Prognostic role of the histological subtype of melanoma on the hands and feet in Caucasians.

PubMed

Prognostic role of the histological subtype of melanoma on the hands and feet in Caucasians.

Acral melanoma (AM) is associated with a poor prognosis in part because of delayed diagnosis, but probably also because of other intrinsic characteristics of location. The aim of this study was to review the specific characteristics and outcome of AM in Caucasians.

This was a cross-sectional retrospective clinical-pathological study of 274 patients identified with AM in the database of a referral unit in Europe from 1986 to 2010. The mean age of the patients was 56.6 (SD 17.7) years. 269 cases could be histologically classified and included in the study. In all, 222 (82.5%) were located on feet.

According to melanoma subtype, 165 (61.3%) were acral lentiginous melanoma (ALM), 84 (31.2%) were superficial spreading melanoma (SSM), and 20 (7.5%) were nodular melanoma (NM). SSM patients were characterized by female predominance (77.4%), younger age, and classic melanoma-risk phenotype (fair skin and multiple nevi). Among the 198 invasive cases with a mean follow-up of 56.2 months, the mean (SD) Breslow's thickness was 3.1 (3.6) mm, being 1.4 (1.4) mm in SSM, 3.5 (4.1) mm in ALM and 4.9 (2.9) mm in NM (P<0.001). Ulceration was present in 33.3%, 2.9% in SSM, 38.6% in ALM, and 76.9% in NM (P<0.001). A total of 29.3% relapsed (7.3% of SSM, 35% of ALM and 55% of NM) and 24.2% died because of AM.

In multivariate analysis, age at diagnosis, Breslow, and histopathological subtype were independent prognostic factors for both disease-free and AM-specific survival. The ALM and NM subtypes presented poorer outcome after weighting Breslow and age (P=0.02). Histological subtype of AM could have an impact on biological behavior, ALM and NM subtypes presenting a poorer prognosis after adjusting for age and Breslow's thickness.

https://www.ncbi.nlm.nih.gov/pubmed/28296711

#cristinacarrera #josepmalvehy #susanapuig #breslow #melanoma #skincancer #breslowthickness #carcinoma #acrallentiginousmelanoma #alm #melanomacaucasians #acralmelanoma #melanomarisk

Patterns of distribution of giant congenital melanocytic nevi (GCMN): The 6B rule.

Patterns of distribution of giant congenital melanocytic nevi (GCMN): The 6B rule.

https://www.ncbi.nlm.nih.gov/pubmed/28325390

BACKGROUND:

Garment-related terms have been used to describe the pattern of distribution of giant congenital melanocytic nevi (GCMN).

OBJECTIVE:

We sought to describe patterns of distribution of GCMN and propose a classification scheme.

METHODS:

Photographic records of patients with GCMN from the Hospital Clinic of Barcelona were analyzed and a classification based on observed GCMN distribution patterns was created. The classification was independently applied by 8 observers to cases found in the literature. The interobserver agreement was assessed.

RESULTS:

Among 22 patients we observed 6 repeatable patterns of distribution of GCMN, which we termed the "6B": bolero (involving the upper aspect of the back, including the neck), back (on the back, without involvement of the buttocks or shoulders), bathing trunk (involving the genital region and buttocks), breast/belly (isolated to the chest or abdomen without involvement of bolero or bathing trunk distributions), body extremity (isolated to extremity), and body (both bolero and bathing trunk involvement). Our literature search found 113 cases of GCMN, which we were able to classify into 1 of the 6B patterns with an overall kappa of 0.89.

LIMITATIONS:

Some patterns occur infrequently with a dearth of images available for analysis.

CONCLUSIONS:

The anatomic distribution of GCMN occurs in 6 recognizable and repeatable patterns.

 

#josepmalvehy #susanapuig #congenitalmelanocytic

El carcinoma de célula de Merkel

El carcinoma de células de Merkel (CCM) es un tipo raro de cáncer de piel, que afecta solamente a unos pocos miles de personas cada año, en comparación con las decenas de miles que padecen melanoma. Pero si bien puede no ser tan común como otros cánceres de piel, es altamente agresivo y a menudo mortal, y también se está volviendo más común, según una nueva investigación publicada en el Journal of the American Academy of Dermatology y presentada en la reunión anual de la American Academy of Dermatology, en San Diego #AAD18.

El CCM se asocia con el virus del polioma de la célula de Merkel, que es bastante común, y que a menudo se encuentra en la piel humana normal y las superficies que con frecuencia se tocan. La gran mayoría de las personas no desarrollan CCM después de la exposición al virus, explica, pero si el sistema inmune de alguien no está funcionando bien debido a la edad avanzada u otros factores, esa persona puede ser más propensa a desarrollar el CCM después de contraerlo.

El CCM también se asocia con la exposición sin protección a la luz ultravioleta, un factor de riesgo para todos los tipos de cáncer de piel. Debido a que la enfermedad probablemente esté ligada a la exposición acumulativa con el tiempo.

Al igual que otros #cánceresdepiel, el #CCM tiene el mejor pronóstico cuando se detecta temprano. Si bien la enfermedad se puede tratar con éxito en sus etapas iniciales, es un cáncer altamente agresivo, que probablemente crezca rápido y haga metástasis. Aunque los tratamientos de inmunoterapia que surgieron en los últimos años han mejorado enormemente las tasas de supervivencia con respecto a los tratamientos de quimioterapia previos, el CCM metastásico aún tiene un alto potencial de ser fatal, dice, lo que hace que la detección temprana sea especialmente vital.

 El CCM no aparece en la piel como un lunar oscuro, como el #melanoma. En cambio, aparece como un bulto firme que es rojo, morado o de color de piel. Algunas personas pueden confundir al CCM con un quiste o una foliculitis,  pero las lesiones del CCM generalmente no son como los bultos causados por estas otras afecciones. Además,  el CCM tiende a crecer rápidamente.

Fuente: Redacción Médica

#carcinoma #melanoma #cancerdepiel #AAD18 #CCM #celulademerkel

¿Que es la inmunoterapia?

La #inmunoterapia ejerce su acción antitumoral estimulando la respuesta inmunológica de los pacientes frente al cáncer, a diferencia de los tratamientos clásicos, que atacan directamente al tumor. Esto implica una serie de ventajas y características de esta novedosa estrategia.

Su principal ventaja es su capacidad de controlar el tumor durante periodos muy largos de tiempo en un determinado porcentaje de pacientes, que varía según el tipo de cáncer. En algunos pacientes con tumores que antes se consideraban incurables, en este momento se están consiguiendo supervivencias muy prolongadas, incluso de años.

En la actualidad, la inmunoterapia con anticuerpos que bloquean los receptores PD-1 o la acción sobre estos receptores de la proteína PD-L1 ha demostrado eficacia frente a un gran número de tumores, incluyendo entre otros el #melanoma, los cánceres de pulmón, riñón, vejiga, estómago, hígado, cabeza y cuello y algunos tumores ginecológicos y linfomas. En un principio su utilización se limitaba a pacientes en los que había fracasado el tratamiento convencional, habitualmente con quimioterapia, pero en pacientes con algunos tipos de tumores, como el #melanoma o algunos cánceres de pulmón, ya se considera el tratamiento de primera elección.
Este tipo de inmunoterapia ha demostrado ser eficaz como tratamiento adyuvante (es decir, para prevenir reapariciones del tumor en pacientes en los que se ha extirpado completamente la enfermedad mediante cirugía, pero en los que puede existir enfermedad microscópica) en pacientes con melanoma. También mejora el control del tumor en pacientes con cáncer de pulmón en estadios localmente avanzados tratados previamente con quimioterapia y radioterapia. Varios estudios en marcha determinarán si estos fármacos también tienen un valor como tratamiento adyuvante en otros tumores, como el cáncer de pulmón, de vejiga o de riñón.

Estos tratamientos suelen administrase por vía intravenosa y su toxicidad suele ser menor que la de los tratamientos convencionales, como la quimioterapia. No obstante, entre un 5-15% de los pacientes pueden desarrollar toxicidades relevantes, que suelen deberse a la activación del sistema inmunológico contra el propio organismo del paciente. Los órganos más frecuentemente afectados por estas reacciones son: el pulmón ("neumonitis”), que se manifiesta en forma de tos y dificultad para respirar; y el tubo digestivo (“colitis”), que se presenta como diarrea. Cuando se utilizan como fármacos únicos, que es lo más habitual hoy en día, la toxicidad no suele ser un problema importante. No obstante, cuando se emplean de forma combinada, su frecuencia y severidad es mayor. Por ello, es necesario que estos pacientes sean controlados por equipos médicos especializados.

Nuevas estrategias de inmunoterapia
A pesar de estos resultados, queda mucho camino por recorrer, dado que en la actualidad sólo se benefician de estos tratamientos entre el 40-60% de los pacientes con melanoma y entre el 10 y el 30% de los pacientes con otros tipos de tumores. Algunas de las principales estrategias en desarrollo para mejorar la eficacia de la inmunoterapia son:

- Inmunoterapia de combinación: durante el desarrollo de un tumor se pueden alterar varias fases de la respuesta inmunológica. Por tanto, la utilización simultánea de dos o más tratamientos de inmunoterapia es una de las estrategias más empleadas para aumentar la eficacia antitumoral. Las combinaciones de inmunoterapia han demostrado una actividad importante en pacientes con #melanoma y cáncer renal. Los principales mecanismos de acción de los fármacos que se utilizan para estas combinaciones son: activar directamente la respuesta inmunológica; desbloquear la inhibición de la respuesta inmunológica producida por muchos tumores; o proporcionar elementos fundamentales para desencadenar la respuesta inmunológica, como antígenos o células del sistema inmunológico

- Nuevas vacunas: las vacunas antitumorales consisten en administrar al paciente antígenos del tumor (pequeños fragmentos del mismo, normalmente proteínas), para que el sistema inmunológico los reconozca y ponga así en marcha la respuesta inmune antitumoral. Las modernas técnicas de biología molecular han permitido avanzar mucho en los procesos de selección de los antígenos con mayores posibilidades de desencadenar estas respuestas y, por ello, ésta es una de las vías más esperanzadoras para el desarrollo de nuevos tratamientos de inmunoterapia.
Además, algunas vacunas frente a enfermedades infecciosas pueden conferir un alto grado de protección frente a los tumores asociados a las mismas (por ejemplo: virus del papiloma humano, asociado al cáncer de cérvix, o virus de la hepatitis B, asociada al #hepatocarcinoma). La vacunación frente a estas infecciones virales reduce de forma dramática la incidencia de los tumores asociados.

- Células CAR-T (Chimeric Antigen Receptor, o receptor antigénico quimérico): consiste en extraer las células inmunológicas del paciente; procesarlas en el laboratorio para que expresen un antígeno que reconozca de forma específica a las células tumorales; y volverlas a administrar al paciente, para que ataquen al tumor. Esta estrategia está teniendo una eficacia considerable en pacientes con algunos tipos de leucemia, aunque su utilización en pacientes con tumores sólidos parece más complicada. Además, se asocia a toxicidades relevantes, aunque la mayoría pueden controlarse con cuidados médicos especializados.

http://www.diagnosisdermatologica.com/es/cancer-cutaneo

Application of in vivo reflectance confocal microscopy (RCM) and ex vivo fluorescence confocal microscopy (FCM) in most common subtypes of Basal Cell Carcinoma and correlation with histopathology

PubMed

Application of in vivo reflectance confocal microscopy (RCM) and ex vivo fluorescence confocal microscopy (FCM) in most common subtypes of Basal Cell Carcinoma and correlation with histopathology.

https://www.ncbi.nlm.nih.gov/pubmed/29405259

Basal cell carcinoma (BCC) accounts for 80% of non-melanoma skin cancer. The identification of the histological subtype is crucial for the correct management of the tumor. In vivo reflectance confocal microscopy (RCM) is a novel technique that has demonstrated high sensitivity and specificity in the in vivo diagnosis of BCC. In an effort to determine reliable criteria for preoperative diagnosis of BCC subtypes, Longo et al. and Peppelman et al., described RCM criteria present in different BCC subtypes.

#josepmalvehy #susanapuig #tonibennassar #melanoma #confocalinvivo #confocal #confocalmicroscopy #microscopiaconfocal #carcinoma #bcc #carcinomas #squamouscellcarcinomas #carcinomabasocelular #DiagnosisDermatologica #topdoctors #dermatologiabarcelona #aad18

Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study

PubMed

Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study

https://www.ncbi.nlm.nih.gov/pubmed/28888850

INTRODUCTION:

Different protocols have been used to follow up melanoma patients in stage I-II. However, there is no consensus on the complementary tests that should be requested or the appropriate intervals between visits. Our aim is to compare an ultrasound-based follow-up with a clinical follow-up.

PATIENTS AND METHODS:

Analysis of two prospectively collected cohorts of melanoma patients in stage IB-IIA from two tertiary referral centres in Barcelona (clinical-based follow-up [C-FU]) and Turin (ultrasound-based follow-up [US-FU]). Kaplan-Meier curves were used to evaluate distant metastases-free survival (DMFS), disease-free interval (DFI), nodal metastases-free survival (NMFS) and melanoma-specific survival (MSS).

RESULTS:

A total of 1149 patients in the American Joint Committee on Cancer stage IB and IIA were included in this study, of which 554 subjects (48%) were enrolled for a C-FU, and 595 patients (52%) received a protocolised US-FU. The median age was 53.8 years (interquartile range [IQR] 41.5-65.2) with a median follow-up time of 4.14 years (IQR 1.2-7.6). During follow-up, 69 patients (12.5%) in C-FU and 72 patients (12.1%) in US-FU developed disease progression. Median time to relapse for the first metastatic site was 2.11 years (IQR 1.14-4.04) for skin metastases, 1.32 (IQR 0.57-3.29) for lymph node metastases and 2.84 (IQR 1.32-4.60) for distant metastases. The pattern of progression and the total proportion of metastases were not significantly different (P = .44) in the two centres. No difference in DFI, DMFS, NMFS and MSS was found between the two cohorts.

CONCLUSION:

Ultrasound-based follow-up does not increase the survival of melanoma patients in stage IB-IIA.

#melanoma #josepmalvehy #malvehy   #americanjointcommitteeoncancer #metastases, #susanapuig #aliciabarreiro  #cristinacarrera #skincancer #dermatologiabarcelona #dermatologobarcelona #centrodermatologico #dermatologicalcenter #topdoctors #aad18

A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

PubMed

A proposed scoring system for assessing the severity of actinic keratosis on the head: actinic keratosis area and severity index

BACKGROUND:

Actinic keratosis (AK) severity is currently evaluated by subjective assessment of patients.

OBJECTIVES:

To develop and perform an initial pilot validation of a new easy-to-use quantitative tool for assessing AK severity on the head.

METHODS:

The actinic keratosis area and severity index (AKASI) for the head was developed based on a review of other severity scoring systems in dermatology, in particular the psoriasis area and severity index (PASI). Initial validation was performed by 13 physicians assessing AK severity in 18 AK patients and two controls using a physician global assessment (PGA) and AKASI. To determine an AKASI score, the head was divided into four regions (scalp, forehead, left/right cheek ear, chin and nose). In each region, the percentage of the area affected by AKs was estimated, and the severities of three clinical signs of AK were assessed: distribution, erythema and thickness.

RESULTS:

There was a strong correlation between AKASI and PGA scores (Pearson correlation coefficient: 0.86). AKASI was able to discriminate between different PGA categories: mean (SD) AKASI increased from 2.88 (1.18) for 'light' to 5.33 (1.48) for 'moderate', 8.28 (1.89) for 'severe', and 8.73 (3.03) for 'very severe' PGA classification. The coefficient of variation for AKASI scores was low and relatively constant across all PGA categories.

CONCLUSIONS:

Actinic keratosis area and severity index is proposed as a new quantitative tool for assessing AK severity on the head. It may be useful in the future evaluation of new AK treatments in clinical studies and the management of AK in daily practice.

https://www.ncbi.nlm.nih.gov/pubmed/28401585

 

#josepmalvehy #erythema #psoriasis #dermatoscopy #dermatology #dermatologiabarcelona #dermatologobarcelona #doctormalvehy #cedilp

 

Dermoscopic Clues for Diagnosing Melanomas That Resemble Seborrheic Keratosis.

PubMed

Abstract

Importance:

Melanomas that clinically mimic seborrheic keratosis (SK) can delay diagnosis and adequate treatment. However, little is known about the value of dermoscopy in recognizing these difficult-to-diagnose melanomas.

Objective:

To describe the dermoscopic features of SK-like melanomas to understand their clinical morphology.

Design, Setting, and Participants:

This observational retrospective study used 134 clinical and dermoscopic images of histopathologically proven melanomas in 134 patients treated in 9 skin cancer centers in Spain, France, Italy, and Austria. Without knowledge that the definite diagnosis for all the lesions was melanoma, 2 dermoscopy-trained observers evaluated the clinical descriptions and 48 dermoscopic features (including all melanocytic and nonmelanocytic criteria) of all 134 images and classified each dermoscopically as SK or not SK. The total dermoscopy score and the 7-point checklist score were assessed. Images of the lesions and patient data were collected from July 15, 2013, through July 31, 2014.

Main Outcomes and Measures:

Frequencies of specific morphologic patterns of (clinically and dermoscopically) SK-like melanomas, patient demographics, and interobserver agreement of criteria were evaluated.

Results:

Of the 134 cases collected from 72 men and 61 women, all of whom were white and who had a mean (SD) age of 55.6 (17.5) years, 110 (82.1%) revealed dermoscopic features suggestive of melanoma, including pigment network (74 [55.2%]), blue-white veil (72 [53.7%]), globules and dots (68 [50.7%]), pseudopods or streaks (47 [35.1%]), and blue-black sign (43 [32.3%]). The remaining 24 cases (17.9%) were considered likely SKs, even by dermoscopy. Overall, lesions showed a scaly and hyperkeratotic surface (45 [33.6%]), yellowish keratin (42 [31.3%]), comedo-like openings (41 [30.5%]), and milia-like cysts (30 [22.4%]). The entire sample achieved a mean (SD) total dermoscopy score of 4.7 (1.6) and a 7-point checklist score of 4.4 (2.3), while dermoscopically SK-like melanomas achieved a total dermoscopy score of only 4.2 (1.3) and a 7-point checklist score of 2.0 (1.9), both in the range of benignity. The most helpful criteria in correctly diagnosing SK-like melanomas were the presence of blue-white veil, pseudopods or streaks, and pigment network. Multivariate analysis found only the blue-black sign to be significantly associated with a correct diagnosis, while hyperkeratosis and fissures and ridges were independent risk markers of dermoscopically SK-like melanomas.

Conclusions and Relevance:

Seborrheic keratosis-like melanomas can be dermoscopically challenging, but the presence of the blue-black sign, pigment network, pseudopods or streaks, and/or blue-white veil, despite the presence of other SK features, allows the correct diagnosis of most of the difficult melanoma cases.

https://www.ncbi.nlm.nih.gov/pubmed/28355453

#josepmalvehy  #aliciabarreiro  #aliciabarreiro #susanapuig #paulaaguilera #cristinacarrera, #cutaneousmelanoma #diagnosisofmelanoma #dermoscopic #seborrheickeratosis #keratosis, #dermoscopy #skincancer

Transforming Dermatologic Imaging for the Digital Era: Metadata and Standards.

Abstract

Imaging is increasingly being used in dermatology for documentation, diagnosis, and management of cutaneous disease. The lack of standards for dermatologic imaging is an impediment to clinical uptake. Standardization can occur in image acquisition, terminology, interoperability, and metadata. This paper presents the International Skin Imaging Collaboration position on standardization of metadata for dermatologic imaging. Metadata is essential to ensure that dermatologic images are properly managed and interpreted. There are two standards-based approaches to recording and storing metadata in dermatologic imaging. The first uses standard consumer image file formats, and the second is the file format and metadata model developed for the Digital Imaging and Communication in Medicine (DICOM) standard. DICOM would appear to provide an advantage over using consumer image file formats for metadata as it includes all the patient, study, and technical metadata necessary to use images clinically. Whereas, consumer image file formats only include technical metadata and need to be used in conjunction with another actor-for example, an electronic medical record-to supply the patient and study metadata. The use of DICOM may have some ancillary benefits in dermatologic imaging including leveraging DICOM network and workflow services, interoperability of images and metadata, leveraging existing enterprise imaging infrastructure, greater patient safety, and better compliance to legislative requirements for image retention.

https://www.ncbi.nlm.nih.gov/pubmed/29344752

#josepmalvehy #skinimaging #dermoscopic #dermatologic #teledermatology #dicom

 

Dermoscopy versus reflectance confocal microscopy for the diagnosis of lentigo maligna

PubMed

Dermoscopy versus reflectance confocal microscopy for the diagnosis of lentigo maligna

BACKGROUND:

Several dermoscopic and in vivo reflectance confocal microscopy (RCM) diagnostic criteria of lentigo maligna (LM)/lentigo maligna melanoma (LMM) have been identified. However, no study compared the diagnostic accuracy of these techniques.

OBJECTIVE:

We evaluated the diagnostic accuracy of dermoscopy and RCM for LM/LMM using a holistic assessment of the images.

METHODS:

223 facial lesions were evaluated by 21 experts. Diagnostic accuracy of the clinical, dermoscopic and RCM examination were compared. Inter-investigator variability and confidence level in the diagnosis were also evaluated.

RESULTS:

Overall diagnostic accuracy of the two imaging techniques was good (area under the curve of the sROC function: 0.89). RCM was more sensitive (80%, versus 61%) and less specific (81% versus 92%) than dermoscopy for LM/LMM. In particular RCM showed a higher sensitivity for hypomelanotic and recurrent LM/LMM. RCM had a higher inter-investigator agreement and a higher confidence level in the diagnosis than dermoscopy.

CONCLUSION:

RCM and dermoscopy are both useful techniques for the diagnosis of facial lesions and in particular LM/LMM. RCM is particularly suitable for the identification of hypomelanotic and recurrent LM/LMM. This article is protected by copyright. All rights reserved.

https://www.ncbi.nlm.nih.gov/pubmed/29341263

This article is protected by copyright. All rights reserved.

 

 

#confocal #cristinacarrera #josepmalvehy #susanapuig #skincancer #invivo #confocalinvivo #cutaneousmelanoma #lentigo #reflactanceconfocal #cedilp #pubmed #microscopy