Skin and soft tissue infections in adolescent chronic myeloid leukemia under dasatinib treatment.

Although skin complications are common adverse events from tyrosine kinase inhibitors (TKIs) for the treatment of chronic myeloid leukemia (CML), no reports have focused on skin and soft tissue infections (SSTIs) associated with TKI use. We herein present five episodes of SSTIs in three CML patients under dasatinib treatment. All patients were adolescents and had been receiving dasatinib for more than 4 years. In contrast, none of 41 adult CML patients experienced SSTIs in a retrospective analysis. Our findings suggest that long-term dasatinib treatment in adolescent patients may be associated with the increased risk of SSTIs.

Prevalence of Psoriatic Arthritis in Nagano Prefecture, Japan, and Efficacy of the Psoriasis Epidemiology Screening Tool: A Real-World Survey.

Pain, stiffness, and swelling are the main joint symptoms of psoriatic arthritis (PsA); however, they are also common symptoms of other joint diseases. Therefore, it is challenging to distinguish PsA from other joint diseases. To evaluate the prevalence of PsA and the frequency of joint symptoms in psoriasis patients, we conducted a prefecture-wide survey using the Psoriasis Epidemiology Screening Tool (PEST), a patient questionnaire for screening PsA to assess joint symptoms. Data were collected from 764 psoriasis patients, all of whom visited hospitals (55.1%) or clinics (44.9%) in Nagano Prefecture, Japan. The proportion of psoriasis patients with PsA was 6.5% (50 of 764); four patients (1.2%) with PsA were treated in clinics, while 46 patients (10.9%) were treated in hospitals. Based on the responses to the PEST, 18.1% of patients with psoriasis had joint symptoms. In contrast, 73.2% of psoriasis patients with joint symptoms did not have PsA. The PEST showed 52% sensitivity and 93.4% specificity for PsA. In addition, fingernail alterations were common in PsA. The proportion of the population with PsA was lower than reported previously in Japan. This may have been due to the enrollment of a large number of patients treated in clinics. Many patients with PsA were treated at hospitals, which likely reflects the tendency of patients with joint symptoms to receive intensive treatment in hospitals. In addition, based on the lower sensitivity of the PEST in this study, further studies are necessary to establish the validity of the PEST.

Significance of 5-S-Cysteinyldopa as a Marker for Melanoma.

Melanoma is one of the most lethal and malignant cancers and its incidence is increasing worldwide, and Japan is not an exception. Although there are numerous therapeutic options for melanoma, the prognosis is still poor once it has metastasized. The main concern after removal of a primary melanoma is whether it has metastasized, and early detection of metastatic melanoma would be effective in improving the prognosis of patients. Thus, it is very important to identify reliable methods to detect metastases as early as possible. Although many prognostic biomarkers (mainly for metastases) of melanoma have been reported, there are very few effective for an early diagnosis. Serum and urinary biomarkers for melanoma diagnosis have especially received great interest because of the relative ease of sample collection and handling. Several serum and urinary biomarkers appear to have significant potential both as prognostic indicators and as targets for future therapeutic methods, but still there are no efficient serum and urinary biomarkers for early detection, accurate diagnosis and prognosis, efficient monitoring of the disease and reliable prediction of survival and recurrence. Levels of 5-S-cysteinyldopa (5SCD) in the serum or urine as biomarkers of melanoma have been found to be significantly elevated earlier and to reflect melanoma progression better than physical examinations, laboratory tests and imaging techniques, such as scintigraphy and echography. With recent developments in the treatment of melanoma, studies reporting combinations of 5SCD levels and new applications for the treatment of melanoma are gradually increasing. This review summarizes the usefulness of 5SCD, the most widely used and well-known melanoma marker in the serum and urine, compares 5SCD and other useful markers, and finally its application to other fields.

Accuracy in melanoma detection: a 10-year multicenter survey.

BACKGROUND: Early excision is the only strategy to reduce melanoma mortality, but unnecessary excision of benign lesions increases morbidity and healthcare costs. OBJECTIVE: To assess accuracy in melanoma detection based on number-needed-to-excise (NNE) values over a 10-year period. METHODS: Information was retrieved on all histopathologically confirmed cutaneous melanomas or melanocytic nevi that were excised between 1998 and 2007 at participating clinics. NNE values were calculated by dividing the total number of excised lesions by the number of melanomas. Analyses included changes in NNE over time, differences in NNE between specialized clinical settings (SCS) versus non-specialized clinical settings (NSCS), and patient factors influencing NNE. RESULTS: The participating clinics contributed a total of 300,215 cases, including 17,172 melanomas and 283,043 melanocytic nevi. The overall NNE values achieved in SCS and NSCS in the 10-year period were 8.7 and 29.4, respectively. The NNE improved over time in SCS (from 12.8 to 6.8), but appeared unchanged in NSCS. Most of the effect on NNE in SCS was due to a greater number of excised melanomas. Higher NNE values were observed in patients younger than 40 years and for lesions located on the trunk. LIMITATIONS: No data concerning the use of dermatoscopy and digital monitoring procedures were collected from the participating centers. CONCLUSION: Over the 10-year study period, accuracy in melanoma detection improved only in specialized clinics maybe because of a larger use of new diagnostic techniques such as dermatoscopy.

Clinical history analysis of Japanese melanoma cases and characteristics of melanoma with childhood onset.

It remains debatable whether melanoma with a clinical history of early childhood onset truly arises from a nevus. To clarify the clinical and genetic characteristics of melanoma detected at birth or several years afterwards, 249 melanoma cases seen at Shinshu University Hospital between 2006 and 2015 were retrospectively analyzed. Ten (4.0%) cases (median age 39.5 years, range 19-70 years; male/female 2/8; lesion site, 6 extremities, 2 trunk, 1 head, 1 face; cumulative sun damage [CSD] skin, 9 low-CSD, 1 high-CSD; detection at birth 3) had recorded early childhood onset. Median Breslow's tumor thickness in those cases was 6.0 mm (range: 0.4-17.5 mm). The frequency of lesions detected at <20 years of age was significantly higher for low-CSD melanoma (17.5%) than for high-CSD (3.3%) and acral (0.8%) melanoma. Although melanoma with a history of early childhood onset is rare, the characteristics of such cases should be established since most have progressed to an advanced stage at the initial visit.

Dermoscopic diagnostic performance of Japanese dermatologists for skin tumors differs by patient origin: A deep learning convolutional neural network closes the gap.

In the dermoscopic diagnosis of skin tumors, it remains unclear whether a deep neural network (DNN) trained with images from fair-skinned-predominant archives is helpful when applied for patients with darker skin. This study compared the performance of 30 Japanese dermatologists with that of a DNN for the dermoscopic diagnosis of International Skin Imaging Collaboration (ISIC) and Shinshu (Japanese only) datasets to classify malignant melanoma, melanocytic nevus, basal cell carcinoma and benign keratosis on the non-volar skin. The DNN was trained using 12 254 images from the ISIC set and 594 images from the Shinshu set. The sensitivity for malignancy prediction by the dermatologists was significantly higher for the Shinshu set than for the ISIC set (0.853 [95% confidence interval, 0.820-0.885] vs 0.608 [0.553-0.664], P < 0.001). The specificity of the DNN at the dermatologists' mean sensitivity value was 0.962 for the Shinshu set and 1.00 for the ISIC set and significantly higher than that for the human readers (both P < 0.001). The dermoscopic diagnostic performance of dermatologists for skin tumors tended to be less accurate for patients of non-local populations, particularly in relation to the dominant skin type. A DNN may help close this gap in the clinical setting.

Dermoscopy of pigmented poromas.

BACKGROUND: To date, little is known about the dermoscopic features of pigmented poromas. METHODS: Twelve cases of pigmented poromas examined by dermoscopy at the Department of Dermatology, Shinshu University Hospital (Matsumoto, Japan), between January 2000 and February 2009 were collected. Retrospectively, digital dermoscopic images were evaluated for the presence of dermoscopic structures. RESULTS: Vascular structures were observed in 8 of 12 cases. Hairpin vessels were found in 3 cases. Most were elongated and irregularly shaped. Polymorphous vessels were observed in 3 cases, of which 2 showed combinations of dotted vessels and linear-irregular vessels and 1 combinations of hairpin vessels and glomerular vessels. Arborizing vessels were observed in 2 cases. Globule-like structures occurred in 7 cases. Globule-like structures and arborizing vessels coexisted in 2 cases. Comedo-like openings were observed in 3 cases, all of which were accompanied by hairpin vessels. CONCLUSIONS: Pigmented poromas mimic a number of skin tumors, including pigmented basal cell carcinomas, seborrheic keratosis and malignant melanoma, because they present various clinical, dermoscopic and histopathological features.

Dermoscopy image-based self-learning on computer improves diagnostic performance of medical students compared with classroom-style lecture in ultra-short period.

The educational effectiveness of dermoscopy image-based self-learning on a computer for medical students has not been well examined. To assess the effect of an image-based self-learning session on the dermoscopic diagnostic performance for malignant melanoma (MM), basal cell carcinoma, melanocytic nevus and seborrheic keratosis (SK) on non-acral regions in comparison with a conventional classroom-style lecture, 114 fourth-year medical students (mean age, 23.7 years; male : female, 73:41) were enrolled. The subjects were randomly assigned to either a self-learning to lecture (SL) or lecture to self-learning (LS) group to receive a 15-min image-based self-learning computer session and a 15-min video lecture session in different orders. The user interface of the digital content was the same as that on a website (https://dz-image.casio.jp). Diagnostic performance was determined using the total number of correct answers for the four diseases and by malignancy prediction in examination A (before training), B (after receiving one session) and C (after receiving both sessions). The examinations were all unique and contained five dermoscopic images each of the four diseases. The total number of correct answers and malignancy prediction results for examination B were significantly higher in the SL group than in LS (11.6 and 15.2 vs 10.1 and 13.4, respectively; both P < 0.01), with no remarkable differences for examination C (13.5 and 16.8 vs 13.3 and 16.4, respectively; P = 0.62 and P = 0.21). In subanalyses, the number of correct answers for SK in examination B was significantly higher in the SL group (3.6 vs. 1.8, P < 0.01), while that for MM was significantly lower (2.2 vs 3.0, P < 0.01). Diagnostic performance was comparable between sexes for examination B. In conclusion, computer-assisted dermoscopy image-based self-learning may be a suitable and non-inferior alternative to classroom-style instruction for medical students within an ultra-short training period.

Japanese Dermatological Association Guidelines: Outlines of guidelines for cutaneous melanoma 2019.

With consideration of the ongoing developments in treatment options for cutaneous melanoma, the Japanese Skin Cancer Society published the first guidelines for cutaneous melanoma in 2007 and later revised them in 2015. Here, we report on an English version of the 2019 Japanese Melanoma Guidelines. In this latest edition, all processes were carried out according to the Grading of Recommendations, Assessment, Development and Evaluation system. A comprehensive published work search, systematic review and determination of recommendations in each clinical question were performed by a multidisciplinary expert panel consisting of dermatologists, a plastic and reconstructive surgeon, and a radiation oncologist. The advent of novel agents, such as immune checkpoint inhibitors and molecular-targeted agents, has drastically changed the nature of treatment for adjuvant and advanced-stage diseases among melanoma patients worldwide. Additionally, recent reports of clinical trials regarding surgical procedures and a better understanding of molecular biology and tumor immunology in clinical types of melanoma have had an impact on clinical practise. Based on these viewpoints, eight relevant clinical questions were raised in this report that aim to help clinicians select the appropriate therapeutic approach.

Clinical and Histopathologic Characteristics of Melanocytic Lesions on the Volar Skin Without Typical Dermoscopic Patterns.

Importance: It is challenging to differentiate melanoma from melanocytic nevus on the volar skin in the absence of typical dermoscopic patterns. Objective: To identify the frequency and clinical and dermoscopic characteristics of melanocytic lesions on the volar skin not displaying a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern on results of dermoscopy. Design, Setting, and Participants: In this retrospective cohort study, a total of 504 melanocytic lesions on the volar skin were evaluated in the Shinshu University Hospital department of dermatology between January 1, 2000, and December 31, 2012. Dermoscopic images were independently assessed by 3 dermoscopists for the presence of established dermoscopic criteria. Statistical analysis was performed from October 1, 2017, to April 30, 2018. Main Outcomes and Measures: Frequency of dermoscopic criteria and corresponding clinical (patient age and size and location of lesion) and histopathologic features. Results: Of 504 lesions, 110 (21.8%) (melanocytic nevus, 97; melanoma, 8; and equivocal melanocytic lesion, 5) from 108 patients (68 female and 40 male patients; mean age, 40.1 years [range, 1-86 years]) did not show a parallel furrow pattern, lattice-like pattern, fibrillar pattern, or parallel ridge pattern. Among them, the mean patient age was significantly higher for melanoma than for melanocytic nevus (65.3 vs 38.0 years; P < .001), as was mean maximum lesion diameter (11.8 vs 5.7 mm; P < .001). Melanomas and equivocal melanocytic lesions tended to be distributed on weight-bearing areas of the foot sole, such as the heel, while nevi were spread over non-weight-bearing regions. Dermoscopically, 95 melanocytic nevi (97.9%) were symmetrical in 1 or 2 axes while melanomas were not. A total of 91 melanocytic nevi (93.8%) had 1 or 2 colors per lesion, and 4 melanomas (50.0%) had more than 2 colors. Vascular structures were seen in 3 melanocytic nevi (3.1%) and 3 melanomas (37.5%). Blue-white structures were seen in 18 melanocytic nevi (18.6%) and 3 melanomas (37.5%). Dots and globules were seen in 22 melanocytic nevi (22.7%) and 4 melanomas (50.0%). Vascular structures, blue-white structures, and dots and globules were irregularly distributed in the melanomas. Ulcer, hyperkeratosis, and irregular streaks were observed only in melanomas. Conclusions and Relevance: More than one-fifth of melanocytic lesions on the volar skin did not display typical dermoscopic patterns. Asymmetry, numerous colors (≥3), and other melanoma-specific dermoscopic findings were more frequently observed for melanomas. Clinical information, including patient age and lesion size and location, was helpful in differentiating melanoma from melanocytic nevus. Further prospective clinical studies are warranted to clarify the diagnostic accuracy of dermoscopy combined with clinical information.