Exploring Small-Diameter Melanomas: A Retrospective Study on Clinical and Dermoscopic Features.

BACKGROUND: Early melanoma detection allows for timely intervention and treatment, significantly improving the chances of favorable outcomes for patients. Small-diameter melanoma (SDM) typically represents an initial growth phase of cutaneous melanoma. One of the challenges in detecting melanoma in their early stage lies in the fact that dermoscopy criteria have been primarily designed for fully developed lesions. Early-stage melanomas may be difficult to detect and possibly even be overlooked or misinterpreted during examinations. METHODS: The primary aim of this study was to identify valuable clinical and dermoscopic clues to enhance the detection of SDMs. To achieve this objective, we conducted a comprehensive retrospective analysis, including forty SDMs with a diameter of 5 mm or less. These cases were diagnosed over an 8-year period and were collected from five referral centers across Brazil. Seven experienced dermatologists independently assessed the dermoscopic features of each lesion. Additionally, this study includes demographic and histological information. RESULTS: The study encompassed a total of 28 patients, of which 16 were females, accounting for 58% of the participants, with an average age of 43.6 years. Among the small-diameter melanomas (SDMs) under investigation, the majority, constituting 27 cases (69.2%), were identified as "de novo" lesions, i.e., not associated with a nevus. Additionally, eight SDMs (20%) exhibited invasive characteristics, with Breslow index measurements ranging between 0.2 to 0.4 mm, suggesting an early stage of malignancy. During dermoscopic examinations, the most prevalent features observed were irregular dots and globules, present in 95% and 87.5% of cases, respectively. Moreover, brown structureless areas were identified in 70% of lesions, followed by atypical network (67.5%), pseudopods (55%), dotted vessels (47.5%), flat structureless blue-gray areas (42.5%), and irregular blotches (40%). Notably, all SDM were diagnosed in patients under surveillance through total body skin photography (TBSP) and Digital Dermoscopy (DD). CONCLUSIONS: Dermoscopy significantly enhances the diagnostic accuracy of melanoma, even in its early stages. Particularly for high-risk patients with numerous nevi, the identification of a new lesion or subtle changes on dermoscopy during follow-up may serve as the sole clue for an early diagnosis. This emphasizes the critical role of dermoscopy in SDM detection and reinforces the importance of surveillance in high-risk patients for timely and effective management.

Acute and chronic effects of exercise on inflammatory markers and B-type natriuretic peptide in patients with coronary artery disease.

BACKGROUND: Few studies have prospectively addressed the effects of exercise in the inflammatory activity of patients with coronary artery disease (CAD). We sought to evaluate the consequences of an acute bout of exercise on inflammatory markers and BNP in untrained CAD patients before and after randomization to a training program. METHODS: 34 CAD patients underwent a 50-min acute exercise session on a cycle-ergometer at 65% peak oxygen uptake before and after blood sampling. They were then randomized to a 4-month chronic exercise program (15 patients) or general lifestyle recommendations (19 patients), undergoing a new acute session of exercise after that. RESULTS: In the overall population, acute exercise caused a significant increase in C-reactive protein [CRP; 1.79 (4.49) vs. 1.94 (4.89) mg/L, P < 0.001], monokine induced by interferon-γ [Mig; 351 (324) vs. 373 (330) pg/mL, P = 0.027] and vascular adhesion molecule-1 [VCAM-1; 226 (82) vs. 252 (110) pg/mL, P = 0.02]. After 4-months, in exercise-trained patients, there was a significant decrease in the inflammatory response provoked by the acute exercise compared to patients in the control group reflected by a significant decrease in the differences between rest and post-exercise levels of CRP [-0.29 (0.84) mg/L vs. -0.11 (0.21) mg/L, P = 0.05]. Resting BNP was also significantly lower in exercise-trained patients when compared to untrained controls [15.6 (16.2) vs. 9.7 (11.4) pg/mL, P = 0.04 and 19.2 (27.8) vs. 23.2 (27.5) pg/mL, P = 0.76; respectively]. CONCLUSIONS: Chronic exercise training might partially reverse the inflammatory response caused by acute exercise in CAD patients. These results suggest that regular exercise is an important nonpharmacological strategy to the improvement in inflammation in CAD patients.

Conhecimentos atuais na fisiopatologia da doença aterosclerótica / Current concepts in the pathophysiology of coronary atherosclerosis

Nosso ponto de vista sobre os mecanismos das complicações agudas da aterosclerose têm se desviado de modo marcante nesta última década. No passado, acreditávamos que as estenoses arteriais, com repercussão no fluxo sanguíneo, e os índices funcionais de isquemia de órgãos poderiam direcionar nossas terapias. Responsabilizávamos as estenoses críticas pelas complicações isquêmicas da aterosclerose. Achados clínicos recentes importantes têm nos obrigado a reconsiderar esses conceitos. As evidências atuais têm estabelecido a importância dos aspectos qualitativos das placas como determinantes na propensão às complicações agudas. Entre as características funcionais das placas associadas à vulnerabilidade, a inflamação tem surgido como mecanismo fisiopatológico fundamental, oferecendo alvos terapêuticos potenciais e novas estratégias de estratificação de risco. Além dos efeitos locais da inflamação na lesão aterosclerótica, os aspectos sistêmicos da resposta inflamatória podem afetar o risco trombótico. A inflamação desequilibra o estado homeostático. O fibrinogênio e o inibidor do ativador de plasminogênio circulam em maiores concentrações nos estados inflamatórios. Nessas condições, portanto, a instabilização da placa aumenta a chance de produção de um trombo oclusivo.