Melanoma Characteristics in Patients with a History of UV Tanning Bed Usage.
- 作者列表："Truong K","Milhem M","Pagedar NA
OBJECTIVE:The purpose of this study was to evaluate the effect of tanning bed use on the behavior of subsequent melanomas. METHODS:Cases of invasive cutaneous melanoma who completed a baseline questionnaire within 1 year of biopsy were ascertained using an institutional registry. Patients were categorized into one of two groups: (1) no history of UV tanning bed usage or (2) any history of tanning bed usage. Data analysis looked for group differences on the following variables: TNM staging, mitotic rate, family history of melanoma, and basic demographic variables. RESULTS:Among 141 cases, a higher percentage of women (48.28%) reported tanning bed usage compared to men (26.51%, P < .01). Additionally, the average age at biopsy for people who reported tanning bed usage was significantly lower compared to those who had not reported using a tanning bed. There was no significant difference in stage at presentation (P = .56). Those with tanning bed usage presented significantly less often with melanoma of unknown primary (MUP). After controlling for the effects of gender and nodal status, tanning bed usage was not a significant independent predictor of 5 year overall survival. CONCLUSIONS:If we remove the subject with MUP on the basis that more of these are mucosal in origin, lower TNM stage at presentation are found in patients with no tanning bed melanoma compared to those with history of tanning bed usage. In addition, tanning bed patients are younger and more likely female but with an equivalent mortality rate. LEVEL OF EVIDENCE:Case Series.
目的: 本研究的目的是评估使用日光浴床对后续黑色素瘤行为的影响。 方法: 使用机构登记处确定在活检 1 年内完成基线问卷的侵袭性皮肤黑色素瘤病例。将患者分为两组 :( 1) 无UV日光浴床使用史或 (2) 任何日光浴床使用史。数据分析寻找以下变量的组间差异: TNM分期、核分裂率、黑色素瘤家族史和基本人口学变量。 结果: 在 141 例病例中，女性 (48.28%) 报告使用日光浴床的比例高于男性 (26.51%，p <.01)。此外，报告使用日光浴床的人的活检平均年龄明显低于未报告使用日光浴床的人。就诊时分期无显著差异 (p =.56)。使用日光浴床的患者明显较少出现未知原发性黑色素瘤 (MUP)。在控制了性别和淋巴结状态的影响后，日光浴床的使用不是 5 年总生存率的显著独立预测因子。 结论: 如果我们在其中更多是粘膜起源的基础上用MUP去除受试者，与有日光浴床使用史的患者相比，在无日光浴床黑色素瘤的患者中发现了较低的TNM分期。此外，日光浴床患者更年轻，更可能是女性，但具有相当的死亡率。 证据水平: 病例系列。
METHODS::Blue rubber bleb naevus syndrome (BRBNS) is an extremely rare venous malformation that often manifests as multiple haemangioma-like lesions in the skin and gastrointestinal tract. The drug sirolimus plays a key role in the signalling pathway of angiogenesis and subsequent development of BRBNS and its use has been described in several case reports. We present a case series of four patients with BRBNS who exhibited good treatment response to sirolimus. All four patients were administered oral sirolimus at doses of 1.0-1.5 mg/m2 /day with a target drug level of 5-10 ng/mL and median treatment duration of 20 months. All patients had a reduction in the size of the lesions and a normalization of coagulopathy with tolerable drug adverse reactions at follow-up. Sirolimus may be effective and safe in paediatric patients with BRBNS. Further prospective studies are suggested to evaluate the long-term effectiveness of this drug.
METHODS:BACKGROUND:Human papillomavirus (HPV) infections are associated with common dermatologic and nondermatologic diseases. Although HPV vaccines are well established as preventive measures for genital warts and cervical neoplasia, their use as therapeutic agents deserves greater attention. OBJECTIVE:To evaluate the use of HPV vaccine(s) as a treatment modality for cutaneous and/or mucosal disease. METHODS:A primary literature search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in January 2019 by using the PubMed and Cochrane databases. RESULTS:A total of 63 articles with 4439 patients were included. The majority of patients with cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas were successfully treated with HPV vaccination. Preliminary data on patients with pre-existing anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia is promising. LIMITATIONS:This review was limited by the lack of controls, patients' previous HPV vaccination status, and publication bias. CONCLUSION:The commercially available three-dose, quadrivalent HPV vaccine is a potential therapeutic option for the treatment of cutaneous warts, recurrent respiratory papillomatosis, and squamous and basal cell carcinomas. Noncommercially available HPV vaccines demonstrate therapeutic response for treating anogenital warts, cervical intraepithelial neoplasia, anal intraepithelial neoplasia, and vulvar intraepithelial neoplasia. The vaccine's efficacy as an adjunct therapy for HPV-associated cutaneous and/or mucosal disease warrants further exploration.
METHODS::Our understanding of melanoma precursors and progression to melanoma has developed as a result of advances in the field of molecular diagnostics. We now better understand the potential for genetic heterogeneity within a single lesion. Combined tumors can pose a diagnostic challenge when deciding the line between benign and malignant, which in turn has direct implications for patient management. Primary cilia (PC) are ubiquitous sensory organelles that have essential functions in cellular proliferation, differentiation, and development. The ciliation index (percentage of ciliated melanocytes) has been shown to reliably differentiate melanoma, which fail to ciliate, from melanocytic nevi, which retain PC. We therefore analyzed the potential for using the ciliation index to differentiate benign and malignant components in combined melanocytic lesions. We collected patient samples (n = 10) of unequivocal combined lesions with both melanoma and associated nevus components. Melanocytes were highlighted with SOX10 and costained with gamma-Tubulin and acetylated alpha-Tubulin to highlight the basal body and cilium, respectively. The number of melanocytes retaining cilia under high-power microscopy was examined. The melanoma component had average of 4% ciliation (SD: 7%), whereas the associated nevus component was significantly higher with 59% ciliation (SD: 17%). These data show that PC may be a reliable means of distinguishing benign from malignant components within a single tumor. The ciliation index may be a helpful tool in distinguishing challenging cases of combined lesions of melanoma in situ with a dermal nevus component from invasive melanoma, thus promoting improved staging and clinical management.