1
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Bhave P, Wong J, McInerney-Leo A, Cust AE, Lawn C, Janda M, Mar VJ. Management of cutaneous melanoma in Australia: a narrative review. Med J Aust 2023; 218:426-431. [PMID: 37120760 DOI: 10.5694/mja2.51910] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/05/2023] [Accepted: 02/28/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Prachi Bhave
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC
- Alfred Hospital, Melbourne, VIC
| | | | - Aideen McInerney-Leo
- Dermatology Research Centre, University of Queensland Diamantina Institute for Cancer Immunology and Metabolic Medicine, Brisbane, QLD
- Australian Centre of Excellence in Melanoma Imaging, Brisbane, QLD
| | - Anne E Cust
- Australian Centre of Excellence in Melanoma Imaging, Brisbane, QLD
- Melanoma Institute Australia, Sydney, NSW
| | - Craig Lawn
- Melanoma Institute Australia, Sydney, NSW
- Centre of Excellence in Melanoma Imaging, Brisbane, QLD
| | - Monika Janda
- Centre for Health Services Research, University of Queensland, Brisbane, QLD
| | - Victoria J Mar
- Alfred Hospital, Melbourne, VIC
- Monash University, Melbourne, VIC
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2
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Yeap I, Becker T, Azimi F, Kernohan M. The management of hereditary melanoma, FAMMM syndrome and germline CDKN2A mutations: a narrative review. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n2.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Familial atypical multiple mole melanoma (FAMMM) syndrome is a rare autosomal dominant disorder, in which patients present with a large number of melanocytic naevi and a strong history of malignant melanoma, usually at a young age. The most common genetic alteration, implicated in 40 per cent of FAMMM syndrome families, is a mutation of cyclin-dependent kinase inhibitor 2A (CDKN2A).1 CDKN2A encodes the tumour suppressor gene p16INK4a, a critical cell cycle inhibitor.2
The diagnosis and management of patients with FAMMM syndrome is relevant to the plastic surgeon who manages melanoma. However, clear guidelines on its diagnostic criteria and its relationship to associated but distinct syndromes, such as hereditary melanoma and B-K mole syndrome, are lacking in the extant literature.
The aim of this review is to clarify the diagnostic criteria and management principles for FAMMM syndrome. We propose a new system of classifying FAMMM syndrome patients as a subset of all patients with hereditary melanoma. We also present a management algorithm for these distinct patient groups (FAMMM syndrome, hereditary melanoma and germline CDKN2A mutations).
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3
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Pauley K, Khan A, Kohlmann W, Jeter J. Considerations for Germline Testing in Melanoma: Updates in Behavioral Change and Pancreatic Surveillance for Carriers of CDKN2A Pathogenic Variants. Front Oncol 2022; 12:837057. [PMID: 35372037 PMCID: PMC8967159 DOI: 10.3389/fonc.2022.837057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/23/2022] [Indexed: 01/13/2023] Open
Abstract
The largest proportion of hereditary melanoma cases are due to pathogenic variants (PVs) in the CDKN2A/p16 gene, which account for 20%-40% of familial melanomas and confer up to a 30%-70% lifetime risk for melanoma in individuals with these variants. In addition, PVs in the CDKN2A gene also increase risk for pancreatic cancer (~5-24% lifetime risk). Individuals with PVs in the CDKN2A gene also tend to have an earlier onset of cancer. Despite these known risks, uptake of germline testing has been limited in the past, largely due to perceptions of limited benefit for patients. Prevention recommendations have been developed for individuals with CDKN2A PVs as well the providers who care for them. On the patient level, behavioral modifications regarding melanoma prevention such as wearing sunscreen, limiting prolonged sun exposure and practicing general sun safety can help reduce risks. Germline testing can provide motivation for some individuals to adhere to these lifestyle changes. On the provider level, pancreatic cancer surveillance for individuals with CDKN2A PVs has been increasingly endorsed by expert consensus, although the efficacy of these surveillance methods remains under study. This review summarizes the updated surveillance guidelines for individuals with CDKN2A PVs and explores the impact of genetic counseling and testing in influencing behavioral changes in these individuals.
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Affiliation(s)
- Kristen Pauley
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Ambreen Khan
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Wendy Kohlmann
- Family Cancer Assessment Clinic, Huntsman Cancer Institute, Salt Lake City, UT, United States
| | - Joanne Jeter
- Department of Internal Medicine, Huntsman Cancer Institute, Salt Lake City, UT, United States
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4
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Liu X, Parks K, Saknite I, Reasat T, Cronin AD, Wheless LE, Dawant BM, Tkaczyk ER. Baseline Photos and Confident Annotation Improve Automated Detection of Cutaneous Graft-Versus-Host Disease. Clin Hematol Int 2021; 3:108-115. [PMID: 34820616 PMCID: PMC8486973 DOI: 10.2991/chi.k.210704.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/18/2021] [Indexed: 11/04/2022] Open
Abstract
Cutaneous erythema is used in diagnosis and response assessment of cutaneous chronic graft-versus-host disease (cGVHD). The development of objective erythema evaluation methods remains a challenge. We used a pre-trained neural network to segment cGVHD erythema by detecting changes relative to a patient’s registered baseline photo. We fixed this change detection algorithm on human annotations from a single photo pair, by using either a traditional approach or by marking definitely affected (“Do Not Miss”, DNM) and definitely unaffected skin (“Do Not Include”, DNI). The fixed algorithm was applied to each of the remaining 47 test photo pairs from six follow-up sessions of one patient. We used both the Dice index and the opinion of two board-certified dermatologists to evaluate the algorithm performance. The change detection algorithm correctly assigned 80% of the pixels, regardless of whether it was fixed on traditional (median accuracy: 0.77, interquartile range 0.62–0.87) or DNM/DNI segmentations (0.81, 0.65–0.89). When the algorithm was fixed on markings by different annotators, the DNM/DNI achieved more consistent outputs (median Dice indices: 0.94–0.96) than the traditional method (0.73–0.81). Compared to viewing only rash photos, the addition of baseline photos improved the reliability of dermatologists’ scoring. The inter-rater intraclass correlation coefficient increased from 0.19 (95% confidence interval lower bound: 0.06) to 0.51 (lower bound: 0.35). In conclusion, a change detection algorithm accurately assigned erythema in longitudinal photos of cGVHD. The reliability was significantly improved by exclusively using confident human segmentations to fix the algorithm. Baseline photos improved the agreement among two dermatologists in assessing algorithm performance.
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Affiliation(s)
- Xiaoqi Liu
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Dermatology Service, 1310 24th Avenue South, Nashville, TN 37212-2637, USA.,Department of Electrical Engineering and Computer Science, Vanderbilt University, 361 Jacobs Hall, Nashville, TN 37235-1662, USA.,Vanderbilt Dermatology Translational Research Clinic (VDTRC.org), Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN 37204, USA
| | - Kelsey Parks
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Dermatology Service, 1310 24th Avenue South, Nashville, TN 37212-2637, USA.,Vanderbilt Dermatology Translational Research Clinic (VDTRC.org), Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN 37204, USA
| | - Inga Saknite
- Vanderbilt Dermatology Translational Research Clinic (VDTRC.org), Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN 37204, USA
| | - Tahsin Reasat
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 361 Jacobs Hall, Nashville, TN 37235-1662, USA
| | - Austin D Cronin
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Dermatology Service, 1310 24th Avenue South, Nashville, TN 37212-2637, USA.,Vanderbilt Dermatology Translational Research Clinic (VDTRC.org), Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN 37204, USA
| | - Lee E Wheless
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Dermatology Service, 1310 24th Avenue South, Nashville, TN 37212-2637, USA.,Vanderbilt Dermatology Translational Research Clinic (VDTRC.org), Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN 37204, USA
| | - Benoit M Dawant
- Department of Electrical Engineering and Computer Science, Vanderbilt University, 361 Jacobs Hall, Nashville, TN 37235-1662, USA
| | - Eric R Tkaczyk
- Department of Veterans Affairs, Tennessee Valley Healthcare System, Dermatology Service, 1310 24th Avenue South, Nashville, TN 37212-2637, USA.,Vanderbilt Dermatology Translational Research Clinic (VDTRC.org), Department of Dermatology, Vanderbilt University Medical Center, 719 Thompson Lane, One Hundred Oaks Suite 26300, Nashville, TN 37204, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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5
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Grochulska K, Betz-Stablein B, Rutjes C, Chiu FPC, Menzies SW, Soyer HP, Janda M. The Additive Value of 3D Total Body Imaging for Sequential Monitoring of Skin Lesions: A Case Series. Dermatology 2021; 238:12-17. [PMID: 34380140 DOI: 10.1159/000517900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Timely diagnosis is the cornerstone of melanoma morbidity and mortality reduction. 2D total body photography and dermoscopy are routinely used to assist with early detection of skin malignancies. Polarized 3D total body photography is a novel technique that enables fast image acquisition of almost the entire skin surface. We aimed to determine the added value of 3D total body photography alongside dermoscopy for monitoring cutaneous lesions. METHODS Lesion images from high-risk individuals were assessed for long-term substantial changes via dermoscopy and 3D total body photography. Three case studies are presented demonstrating how 3D total body photography may enhance lesion analysis alongside traditional dermoscopy. RESULTS 3D total body photography can assist clinicians by presenting cutaneous lesions in their skin ecosystem, thereby providing additional clinical context and enabling a more holistic assessment to aid dermoscopy interpretation. For lesion cases where previous dermoscopy is unavailable, corresponding 3D images can substitute for baseline dermoscopy. Additionally, 3D total body photography is not susceptible to artificial stretch artefacts. CONCLUSION 3D total body photography is valuable alongside dermoscopy for monitoring cutaneous lesions. Furthermore, it is capable of surveilling almost the entire skin surface, including areas not traditionally monitored by sequential imaging.
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Affiliation(s)
- Katarzyna Grochulska
- University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Medical University of Graz, Graz, Austria
| | - Brigid Betz-Stablein
- University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Cancer and Population Studies, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Chantal Rutjes
- University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Frank Po-Chao Chiu
- University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - H Peter Soyer
- University of Queensland Diamantina Institute, University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia,
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6
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Hornung A, Steeb T, Wessely A, Brinker TJ, Breakell T, Erdmann M, Berking C, Heppt MV. The Value of Total Body Photography for the Early Detection of Melanoma: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1726. [PMID: 33578996 PMCID: PMC7916771 DOI: 10.3390/ijerph18041726] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of melanoma. To summarize the current evidence on TBP for the early detection of melanoma, we performed a systematic literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible records up to 6th August 2020. Outcomes of interest included melanoma incidence, incisional and excisional biopsy rates, as well as the Breslow's index of detected tumors. Results from individual studies were described qualitatively. The risks of bias and applicability of the included studies was assessed using the QUADAS-2 checklist. In total, 14 studies published between 1997 and 2020 with an overall sample size of n = 12082 (range 100-4692) were included in the qualitative analysis. Individuals undergoing TBP showed a trend towards a lower Breslow's thickness and a higher proportion of in situ melanomas compared to those without TBP. The number needed to excise one melanoma varied from 3:1 to 14.3:1 and was better for lesions that arose de novo than for tracked ones. The included studies were judged to be of unclear methodological concern with specific deficiencies in the domains "flow and timing" and "reference standard". The use of TBP can improve the early detection of melanoma in high-risk populations. Future studies are warranted to reduce the heterogeneity of phenotypic risk factor definition and the technical implementation of TBP. Artificial intelligence-assisted analysis of images derived from 3-D TBP systems and digital dermoscopy may further improve the early detection of melanoma.
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Affiliation(s)
- Annkathrin Hornung
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Titus J. Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Thomas Breakell
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
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7
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Adler NR, Kelly JW, Guitera P, Menzies SW, Chamberlain AJ, Fishburn P, Button-Sloan AE, Heal C, Soyer HP, Thompson JF. Methods of melanoma detection and of skin monitoring for individuals at high risk of melanoma: new Australian clinical practice. Med J Aust 2018; 210:41-47. [PMID: 30636296 DOI: 10.5694/mja2.12033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The evidence-based national clinical practice guidelines for the management of cutaneous melanoma published in 2008 are currently being updated. This article summarises the findings from multiple chapters of the guidelines on different methods of melanoma detection and of monitoring the skin for patients at high risk of melanoma. Early detection of melanoma is critical, as thinner tumours are associated with enhanced survival; therefore, strategies to improve early detection are important to reduce melanoma-related mortality. MAIN RECOMMENDATIONS Clinicians who perform skin examinations for the purpose of detecting skin cancer should be trained in and use dermoscopy. The use of short term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual melanocytic lesions of concern. The use of long term sequential digital dermoscopy imaging to detect melanomas that lack dermoscopic features of melanoma is recommended to assess individual or multiple melanocytic lesions for routine surveillance of high risk patients. The use of total body photography should be considered in managing patients at increased risk for melanoma, particularly those with high naevus counts and dysplastic naevi. There is insufficient evidence to recommend the routine use of automated instruments for the clinical diagnosis of primary melanoma. MANAGEMENT OVERVIEW Determining the relative indications for each diagnostic method and how each method should be introduced into the surveillance of a patient requires careful consideration and an individualised approach.
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Affiliation(s)
- Nikki R Adler
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, VIC.,Armadale Dermatology, Melbourne, VIC
| | - Pascale Guitera
- Melanoma Institute Australia, Sydney, NSW.,University of Sydney, Sydney, NSW.,Royal Prince Alfred Hospital, Sydney, NSW
| | - Scott W Menzies
- Sydney Melanoma Diagnostic Centre, University of Sydney, Sydney, NSW
| | - Alex J Chamberlain
- Victorian Melanoma Service, Alfred Health, Melbourne, VIC.,Glenferrie Dermatology, Melbourne, VIC
| | | | | | | | - H Peter Soyer
- Dermatology Research Centre, Diamantina Institute, University of Queensland, Brisbane, QLD.,Princess Alexandra Hospital, Brisbane, QLD
| | - John F Thompson
- Melanoma Institute Australia, Sydney, NSW.,University of Sydney, Sydney, NSW
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8
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Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluación de indicadores de estructura en la atención al paciente con cáncer de piel en los servicios de dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:807-812. [DOI: 10.1016/j.ad.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 11/24/2022] Open
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9
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Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluation of Structure Indicators for Assessing Skin Cancer Quality of Care in Dermatology Departments. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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Palkina N, Sergeeva O, Ruksha T, Artyukhov I. Melanoma Screening Day in Krasnoyarsk Krai of the Russian
Federation: Results from 2015-2016. Asian Pac J Cancer Prev 2018; 19:503-507. [PMID: 29480992 PMCID: PMC5980941 DOI: 10.22034/apjcp.2018.19.2.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: The Melanoma Screening Day Campaign started in the Russian Federation in 2006. In the present study,
we analyzed the 2015-2016 survey questionnaire data acquired from screened individuals in the city of Krasnoyarsk in
eastern Siberia, which has a population of one million, in order to understand the level of awareness regarding melanoma/
skin cancer prevention and early diagnosis. Methods: Individuals were enrolled in the screening campaign by mass
media advertising. Free whole-body examinations were provided by the doctors, and the standardized questionnaire
forms (n=444) were completed to obtain relevant demographic, epidemiological, and clinical data. Descriptive and
univariate analyses were conducted to elucidate the main characteristics of the screened population. Percentage frequency
was used to characterize the population. Result: A substantial proportion of the screened individuals were female
(80%). The most common reasons for participating in the screening were a high number of moles, or a change in the
appearance of the moles. Internet recourses were the main channel for obtaining the information about the Melanoma
Day Screening Campaign. 5% of screened individuals had a family history of melanoma/skin cancer. The mean age of
the participants was 36.63±16.31 years. The percentage of screened individuals who took part in this program increased
in 2016 (18%) versus 2015 (8%). In total, 5 individuals with suspected melanoma/skin cancer were identified during
the two-year Campaign, all of whom were referred to the regional oncology center. Conclusion: The analysis of data
from the Melanoma Screening Day Campaign in Krasnoyarsk Krai revealed the necessity to use the media to attract
older subjects with potential melanoma/skin cancer risk to undergo screening. Individuals with suspected malignancies
should be monitored up until the time when a final diagnosis is determined. Moreover, such events are an appropriate
way to inform and educate the public about cutaneous cancer prevention.
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Affiliation(s)
- Nadezhda Palkina
- Department of Pathophysiology, Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation. tatyana_ruksha@ mail.ru
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11
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Abstract
Identifying new or changing melanocytic lesions, particularly in patients with numerous or atypical nevi, can be challenging. Total-body photography and sequential digital dermoscopy imaging, together known as digital follow-up, are 2 prominent forms of noninvasive imaging technology used in mole mapping that have been found to improve diagnostic accuracy, detect earlier-stage melanomas, and reduce costs. Digital follow-up, in combination with direct-to-consumer applications and teledermatology, is already revolutionizing the ways in which physicians and patients participate in melanoma surveillance and will likely continue to enhance early detection efforts.
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Affiliation(s)
- Juliana Berk-Krauss
- Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA; The Ronald O. Perelman Department of Dermatology, NYU School of Medicine, 240 East 38th Street, 11th Floor, New York, NY 10016, USA.
| | - David Polsky
- The Ronald O. Perelman Department of Dermatology, NYU School of Medicine, 240 East 38th Street, 11th Floor, New York, NY 10016, USA
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, NYU School of Medicine, 240 East 38th Street, 11th Floor, New York, NY 10016, USA
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12
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Abstract
Background: Population-based studies have identified several clinical variables associated with an increased risk of developing cutaneous melanoma that include phenotype, amount of and response to sun exposure, and family history. However, these observations are of limited relevance to clinical practice as the risk associated with each factor is individually modest and the characteristics of these variables lack precision when applied to a particular individual. Objective: To review the literature regarding recent advances made in the understanding of the genes and genetics of clinical variables associated with an increased risk of melanoma. Conclusion: Variants of the MC1R (melanocortin-1 receptor) have been identified as major determinants of high-risk phenotypes, such as red hair and pale skin, and the ability to tan in response to UV exposure. Several studies also suggest that such variants may increase melanoma risk independent of their contribution to phenotype. A strong genetic basis for both nevus density and size has been demonstrated and the link between nevi and the development of MM has become better defined. Finally, germline defects in several genes involved in cell cycle regulation, namely, p16 and CDK4, have been demonstrated in many familial melanoma kindreds. This progress has introduced the prospect of genetic testing as a means of identifying a limited number of high-risk individuals who can be targeted with regular screening and education regarding UV exposure and skin self-examination. Ultimately, through rational genetic therapy targeted to correcting the underlying molecular defect, altering the natural history of melanoma development may be possible.
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Affiliation(s)
- Peter Gibbs
- Royal Melbourne Hospital, Parkville, Victoria, Australia
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13
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Weinstock MA, Nguyen FQ, Martin RA. Enhancing Skin Self-Examination with Imaging: Evaluation of a Mole-Mapping Program. J Cutan Med Surg 2016. [DOI: 10.1177/120347540400800101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: To enhance early detection of melanoma with thorough skin self-examination, we have enrolled patients in a mole-mapping program that uses digital imaging of the skin. Objective: The goal of our study was to evaluate the impact of participation in the mole-mapping program on performance of thorough skin self-examination. Methods: The study was carried out by telephone survey of 64 program participants, using self-report to assess impact. Results: Participants were generally satisfied and found the program useful and effective; 97% would recommend it. Almost half (45%) of those who were not performing thorough skin self-examination before participation reported performing it after receiving their images. After participation, a partner such as a spouse or friend was more commonly assisting in these examinations. We also noted a correlation (of borderline statistical significance) between sun protection and performance of self-examination, and differences among different definitions of thorough skin self-examination. Conclusion: Interventions centered around imaging have the potential to substantially enhance and encourage the performance of thorough skin self-examination for the early detection of melanoma.
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Affiliation(s)
- M. A. Weinstock
- Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island, USA
- Dermatoepidemiology Unit, VA Medical Center, Providence, Rhode Island, USA
- Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island, USA
| | - F. Q. Nguyen
- Dermatoepidemiology Unit, VA Medical Center, Providence, Rhode Island, USA
- Department of Dermatology, Brown University School of Medicine, Providence, Rhode Island, USA
| | - R. A. Martin
- Center for Alcohol and Addiction Studies, Brown University School of Medicine, Providence, Rhode Island, USA
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14
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Marino ML, Carrera C, Marchetti MA, Marghoob AA. Practice Gaps in Dermatology: Melanocytic Lesions and Melanoma. Dermatol Clin 2016; 34:353-62. [PMID: 27363893 DOI: 10.1016/j.det.2016.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Early detection remains the most important strategy to reduce melanoma mortality. The identification and evaluation of new or changing skin lesions are important components of melanoma screening and are best performed today using complementary noninvasive imaging technologies, such as total body photography (TBP), dermoscopy, sequential digital dermoscopic imaging (SDDI), and reflectance confocal microscopy (RCM). Despite strong evidence showing that these screening techniques improve diagnostic accuracy for melanoma, they are not widely used by dermatologists. In this practice gaps review, the authors highlight the use, evidence, and rationale for TBP, dermoscopy, SDDI, and RCM.
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Affiliation(s)
- Maria L Marino
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA
| | - Cristina Carrera
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA; Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, CIBERER, University of Barcelona, Villarroel 170, Barcelona 08036, Spain
| | - Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA.
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 16 East 60th Street, New York, NY 10022, USA.
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15
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Truong A, Strazzulla L, March J, Boucher KM, Nelson KC, Kim CC, Grossman D. Reduction in nevus biopsies in patients monitored by total body photography. J Am Acad Dermatol 2016; 75:135-143.e5. [PMID: 26947450 DOI: 10.1016/j.jaad.2016.02.1152] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 10/22/2022]
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Soura E, Eliades PJ, Shannon K, Stratigos AJ, Tsao H. Hereditary melanoma: Update on syndromes and management: Genetics of familial atypical multiple mole melanoma syndrome. J Am Acad Dermatol 2016; 74:395-407; quiz 408-10. [PMID: 26892650 DOI: 10.1016/j.jaad.2015.08.038] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 12/20/2022]
Abstract
Malignant melanoma is considered the most lethal skin cancer if it is not detected and treated during its early stages. About 10% of melanoma patients report a family history of melanoma; however, individuals with features of true hereditary melanoma (ie, unilateral lineage, multigenerational, multiple primary lesions, and early onset of disease) are in fact quite rare. Although many new loci have been implicated in hereditary melanoma, CDKN2A mutations remain the most common. Familial melanoma in the presence of multiple atypical nevi should raise suspicion for a germline CDKN2A mutation. These patients have a high risk of developing multiple primary melanomas and internal organ malignancies, especially pancreatic cancer; therefore, a multidisciplinary approach is necessary in many cases. The value of dermoscopic examination and total body photography performed at regular intervals has been suggested by a number of studies, and should therefore be considered for these patients and their first-degree relatives. In addition, genetic counseling with the possibility of testing can be a valuable adjunct for familial melanoma patients. This must be performed with care, however, and only by qualified individuals trained in cancer risk analysis.
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Affiliation(s)
- Efthymia Soura
- 1st Department of Dermatology, University Clinic, "Andreas Sygros" Hospital, Athens, Greece
| | - Philip J Eliades
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Tufts University School of Medicine, Boston, Massachusetts
| | - Kristen Shannon
- Melanoma Genetics Program/MGH Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander J Stratigos
- 1st Department of Dermatology, University Clinic, "Andreas Sygros" Hospital, Athens, Greece
| | - Hensin Tsao
- Department of Dermatology, Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts; Melanoma Genetics Program/MGH Cancer Center, Massachusetts General Hospital, Boston, Massachusetts.
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Baker J, Miteva M. SnapshotDx Quiz: February 2016. J Invest Dermatol 2016; 136:e19-e20. [PMID: 30477695 DOI: 10.1016/j.jid.2015.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jennifer Baker
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Mariya Miteva
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
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Abstract
Melanoma is a common cancer in the Western world with an increasing incidence. Sun exposure is still considered to be the major risk factor for melanoma. The prognosis of patients with malignant (advanced-stage) melanoma differs widely between countries, but public campaigns advocating early detection have led to significant reductions in mortality rates. As well as sun exposure, distinct genetic alterations have been identified as associated with melanoma. For example, families with melanoma who have germline mutations in CDKN2A are well known, whereas the vast majority of sporadic melanomas have mutations in the mitogen-activated protein kinase cascade, which is the pathway with the highest oncogenic and therapeutic relevance for this disease. BRAF and NRAS mutations are typically found in cutaneous melanomas, whereas KIT mutations are predominantly observed in mucosal and acral melanomas. GNAQ and GNA11 mutations prevail in uveal melanomas. Additionally, the PI3K-AKT-PTEN pathway and the immune checkpoint pathways are important. The finding that programmed cell death protein 1 ligand 1 (PDL1) and PDL2 are expressed by melanoma cells, T cells, B cells and natural killer cells led to the recent development of programmed cell death protein 1 (PD1)-specific antibodies (for example, nivolumab and pembrolizumab). Alongside other new drugs - namely, BRAF inhibitors (vemurafenib and dabrafenib) and MEK inhibitors (trametinib and cobimetinib) - these agents are very promising and have been shown to significantly improve prognosis for patients with advanced-stage metastatic disease. Early signs are apparent that these new treatment modalities are also improving long-term clinical benefit and the quality of life of patients. This Primer summarizes the current understanding of melanoma, from mechanistic insights to clinical progress. For an illustrated summary of this Primer, visit: http://go.nature.com/vX2N9s.
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Vahedi A, Javed MU, Gorse SH. The use of dermatoscopy amongst plastic surgery trainees in the United Kingdom. J Plast Reconstr Aesthet Surg 2015; 68:e111-2. [PMID: 25682591 DOI: 10.1016/j.bjps.2015.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Ali Vahedi
- The Welsh Centre for Burns and Plastic Surgery, Morrsiton Hospital, Swansea, United Kingdom
| | - Muhammad Umair Javed
- The Welsh Centre for Burns and Plastic Surgery, Morrsiton Hospital, Swansea, United Kingdom.
| | - Sarah Hemington Gorse
- The Welsh Centre for Burns and Plastic Surgery, Morrsiton Hospital, Swansea, United Kingdom
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Commentary on Melanoma diagnosed following excision of "dysplastic nevi". Dermatol Surg 2014; 41:159-61. [PMID: 25533165 DOI: 10.1097/dss.0000000000000249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dengel LT, Petroni GR, Judge J, Chen D, Acton ST, Schroen AT, Slingluff CL. Total body photography for skin cancer screening. Int J Dermatol 2014; 54:1250-4. [PMID: 25515157 DOI: 10.1111/ijd.12593] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/22/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Total body photography may aid in melanoma screening but is not widely applied due to time and cost. We hypothesized that a near-simultaneous automated skin photo-acquisition system would be acceptable to patients and could rapidly obtain total body images that enable visualization of pigmented skin lesions. METHODS From February to May 2009, a study of 20 volunteers was performed at the University of Virginia to test a prototype 16-camera imaging booth built by the research team and to guide development of special purpose software. For each participant, images were obtained before and after marking 10 lesions (five "easy" and five "difficult"), and images were evaluated to estimate visualization rates. Imaging logistical challenges were scored by the operator, and participant opinion was assessed by questionnaire. RESULTS Average time for image capture was three minutes (range 2-5). All 55 "easy" lesions were visualized (sensitivity 100%, 90% CI 95-100%), and 54/55 "difficult" lesions were visualized (sensitivity 98%, 90% CI 92-100%). Operators and patients graded the imaging process favorably, with challenges identified regarding lighting and positioning. CONCLUSIONS Rapid-acquisition automated skin photography is feasible with a low-cost system, with excellent lesion visualization and participant acceptance. These data provide a basis for employing this method in clinical melanoma screening.
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Affiliation(s)
- Lynn T Dengel
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Gina R Petroni
- Department of Public Health Sciences, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Joshua Judge
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - David Chen
- Department of Biomedical Engineering, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Scott T Acton
- Department of Biomedical Engineering, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Anneke T Schroen
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Craig L Slingluff
- Department of Surgery, University of Virginia Health Systems, Charlottesville, VA, USA
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Pizzichetta MA, Talamini R, Stanganelli I, Soyer HP. Natural history of atypical and equivocal melanocytic lesions in children: an observational study of 19 cases. Pediatr Dermatol 2014; 31:331-6. [PMID: 24456107 DOI: 10.1111/pde.12259] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Digital dermoscopy follow-up helps to identify patterns of change typical of common atypical nevi and early melanoma and improves the follow-up of patients with atypical nevi. We report the morphologic changes observed over time in 19 atypical or equivocal acquired melanocytic nevi that underwent dermoscopic follow-up. Two observers retrospectively examined digitalized dermoscopic images of 19 atypical melanocytic nevi from 15 children and young adults (median age 12 years, range 3-26 years). The images were assessed for global dermoscopic patterns at baseline and after a median 25-month (range 6-138 mos) follow-up. Ten (52.6%) nevi changed and nine (47.4%) retained a stable dermoscopic pattern. Of the 10 changing lesions, 2 of 4 homogeneous nevi evolved into a reticular pattern and 2 into a mixed pattern; 1 of 2 nevi with a mixed pattern evolved into a homogeneous nevus and 1 into a regressing nevus; 1 of 2 nevi with "other" patterns, such as negative pigment network and peppering throughout the lesion, evolved into a mixed nevus and 1 into a regressing nevus; 1 globular nevus evolved into a mixed pattern; and 1 starburst nevus evolved into a homogeneous nevus. The most striking results of our study were that atypical nevi can evolve into common nevi or they can regress, as documented by long-term dermoscopic follow-up. In children and young adults, dermoscopic follow-up of atypical nevi might be a valid alternative to surgical excision and enables us to achieve new insights into the natural history of these nevi.
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Bronsnick T, Kazi N, Kirkorian AY, Rao BK. Outcomes of biopsies and excisions of dysplastic acral nevi: a study of 187 lesions. Dermatol Surg 2014; 40:455-9. [PMID: 24456372 DOI: 10.1111/dsu.12448] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Despite their frequency in clinical practice, controversy exists regarding the significance and management of dysplastic nevi (DN). Although the perception of DN as precursors to melanoma is questionable, excisions of biopsy-proven DN are commonplace in clinical practice. The management of dysplastic acral nevi is of interest given the challenge of surgery at acral sites. OBJECTIVE To determine the outcomes of biopsies of clinically atypical acral nevi and excisions of histologically dysplastic acral nevi (HDN). MATERIALS AND METHODS Retrospective review of consecutive patients at a private dermatology practice who had a biopsy of an atypical acral nevus from December 2004 to July 2012. RESULTS One hundred eighty-seven atypical acral nevi were biopsied from 168 patients (77 (41%) HDN, 108 (58%) common nevi). Based on initial histology, 30 (39%) HDN were recommended for excision and eight (10%) for clinical observation. Twenty-seven of the 77 HDN were excised; 23 (85%) revealed scar only, and four (15%) revealed residual DN not involving the margin. CONCLUSION Routine excision of biopsy-proven dysplastic acral nevi may not be necessary.
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Affiliation(s)
- Tara Bronsnick
- Department of Dermatology, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
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Abello-Poblete MV, Correa-Selm LM, Giambrone D, Victor F, Rao BK. Histologic outcomes of excised moderate and severe dysplastic nevi. Dermatol Surg 2013; 40:40-5. [PMID: 24320231 DOI: 10.1111/dsu.12391] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Dysplastic nevi (DN) have been a matter of controversy since their initial description in 1978 because of differences in the clinical and histological terminology, and large studies on histological outcomes of excising moderate to severely DN have not previously been described. OBJECTIVE To determine the clinical characteristics of DN and histologic outcomes of excised moderate and severe DN. METHODS Retrospective chart review of patients with DN or Clark's nevi at the Dermatology Department at Rutgers-Robert Wood Johnson Medical School in Somerset, New Jersey, from January 2009 to June 2012. Three hundred ninety-three lesions from 380 patients were included in this study. MAIN OUTCOME MEASURE Histologic results of excised moderate and severe DN. RESULTS Thirty-four percent of DN were excised because of the presence of moderate or severe atypia, personal history of melanoma, or both. None of the excised lesions showed evidence of melanoma; 81.6% of excisions showed scar or granulation tissue. Only 14% of excised lesions were found to have residual lesions, and 4.4% showed recurrent nevi. CONCLUSION In 134 excisions of moderate to severe DN, no melanoma was identified. Most of the excisions showed scar or granulation tissue. The rate of residual lesions after shave biopsy of moderate or severe DN was lower than after punch biopsy.
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McLoone JK, Watts KJ, Menzies SW, Barlow-Stewart K, Mann GJ, Kasparian NA. Melanoma survivors at high risk of developing new primary disease: a qualitative examination of the factors that contribute to patient satisfaction with clinical care. Psychooncology 2013; 22:1994-2000. [DOI: 10.1002/pon.3243] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 12/13/2012] [Accepted: 12/14/2012] [Indexed: 11/10/2022]
Affiliation(s)
- J. K. McLoone
- School of Women's and Children's Health, UNSW Medicine; The University of New South Wales; Kensington; 2052; NSW; Australia
| | | | | | - K. Barlow-Stewart
- Centre for Genetics Education; Royal North Shore Hospital; St Leonards; 2065; NSW; Australia
| | | | - N. A. Kasparian
- School of Women's and Children's Health, UNSW Medicine; The University of New South Wales; Kensington; 2052; NSW; Australia
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Edwards SP, Chamberlain AJ. Photographic artefact simulating regressing melanocytic lesion: a potential pitfall of total body photography. Australas J Dermatol 2012; 53:314-5. [PMID: 23157784 DOI: 10.1111/j.1440-0960.2012.00913.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era: part II. Molecular aspects and clinical management. J Am Acad Dermatol 2012; 67:19.e1-12; quiz 31-2. [PMID: 22703916 DOI: 10.1016/j.jaad.2012.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The dysplastic nevus is a discreet histologic entity that exhibits some clinical and histologic features overlapping with common nevi and melanoma. These overlapping features present a therapeutic challenge, and with a lack of accepted guidelines, the management of dysplastic nevi remains a controversial subject. Although some differences between dysplastic and common nevi can be detected at the molecular level, there are currently no established markers to predict biologic behavior. In part II of this continuing medical education article, we will review the molecular aspects of dysplastic nevi and their therapeutic implications. Our goal is to provide the clinician with an up-to-date understanding of this entity to facilitate clinical management of patients with nevi that have histologic dysplasia.
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Affiliation(s)
- Keith Duffy
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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Duffy K, Grossman D. The dysplastic nevus: from historical perspective to management in the modern era: part I. Historical, histologic, and clinical aspects. J Am Acad Dermatol 2012; 67:1.e1-16; quiz 17-8. [PMID: 22703915 PMCID: PMC3625372 DOI: 10.1016/j.jaad.2012.02.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/14/2012] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
Abstract
Since its description in the 1970s, the dysplastic nevus has been a source of confusion, and whether it represents a precursor to melanoma remains a controversial subject. Although a Consensus Conference in 1992 recommended that the term "dysplastic nevus" no longer be used, the histologic diagnosis continues to present a therapeutic quandary for dermatologists and other physicians, and there remains significant variation in clinical management. In part I of this continuing medical education review, we will discuss the historical origins of the term, the evidence for its distinct histologic basis, and its clinical significance.
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Affiliation(s)
- Keith Duffy
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
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29
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Abstract
Dysplastic nevi have been a subject of much debate since their original description in 1978. Although some question the biological potential of dysplastic nevi themselves, several studies have shown that their presence confers substantial risk for melanoma. In addition to predisposing patients to melanoma, dysplastic nevi have been shown to harbor genetic mutations, indicating their position on a continuum between banal nevi and melanomas. Dysplastic nevi are also clinically relevant as mimickers of melanoma, and can be challenging diagnostically. This article reviews the history, epidemiology, biology and genetics, clinical features, histopathologic features, and management guidelines for patients with these lesions.
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Affiliation(s)
- Michele J Farber
- Jefferson Medical College, Thomas Jefferson University, 1020 Walnut Street, Philadelphia, PA 19107, USA
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30
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Schmitz KH, Speck RM, Rye SA, DiSipio T, Hayes SC. Prevalence of breast cancer treatment sequelae over 6 years of follow-up: the Pulling Through Study. Cancer 2012; 118:2217-25. [PMID: 22488696 DOI: 10.1002/cncr.27474] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is a need to better describe and understand the prevalence of breast cancer treatment-related adverse effects amenable to physical therapy and rehabilitative exercise. Prior studies have been limited to single issues and lacked long-term follow-up. The Pulling Through Study provides data on prevalence of adverse effects in breast cancer survivors followed over 6 years. METHODS A population-based sample of Australian women (n = 287) diagnosed with invasive, unilateral breast cancer was followed for a median of 6.6 years and prospectively assessed for treatment-related complications at 6, 12, and 18 months and 6 years after diagnosis. Assessments included postsurgical complications, skin or tissue reaction to radiation therapy, upper-body symptoms, lymphedema, 10% weight gain, fatigue, and upper-quadrant function. The proportion of women with positive indication for each complication and 1 or more complication was estimated using all available data at each time point. Women were only considered to have a specific complication if they reported the highest 2 levels of the Likert scale for self-reported issues. RESULTS At 6 years after diagnosis, more than 60% of women experienced 1 or more side effects amenable to rehabilitative intervention. The proportion of women experiencing 3 or more side effects decreased throughout follow-up, whereas the proportion experiencing no side effects remained stable around 40% from 12 months to 6 years. Weight gain was the only complication to increase in prevalence over time. CONCLUSIONS These data support the development of a multidisciplinary prospective surveillance approach for the purposes of managing and treating adverse effects in breast cancer survivors.
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Affiliation(s)
- Kathryn H Schmitz
- Division of Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Abramson Cancer Center, Philadelphia, Pennsylvania 19104-6021, USA.
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O'Donnell AT, Kim CC. Update and Clinical Use of Imaging Technologies for Pigmented Lesions of the Skin. ACTA ACUST UNITED AC 2012; 31:38-44. [DOI: 10.1016/j.sder.2011.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/05/2011] [Accepted: 12/05/2011] [Indexed: 11/28/2022]
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Linos K, Slominski A, Ross JS, Carlson JA. Melanoma update: diagnostic and prognostic factors that can effectively shape and personalize management. Biomark Med 2011; 5:333-60. [PMID: 21657842 DOI: 10.2217/bmm.11.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Routine light microscopy remains a powerful tool to diagnose, stage and prognose melanoma. Although it is very economical and efficient, it requires a significant level of expertise and, in difficult cases the final diagnosis is affected by subjective interpretation. Fortunately, new insights into the genomic aberrations characteristic of melanoma, coupled with ancillary studies, are further refining evaluation and management allowing for more confident diagnosis, more accurate staging and the selection of targeted therapy. In this article, we review the standard of care and new updates including four probe FISH, the 2009 American Joint Commission on Cancer staging of melanoma and mutant testing of melanoma, which will be crucial for targeted therapy of metastatic melanoma.
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Hauschild A, Egberts F, Garbe C, Bauer J, Grabbe S, Hamm H, Kerl H, Reusch M, Rompel R, Schlaeger M. Melanocytic nevi. J Dtsch Dermatol Ges 2011; 9:723-34. [PMID: 21762380 DOI: 10.1111/j.1610-0387.2011.07741.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Axel Hauschild
- Department of Dermatology, Venereology and Allergy, University Clinic Schleswig-Holstein–Campus Kiel, Schittenhelmstr. 7D-24105 Kiel, Germany.
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Kroemer S, Frühauf J, Campbell T, Massone C, Schwantzer G, Soyer H, Hofmann-Wellenhof R. Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones. Br J Dermatol 2011; 164:973-9. [DOI: 10.1111/j.1365-2133.2011.10208.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Malignant melanoma kills more people each year than any other skin cancer, with approximately 8000 lives lost and a cost of over 3 billion dollars annually in the US alone. Tumor depth is the most important prognostic factor in melanoma. Thus, early detection has the potential to diagnose melanoma when lesions are thinner, and to improve survival in primary melanomas. In this review, we discuss the implications, barriers, and advantages of melanoma screening, and describe the currently employed methods of detection, newly available modalities, and current areas of research. We also discuss the efficacy, advantages and disadvantages, and clinical practicality of each, and suggest various means of combining different methodologies as well as tailoring various strategies to individual patient needs.
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Goodson AG, Florell SR, Hyde M, Bowen GM, Grossman D. Comparative analysis of total body and dermatoscopic photographic monitoring of nevi in similar patient populations at risk for cutaneous melanoma. Dermatol Surg 2010; 36:1087-98. [PMID: 20653722 DOI: 10.1111/j.1524-4725.2010.01589.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Our previous experience monitoring nevi in high-risk patients using serial digital epiluminescence microscopy (DELM) photography achieved low biopsy rates but was limited by melanomas presenting as new lesions or arising from nevi that had not been photographed. OBJECTIVE To determine whether biopsy rates, efficiency of melanoma detection, and melanoma origin (de novo vs nevus derived) differed in a similar patient population monitored using total body (TB) photography. METHODS One thousand seventy-six patients (including 187 from a prior cohort) underwent TB photography and were monitored using photographs obtained at the initial visit. Risk factors and median monitoring periods for these patients were comparable with those of patients previously monitored using DELM photography. RESULTS Two hundred seventy-five biopsies were performed in 467 patients on follow-up visits. Of 12 melanomas detected on follow-up, five were invasive, five presented as changing lesions and two as new lesions, nine arose de novo, and the remainder were nevus derived. CONCLUSIONS In our experience with both approaches, monitoring patients at risk for melanoma using TB photography was associated with lower biopsy rates and lower nevus-to-melanoma ratios than using DELM and facilitated detection of new and changing lesions. In both cohorts, the majority of melanomas detected on follow-up arose de novo.
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Wang SQ, Hashemi P. Noninvasive Imaging Technologies in the Diagnosis of Melanoma. ACTA ACUST UNITED AC 2010; 29:174-84. [DOI: 10.1016/j.sder.2010.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
In this practical review, we aim to help clinicians identify patients who are at significant risk of developing malignant melanoma. Universal screening is challenging, thus it is important to effectively single out patients who have a high risk of developing the disease. We provide a summary of pertinent questions to review when taking the patient's history, point out the phenotypic features to note during skin examination, and suggest risk stratification as a means to plan initial and long-term surveillance strategy. We mention personal and family history of melanoma as prime risk factors for melanoma, yet the review also focuses on the patient who has no history of melanoma, either in himself or his family, and the proper ways to evaluate his likelihood of developing the disease.
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Affiliation(s)
- Estee L Psaty
- Dermatology Service Department of Medicine Memorial Sloan-Kettering Cancer Center New York, NY 11788, USA
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40
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Tan E, Levell NJ. Regular clinical dermatoscope use with training improves melanoma diagnosis by dermatologists. Clin Exp Dermatol 2010; 34:e876-8. [PMID: 20055853 DOI: 10.1111/j.1365-2230.2009.03629.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Dermatoscopy is not accepted by all dermatologists as a useful diagnostic tool. We set out to test if training followed by regular clinical use of dermatoscopes improved diagnostic accuracy in melanoma diagnosis. Six dermatologists who had not previously used dermatoscopes were studied before and after a 10-month period of dermatoscope use with training and use of the Modified Pattern Analysis Diagnostic Algorithm. Diagnostic accuracy was assessed using test cards containing clinical and dermatoscopic photographs. The number of melanomas undiagnosed after training fell from 18 to 5 and the number potentially left unexcised fell from 18 to 3. The numbers of benign lesions potentially excised remained unchanged. The study shows that the use of dermatoscopes with training greatly increased the accuracy of diagnosis of melanoma by dermatologists. This practical study supports the use of dermatoscopy in pigmented-lesion diagnosis and demonstrates how dermatoscopy training could be incorporated into UK specialist training programmes.
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Affiliation(s)
- E Tan
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK.
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Scurr LL, Pupo GM, Becker TM, Lai K, Schrama D, Haferkamp S, Irvine M, Scolyer RA, Mann GJ, Becker JC, Kefford RF, Rizos H. IGFBP7 is not required for B-RAF-induced melanocyte senescence. Cell 2010; 141:717-27. [PMID: 20478260 DOI: 10.1016/j.cell.2010.04.021] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 11/21/2009] [Accepted: 04/15/2010] [Indexed: 12/11/2022]
Abstract
Induction of senescence permanently restricts cellular proliferation after oncogenic stimulation thereby acting as a potent barrier to tumor development. The relevant effector proteins may therefore be fundamental to cancer development. A recent study identified IGFBP7 as a secreted factor mediating melanocyte senescence induced by oncogenic B-RAF, which is found commonly in cutaneous nevi. In contrast to the previous report, we demonstrate that B-RAF signaling does not induce IGFBP7 expression, nor the expression of the IGFBP7 targets, BNIP3L, SMARCB1, or PEA15, in human melanocytes or fibroblasts. We also found no correlation between B-RAF mutational status and IGFBP7 protein expression levels in 22 melanoma cell lines, 90 melanomas, and 46 benign nevi. Furthermore, using a lentiviral silencing strategy we show that B-RAF induces senescence in melanocytes and fibroblasts, irrespective of the presence of IGFBP7. Therefore, we conclude that the secreted protein IGFBP7 is dispensable for B-RAF(V600E)-induced senescence in human melanocytes.
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Affiliation(s)
- Lyndee L Scurr
- Westmead Institute for Cancer Research, University of Sydney at Westmead Millennium Institute, Westmead Hospital, Westmead, New South Wales 2145, Australia.
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Zalaudek I, Kittler H, Blum A, Hofmann-Wellenhof R, Marghoob AA, Malvehy J, Menzies SW, Puig S, Soyer P, Stolz W, Argenziano G. Who benefits from prophylactic surgical removal of "dysplastic" nevi? J Dtsch Dermatol Ges 2010; 8:279-80. [PMID: 20409087 DOI: 10.1111/j.1610-0387.2010.07377.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Terushkin V, Oliveria SA, Marghoob AA, Halpern AC. Use of and beliefs about total body photography and dermatoscopy among US dermatology training programs: an update. J Am Acad Dermatol 2010; 62:794-803. [PMID: 20223561 DOI: 10.1016/j.jaad.2009.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 08/31/2009] [Accepted: 09/08/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Total body photography (TBP) and dermatoscopy are imaging techniques used to treat patients with pigmented lesions. OBJECTIVE We sought to describe use, training, logistics, and beliefs about these tools among residency programs and to assess changes during a 10-year period. METHODS Surveys were sent to all directors (n = 111) and chief residents (n = 109) of US dermatology training programs. RESULTS A total of 83 (74.8%) attendings answered the questionnaire. In all, 59 (71.1%) reported using TBP, an 11.9% increase (P = .2484) over the past decade. Reasons for using TBP included: reduces patient anxiety (81.4%), helps detect early melanoma (78.0%), and leads to fewer biopsies (66.1%). Logistical (79.2%) and financial (45.8%) constraints were reasons for not using TBP. Seventy respondents (84.3%) reported using dermatoscopy, a 40.0% increase (P = .0001) over the 10-year period. Reasons for dermatoscopy use were consistent over time: helps find melanoma in curable stage (75.7%), reduces patient anxiety (61.4%), and leads to fewer biopsies (57.1%). The most common reason for not using dermatoscopy remained lack of training (38.5%). A total of 92 (84.4%) residents completed their survey, of which 41 (44.6%) and 81 (88.0%) reported using TBP and dermatoscopy, respectively. In all, 62 (67.4%) and 79 (85.9%) respondents would prefer additional training in TBP and dermatoscopy, respectively. LIMITATIONS Results may not be applicable to the general dermatology community. CONCLUSIONS Use of dermatoscopy among residency programs has increased significantly during the last decade. A more modest increase in the use of TBP was observed. Barriers to diffusion of these technologies into practice persist, including insufficient logistics and training.
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Abstract
Approximately 5-10 % of all cutaneous melanomas occur in families with hereditary melanoma predisposition. Worldwide, approximately 20-40% of kindreds with familial elanoma harbor germline mutations in the CDKN2A gene, located on chromosome 9p21, which encodes two different proteins, p16INK4 and p14ARF, both involved in regulation of cell cycle progression and induction of senescence. In different populations several recurring CDKN2A founder mutations have been described. The risk of melanoma in CDKN2A mutations carriers varies between populations and is higher in regions with high sun exposure and high incidence of melanoma in the general population. Some CDKN2A mutations have been associated not only with melanoma but also with increased risk of other malignancies--most notably pancreatic carcinoma. A much smaller number of families have germline mutations in the CDK4 gene on chromosome 12q14, encoding a cyclin dependent kinase which normally interacts with p16INK4A. The management of families with hereditary melanoma is discussed.
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Affiliation(s)
- Johan Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital Solna S-171 76, Stockholm, Sweden.
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Goodson AG, Florell SR, Boucher KM, Grossman D. Low rates of clinical recurrence after biopsy of benign to moderately dysplastic melanocytic nevi. J Am Acad Dermatol 2009; 62:591-6. [PMID: 20018406 DOI: 10.1016/j.jaad.2009.06.080] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 06/08/2009] [Accepted: 06/25/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the recurrence/persistence rates of dysplastic nevi (DN) after biopsy, and whether incompletely removed DN should be re-excised to prevent recurrence. OBJECTIVE Our purpose was to determine the recurrence rates of previously biopsied DN, and to assess whether biopsy method, margin involvement, congenital features, epidermal location, and degree of dysplasia are associated with recurrence. METHODS Patients having a history of a "nevus biopsy" at least 2 years earlier were assessed for clinical recurrence. Slides of original lesions were re-reviewed by a dermatopathologist. RESULTS A total of 271 nevus biopsy sites were assessed in 115 patients. Of 195 DN with greater than 2 years of follow-up, 7 (3.6%) demonstrated recurrence on clinical examination. In all, 98 DN had a follow-up period of at least 4 years with no clinical recurrence. Of 61 benign nevus biopsy sites examined, clinical recurrence was observed in two (3.3%). For all nevi, recurrence was significantly associated with shave biopsy technique but not with nevus dysplasia or subtype, or the presence of positive margin or congenital features. LIMITATIONS Most biopsies were performed in a pigmented lesion clinic at a single tertiary referral center. Determinations of nevus recurrence were made on clinical rather than histologic grounds, and follow-up times were limited in some cases. CONCLUSION In this cohort, rates of clinical recurrence after biopsy of DN and benign nevi were extremely low. Re-excision of nevi, including mildly to moderately DN with a positive margin, may not be necessary.
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Melanoma arising in segmental nevus spilus: Detection by sequential digital dermatoscopy. J Am Acad Dermatol 2009; 61:337-41. [DOI: 10.1016/j.jaad.2008.12.035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 11/24/2008] [Accepted: 12/16/2008] [Indexed: 11/23/2022]
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Goodson AG, Grossman D. Strategies for early melanoma detection: Approaches to the patient with nevi. J Am Acad Dermatol 2009; 60:719-35; quiz 736-8. [PMID: 19389517 DOI: 10.1016/j.jaad.2008.10.065] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 10/20/2008] [Accepted: 10/22/2008] [Indexed: 10/20/2022]
Abstract
UNLABELLED Given its propensity to metastasize and the lack of effective therapies for most patients with advanced disease, early detection of melanoma is a clinical imperative. Although there are no noninvasive techniques for the definitive diagnosis of melanoma, and the "gold standard" remains biopsy with histologic examination, a variety of modalities may facilitate early melanoma diagnosis and the detection of new and changing nevi. This article reviews the general clinical principles of early melanoma detection and various modalities that are currently available or on the horizon, providing the clinician with an up to date understanding of management strategies for their patients with numerous or atypical nevi. LEARNING OBJECTIVE After completing this learning activity, participants should understand the clinical importance of early melanoma detection, appreciate the challenges of early melanoma diagnosis and which patients are at highest risk, know the general principles of early melanoma detection, be familiar with current and emerging modalities that may facilitate early melanoma diagnosis and the detection of new and changing nevi, know the advantages and limitations of each modality, and be able to practice a combined approach to the patient with numerous or clinically atypical nevi.
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Abstract
Relative to other specialties, dermatologists have been slow to adopt advanced technologic diagnostic aids. Most skin disease can be diagnosed by simple visual inspection, and the skin is readily accessible for a diagnostic biopsy. Diagnostic aids, such as total body photography and dermoscopy, improve the clinician's ability to diagnose melanoma beyond unaided visual inspection, however, and are now considered mainstream methods for early detection. Emerging technologies such as in vivo reflectance confocal microscopy are currently being investigated to determine their utility for noninvasive diagnosis of melanoma. This review summarizes the currently available cutaneous imaging devices and new frontiers in noninvasive diagnosis of skin disease. We anticipate that multimodal systems that combine different imaging technologies will further improve our ability to detect, at the bedside, melanoma at an earlier stage.
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Friedman RJ, Farber MJ, Warycha MA, Papathasis N, Miller MK, Heilman ER. The "dysplastic" nevus. Clin Dermatol 2009; 27:103-15. [PMID: 19095156 DOI: 10.1016/j.clindermatol.2008.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Dysplastic nevi have become an increasing focus clinically, with evidence that they are associated with a higher risk of developing melanoma. However, there still is contention regarding the significance of dysplastic nevi. This contribution provides an overview of the history, epidemiology, genetics, clinical and histologic features, and procedures for clinical management of dysplastic nevi. Since dysplastic nevi were described originally in 1978, a great deal of research has examined the epidemiology of these lesions and the genetic factors related to the development of dysplastic nevi. However, there is disagreement regarding the clinical management of dysplastic nevi and the histologic definition of dysplastic nevi. Current recommendations include preventative measures, such as sun protection and careful surveillance and biopsies of suspicious lesions as needed. The advent of new technologies, such as computer-vision systems, have the potential to significantly change treatment of dysplastic nevi in the future.
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Affiliation(s)
- Robert J Friedman
- Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
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Suh KY, Bolognia JL. Signature nevi. J Am Acad Dermatol 2009; 60:508-14. [DOI: 10.1016/j.jaad.2008.10.056] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/26/2022]
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