RESUMO
BACKGROUND: Pigmented actinic keratosis (PAK) is a frequent simulator of lentigo maligna (LM) on the face upon clinical and dermoscopic examination, leading to misdiagnosis and unnecessary excisions. LM and PAK share dermoscopic features, making it difficult to have a confident diagnosis of PAK only with current dermoscopic knowledge. OBJECTIVE: We sought to evaluate sensitivity, specificity, and interobserver reproducibility of a novel dermoscopic feature, inner gray halo (IGH), and establish its histopathological and confocal correlations. METHODS: Dermoscopists blinded to histopathological diagnosis evaluated 58 PAK and 21 LM for the presence of IGH and dermoscopy parameters. Areas exhibiting IGH were marked and imaged with reflectance confocal microscopy before sampling for histopathologic correlation. Reflectance confocal microscopy and transverse histologic sectioning were performed in 14 of 79 cases. RESULTS: IGH was present in 53 of 58 (94.1%) PAK and in 5 of 21 (23.8%) LM in our series (sensitivity 91.4%; specificity 71.4%; positive predictive value 89.8%). Interobserver agreement was excellent (Kappa 0.846). Through transverse and perpendicular histologic sections, a dermoscopic-histologic-confocal correlation of IGH was established. LIMITATIONS: A larger test set is needed to further validate the use of IGH in the differential diagnosis of PAK and facial pigmented lesions. CONCLUSION: IGH is a novel dermoscopic parameter useful for the differentiation of PAK from LM on the face.
Assuntos
Sarda Melanótica de Hutchinson/diagnóstico , Hiperpigmentação/diagnóstico , Ceratose Actínica/diagnóstico , Lesões Pré-Cancerosas/patologia , Neoplasias Cutâneas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha , Brasil , Estudos de Coortes , Intervalos de Confiança , Dermoscopia/métodos , Diagnóstico Diferencial , Face , Feminino , Humanos , Sarda Melanótica de Hutchinson/patologia , Sarda Melanótica de Hutchinson/ultraestrutura , Hiperpigmentação/patologia , Imuno-Histoquímica , Ceratose Actínica/patologia , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/ultraestruturaAssuntos
Quinase 4 Dependente de Ciclina/genética , Genes p16 , Melanoma/genética , Neoplasias Primárias Múltiplas/genética , Nevo Pigmentado/genética , Neoplasias Cutâneas/genética , Adulto , Análise Mutacional de DNA , Humanos , Masculino , Melanoma/patologia , Neoplasias Primárias Múltiplas/patologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: A wide variety of high-throughput microarray platforms have been used to identify molecular targets associated with biological and clinical tumor phenotypes by comparing samples representing distinct pathological states. METHODS: The gene expression profiles of human cutaneous melanomas were determined by cDNA microarray analysis. Next, a robust analysis to determine functional classifications and make predictions based on data-oriented hypotheses was performed. Relevant networks that may be implicated in melanoma progression were also considered. RESULTS: In this study we aimed to analyze coordinated gene expression changes to find molecular pathways involved in melanoma progression. To achieve this goal, ontologically-linked modules with coordinated expression changes in melanoma samples were identified. With this approach, we detected several gene networks related to different modules that were induced or repressed during melanoma progression. Among them we observed high coordinated expression levels of genes involved in a) cell communication (KRT4, VWF and COMP); b) epidermal development (KLK7, LAMA3 and EVPL); and c) functionally related to kallikreins (EVPL, KLK6, KLK7, KLK8, SERPINB13, SERPING1 and SLPI). Our data also indicated that hKLK7 protein expression was significantly associated with good prognosis and survival. CONCLUSIONS: Our findings, derived from a different type of analysis of microarray data, highlight the importance of analyzing coordinated gene expression to find molecular pathways involved in melanoma progression.
Assuntos
Redes Reguladoras de Genes , Melanoma/patologia , Calicreínas Teciduais/genética , Calicreínas Teciduais/metabolismo , Comunicação Celular/genética , Progressão da Doença , Epiderme/crescimento & desenvolvimento , Epiderme/metabolismo , Perfilação da Expressão Gênica , Humanos , Calicreínas/genética , Calicreínas/metabolismo , Melanoma/genética , Melanoma/mortalidade , Análise de Sequência com Séries de Oligonucleotídeos , Prognóstico , RNA Mensageiro/metabolismoRESUMO
This study was performed to analyse the behaviour, risk factors, prognosis and evolution of cutaneous melanoma in childhood and adolescence treated in a single institution. A retrospective study was performed between 1980 and 2000 of patients aged 18 years or younger followed at the Hospital do Cancer de Sao Paulo, Brazil. Data included demographic status, risk factors, clinical and histopathological characteristics of the primary and metastatic lesions, stage and follow-up. Seventeen female (53.1%) and 15 male (46.9%) patients were studied. Twelve patients (37.5%) were aged 12 years or younger. The trunk was the most common location (14 patients; 43.8%). Five patients (15.6%) had giant congenital melanocytic naevus, three (9.4%) had xeroderma pigmentosum and one (3%) had dysplastic melanocytic naevus. Nodular melanoma was the most frequent histological type and 43.8% had a thickness of more than 4 mm. Five of the 32 patients (15.6%) were lost to follow-up and 15 (46.9%) were alive at the last year's follow-up, 11 (34.4%) without disease and four (12.5%) with active disease. The 5-year overall survival was 64.34%. An overall survival of 11.71% was found in patients with visceral metastasis with or without cutaneous and/or lymph node involvement, whereas the corresponding value was 90.48% (P value=0.0002) in patients with only cutaneous and/or lymph node metastasis. Cutaneous melanomas are uncommon in the young and are seldom diagnosed in the early stages, perhaps due to a reluctance to accept this diagnosis in this age group. Prevention and early stage diagnosis depend upon the recognition that this disease is present in the young.
Assuntos
Melanoma/patologia , Neoplasias Cutâneas/patologia , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Demografia , Feminino , Humanos , Lactente , Recém-Nascido , Metástase Linfática , Masculino , Melanoma/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Taxa de SobrevidaRESUMO
O presente trabalho registra um caso de feo-hifomicose subcutanea em paciente do sexo masculino com o diagnostico de sarcoidose pulmonar, submetido a terapeutica por corticosteroides quando apresentou no dorso da mao direita lesoes cutaneas nodulares, eritemato-violaceas, de aspecto infiltrado, exigindo biopsia para o diagnostico. O exame histopatologico revelou processo granulomatoso, com a presenca de hifas e celulas arredondadas demacias...