<i>In vivo</i> assessment of optical properties of basal cell carcinoma and differentiation of BCC subtypes by high-definition optical coherence tomography

High-definition optical coherence tomography (HD-OCT) features of basal cell carcinoma (BCC) have recently been defined. We assessed in vivo optical properties (IV-OP) of BCC, by HD-OCT. Moreover their critical values for BCC subtype differentiation were determined. The technique of semi-log plot whereby an exponential function becomes linear has been implemented on HD-OCT signals. The relative attenuation factor (µ(raf)) at different skin layers could be assessed.(.) IV-OP of superficial BCC with high diagnostic accuracy (DA) and high negative predictive values (NPV) were (i) decreased µ(raf) in lower part of epidermis and (ii) increased epidermal thickness (E-T). IV-OP of nodular BCC with good to high DA and NPV were (i) less negative µ(raf) in papillary dermis compared to normal adjacent skin and (ii) significantly decreased E-T and papillary dermal thickness (PD-T). In infiltrative BCC (i) high µ(raf) in reticular dermis compared to normal adjacent skin and (ii) presence of peaks and falls in reticular dermis had good DA and high NPV. HD-OCT seems to enable the combination of in vivo morphological analysis of cellular and 3-D micro-architectural structures with IV-OP analysis of BCC. This permits BCC sub-differentiation with higher accuracy than in vivo HD-OCT analysis of morphology alone

A Late Dermatologic Presentation of Bullous Pemphigoid Induced by Anti-PD-1 Therapy and Associated with Unexplained Neurological Disorder

Immunotherapy has become the standard of care for various cancer types. The widespread use of immune checkpoints inhibitors confronts us with a whole range of novel immune-related adverse events. Skin toxicity is one of the most frequent adverse events. In this article, we report a case of anti-PD-1 induced late bullous pemphigoid (BP) with mucosal erosions and associated with a troublesome neurological disorder of undetermined origin in a patient with metastatic melanoma. Skin biopsy was essential to make the diagnosis and rapid initiation of systemic prednisolone played a role in favorable clinical outcome of BP. We will discuss the difficulty of early diagnosis of BP, its unusual association with neurological disorders, and the specific management of this particular dermatological entity

Line-Field Confocal Optical Coherence Tomography for the Diagnosis of Skin Carcinomas: Real-Life Data over Three Years

Line-field confocal optical coherence tomography (LC-OCT) can help the clinical diagnosis of skin diseases. The present study aimed to evaluate the sensitivity, specificity, and diagnostic accuracy of LC-OCT for the diagnosis of the most frequent non-melanoma skin cancers (NMSCs), i.e., basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Comparing LC-OCT diagnostic performances with those of dermoscopy, histopathological examination was used as a gold standard. For every study endpoint, the diagnostic ability of LC-OCT revealed superiority over the dermoscopic examination. In particular, a significant increase in specificity was observed. Sensitivity, specificity, and diagnostic accuracy of dermoscopy and LC-OCT for the diagnosis of malignancy were, respectively, 0.97 (CI 0.94–0.99), 0.43 (CI 0.36–0.51), and 0.77 (CI 0.72–0.81) for dermoscopy and 0.99 (CI 0.97–1.00), 0.90 (CI 0.84–0.94), and 0.96 (CI 0.93–0.97) for LC-OCT. The positive predictive value (PPV) resulted in 0.74 (CI 0.69–0.78) for dermoscopy and 0.94 (CI 0.91–0.97) for LC-OCT, and the negative predictive value (NPV) was 0.89 (CI 0.81–0.95) for dermoscopy and 0.98 (CI 0.95–1.00) for LC-OCT. Finally, our real-life study showed a potentially important role of LC-OCT in the non-invasive diagnosis of NMSCs, especially BCC. The real-time imaging technique could spare unnecessary biopsies with an increased sensitivity, a much higher specificity, and better accuracy than clinical assessment with dermoscopy alone

Noninvasive Imaging of Basal Cell Carcinoma With Neuroendocrine Differentiation With Line-Field Confocal Optical Coherence Tomography

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Overview and comparison of the clinical scores in hidradenitis suppurativa: A real-life clinical data

IntroductionPartly due to its clinical heterogeneity, hidradenitis suppurativa (HS) is difficult to score accurately; illustrated by the large number of disease scores. In 2016, a systematic review by Ingram et al. reported the use of about thirty scores, and since then, this number has increased further. Our aim is twofold: to provide a succinct but detailed narrative review of the scores used to date, and to compare these scores with each other for individual patients.Materials and methodsThe review of the literature was done among articles in English and French, on Google, Google scholar, Pubmed, ScienceDirect and Cochrane. To illustrate the differences between scores, data from some Belgian patients included in the European Registry for HS were selected. A first series of patients compares the severity of the following scores: Hurley, Hurley Staging refined, three versions of Sartorius score (2003, 2007, 2009), Hidradenitis Suppurativa Physician Global Assessment (HS-PGA), International Hidradenitis Suppurativa Severity Scoring System (IHS4), Severity Assessment of Hidradenitis Suppurativa (SAHS), Hidradenitis Suppurativa Severity Index (HSSI), Acne Inversa Severity Index (AISI), the Static Metascore, and one score that is not specific to HS: Dermatology Life Quality Index (DLQI). A second set of patients illustrates how some scores change over time and with treatment: Hurley, Hurley Staging refined, Sartorius 2003, Sartorius 2007, HS-PGA, IHS4, SAHS, AISI, Hidradenitis Suppurativa Clinical Response (HiSCR), the very new iHS4-55, the Dynamic Metascore, and DLQI.ResultsNineteen scores are detailed in this overview. We illustrate that for some patients, the scores do not predictably and consistently correlate with each other, either in an evaluation of the severity at a time-point t, or in the evaluation of the response to a treatment. Some patients in this cohort may be considered responders according to some scores, but non-responders according to others. The clinical heterogeneity of the disease, represented by its many phenotypes, seems partly to explain this difference.ConclusionThese examples illustrate how the choice of a score can lead to different interpretations of the response to a treatment, or even potentially change the results of a randomized clinical trial

Prevalence, determinants and risks associated with sunbed use in Europe: results from the Euromelanoma skin cancer prevention campaign and beyond

Introduction. Sunbeds emit ultraviolet (UV) radiation to produce a cosmetic tan and are classified by the World Health Organization as first-group carcinogens: they have been significantly associated with increased risk of melanoma and non-melanoma skin cancer. Despite this, controversies still exist: since sunbeds are able to increase serum vitamin D, the sunbed industry relentlessly tries to promote them as a safe therapeutic measure; and some authors have recently expressed scepticism about the carcinogenicity of sunbeds. Moreover, differences between European countries in terms of prevalence of use have not been extensively studied and a better understanding of the determinants of use in Europe is much needed. Similarly, the association of sunbed use with skin cancer risk factors is poorly understood. Euromelanoma is a skin cancer prevention campaign conducted all over Europe. It offers a once-a-year screening during which participants’ data, including sunbed use and phenotype, are collected via questionnaires.Objectives. To thoroughly describe prevalence, determinants, and risks associated with sunbed use in Europe. To this aim we performed literature reviews (3 publications) and an extensive analysis of the Euromelanoma database, which included data from 30 European countries (2 publications).Methods. For the 3 reviews we searched the most used databases for any literature published in English using all pertinent keywords. As for the 2 Euromelanoma studies, participants filled in questionnaires about demographics and risk factors, including type/duration of sunbed use. Multivariate analyses adjusted for all confounders were employed to assess factors independently associated with sunbed use in each country.Results. Our reviews showed that: (i) European sunbed users are typically young women, sun seekers, and smokers, mostly from northern countries, going to tanning studios with aesthetic motives, although exceptions exist; (ii) in case of vitamin D deficiency, the risk/benefit ratio is clearly in favour of vitamin D supplementation instead of sunbed use; (iii) all epidemiological criteria for causality apply to the relationship between sunbed use and melanoma. The Euromelanoma studies included 227,888 individuals (67.4% females, median age 44) from 30 countries. Overall prevalence of sunbed ever use was 10.6%. Prevalence was higher in northern, sun-deprived countries, with the exception of Italy and Spain. Females displayed higher prevalence than males in all countries. Geographic particularities were found in four regions: Iberian (prevalence ten times higher in Spain than Portugal), Balkan (prevalence disproportionately higher among women), Baltic (highest prevalence among young adults), and Scandinavian (highest prevalence among adolescents). Ever sunbed use was independently associated with nevus count >50 [summary odds ratio (SOR)=1.05 (1.01-1.10)], atypical nevi [SOR=1.04 (1.00-1.09)], lentigines [SOR=1.16 (1.04-1.29)], and suspicion of melanoma [SOR=1.13 (1.00-1.27)]. Conclusions. After a thorough literature revision, we concluded that the debate over whether sunbed use contributes to melanoma should be definitively closed and that sunbeds are not a safe option to increase vitamin D levels. The Euromelanoma analysis on sunbeds and skin cancer risk factors suggests that avoidance/discontinuation of sunbed use should always be encouraged, especially, but not exclusively, for individuals with high-risk phenotypes. The data about prevalence/determinants of sunbed use have public health relevance for future, tailored interventions aimed at reducing indoor tanning in Europe.  Introduction. Les bancs solaires émettent des radiations ultraviolettes (UV) pour induire un bronzage cosmétique. Ils sont classés par l’Organisation Mondiale de la Santé comme carcinogènes de premier groupe: ils sont significativement associés à un risque accru de mélanome et de cancers cutanés non-mélanome. Malgré ça, des controverses existent toujours :comme leur utilisation permet d’accroitre le taux sérique de vitamine D, l’industrie du bronzage artificiel n’a cessé de les promouvoir comme thérapeutique sans danger et certains auteurs ont récemment mis en doute la carcinogénicité des bancs solaires. Par ailleurs, les différences entre les pays européens en terme de prévalence et de facteurs déterminant l’utilisation des bancs solaires n’ont pas été clairement étudiées. De la même façon, la relation entre bronzage artificiel et facteurs de risque de cancérisation cutanée reste floue. Euromelanoma est une campagne pan-européenne annuelle de prévention de cancers cutanés, où des questionnaires récoltent les données des participants (usage des bancs solaires, phénotype et informations cliniques inclus).Objectifs. Décrire de manière approfondie la prévalence, les déterminants et les risques associés à l’utilisation des bancs solaires en Europe. Dans ce but, nous avons réalisé des revues de littérature (3 publications) et une analyse extensive de la base de données Euromelanoma qui couvre 30 pays européens (2 publications).Méthodes. Pour les 3 revues, nous avons cherché dans toute la littérature publiée en anglais sur les moteurs de recherche les plus utilisés, en employant des mots clés pertinents. Les participants des 2 études Euromelanoma ont rempli des questionnaires colligeant les facteurs démographiques et de risque, le type et la durée d’utilisation des bancs solaires. Des analyses multi-variées ont permis d’évaluer les facteurs indépendamment associés à l’usage des bancs solaire dans chaque pays.Résultats. Les revues de littérature ont montré que :(i) les utilisateurs européens sont typiquement des femmes jeunes/adultes, amatrices de soleil, fumeuses, ressortissantes des pays nordiques, motivées par des raisons esthétiques et préférant les centres de bronzage, même si des exceptions existent ;(ii) dans le cas d’une carence en vitamine D, le rapport risque/bénéfice est clairement en faveur de la supplémentation en vitamine D plutôt que du bronzage artificiel ;(iii) tous les critères épidémiologiques de causalité s’appliquent à la relation entre les bancs solaires et le mélanome. Les études Euromelanoma ont été réalisées sur 227,888 individus (67.4% femmes, âge médian 44 ans) issus de 30 pays. La prévalence globale d’utilisation des bancs solaires était 10.6%, mais était plus élevée dans les pays nordiques et non ensoleillés, l’Italie et l’Espagne faisant exception. Dans tous les cas, les femmes avaient une prévalence d’utilisation plus élevée que les hommes. Des particularités géographiques ont été relevées dans 4 régions :la péninsule ibérique (prévalence 10 fois plus élevée en Espagne qu’au Portugal), les Balkans (disproportions excessives de prévalence entre femmes et hommes), les pays baltiques (la prévalence la plus élevée chez les jeunes/adultes), et scandinaves (la prévalence la plus élevée chez les adolescents). Avoir utilisé au moins une fois un banc solaire était indépendamment associé avec :un nombre de naevi >50 [summary odds ratio (SOR)=1.05 (1.01-1.10)], la présence de naevi atypiques [SOR=1.04 (1.00-1.09)] et des lentigines [SOR=1.16 (1.04-1.29)] et la suspicion de mélanome [SOR=1.13 (1.00-1.27)]. Conclusions. La revue complète de la littérature nous permet d’affirmer que le débat sur la relation causale entre bancs solaires et mélanome doit être clos et que leur utilisation pour corriger un déficit sérique en vitamine D n’est pas sans danger. L’analyse Euromelanoma sur l’utilisation des bancs solaires et les facteurs de risque de cancer cutané suggère que le bronzage artificiel devrait toujours être dissuadé, spécialement mais pas exclusivement chez les individus avec des phénotypes à haut risque. Les données de la prévalence et des facteurs déterminant l’utilisation des bancs solaires constituent un intérêt de santé publique et devraient permettre de cibler les actions nécessaires à la réduction du bronzage artificiel en Europe.Doctorat en Sciences médicales (Médecine)info:eu-repo/semantics/nonPublishe

Sunbeds and melanoma risk: time to close the debate

PURPOSE OF REVIEW: In spite of the established scientific evidence on the association of sunbed use with melanoma risk, some have recently expressed scepticism about the carcinogenicity of indoor tanning. This may have raised confusion among both physicians and patients. The purpose of this review is to make the point about the real impact of sunbed use on melanoma risk in light of the most recently published evidence. RECENT FINDINGS: Seven themes were covered: recent studies on age at first sunbed exposure and melanoma risk; sunbed use and melanoma at different body sites; sunbed use and development of additional primary melanomas; new studies on proportion of melanomas attributable to sunbed use; sunbed use and melanoma risk factors; economic burden of sunbed use; and recent debate over whether indoor tanning contributes to melanoma. SUMMARY: We were able to apply all epidemiological criteria for causality to the relationship between sunbed use and melanoma. Together with the new evidence on the strength, dose response, and temporality of the association of sunbeds with melanoma, this will hopefully close the debate over whether indoor tanning contributes to melanoma.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Melanoma epidemiology and sun exposure

The worldwide incidence of melanoma has increased rapidly over the last 50 years. Melanoma is the most common cancer found in the young adult population, and its incidence is very high among geriatric popula-tions. The incidence of melanoma varies by sex, and this factor is also associated with differences in the anatomical site melanoma. Adolescent and young adult women have a higher incidence than men. This may be, in part, due to the greater use of sunbeds, as well as intentional sun exposure among girls and, in general, risky behaviours in seeking to suntan, due to socially-determined aesthetic needs. Indeed, the World Health Organization declared that there is sufficient evidence to classify exposure to ultraviolet radiation (sunbed use and sun exposure) as carcinogenic to humans. Although pigmentation characteristics, such as skin colour, hair and eye colour, freckles and number of common and atypical naevi, do influence susceptibility to melanoma, recommendations regarding prevention should be directed to the entire population and should include avoiding sunbed, covering sun-exposed skin, wearing a hat and sunglasses. Sunscreen use should not be used to prolong intentional sun exposure. Primary prevention should be focused mainly on young adult women, while secondary prevention should be focused mainly on elderly men. In fact, after the age of 40 years, incidence rates reverse, and the incidence of melanoma among men is greater than among women. This is probably due to the fact that men are less likely than women to examine their own skin or present to a dermatologist for skin examination.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Overview on non-melanoma skin cancers in solid organ transplant recipients

The risk of non-melanoma skin cancer (NMSC) is significantly increased in solid organ transplant recipients (SOTRs) due to the long-term immunosuppressive treatment. NMSCs can be more aggressive in SOTRs than in the general population, resulting in significantly higher morbidity and mortality. In contrast to the immunocompetent population, skin cancers in SOTRs are dominated by squamous cell carcinoma, followed by basal cell carcinoma. Life-long radiation exposure, male sex, fair skin, history of prior NMSC, genetic factors, age at transplant along with duration and extent of the immunosuppression therapy have been identified as risk factors for NMSC in SOTRs. Photo-protection, skin self-examination, early diagnosis and treatment of skin lesions, reduction of immunotherapy, switch to mammalian target-of-rapamycin inhibitors and chemopre-vention with oral retinoids are effective measures for the reduction of the incidence of NMSC in such patients.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Dépistage du mélanome

Melanoma represents a major public health problem. Its incidence is constantly rising and the mortality rate can be frightfully important if the diagnosis is delayed. Melanoma also exerts a significant economical burden on the society. Therefore there is a need of concrete and pragmatic public health strategies in order to enhance melanoma prevention. Primary prevention of melanoma consists in avoiding excessive exposure to ultraviolet rays, which represent the main risk factor for the disease occurrence. Secondary prevention is a synonym of melanoma early diagnosis and can be obtained by means of two methods: patients' self examination and medical examination. Both these examinations must be routinely and thoroughly performed, must be based on the ABCDE rule and the ugly duckling sign, and ideally must be aided by the use of total-body photography. Current international guidelines suggest that all cutaneous screenings should be performed using dermoscopy, a non-invasive imaging technique that allows improving considerably the diagnostic performance. More sophisticated imaging techniques, such as confocal microscopy, are also available in specialised centres. The current scientific evidence supports the efficacy of melanoma primary and secondary prevention programs as a tool to decrease melanoma mortality. Many skin cancer prevention campaigns have been organised worldwide. The most famous and successful in Europe is Euromelanoma.SCOPUS: ar.jinfo:eu-repo/semantics/publishe