Ana-Maria Forsea

Melanoma incidence and mortality in Europe: New estimates, persistent disparities

Background  Melanoma incidence and mortality in Europe are high but there are significant gaps in the epidemiological information available across the continent.

Quantification and molecular characterization of regulatory T cells in connective tissue diseases.

The aim of our study was to investigate and characterize regulatory T cells (Treg) in peripheral blood of patients with connective tissue diseases (Systemic lupus erythematosus, systemic sclerosis, Sjögrens syndrome, poly- and dermatomyositis) as compared with blood from healthy controls. Treg cells were quantified and phenotypically characterized by flow cytometry while the expression level of Foxp3 mRNA was evaluated by real time PCR. A reduced percentage of peripheral blood Treg cells was found in patients than in controls, irrespective of the type of connective tissue disease. Treg cells, especially those expressing one of the phenotypical markers, seemed to differ not only between patients and healthy controls but also among types of diseases. Additionally, the presence of autoantibodies as well as disease activity appeared to be correlated with particular Treg cell populations, especially those expressing one of the examined phenotypical markers. Correlations with therapy suggested that glucocorticoids plus antimalarial or other immunosuppressor drugs diminished the percentage of Treg cells, especially of those with memory phenotype. These findings indicated dysregulations at the level of Treg cells and suggested an involvement of these cells in the pathology of connective tissue diseases. Moreover, our data are in agreement with the suggestion that Treg cells could be therapeutic targets for some autoimmune diseases.

Euromelanoma: A dermatology-led European campaign against nonmelanoma skin cancer and cutaneous melanoma. Past, present and future

Euromelanoma is a dermatologist‐led skin cancer prevention programme conducting an annual screening and public education campaign in over 20 European countries. Within its 10‐year history, Euromelanoma has screened over 260 000 individuals across Europe, detecting a significant number of cutaneous melanomas and nonmelanoma skin cancers, identifying high‐risk individuals for further surveillance and promoting awareness on the suspicious features of melanoma and the hazardous effects of ultraviolet exposure. In this review article, we summarize the history of the Euromelanoma campaign, present its organizational structure and discuss the results of the campaign in individual countries and on a European scale. Euromelanoma has had a significant impact on melanoma prevention and early diagnosis in participating countries and, despite many challenges, has positively influenced public health attitudes towards regular mole examination and the implementation of preventive measures against skin cancer.

Melanoma prognosis in Europe: far from equal

Comprehensive, population‐based analysis of melanoma survival throughout Europe is hindered by the uneven coverage and quality of European cancer registries, and by logistical and financial shortcomings. Mortality‐to‐incidence ratios (MIRs) have been used as a proxy for estimating survival for multiple cancers and to model melanoma prognosis, higher MIR values reflecting poorer prognosis. Updated and improved pan‐European estimates of mortality and incidence rates for melanoma have become available through the International Agency for Research of Cancer project Globocan 2008, showing marked differences among European countries.

Factors driving the use of dermoscopy in Europe: a pan-European survey.

When used correctly, dermoscopy is an essential tool for helping clinicians in the diagnosis of skin diseases and the early detection of skin cancers. Despite its proven benefits, there is a lack of data about how European dermatologists use dermoscopy in everyday practice.

Impact, challenges and perspectives of Euromelanoma, a pan-European campaign of skin cancer prevention

Euromelanoma is a pan-European campaign for skin cancer prevention combining a free public screening action with an intense, mass-media-supported public education initiative. The results of Euromelanoma public screening were reported, but very little information is available regarding the campaign’s impact on public and professional education and attitude towards skin cancer prevention. As a first step towards analysing this impact, we surveyed the national coordinators of Euromelanoma in the countries participating in the 2010 campaign, through written questionnaires that explored their opinion about the campaign’s effects on the public attitude towards skin cancer and on the dermatology profession, and about the perceived obstacles and perspectives of development for the campaign. Twenty-one of twenty-seven countries representatives answered the survey, reporting in total up to 260 000 screenees through 2010. Between 20% and 40% of the active dermatologists in each country reportedly participated in the voluntary screening, with constant or increasing rate in most (65%) countries. The rate of population screened annually tended to vary inversely with the total country population (Pearson’s correlation coefficient r = 0.56, P < 0.005) and ranged between 0.6& in Switzerland and 0.047& in Poland (European population data for 2010). All survey respondents considered that Euromelanoma campaign benefited the dermatological profession. Most respondents (Table 1) estimated that Euromelanoma highlighted the central role of dermatologists as skin cancer specialists; increased the visibility of dermatologists and dermatology; increased the public awareness of skin cancer and the public demand for skin cancer screening. The survey respondents estimated that Euromelanoma helped the progress of melanoma prevention in their countries, especially through increasing population’s awareness for skin cancer, increasing the demand for skin examinationongoing beyond the campaign day, and through promoting an intensive involvement of media in delivering preventive messages (Table 1). Raising young people’s interest for prevention, the nationwide cooperation of the dermatologists, the interdisciplinary cooperation and the use of a common Euromelanoma questionnaire progressing towards a harmonized European campaign

The impact of dermoscopy on melanoma detection in the practice of dermatologists in Europe: Results of a pan-European survey.

Dermoscopy is a widely used technique that can increase the sensitivity and specificity of melanoma detection. Information is lacking on the impact of dermoscopy use on the detection of melanoma in the real‐life practice of European dermatologists.

Atypical fibroxanthoma—a diagnosis of exclusion!

SummaryFibrohistiocytic tumors of the skin comprise a large range of lesions. One such tumor is the atypical fibroxanthoma (AFX), which is widely considered as a “pseudomalignant” tumor. It is derived from fibroblasts and expresses a variety of histiocytic markers. We present a case of AFX, localized in the right temporal region of the scalp, successfully treated with surgical excision. Immunohistochemical staining helps differentiate this tumor from others in the clinical differential diagnosis, including malignant melanoma, squamous cell carcinoma, and other nonmelanocytic spindle cell tumors such as leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, liposarcoma, and dermatofibrosarcoma protuberans. Historically, AFX was believed to be a superficial variant of malignant fibrous histiocytoma (MFH). However, MFH is now considered a more generalized term for a sarcomatous neoplasm of the subcutaneous tissue. The histopathology of MFH shares features with some malignant mesenchymal neoplasms such as liposarcoma, leiomyosarcoma, rhabdomyosarcoma, and angiosarcoma, but can be differentiated using immunohistochemistry and/or electron microscopy. More recently, the examples of MFH that do not exhibit a more specific line of differentiation have been reclassified as undifferentiated pleomorphic sarcoma (UPS). Many authors currently cannot draw a distinction between AFX and UPS. The clinical and histopathological differences between AFX and UPS are often difficult to delineate. It is probable that they represent two poles of the same disease. Surgical excision in the patient we describe resulted in excellent aesthetic results with lack of recurrence in the 7-month postoperative period.ZusammenfassungDie fibrohistozytären der Haut zeigen eine große Bandbreite. Eine der Vertreter ist das atypische Fibroxanthom (AFX), welches oftmals als „pseudomaligner“ Tumor angesehen wird. Der Tumor stammt von den Fibroblasten und exprimiert verschiedene histiozytäre Marker. Wir stellen einen Patienten mit AFX der rechten Temporalregion vor, der erfolgreich chirurgisch behandelt wurde. Die Immmunhistologie erlaubt es, den Tumor von anderen differentialdiagnstisch zu erwägenden Entitäten zu unterscheiden, z.B. vom maliugnen Melanom, dem Plattenepithelkarzinom, sowie anderer nicht-melanozytärer Spindelzelltumore wie Leimyosarkom, Rhabdomyosarkom, Angiosarkom, Liposarkom oder Dermatofibrosarcoma protuberans. Aus historischer Sicht wurde das AFX als superfizielle Variante des malignen fibrösen Histiozytoms angesehen (MFH). Nun wird dasMFH als Oberbegriff sarkomatöser Neoplasien des subkutanenFettgewebes verstanden. Histopathologisch gibt es gewisseGemeinsamkeiten des MFH mit einigen malignen mesenchymalen neoplasie wie dem Liposarkom, Leiomyosarkom, Rhabdomyosarkom und Angiosarkom. Andererseits erlauben Immunhistologie und Elektronenmikroskopie eine Differenzierung. In jüngster Zeit wurden die MFH-Tumore, die nicht einer spezifischen Zelllinie zuzuordnen sind, unter dem Terminus Undifferenziertes Pleomorphes Sarkom (UPS) zusammengefaßt. Viele Autoren unterscheiden AFX und OPS. Allerdings sind die Abgrenzungen im Einzelfall schwierig. Möglicherweise repräsentieren sie zwei Pole einer Erkrankung. Die chirurgische Exzision beim vorgestellten patienten zeigte ein exzellentes ästhetisches Ergebnis. In der Nachbeobachtung über 7 Monate kam es zu keinem Rezidiv.

Skin Cancer Prevention Educational Resources: Just a Click Away?

BACKGROUND The general public and health professionals are increasingly choosing the Internet to access skin cancer prevention information. OBJECTIVES To identify the optimal mechanism for finding skin cancer educational resources through the Internet and to characterize the resources currently available on‐line. METHODS A survey of experts involved in skin cancer prevention, followed by standardized searches through popular general Internet search engines using a list of 10 terms relevant to skin cancer prevention resources. RESULTS Internet search was the preferred modality for identifying skin cancer educational resources of all survey participants. The five most‐trusted Internet sites identified by the survey participants ranked within the top 10 most findable web sites using general search engines. Ninety‐six of 1,000 web pages retrieved using general web‐search engines provided information regarding specific skin cancer prevention resources. Seven databases were identified that catalogued educational resources from multiple sources. Peer‐reviewed analysis of the outcomes associated with the educational resources was available for only four of 489 resources identified (2.7%). CONCLUSIONS Information on skin cancer educational resources available on the Internet is abundant but redundant, and direct access to these resources remains difficult. No sites were identified that comprehensively catalogued and characterized the resources available from the leading providers. &NA; The authors have indicated no significant interest with commercial supporters.

Characterization of Human Skin by Fluorescence, Exemplified by Dermatofibroma, Keratoacanthoma, and Seborrheic Keratosis

ABSTRACT In vivo real-time skin evaluation was performed by fluorescence spectroscopy on three examples of benign lesions: keratoacanthoma, seborrheic keratosis, and dermatofibroma. Spectral domains corresponding to elastin crosslinks, flavins, and porphyrins fluorophores were investigated. For all skin lesions, the total area of the fluorescence spectra was higher for healthy skin in comparison with the lesions, whereas specific fluorophores’ areas showed varying behavior. Unlike the total area and the areas of the flavins and porphyrins, which decreased in diseased tissues, the fluorescence area associated with elastin crosslinks showed an increase in keratoacanthoma. This is the first attempt to characterize benign lesions using a single excitation wavelength associated with the calculus of specific spectral areas. The evaluation of the area of spectral domains associated with specific skin fluorophores may quantify changes at the molecular level and lower the errors associated with single wavelength measurements. This work provides a promising perspective on the use of fluorescence spectroscopy in clinical practice, yielding good results, with low acquisition costs and rapid analysis time.