Akrale Melanome machen etwa 2-3% aller Melanome aus. Wegen ihrer Seltenheit und weil sie anfänglich unscheinbar und tendenziell amelanotisch erscheinen, werden sie häufig verkannt. Der vorliegende Fallbericht beschreibt den Fall eines 70-jährigen Mannes mit amelanotischem Melanom, das als nicht heilendes arterielles Ulcus fehldiagnostiziert wurde. Die histopathologische Untersuchung zeigte ein akrolentiginöses Melanom mit einer Tumordicke nach Breslow von 2,3mm, Clark-Level IV, das durch eine chirurgische Intervention definitiv behandelt wurde. Dieser Fall zeigt, dass es wichtig ist, bei der Differentialdiagnose nicht heilender Ulcera auch ein Melanom in Erwägung zu ziehen.
{"title":"Akrales amelanotisches Melanom, das wie ein nicht heilendes arterielles Ulcus erscheint","authors":"Phillip Cantwell, Helena Van Dam","doi":"10.1159/000506794","DOIUrl":"https://doi.org/10.1159/000506794","url":null,"abstract":"Akrale Melanome machen etwa 2-3% aller Melanome aus. Wegen ihrer Seltenheit und weil sie anfänglich unscheinbar und tendenziell amelanotisch erscheinen, werden sie häufig verkannt. Der vorliegende Fallbericht beschreibt den Fall eines 70-jährigen Mannes mit amelanotischem Melanom, das als nicht heilendes arterielles Ulcus fehldiagnostiziert wurde. Die histopathologische Untersuchung zeigte ein akrolentiginöses Melanom mit einer Tumordicke nach Breslow von 2,3mm, Clark-Level IV, das durch eine chirurgische Intervention definitiv behandelt wurde. Dieser Fall zeigt, dass es wichtig ist, bei der Differentialdiagnose nicht heilender Ulcera auch ein Melanom in Erwägung zu ziehen.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115103261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability. We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers. We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded. Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention. Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.
皮肤癌和癌前皮肤病变在肿瘤消融后引起明显的软组织缺损。最近，拱心石襟翼因其简单，多功能性和可靠性而受到欢迎。我们在2个医疗中心评估了改良梯形皮瓣用于皮肤肿瘤消融后软组织重建的疗效。我们回顾了2017年1月至2017年12月皮肤肿瘤切除后接受改良梯形皮瓣的患者的医疗记录。记录诊断、部位、皮瓣大小及并发症。改良拱顶石皮瓣41例，创面尺寸为1 cm × 1 cm ~ 18 cm × 9.5 cm，平均尺寸为9.8 cm × 6.4 cm。根据我们的选择策略，设计了针对软组织缺损的特异性改良拱心石皮瓣。皮瓣大小为2.2 cm × 1 cm ~ 26 cm × 10 cm，平均大小为14.3 cm × 7.5 cm。2例患者出现轻度创面裂开(4.9%)，1例患者出现部分皮瓣丢失(2.4%)，但这些患者均在局部创面护理后愈合，无需手术干预。我们的改良梯形皮瓣的选择策略对于皮肤肿瘤切除后的重建是可行和可靠的选择。
{"title":"Defektdeckung: Stufenweise Modifikation der Lappenpräparation bringt Vorteile","authors":"Marc André Quambusch, Michael Sand","doi":"10.1159/000506852","DOIUrl":"https://doi.org/10.1159/000506852","url":null,"abstract":"Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability. We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers. We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded. Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention. Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115615110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Etwa 15% der Akne-Patienten leiden an einer behandlungsbedürftigen Entstellungsproblematik, einer sogenannten körperdysmorphen Störung [1]. Dabei handelt es sich um eine gestörte Wahrnehmung des eigenen Körpers, die in verschiedenen Schweregraden auftreten kann. Die Reduktion akuter Akne-Läsionen sowie die Minimierung von Rezidiven stellen daher wichtige Ziele in der Akne-Therapie dar [2–4]. «Mit der Fixkombination aus 0,3% Adapalen (ADA) und 2,5% Benzoylperoxid (BPO) kann die Entzündung deutlich reduziert und schnell sichtbare Erfolge erzielt werden», erläuterte Prof. Dr. Stefan Beissert, Dresden, bei einem von Galderma veranstalteten Symposium im Rahmen der Fachtagung Dermatologie KOMPAKT & PRAXISNAH 2020 in Dresden. Ein weiterer Vorteil: Da das Topikum über einen längeren Zeitraum angewendet werden kann, ohne Resistenzen zu bilden, ist es möglich, eine tiefgreifende Verbesserung des Hautbildes bei den Patienten zu erzielen [5]. Insgesamt weisen 43% der Patienten mit einer leichten bis sehr schweren Akne Narben auf [6]. «Diese Problematik sollte in der Akne-Therapie beachtet werden», betonte Prof. Beissert in seinem Vortrag. Akne-Narben können behandlungsbedürftige psychische Folgen haben. Im Rahmen einer Erhebung mit rund 1388 Akne-Patienten von Prof. Dr. Uwe Gieler, Gießen, wurde festgestellt, dass ein deutlicher Trend zur Korrelation zwischen dem Vorhandensein von Akne-Narben und körperdysmorphen Störungen (Odds Ratio: 1,349; 95%-Konfidenzintervall (KI) 0,970– 1,877; p = 0,076 (Mantel-Haenszel)) besteht. Bei Akne-Patienten zeigte sich mit 14,7% eine deutlich höhere Zahl von relevanten Entstellungsproblemen im Vergleich zu repräsentativen Erhebungen in Deutschland mit nur 4,9% [1].
{"title":"PharmaNews","authors":"","doi":"10.1159/000507722","DOIUrl":"https://doi.org/10.1159/000507722","url":null,"abstract":"Etwa 15% der Akne-Patienten leiden an einer behandlungsbedürftigen Entstellungsproblematik, einer sogenannten körperdysmorphen Störung [1]. Dabei handelt es sich um eine gestörte Wahrnehmung des eigenen Körpers, die in verschiedenen Schweregraden auftreten kann. Die Reduktion akuter Akne-Läsionen sowie die Minimierung von Rezidiven stellen daher wichtige Ziele in der Akne-Therapie dar [2–4]. «Mit der Fixkombination aus 0,3% Adapalen (ADA) und 2,5% Benzoylperoxid (BPO) kann die Entzündung deutlich reduziert und schnell sichtbare Erfolge erzielt werden», erläuterte Prof. Dr. Stefan Beissert, Dresden, bei einem von Galderma veranstalteten Symposium im Rahmen der Fachtagung Dermatologie KOMPAKT & PRAXISNAH 2020 in Dresden. Ein weiterer Vorteil: Da das Topikum über einen längeren Zeitraum angewendet werden kann, ohne Resistenzen zu bilden, ist es möglich, eine tiefgreifende Verbesserung des Hautbildes bei den Patienten zu erzielen [5]. Insgesamt weisen 43% der Patienten mit einer leichten bis sehr schweren Akne Narben auf [6]. «Diese Problematik sollte in der Akne-Therapie beachtet werden», betonte Prof. Beissert in seinem Vortrag. Akne-Narben können behandlungsbedürftige psychische Folgen haben. Im Rahmen einer Erhebung mit rund 1388 Akne-Patienten von Prof. Dr. Uwe Gieler, Gießen, wurde festgestellt, dass ein deutlicher Trend zur Korrelation zwischen dem Vorhandensein von Akne-Narben und körperdysmorphen Störungen (Odds Ratio: 1,349; 95%-Konfidenzintervall (KI) 0,970– 1,877; p = 0,076 (Mantel-Haenszel)) besteht. Bei Akne-Patienten zeigte sich mit 14,7% eine deutlich höhere Zahl von relevanten Entstellungsproblemen im Vergleich zu repräsentativen Erhebungen in Deutschland mit nur 4,9% [1].","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"358 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121639892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dermatochirurgie: Der Blick über den Tellerrand lohnt sich","authors":"F. Bechara","doi":"10.1159/000506756","DOIUrl":"https://doi.org/10.1159/000506756","url":null,"abstract":"","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123919599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents. Principal findings: We treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The isolates were assayed for susceptibility to antifungal drugs and ALA-PDT in vitro, revealing sensitivity to terbinafine, itraconazole and voriconazole, with ALA-PDT altering the cell wall and increasing reactive oxygen species production. Conclusions: These results provide the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis.
{"title":"Chromoblastomykose: Mit der Kombination aus PDT und Antimykotika zum Erfolg","authors":"P. Lehmann","doi":"10.1159/000507001","DOIUrl":"https://doi.org/10.1159/000507001","url":null,"abstract":"Background: Chromoblastomycosis is a chronic skin and subcutaneous fungal infection caused by dematiaceous fungi and is associated with low cure and high relapse rates. In southern China, Fonsecaea monophora and Fonsecaea pedrosoi are the main causative agents. Principal findings: We treated 5 refractory and complex cases of chromoblastomycosis with 5-aminolevulinic acid photodynamic therapy (ALA-PDT) combined with oral antifungal drugs. The lesions improved after 4 to 9 sessions of ALA-PDT treatment at an interval of one or two weeks, and in some cases, mycological testing results became negative. The isolates were assayed for susceptibility to antifungal drugs and ALA-PDT in vitro, revealing sensitivity to terbinafine, itraconazole and voriconazole, with ALA-PDT altering the cell wall and increasing reactive oxygen species production. Conclusions: These results provide the basis for the development of a new therapeutic approach, and ALA-PDT combined with oral antifungal drugs constitutes a promising alternative method for the treatment of refractory and complex cases of chromoblastomycosis.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128602959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"DermaCampus in den Zeiten von COVID-19","authors":"M. Mader","doi":"10.1159/000507008","DOIUrl":"https://doi.org/10.1159/000507008","url":null,"abstract":"","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121788044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Real-world studies evaluating patients with challenging-to-treat localizations of psoriasis (scalp, nail, and palmoplantar) are limited. Objective: To characterize patients with versus without psoriasis in challenging-to-treat areas seen in routine US clinical practice. Methods: This retrospective observational study included all adult patients with psoriasis enrolled in the Corrona Psoriasis Registry between April 2015 and May 2018 who initiated a biologic therapy at registry enrollment. Patients were stratified by the presence of scalp, nail, or palmoplantar psoriasis (nonmutually exclusive groups). Patient demographics, clinical characteristics, disease activity, and patient-reported outcome measures (pain, fatigue, itch, EuroQol visual analog scale [EQ VAS], Dermatology Life Quality Index [DLQI], and Work Productivity and Activity Impairment questionnaire [WPAI]) were assessed at registry enrollment and compared between patients with versus without each challenging-to-treat area using nonparametric Kruskal-Wallis tests for continuous variables and χ2 or Fisher exact tests for categorical variables. Generalized linear regression models were used to estimate differences in disease activity and patient-reported outcomes between patients with versus without each challenging-to-treat area. Results: Among 2,042 patients with psoriasis (mean age [±SD], 49.6 ± 14.7 years; 51.5% male), 38.4% had psoriatic arthritis (PsA), 38.1% had scalp psoriasis, 16.0% had nail psoriasis, 10.9% had palmoplantar psoriasis, and 26.2% had a combination of ≥2 challenging-to-treat areas and PsA; only 34.2% had body plaque psoriasis without PsA or challenging-to-treat areas. Patients in all challenging-to-treat groups reported higher (mean [95% CI]) itch (scalp, 58.01 [57.62-58.40] vs. 54.35 [53.99-54.72]; nail, 56.42 [56.02-56.81] vs. 55.59 [55.20-55.97]; palmoplantar, 60.22 [59.86-60.59] vs. 55.15 [54.79-55.54]) and lower EQ VAS (scalp, 68.12 [67.78-68.48] vs. 69.46 [69.12-69.81]; nail, 66.21 [65.89-66.55] vs. 69.48 [69.14-69.83]; palmoplantar, 66.21 [66.07-66.75] vs. 69.29 [68.94-69.94]) scores than those without the respective challenging-to-treat localization. Patients with nail or palmoplantar psoriasis reported higher pain, fatigue, and DLQI scores than those without. Higher proportions of patients with scalp or palmoplantar psoriasis reported work impairment compared with those without. Conclusion: Two-thirds of patients with psoriasis who initiated biologic therapy had PsA and/or ≥1 challenging-totreat area. Patients with challenging-to-treat areas had worse patient-reported outcome scores than those without, indicating a significant burden of challenging-to-treat areas on patients' quality of life.
{"title":"Psoriasis: Lokalisation beeinflusst die Krankheitslast","authors":"W. Sondermann","doi":"10.1159/000506795","DOIUrl":"https://doi.org/10.1159/000506795","url":null,"abstract":"Background: Real-world studies evaluating patients with challenging-to-treat localizations of psoriasis (scalp, nail, and palmoplantar) are limited. Objective: To characterize patients with versus without psoriasis in challenging-to-treat areas seen in routine US clinical practice. Methods: This retrospective observational study included all adult patients with psoriasis enrolled in the Corrona Psoriasis Registry between April 2015 and May 2018 who initiated a biologic therapy at registry enrollment. Patients were stratified by the presence of scalp, nail, or palmoplantar psoriasis (nonmutually exclusive groups). Patient demographics, clinical characteristics, disease activity, and patient-reported outcome measures (pain, fatigue, itch, EuroQol visual analog scale [EQ VAS], Dermatology Life Quality Index [DLQI], and Work Productivity and Activity Impairment questionnaire [WPAI]) were assessed at registry enrollment and compared between patients with versus without each challenging-to-treat area using nonparametric Kruskal-Wallis tests for continuous variables and χ2 or Fisher exact tests for categorical variables. Generalized linear regression models were used to estimate differences in disease activity and patient-reported outcomes between patients with versus without each challenging-to-treat area. Results: Among 2,042 patients with psoriasis (mean age [±SD], 49.6 ± 14.7 years; 51.5% male), 38.4% had psoriatic arthritis (PsA), 38.1% had scalp psoriasis, 16.0% had nail psoriasis, 10.9% had palmoplantar psoriasis, and 26.2% had a combination of ≥2 challenging-to-treat areas and PsA; only 34.2% had body plaque psoriasis without PsA or challenging-to-treat areas. Patients in all challenging-to-treat groups reported higher (mean [95% CI]) itch (scalp, 58.01 [57.62-58.40] vs. 54.35 [53.99-54.72]; nail, 56.42 [56.02-56.81] vs. 55.59 [55.20-55.97]; palmoplantar, 60.22 [59.86-60.59] vs. 55.15 [54.79-55.54]) and lower EQ VAS (scalp, 68.12 [67.78-68.48] vs. 69.46 [69.12-69.81]; nail, 66.21 [65.89-66.55] vs. 69.48 [69.14-69.83]; palmoplantar, 66.21 [66.07-66.75] vs. 69.29 [68.94-69.94]) scores than those without the respective challenging-to-treat localization. Patients with nail or palmoplantar psoriasis reported higher pain, fatigue, and DLQI scores than those without. Higher proportions of patients with scalp or palmoplantar psoriasis reported work impairment compared with those without. Conclusion: Two-thirds of patients with psoriasis who initiated biologic therapy had PsA and/or ≥1 challenging-totreat area. Patients with challenging-to-treat areas had worse patient-reported outcome scores than those without, indicating a significant burden of challenging-to-treat areas on patients' quality of life.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131095872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. Methods: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institutionʼs Institutional Review Board prior to patient enrollment. Discussion: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. Trial Registration: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.
{"title":"Subunguales Melanom: Weniger invasives operatives Verfahren als Standard etablieren","authors":"Saskia Schnabl-Scheu","doi":"10.1159/000506851","DOIUrl":"https://doi.org/10.1159/000506851","url":null,"abstract":"Background: Amputation is the standard of care even for early-stage subungual melanomas (SUMs), known as nail apparatus melanoma, because the nail bed and nail matrix are close to the distal phalanx. However, a recent study demonstrated that not all patients with SUMs had histologic invasion of the underlying distal phalanx. As most SUMs occur in the thumb or big toe, amputation of either the thumb or big toe substantially interferes with activities of daily living, including poor cosmesis, loss of function, and phantom pain. Non-amputative digit preservation surgery can thus be applied in such cases without compromising patient prognosis. Methods: We are conducting a multi-institutional single-arm trial to confirm the safety and efficacy of non-amputative digit preservation surgery. We will compare our results with those reported in the Japanese Melanoma Study, in which patients underwent amputation for SUMs as a traditional standard of care. Patients aged between 20 and 80 years with stage I, II, or III without evidence of tumor invasion to the underlying distal phalanx on preoperative radiograph are included in the study. The primary endpoint is major relapse-free survival (major RFS), which does not include local recurrence as an event; secondary endpoints include overall survival, digit-preservation survival, relapse-free survival, local relapse-free survival, partial relapse-free survival, and incidence of adverse events. A total of 85 patients from 21 Japanese institutions will be recruited within 5.5 years, and the follow-up period will last at least 5 years. The Japan Clinical Oncology Group Protocol Review Committee approved this study protocol in August 2017, and patient enrollment began in November 2017. Ethical approval was obtained from each institutionʼs Institutional Review Board prior to patient enrollment. Discussion: This is the first prospective trial to confirm the safety and efficacy of non-amputative digit preservation surgery for SUM without distant metastasis or bony invasion. The results of this trial could provide evidence to support this less-invasive surgery as a new standard of care to preserve adequately functioning digits. Trial Registration: Registry number: UMIN000029997 . Date of Registration: 16/Nov/2017. Date of First Participant Enrollment: 12/Dec/2017.","PeriodicalId":390963,"journal":{"name":"Karger Kompass Dermatologie","volume":"2014 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127420832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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