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Kottner J, Fastner A, Lintzeri DA, Blume-Peytavi U, Griffiths CEM. Skin health of community-living older people: a scoping review. Arch Dermatol Res 2024; 316:319. [PMID: 38822889 PMCID: PMC11144137 DOI: 10.1007/s00403-024-03059-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 06/03/2024]
Abstract
The population of older people is steadily increasing and the majority live at home. Although the home and community are the largest care settings worldwide, most of the evidence on dermatological care relates to secondary and tertiary care. The overall aims were to map the available evidence regarding the epidemiology and burden of the most frequent skin conditions and regarding effects of screening, risk assessment, diagnosis, prevention and treatment of the most frequent skin conditions in older people living in the community. A scoping review was conducted. MEDLINE, Embase and Epistemonikos were systematically searched for clinical practice guidelines, reviews and primary studies, as well as Grey Matters and EASY for grey literature published between January 2010 and March 2023. Records were screened and data of included studies extracted by two reviewers, independently. Results were summarised descriptively. In total, 97 publications were included. The vast majority described prevalence or incidence estimates. Ranges of age groups varied widely and unclear reporting was frequent. Sun-exposure and age-related skin conditions such as actinic keratoses, xerosis cutis, neoplasms and inflammatory diseases were the most frequent dermatoses identified, although melanoma and/or non-melanoma skin cancer were the skin conditions investigated most frequently. Evidence regarding the burden of skin conditions included self-reported skin symptoms and concerns, mortality, burden on the health system, and impact on quality of life. A minority of articles reported effects of screening, risk assessment, diagnosis, prevention and treatment, mainly regarding skin cancer. A high number of skin conditions and diseases affect older people living at home and in the community but evidence about the burden and effective prevention and treatment strategies is weak. Best practices of how to improve dermatological care in older people remain to be determined and there is a particular need for interventional studies to support and to improve skin health at home.
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Affiliation(s)
- Jan Kottner
- Institute of Clinical Nursing Science, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Alexandra Fastner
- Institute of Clinical Nursing Science, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Ulrike Blume-Peytavi
- Department of Dermatology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christopher E M Griffiths
- Department of Dermatology, King's College Hospital, King's College London, London, UK
- Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester, UK
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Giavina-Bianchi M, Vitor WG, Fornasiero de Paiva V, Okita AL, Sousa RM, Machado B. Explainability agreement between dermatologists and five visual explanations techniques in deep neural networks for melanoma AI classification. Front Med (Lausanne) 2023; 10:1241484. [PMID: 37746081 PMCID: PMC10513767 DOI: 10.3389/fmed.2023.1241484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction The use of deep convolutional neural networks for analyzing skin lesion images has shown promising results. The identification of skin cancer by faster and less expensive means can lead to an early diagnosis, saving lives and avoiding treatment costs. However, to implement this technology in a clinical context, it is important for specialists to understand why a certain model makes a prediction; it must be explainable. Explainability techniques can be used to highlight the patterns of interest for a prediction. Methods Our goal was to test five different techniques: Grad-CAM, Grad-CAM++, Score-CAM, Eigen-CAM, and LIME, to analyze the agreement rate between features highlighted by the visual explanation maps to 3 important clinical criteria for melanoma classification: asymmetry, border irregularity, and color heterogeneity (ABC rule) in 100 melanoma images. Two dermatologists scored the visual maps and the clinical images using a semi-quantitative scale, and the results were compared. They also ranked their preferable techniques. Results We found that the techniques had different agreement rates and acceptance. In the overall analysis, Grad-CAM showed the best total+partial agreement rate (93.6%), followed by LIME (89.8%), Grad-CAM++ (88.0%), Eigen-CAM (86.4%), and Score-CAM (84.6%). Dermatologists ranked their favorite options: Grad-CAM and Grad-CAM++, followed by Score-CAM, LIME, and Eigen-CAM. Discussion Saliency maps are one of the few methods that can be used for visual explanations. The evaluation of explainability with humans is ideal to assess the understanding and applicability of these methods. Our results demonstrated that there is a significant agreement between clinical features used by dermatologists to diagnose melanomas and visual explanation techniques, especially Grad-Cam.
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Alves da Costa F, Ramos A, Bernardo C, Cardoso Borges F, Costa Miranda A. Epidemiological and clinical characterization of a population-based cohort of cutaneous malignant melanoma patients in the South Region of Portugal. Sci Rep 2023; 13:5641. [PMID: 37024631 PMCID: PMC10079850 DOI: 10.1038/s41598-023-32434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
An historical population-based cohort study was conducted aiming to estimate the incidence of cutaneous malignant melanoma in the South Region of Portugal between Jan 2016 and June 2017; to clinically characterize the diagnosed individuals; to describe instituted treatment; and to estimate survival outcomes. Data were extracted from a cancer registry (ROR-Sul) covering 4,800,000 inhabitants (46% of the Portuguese population) and included a total of 789 individuals meeting eligibility criteria. The crude incidence rate (18 months) of melanoma was 13.36/100,000 inhabitants and the Age-Standardized Incidence Rate per 100,000 World population was 9.65/100,000 inhabitants. The most common histological subtypes identified were superficial extension, followed by malignant melanoma and nodular melanoma. Most cases were diagnosed in stage I (50.39%), equally distributed by sex and with a median age of 65 years. During the study period, 174 recurrence events were recorded (23.45%) and recurrence-free survival rate was significantly lower in more advanced stages. Patients had a two-fold risk of recurrence/death when in presence of ulcerated tumors [adjusted hazard ratio (adj HR) = 2.28; 95% confidence interval (CI) 1.40-3.70]. Overall survival rate at 3-years was 80.54% (95% CI 77.58-83.15), higher than previous national reports, and considerably higher for individuals diagnosed at earlier stages (p < 0.001). We have also identified differential survival outcomes in stages II-III explained by the uptake of sentinel lymph node biopsy. The epidemiologic and clinical characteristics of malignant melanoma patients studied are consistent with international literature. The incidence and rates observed suggests additional public health campaigns are needed to modify behaviours of the Portuguese population and thus reduce their risk.
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Affiliation(s)
- Filipa Alves da Costa
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal.
- Research Institute for Medicines (iMED), Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal.
| | - Adriana Ramos
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Catarina Bernardo
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Fábio Cardoso Borges
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
| | - Ana Costa Miranda
- National Cancer Registry and Epidemiology Research Unit, Instituto Português de Oncologia de Lisboa Francisco Gentil, EPE, R. Prof. Lima Basto, Lisboa, Portugal
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Torricelli C, Carron J, Carvalho BF, Macedo LT, Rinck-Junior JA, Lima CSP, Lourenço GJ. Influence of IL1B (rs16944) and IL1R2 (rs4141134) polymorphisms on aggressiveness and prognosis of cutaneous melanoma. Melanoma Res 2021; 31:476-481. [PMID: 34284461 DOI: 10.1097/cmr.0000000000000763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous melanoma is the most aggressive skin cancer with high mortality. Proinflammatory cytokines can modulate the proliferation and survival of cutaneous melanoma cells. Higher levels of interleukin-1β (IL1B) were associated with tumor cell proliferation, invasion, and migration, and the IL-1 type II receptor (IL1R2) serves as an endogenous inhibitor of IL1B signaling. Single-nucleotide variations (SNVs) in these genes (IL1B rs16944 and IL1R2 rs4141134) can modulate cytokine production and binding; however, their role in cutaneous melanoma is still unknown. Thus, we investigated the influence of the above SNVs in clinicopathological aspects and cutaneous melanoma patients' survival. In the present study, we analyzed 193 patients with cutaneous melanoma for IL1B c.-598T>C (rs16944) and IL1R2 c.-2009G>A (rs4141134) genotypes with TaqMan assays. Differences between groups were calculated using χ2 or Fisher's exact test and multiple logistic regression. Progression-free survival (PFS) and melanoma-specific survival were calculated by Kaplan-Meier and Cox methods. The prognostic value of IL1R2 was also analyzed by the online consensus survival webserver for skin cutaneous melanoma (OSskcm). We found that IL1R2 rs4141134 GG genotype was more common in patients with nodular subtype (49.1% vs. 29.8%, P = 0.01) and the frequency of IL1R2 rs4141134 GG or GA was higher in patients with Clark levels III-V (87.4% vs. 75.8%, P = 0.04). Patients with IL1R2 rs4141134 GG or GA genotypes presented lower PFS (hazard ratio: 3.12, 95% confidence interval, 1.10-8.79, P = 0.03) when compared with AA genotype, supported by OSskcm results. Thus, our study presented for the first time preliminary evidence that IL1R2 rs4141134 SNV may modulate cutaneous melanoma clinicopathological aspects and survival possible by allowing IL1B signaling.
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Affiliation(s)
- Caroline Torricelli
- Laboratory of Cancer Genetics, School of Medical Sciences, University of Campinas
| | - Juliana Carron
- Laboratory of Cancer Genetics, School of Medical Sciences, University of Campinas
| | | | - Ligia Traldi Macedo
- Laboratory of Cancer Genetics, School of Medical Sciences, University of Campinas
- Clinical Oncology Service, Department of Radiology, School of Medical Sciences, University of Campinas
| | | | - Carmen Silvia Passos Lima
- Laboratory of Cancer Genetics, School of Medical Sciences, University of Campinas
- Clinical Oncology Service, Department of Radiology, School of Medical Sciences, University of Campinas
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Wainstein AJA, Duprat Neto JP, Enokihara MY, Brechtbühl ER, Riccardi F, Landman G, de Melo AC, de Lima Vazquez V, Munhoz RR, Dunshee De Abranches Oliveira Santos Filho I, Bertolli E, Drummond-Lage AP, Costa Soares de Sá B, Botelho L, Higino Steck J, Belfort FA, Maia M, Bakos RM, Gomes EE, Schmerling R, Cavarsan F. Demographic, Clinical, and Pathologic Features of Patients With Cutaneous Melanoma: Final Analysis of the Brazilian Melanoma Group Database. JCO Glob Oncol 2021; 6:575-582. [PMID: 32293941 PMCID: PMC7193775 DOI: 10.1200/jgo.20.00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE National epidemiologic data on melanoma are scarce in Brazil. The current work presents final demographic, clinical, and pathologic results from the Brazilian Melanoma Group database to detail how patients with melanoma present at diagnosis. METHODS The online database includes patients diagnosed between 1982 and 2015 and evaluated at their centers of origin between 2001 and 2016. The primary objective was to describe the demographic, clinical, and pathologic characteristics of the patients, and secondary objectives were to investigate the association between clinical and pathologic variables of interest. RESULTS A total of 1,596 patients were included. Median age was 52 years, 57% were women, and the majority were identified as white. Invasive melanoma was diagnosed in 1,297 patients, mostly localized, whereas 299 (19%) had in situ disease (TisN0M0). Only 165 patients had initial lymph node involvement. Fitzpatrick skin types I or II were slightly more frequent with in situ melanoma (73%) than with invasive disease (67%; P = .054). The median Breslow thickness was 0.95 mm, Clark levels 2 and 3 comprised nearly 70% of cases, and ulceration was present in 18% of patients. The mitotic rate was significantly associated with the presence of ulceration and both vascular and perineural invasion but not with margin positivity, whereas histologic regression was associated with both intratumoral and peritumoral inflammatory infiltrates. CONCLUSION Despite the limitations of an observational, registry-based study, the current results provide a general profile of patients with cutaneous melanoma in Brazil at the time of diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcus Maia
- Brazilian Melanoma Group, São Paulo, São Paulo, Brazil
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Giavina-Bianchi MH, Festa-Neto C, Sanches JA, Teixeira MLP, Waldvogel BC. Worse survival of invasive melanoma patients in men and "de novo" lesions. An Bras Dermatol 2020; 95:158-164. [PMID: 32057507 PMCID: PMC7175044 DOI: 10.1016/j.abd.2019.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/19/2019] [Indexed: 11/05/2022] Open
Abstract
Background The incidence and mortality of melanoma is increasing in many countries, including Brazil. Survival studies are still scarce in our country, but much needed to know and address this problem better. Objective To analyze the disease-specific survival of patients with invasive melanoma and to correlate it with clinical and histopathological variables. Methods Retrospective cohort analysis of 565 cases of invasive melanoma in a tertiary hospital with the objective of testing variables that could be associated with a worse prognosis, such as gender, phototype, thickness, histological type and presence of pre-existing clinical lesion at the site of the tumor. Results The worst survival rates were significantly associated with thicker tumors (p < 0.001), male sex (p = 0.014), high phototype (p = 0.047), nodular melanoma (p = 0.024) and “de novo” lesions (p = 0.005). When all variables were adjusted for melanoma thickness, male patients (p = 0.011) and “de novo” melanomas (p = 0.025) remained associated with worse survival. Study limitations Retrospective study of a single tertiary hospital. Conclusions Although the causes are still unknown, melanoma-specific survival was statistically worse for males and for “de novo” melanomas even after adjustment of tumor thickness.
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Affiliation(s)
| | - Cyro Festa-Neto
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jose Antonio Sanches
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Monica La Porte Teixeira
- Department of Data Information Analysis and Dissemination, Fundação Sistema Estadual de Análise de Dados, São Paulo, SP, Brazil
| | - Bernadette Cunha Waldvogel
- Department of Data Information Analysis and Dissemination, Fundação Sistema Estadual de Análise de Dados, São Paulo, SP, Brazil
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Steglich RB, Cardoso S, Gaertner MHDCN, Coelho KMDPA, Cestari TF, Franco SC. Differences in the diagnosis of primary cutaneous melanoma in the public and private healthcare systems in Joinville, Santa Catarina State, Brazil. An Bras Dermatol 2018; 93:507-512. [PMID: 30066755 PMCID: PMC6063115 DOI: 10.1590/abd1806-4841.20185767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 05/24/2017] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Cutaneous melanoma accounts for up to 80% of deaths caused by skin cancer. Diagnostic suspicion and access to medical care and early intervention in suspected cases is vital to the patient's prognosis. OBJECTIVES To compare demographic and histopathological characteristics of primary cutaneous melanoma diagnosed in the public healthcare system (Sistema Único de Saúde SUS) and the private system in Joinville, Santa Catarina State, Brazil. METHODS This cross-sectional retrospective study analyzed primary cutaneous melanoma cases recorded from 2003 to 2014 in the resident population of Joinville. Ethical approval was obtained from the local Research Ethics Committee. RESULTS 893 cases of primary cutaneous melanoma were identified. Patients in the private system were mostly younger, while there were more elderly patients in the public healthcare system (p <0.001). There was no statistically significant association between type of care (public/private) and gender or presence of multiple primary cutaneous melanomas. Histological diagnosis of superficial spreading melanoma was more common in patients treated in private healthcare, while nodular melanoma was more frequent in patients in the public healthcare system (p <0.001). Mean Breslow depth in patients treated in private healthcare was 1.35mm, compared to 2.72mm in the public system (p <0.001). STUDY LIMITATIONS This was a retrospective study using secondary databases. CONCLUSIONS thin cutaneous melanoma (in situ cutaneous melanoma and Breslow T1) showed the strongest association with the private healthcare system, while thick cutaneous melanoma was more frequent in the public system (Breslow category T3 and T4) (p <0.001).
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Affiliation(s)
| | - Silvana Cardoso
- Medical student, Universidade da Região de Joinville,
Joinville (SC), Brazil
| | | | | | - Tania Ferreira Cestari
- Dermatology Service, Universidade Federal do Rio Grande do Sul,
Porto Alegre (RS), Brazil
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