0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Case Report/Case Series |

Dark Homogeneous Streak Dermoscopic Pattern Correlating With Specific KIT Mutations in Melanoma

Margaret I. Sanchez, MD1; Harold S. Rabinovitz, MD1; Margaret C. Oliviero, RNP1; George W. Elgart, MD1; Carmen Perez, MD1; Susana Puig, MD2,3; Josep Malvehy, MD2,3; James M. Grichnik, MD, PhD1
[+] Author Affiliations
1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
2Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
3CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
JAMA Dermatol. 2014;150(6):633-639. doi:10.1001/jamadermatol.2013.8442.
Text Size: A A A
Published online

Importance  Mutations driving melanoma growth have diagnostic, prognostic, and therapeutic implications. Traditional classification systems do not correlate optimally with underlying melanoma growth–promoting mutations. Our objective was to determine whether unique dermoscopic growth patterns directly correlate with driving mutations.

Observations  We evaluated common driving mutations in 4 different dermoscopic patterns (rhomboidal, negative pigmented network, polygonal, and dark homogeneous streaks) of primary cutaneous melanomas; 3 melanomas per pattern were tested. Three of the 4 patterns lacked common mutations in BRAF, NRAS, KIT, GNAQ, and HRAS. One pattern, the dark homogeneous streaks pattern, had unique KIT mutations in the second catalytic domain of KIT in exon 17 for all 3 samples tested. Two tumors with the dark homogeneous streaks pattern turned out to be different primary melanomas from the same patient and had different sequence mutations but had an impact on the same KIT domain.

Conclusions and Relevance  While future study is required, these results have multiple implications. (1) The underlying melanoma-driving mutations may give rise to specific dermoscopic growth patterns, (2) BRAF/NRAS mutations in early melanomas may not be as common as previously thought, and (3) patients may be predisposed to developing specific driving mutations giving rise to melanomas or nevi of similar growth patterns.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Melanoma Dermoscopic Growth Patterns

Shown are the 6 dermoscopic patterns that were not subjected to genetic analysis. A and B, Disorganized fine network pattern; the insets show a brown network structure with irregular holes and lines. C and D, Epidermal crease sparing pattern; insets show well-defined epidermal creases surrounded by pigmented structureless areas. E and F, Gray dotted–regression pattern; insets show gray dots and areas of regression. G and H, Homogeneous pattern; the images show light and dark brown irregular structureless areas. I and J, Multicolor multicomponent pattern; the images show light brown, dark brown, and black colors with structureless areas, an irregularly pigmented network, and asymmetrical fingerlike projections. K and L, Perifollicular pigmented pattern; inset shows eccentric annular pigmentation around follicular ostia.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Negative Pigmented Network Pattern

Dermoscopic images with negative pigmented network features of the 3 melanomas (A, D, and G) with their corresponding histologic images at lower and high magnifications (B, C, E, F, H, I). All 3 have similar negative network pattern with light areas forming the “cords” of the network and darker areas filling the holes (insets). B, C, E, F, H, I: hematoxylin-eosin; B, E, and H, original magnification ×4; C and F, ×10; I, ×20.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.
Dark Homogeneous Streak Pattern

Dermoscopic images with streaks and homogeneous features of the 3 melanomas (A, D, and G) with their corresponding histologic images at lower and high magnifications (B, C, E, F, H, and I). All 3 have a similar pattern of dark homogeneous areas with streaks at the margins (insets). B, C, E, F, H, I: hematoxylin-eosin; B, E, and H, original magnification ×4; C, F, and I, ×20.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.
Dark Homogeneous Streak Pattern Revealing Unique Mutations in Exon 17

The location of the KIT gene on chromosome 4. Exon 17 includes the second tyrosine kinase domain. The highlighted bases are those included in the catalytic domain. All 3 mutations identified are in or directly next to the catalytic domain and are shown in the sequences in the panel to the right of each tumor image.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();