Cristina Pellegrini, Ludovica Cardelli, Marina De Padova, Lucia Di Nardo, Valeria Ciciarelli, Tea Rocco, Gianluca Cipolloni, Marco Clementi, Alessio Cortellini, Alessandra Ventura, Pietro Leocata, Maria Concetta Fargnoli
DOI: 10.2340/00015555-3382

Mutations in MAPK signalling genes are driver events in melanoma, and have therapeutic relevance in the metastatic and adjuvant setting. This study evaluated the intra-patient heterogeneity of BRAF, NRAS and c-KIT mutational status between 30 primary melanomas and 39 related metastases, using molecular analysis and immunohistochemistry. BRAF mutations were identified in 46.7% of primary melanomas and 48.7% of metastases and NRAS mutations in 20% and 25.6%, respectively. Intra-patient heterogeneity was detected in 13.3% of patients for both BRAF and NRAS genes and was not associated with clinico-pathological characteristics of melanomas or metastases. High consistency was observed between immunostaining and molecular methods for BRAFV600E (k = 0.90; p < 0.001) and NRASQ61R (k = 0.87; p < 0.001). These findings demonstrate a relevant intra-patient heterogeneity between primary and metastatic lesions that is independent of clinical variables and methodological approach.

Cutaneous melanoma is one of the most aggressive and treatment-resistant tumours. Intra-patient concordance of mutations in genes, such as BRAF, NRAS and c-KIT, between primary melanoma and related metastases is a critical aspect that has become even more relevant with the introduction of therapies targeting specific mutations. This study evaluated the intra-patient heterogeneity of BRAF, NRAS and c-KIT mutational status in 30 primary melanomas and 39 related metastases, using molecular analysis and immunohistochemistry. Clinically meaningful intra-patient heterogeneity was found between primary melanoma and related metastases, independent of the technical approach, thus supporting the polyclonal model of melanoma progression.

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