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Preventive measures, earlier diagnosis, and markedly improved anticancer treatments have resulted in increasingly more patients living with or surviving cancer. Frequently cancer treatment-related cutaneous adverse events (cAEs) occur, which can severely impact patients' quality of life (QoL) and interfere with anticancer treatment outcomes. Currently, cAEs related to anticancer treatment may be under-appreciated to prevent or provide early and effective treatment. The Nordic European Cutaneous Oncodermatology Management (NECOM) project explored clinical insights in cAEs and focused on skincare regimens involving hygiene, moisturization, sun protection, and camouflage products. The NECOM panel discussed and reached a consensus on evidence and opinion-based best practice recommendations for oncology skincare programs to support all stakeholders in the Nordic European healthcare setting working with oncology patients throughout the entire continuum of care achieve optimal outcomes, improving patients' QoL. J Drugs Dermatol. 2021;20:12(Suppl):s4-14.
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Neoplasias , Qualidade de Vida , Administração Cutânea , Humanos , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia , Pele , Higiene da PeleRESUMO
Halo naevi are considered benign. They occur in children and adolescents. Eruptive multiple halo naevi are infrequently seen in adults. The first patient in this case series had previously had melanoma. Positron emission tomography-computed tomography (PET-CT) showed a papillary thyroid carcinoma. Subsequent adult patients underwent an examination programme similar to melanoma patients with unknown primary, including PET scanning. Sixteen patients were followed over a 6-year period. In total there were 2 papillary thyroid cancers, 1 neuroendocrine lung tumour, 1 patient had had lung metastases from a thin melanoma 7 years previously, 3 patients had primary cutaneous melanoma (1 had had halo naevi since excision of 2 melanomas 15 years previously) and 1 had melanoma metastasis with unknown primary. The incidence of melanoma was 955 times higher than expected (standardized incidence rate). The benefits of PET scanning must be validated in a controlled trial prior to implementation into clinical practice.
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Melanoma , Nevo com Halo , Nevo Pigmentado , Neoplasias Cutâneas , Adolescente , Adulto , Criança , Humanos , Melanoma/diagnóstico por imagem , Melanoma/epidemiologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Cutâneas/epidemiologiaAssuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Betacoronavirus , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Humanos , Alta do Paciente , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase , SARS-CoV-2RESUMO
BACKGROUND: Unlicensed use of melanotan-II (MT-II) to promote skin pigmentation has become prevalent amongst young people attending fitness centres. We present a case where the melanocyte stimulation of MT-II in combination with the use of sun tanning beds coincided with cutaneous melanoma. OBSERVATION: A 20-year-old woman with Fitzpatrick skin type II was referred to a dermatology clinic. Clinical examination revealed a suspicious black melanocytic lesion in her left gluteal region. Furthermore, her skin was universally intensely pigmented. The melanocytic lesion was excised, and histology confirmed the diagnosis of melanoma. Three months prior to the excision the patient had conducted a 3- to 4-week course of self-injections with MT-II, intending an augmentation of sunbed tanning. CONCLUSIONS AND RELEVANCE: This observation brings attention to the potential risks related to the use of the cyclic α-melanocyte-stimulating hormone analogue MT-II. There are several hazardous aspects of the possible widespread use of MT-II. As the drug is unlicensed and incompletely tested, the extent and types of adverse effects are unknown. Clinicians are advised to be aware of the problem, and counsel their at-risk patients regarding the potential hazards related to the use of MT-II.
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Melanoma/etiologia , Peptídeos Cíclicos/administração & dosagem , Neoplasias Cutâneas/etiologia , Banho de Sol , alfa-MSH/análogos & derivados , Feminino , Humanos , Melanoma/patologia , Neoplasias Cutâneas/patologia , Adulto Jovem , alfa-MSH/administração & dosagemRESUMO
TINF2 encodes the TINF2 protein, which is a subunit in the shelterin complex critical for telomere regulation. Three recent studies have associated six truncating germline variants in TINF2 that have previously been associated with a cancer predisposition syndrome (CPS) caused by elongation of the telomeres. This has added TINF2 to the long telomere syndrome genes, together with other telomere maintenance genes such as ACD, POT1, TERF2IP, and TERT. We report a clinical study of 102 Danish patients with multiple primary melanoma (MPM) in which a germline truncating variant in TINF2 (p.(Arg265Ter)) was identified in four unrelated participants. The telomere lengths of three variant carriers were >90% percentile. In a routine diagnostic setting, the variant was identified in two more families, including an additional MPM patient and monozygotic twins with thyroid cancer and other cancer types. A total of 10 individuals from six independent families were confirmed carriers, all with cancer history, predominantly melanoma. Our findings suggest a major role of TINF2 in Danish patients with MPM. In addition to melanoma, other cancers in the six families include thyroid, renal, breast, and sarcoma, supporting a CPS in which melanoma, thyroid cancer, and sarcoma predominate. Further studies are needed to establish the full spectrum of associated cancer types and characterize lifetime cancer risk in carriers.
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Melanoma , Neoplasias Primárias Múltiplas , Sarcoma , Neoplasias da Glândula Tireoide , Humanos , Melanoma/genética , Síndrome , Dinamarca/epidemiologia , Proteínas de Ligação a Telômeros/genéticaRESUMO
Merkel cell carcinoma (MCC) is a subtype of nonmelanoma skin cancer (NMSC) with increasing incidence. Clinically, MCC resembles other far less-aggressive NMSCs, and the pathogenesis is still not understood completely. Rapid diagnosis and treatment are essential to improve overall survival. We present a case report of a 74-year-old female, who had noticed a rapidly growing, oozing tumor on her right flank. She was hesitant to contact the dermatology ward where she had regular checkups as she was afraid of contracting COVID-19. This was in the beginning of the COVID-19 pandemic. At presentation, she had a large exophytic MCC on her right flank and multiple metastases. The disease was at a late stage, and palliative care was the only treatment option left. With this case, we wish to report a rather uncharacteristic location and size of an MCC tumor and suggest that fear of the pandemic and the COVID-19 lockdown has impacted dramatically on attendance of symptomatic patients.
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This is a case report of a 15-year-old girl, who developed kerion Celsi on the vulva after contact with a pet rodent. The skin was extremely painful, highly red, severely inflamed and oozing, mimicking a bacterial abscess. The patient's general condition was barely affected. PCR identified Trichophyton mentagrophytes, successfully treated with terbinafin 250 mg for 12 weeks. The majority of incidents in 11 published cases were caused by T. mentagrophytes, sensitive to terbinafin. Knowledge of this rare inflammatory dermatophytosis may cause the surgeon to abstain from surgery and to "keep calm and kerion".
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Antifúngicos , Tinha do Couro Cabeludo , Antifúngicos/uso terapêutico , Arthrodermataceae , Feminino , Humanos , Tinha do Couro Cabeludo/diagnóstico , Tinha do Couro Cabeludo/tratamento farmacológico , Trichophyton , VulvaRESUMO
INTRODUCTION: As the coronavirus disease 2019 (COVID-19) epidemic evolves and test strategies change, understanding the concepts of testing (gold standard and test performance measures) becomes essential. The challenge of any novel disease is that the gold standard has yet to be defined. METHODS: We reanalysed published data on real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) of severe acute respiratory syndrome coronavirus-2 to illustrate how predictive values vary with disease prevalence, sensitivity (set to values between 30% and 95%) and specificity (set to 99% or 99.98%). We used published data on chest CT and RT-qPCR to examine the potential of latent class analysis to estimate the sensitivity and specificity of RT-qPCR when no single gold standard exists. RESULTS: For the various sensitivity values, the negative predictive value of a RT-qPCR test remained above 92% until a COVID-19 prevalence of > 10%. The positive predictive value (PPV) was more variable. For a sensitivity of 95% and a specificity of 99%, the PPV was less-than 10% at a prevalence of 0.1%, increasing to about 90% at a prevalence of 10%. This improved to a PPV of 85% and almost 100%, respectively, when specificity increased to 99.98%. In a restricted latent class analysis, the sensitivity was 97.1% and the specificity was 99.9%, which is similar to figures from the Danish Health Authority. However, derived predictive values depended on model specification. CONCLUSIONS: A high risk of false-positives should be considered when extending the testing strategy, whereas false-negatives may occur during local outbreaks. This may have consequences for, e.g., containment strategies and research. A confirmatory test (e.g., demonstrating seroconversion or repeated RT-qPCR) may be warranted. FUNDING: none. TRIAL REGISTRATION: not relevant.
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Betacoronavirus/genética , Infecções por Coronavirus/diagnóstico , DNA Viral/análise , Publicações Periódicas como Assunto , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , COVID-19 , Infecções por Coronavirus/virologia , Reações Falso-Negativas , Humanos , Pandemias , Pneumonia Viral/virologia , SARS-CoV-2Assuntos
Aminoquinolinas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Pseudolinfoma/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Administração Tópica , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Pseudolinfoma/diagnóstico , Pseudolinfoma/imunologia , Recidiva , Dermatopatias/diagnóstico , Dermatopatias/imunologia , Resultado do TratamentoRESUMO
Treatment of advanced melanoma has undergone a paradigm shift over the last 10-15 years. The frustrating results of studies on medical treatment ten years ago have been replaced by studies constantly improving survival in patients with advanced melanoma. Immune checkpoint inhibitors belong to one group of treatments and targeted therapy to another. Fifty percent of melanomas are BRAF mutation positive. Normally, the mitogen activated protein kinase or MAP kinase (Ras-BRAF-MEK-Erk chain) pathways translate external signals to intracellular growth and proliferation. In BRAF mutated melanoma cells, the mutated BRAF kinase is excessively active leading to autonomous proliferation and cancerous growth. This kinase can be blocked by BRAF-inhibitors. If given to BRAF negative melanoma patients, it may lead to disease progression because Ras is not inhibited in these cells. Development of Squamous cell carcinomas as a serious adverse event to BRAF inhibition may be caused by similar mechanisms in non BRAF mutated keratinocytes. A spontaneous and paradoxical loss of effect is seen with BRAF inhibitors due to various ways melanoma cells bypass BRAF. This is somewhat counteracted by the addition of a MEK1/2 inhibitor. Overall progression-free survival has increased from a median of two months for chemotherapy, via 7-8 months for BRAF inhibitor to 10-14 months for newer BRAF and MEK inhibitor combination therapy.
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Antineoplásicos/uso terapêutico , Melanoma/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Humanos , MAP Quinase Quinase Quinases/antagonistas & inibidores , MAP Quinase Quinase Quinases/metabolismo , Melanoma/metabolismo , Terapia de Alvo Molecular , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Proteínas Proto-Oncogênicas B-raf/metabolismo , Neoplasias Cutâneas/metabolismo , Melanoma Maligno CutâneoRESUMO
AIM OF DATABASE: The aim of the database is to monitor and improve the treatment and survival of melanoma patients. STUDY POPULATION: All Danish patients with cutaneous melanoma and in situ melanomas must be registered in the Danish Melanoma Database (DMD). In 2014, 2,525 patients with invasive melanoma and 780 with in situ tumors were registered. The coverage is currently 93% compared with the Danish Pathology Register. MAIN VARIABLES: The main variables include demographic, clinical, and pathological characteristics, including Breslow's tumor thickness, ± ulceration, mitoses, and tumor-node-metastasis stage. Information about the date of diagnosis, treatment, type of surgery, including safety margins, results of lymphoscintigraphy in patients for whom this was indicated (tumors > T1a), results of sentinel node biopsy, pathological evaluation hereof, and follow-up information, including recurrence, nature, and treatment hereof is registered. In case of death, the cause and date are included. Currently, all data are entered manually; however, data catchment from the existing registries is planned to be included shortly. DESCRIPTIVE DATA: The DMD is an old research database, but new as a clinical quality register. The coverage is high, and the performance in the five Danish regions is quite similar due to strong adherence to guidelines provided by the Danish Melanoma Group. The list of monitored indicators is constantly expanding, and annual quality reports are issued. Several important scientific studies are based on DMD data. CONCLUSION: DMD holds unique detailed information about tumor characteristics, the surgical treatment, and follow-up of Danish melanoma patients. Registration and monitoring is currently expanding to encompass even more clinical parameters to benefit both patient treatment and research.
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OBJECTIVES: The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists. METHODS: A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week. RESULTS: A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P < 0.0001). CONCLUSIONS: The majority of AK patients in Danish dermatology clinics have a history of skin cancer, and NMSC is suspected in almost 10% of AK-affected regions. Cryotherapy is the most frequently used treatment overall, except in instances of severe actinic damage, in which PDT is the first-choice treatment.
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Ácido Aminolevulínico/análogos & derivados , Aminoquinolinas/uso terapêutico , Carcinoma de Células Escamosas/prevenção & controle , Crioterapia/estatística & dados numéricos , Ceratose Actínica/terapia , Fotoquimioterapia/estatística & dados numéricos , Neoplasias Cutâneas/prevenção & controle , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/etiologia , Estudos Transversais , Dinamarca , Dermatologia/estatística & dados numéricos , Feminino , Humanos , Imiquimode , Ceratose Actínica/complicações , Masculino , Pessoa de Meia-Idade , Ambulatório Hospitalar/estatística & dados numéricos , Fármacos Fotossensibilizantes/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Prática Privada/estatística & dados numéricos , Fatores Sexuais , Neoplasias Cutâneas/etiologiaAssuntos
Biodiversidade , Mudança Climática , Infecções por Coronavirus , Reservatórios de Doenças , Ecossistema , Pandemias , Pneumonia Viral , Animais , Betacoronavirus , COVID-19 , Quirópteros , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Atividades Humanas , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , SARS-CoV-2Assuntos
Dermatite Alérgica de Contato/etiologia , Dermatite Ocupacional/etiologia , Dermatoses Faciais/induzido quimicamente , Metronidazol/efeitos adversos , Enfermagem , Exposição Ocupacional , Administração Tópica , Adulto , Idoso , Carcinoma Basocelular/tratamento farmacológico , Dermatite Alérgica de Contato/diagnóstico , Dermatite Ocupacional/diagnóstico , Diagnóstico Diferencial , Dermatoses Faciais/diagnóstico , Feminino , Humanos , Testes do Emplastro/métodos , Rosácea/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Tetraciclina/uso terapêuticoRESUMO
INTRODUCTION: Sun lotions have not been effective in preventing the alarming increase in the incidence of melanoma, possibly, because of incorrect use, lack of protection from UVA and increased exposure times caused by reduced penetration of erythemogenic UVB. Seeking shade prevents deleterious effects from the sun's ultraviolet rays. MATERIAL AND METHODS: We examined the association between UV intensity and the ratio of shadow length to object height. A linear model fitted the data (R = 0.95). With an astronomical navigation equation for the calculation of altitude of the sun and substituting altitude with UV intensity we developed a model predicting the UV load from the point of observation, the time of the year (declination) and the time of day (hour angle). Accumulated UV doses can be calculated by integration. RESULTS: When the shadow to object ratio is 0.5, skin types I and II will experience erythema after a few minutes, when the ratio is 1 erythema appears after 20-30 minutes, and when the ratio is 2 erythema appears after about one hour. In the Mediterranean, accumulated UV exposure from sunrise to sunset in late summer will be 30-50 times the minimal erythema dose (skin types I + II) of which more than 60% is in the interval where the shadow is shorter than its object. DISCUSSION: The shadow rule (short shadows--seek shade) is simple and universal and children can be taught it. A rule of thumb is: when shadows are shorter than objects throwing them, avoid direct sunlight, when shadow and object are of equal length restrict sun exposure to half an hour, and when shadows are twice the length of objects an hour in the sun is permissible.
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Melanoma/prevenção & controle , Neoplasias Induzidas por Radiação/prevenção & controle , Neoplasias Cutâneas/prevenção & controle , Luz Solar/efeitos adversos , Raios Ultravioleta/efeitos adversos , Eritema/etiologia , Eritema/prevenção & controle , Humanos , Modelos Teóricos , Doses de Radiação , Estações do AnoRESUMO
Malignant melanoma (MM) is a frequent form of cancer with increasing incidence. 6-10% of patients with MM report a family history of MM, and in most populations 2% of unselected cases of MM carry a CDKN2A mutation. tvWe present a family with 24 cases of MM in nine persons from several generations, caused by a previously undescribed germ-line intronic mutation in CDKN2A. Through genetic counselling and genetic testing high-risk persons in the family are located and offered regular screening for MM.