Dermoscopy and Reflectance Confocal Microscopy to Estimate Breslow Index and Mitotic Rate in Primary Melanoma.

Introduction: Non-invasive imaging techniques offer the possibility to optimize the first approach to melanoma. Reflectance Confocal Microscopy (RCM) has a promising role in predicting the main prognostic events in the dermo-epidermal and papillary dermis. Objectives: To identify pre-surgical criteria that can predict the main prognostic features of melanoma. Methods: A retrospective cohort-study evaluated dermoscopic, confocal and histopathological characteristics of consecutively diagnosed sporadic melanomas. RCM-melanoma patterns classified into 1) dendritic-cell, 2) round-cell, 3) dermal nest and 4) combined type. Acral, facial and mucosal locations were excluded. Results: Ninety-two primary melanomas were included: 44 males and 48 females (mean age 60.4 years, standard deviation [SD] 16.2) with a mean Breslow of 1.43 mm (SD 1.6). The most frequent dermoscopic presentation was the multicomponent pattern, the predominant confocal pattern was dendritic-cell type (44.6%). The presence of pigmented network on dermoscopy was related to lower Breslow and mitotic rates (both P = 0.002); in contrast to the presence of visible vessels, which was related to higher Breslow and mitotic indexes (both P = 0.001). Confocal observation of dermal nests or atypical cells in the papillary dermis was related to a higher mitotic rate (P = 0.006 and P = 0.03, respectively). Similarly, diffuse inflammatory infiltrates visible in the superficial dermis was associated with higher Breslow (P = 0.04) and mitotic index (P = 0.04). Conclusions: Dermoscopic and RCM in vivo findings on primary melanoma correlate with histopathologic Breslow index, mitotic rate and tumor infiltrating lymphocytes. The architecture and cytology of primary melanoma can be estimated by combining dermoscopy and RCM prior to excision.

Morphological evaluation of melanocytic lesions with three-dimensional line-field confocal optical coherence tomography: correlation with histopathology and reflectance confocal microscopy. A pilot study.

BACKGROUND: Line-field confocal optical coherence tomography (LC-OCT) is a new in vivo emerging technique that provides cellular resolution, allows deep imaging (400 µm) and produces real-time images in both the horizontal and vertical plane and in three dimensions. No previous description of different subtypes of melanocytic lesions and their correlation with histopathology and reflectance confocal microscopy has been reported. AIM: To describe the features of melanocytic lesions by LC-OCT and their correlation with histopathology and reflectance confocal microscopy (RCM) findings. METHODS: Selected melanocytic benign lesions and melanomas were imaged in vivo with RCM and LC-OCT at the Fundación Hospital Clinic (Barcelona, Spain). A minimum area of 4 × 4 mm (block image) at four depths (stratum granulosum, suprabasal, layer dermoepidermal junction and upper dermis) were acquired with RCM and a minimum of three cubes with LC-OCT. Horizontal, vertical sections and three-dimensional (3D) cubes of LC-OCT were matched with RCM (Vivablock two-dimensional composite mosaic) and histopathology, with ~5 µm lateral resolution accuracy (the same cell nuclei were measured in X, Y and Z) and evaluated by three observers experienced in using RCM and histopathology. RESULTS: In total, 12 melanocytic tumours (2 in situ melanomas, 2 invasive melanomas, 4 atypical naevi, 2 intradermal naevi, 1 compound naevus and 1 junctional naevus) were included. High correlation with 5 µm accuracy between RCM and LC-OCT was observed for each tumour. The 3D images of melanocytic lesions were obtained with cellular resolution and correlated with both RCM and histopathology, allowing an understanding of the architecture and precise correlation at the cellular level with RCM. Similarities between LC-OCT and RCM for the described diagnostic features and architecture (nests of melanocytic cells, ringed and meshwork pattern, and cellular details of tumour cells as dendritic and pagetoid cells) were confirmed. The main advantage of diagnosis by RCM fixed probe was the ability to produce larger scans of the lesion using mosaicing compared with an LC-OCT handheld probe. CONCLUSION: LC-OCT allows the architectural and cellular description of different types of melanocytic lesions. LC-OCT showed high correlation with histopathology (vertical sections) and RCM (horizontal sections) in melanocytic lesions. Diagnostic criteria for RCM were similar to those for LC-OCT.

Influence of germline genetic variants on dermoscopic features of melanoma.

Nevus count is highly determined by inherited variants and has been associated with the origin of melanoma. De novo melanomas (DNMMs) are more prevalent in patients with a low nevus count and have distinctive dermoscopic features than nevus-associated melanomas. We evaluated the impact of nine single nucleotide polymorphisms (SNPs) of MTAP (rs10811629, rs2218220, rs7023329 and rs751173), PLA2G6 (rs132985 and rs2284063), IRF4 (rs12203592), and PAX3 (rs10180903 and rs7600206) genes associated with nevus count and melanoma susceptibility, and the MC1R variants on dermoscopic features of 371 melanomas from 310 patients. All MTAP variants associated with a low nevus count were associated with regression structures (peppering and mixed regression), blue-whitish veil, shiny white structures, and pigment network. SNPs of PLA2G6 (rs132985), PAX3 (rs7600206), and IRF4 (rs12203592) genes were also associated with either shiny white structures or mixed regression (all corrected p-values ≤ .06). Melanomas from red hair color MC1R variants carriers showed lower total dermoscopy score (p-value = .015) and less blotches than melanomas from non-carriers (p-value = .048). Our results provide evidence that germline variants protective for melanoma risk and/or associated with a low nevus count are associated with certain dermoscopic features, more characteristic of de novo and worse prognosis melanomas.

Grado de satisfacción de la población con los servicios de enfermería en un área de salud / Satisfaction degree of the population with the nursing services in a health area

Se realizó un estudio descriptivo retrospectivo en la población de Perea en el área de salud Policlínico Venegas teniendo en cuenta la visión que se tiene de la relación enfermera-paciente y de la función que realiza la enfermera en la comunidad. El objetivo de este trabajo fue demostrar el grado de satisfacción de la población con la labor de enfermería medida mediante una encuesta con un cuestionario de satisfacción . Se encontró que la atención de enfermería que se brinda en esta área y la relación enfermera-paciente que se establece satisfizo a un 68,5 por ciento de la población. La mayoría de los pacientes que conformaron la muestra, 128 (93,8 por ciento se mostró satisfecha con el indicador que midió la confianza en su enfermera, sin embargo, la eficiencia de su trabajo sólo alcanzó puntaje de satisfacción en 82 personas (63,1 por ciento). En la muestra estudiada el 82,3 por ciento conoce a su enfermera desde hace 3 años. A pesar de que el trabajo de enfermería que se brinda en esta área de salud puede calificarse de bueno, es necesario reflexionar sobre los posibles aspectos de este trabajo que impide la satisfacción de la población en indicadores importantes como es la eficiencia, la amabilidad y la experencia(AU)

He/she was carried out a retrospective descriptive study in the population of Perea in the area of health Policlínico Venegas keeping in mind the vision that one has of the nurse-patient relationship and of the function that the nurse carries out in the community. The objective of this work was to demonstrate the degree of the population's satisfaction with the infirmary work measured by means of a survey with a questionnaire of satisfaction. It was found that the infirmary attention that you toasts in this area and the nurse-patient relationship that he/she settles down satisfied to the population's 68,5 percent. Most of the patients that conformed the sample, 128 (93,8 percent was shown satisfied with the indicator that measured the trust in its nurse, the efficiency of its work reached puntaje of satisfaction however, only in 82 people (63,1 percent). In the studied sample 82,3 percent knows its nurse for 3 years. Although the infirmary work that you toasts in this area of health can be qualified of good, it is necessary to meditate on the possible aspects of this work that it impedes the population's satisfaction in important indicators as it is the efficiency, the kindness and the experencia(AU)

Grado de satisfacción de la población con los servicios de enfermería en un área de salud / Satisfaction degree of the population with the nursing services in a health area

Se realizó un estudio descriptivo retrospectivo en la población de Perea en el área de salud Policlínico Venegas teniendo en cuenta la visión que se tiene de la relación enfermera-paciente y de la función que realiza la enfermera en la comunidad. El objetivo de este trabajo fue demostrar el grado de satisfacción de la población con la labor de enfermería medida mediante una encuesta con un cuestionario de satisfacción . Se encontró que la atención de enfermería que se brinda en esta área y la relación enfermera-paciente que se establece satisfizo a un 68,5(por ciento) de la población. La mayoría de los pacientes que conformaron la muestra, 128 (93,8(por ciento) se mostró satisfecha con el indicador que midió la confianza en su enfermera, sin embargo, la eficiencia de su trabajo sólo alcanzó puntaje de satisfacción en 82 personas (63,1(por ciento). En la muestra estudiada el 82,3(por ciento) conoce a su enfermera desde hace 3 años. A pesar de que el trabajo de enfermería que se brinda en esta área de salud puede calificarse de bueno, es necesario reflexionar sobre los posibles aspectos de este trabajo que impide la satisfacción de la población en indicadores importantes como es la eficiencia, la amabilidad y la experencia(AU)