Clinics in dermatology最新文献

Fitzpatrick Skin Type (FST) is a classification for skin color, ranging from FST I (lightest skin tone) to FST VI (darkest skin tone), used to study risk and outcomes of cutaneous melanoma. Ocular melanoma includes primary melanoma in the eye region, including the conjunctiva and the uvea. There is little literature on the relationship of FST with ocular melanoma. Regarding conjunctival melanoma, one study evaluated 540 eyes with conjunctival melanoma and found that patients most often demonstrated FST I or II (85%). A comparison between FST I vs. II vs. III-VI showed that FST did not impact 5-year outcomes of metastasis or death. Regarding uveal melanoma, three separate studies evaluated 854 eyes with uveal melanoma and FST data. The first study explored the relationship of FST (FST I vs. II vs. III-V) with iris pigmentation. Patients with FST III-V and brown iris color were found to have larger mean tumor thickness (p=0.003) and basal diameter (p=0.001). The second study identified that patients with FST I demonstrated more high-grade tumor genetic mutations (odds ratio (OR) 2.34, p=0.002) whereas those with FST III-V demonstrated low-grade tumor genetic mutations (OR 2.26, p=0.002). The third report revealed patients with FST I showed greatest 10-year risk for metastasis (25% vs. 15% vs. 14%, p=0.02) and death (9% vs. 3% vs. 4%, p=0.04), perhaps related to advanced tumor genetic mutations. Herein, we summarize the published literature on the relationship of FST in 540 eyes with conjunctival melanoma and in 854 eyes with uveal melanoma.

Epidemiologic characteristics of melanoma in older adolescents and young adults (AYAs) patients aged 15 to 39 years are unknown. We examined the epidemiologic characteristics of melanoma in AYA patients and then extracted demographic and pathologic data for this retrospective cohort study from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2019). Cox regression analyses were used to assess the risk of all-cause death, cancer-specific death, and second primary malignancy. A total of 2,835 AYA patients with melanoma were included, of whom 926 (32.66%) had a second primary malignancy. The incidence of melanoma in AYAs patients decreased from 0.9 per 1,000,000 person-year in 2000 to 0.2 per 1,000,000 person-year in 2019, with the average annual percentage change (AAPC) of -6.3% (95% CI: -7.2% to -5.3%). Melanoma patients who were pigmented (hazard ratio (HR)=3.794; 95%CI: 1.382-10.412) were associated with an increased a risk of second primary malignancies, whereas patients with Breslow depth of >4 mm (HR=0.517; 95%CI: 0.379-0.706), melanoma site in the trunk (HR=0.700; 95%CI: 0.536-0.915), and extremities (HR=0.760; 95%CI: 0.585-0.988) were associated with a decreased risk of second primary malignancies. This study may provide statistical data on the epidemiologic characteristics of melanoma in patients with AYAs.

Authorship on a medical research publication signifies a significant contribution to a study, with first authorship indicating the individual with the most substantial input. Unfortunately, unethical misuse and misinterpretation of authorship persist, driven by increasing pressure on medical students to publish to secure competitive residencies. Assigning first authorship to medical students without meaningful contributions raises ethical concerns. We explore the root causes of authorship misuse, forms of authorship violations, and their practical and ethical implications for residency applications. We advocate for a shift toward a holistic evaluation of residency candidates, emphasizing the importance of fostering authentic and meaningful student research experiences. To uphold research integrity, authorship must be based on substantial contributions to study design, data collection, and manuscript preparation, ensuring fairness and credibility in scientific research.

We analyzed nationally and internationally recognized clinical practice guidelines (CPGs) for melanoma skin cancer to compare their therapeutic and diagnostic strategies. We considered internationally recognized melanoma skin cancer guidelines from the United States (American Academy of Dermatology, AAD), Germany (S3-Leitlinie Melanom) and Australia (Cancer Council Australia, CCA). We found widespread agreement in diagnostic approaches for cutaneous melanoma especially in surgical intervention and therapy for regional lymph node involvement. The first difference encountered was the German guidelines advising lymph node ultrasound from stage IB, while the American and Australian guidelines recommend it only when Sentinel Lymph Node Biopsy (SLNB) is not possible or denied by the patient. A different approach was observed in relation to the assessment of tumor marker S100B in stage III of cutaneous melanoma. The German guidelines advocate for the incorporation of S100B in baseline surveillance while Australia and America do not. Although there were some further minor differences, apart from the aforementioned two, all three guidelines under scrutiny exhibit a substantial level of agreement.

Nevoid melanoma is a rare subtype of melanoma that is regarded as one of the most difficult to diagnose. It clinically and histopathologically resembles a benign nevus, often resulting in misdiagnosis and allowing the skin cancer to progress further before it is identified. It presents clinically as an elevated brown papillomatous polypoid lesion on the trunk, arms, or legs; microscopically, it is defined by its relative symmetry, deep mitoses, and nevus-like melanocytes. In recent decades, studies have been carried out to understand nevoid melanoma and how it develops, progresses, and can be better identified. Technologic advancements in dermatoscopy, microscopy, and immunohistochemistry have allowed dermatologists and pathologists to have a better understanding of this variant of melanoma to permit an earlier diagnosis. Although nevoid melanoma is not any less aggressive or harmful than other subtypes of melanoma, delayed diagnosis of this skin cancer can be associated with adverse patient outcomes.

Pediatric melanoma is a rare but clinically significant public health concern, as it accounts for 7% of all malignancies in adolescents aged 15 to 19. Given the overall rarity of pediatric melanoma, especially in preadolescents, patients can go undetected, leading to a delay in treatment. We divide pediatric melanoma subtypes into three distinct age ranges-infantile, preadolescent, and adolescent-and distinguish the clinical features, prognosis, and associated risk factors of each age range. We next summarize the three predominant melanoma subtypes-Spitzoid melanoma, congenital melanocytic nevus-associated melanoma, and conventional (adult-type) melanoma-and provide distinguishing clinical, histologic, and genetic features from their difficult-to-differentiate benign counterparts. We conclude by reviewing consensus guidelines for pediatric melanoma staging and treatment, with a special emphasis on outlining barriers to adapting the advancements in targeted therapeutics into the standard care of pediatric melanoma.

Nodular melanoma (NM) is the second most common subtype of cutaneous melanoma (CM), accounting for a substantial proportion of melanoma fatalities. We assessed reviews, cross-sectional evaluations, published guidelines, and clinical reports to summarize the epidemiology, risk factors, clinical presentation, histopathology, molecular attributes, and treatment pearls for NM. Briefly, the incidence of NM and severity at diagnosis remain unchanged over recent decades, underscoring key diagnostic challenges driven by its rapid growth rate and sometimes unremarkable clinical presentation. Dermatoscopy and histopathology remain critical tools in diagnosing NM and may be supplemented with non-invasive imaging techniques such as reflectance confocal microscopy. Societal published guidelines do offer differing management recommendations based on CM subtype; yet, the often thicker and higher stage of NM at diagnosis has important implications for biopsy technique, utility of gene expression profiling, early collaboration with medical and surgical oncology colleagues, and initiation of systemic immunotherapies.

Acral lentiginous melanoma (ALM) is a rare subtype of cutaneous malignant melanoma not linked to UV exposure that carries a poor survival prognosis. ALM is defined by its acral location, involving the palms, soles, and subungual regions of the hands and feet, as well as by its unique clinical characteristics. We have reviewed the incidence, diagnostic standards, histopathology, dermatoscopic features, reflectance confocal microscopy features, genomic alterations, and treatment of ALM. In addition, several recent case reports are highlighted that showcase the diagnostic challenge that ALM can pose and the barriers to arriving at a prompt, accurate ALM diagnosis. Increased patient and provider education, empowering early detection and treatment, as well as the development of new more targeted therapeutics are critical to improving ALM outcomes.

Amelanotic melanoma (AM) is a subtype of cutaneous melanoma with little or no pigment on visual or histopathologic examination and accounts for approximately 2% of melanoma cases. This uncommon variant is often misdiagnosed or diagnosed in late stages due to its variable clinical presentation and lack of established criteria for clinical diagnosis. AM often presents nonspecifically as a pink to red macule, papule, or dermal nodule; therefore, dermatoscopy and reflectance confocal microscopy are extremely helpful tools in the diagnosis of AM. Histopathologically, there is an attenuation or complete absence of melanin granules, and immunohistochemistry for melanocytic markers, such as S100, Melan-A, and HMB-45, may be necessary for accurate diagnosis. Like other types of melanomas, the Breslow depth, presence or absence of ulceration, and mitotic rate are necessary for diagnosis, staging, and management. The standard of treatment for AM includes surgical excision with margins based on staging with sentinel lymph node biopsy, if indicated. We present the clinical and histopathologic features, special techniques, differential diagnosis, and current management of AM.

A changing melanocytic nevus during pregnancy should be biopsied promptly. For women with the dysplastic nevus syndrome, there may be more changes in nevi during pregnancy, requiring close monitoring. Melanoma is one of the most common malignancies that occurs during pregnancy. Those diagnosed with a localized melanoma before, during, or after pregnancy do not have an altered prognosis; however, a few studies have noted thicker melanomas and poorer prognosis when melanoma is diagnosed in the first year postpartum, possibly due to a delay in diagnosis. Although local excision of melanomas can be performed safely during pregnancy, sentinel lymph node biopsy during pregnancy is controversial for the timing and method. There are safe methods of imaging with some special precautions for staging in pregnant women. Systemic therapy requires an interdisciplinary team to assist in patient decision-making because some of these agents are teratogenic. There is no reason to withhold combined estrogen-progestin oral contraceptives or menopausal hormone therapy in those with a previous diagnosis of melanoma, nor should future pregnancies be delayed in those diagnosed with localized melanoma. Only limited data are available concerning prognosis for women with a melanoma diagnosis after in vitro fertilization.