Demographic, Clinical, and Pathologic Features of Patients With Cutaneous Melanoma: Final Analysis of the Brazilian Melanoma Group Database.

PURPOSE: National epidemiologic data on melanoma are scarce in Brazil. The current work presents final demographic, clinical, and pathologic results from the Brazilian Melanoma Group database to detail how patients with melanoma present at diagnosis. METHODS: The online database includes patients diagnosed between 1982 and 2015 and evaluated at their centers of origin between 2001 and 2016. The primary objective was to describe the demographic, clinical, and pathologic characteristics of the patients, and secondary objectives were to investigate the association between clinical and pathologic variables of interest. RESULTS: A total of 1,596 patients were included. Median age was 52 years, 57% were women, and the majority were identified as white. Invasive melanoma was diagnosed in 1,297 patients, mostly localized, whereas 299 (19%) had in situ disease (TisN0M0). Only 165 patients had initial lymph node involvement. Fitzpatrick skin types I or II were slightly more frequent with in situ melanoma (73%) than with invasive disease (67%; P = .054). The median Breslow thickness was 0.95 mm, Clark levels 2 and 3 comprised nearly 70% of cases, and ulceration was present in 18% of patients. The mitotic rate was significantly associated with the presence of ulceration and both vascular and perineural invasion but not with margin positivity, whereas histologic regression was associated with both intratumoral and peritumoral inflammatory infiltrates. CONCLUSION: Despite the limitations of an observational, registry-based study, the current results provide a general profile of patients with cutaneous melanoma in Brazil at the time of diagnosis.

Cutaneous angiosarcoma of the head and neck: report of 23 cases from a single institution.

BACKGROUND: To report a single-institution experience in the treatment of cutaneous head and neck angiosarcoma. STUDY DESIGN: Case series. PATIENTS AND METHODS: Twenty-three patients were evaluated: 12 females and 11 males. The primary site of the lesion was the neck in 9 patients, the scalp in 9, and the face in 5. No patient had been submitted to previous treatment but 10 were submitted to incisional biopsy. The lesions' size ranged from 2.5 to 12 cm (median 4 cm). RESULTS: All but one patient were submitted to surgical resection as primary treatment. Twenty-two patients received adjuvant treatment: 8 cases of local recurrence and 12 cases of distant metastasis. Two patients presented synchronous local and distant relapses. The 5-year survival rate was 21.7 percent. In our series, the only factor affecting survival was histological grade (odds ratio = 6.7; 95% confidence interval, 1.6-28.9). CONCLUSION: Our results for 5-year survival are comparable to those in the literature with a treatment based on complete surgical resection. The only significant prognostic factor was tumor histological grade.

Uso da técnica em "spaghetti" para tratamento cirúrgico do lentigo maligno / Use of the "spaghetti" technique for surgical treatment of lentigo maligna

O lentigo maligno (LM) é uma forma de melanoma in situ que mais comumente se apresenta como uma mácula de crescimento lentamente progressivo, pigmentada, na face de idosos com pele danificada pelo sol. Esse melanoma in situ tem um risco (30% a 50%) de progressão para lentigo maligno melanoma. A excisão cirúrgica completa da lesão requer margens de pelo menos 10mm, mesmo para lesões in situ. Porém, quando o crescimento de LM ocorre em áreas de implicações estéticas ou funcionais (face, pescoço, solas), a excisão é frequentemente reduzida para preservar estruturas anatômicas importantes e por razões cosméticas. Além disso, as margens periféricas podem ser clinicamente mal definidas e nem sempre pigmentadas, com extensão subestimada e risco de ressecção insuficiente. A "técnica de espaguete", descrita por Gaudy Marqueste, é uma cirurgia estratégica baseada na amostragem de uma faixa de tecido "spaghettilike" para determinar as margens da lesão antes da remoção do tumor. Após a confirmação anatomopatológica de margens livres de neoplasia, a lesão principal central é ressecada, permitindo a reconstrução do defeito no mesmo procedimento, sendo uma alternativa à cirurgia micrográfica de Mohs.(AU)

Lentigo maligna (LM) is a melanoma in situ that commonly presents as a macula with progressive and irregularly pigmented growth, especially in the face of elderly people with sun-damaged skin. This melanoma in situ has a risk (30-50%) of progression to lentigo maligna melanoma. Complete surgical excision of the lesion requires margins of at least 10 mm, even for lesions in situ. However, when the growth of LM occurs in areas of aesthetic or functional implications (face, neck, and soles), the excision is often reduced to preserve important anatomic structures and for cosmetic purposes. Moreover, the peripheral margins may be clinically ill-defined and not always pigmented, and thus, such cases are associated with underestimated extension and risk of insufficient resection. The "spaghetti" technique, described by Gaudy Marqueste, is a strategic surgical approach based on sampling of a range of "spaghetti-like" strips to determine the margins of the lesion prior to removal of the tumor. After the pathological confirmation of neoplasia-free margins, the main central lesion is resected, allowing reconstruction of the defect in the same procedure, as an alternative to Mohs micrographic surgery. (AU)

A review of the epidemiology and treatment of Merkel cell carcinoma.

Merkel cell carcinoma is a very rare and aggressive neoplasm. Due to its rarity, therapeutic guidelines are not well established, especially for regionally advanced disease. Articles in English, French, Italian, Portuguese, and Spanish from the last 20 years were identified in MEDLINE and reviewed. The key word "Merkel" was used for the search, relevant articles were selected, and their references were examined. The most important articles related to epidemiology, genesis and treatment were reviewed. The incidence of Merkel cell carcinoma is increasing due to the advancing age of the population, higher rates of sun exposure and an increasing number of immunocompromised individuals. With regard to etiology, the recently described Merkel Cell polyomavirus is thought to play a role. Either local or regional surgical intervention remains the standard of care, but adjuvant radiotherapy or radiotherapy as a primary treatment have been discussed as reasonable therapeutic options. An update on this rare neoplasia is essential because of its increasing incidence and changing treatment options.

Dermatoscopia na gestação / Dermatoscopy in pregnancy

O prognóstico do melanoma cutâneo depende principalmente da sua espessura, sendo a detecção precoce de melanomas iniciais extremamente importante para a maior sobrevida dos pacientes. Com a utilização do exame dermatoscópico, pode-se alcançar acurácia de aproximadamente 90%. Alterações em lesões pigmentadas durante a gestação podem ocorrer, porém a dificuldade é saber se são benignas ou se correspondem a melanoma. O recurso diagnóstico da dermatoscopia permite aumentar a margem de acerto no diagnóstico e na detecção do melanoma nos estádios mais iniciais, melhorando o prognóstico e consequentemente a sobrevida do paciente.

A review of the epidemiology and treatment of Merkel cell carcinoma

Merkel cell carcinoma is a very rare and aggressive neoplasm. Due to its rarity, therapeutic guidelines are not well established, especially for regionally advanced disease. Articles in English, French, Italian, Portuguese, and Spanish from the last 20 years were identified in MEDLINE and reviewed. The key word "Merkel" was used for the search, relevant articles were selected, and their references were examined. The most important articles related to epidemiology, genesis and treatment were reviewed. The incidence of Merkel cell carcinoma is increasing due to the advancing age of the population, higher rates of sun exposure and an increasing number of immunocompromised individuals. With regard to etiology, the recently described Merkel Cell polyomavirus is thought to play a role. Either local or regional surgical intervention remains the standard of care, but adjuvant radiotherapy or radiotherapy as a primary treatment have been discussed as reasonable therapeutic options. An update on this rare neoplasia is essential because of its increasing incidence and changing treatment options.

Valor preditivo de características clínicas e histopatológicas do melanoma cutâneo primário sobre a positividade do linfonodo sentinela para micrometástase de melanoma / Preditive value of clinical and histopathological characteristics of primary cutaneous melanoma on the positivity of sentinel lymph node for melanoma micrometastasis

Entre as neoplasias que acometem a pele, o melanoma cutâneo é sem dúvida a mais temida. De início geralmente insidioso, apresenta elevados índices de cura quando tratado precocemente. Um dos principais fatores prognósticos de sobrevida no melanoma cutâneo é o comprometimento linfonodal metastático. A pesquisa do linfonodo sentinela é atualmente procedimento obrigatório no estadiamento do melanoma cutâneo, porém sua indicação é baseada exclusivamente em alguns dados histopatológicos do tumor primário. O objetivo deste estudo foi correlacionar fatores clínicos e histopatológicos do tumor primário com a positividade do linfonodo sentinela para micrometástase de melanoma e procurar identificar grupos de risco. Para tanto, foram analisados e comparados 2 grupos de pacientes: com e sem micrometástase de melanoma no linfonodo sentinela. Foram analisados os prontuários de 265 pacientes atendidos no Departamento de Oncologia Cutânea do Hospital do Câncer ­ A. C. Camargo, no período de setembro de 1997 até dezembro de 2003, com seguimento mínimo de 2 anos, sendo 54 no grupo denominado linfonodo sentinela positivo e 211 no grupo linfonodo sentinela negativo. Em análise univariada as variáveis clínicas fototipo de pele, antecedente familiar, ulceração clínica do tumor primário e nevo melanocítico congênito médio ou gigante e as variáveis histopatológicas sub-tipo de melanoma, espessura do tumor primário (Breslow), nível de Clark, ulceração histológica, índice mitótico, invasão vascular/linfática, invasão perineural, regressão e nódulos satélites foram correlacionadas com maior índice de positividade do LS para micrometástase de melanoma. Em análise multivariada a espessura de Breslow foi correlacionada com o LS+. Nesta população estudada, os pacientes portadores de melanoma cutâneo com subtipo acral lentiginoso, espessura < 1,00mm e sem ulceração apresentaram maior risco de comprometimento metastático do LS.

Among all skin cancers, cutaneous melanoma is the most feared. With insidious beginning, it has high cure rates when treated early. One of the most important prognostic factors of cutaneous melanoma is the lymph node status. Sentinel lymph node biopsy is a standard procedure in the staging of cutaneous melanoma, however its indication is based exclusively on some histological data of the primary tumor. The objective of this study was to correlate clinical and histopathological factors of the primary tumor with the positivity of sentinel lymph node for micrometastatic melanoma and identify risk groups for metastatic disease. It was analyzed and compared 2 groups of patients: with and without metastatic disease at the sentinel lymph node. A total of 265 patients registered at Skin Oncology Group, at Hospital do Câncer ­ A. C. Camargo, from September 1997 until December 2003, where enrolled, fifty four in the positive sentinel group and 211 in the negative sentinel group, with minimum follow-up of 2 years. In univariate analysis, skin fototype, familial history, clinical ulceration of primary tumor and medium or giant congenital melanocytic nevi, melanoma subtype, thickness of the primary tumor (Breslow), Clark's index, histological ulceration, mitotic index, vascular/lymphatic invasion, perineural invasion, regression and satellite nodules had been correlated with higher positivity of sentinel node for micrometastatic disease. In multivariate analysis Breslow thickness was correlated with positivity of sentinel node. In this group of patients, Acral-lentiginous non ulcerated melanomas with less than 1,0mm thickness where correlated with higher risk of metastatic disease on sentinel lymph node.