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Annals of Medicine and Surgery (2012) Sep 2017Congenital and infantile malignant melanomas are rare and typically carry poor prognosis. The purpose of this article was to review the data on congenital and infantile... (Review)
Review
Congenital and infantile malignant melanomas are rare and typically carry poor prognosis. The purpose of this article was to review the data on congenital and infantile malignant melanomas of the scalp in order to understand its presentation, diagnosis, management, and outcomes of congenital melanoma of scalp. We searched PubMed, CINAHL and Cochrane databases. Ten cases of congenital and 3 cases of infantile malignant melanoma of scalp were identified. The diagnosis was confirmed by biopsy and histological analysis for confirmation. The prognosis depends on the origin of disease (congenital melanocytic nevus, transplacental metastasis, or de-novo), tumor thickness, the presence of ulceration and/or necrosis, and anatomic site (scalp lesions having poor prognosis). The most commonly used treatment of the reported cases of congenital and infantile melanoma was surgical excision of the primary lesion. Further modes of treatment may be extrapolated from the treatment of childhood and adult melanomas.
PubMed: 28794873
DOI: 10.1016/j.amsu.2017.07.042 -
The Journal of Investigative Dermatology Sep 2017
Review
Topics: Global Health; Humans; Longitudinal Studies; Morbidity; Nevus, Pigmented; Population Surveillance; Skin Neoplasms
PubMed: 28528913
DOI: 10.1016/j.jid.2017.03.040 -
Medicina Clinica Aug 2016There is a growing concern and awareness of skin cancer. As a result, possibly unnecessary surgeries of melanocytic lesions are carried out as a prophylactic measure. We... (Review)
Review
There is a growing concern and awareness of skin cancer. As a result, possibly unnecessary surgeries of melanocytic lesions are carried out as a prophylactic measure. We performed a systematic review of the medical literature to identify primary studies on the effectiveness and cost-effectiveness of surgery treatment of benign melanocytic lesions for melanoma prevention. We included 19 primary studies on surgical treatment of acquired melanocytic lesions and one economic evaluation. Indicators, such as number needed to treat and the malignancy ratio, depend on several factors such as specialty and experience of the physician, pressure from the patient or patient characteristics. Early diagnosis of melanoma is critical in preventing skin cancer. However, primary studies show through several indicators that there are factors that increase the proportion of lesions treated unnecessarily. Effectiveness can be improved by careful use of techniques to identify suspicious lesions and educational programs for physicians, especially in primary care.
Topics: Australia; Cost-Benefit Analysis; Europe; Humans; Melanoma; Nevus, Pigmented; Precancerous Conditions; Skin Neoplasms; United States; Unnecessary Procedures
PubMed: 27026061
DOI: 10.1016/j.medcli.2016.02.016 -
Lasers in Medical Science Apr 2016Although the application of Q-switched lasers on nevus of Ota (OTA) is well demonstrated, debates about clinical option between Q-switched alexandrite laser (QSA) and... (Comparative Study)
Comparative Study Meta-Analysis Review
Although the application of Q-switched lasers on nevus of Ota (OTA) is well demonstrated, debates about clinical option between Q-switched alexandrite laser (QSA) and Q-switched Nd:YAG laser (QSNY) still remain. This systematic review and meta-analysis estimated the overall successful rate of OTA pigment clearance and complication rate of QSA and QSNY and evaluated which laser could produce a better result. English articles evaluating pigment clearance and complications of QSA and/or QSNY on OTA were screened through predetermined inclusion and exclusion criteria and analyzed. The successful rate of pigment clearance and complication rate of QSA and QSNY were respectively calculated using a random-effects or fixed-effects model, depending on the heterogeneity of the included studies. The successful rate and complication rate of QSA and QSNY were compared statistically. Of the 140 articles searched, 13 met inclusion criteria. Totally, 2153 OTA patients treated by QSA and 316 patients treated by QSNY were analyzed. In QSA and QSNY groups, respectively, the successful rate of OTA pigment clearance was 48.3% (95% confidence interval (CI) 19.9-76.8%) and 41% (95% CI 9.7-72.2%), while the complication rate was 8.0% (95% CI 3.9-12.2%) and 13.4% (95% CI 7.7-19.0%). When compared with QSNY, QSA had a significantly higher successful rate (P = 0.017), and a lower complication rate (P = 0.000). According to this review, QSA may surpass QSNY in treatment for OTA as it had a superior successful rate of pigment clearance and a lower complication rate than QSNY did.
Topics: Humans; Lasers, Solid-State; Low-Level Light Therapy; Nevus of Ota; Skin Neoplasms; Treatment Outcome
PubMed: 26861980
DOI: 10.1007/s10103-016-1885-z -
Pediatric Dermatology 2016Neonatal blue light phototherapy (NBLP) is an established method of managing neonatal hyperbilirubinemia. Approximately 5% of newborns are exposed to NBLP. Evidence of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Neonatal blue light phototherapy (NBLP) is an established method of managing neonatal hyperbilirubinemia. Approximately 5% of newborns are exposed to NBLP. Evidence of whether NBLP predisposes to the development of melanocytic nevi later in life has been conflicting.
OBJECTIVES
The goal of the current study was to conduct a systematic review and meta-analysis to quantitatively assess the effect of NBLP on melanocytic nevus count.
METHODS
We searched for observational studies in Medline, EMBASE, and the Cochrane Central Register from their inception to April 15, 2015. Meta-analysis of Observational Studies in Epidemiology guidelines were followed. DerSimonian and Laird random-effects models were used to calculate the weighted mean difference (WMD). Publication bias was assessed using a funnel plot and the Egger's test.
RESULTS
Five studies with a total of 2,921 subjects were included, of whom 642 underwent NBLP. With random-effects modeling, those who had previous NBLP did not have a significantly higher mean number of melanocytic nevi (WMD = 0.32 [95% confidence interval -0.67, 1.31], p = 0.53). Visual inspection of the funnel plot suggested potential publication bias, although the Egger's test (p = 0.09) indicated no small-study effect.
CONCLUSION
There was no evidence that prior NBLP exposure significantly increased the number of melanocytic nevi. Available evidence has not revealed any cause for major concern for NBLP. Other risk factors such as exposure to sunlight, childhood history of sunburn, and fair skin complexion might play a greater role in the development of melanocytic nevi in childhood.
Topics: Female; Humans; Hyperbilirubinemia; Infant, Newborn; Male; Nevus, Pigmented; Phototherapy; Risk Factors; Skin Neoplasms
PubMed: 26645992
DOI: 10.1111/pde.12730 -
Hematology/oncology and Stem Cell... Mar 2015Features and characteristics of uveal melanoma are well described in adults, but little is known about the presentation of uveal melanoma in infancy. (Review)
Review
BACKGROUND AND OBJECTIVES
Features and characteristics of uveal melanoma are well described in adults, but little is known about the presentation of uveal melanoma in infancy.
DESIGN
Systematic literature review.
METHODS
A review of published, peer-reviewed literature reporting on uveal melanoma presenting during the first two years of life. Outcome measures included demographics, clinical features, histopathological findings, extent of the disease, therapeutic interventions, management outcomes, association with skin lesions or systemic diseases, and survival data.
RESULTS
This review revealed 13 reported cases (seven boys and six girls) of uveal melanoma diagnosed within the first two years of life. The median age at diagnosis was seven months. Orbital mass and proptosis were the most common presentations (38%); only one tumor (8%) was melanotic, and pathologically 10 tumors (77%) had epithelioid component. Associated pigmented skin lesions (cutaneous disease) were seen in six cases (46%). All affected eyes were surgically removed; three patients received chemotherapy, and one received radiotherapy. At a median follow-up of 25months, two patients (15%) had metastasis, and one of them (8%) was dead at six months' follow-up with liver and multi-organ metastasis.
CONCLUSIONS
Uveal melanoma can present within the first two years of life. In very rare cases, it can present as an intraocular tumor that simulates retinoblastoma, but it can also present as an orbital tumor. It has a tendency to affect patients with cutaneous diseases like familial atypical mole, melanoma syndrome, and dysplastic nevus syndrome. Despite this, uveal melanoma in this group has a more favorable prognosis than adult melanoma.
Topics: Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Melanoma; Prognosis; Uveal Neoplasms
PubMed: 25300563
DOI: 10.1016/j.hemonc.2014.09.004 -
The British Journal of Dermatology Jan 2015Understanding how individuals at high-risk of primary cutaneous melanoma are best identified, screened and followed up will help optimize melanoma prevention strategies... (Review)
Review
Understanding how individuals at high-risk of primary cutaneous melanoma are best identified, screened and followed up will help optimize melanoma prevention strategies and clinical management. We conducted a systematic review of international clinical practice guidelines and documented the quality of supporting evidence for recommendations for clinical management of individuals at high risk of melanoma. Guidelines published between January 2000 and July 2014 were identified from a systematic search of Medline, Embase and four guideline databases; 34 guidelines from 20 countries were included. High-risk characteristics that were consistently reported included many melanocytic naevi, dysplastic naevi, family history, large congenital naevi, and Fitzpatrick Type I and II skin types. Most guidelines identify risk factors and recommend that individuals at high risk of cutaneous melanoma be monitored, but only half of the guidelines provide recommendations for screening based on level of risk. There is disagreement in screening and follow-up recommendations for those with an increased risk of future melanoma. High-level evidence supports long-term screening of individuals at high risk and monitoring using dermoscopy. Evidence is low for defining screening intervals and duration of follow-up, and for skin self-examination, although education about skin self-examination is widely encouraged. Clinical practice guidelines would benefit from a dedicated section for identification, screening and follow-up of individuals at high risk of melanoma. Guidelines could be improved with clear definitions of multiple naevi, family history and frequency of follow-up. Research examining the benefits and costs of alternative management strategies for groups at high risk will enhance the quality of recommendations.
Topics: Early Detection of Cancer; Humans; Melanoma; Nevus; Practice Guidelines as Topic; Referral and Consultation; Risk Assessment; Risk Factors; Skin Neoplasms
PubMed: 25204572
DOI: 10.1111/bjd.13403 -
The Lancet. Oncology Apr 2014Sentinel lymph node biopsy has been proposed as a diagnostic method for estimation of the malignant potential of atypical Spitz tumours. However, although cell deposits... (Review)
Review
Sentinel lymph node biopsy has been proposed as a diagnostic method for estimation of the malignant potential of atypical Spitz tumours. However, although cell deposits are commonly detected in the sentinel lymph nodes of patients with atypical Spitz tumours, their prognosis is substantially better than that of patients with melanoma and positive sentinel lymph node biopsies. We did a systematic review of published reports to assess the role of sentinel lymph node biopsy as a prognostic method in the management of atypical Spitz tumours. The results of our analysis did not show any prognostic benefit of sentinel lymph node biopsy; having a positive sentinel lymph node does not seem to predict a poorer outcome for patients with atypical Spitz tumours. These findings indicate that, especially in the paediatric population, it might be prudent initially to use complete excision with clear margins and careful clinical follow-up in patients with atypical Spitz tumours.
Topics: Humans; Lymph Nodes; Lymphatic Metastasis; Nevus, Epithelioid and Spindle Cell; Patient Selection; Predictive Value of Tests; Prognosis; Risk Factors; Sentinel Lymph Node Biopsy; Skin Neoplasms
PubMed: 24694641
DOI: 10.1016/S1470-2045(13)70608-9 -
American Journal of Otolaryngology 2013Divided nevus, which is also known as "kissing nevus," "split ocular nevus" and "panda nevus" is a rare congenital dermatological abnormality that occurs on opposing... (Review)
Review
Divided nevus, which is also known as "kissing nevus," "split ocular nevus" and "panda nevus" is a rare congenital dermatological abnormality that occurs on opposing margins of upper and lower eyelids. There is a paucity of literature on this rare anomaly, with most knowledge from this disease process derived from isolated case reports and series. The purpose of this study is to report a new case of divided nevus of the eyelid and to discuss the unique embryology, pathology, and potential treatment options for this rare entity. A systematic review of literature was performed of the English literature on PubMed and Medline with just under 150 cases reported in the literature. The vast majority of the divided nevi seen in this review were medium sized and of the melanocytic intradermal type. There were no described cases of malignant transformation in any of the documented cases. Numerous methods for reconstruction were described including the entire reconstructive ladder with both one and two staged approaches. In this review, we present basic guidelines to the reconstruction of these complicated defects, although ultimate treatment should be individualized and dependent on surgeon comfort.
Topics: Eyelid Neoplasms; Humans; Nevus, Pigmented; Plastic Surgery Procedures; Skin Neoplasms; Skin Transplantation
PubMed: 23380310
DOI: 10.1016/j.amjoto.2013.01.004 -
Journal of the American Academy of... Mar 2013Large congenital melanocytic nevi (LCMN) are defined as congenital melanocytic nevi having a projected adult size exceeding 20 cm in diameter. They occur in 1 in 20,000... (Review)
Review
BACKGROUND
Large congenital melanocytic nevi (LCMN) are defined as congenital melanocytic nevi having a projected adult size exceeding 20 cm in diameter. They occur in 1 in 20,000 to 1 in 500,000 newborns. Therapeutic management of LCMN remains controversial and is often decided according to melanoma risk.
OBJECTIVE
We sought to synthesize all data available on LCMN-associated melanoma risk, therapeutic assessment, and psychosocial and aesthetic impacts.
METHODS
A MEDLINE search was conducted (1966-February 2011), and 22 French- and English-language databases were consulted. Case reports and reviews were excluded, as were studies with fewer than 20 patients and insufficient information about the nevi. Studies were qualitatively assessed and analyzed according to predefined criteria.
RESULTS
Fourteen studies were selected (956 references). A total of 52 (2%) melanomas (2 in 1 patient) developed in 2578 patients. Age at diagnosis ranged from birth to 58 (mean 12.6) years. Primary melanomas were mostly cutaneous (82%) and 68% were located on the trunk; 7 melanomas were visceral. Melanoma-associated LCMN size exceeded 40 cm for 74% and 94% had satellite nevi. Of melanomas, 55% were fatal, with age at death ranging from 0.9 to 40 (mean 10) years. Eighteen patients were still alive with a mean follow-up of 10.2 years. Melanoma incidence assessable for 216 cases was estimated at 2.3 per 1000 patient-years. Behavioral/emotional problems independent of the lesion were common in children.
LIMITATIONS
Selected studies were heterogeneous.
CONCLUSION
LCMN management should be individualized with respect to melanoma risk, and aesthetic and psychosocial aspects.
Topics: Child; Humans; Infant; Infant, Newborn; Melanoma; Middle Aged; Nevus, Pigmented; Risk; Skin Neoplasms
PubMed: 23182059
DOI: 10.1016/j.jaad.2012.09.039