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Melanocytic proliferations in Hispanic children and adolescents: A study on biopsied lesions
5815
5393
Measuring the outcome of management of hand dermatitis with disease severity tool and quality of life index Erere Otrofanowei, Lagos University Teaching Hospital
Melanocytic proliferations in Hispanic children and adolescents: A study on biopsied lesions Rosbel Gonzalez-Rivera, MD, University of Puerto Rico School of Medicine; Department of Dermatology; Julian O. Barrera Llaurador, MD, Hospital Auxilio Mutuo; Jorge L. Sanchez, MD, University of Puerto Rico School of Medicine; Dermatology Department; Julio E. Sanchez, MD, University of Puerto Rico School of Medicine; Department of Dermatology
Hand dermatitis (HD) is an acute or chronic inflammation of the skin of the hands. It ranges in severity and has a significant impact on the quality of life of its sufferers. The physical and psychosocial burden of the disease is comparable with other chronic diseases such as psoriasis. Quality of life has been shown to correlate negatively with the severity of the disease. The aim of this arm of a larger study was to evaluate the outcome of management of HD with a disease severity tool by the physician and the quality of life as determined by the patient. This was a prospective observational study carried out in the skin clinic of the Lagos University Teaching Hospital over 24 weeks. Patients who met the inclusion criteria filled questionnaires and were clinically examined. Disease severity and the quality of life were measured using the physician global assessment (PGA) and Dermatology Life Quality Index (DLQI) respectively. These were repeated at 6 weeks follow up after necessary investigations and management. Results were collated and analysed with SPSS 17. Hand dermatitis was seen in 177 (13.3 %) of 1,329 patients. There was a favourable outcome in disease management with a statistically significant difference in severity from baseline to six weeks of treatment (P \.00001); reduction in the impact of disease on quality of life (P \.00001) and a positive correlation of the PGA with the DLQI both at baseline and at six weeks (P \.01). Management of HD is rewarding if etiologic factors are put into consideration, as evidenced by the DLQI and PGA at baseline and postmanagement. Commercial support: None identified.
Background: Childhood and adolescence are dynamic periods for the appearance, growth and involution of nevi. Melanoma are uncommon in this population, but early detection is the only effective strategy for reducing mortality. In this study, we sought to analyze the prevalence, characteristics, and diagnostic accuracy of benign melanocytic lesions and melanoma in a Hispanic pediatric population. Methods: We reviewed the dermatopathology reports of nevi and melanomas biopsied in patients younger than 21 years of age at the Department of Dermatology of University of Puerto Rico from 2002 to 2012. Patients were categorized into four subgroups: 0-4, 5-9, 10-14, and 15-21 years. Associations between age, gender, number of biopsied lesions, anatomical location, clinical impression, histologic findings and accuracy were studied. All analyses were done using IBM SPSS, v23.0. Results: 19,642 biopsies matched our search queries and 297 met our inclusion criteria. There were no statistically significant associations between sex and lesion anatomical location (P ¼ .38), histopathology (P ¼ .66) or accuracy of clinical impression (P ¼ .295). No statistically significant associations were identified between age and histopathology (P ¼ .06) or accuracy of clinical impression (P ¼ .08). A statistically significant association was identified between age and anatomical location (P # .001). The head and neck region (H&N) was the most common location (39%), followed by the trunk (33%). Nevi biopsied from the H&N and trunk increased in number when moving to older age, while biopsies of extremities decreased as age increased. Melanoma was suspected in 22% of the analyzed biopsies; however, only one melanoma was identified (H&N, 15-21 age group). No melanomas were identified in children less than 15 years of age. A melanoma incidence of 0.003% was identified in our cohort. Accuracy in melanoma detection was tested using the number needed to biopsy (NNB). The number needed to biopsy over the 11-year study period was 297. Conclusions: Similar histopathologic and anatomic trends reported in other studies were identified for benign melanocytic lesions biopsied in our Hispanic population. However, the melanoma prevalence was lower than that described in the pediatric literature. The overall NNB value in pediatric Hispanic patients over the 11-year study period was 297, meaning that about 297 lesions were biopsied to find one melanoma. This value is 10 times higher than the rates found in adult patients. Commercial support: None identified.
5092 Median time to treatment response in patients with moderate-tosevere plaque psoriasis treated with brodalumab 210 mg or ustekinumab: A pooled analysis of data from two phase 3 randomized clinical trials (AMAGINE-2 and AMAGINE-3) Andrew Blauvelt, MD, Oregon Medical Research Center; Mark Lebwohl, MD, Icahn School of Medicine at Mount Sinai; Lawrence Green, MD, Department of Dermatology; Sylvia Hsu, MD, Department of Dermatology; Varsha Bhatt, PhD, Dow Pharmaceutical Sciences; Shipra Rastogi, PhD, Valeant Pharmaceuticals; Robert Israel, MD, Valeant Pharmacueticals
4497
Conclusions: The median time to achieve sPGA (0/1), PASI 75 and PASI 100 response was significantly shorter with brodalumab 210 mg Q2W compared to ustekinumab (P\.001). Median time to achieve a clinically meaningful response (PASI 75 or sPGA success) was twice as long with ustekinumab (8-10 weeks) when compared with brodalumab (4-5 weeks). Further, twice as many patients achieved PASI 100 at Week 12 with brodalumab compared to ustekinumab.
Melanoma in Hispanic Mexican patients Ana Sofia Ayala-Cortes, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Minerva G omez-Flores, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Sonia Chavez-Alvarez, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Ivett Miranda-Maldonado, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Jorge Ocampo-Candiani, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on Introduction: Cutaneous melanoma is a malignant neoplasm originating from the melanocytes. Its incidence has been increasing worldwide; 20.1 cases/100,000 habitants and 2.7 cases/100,000 habitants global incidence and mortality, respectively has been described. Despite higher rates of melanoma reported in the white population vs Hispanic patients, scarce literature suggests higher metastases and poorer outcomes in the later population. We sought to shed light into this concerning observation by performing a retrospective review of a Hispanic Mexican melanoma database. Methodology: We performed a retrospective study of a pathology electronic database of all melanoma cases diagnosed at the University Hospital ‘‘Dr Jose Eleuterio Gonzalez’’ from January 2000 to May 2015. Gender, age, localization, histologic subtype and prognosis factors were collected. All the slides were evaluated by a dermatopathologist to corroborate the reports. The data was tabulated and statistical analysis with central tendency and dispersion measurements as well as comparison of categorical variables with chi-square and Fisher’s exact test. Results We found 284 cases (49% females). Mean age was 56.6 years (SD+/-17.87). Most frequent involvement site was lower limbs in both genders. Predominant melanoma subtype was superficial spreading, 30% cases; followed by acral lentiginous 27%, lentigo maligna 8% and nodular 8%; 27% comprised other subtypes. We found a high rate of poor prognostic factors, mitosis median was 4 (IQR 2-8), Breslow median was 1.6 (IQR 0.64-4.2); 84 out of 211 cases that described ulceration were ulcerated. Men ulceration rate was higher (P ¼ .015); Breslow and mitosis count corresponded with the presence of ulceration. Conclusion: This study corroborates the prevailing presence of poor prognosis factors in a Hispanic Mexican population. However, similar to white literature, our study found superficial spreading as the commonest melanoma subtype; as opposed to Mexican literature that suggests acral lentiginous to be more common. Melanoma awareness, with public health education and prevention campaigns, is needed in order to allow this neoplasm diagnosis in earlier stages with favorable prognosis factors.
Commercial support: 100% is sponsored by Valeant Pharmaceuticals.
Commercial support: None identified.
Background: Brodalumab is a human monoclonal antibody that binds to and blocks IL-17RA, the receptor subunit shared by the pro-inflammatory cytokines IL-17A, IL17F, and IL-17A/F. While results from phase 3 studies demonstrated high degrees of efficacy for brodalumab in the treatment of moderate-to-severe plaque psoriasis, also important is its speed of response compared to ustekinumab. Objective: To investigate the median time to response for brodalumab 210 mg Q2W versus ustekinumab in the treatment of moderate-to-severe plaque psoriasis. Methods: 12-week induction phase data were analyzed from two multicenter, randomized, double-blind phase 3 studies in moderate-to-severe psoriasis. Patients were treated with brodalumab, ustekinumab, or placebo. Coprimary endpoints were proportion of patients at week 12 who achieved: 1) static Physician’s Global Assessment (sPGA) scores of 0 or 1; 2) Psoriasis Area and Severity Index (PASI) 75 response (brodalumab versus placebo); and 3) PASI 100 response (brodalumab versus ustekinumab). Median time to response was evaluated from Kaplan-Meier estimates of the time taken for 50% of the patients to achieve co-primary endpoints. Results: Overall, 1236 patients were treated with brodalumab 210 mg Q2W and 613 with ustekinumab. At Week 12, 79.1% and 59.1% of brodalumab and ustekinumabtreated patients respectively achieved sPGA 0/1 (P \ .001); 85.7% and 69.7% achieved PASI 75 (P \.001); and 40.5% and 20.1% achieved PASI 100 (P \.001). Based on induction phase data the median time to achieve PASI 75 or sPGA success with brodalumab was 4.14 and 5.43 weeks respectively compared with 8.14 and 10.14 weeks with ustekinumab. The median time to achieve PASI 100 with brodalumab was 12.43 weeks and was inestimable for ustekinumab due to lower rate of response in induction phase.
JUNE 2017
J AM ACAD DERMATOL
AB167
5393
Measuring the outcome of management of hand dermatitis with disease severity tool and quality of life index Erere Otrofanowei, Lagos University Teaching Hospital
Melanocytic proliferations in Hispanic children and adolescents: A study on biopsied lesions Rosbel Gonzalez-Rivera, MD, University of Puerto Rico School of Medicine; Department of Dermatology; Julian O. Barrera Llaurador, MD, Hospital Auxilio Mutuo; Jorge L. Sanchez, MD, University of Puerto Rico School of Medicine; Dermatology Department; Julio E. Sanchez, MD, University of Puerto Rico School of Medicine; Department of Dermatology
Hand dermatitis (HD) is an acute or chronic inflammation of the skin of the hands. It ranges in severity and has a significant impact on the quality of life of its sufferers. The physical and psychosocial burden of the disease is comparable with other chronic diseases such as psoriasis. Quality of life has been shown to correlate negatively with the severity of the disease. The aim of this arm of a larger study was to evaluate the outcome of management of HD with a disease severity tool by the physician and the quality of life as determined by the patient. This was a prospective observational study carried out in the skin clinic of the Lagos University Teaching Hospital over 24 weeks. Patients who met the inclusion criteria filled questionnaires and were clinically examined. Disease severity and the quality of life were measured using the physician global assessment (PGA) and Dermatology Life Quality Index (DLQI) respectively. These were repeated at 6 weeks follow up after necessary investigations and management. Results were collated and analysed with SPSS 17. Hand dermatitis was seen in 177 (13.3 %) of 1,329 patients. There was a favourable outcome in disease management with a statistically significant difference in severity from baseline to six weeks of treatment (P \.00001); reduction in the impact of disease on quality of life (P \.00001) and a positive correlation of the PGA with the DLQI both at baseline and at six weeks (P \.01). Management of HD is rewarding if etiologic factors are put into consideration, as evidenced by the DLQI and PGA at baseline and postmanagement. Commercial support: None identified.
Background: Childhood and adolescence are dynamic periods for the appearance, growth and involution of nevi. Melanoma are uncommon in this population, but early detection is the only effective strategy for reducing mortality. In this study, we sought to analyze the prevalence, characteristics, and diagnostic accuracy of benign melanocytic lesions and melanoma in a Hispanic pediatric population. Methods: We reviewed the dermatopathology reports of nevi and melanomas biopsied in patients younger than 21 years of age at the Department of Dermatology of University of Puerto Rico from 2002 to 2012. Patients were categorized into four subgroups: 0-4, 5-9, 10-14, and 15-21 years. Associations between age, gender, number of biopsied lesions, anatomical location, clinical impression, histologic findings and accuracy were studied. All analyses were done using IBM SPSS, v23.0. Results: 19,642 biopsies matched our search queries and 297 met our inclusion criteria. There were no statistically significant associations between sex and lesion anatomical location (P ¼ .38), histopathology (P ¼ .66) or accuracy of clinical impression (P ¼ .295). No statistically significant associations were identified between age and histopathology (P ¼ .06) or accuracy of clinical impression (P ¼ .08). A statistically significant association was identified between age and anatomical location (P # .001). The head and neck region (H&N) was the most common location (39%), followed by the trunk (33%). Nevi biopsied from the H&N and trunk increased in number when moving to older age, while biopsies of extremities decreased as age increased. Melanoma was suspected in 22% of the analyzed biopsies; however, only one melanoma was identified (H&N, 15-21 age group). No melanomas were identified in children less than 15 years of age. A melanoma incidence of 0.003% was identified in our cohort. Accuracy in melanoma detection was tested using the number needed to biopsy (NNB). The number needed to biopsy over the 11-year study period was 297. Conclusions: Similar histopathologic and anatomic trends reported in other studies were identified for benign melanocytic lesions biopsied in our Hispanic population. However, the melanoma prevalence was lower than that described in the pediatric literature. The overall NNB value in pediatric Hispanic patients over the 11-year study period was 297, meaning that about 297 lesions were biopsied to find one melanoma. This value is 10 times higher than the rates found in adult patients. Commercial support: None identified.
5092 Median time to treatment response in patients with moderate-tosevere plaque psoriasis treated with brodalumab 210 mg or ustekinumab: A pooled analysis of data from two phase 3 randomized clinical trials (AMAGINE-2 and AMAGINE-3) Andrew Blauvelt, MD, Oregon Medical Research Center; Mark Lebwohl, MD, Icahn School of Medicine at Mount Sinai; Lawrence Green, MD, Department of Dermatology; Sylvia Hsu, MD, Department of Dermatology; Varsha Bhatt, PhD, Dow Pharmaceutical Sciences; Shipra Rastogi, PhD, Valeant Pharmaceuticals; Robert Israel, MD, Valeant Pharmacueticals
4497
Conclusions: The median time to achieve sPGA (0/1), PASI 75 and PASI 100 response was significantly shorter with brodalumab 210 mg Q2W compared to ustekinumab (P\.001). Median time to achieve a clinically meaningful response (PASI 75 or sPGA success) was twice as long with ustekinumab (8-10 weeks) when compared with brodalumab (4-5 weeks). Further, twice as many patients achieved PASI 100 at Week 12 with brodalumab compared to ustekinumab.
Melanoma in Hispanic Mexican patients Ana Sofia Ayala-Cortes, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Minerva G omez-Flores, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Sonia Chavez-Alvarez, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Ivett Miranda-Maldonado, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on; Jorge Ocampo-Candiani, MD, Hospital Universitario ‘‘Dr Jose Eleuterio Gonzalez’’ de la Universidad Aut onoma de Nuevo Le on Introduction: Cutaneous melanoma is a malignant neoplasm originating from the melanocytes. Its incidence has been increasing worldwide; 20.1 cases/100,000 habitants and 2.7 cases/100,000 habitants global incidence and mortality, respectively has been described. Despite higher rates of melanoma reported in the white population vs Hispanic patients, scarce literature suggests higher metastases and poorer outcomes in the later population. We sought to shed light into this concerning observation by performing a retrospective review of a Hispanic Mexican melanoma database. Methodology: We performed a retrospective study of a pathology electronic database of all melanoma cases diagnosed at the University Hospital ‘‘Dr Jose Eleuterio Gonzalez’’ from January 2000 to May 2015. Gender, age, localization, histologic subtype and prognosis factors were collected. All the slides were evaluated by a dermatopathologist to corroborate the reports. The data was tabulated and statistical analysis with central tendency and dispersion measurements as well as comparison of categorical variables with chi-square and Fisher’s exact test. Results We found 284 cases (49% females). Mean age was 56.6 years (SD+/-17.87). Most frequent involvement site was lower limbs in both genders. Predominant melanoma subtype was superficial spreading, 30% cases; followed by acral lentiginous 27%, lentigo maligna 8% and nodular 8%; 27% comprised other subtypes. We found a high rate of poor prognostic factors, mitosis median was 4 (IQR 2-8), Breslow median was 1.6 (IQR 0.64-4.2); 84 out of 211 cases that described ulceration were ulcerated. Men ulceration rate was higher (P ¼ .015); Breslow and mitosis count corresponded with the presence of ulceration. Conclusion: This study corroborates the prevailing presence of poor prognosis factors in a Hispanic Mexican population. However, similar to white literature, our study found superficial spreading as the commonest melanoma subtype; as opposed to Mexican literature that suggests acral lentiginous to be more common. Melanoma awareness, with public health education and prevention campaigns, is needed in order to allow this neoplasm diagnosis in earlier stages with favorable prognosis factors.
Commercial support: 100% is sponsored by Valeant Pharmaceuticals.
Commercial support: None identified.
Background: Brodalumab is a human monoclonal antibody that binds to and blocks IL-17RA, the receptor subunit shared by the pro-inflammatory cytokines IL-17A, IL17F, and IL-17A/F. While results from phase 3 studies demonstrated high degrees of efficacy for brodalumab in the treatment of moderate-to-severe plaque psoriasis, also important is its speed of response compared to ustekinumab. Objective: To investigate the median time to response for brodalumab 210 mg Q2W versus ustekinumab in the treatment of moderate-to-severe plaque psoriasis. Methods: 12-week induction phase data were analyzed from two multicenter, randomized, double-blind phase 3 studies in moderate-to-severe psoriasis. Patients were treated with brodalumab, ustekinumab, or placebo. Coprimary endpoints were proportion of patients at week 12 who achieved: 1) static Physician’s Global Assessment (sPGA) scores of 0 or 1; 2) Psoriasis Area and Severity Index (PASI) 75 response (brodalumab versus placebo); and 3) PASI 100 response (brodalumab versus ustekinumab). Median time to response was evaluated from Kaplan-Meier estimates of the time taken for 50% of the patients to achieve co-primary endpoints. Results: Overall, 1236 patients were treated with brodalumab 210 mg Q2W and 613 with ustekinumab. At Week 12, 79.1% and 59.1% of brodalumab and ustekinumabtreated patients respectively achieved sPGA 0/1 (P \ .001); 85.7% and 69.7% achieved PASI 75 (P \.001); and 40.5% and 20.1% achieved PASI 100 (P \.001). Based on induction phase data the median time to achieve PASI 75 or sPGA success with brodalumab was 4.14 and 5.43 weeks respectively compared with 8.14 and 10.14 weeks with ustekinumab. The median time to achieve PASI 100 with brodalumab was 12.43 weeks and was inestimable for ustekinumab due to lower rate of response in induction phase.
JUNE 2017
J AM ACAD DERMATOL
AB167