Fluorescence-advanced videodermatoscopy is not a widespread diagnostic technique. Its application in dermatology can facilitate the diagnosis of diseases such as cutaneous larva migrans by enabling ...us to recognize the precise position of larva in vivo on the skin. Using this noninvasive technique, we detected a case of cutaneous larva migrans in a patient.
Trombiculosis is a skin infestation by larvae of mites of the Trombiculidae family. We used fluorescence-advanced videodermatoscopy to diagnose trombiculosis in a woman in Italy with targetoid ...patches. This method might be useful for identifying atypical manifestations of trombiculosis.
The COVID-19 pandemic-related health crisis has imposed measures aimed at reducing the overcrowding of health facilities, by developing telemedicine and by forcing many sexually transmitted infection ...(STI) clinics to book appointments by telephone. In this work, we evaluate the performance of the nursing telephone triage system, introduced in the major STI center in Northwest Italy, for the adequacy of clinical pathways for of symptomatic STI patients.
From January to March 2021, all symptomatic patients wishing to access the CeMuSS center first underwent nurse-led telephone triage. Symptoms suggestive of STIs were further classified into four syndromic presentations: cutaneous neoformations, genital and oral ulcers, anogenital discharge, and finally other dermatological manifestations. All other clinical pictures were properly managed and eventually referred to other centers and not considered in the analysis. During the following medical examinations, the concordance between presumptive syndromic diagnosis and confirmed clinical diagnosis were recorded. Cohen k test was used to assess concordance.
According to the Cohen k test, a good concordance between telephone presumptive diagnoses and medical clinical assessment was found (73.79% with a k = 0.611), whereas only a scarcely acceptable concordance between expected and real waiting time was established (75.51%, k = 0.34).
Concordance between nursing syndromic diagnosis and syndromic medically confirmed diagnosis is good from a clinical point of view but there is a limitation when considering a public health perspective. An optimal training of nurses may improve the method of telephone triage. For future ongoing emergencies, the implementation of telemedicine with accurate patient management systems is mandatory.
Detection of BRAF
within cell free tumor DNA (ctDNA) is emerging as a promising means to improve patients' stratification or enable BRAF inhibitor (BRAFi) therapeutic monitoring in a minimally ...invasive manner. Here, we investigated whether extracellular vesicle-(EV)-associated-DNA (EV-DNA) has value as an alternative source of circulating BRAF
. To do so, we identified a clinical practice-compatible protocol for the isolation of EV-DNA and assessed BRAF gene status on plasma samples from metastatic melanoma patients at the beginning and during BRAFi therapy. This protocol uses a peptide with high affinity for EVs and it has been found to recover more mutant DNA from plasma than standard ultracentrifugation. Molecular analyses revealed that mutant DNA is largely unprotected from nuclease digestion, interacting with the outer side of the EV membrane or directly with the peptide. When used on clinical samples, we found that the protocol improves the detection of BRAF
gene copies in comparison to the reference protocol for ctDNA isolation. Taken together, these findings indicate that EVs are a promising source of mutant DNA and should be considered for the development of next-generation liquid biopsy approaches.
Folliculotropic Mycosis Fungoides (FMF) is a rare variant of Mycosis Fungoides involving the scalp leading to alopecia. The clinical and trichoscopic features in 18 patients were analyzed and ...compared with the reports in the literature. Gender, age, disease stage, site of onset were taken into consideration. Clinical and trichoscopic analyses were performed on each patient. From a clinical point of view, Folliculotropic Mycosis Fungoides lesions involving the scalp presented as generalized alopecia (27.8%) or patchy-plaque alopecia (72.2%). Trichoscopic analysis revealed six most frequent features: single hair (83.3%), dotted dilated vessels (77.8%), broken-dystrophic hairs (66.7%), vellus hairs (61.1%), spermatozoa-like pattern vessels (55.6%), and yellow dots (55.6%). Additional identified trichoscopic patterns were dilation of follicular openings, scales-crusts, purpuric dots, short hair with split-end, pigtail hairs, perifollicular hyperkeratosis, milky-white globules, black dots, white dots/lines and absence of follicular dots. These trichoscopic features were further correlated to clinical presentations and stage of the disease. The rarity of the disease is a limitation. The relatively high number of patients allowed to identify several clinical and trichoscopic patterns that could be featured as specific or highly suspicious for FMF in order to consider trichoscopy as a complementary diagnostic approach and improve the differential diagnoses between FMF and other scalp disorders.
Background BRAF inhibitor (BRAFi) and MEK inhibitor (MEKi) frequently cause cutaneous adverse events. Objective We sought to investigate the cutaneous safety profile of BRAFi versus BRAFi and MEKi ...combination regimens. Methods We performed a retrospective cohort study, collecting data from 44 patients with melanoma treated either with BRAFi (vemurafenib or dabrafenib) or BRAFi and MEKi combination regimens (vemurafenib + cobimetinib or dabrafenib + trametinib). Patient characteristics, and the occurrence and severity of cutaneous adverse events, are described. Results The development of cutaneous adverse events was significantly less frequent ( P = .012) and occurred after longer treatment time ( P = .025) in patients treated with BRAFi and MEKi combination regimen compared with patients treated with BRAFi monotherapy. Among patients who received both BRAFi and the combination of BRAFi and MEKi at different time points during their treatment course, the development of squamous cell carcinoma or keratoacanthoma was significantly less frequent when they received the combination regimen ( P = .008). Patients receiving vemurafenib developed more cutaneous adverse events ( P = .001) and in particular more photosensitivity ( P = .010) than patients who did not. Limitations There were a limited number of patients. Conclusion Combination regimen with BRAFi and MEKi shows fewer cutaneous adverse events and longer cutaneous adverse event-free interval compared with BRAFi monotherapy.
Abstract Introduction The therapeutic landscape of metastatic melanoma drastically changed after the introduction of targeted therapies and immunotherapy, in particular immune checkpoints inhibitors ...(ICI). In recent years, positive effects on the immune system associated to radiotherapy (RT) were discovered, and radiation has been tested in combination with ICI in both pre-clinical and clinical studies (many of them still ongoing). We here summarize the rationale and the preliminary clinical results of this approach. Materials and methods In the first part of this review article, redacted with narrative non-systematic methodology, we describe the clinical results of immune checkpoints blockade in melanoma as well as the biological basis for the combination of ICI with RT; in the second part, we systematically review scientific publications reporting on the clinical results of the combination of ICI and RT for advanced melanoma. Results The biological and mechanistic rationale behind the combination of ICI and radiation is well supported by several preclinical findings. Retrospective observational series and few prospective trials support the potential synergistic effect between radiation and ICI for metastatic melanoma. Conclusion RT may potentiate anti-melanoma activity of ICI by enhancing response on both target and non-target lesions. Several prospective trials are ongoing with the aim of further exploring this combination in the clinical setting, hopefully confirming initial observations and opening a new therapeutic window for advanced melanoma patients.
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