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Mejía Posada MI, Gutiérrez Gómez M, María Vásquez-Trespalacios E, Garces Abad MA, Londoño García AM, González Álvarez T. Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:130-136. [PMID: 37689350 DOI: 10.1016/j.ad.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. MATERIAL AND METHODS We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. RESULTS A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P <.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). CONCLUSIONS The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network.
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Affiliation(s)
- M I Mejía Posada
- Servicio de Dermatología, Universidad CES, Medellín, Colombia; Facultad de Medicina, Universidad CES, Medellín, Colombia.
| | | | | | - M A Garces Abad
- Servicio de Dermatología, Universidad CES, Medellín, Colombia
| | - A M Londoño García
- Servicio de Dermatología, Universidad CES, Medellín, Colombia; Facultad de Medicina, Universidad CES, Medellín, Colombia
| | - T González Álvarez
- Servicio de Dermatología, Universidad CES, Medellín, Colombia; Facultad de Medicina, Universidad CES, Medellín, Colombia
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Mejía Posada MI, Gutiérrez Gómez M, Vásquez-Trespalacios EM, Garces Abad MA, Londoño García AM, González Álvarez T. [Translated article] Dermoscopic Changes in Melanocytic Lesions in 368 Patients With Atypical Nevus Syndrome and Their Association With Melanoma Incidence: A Cohort Study. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T130-T136. [PMID: 38048957 DOI: 10.1016/j.ad.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/08/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Atypical nevus syndrome has been described as one of the main risk factors for melanoma. The aim of this study was to analyze dermoscopic changes observed in melanocytic lesions over a follow-up period of 5 years in patients with atypical nevus syndrome. MATERIAL AND METHODS We conducted a retrospective follow-up study of a cohort of patients seen at a specialized skin cancer and digital body mapping clinic in Medellin, Colombia, between January 2017 and December 2022. We analyzed the dermoscopic changes observed during this period and explored their association with newly diagnosed melanoma. RESULTS A total of 368 patients (187 women) with a median (interquartile range) age of 43 (37-51) years were included. The dermoscopic features observed at 5 years were an atypical network (222 patients, 60.3%), asymmetric globules (163, 44.2%), white-gray regression areas (105, 28.5%), lesion regression (72, 19.5%), a negative pigment network (59, 16%), asymmetric eccentric pigmentation (28, 7.6%), asymmetric projections (21, 5.7%), and asymmetric vascular patterns (8, 2.1%). Melanoma was diagnosed in 12.2% of patients during follow-up. Features significantly associated with a shorter time to melanoma onset were grayish-white areas (P<.001), asymmetric globules (P=.011), asymmetric eccentric pigmentation (P=.047), and a negative pigment network (P=.001). CONCLUSIONS The main dermoscopic features of melanocytic lesions in patients with atypical nevus syndrome associated with progression to melanoma were grayish-white areas, asymmetric globules, asymmetric spots, and a negative pigment network.
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Affiliation(s)
- M I Mejía Posada
- Servicio de Dermatología, Universidad CES, Medellín, Colombia; Facultad de Medicina, Universidad CES, Medellín, Colombia.
| | | | | | - M A Garces Abad
- Servicio de Dermatología, Universidad CES, Medellín, Colombia
| | - A M Londoño García
- Servicio de Dermatología, Universidad CES, Medellín, Colombia; Facultad de Medicina, Universidad CES, Medellín, Colombia
| | - T González Álvarez
- Servicio de Dermatología, Universidad CES, Medellín, Colombia; Facultad de Medicina, Universidad CES, Medellín, Colombia
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3
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Al-Adwan S, Alqaisi KM, Al Katheri G. Nevus Variations in the Jordanian Population: Effects of Age, Medical Conditions, Environment, Congenital, Inherited, and Genetic Factors. Clin Cosmet Investig Dermatol 2024; 17:17-29. [PMID: 38193026 PMCID: PMC10773247 DOI: 10.2147/ccid.s433447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/07/2023] [Indexed: 01/10/2024]
Abstract
Background Nevi is a common benign proliferation of melanin-producing cells. Many triggers can influence their transformation into either benign or malignant, thus it is important to understand these triggers and their incidence across different populations to take adequate prevention. Here, we aim to examine the different etiologies of nevi changes across the Jordanian population. Methods We carried out a cross-sectional observational study focusing on patients seeking dermatological consultation for normal nevi or nevi with minimal changes. Demographic and clinical variables were collected from the patient's case history. Nevi's characteristics were also recorded. A skilled dermatologist assessed nevi morphology and changes using the ABCDE criteria for potential signs of melanoma. Nevi biopsy samples were fixed in formalin and sent for histopathological analysis and were stained with hematoxylin and eosin (H&E). Results A total of 231 patients were enrolled, with a majority of females (85%) and a median age of 37. Past medical history was positive in 17% of the samples, with hypertension, endocrine diseases, and diabetes mellitus being the most common. The majority of patients (61%) had fewer than three nevi. Changes in nevus size, configuration, and color were reported in 10% of patients, with multiple changes observed in 36% of patients. Microscopic analysis revealed polypoidal intradermal melanocytic blue nevi as the most common histopathological finding (84%). Positive medical history and the number of nevi were significantly associated with nevi changes. Conclusion Our results report that the number of nevi, as well as medical history, is linked to changes in their appearance. Additionally, we provide a detailed account of the various types of observed changes and their occurrence rates.
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Affiliation(s)
- Safwan Al-Adwan
- Department of Cosmetic Science, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, 19328, Jordan
| | - Khalid M Alqaisi
- Department of Cosmetic Science, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, 19328, Jordan
- Department of Medical Laboratory Sciences, Faculty of Allied Medical Sciences, Al-Ahliyya Amman University, Amman, 19328, Jordan
| | - Ghassan Al Katheri
- Department of Pathology, Humboldt General Hospital, Winnemucca, Nevada, 89446, USA
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Modern Concepts in Melanocytic Tumors. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:402-412. [PMID: 36649787 DOI: 10.1016/j.ad.2023.01.001] [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: 11/03/2022] [Revised: 11/29/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
The advent of molecular pathology has fueled unprecedented advances in the diagnosis and understanding of melanocytic tumors. These advances, however, have also generated concepts that may be difficult to grasp for clinical practitioners, who are not always conversant with the array of genetic techniques employed in the laboratory. These same practitioners, however, are being increasingly called on to provide treatments that are often based on the latest molecular findings for melanocytic tumors. We review the most recent concepts in the pathway classification of melanocytic tumors, including intermediate lesions known as melanocytomas. We examine the genetic and molecular techniques used to study these tumors, look at where they overlap, and discuss their limitations and some of the most difficult-to-interpret results.
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5
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Overview of familial syndromes with increased skin malignancies. Arch Dermatol Res 2022; 315:707-727. [PMID: 36342513 DOI: 10.1007/s00403-022-02447-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
The vast majority of skin cancers can be classified into two main types: melanoma and keratinocyte carcinomas. The most common keratinocyte carcinomas include basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Multiple familial syndromes have been identified that can increase the risk of developing SCC, BCC, and/or melanoma. The major syndromes include oculocutaneous albinism for SCC, basal cell nevus syndrome for BCC, familial atypical multiple mole-melanoma syndrome, and hereditary breast and ovarian cancer syndrome for melanoma. In addition, familial syndromes that can predispose individuals to all three major skin cancers include xeroderma pigmentosum and Li-Fraumeni syndrome. This review highlights the epidemiology, risk factors, pathogenesis, and etiology of the major and minor syndromes to better identify and manage these conditions. Current investigational trials in genomic medicine are making their way in revolutionizing the clinical diagnosis of these familial syndromes for earlier preventative measures and improvement of long-term prognosis in these patients.
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Waqar S, George S, Jean-Baptiste W, Yusuf Ali A, Inyang B, Koshy FS, George K, Poudel P, Chalasani R, Goonathilake MR, Mohammed L. Recognizing Histopathological Simulators of Melanoma to Avoid Misdiagnosis. Cureus 2022; 14:e26127. [PMID: 35875272 PMCID: PMC9299949 DOI: 10.7759/cureus.26127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
Melanocytic lesions have a wide morphological spectrum, ranging from benign nevi to malignant melanoma. In contrast to a diagnosis of a benign nevus, a diagnosis of melanoma could mean intensive treatment, lifetime monitoring, and a worse prognosis. Therefore, melanocytic tumors are notoriously challenging and associated with a high risk of litigation in surgical pathology. After describing the basic features of nevi and melanoma, this article describes the detailed clinical and histological features of those lesions that share many similar features with melanoma. The entities included are Spitz nevi and atypical Spitz tumors (AST), Reed nevus, dysplastic nevus, cellular blue nevus (CBN), deep penetrating nevus, combined nevus, recurrent nevus, irritated nevus, congenital pattern nevus, acral nevus, and nevi of special sites. Knowledge of these imitators can help pathologists distinguish between benign and malignant cases and avoid misdiagnosis.
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Mahjoub H, Loya A, Ayaz T, Weng CY. Second Primary Malignancies following a Diagnosis of Conjunctival Melanoma. Curr Eye Res 2022; 47:634-641. [PMID: 34898336 DOI: 10.1080/02713683.2021.2018465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 10/20/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Although incidence of second primary malignancies (SPMs) has been investigated in patients with cutaneous melanoma and uveal melanoma, limited studies have investigated their occurrence subsequent to conjunctival melanoma (CM). We conducted a retrospective observational study to assess incidence of SPMs in patients with primary CM and to identify associated risk factors. METHODS Cases of first primary CM diagnosed from 2000 to 2018 were extracted from the national cancer database Surveillance, Epidemiology, and End Results Program. Standardized incidence ratios (SIR) and excess absolute risk (EAR) of SPMs were calculated compared to a matched cohort from the general population with similar sex, race, age group, and calendar year. EAR was per 10,000 individuals, and a P-value of <0.05 was considered significant. RESULTS A total of 471 patients met inclusion criteria, 57 (12.1%) of whom developed second primary malignancies (excluding eye and orbit melanomas) over an average (±SD) follow-up period of 6.8 (±5.0) years. Average age at diagnosis for the overall cohort was 60.2 (±18.6) years. Patients with CM demonstrated a significantly increased risk for overall SPMs relative to the general population, even after excluding eye and orbit melanomas (SIR 1.52; 95% confidence interval [CI], 1.15-1.97; EAR 67.58). Specific sites and malignancy types with increased risk were cutaneous melanoma (SIR 7.95; 95% CI, 4.45-13.12; EAR 45.34), ophthalmic non-melanoma malignancies (SIR 80.92; 95% CI, 2.05-450.84; EAR 3.41), and non-intrahepatic biliary malignancies (SIR 11.72; 95% CI, 1.42-42.32; EAR 6.32). Risk of overall SPMs (excluding eye and orbit melanomas) was significantly increased 5-10 years from diagnosis date. CONCLUSIONS Patients with CM had an increased incidence of SPMs compared to the general population. Specifically, these patients developed more cutaneous, ophthalmic non-melanoma, and non-intrahepatic biliary malignancies. These second neoplasms could be due to shared pathophysiology or mutual risk factors. Patients with CM may benefit from surveillance for SPMs, such as annual age-appropriate screenings in the first 10 years after diagnosis.
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Affiliation(s)
- Heba Mahjoub
- School of Medicine Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Asad Loya
- School of Medicine Baylor College of Medicine, Houston, Texas, USA
| | - Talha Ayaz
- School of Medicine University of Texas Medical Branch at Galveston, Texas, USA
| | - Christina Y Weng
- School of Medicine Baylor College of Medicine, Houston, Texas, USA
- Department of Ophthalmology Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA
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8
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Saginala K, Barsouk A, Aluru JS, Rawla P, Barsouk A. Epidemiology of Melanoma. Med Sci (Basel) 2021; 9:63. [PMID: 34698235 PMCID: PMC8544364 DOI: 10.3390/medsci9040063] [Citation(s) in RCA: 157] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/26/2021] [Accepted: 10/18/2021] [Indexed: 12/19/2022] Open
Abstract
Melanoma accounts for 1.7% of global cancer diagnoses and is the fifth most common cancer in the US. Melanoma incidence is rising in developed, predominantly fair-skinned countries, growing over 320% in the US since 1975. However, US mortality has fallen almost 30% over the past decade with the approval of 10 new targeted or immunotherapy agents since 2011. Mutations in the signaling-protein BRAF, present in half of cases, are targeted with oral BRAF/MEK inhibitor combinations, while checkpoint inhibitors are used to restore immunosurveillance likely inactivated by UV radiation. Although the overall 5-year survival has risen to 93.3% in the US, survival for stage IV disease remains only 29.8%. Melanoma is most common in white, older men, with an average age of diagnosis of 65. Outdoor UV exposure without protection is the main risk factor, although indoor tanning beds, immunosuppression, family history and rare congenital diseases, moles, and obesity contribute to the disease. Primary prevention initiatives in Australia implemented since 1988, such as education on sun-protection, have increased sun-screen usage and curbed melanoma incidence, which peaked in Australia in 2005. In the US, melanoma incidence is not projected to peak until 2022-2026. Fewer than 40% of Americans report practicing adequate protection (sun avoidance from 10 a.m.-4 p.m. and regular application of broad-spectrum sunscreen with an SPF > 30). A 2-4-fold return on investment is predicted for a US sun-protection education initiative. Lesion-directed skin screening programs, especially for those at risk, have also cost-efficiently reduced melanoma mortality.
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Affiliation(s)
- Kalyan Saginala
- Plains Regional Medical Group Internal Medicine, Clovis, NM 88101, USA;
| | - Adam Barsouk
- Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA;
| | - John Sukumar Aluru
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02212, USA;
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Bujoreanu FC, Bezman L, Radaschin DS, Niculet E, Bobeica C, Craescu M, Nadasdy T, Jicman DS, Ardeleanu V, Nwabudike LC, Marinescu SA, Tatu AL. Nevi, biologics for psoriasis and the risk for skin cancer: A real concern? (Case presentation and short review). Exp Ther Med 2021; 22:1354. [PMID: 34659500 PMCID: PMC8515562 DOI: 10.3892/etm.2021.10789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022] Open
Abstract
Psoriasis is a systemic inflammatory cutaneous disease that affects approximately 2% of the world's population. Systemic treatments and biologic treatment therapies are a powerful option for patients with moderate to severe psoriasis. Some studies from the literature indicate an overall small, but increased, risk of neoplasia in patients with psoriasis treated with phototherapy or systemic medication. The relationship between psoriasis and malignancy is not very well established; there are few studies with conflicting results. We present the case of a 31-year-old male patient, diagnosed with psoriasis, who was deemed eligible for systemic therapy. Treatment with methotrexate was initiated, but without a satisfactory outcome. Given the patient's resistant disease involving 15% of his body surface, his desire to have a clear skin, besides his being naïve to biologic therapy, he was proposed to start treatment with secukinumab 300 mg monthly. The patient experienced complete clearance of lesions and was followed-up on the basis of clinical and biological parameters. There are limited data concerning the relationship between melanocytic lesions, psoriasis and melanoma. Immunologic pathways implicated in psoriasis induce a reduction in the number of melanocytic nevi. Nevertheless, little is known concerning the association of melanocytic nevi with psoriasis. Thorough skin examination, meaning clinical and dermoscopic evaluation of melanocytic lesions, must be encouraged in patients treated with systemic therapies such as biologic agents.
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Affiliation(s)
- Florin Ciprian Bujoreanu
- Department of Dermatology, 'Sf. Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Clinical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania.,Department of Dermatology, Doctoral School of Biological and Medical Sciences, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania
| | - Laura Bezman
- Ophthalmology Department, 'Sf. Apostol Andrei' Clinical Emergency Hospital, 800578 Galați, Romania.,Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania
| | - Diana Sabina Radaschin
- Department of Dermatology, 'Sf. Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Clinical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania
| | - Carmen Bobeica
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania
| | - Mihaela Craescu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania
| | - Thomas Nadasdy
- Department of Dermatology, 'Sf. Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania
| | - Daniela Stan Jicman
- ENT Department, 'Sf. Apostol Andrei' Clinical Emergency Hospital, 800578 Galați, Romania
| | - Valeriu Ardeleanu
- Surgery Department, Arestetic Plastic Surgery Clinic, 800098 Galați, Romania.,Faculty of Medicine, Doctoral School, 'Ovidius' University, 900533 Constanța, Romania.,Surgery Department, CFR General Hospital, 800223 Galați, Romania
| | - Lawrence Chukwudi Nwabudike
- Outpatient Dermatology Department, 'Prof. N. Paulescu' National Institute of Diabetes, 011233 Bucharest, Romania
| | - Silviu Adrian Marinescu
- Department of Plastic and Reconstructive Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alin Laurentiu Tatu
- Department of Dermatology, 'Sf. Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galați, Romania.,Clinical Department, Faculty of Medicine and Pharmacy, 'Dunărea de Jos' University of Galați, 800010 Galați, Romania.,Research Center of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 800010 Galați, Romania
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Abstract
Although spongiotic (eczematous), psoriatic and cutaneous skin infections are among the most common in dermatology consultations, melanocytic lesions - including the different types of nevi and melanomas - are among those that cause a great deal of concern and stress to patients and their clinicians. A diagnosis of benign melanocytic nevus carries a very good prognosis. However, a diagnosis of melanoma might indicate more aggressive treatment, lifelong surveillance and a worse prognosis. Differentiating between these conditions is not always a straightforward process for clinicians and pathologists. Therefore, knowledge of melanoma mimickers is very important for clinicians in general, and dermatologists and pathologists in particular. In this review, we called attention to some of the more frequent benign but unusual melanocytic lesions that are of diagnostic concern for clinicians evaluating these cutaneous proliferations.
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Affiliation(s)
- Caroline Bsirini
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Bruce R Smoller
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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de Sá BCS, Moredo LF, Gomes EE, de Araújo ESS, Duprat JP. Hereditary melanoma: a five-year study of Brazilian patients in a cancer referral center - phenotypic characteristics of probands and pathological features of primary tumors. An Bras Dermatol 2018; 93:337-340. [PMID: 29924249 PMCID: PMC6001076 DOI: 10.1590/abd1806-4841.20186201] [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: 07/27/2016] [Accepted: 03/16/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Approximately five to 10% of all melanomas occur in families with hereditary predisposition and the main high-risk melanoma susceptibility gene is the CDKN2A. OBJECTIVES To describe, after a five-years study, the clinical data of patients (probands) from familial melanoma kindreds, and the pathological characteristics of their melanoma. METHODS The inclusion criteria were melanoma patients with a family history of melanoma or pancreatic cancer (first- or second-degree relatives) or patients with multiple primary melanomas (MPM). RESULTS A total of 124 probands were studied, where 64 were considered familial cases and 60 MPM. Mean age at diagnosis was 50 years. Our results show that the following characteristics were prevalent: skin phototype I/II (89.5%), sunburn during childhood (85.5%), total number of nevi ≥50 (56.5%), Breslow thickness ≤1.0mm (70.2%), tumors located on the trunk (53.2%) and superficial spreading melanomas (70.2%). STUDY LIMITATIONS Analyses of probands' relatives will be demonstrated in future publication. CONCLUSIONS Our findings are in agreement with previous familial melanomas reports. Fifteen new melanomas in 11 patients were diagnosed during follow up, all of which were ≤1.0 mm. This is the largest dataset of Brazilian melanoma prone kindreds to date, thus providing a complete database for future genetic studies.
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Affiliation(s)
| | | | - Elimar Elias Gomes
- Skin Cancer Department, AC Camargo Cancer Center, São
Paulo (SP), Brazil
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12
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Tchernev G. One Step Melanoma Surgery for Patient with Thick Primary Melanomas: "To Break the Rules, You Must First Master Them!". Open Access Maced J Med Sci 2018. [PMID: 29531606 PMCID: PMC5839450 DOI: 10.3889/oamjms.2018.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: We present to the attention of the medical, dermatological and oncosurgical community data that serves to indicate the indispensability of optimisation of the algorithm and recommendations for diagnosis and surgical treatment of cutaneous melanoma. These recommendations could be referred to different subgroups of patients in different clinical stages as well as to patients with different initial characterisation (histological morphology) of the primary tumours. One step surgery is not a myth, even more, it could prove to be one of the best solutions for some patient collectives with advanced stages of melanoma. CASE REPORT: We present a case of a 74 - year old patient with a congenital medium sized melanocytic nevus, located directly above the lateral part of the elbow joint. In one month and a half, an achromatic nodular formation evolves with a diameter of 2.7 x 2.3 cm, prominent over the skin level, painful by palpation and spontaneously bleeding. By the anamnestic, clinical and dermoscopic findings the patient was diagnosed with nodular melanoma associated with a congenital medium sized melanocytic nevus. A primary excision with a field of safety 0.5 cm in all directions was performed. After confirmation of the primary diagnosis (tumour thickness 8 mm with no ultrasonographic detection of enlarged lymph nodes), seven days later are - excision was performed with an additional field of surgical safety of 1.5 cm in all directions. CONCLUSIONS: In this case remains unclear the following question: For what reason a preoperative high - frequent ultrasonography (HFUS) is not recommended to be used as it will allow only one surgical excision with the elimination of a tumour with a safety field of 2cm in all directions? The enigma about the obstacles preventing such a rational optimisation of the current diagnostic and therapeutic algorithm in patients with melanomas remains unresolved. One step surgery for cutaneous melanoma is widely used in many countries although it continues to be considered as a matter of dispute for some experts. Once again, by a clinical case and the following analysis, we would like to focus the attention of the dermatosurgical community on this crucial and highly significant problem. Innovations are very often resulting from the simplicity of logic, which unfortunately is not always accepted appropriately.
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Affiliation(s)
- Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR-Sofia), Department of Dermatology, Venereology and Dermatologic Surgery, General Skobelev 79, 1606, Sofia, Bulgaria.,Onkoderma-Policlinic for Dermatology, Venereology and Dermatologic Surgery, General Skobelev 26, 1606 Sofia, Bulgaria
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13
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Cells to Surgery Quiz: June 2017. J Invest Dermatol 2017; 137:e141. [PMID: 30477639 DOI: 10.1016/j.jid.2017.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Number and size of acquired melanocytic nevi and affecting risk factors in cases admitted to the dermatology clinic. Postepy Dermatol Alergol 2016; 33:375-380. [PMID: 27881943 PMCID: PMC5110627 DOI: 10.5114/ada.2016.62845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 10/02/2015] [Indexed: 01/23/2023] Open
Abstract
Introduction The size and number of acquired melanocytic nevi (AMN) and presence of dysplastic nevi are the leading risk factors that should be recognized in the development of malignant melanoma. Aim To evaluate AMN and risk factors in the development of AMN in all age groups admitted to a dermatology outpatient clinic. Material and methods Four hundred and twelve patients who were admitted to the dermatology outpatient clinic for any dermatological symptom and who accepted to participate in the study were randomly included in the study. For each case, background-family history and dermatological findings were recorded. All AMN observed in the patients were dermatoscopically examined. Results The presence of more than 50 nevi was significantly higher in males, in individuals who had a history of sunburn and smokers. The number of nevi that were 5 mm and below was found to be higher in individuals who regularly sunbathed their face/body, in individuals using sunscreen, in individuals who had a history of sunburn, smokers and alcohol users. The number of nevi that were above 5 mm was higher in smokers. The total dermatoscopy score between 4.75 and 5.45 was found to be higher in individuals who had more than 50 nevi, in individuals exposed to more than one chemical substance and in alcohol users. Conclusions When determining the patient’s risk factors, factors such as the patient’s sunbathing habits and chemical substance exposure features should be taken into consideration besides the number and size of nevi.
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Tchernev G, Chokoeva AA, Lotti T, Philipov S. Melanoma in situ (MIS) in a patient with atypical mole syndrome (AMS): with aggressiveness to success? Wien Med Wochenschr 2016; 167:114-116. [PMID: 27600562 DOI: 10.1007/s10354-016-0503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Affiliation(s)
- G Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior (MVR-Sofia), General Skobelev Nr 79, 1606, Sofia, Bulgaria. .,"Onkoderma" - Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd., Sofia, Bulgaria.
| | - A A Chokoeva
- "Onkoderma" - Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 blvd., Sofia, Bulgaria.,Department of Dermatology and Venereology, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria
| | - T Lotti
- Department of Dermatology, University of Rome "G. Marconi", Rome, Italy.,Department of Biotechnology, Delft University of Technology, 2628 BC, Delft, Netherlands
| | - S Philipov
- Lozenetz University Hospital - Laboratory of Pathomorphology, Sofia University St. Kliment Ohridski - Faculty of medicine - Chair "Anatomy, Histology, Pathology and Forensic Medicine", Sofia, Bulgaria
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Rabaça AN, Arruda DC, Figueiredo CR, Massaoka MH, Farias CF, Tada DB, Maia VC, Silva Junior PI, Girola N, Real F, Mortara RA, Polonelli L, Travassos LR. AC-1001 H3 CDR peptide induces apoptosis and signs of autophagy in vitro and exhibits antimetastatic activity in a syngeneic melanoma model. FEBS Open Bio 2016; 6:885-901. [PMID: 27642552 PMCID: PMC5011487 DOI: 10.1002/2211-5463.12080] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 12/19/2022] Open
Abstract
Antibody‐derived peptides modulate functions of the immune system and are a source of anti‐infective and antitumor substances. Recent studies have shown that they comprise amino acid sequences of immunoglobulin complementarity‐determining regions, but also fragments of constant regions. VH CDR3 of murine mAb AC‐1001 displays antimetastatic activities using B16F10‐Nex2 murine melanoma cells in a syngeneic model. The peptide was cytotoxic in vitro in murine and human melanoma cells inducing reactive oxygen species (ROS) and apoptosis by the intrinsic pathway. Signs of autophagy were also suggested by the increased expression of LC3/LC3II and Beclin 1 and by ultrastructural evidence. AC‐1001 H3 bound to both G‐ and F‐actin and inhibited tumor cell migration. These results are important evidence of the antitumor activity of Ig CDR‐derived peptides.
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Affiliation(s)
- Aline N Rabaça
- Unidade de Oncologia Experimental (UNONEX) Universidade Federal de São Paulo (UNIFESP) Brazil
| | - Denise C Arruda
- Unidade de Oncologia Experimental (UNONEX) Universidade Federal de São Paulo (UNIFESP) Brazil; Núcleo Integrado de Biotecnologia Universidade de Mogi das Cruzes Brazil
| | - Carlos R Figueiredo
- Unidade de Oncologia Experimental (UNONEX) Universidade Federal de São Paulo (UNIFESP) Brazil
| | - Mariana H Massaoka
- Unidade de Oncologia Experimental (UNONEX) Universidade Federal de São Paulo (UNIFESP) Brazil
| | - Camyla F Farias
- Unidade de Oncologia Experimental (UNONEX) Universidade Federal de São Paulo (UNIFESP) Brazil
| | - Dayane B Tada
- Departamento de Ciência e Tecnologia Universidade Federal de São Paulo (UNIFESP) São José dos Campos Brazil
| | | | - Pedro I Silva Junior
- Laboratório Especial de Toxinologia Aplicada Instituto Butantan São Paulo Brazil
| | - Natalia Girola
- Unidade de Oncologia Experimental (UNONEX) Universidade Federal de São Paulo (UNIFESP) Brazil
| | - Fernando Real
- Departamento de Parasitologia Universidade Federal de São Paulo (UNIFESP) Brazil
| | - Renato A Mortara
- Departamento de Parasitologia Universidade Federal de São Paulo (UNIFESP) Brazil
| | - Luciano Polonelli
- Microbiology and Virology Unit Department of Biomedical Biotechnological and Translational Sciences Universitá degli Studi di Parma Italy
| | - Luiz R Travassos
- Unidade de Oncologia Experimental (UNONEX) Universidade Federal de São Paulo (UNIFESP) Brazil
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Patrascu OM, Costache M, Dumitru AV, Mehotin CN, Sajin M, Lazaroiu AM. Expression of Bcl-2, Melan A and HMB-45 in Dysplastic Nevi. MAEDICA 2016; 11:38-43. [PMID: 28465749 PMCID: PMC5394496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND From the first recognition of dysplastic nevi as a pathology per se, many debates have been raised and many histological and immunohistological studies have been conducted in order to establish the true significance of these lesions. Therefore, the aim of this study was to establish if there is a correlation between HMB-45, Melan A and Bcl-2 expression and the grade of dysplasia, as well as between the marker's staining patterns. MATERIAL AND METHODS Ten dysplastic nevi from six female patients were selected and their histological features (size, dysplasia), as well as the immunohistological staining patterns, were studied (HMB-45, Melan A, Bcl-2). The Pearson correlation coefficient and regression was calculated with Windows Excel Data Analysis. RESULTS We demonstrated that there was a notable correlation between the dysplasia and the size of the lesions (r(8)= 0.62 with p-value= 0.052), and also between Melan A and Bcl-2 (a r(6)= 0.73, p<0.05), but we did not obtain a statistically significant correlation between other features (p>0.05). CONCLUSIONS We can affirm, at least in our cases, there is a correlation between the grade of dysplasia and the size of the lesion, and also, that there is a correlation between Melan A and Bcl-2 staining, explained by MITF gene. These results were only partial concordant with those in other studies, therefore a larger number of cases is recommended to be further analyzed in order to clearly draw a conclusion.
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Affiliation(s)
| | - Mariana Costache
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | | | | | - Maria Sajin
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
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Rastgoo M, Garcia R, Morel O, Marzani F. Automatic differentiation of melanoma from dysplastic nevi. Comput Med Imaging Graph 2015; 43:44-52. [PMID: 25797605 DOI: 10.1016/j.compmedimag.2015.02.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/11/2015] [Accepted: 02/25/2015] [Indexed: 11/23/2022]
Abstract
Malignant melanoma causes the majority of deaths related to skin cancer. Nevertheless, it is the most treatable one, depending on its early diagnosis. The early prognosis is a challenging task for both clinicians and dermatologist, due to the characteristic similarities of melanoma with other skin lesions such as dysplastic nevi. In the past decades, several computerized lesion analysis algorithms have been proposed by the research community for detection of melanoma. These algorithms mostly focus on differentiating melanoma from benign lesions and few have considered the case of melanoma against dysplastic nevi. In this paper, we consider the most challenging task and propose an automatic framework for differentiation of melanoma from dysplastic nevi. The proposed framework also considers combination and comparison of several texture features beside the well used colour and shape features based on "ABCD" clinical rule in the literature. Focusing on dermoscopy images, we evaluate the performance of the framework using two feature extraction approaches, global and local (bag of words) and three classifiers such as support vector machine, gradient boosting and random forest. Our evaluation revealed the potential of texture features and random forest as an almost independent classifier. Using texture features and random forest for differentiation of melanoma and dysplastic nevi, the framework achieved the highest sensitivity of 98% and specificity of 70%.
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Affiliation(s)
- Mojdeh Rastgoo
- Computer Vision and Robotics Group, Universitat de Girona, Campus Montilivi, Edifici PIV, s/n, 17071 Girona, Spain; Le2i-UMR CNRS 6306, Université de Bourgogne, BP 47870, 21078 Dijon, France.
| | - Rafael Garcia
- Computer Vision and Robotics Group, Universitat de Girona, Campus Montilivi, Edifici PIV, s/n, 17071 Girona, Spain
| | - Olivier Morel
- Le2i-UMR CNRS 6306, Université de Bourgogne, BP 47870, 21078 Dijon, France
| | - Franck Marzani
- Le2i-UMR CNRS 6306, Université de Bourgogne, BP 47870, 21078 Dijon, France
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Korotkov K, Quintana J, Puig S, Malvehy J, Garcia R. A new total body scanning system for automatic change detection in multiple pigmented skin lesions. IEEE TRANSACTIONS ON MEDICAL IMAGING 2015; 34:317-38. [PMID: 25222947 DOI: 10.1109/tmi.2014.2357715] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The detection of newly appearing and changing pigmented skin lesions (PSLs) is essential for timely diagnosis of cutaneous melanoma. Total body skin examination (TBSE) procedures, currently practiced for this purpose, can be extremely time-consuming for patients with numerous lesions. In addition, these procedures are prone to subjectivity when selecting PSLs for baseline image comparison, increasing the risk of missing a developing cancer. To address this issue, we propose a new photogrammetry-based total body scanning system allowing for skin surface image acquisition using cross-polarized light. Equipped with 21 high-resolution cameras and a turntable, this scanner automatically acquires a set of overlapping images, covering 85%-90% of the patient's skin surface. These images are used for the automated mapping of PSLs and their change estimation between explorations. The maps produced relate images of individual lesions with their locations on the patient's body, solving the body-to-image and image-to-image correspondence problem in TBSEs. Currently, the scanner is limited to patients with sparse body hair and, for a complete skin examination, the scalp, palms, soles and inner arms should be photographed manually. The initial tests of the scanner showed that it can be successfully applied for automated mapping and temporal monitoring of multiple lesions: PSLs relevant for follow-up were repeatedly mapped in several explorations. Moreover, during the baseline image comparison, all lesions with artificially induced changes were correctly identified as "evolved."
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Tchernev G, Ananiev J, Cardoso JC, Chokoeva AA, Philipov S, Penev PK, Lotti T, Wollina U. Multiple primary cutaneous melanomas in patients with FAMMM syndrome and sporadic atypical mole syndrome (AMS): what's worse? Wien Med Wochenschr 2014; 164:302-7. [PMID: 25096163 DOI: 10.1007/s10354-014-0295-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
Abstract
Atypical Mole Syndrome is the most important phenotypic risk factor for cutaneous melanoma, a malignancy that accounts for about 80% of deaths from skin cancer. Since early diagnosis of melanoma is of great prognostic relevance, the identification of Atypical Mole Syndrome carriers (sporadic and familial) is essential, as well as the recommendation of preventative measures that must be undertaken by these patients.We report two rare cases concerning patients with multiple primary skin melanomas in the setting of a familial and a sporadic syndrome of dysplastic nevi: the first patient is a 67-year-old patient with a history of multiple superficial spreading melanomas localized on his back. The second patient presented with multiple primary melanomas in advanced stage in the context of the so-called sporadic form of the syndrome of dysplastic nevi-AMS (atypical mole syndrome). In the first case, excision of the melanomas was carried out with an uneventful post-operative period. In the second case, disseminated metastases were detected, involving the right fibula, the abdominal cavity as well as multiple lesions in the brain. The patient declined BRAF mutation tests as well as chemotherapy or targeted therapies, and suffered a rapid deterioration in his general condition leading to death. We classified the second case as a sporadic form of the atypical mole syndrome, associated with one nodular and two superficial spreading melanomas.There are no data in the literature to allow us to understand if, in patients with multiple primary melanomas, there is any difference in terms of prognosis between those with and without a family history of a similar phenotype. To answer this and other questions related to these rare cases, further studies with a significant number of patients should be carried out.
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Affiliation(s)
- Georgi Tchernev
- Policlinic for Dermatology and Venerology, Saint Kliment Ohridski University, Medical Faculty, University Hospital Lozenetz, Koziak street 1, 1407, Sofia, Bulgaria,
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Bodén I, Nyström J, Geladi P, Naredi P, Lindholm-Sethson B. NIR and skin impedance spectroscopic measurements for studying the effect of coffee and alcohol on skin, and dysplastic naevi. Skin Res Technol 2011; 18:486-94. [PMID: 22175794 DOI: 10.1111/j.1600-0846.2011.00597.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND/PURPOSE Near infrared and impedance spectroscopy can be used for clinical skin measurements and need to be evaluated for possible confounding factors; (i) are skin conditions of the patient and the subsequent skin measurements influenced by alcohol and/or coffee consumption and (ii) are measurements of dysplastic naevi (DN) reproducible over time and significantly different compared to reference skin. METHODS Near infrared and skin impedance spectroscopic data were analysed multivariately. In the first study, the skin characteristics of 15 healthy individuals were examined related to body location, gender, individual differences, and consumption of coffee or alcohol. The second study included five patients diagnosed with dysplastic naevi syndrome. Measurements were taken on DN and reference skin over time. RESULTS In the first study, body location and gender had a major influence on measurement scores. Inter-individual skin characteristics and coffee or alcohol effects on skin characteristics were of minor importance. In the second study, it was shown that DN can be differentiated from reference skin and the measurements are stable over time. CONCLUSIONS Moderate consumption of alcohol and coffee did not influence the results of the measurements. It is possible to follow, stable or changed, characteristics of DN over time.
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Affiliation(s)
- Ida Bodén
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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