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J Am Acad Dermatol ; 82(2): 267-281, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31279808


Dermatomyositis (DM) is an idiopathic inflammatory myopathy that is clinically heterogeneous and that can be difficult to diagnose. Cutaneous manifestations sometimes vary and may or may not parallel myositis and systemic involvement in time course or severity. Recent developments in our understanding of myositis-specific antibodies have the potential to change the diagnostic landscape of DM for dermatologists. Although phenotypic overlap exists, anti-Mi2, -MDA5, -NXP2, -TIF1, and -SAE antibodies may be correlated with distinct DM subtypes in terms of cutaneous manifestations, systemic involvement, and malignancy risk. This review highlights new findings on the DM-specific myositis-specific antibodies and their clinical associations in both adults and children.

J Am Acad Dermatol ; 82(2): 283-296, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31279813


The second article in this continuing medical education series reviews the initial evaluation of patients with suspected dermatomyositis (DM), the relevant work-up for malignancy and interstitial lung disease once a diagnosis of DM is made, and treatment recommendations for patients with DM based on disease severity, the presence of systemic symptoms, and myositis-specific antibody (MSA) profiles. This review emphasizes the emerging role of MSAs in the diagnosis of DM and highlights how MSAs can be used to guide the appropriate work-up for malignancy and interstitial lung disease. The treatment approach proposed by this continuing medical education series discusses both established and novel therapies for DM and highlights the importance of considering lesion type, degree of muscle involvement, presence of systemic symptoms, presence of MSAs, and patient age when determining the best treatment approach for a patient with DM.

J Am Acad Dermatol ; 81(3): 823-833, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30930085


There are multiple, genetically distinct pathways that give rise to melanoma. Melanomas on sun-damaged skin (MSDS), including lentigo maligna and desmoplastic melanoma, have distinct genetic profiles and are uniquely linked to chronic ultraviolet exposure. In this article, we discuss the etiologies of lentigo maligna and desmoplastic melanoma, emerging diagnostic adjuncts that might be helpful for accurately identifying these lesions, and the clinical relevance of their frequent co-occurrence. We present unique and overlapping features of these entities and discuss challenges in MSDS management, including margin assessment, excision, and the potential role of nonsurgical therapy. Last, we address the role of immunotherapy in invasive disease. Understanding MSDS as distinct from melanoma arising on intermittently sun-exposed or sun-protected skin will ultimately help optimize patient outcomes.

Sarda Melanótica de Hutchinson/diagnóstico , Neoplasias Cutâneas/diagnóstico , Pele/patologia , Luz Solar/efeitos adversos , Antígeno B7-H1/genética , Biópsia , Procedimentos Cirúrgicos Dermatológicos , Dermoscopia , Diagnóstico Diferencial , Humanos , Sarda Melanótica de Hutchinson/etiologia , Sarda Melanótica de Hutchinson/terapia , Imiquimode/uso terapêutico , Imunoterapia/métodos , Margens de Excisão , Microscopia Confocal , Taxa de Mutação , Invasividade Neoplásica/genética , Invasividade Neoplásica/patologia , Neurofibromina 1/genética , Proteínas Proto-Oncogênicas c-kit/genética , Radioterapia Adjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele/diagnóstico por imagem , Pele/efeitos da radiação , Envelhecimento da Pele/patologia , Envelhecimento da Pele/efeitos da radiação , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/terapia , Resultado do Tratamento