Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 391
Filter
1.
Arq. bras. med. vet. zootec. (Online) ; 73(4): 827-833, Jul.-Aug. 2021. tab, ilus
Article in English | LILACS, VETINDEX | ID: biblio-1285282

ABSTRACT

This report describes clinical, ultrasonographic and anatomopathological findings in a case of metastatic melanoma in an adult Saanen goat. Clinically, the goat had apathy, an intra-abdominal palpable firm structure, and exophytic keratinized areas on the skin of the udder. Ultrasound revealed non-encapsulated oval structures, with heterogeneous echogenicity and marked central and peripheral vascularization, and hypoechoic hepatic multifocal to coalescent areas. In the udder, there were non-encapsulated oval structures with heterogeneous echogenicity and hyperechoic center surrounded by hypoechogenic tissue. Grossly, there were black multifocal to coalescent areas in the liver, as well as black nodules in mammary and mesenteric lymph nodes, uterus, spleen, and myocardium. Microscopically, multifocal melanocytic neoplastic proliferation was observed in the dermis and junction of the udder epidermis. Most of the neoplastic cells had cytoplasmic granules of melanin. In the liver there were areas of neoplastic tissue compressing the adjacent parenchyma, with central foci of necrosis, mild desmoplasia, and multifocal infiltration of malignant cells into the adjacent tissues. Similar findings were observed in the mammary and mesenteric lymph nodes, uterus, spleen, and myocardium, which characterized metastatic melanoma. Ultrasonography played a key role for establishing the diagnosis of a metastatic melanoma and helped establish a proper clinical management protocol.(AU)


Este relato descreve os achados clínicos, ultrassonográficos e anatomopatológicos em um caso de melanoma metastático em uma cabra Saanen adulta. Clinicamente, a cabra apresentava apatia, estrutura firme palpável intra-abdominal e áreas exofíticas queratinizadas na pele do úbere. A ultrassonografia revelou estruturas ovais não encapsuladas, com ecogenicidade heterogênea e marcada vascularização central e periférica, além de áreas hepáticas multifocais a coalescentes hipoecoicas. No úbere, havia estruturas ovais não encapsuladas, com ecogenicidade heterogênea e centro hiperecogênico circundado por tecido hipoecogênico. Macroscopicamente, havia áreas pretas multifocais a coalescentes no fígado, bem como nódulos pretos nos linfonodos mamários e mesentéricos, no útero, no baço e no miocárdio; microscopicamente, proliferação neoplásica melanocítica multifocal foi observada na derme e na junção da epiderme do úbere. A maioria das células neoplásicas apresentava grânulos citoplasmáticos de melanina. No fígado, havia áreas de tecido neoplásico comprimindo o parênquima adjacente, com focos centrais de necrose, desmoplasia leve e infiltração multifocal de células malignas nos tecidos adjacentes. Achados semelhantes foram observados nos nódulos linfáticos mamários e mesentéricos, no útero, no baço e no miocárdio, que caracterizaram o melanoma metastático. A ultrassonografia desempenhou um papel fundamental para estipular o diagnóstico de um melanoma metastático e ajudou a estabelecer um protocolo de manejo clínico adequado.(AU)


Subject(s)
Animals , Goats , Melanoma/pathology , Melanoma/diagnostic imaging , Neoplasm Metastasis/diagnostic imaging
2.
Gac. méd. Méx ; 157(2): 215-219, mar.-abr. 2021. tab
Article in Spanish | LILACS | ID: biblio-1279104

ABSTRACT

Resumen Antecedentes: Los estudios sobre factores pronóstico de melanoma están basados en poblaciones caucásicas, con predominio de melanomas delgados (Breslow < 3 mm). Los pacientes mexicanos muestran predominio de melanomas gruesos (Breslow ≥ 3 mm). Objetivo: Identificar factores asociados al pronóstico de pacientes con melanomas gruesos. Material y métodos: Se analizó la influencia pronóstica de factores clinicopatológicos en 362 melanomas gruesos. Resultados: La mediana de Breslow fue de 7 mm, 271 (74.9 %) pacientes tuvieron melanoma acral y 49 (13.5 %) melanoma nodular. El 56.6 % de los pacientes se encontró en etapa clínica [EC] III), 269 (74.3 %) tenía ulceración y 15 (4.1 %) márgenes positivos. Las variables asociadas con menor supervivencia global [SG] fueron la EC (p < 0.001), Breslow (p = 0.044), ulceración (p = 0.004), mitosis (p < 0.001) y margen < 2 cm (p < 0.001) . En el análisis multivariante los factores que influyen en SG fueron la EC, mitosis y el margen quirúrgico. Conclusiones: En pacientes con melanomas gruesos la SG es influida por un margen positive, mitosis y EC.


Abstract Background: Studies on prognostic factors in melanoma are based on Caucasian populations, with a predominance of thin melanomas (Breslow <3 mm). Mexican patients show a predominance of thick melanomas (Breslow ≥ 3 mm). Objective: To identify factors associated with the prognosis of patients with thick melanomas. Material and methods: The prognostic influence of clinicopathological factors was analyzed in 362 thick melanomas. Results: The Breslow median was 7 mm, 271 (74.9 %) patients had acral melanoma and 49 (13.5 %) nodular melanoma. The 56.6 % of patients were found in clinical stage [CS] III), 269 (74.3 %) had ulceration, and 15 (4.1 %) had positive margins. The variables associated with lower overall survival [OS] were CS (p < 0.001), Breslow (p = 0.044), ulceration (p = 0.004), mitosis (p < 0.001) and margin < 2 cm (p < 0.001). In the multivariate analysis, the factors influencing OS were CD, mitosis, and the surgical margin. Conclusions: In patients with thick melanomas, OS is influenced by a positive margin, mitosis and CS.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Skin Neoplasms/mortality , Skin Neoplasms/pathology , Tumor Burden , Melanoma/mortality , Melanoma/pathology , Prognosis , Ulcer/pathology , Margins of Excision , Lymphatic Metastasis , Melanoma/classification , Mexico , Mitosis
3.
Autops. Case Rep ; 11: e2021299, 2021. graf
Article in English | LILACS | ID: biblio-1285404

ABSTRACT

Primary malignant melanoma of the oral cavity is a rare tumor in clinical practice. Extensive malignant melanomas are still very rare in the literature. Patients with malignant melanoma of oral cavity are often diagnosed at the advanced stage of the disease due to their painless and nonspecific radiological findings. Histopathology is the gold standard for the final diagnosis and staging of the tumor. Surgery followed by radiotherapy is the standard treatment offered to patients with malignant melanoma. Here we present a rare case of extensive malignant melanoma of oral cavity which was successfully managed by surgical excision followed by adjuvant radiotherapy.


Subject(s)
Humans , Male , Adult , Mouth Neoplasms/pathology , Melanoma/pathology , Mouth Neoplasms/surgery , Mouth Neoplasms/therapy , Radiotherapy, Adjuvant
4.
An. bras. dermatol ; 95(6): 691-695, Nov.-Dec. 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1142133

ABSTRACT

Abstract Background: The mitotic index is no longer used to classify T1 melanoma patients into T1a and T1b, so it should not be used to indicate sentinel node biopsy in these patients. Objectives: To evaluate patients with T1 melanoma who underwent sentinel lymph node biopsy and to compare those who were classified as T1a with those classified T1b, according to the 7th and 8th Edition of the melanoma staging system, regarding a positive biopsy result. The authors also aimed to assess whether there is any difference in the results in both staging systems. Material and methods: This was a retrospective analysis of 1213 patients who underwent sentinel lymph node biopsy for melanoma, from 2000 to 2015, in a single institution. Results: Of 399 patients with thin melanomas, 27 (6.7%) presented positive sentinel lymph nodes; there was no difference in positivity for sentinel node biopsy when comparing T1a vs. T1b in both staging systems. Furthermore, the clinical results were also similar between the two groups. However, in the complete cohort analysis, the mitotic index was associated with positivity for sentinel lymph node biopsy (p < 0.0001), positivity for non-sentinel lymph node (p < 0.0001), recurrence-free survival (p < 0.0001), and specific melanoma survival (p = 0.023). Study limitation: Unicentric study. Conclusion: The mitotic index was shown to be a very important prognostic factor in the present study, but it was not observed in patients classified as T1. The mitotic index should no longer be used as the only reason to refer sentinel lymph node biopsy in patients with thin melanoma.


Subject(s)
Humans , Skin Neoplasms/pathology , Melanoma/pathology , Prognosis , United States , Retrospective Studies , Sentinel Lymph Node Biopsy , Lymphatic Metastasis , Mitotic Index , Neoplasm Staging
5.
Rev. cir. (Impr.) ; 72(5): 464-467, oct. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138740

ABSTRACT

Resumen Objetivos: El melanoma cutáneo presenta un alto potencial metastásico y constituye la fuente extraabdominal más frecuente de lesión del intestino delgado. El diagnóstico de metástasis gastrointestinales es a menudo una expresión de enfermedad avanzada, con una supervivencia media de entre 6 y 9 meses. Materiales y Método: Presentamos el caso de un paciente varón de 63 años diagnosticado de melanoma cutáneo que acudió a urgencias por dolor abdominal y estreñimiento. Se realizó una TC abdominal donde se informó de la existencia de 2 lesiones metastásicas a nivel de intestino delgado que condicionaban oclusión intestinal. Resultados: El paciente fue intervenido quirúrgicamente bajo abordaje laparoscópico con resección de los dos segmentos intestinales afectos y anastomosis intracorpórea. El informe histopatológico confirmó que se trataban de metástasis de melanoma. Discusión: La oclusión intestinal por metástasis de melanoma maligno es muy infrecuente. La cirugía es el tratamiento de elección en pacientes con metástasis intestinales de melanoma. El tratamiento quirúrgico puede mejorar el pronóstico y estaría indicado casos de metástasis únicas o pacientes sintomáticos con intención paliativa. El abordaje mínimamente invasivo ofrece resultados oncológicos similares a la laparotomía.


Aim: Cutaneous melanoma has a high metastatic potential, being the most frequent extra-abdominal source of small bowel metastasis. The diagnosis of gastrointestinal metastases is often an expression of advanced disease, with an average survival of 6-9 months. Materials and Method: We herein present the case of a 63-year-old male patient diagnosed with cutaneous melanoma who arrived to the emergency department complaining of abdominal pain and constipation. An abdominal CT scan was performed, it revealed two metastatic lesions in the small bowel which marked the mechanical obstruction. Results: Patient underwent a laparoscopy and both involved segments were removed. Pathology exam confirmed the diagnosis of melanoma metastases. Discussion: Surgery excision is the treatment of choice in patients with small bowel metastases from melanoma. Surgical management can improve the prognosis and it would be indicated in cases of single metastases or symptomatic patients with a palliative intention. Minimally invasive approach provides similar oncological results as conventional laparotomy. Small bowel obstruction due to metastases of malignant melanoma is extremely rare.


Subject(s)
Humans , Male , Middle Aged , Skin Neoplasms/diagnosis , Melanoma/diagnosis , Skin Neoplasms/pathology , Biopsy , Tomography, X-Ray Computed , Laparoscopy , Gastrointestinal Neoplasms/secondary , Intestinal Obstruction/surgery , Melanoma/pathology
7.
Medicina (B.Aires) ; 80(3): 280-284, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1125080

ABSTRACT

El melanoma desmoplásico es una variedad infrecuente de melanoma que se distingue por su presentación clínico-patológica y su comportamiento biológico. El diagnóstico temprano es un desafío por su presentación clínica variable, con predominio del componente dérmico y la frecuente ausencia de pigmento. En la histología se lo divide en puro y mixto y esta clasificación tiene importantes implicancias pronósticas. El espesor de Breslow promedio al momento del diagnóstico es mayor que en otras variantes de melanoma, sin embargo, la tendencia a generar metástasis ganglionares es menor.


Desmoplastic melanoma is a rare presentation of melanoma with a different clinical behavior compared to other histological variants. Its diagnosis in early stages is a challenge due to its variable clinical presentation, with a predominant dermal component and the frequent absence of pigment. Its histology is divided into pure and mixed type, and this classification has important prognostic implications. The average Breslow thickness at diagnosis is higher than in other melanoma variants. However, the tendency to lymph node metastasis is low.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Melanoma/diagnosis , Melanoma/pathology , Biopsy , Diagnosis, Differential
8.
An. bras. dermatol ; 95(2): 158-164, Mar.-Apr. 2020. tab
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130841

ABSTRACT

Abstract Background: The incidence and mortality of melanoma is increasing in many countries, including Brazil. Survival studies are still scarce in our country, but much needed to know and address this problem better. Objective: To analyze the disease-specific survival of patients with invasive melanoma and to correlate it with clinical and histopathological variables. Methods: Retrospective cohort analysis of 565 cases of invasive melanoma in a tertiary hospital with the objective of testing variables that could be associated with a worse prognosis, such as gender, phototype, thickness, histological type and presence of pre-existing clinical lesion at the site of the tumor. Results: The worst survival rates were significantly associated with thicker tumors (p < 0.001), male sex (p = 0.014), high phototype (p = 0.047), nodular melanoma (p = 0.024) and "de novo" lesions (p = 0.005). When all variables were adjusted for melanoma thickness, male patients (p = 0.011) and "de novo" melanomas (p = 0.025) remained associated with worse survival. Study limitations: Retrospective study of a single tertiary hospital. Conclusions: Although the causes are still unknown, melanoma-specific survival was statistically worse for males and for "de novo" melanomas even after adjustment of tumor thickness.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Skin Neoplasms/mortality , Melanoma/mortality , Skin Neoplasms/pathology , Time Factors , Brazil/epidemiology , Proportional Hazards Models , Sex Factors , Retrospective Studies , Age Factors , Disease-Free Survival , Melanoma/pathology , Middle Aged
9.
Cienc. tecnol. salud ; 7(1): 47-52, 2020.
Article in Spanish | LILACS | ID: biblio-1120310

ABSTRACT

Los estudios de melanoma en Guatemala han sido pocos y únicamente se ha evaluado el aspecto clínico e histológico. El objetivo del presente estudio fue determinar la proporción de casos de melanoma cutáneo por morfología, inmunohistoquímica y mutación del gen BRAF en pacientes con diagnóstico de melanoma en dos centros de referencia, Instituto de Cancerología e Instituto de Dermatología en Guatemala. El estudio es de tipo descriptivo, retrospectivo, transversal. El tipo de muestreo es no probabilístico, con una muestra por conveniencia de 100 casos de tejidos de piel de pacientes, caracterizados por edad, sexo y localización del tumor. Los estudios moleculares incluyeron la determinación de la mutación de la proteína BRAF, por la técnica de PCR-RT. Los resultados muestran que el sexo más afectado es el femenino (54 %). El grupo etario con mayor número de casos es entre 56-75 años (44 %). El tipo histológico predominante es el melanoma lentiginoso acral (59 %) y la localización más frecuente es en miembro inferior (71 %). No se encontraron casos de melanoma lentigo maligno. La mutación del gen BRAF se encontró en el 6 % de los casos, lo que representa un dato importante para el pronóstico y tratamiento del paciente. Por ser uno de los primeros estudios que incluyen el factor molecular, abre paso a una línea de investigación que permita dar continuidad a los pacientes con melanoma en Guatemala, lo que permitirá determinar factores pronóstico y predictivos, así como tratamientos de los casos en estudio.


Studies of melanoma in Guatemala have been few and only the clinical and histological aspects have been evaluated. The objective of this study was to determine the proportion of cases of cutaneous melanoma by morphology, immunohistochemistry and mutation of the BRAF gene in patients diagnosed with Melanoma in two important reference centers, Institute of Cancerology (Incan) and Institute of Dermatology of Guatemala (Inderma). The study is descriptive, retrospective, transversal. The type of sampling is non-probabilistic, with a convenience sample calculation of 100 cases of patient skin biopsies, characterized by age, sex and tumor anatomic location. Molecular studies included the determination of the BRAF protein mutation by means of the RT-PCR technique. Results show that the most affected sex is the female (54 %). Age group with the highest number of cases is between 56 and 75 years old (44 % of cases). The histological type that predominated is acral lentiginous melanoma (59 %) and the most frequent location is in the lower limb (71 %). No cases of malignant lentigo melanoma were found in the cases studied. The BRAF gene mutation was found in 6 % of the cases, which represents an important data for the prognosis and treatment of the patient. In addition, being one of the first studies that include the molecular factor, it opens the way to a line of research that allows patients with melanoma to continue in Guatemala. This would allow to determine prognostic and predictive factors, as well as treatments of the cases under study.


Subject(s)
Immunohistochemistry/methods , Melanoma/diagnosis , Mutation/genetics , Skin Neoplasms , Hospitals, Chronic Disease , Melanoma/pathology
10.
Dermatol. argent ; 26(1): 23-25, 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1146359

ABSTRACT

Antecedentes: En la octava edición del manual de estadificación del cáncer del American Joint Committee on Cancer (AJCC), se introdujeron cambios importantes en las categorías T, N y M. Al entrar en vigencia la octava guía de la AJCC, se modificó no solo el T, sino también la indicación de biopsia del ganglio centinela (BGC). Entre los cambios más significativos en la estadificación se encuentran: la exclusión del índice mitótico (IM) de la categoría T en los melanomas finos (de hasta 1 mm de espesor) y el cambio del punto de corte para el espesor tumoral para discriminar un T1a (< 0,8 mm sin ulceración) de un T1b (≥ 0,8 mm). Objetivo: Comparar la estadificación inicial de los melanomas finos según el criterio utilizado en la séptima edición, con la que tendrían de acuerdo con la perspectiva actual del AJCC, con especial atención en el índice mitótico. Diseño y métodos: Estudio observacional, de corte transversal, realizado mediante la recolección de datos de las historias clínicas desde el 1 de enero de 2000 hasta el 31 de diciembre de 2017. Resultados: De 131 melanomas finos incluidos, 28 tendrían cambios en su estadificación. Al considerar el nuevo punto de corte para el espesor tumoral, 22 melanomas T1a pasarían a T1b. Asimismo, se detectaron 20 melanomas con un IM ≥ 1 mitosis/mm2, de los cuales solo 6 tuvieron indicación de BGC por este criterio exclusivamente y serían clasificados como T1a en la actualidad. De estos, en 2 no se realizó la BGC por autodeterminación de los pacientes y en los 4 restantes el resultado fue negativo. Conclusiones: Veintiocho de nuestros pacientes tendrían hoy diferencias en la indicación de BGC: 22 serían considerados con mayor riesgo de metástasis ganglionares y serían candidatos a su pesquisa. Los otros 6 pacientes ya no tendrían indicación de ese estudio por la baja posibilidad de encontrar metástasis ocultas, lo cual coincide con el resultado negativo de la BGC en los 4 pacientes que se sometieron al procedimiento. (AU)


Background: In the 8th edition of the cancer staging manual of the American Joint Committee on Cancer (AJCC), important changes were made in the T, N and M categories. When the 8th guideline of the AJCC came into effect, not only was the T stage modified, but also the indication for sentinel lymph node biopsy (SLNB). The most significant changes in staging included: the exclusion of the mitotic index (MI) as a determinant of the T category and the change of the threshold of tumor thickness to discriminate a T1a (< 0.8 mm without ulceration) from a T1b (≥ 0.8 mm). Objective: To compare the initial staging of thin melanomas according to the criteria used in the 7th edition, with the one that would have been used according to the current AJCC recommendations, with special focus on MI. Design and methods: Observational, cross-sectional study, carried out through the collection of data from medical records from January 1, 2000 to December 31, 2017. Results: There were 131 thin melanomas included, 28 of which would have had changes in their staging. When considering the modified threshold for tumor thickness, 22 T1a melanomas would be classified as T1b. Among 20 thin melanomas with a MI ≥ 1, only 6 had an indication for SLNB solely due to the MI criterion and would be now classified as T1a. Two of these did not undergo SLNB because they rejected the procedure, and in the remaining 4, there were no SLN metastasis. Conclusions: Nowadays, 28 of our patients would have differences in the indication for SLNB: 22 would be considered to be at greater risk of lymph node metastasis and would be candidates for screening. The other 6 patients would no longer have an indication for this procedure due to the low probability of clinically occult metastases, which seems to concur with the negative result of SLNB in the 4 patients who underwent the procedure. (AU)


Subject(s)
Humans , Skin Neoplasms/pathology , Practice Guidelines as Topic , Sentinel Lymph Node Biopsy , Melanoma/pathology , Mitotic Index , Neoplasm Staging/methods , Skin Neoplasms/diagnosis , Cross-Sectional Studies , Risk Factors , Lymphatic Metastasis , Melanoma/diagnosis
11.
Rev. Col. Bras. Cir ; 47: e20202460, 2020. tab, graf
Article in English | LILACS | ID: biblio-1143691

ABSTRACT

ABSTRACT Objectives: to analyze the survival in juvenile melanoma. Methods: retrospective study conducted by hospital record review and cancer records of patients aged 0 to 19 years, with histologically proven melanoma and treated between 1997 and 2017 at the Erasto Gaertner Hospital in Curitiba-PR. Results: the sample comprised 24 patients, female (62.5%), mean 14.14 ± 4.72 years old, with head and neck melanoma (37.5%), chest (25%) and extremities. (20.8%). Signs and symptoms at diagnosis were increased lesion size (25%), bleeding (20.8%) and pruritus (16.6%). There was a Breslow II and IV index and Clark IV level, with a statistical tendency between Breslow IV and death (p = 0.127), and significance between Clark V and death (p = 0.067). Nine (37.5%) patients had metastases, six (25%) with distant metastases died (p = 0.001), five were girls (20.8%). Surgery was the standard treatment and chemotherapy the most used adjuvant (37.5%). The average time between diagnosis and death was 1.3 ± 1.2 years and survival were 3.7 ± 3.2 years. Conclusion: there was a delay in diagnosis, high morbidity and mortality and average survival less than five years.


RESUMO Objetivos: analisar a sobrevida no Melanoma Infantojuvenil. Métodos: estudo retrospectivo realizado mediante revisão de prontuários e registros hospitalares de câncer, de pacientes na faixa etária de 0 a 19 anos, com melanoma comprovado histologicamente e atendidos entre 1997 e 2017 no Hospital Erasto Gaertner em Curitiba-PR. Resultados: amostra composta por 24 pacientes, sexo feminino (62,5%), média de 14,12 ± 4,72 anos de idade, com melanoma em cabeça e pescoço (37,5%), tórax (25%) e extremidades (20,8%). Os sinais e sintomas ao diagnóstico foram aumento do tamanho da lesão (25%), sangramento (20,8%) e prurido (16,6%). Ocorreu Índice de Breslow II e IV e Nível de Clark IV, com tendência estatística entre Breslow IV e óbito (p=0,127) e significância entre Clark V e óbito (p=0,067). Nove (37,5%) pacientes apresentaram metástases, seis (25%) com metástases à distância morreram (p=0,001), cinco eram meninas (20,8%). A cirurgia foi o tratamento padrão e a quimioterapia o adjuvante mais utilizado (37,5%). A média de tempo entre diagnóstico e óbito foi de 1,3 ± 1,2 anos e de sobrevida foi 3,7 ± 3,2 anos. Conclusão: houve atraso no diagnóstico, alta morbimortalidade e média de sobrevida menor do que cinco anos.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Skin Neoplasms/mortality , Melanoma/mortality , Prognosis , Survival Analysis , Survival Rate , Retrospective Studies , Chemotherapy, Adjuvant/adverse effects , Sentinel Lymph Node , Head and Neck Neoplasms/surgery , Melanoma/pathology , Melanoma/therapy , Neoplasm Metastasis , Neoplasm Staging
12.
Rev. Col. Bras. Cir ; 47: e20202441, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1136569

ABSTRACT

RESUMO Objetivo: Avaliar características do melanoma em idosos. Método: Pesquisa retrospectiva mediante revisão de prontuários de idosos diagnosticados com melanoma cutâneo primário, no período de 2013 a 2017, atendidos no Hospital Erasto Gaertner, em Curitiba-Paraná. Resultados: Amostra com 139 pacientes, mulheres (52,5%), média de 70,3 anos de idade, com lesão em membro superior ou membro inferior (32,3%) e cabeça (24,4%), sinais de ulceração (33,8%) e classificação em tipo histológico nodular (29,5%), extensivo superficial (27,3%) e acral (11,5%). Média do índice de Breslow de 3,7 mm. Metástases ocorreram em 33% dos pacientes, para linfonodos (36%) e sistema nervoso central (20%). Pesquisa do linfonodo sentinela foi realizada em 41,7% e tratamento cirúrgico isolado em 70% dos casos. Houve recidiva em 34,5% pacientes e 17,9% evoluíram com óbito. Esses achados apontam características prognósticas sombrias relacionadas ao diagnóstico e tratamento tardio da neoplasia. Conclusões: Melanoma em membros e cabeça, índice de Breslow intermediário, metastático para linfonodos e sistema nervoso central, recidiva e tem desfecho fatal. Há necessidade de direcionar estratégias para melhor abordagem da doença em idosos, como prevenção, detecção precoce e oferta de tratamento uniforme e adequado.


ABSTRACT Objective: This study evaluates melanoma characteristics in the elderly. Methods: A retrospective descriptive analytical study was carried out by reviewing the medical records of patients aged 60 years or older, diagnosed with primary cutaneous melanoma, and treated at Hospital Erasto Gaertner, Curitiba, Paraná, from 2013 to 2017. Results: We studied 139 patients aged 60-98 years (average, 70.3 years) and found melanoma to be more common in women (52.5%) than in men. Lesions mainly affected the limbs (32.3%) and head (24.4%), showed signs of ulceration (33.8%), and could be classified into the nodular histological (29%), extensive superficial (27%), and acral (12%) types. The average Breslow index was 1.2 mm. Metastasis occurred in 33% of the patients and mainly affected lymph nodes (36%) and the central nervous system (CNS, 20%). The first procedure conducted in 79% of the cases was surgical resection. Sentinel node mapping was carried out in 41.7% of the cases, and surgical treatment alone was indicated in 70% of the patients. The disease recurred in 34.5% of the patients, and 17.9% succumbed to the disease. These results indicate that the elderly have poorer prognosis when cancer treatment is delayed. Conclusion: Melanoma of the limbs and head, intermediate Breslow index, metastatic lymph node and CNS metastases, and relapse result in fatal outcomes. Direct strategies, such as prevention and early detection, as well as uniform and adequate treatment, are needed to improve disease management in the elderly.


Subject(s)
Humans , Male , Female , Adult , Aged , Skin Neoplasms/pathology , Melanoma/pathology , Prognosis , Skin Neoplasms/classification , Retrospective Studies , Melanoma/classification , Middle Aged , Neoplasm Metastasis , Neoplasm Recurrence, Local , Neoplasm Staging
13.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(4): 437-441, dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058720

ABSTRACT

RESUMEN El melanoma mucoso maligno es un tumor neuroectodérmico de menos del 5% de las neoplasias nasosinusales. Es un tumor de mal pronóstico clásicamente su promedio de supervivencia a cinco años es cercano al 28% y 17,5% a diez años, siendo aún peor cuando existe metástasis en cuello. Se presentan a continuación dos casos de melanoma mucoso en cavidad nasal y senos paranasales, el primero mujer 58 años con melanoma septal llevada a septotomía abierta más quimioterapia y radioterapia adyuvante, con recurrencia en cuello submaxilar derecho tratada con vaciamiento supraomohioideo actualmente sin recurrencia; el segundo hombre de 40 años con antecedente de resección melanoma septal quien presenta nuevo melanoma región etmoidal izquierda luego de su primera cirugía y es llevado a resección endoscópica transnasal sin tratamiento adyuvante por decisión del paciente.


ABSTRACT Sinonasal mucosal melanoma is a neuroectodermic tumor account less 5% of nasosinusal tumors. It has a poor prognosis with a five-year average survival near 28% and 17.5% to 10 years; if neck metastasis is even worst. Here we present two clinical cases. First one a woman 58 years old with septal melanoma who receives an open septectomy with chemotherapy and radiotherapy with submaxillary recurrence treated with supraomohyoid neck dissection. The second case, a man 40 years old with previous septal melanoma surgery who has an ethmoid sinus recurrence and receives transnasal endoscopic surgery without adjuvant therapy by patient desire.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Melanoma/pathology , Nasal Mucosa/pathology , Paranasal Sinus Neoplasms/pathology , Paranasal Sinus Neoplasms/therapy , Nasal Obstruction/etiology , Nose Neoplasms/pathology , Nose Neoplasms/therapy , Radiotherapy, Adjuvant , Melanoma/therapy , Nasal Mucosa/surgery
15.
An. bras. dermatol ; 94(6): 721-723, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1054886

ABSTRACT

Abstract Primary male genital melanomas are very rare; they are associated with high mortality and late detection. Scrotal melanoma is the least common presentation and only 23 cases have been reported. Herein, the authors present a 30-year-old patient with stage IIIC (T4b, N2a, M0) scrotal melanoma in order to report the characteristics, treatment, and outcome, as well as to emphasize the importance of examination of the genitals, education of patients about self-examination and destigmatizing genital lesions to increase the likelihood of earlier detection.


Subject(s)
Humans , Male , Adult , Scrotum/pathology , Skin Neoplasms/pathology , Genital Neoplasms, Male/pathology , Melanoma/pathology , Skin Neoplasms/drug therapy , Biopsy , Interferon alpha-2/administration & dosage , Genital Neoplasms, Male/drug therapy , Melanoma/drug therapy , Neoplasm Staging , Antineoplastic Agents/administration & dosage
17.
An. bras. dermatol ; 94(5): 586-589, Sept.-Oct. 2019. graf
Article in English | LILACS | ID: biblio-1054853

ABSTRACT

Abstract Cutaneous neoplasms frequently occur in leprosy, but there are few reports of the coexistence of leprosy and basal cell carcinoma in the same lesion. This case reports a 49-year-old male with an ulcerated plaque on the right lateral nasal wall, bright papules on the sternal region, and a blackened plaque on the right temporal region. The nasal and temporal lesions were diagnosed by histopathology as basal cell carcinoma and melanoma, respectively. The sternal lesions were excised with the repair of the "dog ear" which histopathological examination showed macrophages in the dermis parasitized with acid-fast bacilli, confirming the diagnosis of lepromatous leprosy with Fite-Faraco staining. This case report highlights the importance of referring the dog-ear specimen for histopathologic analysis.


Subject(s)
Humans , Male , Middle Aged , Skin Neoplasms/complications , Carcinoma, Basal Cell/complications , Leprosy, Lepromatous/complications , Melanoma/complications , Skin Neoplasms/pathology , Biopsy , Carcinoma, Basal Cell/pathology , Leprosy, Lepromatous/pathology , Melanoma/pathology
18.
An. bras. dermatol ; 94(4): 458-460, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038300

ABSTRACT

Abstract: Melanoma is widely known as the most lethal skin cancer. Specific tumor-related mortality can be significantly reduced if diagnosis and treatment are properly performed during initial phases of the disease. The current search for biomarkers in early-stage melanomas is a high-priority challenge for physicians and researchers. We aimed to assess the immunoexpression of BRAFV600E and KIT in a case series consisting of 44 early-stage melanomas. Formalin-fixed paraffin-embedded samples were systematically evaluated using a semi-quantitative method based on scores of percentage and intensity for immunostained tumor cells. We observed significant concordance between BRAFV600E and KIT immunoexpression in thin invasive melanomas. Our findings corroborate previous evidence showing abnormal expression of proteins associated with MAPK intracellular signaling pathway in early-stage melanomas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Skin Neoplasms/pathology , Proto-Oncogene Proteins c-kit/analysis , Proto-Oncogene Proteins B-raf/analysis , Melanoma/pathology , Immunohistochemistry , Retrospective Studies , Disease Progression , Proto-Oncogene Proteins c-kit/genetics , Mitogen-Activated Protein Kinases/analysis , Proto-Oncogene Proteins B-raf/genetics , Mutation , Neoplasm Staging
19.
Medicina (B.Aires) ; 79(4): 265-270, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1040519

ABSTRACT

El melanoma maligno es la forma más agresiva de cáncer de piel, con una tasa de mortalidad en Argentina 1997-2001 = 1.1/100 000 en varones y 0.6 en mujeres. El proto-oncogén BRAF es foco de intensa investigación, su mutación es uno de los principales promotores tumorales y pueden presentarse en 50% de los melanomas. Se han aprobado varios fármacos con actividad clínica sobre las mutaciones BRAF. El objetivo del trabajo es evaluar el estado mutacional de BRAF (exón 15) en biopsias con melanoma maligno cutáneo y su relación con las características histopatológicas. Realizamos un estudio observacional, retrospectivo, de muestras fijadas en formol e incluidas en parafina. Revisamos edad, sexo, diagnóstico y datos histopatológicos, tamaño y porcentaje tumoral, viabilidad para análisis molecular y presencia de melanina. Evaluamos mutaciones de BRAF con PCR/secuenciación Sanger. Utilizamos test de Student, Chi cuadrado, Wilcoxon y prueba exacta de Fisher. De 49 casos se pudo purificar y secuenciar el 76% (38/49), 13/38 (34%) mujeres y 25/38 (66%) varones, edad mediana 70 años. Localización más frecuente: tórax con 14/35 (40%). Tipo histológico: extensivo superficial 18/38 (47%). Niveles de Clark, 11/38 (29%): I-II y 27/38 (71%): III, IV y V. Mediana del Breslow: 1.6 mm. Fase de crecimiento radial 11/38 (29%) y 27/38 (71%) vertical. Presentaron mutaciones 16/38 (42%). Como lo informado por otros autores, no se encontró asociación entre el estado mutacional del exón 15 y los parámetros clínicos o histopatológicos.


Malignant melanoma (MM) is the more aggressive form of skin cancer with a mortality rate in Argentina 1997-2001 = 1.1/100 000 in men and 0.6 in women. BRAF proto-oncogene is focus of intense research; its mutation is one of the main tumor promoters and occurs in approximately 50% of MM. Several drugs with clinical activity on BRAF mutations have been approved. The aim of the study is to evaluate the mutational status of BRAF (exon 15) in cutaneous MM biopsies and its relationship with histopathological characteristics. We carried out an observational, retrospective study of samples fixed in formaldehyde and paraffin embedded; reviewing age, sex, diagnosis, histopathological data, tumor size and percentage, viability for molecular analysis and melanin presence. We evaluated BRAF mutations with PCR/Sanger sequencing. For statistics we used Student's t test, Chi square, Wilcoxon and Fisher's exact test. We were able to purify and sequence 76% (38/49) samples, 13/38 (34%) from women and 25/38 (66%) from men, the median age being 70 years. Most frequent location: thorax 14/35 (40%). Histological type: Superficial spreading 18/38 (47%). Clark´s levels, 11/38 (29%): I-II and 27/38 (71%): III, IV and V. Breslow´s median: 1.6 mm. Radial growth phase 11/38 (29%) and 27/38 (71%) vertical. Presented mutations 16/38 (42%). As reported by other authors, no association was found between the mutational state of exon 15 and clinical or histopathological parameters.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Skin Neoplasms/genetics , Proto-Oncogene Proteins B-raf/genetics , Melanoma/genetics , Mutation/genetics , Skin Neoplasms/pathology , DNA Mutational Analysis , Retrospective Studies , Real-Time Polymerase Chain Reaction , Melanoma/pathology
20.
Rev. medica electron ; 41(3): 756-764, mayo.-jun. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1094083

ABSTRACT

RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal.


ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal.


Subject(s)
Humans , Female , Adult , Anus Neoplasms/diagnosis , Anus Neoplasms/pathology , Anus Neoplasms/blood , Cell Transformation, Neoplastic , Sarcoma, Clear Cell/diagnosis , Melanocytes/metabolism , Melanoma/diagnosis , Melanoma/pathology , Melanoma/blood , Anal Canal/physiopathology , Pruritus Ani/diagnosis , Neoplasm Metastasis
SELECTION OF CITATIONS
SEARCH DETAIL