ABSTRACT
In spite of the good prognosis of patients with early-stage melanoma, there is a substantial proportion of them that develop local or distant relapses. With the introduction of targeted and immune therapies for advanced melanoma, including at the adjuvant setting, early detection of recurrent melanoma and/or second primary lesions is crucial to improve clinical outcomes. However, there is a lack of universal guidelines regarding both frequency of surveillance visits and diagnostic imaging and/or laboratory evaluations. In this article, a multidisciplinary expert panel recommends, after careful review of relevant data in the field, a consensus- and experience-based follow-up strategy for melanoma patients, taking into account prognostic factors and biomarkers and the high-risk periods and patterns of recurrence in each (sub) stage of the disease. Apart from the surveillance intensity, healthcare professionals should focus on patients education to perform regular self-examinations of the skin and palpation of lymph nodes. (AU)
Subject(s)
Humans , Consensus , Melanoma/diagnosis , Melanoma/pathology , Melanoma/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/therapy , Follow-Up StudiesABSTRACT
In spite of the good prognosis of patients with early-stage melanoma, there is a substantial proportion of them that develop local or distant relapses. With the introduction of targeted and immune therapies for advanced melanoma, including at the adjuvant setting, early detection of recurrent melanoma and/or second primary lesions is crucial to improve clinical outcomes. However, there is a lack of universal guidelines regarding both frequency of surveillance visits and diagnostic imaging and/or laboratory evaluations. In this article, a multidisciplinary expert panel recommends, after careful review of relevant data in the field, a consensus- and experience-based follow-up strategy for melanoma patients, taking into account prognostic factors and biomarkers and the high-risk periods and patterns of recurrence in each (sub) stage of the disease. Apart from the surveillance intensity, healthcare professionals should focus on patients' education to perform regular self-examinations of the skin and palpation of lymph nodes.
Subject(s)
Melanoma , Skin Neoplasms , Consensus , Follow-Up Studies , Humans , Melanoma/diagnosis , Melanoma/pathology , Melanoma/therapy , Neoplasm Recurrence, Local/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Skin Neoplasms/therapySubject(s)
Panniculitis , Skin Neoplasms , Antineoplastic Combined Chemotherapy Protocols , Humans , Mitogen-Activated Protein Kinase Kinases/therapeutic use , Mutation , Panniculitis/chemically induced , Panniculitis/diagnosis , Protein Kinase Inhibitors/adverse effects , Proto-Oncogene Proteins B-raf/genetics , Proto-Oncogene Proteins B-raf/therapeutic use , Skin Neoplasms/chemically inducedABSTRACT
Chromomycosis is a rare mycotic infection that is more frequent in tropical and subtropical regions. Dematiaceous fungi are the causal agents of this mycosis. Several cases of chromomycosis in organ transplant recipients have been reported. We present a case of chromomycosis by Exophiala jeanselmei in a Spanish male who had received a renal transplant several months previously, and was receiving treatment with tacrolimus, prednisone and mycophenolate mofetil. Very few cases of chromomycosis due to Exophiala have been reported, and this is, to our knowledge, the first European case.
Subject(s)
Exophiala/isolation & purification , Kidney Transplantation , Mycoses/diagnosis , Diagnosis, Differential , Hand , Humans , Immunocompromised Host , Male , Middle Aged , Mycoses/pathologySubject(s)
Angiotensin Receptor Antagonists , Antihypertensive Agents/adverse effects , Benzimidazoles/adverse effects , Immunoglobulin A/drug effects , Skin Diseases, Vesiculobullous/chemically induced , Tetrazoles/adverse effects , Aged , Antihypertensive Agents/administration & dosage , Benzimidazoles/administration & dosage , Biphenyl Compounds , Humans , Hypertension/drug therapy , Immunoglobulin A/metabolism , Male , Skin Diseases, Vesiculobullous/immunology , Tetrazoles/administration & dosageABSTRACT
Since 1998, many cases of antiretroviral therapy-related paronychia of the toes or fingers and ingrown toenails have been reported. Most of them were related to indinavir. Other indinavir-induced mucocutaneous disorders resembling the adverse effects of systemic retinoid therapy have also been reported. Although there is some uncertainty in the literature regarding a cause-effect relationship, results of several epidemiological and in vitro studies, together with cumulated clinical experience leave no doubt that indinavir causes a retinoid-like effect and nail alterations. Indeed, indinavir is the only antiretroviral drug that produces these disorders, although ritonavir may enhance indinavir-induced retinoid-like effects through pharmacokinetic interactions leading to increased plasma indinavir concentrations. Approximately 30% of patients receiving indinavir show two or more retinoid-like manifestations and 4-9% develop paronychia. These adverse effects are not related to other epidemiological variables such as the patient's sex, age or other risk factors or immune status. They seem to be exposure dependent and, therefore, largely dose-dependent. Chronic paronychia is considered generally to be caused by contact irritants and candidal infection. Nevertheless, indinavir is currently the most frequent cause of chronic or recurrent paronychia in HIV-infected patients. In addition, retinoid-like manifestations such as cutaneous xerosis and cheilitis are frequent mucocutaneous adverse effects related to indinavir. The exact mechanism of indinavir-induced retinoid-like effects is unclear. Hypotheses for pathogenesis include interference with retinoid metabolism by enhancing the retinoic acid signalling pathway, or by increasing retinoic acid synthesis, or by reducing cytochrome p450-mediated retinoic acid oxidative metabolism. Replacement of therapy by an antiretroviral regimen not containing indinavir, while retaining other protease inhibitors and lamivudine, resolves retinoid-like manifestations without recurrences.
Subject(s)
Anti-HIV Agents/adverse effects , HIV Infections/drug therapy , Indinavir/adverse effects , Retinoids/adverse effects , Skin Diseases/chemically induced , Skin Diseases/epidemiology , Humans , Incidence , Skin Diseases/pathologyABSTRACT
Two patients presented with nodular lesions on their lower limbs. Histologically, the dermis, in one case, and the panniculus, in the other, displayed pseudocystic lesions delimited by a serpiginous membranous structure showing the staining characteristics of ceroid. One patient had sclerosing panniculitis while the other had a traumatic panniculitis.These cases illustrate that membranous fat necrosis is a non-specific histological finding and that multiple processes are involved in its etiopathogenesis.