The dynamics of circulating tumour DNA (ctDNA) during treatment reflects tumour response in advanced melanoma patients

Despite the introduction of targeted (BRAFi/MEKi) and immune checkpoint inhibitors (ICIs) has significantly reduced the recurrence rate and improved the overall survival (OS) of patients with Stage III and IV melanoma, only a percentage will benefit of durable disease control. The aim of this study was to examine whether the levels of circulating tumour DNA (ctDNA) in plasma of advanced melanoma patients undergoing BRAFi/MEKi or ICIs vary according to the patients' survival outcomes (i.e. progression-free survival (PFS) and OS) and disease progression. Plasma samples of Stage III-IV melanoma patients were collected at baseline (treatment initiation) and thereafter every 3 months. Circulating BRAFV600E/K and NRASQ61R/K mutations were analysed through droplet digital PCR (ddPCR, Bio-Rad) in a total of 177 plasma samples from 48 melanoma patients (19 Stage III, 29 Stage IV). Baseline ctDNA concentration was significantly associated with OS (HR = 1.003, 95% CI = 1.000-1.006, p = 0.043) and PFS (HR = 1.004, 95% CI = 1.000-1.007, p = 0.029) independent of clinical-prognostic confounders. For each unit increase in the ∆ctDNA (concentration difference between the last follow-up and baseline) there was a 24% increased risk of disease progression, irrespective of treatment type and stage at diagnosis (OR = 1.24, 95% CI = 1.03-1.49, p = 0.020, AUC = 0.93). Patients with reduction of ctDNA level from baseline to the last follow-up had longer OS (HR = 0.14; 95% CI = 0.05-0.44, p = 0.001) and PFS (HR = 0.08; 95% CI = 0.03-0.27, p < 0.0001) compared to patients with increased ctDNA, including adjustment for confounding factors. Our findings suggest that variation of ctDNA over time during melanoma treatment reflects the clinical outcome and tumour response to therapy and might be helpful in clinical monitoring.

Polymorphic Skin Eruption in a Middle-Aged Man: A Quiz

Abstract is missing (Quiz)

Melanocytic Lesions with Peripheral Globules: Proposal of an Integrated Management Algorithm

INTRODUCTION

A peripheral rim of globules represents a marker of the horizontal growth phase in nevi and is a common feature in children and adolescents. The observation of melanocytic lesions with peripheral globules (MLPGs) in adulthood deserves more attention, since melanoma may exhibit this feature, albeit rarely. Risk-stratified management recommendations considering a global clinical approach are still missing.

OBJECTIVES

To analyze current knowledge on MLPGs and propose an integrated management algorithm stratified for age groups.

METHODS

We conducted a narrative review of current published data on MLPGs, analyzing clinical dermoscopic and confocal distinguishing features of melanoma from benign nevi.

RESULTS

The risk of finding a melanoma when removing an MLPG increases with age, especially in people >55 years old, and is significantly higher in the extremities, head/neck and in case of a single asymmetrical lesion, ≥6 mm in diameter. Dermoscopic features associated with melanoma diagnosis include atypical peripheral globules, asymmetrical distribution, multiple rims as well as the reappearance of globules after prior loss. In addition, wide blue-grey regression areas, atypical networks, eccentric blotches, tan structureless peripheral areas and vascularization are atypical dermoscopic features. Confocal worrisome findings are represented by pagetoid cells within the epidermis, architectural disarrangement and atypical cells of the dermo-epidermal junction with irregular peripheral nests.

CONCLUSION

We proposed a multi-step age-stratified management algorithm integrating clinical, dermoscopic and confocal findings that may increase the early recognition of melanoma and avoid surgical excision of benign nevi.

A Review of Existing Therapies for Actinic Keratosis: Current Status and Future Directions

Actinic keratosis (AK) is a chronic skin disease in which clinical and subclinical cutaneous lesions coexist on sun-exposed areas such as the head and neck region and the extremities. The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. Evidence indicates that AK may progress into invasive cutaneous squamous cell carcinoma, so the European guidelines recommend treatment of any AK regardless of clinical severity. Given the aging population and therefore the increasing incidence of AK and cutaneous field carcinogenesis, further updates on the long-term efficacy of current therapies and new investigational agents are critical to guide treatment choice. Patients often have difficulty adequately applying topical treatments and coping with adverse local skin reactions, leading to less than optimum treatment adherence. The development of associated local skin symptoms and cosmetic outcomes for the area of interest are also relevant to the choice of an appropriate therapeutic strategy. Treatment is always individually tailored according to the characteristics of both patients and lesions. This review focuses on the therapeutic approaches to AK and illustrates the currently available home-based and physician-managed treatments.

Photodynamic therapy with 5-aminolevulinate patch for the treatment of superficial basal cell carcinomas

5-Aminolevulinate (ALA) patches with red light (630-nm light source and a total light dose of 37 J/cm² ) is an effective treatment indicated by food and drug administration (FDA) and european medicines agency (EMA) only for grade I to II actinic keratosis located on the scalp and face. Currently, there are no efficacy data on their use in the treatment of other types of epithelial neoplasms. We analyzed the efficacy of ALA patches in seven superficial basal cell carcinomas (sBCCs) that occurred in four patients. All lesions were treated with topical ALA patches. A complete response of all sBCCs was achieved at week 24 after treatment. Our study suggests that ALA patches for sBCCs have good efficacy rates and excellent safety profile.

Prevalence of self-reported symptoms related to temporomandibular disorders in an Italian population

The aim of this study was to estimate the prevalence of temporomandibular disorders (TMD) symptoms in an Italian population sample, focusing on gender and age differences. We selected 2005 individuals by telephone survey and asked them about TMD symptoms like difficulty in jaw movement, jaw pain and joint sounds. Also, tooth-clenching and/or tooth-grinding habits were investigated. Of the study population, 8·1% reported limitations in jaw movements, 5·1% reported jaw pain and 33·3% reported joint sounds. Furthermore, 37·3% reported tooth-clenching/tooth-grinding. Confidence intervals of proportions were calculated. Significant gender differences were found for jaw limitation and pain (chi-square test; P < 0·05). Symptoms reduced with increasing age. The prevalence of TMD symptoms in the Italian population was consistent with data reported from similar studies. Gender and age differences were found for jaw pain and limitation in jaw movements.

[Pharmacologic therapy of cranio-cervico-mandibular disorders. Review of the literature]

The recommended treatments of craniomandibular disorders (CMD) are drug therapy, physiotherapy, relaxation procedures, occlusal therapy with and without splint. The purpose of this study is to carry out a survey of the literature on drug therapy in patients affected by CMD. It is essential to recognize the cause of pain (muscular or articular) and the phase of disorder (acute or chronic) in order to establish an adequate pharmacological protocol for each type of CMD. Non-steroidal anti-inflammatory drugs (NSAID) are generally accepted for treatment of internal derangement and myofacial pain, sometimes in association with benzodiazepine.

[Short-term effects of the Michigan splint on muscular and joint pain]

BACKGROUND

In 1966 Ramfjord and Ash proposed the Michigan's splint that, at present, is one of the splints widely accepted for the treatment of craniomandibular disorders (CMD).

METHODS

For this study, thirty-one subjects were examined according to the protocol of the European Academy of CMD; each patient indicated the intensity of pain using a Visual Analogue Scale (VAS). After therapy with Michigan's splint, the visit was repeated and the patient indicated again the VAS.

RESULTS

The results showed that the splint has short-term benefit effects on the muscular and articular pain, even if the effects are lesser on the articular pain.

CONCLUSIONS

The Michigan's splint is a valid device for therapy of CMD, moreover it is very cheap, very easy to use and without contraindications.

Clinical and histological evaluation of thermal injury thresholds in human teeth: a preliminary study

The effect on healthy dental pulp of thermal increases ranging from 8.9 to 14.7 degrees C was evaluated. These temperature increases correspond approximately to those caused by certain restorative procedures, such as tooth preparation with high-speed instruments and the fabrication of direct provisional crowns. Two criteria of evaluation have been used in conjunction, a clinical (symptomatic) and a histological one, to assert with greater precision potential damage to the pulp. The results suggest a low susceptibility of cells to heat, which does not appear to be a major factor of injury, at least in the short term. The main cause of postoperative inflammation or necrosis of the pulp is probably the injury of the dentine, a tissue in direct functional and physiological connection with the pulp.

A clinical evaluation of In-Ceram crowns

In this investigation, 63 In-Ceram crowns were placed in 45 patients in both dental school and private practice settings. The restorations were observed for a period of 24 to 44 months, with a mean of 37.6 months. Both anterior and posterior teeth were treated and occlusal conditions were recorded. One crown fractured, yielding a 98.4% success rate. The single fracture was attributed to crown preparation geometry.

[The biocompatibility of temporary cements. Longitudinal in-vitro analyses of the pH values]

In this longitudinal study the authors analyse the acid-basal characteristics in vitro of seven cements used in dentistry for a period of three weeks. The cements tested were subdivided into three groups based on their composition, whereas Life was presented separately since it is generally used as a sub-base for fillings in conservative treatment. All the materials studied alter the pH of the matter in which they are imbedded. Life and Tempbond present the highest and lowest pH values recorded during the study in vitro. The authors discuss the biological implications of these results.

[An experimental clinical evaluation of the influence of the blood circulation on the parapulpal thermal levels]

The aim of this study is the evaluation of pulpal blood flow effect on the thermal levels measured at the pulpodentin junction in human anesthetized premolars. The value have been recorded as discrepancies between peak temperatures caused by a thermal stimulus applied on the same tooth in two different conditions: with and without pulpal blood supply. Thermal stimuli ranged from 3 to 9 degrees C on a total of twelve teeth giving a mean peak difference of 1.3 degrees C. This result has been interpreted as the effect of thermal dissipation produced by pulpal blood flow. The small magnitude of the value suggests, however, that anesthetized pulp fails to protect itself from injurious heat by increasing pulpal blood flow.

[The incidence of craniomandibular disorders in patients with cervical dysfunctions. A clinico-statistical assessment]

The aim of this research was to measure the incidence of craniomandibular disorders in a group of patients with functional-type cervical alterations. The group consisted of 50 patients undergoing treatment for disorders of the cervical sectors of the spine. Each patient was subjected to a medical examination to investigate the presence of CMD signs or symptoms. From the data statistical analysis a higher percentage of cases with muscular and joint pain, limited mouth opening, deviation and deflection, were found in comparison with the percentage found among the general population. This demonstrates an overloading of the entire masticatory apparatus. Joint noise was less frequent, probably due to its exclusion from our sample of patients with arthrosis-type degenerative pathology.

[Occlusion in the etiology of craniomandibular disorders. Current directions]

Craniomandibular disorders are a pathology with a multifactorial genesis where the aetiological aspects it represented by emotional and occlusal factors. These provoke muscular hyperactivity so determining a change in all components of the stomatognathic apparatus. A critical analysis of the literature leads to an analysis of the importance of the occlusal factor in the aetiology of MCD. The conclusions reached are that the ideal occlusion is a theoretical concept. Physiological occlusion is the situation in which, independently of the number, lay-out and relationship between teeth there exists a subjective occlusal stability and a satisfactory masticatory, phonatory and aesthetic function.

[A radiographic assessment of condylar position after therapy with the Michigan plate]

The paper analyses condylar movement in the sagittal plane following four months of therapy using a Michigan-type plate in a group of 19 patients with craniomandibular disorders. An OLTP radiographic examination was used; X-rays carried out before and after therapy were compared using a special image subtraction technique. From the analysis of results it emerged that 63.12% of patients showed a mono- or bilateral condylar movement which was visible by X-ray.

[Extension bridges. A bibliographic evaluation and the clinical indications]

Extension bridges are a valid alternative to partial and implanted prostheses for the rehabilitation of small intercalary or distal lacunae. Following a critical review of published reports on the subject and the assessment of longitudinal studies, the authors examine the clinical parameters and technical procedures used to implement these prosthetic reconstructions.

[An evaluation of the signs and symptoms in patients with craniomandibular disorders correlated with the radiological pictures obtained by OLTP]

The study evaluated the frequency of noise, pain and alterations of mandibular movements in a group of 88 patients. Condylar position was also studied using OLTP X-ray images, and the presence of arthrotic lesions using multitomography. The condylar position was related to the presence of organic lesions at an articular level, and a higher frequency of the latter was found in anterior condylar displacements; the presence of condyles centered in the glenoid cavity on OLTP examination does not exclude the possibility of arthrotic lesions. Another important finding was the observation of a greater frequency of contralateral organic pathologies in posterior condylar displacements.

[The effects of parafunctional contacts on the natural dentition]

The paper analyses the incidence and etiology of bruxism through a review of the literature. The effects that this pathology has on teeth are discussed and there is a brief discussion of therapy.

The unreliability of facial measurements in the determination of the vertical dimension of occlusion in edentulous patients

The aim of this research was to test the reliability of skin markers in the determination of the V.D.O. in edentulous patients during prosthetic rehabilitation. Two resin baseplates were constructed: on the upper one a modified pin of the Central Bearing Point registration device was fixed with impression compound. The height of the pin could be altered by rotating the pin directly in the patient's mouth with a probe. Two lead spheres were inserted on the resin base-plate as bone markers, and two others were fixed to the skin as markers, one above (end of nose) and one below (point of chin) the oral commissure. Five lateral cephalometric radiographs were exposed for each patient, raising the V.D.O. by 1.2 mm on each occasion. Statistical analysis of measurements made on the resulting radiographs showed a very strong correlation between bone markers and pin position, whereas great variation and considerable differences were found between skin markers and bone as well as measurements.