1
|
Kramer N, Müller G, Zierold S, Röckel M, Fröhlich W, Schefzyk M, Kumbrink J, Hassel JC, Berking C, Ziemer M, Nashan D, French LE, Vera J, Kerl-French KE, Gutzmer R, Heinzerling L. Checkpoint inhibitor-induced bullous pemphigoid differs from spontaneous bullous pemphigoid. J Eur Acad Dermatol Venereol 2024. [PMID: 38400651 DOI: 10.1111/jdv.19860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Affiliation(s)
- N Kramer
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - G Müller
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - S Zierold
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - M Röckel
- Department of Dermatology, Uniklinikum Erlangen, Comprehensive Cancer Center Erlangen - EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - W Fröhlich
- Department of Dermatology, Uniklinikum Erlangen, Comprehensive Cancer Center Erlangen - EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - M Schefzyk
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - J Kumbrink
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - J C Hassel
- Department of Dermatology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
| | - C Berking
- Department of Dermatology, Uniklinikum Erlangen, Comprehensive Cancer Center Erlangen - EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - M Ziemer
- Department of Dermatology, Allergology and Venerology, University Medical Center, Leipzig, Germany
| | - D Nashan
- Department of Dermatology, Hospital Dortmund, Dortmund, Germany
| | - L E French
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - J Vera
- Department of Dermatology, Uniklinikum Erlangen, Comprehensive Cancer Center Erlangen - EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - K E Kerl-French
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
| | - R Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - L Heinzerling
- Department of Dermatology and Allergology, University Hospital, LMU Munich, Munich, Germany
- Department of Dermatology, Uniklinikum Erlangen, Comprehensive Cancer Center Erlangen - EMN, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
2
|
Kähler KC, Hüning S, Nashan D, Meiss F, Rafei-Shamsabadi DA, Rissmann H, Colapietro C, Livingstone E, Maul LV, Heppt M, Hassel JC, Gutzmer R, Loquai C, Heinzerling L, Sachse MM, Bohne AS, Moysig L, Peters W, Rusch J, Blome C. Preferences of German and Swiss melanoma patients for toxicities versus melanoma recurrence during adjuvant treatment (GERMELATOX-A-trial). J Cancer Res Clin Oncol 2023; 149:11705-11718. [PMID: 37405475 PMCID: PMC10465664 DOI: 10.1007/s00432-023-05027-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE Adjuvant treatment with immune checkpoint inhibitors like PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT) in high-risk melanoma patients demonstrate a significant improvement in disease-free survival (DFS). Due to specific side effects, the choice of treatment is very often driven by the risk for toxicity. This study addressed for the first time in a multicenter setting the attitudes and preferences of melanoma patients for adjuvant treatment with (c)ICI and TT. METHODS In this study ("GERMELATOX-A"), 136 low-risk melanoma patients from 11 skin cancer centers were asked to rate side effect scenarios typical for each (c)ICI and TT with mild-to-moderate or severe toxicity and melanoma recurrence leading to cancer death. We asked patients about the reduction in melanoma relapse and the survival increase at 5 years they would require to tolerate defined side-effects. RESULTS By VAS, patients on average valued melanoma relapse worse than all scenarios of side-effects during treatment with (c)ICI or TT. In case of severe side effects, patients required a 15% higher rate of DFS at 5 years for (c)ICI (80%) compared to TT (65%). For survival, patients required an increase of 5-10% for melanoma survival during (c)ICI (85%/80%) compared to TT (75%). CONCLUSION Our study demonstrated a pronounced variation of patient preferences for toxicity and outcomes and a clear preference for TT. As adjuvant melanoma treatment with (c)ICI and TT will be increasingly implemented in earlier stages, precise knowledge of the patient perspective can be helpful for decision making.
Collapse
Affiliation(s)
- Katharina C Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
| | - S Hüning
- Department of Dermatology, Dortmund, Germany
| | - D Nashan
- Department of Dermatology, Dortmund, Germany
| | - F Meiss
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - D A Rafei-Shamsabadi
- Department of Dermatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Rissmann
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - C Colapietro
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - L V Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - M Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany
| | - J C Hassel
- Department of Dermatology and National Center for Tumor Therapy (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - R Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center Minden, Ruhr University Bochum Medical School, Bochum, Germany
| | - C Loquai
- Department of Dermatology, Klinikum Bremen-Ost, Gesundheitnord gGmbH, Bremen, Germany
| | - L Heinzerling
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - M M Sachse
- Department of Dermatology, Bremerhaven, Germany
| | - A S Bohne
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - L Moysig
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - W Peters
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - J Rusch
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg, Hamburg, Germany
| | - C Blome
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg, Hamburg, Germany
| |
Collapse
|
3
|
Kühn LM, Beiteke U, Nashan D. [Useful knowledge regarding tattoos]. Dermatologie (Heidelb) 2023:10.1007/s00105-023-05184-9. [PMID: 37314452 DOI: 10.1007/s00105-023-05184-9] [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] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
The number of people with tattoos has continued to increase in recent years. In the USA about 23% and in Europe 9-12% of the population have tattoos. In the German media (2019) and by the infoportal Statista (2017), it is assumed that 21-25% of citizens have tattoos and that the trend is increasing (Statista 2018: 36%). Men and women wear tattoos equally. The age group 20-29 years dominates with almost 50% having tattoos. The following article describes the new regulations especially the REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) regulation, legal basis, and governmental controls on the subject of "tattoos". The composition of tattooing agents and testing options relevant for the user before and for the performance of tattooing are presented. Dermatologically associated diseases and testing procedures are listed. Since 70% of the population denies knowledge of this information even when they have tattoos themselves, this update is written as an overview for treating physicians and users.
Collapse
Affiliation(s)
- L M Kühn
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - U Beiteke
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
- Hautarztpraxis, Müllheim, Deutschland
| |
Collapse
|
4
|
Fahlbusch S, Hüning S, Lücke A, Nashan D. Chlormethin-Gel-basierte komplette Remission einer CD30-positiven Mycosis fungoides-Plaque. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1547-2838] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungChlormethin-Gel ist seit Mai 2019 als Lokaltherapeutikum bei Erwachsenen für kutane T-Zell-Lymphome vom Typ Mycosis fungoides (MF) zugelassen. Die topische Anwendung erfolgt 1-mal täglich. Im Rahmen der Zulassungsstudie kam es nach einer mindestens 6-monatigen Behandlung mit Chlormethin-Gel bei 76,7 % der Patienten (69 von 90) zu einer ≥ 50 %-igen Verbesserung der klinischen Befunde, gemessen anhand der CAILS-Skala (Composite Assessment of Index Lesion Serverity). Eine komplette Remission wurde bei 19 % (17 von 90) der Patienten beschrieben. Etwas mehr als die Hälfte der behandelten Patienten zeigte lokale Nebenwirkungen mit Hautirritationen, Hautrötungen und auch Hautinfektionen. Weitere mögliche Hautreaktionen sind Pruritus, Blasenbildung und Geschwüre.Im Folgenden wird von einer Patientin mit einer bekannten CD30+-Mycosis fungoides im Stadium IIB (ISCL/EORTC 2007) berichtet. Eine unter verschiedenen Systemtherapien (Bexaroten, Bade-PUVA, Brentuximab Vedotin) immer wieder rezidivierende, ca. handtellergroße Plaque an der Flanke links wurde mit Chlormethin-Gel behandelt.Aufgrund bereits bekannter, langsam progredienter Größenzunahme und wiederholt schmerzhafter Mazerationen dieses Herdes erfolgte auch mit Blick auf mögliche Nebenwirkungen von Chlormethin-Gel die Behandlung in Absprache mit der Patientin nur jeden zweiten Tag.Unter diesem Therapieregime zeigte sich, nach anfänglicher kurzzeitiger Hautreizung, bereits nach 3 Monaten eine komplette, histologisch gesicherte, aktuell 6 Monate anhaltende Remission der Läsion.Diese Kasuistik soll einen eindrucksvollen Therapieverlauf unter Chlormethin-Gel in reduzierter Dosierung und bei guter Verträglichkeit präsentieren.
Collapse
Affiliation(s)
| | | | - A. Lücke
- Pathologisches Institut, Klinikum Dortmund gGmbH
| | | |
Collapse
|
5
|
Dücker P, Brehmer A, Nashan D. Cemiplimab in der Anwendung bei hochbetagten Patienten. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1396-8087] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungWir berichten über den erfolgreichen Einsatz von Cemiplimab bei insgesamt 23 hochbetagten Patienten mit fortgeschrittenen und/oder metastasierten Plattenepithelkarzinomen, die bei guter Verträglichkeit trotz Komorbiditäten nephrogener oder kardialer Genese, Diabetes und auch bei Vorliegen von Zweitmalignomen ein gutes Ansprechen boten. Eine komplette Remission konnte bei 10 Patienten, eine partielle Remission bei 8 Patienten erreicht werden. 6 der 7 Patienten mit Zweittumoren zeigten ein Ansprechen. Ein Ansprechen zeichnete sich meist schon nach wenigen Therapiezyklen ab.
Collapse
Affiliation(s)
- P. Dücker
- Klinik für Dermatologie, Klinikum Mitte Dortmund
| | - A. Brehmer
- Klinik für Dermatologie, Klinikum Mitte Dortmund
| | - D. Nashan
- Klinik für Dermatologie, Klinikum Mitte Dortmund
| |
Collapse
|
6
|
Dücker P, Hüning S, Rohde S, Lorenzen J, Nashan D. [Merkel cell carcinoma in chronic lymphocytic leukemia : Successful treatment with PD-L 1 inhibition, avelumab and chlorambucil]. Hautarzt 2020; 71:553-556. [PMID: 32394077 DOI: 10.1007/s00105-020-04599-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the case of an 85-year-old chronic lymphocytic leukemia patient with a local metastatic MCVPyV-negative Merkel cell carcinoma at initial diagnosis. Therapy comprised surgical excision and radiotherapy but without lymphadenectomy. Six months after the primary diagnosis, liver metastases were detected. They responded to the PD-L1 inhibitor avelumab for more than 15 months. Thus, we postulate a synergistic effect of combined therapy with chlorambucil and avelumab through a mutual improvement of immune function, from which both diseases benefit.
Collapse
Affiliation(s)
- P Dücker
- Klinik für Dermatologie, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - S Hüning
- Klinik für Dermatologie, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - S Rohde
- Institut für Radiologie und Neuroradiologie, Klinikum Dortmund, 44137, Dortmund, Deutschland
| | - J Lorenzen
- Pathologisches Institut, Klinikum Dortmund, 44137, Dortmund, Deutschland
| | - D Nashan
- Klinik für Dermatologie, Klinikum Dortmund, Beurhausstr. 40, 44137, Dortmund, Deutschland
| |
Collapse
|
7
|
Nashan D, Hüning S, Heppt MV, Brehmer A, Berking C. [Actinic keratoses : Current guideline and practical recommendations]. Hautarzt 2020; 71:463-475. [PMID: 32472149 DOI: 10.1007/s00105-020-04619-x] [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] [Indexed: 10/24/2022]
Abstract
The S3 guideline "Actinic keratosis and squamous cell carcinoma of the skin" was published on 30 June 2019. Subsequently, publications, reviews and meta-analyses appeared with new questions regarding the comparability of study data and heterogeneity of the evaluations, which are caused, among other things, by divergent measurement parameters as well as insufficient consideration of pretreatments and combined treatments. This concise overview was written in the context of criticism and in view of necessary developments and research. Topics include epidemiology, pathogenesis, prevention, clinical presentation, therapy and BK5103. Therapy is divided into local destructive procedures and topical applications. Recommendations with quotation marks are based on the actual guideline. Corresponding evidence levels are given. For the implementation in daily routine basic data, side effects and features of therapeutic options are mentioned. The current developments and questions concerning actinic keratoses become clear.
Collapse
Affiliation(s)
- D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - S Hüning
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - M V Heppt
- Hautklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - A Brehmer
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - C Berking
- Hautklinik, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Deutschland
| |
Collapse
|
8
|
Hüning S, von Dücker L, Kohl WK, Nashan D. Erratum zu: Therapie des Herpes zoster und der postherpetischen Neuralgie. Hautarzt 2019; 70:690. [DOI: 10.1007/s00105-019-04476-3] [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: 11/25/2022]
|
9
|
Abstract
BACKGROUND In addition to a broad and clinically diverse spectrum of known primary cutaneous lymphomas, for which an incidence of 1-3:100,000 is postulated, each year further entities are specified and defined. The goal is the presentation of a case series from daily clinical routine. METHODS Over a period of 6 years and 2 months, patients consulting the Department of Dermatology, Medical Center University of Freiburg, were registered. Subsequently, collectives of mycosis fungoides (MF), Sezary syndrome (SS), CD30+ lymphoproliferative diseases, single cases with rare primary cutaneous lymphomas, and subcollectives of B‑cell lymphomas were examined. The high number of MF cases allowed the additional quantitative analyses of the types of therapies used in this group. RESULTS Yearly 16-25 new diagnoses of primary cutaneous lymphoma are made. The evaluation of 163 primary cutaneous lymphoma revealed 111 cases with MF (68.1%), including 9 particular variants, 15 primary cutaneous CD30+ lymphoproliferative diseases (9.2%) dominated by 10 lymphomatoid papulosis (LyP), in addition to 5 primary cutaneous anaplastic large cell lymphoma (PCALCL), 6 SS (3.68%), and 24 cutaneous B‑cell lymphomas (14-72%). Three cases with rare primary cutaneous T/NK cell lymphomas are addressed in detail. In all, 82% of MF cases were stage IA and IB. The descending use of therapies for stage I-III included steroids and diverse UV therapies followed by bexarotene, interferon-α, methotrexate, and extracorporal photophoresis. CONCLUSIONS Diagnoses of cutaneous lymphomas belong to a vast spectrum of differential diagnoses. This registry describes frequent findings and shows rare variants. You can only diagnose what you know; accordingly, a collection of case reports, which we wish to encourage, can help in processing and specification of entities.
Collapse
Affiliation(s)
- D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - C M Friedrich
- Fachhochschule Dortmund - Fachbereich Informatik und Institut für Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Universitätsklinikum Essen, Essen, Deutschland
| | - E Geissler
- Hautklinik, Klinikum Ludwigshafen, Ludwighafen, Deutschland
| | - A Schmitt-Graeff
- Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland
| | - F Klein
- Wissenschaftliche Fachkommunikation, München, Deutschland
| | - F Meiss
- Klinik für Dermatologie und Venerologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
- Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg, Deutschland
| |
Collapse
|
10
|
Ständer HF, Nashan D. [Emergencies in dermatology]. Hautarzt 2018; 69:350-351. [PMID: 29675655 DOI: 10.1007/s00105-018-4158-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- H F Ständer
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
- Dermatologie Bad Bentheim, Praxis im Paulinenkrankenhaus, Paulinenweg 1, 48455, Bad Bentheim, Deutschland.
| | - D Nashan
- Hautklinik, Klinikum Dortmund gGmbH, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| |
Collapse
|
11
|
Abstract
The spectrum of dermato-oncological emergencies is multifaceted. They are particularly observed in cases with malignant melanoma due to the large number of patients and prolonged survival rates that are associated with new therapies for advanced disease. Dermato-oncological patients present to the hospital with symptoms like nausea and emesis, unexpected neurological deficits, various gastrointestinal problems, and even acute abdomen, acute breathlessness, or hemoptysis. Furthermore, emergencies can be caused by hematological problems like anemia and leukopenia. In addition to standardized care for medical emergencies, there are many other problems caused by metastases and/or therapeutic side effects that need interdisciplinary skills to optimize procedures and deliberate on surgical interventions, radiotherapy, and medical therapeutic choices with regard to the overall situation of the patient. The article deals with a spectrum of acute organ-specific emergencies, including recommendations for medical treatment and considerations for therapeutic decisions. Recommendations for supportive care in patients who are severely ill are summarized. In addition to stage-adapted pain therapy, supportive measures such as nutritional supplementation, the use of dronabinol in cases of loss of appetite, and antipruritic therapies are outlined. This article provides a succinct summary of the most frequently observed dermato-oncological emergencies with references to the respective detailed literature of associated medical societies and guidelines.
Collapse
Affiliation(s)
- D Nashan
- Hautklinik, Klinikum Do, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - S Dengler
- Hautklinik, Klinikum Do, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| |
Collapse
|
12
|
Weckesser M, Franzius C, Nashan D, Schober O, Löffler M. Malignant melanoma and 18F-FDG-PET: Should the whole body scan include the legs? Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625186] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Summary:Aim: 18F-FDG-PET (FDG-PET) is established in staging and follow-up of malignant melanoma. The legs are affected in 10-40% at time of diagnosis even if the primary is at the arms and torso. Imaging including the legs may detect distant manifestations but increases duration of the scan by ~30 min. We intended to disclose the diagnostic benefit of scanning the legs and to evaluate the therapeutic benefit resulting. Patients, Methods: In this retrospective analyse 213 consecutive PET studies of 153 patients with suspected or recent malignant melanoma were re-evaluated for metastastic spread by a blinded investigator. Histopathological follow-up was assessed for confirmation. Results: Suspicious findings at the legs were depicted in 53 patients on 76 occasions. 38/53 showed pathologic uptake in the torso as well. In 15/53 patients it was restricted to the legs. One of them had a hitherto unknown, clinically relevant finding that was not apparent in palpation and inspection. In 6 other patients with primary location at the legs a validation of the positive PET findings was not possible up to now. Conclusion: Metastases and local recurrence of malignant melanoma at the legs were found in 41% of women and 27% of men. However, a long scan does not yield relevant additional data. We found isolated new manifestations at the legs in only 1/153 patients. We recommend performing a long scan only in patients with previous melanoma manifestations restricted to the legs. In all other cases a short scan of the torso and proximal thighs is sufficient. This allows a higher number of PET-scans without loss of diagnostic power and a shorter examination time.
Collapse
|
13
|
Haep A, Murday S, Risse A, Nashan D, Ständer HF. [Charcot foot masked by erysipelas and peripheral arterial disease]. Hautarzt 2017; 69:316-320. [PMID: 29184984 DOI: 10.1007/s00105-017-4085-2] [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] [Indexed: 11/25/2022]
Abstract
Charcot foot is also known as Charcot disease or Charcot arthropathy. The associated aseptic destruction of the bones and joints of the foot results due to peripheral neuropathy accompanied by impaired pain perception, impaired vasomotricity with increased vasodilation, and an unequal weight distribution. Because it is frequently diagnosed late and, thus, incorrectly treated, serious complications often result. An 86-year-old man in poor health was diagnosed with erysipelas of the right foot. The foot was glossy and edematously swollen, showing necrosis of the distal phalanx of the third toe. The patient experienced pain after a walking distance of approximately 20 m. In addition to erysipelas, confirmed neuropathic arthropathy and radiological indicators for Charcot foot established peripheral artery disease (PAD) as a third diagnosis. Despite multiple systemic antibiotic therapies, there was a progressive disease pattern marked by increasing inflammation parameters with an increasing decline of the patient's overall health. The patient suffered severe deterioration in spite of vascular surgical measures, ultimately leading to his death. In the present case, the indicators and respective confirmation of the three overlapping diagnoses erysipelas, Charcot foot and PAD are elaborated.
Collapse
Affiliation(s)
- A Haep
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland.
| | - S Murday
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland
| | - A Risse
- Diabeteszentrum, Klinikzentrum Nord, Klinikum Dortmund gGmbH, Münsterstr. 240, 44145, Dortmund, Deutschland
| | - D Nashan
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland
| | - H F Ständer
- Klinik für Dermatologie, Klinikum Dortmund gGmbH, Beurhausstr. 26, 44137, Dortmund, Deutschland.,Dermatologie Bad Bentheim, Praxis im Paulinenkrankenhaus, Paulinenweg 1, 48455, Bad Bentheim, Deutschland
| |
Collapse
|
14
|
Schiller M, Tsianakas A, Sterry W, Dummer R, Hinke A, Nashan D, Stadler R. Dose-escalation study evaluating pegylated interferon alpha-2a in patients with cutaneous T-cell lymphoma. J Eur Acad Dermatol Venereol 2017; 31:1841-1847. [PMID: 28557110 DOI: 10.1111/jdv.14366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/28/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND This open-label, multicenter, dose-escalation study evaluated the safety, tolerability, and efficacy of subcutaneous pegylated (40 kD) interferon α-2a (PEG-IFN α-2a) in patients with cutaneous T-cell lymphoma (CTCL). PATIENTS AND METHODS PEG-IFN α-2a was administered subcutaneously at 180 (n = 4), 270 (n = 6), or 360 μg (n = 3) once weekly for 12 weeks. Efficacy was assessed by the proportion of patients with complete response (CR) or partial response (PR). RESULTS PEG-IFN α-2a was generally well tolerated, with a moderate number of reductions or withholding of doses because of adverse events (AEs) (25% (n = 1), 66% (n = 4), and 0% (n = 0) in the 180-, 270-, and 360-μg/week groups, respectively). The only dose-limiting toxicity was a grade 3 elevation of liver enzymes in the 270-μg dose group. The most common AEs were fatigue, acute flu-like symptoms, and hepatic toxicity. The major response rate (CR or PR) was 50% in the 180-μg group (CR, 50%; PR, 0%), 83% in the 270-μg group (CR, 67%; PR, 17%), and 66% in the 360-μg group (CR, 33%; PR, 33%). CONCLUSION PEG-IFN α-2a at doses up to 360 μg once weekly was well tolerated in patients with CTCL up to the highest dose group and showed good response rates. Due to their good tolerance even in high doses, they might be an option for patients not tolerating standard IFN-α preparations. However, for this purpose and to evaluate comparability between standard and PEG-IFN larger clinical trials are needed, alone and in combination with oral photochemotherapy (PUVA).
Collapse
Affiliation(s)
- M Schiller
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany.,Dermatological Office Professor Schiller, Coesfeld, Germany
| | - A Tsianakas
- Department of Dermatology, University Hospital of Muenster, Muenster, Germany
| | - W Sterry
- Department of Dermatology, Charité, Berlin, Germany
| | - R Dummer
- Department of Dermatology, University Hospital, Zurich, Switzerland
| | - A Hinke
- WiSP Wissenschaftlicher Service Pharma GmbH, Langenfeld, Germany
| | - D Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - R Stadler
- Department of Dermatology, Johannes Wesling Klinikum Minden, University Hospital of Ruhr University of Bochum, Bochum, Germany
| |
Collapse
|
15
|
Zulueta La Rosa P, Giakoumi S, Beiteke U, Witteler A, Kügler K, Nashan D. Fernmetastasiertes malignes Melanom: Langzeitige aber nicht dauerhafte komplette Remission durch BRAF-Inhibitor. Akt Dermatol 2016. [DOI: 10.1055/s-0042-111546] [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: 10/21/2022]
Affiliation(s)
| | - S. Giakoumi
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| | - U. Beiteke
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| | - A. Witteler
- Klinik für Radiologie und Neuroradiologie, Klinikum Dortmund gGmbH
| | - K. Kügler
- Hautarztpraxis Dr. A. Hirschmüller, Dr. K. Kügler, Dortmund
| | - D. Nashan
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| |
Collapse
|
16
|
Nashan D. Aktuelle Entwicklungen der Hautklinik im Klinikum Dortmund. Akt Dermatol 2016. [DOI: 10.1055/s-0042-110165] [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: 10/21/2022]
Affiliation(s)
- D. Nashan
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| |
Collapse
|
17
|
Dengler S, Oji V, Lücke A, Schindler V, Nashan D, Ständer H. Keratitis-ichthyosis-deafness (KID)-Syndrom – Fallbericht einer seltenen hereditären Ichthyoseform. Akt Dermatol 2016. [DOI: 10.1055/s-0042-108020] [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: 10/21/2022]
Affiliation(s)
- S. Dengler
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| | - V. Oji
- Klinik für Hautkrankheiten – Allgemeine Dermatologie und Venerologie, Universitätsklinikum Münster, Münster
| | - A. Lücke
- Pathologisches Institut, Klinikum Dortmund gGmbH
| | - V. Schindler
- Hautarztpraxis Dr. med. Volkhard Schindler, Arnsberg
| | - D. Nashan
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| | - H. Ständer
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| |
Collapse
|
18
|
Murday S, Malek M, Knop A, Nashan D. Doping im Breitensport – und unliebsame Überraschungen. Akt Dermatol 2016. [DOI: 10.1055/s-0042-109581] [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: 10/21/2022]
Affiliation(s)
- S. Murday
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| | - M. Malek
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| | - A. Knop
- Hautärzte am Markt, Dortmund
| | - D. Nashan
- Klinik für Dermatologie und Allergologie, Klinikum Dortmund gGmbH
| |
Collapse
|
19
|
Eigentler TK, Gutzmer R, Hauschild A, Heinzerling L, Schadendorf D, Nashan D, Hölzle E, Kiecker F, Becker J, Sunderkötter C, Moll I, Richtig E, Pönitzsch I, Pehamberger H, Kaufmann R, Pföhler C, Vogt T, Berking C, Praxmarer M, Garbe C. Adjuvant treatment with pegylated interferon α-2a versus low-dose interferon α-2a in patients with high-risk melanoma: a randomized phase III DeCOG trial. Ann Oncol 2016; 27:1625-32. [PMID: 27287206 DOI: 10.1093/annonc/mdw225] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 04/26/2016] [Accepted: 05/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adjuvant treatment with interferon (IFN)-α-2a improved disease-free survival (DFS) and showed a trend for improving overall survival (OS) in melanoma. This trial was designed to examine whether PEG-IFN is superior to IFN with regard to distant metastasis-free survival (DMFS), DFS and OS. PATIENTS AND METHODS In this multicenter, open-label, prospective randomized phase III trial, patients with resected cutaneous melanoma stage IIA(T3a)-IIIB (AJCC 2002) were randomized to receive PEG-IFN (180 μg subcutaneously 1×/week; 24 months) or IFN α-2a (3MIU subcutaneously 3×/week; 24 months). Randomization was stratified for stage, number of metastatic nodes, age and previous IFN treatment. The primary end point was DMFS; secondary end points were OS, DFS, quality of life (QoL) and tolerability. RESULTS A total of 909 patients were enrolled (451 PEG-IFN versus 458 IFN). Neither 5-year DMFS [PEG-IFN 61.0% versus IFN 67.3%; hazard ratio (HR) 1.16, P = 0.21] nor 5-year OS (PEG-IFN 73.2% versus IFN 75.2%; HR 1.05, P = 0.70) nor 5-year DFS (PEG-IFN 57.3% versus IFN 60.9%; HR 1.09, P = 0.40) showed significant differences. Subgroup analyses in patients ± ulcerated primaries and of different tumor stages did not find differences in DMFS, OS or DFS between the treatment groups. One hundred and eighteen patients (26.2%) in the PEG-IFN and 61 patients (13.3%) in the IFN population did not receive the full dosage and length of treatment due to adverse events (P < 0.001). Leukopenia and elevation of liver enzymes were more common in the PEG-IFN arm (56% versus 23.5% LCP; 19.1% versus 9.4% AST; 33.0% versus 16.5% ALT). QoL was identical for nearly all domains. CONCLUSION PEG-IFN did not improve the outcome over IFN. A higher percentage of patients under PEG-IFN discontinued treatment due to toxicity. CLINICAL TRIALSGOV IDENTIFIER NCT00204529.
Collapse
Affiliation(s)
- T K Eigentler
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
| | - R Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Hannover
| | - A Hauschild
- Department of Dermatology, University Hospital Kiel, Kiel
| | - L Heinzerling
- Department of Dermatology, University Hospital Erlangen, Erlangen
| | - D Schadendorf
- Department of Dermatology, University Essen-Duisburg, Essen
| | - D Nashan
- Department of Dermatology, Hospital Dortmund, Dortmund
| | - E Hölzle
- Department of Dermatology, Hospital Oldenburg, Oldenburg
| | - F Kiecker
- Department of Dermatology, Charité Berlin, Berlin
| | - J Becker
- Department of Dermatology, University Essen-Duisburg, Essen
| | - C Sunderkötter
- Department of Dermatology, University Hospital Münster, Münster
| | - I Moll
- Department of Dermatology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E Richtig
- Department of Dermatology, University Hospital Graz, Graz, Austria
| | - I Pönitzsch
- Department of Dermatology, University Hospital Leipzig, Leipzig, Germany
| | - H Pehamberger
- Department of Dermatology, AKH Wien, University Hospital Vienna, Vienna, Austria
| | - R Kaufmann
- Department of Dermatology, University Hospital Frankfurt am Main, Frankfurt/Main
| | - C Pföhler
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - T Vogt
- Department of Dermatology, Saarland University Medical School, Homburg/Saar
| | - C Berking
- Department of Dermatology and Allergy, University Hospital of Munich, Munich, Germany
| | | | - C Garbe
- Department of Dermatology, Center for Dermatooncology, University Medical Center Tübingen, Tübingen
| | | |
Collapse
|
20
|
Livingstone E, Eigentler TK, Windemuth-Kieselbach C, Hauschild A, Rompel R, Trefzer U, Nashan D, Kilian K, Debus D, Kähler KC, Mauerer A, Möllenhoff K, Dippel E, Schadendorf D. Actual practice of melanoma follow-up and treatment in Germany: results of a prospective, longitudinal cohort study. Br J Dermatol 2015; 172:1646-1650. [PMID: 25495472 DOI: 10.1111/bjd.13612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E Livingstone
- Department of Dermatology, University Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - T K Eigentler
- Department of Dermatology, University Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Germany
| | | | - A Hauschild
- Department of Dermatology, University Hopsital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany
| | - R Rompel
- Department of Dermatology Kassel, Clinical Centre Kassel, Mönchebergstr. 41, 34125, Kassel, Germany
| | - U Trefzer
- Department of Dermatology, Charité Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - D Nashan
- Department of Dermatology, University Freiburg, Hauptstr. 7, 79104, Freiburg, Germany.,Department of Dermatology, Clinical Centre Mitte, Beurhausstraße 40, 44137, Dortmund, Germany
| | - K Kilian
- Department of Dermatology, Ludwig-Maximilians University Munich, Frauenlobstrasse 9-11, 80337, München, Germany
| | - D Debus
- Department of Dermatology, University Nürnberg, Prof.-Ernst-Nathan-Straße 1, 90419, Nürnberg, Germany
| | - K C Kähler
- Department of Dermatology, University Hopsital Schleswig-Holstein, Campus Kiel, Schittenhelmstr. 7, 24105, Kiel, Germany
| | - A Mauerer
- Department of Dermatology, University Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - K Möllenhoff
- Department of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - E Dippel
- Department of Dermatology, Clinical Centre Ludwigshafen, Bremserstr. 79, 67073, Ludwigshafen, Germany
| | - D Schadendorf
- Department of Dermatology, University Essen, Hufelandstr. 55, 45122, Essen, Germany
| |
Collapse
|
21
|
Abstract
Offering psycho-oncological care is an essential, guideline-based component of comprehensive care in skin cancer centers. This paper describes the development, implementation and utilization of a specific psycho-oncologic care concept for melanoma patients in the University Dermatology Clinic Freiburg. Based on the stepped-care principle, the concept is composed of interdisciplinary group sessions for patients and their relatives offered every 4-6 weeks addressing medical and psycho-oncological topics related to treatment of malignant melanoma and then individual psycho-oncological sessions modified for the patient's treatment needs. Between April 2010 and July 2012, 67 % of the melanoma patients treated in the Freiburg Skin Cancer Center were reached by the program. A stepped-care concept with a routinely initiated first contact and low-threshold patient education group sessions is a reliable approach to reach patients and inform them about further psycho-oncological care. The advantages justify the allocation of resources and the approach proved successful for routine clinical practice.
Collapse
Affiliation(s)
- K Albrecht
- Klinik für Dermatologie und Venerologie, Hauttumorzentrum Freiburg, Universitätsklinikum Freiburg, Hauptstr. 7, 79104, Freiburg, Deutschland,
| | | | | | | | | |
Collapse
|
22
|
Reich-Schupke S, Alm J, Altmeyer P, Bachter D, Bayerl C, Beissert S, Bieber T, Böhmer J, Dill D, Dippel E, Dücker P, Effendy I, El Gammal S, Elsner P, Enk A, Feldmann-Böddeker I, Frank H, Gehring W, Gieler U, Goebeler M, Görge T, Gollnick H, Grabbe S, Gross G, Gudat W, Happ A, Herbst R, Hermes B, Hoff NP, John SM, Jungelhülsing M, Jünger M, Kaatz M, Kapp A, Kaufmann R, Klode J, Knaber K, König A, Krieg T, Kohl P, Kowalzick L, Lehmann P, Löffler H, Maschke J, Marsch W, Mechtel D, Mohr P, Moll I, Müller M, Nashan D, Ockenfels HM, Peter RU, Pillekamp H, Rompel R, Ruzicka T, Salfeld K, Sander C, Schaller J, Scharffetter-Kochanek K, Schuler G, Schulze HJ, Schwarz T, Splieth B, Stege H, Stolz W, Strölin A, Tran H, Tronnier M, Ulrich J, Vogt T, Wagner G, Welzel J, Willgeroth T, Wollina U, Zillikens D, Zouboulis CC, Zuberbier T, Zutt M, Stücker M. [Phlebology in German departments of dermatology. An analysis on behalf of the German Society of Phlebology]. Hautarzt 2013; 64:685-94. [PMID: 24022632 DOI: 10.1007/s00105-013-2623-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Phlebologic diseases have become extremely common and have major socio-economic impact. However, the percentage of dermatologists working in phlebology appears to be decreasing according to the data of the German Society of Phlebology (DGP). METHODS To investigate the reasons for this development, we--on behalf of the DGP--sent a questionnaire to 120 German Departments of Dermatology in autumn 2012. RESULTS In 76 returned questionnaires, the number of physicians with additional fellowship training in phlebology averaged 1.5; the average number of those who fulfill the criteria for training fellows in phlebology was 0.9. In 71.1 % of the departments there was a phlebologist. A special phlebologic outpatient clinic existed in 73.7 % of the departments. Sonography with Doppler (89.5 %) and duplex (86.8 %) was used as the most frequent diagnostic tool. For therapy, compression (94.7 %), sclerotherapy (liquid 78.9 %, foam 63.2 %, catheter 18.4 %), endoluminal thermic procedures (radio wave 28.9 %, laser 17.1 %) and surgery (especially crossectomy and stripping 67.1 %, phlebectomy of tributaries 75 %) were used. The average number of treatments was very heterogenous in the different departments. CONCLUSIONS Phlebology definitely plays an important role in dermatology. Most departments fulfill the formal criteria for the license to conduct advanced training in phlebology. A wide spectrum of phlebological diagnostic and therapeutic procedures is available.
Collapse
Affiliation(s)
- S Reich-Schupke
- Klinik für Dermatologie, Venerologie und Allergologie, Venenzentrum der Dermatologischen und Gefäßchirurgischen Kliniken, Ruhr-Universität Bochum, Hiltroper Landwehr 11-13, 44805, Bochum, Deutschland,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Felcht M, Heck M, Weiss C, Becker JC, Dippel E, Müller CSL, Nashan D, Sachse MM, Nicolay JP, Booken N, Goerdt S, Klemke CD. Expression of the T-cell regulatory marker FOXP3 in primary cutaneous large B-cell lymphoma tumour cells. Br J Dermatol 2012; 167:348-58. [PMID: 22512270 DOI: 10.1111/j.1365-2133.2012.10987.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Primary cutaneous B-cell lymphomas (PCBCL) are subdivided into the aggressive form, primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT) and two subtypes of indolent behaviour (primary cutaneous follicle centre lymphoma and primary cutaneous marginal zone B-cell lymphoma). The difference in clinical behaviour can be explained by the tumour cell itself, or the lymphoma microenvironment including the antitumour immune response. OBJECTIVES To investigate the presence of regulatory T cells (Treg), CD4+CD25+FOXP3+, in the microenvironment of PCBCL in correlation with clinical outcome. METHODS Tumour specimens of 55 consecutive cases of PCBCL were blinded and analysed for FOXP3, CD4 and CD25 expression by immunohistochemistry. Confocal images were taken with a Leica SP5. Statistical analyses were performed to determine significance. The test was considered significant when P<0.05. RESULTS The CD4 and FOXP3 expression as well as the CD4/FOXP3 ratio were significantly increased in PCBCL of indolent behaviour in contrast to PCLBCL, LT (P=0.0002 for CD4, P<0.0001 for FOXP3 and P=0.0345 for FOXP3/CD4 ratio). CD25 expression did not differ in the three groups (P=0.9414). Within the group of patients with PCLBCL, LT we identified a subgroup with FOXP3+ tumour cells as demonstrated by CD20/FOXP3 double stainings. Patients with FOXP3+ PCLBCL, LT tumour cells showed a better prognosis on Kaplan-Meier analysis. CONCLUSION High numbers of Treg in the lymphoma microenvironment correlate with a better prognosis in PCBCL. In PCLBCL, LT the presence of FOXP3+ tumour cells is beneficial for prognosis suggesting that FOXP3 expression of PCLBCL, LT tumour cells might serve as a tumour suppressor.
Collapse
Affiliation(s)
- M Felcht
- Working Group of Cutaneous Lymphomas of the Arbeitsgemeinschaft für Dermatologische Forschung (ADF), Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Pflugfelder A, Welter AK, Leiter U, Weide B, Held L, Eigentler TK, Dirschka T, Stockfleth E, Nashan D, Garbe C. Open label randomized study comparing 3 months vs. 6 months treatment of actinic keratoses with 3% diclofenac in 2.5% hyaluronic acid gel: a trial of the German Dermatologic Cooperative Oncology Group. J Eur Acad Dermatol Venereol 2011; 26:48-53. [PMID: 21414035 DOI: 10.1111/j.1468-3083.2011.04005.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Actinic keratoses (AK) are carcinomata in situ with the potential to develop into invasive carcinoma. Several studies have demonstrated that 3% diclofenac in 2.5% hyaluronic acid gel (HA) is effective and well tolerated in the treatment of AK. To date there are no large randomized multicentre trials with treatment durations longer than 90 days and histopathological control of treatment outcome. OBJECTIVE The aim of this study was to investigate whether a prolonged treatment with diclofenac in HA of 6 vs. 3 months adds to the efficacy in treatment for AK and if this will influence tolerability and quality of life (QoL). METHODS This was a multicentre, randomized open-label study in which 418 patients with mild to moderate AKs were randomized into two treatment groups. Group A received diclofenac in HA for 3 months and group B for 6 months. Treatment efficacy was assessed by size measurement and a final biopsy of a defined marker AK. Quality of life was measured using the Dermatology Life Quality Index questionnaire. RESULTS Clinical complete clearance was observed in 40% in group A and in 45% in group B (P = 0.38). Histopathological clearance was confirmed in 30% in group A and in 40% in group B (P = 0.16). Treatment was well tolerated and QoL was significantly improved after treatment in both treatment groups. CONCLUSION Treatment with diclofenac in HA is effective and well tolerated during a treatment period of 3 months as well as 6 months. Prolongation of the treatment duration did not significantly affect treatment outcome.
Collapse
Affiliation(s)
- A Pflugfelder
- Centre for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Berlin, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Hüsken A, Tsianakas A, Hensen P, Nashan D, Loquai C, Beissert S, Luger T, Sunderkötter C, Schiller M. Comparison of pegylated interferon α-2b plus psoralen PUVA versus standard interferon α-2a plus PUVA in patients with cutaneous T-cell lymphoma. J Eur Acad Dermatol Venereol 2011; 26:71-8. [DOI: 10.1111/j.1468-3083.2011.04011.x] [Citation(s) in RCA: 23] [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: 11/28/2022]
|
26
|
Nashan D, Meiss F, Braun-Falco M, Hofbauer M, Hofmann S. Multiple target-like pigmented nevi: an inverse halo-nevus phenomenon. J Eur Acad Dermatol Venereol 2010; 24:104-5. [PMID: 20050292 DOI: 10.1111/j.1468-3083.2009.03359.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
27
|
Abstract
Cheilitis granulomatosa (CG) can be associated with many different disorders. A 37-year-old male patient presented with CG as an early manifestation of Crohn's disease. Patients suffering from CG need a thorough diagnostic work-up for associated or underlying diseases. Clinical follow-up examinations are necessary as CG can precede the causative diseases.
Collapse
Affiliation(s)
- G Rehor
- Universitäts-Hautklinik, Klinikum der Albert-Ludwigs-Universität Freiburg, Hauptstr. 7, 79104, Freiburg i. Br., Deutschland
| | | | | | | |
Collapse
|
28
|
Sendi-Naderi A, Lüdecke HJ, Unger S, Kern JS, Wolff G, Bruckner-Tuderman L, Nashan D. A familial case of tricho-rhino-phalangeal syndrome type III with a novel missense mutation in exon 6 of the TRPS1 gene. J Eur Acad Dermatol Venereol 2009; 24:612-4. [PMID: 19758263 DOI: 10.1111/j.1468-3083.2009.03444.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Hofmann SC, Nashan D, Bruckner-Tuderman L. Petechiae on the fingertips as presenting symptom of dermatitis herpetiformis Duhring. J Eur Acad Dermatol Venereol 2009; 23:732-3. [DOI: 10.1111/j.1468-3083.2009.03200.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
|
31
|
Meiss F, Technau K, Nashan D. A rapidly changing scar 18 months after melanoma excision. J Eur Acad Dermatol Venereol 2009; 23:969-71. [PMID: 19207669 DOI: 10.1111/j.1468-3083.2008.03076.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
32
|
Loquai C, Schlüter B, Klötgen H, Luger T, Grabbe S, Nashan D. Autoimmuninduktion durch pegyliertes Interferon-alpha-2b in Korrelation zur Überlebenszeit bei Mittel- und Hochrisikomelanompatienten. Akt Dermatol 2008. [DOI: 10.1055/s-2007-995760] [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: 10/22/2022]
|
33
|
Nashan D, Müller ML, Grabbe S, Wustlich S, Enk A. Systemic therapy of disseminated malignant melanoma: an evidence-based overview of the state-of-the-art in daily routine. J Eur Acad Dermatol Venereol 2007; 21:1305-18. [DOI: 10.1111/j.1468-3083.2007.02475.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
34
|
Volksbeck SIL, Nashan D, Bruckner-Tuderman L, Braun-Falco M. Localized sclerosis of the scalp (alopecia porphyrinica) as predominant presentation of porphyria cutanea tarda. J Eur Acad Dermatol Venereol 2007; 21:1125-7. [PMID: 17714148 DOI: 10.1111/j.1468-3083.2006.02113.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Volz A, Metze D, Böhm M, Bruckner-Tuderman L, Nashan D. Idiopathic eruptive macular pigmentation in a 7-year-old girl: case report and discussion of differences from erythema dyschromicum perstans. Br J Dermatol 2007; 157:839-40. [PMID: 17714566 DOI: 10.1111/j.1365-2133.2007.08127.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
36
|
Abstract
Mycosis fungoides (MF), a low-grade lymphoproliferative disorder, is the most common type of cutaneous T-cell lymphoma. Typically, neoplastic T cells localize to the skin and produce patches, plaques, tumours or erythroderma. Diagnosis of MF can be difficult due to highly variable presentations and the sometimes nonspecific nature of histological findings. Molecular biology has improved the diagnostic accuracy. Nevertheless, clinical experience is of substantial importance as MF can resemble a wide variety of skin diseases. We performed a literature review and found that MF can mimic >50 different clinical entities. We present a structured framework of clinical variations of classical, unusual and distinct forms of MF. Distinct subforms such as ichthyotic MF, adnexotropic (including syringotropic and folliculotropic) MF, MF with follicular mucinosis, granulomatous MF with granulomatous slack skin and papuloerythroderma of Ofuji are delineated in more detail.
Collapse
Affiliation(s)
- D Nashan
- Department of Dermatology, University of Freiburg, Hautstrasse 7, 79104 Freiburg, Germany.
| | | | | | | | | |
Collapse
|
37
|
Kurschat P, Eming S, Nashan D, Krieg T, Mauch C. Early increase in serum levels of the angiogenesis-inhibitor endostatin and of basic fibroblast growth factor in melanoma patients during disease progression. Br J Dermatol 2007; 156:653-8. [PMID: 17263813 DOI: 10.1111/j.1365-2133.2006.07724.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Increased serum levels of angiogenesis-related factors such as endostatin, vascular endothelial cell growth factor (VEGF) or basic fibroblast growth factor (bFGF) have been demonstrated for a variety of solid and nonsolid tumours. Therefore, these factors have been suggested as diagnostic and in some studies as prognostic tumour markers. OBJECTIVES The purpose of the present study was to investigate a possible correlation of endostatin, VEGF or bFGF serum levels with disease progression in melanoma. Especially, we compared these factors to the established melanoma marker S-100 B, which increases in advanced disease but often fails to indicate early metastatic spread to regional lymph nodes. PATIENTS AND METHODS Sera from 197 melanoma patients and 35 healthy controls were measured by enzyme-linked immunosorbent assay; 72 patients had primary tumours (American Joint Committee on Cancer stages I and II), 55 had regional lymph node metastasis (stage III) and 70 patients had distant organ metastasis (stage IV). RESULTS Endostatin, VEGF and bFGF serum levels were significantly elevated in stage IV disease, compared with the control group. In stage III, endostatin and bFGF, but not VEGF or S-100 B, were significantly increased. However, follow-up of this patient group did not show a correlation with the future clinical course including time until progression or overall survival, arguing against a role of endostatin, VEGF or bFGF as prognostic markers. CONCLUSIONS These data indicate that endostatin or bFGF might be useful as diagnostic markers for the early detection of locoregional metastasis.
Collapse
Affiliation(s)
- P Kurschat
- Department of Dermatology and Center for Molecular Medicine CMMC, University of Cologne, Josef-Stelzmann-Str. 9, 50924 Cologne, Germany
| | | | | | | | | |
Collapse
|
38
|
Volz A, Pfister-Wartha A, Bruckner-Tuderman L, Nashan D, Radny P. Mastix, a known herbal allergen, as causative agent in occupation-related dermatitis. Contact Dermatitis 2006; 54:346-7. [PMID: 16787460 DOI: 10.1111/j.0105-1873.2006.0645d.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A Volz
- Department of Dermatology, University of Freiburg, D-79104 Freiburg, Germany.
| | | | | | | | | |
Collapse
|
39
|
Nashan D, Radny P, Kösters NC, Nashan B. [Skin tumors in organ-transplant recipients]. Hautarzt 2006; 58:48-50, 52-3. [PMID: 16758224 DOI: 10.1007/s00105-006-1159-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Skin cancers are a significant medical problem for organ-transplant recipients. Squamous cell carcinoma and basal cell carcinoma are most common tumors. An increasing incidence of melanoma, Kaposi sarcoma, Merkel cell carcinoma, as well as uncommon skin malignancies, is also seen. Predisposing factors include cumulative sun exposure, cumulative immunosuppression, age, gender, skin type, virus detection and genetic alterations. Skin tumors grow rapidly and their number continues to increase in the years following transplantation. Large numbers of tumors, aggressive courses and appearance in young patients are other characteristics of these skin tumors. More general awareness of the need for preventive measures and regular dermatological examinations is desirable. In addition standardized registries are needed to assure the comparability of data, to better correlate immunosuppression with skin tumors and to plan therapeutic studies.
Collapse
Affiliation(s)
- D Nashan
- Universitäts-Hautklinik, Hauptstrasse 7, 70104, Freiburg, Germany.
| | | | | | | |
Collapse
|
40
|
Nashan D, Haufs MG, Kleinheinz J, Al-Dandashi C, Bruckner-Tuderman L. Prolonged Untreated and Treated Course of a Malignant Melanoma. Dermatology 2006; 212:93-5. [PMID: 16319486 DOI: 10.1159/000089034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
41
|
Abstract
Confetti leucoderma can occur in a variety of unrelated skin disorders and is often a diagnostic challenge. We describe a 33-year-old man with a history of mycosis fungoides and vitiligo. He developed disseminated 1-2-mm round-shaped leucodermic lesions 6 months after psoralen photochemotherapy and 12 months after systemic therapy with interferon. The skin lesions had a discrete hyperkeratotic scale. Multiple skin biopsies and immunohistochemical studies showed lamellar orthohyperkeratosis, papillomatosis, hypomelanotic keratinocytes but a normal number of melanocytes. Langerhans cells, in contrast, were reduced in lesional skin. Electron microscopy disclosed only a few type I and II melanosomes in lesional melanocytes, while keratinocytes were largely devoid of any melanosomes. This constellation of clinical, immunohistochemical and ultrastructural findings has not been reported before and distinguishes our case from leucoderma punctatum, idiopathic guttate hypomelanosis and disseminated hypopigmented keratoses. We suggest that the skin lesions observed in our patient represent an unusual response to ultraviolet damage to melanocytes followed by reactive epidermal hyperkeratosis.
Collapse
Affiliation(s)
- C Loquai
- Department of Dermatology, University of Münster, Von Esmarch-Str. 58, D-48149 Münster, Germany
| | | | | | | | | |
Collapse
|
42
|
Loquai C, Schlüter B, Luger TA, Grabbe S, Nashan D. Schilddrüsendysfunktion und Schilddrüsenantikörper unter adjuvanter Therapie mit pegyliertem Interferon alpha-2b bei Hochrisiko-Melanompatienten im Stadium Ib-IIIc. Akt Dermatol 2004. [DOI: 10.1055/s-2004-832531] [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]
|
43
|
Loquai C, Luger TA, Grabbe S, Nashan D. Nebenwirkungsprofil von pegyliertem Interferon alpha-2a unter adjuvanter Therapie bei Hochrisiko-Melanompatienten im Stadium IIa-IV. Akt Dermatol 2004. [DOI: 10.1055/s-2004-832530] [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]
|
44
|
Loquai C, Nashan D, Metze D, Beiteke U, Rüping KW, Luger TA, Grabbe S. Imiquimod, pegyliertes Interferon-?-2b und Interleukin-2 in der Behandlung kutaner Melanommetastasen. Hautarzt 2004; 55:176-81. [PMID: 14968329 DOI: 10.1007/s00105-003-0625-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The immune system plays an important role in the defense against malignant melanoma. Interferon-alpha (IFN-alpha) and interleukin-2 (IL-2) are therapeutically used for unspecific stimulation of the immune system. After intralesional injections of these cytokines into cutaneous melanoma metastases, regression has been observed. In view of its immunomodulating effects, imiquimod appears as an additional promising therapeutic option for treatment of malignant tumors. In a case report, we present combined therapy with intralesional IL-2, pegylated IFN-alpha-2b and topical imiquimod 5% cream for disseminated cutaneous metastatic malignant melanoma stage IIIa. This therapy achieved an almost complete remission. In a treatment period of eight months, side effects remained tolerable. Histologically, both fibrosis and inflammation were found in the regressing lesions. After the end of therapy, no disease progression occurred during 11 months follow-up.
Collapse
Affiliation(s)
- C Loquai
- Klinik und Poliklinik für Hautkrankheiten, Universitätsklinikum Münster.
| | | | | | | | | | | | | |
Collapse
|
45
|
Bohmeyer J, Stadler R, Kremer A, Nashan D, Muche M, Gellrich S, Luger T, Sterry W. Bexarotene - an alternative therapy for progressive cutaneous T-cell lymphoma? First experiences. J Dtsch Dermatol Ges 2003; 1:785-9. [PMID: 16281814 DOI: 10.1046/j.1439-0353.2003.03711.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A standard therapy for advanced cutaneous T-cell lymphomas has not yet been defined. Bexarotene is a new retinoid x receptor-specific retinoid that has been approved for systemic second-line therapy for cutaneous T-cell lymphomas in the USA and Europe. In order to evaluate the efficacy of bexarotene in cutaneous T-cell lymphomas, a pilot trial was initiated. PATIENTS AND METHODS In a pilot project 10 patients with advanced cutaneous T-cell lymphomas, who had received a variety of previous treatments, were treated with bexarotene at the departments of dermatology in Münster, Minden and Charité Berlin, Germany. The patients received bexarotene at a dose of 300 mg/m2 body surface daily. According to the percentage of tumour reduction and affected body surface, the response rates were divided in complete and partial remission, stable disease and progressive disease. Laboratory parameters i.e. cholesterol, triglycerides transaminases, T3, T4, and TSH were screened regularly. RESULTS In 2 patients a short partial remission was achieved; however, after a few weeks progression followed. In 4 patients a lasting stabilisation was obtained. The other 4 patients showed a progressive disease during therapy. 6 patients developed hypertriglyceridemia with levels up to 2000 mg/dl; therapy had to be suspended in 3 patients because of these adverse drug events. CONCLUSION Weighing benefits and risks, bexarotene can at present not be recommended as standard therapy in the treatment of patients with progressive cutaneous lymphomas.
Collapse
Affiliation(s)
- J Bohmeyer
- Department of Dermatology, Medical Centre Minden
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Hoffmann K, Gambichler T, Rick A, Kreutz M, Anschuetz M, Grünendick T, Orlikov A, Gehlen S, Perotti R, Andreassi L, Newton Bishop J, Césarini JP, Fischer T, Frosch PJ, Lindskov R, Mackie R, Nashan D, Sommer A, Neumann M, Ortonne JP, Bahadoran P, Penas PF, Zoras U, Altmeyer P. Diagnostic and neural analysis of skin cancer (DANAOS). A multicentre study for collection and computer-aided analysis of data from pigmented skin lesions using digital dermoscopy. Br J Dermatol 2003; 149:801-9. [PMID: 14616373 DOI: 10.1046/j.1365-2133.2003.05547.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Early detection of melanomas by means of diverse screening campaigns is an important step towards a reduction in mortality. Computer-aided analysis of digital images obtained by dermoscopy has been reported to be an accurate, practical and time-saving tool for the evaluation of pigmented skin lesions (PSLs). A prototype for the computer-aided diagnosis of PSLs using artificial neural networks (NNs) has recently been developed: diagnostic and neural analysis of skin cancer (DANAOS). OBJECTIVES To demonstrate the accuracy of PSL diagnosis by the DANAOS expert system, a multicentre study on a diverse multinational population was conducted. METHODS A calibrated camera system was developed and used to collect images of PSLs in a multicentre study in 13 dermatology centres in nine European countries. The dataset was used to train an NN expert system for the computer-aided diagnosis of melanoma. We analysed different aspects of the data collection and its influence on the performance of the expert system. The NN expert system was trained with a dataset of 2218 dermoscopic images of PSLs. RESULTS The resulting expert system showed a performance similar to that of dermatologists as published in the literature. The performance depended on the size and quality of the database and its selection. CONCLUSIONS The need for a large database, the usefulness of multicentre data collection, as well as the benefit of a representative collection of cases from clinical practice, were demonstrated in this trial. Images that were difficult to classify using the NN expert system were not identical to those found difficult to classify by clinicians. We suggest therefore that the combination of clinician and computer may potentially increase the accuracy of PSL diagnosis. This may result in improved detection of melanoma and a reduction in unnecessary excisions.
Collapse
Affiliation(s)
- K Hoffmann
- Department of Dermatology, Ruhr-University Bochum, Gudrunstrasse 56, D-44791 Bochum, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Löffler M, Weckesser M, Franzius C, Nashan D, Schober O. Malignant melanoma and (18)F-FDG-PET: Should the whole body scan include the legs? Nuklearmedizin 2003; 42:167-72. [PMID: 12937695] [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: 03/04/2023]
Abstract
AIM (18)F-FDG-PET (FDG-PET) is established in staging and follow-up of malignant melanoma. The legs are affected in 10-40% at time of diagnosis even if the primary is at the arms and torso. Imaging including the legs may detect distant manifestations but increases duration of the scan by approximately 30 min. We intended to disclose the diagnostic benefit of scanning the legs and to evaluate the therapeutic benefit resulting. PATIENTS, METHODS In this retrospective analyse 213 consecutive PET studies of 153 patients with suspected or recent malignant melanoma were re-evaluated for metastatic spread by a blinded investigator. Histopathological follow-up was assessed for confirmation. RESULTS Suspicious findings at the legs were depicted in 53 patients on 76 occasions. 38/53 showed pathologic uptake in the torso as well. In 15/53 patients it was restricted to the legs. One of them had a hitherto unknown, clinically relevant finding that was not apparent in palpation and inspection. In 6 other patients with primary location at the legs a validation of the positive PET findings was not possible up to now. CONCLUSION Metastases and local recurrence of malignant melanoma at the legs were found in 41% of women and 27% of men. However, a long scan does not yield relevant additional data. We found isolated new manifestations at the legs in only 1/153 patients. We recommend performing a long scan only in patients with previous melanoma manifestations restricted to the legs. In all other cases a short scan of the torso and proximal thighs is sufficient. This allows a higher number of PET-scans without loss of diagnostic power and a shorter examination time.
Collapse
Affiliation(s)
- M Löffler
- Department of Nuclear Medicine, Münster University, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
| | | | | | | | | |
Collapse
|
48
|
Hoffmeier A, Wagner T, Nashan D, Rukosujew A, Erren M, Schmid C, Wirtz SP, Scheld HH. [Malignomas following heart transplantation]. Z Kardiol 2002; 91:1013-23. [PMID: 12490991 DOI: 10.1007/s00392-002-0888-x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Up to 30% of patients with an organ transplantation develop precancerous lesions and malignant tumors, especially of the skin. All 241 patients who underwent heart transplantation from 1990 to 2000 were evaluated with regard to the development of neoplasias. Those alive in September 1999 were referred for a standardized dermatological exam (n=156) which detected malignancy in 28 patients being transplanted for 4.98 years on average. The skin was the organ most frequently involved (64%, n=18). 18% (n=5) of tumors were found in the urinary and genital tract, 7% (n=2) each in the respiratory and gastrointestinal tract, and 4% (n=1 ) in the breasts. The average age of patients who developed tumors was significantly higher as compared to the overall mean age (59.5+/-5 vs 49.8+/-14.7 years, p=0.00027). There was no correlation between development of malignancy and HLA matching, immunosuppressive drugs used, dosage and serum levels of immunosuppressive medication, and episodes of transplant rejection. Our study shows that the risk to develop tumors is at least doubled after heart transplantation. Due to the high incidence of skin tumors, transplant patients should undergo dermatological examinations on a regular basis.
Collapse
Affiliation(s)
- A Hoffmeier
- Klinik und Poliklinik für Thorax-, Herz- und Gefässchirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Str. 33, 48149 Münster, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Assmann K, Nashan D, Grabbe S, Luger TA, Metze D. [Persistent inflammatory reaction at the injection site of Il-2 with lymphoma-like inflammatory infiltrates]. Hautarzt 2002; 53:554-7. [PMID: 12221472 DOI: 10.1007/s00105-001-0305-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Interleukin-2 (Il-2) is widely used for treatment of carcinomas, leukemia, and melanoma. Adverse drug effects of Il-2 include various systemic and generalized cutaneous drug reactions. In the following we report on a persistent inflammatory reaction at the injection site of Il-2. A patient received chemoimmuno-therapy for treatment of metastasizing melanoma, including subcutaneous application of recombinant interleukin-2 (Proleukin((R))). Within a few days reddish nodules developed at the injection sites that persisted after cessation of Il-2 injections for two years until final lethal outcome. Histologic examination revealed a lobular panniculitis expressing atypical lymphocytes and multinucleated histiocytes.
Collapse
Affiliation(s)
- K Assmann
- Universitäts-Hautklinik Münster, Germany.
| | | | | | | | | |
Collapse
|
50
|
Abstract
Various therapeutic options using cytokines have been described in the treatment of melanoma, T cell lymphoma, B cell lymphoma, squamous cell carcinoma, basal cell carcinoma and Merkel cell carcinoma. The treatment regimens include cytokine substitution, cytokine induction, cytokine transfection and therapeutic cytokine constructs. In the adjuvant treatment of melanomas, IFN-alpha has become well established. Statistical evaluations of different adjuvant trials show that a significant prolongation of recurrence-free intervals can be achieved. IL-2 has a role in the therapy of advanced melanomas as well as in vaccination strategies. Further possible therapeutic immune modulations, which have been evaluated in experimental approaches and pilot studies, include treatment with IL-4, IL-7 and GM-CSF. Treatment with IL-12 promises to open new perspectives. A well established regimen in the treatment of T cell lymphoma stages Ia-IIb is the combination of PUVA and IFN-alpha. In vitro data also indicate an important (patho)physiological role for IL-12, so that this agent has been tested in phase I studies. IL-2, IFN-gamma, and the fused cytokine-toxin molecules DAB389IL-2 offer further therapeutic alternatives. B cell lymphomas are treated with antibody-IL-2 fusion proteins. Advanced or inoperable squamous cell carcinoma and basal cell carcinoma may be treated with local IFN-alpha injections. IFN-alpha or TNF-alpha may be considered for the treatment of recurrent or advanced Merkel cell carcinoma. In dermatological oncology cytokine treatment focuses on melanome an T cell lymphome. Cytokine application is mainly an integral part of multimodal regimens.
Collapse
Affiliation(s)
- D Nashan
- Universitäts-Hautklinik Münster und Ludwig Boltzmann Institut für Zellbiologie und Immunbiologie der Haut
| | | |
Collapse
|