Depth of invasion analysis to predict acral melanoma outcomes.

BACKGROUND: Acral melanoma is a subtype with worse outcomes. The Breslow micrometric measurement is the most critical parameter in planning treatment and predicting outcomes. However, for acral lentiginous melanoma, the value of the Breslow thickness is a matter of debate. Depth of Invasion (DOI) is a well-established measure for staging oral squamous cell carcinoma. OBJECTIVE: This study compared DOI and Breslow thickness for predicting acral melanoma outcomes. METHODS: We performed a retrospective cross-sectional study of 71 acral melanoma lesions subjected to sentinel lymph node biopsy at one Brazilian referral center. RESULTS: Cox model univariate analysis showed that both DOI and Breslow thickness predicted melanoma specific survival (HR 1.12; p = 0.0255 and HR 1.144; p = 0.0006, respectively), although Kaplan Meier curve was only significant for Breslow (χ2 = 5.792; p = 0.0161) and not for DOI (χ2 = 0.2556; p = 0.6132). Sentinel lymph node status and presence or absence of ulceration also predicted specific survival in patients with acral melanoma (χ2 = 6.3514; p = 0.0117 and χ2 = 4.2793; p = 0.0386, respectively). Multivariate analysis, however, demonstrated that Breslow depth was the only independent parameter for predicting acral melanoma specific survival (HR 1.144; p = 0.0006). CONCLUSION: Even though Breslow thickness remains the main predictor for survival in acral melanoma, it is not a perfect parameter. The introduction of DOI in this context opens new perspectives for predicting acral melanoma outcomes.

Proposal for the applicability of modified Breslow (measured from the basal membrane) as a predictor of survival and sentinel lymph node outcome in patients with cutaneous melanoma.

BACKGROUND: Cutaneous melanoma is a neoplasm with a high mortality rate and risk of metastases to distant organs. The Breslow micrometric measurement is considered the most important factor for evaluating prognosis and management, measured from the granular layer to the deepest portion of the neoplasm. Despite its widespread use, the Breslow thickness measurement has some inaccuracies, such as not considering variations in the thickness of the epidermis in different body locations or when there is ulceration. OBJECTIVE: To evaluate the applicability of a modified Breslow measurement, measured from the basal membrane instead of from the granular layer, in an attempt to predict sentinel lymph node examination outcome and survival of patients with melanoma. METHODS: A retrospective and cross-sectional analysis was carried out based on the evaluation of slides stained with hematoxylin & eosin from 275 cases of melanoma that underwent sentinel lymph node biopsy from 2008 to 2021 at a reference center in Brazil. RESULTS: Analysis of the Cox model to evaluate the impact of the Breslow measurement and the modified Breslow measurement on survival showed that both methods are statistically significant. Logistic regression revealed a significant association between both measurements and the presence of metastasis in sentinel lymph nodes. CONCLUSION: Measuring melanoma depth from the basal membrane (modified Breslow measurement) is capable of predicting survival time and sentinel lymph node outcome, as well as the conventional Breslow measurement.

Proposal for the applicability of modified Breslow (measured from the basal membrane) as a predictor of survival and sentinel lymph node outcome in patients with cutaneous melanoma

Abstract Background Cutaneous melanoma is a neoplasm with a high mortality rate and risk of metastases to distant organs. The Breslow micrometric measurement is considered the most important factor for evaluating prognosis and management, measured from the granular layer to the deepest portion of the neoplasm. Despite its widespread use, the Breslow thickness measurement has some inaccuracies, such as not considering variations in the thickness of the epidermis in different body locations or when there is ulceration. Objective To evaluate the applicability of a modified Breslow measurement, measured from the basal membrane instead of from the granular layer, in an attempt to predict sentinel lymph node examination outcome and survival of patients with melanoma. Methods A retrospective and cross-sectional analysis was carried out based on the evaluation of slides stained with hematoxylin & eosin from 275 cases of melanoma that underwent sentinel lymph node biopsy from 2008 to 2021 at a reference center in Brazil. Results Analysis of the Cox model to evaluate the impact of the Breslow measurement and the modified Breslow measurement on survival showed that both methods are statistically significant. Logistic regression revealed a significant association between both measurements and the presence of metastasis in sentinel lymph nodes. Conclusion Measuring melanoma depth from the basal membrane (modified Breslow measurement) is capable of predicting survival time and sentinel lymph node outcome, as well as the conventional Breslow measurement.

Diagnosis of Epidermoid Carcinoma of the Tongue after Treatment of Epidermoid Carcinoma of the Esophagus.

In the present case report, a patient with esophageal squamous cell carcinoma (SCC) developed a second primary tumor in the tongue at the same time. Stage III middle esophageal SCC was discovered in a 60-year-old Caucasian male patient who was institutionalized, a smoker, and had previously struggled with alcoholism. Following treatment, the patient was admitted to the hospital for 15 days due to dysphagia and malnutrition. According to him, he had mouth pain while in the hospital. An intraoral examination revealed tooth mobility, bacterial plaque, dental calculus, and a 1.3-cm ulcerated lesion on the right lateral edge of the tongue. During the extraoral examination, no palpable lymph nodes were found in the submandibular or cervical regions. The tongue lesion was excisionally biopsied, and the histological evaluation agreed. The patient was advised to seek treatment for tongue SCC. Given that patients with esophageal SCC have a 9.3%-11.4% risk of developing head-and-neck SCC, multiprofessional follow-up of patients with esophageal SCC is critical for early detection of this cancer.

The effect of aerobic and resistance exercise on the progression of colorectal cancer in an animal model.

PURPOSE: The aim of this study was to assess the effects of resistance and aerobic exercise on colorectal cancer (CRC) development in mice induced by azoxymethane (AOM) coupled with colitis. METHODS: Forty animals induced with CRC were used, divided into five groups of eight animals each: sedentary; continuous aerobics; continuous anaerobic; aerobic PI; and anaerobic PI. AOM was administered to the animals in two doses of 10 mg/kg each over the course of two weeks, the first dose administered in the third week and the second administered in the fourth. For the colitis, three cycles of dextran sodium sulfate were administered for five days, separated by two weeks of water. The 14th week of the experiment saw the euthanasia, the removal of their colons, and the creation of microscopy slides for histological analysis. RESULTS: Preneoplastic lesions developed in all five groups; there were no significant differences between them. However, in terms of inflammatory symptoms, mucosal ulceration was much more frequently in the exercise groups than in the sedentary group (p = 0.016). The number of polyps overall (p = 0.002), the distal region's polyp development (p = 0.003), and the proximal region's polyp development (p = 0.04) were all statistically different than sedentary group. CONCLUSIONS: The study discovered no significant difference in disease activity index scores between groups, but there was a significant difference in the number of polyps and the presence of mucosal ulceration in the colon.

The effect of aerobic and resistance exercise on the progression of colorectal cancer in an animal model

Purpose: The aim of this study was to assess the effects of resistance and aerobic exercise on colorectal cancer (CRC) development in mice induced by azoxymethane (AOM) coupled with colitis. Methods: Forty animals induced with CRC were used, divided into five groups of eight animals each: sedentary; continuous aerobics; continuous anaerobic; aerobic PI; and anaerobic PI. AOM was administered to the animals in two doses of 10 mg/kg each over the course of two weeks, the first dose administered in the third week and the second administered in the fourth. For the colitis, three cycles of dextran sodium sulfate were administered for five days, separated by two weeks of water. The 14th week of the experiment saw the euthanasia, the removal of their colons, and the creation of microscopy slides for histological analysis. Results: Preneoplastic lesions developed in all five groups; there were no significant differences between them. However, in terms of inflammatory symptoms, mucosal ulceration was much more frequently in the exercise groups than in the sedentary group (p = 0.016). The number of polyps overall (p = 0.002), the distal region's polyp development (p = 0.003), and the proximal region's polyp development (p = 0.04) were all statistically different than sedentary group. Conclusions: The study discovered no significant difference in disease activity index scores between groups, but there was a significant difference in the number of polyps and the presence of mucosal ulceration in the colon.

Use of cyanoacrylate-based surgical adhesives associated to the macroporous tape in skin synthesis in rats.

PURPOSE: To compare the use of new cyanoacrylate surgical adhesive associated with macroporous tapes in cutaneous synthesis. METHODS: Male Wistar rats with a longitudinal incision of 4cm were used on the back, divided into four groups: GI used octyl-cyanoacrylate (Dermabond®), GII used N-2-butylcyanoacrylate, GIII used octyl-cyanoacrylate and macroporous tape and GIV used N-2-butyl cyanoacrylate and macroporous tape. On the fourteenth day, the rats were submitted to euthanasia, were divided in two parts, and a layer of skin subcutaneous tissue through an area of operative healing was removed. One part was submitted to the study of rupture strength with the use of tensiometer, and in the other part histological examination was performed. RESULTS: No force test was similar between groups I and II, being different from groups III and IV (P <0.001), which were identical to each other (P> 0.05). The units were compared among the studied groups, and they were different with the use of macroporous tapes (P> 0.05). CONCLUSIONS: The purpose of macroporous tapes is associated with CA adhesives in cutaneous tissues that provide more resistant scars. The use of a combination of macroporous tapes leads to complete re-epithelialization, without provoking foreign body reaction, has hemostatic properties and does not cause an absorptive reaction.

Use of cyanoacrylate-based surgical adhesives associated to the macroporous tape in skin synthesis in rats

Abstract Purpose: To compare the use of new cyanoacrylate surgical adhesive associated with macroporous tapes in cutaneous synthesis. Methods: Male Wistar rats with a longitudinal incision of 4cm were used on the back, divided into four groups: GI used octyl-cyanoacrylate (Dermabond®), GII used N-2-butylcyanoacrylate, GIII used octyl-cyanoacrylate and macroporous tape and GIV used N-2-butyl cyanoacrylate and macroporous tape. On the fourteenth day, the rats were submitted to euthanasia, were divided in two parts, and a layer of skin subcutaneous tissue through an area of operative healing was removed. One part was submitted to the study of rupture strength with the use of tensiometer, and in the other part histological examination was performed. Results: No force test was similar between groups I and II, being different from groups III and IV (P <0.001), which were identical to each other (P> 0.05). The units were compared among the studied groups, and they were different with the use of macroporous tapes (P> 0.05). Conclusions: The purpose of macroporous tapes is associated with CA adhesives in cutaneous tissues that provide more resistant scars. The use of a combination of macroporous tapes leads to complete re-epithelialization, without provoking foreign body reaction, has hemostatic properties and does not cause an absorptive reaction.

Bullous systemic lupus erythematosus in a 10-year-old child.

Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune subepidermal blistering disease, with few cases described in childhood. It has different clinical-pathological features. We report a case of BSLE in a 10-year-old child with systemic lupus erythematosus, treated with prednisone and hydroxychloroquine. There was complete remission with dapsone, with no recurrence of skin lesions throughout one year of follow-up. We highlight the rarity and early age of occurrence.

Disseminated tungiasis.

The authors report an unusual case of disseminated tungiasis in a 52-year-old patient living in the city of Campo Grande, state of Mato Grosso do Sul, who had crusted-papular-nodular lesions located in feet, hands, and right thigh. Diagnosis was confirmed by dermoscopy and anatomopathological examination.

Autoimmune Syndrome Induced by Adjuvants (ASIA) after Silicone Breast Augmentation Surgery.

Generally, the main complications of silicone implantation are local symptoms. However, some patients develop late-onset systemic symptoms often associated with a rare form of hyperactive immune response, as part of a syndrome known as autoimmune syndrome induced by adjuvants (ASIA). Reported cases of ASIA have shown resolution with explantation, but not with immunomodulatory therapy. In this report, we described a case of a previously healthy 23-year-old woman, who has undergone silicone breast implant augmentation, for aesthetic reasons, and developed localized cutaneous impairment 3 years postsurgery. She received a diagnosis of ASIA with a new presentation: Lupus-like manifestation through localized cutaneous impairment. This patient's symptoms were managed without the need for surgical intervention, which has not been previously reported, because the patient did not want an explantation for aesthetic reasons. The patient was started on hydroxychloroquine, 400 mg per day, and remains asymptomatic after 2 years of treatment. The exact predisposition to ASIA is still unknown. Without implant explantation and with immunomodulatory treatment, this patient's condition substantially improved. Based on our current understanding of this disease, it might not be prudent to indicate breast augmentation with silicone implants in patients with documented autoimmune reaction to an adjuvant, an established autoimmune condition, or genetic predisposition. However, if a patient does develop silicone-induced ASIA, explantation is no longer the only successfully reported option, as these symptoms can be managed with immune suppression.

Disseminated tungiasis

Abstract: The authors report an unusual case of disseminated tungiasis in a 52-year-old patient living in the city of Campo Grande, state of Mato Grosso do Sul, who had crusted-papular-nodular lesions located in feet, hands, and right thigh. Diagnosis was confirmed by dermoscopy and anatomopathological examination.

Bullous systemic lupus erythematosus in a 10-year-old child

Abstract: Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune subepidermal blistering disease, with few cases described in childhood. It has different clinical-pathological features. We report a case of BSLE in a 10-year-old child with systemic lupus erythematosus, treated with prednisone and hydroxychloroquine. There was complete remission with dapsone, with no recurrence of skin lesions throughout one year of follow-up. We highlight the rarity and early age of occurrence.

Disseminated cryptococcosis with cutaneous involvement in an immunocompetent patient

Abstract Cryptococcosis is a fungal infection of opportunistic behavior that is unusual in immunocompetent patients. We report a rare case of disseminated cryptococcosis with cutaneous involvement in an immunocompetent individual. During hospitalization, Cryptococcus gattii was isolated from skin lesions, lung and spinal fluid. The diagnosis of disseminated cryptococcosis was confirmed and treatment was established. The patient showed improvement. Due to the probable clinical severity of the disease and the possibility that skin lesions may be the first manifestation of this illness, prompt diagnosis must be established and treatment provided.

Disseminated cryptococcosis with cutaneous involvement in an immunocompetent patient.

Cryptococcosis is a fungal infection of opportunistic behavior that is unusual in immunocompetent patients. We report a rare case of disseminated cryptococcosis with cutaneous involvement in an immunocompetent individual. During hospitalization, Cryptococcus gattii was isolated from skin lesions, lung and spinal fluid. The diagnosis of disseminated cryptococcosis was confirmed and treatment was established. The patient showed improvement. Due to the probable clinical severity of the disease and the possibility that skin lesions may be the first manifestation of this illness, prompt diagnosis must be established and treatment provided.

Disseminated cutaneous atypical mycobacteriosis by M. chelonae after sclerotherapy of varicose veins in a immunocompetent patient: a case report.

Atypical mycobacteria are saprophytic organisms not transmitted from person to person, which affect mainly immunosuppressed but also immunocompetent individuals. We present a case of atypical mycobacteriosis after a vascular procedure, with widespread cutaneous lesions associated with polyarthralgia. Mycobacterium chelonae was identified by the polymerase chain reaction (PCR) method. The patient showed improvement after treatment with three antibiotics. Mycobacterium chelonae causes skin lesions after invasive procedures. The clinical form depends on the immune state of the host and on the entry points. The diagnosis is based essentially on culture and the mycobacteria is identified by PCR. We highlight the importance of investigating atypical mycobacteriosis when faced with granulomatous lesions associated with a history of invasive procedures.

Rendu-Osler-Weber syndrome: dermatological approach.

The Rendu-Osler-Weber syndrome is a rare systemic fibrovascular dysplasia, recognized by mucocutaneous telangiectasias, arteriovenous malformations, epistaxis and family history. Recurrent bleeding, hypoxemia, congestive heart failure, portosystemic encephalopathy, and symptoms related to angiodysplasia of the central nervous system may occur. Since the treatment is based on supportive measures, early recognition is of utmost importance. This article reports the case of a 53-year-old male patient who presented telangiectasias on fingers, oral cavity and nasal mucosa for 10 years, with a history of recurrent epistaxis of varying severity since childhood. Mother, sister and daughter have similar lesions.

Disseminated cutaneous atypical mycobacteriosis by M. chelonae after sclerotherapy of varicose veins in a immunocompetent patient: a case report

Atypical mycobacteria are saprophytic organisms not transmitted from person to person, which affect mainly immunosuppressed but also immunocompetent individuals. We present a case of atypical mycobacteriosis after a vascular procedure, with widespread cutaneous lesions associated with polyarthralgia. Mycobacterium chelonae was identified by the polymerase chain reaction (PCR) method. The patient showed improvement after treatment with three antibiotics. Mycobacterium chelonae causes skin lesions after invasive procedures. The clinical form depends on the immune state of the host and on the entry points. The diagnosis is based essentially on culture and the mycobacteria is identified by PCR. We highlight the importance of investigating atypical mycobacteriosis when faced with granulomatous lesions associated with a history of invasive procedures.

Rendu-Osler-Weber syndrome: dermatological approach

The Rendu-Osler-Weber syndrome is a rare systemic fibrovascular dysplasia, recognized by mucocutaneous telangiectasias, arteriovenous malformations, epistaxis and family history. Recurrent bleeding, hypoxemia, congestive heart failure, portosystemic encephalopathy, and symptoms related to angiodysplasia of the central nervous system may occur. Since the treatment is based on supportive measures, early recognition is of utmost importance. This article reports the case of a 53-year-old male patient who presented telangiectasias on fingers, oral cavity and nasal mucosa for 10 years, with a history of recurrent epistaxis of varying severity since childhood. Mother, sister and daughter have similar lesions.

American tegumentary leishmaniasis - a case of therapeutic challenge

American Tegumentary Leishmaniasis (ATL) is a chronic, non-contagious, infectious disease affecting millions of people worldwide. The timely and proper treatment is of great importance to prevent the disease from progressing to destructive and severe forms. Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania. It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form. We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.