Dermascanner plus: Half automatic computer assisted full body skin imaging system for dermatology

Prevention is an essential prerequisite to overcome the global burden of cancer. Skin cancer is a prevailing problem for societies. Dermatologists are the only group of specialist doctors appropriately trained for skin cancer detection. With the naked eye already most of melanocytic and non-melanocytic skin cancers can be detected. Further security and enhancement of detection rate is assisted by dermoscopy and in addition video dermoscopy. Patients having a large amount of melanocytic nevi and those suffering from nevus dysplastic syndrome need regular follow-up associated with a complete documentation by hand written methods, drawings and/or single or multi lesion photography. There is an increasing need to develop computer assisted full body skin imaging to support doctors and to reduce workload. It was the aim of our interdisciplinary group of dermatologists, specialists in computer visualistics, medical device manufacturer and automation system specialists to develop a physician assisting half automated full body scanning imaging system. Furthermore, a doctor’s working place for reviewing the online and offline produced pictures including data files of case history, dermpath and surgery records and procedures and decisions steps recording was developed. The automatic recognition of pigmented lesions is classified in three categories a. suspicious b. not suspicious, and, c. doubtful/no decison. The classification is based on a thesaurus of classified lesions by independent experienced dermatologists and stabilized by dermatopathological support of all types of lesions. The device is based on a scanner cabin in which according to the construction type the patient is stepwise rotating and more than 30 different imaging fields of the body surface are documented by high power cameras. A specific computer visualistic software has been developed to reproduce the data files of the actual situation and to compare with preexisting data files. A clinical trial for validation of the system is running

Erratum: Sentinel Lymph Node Biopsy Status Is a Key Parameter to Stratify the Prognostic Heterogeneity of Malignant Melanoma in High-Risk Tumors >4.0 mm

<i>Background:</i> The value of sentinel lymph node biopsy (SLNB) as a useful strategy to assess the risk of future metastasis in high-risk melanomas (>4.0 mm) is controversially discussed. <i>Objectives:</i> In a single-center retrospective study, the prognostic relevance of SLNB and other risk factors in the subgroup of melanomas >4.0 mm was investigated and compared to previously published results. <i>Methods:</i> Using Kaplan-Meier estimates and Cox regressions, we assessed the prognostic relevance of SLNB in our subcohort of 87 patients with thick melanomas >4.0 mm (T4). The mean follow-up for this subgroup was 51 months. We compared SLN value as compared to ulceration. <i>Results:</i> SLN and ulceration, analyzed as separate risk factors as well as their combination, predicted a highly reduced life expectancy in terms of recurrence-free survival (RFS) in our cohort of patients. SLN, but not ulceration, also predicted overall survival (OS). <i>Conclusions:</i> Positive SLNB is an essential predictor of RFS and OS in T4 melanoma patients, whereas ulceration lacked significance with respect to OS in our cohort. Our data thus suggest the routine use of SLNB also for T4 melanoma and may therefore allow to optimize risk-stratified therapeutic regimens

Erratum: Sentinel Lymph Node Biopsy Status Is a Key Parameter to Stratify the Prognostic Heterogeneity of Malignant Melanoma in High-Risk Tumors >4.0 mm

<i>Background:</i> The value of sentinel lymph node biopsy (SLNB) as a useful strategy to assess the risk of future metastasis in high-risk melanomas (>4.0 mm) is controversially discussed. <i>Objectives:</i> In a single-center retrospective study, the prognostic relevance of SLNB and other risk factors in the subgroup of melanomas >4.0 mm was investigated and compared to previously published results. <i>Methods:</i> Using Kaplan-Meier estimates and Cox regressions, we assessed the prognostic relevance of SLNB in our subcohort of 87 patients with thick melanomas >4.0 mm (T4). The mean follow-up for this subgroup was 51 months. We compared SLN value as compared to ulceration. <i>Results:</i> SLN and ulceration, analyzed as separate risk factors as well as their combination, predicted a highly reduced life expectancy in terms of recurrence-free survival (RFS) in our cohort of patients. SLN, but not ulceration, also predicted overall survival (OS). <i>Conclusions:</i> Positive SLNB is an essential predictor of RFS and OS in T4 melanoma patients, whereas ulceration lacked significance with respect to OS in our cohort. Our data thus suggest the routine use of SLNB also for T4 melanoma and may therefore allow to optimize risk-stratified therapeutic regimens

A gain-of-function mutation in the CLCN2 chloride channel gene causes primary aldosteronism

International audiencePrimary aldosteronism is the most common and curable form of secondary arterial hypertension. We performed whole-exome sequencing in patients with early-onset primary aldosteronism and identified a de novo heterozygous c.71G>A/p.Gly24Asp mutation in the CLCN2 gene, encoding the voltage-gated ClC-2 chloride channel 1 , in a patient diagnosed at 9 years of age. Patch-clamp analysis of glomerulosa cells of mouse adrenal gland slices showed hyperpolarization-activated Cl- currents that were abolished in Clcn2-/- mice. The p.Gly24Asp variant, located in a well-conserved 'inactivation domain'2,3, abolished the voltage- and time-dependent gating of ClC-2 and strongly increased Cl- conductance at resting potentials. Expression of ClC-2Asp24 in adrenocortical cells increased expression of aldosterone synthase and aldosterone production. Our data indicate that CLCN2 mutations cause primary aldosteronism. They highlight the important role of chloride in aldosterone biosynthesis and identify ClC-2 as the foremost chloride conductor of resting glomerulosa cells