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1.
J Surg Oncol ; 2024 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-38845222

RESUMEN

BACKGROUND: Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with poor 5-year survival rates. Surgery and radiation are the current first-line treatments for local and nodal disease. OBJECTIVES: The Brazilian Society of Surgical Oncology developed this document aiming to guide the surgical oncology role in multimodal MCC management. METHODS: The consensus was established in three rounds of online discussion, achieving consensus on specific topics including diagnosis, staging, treatment, and follow-up. RESULTS: Patients suspected of having MCC should undergo immunohistochemical examination and preferably undergo pathology review by a dermatopathologist. Initial staging should be performed with dermatologic and nodal physical examination, combined with complementary imaging. Whole-body imaging, preferably with positron emission tomography (PET) or computed tomography (CT) scans, are recommended. Due to the need for multidisciplinary approaches, we recommend that all cases should be discussed in tumor boards and referred to other specialties as soon as possible, reducing potential treatment delays. We recommend that all patients with clinical stage I or II may undergo local excision associated with sentinel lymph node biopsy. The decision on margin size should consider time to recovery, patient's comorbidities, and risk factors. Patients with positive sentinel lymph nodes or the presence of risk factors should undergo postoperative radiation therapy at the primary site. Exclusive radiation is a viable option for patients with low performance. Patients with positive sentinel lymph node biopsy should undergo nodal radiation therapy or lymphadenectomy. In patients with nodal clinical disease, in addition to primary tumor treatment, nodal radiation therapy and/or lymphadenectomy are recommended. Patients with advanced disease should preferably be enrolled in clinical trials and discussed in multidisciplinary meetings. The role of surgery and radiation therapy in the metastatic/advanced setting should be discussed individually and always in tumor boards. CONCLUSION: This document aims to standardize a protocol for initial assessment and treatment for Merkel cell carcinoma, optimizing oncologic outcomes in middle-income countries such as Brazil.

2.
An Bras Dermatol ; 98(6): 793-798, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37355350

RESUMEN

BACKGROUND: In cutaneous melanomas in general, tumor inflammatory infiltrate (TII) can protect against distant metastases, but there is no consensus when only thin primary cutaneous melanomas (TPCM) are considered. OBJECTIVE: To investigate the presence of TII in TPCM and the relationship between TII and the occurrence of metastases. METHODS: Case-control study including 50 patients with TPCM, 22 metastatic (MC group) and 28 non-metastatic (NMC group). The presence of TII was evaluated and, if present, qualified as mild, moderate or marked. RESULTS: The mean age was 50.7 years in the MC and 56.2 years in the NMC group (p = 0.234), and the male sex predominated in the MC group (63.6%). The average Breslow thickness was higher in the MC when compared to that observed in the NMC (respectively 0.8 vs. 0.6 mm, p = 0.012). The presence of ulceration occurred in 22.7% of the MC and 17.9% of the NMC (p = 0.732). TII was present in all 50 TPCM, being marked or moderate in 67.9% of the NMC and 54.5% in the MC group (p = 0.503). In the multivariate analysis, the presence of moderate and marked TII had an Odds Ratio (OR) of 0.57 (95% Confidence Interval [CI]: 0.18‒1.8) and adjusted OR of 0.68 (95% CI 0.13‒3.99). STUDY LIMITATIONS: Small sample size. CONCLUSIONS: TII was present in all TPCM (with and without metastases), and it was not possible to demonstrate a protective effect of TII against the appearance of metastases.


Asunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Masculino , Persona de Mediana Edad , Melanoma/patología , Neoplasias Cutáneas/patología , Estudios de Casos y Controles , Pronóstico , Melanoma Cutáneo Maligno
3.
Pediatr Dermatol ; 28(6): 729-731, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21950562
4.
JCO Glob Oncol ; 6: 575-582, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32293941

RESUMEN

PURPOSE: National epidemiologic data on melanoma are scarce in Brazil. The current work presents final demographic, clinical, and pathologic results from the Brazilian Melanoma Group database to detail how patients with melanoma present at diagnosis. METHODS: The online database includes patients diagnosed between 1982 and 2015 and evaluated at their centers of origin between 2001 and 2016. The primary objective was to describe the demographic, clinical, and pathologic characteristics of the patients, and secondary objectives were to investigate the association between clinical and pathologic variables of interest. RESULTS: A total of 1,596 patients were included. Median age was 52 years, 57% were women, and the majority were identified as white. Invasive melanoma was diagnosed in 1,297 patients, mostly localized, whereas 299 (19%) had in situ disease (TisN0M0). Only 165 patients had initial lymph node involvement. Fitzpatrick skin types I or II were slightly more frequent with in situ melanoma (73%) than with invasive disease (67%; P = .054). The median Breslow thickness was 0.95 mm, Clark levels 2 and 3 comprised nearly 70% of cases, and ulceration was present in 18% of patients. The mitotic rate was significantly associated with the presence of ulceration and both vascular and perineural invasion but not with margin positivity, whereas histologic regression was associated with both intratumoral and peritumoral inflammatory infiltrates. CONCLUSION: Despite the limitations of an observational, registry-based study, the current results provide a general profile of patients with cutaneous melanoma in Brazil at the time of diagnosis.


Asunto(s)
Melanoma , Neoplasias Cutáneas , Brasil/epidemiología , Demografía , Femenino , Humanos , Masculino , Melanoma/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Cutáneas/epidemiología
5.
An. bras. dermatol ; 98(6): 793-798, 2023. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1520048

RESUMEN

Abstract Background In cutaneous melanomas in general, tumor inflammatory infiltrate (TII) can protect against distant metastases, but there is no consensus when only thin primary cutaneous melanomas (TPCM) are considered. Objective To investigate the presence of TII in TPCM and the relationship between TII and the occurrence of metastases. Methods Case-control study including 50 patients with TPCM, 22 metastatic (MC group) and 28 non-metastatic (NMC group). The presence of TII was evaluated and, if present, qualified as mild, moderate or marked. Results The mean age was 50.7 years in the MC and 56.2 years in the NMC group (p = 0.234), and the male sex predominated in the MC group (63.6%). The average Breslow thickness was higher in the MC when compared to that observed in the NMC (respectively 0.8 vs. 0.6 mm, p = 0.012). The presence of ulceration occurred in 22.7% of the MC and 17.9% of the NMC (p = 0.732). TII was present in all 50 TPCM, being marked or moderate in 67.9% of the NMC and 54.5% in the MC group (p = 0.503). In the multivariate analysis, the presence of moderate and marked TII had an Odds Ratio (OR) of 0.57 (95% Confidence Interval [CI]: 0.18‒1.8) and adjusted OR of 0.68 (95% CI 0.13‒3.99). Study limitations Small sample size. Conclusions TII was present in all TPCM (with and without metastases), and it was not possible to demonstrate a protective effect of TII against the appearance of metastases.

7.
PLoS One ; 11(2): e0148160, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26859408

RESUMEN

AIMS: The aim of this study is to confirm the function of tumor-infiltrating lymphocytes (TILs) in sentinel lymph node (SLN) metastasis. MATERIALS AND METHODS: This retrospective study included 633 patients with invasive melanoma who underwent sentinel lymph node biopsy in 7 referral centers certified by the Brazilian Melanoma Group. Independent risk factors of sentinel node metastasis (SNL) were identified by multiple logistic regression. RESULTS: SLN metastasis was detected in 101 of 633 cases (16.1%) and in 93 of 428 patients (21.7%) when melanomas ≤ 1mm were excluded. By multiple logistic regression, the absence of TILs was as an independent risk factor of SLN metastasis (OR = 1.8; 95%CI: 1.1-3.0), in addition to Breslow index (greater than 2.00 mm), lymph vascular invasion, and presence of mitosis. CONCLUSION: SLNB can identify patients who might benefit from immunotherapy, and the determination of predictors of SLNB positivity can help select the proper population for this type of therapy. The absence of TILs is a reproducible parameter that can predict SLNB positivity in melanoma patients, since this study was made with several centers with different dermatopathologists.


Asunto(s)
Recuento de Células , Bases de Datos Factuales , Linfocitos Infiltrantes de Tumor/citología , Melanoma/inmunología , Melanoma/patología , Brasil , Femenino , Humanos , Metástasis Linfática , Masculino , Melanoma/diagnóstico , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos
8.
Hepatogastroenterology ; 50(54): 1937-9, 2003.
Artículo en Inglés | MEDLINE | ID: mdl-14696436

RESUMEN

The aim was to assess the response to the treatment using thermal radiofrequency ablation in patients with pelvic recurrent rectal cancer. The location of the lesions as well as the placement of the percutaneous probe were guided by computed tomography. All ablations were performed with a RITA Medical Systems Starburst XL (nine-array, 5-cm) thermal ablation catheter and the Model 1500 generator (RITA Medical Systems, Inc.). The radiofrequency ablation treatment was performed in two patients with pelvic recurrent rectal cancer with poor response to chemoradiotherapy with no indication of new surgical treatment and suffering strong pain in the sacrum area. The serum carcinoembryonic antigen had a sharp reduction in a sixty-day period. The post-procedure tomography analysis showed the center of the tumor with necrosis and a ring of edema around it. Both patients had no complaints about the procedure, and they needed to take mild analgesics only on the first day right after the procedure for pain. In the follow-up one patient developed an abscess and needed to be readmitted but without recurrent pelvic pain. An effective response was shown by tumor necrosis and total relief of pain of the sacrum area.


Asunto(s)
Adenocarcinoma/secundario , Hipertermia Inducida/instrumentación , Neoplasias Pélvicas/secundario , Neoplasias del Recto/terapia , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/terapia , Biomarcadores de Tumor/sangre , Antígeno Carcinoembrionario/sangre , Terapia Combinada , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Neoplasias Pélvicas/diagnóstico por imagen , Neoplasias Pélvicas/patología , Neoplasias Pélvicas/terapia , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/patología , Recto/patología , Tomografía Computarizada por Rayos X
9.
Appl. cancer res ; 39: 1-8, 2019. Ilustr., Tab.
Artículo en Inglés | LILACS, Inca | ID: biblio-1015366

RESUMEN

Background: The capacity for prognostic prediction of cutaneous melanoma, one of the most aggressive cancers, is still difficult due to the tumor heterogeneity and lack of reliable tumor markers. The objective of this study is to correlate, through immunohistochemistry, a Ki-67 and Kindlin-1 staining in malignant melanomas with the prognosis of the disease. Methods: A historical cohort study. Immunohistochemistry, using mouse anti-human Kindlin-1 and Ki-67 monoclonal antibodies, was performed using tissue blocks from primary cutaneous melanoma patients treated between 2006 and 2014 at our institution. Information regarding pathological data and outcomes were retrieved from medical records. Statistical analyses were conducted in SPSS version 18.0. Results: Thirty patients were included. The median age was from 50.93 ± 15.31 years old. The expression of Ki-67 was detected in all patients with primary cutaneous melanoma, while Kindlin-1 was negative in two. Kindlin expression was not significantly correlated with Ki-67 expression by Spearman's rank correlation analysis (P = 0.46), as well as the expression of both markers and the clinical stage (P = 0.34 and 0.18, respectively). Breslow, Clark and mitotic rate were significantly correlated with AJCC stage (P = 0.001). Conclusion: Other studies investigating clinical evolution are needed to further test the potential of these markers as possible prognostic markers (AU)


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Antígeno Ki-67/metabolismo , Melanoma/patología , Proteínas de la Membrana/metabolismo , Pronóstico , Coloración y Etiquetado , Inmunohistoquímica , Biomarcadores de Tumor , Estudios de Cohortes , Melanoma/diagnóstico , Estadificación de Neoplasias
11.
Nucl Med Commun ; 30(7): 565-8, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19424099

RESUMEN

AIM: To simulate the effects of previous wide cutaneous melanoma excision in sentinel lymph node (SLN) biopsy feasibility through a change in the radiotracer injection site. MATERIALS AND METHODS: Thirty-three patients with cutaneous melanoma underwent two preoperatory lymphoscintigraphic studies. In the first, the radiopharmaceutical was injected intradermally 0.3 cm away from the lesion/scar. Dynamic images were acquired to find the SLN. On the following day, the procedure was repeated with the radiopharmaceutical injected 1 cm farther from the previous injection sites. The number of lymph nodes and sites of drainage were compared with the findings of the first study. All the patients underwent SLN biopsy using a gamma probe and patent blue. RESULTS: Seventy-five SLNs were identified with radiopharmaceutical injected at 0.3 cm from the lesion versus 82 SLNs when injected at 1.3 cm. All lymph nodes visualized with close injection were identified with the farther injection. Twenty-seven (81%) patients presented the same number and location of SLNs. Six (19%) patients presented more SLNs with the expanded technique, three patients in the same basin and three in a new lymph node station. All metastatic SLNs were harvested by the two injection techniques. CONCLUSION: The value of the SLN biopsy in patients with cutaneous melanoma is maintained even after the primary lesion has been removed with a margin of up to 1 cm. Some patients might show an increased number of SLNs and some might show drainage to additional lymph node stations.


Asunto(s)
Melanoma/patología , Melanoma/cirugía , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas/patología , Estudios de Factibilidad , Femenino , Humanos , Inyecciones , Metástasis Linfática/diagnóstico por imagen , Masculino , Melanoma/diagnóstico por imagen , Estadificación de Neoplasias , Trazadores Radiactivos , Cintigrafía , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/cirugía
12.
Rev. Col. Bras. Cir ; 28(6): 401-403, nov.-dez. 2001. tab
Artículo en Portugués | LILACS | ID: lil-496898

RESUMEN

OBJETIVO: Analisar se a presença de neoplasia hematológica acarreta maior risco de complicações para inserção de cateteres totalmente implantáveis e se há diferença de tempo cirúrgico quando o procedimento é realizado por punção ou dissecção venosa. MÉTODO: Foram avaliados 68 pacientes com neoplasia internados no Hospital Santa Rita de Porto Alegre entre fevereiro de 1998 e dezembro de 1999, os quais necessitavam de acesso venoso central para tratamento quimioterápico, sendo 48 do sexo feminino e com idade média de 55,6 anos. Desses, 31 apresentavam neoplasia hematológica. RESULTADOS: Complicações pós-operatórias ocorreram em 13 pacientes (19 por cento), sendo elas: obstrução do sistema (7 por cento), hematoma (6 por cento) e infecção (6 por cento), não havendo diferença quanto ao tipo de neoplasia (p = 0,56). Foram realizadas dissecção e punção venosa em 30 e 38 pacientes, respectivamente, sem diferença em relação ao tempo de implantação do cateter (p = 0,42). CONCLUSÃO: Neoplasias hematológicas não aumentaram o risco de complicações quando do uso de cateteres totalmente implantáveis no presente estudo, além disso, ambas as técnicas cirúrgicas - dissecção ou punção - são exeqüíveis, haja visto o tempo cirúrgico semelhante entre elas, desde que sejam respeitados o valor sérico mínimo de plaquetas (50.000/mL) e a técnica cirúrgica apropriada, com hemostasia rigorosa e curativo compressivo.


BACKGROUND: We analyse whether hematological tumors increase the risk of complications of totally implantable catheters and if there are differences regarding procedure time when it is perfomed through venous dissection or venous puncture. METHODS: We studied 68 patients with neoplasia in Hospital Santa Rita from Porto Alegre, between February 1998 and December 1999, who had required central venous access for chemotherapy. Forty-eight patients were female and the mean age was 55.6 years. Thirty-one patients had hematological tumors. RESULTS: Postoperative complications were observed in 13 patients (7 percent with device obstruction, 6 percent with hematoma and 6 percent with infection), but there was no difference regarding the pattern of the neoplasia (p = 0.56). Venous dissection and venous puncture were performed in 30 and 38 patients, respectively, with no difference concerning surgical time (p = 0.42). CONCLUSIONS: Hematological tumors did not increase the risk of complications of totally implantable catheters; furthermore, both surgical techniques (venous dissection or venous puncture) are acceptable choices, with similar surgical times, since one respects minimal platelet count of 50 000/mL and careful hemostasis techniques and compressive dressings.

13.
In. Belfort, FA; Wainstein, AJA. Melanoma: diagnóstico e tratamento. São Paulo, Lemar, 2010. p.319-332, ilus, tab.
Monografía en Portugués | LILACS | ID: lil-561779
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