The last Brazilian guidelines on melanoma were published in 2002. Development
in diagnosis and treatment made updating necessary. The coordinators
elaborated ten clinical questions, based on PICO system. A Medline search,
according to specific MeSH terms for each of the 10 questions was performed
and articles selected were classified from A to D according to level of
scientific evidence. Based on the results, recommendations were defined and
classified according to scientific strength. The present Guidelines were
divided in two parts for editorial and publication reasons. In the first
part, the following clinical questions were answered: 1) The use of
dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for
patients when compared with clinical examination? 2) Does dermoscopy favor
diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference
when incisional or excisional biopsies are used? 4) Does revision by a
pathologist trained in melanoma contribute to diagnosis and treatment of
primary cutaneous melanoma? What margins should be used to treat lentigo
maligna melanoma and melanoma in situ?
The last Brazilian guidelines on melanoma were published in 2002. Development in
diagnosis and treatment made updating necessary. The coordinators elaborated ten
clinical questions, based on PICO system. A Medline search, according to
specific MeSH terms for each of the 10 questions was performed and articles
selected were classified from A to D according to level of scientific evidence.
Based on the results, recommendations were defined and classified according to
scientific strength. The present Guidelines were divided in two parts for
editorial and publication reasons. In this second part, the following clinical
questions were answered: 1) which patients with primary cutaneous melanoma
benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is
indicated for which patients? 3) Is preventive excision of acral nevi
beneficious to patients? 4) Is preventive excision of giant congenital nevi
beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma
patients be followed?
Melanomas can arise either de novo (70%) or from pre-existing
melanocytic lesions (30%). Of the latter, most cases arise at the dermoepidermal
junction from small congenital or acquired non-blue nevi while only a few arise
from blue nevi, notably the cellular subtype and less commonly the common
(dendritic) type. Melanomas that arise from blue nevi usually occur on the scalp
with greater frequency, as in the case described. Although previous studies have
discussed melanoma arising from giant congenital blue nevi, few have discussed
those arising from intermediate blue nevi. We present a case of a 52-yearold man
with melanoma on the scalp evolving from an intermediate congenital common blue
nevus.
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