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Stolfo JB, Motta ACDA. Density of high endothelial venules and PDL-1 expression: relationship with tumor-infiltrating lymphocytes in primary cutaneous melanomas. AN ACAD BRAS CIENC 2024; 96:e20230441. [PMID: 38511744 DOI: 10.1590/0001-3765202420230441] [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: 04/14/2023] [Accepted: 07/17/2023] [Indexed: 03/22/2024] Open
Abstract
Studies have highlighted melanoma immunogenicity, and the prognostic importance of tumor infiltrating lymphocytes (TILs) and mechanisms of tumor immune evasion, such as hyperexpression of programmed cell death ligand 1 (PDL-1). High endothelial venules (HEV) are specialized blood vessels that can facilitate the lymphocytes migration to the tumor. Here we evaluate the association of HEV density and PDL-1 expression in primary cutaneous melanomas with the presence and degree of TILs and with other clinicopathological variables (age, sex, tumor location, melanoma histological type, Breslow thickness, ulceration, regression signs, mitotic index). HEV density and PDL-1 expression were assessed immunohistochemically in 78 melanoma cases, using a specific antibody, and were detected in 59% and 76% of these, respectively. Positive associations were identified between HEV density and PDL-1 expression with the presence and degree of lymphocytic infiltration, melanoma histological type and ulceration presence. No correlation was found between HEV density and PDL-1 expression. Our findings confirm the HEV role in the recruitment and facilitation of lymphocyte transport in cutaneous melanomas, where HEV density is strongly associated with the degree of TILs. Additionally, PDL-1 hyperexpression suggests a possible mechanism of tumor immune evasion, which may lead to inactivation and reduction of the tumor lymphocytes number.
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Affiliation(s)
- Josiane B Stolfo
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, Escola de Ciências Agrárias, Inovação e Negócios, Campus I, BR 285, Km 171, São José, 99001-970 Passo Fundo, RS, Brazil
| | - Adriana C DA Motta
- Programa de Pós-Graduação em Bioexperimentação, Universidade de Passo Fundo, Escola de Ciências Agrárias, Inovação e Negócios, Campus I, BR 285, Km 171, São José, 99001-970 Passo Fundo, RS, Brazil
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Salomão PR, Costa Pimenta MR, Alves Wainstein AJ, Drummond-Lage AP. Temporal Recurrence of Cutaneous Melanoma: Analysis of a Case Series. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2023; 16:32-38. [PMID: 38125669 PMCID: PMC10729801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Introduction The recurrence of cutaneous melanoma is one of the main reasons for surveillance after primary tumor treatment, and there is still little data on melanoma recurrence related to the Brazilian population. Objective We sought to evaluate the profile of patients with cutaneous melanoma recurrence within five years of (early) and five years after (late) initial diagnosis. Methods Patients diagnosed between 2006 and 2014 in a private reference service in Belo Horizonte, Brazil, were included. Demographic, clinical, histopathological, and disease evolution variables were collected and analyzed using the R version 4.0.0 program. A p-value less than 0.05 was considered significant. Results The sample was composed of 331 patients with melanoma, and the 43 patients with recurrence presented with higher mean age (p=0.049), male predominance (p=0.030), a lower proportion of Breslow thickness under 0.8mm (p<0.001), and a more significant presence of mitosis (p=0.007). The 29 patients (8.8%) with early recurrence presented with tumors with ulceration (p<0.018). Late recurrence occurred in 14 patients (4.2%). Five patients relapsed after 10 years; most of them had tumors up to 1mm thick, without ulceration, regression, or satellitosis, but with the presence of mitosis. Conclusion The possibility of cutaneous melanoma recurrence after five, and even 10, years, although rare, might indicate the need for longer medical follow-up. Multicenter studies may better characterize Brazilian patient profiles of those with early and late recurrence of melanoma.
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Affiliation(s)
- Paula Resende Salomão
- All authors are with Faculdade Ciências Médicas de Minas Gerais, Post-graduation Department, Belo Horizonte, Minas Gerais, Brazil
| | - Matheus Resende Costa Pimenta
- All authors are with Faculdade Ciências Médicas de Minas Gerais, Post-graduation Department, Belo Horizonte, Minas Gerais, Brazil
| | - Alberto Julius Alves Wainstein
- All authors are with Faculdade Ciências Médicas de Minas Gerais, Post-graduation Department, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Paula Drummond-Lage
- All authors are with Faculdade Ciências Médicas de Minas Gerais, Post-graduation Department, Belo Horizonte, Minas Gerais, Brazil
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Borges de Barros Primo R, Brito Nobre A, Santos BN, Nunes LF, Fernandes R, Abrão Possik P, Santos Bernardes S. Impact of clinical and histopathological characteristics on the disease-free survival of stage I-II acral melanoma patients. Int J Dermatol 2023; 62:1281-1288. [PMID: 37596798 DOI: 10.1111/ijd.16800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/31/2023] [Accepted: 07/14/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Acral melanoma is rare and associated with a worse prognosis compared to cutaneous melanoma in other locations. Despite this, few studies have focused on the prognosis of acral melanoma, particularly in patients with initial clinical stage. The aim of this study was to assess the impact of clinical and histopathological characteristics on the disease-free survival (DFS) of stage I-II patients. METHODS We analyzed 154 stage I-II acral melanoma cases, all of whom underwent a review of the histopathological and clinical parameters. Patients were divided into groups based on the presence or absence of disease recurrence within 5 years. We used Cox proportional regression to analyze independent risk factors and computed DFS curves using the Kaplan-Meier method. RESULTS Within 5 years, 27.9% of patients experienced disease recurrence, with 90.4% occurring during the first 3 years. Univariate and multivariate analyses did not identify any clinical parameters with a significant influence on DFS. The DFS rate at 5 years was 72.7%. The median duration of disease recurrence after the initial diagnosis was 21 months. However, Breslow thickness, presence of ulceration, >3 mitosis/mm2 , presence of tumor-infiltrating lymphocytes (TIL), and perineural invasion were significantly associated with a decrease in time to first recurrence. CONCLUSIONS Despite the favorable prognosis of stage I-II acral melanoma compared with advance stage, clinical and histopathological characteristics can impact prognosis. In addition to Breslow thickness and ulceration, attention should be paid to mitotic rate, presence of TIL, and perineural invasion to optimize follow-up of acral melanoma patients diagnosed in the initial clinical stage.
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Affiliation(s)
| | - Aretha Brito Nobre
- Pathology Division, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Bruna Nathália Santos
- Tissue Microenvironment Laboratory, Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luiz Fernando Nunes
- Connective Bone Tissue Division, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Ricardo Fernandes
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
| | - Patricia Abrão Possik
- Program of Immunology and Tumor Biology, Brazilian National Cancer Institute, Rio de Janeiro, Brazil
| | - Sara Santos Bernardes
- Faculty of Health Sciences, Federal University of Grande Dourados, Dourados, Mato Grosso do Sul, Brazil
- Tissue Microenvironment Laboratory, Department of General Pathology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Matrakool P, Chaisrisawadisuk S, Vongviriyangkoon T. Prognostic Factors and Outcomes of Cutaneous Malignant Melanoma: A 174-Patient Cohort Study in a Tertiary Hospital in Thailand. Ann Plast Surg 2023; 90:621-625. [PMID: 36880780 DOI: 10.1097/sap.0000000000003481] [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: 03/08/2023]
Abstract
BACKGROUND Malignant melanoma is a common skin cancer among Asians. However, some features, such as tumor type and initial stages, are not comparable with those found in Western countries. We audited a large cohort of patients at a single tertiary referral hospital in Thailand to identify factors affecting the prognosis. METHODS A retrospective study was conducted of patients diagnosed with cutaneous malignant melanoma between 2005 and 2019. Details of demographic data, clinical characteristics, pathological reports, treatments, and outcomes were collected. Statistical analyses of overall survival and factors affecting survival were investigated. RESULTS The study enrolled 174 patients (79 men and 95 women) with pathologically confirmed cutaneous malignant melanoma. Their mean age was 63 years. The most common clinical presentation was a pigmented lesion (40.8%), with the plantar area being the most common site (25.9%). The mean duration of onset and hospitalization was 17.5 months. The 3 most common types of melanoma were acral lentiginous (50.7%), nodular (28.9%), and superficial spreading (9.9%). Eighty-eight cases (50.6%) had concomitant ulceration. Pathological stage III was the most common (42.1%). The 5-year overall survival was 43%, and the median survival time was 3.91 years. Multivariate analysis showed that clinically palpable lymph nodes, distant metastasis, a Breslow thickness ≥ 2 mm, and evidence of lymphovascular invasion were poor prognostic factors for overall survival. CONCLUSIONS In our study, most patients with cutaneous melanoma presented with a higher pathological stage. Independent factors affecting survival are palpable lymph nodes, distant metastases, Breslow thickness, and the presence of lymphovascular invasion. The overall 5-year survival rate was 43%.
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Affiliation(s)
- Piyawat Matrakool
- From the Division of Plastic surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Di Carlo V, Stiller CA, Eisemann N, Bordoni A, Matz M, Curado MP, Daubisse‐Marliac L, Valkov M, Bulliard J, Morrison D, Johnson C, Girardi F, Marcos‐Gragera R, Šekerija M, Larønningen S, Sirri E, Coleman MP, Allemani C. Does the morphology of cutaneous melanoma help to explain the international differences in survival? Results from 1 578 482 adults diagnosed during 2000-2014 in 59 countries (CONCORD-3). Br J Dermatol 2022; 187:364-380. [PMID: 35347700 PMCID: PMC9542891 DOI: 10.1111/bjd.21274] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND CONCORD-3 highlighted wide disparities in population-based 5-year net survival for cutaneous melanoma during 2000-2014. Clinical evidence suggests marked international differences in the proportion of lethal acral and nodular subtypes of cutaneous melanoma. OBJECTIVES We aimed to assess whether the differences in morphology may explain global variation in survival. METHODS Patients with melanoma were grouped into the following seven morphological categories: malignant melanoma, not otherwise specified (International Classification of Diseases for Oncology, third revision morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722-8723, 8726-8727, 8730, 8740-8741, 8746, 8761, 8770-8774, 8780). We estimated net survival using the nonparametric Pohar Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All-ages survival estimates were standardized using the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death. RESULTS Worldwide, the proportion of nodular melanoma ranged between 7% and 13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). Overall, 36% of tumours were classified as superficial spreading melanoma. During 2010-2014, age-standardized 5-year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but was only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66% and 95%. Nodular melanoma had the poorest prognosis in all countries. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes. CONCLUSIONS This study provides the broadest picture of distribution and population-based survival trends for the main morphological subtypes of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment. What is already known about this topic? The histopathological features of cutaneous melanoma vary markedly worldwide. The proportion of melanomas with the more aggressive acral lentiginous or nodular histological subtypes is higher in populations with predominantly dark skin than in populations with predominantly fair skin. What does this study add? We aimed to assess the extent to which these differences in morphology may explain international variation in survival when all histological subtypes are combined. This study provides, for the first time, international comparisons of population-based survival at 5 years for the main histological subtypes of melanoma for over 1.5 million adults diagnosed during 2000-2014. This study highlights the less favourable distribution of histological subtypes in Asia and Central and South America, and the poorer prognosis for nodular and acral lentiginous melanomas. We found that later stage at diagnosis does not fully explain the higher excess risk of death for nodular and acral lentiginous melanoma compared with superficial spreading melanoma.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | | | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of LübeckRatzeburger Allee160 23538LübeckGermany
| | - Andrea Bordoni
- Ticino Cancer Registry, Dipartimento Sanità e SocialitàDivisione della Salute PubblicaVia Ciseri10 6600LocarnoSwitzerland
| | - Melissa Matz
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | - Maria P. Curado
- Goiânia Cancer Registry, Group of Epidemiology and Statistics on CancerAC Camargo Cancer CenterRua Tamandaré 753 ‐ LiberdadeSP01525‐001São PauloBrazil
| | - Laetitia Daubisse‐Marliac
- Tarn Cancer RegistryInstitut Universitaire du Cancer Toulouse – Oncopole Institut C. Regaud1 Avenue Irène Joliot‐Curie31059ToulouseFrance
| | - Mikhail Valkov
- Northern State Medical UniversityProspekt Troitskiy51 163000ArkhangelskRussian Federation
| | - Jean‐Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
- Neuchâtel and Jura Tumour RegistryNeuchâtelSwitzerland
| | - David Morrison
- Scottish Cancer RegistryGyle Square, 1 South Gyle CrescentEH12 9EBEdinburghUK
| | - Chris Johnson
- Cancer Data Registry of Idaho, 615 North 7th StreetID83701‐1278BoiseUSA
| | - Fabio Girardi
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
- Division of Medical Oncology 2Veneto Institute of Oncology IOV‐IRCCSVia Gattamelata64 35128PadovaItaly
| | - Rafael Marcos‐Gragera
- Epidemiology Unit and Girona Cancer RegistryCatalan Institute of Oncology (ICO), IDIBGI, Oncology Coordination Plan, Department of Health Government of Catalonia17004GironaSpain
- University of Girona (UdG)17004GironaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Mario Šekerija
- Croatian National Cancer RegistryCroatian Institute of Public HealthRockefeller Street7 10000ZagrebCroatia
| | | | - Eunice Sirri
- Epidemiological Cancer Registry of Lower SaxonyOffis Caree GmbHIndustriestr92 6121OldenburgGermany
| | - Michel P. Coleman
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
| | - Claudia Allemani
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
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Time-to-treatment initiation for cutaneous melanoma reflects disparities in healthcare access in Brazil: a retrospective study. Public Health 2022; 210:1-7. [PMID: 35863157 DOI: 10.1016/j.puhe.2022.06.006] [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: 12/15/2021] [Revised: 05/24/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed at identifying the sociodemographic and first treatment characteristics affecting time-to-treatment initiation (TTI) of patients with cutaneous melanoma assisted by the Brazilian Unified Health System (SUS). STUDY DESIGN Retrospective observational study using cutaneous melanoma cases recorded in the Brazilian Hospital-Based Cancer Registries (HBCR). METHODS A total of 12,783 cutaneous melanoma cases were included in the analysis. Based on the legislation, TTI in Brazil is 60 days; therefore, the cohort was dichotomized into TTI within 60 days and over. The association among variables was evaluated through the Chi-squared test. Kaplan-Meier method and log-rank hypothesis test were used to determine the probability of initiating treatment within 60 days. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Median TTI was 28 days (95% CI, 25-29). First treatment in SUS provided more than 60 days after diagnosis (34.8%) was associated with females; low level of formal education; living or getting treatment in northern Brazil; being diagnosed in SUS and treated at different healthcare facilities, in addition to starting treatment with radiotherapy or systemic therapy. There were no significant differences in access to health care before and after the enactment of the 60-day law. CONCLUSION Increased TTI for cutaneous melanoma is associated with sociodemographic and first treatment characteristics in Brazil; approximately one-third of cases did not have access to first treatment within the period established by law. Receiving the diagnosis and treatment at different healthcare facilities (transitions in care) is the main independent factor associated with TTI longer than 60 days.
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Rodríguez-Betancourt JD, Arias-Ortiz N. Cutaneous melanoma incidence, mortality, and survival in Manizales, Colombia: a population-based study. J Int Med Res 2022; 50:3000605221106706. [PMID: 35722901 PMCID: PMC9344176 DOI: 10.1177/03000605221106706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We estimated the cutaneous melanoma (CM) incidence, mortality, and survival in Manizales, Colombia to establish predictors for survival. METHODS This analytical cohort study used CM incident cases during 2006 to 2015 in the Manizales Cancer Registry (n = 132). Incidence and mortality rates were standardized using the direct method. Patients were followed up until 30 November 2020. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the log-rank test for differences. Cox multivariate regression models were fitted. RESULTS Incidence (per 100,000) increased from 1.6 to 3.0 in men and 2.6 to 2.8 in women during 2006-2010 to 2011-2015, respectively. Mortality was low and stable. Five-year survival was 68.7%, with significant differences according to age (hazard ratio [HR] >70 vs. ≤70 years: 3.37); histological subtype (HR for melanoma not otherwise specified and HR for nodular melanoma vs lentigo malignant melanoma and superficial spreading melanoma: 17.39 and 10.16, respectively); and clinical stage (HR stages III-IV vs. stages I-II: 5.94). CONCLUSION CM is characterized by increasing incidence and unfavorable prognosis, particularly in patients aged >70 years, with melanoma not otherwise specified and nodular melanoma, and advanced stages. Promoting photoprotection and early detection and management of suspicious skin lesions is crucial.
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Affiliation(s)
- Juan David Rodríguez-Betancourt
- Young Researchers Program, Ministerio de Ciencia, Tecnología e
Innovación, Bogotá, Colombia
- Population-based Manizales Cancer Registry, Instituto de
Investigaciones en Salud, Universidad de Caldas, Manizales, Colombia
- Departamento de Salud Pública, Universidad de Caldas, Manizales,
Colombia
| | - Nelson Arias-Ortiz
- Population-based Manizales Cancer Registry, Instituto de
Investigaciones en Salud, Universidad de Caldas, Manizales, Colombia
- Departamento de Salud Pública, Universidad de Caldas, Manizales,
Colombia
- Grupo de Investigación Promoción de la Salud y Prevención de la
Enfermedad, Universidad de Caldas, Manizales, Colombia
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Gómez NL, Boccalatte LA, Volonteri V, Larrañaga JJ. Cutaneous Melanoma and Sentinel Lymph Node Biopsy: A Single-Center Retrospective Study of 331 Patients in Argentina. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:332-335. [PMID: 35526930 DOI: 10.1016/j.ad.2020.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/28/2020] [Accepted: 08/22/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- N L Gómez
- Sección Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - L A Boccalatte
- Sección Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - V Volonteri
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J J Larrañaga
- Sección Cirugía de Cabeza y Cuello, Servicio de Cirugía General, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Gómez N, Boccalatte L, Volonteri V, Larrañaga J. [Translated article] Cutaneous Melanoma and Sentinel Lymph Node Biopsy: A Single-Center Retrospective Study of 331 Patients in Argentina. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Paudel K, Adhikari TB, Khanal P, Bhatta R, Paudel R, Bhusal S, Basel P. Sleep quality and its correlates among undergraduate medical students in Nepal: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000012. [PMID: 36962248 PMCID: PMC10021869 DOI: 10.1371/journal.pgph.0000012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/07/2021] [Indexed: 05/07/2023]
Abstract
Poor sleep quality has been found to affect students' learning abilities, academic performance, and interpersonal relationships. However, little is known about this issue in Nepal. This study aimed to identify the factors associated with poor sleep quality among undergraduate medical students in Nepal. A web-based survey was conducted in March 2021 among 212 undergraduate medical students at the Institute of Medicine, Kathmandu, Nepal. Sleep quality was measured using a 19-item Pittsburgh Sleep Quality Index (PSQI). Multivariable logistic regression analysis was done to assess the factors associated with sleep quality. In the study participants, 38.2% of the students were identified as poor sleepers. Factors like being depressed (AOR = 4.5, 95% CI; 1.2-5.4), current alcohol use (AOR = 2.5, 95% CI; 1.8-10.8), poor academic achievement (AOR = 3.4, 95% CI; 1.1-10.9), and being a fourth-year student (AOR = 3.6, 95% CI; 1.1-11.8) were significantly associated with poor sleep quality. Poor sleep quality was common among undergraduate medical students. Routine screening of sleep quality and depressive symptoms is necessary to mitigate their impact among medical students. Medical students of the fourth year, current alcohol users, and those who did not have good academic achievement had poor sleep quality. Special attention on these population subgroups is thus needed to enhance sleep quality.
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Affiliation(s)
- Kiran Paudel
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
- NCD Watch Nepal, Maharajgunj, Kathmandu, Nepal
- * E-mail:
| | - Tara Ballav Adhikari
- NCD Watch Nepal, Maharajgunj, Kathmandu, Nepal
- Department of Public Health, Section for Global Health, Aarhus University, Aarhus, Denmark
- Nepal Development Society, Chitwan, Nepal
| | - Pratik Khanal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Ramesh Bhatta
- Asian College for Advanced Studies, Purbanchal University, Satdobato, Lalitpur, Nepal
| | - Rajan Paudel
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - Sandesh Bhusal
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
- NCD Watch Nepal, Maharajgunj, Kathmandu, Nepal
| | - Prem Basel
- Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu, Nepal
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11
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Kalil LL, Prado EHM, Resende RVU, Pimenta MRC, Wainstein AJA, Drummond-Lage AP. Melanoma Awareness Among Medical Students. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:677-681. [PMID: 31902090 DOI: 10.1007/s13187-019-01685-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Melanoma is the most aggressive skin cancer. Since diagnosis is visual, it is critical to evaluate if students acquire enough knowledge for early detection during medical school. To assess the melanoma knowledge of first-year (freshman) and sixth-year (senior) medical students, in a Brazilian Institution. It was a transversal and quantitative study. A questionnaire with sociodemographic data, knowledge about melanoma, and the habit of skin self-exam was filled out by medical students. A total of 128 first-year and 122 seniors students were included. All the sixth-year students knew melanoma as a skin cancer compared with 46.09% of the first-year students. Melanoma clinical characteristics were known by 30.51% of the freshman and 97.54% of seniors. However, they did not know the most usual site of melanoma occurrence (79.66% of first-year students and 24.59% of senior). About the skin self-exam, only 50% of first-year students and 53.28% of senior had the habit of doing it sometimes. Medical school was effective in providing knowledge about melanoma and its features. However, this was not reflected in an increase in the number of students that did the skin self-exam, which indicates the need for new approaches in teaching.
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Affiliation(s)
- L L Kalil
- Medical Sciences Faculty, School of Medicine, Alameda Ezequiel Dias 275-Centro, Belo Horizonte, 30130-110, Brazil
| | - E H M Prado
- Medical Sciences Faculty, School of Medicine, Alameda Ezequiel Dias 275-Centro, Belo Horizonte, 30130-110, Brazil
| | - R V U Resende
- Medical Sciences Faculty, School of Medicine, Alameda Ezequiel Dias 275-Centro, Belo Horizonte, 30130-110, Brazil
| | - M R C Pimenta
- Medical Sciences Faculty, School of Medicine, Alameda Ezequiel Dias 275-Centro, Belo Horizonte, 30130-110, Brazil
| | - A J A Wainstein
- Medical Sciences Faculty, School of Medicine, Alameda Ezequiel Dias 275-Centro, Belo Horizonte, 30130-110, Brazil
| | - A P Drummond-Lage
- Medical Sciences Faculty, School of Medicine, Alameda Ezequiel Dias 275-Centro, Belo Horizonte, 30130-110, Brazil.
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Basurto-Lozada P, Molina-Aguilar C, Castaneda-Garcia C, Vázquez-Cruz ME, Garcia-Salinas OI, Álvarez-Cano A, Martínez-Said H, Roldán-Marín R, Adams DJ, Possik PA, Robles-Espinoza CD. Acral lentiginous melanoma: Basic facts, biological characteristics and research perspectives of an understudied disease. Pigment Cell Melanoma Res 2020; 34:59-71. [PMID: 32330367 PMCID: PMC7818404 DOI: 10.1111/pcmr.12885] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 12/14/2022]
Abstract
Acral lentiginous melanoma is a histological subtype of cutaneous melanoma that occurs in the glabrous skin of the palms, soles and the nail unit. Although in some countries, particularly in Latin America, Africa and Asia, it represents the most frequently diagnosed subtype of the disease, it only represents a small proportion of melanoma cases in European‐descent populations, which is partially why it has not been studied to the same extent as other forms of melanoma. As a result, its unique genomic drivers remain comparatively poorly explored, as well as its causes, with current evidence supporting a UV‐independent path to tumorigenesis. In this review, we discuss current knowledge of the aetiology and diagnostic criteria of acral lentiginous melanoma, as well as its epidemiological and histopathological characteristics. We also describe what is known about the genomic landscape of this disease and review the available biological models to explore potential therapeutic targets.
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Affiliation(s)
- Patricia Basurto-Lozada
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico
| | - Christian Molina-Aguilar
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico.,Tecnologico de Monterrey, School of Engineering and Sciences, Centre of Bioengineering, Querétaro, Mexico
| | - Carolina Castaneda-Garcia
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico
| | - Martha Estefania Vázquez-Cruz
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico
| | - Omar Isaac Garcia-Salinas
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico.,Wellcome Sanger Institute, Hinxton, Cambridgeshire, CB101SA, UK
| | | | | | - Rodrigo Roldán-Marín
- Dermato-Oncology Clinic, Unidad de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - David J Adams
- Wellcome Sanger Institute, Hinxton, Cambridgeshire, CB101SA, UK
| | - Patricia A Possik
- Program of Immunology and Tumor Biology, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Carla Daniela Robles-Espinoza
- Laboratorio Internacional de Investigación Sobre el Genoma Humano, Universidad Nacional Autónoma de México, Santiago de Querétaro, Mexico.,Wellcome Sanger Institute, Hinxton, Cambridgeshire, CB101SA, UK
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de Carvalho CEB, Capuzzo R, Crovador C, Teixeira RJ, Laus AC, Carvalho AL, Vazquez VL. Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial. Ann Surg Oncol 2020; 27:2906-2912. [DOI: 10.1245/s10434-020-08409-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Indexed: 12/26/2022]
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Comodo-Navarro AN, Fernandes M, Barcelos D, Carapeto FCL, Guimarães DP, de Sousa Moraes L, Cerutti J, Iwamura ESM, Landman G. Intratumor Heterogeneity of KIT Gene Mutations in Acral Lentiginous Melanoma. Am J Dermatopathol 2020; 42:265-271. [PMID: 31393283 DOI: 10.1097/dad.0000000000001475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Melanoma is an aggressive skin malignancy, and the acral lentiginous melanoma (ALM) subtype affects non-sun-exposed sites such as the volar surface of the hands and feet and the subungual region and is most common in Asians, Hispanics, and Afro-descendants. The presence of different clones within the same tumor seems to influence the aggressiveness of tumors. Patients with mutations in the KIT gene have shown a good response to tyrosine kinase inhibitor therapy. We tested the hypothesis of intratumor heterogeneity through analysis of KIT gene mutations in ALM and determined the correlation between KIT mutations and demographic, clinical, and histopathological variables. Twenty-five ALM samples were examined. We selected up to four different regions per tumor for sequencing by the Sanger method for analysis of KIT gene exon 11 and exon 13 mutations. Advanced lesions were predominant, and the main histopathological characteristics of lesions were Breslow index >4.0 mm (17/25, 68%), Clark level IV/V (21/25, 84%), ulceration (16/25, 64%), and >3 mitoses/mm (8/25, 32%). KIT gene mutations were detected in 11/25 cases (44%), and all these 11 cases displayed intratumor heterogeneity, that is, at least 2 tumor regions had different mutational profiles. The predicted effect of most mutations detected was detrimental to protein function. No significant correlations between histopathological variables and either KIT mutations or intratumor heterogeneity were observed. The hypothesis of intratumor heterogeneity of KIT gene mutations in acral lentiginous melanoma was supported.
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Affiliation(s)
| | - Mariana Fernandes
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | - Denise Barcelos
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
| | | | | | - Lais de Sousa Moraes
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Janete Cerutti
- Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Gilles Landman
- Departamento de Patologia, Universidade Federal de São Paulo, São Paulo, Brazil; and
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da Costa LMM, Crovador CDS, de Carvalho CEB, Vazquez VDL. Characteristics of Brazilian melanomas: real-world results before and after the introduction of new therapies. BMC Res Notes 2019; 12:296. [PMID: 31138295 PMCID: PMC6537357 DOI: 10.1186/s13104-019-4336-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022] Open
Abstract
Objective This study is a characterization of the treatment patterns and outcomes of a Brazilian melanoma cohort collected of 1848 patients enrolled between 1996 and 2015. Results The superficial spreading subtype (35.1%) was the most prevalent, and the favoured anatomical location was the trunk (32.8%). The most common clinical stage was I (27.6%). The most frequent initial treatment was surgery (84.7%). Sentinel node biopsy was positive in 23.3% of cases. Chemotherapy was used to treat 298 patients (16.1%), immunotherapy for 67 (3.6%) and targeted therapy for 19 (1.0%). Distant recurrence was commonly observed (22.5%) and the mutation status of the BRAF gene was verified in 132 cases, with 42.4% positivity in this subset of patients. The melanoma specific actuarial 5-year survival for the cohort was 68.8%. There was a higher 5-year survival observed in metastatic melanoma patients who received immunotherapy and/or targeted therapy (34.2%) compared patients treated with just chemotherapy (20.0%). The survival analysis showed that sex, age, Breslow, clinical stage and distant recurrence were significant prognostic factors. This study provides a real-world description of how the introduction of new therapies such as immunotherapy and BRAF inhibitors is changing treatment strategies for melanoma in developing countries. Electronic supplementary material The online version of this article (10.1186/s13104-019-4336-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Camila de Souza Crovador
- Department of Surgery, Melanoma, Sarcoma and Mesenchymal Tumors, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Barretos, SP, 14784-400, Brazil
| | - Carlos Eduardo Barbosa de Carvalho
- Department of Surgery, Melanoma, Sarcoma and Mesenchymal Tumors, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Barretos, SP, 14784-400, Brazil
| | - Vinicius de Lima Vazquez
- Department of Surgery, Melanoma, Sarcoma and Mesenchymal Tumors, Barretos Cancer Hospital, Antenor Duarte Villela, 1331, Barretos, SP, 14784-400, Brazil.
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Melanoma signature in Brazil: epidemiology, incidence, mortality, and trend lessons from a continental mixed population country in the past 15 years. Melanoma Res 2019; 28:629-636. [PMID: 30204684 DOI: 10.1097/cmr.0000000000000511] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The current research aimed to understand melanoma epidemiology in Brazil and to evaluate temporal trends in incidence and mortality. The data came from Brazilian Hospital Cancer Registries, Population Based Cancer Registries, and the National Mortality Information System from 2000 to 2014. Descriptive statistics were used for epidemiological and clinical characteristics. To describe trends in change in incidence and mortality rates, the Average Annual Percentage Change (AAPC) was calculated. Between 2000 and 2013, in men, the median incidence rate rose from 2.52 to 4.84, with an AAPC of +21.5% [95% confidence interval (CI): 15.4-28] and in women from 1.93 to 3.22 per 100 000, with an AAPC of +13.9% (95% CI: 8.1-20). Regarding mortality, between 2000 and 2014, the rates went from 0.85 to 0.9 per 100 000 for men (AAPC=+0.8, 95% CI: 0.4-1.1) and from 0.56 for 0.53 per 100 000 for women (AAPC=-0.1, 95% CI: -0.2 to 0). From the database, a total of 28 624 patients with melanoma were included. Most of the patients were females (51.9%), White (75%) and with stage I or II (53.2%). Sex, ethnicity, education level, geographical area of the cancer center, topography, histology, time between diagnosis and treatment, and early death were significantly associated with distant metastases. Brazil is a large country with a very young population and a low rate of melanoma incidence and prevalence that should increase over the years. Understanding the trends attributed to melanoma is important for behavioral counseling interventions that focus on promoting skin cancer prevention.
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Postsurgical treatment landscape and economic burden of locoregional and distant recurrence in patients with operable nonmetastatic melanoma. Melanoma Res 2019; 28:618-628. [PMID: 30216199 PMCID: PMC6221390 DOI: 10.1097/cmr.0000000000000507] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Surgery is the mainstay treatment for operable nonmetastatic melanoma, but recurrences are common and limit patients’ survival. This study aimed to describe real-world patterns of treatment and recurrence in patients with melanoma and to quantify healthcare resource utilization (HRU) and costs associated with episodes of locoregional/distant recurrences. Adults with nonmetastatic melanoma who underwent melanoma lymph node surgery were identified from the Truven Health MarketScan database (1 January 2008 to 31 July 2017). Locoregional and distant recurrence(s) were identified on the basis of postsurgery recurrence indicators (i.e. initiation of new melanoma pharmacotherapy, new radiotherapy, or new surgery; secondary malignancy diagnoses). Of 6400 eligible patients, 219 (3.4%) initiated adjuvant therapy within 3 months of surgery, mostly with interferon α-2b (n=206/219, 94.1%). A total of 1191/6400 (18.6%) patients developed recurrence(s) over a median follow-up of 23.1 months (102/6400, 1.6% distant recurrences). Among the 219 patients initiated on adjuvant therapy, 73 (33.3%) experienced recurrences (distant recurrences: 13/219, 5.9%). The mean total all-cause healthcare cost was $2645 per patient per month (PPPM) during locoregional recurrence episodes and $12 940 PPPM during distant recurrence episodes. In the year after recurrence, HRU was particularly higher in patients with distant recurrence versus recurrence-free matched controls: by 9.2 inpatient admissions, 54.4 inpatient days, 8.8 emergency department admissions, and 185.9 outpatient visits (per 100 person-months), whereas all-cause healthcare costs were higher by $14 953 PPPM. It remains to be determined whether the new generation of adjuvant therapies, such as immune checkpoint inhibitors and targeted agents, will increase the use of adjuvant therapies, and reduce the risk of recurrences and associated HRU/cost.
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Epidemiological trends in the diagnosis of melanoma in a Southern European population: analysis of a large database from a tertiary referral center. Melanoma Res 2019; 28:348-358. [PMID: 29762190 DOI: 10.1097/cmr.0000000000000456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to present the epidemiological, clinicopathological, and treatment characteristics of patients diagnosed and treated in a tertiary referral center and to analyze independent factors associated with these characteristics. In this cohort study, epidemiological, clinicopathological, and treatment characteristics of 1461 consecutive melanoma patients diagnosed and treated in a tertiary referral center in 1987-2015 were prospectively collected in a registry. All patients underwent resection of their melanoma lesion. Multiple logistic regression analysis was used to examine independent correlations between characteristics. Internal validation of these correlations was performed by the bootstrap method. The median age of the patients was 53 years. Female sex had a slight predominance, whereas the majority were of Southern European origin. Superficial spreading melanoma was associated with younger age (P<0.001), whereas the nodular melanoma histological subtype was associated independently with indoor occupation (P=0.021) and diagnosis in the years 2004-2015 (P=0.002). Melanomas with Breslow thickness above 1.0 mm were associated with skin type III-IV (P=0.021) and diagnosis in the years 1987-2003 (P=0.046). In addition, histological ulceration was associated with older age (P=0.004) and diagnosis in the years 1987-2003 (P<0.001), whereas histological regression was associated independently with older age (P=0.001). This study presented independent associations between epidemiological, histopathological, and treatment characteristics, which might help to better understand melanoma disease and treatment practices in Southern Europe.
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Marami D, Hailu K, Tolera M. Prevalence and associated factors of intestinal parasitic infections among asymptomatic food handlers working at Haramaya University cafeterias, eastern Ethiopia. Ann Occup Environ Med 2018; 30:53. [PMID: 30167309 PMCID: PMC6103851 DOI: 10.1186/s40557-018-0263-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/01/2018] [Indexed: 02/07/2023] Open
Abstract
Background Intestinal parasitic infections are major public health problems worldwide, with high prevalence in low income countries where substandard food hygiene practices are common. Asymptomatic food handlers with poor personal hygiene could be potential sources of parasitic infections. This study was aimed to assess the prevalence of intestinal parasitic infections and associated factors among asymptomatic food handlers working at Haramaya University cafeterias, eastern Ethiopia. Methods A cross-sectional study was conducted among asymptomatic food handlers working at Haramaya University cafeterias from August 2015 to January 2016. Population proportion to size allocation and systematic random sampling techniques were used to identify the study participants. Stool samples were collected and examined simultaneouly using direct and modified formol ether concentration wet smear techniques. Data were entered and analyzed using SPSS version 20.0 software. Logistic regressions were applied to assess association between independent variable and intestinal parasitic infections. Statistical significance was declared at a p-value less than 0.05. Results A total of 417 asymptomatic food handlers were enrolled in this study. Of these, females comprised 79.4%. Large proportion (39.3%) of food handlers were in the age group of 31-40 years. The overall prevalence of intestinal parasitic infections was 25.2% (95% CI: 18.3, 29.6). Entamoeba histolytica/ dispar (46.7%) and A. lumbricoides (14.3%) were the most frequent isolates. Having no formal education [AOR: 2.13, 95% CI: 1.24, 3.67], monthly income of less than 45.7 USD [AOR: 3.86, 95% CI: 1.62, 9.20], lack of hand washing after the use of the toilet with soap [AOR: 2.43, 95% CI: 1.22, 4.86] and untrimmed fingernails [AOR: 3.31, 95% CI: 1.99, 5.49] have significant association with intestinal parasitic infections. Conclusions The high prevalence of intestinal parasitic infections in this study highlights the importance of food handlers as probable sources of parasitic infections. Public health measures and sanitation programs should be strengthened to control the spread of intestinal parasitic infections.
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Affiliation(s)
- Dadi Marami
- 1Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
| | - Konjit Hailu
- 2Higher Health Center, Haramaya University, P.O. Box 138, Dire Dawa, Ethiopia
| | - Moti Tolera
- 3School of Public Health, College of Health and Medical Sciences, Haramaya University, P.O. Box 235, Harar, Ethiopia
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Ferreira T, Santos IDDAO, Oliveira AF, Ferreira LM. Retrospective study of patients with cutaneous melanoma treated at the Federal University of São Paulo. Rev Col Bras Cir 2018; 45:e1715. [PMID: 30088522 DOI: 10.1590/0100-6991e-20181715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/17/2018] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE to evaluate the characteristics of the patients with cutaneous melanoma treated at the São Paulo Hospital - UNIFESP. METHODS we conducted a retrospective study of 184 cases of cutaneous melanoma. We analyzed information on gender, age, tumor characteristics, histological characteristics and staging. RESULTS mean age at diagnosis was 58.7 years, with homogeneous age distribution between genders and predominance in white individuals (70.6%). There was a predominance of trunk involvement in men (36.7%) and lower limbs in women (42%). Sun exposure, with sunburns, was more common among males (31.2%) than among females (23.5%). There was an approximately three-fold increase in lymph node involvement when the mitotic index rose from zero (11.9%) to one or more mitosis per field (36.2%). In addition, the greater the Breslow thickness, the greater the lymph node involvement and poor the outcomes: 10.2% when less than 1mm and 59.2% when greater than 4mm. CONCLUSION the characteristics of patients with cutaneous melanoma treated at Hospital São Paulo are similar to those found in the literature.
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Affiliation(s)
- Tácito Ferreira
- Universidade Federal de São Paulo, Disciplina de Cirurgia Plástica, São Paulo, SP, Brasil
| | | | | | - Lydia Masako Ferreira
- Universidade Federal de São Paulo, Disciplina de Cirurgia Plástica, São Paulo, SP, Brasil
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Brinker TJ, Heckl M, Gatzka M, Heppt MV, Resende Rodrigues H, Schneider S, Sondermann W, de Almeida E Silva C, Kirchberger MC, Klode J, Enk AH, Knispel S, von Kalle C, Stoffels I, Schadendorf D, Nakamura Y, Esser S, Assis A, Bernardes-Souza B. A Skin Cancer Prevention Facial-Aging Mobile App for Secondary Schools in Brazil: Appearance-Focused Interventional Study. JMIR Mhealth Uhealth 2018. [PMID: 29523502 PMCID: PMC5866300 DOI: 10.2196/mhealth.9794] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. Southeast Brazil has especially high incidences of melanoma, and early detection is low. Exposure to ultraviolet (UV) radiation is a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation among adolescents for tanning. A medical student-delivered intervention that takes advantage of the broad availability of mobile phones and adolescents’ interest in their appearance indicated effectiveness in a recent study from Germany. However, the effect in a high-UV index country with a high melanoma prevalence and the capability of medical students to implement such an intervention remain unknown. Objective In this pilot study, our objective was to investigate the preliminary success and implementability of a photoaging intervention to prevent skin cancer in Brazilian adolescents. Methods We implemented a free photoaging mobile phone app (Sunface) in 15 secondary school classes in southeast Brazil. Medical students “mirrored” the pupils’ altered 3-dimensional (3D) selfies reacting to touch on tablets via a projector in front of their whole grade accompanied by a brief discussion of means of UV protection. An anonymous questionnaire capturing sociodemographic data and risk factors for melanoma measured the perceptions of the intervention on 5-point Likert scales among 356 pupils of both sexes (13-19 years old; median age 16 years) in grades 8 to 12 of 2 secondary schools in Brazil. Results We measured more than 90% agreement in both items that measured motivation to reduce UV exposure and only 5.6% disagreement: 322 (90.5%) agreed or strongly agreed that their 3D selfie motivated them to avoid using a tanning bed, and 321 (90.2%) that it motivated them to improve their sun protection; 20 pupils (5.6%) disagreed with both items. The perceived effect on motivation was higher in female pupils in both tanning bed avoidance (n=198, 92.6% agreement in females vs n=123, 87.2% agreement in males) and increased use of sun protection (n=197, 92.1% agreement in females vs n=123, 87.2% agreement in males) and independent of age or skin type. All medical students involved filled in a process evaluation revealing that they all perceived the intervention as effective and unproblematic, and that all pupils tried the app in their presence. Conclusions The photoaging intervention was effective in changing behavioral predictors for UV protection in Brazilian adolescents. The predictors measured indicated an even higher prospective effectiveness in southeast Brazil than in Germany (>90% agreement in Brazil vs >60% agreement in Germany to both items that measured motivation to reduce UV exposure) in accordance with the theory of planned behavior. Medical students are capable of complete implementation. A randomized controlled trial measuring prospective effects in Brazil is planned as a result of this study.
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Affiliation(s)
- Titus Josef Brinker
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.,Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Marlene Heckl
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Martina Gatzka
- Department of Dermatology and Allergic Diseases, Ulm University Hospital, University of Ulm, Ulm, Germany
| | - Markus V Heppt
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | | | - Sven Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Joachim Klode
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexander H Enk
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Sarah Knispel
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christof von Kalle
- Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Germany
| | - Stefan Esser
- Department of Dermatology, Venereology and Allergology, University-Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Aisllan Assis
- School of Medicine, Federal University of Ouro Preto, Ouro Preto, Brazil
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Brinker TJ, Faria BL, Gatzka M, de Faria OM, Heppt MV, Kirchberger MC, Schadendorf D, Nakamura Y, Buslaff F, Lisboa OC, Oliveira ACC, Lino HA, Bernardes-Souza B. A skin cancer prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised controlled trial. BMJ Open 2018; 8:e018299. [PMID: 29511007 PMCID: PMC5855446 DOI: 10.1136/bmjopen-2017-018299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. The Southeast of Brazil has especially high incidences of melanoma, and early detection is low. Exposure to UV radiation represents a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation for adolescents for tanning. A medical student-delivered intervention that harnesses the broad availability of mobile phones as well as adolescents' interest in their appearance may represent a novel method to improve skin cancer prevention. METHODS AND ANALYSIS We developed a free mobile app (Sunface), which will be implemented in at least 30 secondary school classes, each with 21 students (at least 30 classes with 21 students for control) in February 2018 in Southeast Brazil via a novel method called mirroring. In a 45 min classroom seminar, the students' altered three-dimensional selfies on tablets are 'mirrored' via a projector in front of their entire class, showing the effects of unprotected UV exposure on their future faces. External block randomisation via computer is performed on the class level with a 1:1 allocation. Sociodemographic data, as well as skin type, ancestry, UV protection behaviour and its predictors are measured via a paper-pencil questionnaire before as well as at 3 and 6 months postintervention. The primary end point is the group difference in the 30-day prevalence of daily sunscreen use at a 6-month follow-up. Secondary end points include (1) the difference in daily sunscreen use at a 3-month follow-up, (2) if a self-skin examination in accordance with the ABCDE rule was performed within the 6-month follow-up and (3) the number of tanning sessions. ETHICS AND DISSEMINATION Ethical approval was obtained from the ethics committee of the University of Itauna. Results will be disseminated at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03178240; Pre-results.
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Affiliation(s)
- Titus Josef Brinker
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Martina Gatzka
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | | | - Markus V Heppt
- Department of Dermatology and Allergology, University Medical Center Munich, Munich, Germany
| | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venerology and Allergology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Fabian Buslaff
- Department of Dermatology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany
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Reyes E, Uribe C, de Vries E. Population-based incidence and melanoma-specific survival of cutaneous malignant melanoma in a Colombian population 2000-2009. Int J Dermatol 2017; 57:21-27. [PMID: 29231241 DOI: 10.1111/ijd.13839] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/13/2017] [Accepted: 10/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Demographic, clinical, and morphological characteristics of cutaneous melanoma are unknown for the Colombian population. We aim to provide these characteristics as well as population-based incidence and survival data. METHODS All patients with an invasive cutaneous melanoma diagnosed in the period 2000-2009 registered in the population-based cancer registry of the metropolitan area of Bucaramanga were included for analysis (n = 169). Age-standardized incidence rates were calculated and melanoma-specific and overall survival estimated with follow-up until June 9, 2016, using Kaplan-Meier methodology, stratifying for gender, anatomical localization, and type of affiliation to the social security system. RESULTS The age-standardized melanoma incidence rate was 1.7 per 100,000, with lower limbs being the most affected body sites (42.6% of all melanomas). A high proportion of melanomas presented on the plants or palms (16%) and under the nails (7.1%); at least 24.3% of melanomas were ulcerated, and 21.1% had a Breslow thickness more than 2 mm. Melanoma-specific 5-year survival was 79.3%, with worst survival for melanomas localized on the plants (64.6%) and subungual areas (55.6%). Affiliation to the subsidized type of affiliation to the social security system was statistically significantly (P = 0.003) associated with poorer survival (68.8%) compared to the special regimes (95.8%). CONCLUSIONS Melanoma is a relatively rare cancer in Colombia with mainly the acral sites, high proportion of thick and ulcerated melanomas, and relatively poor survival being distinct features, indicating the need for tailor-made primary and secondary prevention strategies. Better training of pathologists in the difficult field of melanoma would improve precision of available data.
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Affiliation(s)
- Evy Reyes
- Grupo de Estudio Genético de Enfermedades Complejas, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
| | - Claudia Uribe
- Grupo de Estudio Genético de Enfermedades Complejas, Facultad de Ciencias de la Salud, Universidad Autónoma de Bucaramanga, Bucaramanga, Santander, Colombia
| | - Esther de Vries
- Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Cundinamarca, Colombia
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Alessi C, Scapulatempo Neto C, Viana CR, Vazquez VDL. PD-1/PD-L1 and VEGF-A/VEGF-C expression in lymph node microenvironment and association with melanoma metastasis and survival. Melanoma Res 2017; 27:565-572. [PMID: 28984690 DOI: 10.1097/cmr.0000000000000396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Regional lymph nodes are affected frequently by melanoma metastasis. Its microenvironment may be associated with tumor progression. We investigated sentinel nodes with and without tumor and negative nodes surrounding positive nodes, looking for patterns related to tumor immune interaction and lymphovascular progression. We quantified programmed cell death protein 1 (PD-1)/programmed cell death-ligand 1, vascular endothelial growth factor (VEGF)-A/VEGF-C expressions in lymph nodes of 103 patients who underwent sentinel lymph node biopsy. Two groups were studied: negative sentinel lymph nodes and positive ones. Negative lymph nodes of sequential lymphadenectomy from positive cases were also studied. Markers were assessed by immunohistochemistry. Results were related to clinical/histological outcomes. VEGF-A/VEGF-C analysis showed higher positivity in metastatic nodes and higher positivity in the surrounding negative nodes from positive cases in comparison with nonmetastatic patients. Programmed cell death-ligand 1, studied only in metastasis, presented high positivity, not associated with prognosis. PD-1 expressions were similar in the groups with a 1% cutoff and higher in the metastasis with a 5% cutoff. Higher VEGF-A expression was related to higher pathological stages. PD-1 expression in the lymph node was associated with higher survival. Other clinical and histopatological variables were not associated with marker expression patterns. VEGF-A and VEGF-C expressions in lymph nodes were associated with the presence of lymph node metastasis. PD-1 expression in the lymph node was related to higher survival rates and this should be explored in the context of adjuvant immunotherapy.
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Affiliation(s)
- Cristina Alessi
- aDepartment of Dermatology in Medical Clinic 'Alessi e Rocha' and Medical Specialists Ambulatories of Barretos bIEP/CEPOM - Research Institute and Molecular Oncology Research Center cDepartment of Surgery - Melanoma and Sarcoma, Barretos Cancer Hospital, Barretos dDepartment of Pathology of Laboratório Bacchi, Botucatu, São Paulo ePathology Service, Américas Centro Oncológico Integrado, Rio de Janeiro, Brazil
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Castaneda CA, Torres-Cabala C, Castillo M, Villegas V, Casavilca S, Cano L, Sanchez J, Dunstan J, Calderon G, De La Cruz M, Cotrina JM, Gomez HL, Galvez R, Abugattas J. Tumor infiltrating lymphocytes in acral lentiginous melanoma: a study of a large cohort of cases from Latin America. Clin Transl Oncol 2017; 19:1478-1488. [PMID: 28577153 DOI: 10.1007/s12094-017-1685-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Acral lentiginous melanoma (ALM) is a poor prognosis subtype and is the most prevalent in non-Caucasian populations. The presence of tumor infiltrating lymphocytes (TILs) has been associated with poor prognosis in melanoma. A large cohort of ALM cases was studied to determine status of TIL and its association with outcome. METHODS All patients with cutaneous melanoma presenting from 2005 to 2012 at Instituto Nacional de Enfermedades Neoplasicas in Peru were retrospectively identified. Clinicopathological information was obtained from the medical charts. A prospective evaluation of TIL was performed. Analysis of association between ALM and clinicopathological features including TIL as well as survival analysis compared the outcome of ALM to whole group and extremity NALM was performed. RESULTS 537 ALM from a total of 824 cutaneous melanoma cases were studied. Older age (p = 0.022), higher Breslow (p = 0.008) and ulceration (p < 0.001) were found to be more frequent in ALM. Acral had worse overall survival (OS) compared with the whole group (p = 0.04). Clinical stage (CS) I-II patients had a median OS of 5.3 (95% CI 4.3-6.2) for ALM and 9.2 (95% CI 5.0-7.0) for extremity NALM (p = 0.016). Grade 0 (absence of TIL), I, II and III were found in 7.5, 34.5, 32.1, and 25.9%, respectively. Lower TIL grade was associated with larger tumor size (p = 0.003), higher Breslow (p = 0.001), higher Clark level (p = 0.007), higher CS (p = 0.002), extremity location (p = 0.048), histological subtype ALM (p = 0.024) and better OS (p = 0.001). CONCLUSIONS ALM is highly prevalent in Peru and carries poor outcome. Lower TIL levels were associated with poor outcome and ALM.
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Affiliation(s)
- C A Castaneda
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru.
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru.
| | - C Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - M Castillo
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - V Villegas
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - S Casavilca
- Pathology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - L Cano
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Sanchez
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Dunstan
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - G Calderon
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - M De La Cruz
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J M Cotrina
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - H L Gomez
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - R Galvez
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Abugattas
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
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Stanienda-Sokół K, Salwowska N, Sławińska M, Wicherska-Pawłowska K, Lorenc A, Wcisło-Dziadecka D, Wydmański J, Majewski W. Primary Locations of Malignant Melanoma Lesions Depending on Patients’ Gender and Age. Asian Pac J Cancer Prev 2017; 18:3081-3086. [PMID: 29172282 PMCID: PMC5773794 DOI: 10.22034/apjcp.2017.18.11.3081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Location of malignant melanoma lesions depends on environmental, genetic, sociological and demographical factors. Available sources do not provide enough information on such dependencies in various populations. There is no data concerning the role of socio-demographic factors for the population of the Central and Eastern Europe. Aim: The aim of this work was to evaluate the anatomical location of the primary malignant melanoma lesion in correlation to patients’ gender and age. Material and methods: A retrospective analysis of medical documentation of 363 patients has been performed. The patients had been diagnosed with malignant melanoma and were undergoing treatment in the years 2010-2014 in two Polish oncologic hospitals. The subject group consisted of 199 (55%) females and 164 (45%) males. The age varied between 19 - 90 years, with the median of 62 years. Results: In women, the melanoma lesions seem to appear more often in their lower extremities, while in case of men such lesions seem to be more often on their torsos. In both cases, the difference was statistically significant (p<0.01 When the specific locations are considered in women the lesions were more often located on their shins (p<0.01), whereas for men the lesions were located on their backs (p<0.01). It has been observed that there is dependency between lesion localization and age of patients. The lesions located on heads and necks were most common in older patients, and the lesions located in lower extremities were most common in younger ones. Conclusion: Differences in location of malignant melanoma lesions may be due to either genetic or environmental reasons. It is often emphasized in literature that correlation between the socio-demographic factors and the process of oncogenesis requires intensive research. In our work, we have tried to fill this gap for the population of Central and Eastern Europe to determine the exact epidemiology of this kind of cancer. This knowledge may be then used for developing cancer prevention methods specific to gender and age.
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Miller KA, In GK, Jiang SY, Ahadiat O, Higgins S, Wysong A, Cockburn MG. Skin Cancer Prevention Among Hispanics: a Review of the Literature. CURRENT DERMATOLOGY REPORTS 2017. [DOI: 10.1007/s13671-017-0191-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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