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Sigurdsson V, Ten Cate O. Do summative entrustment decisions actually lead to entrustment? Clin Teach 2024; 21:e13668. [PMID: 37817015 DOI: 10.1111/tct.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 09/05/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) were introduced across Dutch postgraduate programmes between 2017 and 2019. We aimed to understand the extent to which residents actually were granted increased clinical responsibility upon receiving summative entrustment for an EPA, a critical feature of its use. METHODS A survey study was conducted among all Dutch residents who started dermatology training in 2018 and 2019 and all Dutch dermatology programme directors (PDs). We chose an EPA designed for early entrustment in residency (identification, treatment and care regarding a simple dermatological problem in the ambulatory setting). The survey contained two hypothetical clinical cases that aligned with this EPA. The questions were aimed to determine whether and when residents should request supervision. Similar questions were posed to PDs. FINDINGS Twenty four residents (56%) and 19 PDs (79%) completed the survey. The majority of the residents (65%) and PDs (63%) confirmed that competent dermatology residents (level 4) are generally allowed to perform EPA1 unsupervised, particularly when seeing patients from GPs. However, still a substantial proportion of the level 4 residents, working in University Medical Centers (36%) indicated that they had to request supervision in the assessment of these patients. For 2nd opinions, the results were typically the opposite. DISCUSSION AND CONCLUSION This study demonstrated that, at least in one specialty and one country, the introduction of EPAs and entrustment decision making procedure generally led to the intended autonomy of the resident.
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Affiliation(s)
- Vigfús Sigurdsson
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle Ten Cate
- Utrecht Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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El Sharouni MA, Rawson RV, Potter AJ, Paver EC, Wilmott JS, Witkamp AJ, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, Lo SN, van Gils CH. Melanomas in children and adolescents: Clinicopathologic features and survival outcomes. J Am Acad Dermatol 2023; 88:609-616. [PMID: 36509217 DOI: 10.1016/j.jaad.2022.08.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Melanomas in the first 2 decades of life are uncommon and poorly understood. OBJECTIVE To assess clinicopathologic features and survival of children (≤11 years) and adolescents (12-19 years) diagnosed with melanoma. METHODS A pooled cohort of 514 patients was analyzed (397 Dutch, 117 Australian; 62 children, 452 adolescents). Pathology reports were reevaluated to determine melanoma subtypes. Multivariable Cox models were generated for recurrence-free survival (RFS) and overall survival (OS). RESULTS Melanoma subtypes were conventional melanoma (superficial spreading, nodular, desmoplastic, and acral lentiginous), spitzoid melanoma, and melanoma associated with a congenital nevus in 428, 78, and 8 patients, respectively. Ten-year RFS was 91.5% (95% confidence interval [CI], 82.4%-100%) in children and 86.4% (95% CI, 82.7%-90.3%) in adolescents (P = .32). Ten-year OS was 100% in children and 92.7% (95% CI, 89.8%-95.8%) in adolescents (P = .09). On multivariable analysis possible only for the adolescent cohort due to the small number of children, ulceration status, and anatomic site were associated with RFS and OS, whereas age, sex, mitotic index, sentinel node status and melanoma subtype were not. Breslow thickness >4 mm was associated with worse RFS. LIMITATIONS Retrospective study. CONCLUSIONS Survival rates for children and adolescents with melanomas were high. Ulceration, head or neck location and Breslow thickness >4 mm predicted worse survival in adolescents.
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Affiliation(s)
- Mary-Ann El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Robert V Rawson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Alison J Potter
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - Elizabeth C Paver
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - James S Wilmott
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
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Sharouni MAE, Lo SN, Varey AH, Elias SG, Witkamp AJ, Sigurdsson V, Suijkerbuijk KP, van Diest PJ, van Gils CH, Blokx WA, Scolyer RA, Thompson JF. Plain Language Summary - Development and validation of risk calculators for people with "thin" melanomas on their skin to predict the likelihood that their cancer will return. Future Oncol 2023; 19:97-102. [PMID: 36762595 DOI: 10.2217/fon-2022-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
WHAT IS THIS SUMMARY ABOUT? This is a summary of an article describing the development of risk calculators for use in people who develop a type of melanoma on their skin called "thin" melanoma to predict the likelihood that their cancer will return. The article was originally published in the Journal of Clinical Oncology in 2021. HOW WERE THE CALCULATORS DEVELOPED? Calculations were performed to predict the chance of people with thin melanomas surviving without their melanoma recurring. Three graphical prediction calculators (called nomograms) were developed, along with easy-to-use online calculators using the same underlying calculation methods. The model was developed using data for 25,930 Dutch people diagnosed with thin melanomas (called the "development set"). To test its ability to predict melanoma recurrence, it was then compared with data for 2,968 Australian people with melanoma (the "validation set"). The calculators developed in the Dutch patients were found to accurately predict the risk of melanoma recurring for people with melanoma in the Australian "validation" group. WHAT DO THE RESULTS MEAN? The calculators provide estimates of the risk of the melanoma returning for people with thin melanomas. The easy-to-use online calculators are freely available on a smartphone, tablet or computer, and will assist in providing accurate estimates of recurrence risks for individuals with thin melanomas, allowing more intensive follow-up of those whose predicted risk of their melanoma returning is high.
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Affiliation(s)
- Mary-Ann El Sharouni
- Department of Dermatology, University Medic al Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Alexander Hr Varey
- Department of Dermatology, University Medic al Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Department of Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Sjoerd G Elias
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medic al Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karijn Pm Suijkerbuijk
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Willeke Am Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia.,Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma & Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Cuperus E, Bygum A, Boeckmann L, Bodemer C, Bolling MC, Caproni M, Diociaiuti A, Emmert S, Fischer J, Gostynski A, Guez S, van Gijn ME, Hannulla-Jouppi K, Has C, Hernández-Martín A, Martinez AE, Mazereeuw-Hautier J, Medvecz M, Neri I, Sigurdsson V, Suessmuth K, Traupe H, Oji V, Pasmans SGMA. Proposal for a 6-step-approach for differential diagnosis of neonatal erythroderma. J Eur Acad Dermatol Venereol 2022; 36:973-986. [PMID: 35238435 PMCID: PMC9310754 DOI: 10.1111/jdv.18043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/15/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
The broad differential diagnosis of neonatal erythroderma often poses a diagnostic challenge. Mortality of neonatal erythroderma is high due to complications of the erythroderma itself and the occasionally severe and life-threatening underlying disease. Early correct recognition of the underlying cause leads to better treatment and prognosis. Currently, neonatal erythroderma is approached by a case by case basis. The purpose of this scoping review was to develop a diagnostic approach in neonatal erythroderma. After a systematic literature search in Embase (January 1990 - May 2020, 74 cases of neonatal erythroderma were identified, and 50+ diagnoses could be extracted. Main causes were the ichthyoses (40%) and primary immunodeficiencies (35%). Congenital erythroderma was present in 64% (47/74) of the cases, predominantly with congenital ichthyosis (11/11; 100%), Netherton syndrome (12/14, 86%), and Omenn syndrome (11/23, 48%). Time until diagnosis ranged from 102 days to 116 days for cases of non-congenital erythroderma and congenital erythroderma respectively. Among the 74 identified cases a total of 17 patients (23%) died within a mean of 158 days and were related to Omenn syndrome (35%), graft versus host disease (67%), and Netherton syndrome (18%). Disease history and physical examination are summarized in this paper. Age of onset and a collodion membrane can help to narrow the differential diagnoses. Investigations of blood, histology, hair analysis, genetic analysis and clinical imaging are summarized and discussed. A standard blood investigation is proposed and the need for skin biopsies with Lympho-Epithelial Kazal-Type related Inhibitor-staining is highlighted. Overall, this review shows that diagnostic procedures narrow the differential diagnosis in neonatal erythroderma. A 6-step flowchart for the diagnostic approach for neonatal erythroderma during the first month of life is proposed. The approach was made with the support of expert leaders from international multidisciplinary collaborations in the European Reference Network Skin-subthematic group Ichthyosis.
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Affiliation(s)
- E Cuperus
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
| | - A Bygum
- University of Southern Denmark, Clinical Institute, Denmark & Odense University Hospital, Department of Clinical Genetics, Denmark
| | - L Boeckmann
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - C Bodemer
- Department of Dermatology, Reference Center for Genodermatoses (MAGEC), Necker-Enfants Malades Hospital (AP-HP5), Paris-Centre University, Imagine Institute, INSERM, Paris, France
| | - M C Bolling
- University of Groningen, University Medical Center Groningen, Department of Dermatology, Groningen, the Netherlands
| | - M Caproni
- Department of Health Sciences, Section of Dermatology, USL Toscana Centro, Rare Diseases Unit, University of Florence, Florence, Italy
| | - A Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S Emmert
- University Medical Center Rostock. Clinic and Policlinic for Dermatology and Venereology. Rostock, Germany
| | - J Fischer
- Institute of Human Genetics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
| | - A Gostynski
- Department of Dermatology, Maastricht University Medical Center, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Guez
- Pediatrics Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - M E van Gijn
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, the Netherlands
| | - K Hannulla-Jouppi
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, HUS, Helsinki, Finland
| | - C Has
- Department of Dermatology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - A E Martinez
- Pediatric Dermatology, NHS Foundation Trust, Great Ormond Street, London, UK
| | - J Mazereeuw-Hautier
- Dermatology Department, Reference Center for Rare Skin Diseases, Toulouse, France
| | - M Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - I Neri
- Dermatology - IRCCS Policlinico di Sant'Orsola - Department of Experimental, Diagnostic and Specialty Medicine (DIMES) Alma Mater, Studiorum University of Bologna, Bologna, Italy
| | - V Sigurdsson
- University Medical Center Utrecht and Utrecht University, Department of Dermatology, Utrecht, The Netherlands
| | - K Suessmuth
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - H Traupe
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - V Oji
- Department of Dermatology, University Hospital of Münster, Münster, Germany
| | - S G M A Pasmans
- Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Department of Dermatology, Center of Pediatric Dermatology, The Netherlands
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El Sharouni MA, Scolyer RA, van Gils CH, Ch'ng S, Nieweg OE, Pennington TE, Saw RP, Shannon K, Spillane A, Stretch J, Witkamp AJ, Sigurdsson V, Thompson JF, van Diest PJ, Lo SN. Time interval between diagnostic excision-biopsy of a primary melanoma and sentinel node biopsy: effects on the sentinel node positivity rate and survival outcomes. Eur J Cancer 2022; 167:123-132. [DOI: 10.1016/j.ejca.2021.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/10/2021] [Accepted: 12/30/2021] [Indexed: 11/28/2022]
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El Sharouni MA, Scolyer RA, van Gils CH, Ch'ng S, Nieweg OE, Pennington TE, Saw RP, Shannon K, Spillane A, Stretch J, Witkamp AJ, Sigurdsson V, Thompson JF, van Diest PJ, Lo SN. Effect of the time interval between melanoma diagnosis and sentinel node biopsy on the size of metastatic tumour deposits in node-positive patients. Eur J Cancer 2022; 167:133-141. [PMID: 35216870 DOI: 10.1016/j.ejca.2021.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/10/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This study sought to assess whether the interval between diagnostic excision-biopsy of a primary melanoma and definitive wide excision with sentinel node biopsy (SNB) influenced the size of SN metastatic deposits, which might have implications for management and prognosis. METHODS Data were collected for (i) a Dutch population-based cohort of patients treated between 2004 and 2014 who underwent SNB within 100 days of complete excision of their primary melanoma and who were SN-positive with known SN metastasis diameter (n = 1027) and (ii) a cohort from a large Australian melanoma treatment centre (n = 541) who presented in the same time period. The effects of SNB timing on the size of SN metastatic deposits were analysed. RESULTS Dutch patients whose SNB was performed in the second or third months after diagnosis had significantly larger SN metastasis diameters than patients who had their SNB in the first month (median increases of 17% (95%CI -14, 60%, p = 0.211) and 71% (95%CI 15, 119%, p = 0.004), respectively). No significant difference in tumour diameter for early and late SNB was found in the Australian cohort. CONCLUSIONS SN metastasis diameter became progressively greater with SN biopsy in the second and third months after primary melanoma diagnosis in the larger, population-based patient cohort. An increase in metastasis diameter was not observed in the smaller, institutional cohort, possibly due to detection of larger SN metastases by routine pre-operative ultrasound, with fine-needle biopsy confirmation. These patients did not proceed to SNB and were therefore not included in the study.
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Affiliation(s)
- Mary-Ann El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Thomas E Pennington
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Robyn Pm Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kerwin Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Breast and Melanoma Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jonathan Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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El Sharouni MA, Aivazian K, Witkamp AJ, Sigurdsson V, van Gils CH, Scolyer RA, Thompson JF, van Diest PJ, Lo SN. Association of Histologic Regression With a Favorable Outcome in Patients With Stage 1 and Stage 2 Cutaneous Melanoma. JAMA Dermatol 2021; 157:166-173. [PMID: 33355600 DOI: 10.1001/jamadermatol.2020.5032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Although regression is commonly observed in cutaneous melanoma, it is uncertain whether it is associated with patient prognosis. Objective To determine whether histologically confirmed regression was associated with better or worse survival in patients with primary cutaneous melanoma. Design, Setting, and Participants This cohort study analyzed data from 2 large cohorts of adults (one in the Netherlands and the other in Australia) with histologically proven, stage 1 and 2 primary, invasive cutaneous melanoma with known regression status treated between 2000 and 2014, with median follow-up times of 4.5 and 11.1 years for the Dutch and Australian cohorts, respectively. For the Dutch patients, population-based data from PALGA, the Dutch Pathology Registry, were used, and follow-up data were retrieved from the Netherlands Cancer Registry. For the Australian patients, data from the database of a large, specialized melanoma treatment center were used. Main Outcomes and Measures Multivariable Cox proportional hazards analyses were performed per cohort to assess recurrence-free survival (RFS) and overall survival (OS), and subgroup analyses according to Breslow thickness category and melanoma subtype were performed. Results A total of 17 271 Dutch patients and 4980 Australian patients were included. In both cohorts, survival outcomes were better for patients with disease regression. For Dutch patients, the hazard ratio (HR) for those with disease regression was 0.55 (95% CI, 0.48-0.63; P < .001) for RFS and 0.87 (95% CI, 0.79-0.96; P = .004) for OS; for the Australian patients, the HR was 0.61 (95% CI, 0.52-0.72; P < .001) for RFS and 0.73 (95% CI, 0.64-0.84; P < .001) for OS. Subgroup analyses showed that the presence of regression improved RFS within thin and intermediate Breslow thickness melanomas in both cohorts. For patients with superficial spreading melanoma (SSM) subtype, regression improved RFS and OS in both cohorts. For Dutch patients with SSM, the HR for those with disease regression was 0.54 (95% CI, 0.46-0.63; P < .001) for RFS and 0.86 (95% CI, 0.76-0.96; P = .009) for OS; for the Australian patients with SSM, the HR was 0.67 (95% CI, 0.52-0.85; P = .001) for RFS and 0.72 (95% CI, 0.59-0.88; P = .001) for OS. Conclusions and Relevance In 2 large patient cohorts from 2 different continents, regression was a favorable prognostic factor for patients with stage 1 and 2 melanomas, especially in those with thin and intermediate thickness tumors and those with SSM subtype.
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Affiliation(s)
- Mary-Ann El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karina Aivazian
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Fadaei S, Van Os-Medendorp H, Sloeserwij A, Sigurdsson V, Van Laar JM, Spierings J. AB0884-HPR PERSONALISED TREATMENT GOALS IN PATIENTS WITH IMMUNE MEDIATED INFLAMMATORY DISEASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Immune mediated inflammatory diseases (IMIDs) often have a chronic character and large impact on daily life of patients. In order to provide patient-centred care, insight in personal goals is a key issue.Objectives:The aim of this study was to evaluate treatment goals of patients with IMIDs over time.Methods:Patients with IMIDs were invited to complete a self-designed questionnaire about lifestyle, personal treatment goals and perceived care at their first visit to our centre and one year after referral. Clinical information was collected through the electronic patient record system.Results:41 (30%) patients of the 137 invited, completed both questionnaires. Participants had a mean age of 45.6 years (SD 13.4), N=35 (83%) was female, mean disease duration was 12.7 years (SD 12.7). Patients were diagnosed with connective tissue disease (CTD, n=19; 45%), antiphospholipid syndrome (APS, n=10; 24%), inflammatory arthritis (n=7; 17%) and psoriasis (n=7; 17%). We identified six categories of treatment goals: disease related, daily functioning, lifestyle, emotional wellbeing. Figure 1 shows the reported treatment goals at baseline and follow-up. Most frequently mentioned were goals related to disease, lifestyle and daily functioning. At follow-up we observed a vast increase in reported goals related to psychological wellbeing (from 5% to 16%). At baseline patients with APS chose lifestyle-related goals more often than other patients (RR=3.2; p=0.015). At follow-up patients with CTDs reported disease related-goals less often than other patients (RR=0.4; p=0.002). Patients did not report significant progress in reaching their goals on a Likert scale of 1-10. However, in 90% at first visit and in 83% of patients at follow-up, patients reported that the provided care was addressing issues they personally prioritized.Conclusion:IMID patients’ most frequent treatment goals relate to disease activity, lifestyle and daily functioning. Patients frequently change their treatment goals during the first year of treatment. Better understanding of personal goals can help physicians providing targeted and personalised medicine.Figure 1.themes of treatment goals at baseline and follow-upAcknowledgements:The researchers would like to thank all patients participating in this study and acknowledge the UMC Utrecht research program Infection and Immunity for supporting this initiative.Disclosure of Interests:None declared
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El Sharouni MA, Ahmed T, Witkamp AJ, Sigurdsson V, van Gils CH, Nieweg OE, Scolyer RA, Thompson JF, van Diest PJ, Lo SN. Predicting recurrence in patients with sentinel node-negative melanoma: validation of the EORTC nomogram using population-based data. Br J Surg 2021; 108:550-553. [PMID: 34043770 DOI: 10.1002/bjs.11946] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/08/2020] [Accepted: 06/30/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identifying patients with sentinel node (SN)-negative melanoma who are at greatest risk of recurrence is important. The European Organization for Research and Treatment of Cancer (EORTC) Melanoma Group proposed a prognostic model that has not been validated in population-based data. The EORTC nomogram includes Breslow thickness, ulceration status and anatomical location as parameters. The aim of this study was to validate the EORTC model externally using a large national data set. METHODS Adults with histologically proven, invasive cutaneous melanoma with a negative SN biopsy in the Netherlands between 2000 and 2014 were identified from the Dutch Pathology Registry, and relevant data were extracted. The EORTC nomogram was used to predict recurrence-free survival. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration. RESULTS A total of 8795 patients met the eligibility criteria, of whom 14·7 per cent subsequently developed metastatic disease. Of these recurrences, 20·9 per cent occurred after the first 5 years of follow-up. Validation of the EORTC nomogram showed a C-statistic of 0·70 (95 per cent c.i. 0·68 to 0·71) for recurrence-free survival, with excellent calibration (R2 = 0·99; P = 0·999, Hosmer-Lemeshow test). CONCLUSION This population-based validation confirmed the value of the EORTC nomogram in predicting recurrence-free survival in patients with SN-negative melanoma. The EORTC nomogram could be used in clinical practice for personalizing follow-up and selecting high-risk patients for trials of adjuvant systemic therapy.
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Affiliation(s)
- M A El Sharouni
- Melanoma Institute, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T Ahmed
- Melanoma Institute, The University of Sydney, Sydney, NSW, Australia
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - C H van Gils
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - O E Nieweg
- Melanoma Institute, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - R A Scolyer
- Melanoma Institute, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Departments of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,New South Wales Health Pathology, Sydney, New South Wales, Australia
| | - J F Thompson
- Melanoma Institute, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - S N Lo
- Melanoma Institute, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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El Sharouni MA, Varey AHR, Witkamp AJ, Ahmed T, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, Lo SN, van Gils CH. Predicting sentinel node positivity in patients with melanoma: external validation of a risk-prediction calculator (the Melanoma Institute Australia nomogram) using a large European population-based patient cohort. Br J Dermatol 2021; 185:412-418. [PMID: 33657653 DOI: 10.1111/bjd.19895] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A nomogram to predict sentinel node (SN) positivity [the Melanoma Institute Australia (MIA) nomogram] was recently developed and externally validated using two large single-institution databases. However, there remains a need to further validate the nomogram's performance using population-based data. OBJECTIVES To perform further validation of the nomogram using a European national patient cohort. METHODS Patients with cutaneous melanoma who underwent SN biopsy in the Netherlands between 2000 and 2014 were included. Their data were obtained from the Dutch Pathology Registry. The predictive performance of the nomogram was assessed by discrimination (C-statistic) and calibration. Negative predictive values (NPVs) were calculated at various predicted probability cutoffs. RESULTS Of the 3049 patients who met the eligibility criteria, 23% (691) were SN positive. Validation of the MIA nomogram (including the parameters Breslow thickness, ulceration, age, melanoma subtype and lymphovascular invasion) showed a good C-statistic of 0·69 (95% confidence interval 0·66-0·71) with excellent calibration (R2 = 0·985, P = 0·40). The NPV of 90·1%, found at a 10% predicted probability cutoff for having a positive SN biopsy, implied that by using the nomogram, a 16·3% reduction in the rate of performing an SN biopsy could be achieved with an error rate of 1·6%. Validation of the MIA nomogram considering mitotic rate as present or absent showed a C-statistic of 0·70 (95% confidence interval 0·68-0·74). CONCLUSIONS This population-based validation study in European patients with melanoma confirmed the value of the MIA nomogram in predicting SN positivity. Its use will spare low-risk patients the inconvenience, cost and potential risks of SN biopsy while ensuring that high-risk patients are still identified.
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Affiliation(s)
- M A El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - A J Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - V Sigurdsson
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
| | - R A Scolyer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - C H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
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Cuperus E, Sigurdsson V, van den Akker PC, Bolling MC, van Gijn ME, Pasmans SGMA. Diagnostisches Next Generation Sequencing bei neonataler Erythrodermie. J Dtsch Dermatol Ges 2021; 19:611-614. [PMID: 33861020 DOI: 10.1111/ddg.14298_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Edwin Cuperus
- Department of Dermatology, Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Dermatology, St Jansdal Hospital, Harderwijk, The Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Peter C van den Akker
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Marieke C Bolling
- Department of Dermatology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Mariëlle E van Gijn
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands.,Department of Genetics, University Medical Center Utrecht and Wilhelmina's Children Hospital Utrecht, Utrecht, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
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12
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El Sharouni MA, Ahmed T, Varey AHR, Elias SG, Witkamp AJ, Sigurdsson V, Suijkerbuijk KPM, van Diest PJ, Scolyer RA, van Gils CH, Thompson JF, Blokx WAM, Lo SN. Development and Validation of Nomograms to Predict Local, Regional, and Distant Recurrence in Patients With Thin (T1) Melanomas. J Clin Oncol 2021; 39:1243-1252. [PMID: 33600211 DOI: 10.1200/jco.20.02446] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although the prognosis of patients with thin primary cutaneous melanomas (T1, ≤ 1.0 mm) is generally excellent, some develop recurrence. We sought to develop and validate a model predicting recurrences in patients with thin melanomas. METHODS A Dutch population-based cohort (n = 25,930, development set) and a cohort from an Australian melanoma treatment center (n = 2,968, validation set) were analyzed (median follow-up 6.7 and 12.0 years, respectively). Multivariable Cox models were generated for local, regional, and distant recurrence-free survival (RFS). Discrimination was assessed using Harrell's C-statistic for each outcome. Each nomogram performance was evaluated using calibration plots defining low-risk and high-risk groups as the lowest and top 5% of the nomogram risk score, respectively. The nomograms' C-statistics were compared with those of a model including the current American Joint Committee on Cancer staging parameters (T-stage and sentinel node status). RESULTS Local, regional, and distant recurrences were found in 209 (0.8%), 503 (1.9%), and 203 (0.8%) Dutch patients, respectively, and 23 (0.8%), 61 (2.1%), and 75 (2.5%) Australian patients, respectively. C-statistics of 0.79 (95% CI, 0.75 to 0.82) for local RFS, 0.77 (95% CI, 0.75 to 0.78) for regional RFS, and 0.80 (95% CI, 0.77 to 0.83) for distant RFS were obtained for the development model. External validation showed C-statistics of 0.80 (95% CI, 0.69 to 0.90), 0.76 (95% CI, 0.70 to 0.82), and 0.74 (95% CI, 0.69 to 0.80), respectively. Calibration plots showed a good match between predicted and observed rates. Using the nomogram, the C-statistic was increased by 9%-12% for the development cohort and by 11%-15% for the validation cohort, compared with a model including only T-stage and sentinel node status. CONCLUSION Most patients with thin melanomas have an excellent prognosis, but some develop recurrence. The presented nomograms can accurately identify a subgroup at high risk. An online calculator is available at www.melanomarisk.org.au.
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Affiliation(s)
- Mary-Ann El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Cancer Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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El Sharouni MA, Laeijendecker AE, Suijkerbuijk KP, Witkamp AJ, Sigurdsson V, van Diest PJ, van Gils CH, Blokx WA. High discordance rate in assessing sentinel node positivity in cutaneous melanoma: Expert review may reduce unjustified adjuvant treatment. Eur J Cancer 2021; 149:105-113. [PMID: 33848712 DOI: 10.1016/j.ejca.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/01/2021] [Accepted: 03/05/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Identification of sentinel node (SN) metastases can set the adjuvant systemic therapy indication for patients with stage III melanoma. Studies re-evaluating the diagnosis of initially positive SN biopsies are scarce. MATERIALS AND METHODS Dutch patients with melanoma who underwent SN biopsy between 2003 and 2014 were selected from PALGA, the Dutch Pathology Registry. Histopathological slides of SN-positive patients were retrieved for review. A random sample was reassessed by an expert melanoma pathologist. Recurrence-free survival (RFS) of patients who were misclassified (false-positive) was compared with those with a true positive SN status. For comparison, a group of SN-negative patients was included. Multivariable logistic analysis was performed to assess clinicopathological characteristics associated with misclassification of SN status. RESULTS Diagnosis was downgraded from melanoma metastasis to nodal nevus in 38 of the 322 reviewed patients (11.8%). Considering the inclusion criteria of phase III adjuvant trials, at least 4.3% of patients would have falsely qualified for adjuvant therapy. In multivariable analysis, patients with a low SN tumour burden and subcapsular SN tumour location had a significantly higher chance of being misclassified. The five-year RFS of the 38 downgraded patients was 86.7% (95% confidence interval [CI] = 72.6-96.6), similar to the 85.9% (95% CI = 84.9-86.8, p = 0.18) for 6413 SN-negative patients and better than the 53.2% (95% CI = 47.2-59.9, p = 0.009) of 284 patients who were truly SN positive upon review. CONCLUSION More than 10% of originally positive SN biopsies of patients with melanoma concern misclassified nodal nevi. We advocate that when adjuvant treatment is considered in patients with stage III melanoma, SN biopsies should be reassessed by an expert melanoma pathologist.
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Affiliation(s)
- Mary-Ann El Sharouni
- Department of Dermatology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands.
| | - Annelien E Laeijendecker
- Department of Dermatology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Karijn Pm Suijkerbuijk
- Department of Medical Oncology, University Medical Center Cancer Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Willeke Am Blokx
- Department of Pathology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
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El Sharouni MA, Stodell MD, Ahmed T, Suijkerbuijk KPM, Cust AE, Witkamp AJ, Sigurdsson V, van Diest PJ, Scolyer RA, Thompson JF, van Gils CH, Lo SN. Sentinel node biopsy in patients with melanoma improves the accuracy of staging when added to clinicopathological features of the primary tumor. Ann Oncol 2020; 32:375-383. [PMID: 33253862 DOI: 10.1016/j.annonc.2020.11.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND It has been claimed, without supporting evidence, that knowledge of sentinel node (SN) status does not provide more accurate prognostic information than basic clinicopathological features of a primary cutaneous melanoma. We sought to investigate this claim and to quantify any additional value of SN status in predicting survival outcome. PATIENTS AND METHODS Data for a Dutch population-based cohort of melanoma patients (n = 9272) and for a validation cohort from a large Australian melanoma treatment center (n = 5644) were analyzed. Patients were adults diagnosed between 2004 and 2014 with histologically-proven, primary invasive cutaneous melanoma who underwent SN biopsy. Multivariable Cox proportional hazards analyses were carried out in the Dutch cohort to assess recurrence-free survival (RFS), melanoma-specific survival (MSS) and overall survival (OS). The findings were validated using the Australian cohort. Discrimination (Harrell's C-statistic), net benefit using decision curve analysis and net reclassification index (NRI) were calculated. RESULTS The Dutch cohort showed an improved C-statistic from 0.74 to 0.78 for OS and from 0.74 to 0.76 for RFS when SN status was included in the model with Breslow thickness, sex, age, site, mitoses, ulceration, regression and melanoma subtype. In the Australian cohort, the C-statistic increased from 0.70 to 0.73 for OS, 0.70 to 0.74 for RFS and 0.72 to 0.76 for MSS. Decision curve analyses showed that the 3-year and 5-year risk of death or recurrence were more accurately classified with a model that included SN status. At 3 years, sensitivity increased by 12% for both OS and RFS in the development cohort, and by 10% and 6% for OS and RFS, respectively, in the validation cohort. CONCLUSIONS Knowledge of SN status significantly improved the predictive accuracy for RFS, MSS and OS when added to a comprehensive suite of established clinicopathological prognostic factors. However, clinicians and patients must consider the magnitude of the improvement when weighing up the advantages and disadvantages of SN biopsy for melanoma.
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Affiliation(s)
- M-A El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M D Stodell
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Department of Plastic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - T Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Cancer Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| | - C H van Gils
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - S N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Cuperus E, Sigurdsson V, van den Akker PC, Bolling MC, van Gijn ME, Pasmans SGMA. Diagnostic next generation sequencing in neonatal erythroderma. J Dtsch Dermatol Ges 2020; 19:612-614. [PMID: 33103336 DOI: 10.1111/ddg.14298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Edwin Cuperus
- Department of Dermatology, Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Dermatology, St Jansdal Hospital, Harderwijk, The Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Peter C van den Akker
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Marieke C Bolling
- Department of Dermatology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Mariëlle E van Gijn
- Department of Genetics, University Medical Center, University of Groningen, Groningen, The Netherlands.,Department of Genetics, University Medical Center Utrecht and Wilhelmina's Children Hospital Utrecht, Utrecht, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Center of Pediatric Dermatology, Erasmus MC University Medical Center Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
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16
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El Sharouni MA, van Diest PJ, Witkamp AJ, Sigurdsson V, van Gils CH. Subtyping Cutaneous Melanoma Matters. JNCI Cancer Spectr 2020; 4:pkaa097. [PMID: 33409460 PMCID: PMC7771426 DOI: 10.1093/jncics/pkaa097] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/07/2020] [Accepted: 09/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background Our aim was to investigate the role of melanoma subtype on survival and focus on the effects stratified by Breslow thickness and ulceration status. Methods Patients with cutaneous melanoma stage I, II, or III diagnosed between 2000 and 2014 were derived from the Dutch Nationwide Pathology Registry and overall survival data from the Netherlands Cancer Registry. Patients were followed until 2018. Using multivariable Cox proportional hazards models, hazard ratios were calculated for each melanoma subtype, per Breslow thickness category and ulceration status, and adjusted for age, sex, stage, and localization. Results A total of 48 361 patients were included: 79.3% had superficial spreading melanoma (SSM), 14.6% nodular melanoma (NM), 5.2% lentigo maligna melanoma, and 0.9% acral lentiginous melanoma (ALM). In the total patient group, using SSM as the reference category, adjusted hazard ratios were 1.06 (95% confidence interval [CI] = 1.01 to 1.12) for NM, 1.02 (95% CI = 0.93 to 1.13) for lentigo maligna melanoma, and 1.26 (95% = CI 1.06 to 1.50) for ALM. Among patients with 1.0 mm or less Breslow thickness and no ulceration, NM showed a twofold increased risk (hazard ratio = 1.96, 95% CI = 1.58 to 2.45) compared with SSM. Compared with 1.0 mm or less SSM without ulceration, the hazard ratio for 1.0 mm or less SSM with ulceration was 1.94 (95% CI = 1.55 to 2.44), and the hazard ratio for 1.0 mm or less NM with ulceration was 3.46 (95% CI = 2.17 to 5.50). NM patients with tumors greater than 1.0 mm did not show worse survival than SSM patients with tumors greater than 1.0 mm. Conclusions In this large nationwide study, ALM patients showed worse survival than SSM patients. Among patients with melanomas that were thin (1.0 mm or less), NM subtype patients also showed worse survival than SSM patients.
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Affiliation(s)
- Mary-Ann El Sharouni
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul Johannes van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen Joost Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carla Henrica van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Kerckhoffs KGP, Aallali T, Ambarus CA, Sigurdsson V, Jansen AML, Blokx WAM. Expanding spectrum of "spitzoid" lesions: a small series of 4 cases with MAP2K1 mutations. Virchows Arch 2020; 479:195-202. [PMID: 33040161 PMCID: PMC8298358 DOI: 10.1007/s00428-020-02940-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/10/2020] [Accepted: 09/27/2020] [Indexed: 02/06/2023]
Abstract
The molecular background of a significant proportion of spitzoid neoplasms is still unknown. Recently, activating mutations in MAP2K1 have been described in a few spitzoid lesions, but not in benign Spitz nevi. We report four cases of melanocytic tumors with spitzoid features in which a MAP2K1 mutation was detected. The lesions did not show a single distinct phenotype and ranged from benign to malignant. Two cases resembled desmoplastic Spitz nevi. Based on the combination of morphological, immunohistochemical, and molecular findings, one case was classified as benign, one as probably benign, possibly intermediate low-grade (MELTUMP—melanocytic tumor of unknown malignant potential), one case was classified as intermediate (MELTUMP), and one case was considered a superficial spreading melanoma with spitzoid features. Based on this, we conclude that MAP2K1 mutations can indicate a spitzoid genetic signature and can be found in both benign and malignant spitzoid neoplasms.
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Affiliation(s)
- K G P Kerckhoffs
- Department of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - T Aallali
- Symbiant Pathology Expert Center, Hoorn/Zaandam, The Netherlands
| | - C A Ambarus
- Department of Pathology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A M L Jansen
- Department of Pathology, Division of Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W A M Blokx
- Department of Pathology, Division of Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
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Cuperus E, Bolling MC, de Graaf M, van den Akker PC, van Gijn ME, Simon MEH, Sigurdsson V, Pasmans SGMA. Collodion babies: A 15-year retrospective multicenter study in The Netherlands-Evaluation of severity scores to predict the underlying disease. J Am Acad Dermatol 2020; 84:1111-1113. [PMID: 32534952 DOI: 10.1016/j.jaad.2020.06.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 05/23/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Edwin Cuperus
- Department of Dermatology, Erasmus MC Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marieke C Bolling
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marlies de Graaf
- Department of Dermatology, Utrecht University, University Medical Center Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Peter C van den Akker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marielle E van Gijn
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marleen E H Simon
- Department of Genetics, Utrecht University, University Medical Center Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, Utrecht University, University Medical Center Utrecht-Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Erasmus MC Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Lo S, El Sharouni MA, Suijkerbuijk K, Ahmed T, Arjen W, Cust AE, Sigurdsson V, van Diest PJ, Scolyer RA, Van Gils C, Thompson JF. Quantifying the additional prognostic value of sentinel lymph node status over established clinicopathologic primary tumor features for predicting survival outcomes in melanoma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22105 Background: Sentinel node (SN) staging not only provides important prognostic information for patients with primary cutaneous melanoma but it also assists in assessing eligibility for adjuvant systemic therapy and clinical trials. This study aimed to quantify the incremental value of SN status over established clinicopathologic prognostic factors in predicting survival outcomes. Methods: The training cohort (n = 9272) consisted of all Dutch melanoma patients who underwent SN biopsy (SNB) between 2004 and 2014. Melanoma patients having SNB during the same period were identified from the Melanoma Institute Australia (MIA) database as the validation cohort (n = 5644). Outcomes investigated included overall survival (OS), disease-free survival (DFS) and melanoma-specific survival (MSS, available for the MIA cohort only). Multivariable Cox proportional hazards analyses were performed with and without SN status and compared for each of the outcomes. The effect of adding SN status on the predictive performance of the models was quantified through discrimination index (Harrell’s C-statistic), calibration (plots) and reclassification (Net Reclassification Index (NRI)) at fixed follow-up time points. Results: In the Dutch cohort adding SN status to a model with Breslow thickness, ulceration, mitotic rate, age, gender, melanoma subtype, anatomic site and regression, improved the C-statistic from 0.72 (95% CI 0.70-0.73) to 0.76 (95% CI 0.75-0.77) for DFS and from 0.75 (95% CI 0.73-0.76) to 0.78 (95% CI 0.77-0.79) for OS. These findings were confirmed in the validation cohort, with the C-statistic increasing from 0.69 (95% CI 0.66-0.72) to 0.73 (95% CI 0.70-0.76) for DFS, 0.69 (95% CI 0.66-0.73) to 0.73 (95% CI 0.70-0.76) for OS and 0.71 (95% CI 0.69-0.73) to 0.76 (95% CI 0.74-0.78) for MSS. When setting 10% as the cut-off risk in NRI analysis, 54 Dutch and 26 MIA patients who experienced disease progression within the first 3 years after melanoma diagnosis, but were classified as low-risk patients, would have been reclassified as high-risk with addition of SN status. At the same time, 209 Dutch and 230 MIA patients who were disease-free within the first 3 years, but classified as high-risk would have been reclassified as low-risk with addition of SN status. Conclusions: Adding SN status significantly improved the predictive accuracy for OS, DFS and MSS models in melanoma patients.
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Affiliation(s)
- Serigne Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Mary-Ann El Sharouni
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Tasnia Ahmed
- Melanoma Institute Australia, Sydney, NSW, Australia
| | - Witkamp Arjen
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Anne E. Cust
- Sydney School of Public Health, and Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Paul J. van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Richard A. Scolyer
- The University of Sydney, Melanoma Institute Australia and Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Carla Van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, Netherlands
| | - John F. Thompson
- Melanoma Institute Australia and The University of Sydney, Sydney, NSW, Australia
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Laeijendecker AE, El Sharouni MA, Sigurdsson V, van Diest PJ. Desmoplastic melanoma: The role of pure and mixed subtype in sentinel lymph node biopsy and survival. Cancer Med 2019; 9:671-677. [PMID: 31804771 PMCID: PMC6970026 DOI: 10.1002/cam4.2736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/09/2019] [Accepted: 11/14/2019] [Indexed: 12/16/2022] Open
Abstract
Background Desmoplastic melanoma (DM) is an uncommon type of melanoma. Two histological subtypes of DM can be distinguished: pure and mixed (PDM and MDM). We hypothesized that discrimination between these subtypes is associated with sentinel lymph node biopsy (SLNB) status and survival. Methods Clinicopathological data from PALGA, the Dutch Pathology Register were retrieved from patients diagnosed with DM in The Netherlands between 2000 and 2014. Clinical and pathological variables were extracted from pathology text files, including pure or mixed desmoplastic morphology. A Cox proportional hazard model was performed for overall and recurrence‐free survival (OS and RFS). Results A total of 239 patients with DM were included, representing 0.4% of all primary cutaneous melanoma in The Netherlands. A total of 114 PDM and 125 MDM patients were identified. MDM was significantly associated with positive SLNB status (P = .035). In multivariable analysis, age (HR 1.10, 95% CI 1.07‐1.14, P < .001) and ulceration (HR 1.98, 95% CI 1.05‐3.75, P = .036) were significant predictors for OS. For RFS, mixed subtype (HR 2.72 95% CI 1.07‐6.89, P = .035), male gender (HR 2.54, 95% CI 1.03‐6.27, P = .043), and Breslow thickness (HR 1.13 per mm, 95% CI 1.05‐1.21, P = .001) were significant predictors. Conclusion MDM is significantly associated with a positive SLNB status. Mixed subtype is significantly correlated with RFS, but not with OS. The distinction between pure and mixed desmoplastic subtype therefore seems to be of clinical importance.
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Affiliation(s)
- Annelien E Laeijendecker
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mary-Ann El Sharouni
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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El Sharouni MA, Witkamp AJ, Sigurdsson V, van Diest PJ, Suijkerbuijk KPM. Thick melanomas without lymph node metastases: A forgotten group with poor prognosis. Eur J Surg Oncol 2019; 46:918-923. [PMID: 31901365 DOI: 10.1016/j.ejso.2019.11.510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/16/2019] [Accepted: 11/26/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Although adjuvant therapy is available for melanoma patients with sentinel lymph node (SLN) metastases (pN+), this is not the case for thick melanomas without SLN involvement (pN-). OBJECTIVES We assessed overall and relative survival (OS, RS) in patients with >4.0 mm Breslow thickness (BT) pN- and pN + melanomas and ≤4.0 mm pN+ patients. MATERIALS AND METHODS Clinicopathological data were retrieved from a cohort of >4.0 mm thick and/or pN + melanoma patients in The Netherlands from 2000 to 2014. OS and RS was compared using Kaplan-Meier-curves. A Cox-regression-model was developed to assess determinants of OS in >4.0 mm pN- patients. RESULTS In 54 645 patients, 3940 (7.2%) had >4.0 mm thick melanomas. SLN biopsy was performed in 1150 (29.2%) patients. Five-year OS was 70.5% for >4.0 mm pN- and 48.1% for >4.0 mm pN+ patients (p < 0.001), with a decreasing trend in OS for every mm BT. Five-year OS in 1877 ≤ 4.0 mm pN+ patients was 71.5%, which was not different from >4.0 mm pN- (p = 0.24). Higher age, higher BT category, ulceration and male gender were significantly associated with poor survival in >4.0 mm pN- patients. CONCLUSIONS Thick pN- melanomas have a poor prognosis, comparable to that of less thick pN + melanomas, which is not accounted for in current guidelines. We encourage including these high-risk patients in adjuvant trials.
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Affiliation(s)
- M A El Sharouni
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands.
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
| | - K P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Cancer Center Utrecht, Utrecht University, PO Box 85500 3508, GA, Utrecht, the Netherlands
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22
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de Beer FSA, van Diest PJ, Sigurdsson V, El Sharouni M. Intra-nodal nevi in sentinel node-negative patients with cutaneous melanoma does not influence survival. J Eur Acad Dermatol Venereol 2019; 33:2291-2295. [PMID: 31318994 PMCID: PMC6899805 DOI: 10.1111/jdv.15814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/08/2019] [Indexed: 12/02/2022]
Abstract
Background Melanoma patients with intra‐nodal nevi (INN) and without melanoma metastasis in the sentinel lymph node biopsy (SLNB) are generally treated as patients with negative SLNB. However, diagnosis of INN may be difficult and nodal melanoma metastases may falsely be regarded as INN. Objectives Our aim was to evaluate the clinical significance of INN in the SLNB in patients with primary cutaneous melanoma on a nationwide level in The Netherlands by comparing survival between three groups: patients with INN and without nodal melanoma metastasis (INN group), patients without INN and without nodal melanoma metastasis (negative SLNB group) and patients with nodal melanoma metastasis irrespective of INN (positive SLNB group). Methods Data were obtained from ‘PALGA’, the Dutch Nationwide Network and Registry of Histopathology and Cytopathology, yielding a cohort of adults with histologically proven, primary, invasive cutaneous melanoma patients in The Netherlands diagnosed between 2000 and 2014 who underwent SLNB. Clinical and pathological variables were extracted from the pathology text files. Differences between patients with INN, negative SLNB and positive SLNB were analysed using Kaplan–Meier analysis. Results A total of 11 274 patients were eligible for inclusion. The prevalence of INN in the SLNB was 5.0%. Melanomas with INN had similar median Breslow thickness compared to melanomas with negative SLNB and were more frequently located on trunk and upper limbs and observed in younger patients compared to melanomas with negative and positive SLNB. Overall survival of patients with INN showed no significant difference compared with negative SLNB (median follow‐up of 5.7 years of all patients). Conclusions As there seems to be no difference in overall survival between patients with INN and negative SLNB, the diagnosis of INN seems to be reliable. Current practice to treat patients with INN as patients with negative SLNB appears to be appropriate.
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Affiliation(s)
- F S A de Beer
- Department of Allergology and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Allergology and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M El Sharouni
- Department of Allergology and Dermatology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Affiliation(s)
- Celeste Mirte Boesjes
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bram Doron van Rhijn
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Vigfús Sigurdsson
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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El Sharouni MA, Witkamp A, Sigurdsson V, van Diest PJ. ASO Author Reflections: Sentinel Lymph Node Biopsy Trend in Melanoma: The More the Merrier. Ann Surg Oncol 2019; 26:723-724. [PMID: 31489554 PMCID: PMC6901397 DOI: 10.1245/s10434-019-07660-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Mary-Ann El Sharouni
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Arjen Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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El Sharouni MA, Witkamp AJ, Sigurdsson V, van Diest PJ. Comparison of Survival Between Patients With Single vs Multiple Primary Cutaneous Melanomas. JAMA Dermatol 2019; 155:1049-1056. [PMID: 31241717 DOI: 10.1001/jamadermatol.2019.1134] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Melanoma is one of the most rapidly increasing forms of cancer worldwide. Most studies about survival among patients with melanoma consider only the primary tumor and disregard the potential effect of multiple primary tumors. A better understanding of the prognosis of patients with multiple primary melanoma is important for patient counselling and follow-up strategies. Objective To describe the epidemiologic features of multiple primary melanoma in patients from the Netherlands. Design, Setting, and Participants This retrospective, population-based cohort study included adults with histologically proven, primary, invasive cutaneous melanoma in the Netherlands between January 1, 2000, and December 31, 2014, with a median follow-up of 75.1 months, using data from PALGA, the Dutch Nationwide Network and Registry of Histopathology and Cytopathology. Follow-up data were retrieved from the Netherlands Cancer Registry. Statistical analysis was performed from August 1, 2018, to September 3, 2018. Main Outcomes and Measures A multivariable Cox model with a time-varying covariate was performed to assess overall survival between patients with a single primary melanoma vs those with multiple primary melanomas. Secondary outcomes included incidence of multiple primary melanoma, differences in Breslow thickness, and time between first and second multiple primary melanoma. Results Of the 56 929 study patients, 31 916 (56.1%) were female, with a mean (SD) age of 56.4 (16.2) years. A total of 54 645 single primary melanomas and 4967 multiple primary melanomas in 2284 patients were included. The median Breslow thickness decreased from 0.90 mm (interquartile range, 0.55-1.70 mm) for the first melanoma to 0.65 mm (interquartile range, 0.45-1.10 mm) for the second melanoma (P < .001). For their second melanoma, 370 patients (16.2%) had a higher T stage, 1112 (48.7%) had the same T stage, and 802 (35.1%) had a lower T stage. In addition, 841 of 2284 second melanomas (36.8%) in patients with multiple primary melanomas were found during the first year of follow-up, whereas 624 of 2284 (27.3%) were found after 5 years of follow-up. These proportions did not vary when stratified for melanoma stage. Worse overall survival was seen among patients with multiple primary melanomas compared with patients with a single primary melanoma (hazard ratio, 1.31; 95% CI, 1.20-1.42; P < .001). Conclusions and Relevance A significant decrease in Breslow thickness between the first and second multiple primary melanoma was found, and overall survival among patients with multiple primary melanomas was significantly worse than that among patients with a single primary melanoma. These findings suggest that more strict follow-up strategies may be warranted for patients with multiple primary melanomas.
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Affiliation(s)
- Mary-Ann El Sharouni
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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El Sharouni MA, Witkamp AJ, Sigurdsson V, van Diest PJ, Louwman MWJ, Kukutsch NA. Sex matters: men with melanoma have a worse prognosis than women. J Eur Acad Dermatol Venereol 2019; 33:2062-2067. [PMID: 31246315 DOI: 10.1111/jdv.15760] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/06/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND In Europe, one of the highest melanoma incidences is found in the Netherlands. Like in several other European countries, females are more prone to develop melanoma as compared to males, although survival is worse for men. OBJECTIVE To identify clinicopathological gender-related differences that may lead to gender-specific preventive measures. METHODS Data from the Dutch Nationwide Network and Registry of Histopathology and Cytopathology (PALGA) were retrieved from patients with primary, cutaneous melanoma in the Netherlands between 2000 and 2014. Patients initially presenting as stage I, II and III without clinically detectable nodal disease were included. Follow-up data were retrieved from the Netherlands Cancer Registry. Gender-related differences were assessed, and to compare relative survival between males and females, multivariable relative excess risks (RER) were calculated. RESULTS A total of 54.645 patients were included (43.7% men). In 2000, 41.7% of the cohort was male, as compared to 47.3% in 2014 (P < 0.001). Likewise, in 2000, 51.5% of the deceased cohort was male compared to 60.1% in 2014 (P < 0.001). Men had significantly thicker melanomas at the time of diagnosis [median Breslow thickness 1.00 mm (interquartile range (IQR): 0.60-2.00) vs. 0.82 mm (IQR: 0.50-1.50) for females] and were significantly older at the time of diagnosis, more often had ulcerated melanomas and melanomas localized on the trunk or head and neck. Over time, survival for females improved while that of men decreased (P < 0.001). RER for dying was 1.37 (95% CI: 1.31-1.45) for men in multivariable analysis. CONCLUSION There are evident clinicopathological differences between male and female melanoma patients. After multivariable correction for all these differences, relative survival remains worse for men. Clinicians as well as persons at risk for melanoma should be aware of these differences, as awareness and prevention might lead to a lower incidence and mortality of melanoma. This indicates the need of prevention campaigns integrating and targeting specific risk profiles.
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Affiliation(s)
- M A El Sharouni
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - P J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M W J Louwman
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - N A Kukutsch
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
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El Sharouni MA, Witkamp AJ, Sigurdsson V, van Diest PJ. Probability of sentinel lymph node positivity in melanoma. Eur J Cancer 2019; 116:10-12. [DOI: 10.1016/j.ejca.2019.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/27/2019] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Over recent years, sentinel lymph node biopsy (SLNB) recommendations in guidelines for cutaneous melanoma have changed considerably. We aimed to assess trends in enactment of SLNB to evaluate to what extent guidelines were adhered to, and to identify clinical and pathological determinants of (non-)adherence. METHODS Clinicopathological data from the Dutch nationwide network and registry of histopathology and cytopathology were retrieved from patients diagnosed with primary cutaneous melanoma in The Netherlands between 2003 and 2014. SLNB enactment was analyzed per year. Multivariable regression models were developed to assess the determinants of SLNB enactment. RESULTS A total of 51,510 primary cutaneous melanomas in 49,514 patients were diagnosed, of which 24,603 melanomas were eligible for SLNB as they were staged T1b or higher. In practice, only 9761 (39.7%) patients underwent SLNB, with an increasing trend from 39.1% in 2003 to 47.8% in 2014 (p < 0.001). A total of 759 (2.9%) of 26,426 patients without SLNB indication underwent SLNB anyway. Variables significantly associated with enactment of SLNB were male sex, younger age, and melanoma on sites other than the head and neck. CONCLUSIONS Although there was an increasing trend in time in SLNB enactment, enactment of SLNB did not comply well with recommendations in (inter)national guidelines. Female sex, higher age, and melanoma located on the head and neck were associated with non-enactment of SLNB.
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Affiliation(s)
- Mary-Ann El Sharouni
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Arjen J Witkamp
- Department of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Leijten EFA, Sigurdsson V, Wenink MH, Radstake TRDJ. Screening for psoriatic arthritis using the Psoriasis Epidemiology Screening Tool questionnaire: examining the optimal cut-off. Br J Dermatol 2017; 176:1357-1359. [PMID: 27515861 DOI: 10.1111/bjd.14953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- E F A Leijten
- Department of Rheumatology and Clinical Immunology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - M H Wenink
- Sint Maartenskliniek, Department of Rheumatology, Nijmegen, Gelderland, The Netherlands
| | - T R D J Radstake
- Department of Rheumatology and Clinical Immunology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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Hammoud SM, Kruis RWJ, Sigurdsson V. Prediction of the Occurrence of Melanoma and Non-melanoma Skin Cancer in Patients with Vitiligo. Acta Derm Venereol 2016; 96:106-7. [PMID: 26084211 DOI: 10.2340/00015555-2179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shedia M Hammoud
- Department of Internal Medicine, Tergooi Ziekenhuis, 1201DA Hilversum, The Netherlands.
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Klemans RJB, Le TM, Sigurdsson V, Enters-Weijnen CF, van Hoffen E, Bruijnzeel-Koomen CAFM, Knulst AC. Management of acute food allergic reactions by general practitioners. Eur Ann Allergy Clin Immunol 2013; 45:43-51. [PMID: 23821832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Food is one of the leading causes of anaphylaxis. In the Netherlands, patients visit a general practitioner (GP) as often as an emergency department (ED) in case of an acute food allergic reaction. So far, the management of food allergic reactions by GPs has not been investigated. Therefore, we explored the management of acute food allergic reactions by GPs regarding specific treatment, observation period, prescription of emergency medication to treat new episodes, diet advices and referral to a specialist. METHODS A questionnaire containing three hypothetical cases (two anaphylactic and one mild case) with questions about their management was sent to 571 GPs. RESULTS Overall, treatment choice was dependent on the severity of the reaction (mild vs. anaphylaxis, P < .001). However, epinephrine was used for treatment of anaphylaxis with mainly respiratory symptoms in only 27% and for anaphylaxis with mainly cardiovascular symptoms in 73%. At discharge, the percentages for prescription of self-injectable epinephrine were 53% and 77%, respectively. A short observation period of <2 hours was advised by 42% of general practitioners in case of anaphylaxis. CONCLUSIONS Treatment of food induced anaphylaxis by GPs appears to be suboptimal: a considerable number of patients would not be treated with epinephrine for the acute reaction (especially anaphylactic cases with respiratory symptoms), the observation period chosen by GPs was often too short and self-injectable epinephrine was not always prescribed at discharge to treat possible new episodes. Education programs are needed to increase the awareness of GPs to recognize and treat anaphylactic reactions.
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Affiliation(s)
- R J B Klemans
- Department of Dermatology/Allergology, University Medical Center Utrecht, The Netherlands.
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Kracht PAM, Sigurdsson V, Hoogewerf M, Arends JE. A leg with an ulcer. Neth J Med 2012; 70:85-89. [PMID: 22418756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- P A M Kracht
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands.
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Koek MBG, Sigurdsson V, van Weelden H, Steegmans PHA, Bruijnzeel-Koomen CAFM, Buskens E. Cost effectiveness of home ultraviolet B phototherapy for psoriasis: economic evaluation of a randomised controlled trial (PLUTO study). BMJ 2010; 340:c1490. [PMID: 20406865 PMCID: PMC2857750 DOI: 10.1136/bmj.c1490] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the costs and cost effectiveness of phototherapy with ultraviolet B light provided at home compared with outpatient ultraviolet B phototherapy for psoriasis. DESIGN Cost utility, cost effectiveness, and cost minimisation analyses performed alongside a pragmatic randomised clinical trial (the PLUTO study) at the end of phototherapy (mean 17.6 weeks) and at one year after the end of phototherapy (mean 68.4 weeks). SETTING Secondary care, provided by a dermatologist in the Netherlands. PARTICIPANTS 196 adults with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy were recruited from the dermatology departments of 14 hospitals and were followed until the end of phototherapy. From the end of phototherapy onwards, follow-up was continued for an unselected, consecutive group of 105 patients for one year after end of phototherapy. INTERVENTIONS Ultraviolet B phototherapy provided at home (intervention) and conventional outpatient ultraviolet B phototherapy (control) in a setting reflecting routine practice in the Netherlands. Both treatments used narrowband ultraviolet B lamps (TL-01). MAIN OUTCOME MEASURES Total costs to society, quality adjusted life years (QALYs) as calculated using utilities measured by the EQ-5D questionnaire, and the number of days with a relevant treatment effect (>/=50% improvement of the baseline self administered psoriasis area and severity index (SAPASI)). RESULTS Home phototherapy is at least as effective and safe as outpatient phototherapy, therefore allowing cost minimisation analyses (simply comparing costs). The average total costs by the end of phototherapy were euro800 for home treatment and euro752 for outpatient treatment, showing an incremental cost per patient of euro48 (95% CI euro-77 to euro174). The average total costs by one year after the end of phototherapy were euro1272 and euro1148 respectively (difference euro124, 95% CI euro-155 to euro403). Cost utility analyses revealed that patients experienced equal health benefits-that is, a gain of 0.296 versus 0.291 QALY (home v outpatient) by the end of phototherapy (difference 0.0052, -0.0244 to 0.0348) and 1.153 versus 1.126 QALY by one year after the end of phototherapy (difference 0.0267, -0.024 to 0.078). Incremental costs per QALY gained were euro9276 and euro4646 respectively, both amounts well below the normally accepted standard of euro20 000 per QALY. Cost effectiveness analyses indicated that the mean number of days with a relevant treatment effect was 42.4 versus 55.3 by the end of phototherapy (difference -12.9, -23.4 to -2.4). By one year after the end of phototherapy the number of days with a relevant treatment effect were 216.5 and 210.4 respectively (6.1, -41.1 to 53.2), yielding an incremental cost of euro20 per additional day with a relevant treatment effect. CONCLUSIONS Home ultraviolet B phototherapy for psoriasis is not more expensive than phototherapy in an outpatient setting and proved to be cost effective. As both treatments are at least equally effective and patients express a preference for home treatment, the authors conclude that home phototherapy should be the primary treatment option for patients who are eligible for phototherapy with ultraviolet B light. TRIAL REGISTRATION Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930.
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Affiliation(s)
- Mayke B G Koek
- Department of Dermatology/Allergology (G02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
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Koek MBG, Buskens E, Bruijnzeel-Koomen CA, Sigurdsson V. Authors' reply. West J Med 2009. [DOI: 10.1136/bmj.b2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Koek MBG, Buskens E, van Weelden H, Steegmans PHA, Bruijnzeel-Koomen CAFM, Sigurdsson V. Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study). BMJ 2009; 338:b1542. [PMID: 19423623 PMCID: PMC2679120 DOI: 10.1136/bmj.b1542] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether ultraviolet B phototherapy at home is equally safe and equally effective as ultraviolet B phototherapy in an outpatient setting for patients with psoriasis. DESIGN Pragmatic multicentre single blind randomised clinical trial (PLUTO study). SETTING Dermatology departments of 14 hospitals in the Netherlands. PARTICIPANTS 196 patients with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy. The first 105 consecutive patients were also followed for one year after therapy. INTERVENTION Ultraviolet B phototherapy at home using a TL-01 home phototherapy unit compared with standard narrowband ultraviolet B phototherapy in an outpatient setting. Both therapies were done in a setting reflecting routine daily practice in the Netherlands. MAIN OUTCOME MEASURES The main outcome measure was effectiveness as measured by the proportion of patients with a 50% or more reduction of the baseline psoriasis area and severity index (PASI) or self administered psoriasis area and severity index (SAPASI), called the PASI 50 and SAPASI 50 (relevant treatment effect). Another outcome of effectiveness was the percentage reduction in median scores on the PASI as well as SAPASI. Also the proportions of patients reaching the PASI 75 and SAPASI 75 (successful treatment effect), and the PASI 90 and SAPASI 90 (almost complete clearance) were calculated. Other secondary outcomes were quality of life (SF-36, psoriasis disability index), burden of treatment (questionnaire), patients' preferences and satisfaction (questionnaire), and dosimetry and short term side effects (diary). RESULTS 82% of the patients treated at home compared with 79% of the patients treated in an outpatient setting reached the SAPASI 50 (difference 2.8%, 95% confidence interval -8.6% to 14.2%), and 70% compared with 73% reached the PASI 50 (-2.3%, -15.7% to 11.1%). For patients treated at home the median SAPASI score decreased 82% (from 6.7 to 1.2) and the median PASI score decreased 74% (from 8.4 to 2.2), compared with 79% (from 7.0 to 1.4) and 70% (from 7.0 to 2.1) for patients treated in an outpatient setting. Treatment effect as defined by the mean decline in PASI and SAPASI scores was significant (P<0.001) and similar across groups (P>0.3). Total cumulative doses of ultraviolet B light were similar (51.5 v 46.1 J/cm(2), difference 5.4, 95% confidence interval -5.2 to 16.0), and the occurrence of short term side effects did not differ. The burden of undergoing ultraviolet B phototherapy was significantly lower for patients treated at home (differences 1.23 to 3.01, all P=0.001). Quality of life increased equally regardless of treatment, but patients treated at home more often rated their experience with the therapy as "excellent" (42%, 38/90) compared with patients treated in the outpatient department (23%, 20/88; P=0.001). CONCLUSION Ultraviolet B phototherapy administered at home is equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting. Furthermore, ultraviolet B phototherapy at home resulted in a lower burden of treatment and led to greater patients' satisfaction. Trial registration Current Controlled Trials ISRCTN83025173 and Clinicaltrials.gov NCT00150930.
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Affiliation(s)
- Mayke B G Koek
- Department of Dermatology/Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.
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Abstract
In Sweet's syndrome, the essential features are the characteristic morphology of the lesions, their histologic appearance, the dramatic response to corticosteroids and the absence of scarring. We report an 8-month-old infant in whom Sweet's syndrome was diagnosed and who developed acquired cutis laxa in the skin lesions.
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Affiliation(s)
- L Timmer-DE Mik
- Department of Dermatology and Allergology, University Medical Center, Utrecht, The Netherlands
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Quispel R, van Boxel OS, Schipper ME, Sigurdsson V, Canninga-van Dijk MR, Kerckhoffs A, Smout AJ, Samsom M, Schwartz MP. High prevalence of esophageal involvement in lichen planus: a study using magnification chromoendoscopy. Endoscopy 2009; 41:187-93. [PMID: 19280529 DOI: 10.1055/s-0028-1119590] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND STUDY AIMS The first cases of squamous cell carcinoma in esophageal lichen planus were recently described. We performed a study to establish the prevalence of endoscopic and histopathologic abnormalities consistent with lichen planus and (pre-) malignancy in a cohort of patients with lichen planus. PATIENTS AND METHODS A total of 24 patients with lichen planus were prospectively studied using high-magnification chromoendoscopy. Focal esophageal abnormalities were mapped, classified, and biopsied. Biopsies were also taken from normal-appearing esophageal mucosa at three levels (proximal, middle, and distal). The presence of a lymphohistiocytic interface inflammatory infiltrate and Civatte bodies (i. e. apoptotic basal keratinocytes) at histopathologic examination was considered diagnostic for esophageal lichen planus. Symptoms were assessed using validated questionnaires. RESULTS A total of 38 focal abnormalities were biopsied. These consisted of: layers of mucosa peeling off, hyperemic lesions, papular lesions, submucosal plaques/papules, a flat polypoid lesion, and segments of cylindrical epithelium. No endoscopic signs of dysplasia were present. Esophagitis consistent with gastroesophageal reflux disease was noted in 12 / 24 patients. Histopathology showed chronic inflammation of the esophageal mucosa in the majority (18 / 24) of patients. In 50 % (12 / 24), the diagnosis of esophageal lichen planus was made. Dysplasia was not present. There were no differences in symptoms between patients with and without esophageal lichen planus. CONCLUSIONS At screening endoscopy a high prevalence (50 %) of esophageal lichen planus was found in patients with orocutaneous lichen planus. No dysplasia was found.
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Affiliation(s)
- R Quispel
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Schornagel IJ, Guikers KLH, Van Weelden H, Brijnzeel-Koomen CAFM, Sigurdsson V. The polymorphous light eruption–severity assessment score does not reliably predict the results of phototesting. J Eur Acad Dermatol Venereol 2008; 22:675-80. [DOI: 10.1111/j.1468-3083.2008.02633.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sigurdsson V. [The practice guideline 'Acne' (second revision) from the Dutch College of General Practitioners; a response from the perspective of dermatology]. Ned Tijdschr Geneeskd 2008; 152:1255-1256. [PMID: 18590057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The second revised practice guideline 'Acne' from the Dutch College of General Practitioners contains adequate and scientifically well-supported recommendations for the management of patients with acne. There are some concerns about the initial treatment steps in these guidelines which only allow very slow progress to systemic therapy. This might, in some cases, lead to inadequate treatment of patients with more severe acne.
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Affiliation(s)
- V Sigurdsson
- Universitair Medisch Centrum Utrecht, afd. Dermatologie, Allergologie en Venereologie, Postbus 85.500, 3508 GA Utrecht.
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40
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Tjin-A-ton MLR, van Montfrans C, Koldenhof JJ, Sigurdsson V, Voest EE, Witteveen PO. [Skin eruptions as an adverse reaction to epidermal growth-factor receptor inhibitors]. Ned Tijdschr Geneeskd 2007; 151:945-52. [PMID: 17520845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Inhibition of the epidermal growth-factor receptor (EGFR) is a new strategy in the treatment of solid malignancies. Two men, aged 65 and 59 years, with a metastasized renal carcinoma and a 51-year-old man with a metastasized melanoma developed an acneiform eruption during EGFR inhibition. The second and third patient also developed paronychia. Treatment in all patients consisted of antiseptics and topical antibiotics; the first and third patient also received an oral antibiotic. Withdrawal of the EGFR inhibitor because of progression of the disease led to complete recovery of the cutaneous lesions in the first and the third patient; both died after several months. In the second patient, the side effects reached an acceptable level during continued EGFR therapy. EGFR inhibition is usually accompanied by cutaneous side effects. An acneiform eruption is seen in up to 90% of all treated patients. Other side effects include dry skin, and nail and hair changes. The pathogenesis of these side effects is related to inhibition of EGFR signalling pathways in the skin, but is not yet fully understood. The treatment of EGFR inhibitor-mediated cutaneous toxicity is based mainly on clinical experience.
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Affiliation(s)
- M L R Tjin-A-ton
- Universitair Medisch Centrum Utrecht, divisie Interne Geneeskunde en Dermatologie, Heidelberglaan 100, 3584 CX Utrecht
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Koek MBG, Buskens E, Bruijnzeel-Koomen CAFM, Sigurdsson V. Home ultraviolet B phototherapy for psoriasis: discrepancy between literature, guidelines, general opinions and actual use. Results of a literature review, a web search, and a questionnaire among dermatologists. Br J Dermatol 2006; 154:701-11. [PMID: 16536814 DOI: 10.1111/j.1365-2133.2006.07136.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Home ultraviolet B (UVB) phototherapy is a debated treatment. It is currently being prescribed for patients with psoriasis, although literature on the subject is scarce. Despite the apparent contradiction between clinical practice and literature, no systematic study of either has been conducted. OBJECTIVES To assess and compare the available publications and guidelines about home UVB phototherapy for psoriasis with the actual opinions and use of this therapy. METHODS The literature and guidelines were searched using databases, search engines and e-mail. A postal survey of 343 Dutch dermatologists and 142 dermatologists from 32 other countries was carried out; 255 and 102 dermatologists respectively responded. Outcome measures were the reported advantages, drawbacks and prescription rates of home UVB phototherapy. RESULTS Fourteen publications (nonrandomized) and six guidelines concerning home UVB phototherapy for psoriasis were identified. Most were reticent about the use of this treatment. Publications describing nonclinical research (7/14) reported most of the drawbacks mentioned (24/31). Home UVB phototherapy was prescribed to 5% (median) of all patients with psoriasis in The Netherlands who required UVB. However, 28% (68/244) of the Dutch dermatologists prescribed home UVB in 20 to 100% of their cases. Dermatologists from other countries reported that 0-10% of UVB treatments were offered at home. For both Dutch and other dermatologists, the most important reasons for prescribing home UVB concerned time and travel distance (80%, i.e. 163 of 205 and 75%, i.e. 33 of 44). Therapy-related drawbacks (such as poor service and equipment) were the objections mentioned most often (55%, i.e. 103 of 186 and 63%, i.e. 57 of 91). Concerns about the medicolegal liability of home UVB were rarely expressed by individual respondents, but frequently mentioned in the various reports. CONCLUSIONS A discrepancy exists between the actual use of home UVB phototherapy and the general opinions found in publications. The treatment is prescribed for a considerable number of patients despite the fact that literature and guidelines advise caution. Personal and nonevidence-based opinions on this therapy are widespread while randomized clinical studies have thus far not been conducted.
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Affiliation(s)
- M B G Koek
- Department of Dermatology/Allergology (G 02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Koek MBG, Buskens E, Steegmans PHA, van Weelden H, Bruijnzeel-Koomen CAFM, Sigurdsson V. UVB phototherapy in an outpatient setting or at home: a pragmatic randomised single-blind trial designed to settle the discussion. The PLUTO study. BMC Med Res Methodol 2006; 6:39. [PMID: 16882343 PMCID: PMC1574336 DOI: 10.1186/1471-2288-6-39] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 08/01/2006] [Indexed: 11/22/2022] Open
Abstract
Background Home ultraviolet B (UVB) treatment is a much-debated treatment, especially with regard to effectiveness, safety and side effects. However, it is increasingly being prescribed, especially in the Netherlands. Despite ongoing discussions, no randomised research has been performed, and only two studies actually compare two groups of patients. Thus, firm evidence to support or discourage the use of home UVB phototherapy has not yet been obtained. This is the goal of the present study, the PLUTO study (Dutch acronym for "national trial on home UVB phototherapy for psoriasis"). Methods We designed a pragmatic randomised single-blind multi-centre trial. This trial is designed to evaluate the impact of home UVB treatment versus UVB phototherapy in a hospital outpatient clinic as to effectiveness, quality of life and cost-effectiveness. In total 196 patients with psoriasis who were clinically eligible for UVB phototherapy were included. Normally 85% of the patients treated with UVB show a relevant clinical response. With a power of 80% and a 0.05 significance level it will be possible to detect a reduction in effectiveness of 15%. Effectiveness will be determined by calculating differences in the Psoriasis Area and Severity Index (PASI) and the Self Administered PASI (SAPASI) scores. Quality of life is measured using several validated generic questionnaires and a disease-specific questionnaire. Other outcome measures include costs, side effects, dosimetry, concomitant use of medication and patient satisfaction. Patients are followed throughout the therapy and for 12 months thereafter. The study is no longer recruiting patients, and is expected to report in 2006. Discussion In the field of home UVB phototherapy this trial is the first randomised parallel group study. As such, this trial addresses the weaknesses encountered in previous studies. The pragmatic design ensures that the results can be well generalised to the target population. Because, in addition to effectiveness, aspects such as quality of life and cost-effectiveness are also taken into consideration, this study will produce valuable evidence to either support or discourage prescription of home UVB phototherapy. Trial registration Current controlled trials/Nederlands Trial register: ISRCTN83025173. Clinicaltrials.gov: NCT00150930
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Affiliation(s)
- Mayke BG Koek
- Department of Dermatology/Allergology (G02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Erik Buskens
- Julius Center for Health Sciences and Primary Care (Str. 6.131), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Paul HA Steegmans
- Department of Dermatology/Allergology (G02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Department of Dermatology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Huib van Weelden
- Department of Dermatology/Allergology (G02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Carla AFM Bruijnzeel-Koomen
- Department of Dermatology/Allergology (G02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology/Allergology (G02.124), University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Schornagel IJ, Knol EF, van Weelden H, Guikers CLH, Bruijnzeel-Koomen CAFM, Sigurdsson V. Diagnostic phototesting in polymorphous light eruption: the optimal number of irradiations. Br J Dermatol 2006; 153:1234-6. [PMID: 16307671 DOI: 10.1111/j.1365-2133.2005.06954.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vulink NCC, Sigurdsson V, Kon M, Bruijnzeel-Koomen CAFM, Westenberg HGM, Denys D. [Body dysmorphic disorder in 3-8% of patients in outpatient dermatology and plastic surgery clinics]. Ned Tijdschr Geneeskd 2006; 150:97-100. [PMID: 16440565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To determine the 6-month prevalence of body dysmorphic disorder (BDD) in outpatient clinics of dermatology and plastic surgery in a university medical centre. DESIGN Questionnaire study. METHOD In the period January 2004-June 2004, the self-reported Body dysmorphic disorder questionnaire was completed by 530 and 475 new patients in the outpatient clinics of dermatology and plastic surgery, respectively. The dermatologist or plastic surgeon assessed the severity of the defect. To meet the DSM-IV criteria for BDD, the patient must have been preoccupied with treatment of all or part of their appearance, experienced obvious suffering or restriction of function with minimal or no defect present (defect score 1 or 2). RESULTS In the outpatient clinics ofdermatology and plastic surgery 8.5% (95% CI: 6.1-10.9) and 3.2% (95% CI: 1.7-4.7) of patients screened positive for BDD, respectively. CONCLUSION A high prevalence of BDD was found in the outpatient clinics ofdermatology and plastic surgery. Because dermatologists and plastic surgeons do not often recognise BDD, a simple screening tool is needed.
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Affiliation(s)
- N C C Vulink
- Universitair Medisch Centrum Utrecht, B.01.206, Postbus 85.500, 3508 GA Utrecht.
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Haks K, Schout C, Cremer WS, Sigurdsson V, van Ameijden EJC. [Increased consultations and numbers of sexually transmitted diseases at the STD clinic of Utrecht, 1994-2002]. Ned Tijdschr Geneeskd 2004; 148:1632-5. [PMID: 15455511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To determine trends in numbers of visitors and their demographic characteristics, reasons for visit, number of STDs and high-risk groups. DESIGN Secondary analysis of registration data. METHOD Data of every client that visited the STD clinic in Utrecht, the Netherlands, were aggregated from 1994 to 2002 in order to analyse trends. RESULTS The number of visitors as well as the number of STDs rose strongly over the period investigated. The age of the visitors decreased. In 1994 17% of the visitors was born outside the Netherlands, in 2002 6%. The majority of the clients (56%) visited the STD clinic to get themselves tested preventively and 27% came because of symptoms. Visitors with symptoms or who were warned by others had a three-fold increased risk of having an STD. Other risk groups were: homosexual men, visitors born outside the Netherlands and visitors who have had an STD before. Groups with an increased risk of having a Chlamydia trachomatis infection were: visitors aged under 34 years old and visitors born in Morocco, Surinam and the Antilles. The number of Chlamydia infections rose sharply among homosexual male visitors. CONCLUSION The increase in the number of visitors and of STD requires an increase in STD prevention, aimed at high-risk groups. More research is needed into the limited help-seeking behaviour of immigrants and more attention needs to be paid to Chlamydia trachomatis infections among homosexual men.
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Affiliation(s)
- K Haks
- GG&GD, Postbus 2423, 3500 GK Utrecht.
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Schornagel IJ, Sigurdsson V, Nijhuis EHJ, Bruijnzeel-Koomen CAFM, Knol EF. Decreased Neutrophil Skin Infiltration After UVB Exposure in Patients with Polymorphous Light Eruption. J Invest Dermatol 2004; 123:202-6. [PMID: 15191561 DOI: 10.1111/j.0022-202x.2004.22734.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
UV radiation, in particular UVB, suppresses the skin immune response. In patients with polymorphous light eruption (PLE) the skin immune response seems activated after UV exposure. Typical PLE skin lesions can occur as early as several hours after UV exposure. In healthy volunteers, neutrophils infiltrate the skin shortly after UV exposure. The kinetics and mechanisms of neutrophil infiltration in the skin of PLE patients after UVB exposure was studied. Skin biopsies at 0, 3, 6, and 18 h were taken from five PLE patients and six healthy controls after irradiation with three minimal erythema dose UVB. Furthermore, neutrophils were isolated from blood of five PLE patients and six healthy controls to test their chemotactic activity. Immunohistochemical analysis showed a significant decreased neutrophil infiltration in PLE skin after UVB irradiation compared with healthy controls (p<0.05). In both healthy controls and PLE patients, after UVB irradiation, ICAM-1 and E-selectin expression on endothelial cells increased at 6 h after irradiation. Blood neutrophil chemotactic response towards IL-8 and C5a, as well as the expression of cell surface markers involved in adhesion and chemotaxis, was not different between PLE patients and healthy controls. In conclusion, PLE is marked by a decreased skin infiltration of neutrophils after UVB irradiation, possibly leading to a diminished neutrophil-induced suppression.
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Affiliation(s)
- Ines J Schornagel
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
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47
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Engelen JW, Kooistra MP, Canninga-van Dijk MR, Toonstra J, Sigurdsson V. [Nephrogenic fibrosing dermopathy]. Ned Tijdschr Geneeskd 2003; 147:2435-8. [PMID: 14694555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
A 58-year-old man with renal insufficiency, who was being treated by haemodialysis, developed progressive skin lesions. He had thickening and hardening of the skin at the extremities and swelling of the toes and fingers with flexion contractures. His face was not affected. Laboratory evaluation was unremarkable and a skin biopsy [table: see text] showed an increase of collagen and mucin, without an inflammatory infiltrate. These clinical features resemble a recently reported new disorder: nephrogenic fibrosing dermopathy. This disorder manifests as scleromyxedema-like cutaneous skin lesions without associated paraproteinemia, occurring in the setting of renal disease. The histopathologic features of nephrogenic fibrosing dermopathy, i.e. thickened collagen and mucin deposition, are unique. The incidence, prevalence and cause of the disease are unknown and there is currently no effective treatment. The Centers for Disease Control and Prevention (CDC) in the USA are calling on physicians who have encountered patients suffering from this type of lesions to contact the CDC for an intended control study.
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Affiliation(s)
- J W Engelen
- Afd. Dermatologie, Universitair Medisch Centrum Utrecht, Postbus 85.500, 3508 GA Utrecht.
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Sanders CJG, Van Weelden H, Kazzaz GAA, Sigurdsson V, Toonstra J, Bruijnzeel-Koomen CAFM. Photosensitivity in patients with lupus erythematosus: a clinical and photobiological study of 100 patients using a prolonged phototest protocol. Br J Dermatol 2003; 149:131-7. [PMID: 12890206 DOI: 10.1046/j.1365-2133.2003.05379.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is a clear relationship between ultraviolet (UV) radiation (UVR) and the clinical manifestations of patients with lupus erythematosus (LE). Cutaneous lesions are induced or exacerbated by exposure to UVR. Of patients with LE, 24-83% are reported to be photosensitive to UVR. LE tumidus appears to be the most photosensitive subtype of LE, followed by subacute cutaneous LE (SCLE). In general, the history of patients with LE correlates poorly with the presence or absence of photosensitivity, due to a delayed time interval between UV exposure and exacerbation of skin lesions. Phototesting using artificial UVR and visible light is a reliable way of diagnosing photosensitivity. OBJECTIVES To investigate the photoreactivity of patients with various subtypes of LE using an individualized phototest protocol. The results of phototests were correlated with the history of photosensitivity, the subtype of LE, the presence of autoantibodies and the use of anti-inflammatory medication by these patients. METHODS Phototesting with UVA, UVB and visible light was performed in 100 patients with LE. The diagnosis of LE was established both on clinical examination and skin histology. Serological studies were also performed in all patients. The phototests were performed on large skin areas of the forearm or trunk; the first dose was twice the minimal erythema dose and the dosage was increased according to the individual reactions of the patients at the test sites. Follow-up of skin reactions at the test sites was performed for up to 2 months. Histological examination of the photoprovoked skin lesions was carried out in 57 patients. RESULTS Of the 100 patients included (81 women and 19 men; mean age 41 years, range 17-79), 46 had chronic discoid LE, 30 SCLE and 24 systemic LE. An abnormal reaction to UVR and visible light was found in 93% of our patients with LE. No clinical or histological evidence at the phototest sites of polymorphic light eruption was found. There was no correlation between photosensitivity and LE subtype, presence of autoantibodies or medical history. Concomitant use of anti-inflammatory medication seemed to exert only minimal influence on the results of phototesting. CONCLUSIONS When using an extended phototesting protocol, almost all patients with LE in this study showed clinical and histological evidence of aberrant photosensitivity. Therefore, patients with LE should receive thorough advice and instruction on photoprotective measures, regardless of their history, LE subtype or presence of autoantibodies.
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Affiliation(s)
- C J G Sanders
- Department of Dermatology and Allergology, University Medical Centre, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Abstract
AIM To report on eight patients with severe idiopathic intermediate uveitis (IU) and granuloma annulare (GA), a self limiting cutaneous condition of unknown aetiology. METHODS Retrospective case series. Clinical ophthalmic and dermatological data were studied and fluorescein angiography and skin biopsies were reviewed. RESULTS All patients with idiopathic IU had similar ocular features (eight with vitritis, seven with retinal vasculitis) and developed complications such as cystoid macular oedema (n=5), cataract (n=4), and glaucoma (n=3). Systemic diseases were not found, but a localised type of GA was observed in all. CONCLUSION Seven out of eight patients with IU and GA developed severe retinal vasculitis. Further studies are needed for a better understanding of this association, a common pathogenesis, and its eventual clinical consequences.
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Affiliation(s)
- B van Kooij
- Department of Ophthalmology, FC Donders Institute, University Hospital Utrecht, The Netherlands.
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Mulder MM, Sigurdsson V, van Zuuren EJ, Klaassen EJ, Faber JA, de Wit JB, van Vloten WA. Psychosocial impact of acne vulgaris. evaluation of the relation between a change in clinical acne severity and psychosocial state. Dermatology 2002; 203:124-30. [PMID: 11586010 DOI: 10.1159/000051726] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although knowledge concerning the impact of acne vulgaris on quality of life has increased in recent years, relatively few studies have assessed the effect of a change in clinical severity on psychosocial state. OBJECTIVE Assessment of the effect of a change in clinical acne severity on psychosocial state. METHODS This was investigated by means of questionnaires and clinical assessments by acne patients and dermatologists. Fifty females with mild to moderate facial acne were seen before and after a 9-month treatment with oral contraceptives. RESULTS The results showed a great variability in psychosocial impairment between individuals. After 9 months, a significant reduction in clinical severity was seen overall which did not relate to the significant improvements in self-esteem, stability of self-esteem and acceptance of appearance. CONCLUSION Perceived psychosocial impairment is individually based, is greater in women who subjectively overrate their acne and does not relate to clinical improvement.
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Affiliation(s)
- M M Mulder
- Department of Dermatology and Venereology, University Medical Center Utrecht, The Netherlands
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