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Tejera-Vaquerizo A, Gómez-Tomás Á, Jaka A, Toll A, Del Río M, Ferrándiz-Pulido C, Fuente MJ, Carrasco C, Almazán-Fernández FM, Toledo-Pastrana T, Ferrer-Fuertes A, Ribero S, Avallone G, Cañueto J, Santos-Juanes J, Sanmartín O. Sentinel lymph node biopsy versus observation in high-risk cutaneous squamous cell carcinoma in immunosuppressed and immunocompetent patients: An inverse probability of treatment weighting study. J Eur Acad Dermatol Venereol 2024; 38:1588-1598. [PMID: 38738666 DOI: 10.1111/jdv.20051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/28/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND The survival benefit of sentinel lymph node biopsy (SLNB) in immunocompetent and immunosuppressed patients with high-risk cutaneous squamous cell carcinoma (cSCC) has not been established. OBJECTIVE To determine whether SLNB improves disease-specific survival (DSS) in high-risk cSCC. Secondary objectives were to analyse disease-free survival, nodal recurrence-free survival and overall survival (OS). METHODS Multicentre, retrospective, observational cohort study comparing survival outcomes in immunosuppressed and immunocompetent patients treated with SLNB or watchful waiting. Inverse probability of treatment weighting was used to adjust for possible confounding effects. RESULTS We studied 638 tumours in immunocompetent patients (SLNB n = 42, observation n = 596) and 173 tumours in immunosuppressed patients (SLNB n = 28, observation n = 145). Overall, SLNB was positive in 15.7% of tumours. SLNB was associated with a reduced risk of nodal recurrence (NR) (hazard ratio [HR], 0.05 [95% CI, 0.01-0.43]; p = 0.006), disease specific mortality (HR, 0.17 [95% CI, 0.04-0.72]; p = 0.016) and all-cause mortality (HR, 0.33 [95% CI, 0.15-0.71]; p = 0.004) only in immunocompetent patients. CONCLUSIONS SLNB was associated with improvements in NR, DSS and OS in immunocompetent but not in immunosuppressed patients with high-risk cSCC.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- Cutaneous Oncology Unit, Hospital San Juan de Dios, Córdoba, Spain
- Dermatology Department, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, Spain
| | - Álvaro Gómez-Tomás
- Dermatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ane Jaka
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Agustín Toll
- Dermatology Department, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - María Del Río
- Plastic Surgery Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Carla Ferrándiz-Pulido
- Dermatology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María J Fuente
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Cristian Carrasco
- Plastic Surgery Department, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Tomás Toledo-Pastrana
- Dermatology Department, Hospital Quirón Salud Infanta Luisa, Hospital Quirón Salud Sagrado Corazón, Sevilla, Spain
| | | | - Simone Ribero
- Section of Dermatology, Medical Sciences Department, University of Turin, Turin, Italy
| | - Gianluca Avallone
- Section of Dermatology, Medical Sciences Department, University of Turin, Turin, Italy
| | - Javier Cañueto
- Dermatology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Jorge Santos-Juanes
- Dermatology Department, Central Universitary Hospital of Asturias and Instituto de Investigación Sanitaria of Principado de Asturias, IUOPA, Oviedo University, Oviedo, Spain
| | - Onofre Sanmartín
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
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Łaziński Ł, Koziej M, Antoszewski B, Fijałkowska M. Skin cancer occurrence: single-center experiences from period 2020-2022. POLISH JOURNAL OF SURGERY 2023; 96:26-30. [PMID: 38629283 DOI: 10.5604/01.3001.0053.9174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
<b><br>Introduction:</b> Skin cancers constitute a group of medical disorders remaining a field of interest for surgeons and dermatologists. Currently, this group is typically divided into malignant melanoma (MM) and keratinocyte cancers (KC).</br> <b><br>Aim:</b> The aim of this study is to analyze the cases of skin cancers treated in the Department of Plastic, Reconstructive, and Aesthetic Surgery in Lodz (Poland) during the COVID-19 pandemic (from 2020 to 2022) and then compare the results with the ones from the pre-pandemic period (from 2017 to 2019).</br> <b><br>Material and methods:</b> An analysis of histopathological files from the period between 2020 and 2022 was performed. It was based on the following criteria: sex, age, type of skin cancer, subtype of basal cell carcinoma (BCC), location, and dimensions of the tumor. The study sample consisted of 225 patients presenting 241 cases of skin cancers. There were 74 men and 151 women, with the mean age being 71.7.</br> <b><br>Results:</b> The most common skin cancer was BCC (175 cases, 72.6%) followed by SCC (59 cases, 24.5%), melanoma (5 cases, 2.1%), and other (2 cases, 0.8% - angiosarcoma and sweat gland carcinoma).</br> <b><br>Conclusions:</b> A marked reduction in the number of skin cancers detected during the pandemic period was reported on. Delay in the surgical treatment of skin tumors does not seem to affect the size of the removed lesion. Some models predicting that tumors would be larger after the confinement period are not applicable in reality. However, further investigations with larger samples from multiple centers are needed to confirm these findings and to work out standards on how to deal with healthcare crises in the future.</br>.
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Affiliation(s)
- Łukasz Łaziński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Second Chair of Surgery Medical University of Lodz, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Second Chair of Surgery Medical University of Lodz, Poland
| | - Marta Fijałkowska
- Department of Plastic, Reconstructive and Aesthetic Surgery, Second Chair of Surgery Medical University of Lodz, Poland
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Cantoral R, Espinoza L, Gaete-Peralta C. Exponential behaviour and variational practices in Chilean newscasts: a socioepistemological view. ZDM : THE INTERNATIONAL JOURNAL ON MATHEMATICS EDUCATION 2023; 55:147-161. [PMID: 36742130 PMCID: PMC9885417 DOI: 10.1007/s11858-022-01458-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
The research on which we report in this paper was framed within the socioepistemological theory and dealt with the fundamental role of variational practices in the understanding of COVID-19 pandemic graphs. Given the proliferation of mathematical graphs related to the pandemic in the media, we proposed to analyse the variational practices in use in the interpretation of graphs of exponential behaviour that a Chilean newscast of high rating used to inform the population about the pandemic in Chile. For this purpose, a thematic analysis intertwined with documentary analysis techniques was carried out, in order to describe the types of graphs shown in the newscast, and a variational reference system was studied to analyse the use of variational practices. To obtain our results, the types of graphs most frequently shown in the newscast at the beginning of the pandemic were identified and the use of the variational practices of comparison, seriation and prediction in such graphs was analysed. In conclusion, the need is discussed for the conceptual evolution of the exponential function to be accompanied by a pragmatic evolution in school that favours the use and development of variational practices in the student body.
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Affiliation(s)
- Ricardo Cantoral
- Centro de Investigación y Estudios Avanzados del IPN (Cinvestav, IPN), Mexico, Mexico
| | | | - Claudio Gaete-Peralta
- Departamento de Matemáticas y Ciencias de la Ingeniería, Universidad Bernardo O’Higgins, Santiago, Chile
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Witkowski J, Polak S, Pawelec D, Rogulski Z. In Vitro/In Vivo Translation of Synergistic Combination of MDM2 and MEK Inhibitors in Melanoma Using PBPK/PD Modelling: Part III. Int J Mol Sci 2023; 24:2239. [PMID: 36768563 PMCID: PMC9917191 DOI: 10.3390/ijms24032239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
The development of in vitro/in vivo translational methods and a clinical trial framework for synergistically acting drug combinations are needed to identify optimal therapeutic conditions with the most effective therapeutic strategies. We performed physiologically based pharmacokinetic-pharmacodynamic (PBPK/PD) modelling and virtual clinical trial simulations for siremadlin, trametinib, and their combination in a virtual representation of melanoma patients. In this study, we built PBPK/PD models based on data from in vitro absorption, distribution, metabolism, and excretion (ADME), and in vivo animals' pharmacokinetic-pharmacodynamic (PK/PD) and clinical data determined from the literature or estimated by the Simcyp simulator (version V21). The developed PBPK/PD models account for interactions between siremadlin and trametinib at the PK and PD levels. Interaction at the PK level was predicted at the absorption level based on findings from animal studies, whereas PD interaction was based on the in vitro cytotoxicity results. This approach, combined with virtual clinical trials, allowed for the estimation of PK/PD profiles, as well as melanoma patient characteristics in which this therapy may be noninferior to the dabrafenib and trametinib drug combination. PBPK/PD modelling, combined with virtual clinical trial simulation, can be a powerful tool that allows for proper estimation of the clinical effect of the above-mentioned anticancer drug combination based on the results of in vitro studies. This approach based on in vitro/in vivo extrapolation may help in the design of potential clinical trials using siremadlin and trametinib and provide a rationale for their use in patients with melanoma.
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Affiliation(s)
- Jakub Witkowski
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland
- Adamed Pharma S.A., Adamkiewicza 6a, 05-152 Czosnów, Poland
| | - Sebastian Polak
- Faculty of Pharmacy, Jagiellonian University, Medyczna 9, 30-688 Krakow, Poland
- Simcyp Division, Certara UK Limited, Level 2-Acero, 1 Concourse Way, Sheffield S1 2BJ, UK
| | | | - Zbigniew Rogulski
- Faculty of Chemistry, University of Warsaw, Pasteura 1, 02-093 Warsaw, Poland
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Seretis K, Bounas N, Gaitanis G, Bassukas I. A Meta-Analysis on the Impact of the COVID-19 Pandemic on Cutaneous Melanoma Diagnosis in Europe. Cancers (Basel) 2022; 14:6085. [PMID: 36551570 PMCID: PMC9776971 DOI: 10.3390/cancers14246085] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has been the epicenter of healthcare attention globally for the past two years, and large-scale adaptations in healthcare provision have been required. This study aimed to investigate the impact of the pandemic and the resulting lockdowns on cutaneous melanoma diagnosis and tumor burdens in Europe. A relevant literature search in electronic databases was conducted from inception to September 2022. The inclusion criteria were: controlled studies published in a peer-reviewed journal evaluating cutaneous melanoma in Europe and reporting data on melanoma characteristics from diagnoses. The quality of studies was evaluated using the Cochrane ROBINS-I tool for assessing bias in non-randomized studies. Meta-analysis was conducted utilizing a random effects model to synthesize the data. A total of 25 studies involving 32,231 patients were included in the data analysis models. Statistically significant increases in mean Breslow thickness (0.29 mm (0.03-0.55 mm)), ulceration rates (OR = 1.66 (1.29-2.13)), and resultant tumor staging were observed in the PostCovid group, with subgroup analysis revealing that lockdown-derived data were responsible for this trend. This meta-analysis reported on the impact of COVID-19 restrictions on melanoma diagnosis in Europe, emphasizing the higher tumor burden and disease progression state provoked by healthcare adaptations in the pandemic period.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Nikolaos Bounas
- Department of Plastic Surgery, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
| | - Ioannis Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45100 Ioannina, Greece
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Wihlidal JGJ, Tay KY, MacNeil SD, Nichols AC, Fung K, Yoo JHJ, Mendez AI. Demographic and pathologic factor regression to a growth rate model of
p16
‐negative oral cavity squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2022; 7:1384-1390. [PMID: 36258883 PMCID: PMC9575115 DOI: 10.1002/lio2.831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives The current study aims to quantify the growth rate of p16‐negative oral cavity squamous cell carcinoma, characterize causative relationships between demographic risk factors and tumor growth, and examine pathologic findings associated with the tumor growth rate at a tertiary care institution. It is hypothesized that causative relationships will be drawn between the individual sociodemographic and pathologic factors and oral cavity p16‐negative squamous cell carcinoma growth rate. Methods Prospectively recruited participants, receiving surgical intervention only, were followed from initial staging CT scan to surgical resection. Interval growth was calculated in cm3/week. Demographic information including age, sex, smoking history, alcohol consumption history, previous all‐type malignancy, previous chemotherapy treatment, previous head or neck radiation exposure, and time interval elapsed between diagnosis and surgery was collected from each participant, and regression analysis was applied to determine causality. Results Summary statistics revealed a mean growth rate for the study sample of 1.385cm3/week. Statistically significant regression correlations were detected between tumor growth and alcohol consumption, origination at the retromolar trigone, and clinical nodal stage. Conclusions Through a small prospective cohort sample, the current study suggests clinical associations between alcohol consumption, origination at the retromolar trigone, and clinical nodal stage with rate of tumor growth. Future work will validate these relationships in a larger patient cohort, and against stronger modeling techniques. Level of Evidence Prospective non‐random cohort design.
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Affiliation(s)
- Jacob G. J. Wihlidal
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Keng Yeow Tay
- Department of Radiology, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Anthony C. Nichols
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Kevin Fung
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - John H. J. Yoo
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Adrian I. Mendez
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
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Intergruppo Melanoma Italiano. The effect of COVID-19 emergency in the management of melanoma in Italy. Dermatol Reports 2021; 13:8972. [PMID: 33824708 PMCID: PMC8018261 DOI: 10.4081/dr.2021.8972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic has severely hampered the functioning of any health system, absorbing a considerable amount of resources and with the threat of widespread infection in the health services. The present survey has been carried out in Italy to evaluate if and how COVID-19 also affected skin melanoma management. We enrolled 13 Italian centres highly qualified in the diagnosis and care of skin melanoma. We compared a set of information evaluating the amount of activity for melanoma performed during February-April 2020 with the same quarter in 2019. The number of new melanoma diagnosis, biopsies, wide local excisions, overall pathology reports decreased. However, the most severe cases seem promptly managed with sentinel lymph node biopsies, new systemic treatments (north) and the total number of (advanced) treated patients (centre-south). The COVID-19 experience has underlined the need to exploit the help which may come from telemedicine.
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Affiliation(s)
- Intergruppo Melanoma Italiano
- Andrea Anichini, Salvatore Asero, Melissa Bersanelli, Corrado Caracò, Vincenzo De Giorgi, Anna Maria Di Giacomo, Claudio Feliciani, Virginia Ferraresi, Paola Ghiorzo, Antonio M. Grimaldi, Michele Guida, Mario Mandalà, Daniela Massi, Simone Mocellin, Giuseppe Palmieri, Roberto Patuzzo, Maria Antonietta Pizzichetta, Roberto Ricci, Giulio Rossi, Pietro Quaglino, Paola Queirolo, Rebecca Senetta, Ignazio Stanganelli, Marco Tucci
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Alshiyab DM, Al-Qarqaz FA, Muhaidat JM. Impact of COVID-19 pandemic on the continuity of care for dermatologic patients on systemic therapy during the period of strict lockdown. Ann Med Surg (Lond) 2020; 60:571-574. [PMID: 33251007 PMCID: PMC7686756 DOI: 10.1016/j.amsu.2020.11.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 12/20/2022] Open
Abstract
Background The world has changed dramatically since the COVID-19 pandemic began. Jordan was among countries which enforced early lock-down for most non-vital services. Health care was mainly directed to cope with COVID-19 cases. The pandemic posed challenges for all patients, including dermatology patients especially those on systemic treatments. This resulted in interruption of medical care and exacerbation of pre-existing skin diseases for many patients. Material and methods A cross-sectional, questionnaire-based study of dermatology patients on systemic treatment prior to corona pandemic. After lockdown was lifted, patients taking systemic treatments were evaluated for continuity of care during lockdown period and how that affected their skin condition. Demographic data, details of skin condition, continuity of care and impact on skin condition data were collected and analyzed. Results 154 patients (120 males, 34 females) were included. The majority (around 80%) of patients were unable to attend to dermatology clinics or do the needed lab monitoring. Around one fifth of patients had drug interruption mostly due to no access to hospital pharmacy. Most patients were using oral isotretinoin for acne, others include methotrexate and other immune suppressive agents. Patients with acne and oral isotretinoin treatment were more likely to continue their treatment during lockdown period. Amongst those who stopped treatment, around 42% had flare up of their disease. Conclusion COVID-19 pandemic had an important impact on various aspects of care for dermatology patients especially those on systemic therapy. This study demonstrated limited access to specialist care, inability to do lab tests and discontinuation of treatment during lockdown. Some patients (42%) had flare up of their skin condition as a result. COVID-19 pandemic had dramatic impact on the continuity of care for dermatologic patients especially those on systemic therapy. Health authorities should ensure proper access to medical care for especially patients with severe skin disease treated with systemic drugs during periods of lockdown to minimize complications for these patients.
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Affiliation(s)
- Diala M Alshiyab
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Firas A Al-Qarqaz
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Jihan M Muhaidat
- Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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