Eficacia de nuevos regímenes de inmunoterapia en pacientes con melanoma metastásico con mutaciones de CDKN2A en la línea germinal .

Helgadottir H , Ghiorzo P , van Doorn R , Puig S , Levin M , Kefford R , Lauss M , Queirolo P , Pastorino L , Kapiteijn E , Potrony M , Carrera C , Olsson H , Höiom V , Jönsson G 

Resumen

FONDO:

La mutación heredada de CDKN2A es un fuerte factor de riesgo para el melanoma cutáneo. Además, se ha encontrado que los portadores tienen mala supervivencia específica para el melanoma. En este estudio, se evaluaron las respuestas a nuevos agentes de inmunoterapia en portadores de mutación CDKN2A con melanoma metastásico.

MÉTODOS:

Los portadores de la mutación CDKN2A que han desarrollado un melanoma metastásico y se han sometido a tratamientos de inmunoterapia se identificaron entre los portadores incluidos en estudios de seguimiento para el melanoma familiar. Las respuestas de los portadores se compararon con las respuestas informadas en ensayos clínicos de fase III para los inhibidores de CTLA-4 y PD-1. De los conjuntos de datos disponibles al público, los melanomas con mutación somática de CDKN2A se analizaron para determinar la asociación con la carga mutacional del tumor.

RESULTADOS:

Once de los 19 portadores (58%) respondieron a la terapia, una frecuencia significativamente mayor que la observada en los ensayos clínicos (p = 0.03, prueba binomial contra una tasa esperada del 37%). Además, 6 de los 19 portadores (32%) tuvieron una respuesta completa, una frecuencia significativamente mayor que la observada en los ensayos clínicos (p = 0,01, prueba binomial frente a una tasa esperada del 7%). En 118 melanomas con mutaciones somáticas de CDKN2A , se observaron números totales significativamente mayores de mutaciones en comparación con 761 melanomas sin mutación de CDKN2A (prueba de Wilcoxon, p <0,001).

CONCLUSIÓN:

Los pacientes con melanoma mutado CDKN2A pueden tener mejores respuestas de inmunoterapia debido al aumento de la carga mutacional del tumor, lo que resulta en más neoantígenos y respuestas inmunitarias antitumorales más fuertes.

Fuente: PubMed

https://www.ncbi.nlm.nih.gov/pubmed/30291219

Efficacy of novel immunotherapy regimens in patients with metastatic melanoma with germline CDKN2A mutations.

Abstract

BACKGROUND:

Inherited CDKN2A mutation is a strong risk factor for cutaneous melanoma. Moreover, carriers have been found to have poor melanoma-specific survival. In this study, responses to novel immunotherapy agents in CDKN2A mutation carriers with metastatic melanoma were evaluated.

METHODS:

CDKN2A mutation carriers that have developed metastatic melanoma and undergone immunotherapy treatments were identified among carriers enrolled in follow-up studies for familial melanoma. The carriers' responses were compared with responCDKN2A mutation were analysed for association with tumour mutational load.

ses reported in phase III clinical trials for CTLA-4 and PD-1 inhibitors. From publicly available data sets, melanomas with somatic

RESULTS:

Eleven of 19 carriers (58%) responded to the therapy, a significantly higher frequency than observed in clinical trials (p=0.03, binomial test against an expected rate of 37%). Further, 6 of the 19 carriers (32%) had complete response, a significantly higher frequency than observed in clinical trials (p=0.01, binomial test against an expected rate of 7%). In 118 melanomas with somatic CDKN2A mutations, significantly higher total numbers of mutations were observed compared with 761 melanomas without CDKN2A mutation (Wilcoxon test, p<0.001).

CONCLUSION:

Patients with CDKN2A mutated melanoma may have improved immunotherapy responses due to increased tumour mutational load, resulting in more neoantigens and stronger antitumorous immune responses.

Urticaria solar: epidemiología y fenotipos clínicos en una serie española de 224 pacientes.

Pérez-Ferriols A , Barnadas M , Gardeazábal J , de Argila D , Carrascosa JM , Aguilera P , Giménez-Arnau A , Rodríguez-Granados T , de Gálvez MV , Aguilera J ;

Resumen

FONDO:

La urticaria solar es una urticaria crónica inducible también clasificada como dermatosis idiopática. El objetivo de este trabajo es definir las características fenotípicas de la urticaria solar y evaluar su incidencia.

MATERIAL Y MÉTODO:

Este fue un estudio retrospectivo multicéntrico en el que se recopilaron datos sobre la epidemiología y las características clínicas, fotobiológicas, de laboratorio y terapéuticas de la urticaria solar.

RESULTADOS:

Se incluyeron 224 pacientes (141 mujeres y 83 hombres) de 9 unidades de fotobiología. La edad media de los pacientes fue de 37,9 años (rango, 3-73 años). Se detectó una historia de atopia en el 26,7%, y la presentación más frecuente fue la rinitis alérgica (16,5%). Los signos clínicos se limitaron a áreas expuestas al sol en el 75,9% de los pacientes. El espectro de luz más comúnmente implicado fue solo la luz visible (31,7%), y en el 21% de los casos solo fue posible activar la urticaria solar con luz natural. Los tratamientos más utilizados por los expertos en fotobiología fueron los antihistamínicos orales (65,46%), seguidos de las diferentes formas de fototerapia (34%). La resolución completa se observó con mayor frecuencia en pacientes con urticaria solar activada exclusivamente por luz visible o natural, con diferencias estadísticamente significativas con respecto a otras longitudes de onda (p <0,05).

CONCLUSIONES:

Hemos presentado la serie más grande de urticaria solar publicada hasta la fecha. Los hallazgos epidemiológicos, clínicos y fotobiológicos confirman los datos informados previamente, aunque hubo una tasa particularmente alta de fotopruebas negativas en nuestra serie. La reactividad exclusivamente a la luz visible o natural se asoció con una mayor probabilidad de resolución. No se observó una tendencia creciente en la incidencia anual.

Fuente: PubMed

Solar urticaria: Epidemiology and clinical phenotypes in a Spanish series of 224 patients.

Abstract

BACKGROUND:

Solar urticaria is a chronic inducible urticaria also classified as an idiopathic dermatosis. The objective of this paper is to define the phenotypic characteristics of solar urticaria and to evaluate its incidence.

MATERIAL AND METHOD:

This was a retrospective multicenter study in which data were gathered on the epidemiology and clinical, photobiologic, laboratory, and therapeutic characteristics of solar urticaria.

RESULTS:

A total of 224 patients (141 women and 83 men) were included from 9 photobiology units. The mean age of the patients was 37.9 years (range, 3-73 years). A history of atopy was detected in 26.7%, and the most common presentation was allergic rhinitis (16.5%). Clinical signs were limited to sun-exposed areas in 75.9% of patients. The light spectrum most commonly implicated was visible light only (31.7%), and in 21% of cases it was only possible to trigger solar urticaria with natural light. The treatments most widely used by photobiology experts were oral antihistamines (65.46%), followed by different forms of phototherapy (34%). Complete resolution was observed most often in patients with solar urticaria triggered exclusively by visible or natural light, with statistically significant differences with respect to other wavelengths (P<.05). No increase in the annual incidence of solar urticaria was observed.

CONCLUSIONS:

We have presented the largest series of solar urticaria published to date. The epidemiological, clinical, and photobiologic findings confirm previously reported data, although there was a particularly high rate of negative phototests in our series. Reactivity exclusively to visible or natural light was associated with a higher probability of resolution. No increasing trend was observed in the annual incidence.

Nou de cada deu casos de càncer de pell es podrien evitar amb una bona prevenció

El 90% dels casos de càncer de pell es podrien evitar amb una bona prevenció.
Desde Diagnosis Dermatologica informen  en la necessitat de conscienciar la població sobre els hàbits de risc i d'establir programes de detecció precoç que apliquem a Diagnosis Dermatologica.

Aquests dos factors contribuirien a reduir la incidència del càncer de pell, que va en augment per la major esperança de vida de la població i per una exposició excessiva al sol. El 70% dels melanomes són a causa d'un excés de radiació ultraviolada natural o artificial.
  

    
La incorrecta exposició al sol és la principal causant dels tumors de pell malignes que es diagnostiquen. En aquest sentit  la doctora Susana Puig, ha explicat que hi ha països com França que han decidit prohibir l'ús de les màquines de raig UVA i considera que s'hauria d'informar els usuaris del risc que tenen. El  doctor Josep Malvehy, ha assegurat que la progressió en el diagnòstic d'aquesta malaltia fa que avui "el càncer de pell és més freqüent que tota la resta de càncers junts".
La majoria de tumors malignes cutanis poden curar-se si són diagnosticats en un estadi inicial i aquí rau la importància de la detecció precoç. Avenços tecnològicsL'aplicació dels avenços tecnològics serà d'especial rellevància en els propers anys per detectar de forma precoç possibles casos de càncer. Fins ara, s'han desenvolupat noves tècniques de diagnòstic no invasives que detecten la lesió en la seva etapa inicial. Les aplicacions mòbils en què ja s'està treballant tindran un lloc destacat en el congrés. Per exemple, aplicacions que permeten la utilització de la fotografia del tumor i afavoreixen una comunicació directa amb dermatoleg.

 El seu ús és fonamentals a l'hora de realitzar un diagnòstic que permeti tractar el tumor a temps perquè són els que poder dur a terme una exploració periòdica de la pell dels pacients, detectar qui pot formar part dels grups de risc i derivar-los al dermatòleg en cas de detectar una lesió sospitosa de ser un tumor o de convertir-s'hi. Una nova tècnica Quant al tractament, una tècnica d'avaluació ràpida del tumor intraoperatòria, que pot revolucionar el tractament del càncer de pell i que ha estat desenvolupada per un projecte d'investigació de la Unió Europea (Diagnoptics) .

Es tracta de la microscopia confocal exvivo, que utilitza la llum de diferents làsers. En el tractament del melanoma, els avenços inclouen nous marcadors i tècniques de diagnòstic per detectar la malaltia oculta subclínica; tractaments immunològics i teràpies moleculars amb dianes terapèutiques.

Diagnosis Dermatologica disposa d'aquesta técnica d'avaulació rápida del tumor. Es el primer centre nacional que disposa d'aquesta nova tecnología que revolucionarà el tractament del cáncer de pell (melanoma, carcinoma...)

#susanapuig #josepmalvehy #cancerdepell #melanoma #carcinoma #confocalexvivo #tractamentcancerdepell #tractamentmelanoma #diagnoptics #eado2018 #dermatoleg #dermatologiabarcelona #clinicadermatologica #cirugiademohs #mohs

Pistas dermatoscópicas para el diagnóstico de melanomas que se asemejan a la queratosis seborreica.

Carrera C  , Segura S  , Aguilera P  , Scalvenzi M , Longo C , Barreiro A , Broganelli P , Cavicchini S , Llambrich A , Zaballos P , Thomas L , Malvehy J  , Puig S , Zalaudek I

Resumen

IMPORTANCIA:

Los melanomas que imitan clínicamente la queratosis seborreica (SK) pueden retrasar el diagnóstico y el tratamiento adecuado. Sin embargo, poco se sabe sobre el valor de la dermatoscopia en el reconocimiento de estos melanomas difíciles de diagnosticar.

OBJETIVO:

Describir las características dermatoscópicas de los melanomas tipo SK para comprender su morfología clínica.

DISEÑO, AMBIENTACIÓN Y PARTICIPANTES:

Este estudio observacional retrospectivo utilizó 134 imágenes clínicas y dermatoscópicas de melanomas probados histopatológicamente en 134 pacientes tratados en 9 centros de cáncer de piel en España, Francia, Italia y Austria. Sin saber que el diagnóstico definitivo para todas las lesiones fue melanoma, 2 observadores capacitados en dermatoscopia evaluaron las descripciones clínicas y 48 características dermatoscópicas (incluidos todos los criterios melanocíticos y no melanocíticos) de las 134 imágenes y clasificaron cada dermoscopia como SK o no SK. Se evaluaron la puntuación total de la dermatoscopia y la puntuación de la lista de control de 7 puntos. Las imágenes de las lesiones y los datos de los pacientes se recopilaron desde el 15 de julio de 2013 hasta el 31 de julio de 2014.

PRINCIPALES RESULTADOS Y MEDIDAS:

Se evaluaron las frecuencias de los patrones morfológicos específicos de los melanomas de tipo SK (clínica y dermoscópicamente), la demografía de los pacientes y el acuerdo interobservador de criterios.

RESULTADOS:

De los 134 casos recogidos de 72 hombres y 61 mujeres, todos blancos y con una edad media de 55,6 años, 110 (82,1%) revelaron características dermatoscópicas sugestivas de melanoma, incluida una red de pigmentos (74 [55.2%]), velo azul-blanco (72 [53.7%]), glóbulos y puntos (68 [50.7%]), pseudópodos o rayas (47 [35.1%]) y signo azul-negro (43 [32.3% ]). Los 24 casos restantes (17,9%) se consideraron probables SK, incluso por dermatoscopia. En general, las lesiones mostraron una superficie escamosa e hiperqueratósica (45 [33,6%]), queratina amarillenta (42 [31,3%]), aberturas similares a comedones (41 [30,5%]) y quistes similares a milia (30 [22,4%] ). La muestra completa alcanzó una puntuación media de dermatoscopia total de 4.7 (1.6) y una puntuación de 7 puntos en la lista de control de 4.4 (2.3), mientras que los melanomas dermatoscópicamente similares a SK lograron una puntuación total de dermatoscopia de solo 4.2 (1. 3) y una puntuación de 7 puntos en la lista de verificación de 2.0 (1.9), ambas en el rango de benignidad. Los criterios más útiles para diagnosticar correctamente los melanomas tipo SK fueron la presencia de velo azul-blanco, pseudópodos o estrías y una red de pigmentos. El análisis multivariado encontró que solo el signo azul-negro se asociaba significativamente con un diagnóstico correcto, mientras que la hiperqueratosis, las fisuras y las crestas eran marcadores de riesgo independientes de los melanomas de tipo SK dermatoscópicamente.

CONCLUSIONES Y RELEVANCIA:

Los melanomas tipo queratosis seborreicas pueden ser un reto dermatoscópico, pero la presencia del signo azul-negro, la red de pigmento, los pseudópodos o las estrías y / o el velo azul-blanco, a pesar de la presencia de otras características de SK, permite el diagnóstico correcto de la mayoría de Los casos difíciles de melanoma.

Fuente: PubMed

Dermoscopic Clues for Diagnosing Melanomas That Resemble Seborrheic Keratosis.

Carrera C1, Segura S2, Aguilera P1, Scalvenzi M3, Longo C4, Barreiro A5, Broganelli P6, Cavicchini S7, Llambrich A8, Zaballos P9, Thomas L10, Malvehy J1, Puig S1, Zalaudek I11.

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.

Detección de melanoma desmoplásico con dermatoscopia y microscopía confocal de reflectancia.

Maher NG , Solinas A  , Scolyer RA  , Puig S , Pellacani G  , Guitera P .

Resumen

FONDO:

El melanoma desmoplásico (DM) con frecuencia se diagnostica de forma clínica y a menudo se asocia con melanoma in situ (MIS).

OBJETIVO:

Mejorar la detección de DM mediante dermatoscopia y microscopía confocal de reflectancia (RCM).

MÉTODOS:

Se realizó un análisis descriptivo de las características de dermatoscopia de DM y un estudio de casos y controles dentro de una población de melanoma para la evaluación de características de RCM utilizando datos obtenidos entre 2005 y 2015. Después de identificar retrospectivamente todos los casos de DM con datos de RCM durante el período de estudio (n = 16 ), se seleccionó un grupo de control de pacientes con melanoma sin DM con datos de RCM, en una proporción de al menos 3: 1. El grupo de control se emparejó por edad y ubicación del sitio del tumor primario, dividido en melanomas no invasores de DM (n = 27) y MIS (n = 27). Los melanomas invasivos se seleccionaron de acuerdo con los subtipos de melanoma asociados con los casos de DM. Los principales resultados fueron la frecuencia de las características específicas del melanoma en la dermatoscopia para la DM; y las razones de probabilidad de las características RCM para distinguir la DM de MIS y / o otros melanomas invasivos;

RESULTADOS:

Al menos una de las 14 características específicas del melanoma evaluadas en la dermatoscopia se encontró en el 100% de las DM (n = 15 DM con dermatoscopia). Los predictores de melanoma RCM conocidos se encontraron comúnmente en las DM, como las células pagetoides (100%) y la atipia celular (100%). La característica RCM de las células fusiformes en la dermis superficial fue más común en la DM en comparación con todo el grupo de control de melanoma (OR 3,82; IC del 95%: 1,01 a 14,90), y en particular en comparación con la MIS (OR 5,48; IC del 95%: 1,11-32,36) . Las células nucleadas en la dermis y el RCM se correlacionan con la inflamación dérmica también fueron características significativas de RCM que favorecen la DM en lugar de MIS, así como el melanoma invasivo en MIS.

CONCLUSIÓN:

La dermatoscopia y la RCM pueden ser herramientas útiles para la identificación de la DM. Ciertas características de RCM pueden ayudar a distinguir la DM de MIS y otros melanomas invasivos. Se justifican estudios más amplios.

Fuente: PubMed  https://www.ncbi.nlm.nih.gov/pubmed/28573666

Detection of desmoplastic melanoma with dermoscopy and reflectance confocal microscopy.

Abstract

BACKGROUND:

Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS).

OBJECTIVE:

To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM).

METHODS:

A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation was performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n = 16), a control group of non-DM melanoma patients with RCM data, in a ratio of at least 3 : 1, was selected. The control group was matched by age and primary tumour site location, divided into non-DM invasive melanomas (n = 27) and MIS (n = 27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group.

RESULTS:

At least one of the 14 melanoma-specific features evaluated on dermoscopy was found in 100% of DMs (n = 15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01-14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11-32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS.

CONCLUSION:

Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.

El melanoma ungueal (uñas)

El melanoma  ungueal suele ser una variante del melanoma acral lentiginoso (melanoma que surge en las palmas de las manos y plantas de los pies). Hay otros tipos de melanoma que rara vez surgen bajo las uñas, estos son el melanoma nodular y el melanoma desmoplásico.

El melanoma de la unidad ungueal suele afectar a las uñas de las manos o de los pies, así que puede estar involucrado cualquier dedo. El término incluye:

·         Melanoma subungueal: melanoma procedente de la matriz de la uña.

·         Melanoma ungueal: melanoma que se origina de debajo de la superficie de la uña.

·         Melanoma periungueal: melanoma que se origina a partir de la piel junto a la placa de la uña.

Sin embargo, hasta la mitad de todos los casos de melanoma subungueal es amelanótico (no pigmentadas). El melanomaungueal puede formar un nódulo bajo la superficie de la uña, levantándola (onicolisis). A veces puede parecer una verruga (verrucoso). Por lo general es indoloro, pero el tumor avanzado invade el hueso subyacente, lo que puede causar dolor severo.

https://www.diagnosisdermatologica.com/es/cancer-cutáneo

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

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

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

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

 

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.

https://www.ncbi.nlm.nih.gov/pubmed/28960289

Abstract

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
 

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.

https://www.ncbi.nlm.nih.gov/pubmed/28814886

Abstract

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