Cutaneous melanoma in patients treated with tumour necrosis factor inhibitors: a retrospective series of 15 patients

International audienceBACKGROUND: Several case reports suggested that tumour necrosis factor-α (TNF) inhibitors might increase the incidence and/or alter the natural course of melanoma towards a more aggressive behaviour. OBJECTIVE: Our objective was to point if history of melanoma in patients exposed to TNF inhibitors could present with a particular pattern at diagnosis or during follow-up. METHODS: We performed a retrospective multicentre study settled in the West part of France to collect and analyse all cases of patients with melanoma who received anti-TNF therapy. RESULTS: Fifteen cases were included. First, 10 patients (mean age: 55.6 years; sex ratio: 1) had a melanoma diagnosed after TNF inhibitors initiation. The mean duration between initiation of treatment and melanoma was 48.7 months. Two patients died of metastatic disease. Second, four patients had a past history of melanoma before anti-TNF therapy (mean duration of treatment: 10.8 months). None experienced a progression of melanoma disease. Last, one woman had a past history of melanoma before and then developed a second melanoma when exposed to biotherapy. CONCLUSION: Our case series does not reveal a distinct profile of melanoma in the patients exposed to TNF inhibitors. Additional prospective trials including larger number of patient are needed to demonstrate the possible link between biological therapy with TNF inhibitors and development of melanoma

Dermoscopy of acral melanoma: a multicenter study on behalf of the international dermoscopy society

Background: Most studies on dermoscopy of acral lesions were conducted in Asian populations. In this study, we analyzed these features in a predominantly Caucasian population. Objective: Estimate the prevalence of dermoscopic features in acral lesions, and assess their level of agreement between observers. Methods: In this retrospective multicenter study, 167 acral lesions (66 melanomas) were evaluated for 13 dermoscopic patterns by 26 physicians, via a secured Internet platform. Results: Parallel furrow pattern, bizarre pattern, and diffuse pigmentation with variable shades of brown had the highest prevalence. The agreement for lesion patterns between physicians was variable. Agreement was dependent on the level of diagnostic difficulty. Conclusion: Lesions with a diameter >1 cm were more likely to be melanoma. We found as well that a benign pattern can be seen in parts of melanomas. For this reason one should evaluate an acral lesion for the presence of malignant patterns first. © 2013 S. Karger AG, Basel

Amputação de membros por carcinoma escamocelular da pele: fatores envolvidos nesta evolução desfavorável

OBJETIVO: Analisar retrospectivamente uma série de casos que culminaram em amputação por carcinoma escamocelular avançado. MÉTODOS: Foram estudados oito pacientes com diagnóstico histológico de carcinoma escamocelular de pele que tiveram membros amputados por invasão tumoral, em nossa Instituição entre 2005 e 2008. Foram avaliados: fatores histológicos, institucionais e psicossociais que contribuíram para este desfecho desfavorável. RESULTADOS: A média de idade ao diagnóstico foi 63 anos; 37,5% dos pacientes (três pacientes) tinham exposição abusiva e contínua aos raios solares, e seis (75%) pacientes tinham outros fatores de risco para CEC de pele. Sete pacientes foram diagnosticados quando o tumor já era maior que 2cm, e foi necessário um período grande de tempo (6,7 anos em média) entre o aparecimento da lesão inicial e o diagnóstico histopatológico correto do tumor localmente avançado. CONCLUSÃO: O desfecho desfavorável (amputação) nos pacientes portadores de carcinoma espinocelular pode estar associado à agressividade da neoplasia e às comorbidades relacionadas, podendo ainda sofrer influência de fatores como acesso à saúde pública, qualidade da assistência médica e relação do paciente com a doença