lunes, 29 de enero de 2018

Response to "Phase IV head-to-head randomised controlled trial comparing ingenol mebutate 0.015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp".


We read with attention the recent paper by Stockfleth et al1 on the efficacy and safety of Ingenol Mebutate 0.015% gel (IngMb) vs. diclofenac sodium 3% gel (DS) for the treatment of actinic keratosis (AK). Regarding this interesting study, we would like to address some comments to the authors.In this study, the primary endpoint was complete clearance of AKs (AKCLEAR100) at end of first treatment course (Week8, IngMeb; Week17, DS).
This article is protected by copyright. All rights reserved.

#susanapuig #josepmalvehy #queratosis #akclear100 #treatmentactinickeratosis #actinickeratosis #keratosis #queratosis #tratamientoqueratosisactinica

jueves, 25 de enero de 2018

Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases


Improving diagnostic sensitivity of combined dermoscopy and reflectance confocal microscopy imaging through double reader concordance evaluation in telemedicine settings: A retrospective study of 1000 equivocal cases



Reflectance confocal microscopy (RCM) is an imaging device that permits non-invasive visualization of cellular morphology and has been shown to improve diagnostic accuracy of dermoscopically equivocal cutaneous lesions. The application of double reader concordance evaluation of dermoscopy-RCM image sets in retrospective settings and its potential application to telemedicine evaluation has not been tested in a large study population.


To improve diagnostic sensitivity of RCM image diagnosis using a double reader concordance evaluation approach; to reduce mismanagement of equivocal cutaneous lesions in retrospective consultation and telemedicine settings.


1000 combined dermoscopy-RCM image sets were evaluated in blind by 10 readers with advanced training and internship in dermoscopy and RCM evaluation. We compared sensitivity and specificity of single reader evaluation versus double reader concordance evaluation as well as the effect of diagnostic confidence on lesion management in a retrospective setting.


Single reader evaluation resulted in an overall sensitivity of 95.2% and specificity of 76.3%, with misdiagnosis of 8 melanomas, 4 basal cell carcinomas and 2 squamous cell carcinomas. Combined double reader evaluation resulted in an overall sensitivity of 98.3% and specificity of 65.5%, with misdiagnosis of 1 in-situ melanoma and 2 basal cell carcinomas.


Evaluation of dermoscopy-RCM image sets of cutaneous lesions by single reader evaluation in retrospective settings is limited by sensitivity levels that may result in potential mismanagement of malignant lesions. Double reader blind concordance evaluation may improve the sensitivity of diagnosis and management safety. The use of a second check can be implemented in telemedicine settings where expert consultation and second opinions may be required.

#josepmalvehy  #carcinomabasocelular  #dermatoscopy #confocal #cancerdepiel #confocalinvivo, #microscopy #cutaneousmelanoma #squamouscellcarcinomas #carcinomas  #melanomas #reflectanceconfocal #telemedicine

lunes, 22 de enero de 2018

Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study.

Sentinel lymph node biopsy versus observation in thick melanoma: A multicenter propensity score matching study.


The clinical value of sentinel lymph node (SLN) biopsy in thick melanoma patients (Breslow >4 mm) has not been sufficiently studied. The aim of the study is to evaluate whether SLN biopsy increases survival in patients with thick cutaneous melanoma, and, as a secondary objective, to investigate correlations between survival and lymph node status. We included 1,211 consecutive patients with thick melanomas (>4 mm) registered in the participating hospitals' melanoma databases between 1997 and 2015. Median follow-up was 40 months. Of these patients, 752 were matched into pairs by propensity scores based on sex, age, tumor location, histologic features of melanoma, year of diagnosis, hospital and adjuvant interferon therapy. The SLN biopsy vs. observation was associated with better DFS [adjusted hazard ratio (AHR), 0.74; 95% confidence interval (CI) 0.61-0.90); p = 0.002] and OS (AHR, 0.75; 95% CI, 0.60-0.94; p = 0.013) but not MSS (AHR, 0.84; 95% CI, 0.65-1.08; p = 0.165). SLN-negative patients had better 5- and 10-year MSS compared with SLN-positive patients (65.4 vs. 51.9% and 48.3 vs. 38.8%; p = 0.01, respectively). As a conclusion, SLN biopsy was associated with better DFS but not MSS in thick melanoma patients after adjustment for classic prognostic factors. SLN biopsy is useful for stratifying these patients into different prognostic groups.

#melanoma #josepmalvehy #susanapuig #Mohs #dermoscopy #sentinellymphnode #skincancer #topdoctors #dermatologiabarcelona #cutaneousbarcelona #diagnosisdermatologica

Melanocortin 1 receptor (MC1R) polymorphisms' influence on size and dermoscopic features of nevi.

Melanocortin 1 receptor (MC1R) polymorphisms' influence on size and dermoscopic features of nevi.

The melanocortin 1 receptor (MC1R) is a highly polymorphic gene. The loss-of-function MC1R variants ("R") have been strongly associated with red hair color phenotype and an increased melanoma risk. We sequenced the MC1R gene in 175 healthy individuals to assess the influence of MC1R on nevus phenotype. We identified that MC1R variant carriers had larger nevi both on the back [p-value = .016, adjusted for multiple parameters (adj. p-value)] and on the upper limbs (adj. p-value = .007). Specifically, we identified a positive association between the "R" MC1R variants and visible vessels in nevi [p-value = .033, corrected using the FDR method for multiple comparisons (corrected p-value)], dots and globules in nevi (corrected p-value = .033), nevi with eccentric hyperpigmentation (corrected p-value = .033), a high degree of freckling (adj. p-value = .019), and an associative trend with presence of blue nevi (corrected p-value = .120). In conclusion, the MC1R gene appears to influence the nevus phenotype.

#melanocortin #josepmalvehy #susanapuig #dermoscopic #confocal #Mohs #dermatology #topdoctors #mc1r #melanoma #skincancer #dermatologiabarcelona #clinicadermatologica #cedilp

viernes, 19 de enero de 2018

Seven Non-melanoma Features to Rule Out Facial Melanoma.

Seven Non-melanoma Features to Rule Out Facial Melanoma.


Facial melanoma is difficult to diagnose and dermatoscopic features are often subtle. Dermatoscopic non-melanoma patterns may have a comparable diagnostic value. In this pilot study, facial lesions were collected retrospectively, resulting in a case set of 339 melanomas and 308 non-melanomas. Lesions were evaluated for the prevalence (> 50% of lesional surface) of 7 dermatoscopic non-melanoma features: scales, white follicles, erythema/reticular vessels, reticular and/or curved lines/fingerprints, structureless brown colour, sharp demarcation, and classic criteria of seborrhoeic keratosis. Melanomas had a lower number of non-melanoma patterns (p< 0.001). Scoring a lesion suspicious when no prevalent non-melanoma pattern is found resulted in a sensitivity of 88.5% and a specificity of 66.9% for the diagnosis of melanoma. Specificity was higher for solar lentigo (78.8%) and seborrhoeic keratosis (74.3%) and lower for actinic keratosis (61.4%) and lichenoid keratosis (25.6%). Evaluation of prevalent non-melanoma patterns can provide slightly lower sensitivity and higher specificity in detecting facial melanoma compared with already known malignant features.

#melanoma #malvehy #skincancer #dermatologobarcelona #cedilp #susanapuig #melanomas #dermatoscopic #diagnosisofmelanoma #lentigo

A practical guide to the handling and administration of talimogene laherparepvec in Europe.

A practical guide to the handling and administration of talimogene laherparepvec in Europe.


Talimogene laherparepvec is a herpes simplex virus-1-based intralesional oncolytic immunotherapy and is the first oncolytic virus to be approved in Europe. It is indicated for the treatment of adults with unresectable melanoma that is regionally or distantly metastatic (stage IIIB, IIIC, and IVM1a) with no bone, brain, lung, or other visceral disease. Talimogene laherparepvec is a genetically modified viral therapy, and its handling needs special attention due to its deep freeze, cold-chain requirements, its potential for viral shedding, and its administration by direct intralesional injection. This review provides a practical overview of handling, storage, and administration procedures for this agent in Europe. Talimogene laherparepvec vials should be transported/stored frozen at a temperature of -90°C to -70°C, and once thawed, vials must not be refrozen. Universal precautions for preparation, administration, and handling should be followed to avoid accidental exposure. Health care providers should wear personal protective equipment, and materials that come into contact with talimogene laherparepvec should be disposed of in accordance with local institutional procedures. Individuals who are immunocompromised or pregnant should not prepare or administer this agent. Talimogene laherparepvec is administered by intralesional injection into cutaneous, subcutaneous, and/or nodal lesions that are visible, palpable, or detectable by ultrasound. Treatment should be continued for ≥6 months. As with other immunotherapies, patients may experience an increase in the size of existing lesion(s) or the appearance of new lesions (ie, progression) prior to achieving a response ("pseudo-progression"). As several health care professionals (eg, physicians [dermatologists, surgeons, oncologists, radiologists], pharmacists, nurses) are involved in different stages of the process, there is a need for good interdisciplinary collaboration when using talimogene laherparepvec. Although there are specific requirements for this agent's storage, handling, administration, and disposal, these can be effectively managed in a real-world clinical setting through the implementation of training programs and straightforward standard operating procedures.

#melanoma #skincancer #confocal #malvehy #doctormalvehy #cedilp #cancerdepiel #talimogene
#dermatologiabarcelona #dermatologobarcelona #cancerdepielbarcelona

miércoles, 17 de enero de 2018

Terapia Fotodinámica

¿Qué es la Terapia Fotodinámica (TFD)?

La Terapia Fotodinámica (PDT) es un tratamiento que se utiliza fundamentalmente para el tratamiento de lesiones cutáneas inducidas por el daño solar, como algunos tumores cutáneos superficiales (p.ej. carcinoma basocelular superficial) y lesiones cutáneas en piel dañada por el sol (enfermedad de Bowen, queratosis actínicas). También puede utilizarse para el tratamiento del acné, verrugas vulgares y otras enfermedades inflamatorias de la piel.
¿Cómo será el procedimiento?

Una semana antes del tratamiento se deberá aplicar cada noche una crema de vaselina salicílica sobre la/s lesiones a tratar. En el día del tratamiento se procederá en primer lugar a retirar las costras mediante curetaje si es necesario. En algunos casos que el facultativo lo crea necesario, podrá aplicarse Láser CO2 en modo fraccional sobre el área a tratar para mejorar la absorción posterior de la crema.
Realizados estos procedimientos se aplicará una crema de Metilaminolevulinato (Metvix®) o ácido 5-aminolevulínico en gel (Ameluz®) sobre el área a tratar, se cubrirá con un apósito opaco y se dejará incubar durante 2h30min – 3h. Durante este tiempo usted podrá salir del centro, ir a pasear, irse a su casa….

Cuando vuelva al centro se retirará la crema y se aplicará la lámpara de TFD. Se trata de un LED de luz roja que se aplica a 2cm de distancia del campo a tratar durante un período de entre 9 y 30 minutos según la tolerancia y extensión del área a tratar.

-          Para el tratamiento de Queratosis Actínicas suele ser suficiente 1 sesión de TFD, aunque el facultativo deberá valorar en cada caso la necesidad de tratamientos adicionales.

-          Para el tratamiento de la Enfermedad de Bowen y el Carcinoma Basocelular Superficial serán necesarias 2 sesiones separadas 1 semana.
Efectos secundarios del tratamiento

Durante el tratamiento puede experimentar dolor o discomfort en la zona irradiada. Un discreto dolor o sensación de quemazón y picor pueden persistir 48h después del tratamiento. El área tratada puede inflamarse discretamente las 48h posteriores al tratamiento.
Si tras dos sesiones de tratamiento no se ha conseguido el aclaramiento completo de las lesiones, se considerará un re-tratamiento con dos sesiones adicionales, esta valoración se realizará a los 3 meses del tratamiento inicial.

Incluso si las lesiones han aclarado con el tratamiento, usted deberá continuar sus controles con su dermatólogo cada 6 meses o con mayor frecuencia si el facultativo lo considera.
Tratamientos Alternativos
Aldara®, Solaraze®, Actikeral®, Zyclara®, Picato®, Actixicam®

#terapiafotodinamica #aldara #solaraze #zyclara #picato #actikeral #carcinomabasocelular #fotodinámica #paulaaguilera #diagnosisdermatologica #dermatologabarcelona #dermatologobarcelona #queratosis #queratosisactinica #bowen #tfd

jueves, 11 de enero de 2018

La Cirugia Micrografica de Mohs. ¿Que és?

La incidencia del cáncer de piel en España ha aumentado un 38% en los últimos cuatro años según datos aportados en el 45 Congreso Nacional de Dermatología y Venereología.

En España se diagnostican alrededor de 4.000 nuevos casos al año y puede afectar a cualquier persona de cualquier edad, siendo la más común en personas mayores de 50 años, personas sometidas a una prolongada exposición al sol sin protección y en personas de piel, ojos y cabellos claros. Aunque también puede producirse en personas sin estos factores de riesgo.

Según la Academia de Dermatología y Venereología la mortalidad por cáncer de piel afortunadamente no ha aumentado y los dermatólogos están consiguiendo grandes logros en la lucha diaria contra el cáncer cutáneo.
Una técnica quirúrgica eficaz y segura que en las últimas décadas se está desarrollando cada vez más en España para el tratamiento del cáncer cutáneo es la cirugía micrográfica de Mohs, o microscópicamente controlada, que consigue entre el 97% y 99% de curación.
En EEUU el 30% de los carcinomas cutáneos se tratan de esta manera, siendo una técnica muy implantada así mismo en Reino Unido y en Australia.
Modalidad de cirugía dermatológica que asegura el estudio microscópico del 100% del tejido extirpado. Está indicada en ciertos tumores cutáneos, habitualmente localizados en áreas centro faciales o de mayor riesgo, y para tumores que precisan una extirpación de márgenes de seguridad suficientemente amplio para ser curativo, pero a la vez tratando de ahorrar el máximo de tejido sano alrededor. Su dermatólogo será quien le indique los casos en los que sea recomendable realizarse, y son cirujanos dermatológicos especializados en este tipo de cirugía quienes pueden llevarla a cabo.
#cirugiademohs #mohs #cancerdepiel #carcinoma #melanoma #cirugiamohs #cancerpiel #dermatologobarcelona #dermatologabarcelona #centrodermatologico #cirugiademohsbarcelona