RESUMEN
We present a case series of 13 patients, the first Australian single-centre study of bullous pemphigoid (BP) associated with immune checkpoint inhibitors (ICI): cytotoxic T-lymphocyte antigen (CTLA4) and programmed cell death receptor (PD1) inhibitors. All our patients achieved adequate control of BP with a combination of treatments including oral prednisolone, intravenous immunoglobulin, rituximab and omalizumab. The majority of patients ceased or interrupted immunotherapy treatment upon diagnosis of BP and greater tumour progression was seen in the cohort who ceased immunotherapy.
Asunto(s)
Inhibidores de Puntos de Control Inmunológico , Penfigoide Ampolloso , Humanos , Australia , Antígeno B7-H1/efectos de los fármacos , Muerte Celular , Penfigoide Ampolloso/etiología , Penfigoide Ampolloso/patología , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Inhibidores de Puntos de Control Inmunológico/uso terapéuticoRESUMEN
With new, effective treatments for chronic lymphocytic leukaemia (CLL) the impact of second malignancies is increasingly important. We performed a retrospective case-controlled study examining the effect of CLL and its treatment on melanoma-specific survival and recurrence. A total of 56 patients with melanoma with CLL were matched 1:1 to patients without CLL for age, date of diagnosis, gender and melanoma tumour, node, metastasis (TNM) stage. Multivariate analysis found CLL was associated with significantly worse melanoma-specific mortality (hazard ratio [HR] 2.46, 95% confidence interval [CI] 1.27-4.74, p = 0.007) and recurrence (HR 3.44, 95% CI 1.79-6.63, p < 0.001). Patients with CLL had poor immunotherapy tolerance and prior CLL treatment was not associated with melanoma outcomes.
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Leucemia Linfocítica Crónica de Células B , Melanoma , Neoplasias Primarias Secundarias , Estudios de Casos y Controles , Humanos , Melanoma/terapia , Estudios RetrospectivosRESUMEN
Since the concurrence of bullous pemphigoid (BP) and psoriasis was first reported in 1929, an increasing number of studies has been published to analyse their relationship in recent years. However, the pathogenesis of the concurrence is not yet well understood, and the coexistence of the two conditions imposes a difficult therapeutic challenge. This case report demonstrates the first case of secukinumab achieving a dramatic clinical improvement of both chronic psoriasis and active BP.
Asunto(s)
Enfermedad Injerto contra Huésped , Penfigoide Ampolloso , Psoriasis , Anticuerpos Monoclonales Humanizados/uso terapéutico , Humanos , Penfigoide Ampolloso/complicaciones , Penfigoide Ampolloso/tratamiento farmacológico , Penfigoide Ampolloso/patología , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Psoriasis/patologíaRESUMEN
BACKGROUND: Clinical quality registries aim to identify significant variations in care and provide anonymised feedback to institutions to improve patient outcomes. Thirty-six Australian organisations with an interest in melanoma, raised funds through three consecutive Melanoma Marches, organised by Melanoma Institute Australia, to create a national Melanoma Clinical Outcomes Registry (MelCOR). This study aimed to formally develop valid clinical quality indicators for the diagnosis and early management of cutaneous melanoma as an important step in creating the registry. METHODS: Potential clinical quality indicators were identified by examining the literature, including Australian and international melanoma guidelines, and by consulting with key melanoma and registry opinion leaders. A modified two-round Delphi survey method was used, with participants invited from relevant health professions routinely managing melanoma as well as relevant consumer organisations. RESULTS: Nineteen participants completed at least one round of the Delphi process. 12 of 13 proposed clinical quality indictors met the validity criteria. The clinical quality indicators included acceptable biopsy method, appropriate excision margins, standardised pathology reporting, indications for sentinel lymph node biopsy, and involvement of multidisciplinary care and referrals. CONCLUSION: This study provides a multi-stakeholder consensus for important clinical quality indicators that define optimal practice that will now be used in the Australian Melanoma Clinical Outcomes Registry (MelCOR).
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Melanoma , Neoplasias Cutáneas , Australia , Técnica Delphi , Humanos , Melanoma/patología , Indicadores de Calidad de la Atención de Salud , Sistema de Registros , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND/OBJECTIVES: Merkel cell carcinoma (MCC) is a highly invasive cutaneous malignancy. The objective of this study was to investigate the incidence and trends of MCC in Victoria, Australia, between 1986 and 2016. METHODS: Population-based, descriptive analysis of Victorian Cancer Registry (VCR) data. The de-identified records of patients with MCC were obtained from Victoria residents diagnosed between 1986 and 2016. Trends in age-standardised incidences were examined using joinpoint analysis. RESULTS: A total of 1095 cases were found. Incidence of MCC was 3.9 per 100 000 for men and 1.5 per 100 000 for women. The incidence of MCC in men 66-85 is increasing at an annual rate of 4.2% (2.8-5.8%, 95% CI). However, since 2002 the incidence in women in the same age group has been decreasing. Whilst there is an overall stabilisation in the incidence of MCC, incidence of MCC for males is increasing. For MCC in males 85 years old and over, the incidence of MCC was 26.8 per 100 000 between 2012 and 2016. Relative 5-year survival for patients diagnosed between 2008 and 2012 is 50%. CONCLUSION: Merkel cell carcinoma remains an aggressive cancer, especially among older men. Differences in trends seen in local data can help target preventative and early intervention management strategies in specific groups.
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Carcinoma de Células de Merkel/epidemiología , Neoplasias Cutáneas/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Sistema de Registros , Distribución por Sexo , Victoria/epidemiología , Adulto JovenRESUMEN
BACKGROUND/OBJECTIVES: To describe the characteristics, subsequent management and outcomes of patients referred for further management following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). METHODS: Retrospective analysis of patients referred to a quaternary cancer centre from 2000 to 2015. RESULTS: In total, 83 lesions in 82 patients were referred for further management; 52 (62%) were SCC and 80 (96%) were located in the head and neck. Reasons for referral included high-risk disease for consideration for adjuvant radiotherapy (37/83, 45%), inadequate resection (28/83, 34%) or recurrence following previous MMS (15/83, 17%). Fewer than 40% of the 69 referrals received from MMS surgeons included photos or an operative report and diagram. There was discordance in pathology opinion in 11 (13%) of cases. Histopathology from MMS was reviewed in eight cases and there was discordance with the in-hospital pathology opinion in six of these. In-hospital re-excision was performed in 19 cases and in five of these the pathology report on the paraffin-sectioned re-excised tissue was discordant with prior MMS assessment. Significantly, two cases were associated with a misinterpretation of lymphocytic infiltrate as residual disease in patients with chronic lymphocytic leukaemia (CLL). CONCLUSION: This study highlights some of the challenges and limitations of MMS. Early referral for multidisciplinary management is recommended when MMS resection margins are inadequate or uncertain, especially for high-risk SCC. We recommend that referrals be accompanied by histological material, as well as a detailed report with operative photos and diagrams. CLL can pose an intraoperative diagnostic challenge. Discrepancies in the interpretation of MMS slides present an opportunity for improvement, and our findings support the role of ongoing quality assurance programs.
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Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias de Cabeza y Cuello/cirugía , Cirugía de Mohs , Recurrencia Local de Neoplasia/terapia , Neoplasias Cutáneas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/patología , Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Documentación , Femenino , Humanos , Masculino , Márgenes de Escisión , Auditoría Médica , Persona de Mediana Edad , Neoplasia Residual , Fotograbar , Radioterapia Adyuvante , Derivación y Consulta , Reoperación , Retratamiento , Estudios Retrospectivos , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/radioterapia , Resultado del TratamientoAsunto(s)
Linfoma Anaplásico de Células Grandes/patología , Micosis Fungoide/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Antígeno Ki-1/metabolismo , Linfoma Anaplásico de Células Grandes/metabolismo , Masculino , Persona de Mediana Edad , Micosis Fungoide/metabolismo , Neoplasias Primarias Múltiples/metabolismo , Pronóstico , Neoplasias Cutáneas/metabolismo , Tasa de SupervivenciaRESUMEN
Primary cutaneous large cell anaplastic lymphoma (C-ALCL) and lymphomatoid papulosis (LyP) are cutaneous CD30+ lymphoproliferative disorders (CD30+ LPD). An association with CD30+ LPD and pseudoepitheliomatous hyperplasia has been recognized. Additionally, rare reports of epithelial neoplasms such as keratoacanthomas and squamous cell carcinomas (SCC) occurring in association with both C-ALCL and LyP have been reported. We report two cases of CD30+ LPD with associated epithelial neoplasms; one patient with a primary cutaneous CD30+ LPD and SCC identified within the same lesion, and the other with a keratoacanthoma arising in a lesion of LyP. The pathogenesis of this association is poorly understood although various hypotheses exist. Awareness of the coexistence of these entities will avoid misdiagnosis and incorrect treatment.
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Carcinoma de Células Escamosas/patología , Queratoacantoma/patología , Papulosis Linfomatoide/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Cutáneas/patología , Adulto , Humanos , Queratoacantoma/complicaciones , Papulosis Linfomatoide/complicaciones , Masculino , Neoplasias Cutáneas/complicacionesAsunto(s)
Carcinoma Basocelular/etiología , Neoplasias de Cabeza y Cuello/etiología , Neoplasias Meníngeas/etiología , Meningioma/etiología , Neoplasias Primarias Múltiples/etiología , Neoplasias Primarias Secundarias/etiología , Cuero Cabelludo , Neoplasias Cutáneas/etiología , Terapia por Rayos X/efectos adversos , Anciano , Niño , Femenino , Humanos , Tiña del Cuero Cabelludo/radioterapiaRESUMEN
BACKGROUND: Vemurafenib has been approved for the treatment of patients with advanced BRAF(V600E)-mutant melanoma. This report by the Vemurafenib Dermatology Working Group presents the characteristics of dermatologic adverse events (AEs) that occur in vemurafenib-treated patients, including cutaneous squamous cell carcinoma (cuSCC). METHODS: Dermatologic AEs were assessed from three ongoing trials of BRAF(V600E) mutation-positive advanced melanoma. Histologic central review and genetic characterization were completed for a subset of cuSCC lesions. RESULTS: A total of 520 patients received vemurafenib. The most commonly reported AEs were dermatologic AEs, occurring in 92%-95% of patients. Rash was the most common AE (64%-75% of patients), and the most common types were rash not otherwise specified, erythema, maculopapular rash, and folliculitis. Rash development did not appear to correlate with tumor response. Photosensitivity occurred in 35%-63% of patients, and palmar-plantar erythrodysesthesia (PPE) occurred in 8%-10% of patients. The severity of rash, photosensitivity, and PPE were mainly grade 1 or 2. In all, 19%-26% of patients developed cuSCC, mostly keratoacanthomas (KAs). The majority of patients with cuSCC continued therapy without dose reduction after resection. Genetic analysis of 29 cuSCC/KA samples demonstrated HRAS mutations in 41%. CONCLUSIONS: Dermatologic AEs associated with vemurafenib treatment in patients with melanoma were generally manageable with supportive care measures. Dose interruptions and/or reductions were required in <10% of patients.
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Indoles/efectos adversos , Indoles/uso terapéutico , Melanoma/tratamiento farmacológico , Neoplasias Primarias Secundarias/inducido químicamente , Enfermedades de la Piel/inducido químicamente , Neoplasias Cutáneas/tratamiento farmacológico , Sulfonamidas/efectos adversos , Sulfonamidas/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ensayos Clínicos como Asunto , Femenino , Humanos , Masculino , Melanoma/patología , Persona de Mediana Edad , Neoplasias Primarias Secundarias/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias Cutáneas/patología , Resultado del Tratamiento , Vemurafenib , Adulto JovenAsunto(s)
Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Melanoma/patología , Persona de Mediana Edad , Factores de Riesgo , Distribución por Sexo , Neoplasias Cutáneas/patología , Victoria/epidemiología , Adulto Joven , Melanoma Cutáneo MalignoRESUMEN
Methotrexate is a synthetic folic acid analogue valued for both its anti-proliferative and anti-inflammatory properties. Considered one of the original immune-modifying agents, it is used widely for the treatment of steroid-recalcitrant inflammatory diseases. While there are abundant studies documenting its efficacy in rheumatic diseases, the use of methotrexate for dermatological conditions, with the exception of psoriasis, has yet to be comprehensively explored. This two-part review firstly outlines current data concerning the pharmacology of methotrexate, including its mechanism of action, side-effect profile and recommended therapeutic approach, and, secondly, examines the emerging evidence for methotrexate's efficacy in a wide range of cutaneous disorders.
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Fármacos Dermatológicos/farmacología , Metotrexato/farmacología , Enfermedades de la Piel/tratamiento farmacológico , Fármacos Dermatológicos/efectos adversos , Fármacos Dermatológicos/uso terapéutico , Humanos , Metotrexato/efectos adversos , Metotrexato/uso terapéutico , Guías de Práctica Clínica como AsuntoAsunto(s)
Antineoplásicos/administración & dosificación , Papulosis Linfomatoide/tratamiento farmacológico , Metotrexato/administración & dosificación , Neoplasias Cutáneas/tratamiento farmacológico , Adulto , Anciano , Australia , Estudios de Cohortes , Bases de Datos Factuales , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Papulosis Linfomatoide/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Cutáneas/diagnóstico , Resultado del TratamientoAsunto(s)
Anemia Hemolítica Autoinmune , Leucemia Linfocítica Crónica de Células B , Melanoma , Neoplasias Cutáneas , Anemia Hemolítica Autoinmune/diagnóstico , Anemia Hemolítica Autoinmune/tratamiento farmacológico , Humanos , Ipilimumab/efectos adversos , Leucemia Linfocítica Crónica de Células B/complicaciones , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Melanoma/complicaciones , Melanoma/tratamiento farmacológico , Nivolumab , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
Atypical cutaneous melanocytic lesions, including those with Spitzoid features, can be difficult to categorize as benign or malignant. This can lead to suboptimal management, with potential adverse patient outcomes. Recent studies have enhanced knowledge of the molecular and genetic biology of these lesions and, combined with clinicopathological findings, is further defining their biological spectrum, classification, and behavior. Sentinel node biopsy provides important prognostic information in patients with cutaneous melanoma, but its role in the management of melanocytic lesions of uncertain malignant potential (MELTUMP) is controversial. This paper examines the role of molecular testing and sentinel node biopsy in MELTUMPs, particularly atypical Spitzoid tumors.