-
Current Opinion in Hematology Mar 2020Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy with historically poor outcomes. It typically manifests as... (Review)
Review
PURPOSE OF REVIEW
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematologic malignancy with historically poor outcomes. It typically manifests as asymptomatic skin lesions and cytopenias, which result from bone marrow involvement. Less commonly, it will present in lymph nodes or visceral organs as well. Although rare, BPDCN has been discussed more frequently in recent years as new drugs have been developed that could be effective at treating this disease.
RECENT FINDINGS
Until recently, treatment for BPDCN commonly included intensive chemotherapy regimens, which are generally reserved for management of acute myeloid leukemia or acute lymphoblastic leukemia. However, in 2018 tagraxofusp (SL-401) was approved as the only treatment specifically indicated for BPDCN. Additional clinical trials are ongoing evaluating the efficacy of newer agents, which could potentially further improve the long-term outcomes for patients with BPDCN.
SUMMARY
This manuscript reviews the diagnosis, manifestations and treatment of BPDCN.
Topics: Dendritic Cells; Humans; Skin Neoplasms; Soft Tissue Neoplasms
PubMed: 31972688
DOI: 10.1097/MOH.0000000000000569 -
Journal of Drugs in Dermatology : JDD Oct 2018Epidemiologic studies of patients who present to dermatology clinics are necessary to identify the needs of patients.
BACKGROUND
Epidemiologic studies of patients who present to dermatology clinics are necessary to identify the needs of patients.
OBJECTIVE
To quantify and compare diagnoses according to race, ethnicity, and socioeconomic status (SES) at 6 general dermatology clinics from January 2013 to December 2016.
METHODS
A retrospective cohort of new patients was established using an electronic medical record database. Primary diagnoses and diagnostic codes were recorded. Geocoding was utilized to obtain SES.
RESULTS
There were 65969 new patient visits. Racial and ethnic demographics were obtained with the overall top 3 conditions being eczema or dermatitis, benign skin neoplasm, and adnexal disease. In blacks, however, follicular disorders were the third most common condition seen. The most frequently encountered diagnoses at the clinics with the highest and lowest SES were benign skin neoplasm and eczema or dermatitis, respectively.
LIMITATIONS
Only primary diagnoses were included in analysis. Determining one's race is increasingly difficult.
CONCLUSION
Follicular disorders occurred with an increased frequency in blacks. When examining SES, eczema or dermatitis was the most frequently encountered primary diagnosis at the clinic with the lowest SES, with benign skin neoplasm seen with the highest frequency at the clinic with the highest SES. J Drugs Dermatol. 2018;17(10):1032-1036.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Cohort Studies; Eczema; Ethnicity; Female; Humans; Infant; Male; Medical Records; Michigan; Middle Aged; Office Visits; Retrospective Studies; Skin Diseases; Skin Neoplasms; Socioeconomic Factors; Young Adult
PubMed: 30365582
DOI: No ID Found -
Gan To Kagaku Ryoho. Cancer &... Oct 2006The definition of the TNM classification and staging system of malignant melanoma have been fundamentally revised. Moreover, several clinical guidelines for the... (Review)
Review
The definition of the TNM classification and staging system of malignant melanoma have been fundamentally revised. Moreover, several clinical guidelines for the management of this neoplasm were recently proposed. Advances in surgical procedures are excision of primary lesions with narrow margin and introduction of sentinel node biopsy, which contribute to maintain the good quality of life of patients. The significance of high-dose interferon-alpha as adjuvant therapy is still controversial. No effective chemotherapy or biotherapy has been established to date, however, interesting new findings were recently reported in the fields of immunotherapy and molecular targeting therapy.
Topics: Combined Modality Therapy; Humans; Immunotherapy; Interferon-alpha; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Melanoma; Neoplasm Staging; Sentinel Lymph Node Biopsy; Skin Neoplasms; Survival Rate
PubMed: 17033225
DOI: No ID Found -
European Journal of Cancer (Oxford,... Sep 2023Convolutional neural networks (CNNs) have outperformed dermatologists in classifying pigmented skin lesions under artificial conditions. We investigated, for the first...
Diagnostic performance of augmented intelligence with 2D and 3D total body photography and convolutional neural networks in a high-risk population for melanoma under real-world conditions: A new era of skin cancer screening?
BACKGROUND
Convolutional neural networks (CNNs) have outperformed dermatologists in classifying pigmented skin lesions under artificial conditions. We investigated, for the first time, the performance of three-dimensional (3D) and two-dimensional (2D) CNNs and dermatologists in the early detection of melanoma in a real-world setting.
METHODS
In this prospective study, 1690 melanocytic lesions in 143 patients with high-risk criteria for melanoma were evaluated by dermatologists, 2D-FotoFinder-ATBM and 3D-Vectra WB360 total body photography (TBP). Excision was based on the dermatologists' dichotomous decision, an elevated CNN risk score (study-specific malignancy cut-off: FotoFinder >0.5, Vectra >5.0) and/or the second dermatologist's assessment with CNN support. The diagnostic accuracy of the 2D and 3D CNN classification was compared with that of the dermatologists and the augmented intelligence based on histopathology and dermatologists' assessment. Secondary end-points included reproducibility of risk scores and naevus counts per patient by medical staff (gold standard) compared to automated 3D and 2D TBP CNN counts.
RESULTS
The sensitivity, specificity, and receiver operating characteristics area under the curve (ROC-AUC) for risk-score-assessments compared to histopathology of 3D-CNN with 95% confidence intervals (CI) were 90.0%, 64.6% and 0.92 (CI 0.85-1.00), respectively. While dermatologists and augmented intelligence achieved the same sensitivity (90%) and comparable classification ROC-AUC (0.91 [CI 0.80-1.00], 0.88 [CI 0.77-1.00]) with 3D-CNN, their specificity was superior (92.3% and 86.2%, respectively). The 2D-CNN (sensitivity: 70%, specificity: 40%, ROC-AUC: 0.68 [CI 0.46-0.90]) was outperformed by 3D CNN and dermatologists. The 3D-CNN showed a higher correlation coefficient for repeated measurements of 246 lesions (R = 0.89) than the 2D-CNN (R = 0.79). The mean naevus count per patient varied significantly (gold standard: 210 lesions; 3D-CNN: 469; 2D-CNN: 1324; p < 0.0001).
CONCLUSIONS
Our study emphasises the importance of validating the classification of CNNs in real life. The novel 3D-CNN device outperformed the 2D-CNN and achieved comparable sensitivity with dermatologists. The low specificity of CNNs and the lack of automated counting of TBP nevi currently limit the use of augmented intelligence in clinical practice.
Topics: Humans; Reproducibility of Results; Prospective Studies; Dermatologists; Early Detection of Cancer; Skin Neoplasms; Melanoma; Neural Networks, Computer; Nevus; Nevus, Pigmented; Risk Factors; Photography
PubMed: 37453242
DOI: 10.1016/j.ejca.2023.112954 -
Plastic and Reconstructive Surgery Sep 2013The incidence of melanoma is increasing worldwide. Melanomas represent 3 percent of all skin cancers but 65 percent of skin cancer deaths. Melanoma is now the fifth most... (Review)
Review
The incidence of melanoma is increasing worldwide. Melanomas represent 3 percent of all skin cancers but 65 percent of skin cancer deaths. Melanoma is now the fifth most common cancer diagnosed in the United States. Excisional biopsy should be performed for lesions suspicious for melanoma. The pathologist's report provides essential information for surgical treatment; the most important information is the Breslow depth of the lesion. In addition to wide surgical excision of the primary lesion, sentinel lymph node biopsy is the standard of care for early identification of regional metastasis. Nodal metastasis found in the sentinel lymph node biopsy should be followed with a complete lymph node dissection. Although surgery remains the primary treatment of melanoma, recent advances in chemotherapy may offer further survival benefits to patients with metastatic disease.
Topics: Antineoplastic Agents; Biopsy; Chemotherapy, Adjuvant; Humans; Lymph Node Excision; Lymphatic Metastasis; Melanoma; Neoplasm Metastasis; Neoplasm Staging; Radiotherapy, Adjuvant; Risk Factors; Sentinel Lymph Node Biopsy; Skin; Skin Neoplasms
PubMed: 23985656
DOI: 10.1097/PRS.0b013e31829ad411 -
ANZ Journal of Surgery Nov 2020Pleomorphic dermal sarcoma (PDS) is a rare, poorly defined skin neoplasm with features similar to atypical fibroxanthoma, but with adverse histopathological...
BACKGROUND
Pleomorphic dermal sarcoma (PDS) is a rare, poorly defined skin neoplasm with features similar to atypical fibroxanthoma, but with adverse histopathological characteristics indicating metastatic potential such as tumour necrosis, invasion beyond superficial subcutis or vascular and/or perineural infiltration. Optimal treatment for PDS is uncertain and reported outcomes vary due to the rarity of this diagnosis and uncertainty over histopathological categorization. The aim of this study was to review the clinical and histopathological features of PDS in a single Australian centre.
METHODS
A retrospective review of all patients managed at the Peter MacCallum Cancer Centre with PDS between 2003 and 2017 was performed by a search of electronic records and histories reviewed.
RESULTS
A total of 27 patients were identified, mostly elderly males (85.2%, mean age 79.8 years). Lesions were seen most commonly on the head and neck region (96.3%), predominantly on the scalp (63%). Mean tumour radial surgical excision margin was 12.8 mm. Eighteen patients (66.7%) underwent radiotherapy; 13 adjuvant, three neoadjuvant and two with palliative intent. After median follow-up of 46.4 months, two patients had recurrence (7.4%); both had inadequate deep margins at first excision. There were three all-cause deaths in the cohort. There was one disease-specific mortality with metastatic PDS disease at the time of initial presentation.
CONCLUSION
PDS is a rare cutaneous malignancy most commonly found in the head and neck region in elderly men, which is best managed with adequate surgical excision. The role of radiotherapy is undefined and an area for future investigation.
Topics: Aged; Australia; Humans; Male; Neoplasm Recurrence, Local; Retrospective Studies; Sarcoma; Skin Neoplasms
PubMed: 32338819
DOI: 10.1111/ans.15909 -
Lancet (London, England) Aug 1991
Topics: Humans; Melanoma; Neoplasm Invasiveness; Neoplasm Staging; Observer Variation; Skin Neoplasms
PubMed: 1677705
DOI: No ID Found -
Journal of Surgical Oncology Feb 2022
Topics: Humans; Immune Checkpoint Inhibitors; Melanoma; Neoplasm Recurrence, Local; Sentinel Lymph Node Biopsy; Skin Neoplasms
PubMed: 34535908
DOI: 10.1002/jso.26677 -
The Laryngoscope May 1994Merkel cell carcinoma (MCC) is an aggressive skin neoplasm of neuroendocrine origin. To clarify those factors important in improving survival, we retrospectively... (Clinical Trial)
Clinical Trial
Merkel cell carcinoma (MCC) is an aggressive skin neoplasm of neuroendocrine origin. To clarify those factors important in improving survival, we retrospectively reviewed the charts of all patients with Merkel cell carcinoma treated at two tertiary referral centers. Eighty percent of the patients with stage I disease were initially treated with local therapy alone, while all of the patients with stage II disease were treated with local and regional therapy. The overall survival rate for all patients was 64%. Regardless of stage, patients treated with local excision alone had a 52% 5-year survival rate, while patients treated with local excision and lymph node dissection had an 87% survival rate. We conclude that the aggressive nature of this tumor warrants radical therapy.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Merkel Cell; Female; Follow-Up Studies; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Parotid Neoplasms; Prognosis; Retrospective Studies; Severity of Illness Index; Skin Neoplasms; Survival Rate; Time Factors
PubMed: 8189981
DOI: 10.1002/lary.5541040504 -
Dermatologic Therapy 2008Dermatofibrosarcoma protuberans is a rare cutaneous malignancy that is locally invasive, occurs mainly over the trunk and proximal extremities, and has a tendency to...
Dermatofibrosarcoma protuberans is a rare cutaneous malignancy that is locally invasive, occurs mainly over the trunk and proximal extremities, and has a tendency to recur after wide local excision. The epidemiology, clinical features, diagnosis, histology, and treatment options are discussed.
Topics: Dermatofibrosarcoma; Humans; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Skin Neoplasms
PubMed: 19076619
DOI: 10.1111/j.1529-8019.2008.00242.x