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1.
J Musculoskelet Neuronal Interact ; 20(3): 339-346, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32877971

RESUMO

OBJECTIVES: To examine the effect of denosumab administration in the peripheral blood white cell population, to further elucidate a plausible pathophysiological link between denosumab and osteonecrosis of the jaw. METHODS: Thirty women with osteoporosis, after denosumab treatment were included. Peripheral blood samples were obtained prior to and 48-72 hours following denosumab administration. Flow cytometry gated at the monocyte population for CD14/CD23/CD123/CD16 stainings were performed. RESULTS: We were able to record a number of changes in the monocyte populations between baseline and after denosumab administration. Most importantly, in the monocyte populations we were able to detect statistically significant increased populations of CD14+/CD23+ (p=0.044), CD14-/CD23+ (p=0.044), CD14+/CD123+ (p=0.011), CD14+/CD123- (p=0.011) and CD14-/CD16+ (p=0.028). In contrast, statistically significant decreased populations of CD14-/CD123+ (p=0.034), CD14+/CD16+ (p=0.037) and CD14+/CD16- (p=0.014) were detected. CONCLUSIONS: Our results provide evidence supporting the hypothesis that denosumab administration modifies the monocyte mediated immune response in a manner similar to that of bisphosphonates. This may partly explain the trivial immunity changes recorded with denosumab.

3.
Artigo em Inglês | MEDLINE | ID: mdl-32749663

RESUMO

INTRODUCTION: Few data on possible local factors that can influence the achievement of response in nonsegmental vitiligo (NSV) treated with narrowband ultraviolet B (Nb-UVB) phototherapy are available. Our objective is to evaluate possible correlations between therapeutic outcomes and dermoscopic and local (lesional) clinical findings of vitiligous lesions undergoing Nb-UVB phototherapy to find positive and/or negative response predictor factors to such treatment. METHODS: For each target patch, we calculated the extension area using a computer-aided method and assessed dermoscopic and local (lesional) clinical findings at baseline. After 30 phototherapy sessions (twice weekly), surface area of the lesions was reevaluated to assess clinical improvement, correlating the therapeutic outcome with initial clinical and dermoscopic features. RESULTS: A total of 70 lesions were finally included in the study. At the end of therapy, 18 patches (25.7%) achieved improvement, and the presence of perifollicular pigmentation on baseline dermoscopic examination was found to be associated with a 12-fold higher probability of having a positive therapeutic outcome. Similarly, face localization was also correlated with clinical amelioration, with a sevenfold higher probability for improvement. No association (p > 0.05) between therapeutic outcomes (either good or poor) and other dermoscopic or local clinical variables (including leukotrichia) was observed. CONCLUSIONS: Therapeutic response of vitiligo to Nb-UVB phototherapy may be positively affected by local features of the lesions, i.e., face localization and presence of perifollicular pigmentation on baseline dermoscopic examination, which might be considered as positive response predictor factors to optimize treatment of vitiligo.

4.
J Am Acad Dermatol ; 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32652193

RESUMO

BACKGROUND: Digital dermoscopy monitoring (DDM) helps to recognize melanomas lacking specific dermoscopic features at baseline, but the number of melanomas eventually developing specific features is still unknown. OBJECTIVE: To assess how many melanomas are identified because they develop melanoma-specific criteria over time compared with melanomas recognized by side-by-side image comparison. METHODS: A case-control study was conducted collecting 206 melanomas: 103 melanomas diagnosed during DDM follow-up and 103 melanomas diagnosed at baseline. The control group was composed of 309 benign lesions consisting of 103 nevi excised for diagnostic reasons, 103 not excised nevi, and 103 not excised seborrheic keratoses. Dermoscopic images of all 515 lesions were randomly presented to 2 blinded experts to give a diagnosis and to score the criteria of the 7-point checklist. RESULTS: Of the 103 melanomas diagnosed at baseline, 78.6% (n = 81) were correctly identified compared with only 40.8% (n = 42) of melanomas diagnosed after DDM (P < .001). Of the 103 melanomas excised after DDM, 59.2% (n = 61), did not develop melanoma-specific criteria and were identified only because of the side-by-side image comparison. LIMITATIONS: The type of morphologic changes considered as suspicious on DDM was not assessed. CONCLUSIONS: Most melanomas are diagnosed with DDM by side-by-side image comparison.

5.
Int J Dermatol ; 59(7): 813-821, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32406113

RESUMO

BACKGROUND: Nevus-associated melanoma (NAM) has been regarded as a distinct biological entity from de-novo melanoma (DNM); however, static dermoscopy often fails in differentiating these entities. Digital dermoscopic monitoring allows to identify dynamic changes occurring during follow-up; this may improve diagnostic accuracy and potentially our knowledge on NAM biology. We aimed to define main independent factors associated with NAM diagnosis and those influencing follow-up time in a population of melanomas excised at follow-up. METHODS: A cohort of melanomas excised at follow-up was retrospectively and consecutively selected. NAMs and DNMs were compared according to baseline features and main dermoscopic changes occurring during follow-up. Univariate and multivariable logistic and Cox's regression analysis were performed to respectively define factors associated with NAM diagnosis and those influencing the risk for excision. RESULTS: Eighty-six melanomas were enrolled, of which 21 (24.4%) were nevus-associated. During follow-up NAMs mainly underwent atypical network modifications (47.6%), followed by inverse network (28.6%) and dermoscopic island (23.8%) worsening or appearance. DNMs were also mainly characterized by atypical network modifications (47.7%), however, a significant proportion of cases underwent irregular pigmentation/dots/globules or regression changes (29.2%), which were rarely seen among NAMs. Furthermore, both multivariable logistic and Cox's regression analysis demonstrated a significant association between NAM and a longer follow-up. CONCLUSIONS: We demonstrated that among melanomas excised at follow-up, different patterns of dermoscopic changes may be found between NAMs and DNMs. This finding, together with the association of NAM with a longer follow-up time, supports the hypothesis of different biological behavior of these two entities.

6.
Eur J Clin Pharmacol ; 76(2): 161-174, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31768574

RESUMO

PURPOSE: The aim of this systematic review was to evaluate current evidence on the efficacy and safety of levetiracetam as migraine prophylaxis in adult patients suffering from migraine attacks. METHODS: PubMed, Scopus, Cochrane Central Register of Controlled Trials, and International Web of Science were searched (last search in August 2018) for studies investigating levetiracetam for migraine prophylaxis in adults. Both randomized and non-randomized trials were eligible. Efficacy was the primary outcome, but tolerability was also investigated. The study is registered on PROSPERO, number CRD42018088900. RESULTS: Nine studies, enrolling 215 patients, were included. Levetiracetam decreased the frequency of attacks with headache in all studies, with a pooled mean difference of -3.02 (95% CI: -4.59 to -1.45; I2 = 0%), -4.65(-7 to -2.3; I2 = 0%), and -5.71 (-8.60 to -2.82; I2 = 0%) at 1, 3, and 6 months compared with baseline. Three randomized controlled trials were included, and levetiracetam was superior to placebo in two but was inferior to sodium valproate in reducing headache frequency. Similar results were found in the other indices of efficacy, and levetiracetam was generally well tolerated. CONCLUSION: Levetiracetam may be a relatively safe and efficacious treatment for the prophylaxis of migraine based on limited evidence, most from uncontrolled studies. Further evidence from randomized controlled trials is necessary.

7.
J Am Acad Dermatol ; 82(2): 398-406, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31499156

RESUMO

BACKGROUND: In retrospective studies, a second primary melanoma (SPM) develops in 2%-20% of melanoma patients. Scarce evidence exists on the usefulness of total-body photography (TBP) and digital dermatoscopic documentation (DDD) for detecting SPMs. OBJECTIVE: The primary aim was to quantify the risk and investigate the time of occurrence of SPMs. Secondary aims were to identify risk factors for SPM and to assess the usefulness of TBP and DDD for SPM detection. METHODS: This prospective cohort included patients with recently diagnosed melanoma that underwent sequential clinical and dermatoscopic examinations for up to 5 years. Life table analysis and Kaplan-Meier survival analysis were performed. Multivariate Cox models were constructed to identify factors affecting the outcome. RESULTS: An SPM developed in 46 of 977 (4.7%) patients. Life table analysis revealed a 5-year cumulative risk of 8.0% for SPM. High nevus count, fair phototype, and occupational sun exposure were potent predictors of SPM. Of all new melanomas, 17.3% were diagnosed by clinical and dermatoscopic examination, 48.1% by TBP, and 34.6% by DDD. LIMITATIONS: All patients followed the same protocol and diagnostic bias associated with sequential dermatoscopic imaging. CONCLUSION: In this cohort, melanoma patients were at 8% risk of an SPM developing within 5 years. TBP and DDD significantly contributed to the early detection of SPM.

8.
Artigo em Inglês | MEDLINE | ID: mdl-31804052

RESUMO

BACKGROUND: Metastasis from cutaneous squamous cell carcinoma (cSCC) mainly involve the regional nodal basin, with an incidence ranging from 2%-4% until 15% in case of high-risk tumors. When dealing with high-risk cSCC, ultrasound examination is recommended every 3- 4 months during follow up. We aimed to determine the role of US examination in the early diagnosis of nodal metastasis from cSCC. METHODS: We conducted a retrospective cohort study enrolling consecutive cases of histopathologically verified cSCCs from January 2007 to March 2018. All the enrolled cases were followed for at least one year and all cases of histopathologically verified metastasis were registered. We also reported if ultrasound of the regional basin was performed between the primary diagnosis and metastasis and how the latter was identified, through ultrasounds or clinically. A Kaplan-Meier survival analysis was conducted on patients undergoing ultrasounds during follow up. RESULTS: A total of 1881 cases, belonging to 1441 patients were included. Thirty-one cases of nodal metastasis diagnosed after the primary tumor, in as many patients, were identified. All of the selected metastasis derived from high-risk primary cSCCs. Only in 19 cases ultrasound examination was performed during follow up; of these, 10 were diagnosed through ultrasounds and 9 clinically. Survival analysis demonstrated that the time interval between primary tumor and metastasis was significantly lower for patients with metastasis diagnosed by ultrasounds than clinically (p:0.036). CONCLUSIONS: Our study highlights the need to optimize the use of nodal ultrasound examination for high-risk cSCCs in order to early detect metastasis.

9.
Eur J Dermatol ; 29(5): 490-499, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31789273

RESUMO

Non-melanoma skin cancer (NMSC) is the commonest malignancy worldwide (>80% located in the head and neck area). The aim of this study was to assess risk factors predisposing to local recurrence of NMSC of the middle third of the face (MTF). This was a single-centre retrospective analysis of patients with NMSC of the MTF treated during 1995-2010. Data on epidemiological and tumour characteristics were collected. Survival analysis was performed and log-rank tests were used to compare differences in survival for each variable. A total of 531 patients with basal cell carcinoma (BCC) of the MTF were identified. Most tumours were nodular type (28.4%), located on the nose (34.3%), and confined to the dermis (75.5%). Negative margins were achieved in 91% of cases. Median follow-up time was 35 months and 15.2% of patients developed local recurrence. Incomplete excision was the only variable predisposing to local recurrence. The cohort also included 114 patients with squamous cell carcinoma (SCC). Most tumours were well differentiated (43.9%), located at the zygomatic area (49.1%), excised with negative margins (93%), and confined to the dermis (67.8%). At a median follow-up time of 42 months, local recurrence occurred in 15.7% of patients. Tumour size, depth of invasion, and prior history of head and neck SCC were risk factors for local recurrence. The variables predictive of recurrence of BCC were incomplete excision and for SCC tumour size, depth of invasion, and a prior history of head and neck SCC.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Faciais/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Cutâneas/patologia , Idoso , Carcinoma Basocelular/radioterapia , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Intervalo Livre de Doença , Neoplasias Faciais/radioterapia , Neoplasias Faciais/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/cirurgia , Carga Tumoral
10.
Dermatology ; 235(6): 471-477, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390623

RESUMO

BACKGROUND: The quality of outcome assessment in acne studies has been either subjective/insufficient or time consuming through the ordinary lesion counting. OBJECTIVE: To evaluate the application of multimodal clinical imaging (MCI), a combination of imaging technology and computation, in the assessment of acne lesions in a clinical study setting. METHODS: A prospective, monocentric, single-group open study designed to evaluate the efficacy and tolerance of a cosmetic product (IP/SG) in subjects with mild-to-moderate facial acne by classical clinical counting (CCC) - change in the total/inflammatory/noninflammatory acne lesion number compared with baseline (D0) - Investigator Global Assessment (IGA) and self-reported outcomes. Concomitantly, MCI was administered. The study was performed for 12 weeks (D84) with a 4-week follow-up (D112). RESULTS: Mean age of patients (n = 49) was 18.2 ± 3.7 years (range 13-25). The mean acne duration was 3.8 ± 2.8 years. The total number of lesions did not differ significantly between D0/D84 by both CCC and MCI. However, the Cardiff Acne Disability Index (CADI) and uncomfortable feeling improved at D28/D0, the perception of oily skin improved at D14/D0, and the perception of sticky skin improved from D28/D0 to D56/D0. Deterioration was detected between D84/D0 and D112/D0, namely after product discontinuation. Interestingly, a change in trend was recorded for acne lesions at D14/D0 by MCI but not by CCC. CONCLUSION: MCI, applied for the first time in a small clinical study setting, is at least as reliable as CCC and may allow for a sensitive longitudinal evaluation of single acne lesions and their response to products, especially in conditions where clinical evaluation reaches its limits.


Assuntos
Acne Vulgar/diagnóstico por imagem , Acne Vulgar/tratamento farmacológico , Cosméticos/uso terapêutico , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/tratamento farmacológico , Imagem Óptica/métodos , Adolescente , Adulto , Feminino , Fluorescência , Humanos , Masculino , Imagem Multimodal , Medidas de Resultados Relatados pelo Paciente , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Adulto Jovem
11.
Am J Clin Dermatol ; 20(4): 503-513, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31073704

RESUMO

BACKGROUND: Hidradenitis suppurativa/acne inversa is a disease with deep-seated chronic painful nodules, abscesses, and draining sinus tracts, which manifests on the apocrine gland-rich skin areas of the body. Observational findings demonstrate that the disease usually appears after puberty, exhibits pre-menstrual flares in women, improves in pregnancy, and worsens post-partum, which indicates a role of hormones and particularly of androgens in its pathophysiology. Because increased androgen levels in serum have not been widely reported, an end-organ androgen hypersensitivity has been postulated. OBJECTIVE: The aim of this systematic review was to identify and present evidence for antiandrogen therapeutic options for the treatment of hidradenitis suppurativa/acne inversa. METHODS: A literature search was conducted in different medical electronic databases using the keywords "hidradenitis", "suppurativa", "acne inversa", and "antiandrogen" on 1 December, 2018. The main therapeutic options were subsequently used as separate keywords with the disease terms in a separate search. RESULTS: The main therapeutic options yielded were cyproterone acetate, spironolactone, finasteride, and metformin. One randomized controlled crossover trial and seven case series were identified following use of a standard extraction form for eligibility. CONCLUSION: The existing studies do not allow a robust evidence-based recommendation for the use of antiandrogens in the treatment of hidradenitis suppurativa/acne inversa. Further randomized controlled trials are needed to define the role of hormonal treatment as an alternative or concomitant therapy together with antibiotics or biologics.


Assuntos
Antagonistas de Androgênios/uso terapêutico , Androgênios/metabolismo , Hidradenite Supurativa/tratamento farmacológico , Antagonistas de Androgênios/farmacologia , Acetato de Ciproterona/farmacologia , Acetato de Ciproterona/uso terapêutico , Quimioterapia Combinada/métodos , Finasterida/farmacologia , Finasterida/uso terapêutico , Hidradenite Supurativa/etiologia , Hidradenite Supurativa/patologia , Humanos , Metformina/farmacologia , Metformina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele/efeitos dos fármacos , Pele/metabolismo , Pele/patologia , Espironolactona/farmacologia , Espironolactona/uso terapêutico , Resultado do Tratamento
12.
G Ital Dermatol Venereol ; 154(4): 457-465, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30762033

RESUMO

Since their first description by Sophie Spitz, Spitz nevi have been a subject of controversy among clinicians for many decades, and remain a clinical conundrum until today as their etiology, morphology, biological behavior and natural evolution is still not totally clear. This is because their clinical, dermoscopic and histopathologic features sometimes overlap with those of melanoma, rendering the management of spitzoid lesions particularly difficult. In addition, cases of histopatologically equivocal lesions do exist and their classification might sometimes be very challenging. Among several terms that have been used to describe these morphologically "intermediate" lesions, atypical Spitz tumor (AST) is the most widely used. The aim of this review paper was to describe the dermoscopic patterns and structures seen in Spitz/Reed nevi, spitzoid melanoma and AST. Finally, this article provides an evidence-based update on the available options for the management of spitzoid lesions, before and after histopathologic diagnosis.


Assuntos
Dermoscopia/métodos , Nevo de Células Epitelioides e Fusiformes/diagnóstico , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Humanos , Melanoma/diagnóstico , Melanoma/patologia , Nevo de Células Epitelioides e Fusiformes/patologia , Neoplasias Cutâneas/patologia
13.
Exp Dermatol ; 28(2): 129-135, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30506970

RESUMO

Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus-like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n = 83/108; 76.9%; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs 59.6%; P < 0.001) and were more frequently widespread distributed (65.6% vs 20.0%; P < 0.001) and both dendritic and roundish (36.6% vs 15.4%; P < 0.001) in shape. Aspecific architecture at the dermo-epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs 11.9%; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs 18.3% and 19.4% vs 3.7%; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.

14.
Eur J Pharmacol ; 834: 169-175, 2018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-30030987

RESUMO

Fentanyl, a µ-opioid receptor agonist, has been studied for its neuro/psycho-pharmacological effects since its first clinical use; however, its effect on the release rate of the Central Nervous System (CNS) neurotransmitters has not been yet elucidated. In the present study the influence of fentanyl on the release rates of glutamate and GABA is investigated. Specifically, we examined the effects of intravenous (10 µg/kg) as well as intrahypothalamic (0.1nmol/min) fentanyl administration on the release rates of GABA and glutamate in the superfusate of anterior hypothalamus, under tail pinch manipulation. The release rate of the neurotransmitters was monitored by the push-pull superfusion technique. To investigate the role of fentanyl the opioid antagonist, naloxone 0.1 mg/kg was administered intravenously, or 50nmol/min intrahypothalamicaly. The amino acids were determined by High Performance Liquid Chromatography (HPLC) and fluorimetric detection after NBD-Cl derivatisation. After intravenous fentanyl administration a significant decrease of glutamate and increase of GABA release rates were observed. However during the pain manipulations, the release rate of glutamate was increased. Intravenous naloxone did not affect significantly the release rates of both amino acids, while intrahypothalamic antagonist administration reversed the alterations in both neurotransmitters release rates. Our results demonstrate that there is an opioid-glutamatergic transmission pathway, located in hypothalamus and that opioids can activate NMDA receptors, thus reducing the nociceptive threshold and the opioid analgesic effect.


Assuntos
Fentanila/farmacologia , Ácido Glutâmico/metabolismo , Hipotálamo Anterior/efeitos dos fármacos , Hipotálamo Anterior/metabolismo , Naloxona/farmacologia , Ácido gama-Aminobutírico/metabolismo , Animais , Masculino , Ratos , Ratos Wistar
15.
Australas J Dermatol ; 59(4): 309-314, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29569417

RESUMO

BACKGROUND/OBJECTIVES: Little is known about the dermoscopic features of atypical fibroxanthoma. METHODS: This was a case-control study. Atypical fibroxanthoma lesions were compared with a control group with non-melanoma skin cancer. RESULTS: Altogether 40 atypical fibroxanthoma were collected. Most developed in men (93%), appearing mainly as nodular (63%), amelanotic (93%) and ulcerated (78%) lesions. Most lesions were located on the scalp (55%) and the ears (13%). Dermoscopically, most atypical fibroxanthoma displayed red (83%) and white (70%) structureless areas and irregular linear vessels (43%). A series of features achieved statistical significance when comparing atypical fibroxanthoma with non-melanoma skin cancer. The presence of red and white structureless areas and white lines, and the absence of yellowish-white opaque scales, hairpin vessels and arborising vessels were predictive of atypical fibroxanthoma in univariate analysis. However, when squamous cell carcinoma was excluded from the analysis, none of the criteria achieved statistical significance. When basal cell carcinoma was excluded, three variables achieved statistical significance in predicting atypical fibroxanthoma: red, structureless areas, the absence of opaque yellowish-white scales and absence of white circles. CONCLUSIONS: Atypical fibroxanthomas seem to be barely distinguishable from basal cell carcinoma dermoscopically, but they are more easily distinguishable from a well to moderately differentiated squamous cell carcinoma. A histopathological examination is needed for the final diagnosis.


Assuntos
Carcinoma Basocelular/diagnóstico por imagem , Carcinoma de Células Escamosas/diagnóstico por imagem , Dermoscopia , Fibroma/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Xantomatose/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Fibroma/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Sociedades Médicas , Xantomatose/patologia
16.
JAMA Dermatol ; 154(4): 414-419, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29466542

RESUMO

Importance: The accuracy of melanoma-specific dermoscopic criteria has been tested mainly in studies including invasive tumors. Scarce evidence exists on the usefulness of these criteria for the diagnosis of melanoma in situ (MIS). Objective: To investigate the diagnostic accuracy of dermoscopic criteria for the diagnosis of MIS. Design, Setting, and Participants: A diagnostic accuracy study with retrospective patient enrollment was conducted in 3 centers specializing in skin cancer diagnosis and management. A total of 1285 individuals with histopathologically diagnosed MIS or other flat, pigmented skin tumors that were histopathologically diagnosed or monitored for at least 1 year were included. Dermoscopic images of MIS and other flat, pigmented skin tumors were evaluated by 3 independent investigators for the presence of predefined criteria. Evaluators were blinded to the clinic dermoscopic and histopathologic diagnosis. Main Outcomes and Measures: Frequencies of dermoscopic criteria per diagnosis were calculated. Crude odds ratios, adjusted odds ratios, and corresponding 95% CIs were calculated by univariate and multivariate logistic regression, respectively. Results: A total of 1285 patients were included in the study (642 [50%] male); mean age was 45.9 years (range, 9-91 years). Of a total of 1285 lesions obtained from these patients, 325 (25.3%) were MIS; 574 (44.7%) were nevi (312 [24.3%] excised and 262 [20.4%] not excised); 67 (5.2%) were seborrheic keratoses, solar lentigines, or lichen planus-like keratoses; 91 (7.1%) were pigmented superficial basal cell carcinomas; 26 (2.0%) were pigmented intraepithelial carcinomas; 100 (7.8%) were Reed nevi; and 102 (7.9%) were invasive melanomas with a Breslow thickness less than 0.75 mm. The most frequent dermoscopic criteria for MIS were regression (302 [92.9%]), atypical network (278 [85.5%]), and irregular dots and/or globules (163 [50.2%]). The multivariate analysis revealed 5 main positive dermoscopic indicators of MIS: atypical network (3.7-fold; 95% CI, 2.5-5.4), regression (4.7-fold; 95% CI, 2.8-8.1), irregular hyperpigmented areas (5.4-fold; 95% CI, 3.7-8.0), prominent skin markings (3.4-fold; 95% CI, 1.9-6.1), and angulated lines (2.2-fold; 95% CI, 1.2-4.1). When compared only with excised nevi, 2 of these criteria remained potent MIS indicators, namely, irregular hyperpigmented areas (4.3-fold; 95% CI, 2.7-6.8) and prominent skin markings (2.7-fold; 95% CI, 1.3-5.7). Conclusions and Relevance: Clinicians should take into consideration the aforementioned dermoscopic indicators for the diagnosis of MIS.


Assuntos
Carcinoma in Situ/diagnóstico por imagem , Carcinoma Basocelular/diagnóstico por imagem , Dermoscopia , Melanoma/diagnóstico por imagem , Nevo Pigmentado/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diagnóstico Diferencial , Feminino , Humanos , Ceratose Seborreica/diagnóstico por imagem , Lentigo/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
17.
J Am Acad Dermatol ; 77(5): 938-945.e4, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28864306

RESUMO

The reported prevalence of nevus-associated melanoma varies substantially. We performed a systematic review and meta-analysis to determine the incidence and prevalence of this disease; we also performed subanalyses considering age, tumor thickness, and nevus-type classification. In 38 observational cohort and case-control studies, 29.1% of melanomas likely arose from a preexisting nevus and 70.9% de novo. Any given melanoma was 64% less likely to be nevus-associated than de novo (risk ratio 0.36, 95% confidence interval [CI] 0.29-0.44; P < .001; I2 = 99%); nevus-associated melanomas had a lower mean Breslow thickness than de novo melanomas (mean difference -0.39 mm; 95% CI -0.60 to -0.18; P = .0003; I2 = 66%). No significant differences were noted regarding the association of nevus-associated melanomas with nondysplastic nevi or dysplastic nevi (risk ratio 0.77, 95% CI 0.49-1.20; P = .24; I2 = 98%).


Assuntos
Síndrome do Nevo Displásico/epidemiologia , Síndrome do Nevo Displásico/patologia , Melanoma/epidemiologia , Melanoma/patologia , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/patologia , Adulto , Idoso , Transformação Celular Neoplásica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Medição de Risco , Neoplasias Cutâneas/epidemiologia
18.
Clin Cosmet Investig Dermatol ; 10: 171-177, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28546761

RESUMO

Vismodegib is approved for the treatment of adult patients with metastatic (mBCC) or locally advanced basal cell carcinoma (laBCC) that have recurred following surgery or for those who are not good candidates for surgery (risk/benefit ratio is against patient's benefit, either because of the general condition or because of the expected morbidity from the surgery) or radiation therapy. This article provides an evidence-based review of its current place in therapy. Analytically, the clinical implications in the management of laBCCs and mBCCs and possible new indications, including the neoadjuvant use before surgical excision, are discussed, while in the end, the challenges regarding class-related adverse events and their optimal management are highlighted.

19.
Melanoma Res ; 27(4): 289-299, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28430756

RESUMO

The literature has not been able to conclude whether pregnancy influences the prognosis of melanoma. The aim of this study was to explore the prognosis of melanoma diagnosed during pregnancy or post partum [pregnancy-associated melanoma (PAM)] compared with melanoma in female patients who were not pregnant. We systematically searched for studies of female patients with melanoma that reported outcomes related to survival. Fifteen eligible studies were found. Overall, PAM was associated with a 17% higher mortality compared with melanoma diagnosed in female patients who were not pregnant (hazard ratio=1.17, 95% confidence interval: 1.03-1.33, P=0.02). The heterogeneity associated with this test was moderate (P=0.07; I=38%). PAM was also associated with a 50% higher recurrence rate compared with melanoma not associated with pregnancy (hazard ratio=1.50, 95% confidence interval: 1.19-1.90, P<0.001). The heterogeneity associated with this test was low (P=0.69; I=0%). A limitation of this meta-analysis is the definition of PAM, which is not unanimous among the studies included. Our results indicate that PAM is associated with a worse prognosis than melanoma not related to pregnancy, both in terms of overall survival and disease-free survival. On the basis of our data, we anticipate that the survival difference we report here will be further amplified with the addition of future well-carried out studies. We suggest that detection of PAM requires particular awareness by healthcare professionals.


Assuntos
Melanoma/mortalidade , Neoplasias Cutâneas/mortalidade , Adulto , Feminino , Humanos , Melanoma/patologia , Gravidez , Prognóstico , Neoplasias Cutâneas/patologia
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