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Sahu A, Kraehenbuehl L, Holland A, Cordova M, Gill M, Alessi-Fox C, Gonzalez S, Kurtansky N, Rossi A, Marghoob A, Guitera P, Pulitzer M, Jason Chen C, Merghoub T, Rajadhyaksha M. 834 In vivo phenotyping of the tumor-immune microenvironment in skin cancers. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.848] [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: 11/24/2022]
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Ho G, Schwartz RJ, Regio Pereira A, Dimitrou F, Paver E, McKenzie C, Saw RPM, Scolyer RA, Long GV, Guitera P. Reflectance confocal microscopy - a non-invasive tool for monitoring systemic treatment response in stage III unresectable primary scalp melanoma. J Eur Acad Dermatol Venereol 2022; 36:e583-e585. [PMID: 35285090 DOI: 10.1111/jdv.18076] [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] [Received: 11/08/2021] [Accepted: 03/04/2022] [Indexed: 11/27/2022]
Affiliation(s)
- G Ho
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - R J Schwartz
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - A Regio Pereira
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Federal University of Sao Paulo, Sao Paulo, Brazil
| | - F Dimitrou
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - E Paver
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- NSW Health Pathology, Sydney, New South Wales, Australia
| | - C McKenzie
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Sydney, New South Wales, Australia
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - G V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital and Mater Hospitals, Sydney, New South Wales, Australia
| | - P Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Fuchs CSK, Ortner VK, Mogensen M, Rossi AM, Pellacani G, Welzel J, Mosterd K, Guitera P, Nayahangan LJ, Johnsson VL, Haedersdal M, Tolsgaard MG. 2021 international consensus statement on optical coherence tomography for basal cell carcinoma: image characteristics, terminology and educational needs. J Eur Acad Dermatol Venereol 2022; 36:772-778. [PMID: 35141952 DOI: 10.1111/jdv.17969] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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: 09/22/2021] [Revised: 12/02/2021] [Accepted: 01/07/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Despite the widespread use of optical coherence tomography (OCT) for imaging of keratinocyte carcinoma, we lack an expert consensus on the characteristic OCT features of basal cell carcinoma (BCC), an internationally vetted set of OCT terms to describe various BCC subtypes, and an educational needs assessment. OBJECTIVES To identify relevant BCC features in OCT images, propose terminology based on inputs from an expert panel and identify content for a BCC-specific curriculum for OCT trainees. METHODS Over three rounds, we conducted a Delphi consensus study on BCC features and terminology between March and September 2020. In the first round, experts were asked to propose BCC subtypes discriminable by OCT, provide OCT image features for each proposed BCC subtypes and suggest content for a BCC-specific OCT training curriculum. If agreement on a BCC-OCT feature exceeded 67%, the feature was accepted and included in a final review. In the second round, experts had to re-evaluate features with less than 67% agreement and rank the ten most relevant BCC OCT image features for superficial BCC, nodular BCC and infiltrative and morpheaphorm BCC subtypes. In the final round, experts received the OCT-BCC consensus list for a final review, comments and confirmation. RESULTS The Delphi included six key opinion leaders and 22 experts. Consensus was found on terminology for three OCT BCC image features: (i) hyporeflective areas, (ii) hyperreflective areas and (iii) ovoid structures. Further, the participants ranked the ten most relevant image features for nodular, superficial, infiltrative and morpheaform BCC. The target group and the key components for a curriculum for OCT imaging of BCC have been defined. CONCLUSION We have established a set of OCT image features for BCC and preferred terminology. A comprehensive curriculum based on the expert suggestions will help implement OCT imaging of BCC in clinical and research settings.
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Affiliation(s)
- C S K Fuchs
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - V K Ortner
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - M Mogensen
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - A M Rossi
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J Welzel
- Department of Dermatology, General Hospital Augsburg, Augsburg, Germany
| | - K Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - P Guitera
- Melanoma Institute Australia, Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - L J Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - V L Johnsson
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - M Haedersdal
- Department of Dermatology and Wound Healing Centre, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - M G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
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Star P, Rawson RV, Drummond M, Lo S, Scolyer RA, Guitera P. Lentigo maligna: defining margins and predictors of recurrence utilizing clinical, dermoscopic, confocal microscopy and histopathology features. J Eur Acad Dermatol Venereol 2021; 35:1811-1820. [PMID: 33998703 DOI: 10.1111/jdv.17349] [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] [Received: 01/09/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lentigo maligna (LM) is a subtype of melanoma in situ with poorly defined margins and a high recurrence rate. The biological behaviour of LM appears to differ widely between cases, from biologically indolent to biologically active variants, with some patients experiencing multiple recurrences. It is not known whether this is secondary to inadequate margins, field cancerization or the innate biology of the lesion itself. OBJECTIVES (a) Describe the margins of LM in detail by analysing LM in three zones, that is centre, edge and surround using reflectance confocal microscopy (RCM) and histopathology; (b) ascertain association of histological distance of LM and atypical melanocytic hyperplasia from the surgical margin with multi-recurrent (MR) disease and (c) identify features (clinical, dermoscopy, RCM and histopathology) associated with MR LM. METHODS (1) Descriptive observational study comparing the centre, edge and surround of LM on histopathology and RCM; (2) retrospective cohort study comparing parameters associated with MR and non-recurrent (NR) LM. RESULTS 30 patients (median follow-up time 6.2 years) were included. On histopathology, confluent or near confluent lentiginous proliferation, melanocyte density >15 per 0.5 mm and adnexal spread were best for distinguishing surround from edge of LM. On RCM, predominant melanocytes, lentiginous proliferation and pleomorphism distinguished surround from centre/edge. MR patients had a median histological distance of LM from the surgical margin of 2mm (versus NR patients with an average distance of 4mm). MR patients had a greater proportion of more florid features, compared with NR on histopathology at both the centre and the edge but were similar in the surround. CONCLUSION These data may help pathologists and confocalists better define margins of LM. More florid features in MR patients, despite a similar background of sun-damaged skin, suggest the innate biology of the lesion rather than the field of cancerization may explain MR LM.
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Affiliation(s)
- P Star
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - R V Rawson
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, Sydney, NSW, Australia
| | - M Drummond
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - S Lo
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Camperdown, Sydney, NSW, Australia
| | - P Guitera
- Melanoma Institute Australia (MIA), The University of Sydney, North Sydney, NSW, Australia.,Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre (SMDC), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Garbarino F, Pampena R, Lai M, Pereira AR, Piana S, Cesinaro AM, Cinotti E, Fiorani D, Ciardo S, Farnetani F, Chester J, Pellacani G, Guitera P, Longo C. Flat scalp melanoma dermoscopic and reflectance confocal microscopy features correspond to histopathologic type and lesion location. J Eur Acad Dermatol Venereol 2021; 35:1670-1677. [PMID: 33960517 PMCID: PMC8361774 DOI: 10.1111/jdv.17313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/04/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
Background Dermoscopy and Reflectance Confocal Microscopy (RCM) features of scalp melanoma according to lesion location and histopathology have not been fully investigated. Objectives To reveal dermoscopic and RCM features of scalp melanoma according to lesion location and histopathology. Methods We retrospectively retrieved images of suspicious, atypical excised, flat melanocytic lesions of the scalp, assessed on dermoscopy and RCM at five centres, from June 2007 to April 2020. Lesions were classified according to histopathological diagnoses of nevi, lentigo maligna melanoma (LM/LMM) or superficial spreading melanoma (SSM). Clinical, dermoscopic and RCM images were evaluated; LM/LMM and SSM subtypes were compared through multivariate analysis. Results Two hundred forty‐seven lesions were included. In situ melanomas were mostly LM (81.3%), while invasive melanomas were mostly SSM (75.8%). Male sex, baldness and chronic sun‐damaged skin were associated with all types of melanomas and in particular with LM/LMM. LMs were mostly located in the vertex area and SSM in the frontal (OR: 8.8; P < 0.05, CI 95%) and temporal (OR: 16.7; P < 0.005, CI 95%) areas. The dermoscopy presence of pseudo‐network, pigmented rhomboidal structures, obliterated hair follicles and annular–granular pattern were associated with LM diagnoses, whereas bluish‐white veil was more typical of SSM. Observations on RCM of atypical roundish and dendritic cells in the epidermis were associated with SSM (42.4%) and dendritic cells with LM (62.5%) diagnoses. Folliculotropism on RCM was confirmed as a typical sign of LM. Conclusions Flat scalp melanomas reveal specific dermoscopic and RCM features according to histopathologic type and scalp location.
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Affiliation(s)
- F Garbarino
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - R Pampena
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - M Lai
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - A R Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - S Piana
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A M Cesinaro
- Department of Pathology, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - D Fiorani
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - S Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Department of Dermatology, University of La Sapienza, Roma, Italy
| | - P Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
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Collgros H, Rodriguez-Lomba E, Regio Pereira A, Lo SN, Scolyer RA, Guitera P. Lentiginous melanoma (lentigo maligna and lentigo maligna melanoma) in Australia: clinicopathological characteristics, management and recurrence rates after 10-year follow-up at a tertiary centre. J Eur Acad Dermatol Venereol 2021; 35:1315-1322. [PMID: 33502077 DOI: 10.1111/jdv.17135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lentiginous melanoma or lentigo maligna is a slow-growing type of melanoma frequently arising in sun-damaged skin and often first diagnosed in the elderly. Few studies report long-term follow-up. OBJECTIVES To define characteristics of lentiginous melanoma in situ (LM) and invasive lentiginous melanoma (LMM) in Australian patients managed at a tertiary centre and describe local recurrence or treatment failure rates after long-term follow-up. METHODS Retrospective single-centre study of LM/LMM patients evaluated between January 2005 and March 2007. Medical and photographic records were reviewed. RESULTS One hundred two patients were included, with a total of 117 lesions (70 LM and 47 LMM). Seventy-nine were new primary LM/LMM, and 38 were recurrences. Primary cases were mostly pigmented (71%), while 77% of recurrent cases were partially pigmented/light brown or amelanotic. The margins were clinically ill-defined in the majority of cases (64% of primary cases and 94% of recurrent cases). Dermoscopy of the primary LM/LMM showed either classic 'common' melanoma features (33%) or classic LM/LMM features (41%), while 95% of recurrent cases had no features for melanoma or LM/LMM. Primary cases that were initially excised (113, 97%) had mean histopathological clear margins of 4.9 mm (range 0.1-22 mm). The median follow-up time was 7.5 years (95% CI 5.2-10.0) with more than 10-year follow-up in 32% and 5-10 years in 24% of patients. There were 44 (38%) recurrences over the entire follow-up period. Half of the patients who recurred did so within the first 3.8 years after the first treatment. CONCLUSION LM/LMM often recur late and are clinically subtle; therefore, careful monitoring and long-term follow-up are required.
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Affiliation(s)
- H Collgros
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - E Rodriguez-Lomba
- Dermatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Regio Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Federal University of Sao Paulo, Sao Paulo, Brazil
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and New South Wales Health Pathology, Sydney, NSW, Australia.,Central Clinical School, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - P Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Gill M, Pellacani G, Grant-Kels JM, Ardigò M, Chen CSJ, Gonzalez S, Guitera P, Longo C, Malvehy J, Markowitz O, Puig S, Rabinovitz H, Rao BK, Scope A, Ulrich M. Lost in translation: true clinical impact of reflectance confocal microscopy overlooked in 'Biopsy outperforms reflectance confocal microscopy in diagnosing and subtyping basal cell carcinoma: results and experiences from a randomized controlled multicentre trial'. Br J Dermatol 2020; 184:775-776. [PMID: 33090465 DOI: 10.1111/bjd.19602] [Citation(s) in RCA: 1] [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] [Received: 09/10/2020] [Accepted: 10/11/2020] [Indexed: 01/12/2023]
Affiliation(s)
- M Gill
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA.,SkinMedical Research and Diagnostics, P.L.L.C., Dobbs Ferry, NY, USA.,Faculty of Medicine and Health Sciences, University of Alcala de Henares, Madrid, Spain
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT, USA.,Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - M Ardigò
- San Gallicano Institute IRCCS, Rome, Italy
| | - C-S J Chen
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - S Gonzalez
- Faculty of Medicine and Health Sciences, University of Alcala de Henares, Madrid, Spain
| | - P Guitera
- Sydney Melanoma Diagnostics Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unità Sanitaria Locale-Istituto di Ricovero e Cura a Carattere Scientifico di Reggio Emilia, Reggio Emilia, Italy
| | - J Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - O Markowitz
- Icahn School of Medicine, Kimberly and Eric J. Waldman Department of Dermatology, Mount Sinai Hospital System, New York, NY, USA
| | - S Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain
| | | | - B K Rao
- Departments of Dermatology and Pathology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ, USA.,Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - A Scope
- The Kittner Skin Cancer Screening & Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - M Ulrich
- CMB Collegium Medicum Berlin, Berlin, Germany
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Fogarty GB, Hong AM, Rocha L, Vilain RE, Ferguson P, Guitera P. Is more dose and skin reaction required when treating early lentigo maligna definitively with radiotherapy? A case series. ACTA ACUST UNITED AC 2020. [DOI: 10.15406/ijrrt.2020.07.00280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Introduction: Atypical intraepidermal melanocytic proliferation (AIMP) is an early form of lentigo maligna (LM) which itself is a precursor to melanoma. It presents commonly on the head and neck where tissue conserving therapies are attractive. When treating LM with imiquimod, dermatologists treat until a certain level of skin inflammation is achieved. Radiation oncologists treat to a set dose of radiation irrespective of the skin reaction at completion. The dose of radiotherapy for AIMP is unknown and these lesions are currently treated in the same manner as LM. Case series: Five immunocompetent patients (average age 80 years) with AIMP or early LM (ELM) on the head and neck region were treated with RADICAL radiotherapy (RT) protocols. All treatment sites were mapped with in vivo reflectance confocal microscopy (RCM) and measured on average 4.0 cm in diameter (range 2.0–6.0 cm). The median RT dose administered was 50 Gray (Gy) [45-54 Gy] in 1.8-2Gy per fraction to the planning target volume (PTV), usually by megavoltage electrons. All patients completed RT. The peak radiation acute skin toxicity observed at any time in all patients was only dry desquamation, equivalent to a grade 2 acute radiation dermatitis reaction by Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. At a median of follow up of 10 months, all patients had biopsy proven recurrence of AIMP (n=3) or LM (n=2). All recurrences were within the RT field. Patients were followed for an average total of five years post salvage treatment (range: 26 - 124 months). Discussion: This series raises questions. First, what radiation dose is required to cure AIMP and ELM? This series suggests that the same dose, if not higher, used in established in-situ disease, is required. Second, should radiation oncologists treat to a grade 3 skin reaction? It may be then advisable to use standard fractionation (2Gy or less) so that the peak RT reaction coincides with the end of treatment and allows for titration and extra dose to be added.
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Navarrete-Dechent C, Liopyris K, Molenda MA, Braun R, Curiel-Lewandrowski C, Dusza SW, Guitera P, Hofmann-Wellenhof R, Kittler H, Lallas A, Malvehy J, Marchetti MA, Oliviero M, Pellacani G, Puig S, Soyer HP, Tejasvi T, Thomas L, Tschandl P, Scope A, Marghoob AA, Halpern AC. Human surface anatomy terminology for dermatology: a Delphi consensus from the International Skin Imaging Collaboration. J Eur Acad Dermatol Venereol 2020; 34:2659-2663. [PMID: 32770737 DOI: 10.1111/jdv.16855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/29/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is no internationally vetted set of anatomic terms to describe human surface anatomy. OBJECTIVE To establish expert consensus on a standardized set of terms that describe clinically relevant human surface anatomy. METHODS We conducted a Delphi consensus on surface anatomy terminology between July 2017 and July 2019. The initial survey included 385 anatomic terms, organized in seven levels of hierarchy. If agreement exceeded the 75% established threshold, the term was considered 'accepted' and included in the final list. Terms added by the participants were passed on to the next round of consensus. Terms with <75% agreement were included in subsequent surveys along with alternative terms proposed by participants until agreement was reached on all terms. RESULTS The Delphi included 21 participants. We found consensus (≥75% agreement) on 361/385 (93.8%) terms and eliminated one term in the first round. Of 49 new terms suggested by participants, 45 were added via consensus. To adjust for a recently published International Classification of Diseases-Surface Topography list of terms, a third survey including 111 discrepant terms was sent to participants. Finally, a total of 513 terms reached agreement via the Delphi method. CONCLUSIONS We have established a set of 513 clinically relevant terms for denoting human surface anatomy, towards the use of standardized terminology in dermatologic documentation.
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Affiliation(s)
- C Navarrete-Dechent
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - K Liopyris
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Andreas Syggros Hospital of Cutaneous & Venereal Diseases, University of Athens, Athens, Greece
| | | | - R Braun
- Department of Dermatology, University Hospital Zürich, Zurich, Switzerland
| | - C Curiel-Lewandrowski
- Department of Dermatology, The University of Arizona Cancer Center, University of Arizona, Tucson, AZ, USA
| | - S W Dusza
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - P Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | | | - H Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - J Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - M A Marchetti
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M Oliviero
- Dermatology Associates, Plantation, FL, USA
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Puig
- Melanoma Unit, Department of Dermatology, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Barcelona, Spain
| | - H P Soyer
- Dermatology Research Center, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia
| | - T Tejasvi
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - L Thomas
- Service de Dermatologie, Centre Hospitalier Lyon Sud, Lyon 1 University and Cancer Research Center of Lyons INSERM U1052 - CNRS UMR5286, Lyon, France
| | - P Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - A Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A A Marghoob
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A C Halpern
- Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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10
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11
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Pellacani G, De Carvalho N, Ciardo S, Ferrari B, Cesinaro A, Farnetani F, Bassoli S, Guitera P, Star P, Rawson R, Rossi E, Magnoni C, Gualdi G, Longo C, Scope A. The smart approach: feasibility of lentigo maligna superficial margin assessment with hand-held reflectance confocal microscopy technology. J Eur Acad Dermatol Venereol 2018; 32:1687-1694. [DOI: 10.1111/jdv.15033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022]
Affiliation(s)
- G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - N. De Carvalho
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Ciardo
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - B. Ferrari
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - A.M. Cesinaro
- Department of Pathology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - S. Bassoli
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - P. Guitera
- Melanoma Institute Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - P. Star
- Melanoma Institute Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
| | - R. Rawson
- Melanoma Institute Australia; Sydney NSW Australia
- The University of Sydney; Sydney NSW Australia
- Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Camperdown NSW Australia
| | - E. Rossi
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Magnoni
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - G. Gualdi
- Department of Dermatolgy; Spedali Civili di Brescia; Brescia Italy
| | - C. Longo
- Skin Cancer Unit; IRCCS - Santa Maria Nuova; Reggio Emilia Italy
| | - A. Scope
- Medical Screening Institute; Sheba Medical Center and Sackler School of Medicine; Tel Aviv University; Tel Aviv Israel
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12
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Cinotti E, Labeille B, Debarbieux S, Carrera C, Lacarrubba F, Witkowski A, Moscarella E, Arzberger E, Kittler H, Bahadoran P, Gonzalez S, Guitera P, Agozzino M, Farnetani F, Hofmann-Wellenhof R, Ardigò M, Rubegni P, Tognetti L, Łudzik J, Zalaudek I, Argenziano G, Longo C, Ribero S, Malvehy J, Pellacani G, Cambazard F, Perrot J. Dermoscopy vs. reflectance confocal microscopy for the diagnosis of lentigo maligna. J Eur Acad Dermatol Venereol 2018; 32:1284-1291. [DOI: 10.1111/jdv.14791] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- E. Cinotti
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
| | - B. Labeille
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
| | - S. Debarbieux
- Departments of Dermatology; Centre Hospitalier Lyon Sud; Pierre Benite France
| | - C. Carrera
- Melanoma Unit; Department of Dermatology; Hospital Clínic de Barcelona; IDIBAPS; Barcelona University; Barcelona Spain
| | - F. Lacarrubba
- Dermatology Clinic; University of Catania; Catania Italy
| | - A.M. Witkowski
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - E. Moscarella
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - E. Arzberger
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - H. Kittler
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - P. Bahadoran
- Department of Dermatology; Clinical Research Center; Hopital Archet 2; Nice France
| | - S. Gonzalez
- Medicine and Medical Specialities Department; Madrid and Dermatology Department; Alcalá University; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - P. Guitera
- Department of Dermatology; The University of Sydney; Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia; Sydney NSW Australia
| | - M. Agozzino
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - F. Farnetani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - R. Hofmann-Wellenhof
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - M. Ardigò
- Clinical Dermatology; San Gallicano Dermatological Institute; Rome Italy
| | - P. Rubegni
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
| | - L. Tognetti
- Department of Medical; Surgical and Neurological Science; Dermatology Section; University of Siena; S. Maria alle Scotte Hospital; Siena Italy
- Department of Medical Biotechnologies; University of Siena; Siena Italy
| | - J. Łudzik
- Department of Bioinformatics and Telemedicine; Jagiellonian University Medical College; Krakow Poland
| | - I. Zalaudek
- Department of Dermatology and Venerology; Medical University of Graz; Graz Austria
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Nuovo Policlinico; Naples Italy
| | - C. Longo
- Dermatology and Skin Cancer Unit; Arcispedale Santa Maria Nuova-IRCCS; Reggio Emilia Italy
| | - S. Ribero
- Department of Medical Sciences; University of Turin; Turin Italy
| | - J. Malvehy
- Melanoma Unit; Department of Dermatology; Hospital Clínic de Barcelona; IDIBAPS; Barcelona University; Barcelona Spain
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - F. Cambazard
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
| | - J.L. Perrot
- Department of Dermatology; University Hospital of St-Etienne; Saint-Etienne France
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13
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Rocha L, Menzies SW, Lo S, Avramidis M, Khoury R, Jackett L, Guitera P. Analysis of an electrical impedance spectroscopy system in short-term digital dermoscopy imaging of melanocytic lesions. Br J Dermatol 2017; 177:1432-1438. [PMID: 28421597 DOI: 10.1111/bjd.15595] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Electrical impedance spectroscopy (EIS) is a noninvasive diagnostic technique that measures tissue impedance. OBJECTIVES To evaluate the effect of adding an EIS measurement at baseline to suspicious melanocytic lesions undergoing routine short-term sequential digital dermoscopy imaging (SDDI). METHODS Patients presented with suspicious melanocytic lesions that were eligible for short-term SDDI (with no clear feature of melanoma on dermoscopy). EIS measurement was performed at the first visit following dermoscopic photography. Normally, an EIS score of ≥ 4 is considered positive; however, this protocol investigated a higher cut-off in combination with SDDI. When the EIS score was ≥ 7 the lesion was excised immediately owing to the high risk of melanoma. Lesions with a score < 7 were monitored with standard SDDI over a 3-month period. RESULTS From a total of 160 lesions analysed, 128 of 154 benign lesions received an EIS score of 0-6, giving a specificity of the EIS method for the diagnosis of melanoma of 83·1% [95% confidence interval (CI) 76·3-88·7]. Five of the six melanomas found in this study had an EIS score ≥ 7, with a sensitivity for melanoma diagnosis of 83·3% (95% CI 35·9-99·6). When EIS 0-6 lesions were subsequently followed up with SDDI, one additional melanoma was detected (EIS = 6) giving a sensitivity for the diagnosis of melanoma overall of 100% (95% CI 54·1-100; six of six malignant melanomas excised) and a specificity of 69·5% (95% CI 61·5-76·6; 107 of 154 benign lesions not excised). CONCLUSIONS If utilizing a protocol where an EIS score ≤ 3 requires no SDDI and ≥ 7 requires immediate excision, it reduced the need for SDDI by 46·9% (n = 75/160; 95% CI 39·0-54·9).
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Affiliation(s)
- L Rocha
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - S W Menzies
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,The University of Sydney, Sydney Medical School, Discipline of Dermatology, Camperdown, NSW, Australia
| | - S Lo
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - M Avramidis
- Melanoma Institute Australia, North Sydney, NSW, Australia
| | - R Khoury
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - L Jackett
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,The University of Sydney, Sydney Medical School, Camperdown, NSW, Australia
| | - P Guitera
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Discipline of Dermatology, University of Sydney and Sydney Melanoma Diagnostic Centre, Camperdown, NSW, Australia
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14
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Maher NG, Solinas A, Scolyer RA, Puig S, Pellacani G, Guitera P. Detection of desmoplastic melanoma with dermoscopy and reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2017; 31:2016-2024. [PMID: 28573666 DOI: 10.1111/jdv.14381] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Desmoplastic melanoma (DM) is frequently misdiagnosed clinically and often associated with melanoma in situ (MIS). OBJECTIVE To improve the detection of DM using dermoscopy and reflectance confocal microscopy (RCM). METHODS A descriptive analysis of DM dermoscopy features and a case-control study within a melanoma population for RCM feature evaluation was performed blindly, using data obtained between 2005 and 2015. After retrospectively identifying all DM cases with RCM data over the study period (n = 16), a control group of non-DM melanoma patients with RCM data, in a ratio of at least 3 : 1, was selected. The control group was matched by age and primary tumour site location, divided into non-DM invasive melanomas (n = 27) and MIS (n = 27). Invasive melanomas were selected according to the melanoma subtypes associated with the DM cases. The main outcomes were the frequency of melanoma-specific features on dermoscopy for DM; and the odds ratios of RCM features to distinguish DM from MIS and/or other invasive melanomas; or MIS from the combined invasive melanoma group. RESULTS At least one of the 14 melanoma-specific features evaluated on dermoscopy was found in 100% of DMs (n = 15 DM with dermoscopy). Known RCM melanoma predictors were commonly found in the DMs, such as pagetoid cells (100%) and cell atypia (100%). The RCM feature of spindle cells in the superficial dermis was more common in DM compared with the entire melanoma control group (OR 3.82, 95% CI 1.01-14.90), and particularly compared to MIS (OR 5.48, 95% CI 1.11-32.36). Nucleated cells in the dermis and the RCM correlate of dermal inflammation were also significant RCM features favouring DM over MIS, as well as invasive melanoma over MIS. CONCLUSION Dermoscopy and RCM may be useful tools for the identification of DM. Certain RCM features may help distinguish DM from MIS and other invasive melanomas. Larger studies are warranted.
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Affiliation(s)
- N G Maher
- Melanoma Institute Australia, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia
| | - A Solinas
- Melanoma Institute Australia, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - P Guitera
- Melanoma Institute Australia, Sydney, NSW, Australia.,The University of Sydney, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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15
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Maher N, Guitera P. Imiquimod treatment for lentigo maligna: LIMIT-1 trial. Br J Dermatol 2017; 177:324-325. [DOI: 10.1111/bjd.15511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- N.G. Maher
- Melanoma Institute Australia; Sydney Australia
- The University of Sydney; Sydney Australia
| | - P. Guitera
- Melanoma Institute Australia; Sydney Australia
- The University of Sydney; Sydney Australia
- Sydney Melanoma Diagnostic Centre; Royal Prince Alfred Hospital; Sydney Australia
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16
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Maher NG, Blumetti TP, Gomes EE, Cheng HM, Satgunaseelan L, Lo S, Rezze GG, Scolyer RA, Guitera P. Melanoma diagnosis may be a pitfall for optical coherence tomography assessment of equivocal amelanotic or hypomelanotic skin lesions. Br J Dermatol 2017; 177:574-577. [DOI: 10.1111/bjd.15187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- N G Maher
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - T P Blumetti
- AC Camargo Cancer Center, Cutaneous Oncology Department, São Paulo, Brazil
| | - E E Gomes
- AC Camargo Cancer Center, Cutaneous Oncology Department, São Paulo, Brazil
| | - H M Cheng
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - L Satgunaseelan
- Melanoma Institute Australia, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Sydney, Australia
| | - S Lo
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - G G Rezze
- AC Camargo Cancer Center, Cutaneous Oncology Department, São Paulo, Brazil
| | - R A Scolyer
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Tissue Pathology and Diagnostic Oncology, Sydney, Australia
| | - P Guitera
- Melanoma Institute Australia, Sydney, Australia.,The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
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17
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Wurm E, Pellacani G, Longo C, Soyer HP, Gonzalez S, Hofmann-Wellenhof R, Ahlgrimm-Siess V, Guitera P, Sinz C, Kittler H. The value of reflectance confocal microscopy in diagnosis of flat pigmented facial lesions: a prospective study. J Eur Acad Dermatol Venereol 2017; 31:1349-1354. [PMID: 28214381 DOI: 10.1111/jdv.14171] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Flat pigmented facial lesions are difficult to diagnose even with dermatoscopy. It is controversial how additional information obtained by in vivo reflectance confocal microscopy (RCM) impacts the diagnosis and management. OBJECTIVE To examine what in vivo reflectance confocal microscopy of flat pigmented facial lesions adds to clinical examination using dermatoscopy including digital dermatoscopic monitoring. METHODS We prospectively collected 70 cases of flat pigmented facial lesions and recorded diagnoses and management decisions by experts based on direct clinical examination aided by dermatoscopy including digital dermatoscopic monitoring and by remote experts who reviewed the corresponding confocal images. The expert confocal readers were blinded to the clinical and dermatoscopic appearance of the lesion. RESULTS The sensitivity of dermatoscopy plus digital dermatoscopic monitoring was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 84.0% (95% CI 70.89% to 92.83%). The sensitivity of RCM was 95.0% (95% CI 75.13% to 99.87%) and the specificity was 82.0% (95% CI 68.56% to 91.42%). CONCLUSION Although most flat pigmented facial lesions can be managed by clinical examination and dermatoscopy alone, confocal microscopy is a useful adjunct in selected lesions. If RCM is not correlated with clinical and dermatoscopic information, there is risk of overdiagnosis of actinic keratosis, however.
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Affiliation(s)
- E Wurm
- Department of General Dermatology, Medical University of Vienna, Vienna General Hospital (AKH), Vienna, Austria
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - C Longo
- Skin Cancer Unit, Arcispedale Santa Maria, Nuova-IRCCS, Reggio Emilia, Italy
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Brisbane, QLD, Australia
| | - S Gonzalez
- Medicine Department, Alcalá University, Madrid, Spain.,Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - V Ahlgrimm-Siess
- Department of Dermatology, University Clinic Salzburg, Salzburg, Austria
| | - P Guitera
- Melanoma Institute Australia and the Sydney Melanoma Diagnostic Centre, and the Faculty of Dermatology, University of Sydney, Sydney, NSW, Australia
| | - C Sinz
- Department of General Dermatology, Medical University of Vienna, Vienna General Hospital (AKH), Vienna, Austria
| | - H Kittler
- Department of General Dermatology, Medical University of Vienna, Vienna General Hospital (AKH), Vienna, Austria
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18
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Ulrich M, Reinhold U, Skov T, Elvang Søndergaard R, Guitera P. Histological examination confirms clinical clearance of actinic keratoses following treatment with ingenol mebutate 0·05% gel. Br J Dermatol 2016; 176:71-80. [DOI: 10.1111/bjd.14968] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2016] [Indexed: 12/19/2022]
Affiliation(s)
- M. Ulrich
- Charité Universitätsmedizin Berlin Department of Dermatology Charitéplatz 1 Berlin Germany
- Dermatologie am Regierungsviertel/Collegium Medicum Berlin Germany
| | - U. Reinhold
- Department of Dermatology Dermatological Center Bonn Friedensplatz Friedensplatz Bonn Germany
| | - T. Skov
- LEO Pharma A/S Ballerup Denmark
| | | | - P. Guitera
- Sydney Melanoma Diagnostic Centre and Melanoma Institute Australia Discipline of Dermatology The University of Sydney Sydney NSW Australia
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19
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Guitera P, Menzies SW, Argenziano G, Longo C, Losi A, Drummond M, Scolyer RA, Pellacani G. Dermoscopy and in vivo confocal microscopy are complementary techniques for diagnosis of difficult amelanotic and light-coloured skin lesions. Br J Dermatol 2016; 175:1311-1319. [PMID: 27177158 DOI: 10.1111/bjd.14749] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Amelanotic melanomas are often difficult to diagnose. OBJECTIVES To find and test the best methods of diagnosis using dermoscopy and reflectance confocal microscopy (RCM) tools. METHODS We selected consecutive, difficult-to-diagnose, light-coloured and amelanotic skin lesions from three centres (in Australia and Italy). Dermoscopy and RCM diagnostic utility were evaluated under blinded conditions utilizing 45 melanomas (16 in situ, 29 invasive), 68 naevi, 48 basal cell carcinomas (BCCs), 10 actinic keratoses, 10 squamous cell carcinomas (SCCs) and 13 other benign lesions. RESULTS Sensitivity and specificity for melanoma with dermoscopy pattern analysis by two blinded observers and their 'confidence in diagnosis' were low. The amelanotic dermoscopy method had the highest sensitivity (83%) for a diagnosis of malignancy (melanoma, BCC or SCC), but specificity was only 18%. Multivariate analysis confirmed the utility of RCM features previously identified for the diagnosis of BCC and melanoma (highest odds ratio for melanoma: epidermal disarray, dark and/or round pagetoid cells). RCM sensitivity was 67% and 73% for melanoma and BCC diagnosis, respectively, and its specificity for nonmalignant lesion diagnosis was 56%. RCM reader confidence was higher than for dermoscopy; 84% of melanomas would have been biopsied and biopsy avoided in 47% of benign lesions. All melanomas misclassified by either dermoscopy or RCM were detected by the other tool. CONCLUSIONS Dermoscopy and RCM represent complementary/synergistic methods for diagnosis of amelanotic/light-coloured skin lesions.
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Affiliation(s)
- P Guitera
- Sydney Melanoma Diagnostic Centre and Dermatology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW, Australia
| | - S W Menzies
- Sydney Melanoma Diagnostic Centre and Dermatology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Dermatology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - G Argenziano
- Dermatology Unit, Second University of Naples, Naples, Italy
| | - C Longo
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, University of Modena and Reggio Emilia, Modena, Italy
| | - A Losi
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - M Drummond
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - R A Scolyer
- Melanoma Institute Australia, 40 Rocklands Road, North Sydney, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Discipline of Pathology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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20
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Cheng HM, Lo S, Scolyer R, Meekings A, Carlos G, Guitera P. Accuracy of optical coherence tomography for the diagnosis of superficial basal cell carcinoma: a prospective, consecutive, cohort study of 168 cases. Br J Dermatol 2016; 175:1290-1300. [PMID: 27146027 DOI: 10.1111/bjd.14714] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Superficial basal cell carcinoma (sBCC) can be safely treated topically. Potentially noninvasive imaging techniques, such as optical coherence tomography (OCT), may be useful to diagnose and manage patients with sBCC and obviate the need for biopsy. OBJECTIVES To evaluate in OCT (i) the sensitivity and specificity for sBCC diagnosis, (ii) the accuracy in determining BCC depth and (iii) the role in management of sBCC mimickers. METHODS A prospective, consecutive cohort of lesions for which sBCC was considered in the differential diagnosis. These lesions underwent clinical, dermoscopic and OCT assessment. Diagnosis and its confidence were recorded for each modality and were correlated with the histopathological diagnosis (punch biopsy). Interpretation of the OCT images and assessment of individual features were performed blinded to the biopsy results. RESULTS In total, 168 lesions were recruited: 52% were sBCC, 26% were other BCC variants and the remaining lesions were actinic keratosis, squamous cell carcinoma in situ, other benign inflammatory processes and two other malignant tumours. The sensitivity and specificity of OCT for diagnosis of sBCC were 0·87 and 0·80, respectively. There was excellent correlation between OCT and biopsy for tumour depth amongst tumours ≤ 0·4 mm (Pearson correlation r = 0·86, P < 0·001), but the correlation was less as depth increased (Pearson correlation r = 0·71, P < 0·001 for all tumours < 1·0 mm). CONCLUSIONS OCT has good diagnostic accuracy for diagnosing sBCC and measuring depth in tumours ≤ 0·4 mm. Potentially OCT can reduce the need for biopsy in clinically suspected sBCCs. However, careful follow-up is required in such cases as there is a small risk (5%) of misdiagnosis.
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Affiliation(s)
- H M Cheng
- Melanoma Institute Australia, North Sydney, NSW, Australia.,University of Sydney, Sydney Medical School, Sydney, NSW, Australia
| | - S Lo
- Melanoma Institute Australia, North Sydney, NSW, Australia.,University of Sydney, Sydney Medical School, Sydney, NSW, Australia
| | - R Scolyer
- Melanoma Institute Australia, North Sydney, NSW, Australia.,University of Sydney, Sydney Medical School, Sydney, NSW, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A Meekings
- Guy's and St Thomas' NHS Foundation Trust, Department of Medical Physics, London, U.K
| | - G Carlos
- Melanoma Institute Australia, North Sydney, NSW, Australia.,University of Sydney, Sydney Medical School, Sydney, NSW, Australia
| | - P Guitera
- Melanoma Institute Australia, North Sydney, NSW, Australia.,University of Sydney, Sydney Medical School, Sydney, NSW, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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21
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Abstract
Optical coherence tomography (OCT) is a noninvasive imaging tool used in vivo in real time for diagnosis, treatment delineation and monitoring of basal cell carcinoma (BCC). Features of BCC on OCT have been widely described and reviewed. However, the diagnostic accuracy of OCT in these various applications is unclear. We systematically reviewed the literature to assess the accuracy of OCT in diagnosis and management of BCC using the Embase and Medline databases. In total 179 unique references were identified in the initial search, of which 22 studies with 556 histologically proven BCCs were eligible. Assessment of the quality of eligible studies was undertaken using the STROBE criteria. Data extraction and quality assessment were performed independently by the two authors. This systematic review provides an overview of the clinical applications of OCT in the diagnosis and management of BCC. OCT has been suggested to be useful in the diagnosis, treatment planning and treatment monitoring of BCC. As the technology improves and its utility increases, further studies with good methodological quality will be needed to implement OCT into daily practice.
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Affiliation(s)
- H M Cheng
- Melanoma Institute Australia, 40 Rocklands Rd, North Sydney, NSW, 2060, Australia
| | - P Guitera
- Department of Dermatology, University of Sydney, Sydney New South Wales, Australia
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Fogarty GB, Hong A, Scolyer RA, Lin E, Haydu L, Guitera P, Thompson J. Radiotherapy for lentigo maligna: a literature review and recommendations for treatment. Br J Dermatol 2015; 170:52-8. [PMID: 24032599 DOI: 10.1111/bjd.12611] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 11/28/2022]
Abstract
Lentigo maligna (LM) incidence is increasing. LM frequently involves the face near critical anatomical structures and as a consequence clinical management is challenging. Nonsurgical therapies, including radiotherapy (RT), are increasingly used. Evidenced-based treatment guidelines are lacking. We conducted a review of previously published data analysing RT treatment of LM. A search of PubMed, Embase and Medline databases to June 2012 identified nine clinical studies that examined the use of RT for LM treatment in at least five patients. Nine studies described 537 patients with LM treated with definitive primary RT, between 1941 and 2009, with a median reported follow-up time of 3 years. Eight articles could be reviewed for oncological outcome data. There were 18 recurrences documented in a total of 349 assessable patients (5%). Salvage was successful in the majority of recurrent LM cases by using further RT, surgery or other therapies. Progression to LM melanoma (LMM) occurred in five patients (five out of 349, 1.4%) who all had poor outcomes. There were five marginal recurrences documented out of 123 assessable patients (4%). There were eight in-field recurrences documented with either LM (five) or LMM (three) out of 171 assessable patients (5%). A series of recommendations were then developed for RT parameters for treatment of LM. These parameters include treatment volume, dose, dose per fraction and outcome measures. These may be of use in prospective data collection.
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Affiliation(s)
- G B Fogarty
- Melanoma Institute Australia, Poche Centre, 40 Rocklands Road, North Sydney, NSW, 2060, Australia; Genesis Cancer Care, Mater Sydney Radiation Oncology Centre, Mater Hospital, 25 Rocklands Road, North Sydney, NSW, 2060, Australia
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de Masson A, Guitera P, Brice P, Moulonguet I, Mouly F, Bouaziz JD, Battistella M, Madelaine I, Roux J, Ram-Wolff C, Cayuela JM, Bachelez H, Bensussan A, Michel L, Bagot M. Long-term efficacy and safety of alemtuzumab in advanced primary cutaneous T-cell lymphomas. Br J Dermatol 2014; 170:720-4. [PMID: 24438061 DOI: 10.1111/bjd.12690] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alemtuzumab has been proposed as salvage therapy for refractory cutaneous T-cell lymphomas (CTCLs). Long-term follow-up data are scarce. OBJECTIVES To assess the efficacy and safety of alemtuzumab in the treatment of advanced CTCL. METHODS A multicentre retrospective analysis was carried out of 39 patients with advanced CTCL treated with alemtuzumab between 2003 and 2013. RESULTS Thirty-nine patients (median age 62 years, range 20-83) with Sézary syndrome (SS, n = 23) or advanced mycosis fungoides (MF, n = 16) received alemtuzumab 30 mg two to three times per week for a median duration of 12 weeks (range 1-35). Fifteen patients received maintenance therapy for a median duration of 24 weeks (range 6-277). Eleven patients (28%) had transformed disease (MF, n = 10; SS, n = 1). After a median follow-up of 24 months (range 0.3-124), eight patients (21%) were still alive. The overall response rate was 51% in the whole study group (partial response, n = 13; complete response, n = 7); 70% in patients with SS and 25% in patients with MF (P = 0.009). The median time to progression was 3.4 months (range 0.4-42). Six patients (15%; SS, n = 5; MF, n = 1) remained progression free for > 2 years (median 56 months, range 28-117). Five patients experienced cutaneous large T-cell transformation during alemtuzumab treatment and one patient developed primary cutaneous large B-cell lymphoma. Twenty-four patients (62%) had a grade three or higher infectious adverse event and 10 (26%) a haematological toxicity, which led to treatment discontinuation in 17 cases (44%) and death in two (5%). CONCLUSIONS Alemtuzumab may induce long-term remission in SS but seems ineffective in MF and transformed CTCL.
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Affiliation(s)
- A de Masson
- Service de Dermatologie, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France; INSERM UMR-S976, 'Immunologie, Dermatologie, Oncologie', Université Paris VII, 1 Avenue Claude Vellefaux, 75010 Paris, France
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Santos D, Green J, Bhandari N, Hong A, Guitera P, Fogarty G. Tangential Volumetric Modulated Radiation Therapy Is Superior to Brachytherapy for Large Scalp Lesions: A Case Study in Lentigo Maligna. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Laing ME, Coates E, Jopp-McKay A, Scolyer RA, Guitera P. Atypical naevus spilus: detection by in vivo confocal microscopy. Clin Exp Dermatol 2014; 39:616-9. [PMID: 24934914 DOI: 10.1111/ced.12354] [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] [Accepted: 01/06/2014] [Indexed: 11/27/2022]
Abstract
Naevus spilus (NS) is a naevoid disorder characterized by hyperpigmented macules or papules scattered over a café-au-lait macule. Such café-au-lait macules are often present at birth, and the darker pigmented speckles of NS slowly increase in number and size over a period of several years. NS can therefore be difficult to evaluate clinically for the development of melanoma. In vivo confocal microscopy (IVCM) is a novel method that allows examination at cellular resolution of cutaneous lesions in vivo. IVCM has been shown to have twice the specificity of dermoscopy for the diagnosis of melanoma, with comparable sensitivity. It has been shown to be useful in the detection and grading of dysplastic naevi, which are recognized precursors of melanoma in some cases. In this report, we highlight that IVCM can also be used as a tool complementary to dermoscopy to identify areas of dynamic change in clinically and dermoscopically equivocal lesions. IVCM may thereby assist in the early detection of melanocytic atypia and melanoma arising in NS, in turn leading to excision of melanoma at an early stage, which is associated with a favourable outcome. We also outline some of the difficulties encountered in confocal microscopy and histology when differentiating melanoma from dysplastic naevi.
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Affiliation(s)
- M E Laing
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Dermatology, Royal Prince Alfred Hospital, Sydney, Australia; Melanoma Institute Australia, Sydney, Australia
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Losi A, Longo C, Cesinaro A, Benati E, Witkowski A, Guitera P, Pellacani G. Hyporeflective pagetoid cells: a new clue for amelanotic melanoma diagnosis by reflectance confocal microscopy. Br J Dermatol 2014; 171:48-54. [DOI: 10.1111/bjd.12781] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- A. Losi
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - C. Longo
- Skin Cancer Unit; Arcispedale Santa Maria Nuova - IRCCS; Viale Risorgimento 80 42100 Reggio Emilia Italy
| | - A.M. Cesinaro
- Department of Pathology; University of Modena and Reggio Emilia; Modena Italy
| | - E. Benati
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - A. Witkowski
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - P. Guitera
- Melanoma Institute Australia; The University of Sydney and Sydney Melanoma Diagnostic Centre; Royal Prince Alfred Hospital; Sydney NSW Australia
| | - G. Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
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Guitera P, Haydu LE, Menzies SW, Scolyer RA, Hong A, Fogarty GB, Gallardo F, Segura S. Surveillance for treatment failure of lentigo maligna with dermoscopy and in vivo confocal microscopy: new descriptors. Br J Dermatol 2014; 170:1305-12. [PMID: 24641247 DOI: 10.1111/bjd.12839] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonsurgical treatment (radiotherapy, imiquimod) is increasingly employed for the management of lentigo maligna (LM). While the diagnosis of LM remains difficult, the detection of treatment failure is even more challenging. OBJECTIVES To describe the sensitivity and specificity for the diagnosis of LM of individual features and methods using dermoscopy and in vivo reflectance confocal microscopy (RCM) to aid in the detection of treatment failure of LM following nonsurgical treatment. METHODS A retrospective study of dermoscopy and RCM images (blinded to the correlation with pathology) in patients with biopsy-confirmed LM who were undergoing nonsurgical treatment in two referral institutions - one in Sydney, Australia, and the other in Barcelona, Spain. Ninety-eight patients were treated nonsurgically for LM during the period 2006-2012. Thirty-one patients had abnormal dermoscopy or RCM evaluation, and had a biopsy that identified LM recurrence in 15 patients and nonmelanoma diagnoses in 16 patients (one Bowen disease, 15 solar changes). RESULTS The diagnosis of treatment failure was difficult with dermoscopy, with a sensitivity of 80% and specificity of 56%, even with the interpretation of an expert. The best criterion was asymmetric hyperpigmented follicular openings, but this was present in only 47% of treatment failure LM. Isolated, very fine brown dots ('dust' appearance) correlated highly with the diagnosis of treatment failure LM (73% sensitivity and 88% specificity) and with pagetoid cells seen with RCM. The LM score, comprising six criteria, had a specificity of 94% and sensitivity of 100%. CONCLUSIONS These methods and descriptors should help to manage the diagnosis of treatment failure.
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Affiliation(s)
- P Guitera
- Melanoma Institute Australia, Poche Centre, 40 Rocklands Road, North Sydney, NSW, 2060, Australia; Department of Sydney Melanoma Diagnostic Centre, Missenden Road Camperdown, NSW, 2050, Australia; Discipline of Dermatology, The University of Sydney, Sydney, NSW, Australia
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Guitera P, Scolyer R, Gill M, Akita H, Arima M, Yokoyama Y, Matsunaga K, Longo C, Bassoli S, Bencini P, Giannotti R, Pellacani G, Alessi-Fox C, Dalrymple C. Reflectance confocal microscopy for diagnosis of mammary and extramammary Paget’s disease. J Eur Acad Dermatol Venereol 2012; 27:e24-9. [DOI: 10.1111/j.1468-3083.2011.04423.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Levy JL, Guitera P, Salomon D. [Evaluations and measures in dermatology: new approaches]. Rev Med Suisse 2011; 7:759-763. [PMID: 21568098] [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: 05/30/2023]
Abstract
Advances in computing and digital imaging now make it possible to photograph and compare skin lesions at regular intervals. It is also possible to measure changes in the skin and observing the skin in vivo at the microscopic level. This article presents some of these techniques that are passed from the world of research to the clinic to monitor or diagnose melanocytic lesions.
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Affiliation(s)
- J-L Levy
- Centre laser dermatologique, Marseille, France
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Guitera P, Li L, Crotty K, FitzGerald P, Mellenbergh R, Pellacani G, Menzies S. Melanoma histological Breslow thickness predicted by 75-MHz ultrasonography. Br J Dermatol 2008; 159:364-9. [DOI: 10.1111/j.1365-2133.2008.08681.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lean C, Guitera P, Bourne R, Stanwell P, King S, Scolyer R, Stretch J, Thompson J, Mountford CE. 3 Tesla Magnetic Resonance (MR) Microimaging of Primary Cutaneous Melanoma. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2005-931827] [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]
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Lean C, Guitera P, Bourne R, Stanwell P, King S, Scolyer R, Stretch J, Thompson J, Mountford CE. 3 Tesla Magnetic Resonance (MR) Microimaging of Primary Cutaneous Melanoma. ROFO-FORTSCHR RONTG 2006. [DOI: 10.1055/s-2006-931858] [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: 10/27/2022]
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Levy A, Guitera P, Kerob D, Ollivaud L, Archimbaud A, Dubertret L, Basset-Seguin N. Hypersensibilité à la dacarbazine chez les malades traités pour mélanome métastatique. Ann Dermatol Venereol 2006; 133:157-60. [PMID: 16508601 DOI: 10.1016/s0151-9638(06)70868-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 11/19/2022]
Abstract
BACKGROUND Dacarbazine (DTIC) is the first-line chemotherapy for metastatic malignant melanoma without cerebral metastasis. Its clinical and hematological safety is usually good. Hypersensitivity in hepatic failure patients is the most serious side effect described. PATIENTS AND METHODS This was a retrospective study of the prevalence of hypersensitivity in patients treated with DTIC for metastatic melanoma between 11/01/2002 and 10/31/2003. Hypersensitivity was diagnosed in the event of fever, hypereosinophilia (> 500/mm3) with or without liver dysfunction (> twice pre-therapeutic values). Clinical data, DTIC administration modalities, number of courses and clinical and laboratory safety data were recorded. RESULTS Twenty patients were included, 11 women and 9 men of median age 58.6 years (22-82 years) with multiple metastases in all cases. DTIC was the first-line treatment for 19 patients, being administered for 4 days to 10 patients and for 1 day to the other 10 patients, depending on their overall health status. Five hypersensitivity-like manifestations were observed, all in the 4-day treatment group. In 3 patients, fever and hypereosinophilia were seen without liver dysfunction at D3 of the second course of treatment. In 2 patients, treatment was stopped after the second course because of disease progression. In the third patient, 4 courses were given with recurrence of symptoms, although the latter were controlled during the fifth course with corticosteroids and antihistamines given 15 minutes before the start of treatment. Two patients experienced severe forms of hypersensitivity with fever, hypereosinophilia, liver dysfunction (cytolysis and cholestasis) and delayed medullar aplasia, after the first and second course respectively. In one patient, bone marrow examination showed a block at the promyelocytic stage consistent with a toxic etiology. Treatment with DTIC was stopped, and all signs regressed with symptomatic treatment. DISCUSSION Hypersensitivity with DTIC seems to be frequent, being observed in 20% of our patients, with early onset (after the first or second course) and absence of dose-dependence. We describe for the first time two cases of medullar aplasia occurring in association with DTIC hypersensitivity. During phase I studies, the hematologic toxicity of DTIC was moderate, rarely affecting red cells, and was observed with higher doses than those used in metastatic malignant melanoma. We suggest that this aplasia forms part of the signs of hypersensitivity because of the bone marrow morphology, the existence of anemia and concomitant resolution with all the others signs of hypersensitivity. CONCLUSION Laboratory monitoring (NFS, liver enzymes) is thus justified, particularly after the first and second courses of DTIC. In case of fever and hypereosinophilia without liver dysfunction, DTIC may be continued together with symptomatic treatment. In the event of hepatic dysfunction, and of course severe hematological disorders, potentially fatal complications can occur and treatment must be stopped.
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Affiliation(s)
- A Levy
- Service de Dermatologie I, Hôpital Saint-Louis, Paris
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Guitera P, Bourrier P, Basset-Seguin N, Dubertret L. L’échographie devrait devenir l’examen de référence dans la détection de l’atteinte ganglionnaire du mélanome. Ann Dermatol Venereol 2004; 131:937-9. [PMID: 15602377 DOI: 10.1016/s0151-9638(04)93800-8] [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: 11/18/2022]
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