Management of cutaneous melanoma: comparison of the leading international guidelines updated to the 8th American Joint Committee on Cancer staging system and workup proposal by the Italian Society of Dermatology

Argenziano, Giuseppe; Brancaccio, Gabriella; Moscarella, Elvira; Dika, Emi; Fargnoli, Maria Concetta; Ferrara, Gerardo; Longo, Caterina; Pellacani, Giovanni; Peris, Ketty; Pimpinelli, Nicola; Quaglino, Pietro; Rongioletti, Franco; Simonacci, Marco; Zalaudek, Iris; Pinton, Piergiacomo Calzavara

doi:10.23736/s0392-0488.19.06383-1

Cited by 8 publications

(5 citation statements)

References 73 publications

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“…4 In Italy, melanoma management has been recently unified by Italian guidelines. 5 Pigmented lesion clinics of Reggio Emilia and Rome Laws and restrictions were not applied to oncology units that were always opened to guarantee patient care and follow-up visits. However, we observed a dramatic reduction of patient flux in our hospitals.…”

Section: Melanoma Diagnosis At the Time Of Covid-19mentioning

confidence: 99%

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Melanoma diagnosis at the time of COVID‐19

et al. 2020

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learning, there are no correct output values. Instead, algorithms are able to function freely in order to learn more about the data and present interesting findings. It is popular in the applications of clustering or the act of uncovering groups within data and association, or act of predicting rules that describe the data. In a study by Kharazmi et al., 4 basal cell carcinoma (BCC) was detected by unsupervised learning framework to learn comprehensive BCC vascular features on dermoscopy directly from the data instead of manually designing multiple sets of patternspecific features for every vascular type like in conventional supervised learning. The most important advantage of supervised learning models over unsupervised is the precise information regarding the data, but classifying big data can be a real challenge in supervised learning, and this system has trouble dealing with new information too. There should be frequent use of the unsupervised method in ML as the supervised method is incapable of satisfactory performance in situations where the statistics vary substantially. The clustering in unsupervised learning has an advantage in cases where images look substantially different from one another. There is an advantage of the omitting training phase, which is a tedious step in the procedure. In unsupervised learning, the greatest source of error is likely to be the shape of the skin lesion images. Pixels of skin have equal representation whether they are of the actual skin lesion or the surrounding healthy skin, and this may cause significant confusion. A segmentation algorithm can somehow ensure that the unsupervised algorithm focuses on the damaged skin. 5 Reinforcement learning, another category of ML, is a hybrid of both supervised and unsupervised learning which learns by trial and error and input from the environment, but it is yet to be explored in dermatology. 6 There is a concept of semi-supervised learning, which uses both labeled and unlabeled data to overcome the problems of supervised learning when there is not enough labeled data. This approach is more practical as it can operate even when there is less availability of labeled data by unlabeled data. Labeling of data in dermatology in terms of images is a tough task. This approach may prove to be a better and safer ML approach in dermatology; therefore, it warrants more clinical trials and studies in the future.

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Section: Melanoma Diagnosis At the Time Of Covid-19mentioning

confidence: 99%

“…Late diagnosis highly influences patients’ survival and may also lead to the disappearance of the primary cutaneous lesion 4 . In Italy, melanoma management has been recently unified by Italian guidelines 5 …”

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confidence: 99%

Melanoma diagnosis at the time of COVID‐19

et al. 2020

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“…Other patients with COVID-19 and thrombotic events develop antiphospholipid antibodies, suggesting an antiphospholipid syndrome-like condition. 5 Patients with speckled lentiginous nevi, whether associated with a syndrome or not, are at increased risk for melanoma, so regular skin checks for any suspicious lesions are crucial. 1 In addition, the nevi may progress with pregnancy or sun exposure, so patients should be aware that the appearance may change over time and new macules and papules may develop.…”

Section: Rt-pcr and Serologic Tests For Covidmentioning

confidence: 99%

Digital ischemia triggered by coronavirus disease 2019 in a patient under cemiplimab treatment

et al. 2020

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Digital ischemia triggered by coronavirus disease 2019 in a patient under cemiplimab treatment Dear Editor, Cutaneous manifestations of coronavirus disease 2019 (COVID-19), including pseudo-chilblain, vesicular, maculopapular, urticaria, and livedo/necrosis 1 lesions, have been widely reported. Anti-programmed cell death protein-1 (PD-1) immune checkpoint inhibitors have dramatically changed the treatment of locally advanced and metastatic squamous cell carcinoma (SCC). Likewise, Raynaud's phenomenon and acral necrosis related to anti-PD-1 have been described. 2 We present the case of a woman receiving cemiplimab who presented with digital ischemia and positive COVID-19 serological tests. A heavy-smoker, 48-year-old woman with a history of hypertension and an unresectable facial basal cell carcinoma, receiving cemiplimab 350 mg intravenously every 3 weeks in a clinical trial (REGN-1620), because of tumoral progression and side effects from treatment with vismodegib, presented in January 2020 (17 months after initiating cemiplimab) with de novo erythematous papulonodular lesions, pallor, and cyanosis on fingertips. She was diagnosed with idiopathic chilblains and Raynaud's phenomenon, which resolved after cold avoidance strategies. In April 2020, she presented at the Emergency Department with painful digital distal ulcers. She denied having COVID-19-related respiratory symptoms. Physical examination showed white-grayish coloration with a necrotic scar and bullae formation on the second, third, and fourth fingertips of the right hand, and erythema with a punctiform necrotic scar on the fifth fingertip of the left hand (Fig. 1). RT-PCR and serologic tests for COVID-19 were performed, revealing negative PCR, positive IgG, and negative IgM antibodies. Blood tests showed high D-Dimer levels (2,500 ng/ ml, reference value <500) and low titer (1:40) antinuclear antibodies. Systemic sclerosis and antiphospholipid syndrome antibodies were negative. Angiotensin-converting enzyme inhibitors and beta-blockers were stopped, while amlodipine 10 mg b.i.d.

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“…Regional lymph nodes (LNs) and skin are the first and the most common metastatic sites, followed by distant visceral sites (lungs, liver, and central nervous system), and bones 5 . Currently, the therapeutic options for patients with stage III (clinically positive LNs or clinical satellite/in‐transit metastases) and stage IV (distant metastases) MM include surgery and/or systemic therapy 6,7 . Moreover, the choice of systemic therapy depends on the presence of BRAF‐activating mutations 6 .…”

Section: Introductionmentioning

confidence: 99%

“… 5 Currently, the therapeutic options for patients with stage III (clinically positive LNs or clinical satellite/in‐transit metastases) and stage IV (distant metastases) MM include surgery and/or systemic therapy. 6 , 7 Moreover, the choice of systemic therapy depends on the presence of BRAF‐activating mutations. 6 In these clinical settings, fine‐needle aspiration (FNA) is a useful tool to obtain neoplastic cells for rapid and accurate diagnosis and for molecular evaluations as recommended by relevant guidelines.…”

Section: Introductionmentioning

confidence: 99%

Cytologic diagnosis of metastatic melanoma by FNA: A practical review

Ronchi

Montella

Marino

et al. 2021

Cancer Cytopathology

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Malignant melanoma (MM) is a highly aggressive neoplasm with a growing worldwide incidence. It is not uncommon that the disease is already metastatic at the time of the first diagnosis. Regional lymph nodes and skin are the first and most common metastatic sites, followed by distant visceral sites (lungs, liver, and central nervous system) and bone. In this clinical setting, fine-needle aspiration (FNA) often represents the first diagnostic approach. FNA is a useful tool to obtain a rapid and accurate diagnosis, in conjunction with ancillary techniques and molecular analysis, as recommended by recent guidelines.The aim of this review was to describe the cytomorphology, immunocytochemical tools, and molecular tools used for the diagnosis of MM metastases on FNA. Cancer Cytopathol 2021;0:1-12.

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Management of cutaneous melanoma: comparison of the leading international guidelines updated to the 8th American Joint Committee on Cancer staging system and workup proposal by the Italian Society of Dermatology

Cited by 8 publications

References 73 publications

Melanoma diagnosis at the time of COVID‐19

Melanoma diagnosis at the time of COVID‐19

Digital ischemia triggered by coronavirus disease 2019 in a patient under cemiplimab treatment

Cytologic diagnosis of metastatic melanoma by FNA: A practical review

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