Mostrando entradas con la etiqueta cristinacarrera. Mostrar todas las entradas
Mostrando entradas con la etiqueta cristinacarrera. Mostrar todas las entradas

viernes, 21 de febrero de 2020

Monthly changes in serum levels of S100B protein as a predictor of metastasis development in high-risk melanoma patients.

https://www.ncbi.nlm.nih.gov/pubmed/31967695

Abstract

BACKGROUND:

The role of S100B protein in detecting early melanoma relapses is controversial, since most metastasis occur within normal values of S100B.

OBJECTIVE:

The aim of this study was to assess the performance of S100B in detecting early disease progression in high-risk melanoma patients.

METHODS:

Retrospective cohort study including patients with an initial diagnosis of stage IIB, IIC and III melanoma between January 2003 and July 2013. All patients were followed up in accordance with an intensive protocol based on imaging studies and serum S100B levels every 3 to 6 months. We compared two methods to evaluate changes in S100B. The classic method, referring to a single determination of S100B above the cut-off level at the time of #metastasis, which was evaluated in all patients. And a new method based on monthly changes of S100, which was used in the setting of patients with S100B levels within the normal range.

RESULTS:

Overall, 289 of patients were followed up for 44 months (IQR 17-73) and 45% developed metastases. During the study period 129 patient relapsed of which 46 (35.7%) present elevated values of S100B at the time of relapse. The classic method had a sensitivity and specificity of S100B protein of 35.7% and 92.5% respectively. Furthermore, for the patients that relapsed with normal values of S100B, the new method was applied and showed a sensitivity and specificity of 41.1% and 92.4%, respectively; allowing to detect additional relapses that were missing by the classic method.

CONCLUSION:

During follow-up of high-risk melanoma patients, rising serum S100B values within the normal range can be an important clue to disease progression.

jueves, 20 de febrero de 2020

Distribution of MC1R variants among melanoma subtypes: p.R163Q is associated with lentigo maligna melanoma in a Mediterranean population

https://doi.org/10.1111/bjd.12418

Distribution of MC1R variants among melanoma subtypes: p.R163Q is associated with lentigo maligna melanoma in a Mediterranean population

LINK:  https://doi.org/10.1111/bjd.12418


Funding sources The research at the Melanoma Unit in Barcelona was partially funded by Grants 03/0019, 05/0302, 06/0265 and 09/01393 from Fondo de Investigaciones Sanitarias, Spain; by the CIBER de Enfermedades Raras of the Instituto de Salud Carlos III, Spain; by the AGAUR 2009 SGR 1337 of the Catalan Government, Spain; by the European Commission under the 6th Framework Programme, contract no. LSHCCT2006018702 (GenoMEL) and by the National Cancer Institute of the U.S. National Institutes of Health (CA83115). The work was carried out at the Esther Koplowitz Centre, Barcelona, Spain. The samples from the Instituto Valenciano de Oncología were collected from the Biobanco del Instituto Valenciano de Oncología.

Background

Cutaneous melanoma tumour is classified into clinicohistopathological subtypes that may be associated with different genetic and host factors. Variation in the MC1R gene is one of the main factors of risk variation in sporadic melanoma. The relationship between MC1R variants and the risk of developing a specific subtype of melanoma has not been previously explored.

Objectives


To analyse whether certain MC1R variants are associated with particular melanoma subtypes with specific clinicohistopathological features.

Methods


An association study was performed between MC1R gene variants and clinicopathological subtypes of primary melanoma derived from 1679 patients.

Results


We detected 53 MC1R variants (11 synonymous and 42 nonsynonymous). Recurrent nonsynonymous variants were p.V60L (30·0%), p.V92M (11·7%), p.D294H (9·4%), p.R151C (8·8%), p.R160W (6·2%), p.R163Q (4·2%) p.R142H (3·3%), p.I155T (3·8%), p.V122M (1·5%) and p.D84E (1·0%). Melanoma subtypes showed differences in the total number of MC1R variants (= 0·028) and the number of red hair colour variants (= 0·035). Furthermore, an association between p.R163Q and lentigo maligna melanoma was detected under a dominant model of heritance (odds ratio 2·16, 95% confidence interval 1·07–4·37; = 0·044). No association was found between p.R163Q and Fitzpatrick skin phototype, eye colour or skin colour, indicating that the association was independent of the role of MC1R in pigmentation. No association was observed between MC1R polymorphisms and other melanoma subtypes.

Conclusions


Our findings suggest that certain #MC1R variants could increase melanoma risk due to their impact on pathways other than pigmentation, and may therefore be linked to specific melanoma subtypes
 
#malvehy #susanapuig #cristinacarrera  #paulaaguilera #jmalvehy #melanoma #skincancer  #mc1r #genomel
J.A. PuigButillé C. Carrera R. Kumar Z. GarciaCasado P. Aguilera J. Malvehy E. Nagore S. Pui

 

lunes, 21 de enero de 2019

Anormalidades genéticas en nevus congénitos de grandes a gigantes: más allá de las mutaciones NRAS.

Martins da Silva V Martinez-Barrios E Tell-Martí G Dabad M Carrera C Aguilera P Brualla D Esteve-Codina A Vicente A , Puig S Puig- Butillé JA Malvehy J



Resumen



Los nevus melanocíticos congénitos grandes y gigantes (CMN, por sus siglas en inglés) son lesiones melanocíticas poco comunes causadas en su mayoría por la alteración NZ postcigótica. La caracterización molecular generalmente se centra en los genes NRAS y BRAF en una muestra única de biopsia del CMN. Sin embargo, los CMN grandes / gigantes pueden exhibir diferencias fenotípicas entre áreas distintas, y los pacientes difieren en características tales como la presencia de múltiples CMN o lesiones similares a spilus. 
En este documento, hemos caracterizado una serie de 21 CMN grandes / gigantes que incluyen pacientes con nevus tipo spilus (9/21 pacientes, 42.8%). En total, se analizaron 53 muestras de biopsias congeladas frescas correspondientes a 40 áreas caracterizadas fenotípicamente de CMN grandes / gigantes y 13 lesiones satélites con un panel multigénico y secuenciación de ARN. La detección mutacional mostró mutaciones en el 76,2% (16/21) de CMN grandes / gigantes. Se encontró una mutación NRAS en el 57,1% (12/21) de los pacientes, y las mutaciones en otros genes como BRAF, KRAS, APC y MET se detectaron en el 14,3% (3/21) de los pacientes. La secuenciación de ARN mostró la transcripción de fusión ZEB2-ALK y SOX5-RAF1 en CMN grande / gigante de dos pacientes sin mutaciones sin sentido. Ambas alteraciones no se detectaron en la piel no afectada y se detectaron en diferentes áreas de la piel afectada. Estos hallazgos sugieren que CMN grande / gigante puede resultar de eventos moleculares distintos además de mutaciones NRAS, incluidas mutaciones puntuales y transcripciones de fusión.

Fuente: PubMed

Genetic Abnormalities in Large to Giant Congenital Nevi: Beyond NRAS Mutations.


Abstract

Large and giant congenital melanocytic nevi (CMN) are rare melanocytic lesions mostly caused by postzygotic NRAS alteration. Molecular characterization is usually focused on NRAS and BRAF genes in a unique biopsy sample of the CMN. However, large/giant CMN may exhibit phenotypic differences among distinct areas, and patients differ in features such as presence of multiple CMN or spilus-like lesions. Herein, we have characterized a series of 21 large/giant CMN including patients with spilus-type nevi (9/21 patients, 42.8%). Overall, 53 fresh frozen biopsy samples corresponding to 40 phenotypically characterized areas of large/giant CMNs and 13 satellite lesions were analyzed with a multigene panel and RNA sequencing. Mutational screening showed mutations in 76.2% (16/21) of large/giant CMNs. A NRAS mutation was found in 57.1% (12/21) of patients, and mutations in other genes such as BRAF, KRAS, APC, and MET were detected in 14.3% (3/21) of patients. RNA sequencing showed the fusion transcript ZEB2-ALK and SOX5-RAF1 in large/giant CMN from two patients without missense mutations. Both alterations were not detected in unaffected skin and were detected in different areas of affected skin. These findings suggest that large/giant CMN may result from distinct molecular events in addition to NRAS mutations, including point mutations and fusion transcripts.

lunes, 19 de noviembre de 2018

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.

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.

lunes, 12 de noviembre de 2018

Eficacia de una crema hidratante protectora diaria con fotoprotección de UVB y UVA alta en la disminución del daño ultravioleta: evaluación mediante microscopía confocal de reflectancia.

Resumen


Gomes-Neto A  , Aguilera P , Prieto L , Seite S , Moyal D , Carrera C , Malvehy J , Puig S .


Los pacientes con fotodermatosis o queratosis actínica se benefician de una fotoprotección ultravioleta B-ultravioleta A (UVB-UVA) muy alta. Sin embargo, el mal cumplimiento es un problema que pone en peligro la protección adecuada, lo que lleva a la recurrencia de la enfermedad. 
Este estudio evaluó la eficacia de una crema hidratante protectora diaria con fotoprotección UVB y UVA alta aplicada 8 h antes de la irradiación. Se realizó un estudio piloto de control monocéntrico, abierto, prospectivo, que incluyó 10 pacientes. Los pacientes fueron irradiados con UVB y UVA antes y 8 h después de la aplicación tópica del producto. 
La evaluación con microscopía confocal de reflectancia (RCM) se realizó 24 h más tarde. La evaluación clínica mostró un aumento estadísticamente significativo en la dosis mínima de eritema (MED) después de la aplicación del producto (p <0,001). No se observaron signos de daño por UV según RCM en la piel fotoprotegida (p <0.05). La piel irradiada 8 h después de la aplicación de un humectante protector diario presentó un aumento en los hallazgos de MED y RCM que igualan los hallazgos para la piel no irradiada.


Fuente: PubMed

Efficacy of a Daily Protective Moisturizer with High UVB and UVA Photoprotection in Decreasing Ultraviolet Damage: Evaluation by Reflectance Confocal Microscopy.


Abstract

Patients with photodermatoses or actinic keratosis benefit from very high ultraviolet B-ultraviolet A (UVB-UVA) photoprotection. However, poor compliance is an issue that jeopardizes adequate protection, leading to disease recurrence. This study evaluated the efficacy of a daily protective moisturizer with high UVB and UVA photoprotection applied 8 h before irradiation. A monocentric, open-label, prospective, control pilot study was performed including 10 patients. Patients were irradiated with UVB and UVA before and 8 h after topical application of the product. Reflectance confocal microscopy (RCM) assessment was performed 24 h later. Clinical assessment showed a statistically significant increase in minimal erythema dose (MED) after application of the product (p <0.001). Signs of UV damage according to RCM were not observed on photoprotected skin (p <0.05). Skin irradiated 8 h after applying a daily protective moisturizer presented an increase in MED and RCM findings that equal the findings for non-irradiated skin.

lunes, 17 de septiembre de 2018

Sex as a predictor of response to cancer immunotherapy

jueves, 19 de julio de 2018

Genome-wide linkage analysis in Spanish melanoma-prone families identifies a new familial melanoma susceptibility locus at 11q

 
The main genetic factors for familial melanoma remain unknown in >75% of families. CDKN2A is mutated in around 20% of melanoma-prone families. Other high-risk melanoma susceptibility genes explain <3% of families studied to date. We performed the first genome-wide linkage analysis in CDKN2A-negative Spanish melanoma-prone families to identify novel melanoma susceptibility loci. We included 68 individuals from 2, 3, and 6 families with 2, 3, and at least 4 melanoma cases. We detected a locus with significant linkage evidence at 11q14.1-q14.3, with a maximum het-TLOD of 3.449 (rs12285365:A>G), using evidence from multiple pedigrees. The genes contained by the subregion with the strongest linkage evidence were: DLG2, PRSS23, FZD4, and TMEM135. We also detected several regions with suggestive linkage evidence (TLOD >1.9) (1q, 6p, 7p, 11q, 12p, 13q) including the region previously detected in melanoma-prone families from Sweden at 3q29. The family-specific analysis revealed three loci with suggestive linkage evidence for family #1: 1q31.1-q32.1 (max. TLOD 2.447), 6p24.3-p22.3 (max. TLOD 2.409), and 11q13.3-q21 (max. TLOD 2.654). Future next-generation sequencing studies of these regions may allow the identification of new melanoma susceptibility genetic factors.

https://www.ncbi.nlm.nih.gov/pubmed/29706638

#acralmelanoma  #melanoma  #susanapuig #josepmalvehy #cristinacarrera #skincancer #paulaaguilera  #thegooddoctor #topdoctors #familialmelanoma #cdkn2a #skincancer #skinmelanoma  

viernes, 18 de mayo de 2018

Como aplicar las cremas de fotoproteccion solar

Modo de Empleo
  Aplicar antes de toda exposición solar en todas las zonas descubiertas de la piel. Rec 15/20' antes
·         Para obtener el nivel de protección indicado, aplicar el producto en cantidad suficiente como señalan los esquemas:
1 dedo para la zona 1
2 dedos para cada una de las zonas 2 a 11

Atención: si reduce esta dosis disminuirá el nivel de protección.
Spray: por ejemplo 6 pulverizaciones de media sobre el antebrazo de un adulto (3-4 para un niño)
Sticks (especialmente indicado en cicatrices): realizar 7 pasadas sobre la zona a proteger

Consejos para protegerse del sol con total seguridad
1.    Aplíquese el protector solar antes de la exposición al sol y renueve frecuentemente su aplicación, aproximadamente cada dos horas y sobre todo después de cada baño.
2.     Expóngase progresivamente al sol y evite la exposición solar entre las 12h. y las 16h.
3.     No exponga a insolación directa a los niños menores de 5 años.
4.     No olvide que también puede quemarse realizando cualquier actividad al aire libre: montando en bicicleta, paseando, realizando deporte, en el jardín… En todas estas ocasiones aplíquese un fotoprotector. +50
5.     No se fíe de las circunstancias que comportan un riesgo suplementario o una falsa seguridad: altitud, nubosidad, superficies reflectoras (nieve, arena, hierba, agua), viento fresco.
6.     6..     Protéjase con gorra y gafas de sol con cristales homologados capaces de filtrar los rayos UVA y UVB.
C    7. Comprobar si está medicándose que los medicamentos no sean fotosensibilizantes, pues pueden provocarle quemaduras.
8.     Evitar usar colonias con alcohol pues pueden producir manchas.
9.     Beba agua en abundancia y frecuentemente. El sol deshidrata nuestro organismo. Vigile sobre todo a las personas mayores, cuya sensación de sed está atenuada y a los niños, cuya necesidad de agua es importante y sus centros de termoregulación son todavía inmaduros.
10.   Si advierte que una peca o lunar cambia de forma, tamaño o color consulte a su dermatólogo. www.diagnosisdermatologica.com

#dermatologobarcelona #dermatologabarcelona #fotoproteccion #rayosuva #centrodermatologico #diagnosisdermatologica #melanoma #proteccionsolar #cremasfotoproteccion #centrodermatologico #clinicadermatologica #dermatologiabarcelona #cremasolar


miércoles, 18 de abril de 2018

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

jueves, 22 de febrero de 2018

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


jueves, 15 de febrero de 2018

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

jueves, 8 de febrero de 2018

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




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