title: An interstitial deletion within 9p21.3 and extending beyondCDKN2Apredisposes to melanoma, neural system tumours and possible haematological malignancies.
abstract: Familial atypical multiple mole melanoma syndrome (FAMMM) is characterised by dysplastic naevi, malignant melanoma and pancreatic cancer. Given that large deletions involvingCDKN2A(cyclin-dependent kinase inhibitor 2A) account for only 2% of cases, we describe a family that highlights the co-occurrence of both melanoma and neural system tumours to aid clinical recognition and propose a management strategy. A patient with multiple neurofibromas was referred with a provisional diagnosis of neurofibromatosis type 1 (NF1). Prior molecular testing, though, had failed to identify anNF1mutation by sequencing and multiplex ligation-dependent probe amplification. His family history was significant for multiple in situ/malignant melanomas at young ages and several different cancers reminiscent of an underlying syndrome. A search of the Familial Cancer Database, FaCD Online, highlighted several families with cutaneous melanoma and nervous system tumours who were subsequently identified to have large deletions spanningCDKN2AAlthough sequencing ofCDKN2AandTP53failed to identify a mutation, a heterozygousCDKN2Adeletion was identified by targeted array comparative genomic hybridisation (CGH). Whole-genome oligonucleotide array CGH and SNP analysis identified an interstitial deletion of at least 1.5 Mb within 9p21.3 and spanning approximately 25 genes. Identification of the underlying molecular abnormality permits predictive testing for at-risk relatives. Given the young cancer diagnoses, a surveillance regimen was developed and a clinical team organised for ongoing management so that genetic testing could be offered to both adults and minor children. Surveillance recommendations addressed cancer risks associated with FAMMM, and other cancers exhibited by this family with a large contiguous gene deletion.
authors.affiliation: Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA.
authors.forename: Maria J
authors.identifier: http://orcid.org/0000-0002-2970-3418
authors.initials: MJ
authors.lastname: Baker
authors.affiliation: Division of Cancer Epidemiology and Genetics, Genetic Epidemiology Branch, National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Alisa M
authors.initials: AM
authors.lastname: Goldstein
authors.affiliation: Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Gordon
authors.affiliation: Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA.
authors.forename: Kimberly S
authors.initials: KS
authors.lastname: Harbaugh
authors.affiliation: Department of Radiation Oncology, Penn State Milton S. Hershey Medical Center, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA.
authors.forename: Heath B
authors.initials: HB
authors.lastname: Mackley
authors.affiliation: Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Glantz
authors.affiliation: Department of Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey Cancer Institute, Hershey, Pennsylvania, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Drabick
keywords: Cancer: CNS; Cancer: dermatological; Clinical genetics; Genetic screening/counselling; Molecular genetics