RESUMO
BACKGROUND: Primary cutaneous lymphomas (PCLs) are a heterogeneous group of T-cell (CTCL) and B-cell (CBCL) malignancies. Little is known about their epidemiology at initial presentation in Europe and about potential changes over time. OBJECTIVES: The aim of this retrospective study was to analyse the frequency of PCLs in the French Cutaneous Lymphoma Registry (GFELC) and to describe the demography of patients. METHODS: Patients with a centrally validated diagnosis of primary PCL, diagnosed between 2005 and 2019, were included. RESULTS: The calculated incidence was unprecedently high at 1·06 per 100 000 person-years. The number of included patients increased yearly. Most PCL subtypes were more frequent in male patients, diagnosed at a median age of 60 years. The relative frequency of rare CTCL remained stable, the proportion of classical mycosis fungoides (MF) decreased, and the frequency of its variants (e.g. folliculotropic MF) increased. Similar patterns were observed for CBCL; for example, the proportion of marginal-zone CBCL increased over time. CONCLUSIONS: Changes in PCL frequencies may be explained by the emergence of new diagnostic criteria and better description of the entities in the most recent PCL classification. Moreover, we propose that an algorithm should be developed to confirm the diagnosis of PCL by central validation of the cases.
Assuntos
Linfoma de Células B , Linfoma Cutâneo de Células T , Micose Fungoide , Neoplasias Cutâneas , Europa (Continente) , Humanos , Linfoma Cutâneo de Células T/epidemiologia , Masculino , Pessoa de Meia-Idade , Micose Fungoide/epidemiologia , Sistema de Registros , Estudos Retrospectivos , Neoplasias Cutâneas/epidemiologiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Cetuximab/administração & dosagem , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Intervalo Livre de Progressão , Estudos Retrospectivos , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/cirurgia , Resultado do TratamentoRESUMO
Whereas immune checkpoint inhibitors of serine/threonine protein kinase B-raf therapy dramatically changed metastatic outcomes of patients with melanoma, they remain at high risk of brain extension. Additional local treatment can be offered in this situation such as surgery and or stereotactic radiotherapy. In this review article, we describe the different options with published data and their optimal timing.
Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Melanoma/secundário , Melanoma/terapia , Antineoplásicos Imunológicos/uso terapêutico , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Antígeno CTLA-4/antagonistas & inibidores , Fracionamento da Dose de Radiação , Humanos , Melanoma/patologia , Mutação , Necrose/etiologia , Necrose/prevenção & controle , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Proteínas Proto-Oncogênicas B-raf/genética , Radiocirurgia , Neoplasias Cutâneas/patologiaAssuntos
Produtos Biológicos/efeitos adversos , Linfoma de Células B/epidemiologia , Linfoma Cutâneo de Células T/epidemiologia , Neoplasias Cutâneas/epidemiologia , Biópsia , Bases de Dados Factuais/estatística & dados numéricos , Seguimentos , França/epidemiologia , Humanos , Linfoma de Células B/induzido quimicamente , Linfoma de Células B/diagnóstico , Linfoma de Células B/patologia , Linfoma Cutâneo de Células T/induzido quimicamente , Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/patologia , Farmacovigilância , Pitiríase Rubra Pilar/tratamento farmacológico , Psoríase/tratamento farmacológico , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologiaAssuntos
Antibióticos Antineoplásicos/administração & dosagem , Depsipeptídeos/administração & dosagem , Micose Fungoide/tratamento farmacológico , Síndrome de Sézary/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Antibióticos Antineoplásicos/efeitos adversos , Depsipeptídeos/efeitos adversos , Progressão da Doença , Seguimentos , França/epidemiologia , Humanos , Infusões Intravenosas , Micose Fungoide/diagnóstico , Intervalo Livre de Progressão , Índice de Gravidade de Doença , Síndrome de Sézary/diagnóstico , Síndrome de Sézary/mortalidade , Pele/efeitos dos fármacos , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/mortalidade , Fatores de TempoRESUMO
The development of immune checkpoint inhibitors (monoclonal antibodies targeting PD-1/PD-L1 or CTLA-4) represents a significant advance in the treatment of multiple cancers. Given their particular mechanism of action, which involves triggering CD4+/CD8+ T-cell activation and proliferation, they are associated with a specific safety profile. Their adverse events are primarily immune-related, and can affect practically all organs. In this context, dermatological toxicity is the most common, though it mostly remains mild to moderate and does not require discontinuation of treatment. More than a third of patients are faced with cutaneous adverse events, usually in the form of a maculopapular rash, pruritus or vitiligo (only in patients treated for melanoma). Much more specific dermatologic disorders, however, may occur such as lichenoid reactions, induced psoriasis, sarcoidosis, auto-immune diseases (bullous pemphigoid, dermatomyositis, alopecia areata), acne-like rash, xerostomia, etc. Rigorous dermatological evaluation is thus mandatory in the case of atypical, persistent/recurrent or severe lesions. In this article, we review the incidence and spectrum of dermatologic adverse events reported with immune checkpoint inhibitors. Finally, a management algorithm is proposed.
Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Toxidermias/etiologia , Algoritmos , Antígeno CTLA-4/antagonistas & inibidores , Toxidermias/patologia , Humanos , Receptor de Morte Celular Programada 1/antagonistas & inibidoresRESUMO
BACKGROUND: Regular cannabis use may be associated with several oral changes not usually identified by dermatologists: xerostomia, increased risk of caries, periodontitis, leukoedema, gingival hyperplasia, and higher prevalence and density of Candida albicans, leukoplakia or gingivitis. PATIENTS AND METHODS: We report herein the appearance of a characteristic green tongue in a patient following intensive marijuana inhalation. DISCUSSION: This complication has rarely been reported in the medical literature. Paradoxically, it is clearly described in different Internet search engines, particularly Google.
Assuntos
Abuso de Maconha/complicações , Doenças da Língua/diagnóstico , Doenças da Língua/etiologia , Cor , Humanos , Internet , Masculino , Adulto JovemAssuntos
Quimiorradioterapia Adjuvante/métodos , Porocarcinoma Écrino/terapia , Recidiva Local de Neoplasia/terapia , Neoplasias das Glândulas Sudoríparas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cetuximab/administração & dosagem , Feminino , Humanos , Pessoa de Meia-Idade , Paclitaxel/administração & dosagemRESUMO
Xeroderma pigmentosum (XP) is an orphan disease of poor prognosis. We report one case of parallel efficacy with anti-programmed cell death-1 (PD-1) antibody on both melanoma and skin carcinoma in a patient with XP. A 17-year-old patient presented with metastatic melanoma and multiple nonmelanoma skin cancers. He was treated with pembrolizumab, a monoclonal anti-PD-1 antibody, at a dose of 2 mg kg-1 , every 3 weeks. Parallel therapeutic efficacy of anti-PD-1 was observed in metastatic melanoma and skin carcinomas, and maintained at week 24. This observation suggests anti-PD-1 may be considered in patients with XP and metastatic melanoma in addition to advanced nonmelanoma skin cancer.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antineoplásicos Imunológicos/administração & dosagem , Imunoterapia/métodos , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Adolescente , Esquema de Medicação , Humanos , Masculino , Melanoma/secundário , Metástase Neoplásica , Receptor de Morte Celular Programada 1/imunologia , Resultado do Tratamento , Xeroderma Pigmentoso/complicaçõesAssuntos
Antineoplásicos/uso terapêutico , Melanoma/tratamento farmacológico , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Carbamatos/uso terapêutico , Substituição de Medicamentos , Humanos , Imidazóis/uso terapêutico , Indóis/uso terapêutico , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Oximas/uso terapêutico , Estudos Retrospectivos , Sulfonamidas/uso terapêutico , Vemurafenib , Adulto JovemRESUMO
BACKGROUND & AIMS: Hepatitis B virus (HBV) infection is a major public health burden in France and worldwide. Routine screening for hepatitis B is not currently recommended in France. Medical experts and public health agencies opinions can differ concerning targeting criteria. Our study aims at developing a risk assessment strategy for identifying possible hepatitis B cases among the patients consulting in a French Sexually Transmitted Infection (STI) clinic. METHODS: 6194 asymptomatic patients requesting an STI screening were also screened for hepatitis B infection. The association between hepatitis B surface antigen (HBsAg) positivity and/or total hepatitis B core antibody (anti-HBc) positivity and self-reported risk factors for hepatitis were analysed. RESULTS: Only male gender, lack of employment, and birth, in medium or high endemic country, were independently associated with HBsAg positivity in multivariate analysis. Sexual behaviour or self-reported vaccination status is therefore not necessary to target high-risk populations. These three simple criteria could save 25% of unnecessary tests and 6-16% undiagnosed hepatitis B compared to usual targeting criteria. CONCLUSIONS: To detect HBsAg carriers, only three simple targeting criteria, without taking into account the self-reported vaccination status or sexual behaviour, could improve screening efficiency and save unnecessary testing.
Assuntos
Hepatite B/prevenção & controle , Programas de Rastreamento/métodos , Adulto , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Doenças Endêmicas , Feminino , França/epidemiologia , Hepatite B/epidemiologia , Hepatite B/transmissão , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Ambulatório Hospitalar , Fatores de Risco , Assunção de Riscos , Desemprego , Adulto JovemAssuntos
Psoríase/tratamento farmacológico , Psoríase/fisiopatologia , Comorbidade , Fármacos Dermatológicos/efeitos adversos , Humanos , Cirrose Hepática/induzido quimicamente , Cirrose Hepática/prevenção & controle , Metotrexato/efeitos adversos , Psoríase/genética , Fatores de Risco , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator A de Crescimento do Endotélio Vascular/genéticaAssuntos
Artrite Psoriásica/tratamento farmacológico , Analgésicos/uso terapêutico , Antirreumáticos/uso terapêutico , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Injeções Intra-Articulares , Isoxazóis/uso terapêutico , Leflunomida , Metotrexato/uso terapêutico , Sulfassalazina/uso terapêutico , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
BACKGROUND: Patients with cancer are at a high risk of thromboembolism (TE), which contributes to morbidity and mortality. Several case reports of thromboembolic events have been reported in patients with melanoma in the literature. OBJECTIVE: The aim of this study was to evaluate the prevalence of venous thromboembolism (VTE) in stage IV melanoma and determine risk factors, outcomes associated with the development of VTE and the number of haemorrhagic complications in patients under anti-coagulant treatment. PATIENTS AND METHODS: In this retrospective study, we included all consecutive patients with stage IV melanoma among 290 patients followed-up in the department of Dermatology each year between January 2005 and 31 December 2007. The diagnosis of VTE was confirmed by venous ultrasound, pulmonary perfusion-ventilation technetium scan and angiography. The primary outcome was to evaluate the number of TE diagnosed in stage IV melanoma patients. The secondary outcomes were to study the influence of TE on survival, its prevalence according to metastatic sites and to evaluate the number of haemorrhagic complications. RESULTS: Twenty-four VTE events were found [25.2% (CI: 16.5-34)]. Eighteen VTE were deep venous thrombosis in lower limbs associated with pulmonary embolism (PE) in 50% of cases. Twenty-five percent were asymptomatic and were revealed in the pulmonary scan performed for follow-up. Eight percent of VTE events revealed stage IV melanoma. Seventeen patients developed thrombosis at home after stopping heparin prophylaxis. Seven thrombotic events occurred during oral anti-coagulant therapy. CONCLUSION: We found as high a prevalence of VTE in stage IV melanoma as in lung and gastrointestinal cancers. All patients suffered thrombotic events when they were treated with chemotherapy and at home when they stopped heparin prophylaxis. Therefore, heparin prophylaxis should be maintained at home.
Assuntos
Melanoma/complicações , Neoplasias Cutâneas/complicações , Tromboembolia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Feminino , Heparina/efeitos adversos , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Embolia Pulmonar/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/patologia , Trombose Venosa/epidemiologiaRESUMO
A range of light-based treatments in acne have been used including visible light, specific narrowband light, intense pulsed light, pulsed dye laser with or without photosensitizing agents. The clinical studies in this topic have often lacked controls and included only small numbers of patients The purpose of this presentation was to assess the level of evidence in the literature on this subject, remember the scientific rational and targets of light-based therapy and remember procedures for approving the devices in the US.
Assuntos
Acne Vulgar/terapia , Terapia a Laser , Fototerapia , HumanosAssuntos
Produtos Biológicos/uso terapêutico , Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Psoríase/tratamento farmacológico , Produtos Biológicos/efeitos adversos , Contraindicações , Vias de Administração de Medicamentos , Monitoramento de Medicamentos , Feminino , Ácido Fólico/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Nefropatias , Tuberculose Latente/complicações , Cirrose Hepática/induzido quimicamente , Anamnese , Metotrexato/efeitos adversos , Gravidez , Complicações na Gravidez/prevenção & controle , Fibrose Pulmonar/induzido quimicamente , Recidiva , Fator de Necrose Tumoral alfa/antagonistas & inibidores , VacinaçãoAssuntos
Psoríase , Adalimumab , Adolescente , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/epidemiologia , Terapia Biológica/efeitos adversos , Ensaios Clínicos como Assunto , Comorbidade , Fármacos Dermatológicos/uso terapêutico , Emolientes , Etanercepte , Feminino , Preparações para Cabelo , Humanos , Imunoglobulina G/efeitos adversos , Imunoglobulina G/uso terapêutico , Masculino , Psoríase/tratamento farmacológico , Psoríase/economia , Psoríase/epidemiologia , Qualidade de Vida , Receptores do Fator de Necrose Tumoral/uso terapêutico , Índice de Gravidade de Doença , Ustekinumab , Adulto JovemRESUMO
BACKGROUND: Folliculotropic lymphoma is a variant of fungoid mycosis distinguished by its clinical features, histology, poor prognosis and poor response to the standard treatments for cutaneous T-cell lymphomas. The purpose of our study was to evaluate the efficacy and safety of bexarotene, an RXR receptor-selective retinoid, in the treatment of folliculotropic lymphoma after 3 months and 6 months of therapy. PATIENTS AND METHODS: This retrospective, prospective, descriptive study was conducted between October 2004 and November 2005. It was carried out using all available dossiers for patients with folliculotropic lymphoma treated with bexarotene. Patients were included where diagnosis of folliculotropic lymphoma was based on histological evidence, provided they had received at least one prior treatment (PUVA therapy, Retinol/PUVA therapy, Caryolysine, Bicnu, methotrexate), and the affected body surface area could be calculated from initial whole-body photographs using the rule of 9. RESULTS: Eight patients were included, all males. Partial remission was seen after 3 months and 6 months of treatment in 75% of patients. According to the Physical Global Assessment Scale (7-item evaluation scale), 75% of patients presented global improvement after 3 months of treatment compared with 87.5% after 6 months. Five of the 8 patients experienced sexual dysfunction while on treatment with bexarotene, which resolved one month after discontinuation of therapy in four cases. Onset or worsening of dyslipidaemia was seen in all patients, with five developing central hypothyroidism. DISCUSSION: These global response levels confirm the place of bexarotene in the treatment of folliculotropic lymphoma. Combined therapy appears to be warranted due to the difficulty in maintaining optimal dosages of the drug because of the frequency of adverse effects. Preventive therapy for the hypothyroidism seen in practically all cases should prevent adverse effects of the drug on sexual function.