Risultati per: Valutazione e gestione del Melanoma

Kerr et al report a study of pathologists who reviewed slides of melanocytic nevi and melanomas. The pathologists were asked to grade the atypia of lesions as low vs high and to distinguish them from invasive melanoma. Seeking to identify pathologist characteristics associated with tumor categorization, the authors found that dermatopathologists were more likely than general pathologists to classify lesions as higher grade and to diagnose low-risk (pT1a, nonmitogenic) invasive melanoma. This difference was not seen for intermediate- or high-risk melanomas. There were important limitations to the study. No outcomes data were available, including that it was not known whether the melanomas classified as low risk were indeed indolent. Furthermore, grading melanocytic nevi and grouping cases with high-grade atypia together with melanoma in situ is controversial. Nonetheless, the findings of the study raise the question of whether subspecialization in dermatopathology may be a factor contributing to the epidemiologic phenomenon of overdiagnosis—that is, the discordance in the rise of melanoma incidence and relatively constant annual mortality rates over many decades. The findings also invite a discussion about strategies to minimize harm from overdiagnosis for both patients and the health care system.

Proteina della celiachia ruolo chiave nella regolazione melanoma

Circulation, Volume 148, Issue Suppl_1, Page A12587-A12587, November 6, 2023. Introduction:The introduction of immunotherapy has revolutionized the treatment of cancer, with improved clinical outcomes. One of such agents include Pembrolizumab a humanized antibody which acts as an immune check point inhibitor by binding to Programmed cell death Protein 1 receptors. One principal setback is its autoimmune-dysfunctional side effect.Case Presentation:A 74-year-old male with BRAF-negative malignant melanoma status post resection, with recurrent neoplasm involving lymph nodes of the base of the left neck presented to the emergency department with palpitations, diarrhea and difficulty in breathing. Symptoms began three weeks after his fourth course of adjuvant therapy. On presentation he was hemodynamically unstable with positive Kussmaul sign on examination. His heart sounds were muffled, with clear lung bases bilaterally. Results of EKG and echo are has shown below.Decision-Making:Patient was commenced on Intravenous fluid normal saline, oxygen therapy, was evaluated by cardiology and had emergency pericardiocentesis with about 250mls of fluid drained from the pericardial cavity and improvement of symptoms. Pericardial fluid analysis showed acute inflammation without malignant cells. Patient was placed on steroids and a consensus was reached to discontinue Pembrolizumab and pursue other lines of treatment as determined by the hospital tumor board.Discussion:The exact incidence of pericardial disease in cancer patients treated with Immune check inhibitors including Pembrolizumab is unknown. When effusion occurs, urgent intervention should be performed to prevent life threatening cardiac events. Treatment with steroids has shown improved outcomes and should be encouraged.Conclusion:Pericardial effusion is a fatal complication of Pembrolizumab. Though incidence remains rare, a high index of suspicion should be maintained in Patients receiving this immune check point inhibitor. The Decision to continue therapy after a cardiovascular event such as Pericardial Effusion should be individualized.

Circulation, Volume 148, Issue Suppl_1, Page A17445-A17445, November 6, 2023. Introduction:Metastatic tumors to the heart can have varied clinical presentations depending on location. We present a case of right atrial (RA) metastatic melanoma with near obstruction of the tricuspid valve resulting in significant hypoxia.Case Presentation:A 34-year-old man with a history of retinoblastoma and astrocytoma presented to the emergency department with 2 weeks of progressively worsening shortness of breath. On examination he was hypoxic and in respiratory distress. Computed tomography of the chest with contrast showed a large hypoattenuating homogeneous mass in the RA that protruded into the right ventricle and extended to the superior and inferior vena cavae. Transthoracic echocardiography (TTE) showed a large (9.1 x 4.6 cm) echodensity filling the RA and almost completely obstructing the tricuspid valve. Due to worsening hypoxia, the patient underwent palliative surgical resection of the mass. Intraoperatively, the mass was densely adherent to all walls of the RA. Surgical pathology identified the mass as metastatic malignant melanoma. The patient was started on pembrolizumab and discharged home in stable condition. At his 1-month follow-up, his symptoms had improved and he had returned to work.Discussion:Metastases to the heart are more common than primary cardiac tumors. Left-sided cardiac masses are commonly benign, whereas right-sided masses raise suspicion for metastatic disease. Melanoma, lymphoma, leukemia, and breast and lung cancers commonly metastasize to the heart. The size of the RA mass in this patient was significant enough to cause hypoxia and near occlusion of the tricuspid valve. Successful palliative resection of the mass resulted in a large improvement in symptoms.Conclusion:As the incidence of malignant melanoma increases, clinicians need to have a high index of suspicion for cardiac metastasis. Early identification of cardiac metastasis is critical as these cases can often be associated with poor prognosis.

Circulation, Volume 148, Issue Suppl_1, Page A16756-A16756, November 6, 2023. Introduction:Melanoma is the fifth most common cancer diagnosis in the United States. With recent advances in treatment modalities, including immune checkpoint inhibitors (ICIs), targeted therapies, there has been improvement in survival among melanoma patients. However, increasing resistance and treatment related adverse effects (TrAEs) are being reported including cardiovascular side effects.Objectives:To evaluate the trend of cardiovascular specific death rate among patients with melanoma.Methods:We used Surveillance, Epidemiology, and End Results (SEER) Program database 17 registries from 2000 to 2019 and SEER*Stat Version 8.4.1 software to analyze the data using the rate session. Joinpoint software, version 4.7.1.0 was used to create log-linear time trends annually.Results:Our study included 301,632 patients with melanoma from 2005 to 2019. The annual percentage change (APC) of melanoma was 0.46% (95% CI -1.45 to 1.07, p >0.05) annually from 2005 to 2011 and 3.33% (95% CI 1.79 to 4.27, p0.05) annually from 2014 to 2019. Melanoma specific mortality rate increased annually by 2.03 % (95% CI 0.78 to 3.94, P

This cohort study compares costs, survival, and time toxicity among patients with melanoma in 2007 to 2012 vs 2018 to 2019.

This retrospective cohort study estimates stage-specific recurrence and melanoma-specific mortality rates, estimates absolute stage-specific risks of recurrence and mortality, and describes stage-specific recurrence patterns in Danish patients.

This diagnostic study builds synthetic data sets for diagnosing melanoma and melanocytic nevus with artificial intelligence (AI) using unstandardized photographs on the internet.

The challenging task of skin cancer classification via artificial intelligence (AI) is a combined effort of dermatologists, patients, and the machine-learning community. A classifier in this case is a software based on AI that assigns skin photographs to categories (ie, benign or malignant).

Esperti, cambio paradigma assistenza per vincere sfida Onu 2030

New England Journal of Medicine, Ahead of Print.