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1.
Acta Dermatovenerol Croat ; 291(1): 58, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34477068

RESUMO

The year 2020 has been marked by the coronavirus disease 2019 (COVID-19) pandemic, caused by an RNA virus called SARS-COV2 (severe acute respiratory syndrome coronavirus). The fight against this epidemic has become the center of our daily clinical practice as well as of our private lives, in which avoiding infection has become one of our most important goals. Even though COVID-19 is a potentially lethal disease, especially for the elderly and people with chronic diseases, it did not cause all the other life-threatening diseases to vanish. On the contrary, many scheduled medical activities and procedures, especially preventive and non-urgent internal and surgical activities, had to be postponed due to COVID-19 crisis. This interruption in the health care system can negatively affect the diagnosis and management of our patients with other health issues, namely malignant skin tumors, of which melanoma is the most aggressive. In this letter, we as dermatovenereologists from the Croatian Referral Centre of The Ministry of Health for Melanoma needed to express our concern regarding the increasing number of patients with delayed diagnosis of skin cancer, with special emphasis on melanoma detection and treatment. In the last few months, a large number of our newly-diagnosed patients with melanoma, as well as those with non-melanoma skin cancers, reported that they had noticed a suspicious skin lesion a few months ago but decided not to seek help from dermatologist due to the worrisome epidemiologic situation. In the current environment, clinical skin examination may be viewed as less important and thus postponed, but neglecting melanoma throughout the virus outbreak may lead to increased rates of morbidity, mortality, and consequently a greater financial burden for the health system (1). There are several reasons for such a relaxed attitude towards skin health in our patients. Unlike cardiac, pulmonary, or digestive difficulties, which patients consider life-threatening and for which they seek emergency care despite the coronavirus pandemic, skin tumors do not cause great subjective or significantly noticeable objective symptoms. Moreover, all of the skin tumors and especially melanoma , mostly present as small changes of just a few millimeters in diameter in the early stage at which they are prognostically most favorable. For the average person with no medical education, such small lesions usually do not cause any concern as they have no awareness of the fact that small and inconspicuous skin lesions may be dangerous and potentially even lethal. According to the recommendations concerning patient management during COVID-19 pandemic, oncological examinations should still be performed regularly (2). In spite of that, the cancelation of appointments, especially by patients who are being monitored for high-risk lesions, is inevitable when COVID-19 is disrupting everyone's lives. With the pandemic evolving and no clear solutions in sight, now is the time to emphasize the importance of self-examination and teledermatology in early melanoma diagnosis. Even though diagnosing and managing pigmented skin lesions usually requires face-to-face examinations and dermoscopy as a crucial tool in early melanoma detection, in these times, and especially for people with a higher risk of SARS-COV2 infection, remote communication could prevent delays resulting in worse prognosis and could also eliminate the risk of infecting healthcare workers. Moreover, teledermatology can also be initiated by doctors asking patients to monitor lesions between clinical visits (3). However, we should not rely solely on this technology but should instead assess every patient individually and insist on a face-to-face examination for those at greater risk, with the aim that, if necessary, surgery be performed in timely manner. The collaboration between general practitioners and dermatologists represents an important aspect of achieving the most rational and effective health care in terms of performing triage of patients who can be assessed by teledermatology as well as referring to hospital centers those who need face-to-face examination and further treatment. During the first breakout of the epidemic in March 2020, the multidisciplinary team for melanoma from the Croatian National Referral Melanoma Centre provided recommendations for the management of patients with melanoma during COVID epidemic, designed according to the guidelines of the National Comprehensive Cancer Network (NCCN) (4) and considering the specifics of health care and clinical practice in the Republic of Croatia. Due to epidemic circumstances, preventive actions such as Euromelanoma and many other campaigns that included massive preventive skin examinations of the population and which were conducted for years by Croatian dermatologists throughout the country, could not be organized this year. This is particularly worrisome because on average about 800 patients are diagnosed with melanoma annually in Croatia, of which 60 during public health preventive actions. Despite these circumstances, we were able to maintain public awareness of the importance of early skin cancer recognition by sending the message through different media such as newspapers, television, and social media (Facebook and Instagram). We find that now more than ever it is essential to remind and teach the population about the importance of regular monthly skin self-examinations and recognition of atypical lesions. Clearly, a thorough dermatological examination includes full skin examination from head to toe. Herein we would also like to remind our readers that most skin cancers develop in the head and neck area, which is the most UV-exposed part of the body. Therefore, despite the epidemic conditions, the removal of patients' masks and thorough inspection of the face is mandatory. We find it most practical and efficient to perform the body and scalp examination first, followed by the face examination after the patient gets dressed. Prior to removal of the mask, we ask the patient not to talk during close examination. Even though this could make dermoscopic examination harder to perform, we strongly suggest wearing a protective shield and mask during close examination whenever possible. Between patients, the examining room should be disinfected and ventilated. As doctors, we live in uncertain times when we are heavily burdened by the currently unstoppable COVID epidemic, always awaiting new instructions from the state administration every day and wondering whether perhaps tomorrow we dermatologists will be assigned solely to the service of patients with COVID-19. In the end, we would like to once again remind you that despite the ravaging COVID pandemic and all the epidemiological measures that come with it, other diseases still exist. It is expected of us to draw attention to the still growing incidence of skin cancers and the serious consequences that can occur as a result of a delayed diagnosis.


Assuntos
COVID-19/epidemiologia , Diagnóstico Tardio , Melanoma/diagnóstico , Melanoma/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Tempo para o Tratamento , Croácia/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , SARS-CoV-2
2.
Acta Dermatovenerol Croat ; 29(2): 111-113, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34477079

RESUMO

Dear Editor, The ongoing pandemic of coronavirus disease 2019 (COVID-19) was declared by the World Health Organization on March 11, 2020, and remains a global challenge. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), transmitted primarily through respiratory droplets and aerosols. Even though the COVID-19 vaccine has become available since December 2020, the main preventive measures still include social distancing, hand washing, and the use of protective face masks. By May 22, 2021, 3,437,545 deaths caused by SARS-CoV-2 have been registered by WHO, confirming the burden of this disease (1). Consequently, the pandemic has become a challenge for health care systems, as they had to be focused on the care of patients with COVID-19. During the first lockdown from March to May 2020, it was advised to postpone clinical visits whenever this could be done without risk. This recommendation was mainly aimed at older patients and those with chronic diseases, as it has been shown that they are at greater risk for complications from COVID-19. Renal transplant recipients (RTRs) are at a greater risk for infections and different cancers due to their permanent immunosuppressive therapy. The most common malignancies in RTRs are skin cancers, particularly non-melanoma skin cancers. It has been estimated that RTRs have a 65-250 times higher risk for cutaneous squamous cell carcinoma (SCC), 10 times higher risk for basal cell carcinoma, and 2-5 times higher risk for melanoma when compared with the general population (2-4). RTRs are at a higher risk for complications from COVID-19, not only because of their immunosuppressive therapy but also because of different comorbidities, such as hypertension, cardiovascular disease, and diabetes mellitus (5). Therefore, RTRs tend to limit their medical visits and postpone clinical examinations for skin cancer screenings. Moreover, during clinical visits the patients are commonly asked to keep their protective masks on, increasing the risk of overlooking their facial skin changes. Herein we present two RTRs who developed skin cancers during the COVID-19 pandemic, and the tumors were diagnosed with a significant delay. Patient 1 A 67-year-old woman with unknown primary kidney disease received a renal allograft from a deceased donor in 2014. The immunosuppressive protocol included antithymocyte globulin induction with tacrolimus, mycophenolate mofetil, and steroid maintenance. In January 2020, she had noticed a reddish squamous lesion on her right cheek, which enlarged slowly. Since there were no other symptoms, she postponed the dermatologic examination. Additionally, she further postponed the visit to her physician during the pandemic as she wanted to avoid social contact as much as possible. One year later, at the nephrologist's examination, she was asked to take off her face mask for a skin check, and two skin tumors on her right cheek were noticed (Figure 1). One lesion was located at the angle of her mandible and presented as a hypertrophic, sharply marginated lesion with central crusting and a diameter of 2 cm. The other lesion was at the right zygomatic region and appeared as a scaly, erythematous lesion with a diameter of 7 mm. The patient was referred to a dermatologist, and a biopsy of both lesions was indicated. The pathohistological analysis revealed cutaneous SCC in situ for the mandibular lesion and actinic keratosis for the zygomatic lesion. SCC in situ has been excised, and actinic keratosis was treated by cryosurgery. Patient 2 A 66-year-old woman received a renal allograft from a deceased donor in 2010 due to chronic glomerulonephritis without biopsy. The immunosuppressive protocol included basiliximab induction with tacrolimus, mycophenolate mofetil, and steroid maintenance. In June 2020, an erosion occurred at her left infraocular area and did not heal but instead gradually enlarged. The patient suspected that the "wound" developed due to the friction from the rim of her eyeglasses. Six months later, the nephrologist noticed the erosion which was 10×5 mm in size with a slightly elevated, pearl-colored margin (Figure 2). The patient was referred to a dermatologist who indicated tumor excision due to suspected basal cell carcinoma. The pathohistological analysis confirmed the clinical diagnosis. DISCUSSION Both presented patients did not inform their family physicians about their skin changes because they avoided all non-nephrological medical visits during the pandemic. The additional reason for the diagnostic delay was the fact that they kept the masks on their faces during most examinations, with the skin lesions behind the mask consequently remaining unnoticed. The problem of diagnostic delay of skin cancers during the COVID-19 pandemic has been recognized by several studies. Canadian authors compared the number of biopsies for skin cancers during the first 15 weeks in 2020 and during the same period in 2019. They found a decrease in the number of biopsies for non-melanoma skin cancers (NMSC) and melanoma of 18% and 27%, respectively (6). A multicenter study performed in northern-central Italy showed that the number of skin cancer (NMSC and melanoma) diagnoses fell by 56.7% in weeks 11 to 20 of 2020 compared with the average number noted in the same periods of 2018 and 2019 (7). Furthermore, a single-center retrospective study in Italy demonstrated that the number of advanced skin cancers surgically treated between May 18 and November 18, 2020, was significantly higher than in the same period in 2019. These findings led the authors to conclude that the surgical excisions were postponed due to the delay in follow-ups, which resulted in increased incidence of advanced skin cancers (8). RTRs are at particular risk of severe consequences from diagnostic delay with regard to skin cancers. Namely, skin cancers in RTRs are more aggressive and are associated with a higher incidence rate of metastases and recurrences than in the general population (9). Therefore, RTRs should be advised to regularly check their skin for potential skin cancer, which includes self-examinations and dermatologic follow-ups.


Assuntos
COVID-19/epidemiologia , Diagnóstico Tardio , Transplante de Rim , Equipamento de Proteção Individual , Neoplasias Cutâneas/diagnóstico , Transplantados , Idoso , Carcinoma Basocelular/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Comorbidade , Feminino , Humanos , Hospedeiro Imunocomprometido , Melanoma/diagnóstico , Pandemias , Fatores de Risco , SARS-CoV-2
3.
Clin Plast Surg ; 48(4): 543-550, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503715

RESUMO

In the Western population, 1 out of every 50 individuals will develop melanoma. The incidence of melanoma is increasing faster than any other malignancy. The development of melanoma is multifactorial arising from an interaction between genetic susceptibility and environmental exposures. Sixty to seventy percent of melanomas are thought to be caused by ultraviolet radiation. Most cutaneous melanomas are of increased risk. Prevention strategies involve mitigating the environmental risk factors and identifying individuals with phenotypic risk factors for increased surveillance.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Incidência , Melanoma/epidemiologia , Melanoma/etiologia , Melanoma/prevenção & controle , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Raios Ultravioleta/efeitos adversos
4.
Clin Plast Surg ; 48(4): 551-560, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503716

RESUMO

Melanoma is the most lethal type of skin cancer, originating from the uncontrolled proliferation of melanocytes. The transformation of normal melanocytes into malignant tumor cells has been a focus of research seeking to better understand melanoma's pathogenesis and develop new therapeutic targets. Over the past few decades, a conglomeration of studies has pinpointed several driver mutations and their associated signaling pathways. In this review, we summarize the key signaling pathways and the driver mutations involved in melanoma tumorigenesis and also discuss the potential underlying mechanisms.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Melanócitos , Melanoma/genética , Transdução de Sinais , Neoplasias Cutâneas/genética
5.
Clin Plast Surg ; 48(4): 561-576, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503717

RESUMO

Despite the ability of immune-based interventions to dramatically increase the survival of patients with melanoma, a significant subset fail to benefit from this treatment, underscoring the need for accurate means to identify the patient population likely to respond to immunotherapy. Understanding how melanoma evades natural or manipulated immune responses could provide the information needed to identify such resistant individuals. Efforts to address this challenge are hampered by the vast immune diversity characterizing tumor microenvironments that remain largely understudied. It is thus important to more clearly elucidate the complex interactions that take place between the tumor microenvironment and host immune system.


Assuntos
Melanoma , Humanos , Imunoterapia , Melanoma/terapia , Microambiente Tumoral
6.
Clin Plast Surg ; 48(4): 577-585, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503718

RESUMO

Early detection of melanoma is important in improving patient survival. The treatment of melanoma is multidisciplinary and begins by obtaining an accurate diagnosis. The mainstays of melanoma diagnosis include examination of the lesion and surrounding areas and an excisional biopsy so that a pathologic diagnosis can be obtained. The pathology results will help guide treatment recommendations, and some information can be used for prognosis. Further workup of the patient may include laboratory studies and imaging for staging and surveillance.


Assuntos
Melanoma , Neoplasias Cutâneas , Biópsia , Humanos , Melanoma/diagnóstico por imagem , Melanoma/patologia , Estadiamento de Neoplasias , Prognóstico , Neoplasias Cutâneas/diagnóstico por imagem
7.
Clin Plast Surg ; 48(4): 587-598, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503719

RESUMO

Conventional histopathology is the primary means of melanoma diagnosis. Both architectural and cytologic features aid in discrimination of melanocytic nevi from melanoma. Communication between the clinician and pathologist regarding the history, examination, differential diagnosis, prior biopsy findings, method of sampling, and specimen orientation is critical to an accurate diagnosis. A melanoma pathology report includes multiple prognostic indicators to guide surgical and medical management. In challenging cases, immunohistochemistry and molecular diagnostics may be of benefit.


Assuntos
Melanoma , Nevo Pigmentado , Neoplasias Cutâneas , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Melanoma/diagnóstico , Melanoma/genética , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/genética , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/genética
8.
Clin Plast Surg ; 48(4): 599-606, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503720

RESUMO

The eighth edition of the American Joint Committee on Cancer melanoma staging system relies on assessments of the primary tumor (T), regional lymph nodes (N), and distant metastatic sites (M). Its notable updates include tumor thickness measurements to the nearest 0.1 mm, revision of T1a and T1b definitions, re-evaluation of N category descriptors, increased number of stage III subgroupings, and incorporation of a new M1d designation, among others. These changes were based on analyses of a large contemporary international melanoma database. Ultimately, these revisions were made to improve staging and prognostication, risk stratification, and selection of patients for clinical trials.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Metástase Linfática , Melanoma/patologia , Estadiamento de Neoplasias , Prognóstico , Estados Unidos/epidemiologia
9.
Clin Plast Surg ; 48(4): 607-616, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503721

RESUMO

Melanoma tumor thickness and ulceration are the strongest predictors of nodal spread. The recommendations for sentinel lymph node biopsy (SLNB) have been updated in recent American Joint Committee on Cancer and National Comprehensive Cancer Network guidelines to include tumor thickness ≥0.8 mm or any ulcerated melanoma. Mitotic rate is no longer considered an indicator for determining T category. Improvements in disease-specific survival conferred from SLNB were demonstrated through level I data in the Multicenter Selective Lymphadenectomy Trial (MSLT) I. The role for completion lymph node dissection has evolved to less surgery in lieu of recent domestic (MSLT II) and international (Dermatologic Cooperative Oncology Group Selective Lymphadenectomy Trial [DeCOG-SLT]) level I data having similar melanoma-specific survival. Treatment options for the prevention of treatment of lymphedema have progressed to include immediate lymphatic reconstruction, lymphovenous anastomosis, and vascularized lymph node transfer.


Assuntos
Linfedema , Melanoma , Neoplasias Cutâneas , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática , Linfedema/cirurgia , Melanoma/cirurgia , Estudos Multicêntricos como Assunto , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia
10.
Clin Plast Surg ; 48(4): 617-629, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503722

RESUMO

As our knowledge and understanding of melanoma evolve, melanoma surveillance guidelines will reflect these findings. Currently, there is no consensus across international guidelines for melanoma follow-up. However, it is accepted that more aggressive surveillance is recommended for more advanced disease. When examining high-risk individuals, a systematic approach should be followed. Future considerations include the use of noninvasive imaging techniques, 'liquid biopsies,' and artificial intelligence to enhance detection of melanomas.


Assuntos
Melanoma , Neoplasias Cutâneas , Inteligência Artificial , Seguimentos , Humanos , Melanoma/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem
11.
Clin Plast Surg ; 48(4): 631-642, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503723

RESUMO

Malignant melanoma is the 5th most common cancer and stage IV melanoma accounts for approximately 4% of new melanoma diagnoses in the United States. The prognosis for regionally advanced disease is poor, but there have been numerous recent advances in the medical management of melanoma in-transit metastases. The goal of this paper is to review currently accepted treatment options for in-transit metastases and introduce emerging therapies. Therapies to be discussed include limb perfusion and infusion, immunotherapy, checkpoint inhibitors, and radiation therapy.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Imunoterapia , Melanoma/terapia , Neoplasias Cutâneas/terapia , Estados Unidos
12.
Clin Plast Surg ; 48(4): 643-649, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503724

RESUMO

While primary treatment for melanoma consists of surgical resection and chemotherapeutics, radiation can be used as either definitive or adjuvant therapy in certain clinical scenarios. This chapter aims to explore the indications for primary definitive radiotherapy as well as adjuvant treatment following resection. Delivery, dose, fractionation, and toxicity of radiation treatment will be discussed. As our understanding of melanoma tumor biology increases, the role of radiotherapy may expand for more effective treatment of oligometastatic disease.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Melanoma/radioterapia , Neoplasias Cutâneas/radioterapia , Resultado do Tratamento
13.
Clin Plast Surg ; 48(4): 651-658, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503725

RESUMO

Adjuvant therapy plays an integral role in the treatment algorithm for stage III and stage IV cutaneous melanoma. Current ongoing clinical trials are exploring the effects of neoadjuvant therapeutics, specifically for the presurgical treatment of high-risk, borderline resectable disease. In both the adjuvant and neoadjuvant settings, the early chemotherapeutic and biochemical antitumor agents are making way to newer immune therapies, mutation-specific targeted therapies, and oncolytic vaccines that are transforming the treatment of malignant melanoma. The use of these systemic therapies in addition to surgical resection has been shown to increase both overall and progression-free survival.


Assuntos
Melanoma , Neoplasias Cutâneas , Quimioterapia Adjuvante , Terapia Combinada , Humanos , Melanoma/tratamento farmacológico , Terapia Neoadjuvante , Neoplasias Cutâneas/terapia
14.
Clin Plast Surg ; 48(4): 659-668, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503726

RESUMO

The incidence of melanoma is continuing to rise in the United States, and head and neck melanomas account for 25% of all cutaneous melanomas. The National Comprehensive Cancer Network guideline recommendations for surgical margins and sentinel lymph node biopsy in head and neck melanomas are the same as cutaneous melanoma located in other regions, but require special considerations when performing wide local excision, sentinel lymph node biopsy, and completion lymph node dissection and reconstruction taking into account the location of the melanoma and structures involved in and around the suggested margins.


Assuntos
Neoplasias de Cabeça e Pescoço , Melanoma , Neoplasias Cutâneas , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos , Melanoma/epidemiologia , Melanoma/cirurgia , Pescoço , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia
15.
Clin Plast Surg ; 48(4): 669-675, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503727

RESUMO

Lentigo maligna (LM) is a melanocytic neoplasm found on chronically sun-exposed areas of the body, particularly the head and neck. It commonly occurs in the elderly and has been referred to as a "senile freckle." It has also been termed "Hutchinson melanotic freckle," as it was first described by John Hutchinson in 1892. LM is defined as melanoma in situ and thus confined to the epidermis. LM lesions that invade the dermis are termed lentigo maligna melanoma, 1 of the 4 subtypes of malignant melanoma.


Assuntos
Sarda Melanótica de Hutchinson , Melanoma , Neoplasias Cutâneas , Idoso , Humanos
16.
Clin Plast Surg ; 48(4): 677-686, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503728

RESUMO

The Spitz nevus is an uncommon melanocytic nevus. These lesions classically appear in childhood as a red, dome-shaped papule. They appear rarely in adults and may be pigmented. The Spitz nevus can develop suddenly and grow rapidly, reaching a 1-cm diameter in 6 months or less. There are 3 classes of spitzoid neoplasms: typical Spitz nevus, atypical Spitz nevus, and spitzoid melanoma. The diagnosis should be cautiously differentiated, especially in children. Immunohistochemistry and molecular studies have been helpful in differentiating difficult cases; however, no set of criteria has been accepted to predict biological behavior of atypical Spitz nevi.


Assuntos
Melanoma , Nevo de Células Epitelioides e Fusiformes , Neoplasias Cutâneas , Adulto , Criança , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Melanoma/diagnóstico , Nevo de Células Epitelioides e Fusiformes/diagnóstico , Neoplasias Cutâneas/diagnóstico
17.
Clin Plast Surg ; 48(4): 687-698, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503729

RESUMO

Melanomas only account for 4% of all dermatologic cancers yet are responsible for 80% of deaths. Notably, melanomas of the hand and foot have a worse prognosis when compared with melanomas of other anatomic regions. Likely this is due to intrinsic biologic characteristics, delayed diagnosis, difficult surgical excision due to delicate anatomy, and lack of definitive diagnostic and therapeutic guidelines. The most common locations of melanoma of the hand, in order of decreasing frequency, are subungual area, dorsal surface, and palmar surface. The most common locations of melanoma of the foot are the plantar surface, dorsal surface, and subungual area, in decreasing frequency. Diagnosis of melanoma of the hand and foot can be difficult because the traditional "ABCDE" (asymmetric shape, border, color, diameter, evolution) rules do not apply. Newer acronyms have been proposed in literature including "CUBED" (colored, uncertain, bleeding, enlarged, delayed) and "ABC rule for Subungual Melanoma." Once diagnosed, treatment is primarily surgical excision and reconstruction. The goal for the surgeon is to maintain the function and anatomy of the hand or foot.


Assuntos
Melanoma , Neoplasias Cutâneas , Mãos/cirurgia , Humanos , Melanoma/diagnóstico , Melanoma/cirurgia , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia
18.
Clin Plast Surg ; 48(4): 699-705, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503730

RESUMO

Rare variants of melanoma include melanoma in pregnancy and pediatric melanoma. Because of their low incidence, treatment recommendations are based on standards of treatment for cutaneous melanoma; however, each of these forms requires specific considerations during diagnosis, staging, and treatment.


Assuntos
Melanoma , Pediatria , Neoplasias Cutâneas , Criança , Feminino , Humanos , Incidência , Melanoma/diagnóstico , Melanoma/epidemiologia , Melanoma/terapia , Estadiamento de Neoplasias , Gravidez , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia
19.
Clin Plast Surg ; 48(4): 707-711, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503731

RESUMO

Mucosal melanoma is a rare but aggressive cancer arising in mucosal surfaces most commonly in the head and neck. The clinical presentation is often nonspecific and differs in relation to the site of origin so often diagnosis is delayed resulting in poor prognosis. Mucosal melanoma has a 5-year survival of only 25%. Surgery with negative margins is the mainstay of treatment but dependent on several variables including anatomic location, involved structures, and size of tumor. Although not well defined given the rarity of mucosal melanoma, there is a role for radiation and systemic therapy in the treatment of this disease.


Assuntos
Neoplasias de Cabeça e Pescoço , Melanoma , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Melanoma/diagnóstico , Melanoma/terapia , Membrana Mucosa , Prognóstico
20.
Clin Plast Surg ; 48(4): 713-733, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503732

RESUMO

Great strides in immunotherapy and targeted therapy have revolutionized the management of previously devastating, advanced melanomas. Although these subfields continue to progress, novel approaches in intratumoral oncolytic therapy, adoptive cell therapy, and vaccine therapies are being developed as adjuncts or alternatives. Cytokines, meanwhile, are seeing a resurgence as a viable option as well. The array of effective agents will, in the next few years, provide options for therapy not only in the adjuvant or unresectable settings but also in the neoadjuvant settings. Perhaps, too, in earlier stage melanomas.


Assuntos
Melanoma , Humanos , Imunoterapia , Melanoma/terapia , Terapia Neoadjuvante
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