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Ríos-Viñuela E, García-Vázquez M, Juan MJ, Nagore E, Requena C, Sanmartín O, Llombart B. Avelumab to treat Merkel cell carcinoma: real-life experience in a dedicated oncology center. Actas Dermosifiliogr 2024:S0001-7310(24)00059-0. [PMID: 38423921 DOI: 10.1016/j.ad.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/14/2024] [Accepted: 01/15/2024] [Indexed: 03/02/2024] Open
Abstract
The arrival of immunotherapy has revolutioned the management of patients with metastatic Merkel cell carcinoma (MCC). We conducted an observational, retrospective study of 14 cases treated with avelumab. The response rate was 57%: complete response was reached in 29% of patients, and partial responses in 29%. The drug proved effective in 83% (5/6) of the patients with a single metastatic site. However, the disease progressed in 75% (3/4) of the patients with bone metastases. PD1-L expression, MCC polyomavirus (MCPyV) positivity, and an impaired neutrophil-to-lypmhocyte ratio (NLR) could not be associated with responses to the therapy. Avelumab is an effective and safe drug for the management of advanced MCC, and its effectiveness appears to be impacted by the number and location of metastases.
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Affiliation(s)
- E Ríos-Viñuela
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, España; Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - M García-Vázquez
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - M J Juan
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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Massa A, Isasi-Fuster A, Requena C, Manrique-Silva E, Kumar R, Nagore E. Nodular type but not vitamin D levels increases the risk of second primary cancers in melanoma patients: An observational study of 663 patients. Actas Dermosifiliogr 2024; 115:143-149. [PMID: 37832865 DOI: 10.1016/j.ad.2023.10.001] [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: 08/05/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Vitamin D deficiency associates with the risk of developing many diseases, including cancer. At the molecular level, vitamin D appears to have an antineoplastic effect. However, the role of vitamin D deficiency in cancer pathogenesis remains unelucidated and numerous studies have resulted in discordant results. This study aimed to determine whether vitamin D deficiency during melanoma diagnosis increases the risk of developing non-cutaneous second primary cancers (SPC). MATERIALS AND METHODS A retrospective study on 663 patients diagnosed with melanoma between 1 January 2011 and 31 October 2022. The effect of each variable on the development of a subsequent non-cutaneous cancer was performed using Kaplan-Meier curves and differences were assessed by log-rank tests. Cox proportional hazard univariate and multivariate models were used to quantify the effect of each variable in the time to develop a non-cutaneous neoplasia. RESULTS Out of 663 patients, 34 developed a non-cutaneous SPC. There was no statistically significant association between vitamin D levels and non-cutaneous SPC development (log-rank, p=0.761). Age>60 years, stage III/IV, and nodular melanoma subtype were significantly associated with the development of a SPC. After multivariate analysis, only age>60 years (HR 3.4; HR CI 95%: 1.5-7.6) and nodular melanoma subtype (HR 2.2; HR CI 95%: 1.0-4.8) were included in the final model. CONCLUSIONS Our results suggest that vitamin D deficiency is not associated with an increased risk of developing non-cutaneous SPC in melanoma patients. However, age over 60 years and nodular melanoma subtype increase the risk for non-cutaneous SPC development.
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Affiliation(s)
- A Massa
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - A Isasi-Fuster
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - C Requena
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain
| | - E Manrique-Silva
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain
| | - R Kumar
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany; Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
| | - E Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain; Department of Dermatology, Fundación Instituto Valenciano de Oncología, València, Spain.
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Massa A, Isasi-Fuster A, Requena C, Manrique-Silva E, Kumar R, Nagore E. Nodular Type but Not Vitamin D Levels Increases the Risk of Second Primary Cancers in Melanoma Patients: An Observational Study of 663 Patients. Actas Dermosifiliogr 2024; 115:T143-T149. [PMID: 38048949 DOI: 10.1016/j.ad.2023.10.038] [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: 08/05/2023] [Accepted: 10/08/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Vitamin D deficiency associates with the risk of developing many diseases, including cancer. At the molecular level, vitamin D appears to have an antineoplastic effect. However, the role of vitamin D deficiency in cancer pathogenesis remains unelucidated and numerous studies have resulted in discordant results. This study aimed to determine whether vitamin D deficiency during melanoma diagnosis increases the risk of developing non-cutaneous second primary cancers (SPC). MATERIALS AND METHODS A retrospective study on 663 patients diagnosed with melanoma between 1 January 2011 and 31 October 2022. The effect of each variable on the development of a subsequent non-cutaneous cancer was performed using Kaplan-Meier curves and differences were assessed by log-rank tests. Cox proportional hazard univariate and multivariate models were used to quantify the effect of each variable in the time to develop a non-cutaneous neoplasia. RESULTS Out of 663 patients, 34 developed a non-cutaneous SPC. There was no statistically significant association between vitamin D levels and non-cutaneous SPC development (log-rank, p=0.761). Age>60 years, stage III/IV, and nodular melanoma subtype were significantly associated with the development of a SPC. After multivariate analysis, only age>60 years (HR 3.4; HR CI 95%: 1.5-7.6) and nodular melanoma subtype (HR 2.2; HR CI 95%: 1.0-4.8) were included in the final model. CONCLUSIONS Our results suggest that vitamin D deficiency is not associated with an increased risk of developing non-cutaneous SPC in melanoma patients. However, age over 60 years and nodular melanoma subtype increase the risk for non-cutaneous SPC development.
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Affiliation(s)
- A Massa
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - A Isasi-Fuster
- Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, València, Spain
| | - E Manrique-Silva
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, València, Spain
| | - R Kumar
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany; Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
| | - E Nagore
- Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, València, Spain; Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, València, Spain.
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Garcia-Casado Z, Millán-Esteban D, Manrique-Silva E, Requena C, Traves V, Nagore E. Germline cancer-related mutations detected by routine targeted NGS for tumour analysis: A series of 357 melanoma patients. J Eur Acad Dermatol Venereol 2023; 37:e1384-e1387. [PMID: 37422710 DOI: 10.1111/jdv.19323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Z Garcia-Casado
- Laboratory of Molecular Biology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - D Millán-Esteban
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - E Manrique-Silva
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - V Traves
- Department of Pathological Anatomy, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - E Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
- Department of Dermatology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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Pellegrini C, Cardelli L, Ghiorzo P, Pastorino L, Potrony M, García-Casado Z, Elefanti L, Stefanaki I, Mastrangelo M, Necozione S, Aguilera P, Rodríguez-Hernández A, Di Nardo L, Rocco T, Del Regno L, Badenas C, Carrera C, Malvehy J, Requena C, Bañuls J, Stratigos AJ, Peris K, Menin C, Calista D, Nagore E, Puig S, Landi MT, Fargnoli MC. High- and intermediate-risk susceptibility variants in melanoma families from the Mediterranean area: A multicentre cohort from the MelaNostrum Consortium. J Eur Acad Dermatol Venereol 2023; 37:2498-2508. [PMID: 37611275 PMCID: PMC10842987 DOI: 10.1111/jdv.19461] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 06/01/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Most of large epidemiological studies on melanoma susceptibility have been conducted on fair skinned individuals (US, Australia and Northern Europe), while Southern European populations, characterized by high UV exposure and dark-skinned individuals, are underrepresented. OBJECTIVES We report a comprehensive pooled analysis of established high- and intermediate-penetrance genetic variants and clinical characteristics of Mediterranean melanoma families from the MelaNostrum Consortium. METHODS Pooled epidemiological, clinical and genetic (CDKN2A, CDK4, ACD, BAP1, POT1, TERT, and TERF2IP and MC1R genes) retrospective data of melanoma families, collected within the MelaNostrum Consortium in Greece, Italy and Spain, were analysed. Univariate methods and multivariate logistic regression models were used to evaluate the association of variants with characteristics of families and of affected and unaffected family members. Subgroup analysis was performed for each country. RESULTS We included 839 families (1365 affected members and 2123 unaffected individuals). Pathogenic/likely pathogenic CDKN2A variants were identified in 13.8% of families. The strongest predictors of melanoma were ≥2 multiple primary melanoma cases (OR 8.1; 95% CI 3.3-19.7), >3 affected members (OR 2.6; 95% CI 1.3-5.2) and occurrence of pancreatic cancer (OR 4.8; 95% CI 2.4-9.4) in the family (AUC 0.76, 95% CI 0.71-0.82). We observed low frequency variants in POT1 (3.8%), TERF2IP (2.5%), ACD (0.8%) and BAP1 (0.3%). MC1R common variants (≥2 variants and ≥2 RHC variants) were associated with melanoma risk (OR 1.4; 95% CI 1.0-2.0 and OR 4.3; 95% CI 1.2-14.6, respectively). CONCLUSIONS Variants in known high-penetrance genes explain nearly 20% of melanoma familial aggregation in Mediterranean areas. CDKN2A melanoma predictors were identified with potential clinical relevance for cancer risk assessment.
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Affiliation(s)
- C Pellegrini
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - L Cardelli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - P Ghiorzo
- IRCCS Ospedale Policlinico San Martino, Genetica dei Tumori rari, Genoa, Italy
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - L Pastorino
- IRCCS Ospedale Policlinico San Martino, Genetica dei Tumori rari, Genoa, Italy
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - M Potrony
- Department of Biochemistry and Molecular Genetics, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Z García-Casado
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, València, Spain
| | - L Elefanti
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - I Stefanaki
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - M Mastrangelo
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - S Necozione
- Epidemiology Unit, Department of Life, Health and Environmental Science, University of L'Aquila, L'Aquila, Italy
| | - P Aguilera
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | | | - L Di Nardo
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - T Rocco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, Ospedale San Salvatore, L'Aquila, Italy
| | - L Del Regno
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Badenas
- Department of Biochemistry and Molecular Genetics, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - C Carrera
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - J Malvehy
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - C Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - J Bañuls
- Department of Dermatology, Hospital General Universitario de Alicante, Alicante, Spain
| | - A J Stratigos
- 1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - K Peris
- UOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Menin
- Immunology and Diagnostic Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - D Calista
- Department of Dermatology, Maurizio Bufalini Hospital, Cesena, Italy
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - S Puig
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Biomedical Research Networking Center on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - M T Landi
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - M C Fargnoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- Dermatology Unit, Ospedale San Salvatore, L'Aquila, Italy
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Benavent MP, Viñuela ER, Nagore E, Monteagudo C, Aguerralde M, Cano DM, Llombart B, Guillén CS, Canales IP, Requena C, Sanmartín O. [[Translated article]]Lymphovascular Invasion and High Mitotic Count Are Associated With Increased Risk of Recurrence in Pleomorphic Dermal Sarcoma. Actas Dermosifiliogr 2023:S0001-7310(23)00479-9. [PMID: 37302481 DOI: 10.1016/j.ad.2023.06.010] [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: 01/19/2023] [Accepted: 04/02/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Atypical fibroxanthoma and pleomorphic dermal sarcoma (PDS) are rare mesenchymal tumors. Due to the low incidence of PDS and a historically confusing nomenclature, little is known about the true aggressiveness of this tumor. The aim of this study was to investigate clinical and histologic risk factors for recurrence in PDS. MATERIAL AND METHODS Retrospective, observational, bicentric study of 31 PDSs diagnosed and treated at Hospital Clínico Universitario de Valencia and Instituto Valenciano de Oncología in Valencia, Spain, between 2005 and 2020. We described the clinical and histologic features of these tumors and performed univariate analysis and multivariate Cox regression analysis. RESULTS In the univariate analysis, tumor recurrence (P < .001), necrosis (P = .020), lymphovascular invasion (P = .037), perineural invasion (P = .041), and mitotic count (< 18 vs ≥ 18 mitoses per 10 high-power fields) (P = .093) were associated with worse disease-free survival. In the multivariate Cox regression analysis, mitotic count and lymphovascular invasion retained their significance as predictors of worse disease-free survival (P < .05). CONCLUSIONS PDS is an aggressive tumor in which a high mitotic count (≥ 18) and lymphovascular invasion are associated with a higher risk of recurrence and worse disease-free survival. Necrosis and perineural invasion are also probably linked to increased tumor aggressiveness.
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Affiliation(s)
- M Pons Benavent
- Servicio de Dermatología, Hospital Virgen de Los Lírios, Alcoy (Alicante), España
| | - E Ríos Viñuela
- Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario, Valencia, España
| | - M Aguerralde
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - D Mata Cano
- Servicio de Anatomía Patológica, Hospital de Tortosa Verge de la Cinta, Tortosa (Tarragona), España
| | - B Llombart
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Serra Guillén
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - I Pinazo Canales
- Servicio de Dermatología, Hospital Clínico Universitario, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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Requena C, Traves V, Ferrandis E, Almero MA, Casado ZG, Silva EM, Briz ÁS, Escalonilla P, Nagore E. [[Translated article]]Melanoma arising in plaque-type blue nevus and dermal melanocytosis: Diagnostic and prognostic value of BAP1. Actas Dermosifiliogr 2023:S0001-7310(23)00477-5. [PMID: 37302484 DOI: 10.1016/j.ad.2023.06.008] [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: 02/15/2023] [Accepted: 04/02/2023] [Indexed: 06/13/2023] Open
Abstract
Melanoma arising in blue nevus, also known as melanoma ex blue nevus, is a specific form of melanoma whose genetic profile is different to that of other cutaneous melanomas and surprisingly similar to that of uveal melanoma. Although melanoma ex blue nevus can appear de novo, it usually arises in a preexisting blue nevus or dermal melanocytosis. Not all nodular lesions arising in association with blue nevus or dermal melanocytosis are melanomas, however, and because clinical and histologic findings may be insufficient for a definitive diagnosis, additional studies such as comparative genomic hybridization are important. Detection of chromosomal aberrations supports a diagnosis of malignancy. Studies of the BAP1 gene are particularly useful in this setting because loss of expression is indicative of melanoma. We present 3 cases on the spectrum of blue nevus to melanoma ex blue nevus that were studied using molecular biology techniques.
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Affiliation(s)
- C Requena
- Servicios de Dermatología, Anatomía Patológica, Spain; Otorrinolaringología y Biología molecular, Spain; del Instituto Valenciano de Oncología. Servicios de Anatomía Patológica, Spain; del Hospital Universitario Salamanca y Dermatología, Spain; del Hospital Nuestra Señora de Sonsoles de Ávila, Spain.
| | - Víctor Traves
- Servicios de Dermatología, Anatomía Patológica, Spain
| | - E Ferrandis
- Otorrinolaringología y Biología molecular, Spain
| | | | - Z García Casado
- del Instituto Valenciano de Oncología. Servicios de Anatomía Patológica, Spain
| | - E Manrique Silva
- Servicios de Dermatología, Anatomía Patológica, Spain; Otorrinolaringología y Biología molecular, Spain; del Instituto Valenciano de Oncología. Servicios de Anatomía Patológica, Spain; del Hospital Universitario Salamanca y Dermatología, Spain; del Hospital Nuestra Señora de Sonsoles de Ávila, Spain
| | - Á Santos Briz
- del Hospital Universitario Salamanca y Dermatología, Spain
| | - P Escalonilla
- del Hospital Nuestra Señora de Sonsoles de Ávila, Spain
| | - E Nagore
- Servicios de Dermatología, Anatomía Patológica, Spain; Otorrinolaringología y Biología molecular, Spain; del Instituto Valenciano de Oncología. Servicios de Anatomía Patológica, Spain; del Hospital Universitario Salamanca y Dermatología, Spain; del Hospital Nuestra Señora de Sonsoles de Ávila, Spain
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Requena C, Traves V, Ferrandis E, Antón Almero M, García-Casado Z, Manrique-Silva E, Santos Briz Á, Escalonilla P, Nagore E. Melanoma Arising in Plaque-Type Blue Nevus and Dermal Melanocytosis: Diagnostic and Prognostic Value of BAP1. Actas Dermosifiliogr 2023:S0001-7310(23)00299-5. [PMID: 37088284 DOI: 10.1016/j.ad.2023.04.016] [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: 02/15/2023] [Revised: 03/21/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
Melanoma arising in blue nevus, also known as melanoma ex blue nevus, is a specific form of melanoma whose genetic profile is different to that of other cutaneous melanomas and surprisingly similar to that of uveal melanoma. Although melanoma ex blue nevus can appear de novo, it usually arises in a preexisting blue nevus or dermal melanocytosis. Not all nodular lesions arising in association with blue nevus or dermal melanocytosis are melanomas, however, and because clinical and histologic findings may be insufficient for a definitive diagnosis, additional studies such as comparative genomic hybridization are important. Detection of chromosomal aberrations supports a diagnosis of malignancy. Studies of the BAP1 gene are particularly useful in this setting because loss of expression is indicative of melanoma. We present 3 cases on the spectrum of blue nevus to melanoma ex blue nevus that were studied using molecular biology techniques.
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Affiliation(s)
| | | | | | | | | | | | - Á Santos Briz
- del Instituto Valenciano de Oncología. Servicios de Anatomía Patológica, Spain
| | - P Escalonilla
- del Hospital Universitario Salamanca y Dermatología del Hospital Nuestra Señora de Sonsoles de Ávila, Spain
| | - E Nagore
- Servicios de Dermatología, Spain
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Pons Benavent M, Ríos-Viñuela E, Nagore E, Monteagudo C, Aguerralde M, Mata Cano D, Llombart B, Serra-Guillén C, Pinazo Canales I, Requena C, Sanmartín O. Lymphovascular Invasion and High Mitotic Count Are Associated With Increased Risk of Recurrence in Pleomorphic Dermal Sarcoma. Actas Dermosifiliogr 2023:S0001-7310(23)00301-0. [PMID: 37088288 DOI: 10.1016/j.ad.2023.04.018] [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: 01/19/2023] [Revised: 03/22/2023] [Accepted: 04/02/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Atypical fibroxanthoma and pleomorphic dermal sarcoma (PDS) are rare mesenchymal tumors. Due to the low incidence of PDS and a historically confusing nomenclature, little is known about the true aggressiveness of this tumor. The aim of this study was to investigate clinical and histologic risk factors for recurrence in PDS. MATERIAL AND METHODS Retrospective, observational, bicentric study of 31 PDSs diagnosed and treated at Hospital Clínico Universitario de Valencia and Instituto Valenciano de Oncología in Valencia, Spain, between 2005 and 2020. We described the clinical and histologic features of these tumors and performed univariate analysis and multivariate Cox regression analysis. RESULTS In the univariate analysis, tumor recurrence (P < .001), necrosis (P = .020), lymphovascular invasion (P = .037), perineural invasion (P = .041), and mitotic count (< 18 vs ≥ 18 mitoses per 10 high-power fields) (P = .093) were associated with worse disease-free survival. In the multivariate Cox regression analysis, mitotic count and lymphovascular invasion retained their significance as predictors of worse disease-free survival (P < .05). CONCLUSIONS PDS is an aggressive tumor in which a high mitotic count (≥ 18) and lymphovascular invasion are associated with a higher risk of recurrence and worse disease-free survival. Necrosis and perineural invasion are also probably linked to increased tumor aggressiveness.
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Affiliation(s)
- M Pons Benavent
- Servicio de Dermatología, Hospital Virgen de Los Lírios, Alcoy (Alicante), España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario, Valencia, España
| | - M Aguerralde
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - D Mata Cano
- Servicio de Anatomía Patológica, Hospital de Tortosa Verge de la Cinta, Tortosa (Tarragona), España
| | - B Llombart
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Serra-Guillén
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - I Pinazo Canales
- Servicio de Dermatología, Hospital Clínico Universitario, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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10
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Requena C, Manrique E, Nagore E. [[Translated article]]Update on Lentigo Maligna: Diagnostic Signs and Treatment. Actas Dermosifiliogr 2023; 114:T413-T424. [PMID: 37086944 DOI: 10.1016/j.ad.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/28/2023] [Indexed: 04/24/2023] Open
Abstract
Lentigo maligna (LM) is an in situ cutaneous melanoma that arises in sun-damaged skin. Its most common presentation is a progressive, slow-growing, irregularly pigmented spot on the face of older patients. Although the exact percentage of LMs that progress to invasive tumors is unknown, it is thought to lie between 2% and 5%. Both the clinical and histologic diagnosis of LM can be challenging, especially in patients with early-stage or atypical disease. Treatment also holds challenges, because lesions are located in highly visible areas and are often large. Surgery can thus compromise cosmetic and sometimes functional outcomes. We review clinical and histopathological findings that can facilitate the diagnosis of LM. We also examine treatment options, with a focus on surgery.
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Affiliation(s)
- C Requena
- Servicio de Dermatología. Instituto Valenciano de Oncología, Valencia, Spain.
| | - E Manrique
- Servicio de Dermatología. Instituto Valenciano de Oncología, Valencia, Spain
| | - E Nagore
- Servicio de Dermatología. Instituto Valenciano de Oncología, Valencia, Spain.
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11
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Requena C, Manrique E, Nagore E. Update on Lentigo Maligna: Diagnostic Signs and Treatment. Actas Dermosifiliogr 2023; 114:413-424. [PMID: 36925098 DOI: 10.1016/j.ad.2023.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 12/13/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/15/2023] Open
Abstract
Lentigo maligna (LM) is an in situ cutaneous melanoma that arises in sun-damaged skin. Its most common presentation is a progressive, slow-growing, irregularly pigmented spot on the face of older patients. Although the exact percentage of LMs that progress to invasive tumors is unknown, it is thought to lie between 2% and 5%. Both the clinical and histologic diagnosis of LM can be challenging, especially in patients with early-stage or atypical disease. Treatment also holds challenges, because lesions are located in highly visible areas and are often large. Surgery can thus compromise cosmetic and sometimes functional outcomes. We review clinical and histopathological findings that can facilitate the diagnosis of LM. We also examine treatment options, with a focus on surgery.
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Affiliation(s)
- C Requena
- Servicio de Dermatología. Instituto Valenciano de Oncología, Valencia, Spain.
| | - E Manrique
- Servicio de Dermatología. Instituto Valenciano de Oncología, Valencia, Spain
| | - E Nagore
- Servicio de Dermatología. Instituto Valenciano de Oncología, Valencia, Spain.
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12
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Ríos-Viñuela E, Álvarez P, Lavernia J, Serra-Guillén C, Requena C, Bernia E, Diago A, Llombart B, Sanmartín O. Cemiplimab in Advanced Cutaneous Squamous Cell Carcinoma: Real-World Experience in a Monographic Oncology Center. Actas Dermo-Sifiliográficas 2022; 113:610-615. [DOI: 10.1016/j.ad.2021.04.011] [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] [Received: 02/16/2021] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 10/18/2022] Open
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13
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Requena C, Serra-Guillén C, Sanmartín O. [Translated article] Histologically agressive basal cell carcinoma with particular emphasis on galeal infiltration of the scalp. Actas Dermo-Sifiliográficas 2022; 113:T575-T582. [DOI: 10.1016/j.ad.2022.05.009] [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] [Received: 07/03/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022] Open
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14
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Requena C, Serra-Guillén C, Sanmartín. O. Carcinoma basocelular histológicamente agresivo con especial atención a la infiltración galeal del cuero cabelludo. Actas Dermo-Sifiliográficas 2022; 113:575-582. [DOI: 10.1016/j.ad.2022.01.026] [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] [Received: 07/03/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022] Open
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15
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Ríos-Viñuela E, Álvarez P, Lavernia J, Serra-Guillén C, Requena C, Bernia E, Diago A, Llombart B, Sanmartín O. [Artículo traducido] Cemiplimab en el carcinoma de células escamosas cutáneo avanzado: experiencia del mundo real en un centro oncológico monográfico. Actas Dermo-Sifiliográficas 2022; 113:T610-T615. [DOI: 10.1016/j.ad.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/05/2021] [Indexed: 12/20/2022] Open
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16
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Moro R, Sánchez-Silva A, Aguerralde-Martin M, González-Cuevas R, Peruilh-Bagolini L, Traves V, Manrique-Silva E, Requena C, Nagore E. [Translated article] Prognostic Value of Vitamin D Serum Levels in Cutaneous Melanoma. Actas Dermo-Sifiliográficas 2022. [DOI: 10.1016/j.ad.2021.11.007] [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: 10/18/2022] Open
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17
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. [Translated article] Subungual Melanocytic Lesions in Pediatric Patients. Actas Dermo-Sifiliográficas 2022. [DOI: 10.1016/j.ad.2021.10.012] [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: 11/26/2022] Open
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18
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Moro R, Sánchez-Silva A, Aguerralde-Martin M, González-Cuevas R, Peruilh-Bagolini L, Traves V, Manrique-Silva E, Requena C, Nagore E. Prognostic Value of Vitamin D Serum Levels in Cutaneous Melanoma. Actas Dermosifiliogr 2022; 113:347-353. [PMID: 35623724 DOI: 10.1016/j.ad.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/01/2021] [Revised: 09/28/2021] [Accepted: 11/01/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Vitamin D plays a fundamental role in many metabolic pathways, including those involved in cell proliferation and the immune response. Serum levels of this vitamin have been linked to melanoma risk and prognosis. This study aimed to assess the prognostic value of vitamin D serum level in melanoma. MATERIAL AND METHODS Retrospective, observational, longitudinal, and analytical study of 286 patients with a histologic diagnosis of melanoma in whom serum levels of vitamin D were measured at the time of diagnosis. We analyzed associations between serum level and epidemiologic and clinical variables and pathology findings; we also analyzed the influence of vitamin D on overall survival. An iterative loop was used to identify a vitamin D serum level to test for its an association with survival. RESULTS A vitamin D level less than 9.25ng/mL was associated with a histologic finding of ulceration. After a median follow-up period of 39.4 months, 24 patients (8.4%) had died. The cutoff of 9.25ng/mL was associated with lower overall survival according to both the Kaplan-Meier curves and multivariate Cox regression analysis. CONCLUSION Vitamin D levels less than 9.25ng/mL are associated with ulceration in melanoma and serve as an independent prognostic factor for overall survival in this disease.
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Affiliation(s)
- R Moro
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, España; Clinica San Carlo, Paderno Dugnano, Italia
| | - A Sánchez-Silva
- Facultad de Medicina, Universidad Católica de Valencia San Vicente Mártir, Valencia, España
| | - M Aguerralde-Martin
- Máster de Ingeniería de Análisis de Datos, Toma de Decisiones y Mejora de Procesos, Universidad Politécnica de Valencia, Valencia, España
| | - R González-Cuevas
- Servicio de Dermatología, Hospital del Salvador, Santiago, Chile; Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - L Peruilh-Bagolini
- Facultad de Medicina, Universidad de Chile, Santiago, Chile; Fundación Arturo López Pérez (FALP), Oncologic Institute, Santiago, Chile
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - E Manrique-Silva
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, España; Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Máster de Ingeniería de Análisis de Datos, Toma de Decisiones y Mejora de Procesos, Universidad Politécnica de Valencia, Valencia, España; Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
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19
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Ríos-Viñuela E, Manrique-Silva E, Nagore E, Nájera-Botello L, Requena L, Requena C. Subungual Melanocytic Lesions in Pediatric Patients. Actas Dermosifiliogr 2022; 113:388-400. [PMID: 35623729 DOI: 10.1016/j.ad.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/22/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 01/07/2023] Open
Abstract
The study of subungual melanocytic lesions can present challenges because of the clinical and histologic characteristics of the nail unit and the difficulty of performing nail biopsies and processing specimens. These lesions can be even more challenging in children due to differences in clinical and epidemiological profiles between the adult and pediatric populations. Many of the clinical features of subungual melanocytic lesions that would raise alarm in an adult do not have the same implications in children. Consensus is also lacking on when a nail biopsy is needed to rule out malignancy in the pediatric setting. In view of these considerations and the rarity of subungual melanoma in childhood, the recommended approach in most cases is a watch-and-wait strategy. Subungual melanocytic lesions in children may also show atypical histopathologic features that are not necessarily associated with aggressive behavior. Subungual melanoma is very rare in childhood, with just 21 cases described to date. None of the patients developed visceral metastasis or died as a result and the diagnosis was controversial in many of the cases. Considering the above and the significantly higher frequency and particular characteristics of longitudinal melanonychia with a benign etiology in children, subungual melanocytic lesions should be managed differently in this setting than in adults. In most cases, a watch-and-wait approach is the most appropriate strategy.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - E Manrique-Silva
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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20
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. Actas Dermosifiliogr (Engl Ed) 2021; 112:S1578-2190(21)00166-9. [PMID: 34053897 DOI: 10.1016/j.adengl.2021.05.007] [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: 11/09/2020] [Accepted: 12/26/2020] [Indexed: 11/15/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta del Hierro, Madrid, Spain
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, Spain
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
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21
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Moro R, Requena C, Ríos-Viñuela E, Manrique-Silva E, Traves V, Calzavara-Pinton PG, Gualdi G, Nagore E. May melanophages hinder the subclinical spread of lentigo maligna and lentigo maligna melanoma? Results from a pilot study. J Eur Acad Dermatol Venereol 2021; 35:e365-e367. [PMID: 33462879 DOI: 10.1111/jdv.17127] [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: 09/04/2020] [Revised: 12/10/2020] [Accepted: 01/14/2021] [Indexed: 12/31/2022]
Affiliation(s)
- R Moro
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain.,Dermatologia, Clinica San Carlo, Paderno Dugnano, Italy
| | - C Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - E Ríos-Viñuela
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - E Manrique-Silva
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain.,Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - V Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - P G Calzavara-Pinton
- Department of Dermatology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - G Gualdi
- Dermatologic Clinic, Department of Medicine and Aging Science, Università degli Studi "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - E Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
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22
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Ríos-Viñuela E, Nájera-Botello L, Requena L, Nagore E, Requena C. Subungual Melanocytic Lesions: Key Clinical and Pathologic Concepts and Biopsy Techniques. Actas Dermosifiliogr (Engl Ed) 2021; 112:S0001-7310(21)00003-X. [PMID: 33465340 DOI: 10.1016/j.ad.2020.12.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022] Open
Abstract
Both dermatologists and pathologists sometimes find daunting the evaluation of melanonychia (especially subungual melanocytic lesions) because of the fear of performing nail surgery due to the risk of dystrophy, difficulties processing and interpreting nail biopsy specimens, and a general lack of experience in the field. Nevertheless, mastery of nail biopsy techniques, correct processing and orientation of specimens, and familiarity with the histologic particularities of the nail apparatus can attenuate the undoubted complexity and facilitate the tasks involved. Longitudinal excision is the biopsy technique that ensures the simplest histologic interpretation, and it is associated with a low risk of nail dystrophy when performed correctly. Clinical and epidemiological data are crucial. Subungual melanoma in childhood, for instance, is very rare and even lesions with atypical clinical and/or histologic features are probably benign. The presence of suprabasal melanocytes and other findings that would suggest malignancy at other sites are considered normal in the nail apparatus. Subungual melanoma shows a lentiginous pattern in the early stages of disease, and detection of an inflammatory infiltrate accompanying atypical lentiginous subungual lesions would appear to be one of the first diagnostic findings.
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Affiliation(s)
- E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | - L Nájera-Botello
- Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Madrid, España
| | - L Requena
- Servicio de Dermatología, Fundación Jiménez Díaz, Madrid, España
| | - E Nagore
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
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Tejera-Vaquerizo A, Fernández-Figueras M, Santos-Briz Á, Ríos-Martín J, Monteagudo C, Fernández-Flores Á, Requena C, Traves V, Descalzo-Gallego M, Rodríguez-Peralto J. Protocol for the Histologic Diagnosis of Cutaneous Melanoma: Consensus Statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry. Actas Dermo-Sifiliográficas (English Edition) 2021. [DOI: 10.1016/j.adengl.2020.12.009] [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: 11/30/2022] Open
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24
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Tejera-Vaquerizo A, Fernández-Figueras MT, Santos-Briz A, Ríos-Martín JJ, Monteagudo C, Fernández-Flores A, Requena C, Traves V, Descalzo-Gallego MA, Rodríguez-Peralto JL. Protocol for the Histologic Diagnosis of Cutaneous Melanoma: Consensus Statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry. Actas Dermosifiliogr (Engl Ed) 2021; 112:32-43. [PMID: 33038295 PMCID: PMC7540207 DOI: 10.1016/j.ad.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/23/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España; Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, España.
| | - M T Fernández-Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Grupo Quironsalud, Sant Cugat del Vallès, Barcelona, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - A Fernández-Flores
- Servicio de Anatomía Patológica, Hospital del Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Academia Española de Dermatología y Venereología, Madrid, España
| | - J L Rodríguez-Peralto
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
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Bernia E, Requena C, Llombart B. Eritema papular semicircular recidivante: ¿nueva entidad o subtipo de eritema anular centrífugo? Actas Dermo-Sifiliográficas 2020; 111:788-790. [DOI: 10.1016/j.ad.2019.04.012] [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] [Received: 12/06/2018] [Revised: 03/06/2019] [Accepted: 04/14/2019] [Indexed: 10/23/2022] Open
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Bernia E, Requena C, Llombart B. Erythema Papulosa Semicircularis Recidivans: A New Entity or a Subtype of Erythema Annulare Centrifugum? Actas Dermo-Sifiliográficas (English Edition) 2020. [DOI: 10.1016/j.adengl.2020.10.012] [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] Open
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Abstract
INTRODUCTION Semantic content processing is associated with the potential N400, and the P600 is linked with the processing of syntactic and grammatical rules. AIM To verify whether the semantic processing of complex visual stimuli such as repetition, identity, order and double incongruence is recursive or computable. SUBJECTS AND METHODS 27 university students responded to an adapted N400 paradigm with five conditions, each with 80 tasks, while recording their brain activity with a 64-channel cap. RESULTS Two temporal windows of 400 to 550 ms and 550 to 800 ms were analyzed using an ANOVA contrast of the condition factor by regions of interest. In addition, the inverse solution of the windows was calculated by low resolution electromagnetic tomography (LORETA) to identify the main sources related to the electrical power. The significant differences (p <0.05) in the results for the N400 and P600 in frontal and centroparietal areas in the logical operators studied are corroborated. CONCLUSION It is confirmed that the brain processing of complex images is modulated by repetition, identity and order, but not by negation. Therefore, it can be said that the semantic processing of complex images is semi-computable.
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Affiliation(s)
| | - C Requena
- Universidad de Leon, 24071 Leon, Espana
| | - F Salto
- Universidad de Leon, 24071 Leon, Espana
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28
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Manrique-Silva E, Rachakonda S, Millán-Esteban D, García-Casado Z, Requena C, Través V, Kumar R, Nagore E. Clinical, environmental and histological distribution of BRAF, NRAS and TERT promoter mutations among patients with cutaneous melanoma: a retrospective study of 563 patients. Br J Dermatol 2020; 184:504-513. [PMID: 32506424 DOI: 10.1111/bjd.19297] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The distinct somatic mutations that define clinical and histopathological heterogeneity in cutaneous melanoma could be dependent on host susceptibility to exogenous factors like ultraviolet radiation. OBJECTIVES Firstly, to characterize patients with cutaneous melanoma clinically and pathologically based on the mutational status of BRAF, NRAS and TERT promoter. Secondly, to elucidate the modified features due to the presence of TERT promoter mutations over the background of either BRAF or NRAS mutations. METHODS We performed a retrospective study on 563 patients with melanoma by investigating somatic mutations in BRAF, NRAS and TERT promoter. RESULTS We observed co-occurrence of TERT promoter mutations with BRAF and NRAS mutations in 26.3% and 6.9% of melanomas, respectively. Multivariate analysis showed an independent association between BRAF mutations and a decreased presence of cutaneous lentigines at the melanoma site, and an increased association with the presence of any MC1R polymorphism. We also observed an independent association between TERT promoter mutations and increased tumour mitotic rate. Co-occurrence of BRAF and TERT promoter mutations was independently associated with occurrence of primary tumours at usually sun-exposed sites, lack of histological chronic sun damage in surrounding unaffected skin at the melanoma site, and increased tumour mitotic rate. Co-occurrence of NRAS and TERT promoter mutations was independently associated with increased tumour mitotic rate. The presence of TERT promoter together with BRAF or NRAS mutations was associated with statistically significantly worse survival. CONCLUSIONS The presence of TERT promoter mutations discriminates BRAF- and NRAS-mutated tumours and indicates a higher involvement of ultraviolet-induced damage and tumours with worse melanoma-specific survival than those without any mutation. These observations refine classification of patients with melanoma based on mutational status.
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Affiliation(s)
- E Manrique-Silva
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,Department of Dermatology, Instituto Valenci, Valencia, Spain
| | - S Rachakonda
- Division of Molecular Genetic Epidemiology, Division of Functional Genome Analysis, German Cancer Research Center, Heidelberg, Germany
| | - D Millán-Esteban
- Department of Molecular Biology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - Z García-Casado
- Department of Molecular Biology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - C Requena
- Department of Dermatology, Instituto Valenci, Valencia, Spain
| | - V Través
- Department of Pathology, Instituto Valenciano de Oncologia (IVO), Valencia, Spain
| | - R Kumar
- Division of Molecular Genetic Epidemiology, Division of Functional Genome Analysis, German Cancer Research Center, Heidelberg, Germany
| | - E Nagore
- Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
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Moro R, Traves V, Requena C, Nagore E. Staged Excision With Micrographic Monitoring of Margins in Lentigo Maligna. Actas Dermo-Sifiliográficas (English Edition) 2020. [DOI: 10.1016/j.adengl.2019.09.005] [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: 11/16/2022] Open
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Moro R, Traves V, Requena C, Nagore E. Cirugía por etapas con control micrográfico de los márgenes del lentigo maligno. Actas Dermo-Sifiliográficas 2020; 111:522-523. [DOI: 10.1016/j.ad.2019.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/06/2019] [Accepted: 09/29/2019] [Indexed: 10/24/2022] Open
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31
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Requena C, Llombart B. Oral Contraceptives in Dermatology. Actas Dermo-Sifiliográficas (English Edition) 2020. [DOI: 10.1016/j.adengl.2019.06.008] [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: 10/24/2022] Open
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Boada A, Tejera-Vaquerizo A, Ribero S, Puig S, Moreno-Ramírez D, Osella-Abate S, Cassoni P, Malvehy J, Podlipnik S, Requena C, Manrique-Silva E, Rios-Martin JJ, Ferrándiz C, Nagore E. Age as a prognostic factor in thick and ultrathick melanomas without lymph node metastasis. J Eur Acad Dermatol Venereol 2020; 34:e513-e517. [PMID: 32259328 DOI: 10.1111/jdv.16423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/05/2020] [Accepted: 03/24/2020] [Indexed: 02/06/2023]
Affiliation(s)
- A Boada
- Dermatology Department, Hospital Universitari Germans Trial i Pujol, Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Spain
| | - A Tejera-Vaquerizo
- Dermatology Department, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, Spain
| | - S Ribero
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - D Moreno-Ramírez
- Melanoma Unit, Medical-&-Surgical Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - S Osella-Abate
- Section of Surgical Pathology, Medical Science Department, University of Turin, Turin, Italy
| | - P Cassoni
- Section of Surgical Pathology, Medical Science Department, University of Turin, Turin, Italy
| | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - S Podlipnik
- Melanoma Unit, Dermatology Department, Hospital Clinic, Universitat de Barcelona, Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Raras, Barcelona, Spain
| | - C Requena
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - E Manrique-Silva
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - J J Rios-Martin
- Pathology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - C Ferrándiz
- Dermatology Department, Hospital Universitari Germans Trial i Pujol, Fundació Institut d'Investigació Germans Trias i Pujol, Badalona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Badalona, Spain
| | - E Nagore
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
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Pastor-Tomás N, Martínez-Franco A, Bañuls J, Peñalver JC, Traves V, García-Casado Z, Requena C, Kumar R, Nagore E. Risk factors for the development of a second melanoma in patients with cutaneous melanoma. J Eur Acad Dermatol Venereol 2020; 34:2295-2302. [PMID: 32163215 DOI: 10.1111/jdv.16341] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cutaneous melanoma patients have an increased risk of developing other neoplasms, especially cutaneous neoplasms and other melanomas. Identifying factors associated with an increased risk might be useful in the development of melanoma guidelines. OBJECTIVES To identify risk factors related to the development of a second primary melanoma in a series of patients diagnosed with sporadic melanoma and to establish the estimated incidence rate. METHODS A longitudinal study based on prospective follow-up information of patients diagnosed with sporadic cutaneous melanoma at our centre from 2000 to 2015 was performed. Cumulative incidence was estimated based on competing risk models, and the association of characteristics with the risk of a second melanoma was performed by Cox proportional hazard models. RESULTS Out of 1447 patients included in the study, after a median follow-up of 61 months, 55 patients (3.8%) developed a second melanoma. Fair hair colour, more than 100 common melanocytic nevi and the presence of more than 50 cherry angiomas were independently associated with the development of a second melanoma. The site and the histological subtype of the first and second melanomas were not consistent. The second melanomas were thinner than the first ones. CONCLUSIONS Fair-haired and multiple-nevi patients might benefit from more intensive prevention measures. The finding of cherry angiomas as a risk factor suggests that these lesions could be markers of skin sun damage in the setting of certain degree of genetic susceptibility.
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Affiliation(s)
- N Pastor-Tomás
- Department of Dermatology, Hospital General Universitario de Elda, Alicante, Spain.,Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - A Martínez-Franco
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - J Bañuls
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain.,Departament of Medicina Clínica, Universidad Miguel Hernández. Sant Joan D'Alacant, Alicante, Spain
| | - J C Peñalver
- Department of Thoracic Surgery, Instituto Valenciano de Oncología, València, Spain
| | - V Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Z García-Casado
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, València, Spain
| | - C Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - R Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - E Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain.,Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
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Requena C, Llombart B. Oral Contraceptives in Dermatology. Actas Dermosifiliogr (Engl Ed) 2020; 111:351-356. [PMID: 32404240 DOI: 10.1016/j.ad.2019.06.006] [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: 05/10/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 10/24/2022] Open
Abstract
Oral contraceptives combine estrogen and progesterone to suppress ovulation. Synthetic forms are usually used. In dermatology, oral contraceptives are prescribed for 2 main reasons: to prevent pregnancy when teratogenic drugs must be taken and to treat skin manifestations of hyperandrogenism. Most oral contraceptives improve both acne and hirsutism, but the androgenic effect of progestogens - particularly if the contraceptive contains first- or second-generation progestogens- can trigger or exacerbate acne. One of the most serious side effects of oral contraceptives, thrombosis, is mainly caused by the estrogen component and its dose. If we mainly consider a contraceptive's thrombotic profile when prescribing, the choice would be to have 30μg or less of ethinyl estradiol combined with levonorgestrel. On the other hand, if our main objective is to treat signs of androgenization, we would prefer contraceptives containing progestogens with antiandrogenic effects.
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Affiliation(s)
- C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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35
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Abstract
The original Rivermead Behavioural Memory Test (RBMT) suggests a cutoff global score of 10 points. However, this limit may be too stringent for older adults attending memory training programs, particularly for those with low education levels. This study aims to provide appropriately adjusted age and education norms for the RBMT. Data from 711 subjects were grouped based on age (65-67, 68-71, 72-75 and 76-83) and education level (primary school, high school and university studies). The data exhibit a clear trend of scores decreasing with age. The diminution in scores does not reach trend levels of significance between neighboring (< 5 years) age intervals, but it is statistically significant at the designated alpha level (p = .05) when younger and older adults are compared over a range of 5 years of difference. 81.86% of our sample has global scores below the suggested cutoff of 10 points. The present study provides a more accurate representation of RBMT global score performance in older adults for specific age and education stratifications.
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Affiliation(s)
- C Requena
- 1Department of Psychology, Sociology and Philosophy, University of León, Campus Vegazana, s/n, 24071 León, Spain
| | - P Alvarez-Merino
- 1Department of Psychology, Sociology and Philosophy, University of León, Campus Vegazana, s/n, 24071 León, Spain
| | - G W Rebok
- 2Department of Mental Health and Center on Aging and Health, Johns Hopkins University, 624 N. Broadway, Hampton House 833, Baltimore, MD 21205 USA
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Bancalari B, Llombart B, Requena C, Vendrell J. Parotid Fistula After Skin Biopsy: Treatment With Botulinum Toxin. Actas Dermo-Sifiliográficas (English Edition) 2019. [DOI: 10.1016/j.adengl.2019.07.006] [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: 10/26/2022] Open
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Tejera-Vaquerizo A, Descalzo-Gallego MA, Traves V, Requena C, Bolumar I, Pla A, Nagore E. No association between smoking and sentinel lymph node metastasis and survival in cutaneous melanoma. J Eur Acad Dermatol Venereol 2019; 33:2283-2290. [PMID: 31283036 DOI: 10.1111/jdv.15789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/21/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND There is little evidence that smoking is associated with metastasis in patients with cutaneous melanoma. OBJECTIVE Using a propensity score matching analysis, we assessed whether smoking was associated with a higher rate of sentinel lymph node (SLN) metastasis and worse survival in these patients. METHODS Retrospective cohort study at a referral hospital for melanoma. We studied 762 patients with known smoking status from the melanoma database of the Instituto Valenciano de Oncología who underwent SLN biopsy between 1 January 2000 and 31 December 2016. The patients were matched by smoking status. The matching procedure was implemented using three logistic regression models featuring never vs. former smokers, never vs. current smokers and former vs. current smokers. The study outcomes were disease-free survival (DFS), melanoma-specific survival (MSS), overall survival (OS) and SLN status. RESULTS The following groups were formed based on the propensity matching scores: 114 pairs of smokers vs. never smokers, 113 pairs of smokers vs. former smokers and 174 pairs of never smokers vs. former smokers. Smoking status was not associated with SLN metastasis or with DFS, MSS or OS in any of the three groups. CONCLUSION Smoking does not influence SLN metastasis or survival in patients with cutaneous melanoma.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río (Córdoba), Spain
| | | | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, Spain
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
| | - I Bolumar
- Servicio de Cirugía, Instituto Valencia de Oncología, Valencia, Spain
| | - A Pla
- Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, Spain
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
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Bancalari B, Llombart B, Requena C, Vendrell JB. Parotid Fistula After Skin Biopsy: Treatment With Botulinum Toxin. Actas Dermosifiliogr (Engl Ed) 2019; 110:693-695. [PMID: 31151670 DOI: 10.1016/j.ad.2018.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/13/2018] [Accepted: 02/19/2018] [Indexed: 10/26/2022] Open
Affiliation(s)
- B Bancalari
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - J B Vendrell
- Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, España
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Llombart B, Serra-Guillén C, Requena C, Alsina M, Morgado-Carrasco D, Machado I, Sanmartín O. Leiomyosarcoma and Pleomorphic Dermal Sarcoma: Guidelines for Diagnosis and Treatment. Actas Dermo-Sifiliográficas (English Edition) 2019. [DOI: 10.1016/j.adengl.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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40
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Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Través V, Sanmartín O. Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans. Actas Dermo-Sifiliográficas (English Edition) 2018. [DOI: 10.1016/j.adengl.2018.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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41
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Llombart B, Serra-Guillén C, Requena C, Alsina M, Morgado-Carrasco D, Machado I, Sanmartín O. Leiomyosarcoma and Pleomorphic Dermal Sarcoma: Guidelines for Diagnosis and Treatment. Actas Dermosifiliogr (Engl Ed) 2018; 110:4-11. [PMID: 30409380 DOI: 10.1016/j.ad.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/14/2018] [Accepted: 06/24/2018] [Indexed: 11/25/2022] Open
Abstract
There are 3 types of leiomyosarcoma of the skin: dermal, subcutaneous, and metastatic cutaneous. Dermal leiomyosarcoma arises from smooth muscle fibers in arrector pili muscles, genital dartos muscles, and the nipple-areola complex. It is an intermediate-grade tumor associated with a tendency for local recurrence (24%) and low metastatic potential (4%). Subcutaneous leiomyosarcoma originates from smooth muscle in blood vessel walls and has higher rates of local recurrence (37%) and metastasis (43%). Plemorphic dermal sarcoma typically affects elderly patients and arises in sun-exposed areas (e.g., the scalp). Its histologic and immunohistochemical characteristics are similar to those of atypical fibroxanthoma, but it is more aggressive (metastasis rate of 10-20%). Histologically, it can be distinguished from atypical fibroxanthoma by the observation of subcutaneous tissue invasion, perineural invasion, and foci of necrosis.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - C Serra-Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Alsina
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - I Machado
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Bernia E, Llombart B, Serra-Guillén C, Bancalari B, Nagore E, Requena C, Calomarde L, Diago A, Lavernia J, Traves V, Guillén C, Sanmartín O. Experience With Vismodegib in the Treatment of Advanced Basal Cell Carcinoma at a Cancer Center. Actas Dermo-Sifiliográficas (English Edition) 2018. [DOI: 10.1016/j.adengl.2018.09.010] [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: 10/28/2022] Open
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43
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Diago A, Llombart B, Requena C, Sanmartín O, Guillén C. Postirradiation Morphea in Patients With Breast Cancer: Possible Association With Other Autoimmune Diseases. Actas Dermosifiliogr (Engl Ed) 2018; 110:153-159. [PMID: 30389122 DOI: 10.1016/j.ad.2017.10.028] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 10/28/2022] Open
Abstract
Postirradiation morphea is an uncommon entity that has been mostly described in women with breast cancer. The increasing use of radiotherapy to treat breast cancer and the clinical similarities between morphea and other conditions, such as radiodermatitis, postirradiation fibrosis, and tumor recurrence, highlights the need for dermatologists to be familiar with this entity. We present a series of 6 women with a mean age of 64.2 years and a mean latency of 9.5 years between radiotherapy for breast cancer and onset of morphea. Four of the patients had a history of autoimmune disease: rheumatoid arthritis, Sjögren syndrome, vitiligo, and Crohn disease. No specific risk factors for postirradiation morphea have been identified to date, although it would appear that a history of autoimmune disease could be associated with an increased risk of morphea in patients treated with radiation therapy.
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Affiliation(s)
- A Diago
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Requena C, Alsina M, Morgado-Carrasco D, Cruz J, Sanmartín O, Serra-Guillén C, Llombart B. Kaposi Sarcoma and Cutaneous Angiosarcoma: Guidelines for Diagnosis and Treatment. Actas Dermosifiliogr (Engl Ed) 2018; 109:878-887. [PMID: 30262126 DOI: 10.1016/j.ad.2018.06.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/11/2018] [Revised: 06/15/2018] [Accepted: 06/24/2018] [Indexed: 12/20/2022] Open
Abstract
Kaposi sarcoma is a vascular sarcoma with 4 clinical variants: classic Kaposi sarcoma, which mainly affect the extremities of elderly patients and follows a chronic, generally indolent course; African Kaposi sarcoma; immunosuppression-associated Kaposi sarcoma; and AIDS-associated Kaposi sarcoma. Type8 human herpesvirus is the etiologic agent in all 4variants. Cutaneous angiosarcoma is a cutaneous neoplasm with a very poor prognosis. It carries a high probability of local relapse and has a 10% to 15% survival rate at 5years. There are 3 main variants of cutaneous angiosarcoma: idiopathic angiosarcoma of the face and scalp; Stewart-Treves syndrome; and postradiation angiosarcoma. The only potentially curative treatment is surgery with or without radiotherapy. However, its indistinct borders and multicentric nature mean that treatment is often palliative with chemotherapy, radiotherapy, or both.
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Affiliation(s)
- C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Alsina
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - J Cruz
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Serra-Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
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Serra-Guillén C, Nagore E, Bancalari E, Kindem S, Sanmartín O, Llombart B, Requena C, Serra-Guillén I, Calomarde L, Diago A, Bernia E, Guillén C. A randomized intraindividual comparative study of methyl-5-aminolaevulinate vs. 5-aminolaevulinic acid nanoemulsion (BF-200 ALA) in photodynamic therapy for actinic keratosis of the face and scalp. Br J Dermatol 2018; 179:1410-1411. [PMID: 30019337 DOI: 10.1111/bjd.17014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- C Serra-Guillén
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain.,Department of Skin and Sensory Organs, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - E Nagore
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain.,Facultad de Medicina Universidad Católica de Valencia, Department of Dermatology, Valencia, Spain
| | - E Bancalari
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain
| | - S Kindem
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain
| | - O Sanmartín
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain.,Facultad de Medicina Universidad Católica de Valencia, Department of Dermatology, Valencia, Spain
| | - B Llombart
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain
| | - C Requena
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain
| | - I Serra-Guillén
- Department of Nursing, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
| | - L Calomarde
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain
| | - A Diago
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain
| | - E Bernia
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain
| | - C Guillén
- Fundacion Instituto Valenciano de Oncologia, Department of Dermatology, Valencia, Spain.,Department of Skin and Sensory Organs, Facultad de Ciencias de la Salud, Universidad CEU Cardenal Herrera, Valencia, Spain
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Llombart B, Serra C, Requena C, Alsina M, Morgado-Carrasco D, Través V, Sanmartín O. Guidelines for Diagnosis and Treatment of Cutaneous Sarcomas: Dermatofibrosarcoma Protuberans. Actas Dermosifiliogr (Engl Ed) 2018; 109:868-877. [PMID: 30539729 DOI: 10.1016/j.ad.2018.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/06/2017] [Revised: 04/21/2018] [Accepted: 05/23/2018] [Indexed: 12/26/2022] Open
Abstract
Sarcomas comprise a broad group of tumors, many of whose biological behavior and aggressiveness differ from one type to another. The therapeutic approach is generally multidisciplinary and often complex. Developments in surgical and oncological dermatology during the last few decades have positioned dermatologists as specialists in the diagnosis and treatment of skin cancer. The aim of this article is to review the main soft tissue sarcomas that typically affect the skin. Dermatofibrosarcoma protuberans is a low-grade malignant sarcoma. It exhibits slow-growth, is locally invasive, and has low metastatic potential (<3%). Mohs micrographic surgery is the treatment of choice. The COL1A1-PDGFB translocation should be analyzed in cases of unclear diagnosis and when it is necessary to identify candidates for tyrosine kinase inhibitors. Imatinib is indicated for the treatment of locally advanced and metastatic dermatofibrosarcoma protuberans.
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Affiliation(s)
- B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
| | - C Serra
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Alsina
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - V Través
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Serra-Guillén C, Nagore E, Llombart B, Sanmartín O, Requena C, Calomarde L, Guillén C. A 12-Day Course of Imiquimod 5% for the Treatment of Actinic Keratosis: Effectiveness and Local Reactions. Actas Dermo-Sifiliográficas (English Edition) 2018. [DOI: 10.1016/j.adengl.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Serra-Guillén C, Nagore E, Llombart B, Sanmartín O, Requena C, Calomarde L, Guillén C. A 12-Day Course of Imiquimod 5% for the Treatment of Actinic Keratosis: Effectiveness and Local Reactions. Actas Dermosifiliogr (Engl Ed) 2017; 109:248-253. [PMID: 29246367 DOI: 10.1016/j.ad.2017.10.008] [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: 07/17/2017] [Revised: 09/08/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Imiquimod is an excellent option for patients with actinic keratosis, although its use may be limited by the long course of treatment required (4 weeks) and the likelihood of local skin reactions. The objectives of the present study were to demonstrate the effectiveness of a 12-day course of imiquimod 5% for the treatment of actinic keratosis and to examine the association between treatment effectiveness and severity of local reactions. PATIENTS AND METHODS We included patients with at least 8 actinic keratoses treated with imiquimod 5% cream for 12 consecutive days. Local reactions were classified as mild, moderate, or severe. The statistical analysis of the association between local reactions and clinical response was based on the Pearson χ2 test and the Spearman rank correlation test. RESULTS Sixty-five patients completed the study. Complete response was recorded in 52.3% and partial response in 75.4%. We found a statistically significant association between severity of the local reaction and response to treatment in both the Pearson χ2 test and the Spearman rank correlation test. CONCLUSIONS A 12-day course of imiquimod 5% proved effective for the treatment of actinic keratosis. Severity of local reactions during treatment was correlated with clinical response.
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Affiliation(s)
- C Serra-Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Piel y Órganos de los Sentidos, Facultad de Medicina, Universidad CEU Cardenal Herrera, Valencia, España.
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Dermatología, Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - B Llombart
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Dermatología, Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - L Calomarde
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - C Guillén
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España; Departamento de Piel y Órganos de los Sentidos, Facultad de Medicina, Universidad CEU Cardenal Herrera, Valencia, España
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Olmedo D, Brotons-Seguí M, del Toro C, González M, Requena C, Traves V, Pla A, Bolumar I, Moreno-Ramírez D, Nagore E. Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis. Actas Dermo-Sifiliográficas (English Edition) 2017. [DOI: 10.1016/j.adengl.2017.10.005] [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: 10/18/2022] Open
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Olmedo D, Brotons-Seguí M, Del Toro C, González M, Requena C, Traves V, Pla A, Bolumar I, Moreno-Ramírez D, Nagore E. Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis. Actas Dermosifiliogr 2017; 108:931-938. [PMID: 28801012 DOI: 10.1016/j.ad.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/22/2017] [Revised: 04/26/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB. MATERIALS AND METHODS We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy. RESULTS Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00). CONCLUSIONS Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients.
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Affiliation(s)
- D Olmedo
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - M Brotons-Seguí
- Facultad de Medicina, Universidad Católica de Valencia, Valencia, España
| | - C Del Toro
- Servicio de Radiodiagnóstico, Instituto Valenciano de Oncología, Valencia, España
| | - M González
- Servicio de Radiodiagnóstico, Instituto Valenciano de Oncología, Valencia, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - A Pla
- Servicio de Otorrinolaringología, Instituto Valenciano de Oncología, Valencia, España
| | - I Bolumar
- Servicio de Cirugía, Instituto Valenciano de Oncología, Valencia, España
| | - D Moreno-Ramírez
- Unidad de Gestión Clínica de Dermatología MQ, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Nagore
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España.
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