[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]. / Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel. Documento de consenso de la "Xarxa de Centres de Melanoma de Catalunya i Balears"

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

[Lymphoscintigraphy in the study of lymphatic drainage patterns in patients with melanoma]. / La linfogammagrafía en el estudio de los patrones de drenaje linfático en los pacientes con melanoma.

BACKGROUND: In order to plan the pertinent surgical technique for each patient with melanoma or other skin malignancies, it is mandatory to identify those lymphatic basins at risk for metastases. The advent of radiotracers for functional studies of the cutaneous lymphatic system during the last decade has resulted in the disclosure of an unexpected interindividual variability of the lymphatic drainage in both head and neck and trunk. OBJECTIVE: To ascertain the usefulness of lymphoscintigraphy for depicting the cutaneous lymphatic draining basins in patients with primary melanoma of the head, trunk and limbs, and to compare the observed lymphatic drain with the expected pattern of lymph flow according to the classical anatomical studies. MATERIAL AND METHODS: Prospective study in a university hospital (Barcelones Nord area). Consecutive patients with the diagnosis of cutaneous melanoma were recruited after excisional biopsy of the primary tumor. Every patient was intradermally injected with rhenium-sulfide colloids or colloidal technetium labelled with Tc-99m in four quadrant doses of 0.3 ml around the lesions or its excisional scar. Scintigraphic imaging of the migrating radiotracer resulted in a flow pattern that was compared with its "classical" expected counterpart. RESULTS: Altogether, 55 lesions were studied, including 9 in the head, 21 in the trunk and 25 in the limbs (7 upper and 18 lower). The scintigraphic drain pattern did not match the expected classical pattern in 37.0% of the lesions overall (14% upper limbs, 42% truncal lesions out from an area 2.5 cm at both sides of Sapey's line or the midline, 16.6% lower limbs and 89% head and neck). CONCLUSIONS: Lymphatic drain of the skin shows a very high intrapersonal variability leading to the need for an individual work-up in order to know the lymphatic basins at risk for metastases. The high rate of unexpected or non-matching patterns casts some doubts over those previous studies that did not include lymphoscintigraphy on a patient-basis.

[The role of sentinel lymph node biopsy in the diagnosis and prognosis of malignant melanoma]. / La biopsia del ganglio centinela: su papel diagnóstico y pronóstico en el melanoma maligno.

Sentinel lymph node biopsy was introduced into the management of cancer patients 20 years ago. Most hospitals now currently use the technique as a routine diagnostic tool in patients with localized malignant melanoma. However, the technique is complex and numerous details need to be determined and assessed to provide reliable diagnostic and prognostic information. In addition, the introduction of immunohistochemical and molecular techniques in the last decade has extended the information provided by the study of sentinel lymph nodes and created valuable opportunities for investigating the pathogenesis of this type of cancer. The aim of this review is to offer the reader a detailed analysis of the most important studies in the literature and the factors that should currently be considered in determining the indication for sentinel lymph node biopsy, performing the procedure correctly, and interpreting the findings in patients with malignant melanoma.

Generalized nevus spilus and nevus anemicus in a patient with a primary lymphedema: a new type of phakomatosis pigmentovascularis?

A patient with a generalized nevus spilus associated with a nevus anemicus and primary lymphedema is reported. We believe that this association does not reflect the merely coincidental coexistence of three kinds of anomalies but that it may represent a new type of phakomatosis pigmentovascularis.

Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel. Documento de consenso de la 'Xarxa de Centres de Melanoma de Catalunya i Balears' / Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the network of Catalan and Balearic Melanoma Centers

El documento de consenso respecto al manejo del melanoma primario de la piel, que detallamos a continuación, nace de la puesta en común, aceptación, revisión y confrontación con la literatura reciente (incluyendo guías clínicas nacionales e internacionales), así como de los protocolos de diagnóstico, seguimiento y tratamiento consensuados en los diferentes centros hospitalarios de toda Cataluña y Balerares pertenencientes a la Xarxa de Centres de Melanoma de Catalunya i Balears. El objetivo principal de este documento es exponer de forma conjunta el manejo habitual del paciente con melanoma que actualmente se realiza en nuestro medio. Sin embargo, este documento no pretende, ni puede, por lo que tampoco debiera ser usado como un protocolo de obligado cumplimiento por los profesionales que atendemos a este grupo de enfermos. En este sentido, cabe mencionar que la consulta de este documento por parte del profesional no es vinculante para su acción, y en ningún caso este texto podrá ser utilizado para garantizar o buscar responsabilidades del juicio médico concreto. El grupo de dermatólogos que firman dicho documento se formó hace ahora tres años, con la intención de dar a conocer a nuestras autoridades la importancia de este complejo tumor, que en nuestro país creemos que se encuentra erróneamente infravalorada con respecto a otros tipo de cáncer. Además, fruto de las reuniones periódicas del grupo, han surgido también interesantes propuestas de colaboración en distintos proyectos de investigación epidemiológica, clínica y básica aplicada en torno al melanoma maligno en nuestra sociedad (AU)

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society (AU)

La biopsia del ganglio centinela: su papel diagnóstico y pronóstico en el melanoma maligno / The role of sentinel lymph node biopsy in the diagnosis and prognosis of malignant melanoma

La biopsia del ganglio centinela (BGC) en el manejo del paciente oncológico fue introducida hacecasi 20 años y actualmente es ya considerada, en la mayoría de los centros hospitalarios, como una herramientade diagnóstico de rutina para los pacientes con melanoma maligno (MM) localizado. Sin embargo la técnicaes compleja, con numerosos detalles a conocer y a evaluar, ya que de ellos depende su fiabilidad diagnóstica ypronóstica. Además, en la última década, y gracias a la aplicación de técnicas inmunohistoquímicas y moleculares,la información que podemos obtener del estudio del ganglio centinela es cada vez más amplia, ofreciendoun interesante campo para la investigación de la patogenia del cáncer. Esta revisión tiene como objetivo ofreceral lector un detallado análisis de aquellos factores y series publicadas más importantes a tener en cuenta hoyen día para la correcta indicación, realización e interpretación de los resultados de la BGC en los pacientescon MM (AU)

Sentinel lymph node biopsy was introduced into the management of cancer patients 20 years ago.Most hospitals now currently use the technique as a routine diagnostic tool in patients with localized malignantmelanoma. However, the technique is complex and numerous details need to be determined and assessed toprovide reliable diagnostic and prognostic information. In addition, the introduction of immunohistochemicaland molecular techniques in the last decade has extended the information provided by the study of sentinellymph nodes and created valuable opportunities for investigating the pathogenesis of this type of cancer. Theaim of this review is to offer the reader a detailed analysis of the most important studies in the literature and thefactors that should currently be considered in determining the indication for sentinel lymph node biopsy,performing the procedure correctly, and interpreting the findings in patients with malignant melanoma (AU)