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Moreno-Ramírez D, Fernández-Orland A, Ferrándiz L. Immunotherapy and Targeted Therapy in Patients With Advanced Melanoma and the V600 BRAF Mutation: Which One First? Actas Dermosifiliogr 2024; 115:48-55. [PMID: 37321549 DOI: 10.1016/j.ad.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/17/2023] Open
Abstract
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma.
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Affiliation(s)
- D Moreno-Ramírez
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - A Fernández-Orland
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - L Ferrándiz
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Sevilla, España
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2
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Moreno-Ramírez D, Fernández-Orland A, Ferrándiz L. [Translated article] Immunotherapy and Targeted Therapy in Patients With Advanced Melanoma and the V600 BRAF Mutation: Which One First? Actas Dermo-Sifiliográficas 2024; 115:T48-T55. [PMID: 37923078 DOI: 10.1016/j.ad.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 11/07/2023] Open
Abstract
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma.
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Affiliation(s)
- D Moreno-Ramírez
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Seville, Spain.
| | - A Fernández-Orland
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Seville, Spain
| | - L Ferrándiz
- Unidad de Melanoma, Servicio de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Virgen Macarena, Seville, Spain
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3
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Moreno-Ramírez D, Fernández-Orland A, Ojeda-Vila T, Reina-Moreno A, Cambil T, de-la-Riva P, Ríos-Martín JJ, Ferrándiz L. Conservative nodal surgery for the treatment of patients with cutaneous melanoma and low-burden lymph node metastases. J Eur Acad Dermatol Venereol 2023; 37:e1390-e1392. [PMID: 37458225 DOI: 10.1111/jdv.19335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Affiliation(s)
- D Moreno-Ramírez
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Medicine School, University of Seville, Seville, Spain
| | - A Fernández-Orland
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Medicine School, University of Seville, Seville, Spain
| | - T Ojeda-Vila
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Medicine School, University of Seville, Seville, Spain
| | - A Reina-Moreno
- Department of Medical-&-Surgical Dermatology, University Hospital Virgen Macarena, Seville, Spain
| | - T Cambil
- Nuclear Medicine Unit, University Hospital Virgen Macarena, Seville, Spain
| | - P de-la-Riva
- Nuclear Medicine Unit, University Hospital Virgen Macarena, Seville, Spain
| | - J J Ríos-Martín
- Pathology Unit, University Hospital Virgen Macarena, Seville, Spain
| | - L Ferrándiz
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Medicine School, University of Seville, Seville, Spain
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4
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Silva-Clavería F, Álvarez-Muñoz A, Ferrándiz L, Fernández-Orland A, Conde-Martin AF, Moreno-Ramírez D, Ríos-Martín JJ. Difficult to Diagnose Cutaneous Melanoma in a Patient with BAP1 Tumor Predisposition Syndrome. Int J Surg Pathol 2023; 31:1398-1402. [PMID: 36803128 DOI: 10.1177/10668969231152579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BRCA1-associated protein 1 (BAP1)-inactivated melanomas can occur sporadically or in germline contexts, particularly in recently recognized BAP1-tumor predisposition syndrome. Diagnosis represents a clinical and histopathological challenge, requiring comprehensive analysis of morphology and sometimes molecular analysis in addition to immunohistochemistry. We report a BAP1-inactivated cutaneous melanoma initially diagnosed as an atypical Spitz tumor on the auricle in a patient with BAP1-tumor predisposition syndrome. Immunohistochemistry, fluorescence in situ hybridization, and comparative genomic hybridization allowed diagnosis. Cutaneous BAP1-inactivated melanocytic tumors, previously classified as atypical Spitz Nevi, may have a dermal mitotic activity that can resemble melanoma and on the other hand, atypical Spitz tumors are sometimes difficult to differentiate from BAP1-inactivated melanoma. Specific criteria, requiring molecular diagnosis have been proposed in order to support melanoma diagnosis.
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Affiliation(s)
- Francisca Silva-Clavería
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Seville, Spain
| | | | - Lara Ferrándiz
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Seville, Spain
| | - Almudena Fernández-Orland
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Seville, Spain
| | | | - David Moreno-Ramírez
- Melanoma Unit, Department of Medical & Surgical Dermatology, University Hospital Virgen Macarena, Seville, Spain
| | - Juan J Ríos-Martín
- Pathology Department, University Hospital Virgen Macarena, Seville, Spain
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5
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Moreno-Ramírez D, Duarte-Ferreras MA, Ojeda-Vila T, García-Morales I, Conejo-Mir MD, Fernández-Orland A, Sánchez-del-Campo AI, Eiris N, Carrizosa AM, Ruiz-de-Casas A, de-la-Torre JM, Herrerías-Esteban JM, Ferrándiz L. Telemedicine management of systemic therapy with isotretinoin of patients with moderate-to-severe acne during the COVID-19 pandemic: A longitudinal prospective feasibility study. J Am Acad Dermatol 2022; 87:1186-1189. [PMID: 35271937 PMCID: PMC8901237 DOI: 10.1016/j.jaad.2022.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 01/17/2023]
Affiliation(s)
- David Moreno-Ramírez
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain.
| | | | - Teresa Ojeda-Vila
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
| | - Irene García-Morales
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
| | - Maria D. Conejo-Mir
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
| | | | | | - Noemí Eiris
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
| | - Ana M. Carrizosa
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
| | - Andrés Ruiz-de-Casas
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
| | - Jose M. de-la-Torre
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
| | | | - Lara Ferrándiz
- Dermatology Digital Center, Department of Medical and Surgical Dermatology, Seville, Spain
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6
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Tejera-Vaquerizo A, Boada A, Ribero S, Puig S, Paradela S, Moreno-Ramírez D, Cañueto J, de Unamuno-Bustos B, Brinca A, Descalzo-Gallego MA, Osella-Abate S, Cassoni P, Podlipnik S, Carrera C, Vidal-Sicart S, Pigem R, Toll A, Rull R, Alos L, Requena C, Bolumar I, Traves V, Pla Á, Fernández-Orland A, Jaka A, Fernández-Figueras MT, Richarz NA, Vieira R, Botella-Estrada R, Román-Curto C, Ferrándiz-Pulido L, Iglesias-Pena N, Ferrándiz C, Malvehy J, Quaglino P, Nagore E. Sentinel Lymph Node Biopsy vs. Observation in Thin Melanoma: A Multicenter Propensity Score Matching Study. J Clin Med 2021; 10:jcm10245878. [PMID: 34945175 PMCID: PMC8708109 DOI: 10.3390/jcm10245878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022] Open
Abstract
The therapeutic value of sentinel lymph node biopsy (SLNB) in thin melanoma remains controversial. The aim of this study is to determine the role of SLNB in the survival of thin melanomas (≤1 mm). A multicenter retrospective observational study was designed. A propensity score matching was performed to compare patients who underwent SLNB vs. observation. A multivariate Cox regression was used. A total of 1438 patients were matched by propensity score. There were no significant differences in melanoma-specific survival (MSS) between the SLNB and observation groups. Predictors of MSS in the multivariate model were age, tumor thickness, ulceration, and interferon treatment. Results were similar for disease-free survival and overall survival. The 5- and 10-year MSS rates for SLN-negative and -positive patients were 98.5% vs. 77.3% (p < 0.001) and 97.3% vs. 68.7% (p < 0.001), respectively. SLNB does not improve MSS in patients with thin melanoma. It also had no impact on DSF or OS. However, a considerable difference in MSS, DFS, and OS between SLN-positive and -negative patients exists, confirming its value as a prognostic procedure and therefore we recommend discussing the option of SLNB with patients.
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Affiliation(s)
- Antonio Tejera-Vaquerizo
- Dermatology Department, Instituto Dermatológico GlobalDerm, 14700 Palma del Río, Spain
- Cutaneous Oncology Unit, Hospital San Juan de Dios, 14012 Córdoba, Spain
- Correspondence: ; Tel.: +34-957644564
| | - Aram Boada
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | - Simone Ribero
- Medical Sciences Department, Section of Dermatology, University of Turin, 10124 Turin, Italy; (S.R.); (P.Q.)
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Sabela Paradela
- Departamento de Dermatología, Hospital Universitario de la Coruña, 15006 La Coruña, Spain; (S.P.); (N.I.-P.)
| | - David Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (D.M.-R.); (A.F.-O.); (L.F.-P.)
| | - Javier Cañueto
- Dermatology Department, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain; (J.C.); (C.R.-C.)
| | - Blanca de Unamuno-Bustos
- Dermatology Department, Hospital Universitario La Fe, 46126 Valencia, Spain; (B.d.U.-B.); (R.B.-E.)
| | - Ana Brinca
- Departament of Dermatology, University Hospital of Coimbra, 3000-075 Coimbra, Portugal; (A.B.); (R.V.)
| | | | - Simona Osella-Abate
- Medical Sciences Department, Section of Surgical Pathology, University of Turin, 10124 Turin, Italy; (S.O.-A.); (P.C.)
| | - Paola Cassoni
- Medical Sciences Department, Section of Surgical Pathology, University of Turin, 10124 Turin, Italy; (S.O.-A.); (P.C.)
| | - Sebastian Podlipnik
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Sergi Vidal-Sicart
- Nuclear Medicine Department, Hospital Clinic Barcelona, Universitat de Barcelona, Institut d’investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain;
| | - Ramón Pigem
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Agustí Toll
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Ramón Rull
- Surgery Department, Hospital Clinic, Universidad de Barcelona, 08036 Barcelona, Spain;
| | - Llucìa Alos
- Pathology Department, Hospital Clinic, Universidad de Barcelona, 08036 Barcelona, Spain;
| | - Celia Requena
- Dermatology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain; (C.R.); (E.N.)
| | - Isidro Bolumar
- Surgery Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Víctor Traves
- Pathology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Ángel Pla
- Otorhinolaringology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | - Almudena Fernández-Orland
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (D.M.-R.); (A.F.-O.); (L.F.-P.)
| | - Ane Jaka
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | | | - Nina Anika Richarz
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | - Ricardo Vieira
- Departament of Dermatology, University Hospital of Coimbra, 3000-075 Coimbra, Portugal; (A.B.); (R.V.)
| | - Rafael Botella-Estrada
- Dermatology Department, Hospital Universitario La Fe, 46126 Valencia, Spain; (B.d.U.-B.); (R.B.-E.)
| | - Concepción Román-Curto
- Dermatology Department, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain; (J.C.); (C.R.-C.)
- Instituto de Investigación Biomédica de Salamanca, Complejo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain
| | - Lara Ferrándiz-Pulido
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (D.M.-R.); (A.F.-O.); (L.F.-P.)
| | - Nicolás Iglesias-Pena
- Departamento de Dermatología, Hospital Universitario de la Coruña, 15006 La Coruña, Spain; (S.P.); (N.I.-P.)
| | - Carlos Ferrándiz
- Dermatology Department, Hospital Universitari Germans Trials i Pujol, Institut d’Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain; (A.B.); (A.J.); (N.A.R.); (C.F.)
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (S.P.); (S.P.); (C.C.); (R.P.); (A.T.); (J.M.)
- Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, 28029 Barcelona, Spain
| | - Pietro Quaglino
- Medical Sciences Department, Section of Dermatology, University of Turin, 10124 Turin, Italy; (S.R.); (P.Q.)
| | - Eduardo Nagore
- Dermatology Department, Instituto Valenciano de Oncología, 46009 Valencia, Spain; (C.R.); (E.N.)
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Moreno-Ramírez D, Silva-Clavería F, Fernández-Orland A, Eiris N, Ruiz de Casas A, Férrandiz L. Surgery for Cutaneous Squamous Cell Carcinoma and its Limits in Advanced Disease. Dermatol Pract Concept 2021; 11:e2021167S. [PMID: 34877075 DOI: 10.5826/dpc.11s2a167s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 10/31/2022] Open
Abstract
Surgery remains the first-line therapeutic option for most patients with cutaneous squamous cell carcinoma (cSCC). However, in the current therapeutic landscape, surgery must attempt to the complete tumor resection (R0 resection) with the lowest risk of surgical complications. This double aim is usually accomplished through standard excision with clinical margins in patients with low-risk tumors or by some of the micrographically controlled surgery procedures for patients with tumors at high-risk of local recurrence and metastasis. Surgery is also a first-line treatment for nodal metastases of cSCC as well as an option to consider in patients who develop recurrences while receiving immunotherapy, or as a palliation procedure in patients with advanced tumors. Neoadjuvant immunotherapy, that is the use of a medical treatment before surgery, is under investigation in patients with cSCC. The decision-making process and guidelines recommendations regarding cSCC surgery are reviewed in this manuscript.
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Affiliation(s)
- David Moreno-Ramírez
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Francisca Silva-Clavería
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Almudena Fernández-Orland
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Noemí Eiris
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Andrés Ruiz de Casas
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
| | - Lara Férrandiz
- Department of Medical-&-Surgical Dermatology. University Hospital Virgen Macarena. Medicine School, University of Sevilla. Seville, Spain
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Barros-Tornay R, Ferrándiz L, Martín-Gutiérrez FJ, Fernández-Orland A, Serrano-Gotarredona A, de la Torre JM, Conejo-Mir MD, Ojeda-Vila T, Márquez-Enríquez J, Hernández C, Ocaña MJ, Herrerías-Esteban JM, Moreno-Ramírez D. Feasibility and cost of a telemedicine-based short-term plan for initial access in general dermatology in Andalusia, Spain. JAAD Int 2021; 4:52-57. [PMID: 34409393 PMCID: PMC8362296 DOI: 10.1016/j.jdin.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 01/30/2023] Open
Abstract
Background In developed countries, health care delivery in dermatology is hampered by the low availability of dermatologists. Objective To analyze the feasibility of a teledermatology-based action plan to provide initial dermatologic care in areas with low availability of dermatologists. Methods A cross-sectional study describing the feasibility and cost of a 12-month action plan based on a store-and-forward teledermatology (TD) connecting primary care centers and a TD center. Teleconsultations from patients complaining of any cutaneous condition were included. The primary outcome measure was the percentage of patients not referred to the local dermatologist. Results Among the total of 15,523 teleconsultations attended in the TD-based action plan, 3360 (21.65%) required a face-to-face visit with a local dermatologist. In 32.32% (n = 5017) of the cases, a therapeutic and follow-up plan report was issued. The most common conditions managed were melanocytic nevi (15.63%, n = 2426), followed by seborrheic keratosis (14.89%, n = 2312), and actinic keratosis (8.65%, n = 1342). The average response time was 14.52 days (95% CI 14.35-15.23). The additional total investment in this action plan was $142,681.01, with a unit cost of 9.20$/patient. Limitations Noncontrolled study. Conclusions Experienced dermatologists working with store-and-forward TD can deliver a fast and effective response in health care areas with access limitations.
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Affiliation(s)
- Ruben Barros-Tornay
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Lara Ferrándiz
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Francisco J Martín-Gutiérrez
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Almudena Fernández-Orland
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Amalia Serrano-Gotarredona
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - José M de la Torre
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - María D Conejo-Mir
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Teresa Ojeda-Vila
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - María J Ocaña
- Dermatology Unit, Hospital San Agustín, Linares, Spain
| | | | - David Moreno-Ramírez
- Teledermatology Group, Department of Medical-&-Surgical Dermatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
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9
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Pérez-Pérez M, Umbría-Jiménez S, Mora-Cabeza M, Fernández-Orland A, Ríos-Martín JJ. Basal cell carcinoma colonized by lentigo maligna melanoma, with perineural invasion by both neoplasms. J Cutan Pathol 2020; 47:1232-1236. [PMID: 32989833 DOI: 10.1111/cup.13886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Manuel Pérez-Pérez
- Department of Anatomic Pathology, Virgen Macarena University Hospital, Seville, Spain
| | | | | | | | - Juan J Ríos-Martín
- Department of Anatomic Pathology, Virgen Macarena University Hospital, Seville, Spain
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Boada A, Tejera-Vaquerizo A, Ribero S, Puig S, Moreno-Ramírez D, Quaglino P, Osella-Abate S, Cassoni P, Malvehy J, Carrera C, Pigem R, Barreiro-Capurro A, Requena C, Traves V, Manrique-Silva E, Fernández-Orland A, Ferrandiz L, García-Senosiain O, Fernández-Figueras MT, Ferrándiz C, Nagore E. Corrigendum to "Factors associated with sentinel lymph node status and prognostic role of completion lymph node dissection for thick melanoma" [Eur J Surg Oncol 46 2 (2019) 263-271]. Eur J Surg Oncol 2020; 46:928. [PMID: 32165000 DOI: 10.1016/j.ejso.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Aram Boada
- Dermatology Department, Hospital Universitari Germans Trial i Pujol, Institut d'investigació en ciències de la salut Germans Trias i Pujol, Badalona, Departament de Medicina, Universitat Autònoma de Barcelona, Spain.
| | | | - Simone Ribero
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - David Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Pietro Quaglino
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - Simona Osella-Abate
- Section of Surgical Pathology, Medical Science Department, University of Turin, Italy
| | - Paola Cassoni
- Section of Surgical Pathology, Medical Science Department, University of Turin, Italy
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Ramon Pigem
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Alicia Barreiro-Capurro
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Celia Requena
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Victor Traves
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Almudena Fernández-Orland
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Lara Ferrandiz
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Carlos Ferrándiz
- Dermatology Department, Hospital Universitari Germans Trial i Pujol, Institut d'investigació en ciències de la salut Germans Trias i Pujol, Badalona, Departament de Medicina, Universitat Autònoma de Barcelona, Spain
| | - Edurado Nagore
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
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Boada A, Tejera-Vaquerizo A, Ribero S, Puig S, Moreno-Ramírez D, Quaglino P, Osella-Abate S, Cassoni P, Malvehy J, Carrera C, Pigem R, Barreiro-Capurro A, Requena C, Traves V, Manrique-Silva E, Fernández-Orland A, Ferrandiz L, García-Senosiain O, Fernández-Figueras MT, Ferrándiz C, Nagore E. Factors associated with sentinel lymph node status and prognostic role of completion lymph node dissection for thick melanoma. Eur J Surg Oncol 2019; 46:263-271. [PMID: 31594672 DOI: 10.1016/j.ejso.2019.09.189] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/14/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Sentinel lymph node (SLN) biopsy is useful for the prognostic stratification of patients with thick melanoma. Identifying which variables are associated with SLN involvement and establishing risk in different subgroups of patients could be useful for guiding the indication of SLN biopsy. The value of complete lymph node dissection (CLND) in patients with a positive SLN biopsy is currently under debate. MATERIALS AND METHODS To identify factors associated with SLN involvement in thick melanoma we performed a multicentric retrospective cohort study involving 660 patients with thick melanoma who had undergone SLN biopsy. To analyze the role of CLND in thick melanoma patients with a positive SLN biopsy, we built a multivariate Cox proportional hazards model for melanoma-specific survival (MSS) and disease-free survival (DFS) and compared 217 patients who had undergone CLND with 44 who had not. RESULTS The logistic regression analysis showed that age, histologic subtype, ulceration, microscopic satellitosis, and lymphovascular invasion were associated with nodal disease. The CHAID (Chi-squared Automatic Interaction Detection) decision tree showed ulceration to be the most important predictor of lymphatic involvement. For nonulcerated melanomas, the histologic subtype lentigo maligna melanoma was associated with a low rate of SLN involvement (4.3%). No significant differences were observed for DFS and MSS between the CLND performed and not-performed groups. Nodal status on CLND was associated with differences in DFS and MSS rates. CONCLUSION We identified subgroups of thick melanoma patients with a low likelihood of SLN involvement. CLND does not offer survival benefit, but provides prognostic information.
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Affiliation(s)
- Aram Boada
- Dermatology Department, Hospital Universitari Germans Trial i Pujol, Institut d'investigació en ciències de la salut Germans Trias i Pujol. Badalona, Universitat Autònoma de Barcelona, Spain.
| | | | - Simone Ribero
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - Susana Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - David Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Pietro Quaglino
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - Simona Osella-Abate
- Section of Surgical Pathology, Medical Science Department, University of Turin, Italy
| | - Paola Cassoni
- Section of Surgical Pathology, Medical Science Department, University of Turin, Italy
| | - Josep Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Cristina Carrera
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Ramon Pigem
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Alicia Barreiro-Capurro
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - Celia Requena
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Victor Traves
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Almudena Fernández-Orland
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Lara Ferrandiz
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Carlos Ferrándiz
- Dermatology Department, Hospital Universitari Germans Trial i Pujol, Institut d'investigació en ciències de la salut Germans Trias i Pujol. Badalona, Universitat Autònoma de Barcelona, Spain
| | - Edurado Nagore
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
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Padilla-España L, Toledo-Pastrana T, Fernández-Orland A, Ferrándiz-Pulido L. Electrochemotherapy With Intravenous Bleomycin in the Treatment of Unresectable Merkel Cell Carcinoma. Actas Dermosifiliogr (Engl Ed) 2018; 110:687-688. [PMID: 30126606 DOI: 10.1016/j.ad.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- L Padilla-España
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España.
| | - T Toledo-Pastrana
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Fernández-Orland
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
| | - L Ferrándiz-Pulido
- Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen Macarena, Sevilla, España
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Ferrándiz L, Morales-Conde M, Fernández-Orland A, Martín-Gutiérrez FJ, Raya-Maldonado J, Toledo-Pastrana T, Moreno-Ramírez D. Teledermatology-driven topical therapy of actinic keratosis: a comparative study of clinical effectiveness and compliance. J Eur Acad Dermatol Venereol 2018; 32:2149-2152. [PMID: 29797670 DOI: 10.1111/jdv.15085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/03/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Teledermatology (TD) provides efficient care for skin cancer patients. OBJECTIVE To compare the clinical effectiveness of imiquimod 5% for the treatment of AK with in-person care and through TD. METHODS Longitudinal prospective controlled study including patients with single AK diagnosed and treated at face-to-face visits (FTF group) or through teledermatology (TD group) with imiquimod 5% cream. The main outcome measures assessed were the complete and global response percentage (CR and GR) under per-protocol (PP) and intention-to-treat (ITT) analysis. RESULTS A total of 157 patients were enrolled (FTF = 75, TD = 82). PP analysis showed CR in 66.7% of FTF patients and 65.6% in TD patients (P > 0.05). The ITT yielded CR in 64.0% and 51.2% in FTF visits and TD, respectively (P = 0.073). The analysis showed an advantage of FTF care against TD in achieving GR (84.0% vs. 70.7%; P = 0.036). Facial location and local adverse reactions were the only explanatory factors of complete response in the ITT approach. Treatment completion was found in 90.7% and 72.0% in the FTF and TD groups, respectively (P = 0.004). CONCLUSIONS Improvements in patient counselling at the primary care centre are needed before the implementation of TD as a routine methodology for the management of AK.
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Affiliation(s)
- L Ferrándiz
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen, Macarena, Sevilla, Spain
| | - M Morales-Conde
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen, Macarena, Sevilla, Spain
| | - A Fernández-Orland
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen, Macarena, Sevilla, Spain
| | - F J Martín-Gutiérrez
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen, Macarena, Sevilla, Spain
| | - J Raya-Maldonado
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen, Macarena, Sevilla, Spain
| | - T Toledo-Pastrana
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen, Macarena, Sevilla, Spain
| | - D Moreno-Ramírez
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen, Macarena, Sevilla, Spain
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Ferrándiz L, Fernández-Orland A, Moreno-Ramírez D. Finding the needle in the haystack is teledermoscopy's task. J Eur Acad Dermatol Venereol 2017; 32:e191-e192. [PMID: 29150883 DOI: 10.1111/jdv.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- L Ferrándiz
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen Macarena, Seville, Spain
| | - A Fernández-Orland
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen Macarena, Seville, Spain
| | - D Moreno-Ramírez
- Dermatology Unit & Teledermatology Network, Hospital Universitario Virgen Macarena, Seville, Spain
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Moreno-Ramírez D, Raya-Maldonado J, Morales-Conde M, Ojeda-Vila T, Martín-Gutiérrez FJ, Ruíz-de-Casas A, Fernández-Orland A, Jm HE, Ferrándiz L. Increasing Frequency of Seborrheic Keratosis Diagnoses as a Favorable Consequence of Teledermatology-Based Skin Cancer Screening: A Cross-sectional Study of 34,553 Patients. Am J Clin Dermatol 2017; 18:681-685. [PMID: 28397109 DOI: 10.1007/s40257-017-0283-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Screening of skin cancer by teledermatology (TD) has improved the early detection of skin cancer by enhancing access to skin cancer clinics. OBJECTIVE We sought to analyze how TD-based skin cancer screening has changed the frequency of consultations for benign lesions. PATIENTS AND METHODS A cross-sectional study including teleconsultations received during a 7-year period was conducted to analyze and compare the trendlines of each lesion type over the study period. Trendlines were analyzed using a linear regression model with the R-squared (R 2) test for goodness of fit. RESULTS A total of 34,553 teleconsultations were included in the study. Seborrheic keratoses, followed by benign melanocytic lesions, were the most frequent lesions diagnosed. The pick-up rate for malignant lesions was 1:8.6 teleconsultations. Seborrheic keratoses and precancerous lesions showed a positive trendline with good fit to the linear model (R 2 = 0.8 and R 2 = 0.8, respectively). Tis-T1 malignant melanoma (in situ melanoma or melanoma with a Breslow thickness <1 mm) showed an increasing trendline with moderate-to-low fit to the model (R 2 = 0.4). CONCLUSIONS TD-based screening of skin cancer is associated with an increasing rate of consultations involving seborrheic keratoses, which can be considered a consequence of improved access to dermatologists resulting from TD implementation.
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Affiliation(s)
- David Moreno-Ramírez
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain.
| | - Jesús Raya-Maldonado
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Macarena Morales-Conde
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Teresa Ojeda-Vila
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Francisco J Martín-Gutiérrez
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Andrés Ruíz-de-Casas
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | - Almudena Fernández-Orland
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
| | | | - Lara Ferrándiz
- Chief of the Medical and Surgical Dermatology Unit, HUVM Teledermatology Network, Hospital Universitario Virgen Macarena, Avda. Dr. Fedriani s/n, 41009, Seville, Spain
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Tejera-Vaquerizo A, Mendiola-Fernández M, Fernández-Orland A, Herrera-Ceballos E. Thick melanoma: the problem continues. J Eur Acad Dermatol Venereol 2008; 22:575-9. [DOI: 10.1111/j.1468-3083.2007.02517.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tejera-Vaquerizo A, Bosch-García RJ, Fernández-Orland A, Herrera-Ceballos E. [Resolution of recalcitrant condyloma acuminata in a patient with human immunodeficiency virus treated with cidofovir]. Actas Dermosifiliogr 2008; 99:162-163. [PMID: 18346446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Tejera-Vaquerizo A, Bosch-García R, Fernández-Orland A, Herrera-Ceballos E. Resolution of Recalcitrant Condylomata Acuminata in a Patient With Human Immunodeficiency Virus Treated With Topical Cidofovir. Actas Dermo-Sifiliográficas (English Edition) 2008. [DOI: 10.1016/s1578-2190(08)70224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tejera-Vaquerizo A, Barrera-Vigo M, Fernández-Canedo I, Blázquez-Sánchez N, Mendiola-Fernández M, Fernández-Orland A, Bosch-García R, de Troya-Martín M, Herrera-Ceballos E. Estudio temporal de los diferentes patrones metastásicos en la progresión del melanoma cutáneo. Actas Dermo-Sifiliográficas 2007. [DOI: 10.1016/s0001-7310(07)70128-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Tejera-Vaquerizo A, Barrera-Vigo MV, Fernández-Canedo I, Blázquez-Sánchez N, Mendiola-Fernández M, Fernández-Orland A, Bosch-García R, de Troya-Martín M, Herrera-Ceballos E. [Longitudinal study of different metastatic patterns in the progression of cutaneous melanoma]. Actas Dermosifiliogr 2007; 98:531-538. [PMID: 17919427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION Compared with other tumors, melanoma has displayed one of the largest increases in incidence in recent years, and it is known to have a high metastatic potential. In cases of metastasis, approximately two-thirds of patients have lymph-node metastases and one-third develop systemic metastases. However, few studies have been reported that analyzed different metastatic patterns according to the natural history of melanoma. The main aim of this study was to analyze the different metastatic pathways and patterns and to assess the time course of development of metastases from cutaneous melanoma. MATERIAL AND METHODS A retrospective study was performed in 575 patients with onset of primary melanoma between 1990 and 2004. During follow-up, 67 patients developed metastases. Different pathways for metastasis were established and evaluated. We identified 4 metastatic pathways according to the metastatic pattern during progression of the melanoma. The time course of metastases was also evaluated. Finally, we analyzed melanomas with local recurrence in terms of whether or not systemic progression occurred. RESULTS Melanoma metastases first occurred in local lymph nodes in 55.2 % of the patients. Initial metastasis was systemic in 14.9 % of the patients. The anatomical location and tumor thickness influenced which metastatic pathway was followed. Distant metastases occurred after a mean of 25 months regardless of the pathway followed CONCLUSIONS The development of distant metastases displays a constant time course and the time to onset is independent of the metastatic pathway. This observation may explain why sentinel lymph node biopsy has a limited impact on overall survival of melanoma patients.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología. Hospital Universitario Virgen de la Victoria. Málaga. España.
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