Dermoscopy and reflectance confocal microscopy of solitary flat pink lesions: A new combined score to diagnose amelanotic melanoma.

BACKGROUND: Differential diagnosis of amelanotic/hypomelanotic melanoma among solitary flat pink lesions is challenging, due to limited clinical and dermoscopic clues. Dermoscopy and reflectance confocal microscopy assessments improve diagnostic accuracy, but their combined capacity among solitary flat pink lesions is yet to be defined. OBJECTIVES: To determine (i) whether diagnostic accuracy is improved with combined dermoscopy and reflectance confocal microscopy, (ii) a model to estimate probability of flat amelanotic/hypomelanotic melanoma among solitary flat pink lesions. METHODS: A retrospective single-centre study of solitary flat pink lesions, excised for suspected malignancy between 2011 and 2022 was performed. Images were independently evaluated by two dermatologists, blinded to histopathological diagnosis. Diagnostic performance was evaluated on the receiver operating characteristic curve and the area under the curve. Predictive features were identified by univariate and multivariate logistic regression analyses. A final predictive nomogram of independent risk factors was calculated by backward likelihood ratio. Hypothesis being tested was formulated before data collection. RESULTS: A total of 184 patients (87 females, 47.3%) were included; mean age was 57.6 years (19-95). Combined dermoscopy and reflectance confocal microscopy was more sensitive (83%, CI 69.2-92.4 and 91.5%, CI 79.6-97.6) than dermoscopy alone (76.6%, CI 62.0-87.7 and 85.1%, CI 71.7-93.8). Predictive features defined the new model, including linear irregular vessels (4.26-folds, CI 1.5-12.1), peripheral pigment network (6.07-folds, CI 1.83-20.15), remnants of pigmentation (4.3-folds, CI 1.27-14.55) at dermoscopy and atypical honeycomb (9.98-folds, CI 1.91-51.96), disarranged epidermal pattern (15.22-folds, CI 2.18-106.23), dendritic pagetoid cells in the epidermis (3.77-folds, CI 1.25-11.26), hypopigmented pagetoid cells (27.05-folds, CI 1.57-465.5), and dense and sparse nests (3.68-folds, CI 1.24-10.96) in reflectance confocal microscopy. Diagnostic accuracy of the model was high (AUC 0.91). CONCLUSIONS: Adjunctive reflectance confocal microscopy increases diagnostic sensitivity of flat amelanotic/hypomelanotic melanoma differential diagnosis. The proposed model requires validation.

Differences in cancer amputee survival based on marital status: an analysis of the Surveillance, Epidemiology, and End Results (SEER) database.

PURPOSE: Limb amputation is a life-altering procedure used to treat certain cancer patients. The influence of psychosocial factors (such as marital status) on outcomes is poorly understood, hindering the development of targeted resources for the specific needs of these patients. This study was conducted to characterize the influence of marital status on survival after cancer-related amputation. DESIGN/RESEARCH APPROACH: Retrospective cohort study. SAMPLE: 1,516 patients with cancer-related amputation were studied from the Surveillance, Epidemiology and End Results database. METHODS: Patients were grouped by marital status as single, married or divorced/separated/widowed and survival was compared using multivariate cox regression adjusted for demographic, tumor and treatment factors. FINDINGS: Adjusted analysis showed that single (HR, 1.213; p = .044) patients had a significantly higher overall mortality-risk, while divorced/separated/widowed patients had both a significantly higher overall (HR, 1.397; p < .001) and cause-specific mortality-risk (HR, 1.381; p = .003) compared to married patients. CONCLUSION: We posit that the increased psychosocial support available to married cancer patients may play a key role in improving survival. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: These findings provide new insight about the psychosocial needs of cancer amputees and the prognostic implications for those lacking social support of a spouse.

[Plasma prorenin as an index of prognostic evaluation in diabetes]. / La prorenina plasmatica quale indice di valutazione prognostica nella malattia diabetica.

Plasma renin exists in an active form or as an inactive zymogen (P.P.) which is converted into active enzyme by exposure to trypsin. Inactive renin was first shown to be increased in patients with diabetes mellitus by Bye et al. The relationship between microalbuminuria (M.A.) in diabetic patients and the level of plasma inactive renin activated by trypsin was examined. The patients were divided into two groups: 1st group (Albustix+) and 2nd group (Albustix-). In the 1st group the inactive renin was greatly increased. In the patients with Albustix- albuminuria was measured by the R.I.A. method and two subgroups were identified. In the patients with albumin excretion over 40 mg/24 hr, prorenin was increased and correlated directly (r = 0.60) with M.A. In the group with albumin excretion below 40 mg/24 hr prorenin was normal except in three patients with increased M.A. These findings suggest that increased plasma prorenin levels in uncomplicated diabetes could anticipate the development of overt nephropathies.

Detection of TSH-binding inhibiting immunoglobulins in patients with Graves' disease and non toxic goiter.

The test of TSH-binding inhibiting antibodies is proving to be very useful for diagnosis and prognosis of hyperthyroidism. The aim of this investigation was to detect, with radioreceptor assay system, the incidence of TSH-binding inhibiting immunoglobulins (TIBAb) in our people. Therefore were examined sera of 19 patients with Graves' hyperthyroidism (150 and 40, mean age 39.9 years, range 24-62) and 9 patients with non toxic goiter (70, 20 mean age 46.6 years, range 25-46) at the first assessment, during treatment along twelve months and after another four months at the end of drug management. 12/19 patients with Graves' syndrome were TIBAB positive (sensitivity 63%) before drug therapy. The prevalence of TIBAb in sera increased after therapy (14/19) but values at the end declined. Three patients (two with persistent high levels of TIBAb at the end of treatment) relapsed. TIBAb were negative in patients with non toxic goiter (and in all normal subjects).