ABSTRACT
BACKGROUND: Most surgical margins for lentigo maligna melanomas reported in the literature are clinical and not histologic. OBJECTIVES: We sought to determine whether histologic margin status is an independent predictor of progression. METHODS: Clinicopathologic information of 268 invasive lentigo maligna melanomas diagnosed from 1990-2019 were analyzed. Statistical analyses were performed using Cox proportional hazards model and Boruta method. RESULTS: A total of 75% of the lesions were located on the head and neck. The range of follow-up for all patients was 0 to 31.8 years (median, 10.2 years). Time to local recurrence ranges from 0 to 20 years (median, 3 years). Progression developed in 54 (20.1%) of 268 patients. Local recurrence was seen only in 36 (13.4%), both local recurrence and subsequent metastasis in 7 (2.6%), and only metastasis in 11 (4.1%) of 268 patients. Histologic margin status (positive and close/<3 mm) and tumor site (head and neck location) significantly correlated with worse progression-free survival. LIMITATIONS: Single institution and retrospective study. CONCLUSIONS: Histologic margin status is the strongest predictor of progression for lentigo maligna melanoma. Patients with positive or close/<3 mm histologic margins should consider a re-excision due to the increased risk of relapse.
ABSTRACT
PURPOSE OF REVIEW: Vascular malformations (VaMs) are a consequence of disrupted morphogenesis that may involve arterial, capillary, venous, or lymphatic endothelium alone or in a combination. VaMs can have serious health impacts, leading to life-threatening conditions sometimes. Genetic mutations affecting proliferation, migration, adhesion, differentiation, and survival of endothelial cells, as well as integrity of extracellular matrix are believed to be the pathogenesis of these disorders. Here, we present an updated review of genetic mutations and potential therapeutic targets for VaMs. RECENT FINDINGS: Increased number of genetic mutations have been discovered in vascular anomalies via targeted deep sequencing. When a genetic defect is identified, it often presents in only a small percentage of cells within the malformation. In addition, mutations within the same gene may result in different clinical phenotypes. Management of VaMs can be challenging depending on the severity and functional impairment associated. There are no standard treatment algorithms available to date for VaMs, therefore the disorder has significant unmet clinical needs. Currently, the focus of therapeutic development is to target constitutively activated intracellular signaling pathways resulted from genetic mutations. SUMMARY: Knowledge about the genetic mutations and altered signaling pathways related to VaMs have improved our understanding about the pathogenesis of vascular anomalies and provided insights to the development of new targeted therapies.
Subject(s)
Molecular Targeted Therapy , Mutation/genetics , Signal Transduction/genetics , Vascular Diseases/genetics , Vascular Malformations/genetics , Vascular Malformations/therapy , Endothelial Cells , Genetic Markers , Humans , Phenotype , Vascular Malformations/pathologyABSTRACT
AIMS: Acral lentiginous melanoma (ALM) is the most common type of melanoma in people with darker skin phototypes. There is some evidence that the aetiology, pathogenesis, risk factors and natural history of ALM differ from those of superficial spreading melanoma (SSM). ALM behaves more aggressively than SSM, but the biological explanation for these differences remains unknown. The presence of one subtype of macrophages, termed M2-macrophage (M2-M), has been found to be related to local progression, metastasis and poor prognosis in several neoplasms. The aim of this study was to compare the density of M2-Ms in ALMs versus SSMs, and to examine whether or not the density of M2-Ms is associated with histopathological features predictive of adverse prognosis in cutaneous melanoma (CM), as well as development of metastasis. METHODS AND RESULTS: Sixty-seven ALMs and 67 SSMs cases were analysed. The tumours were classified according to thickness, ulceration, mitosis and metastasis. M2-M quantity was evaluated using immunohistochemistry with anti-CD163 and anti-CD206 antibodies. M2-Ms were increased in ALM compared with SSM, and were related to the histopathological features predictive of adverse prognosis in CM, such as thickness > 1.0 mm, ulceration and mitotic activity, and the development of metastasis. CONCLUSIONS: Our study is the first, to our knowledge, to demonstrate the increased presence of M2-Ms in ALM compared with SSM. Our findings suggest that the increased M2-Ms in ALM are associated with the main histopathological features predictive of adverse prognosis in CM, as well as the presence of metastasis, and that these cells can be related to the aggressive behaviour seen in ALMs.
Subject(s)
Macrophages/pathology , Melanoma/pathology , Skin Neoplasms/pathology , Skin/pathology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Prognosis , Young AdultABSTRACT
La implantación de marcapaso definitivo (MPD) se realiza en portadores de alteraciones en la generación del impulso eléctrico del corazón y/o con trastornos de la conducción. Las guías clínicas para su manejo proponen un seguimiento precoz, regular y de por vida, posterior al implante de MPD, con el fin de pesquisar alteraciones. Objetivo: caracterizar y evaluar adherencia a seguimiento en pacientes con primoimplante de MPD del Hospital Gustavo Fricke (HGF) en el período 2007. Pacientes y método: estudio descriptivo y retrospectivo, cuyo universo fueron los pacientes con primoimplante de MPD del HGF en el año 2007. Se caracterizaron los pacientes de acuerdo a sexo, edad y diagnóstico de indicación de MPD; se describió el porcentaje de inasistencia al primer, segundo y tercer control post-implante del MPD (correspondiente por garantías explícitas en salud) y finalmente se buscaron causas de inasistencia a estos controles. Resultados: el universo fue de 181 pacientes, 101 hombres. El grupo etáreo predominante fueron mayores de 70 años (56,9 por ciento). Los diagnósticos más frecuentes fueron: bloqueo auriculoventricular completo (31,4 por ciento) y enfermedad del nodo sinusal (30,9 por ciento). De los 181 pacientes del universo, 110 faltaron al menos a un control con una curva de insistencia ascendente en el tiempo, observándose que a los 6 meses (tercer control) más de la mitad estuvo inasistente. De estos 110 pacientes, 60 pudieron ser contactados telefónicamente para aplicarles una encuesta de causas de inasistencia, encontrándose que 37 de ellos no asistieron a control por falta de citación. La caracterización de pacientes respecto a sexo, edad y diagnóstico de indicación de MPD coincidió con la literatura. Conclusiones: el importante ascenso de las inasistencias a controles post-implante de MPD contrasta con las recomendaciones de seguimiento.
The difinitive pacemaker (DPM) implantation is performed in patients with alterations in the generation of electrical impulse from heart and / or conduction disturbances. Clinical guidelines for management proposed early tracking, regular and for life, post DPM implantation in order to detect alterations. Aim: characterize and assess adherence to monitoring in patients with first DPM implantation at the Hospital Gustavo Fricke (HGF) during 2007. Method and patients: retrospective and descriptive study. The universe were patients with first DPM implantation at HGF during 2007. Patients were characterized according to sex, age and diagnosis of DPM indication; percentage of absence at the first, second and third control post DPM implantation (corresponding to clinical guidelines in Chile) was described and finally causes of absences to the controls were investigated. Results: the universe was 181 patients; 101 men. The most frequent age group were older than 70 years (56.9 percent). The most common diagnoses were: complete atrioventricular block (31.4 percent) and sinus node disease (30.9 percent). Of 181 patients of the universe, 110 missed at least one control in an ascending curve in time so that at 6 months (third control) more of 50 percent did not attend the medical control. Of these 110 patients, 60 could be contacted to make a telephone poll to know the causes of the absence and it was found that 37 of them did not attend due to lack of appointment. Characterization of patients regarding sex, age and diagnosis of DPM indication coincided broadly with those reported in the literature. Conclusions: the significant rise in absences to post implantation DPM controls contrasts sharply with the follow-up recommendations.
