JAMA dermatology最新文献

Importance: Acral lentiginous melanoma (ALM) is a rare but aggressive melanoma subtype. Distinguishing ALM from acral nevi remains difficult, underscoring the need for reliable dermoscopic criteria.

Objective: To systematically evaluate dermoscopic patterns that differentiate ALM from benign acral nevi.

Data sources: Embase, PubMed, Web of Science, MEDLINE, and the Cochrane Library were searched from January 1970 through March 2023 using controlled vocabulary (MeSH and Emtree) and natural language terms associated with acral melanoma, nevi, and diagnostic techniques. Searches were limited to English-language and human studies. Data analysis was conducted on November 1, 2024.

Data extraction and synthesis: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, reviewers independently extracted study data. Pooled proportions and prevalence differences were assessed using random-effects models.

Main outcomes and measures: The main outcome was the prevalence of dermoscopic features, including parallel ridge, parallel furrow, latticelike, multicomponent, and other pigmentation patterns, with pooled differences between ALM and nevi.

Results: Forty-one studies were included, comprising 8845 acral nevi (from 35 studies) and 801 ALMs (from 18 studies). The parallel ridge pattern was the most sensitive and specific feature for ALM (79.6% [95% CI, 71.4%-87.8%] vs 0.6% [95% CI, 0.3%-0.9%] in nevi; pooled difference, -77.3%; 95% CI, -85.0% to -69.6%; P < .001). Multicomponent structures were also significantly associated with ALM (45.8% [95% CI, 19.3%-72.2%] vs 5.0% [95% CI, 3.7%-6.2%] in nevi; pooled difference, -38.5%; 95% CI, -65.7% to -11.2%; P = .01). Conversely, parallel furrow (51.8% [95% CI, 46.7%-56.8%] in nevi vs 8.9% [95% CI, 5.3%-12.5%] in ALM; pooled difference, 41.3%; 95% CI, 33.1%-49.5%; P < .001) and latticelike patterns (13.0% [95% CI, 10.6%-15.5%] in nevi vs 2.7% [95% CI, 1.0%-4.5%] in ALM; pooled difference, 8.9%; 95% CI, 4.2%-13.6%; P < .001) were significantly more common in nevi. Other features, including fibrillar, homogeneous, globular, reticular, other, and nontypical patterns, showed inconsistent or nonsignificant associations.

Conclusions and relevance: While the parallel ridge and parallel furrow patterns remain key diagnostic indicators of ALM and benign acral lesions, this systematic review and meta-analysis establishes the additional diagnostic significance of multicomponent and latticelike features. Nearly 20% of ALM lacked the parallel ridge pattern, demonstrating the need for new specific features for melanoma diagnosis. These findings provide evidence-based benchmarks to potentially improve diagnostic accuracy, guide dermoscopy training, and enhance early detection of ALM.

Importance: Hand-foot syndrome (HFS) is a common dose-limiting toxic effect of several chemotherapy agents, particularly capecitabine. Despite its substantial impact on the patient's quality of life and potential to compromise therapeutic efficacy, effective preventive strategies remain limited.

Objective: To evaluate and compare the efficacy of pharmacologic interventions for the prevention of chemotherapy-induced HFS through a network meta-analysis of published results of randomized clinical trials (RCTs).

Data sources: PubMed, Embase, and Cochrane CENTRAL were systematically searched from inception through November 2024 for relevant RCTs.

Study selection: Eligible studies were phase 2 or 3 RCTs that compared systemic or topical prophylactic interventions for the prevention of HFS.

Data extraction and synthesis: Data extraction was performed by 2 reviewers, and disagreements were resolved by consensus. Risk of bias was assessed using the Cochrane Risk of Bias tool. A frequentist random-effects network meta-analysis was conducted.

Main outcomes and measures: The primary income was incidence of grade 2 or higher HFS. The secondary outcome was the incidence of any-grade HFS. Odds ratios (ORs) with 95% CIs were estimated. Ranking was assessed using P-scores and surface under the cumulative ranking (SUCRA) values.

Results: Nineteen RCTs were included, of which 17 trials comprising 2192 patients (median [range] age, 57 [56-61] years) were analyzed for the primary outcome. Compared with placebo, topical silymarin (OR, 0.08; 95% CI, 0.01-0.71), diclofenac (OR, 0.23; 95% CI, 0.08-0.62), 400-mg pyridoxine (OR, 0.28; 95% CI, 0.09-0.88), and celecoxib (OR, 0.41; 95% CI, 0.18-0.95) significantly reduced grade 2 or higher HFS. Diclofenac (OR, 0.30; 95% CI, 0.13-0.69) and celecoxib (OR, 0.46; 95% CI, 0.22-0.94) also reduced overall HFS incidence. In contrast, silymarin and 400-mg pyridoxine did not show benefit for overall HFS, while mapisal increased HFS risk (OR, 3.04; 95% CI, 1.07-8.64). Ranking analyses showed the highest SUCRA value for silymarin (0.91) and diclofenac (0.76).

Conclusions and relevance: In this systematic review and network meta-analysis, diclofenac and silymarin were the most effective preventive strategies for HFS, with silymarin requiring confirmation in a larger randomized trial. Diclofenac emerged as the agent with the best overall supporting evidence, informed by both effect estimates and study quality.

Importance: Localized melanomas account for the highest proportion of melanoma deaths; however, few studies have assessed factors associated with risk of recurrence of localized melanomas.

Objective: To determine the clinical and pathologic factors associated with the risk of melanoma recurrence for localized (stage IA to IIC) melanomas.

Design, setting, and participants: Results of this study suggest that factors in addition to melanoma ulceration and thickness provide an important guide for patient surveillance and counseling about potential recurrence. Participants were individuals diagnosed with stage IA to IIC melanomas from 2010 to 2017. Patients with more than 1 melanoma diagnosed during this time frame, whose index melanomas were recurrences, and whose melanomas were noncutaneous were excluded (125 melanomas). Data were analyzed from January 1 to March 15, 2025.

Main outcomes and measures: The presence or absence of melanoma recurrence and time to melanoma recurrence.

Results: In 1092 patients with melanoma diagnosed from 2010 to 2017, the median age at the time of diagnosis was 60 (range, 0-96) years; most patients were male (57.0% [622]); race and ethnicity categories were Hispanic (4.1% [45]), non-Hispanic (94.4% [1031]), White (96.7% [1056]), other (3.3% [36]), and unknown (1.5% [16]). Multivariable analysis identified 6 variables significantly associated with time to recurrence: ulceration (hazard ratio [HR], 3.48; 95% CI, 2.51-4.82; P < .001), thickness (HR, 1.09; 95% CI, 1.05-1.13; P < .001), tumor location on the scalp or neck (HR, 3.22; 95% CI, 1.94-5.37; P < .001) or face (HR, 2.14; 95% CI, 1.29-3.53; P = .003) compared with the arms, neurotropism (HR, 1.96; 95% CI, 1.03-3.72; P = .04), lymphovascular invasion (HR, 2.52; 95% CI, 1.00-6.34; P = .049), and mitoses (HR, 3.93; 95% CI, 2.47-6.26; P < .001).

Conclusions and relevance: In this study, for localized melanomas, variables beyond those currently considered standard for staging for survival prognosis were associated with time to melanoma recurrence; consideration of factors beyond thickness and ulceration could be valuable in helping to guide surveillance for recurrences.