黑素瘤高危因素的认识及其临床意义

不象其它肿瘤的发生常隐匿，黑素瘤的发现只需做一项简单的工作─—皮肤检查。如果能够早期发现及合理治疗，黑素瘤可以达到治愈。这里综述了发生黑素瘤的重要高危因素，包括：不典型痣及痣总数；发育不良性痣先天性痣；掌跖、甲下和粘膜色素斑；人种；黑素瘤个人史及家族史；目光敏感以及过度日晒。认识这些高危因素可发现高危人群并正确处理，从而达到预防及早期治疗的目的，减少此病的患病率及死亡率。     

皮肤恶性黑素瘤的易感基因

皮肤恶性黑素瘤是一种多因素相关疾病 ,遗传因素与其密切相关。目前 ,两个高风险性皮肤恶性黑素瘤易感基因%D细胞周期素依赖性激酶抑制剂 2A和细胞周期蛋白依赖性激酶 4已被确认 ,而基因p14 ARF和细胞周期素D1基因也可能起一定作用。另外 ,由于发现有染色体 9p2 1不相关家族 ,故其他高风险性基因也可能存在。黑皮质素受体 - 1已确认为低风险黑素瘤易感基因。目前的研究是为了明确其他易感基因及其作用     

黑素瘤与DNA甲基化研究进展

黑素瘤作为一种侵袭性强的皮肤恶性肿瘤,在发病率和死亡率方面都在上升,目前仍缺乏较为有效的治疗手段.近年来,随着人们对黑素瘤认识的逐渐深入,黑素瘤的表观遗传学修饰特别是在DNA甲基化方面的研究也受到广泛关注.DNA甲基化在肿瘤细胞中的改变相对较常见,包括黑素瘤细胞.因此,DNA甲基化相关基因可以作为黑素瘤早期筛查、诊断、预后、治疗分期以及治疗后监测的生物标记.     

恶性黑素瘤的诱发因素及早期诊断

恶性黑素瘤的诱发因素及早期诊断周云龙近年来恶性黑素瘤（Ｍａｌｉｇｎａｎｔｍｅｌａｎｏｍａ，ＭＭ）的发生率呈明显的增长趋势。据报道美国１９９１年皮肤癌的新诊断病例为５０～６０万，其中ＭＭ为３２，０００例，后者约为过去４０年总和的３倍，其增加的速度比所有...     

BRAF基因突变与皮肤恶性黑素瘤

BRAF基因,位于染色体7q34编码一个67 000～99 000的丝,苏氨酸蛋白激酶,其产物在丝裂原活化蛋白激酶信号途径中起重要调控作用.国内外的研究者先后发现并揭示出BRAF基因变异与皮肤恶性黑素瘤的关系.随着探索的深入,部分学者以BRAF基因作为治疗靶向进行研究,并初步取得成果.对BRAF基因及其突变的研究可能在未来恶性黑素瘤诊断、治疗以及预后等方面产生临床价值,为恶性黑素瘤的治疗开辟新的方向.     

皮肤恶性黑素瘤光动力学治疗研究进展

恶性黑素瘤起源于痣细胞或黑素细胞，好发于皮肤黏膜，恶性程度高，预后差，治疗手段多样．但疗效多不确切。光动力学治疗是近20年来兴起并不断发展的新技术，光动力学治疗肿瘤具有抗瘤谱广、选择性杀伤肿瘤细胞作用强、对正常细胞器官损伤轻微等特点，现已成为治疗许多恶性肿瘤的研究热点。     

皮肤恶性黑素瘤光动力学治疗研究进展

恶性黑素瘤起源于痣细胞或黑素细胞,好发于皮肤黏膜,恶性程度高,预后差,治疗手段多样,但疗效多不确切。光动力学治疗是近20年来兴起并不断发展的新技术,光动力学治疗肿瘤具有抗瘤谱广、选择性杀伤肿瘤细胞作用强、对正常细胞器官损伤轻微等特点,现已成为治疗许多恶性肿瘤的研究热点。     

足跟部原发性血管瘤样恶性黑素瘤一例

患者女,72岁.因左足跟皮肤溃烂半年于2009年7月2日至本院就诊,半年前患者左足跟皮肤不慎裂伤,继之局部反复化脓,皮肤溃烂不愈合.有Ⅱ型糖尿病史2年.     

BRAF基因突变与皮肤恶性黑素瘤

BRAF基因,位于染色体7q34编码一个67 000～99 000的丝,苏氨酸蛋白激酶,其产物在丝裂原活化蛋白激酶信号途径中起重要调控作用.国内外的研究者先后发现并揭示出BRAF基因变异与皮肤恶性黑素瘤的关系.随着探索的深入,部分学者以BRAF基因作为治疗靶向进行研究,并初步取得成果.对BRAF基因及其突变的研究可能在未来恶性黑素瘤诊断、治疗以及预后等方面产生临床价值,为恶性黑素瘤的治疗开辟新的方向.     

BRAF基因突变与皮肤恶性黑素瘤

BRAF基因,位于染色体7q34编码一个67 000～99 000的丝,苏氨酸蛋白激酶,其产物在丝裂原活化蛋白激酶信号途径中起重要调控作用.国内外的研究者先后发现并揭示出BRAF基因变异与皮肤恶性黑素瘤的关系.随着探索的深入,部分学者以BRAF基因作为治疗靶向进行研究,并初步取得成果.对BRAF基因及其突变的研究可能在未来恶性黑素瘤诊断、治疗以及预后等方面产生临床价值,为恶性黑素瘤的治疗开辟新的方向.     

Incidence and risk factors of medical device-related pressure injuries among patients undergoing prone position spine surgery in the operating room

AimWe aimed to investigate the incidence rate and risk factors of medical device-related pressure injuries (MDRPIs) among patients undergoing prone position spine surgery.Materials and methodsThis was a prospective observational study of 147 patients who underwent spine surgery in an orthopaedic hospital in Korea. The incidence of MDRPI according to intrinsic and extrinsic factors was assessed using the independent t-, χ² -, or Fisher's exact tests. A logistic regression analysis was performed exclusively for MDRPI areas with an incidence rate >5%.ResultsThe mean incidence rate of overall MDRPI was 27.4%, while that of MDRPI by Wilson frame, bi-spectral index, and endotracheal tube (ETT) was 56.5%, 52.4%, and 9.5%, respectively. The risk factors under Wilson frame were operation time and body mass index classification. Compared to their normal weight counterparts, those who were underweight, overweight, and obese had a 46.57(95% CI: 6.37–340.26), 3.96 (95% CI: 1.13–13.86), and 5.60 times (95% CI: 1.62–19.28) higher risk of developing MDRPI, respectively. The risk factors by bi-spectral index were sex, operation time, and the American Society of Anaesthesiologists classification. Compared to ETT intubation of <2 h, the risk of MDRPI increased by 7.16 times (95% CI: 1.35–38.00) and 7.93 times (95% CI: 1.45–43.27) for<3 and ≥3 h’ duration, respectively.ConclusionThe difficulty of device repositioning can increase the incidence of MDRPI, and prolonged surgery was a significant risk factor. Thus, appropriate planning and correct equipment utilization is needed during prone position spine surgeries.     

A melanoma risk score in a Brazilian population

BACKGROUND:

Important risk factors for cutaneous melanoma (CM) are recognized, but standardized scores for individual assessment must still be developed.

OBJECTIVES:

The objective of this study was to develop a risk score of CM for a Brazilian sample.

METHODS:

To verify the estimates of the main risk factors for melanoma, derived from a meta-analysis (Italian-based study), and externally validate them in a population in southern Brazil by means of a case-control study. A total of 117 individuals were evaluated. Different models were constructed combining the summary coefficients of different risk factors, derived from the meta-analysis, multiplied by the corresponding category of each variable for each participant according to a mathematical expression.

RESULTS:

the variable that best predicted the risk of CM in the studied population was hair color (AUC: 0.71; 95% CI: 0.62-0.79). Other important factors were freckles, sunburn episodes, and skin and eye color. Consideration of other variables such as common nevi, elastosis, family history, and premalignant lesions did not improve the predictive ability of the models.

CONCLUSION:

The discriminating capacity of the proposed model proved to be superior or comparable to that of previous risk models proposed for CM.     

p53 mutation in metastatic melanomas and primary melanomas from sun-exposed and sun-protected sites

Background p53 mutation has been observed in many human malignancies, including skin cancers. However, the data in melanoma has been conflicting. Material and methods We have examined, by immunohistochemistry, using the DO7 and CM1 antibodies, the frequency of p53 overexpression in 14 metastatic melanomas and 61 primary melanomas, of which 30 were from sun-protected sites and 31 from sun-exposed sites. Results Ten of 14 metastatic melanomas showed p53 overexpression compared to only eight of 61 primary melanomas (P < 0.004). No significant difference in p53 expression was found between primary melanomas from sun-protected (2/30) and sun-exposed sites (6/31). We have also examined p53 mutation by single-strand conformation polymorphism (SSCP) analysis of four melanoma cell lines. One cell line established from a primary melanoma from a sun-protected site showed evidence of an altered migration pattern in exon 7. Sequencing analysis of this region confirmed a point mutation in codon 244, showing a G to C transversion. This mutation is unlikely to be due to ultraviolet (UV) radiation since mutations caused by UV radiation are predominantly CC → TT or C → T transitions. Conclusions In summary, p53 mutation in primary melanoma is uncommon and does not appear to be related to UV radiation. p53 mutation is more common in metastatic melanomas suggesting that it may be involved as a late event in melanoma progression.     

Dermoscopic features of thin melanomas: a comparative study of melanoma in situ and invasive melanomas smaller than or equal to 1mm

BACKGROUND

Dermoscopy allows the early detection of melanomas. The preoperative determination of Breslow index by dermoscopy could be useful in planning the surgical approach and in selecting patients for sentinel lymph node biopsy.

OBJECTIVES

This study aims at describing the dermoscopic features of thin melanomas and comparing melanomas in situ with invasive melanomas less than or equal to 1 mm thick.

METHODS

This was an observational retrospective study in which the dermoscopy photographs of 41 thin melanomas were evaluated. Three observers evaluated together 14 dermoscopic criteria.

RESULTS

Among thin melanomas, the most frequent criteria were presence of asymmetry in two axes in 95% of cases (39 cases), 3 or more colors in 80.4% of cases (33 cases), atypical dots or globules in 58.5% of cases (24 cases) and atypical network or streaks in 53.6% of cases (22 cases). The group of invasive melanomas presented with a higher frequency and statistical significance (p <0.05) 3 or more colors (OR: 16.1), milky red areas (OR: 4.8) and blue-white veil (OR: 20.4), and a greater tendency to have streaks or atypical network (OR: 3.66).

CONCLUSIONS

Thin melanomas tend to have asymmetry in the two axes, 3 or more colors, atypical dots or globules and atypical network or streaks. Melanomas in situ tend to have up to 2 colors, no blue-white veil and no milky red area. Invasive melanomas tend to have 3 or more colors, a milky red area, blue-white veil, and atypical network or streaks. Further studies are needed to confirm these findings.     

恶性黑素瘤中BRAF癌基因突变研究新进展

恶性黑素瘤是死亡率较高的皮肤肿瘤之一,研究发现恶性黑素瘤中存在高频BRAF癌基因突变.紫外线是引起突变的高危因素,不同种族、发病部位以及病理类型的恶性黑素瘤间BRAF突变率存在差异.此突变与遗传、预先存在的色素痣、肿瘤侵袭性及预后之间的关系还存在争论.BRAF突变相关的MAPK信号传导分子是治疗恶性黑素瘤的靶点.综述近几年的研究,以认识BRAF突变与恶性黑素瘤的关系.     

外伤相关黑素瘤87例临床病理特点与预后分析

目的:分析外伤相关黑素瘤的临床病理特点及其与患者预后间的关系。方法:回顾性分析2009—2020年第四军医大学西京皮肤医院87例外伤相关黑素瘤的临床病理特点,通过Mann-Whitney检验分析不同年龄、性别患者间肿瘤Breslow厚度的差异;通过Spearman秩相关分析外伤至发现皮疹的时间与Breslow厚度之间的...     

Primary cutaneous mucormycosis: a diagnosis to consider

Primary cutaneous mucormycosis is a deep fungal infection, mainly seen in diabetics and immunocompromised subjects. Rapid diagnosis and therapy are necessary to avoid fatal outcome. We describe the complete histopathological and microbiological studies of primary cutaneous mucormycosis in a 74-year-old man with several risk factors, such as chronic obstructive pulmonary disease, respiratory acidosis, hemolytic anemia, myelodysplastic syndrome and iatrogenic diabetes, due to corticosteroid therapy. He developed two cutaneous necrotic scars on his left leg. Mucormycosis was suspected and specimens from surgical débridement were histopathologically and microbiologically studied confirming the clinical diagnosis. Amphotericin B was given topically and intravenously resulting in complete healing of the ulcer. Risk factors and microbiological studies are compared with those in the current literature. It is necessary in certain cases to suspect mucormycosis infections in diabetics, immunocompromised subjects and even in healthy individuals. Rapid diagnosis and treatment are important, but they should be based on complete histopathological and microbiological studies, to establish the genus of the causal agent.