph nodes. In the remaining half of the patient sample the first metastasis developed in the lymphatic drainage area in front of the regional lymph nodes, as satellite or in-transit metastases (21.7%) or as direct distant metastases (28.1%). Anatomical location, sex and tumour thickness were significant risk factors for the development of metastasis by different pathways. The most important risk factor appeared to be the location of the primary tumour. The median intervals elapsing before the first metastasis differed significantly between the different metastatic pathways. The direct distant metastases became manifest after a median period of 25 months, thus later than the direct regional lymph node metastases (median latency period, 16 months) and the direct satellite and in-transit metastases (median latency period, 17 months). In patients who developed distant metastases the period of development was independent of the metastatic route. The time at which the distant metastases developed was roughly the same (between 24 and 30 months after the detection of the primary tumour), irrespective of whether satellite or in-transit metastases, lymph node metastases or distant metastases were the first to occur. The time course of the development of distant metastasis was more or less the same irrespective of the metastatic pathway; this suggests that in patients with in-transit or satellite metastasis or regional lymph node metastasis, haematogenic metastatic spread had already taken place. Thus, the diagnostic value of sentinel lymph node biopsy and the therapeutic benefit of elective lymph node dissection may be limited, as satellite and in-transit metastases or direct distant metastases will not be detected and haematogenous spread may already have taken place when the intervention is performed.
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            Patterns of lymphatic drainage from the skin in patients with melanoma.

            John Giles, Roger Uren, John F Thompson (2003)
            An essential prerequisite for a successful sentinel lymph node biopsy (SLNB) procedure is an accurate map of the pattern of lymphatic drainage from the primary tumor site in each patient. In melanoma patients, mapping requires high-quality lymphoscintigraphy, which can identify the actual lymphatic collecting vessels as they drain into the sentinel lymph nodes. Small-particle radiocolloids are needed to achieve this goal, and imaging protocols must be adapted to ensure that all true sentinel nodes, including those in unexpected locations, are found in every patient. Clinical prediction of lymphatic drainage from the skin is not possible. The old clinical guidelines based on Sappey's lines therefore should be abandoned. Patterns of lymphatic drainage from the skin are highly variable from patient to patient, even from the same area of the skin. Unexpected lymphatic drainage from the skin of the back to sentinel nodes in the triangular intermuscular space and, in some patients, through the posterior body wall to sentinel nodes in the para-aortic, paravertebral, and retroperitoneal areas has been found. Lymphatic drainage from the head and neck frequently involves sentinel nodes in multiple node fields and can occur from the base of the neck up to nodes in the occipital or upper cervical areas or from the scalp down to nodes at the neck base, bypassing many node groups. The sentinel node is not always found in the nearest node field and is best defined as "any lymph node receiving direct lymphatic drainage from a primary tumor site." Lymphatic drainage can occur from the upper limb to sentinel nodes above the axilla. Drainage to the epitrochlear region from the hand and arm as well as to the popliteal region from the foot and leg is more common than was previously thought. Interval nodes, which lie along the course of a lymphatic vessel between a lesion site and a recognized node field, are not uncommon, especially in the trunk. Drainage across the midline of the body is quite common in the trunk and in the head and neck. Micrometastatic disease can be present in any sentinel node regardless of its location, and for the SLNB technique to be accurate, all true sentinel nodes must be biopsied in every patient.
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              Melanoma cells undergo aggressive coalescence in a 3D Matrigel model that is repressed by anti-CD44

              Deborah Wessels, Daniel Lusche, Edward Voss … (2017)
              Using unique computer-assisted 3D reconstruction software, it was previously demonstrated that tumorigenic cell lines derived from breast tumors, when seeded in a 3D Matrigel model, grew as clonal aggregates which, after approximately 100 hours, underwent coalescence mediated by specialized cells, eventually forming a highly structured large spheroid. Non-tumorigenic cells did not undergo coalescence. Because histological sections of melanomas forming in patients suggest that melanoma cells migrate and coalesce to form tumors, we tested whether they also underwent coalescence in a 3D Matrigel model. Melanoma cells exiting fragments of three independent melanomas or from secondary cultures derived from them, and cells from the melanoma line HTB-66, all underwent coalescence mediated by specialized cells in the 3D model. Normal melanocytes did not. However, coalescence of melanoma cells differed from that of breast-derived tumorigenic cell lines in that they 1) coalesced immediately, 2) underwent coalescence as individual cells as well as aggregates, 3) underwent coalescence far faster and 4) ultimately formed long, flat, fenestrated aggregates that were extremely dynamic. A screen of 51 purified monoclonal antibodies (mAbs) targeting cell surface-associated molecules revealed that two mAbs, anti-beta 1 integrin/(CD29) and anti-CD44, blocked melanoma cell coalescence. They also blocked coalescence of tumorigenic cells derived from a breast tumor. These results add weight to the commonality of coalescence as a characteristic of tumorigenic cells, as well as the usefulness of the 3D Matrigel model and software for both investigating the mechanisms regulating tumorigenesis and screening for potential anti-tumorigenesis mAbs.
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                Author and article information

                Journal
                Journal ID (publisher-id): cpil
                Title: Cirugía Plástica Ibero-Latinoamericana
                Abbreviated Title: Cir. plást. iberolatinoam.
                Publisher: Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                ISSN (Print): 0376-7892
                ISSN (Electronic): 1989-2055
                Publication date (Print and electronic): March 2021
                Volume: 47
                Issue: 1
                Pages: 105-110
                Affiliations
                [1] Alicante orgnameHospital General Universitario de Alicante orgdiv1Servicio de Cirugía Plástica España
                [5] Alicante orgnameHospital General Universitario de Alicante orgdiv1Servicio de Cirugía Plástica España
                [2] Alicante orgnameHospital General Universitario de Alicante orgdiv1Servicio de Cirugía Plástica España
                [4] Alicante orgnameHospital General Universitario de Alicante orgdiv1Servicio de Cirugía Plástica España
                [3] Alicante orgnameHospital General Universitario de Alicante orgdiv1Servicio de Cirugía Plástica España
                Article
                Publisher ID: S0376-78922021000100105 Publisher ID: S0376-7892(21)04700100105
                DOI: 10.4321/s0376-78922021000100014
                SO-VID: 92dbfe3e-b77e-4ecb-a76e-5902afb20405
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                Date accepted : 28 January 2021
                Date received : 24 November 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 20, Pages: 6
                Product

                SciELO Spain

                Categories
                Subject: Reconstructiva

                Keywords: Melanoma,Metastases,Sentinel lymph node,Metástasis,Ganglio centinela
                Data availability:
                Keywords: Melanoma, Metastases, Sentinel lymph node, Metástasis, Ganglio centinela

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