Search

Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.

International audience; Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.

A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team (“Tumor Board”). Adjuvant therapies in stage III/IV patients are primarily anti–PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future., SCOPUS: ar.j, info:eu-repo/semantics/published

Backgrounds: As there are few radiotherapists in Japan, it is impossible to perform post-radiotherapy examinations in some cases. we conducted a questionnaire-based survey to discover whether patients desired to undergo follow-up examinations at the radiation oncology department in addition to the examinations performed by the attending physician after radiotherapy and to discover the types of patients who desired such examinations.Aim: To know how many patients desire re-examination in radiotherapy department.Materials and Methods: We conducted a questionnaire-based survey of 109 patients to investigate the number of patients who desired to undergo follow-up examinations at the radiation oncology department similar to those received at the department of their attending physician.Results: Forty-three percentage of the patients desired followup examinations. A statistically significant number of men reported that they desired follow-up examinations at both departments. Patients with brain tumors did not desire follow-up examinations at both departments. There was a great individual variation in the desire for follow-up examinations at the radiation oncology department.Conclution: As a whole, 43% of patients hope for the second visit. It is necessary to repair these present conditions in Japan.

Einleitung: In der Erstdiagnostik von potenziell polytraumatisierten Patienten haben sich Ultraschalluntersuchungen neben der Durchführung einer Ganzkörper- Computertomografie (CT) etabliert und sind Bestandteil nationaler und internationaler Leitlinien. Auch im weiteren klinischen Verlauf finden Ultraschallverlaufskontrollen bei polytraumatisierten Patienten eine häufige Anwendung. Der klinische Nutzen eines routinemäßigen Einsatzes von Kontrollultraschalluntersuchungen bei initial unauffälligem CT-Befund des Abdomens ist jedoch bisher nur unzureichend untersucht. Zudem stellt die Durchführung von Ultraschallverlaufskontrollen in Kliniken der Maximalversorgung einen hohen zeitlichen und finanziellen Aufwand für die radiologische Abteilung dar. Sollen Verlaufskontrollen innerhalb eines festen Zeitfensters stattfinden, müssen diese auch zu Dienstzeiten erfolgen, in denen eine radiologische Abteilung geringer besetzt ist und Notfalluntersuchungen Priorität haben müssen. Hierdurch kann es zu Verzögerungen im Ablauf bei Notfalluntersuchungen kommen. Ziel der vorliegenden Arbeit war eine Evaluation von abdominellen Ultraschallverlaufskontrollen hinsichtlich therapierelevanter Neubefunde bei potenziell polytraumatisierten Patienten nach initialer Computertomografie und der hierbei aus Sicht einer radiologischen Klinik entstehenden Kosten. Methodik: In einem Studienkollektiv von 176 Patienten (126 männliche und 50 weibliche Patienten) mit einer potenziellen Polytraumatisierung erfolgte eine retrospektive Auswertung von Ultraschallverlaufskontrollen hinsichtlich Neubefunden im Vergleich mit der initialen Ganzkörper-Computertomografie. Zudem wurden Sensitivität und Spezifität des FAST-Ultraschalls, verglichen mit der Ganzkörper-CT, ermittelt. Auf der Basis eines Prozessmodells wurden Personal-, Material-, und die Gesamtkosten von Ultraschallverlaufskontrollen berechnet. Ergebnisse: Bei 19 der 176 Patienten wurden in der FAST-Untersuchung im Schockraum 26 abdominelle Befunde (freie intraabdominelle Flüssigkeit und/oder Organverletzungen) detektiert. In der sich anschließenden CT-Untersuchung wurden 32 Befunde bei insgesamt 25 Patienten festgestellt. Die ermittelte Sensitivität der FAST- Untersuchung betrug dabei 81,3% bei einer Spezifität von 100%. Im Rahmen der Ultraschallverlaufskontrolle konnten bei 2 Patienten, mit in der Abdomen-CT nachgewiesenen Verletzungen, Neubefunde festgestellt werden. Diese Befunde führten jedoch nicht zu einer maßgeblichen Änderung des geplanten Behandlungspfades. Bei den übrigen 151 Patienten ohne abdominelle Verletzungen in der initialen CT konnte mittels Ultraschallverlaufskontrolle kein Neubefund detektiert werden. Die ermittelten Gesamtkosten je durchgeführter Ultraschallverlaufskontrolle betrugen je nach Dienstart zwischen 28,93 Euro und 33,96 Euro. Für die Gesamtzahl der Ultraschallverlaufskontrolluntersuchung aller Patienten ergab sich ein Betrag von 5 658,23 Euro. Schlussfolgerung: Die Ergebnisse der vorliegenden Arbeit zeigen, dass Ultraschallverlaufskontrollen nach initialer Computertomografie nur in Ausnahmefällen einen Neubefund erbrachten. Bei Patienten mit initial unauffälliger Abdomen-CT waren keine Neubefunde nachzuweisen. Eine routinemäßige Anwendung von Ultraschallverlaufskontrollen beim vorliegenden Patientenkollektiv führt zu einem geringen diagnostischen Zugewinn bei gleichzeitig geringem Kosten- aber hohem Personalaufwand., Introduction: As well as whole-body computed tomography (CT), ultrasound examinations are now a well established procedure in the initial diagnosis of polytrauma patients. They are an integral part of national and international polytrauma guidelines. Ultrasound is not only routinely used in the initial examination, but is also a follow-up tool in the clinical management of these patients. However, the diagnostic benefits of these follow-up examinations in patients with no findings in the initial abdominal computed tomography have not been sufficiently evaluated to date. In hospitals providing maximum care, a radiological clinic is short-staffed at night and during weekend shifts. Especially during on-duty-services, emergencies have to take priority over follow-up examinations. There is a risk that emergency examinations will be delayed if ultrasound-follow-ups have to be carried out within a tight time frame. The purpose of this study was to evaluate the costs and the diagnostic benefits of abdominal ultrasound follow-up of suspected polytrauma patients who had been initially examined using whole-body CT. Methods: A total of 176 patients (126 men and 50 women) with suspected multiple trauma were retrospectively analysed with regard to new and additional findings in ultrasound follow-up examinations compared with the findings of the initial whole-body computed tomography. Additionally, the sensitivity and specificity of the FAST in the emergency room were analysed. A process model was established to document the total costs of ultrasound-follow ups (staff-, material-, equipment costs). Results: The FAST examination in the emergency room revealed 26 abdominal findings in 19 patients while the computed tomography subsequently detected 32 findings in 25 patients. The calculated sensitivity of the FAST to detect organ injuries and/or free abdominal fluid was 81.3% and the specificity 100%, respectively. During the abdominal ultrasound follow-up examination 2 new findings were detected. In both cases the patients had abdominal injuries detected in the initial computed tomography, and both patients had new free abdominal fluid in the follow-up. In both patients the clinical pathway did not have to be changed. The follow- up ultrasound revealed no new results in patients with normal findings in the abdominal CT (151 patients). The costs of ultrasound follow-up examinations were calculated in this study and ranged from EUR 28.93 to EUR 33.96, depending on the type of service provided. The total cost of all follow-up ultrasound examinations performed in this study was EUR 5,658.23. Conclusion: The results of this study show that a routinely used ultrasound follow-up examination after initial computed tomography only revealed new findings in exceptional cases. With patients with normal abdominal CT-scan findings, there were no new findings in the ultrasound follow-up. In conclusion, the follow-up ultrasound examination in our study had a low overall diagnostic benefit, while being associated with low cost but high personnel expenses for a radiological department.