RESUMO
Antecedentes y objetivo: La incidencia del melanoma se ha incrementado significativamente y la forma más efectiva para disminuir su mortalidad es el diagnóstico precoz. La dermatoscopia aumenta la sensibilidad en el diagnóstico del melanoma, y por medio del análisis de las estructuras dermatoscópicas es posible estimar su grosor. Nuestro objetivo fue analizar la influencia del Breslow en las características dermatoscópicas del melanoma. Materiales y métodos: Estudio observacional de corte transversal. Se incluyeron pacientes con melanoma confirmado histológicamente y una imagen dermatoscópica del mismo. Se dividieron en tres grupos, melanoma in situ, melanoma fino (< 1 mm de Breslow) y melanoma grueso (≥ 1 mm de Breslow), y se analizaron el sexo, la edad, la localización, las características histológicas y las características dermatoscópicas. Resultados: Se analizaron 215 pacientes, 88 con melanoma in situ, 73 con melanoma fino y 54 con melanoma grueso. Las estructuras dermatoscópicas que incrementaron su frecuencia a medida que aumentó el Breslow del melanoma fueron el velo azul blanquecino (p < 0,001), las estructuras blanco brillantes (p < 0,001) y las áreas rojo lechosas (p < 0,003). Por otro lado, las líneas anguladas disminuyeron su frecuencia a medida que se incrementó el Breslow (p < 0,002). Conclusiones: La evaluación dermatoscópica tiene un importante rol, no solo en la precisión diagnóstica de las lesiones pigmentadas, sino también en ayudarnos a estimar el grosor preoperatorio del melanoma (AU)
Background and objective: The incidence of melanoma has increased significantly, and early diagnosis is the most effective way to reduce associated deaths. Dermoscopy increases diagnostic accuracy in melanoma and analysis of dermoscopic structures can help in the estimation of tumor thickness. The aim of this study was to analyze the influence of Breslow thickness on the dermoscopic characteristics of melanoma. Material and methods: Observational, cross-sectional study of patients with histologically confirmed melanoma and dermoscopic images of the tumor. The patients were divided into three groups: melanoma in situ, thin melanoma (≥ 1 mm Breslow thickness), and thick melanoma (≥ 1 mm Breslow thickness). Age, sex, tumor location, and histologic and dermoscopic characteristics were analyzed in all cases. Results: We studied 215 patients: 88 with melanoma in situ, 73 with thin melanoma, and 54 with thick melanoma. The frequency of the following dermoscopic features increased with increasing Breslow thickness: the blue-white veil (p < 0.001), white shiny structures (p < 0.001), and milky-red areas (p < 0.003). Angulated lines, by contrast, became less common with increasing thickness (p < 0.002). Conclusions: Dermoscopy not only improves diagnostic accuracy for pigmented lesions but also helps in the preoperative assessment of Breslow thickness in melanoma (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Cutâneas/diagnóstico por imagem , Melanoma/diagnóstico por imagem , Dermoscopia/métodos , Sensibilidade e Especificidade , Estudos TransversaisRESUMO
BACKGROUND AND OBJECTIVE: The incidence of melanoma has increased significantly, and early diagnosis is the most effective way to reduce associated deaths. Dermoscopy increases diagnostic accuracy in melanoma and analysis of dermoscopic structures can help in the estimation of tumor thickness. The aim of this study was to analyze the influence of Breslow thickness on the dermoscopic characteristics of melanoma. MATERIAL AND METHODS: Observational, cross-sectional study of patients with histologically confirmed melanoma and dermoscopic images of the tumor. The patients were divided into three groups: melanoma in situ, thin melanoma (≥ 1 mm Breslow thickness), and thick melanoma (≥ 1 mm Breslow thickness). Age, sex, tumor location, and histologic and dermoscopic characteristics were analyzed in all cases. RESULTS: We studied 215 patients: 88 with melanoma in situ, 73 with thin melanoma, and 54 with thick melanoma. The frequency of the following dermoscopic features increased with increasing Breslow thickness: the blue-white veil (p < 0.001), white shiny structures (p < 0.001), and milky-red areas (p < 0.003). Angulated lines, by contrast, became less common with increasing thickness (p < 0.002). CONCLUSIONS: Dermoscopy not only improves diagnostic accuracy for pigmented lesions but also helps in the preoperative assessment of Breslow thickness in melanoma.
Assuntos
Melanoma , Neoplasias Cutâneas , Estudos Transversais , Dermoscopia , Humanos , Melanoma/diagnóstico por imagem , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagemRESUMO
INTRODUCTION: Shingles is the cutaneous expression of the reactivation of latent varicella zoster virus infection in sensory ganglia. It presents as vesicles in the corresponding dermatome. The condition is called disseminated herpes zoster (DHZ) when more than 2 contiguous dermatomes are affected, more than 20 vesicles are observed outside the initial dermatome, or involvement is systemic. DHZ is rare and most frequently occurs in immunocompromised patients. OBJECTIVES: To describe the epidemiology, predisposing factors, clinical presentation, laboratory findings, and clinical course of patients with DHZ, and to compare the findings in immunocompromised and immunocompetent patients. METHODOLOGY: We analyzed a retrospective case series of adults hospitalized between February 2010 and October 2015. RESULTS: Forty-one patients with virologically confirmed manifestations of DHZ were included. Stress as a trigger factor was detected in 39% and immunodepression in 58.5%. Immunocompromised patients were younger than the immunocompetent patients (mean ages, 60.5 vs 82 years, P<.01). The 8 immunocompetent patients with no detectable trigger factors were older (mean age, 85 years). In 95% of cases, DHZ was initially limited to a single dermatome and then spread to other dermatomes or became disseminated. Thrombocytopenia was detected in 56% of cases. Complication rates were similar in immunocompromised and immunocompetent patients (54% vs 59%, P>.01). Six patients died; there was no difference in mortality between the 2 groups. CONCLUSION: This study provides evidence on the relationship between DHZ, the presence of underlying immunodepression, and complications. Immunosenescence may play an important role in the onset of this disease in older immunocompetent patients.
