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Elshot YS, Lasso Peña DJP, Zupan-Kajcovski B, Bekkenk MW, Balm AJM, Klop WMC, de Rie MA. Successful implementation of handheld reflectance confocal microscopy as the standard of care in the (surgical) management of lentigo maligna (melanoma). J Eur Acad Dermatol Venereol 2024. [PMID: 38923079 DOI: 10.1111/jdv.20210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) has shown promise in predicting surgical outcomes by non-invasively detecting subclinical lentigo maligna (melanoma) (LM/LMM). OBJECTIVES To assess the effects of presurgical mapping using handheld RCM (HH-RCM) on surgical treatment, follow-up outcomes and management decisions. METHODS A total of 117 consecutive LM/LMM cases (2015-2023) were included. The diagnostic accuracy of HH-RCM in detecting subclinical LM and invasive components was evaluated. The primary endpoints included histological margin status and changes in management based on the outcomes of the HH-RCM mapping procedure. Margin and follow-up outcomes were compared to a historical cohort before HH-RCM was introduced in our center (n = 94) (2003-2014). RESULTS HH-RCM detected subclinical LM in 60% (n = 60) of cases. The median mapping duration was 14 min (range 4-50). In 27% (n = 33), the mapping procedure resulted in modified management, the majority consisting of limited surgery with adjuvant imiquimod (n = 15) or imiquimod monotherapy (n = 14). The remaining cases (n = 84) underwent HH-RCM-assisted surgery. Histological margins were cleared in 96.5% of the patients with a median histological margin of 3.0 mm, significantly higher than 81% in the historical cohort (median 2.0 mm) (p = 0.001). The sensitivity and specificity for detecting the extent of subclinical LM were 94% (95% CI 80.4-99.3) and 84% (95% CI 70.3-92.7), respectively. The negative predictive value for the detection of LMM was 94% (95% CI 84.4-97.7), and 75% of the initially missed LMM (n = 12) were identified during the HH-RCM mapping procedure. The study cohort had a 1.6% local recurrence rate compared with 25% in the historical cohort. CONCLUSIONS Integrating HH-RCM as the standard of care could lead to more personalized treatment strategies for LM/LMM and allows for the selection of patients suitable for nonsurgical treatment.
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Affiliation(s)
- Y S Elshot
- Department of Dermatology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - D J P Lasso Peña
- Department of Dermatology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - B Zupan-Kajcovski
- Department of Dermatology, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - M W Bekkenk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W M C Klop
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M A de Rie
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Löper R, Schön MP, Mitteldorf C. Melanocyte Density in the Diagnosis of Melanoma In Situ in Sun-Damaged Skin. Am J Dermatopathol 2024; 46:358-364. [PMID: 38513120 DOI: 10.1097/dad.0000000000002680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
ABSTRACT Histologic differentiation between melanoma in situ in chronically sun-damaged skin (CSDS) [lentigo maligna (LM)] and CSDS without malignancy is difficult because signs of melanocyte activation and proliferation are found in both. A potentially reliable and quantifiable criterion is melanocyte density (MD). Here, we evaluated whether and to what extent MD allows the distinction between LM and CSDS, which is particularly relevant for the evaluation of borderline cases and surgical margins.Articles assessing MD in LM and/or CSDS were evaluated in a systematic review. The results were categorized and compared according to staining. Cutoff values were included whenever stated.Twenty articles matched the selection criteria. Six hundred forty-four samples of CSDS and 227 samples of LM were considered. In each individual study, mean MD scores were higher for LM than for CSDS. However, looking at the overall study situation, it becomes clear that the data are very heterogeneous and show overlaps. Therefore, no reliable orientation value can be derived. Only 1 article defined a cutoff value.The data of MD in LM in contrast to CSDS were sparse, and a defined cutoff value was only mentioned in 1 article for microphthalmia-associated transcription factor, which cannot yet be generalized. Especially regarding the importance for the definition of surgical resection margins, this unsatisfactory data set highlights the need for further studies. More precise diagnostic criteria could spare some patients extensive and possibly disfiguring surgery.
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Affiliation(s)
- Rieke Löper
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
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3
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Longo C, Sticchi A, Curti A, Kaleci S, Moscarella E, Argenziano G, Thomas L, Guitera P, Huang C, Tiodorovic D, Apalla Z, Peris K, Del Regno L, Guida S, Lallas A, Kittler H, Pellacani G, Navarrete-Dechent C. Lentigo maligna and lentigo maligna melanoma in patients younger than 50 years: a multicentre international clinical-dermoscopic study. Clin Exp Dermatol 2024; 49:128-134. [PMID: 37758301 DOI: 10.1093/ced/llad325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Lentigo maligna/lentigo maligna melanoma (LM/LMM) is usually diagnosed in older patients, when lesions are larger. However, it is important to detect it at an earlier stage to minimize the area for surgical procedure. OBJECTIVES To determine and define clinical, dermoscopic and reflectance confocal microscopy (RCM) features of LM/LMM in patients < 50 years old. METHODS This was a multicentre study involving tertiary referral centres for skin cancer management. The study included cases of consecutively excised LM/LMM arising in patients < 50 years of age with a histopathological diagnosis of LM/LMM and a complete set of clinical and dermoscopic images; RCM images were considered when present. RESULTS In total, 85 LM/LMM of the face from 85 patients < 50 years were included in the study. A regression model showed a direct association with the size of the lesion (R2 = 0.08; P = 0.01) and with the number of dermoscopic features at diagnosis (R2 = 0.12; P < 0.01). In a multivariable analysis, an increasing number of dermoscopic features correlated with increased patient age (P < 0.01), while the presence of grey colour was a predictor of younger age at diagnosis (P = 0.03). RCM revealed the presence of melanoma diagnostic features in all cases (pagetoid cells and atypical nesting). CONCLUSIONS LM is not a disease limited to older people as previously thought. LM presenting in young adults tends to be smaller and with fewer dermoscopic features, making its diagnosis challenging. Careful evaluation of facial pigmented lesions prior to cosmetic procedures is imperative to avoid incorrectly treating early LM as a benign lesion.
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Affiliation(s)
- Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Alberto Sticchi
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Alex Curti
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Shaniko Kaleci
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Elvira Moscarella
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luc Thomas
- Department of Dermatology, Claude Bernard University Lyon 1, and Cancer Research Center Lyon, Lyon, France
| | - Pascale Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Melanoma Institute Australia, Sydney, NSW, Australia
| | - Chen Huang
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Danica Tiodorovic
- Clinic of Dermatovenereology, Clinical Centre Nis, Medical Faculty, University of Nis, Serbia
| | | | - Ketty Peris
- Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Laura Del Regno
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Stefania Guida
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Dermatology Clinic, IRCCS San Raffaele Hospital, Milan, Italy
| | - Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Harald Kittler
- Department of Dermatology, Medical University of Vienna, Austria
| | - Giovanni Pellacani
- Department of Dermatology and Venereology at the University of La Sapienza, Rome, Italy
| | - Cristian Navarrete-Dechent
- Department of Dermatology
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Khalid M, Sutterfield B, Minley K, Ottwell R, Abercrombie M, Heath C, Torgerson T, Hartwell M, Vassar M. The Reporting and Methodological Quality of Systematic Reviews Underpinning Clinical Practice Guidelines Focused on the Management of Cutaneous Melanoma: Cross-Sectional Analysis. JMIR DERMATOLOGY 2023; 6:e43821. [PMID: 38060306 PMCID: PMC10739238 DOI: 10.2196/43821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) inform evidence-based decision-making in the clinical setting; however, systematic reviews (SRs) that inform these CPGs may vary in terms of reporting and methodological quality, which affects confidence in summary effect estimates. OBJECTIVE Our objective was to appraise the methodological and reporting quality of the SRs used in CPGs for cutaneous melanoma and evaluate differences in these outcomes between Cochrane and non-Cochrane reviews. METHODS We conducted a cross-sectional analysis by searching PubMed for cutaneous melanoma guidelines published between January 1, 2015, and May 21, 2021. Next, we extracted SRs composing these guidelines and appraised their reporting and methodological rigor using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklists. Lastly, we compared these outcomes between Cochrane and non-Cochrane SRs. All screening and data extraction occurred in a masked, duplicate fashion. RESULTS Of the SRs appraised, the mean completion rate was 66.5% (SD 12.29%) for the PRISMA checklist and 44.5% (SD 21.05%) for AMSTAR. The majority of SRs (19/50, 53%) were of critically low methodological quality, with no SRs being appraised as high quality. There was a statistically significant association (P<.001) between AMSTAR and PRISMA checklists. Cochrane SRs had higher PRISMA mean completion rates and higher methodological quality than non-Cochrane SRs. CONCLUSIONS SRs supporting CPGs focused on the management of cutaneous melanoma vary in reporting and methodological quality, with the majority of SRs being of low quality. Increasing adherence to PRISMA and AMSTAR checklists will likely increase the quality of SRs, thereby increasing the level of evidence supporting cutaneous melanoma CPGs.
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Affiliation(s)
- Mahnoor Khalid
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Bethany Sutterfield
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Kirstien Minley
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Ryan Ottwell
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - McKenna Abercrombie
- Dermatology Residency, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Christopher Heath
- Dermatology Residency, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Trevor Torgerson
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Matt Vassar
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
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Tognetti L, Cinotti E, Farnetani F, Lallas A, Paoli J, Longo C, Pampena R, Moscarella E, Argenziano G, Tiodorovic D, Stanganelli I, Magi S, Suppa M, Del Marmol V, Dika E, Zelin E, Zalaudek I, Pizzichetta MA, Pellacani G, Perrot JL, Bertello M, Cataldo G, Cevenini G, Rubegni P, Cartocci A. Development and Implementation of a Web-Based International Registry Dedicated to Atypical Pigmented Skin Lesions of the Face: Teledermatologic Investigation on Epidemiology and Risk Factors. Telemed J E Health 2023; 29:1356-1365. [PMID: 36752711 DOI: 10.1089/tmj.2022.0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Background: Atypical pigmented facial lesions (aPFLs) often display clinical and dermoscopic equivocal and/or overlapping features, thus causing a challenging and delayed diagnosis and/or inappropriate excisions. No specific registry dedicated to aPFL paired with clinical data is available to date. Methods: The dataset is hosted on a specifically designed web platform. Each complete case was composed of the following data: (1) one dermoscopic picture; (2) one clinical picture; (3) two lesion data, that is, maximum diameter and facial location (e.g., orbital area/forehead/nose/cheek/chin/mouth); (4) patient's demographics: family history of melanoma, history of sunburns in childhood, phototype, pheomelanine, eyes/hair color, multiple nevi/dysplastic nevi on the body; and (5) acquisition device (videodermatoscope/camera-based/smartphone-based system). Results: A total of 11 dermatologic centers contributed to a final teledermoscopy database of 1,197 aPFL with a distribution of 353 lentigo maligna (LM), 146 lentigo maligna melanoma (LMM), 231 pigmented actinic keratoses, 266 solar lentigo, 125 atypical nevi, 48 seborrheic keratosis, and 28 seborrheic-lichenoid keratoses. The cheek site was involved in half of aPFL cases (50%). Compared with those with the other aPFL cases, patients with LM/LMM were predominantly men, older (69.32 ± 12.9 years on average vs. 62.69 ± 14.51), exhibited larger lesions (11.88 ± 7.74 mm average maximum diameter vs. 9.33 ± 6.46 mm), and reported a positive history of sunburn in childhood. Conclusions: The iDScore facial dataset currently represents a precious source of data suitable for the design of diagnostic support tools based on risk scoring classifiers to help dermatologists in recognizing LM/LMM among challenging aPFL in clinical practice.
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Affiliation(s)
- Linda Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Francesca Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Aimilios Lallas
- First Department of Dermatology, Aristotele University, Thessaloniki, Greece
| | - John Paoli
- Department of Dermatology and Venereology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unita Sanitaria, Reggio Emilia, Italy
| | - Riccardo Pampena
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
- Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unita Sanitaria, Reggio Emilia, Italy
| | - Elvira Moscarella
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Ignazio Stanganelli
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto per La Ricerca Scientifica e Tecnologica (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | - Serena Magi
- Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto per La Ricerca Scientifica e Tecnologica (IRST), Meldola, Italy
| | - Mariano Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
- Department of Dermatology, Institut Jules Bordet, Pizzi Brussels, Belgium
| | - Veronique Del Marmol
- Groupe d'Imagerie Cutanée Non Invasive (GICNI) of the Société Française de Dermatologie (SFD), Paris, France
- Department of Dermatology, Institut Jules Bordet, Pizzi Brussels, Belgium
| | - Emi Dika
- Dermatology, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Italy
| | - Enrico Zelin
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
| | - Maria Antonietta Pizzichetta
- Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), (IRCCS), Aviano, Italy
| | - Giovanni Pellacani
- Department of Dermatology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Jean Luc Perrot
- Dermatology Unit, University Hospital of St-Etienne, Saint Etienne, France
| | - Martina Bertello
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Gennaro Cataldo
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gabriele Cevenini
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - Alessandra Cartocci
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Long GV, Swetter SM, Menzies AM, Gershenwald JE, Scolyer RA. Cutaneous melanoma. Lancet 2023:S0140-6736(23)00821-8. [PMID: 37499671 DOI: 10.1016/s0140-6736(23)00821-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 07/29/2023]
Abstract
Cutaneous melanoma is a malignancy arising from melanocytes of the skin. Incidence rates are rising, particularly in White populations. Cutaneous melanoma is typically driven by exposure to ultraviolet radiation from natural sunlight and indoor tanning, although there are several subtypes that are not related to ultraviolet radiation exposure. Primary melanomas are often darkly pigmented, but can be amelanotic, with diagnosis based on a combination of clinical and histopathological findings. Primary melanoma is treated with wide excision, with margins determined by tumour thickness. Further treatment depends on the disease stage (following histopathological examination and, where appropriate, sentinel lymph node biopsy) and can include surgery, checkpoint immunotherapy, targeted therapy, or radiotherapy. Systemic drug therapies are recommended as an adjunct to surgery in patients with resectable locoregional metastases and are the mainstay of treatment in advanced melanoma. Management of advanced melanoma is complex, particularly in those with cerebral metastasis. Multidisciplinary care is essential. Systemic drug therapies, particularly immune checkpoint inhibitors, have substantially increased melanoma survival following a series of landmark approvals from 2011 onward.
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Affiliation(s)
- Georgina V Long
- Melanoma Institute Australia, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Medical Oncology, Mater Hospital, Sydney, NSW, Australia.
| | - Susan M Swetter
- Department of Dermatology and Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, CA, USA; Department of Dermatology, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexander M Menzies
- Melanoma Institute Australia, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Medical Oncology, Mater Hospital, Sydney, NSW, Australia
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology and Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; NSW Health Pathology, Sydney, NSW, Australia
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7
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Martinez-Molina M, Richarz N, Jaka A, Bassas-Vila J, Mora-Fernández V, Pi-Sunyer AQ, Podlipnik S, Carrascosa JM, Boada A. Spaghetti Technique Versus Wide Local Excision for Lentigo Maligna Affecting the Head and Neck Regions: Surgical Outcome and Descriptive Analysis of 79 Cases from a Single Practice Cohort. Dermatol Pract Concept 2023; 13:e2023193. [PMID: 37557139 PMCID: PMC10412079 DOI: 10.5826/dpc.1303a193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Lentigo maligna is a subtype of melanoma in situ that typically affects the head and neck region with an increasing incidence. Margin-controlled techniques, such as spaghetti technique (ST), have gained popularity over wide local excision (WLE) with a margin of 5 mm. OBJECTIVES To evaluate the outcomes of lentigo maligna cases in the head and neck area treated by either WLE or ST in a tertiary referral hospital. The secondary goal was to describe the demographic and clinical characteristics of our series. METHODS Cohort study of patients diagnosed with lentigo maligna on the head and neck region between January 2014 and February 2022 in a tertiary hospital. RESULTS In total, 79 lentigo maligna were studied, corresponding to 77 patients. Fifty-three lesions (67%) were treated with WLE and 26 (33%) with ST. The mean age of the patients was 73 years and 58% were men. Most of the tumors were located on the cheek (50%) and mean lesion diameter was 2.2 cm for the ST group and 1.2 cm for the WLE group. Mean duration follow-up was 44 months. There were two local recurrences in the WLE group (2/53; 3.7%) and none in the ST group. CONCLUSIONS Both WLE and ST are appropriate surgical approaches for lentigo maligna. ST offers an efficient alternative to Mohs surgery for treating lentigo maligna in the head and neck area, especially when guided by reflectance confocal microscopy.
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Affiliation(s)
- Manel Martinez-Molina
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Nina Richarz
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Ane Jaka
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Juli Bassas-Vila
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Verónica Mora-Fernández
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Ariadna Quer Pi-Sunyer
- Department of Pathology, Hospital University Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Sebastian Podlipnik
- Department of Dermatology, Melanoma Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - José Manuel Carrascosa
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
| | - Aram Boada
- Department of Dermatology, Hospital University Germans Trias i Pujol, Badalona. Autonomous University of Barcelona, Barcelona, Spain
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8
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Garcia-Mouronte E, Berna-Rico E, de Nicolas-Ruanes B, Azcarraga-Llobet C, Alonso-Martinez de Salinas L, Bea-Ardebol S. Imiquimod as Local Immunotherapy in the Management of Premalignant Cutaneous Conditions and Skin Cancer. Int J Mol Sci 2023; 24:10835. [PMID: 37446011 DOI: 10.3390/ijms241310835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Cutaneous cancers are, by far, the most common malignant neoplasms of the human being. Due to the great array of clinical conditions, their worldwide increasing incidence and the steady ageing of the population, non-invasive treatments modalities that show a good clinical response, a proper benefit-risk ratio and cosmetic results are becoming increasingly important in the clinical setting. Imiquimod is a topically applied immunomodulator which is often used in the management of several premalignant and malignant cutaneous disorders. This article is a review of the current literature on its mechanism of action, pharmacokinetics, and therapeutical effects.
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Affiliation(s)
| | - Emilio Berna-Rico
- Dermatology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
| | | | | | | | - Sonia Bea-Ardebol
- Dermatology Department, Hospital Universitario Ramon y Cajal, 28034 Madrid, Spain
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Elshot YS, Tio DCKS, van Haersma-de With ASE, Ouwerkerk W, Zupan-Kajcovski B, Crijns MB, Limpens CEJM, Klop WMC, Bekkenk MW, Balm AJM, de Rie MA. Lentigo maligna (melanoma): A systematic review and meta-analysis on surgical techniques and presurgical mapping by reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2023; 37:871-883. [PMID: 36652277 DOI: 10.1111/jdv.18880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
Because of an increased risk of local recurrence following surgical treatment of lentigo maligna (melanoma) (LM/LMM), the optimal surgical technique is still a matter of debate. We aimed to evaluate the effect of different surgical techniques and reflectance confocal microscopy (RCM) on local recurrence and survival outcomes. We searched MEDLINE, Embase and PubMed databases through 20 May 2022. Randomized and observational studies with ≥10 lesions were eligible for inclusion. Bias assessment was performed using the Methodological Index for Non-Randomized Studies instrument. Meta-analysis was performed for local recurrence, as there were insufficient events for the other clinical outcomes. We included 41 studies with 5059 LM and 1271 LMM. Surgical techniques included wide local excision (WLE) (n = 1355), staged excision (n = 2442) and Mohs' micrographic surgery (MMS) (n = 2909). Six studies included RCM. The guideline-recommended margin was insufficient in 21.6%-44.6% of LM/LMM. Local recurrence rate was lowest for patients treated by MMS combined with immunohistochemistry (<1%; 95% CI, 0.3%-1.9%), and highest for WLE (13%; 95% CI, 7.2%-21.6%). The mean follow-up varied from 27 to 63 months depending on surgical technique with moderate to high heterogeneity for MMS and WLE. Handheld-RCM decreased both the rate of positive histological margins (p < 0.0001) and necessary surgical stages (p < 0.0001). The majority of regional (17/25) and distant (34/43) recurrences occurred in patients treated by WLE. Melanoma-associated mortality was low (1.5%; 32/2107), and more patients died due to unrelated causes (6.7%; 107/1608). This systematic review shows a clear reduction in local recurrences using microscopically controlled surgical techniques over WLE. The use of HH-RCM showed a trend in the reduction in incomplete resections and local recurrences even when used with WLE. Due to selection bias, heterogeneity, low prevalence of stage III/IV disease and limited survival data, it was not possible to determine the effect of the different surgical techniques on survival outcomes.
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Affiliation(s)
- Y S Elshot
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - D C K S Tio
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | - W Ouwerkerk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Infection & Immunity Institute, Cancer Center, University of Amsterdam, Amsterdam, The Netherlands.,National Heart Centre Singapore, Singapore, Singapore
| | - B Zupan-Kajcovski
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M B Crijns
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - C E J M Limpens
- Research Support, Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W M C Klop
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M W Bekkenk
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M A de Rie
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Zoutendijk J, Koljenovic S, Wakkee M, Mooyaart A, Nijsten T, van den Bos R. Clinical findings are not helpful in detecting lentigo maligna melanoma in patients with biopsy-proven lentigo maligna. J Eur Acad Dermatol Venereol 2022; 36:2325-2330. [PMID: 35730990 PMCID: PMC9796129 DOI: 10.1111/jdv.18346] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Lentigo maligna (LM) based on biopsy material might be lentigo maligna melanoma (LMM) after excision. OBJECTIVES Investigate whether clinical and dermoscopic mapping increases the detection rate of LMM when investigating staged excision specimens of biopsy proven LM. METHODS Patients with biopsy-proven LM planned for staged excision were included. Using clinical inspection and dermoscopy, spots suspicious for LMM were marked. After the excision, needles were placed at the marked spots. Histological examination using vertical sections was done at the needles followed by the standard amount of vertical sections. RESULTS In 28 of the 58 biopsy-proven LM, there was clinical suspicion of LMM, only 3 of these 28 cases were upgraded into LMM. These three cases showed LMM in other sections, whereas only 1 case showed LMM around the needle. Within the group without clinical suspicion of LMM, 2 cases were LMM. Biopsy-proven LM were in fact LMM in 8.6% of the cases and were found without the clinical guidance of the dermatologist. CONCLUSIONS 8.6% of the biopsy-proven LM were LMM after complete histological examination. In this study, the dermatologist was not able to increase the detection rate of LMM by using clinical and dermoscopic mapping.
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Affiliation(s)
- J. Zoutendijk
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - S. Koljenovic
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands,Department of PathologyAntwerp University HospitalAntwerpBelgium
| | - M. Wakkee
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - A.L. Mooyaart
- Department of PathologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - T. Nijsten
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - R.R. van den Bos
- Department of Dermatology, Erasmus MC Cancer InstituteUniversity Medical Center RotterdamRotterdamThe Netherlands
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11
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Gaetano L, Domenico B, Lo SN, Hamed T, Potter AJ, Thompson JF, Scolyer RA, Guitera P. Association between excision margins and local recurrence in 1407 patients with primary in situ melanomas. JAAD Int 2022; 8:102-108. [PMID: 35875393 PMCID: PMC9305371 DOI: 10.1016/j.jdin.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Reliable evidence to guide the management of melanoma in situ (MIS) and minimize the risk of recurrence is lacking. Objective To identify clinicopathological predictors of local recurrence (LR) in patients with MIS and evaluate long-term outcomes according to pathological excision margins. Methods A case-control study of patients with MIS treated at a large Australian melanoma treatment center from January 2008 to December 2012 was undertaken. Clinicopathological characteristics of patients who developed LR and those who did not were compared. Results LR developed in 34 of 1407 patients with MIS (2.5%). Median time to LR was 20 months. The primary lesion was removed with pathological margins <4 mm (P < .001) in 67.6 % of patients with LR. Four patients died of metastatic melanoma following LR. Comparing patients with pathological margins <4 mm and ≥4 mm, the former were older (>60y, P < .001), more frequently had MIS on the head or neck (P < .001), had a greater LR rate (P < .001), and had a higher mortality from all causes (P < .001). Limitations Retrospective, single-institution study. Conclusions Pathological margins of ≥4 mm should be considered for patients with MIS who are treated with standard surgical excision and assessed by examining serial slices taken from the formalin-fixed, paraffin-embedded specimen.
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12
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Elshot YS, Zupan-Kajcovski B, Ouwerkerk W, Klop WMC, Lohuis PJFM, Bol M, Crijns MB, Bekkenk MW, de Rie MA, Balm AJM. A cohort analysis of surgically treated primary head and neck lentigo maligna (melanoma): Prognostic value of melanoma subtype and new insights in the clinical value of guideline adherence. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:818-824. [PMID: 36031471 DOI: 10.1016/j.ejso.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/07/2022] [Accepted: 08/12/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Knowledge about lentigo maligna (melanoma) (LM/LMM) and its associated prognostic clinicopathological characteristics are limited compared to that of non-LM/LMM subtypes. The current study aimed to determine the clinical relevance of the LM/LMM subtype and its influence on recurrence and survival outcomes. METHODS All consecutive cases of primary cutaneous head and neck LM/LMM treated by wide local excision over a ten-year period were retrospectively reviewed and compared to non-LM/LMM. Clinical outcome and prognostic factors were assessed by cumulative incidence and competing risk analyses. RESULTS A total of 345 patients were identified. Specific clinicopathological characteristics such as lower median Breslow thickness (1.6 mm versus 2.1 mm; P = 0.013), association with diagnostic sampling errors (17.3% versus 5.2%; P = 0.01), and increased risk of local recurrences due to incomplete resection (18.7% versus 2.3%; P < 0.001), were significantly associated with LM/LMM. Guideline adherence was similar between the two study groups. The positive nodal status at baseline for LMM was low compared to non-LM/LMM (4.2% vs 17.9%; P = 0.037). The LMM subtype, facial localization, and reduced surgical margins (i.e., guideline non-adherence) were not shown to be independent prognostic factors for disease-free, melanoma-specific, or overall survival after correction for competing risks such as patient age and Breslow thickness. CONCLUSIONS The LMM subtype was not shown to be prognostically different from non-LM/LMM when corrected for other variables of influence such as patient age and Breslow thickness. Reduced resection margins did not seem to affect disease-free, and melanoma-specific survival and warrant LM/LMM-specific guidelines. Further research is needed to evaluate the value of SLNB in LMM patients.
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Affiliation(s)
- Yannick S Elshot
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands; Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Biljana Zupan-Kajcovski
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands
| | - Wouter Ouwerkerk
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute, Cancer Center, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - W Martin C Klop
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Peter J F M Lohuis
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Mijke Bol
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands
| | - Marianne B Crijns
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Menno A de Rie
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
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13
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Naik PP. Diagnosis and Management of Lentigo Maligna: Clinical Presentation and Comprehensive Review. J Skin Cancer 2021; 2021:7178305. [PMID: 34350036 PMCID: PMC8328731 DOI: 10.1155/2021/7178305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/10/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022] Open
Abstract
Lentigo maligna (LM), also known as Hutchinson's melanotic freckle, is a form of in situ melanoma characterized by the proliferation of atypical melanocytes along the basal epidermis in sun-damaged skin. If left untreated, LM will progress to lentigo maligna melanoma (LMM), a form of invasive melanoma with the same prognosis as other forms of invasive melanoma. LM is more common in the elderly, with a peak occurrence between the ages of 65 and 80 years. LM, however, is rarely present on the trunk and extremities. The diagnosis of LM, confirmed by histopathological and biopsy examination, is based on clinical and dermoscopic features. It typically begins as a tan-brown macule or patch, but it can progress to a variegated pigmentation with dark black color or even amelanotic characteristics. The risk factors involved in the LM development include a history of sunburns, lighter skin types, advanced age, history of nonmelanoma skin cancers, and tendency to form solar lentigines. This article explains the clinical presentation of LM, also reviews the available information on the diagnosis and management of LM, and discusses the potential of such information in facilitating the future prospective.
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Affiliation(s)
- Piyu Parth Naik
- Department of Dermatology, Saudi German Hospitals and Clinics, Hessa Street 331 West, Al Barsha 3, Exit 36 Sheikh Zayed Road, Opposite of American School, Dubai, UAE
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14
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NAGORE E, MORO R. Surgical procedures in melanoma: recommended deep and lateral margins, indications for sentinel lymph node biopsy, and complete lymph node dissection. Ital J Dermatol Venerol 2021; 156:331-343. [DOI: 10.23736/s2784-8671.20.06776-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Iznardo H, Garcia-Melendo C, Yélamos O. Lentigo Maligna: Clinical Presentation and Appropriate Management. Clin Cosmet Investig Dermatol 2020; 13:837-855. [PMID: 33223843 PMCID: PMC7671473 DOI: 10.2147/ccid.s224738] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/15/2020] [Indexed: 01/12/2023]
Abstract
Lentigo maligna (LM) is a type of melanoma in situ that has distinctive characteristics regarding epidemiology, risk factors and clinical features. In addition, LM has a potential to progress to an invasive tumor with potentially aggressive behavior: lentigo maligna melanoma (LMM). Overall, LM has a very good prognosis, whereas LMM has the same prognosis as other invasive melanomas with similar Breslow thickness. LM/LMM represents a challenging entity not only regarding the diagnosis but also regarding the management. Diagnostic criteria are not well established, and there is an overlap of clinical, dermoscopic and pathological features with other benign pigmented skin lesions such as lentigines, pigmented actinic keratoses or macular seborrheic keratoses. LM/LMM's common appearance within photodamaged skin makes lesion border identification difficult. Wide excisions are often required, but since LM/LMM typically appears on cosmetically sensitive areas such as the face, sometimes large excisions are not possible nor desirable. In this sense, specialized approaches have been developed such as margin-controlled surgery or image-guided treatment using reflectance confocal microscopy. Other treatments for LM such as cryosurgery, imiquimod, radiotherapy or photodynamic therapy have been proposed, although recurrence/persistence is common. The current manuscript reviews extensively the published data regarding the diagnosis, treatment and management of both complex entities LM and LMM.
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Affiliation(s)
- Helena Iznardo
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Garcia-Melendo
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Yélamos
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Dermatology Service, Centro Médico Teknon - Quirónsalud, Barcelona, Spain
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16
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Megna M, Ruggiero A, Fabbrocini G, Zaslavsky D, Nasyrov R, Sidikov A, Timoshchuk E. Giant nodular melanoma of the nose in a 78-year-old female refusing complete excision. Dermatol Ther 2020; 33:e14056. [PMID: 32700784 DOI: 10.1111/dth.14056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/16/2020] [Accepted: 07/18/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Angelo Ruggiero
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | | | - Denis Zaslavsky
- Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Ruslan Nasyrov
- Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Akmal Sidikov
- Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Elena Timoshchuk
- Department of Dermatovenereology, Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
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17
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Shahriari N, Grant-Kels JM, Rabinovitz H, Oliviero M, Scope A. Reflectance confocal microscopy: Principles, basic terminology, clinical indications, limitations, and practical considerations. J Am Acad Dermatol 2020; 84:1-14. [PMID: 32553679 DOI: 10.1016/j.jaad.2020.05.153] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022]
Abstract
Reflectance confocal microscopy (RCM) is a noninvasive imaging tool used for in vivo visualization of the skin. It has been extensively studied for use in the evaluation of equivocal cutaneous neoplasms to decrease the number of biopsy procedures in patients with benign lesions. Furthermore, its applications are broadening to include presurgical cancer margin mapping, tumor recurrence surveillance, monitoring of ablative and noninvasive therapies, and stratification of inflammatory disorders. With the approval of category I Current Procedural Terminology reimbursement codes for RCM image acquisition and interpretation, use of this technology has been increasingly adopted by dermatologists. The first article in this 2-part continuing medical education series highlights basic terminology, principles, clinical applications, limitations, and practical considerations in the clinical use of RCM technology.
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Affiliation(s)
- Neda Shahriari
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida, Gainesville, Florida
| | - Harold Rabinovitz
- Skin and Cancer Associates, Plantation, Florida; Dermatology Department, Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Alon Scope
- The Kittner Skin Cancer Screening and Research Institute, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dermatology Service, Memorial Sloan-Kettering Center, New York, New York
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18
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Classification of Lentigo Maligna at Patient-Level by Means of Reflectance Confocal Microscopy Data. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10082830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Reflectance confocal microscopy is an appropriate tool for the diagnosis of lentigo maligna. Compared with dermoscopy, this device can provide abundant information as a mosaic and/or a stack of images. In this particular context, the number of images per patient varied between 2 and 833 images and the objective, ultimately, is to be able to discern between benign and malignant classes. First, this paper evaluated classification at the image level, with the help of handcrafted methods derived from the literature and transfer learning methods. The transfer learning feature extraction methods outperformed the handcrafted feature extraction methods from literature, with a F 1 score value of 0.82. Secondly, this work proposed patient-level supervised methods based on image decisions and a comparison of these with multi-instance learning methods. This study achieved comparable results to those of the dermatologists, with an auc score of 0.87 for supervised patient diagnosis and an auc score of 0.88 for multi-instance learning patient diagnosis. According to these results, computer-aided diagnosis methods presented in this paper could be easily used in a clinical context to save time or confirm a diagnosis and can be oriented to detect images of interest. Also, this methodology can be used to serve future works based on multimodality.
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