Éntrevista a la Dra Susana Puig en IM MEDICO

"ACTUALMENTE, INVESTIGAMOS LOS FACTORES ASOCIADOS A UNA MEJOR RESPUESTA A LOS TRATAMIENTOS INMUNOLÓGICOS DEL MELANOMA"

https://www.immedicohospitalario.es/noticia/14000/actualmente-investigamos-los-factores-asociados-a-una-mejor-respuesta

#susanapuig #melanoma #tratamientoinmunologicodelmelanoma #cancerdepiel #tratamientomelanoma #tratamientocancerdepiel #carcinoma #cedilp #diagnosisdermatologica #dermatologabarcelona

 

Adjuvant Pembrolizumab versus Placebo in Resected Stage III Melanoma

Este estudio publicado en el N Eng J Med demuestra la utilidad del tratamiento adyuvante con pembrolizumab en pacientes con #melanoma.

El estudio fase III EORTC1325/KEYNOTE-0541 demuestra que la utilización de pembrolizumab (Keytruda) reduce un 43% el riesgo de recaída en pacientes con melanoma estadío III libres de enfermedad tras cirugía de metastasis ganglionares. La hazard ratio de supervivencia libre de enfermedad resultó ser de 0.57 para pembrolizumab comparado con pla...cebo (98.4% CI, 0.43-0.74; P <.0001). En este estudio KEYNOTE-054 se identificaron los mismos efectos adversos ya conocidos y propios de los inhibidores de PD-1. El estudio continua y ofrecerá nueva información sobre supervivencia global y beneficios a largo plazo. Como coautora de este estudio, destaco la importancia de estos resultado que pueden cambiar el tratamiento de los pacientes con melanomas de alto riesgo antes de que estos tengan enfermedad diseminada, disminuyendo el riesgo de recaída prácticamente a la mitad.

Este estudio doble ciego incluyó 1019 pacientes con melanoma con afectación ganglionar de más de 1 mm de diámetro tras cirugía y recibían 200 mg e.v. cada 21 días durante un año. Los pacientes del Hospital Clínic han recibido este tratamiento en el Hospital de Día de Dermatología del Institut Clínic de Medicina i Dermatologia (ICMiD). Se trata de un tratamiento globalmente bien tolerado aunque algunos pacientes han presentado efectos adversos inmunorelacionados.

En Diciembre del 2017 la FDA aprobó otro inhibidor de PD-1 (Opdivo) como tratamiento adyuvante de pacientes con metástasis de melanoma libres de enfermedad tras cirugía en base a los resultados de otro estudio fase III CheckMate-238.2

 Ambos fármacos están pendientes de aprobación por EMA para poder ser utilizados en pacientes Europeos en esta indicación.

https://www.nejm.org/doi/full/10.1056/NEJMoa1802357#.WudA2J0z02c.Facebook

#susanapuig #eortc #pembrolizumab #diagnosisdermatologica #cedilp

Entrevista a la Dra Susana Puig en IM MEDICO "tratamientos inmunologicos del melanoma"

Investigación factores asociados a una mejor respuesta a los tratamientos inmunológicos del melanoma

http://www.immedicohospitalario.es/revista/25/38/

#immedico #susanapuig #dermatologabarcelona #melanoma #inmunológico #tratamientomelanoma #cancerdepiel #doctorapuig #dermatologiabarcelona #clinicadermatologica #diagnosisdermatologica #tratamientoinmunologicodelmelanoma #idibaps #drapuig #doctorapuig #dermatologasusanapuig #centrodermatologico

Dermatosis

Dermatosis
Según un informe de la mutua laboral MAZ, diagnostican casi 100mil casos de #dermatosis
Las dermatosis son las enfermedades que afectan a la piel y sus anexos que incluyen el cabello y las uñas. Cuando esta afección es de tipo inflamatorio o infeccioso se emplea entonces el término dermatitis.
La dermatitis es un término general que describe una inflamación de la piel. La dermatitis puede tener distintas causas y manifestarse de muchas formas. Generalmente, produce una erupción con comezón sobre la piel enrojecida e inflamada.
La piel afectada por la dermatitis puede formar ampollas, supurar, formar una costra o descamarse. Ejemplos de dermatitis incluyen la dermatitis atópica (eccema), la caspa y las erupciones cutáneas provocadas por el contacto con distintas sustancias, como la hiedra venenosa, los jabones y las joyas con níquel.
La dermatitis es una afección frecuente que no es contagiosa, pero puede hacerte sentir incómodo y cohibido. Una combinación de pasos de autocuidado y medicamentos puede ayudarte a tratar la dermatitis.
Acuda al dermatólogo/a para tratar la dermatitis

#dermatologa #centrodermatologico #dermatologia #dermatologobarcelona #dermatologabarcelona #centrodermatologico #dermatitis #melanoma #cancerdepiel

AURKA Overexpression Is Driven by FOXM1 and MAPK/ERK Activation in Melanoma Cells Harboring BRAF or NRAS Mutations: Impact on Melanoma Prognosis and Therapy

AURKA Overexpression Is Driven by FOXM1 and MAPK/ERK Activation in Melanoma Cells Harboring BRAF or NRAS Mutations: Impact on Melanoma Prognosis and Therapy

Abstract

The cell cycle-related genes AURKA and FOXM1 are overexpressed in melanoma. We show here that AURKA overexpression is associated with poor prognosis in three independent cohorts of melanoma patients and correlates with the presence of genomic amplification of AURKA locus and BRAF^V600E mutation. AURKA overexpression may also be driven by increased promoter activation through elements such as ETS and FOXM1 found within the 5' proximal promoter region. Activated MAPK/ERK signaling pathway mediates robust AURKA promoter activation, thereby knockdown of BRAF^V600E and ERK inhibition results in reduced AURKA transcription and expression. We show a positive correlation between FOXM1 and AURKA expression in three independent cohorts of melanoma patients. FOXM1 silencing decreases expression of AURKA and late cell cycle genes in melanoma cells. We further found that FOXM1 expression levels are significantly higher in tumors carrying the BRAF^V600E mutation compared with the wild-type BRAF (BRAF^wt). Accordingly, the knockdown of BRAF^V600E also reduces the expression of FOXM1 in BRAF^V600E cells. Moreover, Aurora kinase A and FOXM1 inhibition by either genetic knockdown or pharmacologic inhibitors impair melanoma growth and survival both in culture and in vivo, underscoring their therapeutic value for melanoma patients who fail to benefit from BRAF/MEK signaling inhibition.

https://www.ncbi.nlm.nih.gov/pubmed/28188776

#mutationsmelanoma #melanoma #malvehy #josepmalvehy #skincancer #aurka #braf

Ugly Duckling Sign as a Major Factor of Efficiency in Melanoma Detection

Importance:

Understanding the contribution of the ugly duckling sign (a nevus that is obviously different from the others in a given individual) in intrapatient comparative analysis (IPCA) of nevi may help improve the detection of melanoma.

Objectives:

To assess the agreement of dermatologists on identification of the ugly duckling sign and estimate the contribution of IPCA to the diagnosis of melanoma.

Design, Setting, and Participants:

The same 2089 digital images of the nevi of a sample of 80 patients (mean age, 42 years [range, 19-80 years]; 33 men and 47 women), as well as 766 dermoscopic images from a subset of 30 patients (mean age, 40 years [range, 21-75 years]; 12 men and 18 women), were randomly presented to the same 9 dermatologists for blinded assessment from September 22, 2011, to April 1, 2013. The first experiment was designed to mimic an IPCA situation, with images of all nevi of each patient shown to the dermatologists, who were asked to identify ugly duckling nevi (UDN). The second experiment was designed to mimic a lesion-focused analysis to identify morphologically suspicious nevi. Data analysis was conducted from November 1, 2012, to June 1, 2013.

Main Outcomes and Measures:

Number of nevi labeled UDN and morphologically suspicious nevi, specificity of lesion-focused analysis and IPCA, and number of nevi identified for biopsy.

Results:

Of the 2089 clinical images of nevi from 80 patients (median number of nevi per patient, 26 [range, 8-81]) and 766 dermoscopic images (median number of nevi per patient, 19 [range, 8-81]), all melanomas were labeled UDN and as morphologically suspicious nevi by the 9 dermatologists. The median number of UDN detected per patient was 0.8 among the clinical images of nevi (mean, 1.0; range, 0.48-2.03) and 1.26 among the dermoscopic images (mean, 1.4; range, 1.00-2.06). The propensity to consider more or fewer nevi as having ugly duckling signs was independent of the presentation (clinical or dermoscopic). The agreement among the dermatologists regarding UDN was lower with dermoscopic images (mean pairwise agreement, 0.53 for clinical images and 0.50 for dermoscopic images). The specificity of IPCA was 0.96 for clinical images and 0.95 for dermoscopic images vs 0.88 and 0.85, respectively, for lesion-focused analysis. When both IPCA and lesion-focused analyses were used, the number of nevi considered for biopsy was reduced by a factor of 6.9 compared with lesion-focused analysis alone.

Conclusions and Relevance:

Intrapatient comparative analysis is of major importance to the effectiveness of the diagnosis of melanoma. Introducing IPCA using the ugly duckling sign in computer-assisted diagnosis systems would be expected to improve performance.

#josepmalvehy #clinicadermatologica #dermatologobarcelona #melanoma #cancerdepiel #diagnosismelanoma #canceruña #skincancer #dermatologabarcelona #bestdoctor #topdoctors #nevus #confocal #susanapuig

Proposed Technical Guidelines for the Acquisition of Clinical Images of Skin-Related Conditions.

Importance:

Standardizing dermatological imaging is important to improve monitoring of skin lesions and skin conditions, ensure the availability of high-quality images for teledermatology, and contribute to the development of a robust archive of skin images to be used for research.

Objective:

To provide guidelines for the clinical application of the Standards for Dermatological Imaging set forward by the ISIC.

Evidence Review:

The ISIC recommendations were developed through a hybrid Delphi methodology. The methods for achieving consensus have been described previously. The practical application of these recommendations was evaluated by 2 clinical photographers with expertise in skin imaging. Images corresponding to each recommendation were taken by a clinical photographer and provided as visual examples of how these recommendations can be implemented in clinical practice.

Results:

The Standards for Dermatological Imaging developed by the ISIC members could be followed in the clinical setting. Images showing appropriate lighting, background color, field of view, image orientation, focus and depth of field, resolution, and scale and color calibration were obtained by the clinical photographer, by following the detailed recommendations for regional, close-up and dermoscopic images.

Conclusions and Relevance:

Adhering to the recommendations is both feasible and achievable in practice. Adopting these Standards is the first step in achieving international standardization of skin imaging, with the potential to improve clinical outcomes and research activities.

https://www.ncbi.nlm.nih.gov/pubmed/28241182

#josepmalvehy #skinimages #clinicadermatologica #dermatologobarcelona #dermatologabarcelona #skincenter #clinicaldermatology #clinicalimages #melanoma #skinmelanoma #dermatologiabarcelona