Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 5 Articles
Background: Melanoma is the fastest growing tumor of the skin, which disproportionately affects younger\r\nand middle-aged adults. As melanomas are visible, recognizable, and highly curable while in early stages, early\r\ndiagnosis is one of the most effective measures to decrease melanoma-related mortality. Skin self-examination\r\nresults in earlier detection and removal of the melanoma. Due to the elevated risk of survivors for developing\r\nsubsequent melanomas, monthly self-exams are strongly recommended as part of follow-up care. Yet, only a\r\nminority of high-risk individuals practices systematic and regular self-exams. This can be improved through patient\r\neducation. However, dermatological education is effective only in about 50% of the cases and little is known about\r\nthose who do not respond. In the current literature, psychosocial variables like distress, coping with cancer, as well\r\nas partner and physician support are widely neglected in relation to the practice of skin self-examination, despite\r\nthe fact that they have been shown to be essential for other health behaviors and for adherence to medical advice.\r\nMoreover, the current body of knowledge is compromised by the inconsistent conceptualization of SSE. The main\r\nobjective of the current project is to examine psychosocial predictors of skin self-examination using on a rigorous\r\nand clinically sound methodology.\r\nMethods/Design: The longitudinal, mixed-method study examines key psychosocial variables related to the\r\nacquisition and to the long-term maintenance of skin self-examination in 200 patients with melanoma. Practice of\r\nself-exam behaviors is assessed at 3 and 12 months after receiving an educational intervention designed based on\r\nbest-practice standards. Examined predictors of skin self-exam behaviors include biological sex, perceived self-exam\r\nefficacy, distress, partner and physician support, and coping strategies. Qualitative analyses of semi-structured\r\ninterviews will complement and enlighten the quantitative findings.\r\nDiscussion: The identification of short and long-term predictors of skin self-examination and an increased\r\nunderstanding of barriers will allow health care professionals to better address patient difficulties in adhering to this\r\nlife-saving health behavior. Furthermore, the findings will enable the development and evaluation of evidencebased,\r\ncomprehensive intervention strategies. Ultimately, these findings could impact a wide range of outreach\r\nprograms and secondary prevention initiatives for other populations with increased melanoma risk....
Background: Calciphylaxis (calcific uremic arteriolopathy) is rare and its pathogenesis is not fully understood.\r\nIndeed, Calciphylaxis presents a challenge through the course of its management which involve different\r\nspecialities but unfortunately this disease so far has a poor prognosis. We herein present, in this case report, a\r\nmultidisciplinary approach involving plastic surgeons with special regards to reconstructive approach after\r\ndebridement procedures.\r\nCase presentation: We present a 21 years old male with a BMI of 38,2, who was transferred to our department\r\nfrom another hospital. Calciphylaxis has been diagnosed after receiving anticoagulation with phenprocoumon after\r\na single event of pulmonary embolism. The INR on admission was 1,79. He had necrotic spots on both sides of the\r\nabdominal wall and on both thighs medially. During this time he underwent several reconstructive procedures in\r\nour department.\r\nConclusion: It can be suggested that this agonizing disease needs indeed a multidisciplinary approach involving\r\nNephrologists, Dermatologists, Intensive Care Physicians and Plastic Surgeons, taking into consideration that surgical\r\ncorrection can achieve further improvement in a specialized centre. Notwithstanding, further cohort studies should\r\nbe approached clinically to insight the light on this disease with special regard to the prognosis after this approach...
Background: Since the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients\nwith clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of\nSLNB for melanoma.\nMethods: A single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma\n(tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head\nand neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and\nintraoperative gamma probe interrogation.\nResults: The SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was\nsignificantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5\n(5ââ?¬â??97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002).\nFive-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant\ndifference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and\np = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients.\nConclusion: Our data confirm previous studies and support the clinical usefulness of SLNB as a reliable and\naccurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in\npatients with positive SLN remains to be demonstrated....
Background. Some observational studies have suggested that excess dietary intake of polyunsaturated fatty acids such as linoleic acid increases cutaneous melanoma risk. We aimed at examining the association between serum fatty acids and melanoma risk by conducting a population-based case-control study in a northern Italy community. Methods. The percentage composition of 12 fatty acids was determined in 51 newly diagnosed melanoma patients and 51 age- and sex-matched population controls by extracting total lipids from serum samples using thin layer and gas chromatography. Conditional logistic regression was used to estimate the relative risk of melanoma associated with tertiles of percentage composition of each fatty acid as well as groupings including saturated, monounsaturated, and polyunsaturated fatty acids. Results. We found a slightly increased melanoma risk for stearic and arachidic acids proportion, with and without adjustment for potential confounders. For an n-3 polyunsaturated fatty acid, docosapentaenoic acid, we found a male-specific direct association with melanoma risk. No other associations emerged for the other saturated, monounsaturated, and polyunsaturated fatty acids, individually or grouped by type. Conclusions. These findings do not suggest a major role of fatty acids, including linoleic acid, on risk of cutaneous melanoma, though their evaluation is limited by the small sample size....
Background: Sebaceous glands are components of the skin essential for its normal lubrication by the production\r\nof sebum. This contributes to skin health and more importantly is crucial for the skin barrier function. A mechanistic\r\nunderstanding of sebaceous gland cells growth and differentiation has lagged behind that for keratinocytes, partly\r\nbecause of a lack of an in vitro model that can be used for experimental manipulation.\r\nMethods: We have developed an in vitro culture model to isolate and grow primary human sebocytes without\r\ntransformation that display functional characteristics of sebocytes. We used this novel method to probe the effect\r\nof Transforming Growth Factor �Ÿ (TGF�Ÿ) signaling on sebocyte differentiation, by examining the expression of\r\ngenes involved in lipogenesis upon treatment with TGF�Ÿ1. We also repressed TGF�Ÿ signaling through knockdown\r\nof the TGF�Ÿ Receptor II to address if the effect of TGF�Ÿ activation is mediated via canonical Smad signal\r\ntransduction.\r\nResults: We find that activation of the TGF�Ÿ signaling pathway is necessary and sufficient for maintaining\r\nsebocytes in an undifferentiated state. The presence of TGF�Ÿ ligand triggered decreased expression in genes\r\nrequired for the production of characteristics sebaceous lipids and for sebocyte differentiation such as FADS2 and\r\nPPAR?, thereby decreasing lipid accumulation through the TGF�Ÿ RII-Smad2 dependent pathway.\r\nConclusion: TGF�Ÿ signaling plays an essential role in sebaceous gland regulation by maintaining sebocytes in an\r\nundifferentiated state. This data was generated using a novel method for human sebocyte culture, which is likely to\r\nprove generally useful in investigations of sebaceous gland growth and differentiation. These findings open a new\r\nparadigm in human skin biology with important implications for skin therapies....
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