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Iris Zalaudek - One of the best experts on this subject based on the ideXlab platform.
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Dermatoscopic features of thin (≤2 mm Breslow thickness) vs. thick (>2 mm Breslow thickness) Nodular Melanoma and predictors of Nodular Melanoma versus Nodular non-Melanoma tumours: a multicentric collaborative study by the International Dermoscopy S
Journal of the European Academy of Dermatology and Venereology : JEADV, 2020Co-Authors: Dimitrios Sgouros, Giuseppe Argenziano, Aimilios Lallas, Harald Kittler, A. Zarras, A. Kyrgidis, Chryssoula Papageorgiou, S. Puig, Alon Scope, Iris ZalaudekAbstract:BACKGROUND Thin Nodular Melanoma (NM) often lacks conspicuous Melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour. OBJECTIVE To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other Nodular tumours. METHODS Retrospective, morphological case-control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other Nodular tumours from 19 skin cancer centres worldwide were collected and analysed. RESULTS Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-Melanoma Nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-Melanoma Nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-Melanoma Nodular lesions. LIMITATIONS Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community. CONCLUSIONS Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-Melanoma Nodular tumours.
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dermatoscopic features of thin 2 mm breslow thickness vs thick 2 mm breslow thickness Nodular Melanoma and predictors of Nodular Melanoma versus Nodular non Melanoma tumours a multicentric collaborative study by the international dermoscopy society
Journal of The European Academy of Dermatology and Venereology, 2020Co-Authors: Dimitrios Sgouros, Giuseppe Argenziano, Aimilios Lallas, Harald Kittler, A. Zarras, A. Kyrgidis, Chryssoula Papageorgiou, S. Puig, Alon Scope, Iris ZalaudekAbstract:Background Thin Nodular Melanoma (NM) often lacks conspicuous Melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour. Objective To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other Nodular tumours. Methods Retrospective, morphological case-control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other Nodular tumours from 19 skin cancer centres worldwide were collected and analysed. Results Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-Melanoma Nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-Melanoma Nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-Melanoma Nodular lesions. Limitations Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community. Conclusions Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-Melanoma Nodular tumours.
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Improving the early diagnosis of early Nodular Melanoma: can we do better?
Expert review of anticancer therapy, 2018Co-Authors: Paola Corneli, Iris Zalaudek, Giovanni Magaton Rizzi, Nicola Di MeoAbstract:ABSTRACTIntroduction: Cutaneous Melanoma is the sixth most common malignant cancer in the USA. Among different subtypes of Melanoma, Nodular Melanoma (NM) accounts about 14% of all cases but is responsible for more than 40% of Melanoma deaths. Early diagnosis is the best method to improve Melanoma prognosis. Unfortunately, early diagnosis of NM is particularly challenging given that patients often lack identifiable risk factors such as many moles or freckles. Moreover, early NM may mimic a range of benign skin lesions that are not routinely excised or biopsied in every day practice. For this reason, specific clinical and skin imaging clues have been proposed to improve early detection of NM.Areas covered: The review discusses about the noninvasive tools to diagnose thin Melanoma, particularly NM.Expert commentary: Currently, dermatologists present a wide opportunity of diagnostic tools. Current data suggest that the early diagnosis of NM is a major challenge as the majority of early NM are symmetric, roun...
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Performance of the "if in doubt, cut it out" rule for the management of Nodular Melanoma.
Dermatology practical & conceptual, 2017Co-Authors: Elvira Moscarella, Iris Zalaudek, Aimilios Lallas, Caterina Longo, Stefano Caccavale, Alessio Gambardella, Amalia Lupoli, Roberto Alfano, Giuseppe ArgenzianoAbstract:Background: The recognition of Nodular Melanoma is clinically challenging, and the diagnostic accuracy of dermoscopy and confocal microscopy is lower than for superficial spreading Melanoma. Objectives: To test a management strategy consisting in the excision of any Nodular lesion that cannot be confidently and precisely classified as a benign tumor after clinical and dermoscopic examination. Methods: Clinical and dermoscopic images of excised Nodular lesions were retrospectively collected and evaluated. The evaluators were asked to record the level of diagnostic confidence for each lesion, by declaring if they were confident or doubtful about the given diagnosis. The NNE (number needed to excise) value was used to evaluate the efficacy of the proposed method. Results: A total of 1,319 excised Nodular lesions formed the study set. The NNE for any malignancy was 3.9 (634/164), while the NNE for Melanoma was 13.2 (634/48). NNE for hypo and amelanotic Melanoma was 27.3 (327/12). Conclusions: Excising doubtful Nodular lesions seems to be an effective management strategy not to miss Nodular Melanoma, resulting in an acceptable rate of unnecessary excision of benign lesions.
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Dermoscopic Evaluation of Nodular Melanoma
JAMA dermatology, 2013Co-Authors: Scott W. Menzies, Fergal J. Moloney, Karen Byth, Michelle Avramidis, Giuseppe Argenziano, Iris Zalaudek, Ralph P. Braun, Josep Malvehy, Susana Puig, Harold S. RabinovitzAbstract:Nodular Melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical.
Irianiwati - One of the best experts on this subject based on the ideXlab platform.
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BRAF V600 mutation profiling in primary skin Nodular Melanoma in Indonesia: an analysis using high resolution pyrosequencing
BMC research notes, 2020Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, Sumadi Lukman Anwar, IrianiwatiAbstract:We aimed to investigate the prevalence and type of BRAF V600 mutations and the associations with clinicopathological variables in primary skin Nodular Melanoma cases in Yogyakarta and Central Java, Indonesia using pyrosequencing. BRAF V600 mutations of the V600E type were found in 21 (53.85%) specimens. The variant allele frequencies (VAFs) ranged from 5.07 to 94.70%, averaging 29.05%. However, most cases had low VAFs, with 13 (61.9%) specimens below 20% and 4 (19.05%) below 10%.
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BRAF V600 mutation profiling in primary skin Nodular Melanoma in Indonesia: an analysis using high resolution pyrosequencing
2020Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, Sumadi Lukman Anwar, IrianiwatiAbstract:Abstract Objective: We aimed to investigate the prevalence and type of BRAF V600 mutations and the associations with clinicopathological variables in primary skin Nodular Melanoma cases in Yogyakarta and Central Java, Indonesia using pyrosequencing. Results: BRAF V600 mutations of the V600E type were found in 21 (53.85%) specimens. The variant allele frequencies (VAFs) ranged from 5.07% to 94.70%, averaging 29.05%. However, most cases had low VAFs, with 13 (61.9%) specimens below 20% and 4 (19.05%) below 10%.
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Low BRAF V600 mutation prevalence in primary skin Nodular Melanoma in Indonesia: a real-time PCR detection among Javanese patients.
BMC proceedings, 2019Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Ni'mah Hayati, Maria Fransiska Pudjohartono, Bidari Kameswari, IrianiwatiAbstract:Cutaneous Melanoma is a rare, aggressive skin malignancy with a high mortality rate. Although only contributing 7.6% of the cases worldwide, Asia is responsible for 18.6% of deaths from cutaneous Melanoma. BRAF V600 mutation presents a potential prognostic predictor in Melanoma. Unfortunately, studies on that mutation in Melanoma, particularly Nodular subtype, in Indonesia are still scarce. This research aimed to investigate the prevalence of BRAF V600 mutation in primary skin Nodular Melanoma in Yogyakarta and Central Java, Indonesia. Its association with clinicopathological parameters was also analyzed. Forty paraffin-embedded tissue samples from primary skin Nodular Melanoma cases in 2011-2018 were collected from the two biggest referral hospitals in Yogyakarta and Central Java, Indonesia. The BRAF V600 mutation status was assessed using qualitative real-time PCR and its associations with age, sex, anatomic location, lymph node metastasis, tumor thickness, ulceration, mitotic index, necrosis, lymphovascular invasion, and tumor-infiltrating lymphocytes were analyzed. BRAF V600 mutations were found in 4 (10%) samples. These mutations were significantly associated with the central (non-extremity) region (p = 0.013) and presence of lymphovascular invasion (p = 0.005). However, it was not associated with any other variables analyzed in this study. The prevalence of BRAF V600 mutation in Indonesian primary skin Nodular Melanoma cases is low and significantly associated with anatomic location and lymphovascular invasion. It is lower than prevalences in other Asian populations as well as in Caucasian populations and suggests that Melanoma cases in Javanese people may have distinct clinicopathological characteristics from other Asian ethnicities. © The Author(s). 2019.
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Low BRAF V600 mutation prevalence in primary skin Nodular Melanoma in Indonesia: a real-time PCR detection among Javanese patients
BMC Proceedings, 2019Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, IrianiwatiAbstract:Cutaneous Melanoma is a rare, aggressive skin malignancy with a high mortality rate. Although only contributing 7.6% of the cases worldwide, Asia is responsible for 18.6% of deaths from cutaneous Melanoma. BRAF V600 mutation presents a potential prognostic predictor in Melanoma. Unfortunately, studies on that mutation in Melanoma, particularly Nodular subtype, in Indonesia are still scarce. This research aimed to investigate the prevalence of BRAF V600 mutation in primary skin Nodular Melanoma in Yogyakarta and Central Java, Indonesia. Its association with clinicopathological parameters was also analyzed. Forty paraffin-embedded tissue samples from primary skin Nodular Melanoma cases in 2011–2018 were collected from the two biggest referral hospitals in Yogyakarta and Central Java, Indonesia. The BRAF V600 mutation status was assessed using qualitative real-time PCR and its associations with age, sex, anatomic location, lymph node metastasis, tumor thickness, ulceration, mitotic index, necrosis, lymphovascular invasion, and tumor-infiltrating lymphocytes were analyzed. BRAF V600 mutations were found in 4 (10%) samples. These mutations were significantly associated with the central (non-extremity) region (p = 0.013) and presence of lymphovascular invasion (p = 0.005). However, it was not associated with any other variables analyzed in this study. The prevalence of BRAF V600 mutation in Indonesian primary skin Nodular Melanoma cases is low and significantly associated with anatomic location and lymphovascular invasion. It is lower than prevalences in other Asian populations as well as in Caucasian populations and suggests that Melanoma cases in Javanese people may have distinct clinicopathological characteristics from other Asian ethnicities.
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Low BRAF V600 mutation prevalence in primary skin Nodular Melanoma in Indonesia: a real-time PCR detection among Javanese patients
BMC Proceedings, 2019Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, IrianiwatiAbstract:Abstract Background Cutaneous Melanoma is a rare, aggressive skin malignancy with a high mortality rate. Although only contributing 7.6% of the cases worldwide, Asia is responsible for 18.6% of deaths from cutaneous Melanoma. BRAF V600 mutation presents a potential prognostic predictor in Melanoma. Unfortunately, studies on that mutation in Melanoma, particularly Nodular subtype, in Indonesia are still scarce. This research aimed to investigate the prevalence of BRAF V600 mutation in primary skin Nodular Melanoma in Yogyakarta and Central Java, Indonesia. Its association with clinicopathological parameters was also analyzed. Methods Forty paraffin-embedded tissue samples from primary skin Nodular Melanoma cases in 2011–2018 were collected from the two biggest referral hospitals in Yogyakarta and Central Java, Indonesia. The BRAF V600 mutation status was assessed using qualitative real-time PCR and its associations with age, sex, anatomic location, lymph node metastasis, tumor thickness, ulceration, mitotic index, necrosis, lymphovascular invasion, and tumor-infiltrating lymphocytes were analyzed. Results BRAF V600 mutations were found in 4 (10%) samples. These mutations were significantly associated with the central (non-extremity) region (p = 0.013) and presence of lymphovascular invasion (p = 0.005). However, it was not associated with any other variables analyzed in this study. Conclusion The prevalence of BRAF V600 mutation in Indonesian primary skin Nodular Melanoma cases is low and significantly associated with anatomic location and lymphovascular invasion. It is lower than prevalences in other Asian populations as well as in Caucasian populations and suggests that Melanoma cases in Javanese people may have distinct clinicopathological characteristics from other Asian ethnicities.
Hanggoro Tri Rinonce - One of the best experts on this subject based on the ideXlab platform.
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BRAF V600 mutation profiling in primary skin Nodular Melanoma in Indonesia: an analysis using high resolution pyrosequencing
BMC research notes, 2020Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, Sumadi Lukman Anwar, IrianiwatiAbstract:We aimed to investigate the prevalence and type of BRAF V600 mutations and the associations with clinicopathological variables in primary skin Nodular Melanoma cases in Yogyakarta and Central Java, Indonesia using pyrosequencing. BRAF V600 mutations of the V600E type were found in 21 (53.85%) specimens. The variant allele frequencies (VAFs) ranged from 5.07 to 94.70%, averaging 29.05%. However, most cases had low VAFs, with 13 (61.9%) specimens below 20% and 4 (19.05%) below 10%.
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BRAF V600 mutation profiling in primary skin Nodular Melanoma in Indonesia: an analysis using high resolution pyrosequencing
2020Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, Sumadi Lukman Anwar, IrianiwatiAbstract:Abstract Objective: We aimed to investigate the prevalence and type of BRAF V600 mutations and the associations with clinicopathological variables in primary skin Nodular Melanoma cases in Yogyakarta and Central Java, Indonesia using pyrosequencing. Results: BRAF V600 mutations of the V600E type were found in 21 (53.85%) specimens. The variant allele frequencies (VAFs) ranged from 5.07% to 94.70%, averaging 29.05%. However, most cases had low VAFs, with 13 (61.9%) specimens below 20% and 4 (19.05%) below 10%.
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Low BRAF V600 mutation prevalence in primary skin Nodular Melanoma in Indonesia: a real-time PCR detection among Javanese patients.
BMC proceedings, 2019Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Ni'mah Hayati, Maria Fransiska Pudjohartono, Bidari Kameswari, IrianiwatiAbstract:Cutaneous Melanoma is a rare, aggressive skin malignancy with a high mortality rate. Although only contributing 7.6% of the cases worldwide, Asia is responsible for 18.6% of deaths from cutaneous Melanoma. BRAF V600 mutation presents a potential prognostic predictor in Melanoma. Unfortunately, studies on that mutation in Melanoma, particularly Nodular subtype, in Indonesia are still scarce. This research aimed to investigate the prevalence of BRAF V600 mutation in primary skin Nodular Melanoma in Yogyakarta and Central Java, Indonesia. Its association with clinicopathological parameters was also analyzed. Forty paraffin-embedded tissue samples from primary skin Nodular Melanoma cases in 2011-2018 were collected from the two biggest referral hospitals in Yogyakarta and Central Java, Indonesia. The BRAF V600 mutation status was assessed using qualitative real-time PCR and its associations with age, sex, anatomic location, lymph node metastasis, tumor thickness, ulceration, mitotic index, necrosis, lymphovascular invasion, and tumor-infiltrating lymphocytes were analyzed. BRAF V600 mutations were found in 4 (10%) samples. These mutations were significantly associated with the central (non-extremity) region (p = 0.013) and presence of lymphovascular invasion (p = 0.005). However, it was not associated with any other variables analyzed in this study. The prevalence of BRAF V600 mutation in Indonesian primary skin Nodular Melanoma cases is low and significantly associated with anatomic location and lymphovascular invasion. It is lower than prevalences in other Asian populations as well as in Caucasian populations and suggests that Melanoma cases in Javanese people may have distinct clinicopathological characteristics from other Asian ethnicities. © The Author(s). 2019.
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Low BRAF V600 mutation prevalence in primary skin Nodular Melanoma in Indonesia: a real-time PCR detection among Javanese patients
BMC Proceedings, 2019Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, IrianiwatiAbstract:Cutaneous Melanoma is a rare, aggressive skin malignancy with a high mortality rate. Although only contributing 7.6% of the cases worldwide, Asia is responsible for 18.6% of deaths from cutaneous Melanoma. BRAF V600 mutation presents a potential prognostic predictor in Melanoma. Unfortunately, studies on that mutation in Melanoma, particularly Nodular subtype, in Indonesia are still scarce. This research aimed to investigate the prevalence of BRAF V600 mutation in primary skin Nodular Melanoma in Yogyakarta and Central Java, Indonesia. Its association with clinicopathological parameters was also analyzed. Forty paraffin-embedded tissue samples from primary skin Nodular Melanoma cases in 2011–2018 were collected from the two biggest referral hospitals in Yogyakarta and Central Java, Indonesia. The BRAF V600 mutation status was assessed using qualitative real-time PCR and its associations with age, sex, anatomic location, lymph node metastasis, tumor thickness, ulceration, mitotic index, necrosis, lymphovascular invasion, and tumor-infiltrating lymphocytes were analyzed. BRAF V600 mutations were found in 4 (10%) samples. These mutations were significantly associated with the central (non-extremity) region (p = 0.013) and presence of lymphovascular invasion (p = 0.005). However, it was not associated with any other variables analyzed in this study. The prevalence of BRAF V600 mutation in Indonesian primary skin Nodular Melanoma cases is low and significantly associated with anatomic location and lymphovascular invasion. It is lower than prevalences in other Asian populations as well as in Caucasian populations and suggests that Melanoma cases in Javanese people may have distinct clinicopathological characteristics from other Asian ethnicities.
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Low BRAF V600 mutation prevalence in primary skin Nodular Melanoma in Indonesia: a real-time PCR detection among Javanese patients
BMC Proceedings, 2019Co-Authors: Hanggoro Tri Rinonce, Rovi Panji Mustiko Aji, Maria Fransiska Pudjohartono, Bidari Kameswari, Ni’mah Hayati, IrianiwatiAbstract:Abstract Background Cutaneous Melanoma is a rare, aggressive skin malignancy with a high mortality rate. Although only contributing 7.6% of the cases worldwide, Asia is responsible for 18.6% of deaths from cutaneous Melanoma. BRAF V600 mutation presents a potential prognostic predictor in Melanoma. Unfortunately, studies on that mutation in Melanoma, particularly Nodular subtype, in Indonesia are still scarce. This research aimed to investigate the prevalence of BRAF V600 mutation in primary skin Nodular Melanoma in Yogyakarta and Central Java, Indonesia. Its association with clinicopathological parameters was also analyzed. Methods Forty paraffin-embedded tissue samples from primary skin Nodular Melanoma cases in 2011–2018 were collected from the two biggest referral hospitals in Yogyakarta and Central Java, Indonesia. The BRAF V600 mutation status was assessed using qualitative real-time PCR and its associations with age, sex, anatomic location, lymph node metastasis, tumor thickness, ulceration, mitotic index, necrosis, lymphovascular invasion, and tumor-infiltrating lymphocytes were analyzed. Results BRAF V600 mutations were found in 4 (10%) samples. These mutations were significantly associated with the central (non-extremity) region (p = 0.013) and presence of lymphovascular invasion (p = 0.005). However, it was not associated with any other variables analyzed in this study. Conclusion The prevalence of BRAF V600 mutation in Indonesian primary skin Nodular Melanoma cases is low and significantly associated with anatomic location and lymphovascular invasion. It is lower than prevalences in other Asian populations as well as in Caucasian populations and suggests that Melanoma cases in Javanese people may have distinct clinicopathological characteristics from other Asian ethnicities.
John W. Kelly - One of the best experts on this subject based on the ideXlab platform.
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An assessment of clinical pathways and missed opportunities for the diagnosis of Nodular Melanoma versus superficial spreading Melanoma.
The Australasian journal of dermatology, 2015Co-Authors: Mark Cicchiello, Matthew J Lin, Yan Pan, Catriona Mclean, John W. KellyAbstract:Background Missed opportunities in the diagnosis of Nodular Melanoma (NM) carry high prognostic penalties due to the rapid rate of NM growth. To date, an assessment of the pathways to diagnosis of NM versus superficial spreading Melanoma (SSM) specifically comparing numbers of opportunities missed to undertake biopsy has not been performed. Methods A retrospective questionnaire of 120 patients (60 NM patients, age and sex matched to 60 SSM patients) from the Victorian Melanoma Service (VMS) database was undertaken to assess pathways to diagnosis. The numbers of opportunities missed to undertake a biopsy and doctor behaviour at such encounters were recorded. Diagnostic delay (overall, patient's and doctor's delay) in terms of time was assessed. Results Significant differences in opportunities missed to make a diagnosis of NM compared to SSM were found. In all, 43% of NM were biopsied at a first encounter compared to 70% of SSM. All SSM were diagnosed within three reviews. Overall, 33% of NM required at least three and up six reviews until biopsy. Patients with NM were more likely than those with SSM to be reassured that their lesions were benign. No significant differences in terms of time delay to diagnosis between NM and SSM were found. Conclusions NM contributes disproportionately to Melanoma mortality in Australia. Addressing earlier diagnosis of NM with renewed focus may make the biggest impact on the overall mortality of Melanoma. The message that a period of observation is not appropriate for patients re-presenting with lesions of concern must be more effectively communicated.
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Nodular Melanoma: A distinct clinical entity and the largest contributor to Melanoma deaths in Victoria, Australia
Journal of the American Academy of Dermatology, 2012Co-Authors: Victoria Mar, Hugh Roberts, Rory Wolfe, Dallas R. English, John W. KellyAbstract:Background There is a growing body of evidence that Nodular Melanoma (NM), because of its association with increased growth rate and thickness at diagnosis, accounts for a substantial proportion of Melanoma deaths. Objective We sought to assess the contribution of NM to Melanoma deaths in comparison with other tumor subtypes. Methods Four cohorts were established comprising 5775 cases of invasive primary cutaneous Melanoma reported to the Victorian Cancer Registry during 1989, 1994, 1999, and 2004. Original pathology reports were reviewed. Age-standardized Melanoma incidence rates were compared from 1989 to 2004 with annual percentage change using Poisson regression. Results The incidence of thick tumors (>4 mm) increased by 3.8% (95% confidence interval 1.4 to 6.2) and 2.5% (95% confidence interval −0.5 to 5.5) per year for male and female patients, respectively. The median thickness of NM at diagnosis was 2.6 mm compared with 0.6 mm for superficial spreading Melanoma. A third of patients who died from Melanoma during the follow-up period had thick tumors (>4 mm), most of which were Nodular subtype (61%). NM accounted for 14% of invasive Melanomas, but was responsible for 43% of Melanoma deaths in a total of 57,461 person-years of follow-up. By comparison, superficial spreading Melanoma contributed 56% of invasive Melanoma but only 30% of deaths. Limitations Pathology review was limited to reports only. Mortality information relied mostly on death certificate information. Conclusion The incidence of thick Melanomas continues to increase. Nodular Melanoma is clinically distinct and the predominant contributor to Melanoma-related deaths, representing a public health challenge in reducing skin cancer mortality.
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Historical, Clinical, and Dermoscopic Characteristics of Thin Nodular Melanoma
Archives of dermatology, 2010Co-Authors: Sara Kalkhoran, Iris Zalaudek, Josep Malvehy, Susana Puig, John W. Kelly, Olivia Milne, Ashfaq A. MarghoobAbstract:Background Nodular Melanoma (NM), representing 15% to 30% of all Melanomas, constitutes nearly half of all Melanomas thicker than 2 mm. Nodular Melanoma frequently lacks clinical features seen in other Melanoma subtypes and has a faster growth rate. We reviewed a series of cases of NM that was less than 1.3 mm thick to identify historical, clinical, and dermoscopic factors that may facilitate earlier diagnosis of NM, with the hope of reducing its associated morbidity and mortality. Observations The thin NM lesions we analyzed had a rather subtle clinical appearance, often lacking the ABCD ( a symmetry, b order irregularity, c olor variegation, and d iameter greater than 6 mm) criteria. On dermoscopy, most lesions had a homogeneous disorganized asymmetric pattern or a featureless pattern with atypical vessels. Although many dermoscopic features seen in other Melanoma subtypes were frequently absent, some features such as a blue-white veil, structureless areas, and atypical vascular structures were often identified. Conclusions The often unremarkable clinical presentation of NM necessitates physicians and patients to be wary of new or changing lesions. Dermoscopy may help increase suspicion in early NM because dermoscopic features are typically more suggestive of malignancy than clinical ones. We hope that secondary prevention efforts combined with prompt dermatologic consultations will allow for the timely diagnosis and management of NM.
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Historical, clinical, and dermoscopic characteristics of thin Nodular Melanoma
Archives of Dermatological Research, 2010Co-Authors: Sara Kalkhoran, Iris Zalaudek, Josep Malvehy, Susana Puig, John W. Kelly, Olivia Milne, Ashfaq A. MarghoobAbstract:Background: Nodular Melanoma (NM), representing 15% to 30% of all Melanomas, constitutes nearly half of all Melanomas thicker than 2 mm. Nodular Melanoma frequently lacks clinical features seen in other Melanoma subtypes and has a faster growth rate. We reviewed a series of cases of NM that was less than 1.3 mm thicktoidentifyhistorical,clinical,anddermoscopicfactors that may facilitate earlier diagnosis of NM, with the hope of reducing its associated morbidity and mortality. Observations:The thin NM lesions we analyzed had a rathersubtleclinicalappearance,oftenlackingtheABCD (asymmetry, border irregularity, color variegation, and diameter greater than 6 mm) criteria. On dermoscopy, mostlesionshadahomogeneousdisorganizedasymmetric pattern or a featureless pattern with atypical vessels. AlthoughmanydermoscopicfeaturesseeninotherMelanomasubtypeswerefrequentlyabsent,somefeaturessuch as a blue-white veil, structureless areas, and atypical vascular structures were often identified. Conclusions: The often unremarkable clinical presentation of NM necessitates physicians and patients to be wary of new or changing lesions. Dermoscopy may help increasesuspicioninearlyNMbecausedermoscopicfeatures are typically more suggestive of malignancy than clinical ones. We hope that secondary prevention efforts combined with prompt dermatologic consultations will allow for the timely diagnosis and management of NM. Arch Dermatol. 2010;146(3):311-318
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Nodular Melanoma. No longer as simple as ABC.
Australian family physician, 2003Co-Authors: John W. Kelly, Alexander J. Chamberlain, Margaret Staples, Brian R McavoyAbstract:BACKGROUND: Malignant Melanoma is the fourth most commonly diagnosed malignancy in Australia. Nodular Melanoma (NM) comprise less than 15% of all Melanoma but account for up to 70% of those thicker than 3 mm. OBJECTIVE: This article describes the clinical features of NM, its prognosis and management. DISCUSSION: Nodular Melanoma presents very differently from superficial spreading Melanoma, and does not meet the 'ABCD' criteria used to alert doctors and patients to the possibility of this diagnosis. Due to their rapidly developing depth of invasion, urgent referral and wide excision are advised. (author abstract)
Giuseppe Argenziano - One of the best experts on this subject based on the ideXlab platform.
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Dermatoscopic features of thin (≤2 mm Breslow thickness) vs. thick (>2 mm Breslow thickness) Nodular Melanoma and predictors of Nodular Melanoma versus Nodular non-Melanoma tumours: a multicentric collaborative study by the International Dermoscopy S
Journal of the European Academy of Dermatology and Venereology : JEADV, 2020Co-Authors: Dimitrios Sgouros, Giuseppe Argenziano, Aimilios Lallas, Harald Kittler, A. Zarras, A. Kyrgidis, Chryssoula Papageorgiou, S. Puig, Alon Scope, Iris ZalaudekAbstract:BACKGROUND Thin Nodular Melanoma (NM) often lacks conspicuous Melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour. OBJECTIVE To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other Nodular tumours. METHODS Retrospective, morphological case-control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other Nodular tumours from 19 skin cancer centres worldwide were collected and analysed. RESULTS Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-Melanoma Nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-Melanoma Nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-Melanoma Nodular lesions. LIMITATIONS Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community. CONCLUSIONS Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-Melanoma Nodular tumours.
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dermatoscopic features of thin 2 mm breslow thickness vs thick 2 mm breslow thickness Nodular Melanoma and predictors of Nodular Melanoma versus Nodular non Melanoma tumours a multicentric collaborative study by the international dermoscopy society
Journal of The European Academy of Dermatology and Venereology, 2020Co-Authors: Dimitrios Sgouros, Giuseppe Argenziano, Aimilios Lallas, Harald Kittler, A. Zarras, A. Kyrgidis, Chryssoula Papageorgiou, S. Puig, Alon Scope, Iris ZalaudekAbstract:Background Thin Nodular Melanoma (NM) often lacks conspicuous Melanoma-specific dermatoscopic criteria and escapes clinical detection until it progresses to a thicker and more advanced tumour. Objective To investigate the dermatoscopic morphology of thin (≤2 mm Breslow thickness) vs. thick (>2 mm) NM and to identify dermatoscopic predictors of its differential diagnosis from other Nodular tumours. Methods Retrospective, morphological case-control study, conducted on behalf of the International Dermoscopy Society. Dermatoscopic images of NM and other Nodular tumours from 19 skin cancer centres worldwide were collected and analysed. Results Overall, 254 tumours were collected (69 NM of Breslow thickness ≤2 mm, 96 NM >2 mm and 89 non-Melanoma Nodular lesions). Light brown coloration (50.7%) and irregular brown dots/globules (42.0%) were most frequently observed in ≤2 mm NMs. Multivariate analysis revealed that dotted vessels (3.4-fold), white shiny streaks (2.9-fold) and irregular blue structureless area (2.4-fold) were predictors for thinner NM compared to non-Melanoma Nodular tumours. Overall, irregular blue structureless area (3.4-fold), dotted vessels (4.6-fold) and serpentine vessels (1.9-fold) were predictors of all NM compared to non-Melanoma Nodular lesions. Limitations Absence of a centralized, consensus pathology review and cases selected form tertiary centres maybe not reflecting the broader community. Conclusions Our study sheds light into the dermatoscopic morphology of thin NM in comparison to thicker NM and could provide useful clues for its differential diagnosis from other non-Melanoma Nodular tumours.
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Performance of the "if in doubt, cut it out" rule for the management of Nodular Melanoma.
Dermatology practical & conceptual, 2017Co-Authors: Elvira Moscarella, Iris Zalaudek, Aimilios Lallas, Caterina Longo, Stefano Caccavale, Alessio Gambardella, Amalia Lupoli, Roberto Alfano, Giuseppe ArgenzianoAbstract:Background: The recognition of Nodular Melanoma is clinically challenging, and the diagnostic accuracy of dermoscopy and confocal microscopy is lower than for superficial spreading Melanoma. Objectives: To test a management strategy consisting in the excision of any Nodular lesion that cannot be confidently and precisely classified as a benign tumor after clinical and dermoscopic examination. Methods: Clinical and dermoscopic images of excised Nodular lesions were retrospectively collected and evaluated. The evaluators were asked to record the level of diagnostic confidence for each lesion, by declaring if they were confident or doubtful about the given diagnosis. The NNE (number needed to excise) value was used to evaluate the efficacy of the proposed method. Results: A total of 1,319 excised Nodular lesions formed the study set. The NNE for any malignancy was 3.9 (634/164), while the NNE for Melanoma was 13.2 (634/48). NNE for hypo and amelanotic Melanoma was 27.3 (327/12). Conclusions: Excising doubtful Nodular lesions seems to be an effective management strategy not to miss Nodular Melanoma, resulting in an acceptable rate of unnecessary excision of benign lesions.
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Pigmented Nodular Melanoma: The predictive value of dermoscopic features using multivariate analysis
The British journal of dermatology, 2015Co-Authors: Maria Antonietta Pizzichetta, Harald Kittler, Ignazio Stanganelli, R. Bono, Stefano Cavicchini, V. De Giorgi, G. Ghigliotti, Pietro Quaglino, Pietro Rubegni, Giuseppe ArgenzianoAbstract:SummaryBackground Nodular Melanoma (NM), representing 10–30% of all Melanomas, plays a major role in global mortality related to Melanoma. Nonetheless, the literature on dermoscopy of NM is scanty. Objectives To assess odds ratios (ORs) to quantify dermoscopic features of pigmented NM vs. pigmented superficial spreading Melanoma (SSM), and pigmented Nodular nonmelanocytic and benign melanocytic lesions. Methods To assess the presence or absence of global patterns and dermoscopic criteria, digitized images of 457 pigmented skin lesions from patients with a histopathological diagnosis of NM (n = 75), SSM (n = 93), and Nodular nonmelanocytic and benign melanocytic lesions (n = 289; namely, 39 basal cell carcinomas, 85 seborrhoeic keratoses, 81 blue naevi, and 84 compound/dermal naevi) were retrospectively collected and blindly evaluated by three observers. Results Multivariate analysis showed that ulceration (OR 4·07), homogeneous disorganized pattern (OR 10·76), and homogeneous blue pigmented structureless areas (OR 2·37) were significantly independent prognostic factors for NM vs. SSM. Multivariate analysis of dermoscopic features of NM vs. nonmelanocytic and benign melanocytic lesions showed that the positive correlating features leading to a significantly increased risk of NM were asymmetric pigmentation (OR 6·70), blue–black pigmented areas (OR 7·15), homogeneous disorganized pattern (OR 9·62), a combination of polymorphous vessels and milky-red globules/areas (OR 23·65), and polymorphous vessels combined with homogeneous red areas (OR 33·88). Conclusions Dermoscopy may be helpful in improving the recognition of pigmented NM by revealing asymmetric pigmentation, blue–black pigmented areas, homogeneous disorganized pattern and abnormal vascular structures, including polymorphous vessels, milky-red globules/areas and homogeneous red areas.
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Dermoscopic Evaluation of Nodular Melanoma
JAMA dermatology, 2013Co-Authors: Scott W. Menzies, Fergal J. Moloney, Karen Byth, Michelle Avramidis, Giuseppe Argenziano, Iris Zalaudek, Ralph P. Braun, Josep Malvehy, Susana Puig, Harold S. RabinovitzAbstract:Nodular Melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical.