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Alfieri S, Romanò R, Marceglia S, De Giorgi V, Peris K, Sollena P, Piccerillo A, Moro R, Gualdi G, Ascierto PA, Palla M, Paone M, Eibenschutz L, Spagnolo F, Queirolo P, Filippini DM, Cavalieri S, Resteghini C, Bergamini C, Manocchio A, Licitra L, Bossi P. Hedgehog Inhibitors Beyond Clinical Complete Response in Basal Cell Carcinoma: Should I Stop or Should I Go? Oncologist 2024; 29:e699-e707. [PMID: 38127280 PMCID: PMC11067794 DOI: 10.1093/oncolo/oyad319] [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: 06/10/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION In advanced basal cell carcinoma (BCC), the issue of whether Hedgehog inhibitors (HHIs) should be stopped or not after clinical complete response (cCR) achievement remains an unmet clinical need. MATERIALS AND METHODS We conducted a retrospective, multicenter study across 7 Italian dermato-oncology units including patients with BCC who continued vismodegib after cCR between 2012 and 2019. We assessed the relationship between the duration of vismodegib intake (days to cCR [DTCR], days to stop after cCR [DTS], total treatment days [TTD]), and disease-free survival (DFS). Reasons to stop vismodegib were (R1) toxicity and (R2) disease recurrence. The relationship between DTCR, DTS, TTD, and DFS in the whole population and in R1 subgroup was assessed by Pearson's correlation coefficient (P < .05) and Bayesian statistics (BF10). RESULTS Sixty-eight BCC patients with a median (m) age of 75.5 years (39-100) were included. Most patients were male (N = 43, 63%), without Gorlin syndrome (N = 56, 82%) and with head and neck area as primary site (N = 51, 75%). After cCR, out of 68 patients, 90% (N = 61/68) discontinued vismodegib: 82% (N = 50/61) due to toxicity (R1), and 18% (N = 11/61) due to recurrence (R2). Conversely, 10% (N = 7/68) continued vismodegib until last follow-up. In the whole population (N = 68), cCR was achieved with a mDTCR of 180.50 days. DFS showed a significant correlation with DTS (P < .01, BF10 = 39.2) and TTD (P < .01, BF10 = 35566), while it was not correlated to DTCR (BF10 < 0.1). The analysis of R1 subgroup (N = 50) confirmed these results. DFS correlated with DTS in all recurrent patients (N = 38, r = 0.44, P < .01) and in the recurrent patients who stopped vismodegib for toxicity (N = 26, r = 0.665, P < .01). DFS was longer when vismodegib was maintained for >2 months after cCR (mDFS > 2 months, N = 54 vs. ≤ 2 months, N = 14: 470 vs. 175 d, P < .01). CONCLUSIONS Our retrospective results suggest that HHIs should be continued after cCR to improve DFS in BCC.
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Affiliation(s)
- Salvatore Alfieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Rebecca Romanò
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, Firenze, Italy
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A Gemelli - IRCCS, Roma, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Pietro Sollena
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A Gemelli - IRCCS, Roma, Italy
| | - Alfredo Piccerillo
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A Gemelli - IRCCS, Roma, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Ruggero Moro
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Martir, Valencia, Spain
| | - Giulio Gualdi
- Dermatologic Clinic, Department of Medicine and Aging Science, Università G d’Annunzio, Chieti-Pescara, Italy
| | - Paolo Antonio Ascierto
- Unit of Melanoma Cancer Immunotherapy and Innovative Therapy, National Tumour Institute IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Marco Palla
- Unit of Melanoma Cancer Immunotherapy and Innovative Therapy, National Tumour Institute IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Miriam Paone
- Unit of Melanoma Cancer Immunotherapy and Innovative Therapy, National Tumour Institute IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Laura Eibenschutz
- Dermatologia Oncologica e Prevenzione, Istituto San Gallicano IRCCS, Roma, Italy
| | - Francesco Spagnolo
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), Plastic Surgery Division, University of Genova, Genova, Italy
| | | | - Daria Maria Filippini
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Stefano Cavalieri
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Carlo Resteghini
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Cristiana Bergamini
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Antonello Manocchio
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Lisa Licitra
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paolo Bossi
- Medical Oncology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Spallone G, Carbone A, Sperati F, Frascione P, Eibenschutz L. Clinical determinants of clinical response to Sonidegib in advanced basal cell carcinoma: a monocenter experience. Eur Rev Med Pharmacol Sci 2024; 28:2923-2928. [PMID: 38639529 DOI: 10.26355/eurrev_202404_35923] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The purpose of this study is to evaluate the clinical determinants of complete response in locally advanced basal cell carcinoma (laBCC) patients receiving Sonidegib in a real-life, retrospective, observational study. Hedgehog pathway inhibitors (Vismodegib and Sonidegib) are approved for the systemic treatment of locally advanced basal cell carcinoma (laBCC). The objective response rate was the primary endpoint of the trials for both drugs. PATIENTS AND METHODS Adult patients with laBCC treated with Sonidegib at the Dermato-Oncology Unit of IFO San Gallicano between June 2020 and September 2022 were included in the study. Patient, tumor, and treatment characteristics were recorded. The complete response rate was the primary outcome. The median time to the best response and complete response were the secondary outcomes. Treatment-related adverse events (TRAEs) and dose adjustments were recorded. RESULTS Of the 19 patients included in the study, eight (42.1%) achieved a complete response, seven (36.8%) had a partial response, and four experienced progressive disease (21%). The median time to the best response was 3 months in the group of patients with partial response (range 2.0-4.0, with three patients not evaluable) and 3.5 months in the group of patients with complete response (range 2-5). TRAEs occurred in 14 (73.6%) patients, with 8 (57.1%) reporting ≤2 TRAE categories and 6 (42.8%) >2. A total of 78.9% of patients received a modified treatment schedule; 12.5% of patients who achieved a complete response received full dosage from the beginning to the end of treatment, compared with 27.3% of those with a partial response. CONCLUSIONS The associations between the clinical outcome of interest (objective response rate) and the clinicopathological and treatment characteristics were evaluated. No statistically significant association was observed. Our analysis confirms the observation that no statistically significant correlation exists between clinical response and Sonidegib alternate dose regimen.
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Affiliation(s)
- G Spallone
- Oncologic and Preventive Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.
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Moscarella E, Di Brizzi EV, Alpi P, Arcelli A, Badellino S, Bossi P, Calzavara-Pinton PG, Di Stefani A, Dika E, Eibenschutz L, Fargnoli MC, Fionda B, Gravina GL, Leonulli BG, Longo C, Lospalluti L, Nardone V, Pimpinelli N, Quaglino P, Queirolo P, Rubegni P, Tagliaferri L, Troiani T, Vavassori A, Argenziano G. Indications for adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma with clear margins: a Delphi consensus. Br J Dermatol 2024; 190:578-579. [PMID: 38092023 DOI: 10.1093/bjd/ljad495] [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] [Received: 07/26/2023] [Revised: 10/31/2023] [Accepted: 01/13/2024] [Indexed: 03/16/2024]
Abstract
The aim of this study was to provide indications for adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma.
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Affiliation(s)
- Elvira Moscarella
- Dermatology Unit, University of Campania L. Vanvitelli, Naples,Italy
| | | | - Paolo Alpi
- Radiation Oncology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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D’Arino A, Caputo S, Eibenschutz L, Piemonte P, Buccini P, Frascione P, Bellei B. Skin Cancer Microenvironment: What We Can Learn from Skin Aging? Int J Mol Sci 2023; 24:14043. [PMID: 37762344 PMCID: PMC10531546 DOI: 10.3390/ijms241814043] [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: 08/04/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Aging is a natural intrinsic process associated with the loss of fibrous tissue, a slower cell turnover, and a reduction in immune system competence. In the skin, the continuous exposition of environmental factors superimposes extrinsic damage, mainly due to ultraviolet radiation causing photoaging. Although not usually considered a pathogenic event, photoaging affects cutaneous biology, increasing the risk of skin carcinogenesis. At the cellular level, aging is typified by the rise of senescence cells a condition characterized by reduced or absent capacity to proliferate and aberrant hyper-secretory activity. Senescence has a double-edged sword in cancer biology given that senescence prevents the uncontrolled proliferation of damaged cells and favors their clearance by paracrine secretion. Nevertheless, the cumulative insults and the poor clearance of injured cells in the elderly increase cancer incidence. However, there are not conclusive data proving that aged skin represents a permissive milieu for tumor onset. On the other hand, tumor cells are capable of activating resident fibroblasts onto a pro-tumorigenic phenotype resembling those of senescent fibroblasts suggesting that aged fibroblasts might facilitate cancer progression. This review discusses changes that occur during aging that can prime neoplasm or increase the aggressiveness of melanoma and non-melanoma skin cancer.
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Affiliation(s)
- Andrea D’Arino
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00141 Rome, Italy
| | - Silvia Caputo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00141 Rome, Italy
| | - Laura Eibenschutz
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00141 Rome, Italy
| | - Paolo Piemonte
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00141 Rome, Italy
| | - Pierluigi Buccini
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00141 Rome, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00141 Rome, Italy
| | - Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, 00141 Rome, Italy
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5
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Alfieri S, Marceglia S, Filippini D, Bergamini C, Resteghini C, Cavalieri S, Peris K, Sollena P, Piccerillo A, Gualdi G, Ascierto P, Curvietto M, Palla M, De Giorgi V, Eibenschutz L, Spagnolo F, Orlandi E, Locati L, Licitra L, Bossi P. 1065P A retrospective multicenter Italian analysis of the effect of longer vismodegib intake in 68 basal cell carcinoma patients who achieved clinical complete remission. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1450] [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: 10/20/2022] Open
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Carbone A, Silipo V, Eibenschutz L, Piemonte P, Ferrari A, Buccini P, Iorio A, Frascione P. Actinic keratoses: when and how to treat a single lesion. GIORN ITAL DERMAT V 2020; 155:527-528. [DOI: 10.23736/s0392-0488.18.06082-0] [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: 11/08/2022]
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Persechino F, Franceschini C, Iorio A, Carbone A, Ferrari A, Buccini P, Piemonte P, Eibenschutz L, Sperduti I, Cota C, Frascione P, Ardigo M. Clinical management of very small pigmented lesions: Improved clinical outcome through dermoscopy and reflectance confocal microscopy combination. Skin Res Technol 2020; 26:718-726. [PMID: 32207544 DOI: 10.1111/srt.12863] [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] [Received: 12/27/2019] [Accepted: 02/29/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Small-sized pigmented lesions (SSPL) <3 mm in diameter are common pitfall in the daily dermatology practice. Dermoscopy alone is hampered by the lack of specific features inversely proportional to the diameter of the lesions and its performance is highly operator-dependent. Reflectance confocal microscopy (RCM) has been demonstrated to be effective in the diagnosis of several difficult lesions where dermoscopy lacks to provide conclusive information. MATERIALS AND METHODS A total of 179 lesions with uncertain or equivocal clinical and dermoscopy appearance were selected. Dermoscopist has been requested to express a diagnostic suspect when possible. Equivocal lesions underwent RCM performed by expert for second-level evaluation before surgical excision for histological diagnosis. Results have been later statistically analysed. RESULTS Dermoscopy was not diagnostic in large number of lesions with low concordance histology (39.1%) instead of a much high concordance when combined with RCM (93.9%). CONCLUSIONS Small-sized pigmented lesions were more likely to be located on the face area. Diagnosis of pigmented BCC was relatively easy on dermoscopy and also in the case of small lesions showing typical signs of BCC. LM and MM have been seen to be particularly difficult to be diagnosed using only dermoscopy. The combination of digital dermoscopy and RCM represents the correct approach of SSPL.
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Affiliation(s)
- Flavia Persechino
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.,Clinical Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Chiara Franceschini
- Clinical Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Alessandra Iorio
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Anna Carbone
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Angela Ferrari
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Pierluigi Buccini
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Paolo Piemonte
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Laura Eibenschutz
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Scientific Direction, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Carlo Cota
- Dermatopathology Laboratory, San Gallicano Dermatological Institute, Rome, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology, IFO-San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Marco Ardigo
- Clinical Dermatology, San Gallicano Dermatological Institute-IRCCS, Rome, Italy
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Bellei B, Caputo S, Carbone A, Silipo V, Papaccio F, Picardo M, Eibenschutz L. The Role of Dermal Fibroblasts in Nevoid Basal Cell Carcinoma Syndrome Patients: An Overview. Int J Mol Sci 2020; 21:ijms21030720. [PMID: 31979112 PMCID: PMC7037136 DOI: 10.3390/ijms21030720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 12/14/2022] Open
Abstract
Nevoid basal cell carcinoma syndrome (NBCCS), also named Gorlin syndrome, is a rare multisystem genetic disorder characterized by marked predisposition to basal cell carcinomas (BCCs), childhood medulloblastomas, maxillary keratocysts, celebral calcifications, in addition to various skeletal and soft tissue developmental abnormalities. Mutations in the tumor suppressor gene PATCHED1 (PTCH1) have been found to be associated in the majority of NBCCS cases. PATCH1 somatic mutations and loss of heterozygosity are also very frequent in sporadic BCCs. Unlike non-syndromic patients, NBCCS patients develop multiple BCCs in sun-protected skin area starting from early adulthood. Recent studies suggest that dermo/epidermal interaction could be implicated in BCC predisposition. According to this idea, NBCCS fibroblasts, sharing with keratinocytes the same PTCH1 germline mutation and consequent constitutive activation of the Hh pathway, display features of carcinoma-associated fibroblasts (CAF). This phenotypic traits include the overexpression of growth factors, specific microRNAs profile, modification of extracellular matrix and basement membrane composition, increased cytokines and pro-angiogenic factors secretion, and a complex alteration of the Wnt/β-catenin pathway. Here, we review studies about the involvement of dermal fibroblasts in BCC predisposition of Gorlin syndrome patients. Further, we matched the emerged NBCCS fibroblast profile to those of CAF to compare the impact of cell autonomous “pre-activated state” due to PTCH1 mutations to those of skin tumor stroma.
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Affiliation(s)
- Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, 00100 Rome, Italy; (S.C.); (F.P.); (M.P.)
- Correspondence: ; Tel.: +39-065-266-6246; Fax: +39-065-266-6247
| | - Silvia Caputo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, 00100 Rome, Italy; (S.C.); (F.P.); (M.P.)
| | - Anna Carbone
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, IRCCS, 00100 Rome, Italy; (A.C.); (V.S.); (L.E.)
| | - Vitaliano Silipo
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, IRCCS, 00100 Rome, Italy; (A.C.); (V.S.); (L.E.)
| | - Federica Papaccio
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, 00100 Rome, Italy; (S.C.); (F.P.); (M.P.)
| | - Mauro Picardo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatologic Institute, IRCCS, 00100 Rome, Italy; (S.C.); (F.P.); (M.P.)
| | - Laura Eibenschutz
- Oncologic and Preventative Dermatology, San Gallicano Dermatological Institute, IRCCS, 00100 Rome, Italy; (A.C.); (V.S.); (L.E.)
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Carbone A, Persechino F, Paolino G, Cota C, Piemonte P, Franceschini C, Eibenschutz L, Ferrari A, Buccini P, Frascione P, Calvieri S, Ardigò M. Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopic and confocal microscopy study. Ital J Dermatol Venerol 2019. [PMID: 31760729 DOI: 10.23736/s0392-0488.19.06471-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Enlarging melanocytic lesions with peripheral globular pattern (EMLPGP) are a pitfall in dermoscopy. Our aim was to evaluate the meaning of EMLPGP and to assess the use of dermoscopy and reflectance confocal microscopy (RCM) in order to improve the clinical management of this subtype of melanocytic lesions. METHODS A total of 135 EMLPGP were recruited and, accordingly to the dermoscopy features, were removed; later, an expert dermoscopist reviewed the lesions blinded to histology. Moreover, a subgroup of 63 lesions who underwent also to RCM, were reviewed by an expert confocalist. RESULTS Patients had a median age of 41 years old and a female prevalence (61.5%). The main anatomic site was the trunk (86%). Histology of the 135 excised EMLPGP disclosed 116 nevi (86%; P<0.0001) and 19 melanomas (14%). On dermoscopy, statistical significance was detected for small globules that were observed in 106 cases (78.5%; P<0.0001), while globules distribution and color did not impact the diagnosis prediction, as well as age, sex or any other patient profile. Considering the RCM, atypical cytology and irregular architecture were detected in 100% of melanomas (P<0.0001). CONCLUSIONS Our study shows that EMLPGPs are detectable in every age and can be a pitfall in especially in high risk patients with an over-excision of lesions. The presence of peripheral globules should be evaluated considering the overall dermoscopic features. RCM can contribute significantly in the management of lesions trough the detection of cyto-architectural atypia. Therefore, RCM in combination with dermoscopy can optimize the reduction of harmless lesions.
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Affiliation(s)
- Anna Carbone
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy -
| | - Flavia Persechino
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Giovanni Paolino
- Department of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.,Dermatology Clinic, Sapienza University, Rome, Italy
| | - Carlo Cota
- Dermatopathology Research Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Paolo Piemonte
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Chiara Franceschini
- Rare Disease Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Laura Eibenschutz
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Angela Ferrari
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pierluigi Buccini
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | | | - Marco Ardigò
- Rare Disease Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Carbone A, Persechino F, Paolino G, Cota C, Piemonte P, Franceschini C, Eibenschutz L, Ferrari A, Buccini P, Frascione P, Calvieri S, Ardigò M. Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopic and confocal microscopy study. Ital J Dermatol Venerol 2019; 156:467-472. [PMID: 31760729 DOI: 10.23736/s2784-8671.19.06471-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Enlarging melanocytic lesions with peripheral globular pattern (EMLPGP) are a pitfall in dermoscopy. Our aim was to evaluate the meaning of EMLPGP and to assess the use of dermoscopy and reflectance confocal microscopy (RCM) in order to improve the clinical management of this subtype of melanocytic lesions. METHODS A total of 135 EMLPGP were recruited and, accordingly to the dermoscopy features, were removed; later, an expert dermoscopist reviewed the lesions blinded to histology. Moreover, a subgroup of 63 lesions who underwent also to RCM, were reviewed by an expert confocalist. RESULTS Patients had a median age of 41 years old and a female prevalence (61.5%). The main anatomic site was the trunk (86%). Histology of the 135 excised EMLPGP disclosed 116 nevi (86%; P<0.0001) and 19 melanomas (14%). On dermoscopy, statistical significance was detected for small globules that were observed in 106 cases (78.5%; P<0.0001), while globules distribution and color did not impact the diagnosis prediction, as well as age, sex or any other patient profile. Considering the RCM, atypical cytology and irregular architecture were detected in 100% of melanomas (P<0.0001). CONCLUSIONS Our study shows that EMLPGPs are detectable in every age and can be a pitfall in especially in high risk patients with an over-excision of lesions. The presence of peripheral globules should be evaluated considering the overall dermoscopic features. RCM can contribute significantly in the management of lesions trough the detection of cyto-architectural atypia. Therefore, RCM in combination with dermoscopy can optimize the reduction of harmless lesions.
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Affiliation(s)
- Anna Carbone
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy -
| | - Flavia Persechino
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Giovanni Paolino
- Department of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.,Dermatology Clinic, Sapienza University, Rome, Italy
| | - Carlo Cota
- Dermatopathology Research Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Paolo Piemonte
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Chiara Franceschini
- Rare Disease Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Laura Eibenschutz
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Angela Ferrari
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pierluigi Buccini
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | | | - Marco Ardigò
- Rare Disease Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Carbone A, Sperduti I, De Simone P, Piemonte P, Ferrari A, Buccini P, Silipo V, Iorio A, Frascione P, Eibenschutz L. Daylight photodynamic therapy: experience in the treatment of actinic keratosis in the San Gallicano Institute (Rome) and a review of literature. GIORN ITAL DERMAT V 2018; 155:312-319. [PMID: 29368865 DOI: 10.23736/s0392-0488.18.05880-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a photo-induced skin lesion. It has been considered by several authors as in-situ squamous cell carcinoma (SCC), that can evolve to invasive SCC (iSCC). Given the malignant potential and because it is impossible predict which AK will evolve in iSCC, it is necessary to treat each lesion. Multiple therapeutic approaches have been described to treat AKs. In addition to the topical drugs, photodynamic therapy (PDT) has become an established therapeutic modality for grade I and II of AKs of face and scalp. Recently the daylight photo-dynamic therapy (DL-PDT) has found extensive use in the care of the AK and in the field cancerization. METHODS The study included 101 patients, 90 males and 11 females, mean age 71, phototype I-II, with multiple AK I and II of the face and the scalp, treated with DL-PDT. Patients were clinically evaluated for 3 months. The aim of this study was to show our experience in Daylight Photodynamic Therapy, to confirm the validity in term of efficacy and safety of DL-PDT for I and II AK of face and scalp and to underline the patient's higher satisfaction for this type of treatment and his availability to be retreated with the DL-PDT. RESULTS The efficacy was complete in 16 patients (15.8%), in 71 patients (70.3%) was much improved or improved and only in 14 (13.9%) subjects were minimal, while nobody had worsened or changed. The majority of patients (84.2%) patients were satisfied of the efficacy as well of the cosmetic results, only 15 (14.9%) were low satisfied and one patient was not satisfied. CONCLUSIONS This study confirms that the DL-PDT is a good alternative to c-PDT for the treatment of grade I and II AK of the face and scalp and in Rome, as in Southern Europe, it is possible to perform the DL-PDT in almost every month of year.
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Affiliation(s)
- Anna Carbone
- San Gallicano Dermatological Institute IRCCS, Rome, Italy -
| | - Isabella Sperduti
- Department of Bio-Statistics, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Paolo Piemonte
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Angela Ferrari
- San Gallicano Dermatological Institute IRCCS, Rome, Italy
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Fargnoli MC, Ibbotson SH, Hunger RE, Rostain G, Gaastra MTW, Eibenschutz L, Cantisani C, Venema AW, Medina S, Kerrouche N, Pérez-Garcia B. Patient and physician satisfaction in an observational study with methyl aminolevulinate daylight photodynamic therapy in the treatment of multiple actinic keratoses of the face and scalp in six European countries. J Eur Acad Dermatol Venereol 2017; 32:757-762. [PMID: 29136306 PMCID: PMC6084323 DOI: 10.1111/jdv.14691] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Guidelines recommend treating actinic keratoses (AKs) as they are recognized as precursors of invasive squamous cell carcinoma. OBJECTIVE The objective of this study was to collect real-world clinical data on the use of methyl aminolevulinate daylight photodynamic therapy (MAL DL-PDT) for the treatment of face and scalp AK in Europe. METHODS A prospective, multicenter, non-interventional study was conducted in six European countries in patients receiving a single treatment of MAL DL-PDT for face and/or scalp AK. Patient-reported outcomes were assessed by patient questionnaires at baseline and at 3 months after treatment, efficacy was assessed at 3 months using a 6-point global improvement scale, and adverse events (AE) were recorded at each visit. RESULTS Overall, 325 patients were enrolled from 52 investigational centres, 314 of whom attended the 3-month visit. Most patients had multiple lesions (58.4% had >10 lesions) with lesions mainly located on the scalp (60.0%) and/or forehead (54.2%). AKs were predominantly grade I (39.4%) or grade II (33.2%), and 10.5% of patients had grade III lesions. The proportions of patients and physicians that were overall satisfied to very satisfied with the MAL DL-PDT treatment were 80.4% and 90.3%, respectively. The vast majority of patients (90.0%) would consider using MAL DL-PDT again if needed. Physician-assessed efficacy at 3 months was at least much improved in 83.5% of patients, with 45.9% of patients requiring no retreatment. Related AEs were reported in 15% of patients. CONCLUSION Use of MAL DL-PDT for multiple face and/or scalp AKs resulted in high levels of patient and physician satisfaction in clinical practice in Europe, reflecting the good efficacy and high tolerability of this convenient procedure.
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Affiliation(s)
- M C Fargnoli
- Department of Dermatology, University of L'Aquila, L'Aquila, Italy
| | - S H Ibbotson
- Photobiology Unit, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
| | - R E Hunger
- Department of Dermatology, Bern University Hospital, Inselspital, Bern, Switzerland
| | | | | | - L Eibenschutz
- Dermato Oncology Unit, San Gallicano Dermatological Institute, Rome, Italy
| | - C Cantisani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - S Medina
- Dermatology Department, Príncipe de Asturias University Hospital, Madrid, Spain
| | | | - B Pérez-Garcia
- Department of Dermatology, Ramón y Cajal University Hospital, Madrid, Spain
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13
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Carbone A, Ferrari A, Paolino G, Buccini P, De Simone P, Eibenschutz L, Piemonte P, Silipo V, Sperduti I, Catricalà C, Frascione P. Lentigo maligna of the face: A quantitative simple method to identify individual patient risk probability on dermoscopy. Australas J Dermatol 2017; 58:286-291. [PMID: 28589538 DOI: 10.1111/ajd.12595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 09/27/2016] [Accepted: 11/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES The clinical and dermoscopic differential diagnosis of flat pigmented facial lesions represents a great challenge for the clinicians. Our aim was to report a quantitative method based on dermoscopic features to better classify pigmented facial lesions. METHODS This is a retrospective case-series study that analysed the dermoscopic features of 582 pigmented facial lesions. RESULTS The individual patient probability of lentigo maligna (LM) was predicted by a multivariate model, with an accuracy of 0.72. According to the odds ratio at the multivariate analysis, an individual scoring index was assigned to each criterion, and a value of 4.56 was identified as optimal cut-off point. Up to a score of 2.5, the probability that a lesion is an LM is 0. The probability increases from 10 to 50% for a score ranging between 4.5 and 6. It is about 90% for a score of 7. CONCLUSION The optimal cut-off point obtained and the curve that identifies the probability of a patient having a LM could improve the classification and the management strategies of equivocal pigmented facial lesions.
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Affiliation(s)
- Anna Carbone
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Angela Ferrari
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Giovanni Paolino
- Department of Dermatology, Clinica Dermatologica, La Sapienza University of Rome, Rome, Italy
| | - Pierluigi Buccini
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Paola De Simone
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Laura Eibenschutz
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Paolo Piemonte
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Vitaliano Silipo
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Isabella Sperduti
- Department of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
| | - Caterina Catricalà
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pasquale Frascione
- Department of Oncological and Preventative Dermatological, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Eibenschutz L, Silipo V, De Simone P, Buccini P, Ferrari A, Carbone A, Catricalà C. A 9-month, randomized, assessor-blinded, parallel-group study to evaluate clinical effects of film-forming medical devices containing photolyase and sun filters in the treatment of field cancerization compared with sunscreen in patients after successful p. Br J Dermatol 2016; 175:1391-1393. [DOI: 10.1111/bjd.14721] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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15
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Paolino G, Bekkenk MW, Didona D, Eibenschutz L, Richetta AG, Cantisani C, Viti G, Carbone A, Buccini P, De Simone P, Ferrari A, Scali E, Calvieri S, Silipo V, Cigna E, Viti GP, Bottoni U. Is the prognosis and course of acral melanoma related to site-specific clinicopathological features? Eur Rev Med Pharmacol Sci 2016; 20:842-848. [PMID: 27010139] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Acral melanoma is an uncommon type of melanoma in Caucasian patients. However, acral melanoma is the most common type of melanoma in African and Asian patients. Comparison analyses between hand-acral melanoma and foot-acral melanoma have been rarely reported in the literature. Acral melanoma is an uncommon melanocytic tumor characterized by an intrinsic aggressiveness, with specific histological and clinicopathological features. Acral melanoma involves the palms, soles and sub-ungueal sites. PATIENTS AND METHODS A total of 244 patients with acral melanoma were included in our analysis. The current study was performed in three different medical centers: Sapienza University of Rome, San Gallicano Institute of Rome and University of Magna Graecia (Italy). The Kaplan-Meier product was used to estimate survival curves for disease-free survival and overall survival. The log-rank test was used to evaluate differences between the survival curves. Assuming that the effects of the predictor variables are constant over time, the independent predictive factors were assessed by Spearman's test and subsequently data were analyzed performing Cox proportional-hazard regression. RESULTS In both univariate and multivariate analyses Breslow thickness (p < 0.0001) and ulceration (p = 0.003) remained the main predictors. General BRAF mutation was detected in 13.8% of cases. We found that median Breslow value and the percentage of recurrences were similar in hand-acral melanoma and foot-acral melanoma, as well as there were no differences in both short and long-term. CONCLUSIONS The absence of differences in survival between hand-acral melanoma and foot-acral melanoma shows that the aggressiveness of the disease is related to distinct mutational rate, as well as to anatomical site-specific features, rather than to the visibility of the primary lesion.
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Affiliation(s)
- G Paolino
- Dermatologic Clinic, "La Sapienza" University of Rome, Rome, Italy.
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Moscarella E, Kyrgidis A, Sperduti I, Abramavicus A, Argenziano G, Cota C, Eibenschutz L, De Simone P, Longo C, Hofmann-Wellenhof R, Zalaudek I. Age-related prevalence and morphological appearance of facial skin tumours: a prospective, cross-sectional, observational, multicentre study with special emphasis on melanocytic tumours. J Eur Acad Dermatol Venereol 2014; 29:1331-8. [DOI: 10.1111/jdv.12844] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- E. Moscarella
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - A. Kyrgidis
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - I. Sperduti
- Biostatistical Unit; Regina Elena National Cancer Institute; Rome Italy
| | - A. Abramavicus
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - G. Argenziano
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - C. Cota
- Dermatopathology Unit; San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - L. Eibenschutz
- Oncologic Dermatology; San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - P. De Simone
- Oncologic Dermatology; San Gallicano Dermatological Institute; IRCCS; Rome Italy
| | - C. Longo
- Dermatology and Skin Cancer Unit; 1st Medical Department; Arcispedale Santa Maria Nuova; IRCCS; Reggio Emilia Italy
| | - R. Hofmann-Wellenhof
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - I. Zalaudek
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
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17
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Ferrari A, Argenziano G, Buccini P, Cota C, Sperduti I, De Simone P, Eibenschutz L, Silipo V, Zalaudek I, Catricalà C. Typical and atypical dermoscopic presentations of dermatofibroma. J Eur Acad Dermatol Venereol 2012; 27:1375-80. [PMID: 23176079 DOI: 10.1111/jdv.12019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dermatofibroma is a common skin neoplasm that is usually easy to recognize, but in some cases its differentiation from melanoma and other tumours may be difficult. OBJECTIVE To describe the dermoscopic features of dermatofibromas, with special emphasis on the characteristics of atypical patterns, and to calculate pattern frequency according to the patients age and gender, anatomical site and histopathological subtype. METHODS Two groups of patients were consecutively seen, one with dermatofibromas that were surgically excised because of clinically and/or dermoscopically equivocal aspects or following patient request, and another with non-equivocal dermatofibromas. Each lesion was scored for previously reported global dermoscopic patterns and for additional features. RESULTS A typical pattern was observed in 92 of 130 (70.8%) lesions, whereas an atypical pattern, that we named the 'non Dermatofibroma (DF)-like' pattern, was seen in 38 of 130 (29.2%). Atypical dermatofibromas showed features reminiscent of different conditions, such as melanoma in 21(16.2%) cases, vascular tumour in six (4.6%), basal cell carcinoma in five (3.8%), collision tumour in three (2.3%) and psoriasis in three (2.3%). A significant association was found between the 'melanoma-like' pattern/'vascular tumour-like' pattern and males, whereas a trend was observed between the above-mentioned patterns and hemosiderotic/aneurysmal DFs. 'Peripheral pigment network and central white scar-like patch' pattern was found associated with females and classic histopathological variant of DF. CONCLUSION Dermatofibromas may display different morphological faces. The typical dermoscopic patterns allow a confident diagnosis, whereas a full surgical excision is always recommended in all doubtful cases.
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Affiliation(s)
- A Ferrari
- Department of Oncologic Dermatology, San Gallicano Dermatological Institute, Rome, ItalyDermatology Unit, Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, ItalyLaboratory of Pathology, San Gallicano Dermatologic Institute, Rome, ItalyUnit of Biostatistics, Regina Elena National Cancer Institute, Rome, Italy
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18
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Zalaudek I, Giacomel J, Schmid K, Bondino S, Rosendahl C, Cavicchini S, Tourlaki A, Gasparini S, Bourne P, Keir J, Kittler H, Eibenschutz L, Catricalà C, Argenziano G. Dermatoscopy of facial actinic keratosis, intraepidermal carcinoma, and invasive squamous cell carcinoma: A progression model. J Am Acad Dermatol 2012; 66:589-97. [DOI: 10.1016/j.jaad.2011.02.011] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 02/03/2011] [Accepted: 02/19/2011] [Indexed: 10/17/2022]
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19
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Pedace L, De Simone P, Castori M, Sperduti I, Silipo V, Eibenschutz L, De Bernardo C, Buccini P, Moscarella E, Panetta C, Ferrari A, Grammatico P, Catricalà C. Clinical features predicting identification of CDKN2A mutations in Italian patients with familial cutaneous melanoma. Cancer Epidemiol 2011; 35:e116-20. [DOI: 10.1016/j.canep.2011.07.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 07/24/2011] [Accepted: 07/29/2011] [Indexed: 12/12/2022]
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Moscarella E, Zalaudek I, Pellacani G, Eibenschutz L, Catricalà C, Amantea A, Panetta C, Argenziano G. Lichenoid keratosis-like melanomas. J Am Acad Dermatol 2011; 65:e85-e87. [PMID: 21839306 DOI: 10.1016/j.jaad.2011.02.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 12/25/2010] [Accepted: 02/15/2011] [Indexed: 11/26/2022]
Affiliation(s)
- Elvira Moscarella
- Department of Oncologic Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - Iris Zalaudek
- Department of Dermatology, Medical University of Graz, Austria
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Eibenschutz
- Department of Oncologic Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - Caterina Catricalà
- Department of Oncologic Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | - Ada Amantea
- Department of Dermatopathology, San Gallicano Dermatological Institute, Rome, Italy
| | - Chiara Panetta
- Department of Dermatopathology, San Gallicano Dermatological Institute, Rome, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, 1st Medical Department, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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Argenziano G, Catricalà C, Ardigo M, Buccini P, De Simone P, Eibenschutz L, Ferrari A, Mariani G, Silipo V, Sperduti I, Zalaudek I. Seven-point checklist of dermoscopy revisited. Br J Dermatol 2011; 164:785-90. [PMID: 21175563 DOI: 10.1111/j.1365-2133.2010.10194.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G Argenziano
- Dermatology Unit, 1st Medical Department, Arcispedale Santa Maria Nuova, 42100 Reggio Emilia, Italy.
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22
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Argenziano G, Catricalà C, Ardigo M, Buccini P, De Simone P, Eibenschutz L, Ferrari A, Mariani G, Silipo V, Zalaudek I. Dermoscopy of patients with multiple nevi: Improved management recommendations using a comparative diagnostic approach. ACTA ACUST UNITED AC 2011; 147:46-9. [PMID: 21242392 DOI: 10.1001/archdermatol.2010.389] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the outcome on management recommendations of a comparative approach vs a morphologic approach in evaluating dermoscopic images of lesions from a series of patients with multiple nevi. DESIGN In a 2-step study, 6 experienced dermoscopists were asked to provide management recommendations (excision or follow-up) for a series of lesions from patients with multiple nevi based on dermoscopic images of the lesions. In the first step, participating dermoscopists evaluated individual images of lesions based only on morphologic structure (morphologic approach). In the second step, the same lesions were grouped by patient, allowing the participants to evaluate the lesions in the context of other nevi from the same patient (comparative approach). SETTING Academic referral center. PATIENTS Seventeen patients with 190 lesions (184 monitored nevi, 4 excised nevi, and 2 excised melanomas). MAIN OUTCOME MEASURE Using pooled data from each step, excision recommendation rates for the comparative approach and the morphologic approach were calculated. RESULTS Using the morphologic approach, 55.1% of overall recommendations favored excision; using the comparative approach, the rate decreased to 14.1%. The 2 melanomas included in the study were correctly judged to merit excision by all participants in step 1 and in step 2. Conclusion Among patients with multiple nevi, evaluation of equivocal lesions in the context of a patient's other nevi results in a lower rate of excision recommendations compared with evaluation of individual lesions based on morphologic structure alone.
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Affiliation(s)
- Giuseppe Argenziano
- Pigmented Lesions Clinic, Department of Dermatology, Second University of Naples, Italy.
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Ferrari A, Zalaudek I, Argenziano G, Buccini P, De Simone P, Silipo V, Eibenschutz L, Mariani G, Covello R, Sperduti I, Mariani L, Catricalà C. Dermoscopy of pigmented lesions of the vulva: a retrospective morphological study. Dermatology 2011; 222:157-66. [PMID: 21311169 DOI: 10.1159/000323409] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 12/01/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The dermoscopic patterns of pigmented skin tumors are influenced by the body site. OBJECTIVE To evaluate the clinical and dermoscopic features associated with pigmented vulvar lesions. METHODS Retrospective analysis of clinical and dermoscopic images of vulvar lesions. The χ² test was used to test the association between clinical data and histopathological diagnosis. RESULTS A total of 42 (32.8%) melanocytic and 86 (67.2%) nonmelanocytic vulvar lesions were analyzed. Nevi significantly prevailed in younger women compared with melanomas and melanosis and exhibited most commonly a globular/cobblestone (51.3%) and a mixed (21.6%) pattern. Dermoscopically all melanomas showed a multicomponent pattern. Melanotic macules showed clinical overlapping features with melanoma, but their dermoscopic patterns differed significantly from those observed in melanomas. CONCLUSION The diagnosis and management of pigmented vulvar lesions should be based on a good clinicodermoscopic correlation. Dermoscopy may be helpful in the differentiation of solitary melanotic macules from early melanoma.
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Affiliation(s)
- Angela Ferrari
- Department of Oncologic Dermatology, Santa Maria and San Gallicano Institute of Rome, Rome, Italy
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Catricalà C, Marenda S, Muscardin LM, Donati P, Lepri A, Eibenschutz L. Angiomatous reaction Kaposi-sarcoma-like as a side effect of topical corticosteroid therapy in lichen sclerosus of the penis. Dermatol Ther 2009; 22:379-82. [PMID: 19580581 DOI: 10.1111/j.1529-8019.2009.01249.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Lichen sclerosus (LS) is a chronic inflammatory skin condition usually located in the anogenital area. Topical corticosteroid therapy is the first choice treatment which may arrest or delay the progression of the disorder. We report the case of a 74-year-old man presented with a 6-month history of nodular lesions localized on penis. The man had a previous history of genital lesions that had been diagnosed as LS and treated with long-term topical corticosteroid therapy. After 3 months of corticosteroid therapy, the patient observed the appearance of several nodular erythematous lesions on the penis with progressive disappearance of the clinical symptoms of LS. These purple to red asymptomatic angiomatoid nodules resembled the clinical features of Kaposi sarcoma.
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Affiliation(s)
- Caterina Catricalà
- Department of Dermatology-Oncology, S. Gallicano Institute, IRCCS, Rome, Italy.
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25
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Ferrari A, Buccini P, Covello R, De Simone P, Silipo V, Mariani G, Eibenschutz L, Mariani L, Catricalà C. The ringlike pattern in vulvar melanosis: a new dermoscopic clue for diagnosis. ACTA ACUST UNITED AC 2008; 144:1030-4. [PMID: 18711077 DOI: 10.1001/archderm.144.8.1030] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Vulvar melanosis is a benign pigmented lesion that may clinically mimic melanoma. Whereas the dermoscopic features of other pigmented skin lesions have been extensively described, little is known about vulvar melanosis. OBSERVATIONS A retrospective dermoscopic study was conducted on 87 lesions with histopathologically proved melanosis. We describe and define, for the first time to our knowledge, a ringlike pattern, found in 28 of 87 melanotic lesions (32%), characterized by multiple round to oval structures, white to tan, with dark brown, well-defined regular borders. The structureless and globularlike patterns were observed in 18 of 87 lesions (21%), the parallel pattern in 15 (17%), and the cobblestonelike and reticularlike patterns in 4 (5%). A significant association was found between the distribution of multifocal lesions showing a ringlike vs a nonringlike pattern (82% vs 52%; P = .008), whereas a weak association was found between anatomical site and the different patterns (P = .55). The ringlike pattern was frequently combined with multifocality and simultaneous occurrence at the labia majora and the labia minora. CONCLUSION Dermoscopy can be useful for the clinical detection of vulvar melanosis, and the ringlike pattern may represent a new dermoscopic clue for the diagnosis of this lesion.
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Affiliation(s)
- Angela Ferrari
- Department of Dermatologic Oncology, Santa Maria and San Gallicano Dermatologic Institute, IFO of Rome, Via Elio Chianesi 53, 00144 Rome, Italy.
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26
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Majore S, De Simone P, Crisi A, Eibenschutz L, Binni F, Antigoni I, De Bernardo C, Catricalà C, Grammatico P. CDKN2A/CDK4 molecular study on 155 Italian subjects with familial and/or primary multiple melanoma. Pigment Cell Melanoma Res 2008; 21:209-11. [DOI: 10.1111/j.1755-148x.2008.00446.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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27
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Majore S, Catricalà C, Binni F, De Simone P, Eibenschutz L, Grammatico P. CDKN2A: The IVS2-105A/G Intronic Mutation Found in an Italian Patient Affected by Eight Primary Melanomas. J Invest Dermatol 2004; 122:450-1. [PMID: 15009729 DOI: 10.1046/j.0022-202x.2004.22222.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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28
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Giorda E, Sibilio L, Martayan A, Moretti S, Venturo I, Mottolese M, Ferrara GB, Cappellacci S, Eibenschutz L, Catricalà C, Grammatico P, Giacomini P. The antigen processing machinery of class I human leukocyte antigens: linked patterns of gene expression in neoplastic cells. Cancer Res 2003; 63:4119-27. [PMID: 12874016] [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: 03/03/2023]
Abstract
The ultimate outcome of an immune response (escape or surveillance) depends on a delicate balance of opposing signals delivered by activating and inhibitory immune receptors expressed by cytotoxic T lymphocytes and natural killer cells. In this light, loss and down-regulation of human leukocyte antigens (HLA) class I molecules, while important for keeping tumors below the T-cell detection levels, may incite recognition of missing self. Conversely, the maintenance of normal levels of expression (or even up-regulation) may be favorable to tumors, at least in certain cases. In this study, we took advantage of a previously characterized panel of 15 early passage tumor cell lines (mainly from melanoma and lung carcinoma lesions) enriched with class I-low phenotypes. These cells were systematically characterized by Northern and/or Western blotting (e.g., mini-transcriptome/mini-proteome analysis) for the expression of HLA-A, -B, -C, beta(2)-microglobulin, and the members of the "antigen processing machinery" of class I molecules (LMP2, LMP7, TAP1, TAP2, tapasin, calreticulin, calnexin, and ERp57). In addition, we established four pairs of cultures, each comprising melanoma cells and normal melanocytes from the same patient. We found that approximately 97% of the 185 tested gene products are expressed (although often weakly), and in many cases coordinately regulated in 18 of 19 tumor cell lines. Linked expression patterns could be hierarchically arranged by statistical methods and graphically described as a class I HLA "coordinome." Deviations (both down- and up-regulation) from the coordinome expression pattern inherited from the normal, paired melanocyte counterpart, were allowed but limited in magnitude, as if melanoma cells were trying to keep a "low profile" HLA phenotype. We conclude that irreversible HLA loss is a rare event, and class I expression in tumor cells almost invariably results from reversible gene regulatory (rather than gene disruption) events.
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Affiliation(s)
- Ezio Giorda
- Laboratory of Immunology, Regina Elena Cancer Institute CRS, 00158 Rome, Italy
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29
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Serrone L, Solivetti FM, Thorel MF, Eibenschutz L, Donati P, Catricalà C. High frequency ultrasound in the preoperative staging of primary melanoma: a statistical analysis. Melanoma Res 2002; 12:287-90. [PMID: 12140386 DOI: 10.1097/00008390-200206000-00013] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
High frequency sonography has been shown to be a useful tool in the preoperative staging of malignant melanoma. In the present study sonometric and histometric data concerning tumour thickness were compared, using appropriate statistical methods, in order to assess the accuracy of ultrasonography. From December 1997 all pigmented lesions suspected of being melanoma were preoperatively assessed by a 20 MHz ultrasound B scan. The results of these ultrasound examinations were compared with histometric data. Pearson's correlation coefficient and absolute and relative differences were used for statistical analysis. Of the 261 examined lesions, 193 were malignant melanoma. A high correlation between sonometry and histometry was computed (r = 0.95), with an absolute difference of 0.32 +/- 0.03 mm (mean +/- SEM) and a mean relative difference of 27.2% (95% confidence interval 23-31.4%). The highest correlation was found in melanoma > or = 1.51 mm thick and the lowest correlation in melanoma < or = 0.75 mm. In conclusion, the high accuracy of this technique in the preoperative staging of malignant melanoma would offer a basis for defining the surgical margins of > or = 0.76 mm thick lesions. The limited accuracy of sonometry in the preoperative staging of thin melanoma < or = 0.75 mm has emerged by applying adequate statistical methods.
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Affiliation(s)
- L Serrone
- Regina Elena Institute, Division of Medical Oncology A, via Elio Chianesi, 53-00128, Rome, Italy.
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30
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Grammatico P, Binni F, Eibenschutz L, De Bernardo C, Grammatico B, Rinaldi R, De Simone P, Catricalà C. CDKN2A novel mutation in a patient from a melanoma-prone family. Melanoma Res 2001; 11:447-9. [PMID: 11595880 DOI: 10.1097/00008390-200110000-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 10/27/2022]
Abstract
CDKN2A is thought to be the main candidate gene for melanoma susceptibility. Deletion or mutations in the CDKN2A gene may produce an imbalance between functional p16 and cyclin D, causing abnormal cell growth. We here describe a novel mutation consisting of a 1 bp deletion at nucleotide position 201 (codon 67) (CACGGcGCG) resulting in a truncated protein (stop codon 145). The patient, a female subject from a melanoma-prone family, presented at the age of 47 years with a superficial spreading melanoma of the trunk. Her father had colon cancer at the age of 43 years and melanoma at 63 years, her uncle suffered from gastric cancer, and her grandfather had laryngeal cancer.
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Affiliation(s)
- P Grammatico
- Medical Genetics, University of Rome 'La Sapienza', c/o Osp. L. Spallanzani, V. Portuense n. 292, 00149 Rome, Italy.
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31
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Picardo M, Maresca V, Eibenschutz L, De Bernardo C, Rinaldi R, Grammatico P. Correlation between antioxidants and phototypes in melanocytes cultures. A possible link of physiologic and pathologic relevance. J Invest Dermatol 1999; 113:424-5. [PMID: 10469346 DOI: 10.1046/j.1523-1747.1999.00714.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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32
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Grammatico P, Eibenschutz L, Roccella F, Amantea A, Roccella M, Catricalà C, Micci F, Del Porto G. Cytogenetic follow-up in a case with a primary cutaneous melanoma and five metastatic lesions. Pigment Cell Res 1998; 11:314-9. [PMID: 9877103 DOI: 10.1111/j.1600-0749.1998.tb00741.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cytogenetic analyses conducted on several cases of melanoma have contributed to the identification of the chromosomal regions where the sequences responsible for malignant transformation and the evolution of this tumor are probably located. With regard to these problems, it is very important to have the possibility to analyze, through the use of cytogenetics, both the primary melanoma and the metastatic lesions from the same patient. We present a case in which the primary melanoma and five different metastases were studied by using cytogenetics. The primary tumor showed an inversion of chromosome 1 where the p36 region, often proposed in literature as the location of a melanoma susceptibility gene, was involved. Three cutaneous and one lymphonodal metastases presented the same nine clonal chromosomal aberrations. In particular, one is a further rearrangement of the marker present in the primary tumor; another is a deletion of the 9p21pter region in which the p16 gene is located. Our results can provide a contribution to the hypothesis of the location of a candidate gene for melanoma in the 1p36 region and can also underscore the role of the 9p21 region in the progression of melanoma.
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Affiliation(s)
- P Grammatico
- Medical Genetics, University La Sapienza, Rome, Italy.
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33
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Maresca V, Eibenschutz L, Briganti S, Cristaudo A, Picardo M. Correlation between blood level of antioxidants and minimal erythema dose in melanoma patients. J Dermatol Sci 1998. [DOI: 10.1016/s0923-1811(98)83606-2] [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: 11/28/2022]
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34
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Abstract
We report cytogenetic studies performed on 20 patients with cutaneous malignant melanoma, characterized by clinical and histological parameters. Cytogenetic analyses were performed on peripheral blood lymphocytes, in order to exclude the presence of constitutional chromosomal aberrations, and on primary cell cultures obtained from neoplastic skin lesions. A metastasis was also cultured in order to characterize chromosome markers. Specific markers found in more than one patient were t(1;14)(q21;q32) and aberrations of the 4q21,8q24 and 10q24q26 regions. The research aims to identify possible subtypes of melanomas related to specific chromosomal markers. It is hoped that this will contribute to understanding of the aetiology and evolution of the disease in order to obtain a more exact classification. We compare our results with the data reported in the literature and discuss the possible role of the cytogenetic analyses in human malignant melanoma.
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Affiliation(s)
- P Grammatico
- Cattedra di Genetica Medica, Università degli Studi, La Sapienza, Roma, Italy
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