Search

Background Sentinel lymph node dissection ( SLND) is considered a standard staging procedure providing important prognostic information on melanoma patients. It remains a matter of debate, whether SLND and hence, removal of potential lymph node micrometastasis will alter survival outcome. Objective The aim of this group-matched analysis was to compare survival data of a large cohort of melanoma patients who were treated by wide local excision only ( WLE) and nodal observation ( WLE group) to a group of patients treated with WLE plus SLND group to investigate the potential therapeutic benefit of SLND in the treatment of patients with melanoma. Methods and materials A total of 596 consecutive patients who had undergone WLE plus SLND between 1996 and 2003 were assessed. As a historical control group 596 patients treated with WLE and nodal observation but without SLND between 1986 and 1995 were selected. The groups were matched according to sex, age, Breslow tumour thickness and localization of primary tumour. The adjuvant treatment and follow-up examinations were performed according to protocols of the German Dermatologic Cooperative Oncology Group (De COG) and applicable study protocols that our clinic participated in; and hence, subject to change over time. Results Kaplan-Meier testing revealed significant differences in survival in favour of the SLND group. Mean overall tumour-specific survival ( OS) was 102.7 months in the SLND group vs. 97.0 months in the WLE group respectively ( P-value: 0.024). Disease-free survival (log-rank test: 0.003) and time to lymph node progression ( P-value: <0.01) also differed significantly between the two groups. Conclusion SLND is not only an important diagnostic procedure, but might also be of therapeutic benefit in terms of disease-free and overall tumour-specific survival of melanoma patients. [ABSTRACT FROM AUTHOR]

Background Optical coherence tomography ( OCT) has become a valuable non-invasive tool in the in vivo diagnosis of non-melanoma skin cancer, especially of basal cell carcinoma ( BCC). Due to an updated software-supported algorithm, a new en-face mode - similar to the horizontal en-face mode in high-definition OCT and reflectance confocal microscopy - surface-parallel imaging is possible which, in combination with the established slice mode of frequency domain ( FD-) OCT, may offer additional information in the diagnosis of BCC. Objectives To define characteristic morphologic features of BCC using the new en-face mode in addition to the conventional cross-sectional imaging mode for three-dimensional imaging of BCC in FD- OCT. Methods A total of 33 BCC were examined preoperatively by imaging in en-face mode as well as cross-sectional mode in FD- OCT. Characteristic features were evaluated and correlated with histopathology findings. Results Features established in the cross-sectional imaging mode as well as additional features were present in the en-face mode of FD- OCT: lobulated structures (100%), dark peritumoral rim (75%), bright peritumoral stroma (96%), branching vessels (90%), compressed fibrous bundles between lobulated nests ('star shaped') (78%), and intranodular small bright dots (51%). These features were also evaluated according to the histopathological subtype. In the en-face mode, the lobulated structures with compressed fibrous bundles of the BCC were more distinct than in the slice mode. Conclusion FD- OCT with a new depiction for horizontal and vertical imaging modes offers additional information in the diagnosis of BCC, especially in nodular BCC, and enhances the possibility of the evaluation of morphologic tumour features. [ABSTRACT FROM AUTHOR]

Background Demodex mites seem to serve as a pathogenic trigger in many Demodex-associated diseases such as rosacea. In facial skin of patients with rosacea significantly higher numbers of Demodex mites have been shown compared with healthy controls. Reflectance confocal microscopy ( RCM) allows the detection and quantification of Demodex mites in vivo noninvasively. It is hypothesized that a reduction of Demodex mites under rosacea therapy can be monitored by RCM. Objectives To use RCM to monitor the density of Demodex mites in patients with rosacea before and after treatment. Methods In 25 patients with facial rosacea RCM was performed before and after therapy. Mosaics of 5 × 5 mm2 and 8 × 8 mm2 were scanned, and the total numbers of mites per follicle and per area were counted, along with the number of follicles per area. Results In all patients Demodex folliculorum could be detected and quantified using RCM. RCM showed significant differences pre- and post-treatment ( P = 0·0053 for 5 × 5 mm2 and P < 0·001 for 8 × 8 mm2). The mean numbers of mites per follicle were 0·63 (range 0·16-2·28) per 8 × 8 mm2 area and 0·70 (range 0·11-2·20) per 5 × 5 mm2 area before treatment, and 0·41 (range 0·074-1·75) and 0·51 (range 0·094-1·70), respectively, after treatment. The corresponding mean numbers of mites were 155 (range 45-446) and 86·2 (range 12-286), respectively, before treatment and 96·2 (range 18-363) and 58·5 (range 12-230), respectively, after treatment. Conclusions By RCM, a reduction in the density of Demodex mites in facial skin of patients with rosacea under therapy, correlating to clinical improvement, can be quantified and monitored noninvasively. Possible reasons for this therapeutic effect are discussed. [ABSTRACT FROM AUTHOR]

Background The clinical diagnosis of amelanotic melanoma is often challenging, because the classical clinical and dermoscopic features of pigmented melanoma are usually missing. The reflectance confocal microscopy (RCM) offers an additional possibility of an in vivo diagnosis of both pigmented and amelanotic melanoma lesions. Objectives To test the value of RCM in vivo in the preoperative prediction of melanoma lesions lacking significant pigment and to compare the results with the evaluation by dermoscopy and histopathology. Methods We examined seven patients with the clinically uncertain differential diagnosis of partially or completely amelanotic melanoma by RCM and dermoscopy prior to surgical excision of the lesions according to the previously suggested dermoscopy algorithm and RCM score for melanoma. The following RCM features were evaluated: major criteria scored +2 (non-edged papillae, cytological atypia at the dermo-epidermal junction) and minor criteria +1 (roundish pagetoid cells, widespread pagetoid infiltration, nucleated cells within dermal papillae, cerebriform cell clusters). The dermoscopic evaluation included the following criteria: polymorphous vessels, dotted and linear irregular vessels, hairpin vessels, pink-erythematous colour, milky red areas, irregularly shaped depigmentation, blue-grey dots and subtle pigmentation. Results The preoperative in vivo RCM analysis revealed common features of melanoma also found in pigmented melanoma lesions. All lesions showed a score above three in the applied RCM algorithm which was proposed earlier as the threshold for malignancy. In dermoscopy, five of seven lesions showed characteristic vascular changes. Conclusion In vivo RCM is a valuable tool in the preoperative diagnosis of partially and completely amelanotic tumours suspicious for melanoma in addition to dermoscopic evaluation. [ABSTRACT FROM AUTHOR]

Background In many Demodex-associated skin diseases Demodex mites are present in abundance and seem to be at least partially pathogenic. So far all diagnostic approaches such as scraping or standardized superficial skin biopsy are (semi-)invasive and may cause discomfort to the patient. Objectives To see whether confocal laser scanning microscopy (CLSM) - a noninvasive method for the visualization of superficial skin layers - is able to detect and quantify D. folliculorum in facial skin of patients with rosacea. Methods Twenty-five patients (34-72 years of age) with facial rosacea and 25 age- and sex-matched normal controls were examined by CLSM. Mosaics of 8 × 8 mm and 5 × 5 mm were created by scanning horizontal layers of lesional skin and quantification of mites per follicle and per area as well as follicles per area was performed. Results In all patients D. folliculorum could be detected by CLSM and presented as roundish or lengthy cone-shaped structures. CLSM allowed the quantification of Demodex mites and revealed significant differences ( P < 0·0001): the mean number of mites was 165·4 per 8 × 8 mm area and 94·2 per 5 × 5 mm area in the patients compared with 34·7 and 22·4, respectively, in the controls. The corresponding mean number of mites per follicle was 0·7 and 0·8, respectively, in the patients and 0·1 and 0·2, respectively, in the controls. Conclusions With the help of CLSM it is possible to detect, image and quantify Demodex mites noninvasively in facial skin of patients with rosacea. [ABSTRACT FROM AUTHOR]

A response from the author of the article regarding the usefulness of confocal laser scanning microscopy (CLSM) in quantifying Demodex mites are presented.