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1.
J Am Acad Dermatol ; 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32360759

RESUMO

The growth of molecular technologies analyzing skin cells and inherited genetic variations has the potential to address current gaps in both diagnostic accuracy and prognostication in melanoma patients or in individuals at risk for developing melanoma. In part II of this continuing medical education article, novel molecular technologies are reviewed. These have been developed as adjunct tools for melanoma management and include the Pigmented Lesion Assay (PLA), myPath Melanoma, and DecisionDx-Melanoma tests, and genetic testing in patients with a strong familial melanoma history. These tests are commercially available and marketed as ancillary tools for clinical decision-making, diagnosis, and prognosis. Here we review fundamental principles behind each test, discuss peer-reviewed literature assessing their performance, and highlight the utility and limitations of each assay. The goal of this article is to provide a comprehensive, evidence-based foundation for clinicians regarding management of patients with difficult pigmented lesions.

2.
J Am Acad Dermatol ; 2020 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-32348823

RESUMO

Managing the balance between accurately identifying early-stage melanomas while avoiding biopsies of benign lesions (i.e. over-biopsy) is the major challenge of melanoma detection. Decision-making can be especially difficult in patients with extensive atypical nevi. Recognizing that the primary screening modality for melanoma is subjective examination, studies have shown a tendency towards over-biopsy. Even low-risk routine surgical procedures are associated with morbidity, mounting healthcare costs, and patient anxiety. Recent advancements in noninvasive diagnostic modalities have helped to improve diagnostic accuracy, especially when managing melanocytic lesions of uncertain diagnosis. Breakthroughs in artificial intelligence have also shown exciting potential in changing the landscape of melanoma detection. In part I of this continuing medical education article, we review novel diagnostic technologies such as automated 2D and 3D total body imaging with sequential digital dermoscopic imaging, reflectance confocal microscopy, and electrical impedance spectroscopy, and we explore the logistics and implications of potentially integrating artificial intelligence into existing melanoma management paradigms.

3.
J Am Acad Dermatol ; 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32114083

RESUMO

BACKGROUND: MoleMap NZ is a novel New Zealand-based store-and-forward telemedicine service to detect melanoma. It uses expert review of total body photography and close-up and dermoscopic images of skin lesions that are suspicious for malignancy. OBJECTIVE: The purpose of this study was to assess the effectiveness of MoleMap NZ as a melanoma early detection program. METHODS: We conducted a review of 2108 melanocytic lesions recommended for biopsy/excision by MoleMap NZ dermoscopists between January 2015 and December 2016. RESULTS: Pathologic diagnoses were available for 1571 lesions. Of these, 1303 (83%) lesions were benign and 260 (17%) lesions were diagnosed as melanoma, for a melanoma-specific benign:malignant ratio of 5.0:1. The number needed to biopsy to obtain 1 melanoma was 6. Among melanomas with available tumor thickness data (n = 137), 92% were <0.8 mm (range in situ to 3.1 mm), with in situ melanomas comprising 74%. LIMITATIONS: Only lesions recommended for excision were analyzed. Pathology results were available for 75% of these cases. Tumor thickness data were available for 53% of melanomas diagnosed. CONCLUSIONS: This real-world study of MoleMap NZ, a community-based teledermoscopy program, suggests that it has the potential to increase patients' access to specialist expertise via telemedicine. Additional studies are needed to more accurately define its efficacy.

4.
Skinmed ; 18(1): 46-49, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32167457

RESUMO

A 45-year-old woman with cirrhosis secondary to alcohol abuse was transferred from an outside hospital for management of a painful cutaneous eruption, progressively worsening over 2 weeks. On examination, the patient was a middle-aged white woman lying in bed in no acute distress, with jaundice and a protuberant abdomen consistent with ascites. The patient was afebrile (98.2°F), heart rate of 79 beats per minute, blood pressure of 105/61 mmHg, respiratory rate of 18 breaths per minute, and oxygen saturation of 93% on room air. She had multiple large stellate lesions of retiform purpura with central hemorrhagic necrosis on both thighs, with surrounding induration (Figures 1 and 2). These purpuric plaques and perilesional skin were exquisitely painful to palpation.

5.
J Clin Aesthet Dermatol ; 12(6): 42-44, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31360287

RESUMO

Acquired ichthyosis is an uncommon disorder of cornification. It characteristically presents as symmetric scaling of the skin on the trunk and extensor surfaces of the extremities. It is clinically and histologically similar to ichthyosis vulgaris; however, acquired ichthyosis develops later in life and has been associated with various malignancies, infections, medications, autoimmune diseases, metabolic disorders, and malnutrition. We describe a case of a 35-year-old woman with active pulmonary tuberculosis and a history of breast cancer who presented with a several-month history of a widespread, scaly, pruritic skin eruption. Physical examination revealed fine, scaly patches on the extremities with relative sparing of the flexures and larger, scaly, ichthyosiform patches on the chest and back. Skin biopsy revealed orthokeratotic hyperkeratosis and a diminished granular layer, consistent with a diagnosis of acquired ichthyosis. Further evaluation, including positron-emission tomography/computed tomography scan, revealed hypermetabolic infiltrates and cavitation in the lungs, consistent with active pulmonary tuberculosis; there was no evidence of new or recurrent malignancy. The patient was treated with antituberculosis drugs and topical ammonium lactate cream. With incident cases rarely reported in the literature, this case of new-onset ichthyosis in the setting of active pulmonary tuberculosis highlights the distinctive clinical and histologic features of acquired ichthyosis and emphasizes the relationship of acquired ichthyosis with underlying systemic disease, particularly infection.

7.
Skinmed ; 16(4): 281-284, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30207535

RESUMO

We present the case of a 66-year-old woman with a history of systemic lupus erythematosus, who presented with tender nodules on the forearms. The patient reported an 8-year history of pink bumps on the extensor surfaces of the forearms bilaterally that would arise episodically for a few weeks and subsequently resolve with no intervention. Her systemic lupus erythematosus was under good control with oral prednisone 10 mg daily, and the development of these lesions was not associated with concomitant flares of the systemic lupus erythematosus.


Assuntos
Dermatite/etiologia , Dermatite/patologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/patologia , Idoso , Feminino , Humanos , Recidiva
8.
Dermatol Ther (Heidelb) ; 8(4): 503-507, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30229459

RESUMO

This article, co-authored by a patient diagnosed with acral melanoma, discusses the patient's experience of being diagnosed with and treated with surgery for this disease. The physician discusses the epidemiology, genetics, diagnosis, treatment, and prognosis of acral melanoma. Follow-up care plans are also discussed.

9.
Dermatol Online J ; 24(6)2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-30142726

RESUMO

Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a recently described clinical entity and should be considered in children who present with oral (94% of patients), ocular (82% of patients), and urogenital lesions (63% of patients). MIRM was first described as a distinct clinical entity from Stevens Johnson syndrome/Toxic epidermal necrolysis (SJS)/(TEN) in 2015 [1]. As a new, uncommon diagnosis it frequently poses a diagnostic and therapeutic challenge for pediatricians and dermatologists. We report a case of MIRM in a previously healthy 15-year-old boy.


Assuntos
Doenças da Boca/microbiologia , Mucosite/microbiologia , Infecções por Mycoplasma/diagnóstico , Mycoplasma pneumoniae , Adolescente , Diagnóstico Diferencial , Humanos , Masculino , Doenças da Boca/diagnóstico , Mucosa Bucal/patologia , Mucosite/diagnóstico , Mycoplasma pneumoniae/isolamento & purificação
10.
J Am Acad Dermatol ; 79(6): 1133-1140.e3, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30055204

RESUMO

BACKGROUND: The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. Although melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy or increased exogenous hormones from oral contraceptive pills and hormone replacement affect MM prevalence and outcome. OBJECTIVE: We sought to examine potential associations between in vitro fertilization (IVF) and melanoma. METHODS: A literature review was conducted. Primary outcomes were reported as associations between IVF and melanoma risk compared with the general population. Secondary outcomes included associations stratified by type of IVF regimen and subgroup, such as parous versus nulliparous patients. RESULTS: Eleven studies met our inclusion criteria. Five studies found no increased risk for MM among IVF users compared with the general population. Two studies found an increase in MM in clomiphene users, and 4 studies found an increase in MM among patients who were gravid or parous either before or after IVF. CONCLUSION: The reviewed studies do not reveal consistent patterns of association between IVF and MM among all infertile women. However, the data indicates a potential increased risk for MM in ever-parous patients treated with IVF. High-quality studies including a large number of MM cases that control for well-established MM risk factors are needed to adequately assess the relationship between IVF and MM, particularly among ever-parous women.


Assuntos
Clomifeno/efeitos adversos , Estrogênios , Fertilização In Vitro , Melanoma/induzido quimicamente , Neoplasias Hormônio-Dependentes/induzido quimicamente , Indução da Ovulação/efeitos adversos , Feminino , Fertilização In Vitro/métodos , Gonadotropinas Hipofisárias/efeitos adversos , Gonadotropinas Hipofisárias/farmacologia , Humanos , Infertilidade Feminina/complicações , Melanócitos/efeitos dos fármacos , Melanócitos/patologia , Melanoma/epidemiologia , Neoplasias Hormônio-Dependentes/epidemiologia , Paridade , Gravidez , Receptores Estrogênicos/efeitos dos fármacos
11.
J Drugs Dermatol ; 17(7): 807-809, 2018 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30005106

RESUMO

Treatment of malignancy with anti-programmed cell death 1 (PD-1) immune checkpoint inhibitors can cause mucocutaneous side effects resulting from T cell activation. Due to their recent development, the full side effect profile remains to be fully elucidated, however dermatologic adverse events are most common. The main oral toxicities of these immune checkpoint inhibitors include: xerostomia, dysgeusia, and lichenoid reactions. Oral mucositis occurs more rarely in the setting of PD-1 inhibition, and few other reports of a Grade 3 or higher, severe, stomatitis have been reported in the literature. We present a case of a 78-year-old woman with Grade 3 ulcerative oral mucositis that occurred 13 months after initiation of PD-1 inhibitor, pembrolizumab, for the treatment for lung adenocarcinoma. She was successfully treated with prednisone, and pembrolizumab was temporarily held by her oncologist. Physicians should be aware of the possibility of severe mucositis in the setting of PD-1 inhibitors, as well as the management. J Drugs Dermatol. 2018;17(7):807-809.


Assuntos
Adenocarcinoma/tratamento farmacológico , Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Neoplasias Pulmonares/tratamento farmacológico , Estomatite/induzido quimicamente , Adenocarcinoma/secundário , Idoso , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/patologia , Melanoma , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Índice de Gravidade de Doença , Estomatite/diagnóstico , Estomatite/tratamento farmacológico
12.
Int J Womens Dermatol ; 4(2): 113-115, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29872687

RESUMO

Managing pregnant patients with a history of melanoma or with a melanoma diagnosis can be daunting and confusing for dermatologists. We present three clinical scenarios that raise questions about the safety of pregnancy in patients with a history of melanoma, skin biopsies during pregnancy, and excisions and sentinel lymph node biopsies during pregnancy. Our recommendations incorporate the most up-to-date clinical data to help guide clinicians when faced with pigmented lesions and melanoma in a pregnant patient.

17.
Dermatol Online J ; 24(12)2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30677794

RESUMO

Folliculotropic mycosis fungoides (MF) is a distinct subset of cutaneous T cell lymphoma (CTCL). The disease is typically marked by an aggressive course and is often recalcitrant to skin-direct therapy. We report a case of an 83-year-old woman with folliculotropic MF characterized by erythematous, scaly plaques on the forehead along with poliosis and alopecia of the right medial eyebrow.


Assuntos
Neoplasias Faciais/patologia , Micose Fungoide/patologia , Neoplasias Cutâneas/patologia , Idoso de 80 Anos ou mais , Alopecia/etiologia , Sobrancelhas , Neoplasias Faciais/complicações , Neoplasias Faciais/diagnóstico , Feminino , Humanos , Micose Fungoide/complicações , Micose Fungoide/diagnóstico , Transtornos da Pigmentação/etiologia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico
18.
Dermatol Online J ; 24(12)2018 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-30677800

RESUMO

Calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome is a form of a rare, clinical subtype of systemic sclerosis, known as limited systemic sclerosis. Limited systemic sclerosis, including CREST syndrome, manifests as fibrotic skin changes restricted to the hands and face, with vascular, musculoskeletal, and visceral involvement. We present a case of a 75-year-old woman with a longstanding history of CREST syndrome complicated by a digital ulceration and persistent pain associated with recalcitrant Raynaud phenomenon. After failing a number of first-line pharmacologic therapies such as diltiazem, sildenafil, and topical nitropaste, the patient was started on a trial of botulinum toxin for the left second digit, with 10 unit injections into both webspaces for a total of 20 units. Following injection, the patient reported no further baseline pain in the affected finger and an over fifty-percent improvement in discomfort with manipulation of the digit at a follow-up time of one week. The ulceration started healing within the following three weeks. This result was maintained at a follow-up time of six weeks.


Assuntos
Inibidores da Liberação da Acetilcolina/uso terapêutico , Toxinas Botulínicas/uso terapêutico , Doença de Raynaud/tratamento farmacológico , Administração Tópica , Idoso , Síndrome CREST/tratamento farmacológico , Diltiazem/uso terapêutico , Feminino , Humanos , Nitroglicerina/uso terapêutico , Dor/etiologia , Doença de Raynaud/complicações , Citrato de Sildenafila/uso terapêutico , Falha de Tratamento , Úlcera/etiologia , Vasodilatadores/uso terapêutico
20.
Pediatr Dermatol ; 34(3): e137-e139, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28317165

RESUMO

Distinguishing benign acral nevi from small early acral melanomas may be challenging in certain cases. Dermoscopy is a noninvasive imaging technique that can help clinicians better visualize deeper lesion structures and thus more easily differentiate benign nevi from melanoma. We report the case of a 13-year-old girl with a changing dark brown to black macule with a central papular component on the volar surface of the right third finger. Dermoscopy revealed asymmetrically distributed irregular black blotches on a bluish-black background. Histopathology revealed a traumatized compound melanocytic nevus. Certain melanocytic nevi, although histologically benign, may not conform to the limited selection of reassuring benign dermoscopic patterns. Nevi in children are often dynamic and have a high likelihood of dermoscopic change.


Assuntos
Dermoscopia/métodos , Dedos/patologia , Melanoma/diagnóstico , Nevo Pigmentado/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adolescente , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Melanoma/patologia , Nevo Pigmentado/patologia , Nevo Pigmentado/cirurgia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/cirurgia , Medição de Risco , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento
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