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Clinical multiphoton tomography of malignant melanoma
Atypical pigmented lesion on face
Clinical multiphoton tomography of malignant melanoma
Alicia Lapresta, MD, Virgen de la Salud Hospital, Toledo, Spain; Ana Isabel Sanchez-Moya, Virgen de la Salud Hospital, toledo, Spain; Carmen Galera, MD, Virgen de la Salud Hospital, Toledo, Spain; Cristina Schoendorff, MD, Virgen de la Salud Hospital, Toledo, Spain; Domingo Garcıa-Almagro, PhD, Virgen de la Salud Hospital, Toledo, Spain; Rebeca de Miguel, PhD, Virgen de la Salud Hospital, Toledo, Spain Background: Becker nevus is an acquired disorder that usually manifests in late childhood or adolescence. It is characterized by a patchy hyperpigmented with irregular outline hypertrichosis. The border is irregular and sharply demarcated. Malignancy has never been reported. Case report: A 12-year-old girl presented with a gradually enlarging patch in her left cheek. She did not report any symptoms. During the beginning of puberty, terminal hair developed on the patch. Physical examination revealed a 9 3 6 cm brownish patch, slightly scaly, ill-defined with hypertrichosis. Full skin examination was otherwise unremarkable and no skeletal abnormalities were detected. A biopsy was performed. The histologic specimen showed epidermal acanthosis and regular elongation of the rete ridges. There was hyperpigmentation of the basal layer of the epidermis. These findings were consistent with Becker nevus. Conclusion: Becker nevus is a cutaneous hamartoma. Although it may be present at birth, majority of the cases and hypertrichosis are first noted at puberty. It is more frequently seen in males than females. Therefore, a relationship between androgen metabolism and Becker nevus has been proposed. The lesions are more often localized on the upper extremities and trunk, and more rarely they have been described in the lower extremities. Much more rarely than this, less than 10 cases of Becker nevus on face have been reported until now. The lesion is usually too large to remove by excision. The hair may be shaved or permanently removed by laser. We present this case because we believe it is interesting due to its atypical clinical presentation.
Karsten Koenig, PhD, Saarland University, Saarbruecken, Germany; Enrico Dimitrow, PhD, MD, University Hospital Jena, Jena, Germany; Martin Kaatz, MD, University Hospital Jena, Jena, Germany
(Poster reference number 5590)
(Poster reference number 5545)
Multiphoton tomography based on near infrared femtosecond laser technology has been applied to thousands of patients suffering from skin diseases in Australia, Japan, US, and Europe. Here we present the clinic its study on 46 melanocytic lesions of patients with white skin. The multiphoton tomograph was able to detect melanocytes based on melanin fluorescence, the extracellular matrix proteins collagen and elastin due to the second harmonic generation and two-photon excited autofluorescence as well as cells based on NADH emission. The results showed distinct morphological differences in melanoma compared to melanocytic nevi. Significant differences in fluorescence lifetime and spectral behavior of keratinocytes in contrast to melanocytes were also observed. A 3-D reconstruction of the tumor down to a depth of 0.2 mm was possible based on optical sectioning with submicron spatial resolution. The noninvasive multiphoton tomographic system described here allows early diagnosis of malignant melanoma with high specificity (up to 97%) and sensitivity (up to 95%). Commercial support: None identified.
Commercial support: None identified.
Change in patient performance of skin self-examination after intervention with interactive education and text reminders: A randomized controlled study
(Poster reference number 5316)
Angela Brimhall, DO, MPH, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Diana Carlson, University Hospitals Case Medical Center, Cleveland, Ohio, Cleveland, OH, United States; Douglas R. Kast, DO, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Jeremy S. Bordeaux, MD, MPH, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Kevin D. Cooper, MD, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Savina Aneja, Case Western Reserve University School of Medicine, Cleveland, OH, United States Background: Previous studies have demonstrated that early diagnosis improves survival in malignant melanoma (MM). Patient performance of regular self-skin examinations (SSEs) augments early detection and may reduce the mortality of MM. Objective: We sought to determine if interactive computer assisted patient education in addition to text and other telecommunication reminders could be combined to effectively increase patient performance of SSEs. Methods: 210 participants presenting to a University dermatology clinic were enrolled in an interventional study undergoing randomization to a control or intervention group after stratification based on MM risk factors. The intervention group: (1) participated in a computer assisted learning tutorial, (2) took part in a kinesthetic role-playing self-skin examinationtutorial, and (3) received monthly text or other telecommunication reminders to perform self-skin exams for the duration of the study (twelve weeks). Participants in both groups completed survey data at four timevpoints: (1) day of enrollment prior to educational intervention, (2) immediately after intervention, (3) one month and (4) three months after enrollment. The primary outcomes measure was change in behavior. Change in behavior was assessed by performance of self-skin examination, use of sun protective clothing, and use of sunblock.
Clinicopathologic study of 85 cases of melanoma of the female genitalia
(Poster reference number 5052)
Results: Of the 210 participants 129 were female and 81 were male. 81.4% identified as white, 12.3% as black, 3.8% as Asian, 0.9% as Hispanic and 1.4% did not report a race. 49.5% reported having a college or advanced degree. Follow-up data were collected from 63.8% designated to the control group (n ¼ 60) and 63.1% (n ¼ 53) in the intervention group. 44.3% of subjects reported performing SSEs at baseline. 79.2% in the intervention group and 63.3% in the control group reported performing SSEs three months after enrollment. 52.8% in the intervention group and 48.3% in the control group reported using sunscreen clothing ‘‘always’’ or ‘‘frequently.’’ 50.9% in the intervention group and 45% in the control group reported wearing sun protective clothing ‘‘always’’ or ‘‘frequently.’’ Conclusion: Interactive computer assisted patient education used in conjunction with kinesthetic role-playing, and text or other telecommunication reminders can effectively increase patient performance of self-skin examinations.
Win Janet Tcheung, MD, Duke University Medical Center, Durham, NC, United States; Amy Abernethy, MD, Duke University Medical Center, Durham, NC, United States; James Herndon, PhD, Duke University Medical Center, Durham, NC, United States; Kelly Nelson, MD, Duke University Medical Center, Durham, NC, United States; Maria Angelica Selim, MD, Duke University Medical Center, Durham, NC, United States Malignant melanoma is the most serious form of skin cancer, and melanoma of the female genitalia has an especially poor overall prognosis—5-year survival rates have been cited between 8-55% (mean, 36%). To examine prognostic factors influencing survival, the Duke Melanoma and Tumor Registry Databases were queried for patients who had received their clinical care at Duke University Medical Center, with a diagnosis of primary melanoma of the female genitalia between 1970 and 2009. From this group, any available histopathologic specimens were procured for further review. 85 subjects (78 whites, 5 African Americans, 1 Hispanic, and 1 race not reported) were identified. The median follow-up time was 8.8 years with 60% of the subjects experiencing melanoma-related mortality at last follow-up. Cohort survival rates were as follows: 85% (1-year), 51% (5-year), and 30% (10-year). The mean tumor thickness, available for 51 cases, was 3.2 mm (median, 2.3 mm). The available histopathologic specimens from 36 cases were reviewed by a dermatopathologist (M.A.S.). Of these 36 cases, the most common subtype was superficial spreading; nodular and acral lentiginous melanoma subtypes were also observed. Other histopathologic features included the following: 31/36 cases arose de novo, without a pre-existing nevus; 12/36 cases were amelanotic; and 15/36 had atypical melanocytic hyperplasia noted adjacent to the primary melanoma. Tumor thickness, lymph node status, systemic therapy, and surgery were also examined for differences in survival distributions using the log rank test. In general, survival was inversely correlated with tumor thickness, extent of nodal involvement, and provision of systemic therapy. A higher survival rate was observed among those who received wide local excision. In summary, subjects with thinner melanomas amenable to surgical resection had a better prognosis than those with more extensive, metastatic disease at presentation. In addition, the presence of atypical melanocytic hyperplasia on the skin of the female genitalia disputes the notion that this phenomenon is only associated with chronically sun-damaged skin.
Commercial support: None identified.
Commercial support: None identified.
AB142
J AM ACAD DERMATOL
APRIL 2012
Clinical multiphoton tomography of malignant melanoma
Alicia Lapresta, MD, Virgen de la Salud Hospital, Toledo, Spain; Ana Isabel Sanchez-Moya, Virgen de la Salud Hospital, toledo, Spain; Carmen Galera, MD, Virgen de la Salud Hospital, Toledo, Spain; Cristina Schoendorff, MD, Virgen de la Salud Hospital, Toledo, Spain; Domingo Garcıa-Almagro, PhD, Virgen de la Salud Hospital, Toledo, Spain; Rebeca de Miguel, PhD, Virgen de la Salud Hospital, Toledo, Spain Background: Becker nevus is an acquired disorder that usually manifests in late childhood or adolescence. It is characterized by a patchy hyperpigmented with irregular outline hypertrichosis. The border is irregular and sharply demarcated. Malignancy has never been reported. Case report: A 12-year-old girl presented with a gradually enlarging patch in her left cheek. She did not report any symptoms. During the beginning of puberty, terminal hair developed on the patch. Physical examination revealed a 9 3 6 cm brownish patch, slightly scaly, ill-defined with hypertrichosis. Full skin examination was otherwise unremarkable and no skeletal abnormalities were detected. A biopsy was performed. The histologic specimen showed epidermal acanthosis and regular elongation of the rete ridges. There was hyperpigmentation of the basal layer of the epidermis. These findings were consistent with Becker nevus. Conclusion: Becker nevus is a cutaneous hamartoma. Although it may be present at birth, majority of the cases and hypertrichosis are first noted at puberty. It is more frequently seen in males than females. Therefore, a relationship between androgen metabolism and Becker nevus has been proposed. The lesions are more often localized on the upper extremities and trunk, and more rarely they have been described in the lower extremities. Much more rarely than this, less than 10 cases of Becker nevus on face have been reported until now. The lesion is usually too large to remove by excision. The hair may be shaved or permanently removed by laser. We present this case because we believe it is interesting due to its atypical clinical presentation.
Karsten Koenig, PhD, Saarland University, Saarbruecken, Germany; Enrico Dimitrow, PhD, MD, University Hospital Jena, Jena, Germany; Martin Kaatz, MD, University Hospital Jena, Jena, Germany
(Poster reference number 5590)
(Poster reference number 5545)
Multiphoton tomography based on near infrared femtosecond laser technology has been applied to thousands of patients suffering from skin diseases in Australia, Japan, US, and Europe. Here we present the clinic its study on 46 melanocytic lesions of patients with white skin. The multiphoton tomograph was able to detect melanocytes based on melanin fluorescence, the extracellular matrix proteins collagen and elastin due to the second harmonic generation and two-photon excited autofluorescence as well as cells based on NADH emission. The results showed distinct morphological differences in melanoma compared to melanocytic nevi. Significant differences in fluorescence lifetime and spectral behavior of keratinocytes in contrast to melanocytes were also observed. A 3-D reconstruction of the tumor down to a depth of 0.2 mm was possible based on optical sectioning with submicron spatial resolution. The noninvasive multiphoton tomographic system described here allows early diagnosis of malignant melanoma with high specificity (up to 97%) and sensitivity (up to 95%). Commercial support: None identified.
Commercial support: None identified.
Change in patient performance of skin self-examination after intervention with interactive education and text reminders: A randomized controlled study
(Poster reference number 5316)
Angela Brimhall, DO, MPH, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Diana Carlson, University Hospitals Case Medical Center, Cleveland, Ohio, Cleveland, OH, United States; Douglas R. Kast, DO, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Jeremy S. Bordeaux, MD, MPH, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Kevin D. Cooper, MD, Department of Dermatology, University Hospitals Case Medical Center, Cleveland, OH, United States; Savina Aneja, Case Western Reserve University School of Medicine, Cleveland, OH, United States Background: Previous studies have demonstrated that early diagnosis improves survival in malignant melanoma (MM). Patient performance of regular self-skin examinations (SSEs) augments early detection and may reduce the mortality of MM. Objective: We sought to determine if interactive computer assisted patient education in addition to text and other telecommunication reminders could be combined to effectively increase patient performance of SSEs. Methods: 210 participants presenting to a University dermatology clinic were enrolled in an interventional study undergoing randomization to a control or intervention group after stratification based on MM risk factors. The intervention group: (1) participated in a computer assisted learning tutorial, (2) took part in a kinesthetic role-playing self-skin examinationtutorial, and (3) received monthly text or other telecommunication reminders to perform self-skin exams for the duration of the study (twelve weeks). Participants in both groups completed survey data at four timevpoints: (1) day of enrollment prior to educational intervention, (2) immediately after intervention, (3) one month and (4) three months after enrollment. The primary outcomes measure was change in behavior. Change in behavior was assessed by performance of self-skin examination, use of sun protective clothing, and use of sunblock.
Clinicopathologic study of 85 cases of melanoma of the female genitalia
(Poster reference number 5052)
Results: Of the 210 participants 129 were female and 81 were male. 81.4% identified as white, 12.3% as black, 3.8% as Asian, 0.9% as Hispanic and 1.4% did not report a race. 49.5% reported having a college or advanced degree. Follow-up data were collected from 63.8% designated to the control group (n ¼ 60) and 63.1% (n ¼ 53) in the intervention group. 44.3% of subjects reported performing SSEs at baseline. 79.2% in the intervention group and 63.3% in the control group reported performing SSEs three months after enrollment. 52.8% in the intervention group and 48.3% in the control group reported using sunscreen clothing ‘‘always’’ or ‘‘frequently.’’ 50.9% in the intervention group and 45% in the control group reported wearing sun protective clothing ‘‘always’’ or ‘‘frequently.’’ Conclusion: Interactive computer assisted patient education used in conjunction with kinesthetic role-playing, and text or other telecommunication reminders can effectively increase patient performance of self-skin examinations.
Win Janet Tcheung, MD, Duke University Medical Center, Durham, NC, United States; Amy Abernethy, MD, Duke University Medical Center, Durham, NC, United States; James Herndon, PhD, Duke University Medical Center, Durham, NC, United States; Kelly Nelson, MD, Duke University Medical Center, Durham, NC, United States; Maria Angelica Selim, MD, Duke University Medical Center, Durham, NC, United States Malignant melanoma is the most serious form of skin cancer, and melanoma of the female genitalia has an especially poor overall prognosis—5-year survival rates have been cited between 8-55% (mean, 36%). To examine prognostic factors influencing survival, the Duke Melanoma and Tumor Registry Databases were queried for patients who had received their clinical care at Duke University Medical Center, with a diagnosis of primary melanoma of the female genitalia between 1970 and 2009. From this group, any available histopathologic specimens were procured for further review. 85 subjects (78 whites, 5 African Americans, 1 Hispanic, and 1 race not reported) were identified. The median follow-up time was 8.8 years with 60% of the subjects experiencing melanoma-related mortality at last follow-up. Cohort survival rates were as follows: 85% (1-year), 51% (5-year), and 30% (10-year). The mean tumor thickness, available for 51 cases, was 3.2 mm (median, 2.3 mm). The available histopathologic specimens from 36 cases were reviewed by a dermatopathologist (M.A.S.). Of these 36 cases, the most common subtype was superficial spreading; nodular and acral lentiginous melanoma subtypes were also observed. Other histopathologic features included the following: 31/36 cases arose de novo, without a pre-existing nevus; 12/36 cases were amelanotic; and 15/36 had atypical melanocytic hyperplasia noted adjacent to the primary melanoma. Tumor thickness, lymph node status, systemic therapy, and surgery were also examined for differences in survival distributions using the log rank test. In general, survival was inversely correlated with tumor thickness, extent of nodal involvement, and provision of systemic therapy. A higher survival rate was observed among those who received wide local excision. In summary, subjects with thinner melanomas amenable to surgical resection had a better prognosis than those with more extensive, metastatic disease at presentation. In addition, the presence of atypical melanocytic hyperplasia on the skin of the female genitalia disputes the notion that this phenomenon is only associated with chronically sun-damaged skin.
Commercial support: None identified.
Commercial support: None identified.
AB142
J AM ACAD DERMATOL
APRIL 2012