ABSTRACT
BACKGROUND: Acral lentiginous melanoma has increased mortality compared with other melanoma subtypes and disproportionately affects ethnic minorities. Acral melanocytic lesions have not been well studied in diverse populations of the United States. OBJECTIVE: We sought to assess the prevalence, awareness, and dermoscopic patterns of acral melanocytic lesions in skin-of-color and non-Hispanic white patients. METHODS: We prospectively examined the palms and soles of 1052 patients presenting to dermatology clinics in New York, NY, and Miami, FL, from October 2013 to April 2015. RESULTS: Acral melanocytic lesions were observed in 36% of our cohort. Skin-of-color patients were more likely to have acral melanocytic lesions than non-Hispanic white patients (P < .01). Acral melanocytic lesions correlated with increased mole counts, particularly on non-Hispanic white patients. The majority of lesions demonstrated benign dermoscopic patterns. We observed 2 lesions with the parallel ridge pattern in our cohort, both found to be atypical nevi on biopsy specimen. Patients often lacked awareness of the presence of their lesions. LIMITATIONS: Interobserver variability in assessing dermoscopic patterns is a limitation. CONCLUSIONS: Melanocytic lesions of the palms and soles are common, particularly in a cohort of multiple ethnicities from the United States. Dermoscopy of acral lesions is an important clinical tool for diagnosis and management of these lesions.
Subject(s)
Dermoscopy/methods , Melanoma/diagnosis , Nevus, Pigmented/diagnosis , Skin Neoplasms/diagnosis , Skin Pigmentation/physiology , White People/statistics & numerical data , Aged , Aged, 80 and over , Awareness , Biopsy, Needle , Cohort Studies , Female , Florida/epidemiology , Humans , Immunohistochemistry , Male , Melanoma/ethnology , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging , Nevus, Pigmented/ethnology , Observer Variation , Prevalence , Prospective Studies , Risk Assessment , Skin Neoplasms/ethnology , United States/epidemiologyABSTRACT
PURPOSE: To characterize and implement the 4D Integrated Extended Cardiac Torso (XCAT) digital phantom for 4D radiotherapy (RT) application. METHODS: A computer program was developed to facilitate the characterization and implementation of the 4D XCAT phantom. The program can (1) generate 4D XCAT images with customized parameter files; (2) review 4D XCAT images; (3) generate composite images from 4D XCAT images; (4) track motion of selected region-of-interested (ROI); (5) convert XCAT raw binary images into DICOM format; (6) analyze clinically acquired 4DCT images and Real-time Position Management (RPM) respiratory signal. Validation of the motion tracking algorithm was made by comparing to manual method. Major characteristics of the 4D XCAT phantom were studied including the dependence of lesion motion on its location/size and inputted diaphragm profile. An end-to-end test from image generation to treatment planning was also performed. RESULTS: The comparison between motion tracking and manual measurements of lesion motion trajectory showed a small difference between the two (mean difference in motion amplitude: 1.2 mm). The maximum lesion motion decreased nearly linearly (R2=0.97) as its distance to the diaphragm (DD) increased. At any given DD, lesion motion amplitude increased nearly linearly (R2 range: 0.89 to 0.95) as the inputted diaphragm motion increased. For a given diaphragm motion, the lesion motion is independent f the lesion size at any given DD. The 4D XCAT phantom can closely reproduce irregular breathing profile: the mean difference in motion amplitude between the inputted and the measured motion profile was 1.4 mm. The end-to-end test showed that clinically comparable treatment plans can be generated successfully based on 4D XCAT images. CONCLUSIONS: An integrated computer program has been developed to generate, review, analyze, process, and export the 4D XCAT images. A robust workflow has been established to implement the 4D XCAT phantom for 4D RT application.
ABSTRACT
We present a retrospective study of the frequency, pattern, and management of infections in advanced cancer. Three hundred ninety-three patients were admitted to an acute care palliative medicine unit in an 8-month period for evaluation and palliation of cancer-related symptoms and complications. One hundred fifteen had at least one positive bacteriological culture, and 100 of these patients were evaluable. One hundred fifty-two infections and 192 isolates were identified. Sixty-eight patients had polymicrobial infections. Sixty-six patients had urinary tract infections. Forty-one were found to have multisystemic infections. Eighty-one had invasive devices; 32 had more than one invasive device. Fifty-three were taking corticosteroids at the time of infection. Only 3 were neutropenic. Urinary tract infections were significantly more common in those taking corticosteroids. The median duration of antibiotic treatment was 11 days and the median hospital stay, 14 days. Twenty-eight patients died in the hospital; 10 of those who died had lung cancer, which was a statistically significant observation. In conclusion, infections are an underrecognized but common complication in nonneutropenic hospitalized patients with advanced solid tumors. Urinary tract infections appear to be associated with the use of corticosteroids. Lung cancer patients are at greater risk for fatal infections. Infections increase morbidity in debilitated patients with solid tumors, are a frequent cause of hospital admission, and are associated with significant mortality.
