Skin autofluorescence provides additional information to the UK Prospective Diabetes Study (UKPDS) risk score for the estimation of cardiovascular prognosis in type 2 diabetes mellitus.

AIMS/HYPOTHESIS: The UK Prospective Diabetes Study (UKPDS) risk engine has become a standard for cardiovascular risk assessment in type 2 diabetes mellitus. Skin autofluorescence was recently introduced as an alternative tool for cardiovascular risk assessment in diabetes. We investigated the prognostic value of skin autofluorescence for cardiovascular events in combination with the UKPDS risk engine in a cohort of patients with type 2 diabetes managed in primary care. METHODS: Clinical, UKPDS risk engine and skin autofluorescence data were obtained at baseline in 2001-2002 in the type 2 diabetes group (n = 973). Follow-up data concerning fatal and non-fatal cardiovascular events (primary endpoint) were obtained till 2005. Patients were classified as 'low risk' when their 10 year UKPDS risk score for fatal cardiovascular events was <10%, and 'high risk' if >10%. Skin autofluorescence was measured non-invasively with an autofluorescence reader. Skin autofluorescence was classified by the median (i.e. low risk < median, high risk > median). RESULTS: The incidence of cardiovascular events was 119 (44 fatal, 75 non-fatal). In multivariate analysis, skin autofluorescence, age, sex and diabetes duration were predictors for the primary endpoint. Addition of skin autofluorescence information to that from the UKPDS risk engine resulted in re-classification of 55 of 203 patients from the low-risk to the high-risk group. The 10 year cardiovascular event rate was higher in patients with a UKPDS score >10% when skin autofluorescence was above the median (55.8% vs 38.9%). CONCLUSIONS/INTERPRETATION: Skin autofluorescence provides additional information to the UKPDS risk engine which can result in risk re-classification of a substantial number of patients. It furthermore identifies patients who have a particularly high risk for developing cardiovascular events.

[Distinguishing nodal naevus from melanoma metastases in the sentinel node in patients with melanoma]. / Een nodale naevus in de schildwachtklier bij patiënten met melanoom: onderscheid met melanoommetastase.

OBJECTIVE: Establishing the frequency of nodal naevi in lymph-node dissections from patients with a melanoma who have undergone a sentinel-node procedure and/or regional node dissection and distinguishing naevi from melanoma metastases. DESIGN: Retrospective and descriptive. METHODS: Patients with a nodal naevus in the sentinel node were selected from a database containing clinical and pathological data on all 65 patients who underwent a sentinel-node procedure for melanoma at our hospital between 1998 and 2001. Also data from the pathology department on the case frequency and the nodal frequency of nodal naevi in the total number of patients with melanoma in whom a sentinel-node procedure and/or therapeutic node dissection had been carried out during the same period, were examined. RESULTS: In 5 patients a nodal naevus was found in the sentinel node. The case frequency was 6.2% and the nodal frequency 0.65%. Distinction from melanoma metastases was made by the use of H&E colouring, localization, architectural and morphological features of the melanocyte cell clusters in the lymph node and sometimes after consultation with the National Melanoma Panel. Immunohistochemical markers provided supplementary information only. CONCLUSION: Nodal naevi in lymph nodes were not uncommon in people with melanoma and can be distinguished from the micrometastases from melanoma.