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Clinical and dermatoscopic follow-up of acquired melanocytic nevi in organ transplant recipients: A preliminary study
P2808
P2810
Melanoma opportunistic screening: Facilitators, barriers, and performance toward detection and recognition by third-year medical students. Ann Cameron Haley, Chicago, IL, United States; Jennifer Bierman, MD, Chicago, IL, United States; June K. Robinson, MD, Chicago, IL, United States; Peter Lio, MD, Chicago, IL, United States; William McGaghie, PhD, Chicago, IL, United States
Sensitivity of preoperative PET/CT imaging for the detection of metastatic melanoma in patients with AJCC stage 0 to stage IIC Randa Khoury, MD, Washington Cancer Institute, Washington, DC, United States; Alicia Ogram, MD, Washington Cancer Institute, Washington, DC, United States; Gary Peck, MD, Washington Cancer Institute, Washington, DC, United States; Marc Boisvert, MD, Washington Cancer Institute, Washington, DC, United States; Suraj Venna, MD, Washington Cancer Institute, Washington, DC, United States Purpose: PET/CT scans are invaluable for detecting many types of malignancies, but are very costly and result in exposure of the patient to substantial amounts of radiation. There are data to suggest that PET/CT is of limited utility in detecting metastases of melanoma. We reviewed data from our melanoma referral center of patients presenting with Stage 0 to IIC melanoma who underwent a preoperative PET/CT scan.
Background: About one quarter of melanomas are discovered by a physician, most often, a primary care physician; however, most primary care physicians do not routinely conduct complete skin examinations. Because physician skills and habits are formed initially as medical students, we explored attitudes about opportunistic melanoma screening and the performance of such screening with third-year medical students at an academic medical center in Chicago. Methods: During the primary care clerkship from January through April 2010, 59 medical students participated in a 1-hour focus group about melanoma, and as part of their customary education 35 students were videotaped performing a 20-minute history and physical with a standardized patient (SP) presenting with dizziness, who had a melanoma moulage placed on the right neck below the ear. Half of the students participated in the focus group before the SP, and half did the reverse. Audiotapes of the four focus groups were transcribed and common themes developed. Videotapes of the SP encounters were reviewed by two investigators for detection and recognition of the ‘‘melanoma,’’ inquiring how long the lesion was present, and if it had changed, performance of a complete skin examination, examination of lymph nodes, and counseling the patient to seek care for the ‘‘melanoma.’’ Results: Among the 35 students, eight detected the melanoma. The rate of detection of the melanoma was not different between the students having the focus group precede versus follow the SP. Of the eight students who detected the ‘‘melanoma,’’ five counseled the SP to seek care. The common themes were: (a) lack of confidence in skills because of limited knowledge and experience. (b) Because primary care physician mentors perform a skin examination only at the patient’s request, the medical students felt it was not worth the time of the primary care doctor to do opportunistic screening. (c) Since many patients are not disrobed and gowned during the visit to the primary care physician, the opportunities for complete skin examination are limited. (d) Because dermatology education is limited to 1.5 weeks of lectures which are not repeated, it must not be important.
Methods: Retrospective analysis of patients with stage 0 to IIC melanoma who presented to our center for consultation of newly diagnosed melanoma and underwent a preoperative PET/CT scan. The findings of the PET/CT scans including subsequent evaluation of worrisome findings were reviewed. Results: We identified 76 patients who underwent PET/CT scanning, including one melanoma in situ. Of the 76 patients who underwent PET/CT scanning for melanoma, 25% (19 patients) had findings suspicious for metastatic melanoma. Seventy-five percent of these suspicious cases were found not to be melanoma. The overall incidence of metastatic melanoma detection by PET/CT scanning was 6.6% (5 patients). Conclusion: The routine use of PET/CT scanning preoperatively for skin limited melanoma is associated with a high rate of false positivity. Of the potential worrisome findings, 75% were not melanoma but may generate substantial anxiety for the patient. Evaluation of these findings may also have associated morbidity. However, once a patient is found to have metastatic melanoma, PET/CT scanning may be useful to determine the extent of metastatic disease. Commercial support: None identified.
Conclusion: Discussion of warning signs of melanoma and the at risk populations did not enhance melanoma detection. Mentor role modeling and skills training with the opportunity to make decisions about a range of benign and malignant lesions offer a promising approach to enhance physicians’ skills in performing opportunistic screening. Commercial support: None identified.
P2809 Clinical and dermatoscopic follow-up of acquired melanocytic nevi in organ transplant recipients: A preliminary study Deniz Sec¸kin, MD, Baskent University Faculty of Medicine, Department of € lk€ Dermatology, Ankara, Turkey; U u Askin, MD, Baskent University Faculty of Medicine, Department of Dermatology, Ankara, Turkey Organ transplant recipients (OTRs) have a higher incidence of melanoma compared to that in general population. OTRs have an increased number of acquired melanocytic nevi and immunosuppression may have a role in that increase. The relationship between the structural changes of acquired melanocytic nevi and melanoma development in OTR is unknown. Fifteen OTRs and 14 immunocompetent individuals were included in the study. Twelve OTRs and 12 immunocompetent individuals were reevaluated every 3 months for at least 9 months, and five OTRs and three immunocompetent individuals for 1 year. After a clinical history, acquired melanocytic nevi on the whole body were counted. A whole body cutaneous photography, and clinical and dermatoscopic photography of index nevi were taken. The changes in clinical and dermatoscopic (diameter and total dermatoscopy score [TDS]) features of index nevi were investigated. Findings of the first and ninth month examinations in two groups were compared. The findings of OTRs at two examinations were also compared. The effects of duration of immunosuppression, immunosuppressive drugs, and the other risk factors were also investigated. No melanoma developed in neither groups during the study period. In terms of total number of nevi and mean TDS of index nevi, there was no difference between the groups at the first and ninth month examinations (P[.05). The mean diameter of index nevi in controls was greater than OTR at both first and ninth month examinations (P \.05). During the follow-up period of OTR, no significant difference in the total number of nevi, and mean diameter and TDS of index nevi was found (P [ .05). The duration of immunosuppression had no significant effect on the total number of nevi and diameter and TDS of index nevi (P[.05). The mean diameter of index nevi in patients taking prednisolone+CsA+MMF was significantly greater than that in the other groups (P\.05). The patients having the history of CsA use had a greater mean index nevi diameter than the others; those having the history of tacrolimus use had a smaller mean index nevi diameter than the others (P \.05). However, no immunosuppressive drug had an independent effect on the index nevi diameter (P [.05). OTR with skin phototype II had a larger index nevi diameter (P \.05). OTR using sunscreens had a smaller mean index nevi diameter(P \.05). In terms of melanoma development, acquired melanocytic nevi in OTRs did not have a greater risk than those in the general population. Melanomas in OTR may develop de novo. Commercial support: None identified.
AB120
J AM ACAD DERMATOL
P2811 An unusual manifestation of a metastatic melanoma Salvador Arias-Santiago, MD, San Cecilio Clinical Hospital, Department of Dermatology, Granada, Spain; Francisco O’Valle, MD, PhD, San Cecilio Clinical Hospital, Department of Pathology, Granada, Spain; Husein Husein-ElAhmed, MD, San Cecilio Clinical Hospital, Department of Dermatology, Granada, Spain; Jose Aneiros-Fernandez, MD, San Cecilio Clinical Hospital, Department of Pathology, Granada, Spain; Maria Teresa Gutierrez Salmer on, MD, San Cecilio Clinical Hospital, Department of Pathology, Granada, Spain Background: Vitiligo-like depigmentation, halo nevus, and leukoderma in patients with malignant melanoma are a poorly understood phenomenon. We present a clinical case of a patient refereeing that all her nevi had disappeared as the first clinical manifestation of a metastatic melanoma. Case report: A 55-year-old woman was derived to our clinic referring that all her nevi had disappeared in a few months and with a subcutaneous lesion that her family doctor had diagnosed with lipoma. Physical examination revealed that all the nevi, but not lentigos, had disappeared leaving a white pigmentation and a hard consistency subcutaneous lesion on her left flank. Fine-needle aspiration of the subcutaneous lesion was consistent with metastatic melanoma and CT scan revealed multiple metastases in lungs, inguinal, and iliac nodes. A skin biopsy specimen of the white lesion revealed an inflammatory infiltrate T CD8+ without melanocytes. Initial chemotherapy with dacarbazine was given. Discussion: In melanoma, immunogenic factors may play a key role in the disease course. There are antibodies that cross-react with antigens on melanocytes and melanoma cells, such as tyrosinase and tyrosinase-related proteins 1 and 2, which can lead to disappearing of all nevi and tumor regression as in the present case. Despite vitiligo-like depigmentation, patients with melanoma have a favorable prognosis; in this case, the patient presented with many metastases. Commercial support: None identified.
FEBRUARY 2011
P2810
Melanoma opportunistic screening: Facilitators, barriers, and performance toward detection and recognition by third-year medical students. Ann Cameron Haley, Chicago, IL, United States; Jennifer Bierman, MD, Chicago, IL, United States; June K. Robinson, MD, Chicago, IL, United States; Peter Lio, MD, Chicago, IL, United States; William McGaghie, PhD, Chicago, IL, United States
Sensitivity of preoperative PET/CT imaging for the detection of metastatic melanoma in patients with AJCC stage 0 to stage IIC Randa Khoury, MD, Washington Cancer Institute, Washington, DC, United States; Alicia Ogram, MD, Washington Cancer Institute, Washington, DC, United States; Gary Peck, MD, Washington Cancer Institute, Washington, DC, United States; Marc Boisvert, MD, Washington Cancer Institute, Washington, DC, United States; Suraj Venna, MD, Washington Cancer Institute, Washington, DC, United States Purpose: PET/CT scans are invaluable for detecting many types of malignancies, but are very costly and result in exposure of the patient to substantial amounts of radiation. There are data to suggest that PET/CT is of limited utility in detecting metastases of melanoma. We reviewed data from our melanoma referral center of patients presenting with Stage 0 to IIC melanoma who underwent a preoperative PET/CT scan.
Background: About one quarter of melanomas are discovered by a physician, most often, a primary care physician; however, most primary care physicians do not routinely conduct complete skin examinations. Because physician skills and habits are formed initially as medical students, we explored attitudes about opportunistic melanoma screening and the performance of such screening with third-year medical students at an academic medical center in Chicago. Methods: During the primary care clerkship from January through April 2010, 59 medical students participated in a 1-hour focus group about melanoma, and as part of their customary education 35 students were videotaped performing a 20-minute history and physical with a standardized patient (SP) presenting with dizziness, who had a melanoma moulage placed on the right neck below the ear. Half of the students participated in the focus group before the SP, and half did the reverse. Audiotapes of the four focus groups were transcribed and common themes developed. Videotapes of the SP encounters were reviewed by two investigators for detection and recognition of the ‘‘melanoma,’’ inquiring how long the lesion was present, and if it had changed, performance of a complete skin examination, examination of lymph nodes, and counseling the patient to seek care for the ‘‘melanoma.’’ Results: Among the 35 students, eight detected the melanoma. The rate of detection of the melanoma was not different between the students having the focus group precede versus follow the SP. Of the eight students who detected the ‘‘melanoma,’’ five counseled the SP to seek care. The common themes were: (a) lack of confidence in skills because of limited knowledge and experience. (b) Because primary care physician mentors perform a skin examination only at the patient’s request, the medical students felt it was not worth the time of the primary care doctor to do opportunistic screening. (c) Since many patients are not disrobed and gowned during the visit to the primary care physician, the opportunities for complete skin examination are limited. (d) Because dermatology education is limited to 1.5 weeks of lectures which are not repeated, it must not be important.
Methods: Retrospective analysis of patients with stage 0 to IIC melanoma who presented to our center for consultation of newly diagnosed melanoma and underwent a preoperative PET/CT scan. The findings of the PET/CT scans including subsequent evaluation of worrisome findings were reviewed. Results: We identified 76 patients who underwent PET/CT scanning, including one melanoma in situ. Of the 76 patients who underwent PET/CT scanning for melanoma, 25% (19 patients) had findings suspicious for metastatic melanoma. Seventy-five percent of these suspicious cases were found not to be melanoma. The overall incidence of metastatic melanoma detection by PET/CT scanning was 6.6% (5 patients). Conclusion: The routine use of PET/CT scanning preoperatively for skin limited melanoma is associated with a high rate of false positivity. Of the potential worrisome findings, 75% were not melanoma but may generate substantial anxiety for the patient. Evaluation of these findings may also have associated morbidity. However, once a patient is found to have metastatic melanoma, PET/CT scanning may be useful to determine the extent of metastatic disease. Commercial support: None identified.
Conclusion: Discussion of warning signs of melanoma and the at risk populations did not enhance melanoma detection. Mentor role modeling and skills training with the opportunity to make decisions about a range of benign and malignant lesions offer a promising approach to enhance physicians’ skills in performing opportunistic screening. Commercial support: None identified.
P2809 Clinical and dermatoscopic follow-up of acquired melanocytic nevi in organ transplant recipients: A preliminary study Deniz Sec¸kin, MD, Baskent University Faculty of Medicine, Department of € lk€ Dermatology, Ankara, Turkey; U u Askin, MD, Baskent University Faculty of Medicine, Department of Dermatology, Ankara, Turkey Organ transplant recipients (OTRs) have a higher incidence of melanoma compared to that in general population. OTRs have an increased number of acquired melanocytic nevi and immunosuppression may have a role in that increase. The relationship between the structural changes of acquired melanocytic nevi and melanoma development in OTR is unknown. Fifteen OTRs and 14 immunocompetent individuals were included in the study. Twelve OTRs and 12 immunocompetent individuals were reevaluated every 3 months for at least 9 months, and five OTRs and three immunocompetent individuals for 1 year. After a clinical history, acquired melanocytic nevi on the whole body were counted. A whole body cutaneous photography, and clinical and dermatoscopic photography of index nevi were taken. The changes in clinical and dermatoscopic (diameter and total dermatoscopy score [TDS]) features of index nevi were investigated. Findings of the first and ninth month examinations in two groups were compared. The findings of OTRs at two examinations were also compared. The effects of duration of immunosuppression, immunosuppressive drugs, and the other risk factors were also investigated. No melanoma developed in neither groups during the study period. In terms of total number of nevi and mean TDS of index nevi, there was no difference between the groups at the first and ninth month examinations (P[.05). The mean diameter of index nevi in controls was greater than OTR at both first and ninth month examinations (P \.05). During the follow-up period of OTR, no significant difference in the total number of nevi, and mean diameter and TDS of index nevi was found (P [ .05). The duration of immunosuppression had no significant effect on the total number of nevi and diameter and TDS of index nevi (P[.05). The mean diameter of index nevi in patients taking prednisolone+CsA+MMF was significantly greater than that in the other groups (P\.05). The patients having the history of CsA use had a greater mean index nevi diameter than the others; those having the history of tacrolimus use had a smaller mean index nevi diameter than the others (P \.05). However, no immunosuppressive drug had an independent effect on the index nevi diameter (P [.05). OTR with skin phototype II had a larger index nevi diameter (P \.05). OTR using sunscreens had a smaller mean index nevi diameter(P \.05). In terms of melanoma development, acquired melanocytic nevi in OTRs did not have a greater risk than those in the general population. Melanomas in OTR may develop de novo. Commercial support: None identified.
AB120
J AM ACAD DERMATOL
P2811 An unusual manifestation of a metastatic melanoma Salvador Arias-Santiago, MD, San Cecilio Clinical Hospital, Department of Dermatology, Granada, Spain; Francisco O’Valle, MD, PhD, San Cecilio Clinical Hospital, Department of Pathology, Granada, Spain; Husein Husein-ElAhmed, MD, San Cecilio Clinical Hospital, Department of Dermatology, Granada, Spain; Jose Aneiros-Fernandez, MD, San Cecilio Clinical Hospital, Department of Pathology, Granada, Spain; Maria Teresa Gutierrez Salmer on, MD, San Cecilio Clinical Hospital, Department of Pathology, Granada, Spain Background: Vitiligo-like depigmentation, halo nevus, and leukoderma in patients with malignant melanoma are a poorly understood phenomenon. We present a clinical case of a patient refereeing that all her nevi had disappeared as the first clinical manifestation of a metastatic melanoma. Case report: A 55-year-old woman was derived to our clinic referring that all her nevi had disappeared in a few months and with a subcutaneous lesion that her family doctor had diagnosed with lipoma. Physical examination revealed that all the nevi, but not lentigos, had disappeared leaving a white pigmentation and a hard consistency subcutaneous lesion on her left flank. Fine-needle aspiration of the subcutaneous lesion was consistent with metastatic melanoma and CT scan revealed multiple metastases in lungs, inguinal, and iliac nodes. A skin biopsy specimen of the white lesion revealed an inflammatory infiltrate T CD8+ without melanocytes. Initial chemotherapy with dacarbazine was given. Discussion: In melanoma, immunogenic factors may play a key role in the disease course. There are antibodies that cross-react with antigens on melanocytes and melanoma cells, such as tyrosinase and tyrosinase-related proteins 1 and 2, which can lead to disappearing of all nevi and tumor regression as in the present case. Despite vitiligo-like depigmentation, patients with melanoma have a favorable prognosis; in this case, the patient presented with many metastases. Commercial support: None identified.
FEBRUARY 2011