Melanoma

M. Shane Chapman, MD

Vitamin A is required for the proper functioning of many important metabolic and physiologic activities, including vision, gene transcription, the immune system and skin cell differentiation. Both excessive and deficient levels of vitamin A lead to poor functioning of many human systems. The biologically active form, retinoic acid, binds to nuclear receptors that facilitate transcription that ultimately leads to it’s physiological effects. Retinoids are derivatives of vitamin A that are medications used to treat acne vulgaris, psoriasis, ichthyosis (and other disorders of keratinization), skin cancer prevention as well as several bone marrow derived neoplasias. Systemic retinoids are teratogenic and have to be prescribed with caution and close oversight. Other potential adverse events are controversial. These include the relationship of retinoid derivatives in sunscreens, their effects on bone mineral density, depression and suicidal ideation and inflammatory bowel disease. These controversies will be discussed in detail.

*For a PDF of the full article, click on the link to the left of this introduction.

M. Shane Chapman, MD

Vitamin A is required for the proper functioning of many important metabolic and physiologic activities, including vision, gene transcription, the immune system and skin cell differentiation. Both excessive and deficient levels of vitamin A lead to poor functioning of many human systems. The biologically active form, retinoic acid, binds to nuclear receptors that facilitate transcription that ultimately leads to it’s physiological effects. Retinoids are derivatives of vitamin A that are medications used to treat acne vulgaris, psoriasis, ichthyosis (and other disorders of keratinization), skin cancer prevention as well as several bone marrow derived neoplasias. Systemic retinoids are teratogenic and have to be prescribed with caution and close oversight. Other potential adverse events are controversial. These include the relationship of retinoid derivatives in sunscreens, their effects on bone mineral density, depression and suicidal ideation and inflammatory bowel disease. These controversies will be discussed in detail.

*For a PDF of the full article, click on the link to the left of this introduction.

M. Shane Chapman, MD

Vitamin A is required for the proper functioning of many important metabolic and physiologic activities, including vision, gene transcription, the immune system and skin cell differentiation. Both excessive and deficient levels of vitamin A lead to poor functioning of many human systems. The biologically active form, retinoic acid, binds to nuclear receptors that facilitate transcription that ultimately leads to it’s physiological effects. Retinoids are derivatives of vitamin A that are medications used to treat acne vulgaris, psoriasis, ichthyosis (and other disorders of keratinization), skin cancer prevention as well as several bone marrow derived neoplasias. Systemic retinoids are teratogenic and have to be prescribed with caution and close oversight. Other potential adverse events are controversial. These include the relationship of retinoid derivatives in sunscreens, their effects on bone mineral density, depression and suicidal ideation and inflammatory bowel disease. These controversies will be discussed in detail.

*For a PDF of the full article, click on the link to the left of this introduction.

Brian Poligone, MD, PhD, and Peter Heald, MD

In the management of patients with cutaneous T-cell lymphoma (CTCL), there are numerous distinct therapy options. Each of these therapies is discussed in terms of when to use it, what factors limit the success of the treatment, and what to expect. A menu is defined as a list of items from which to choose. The treatments for CTCL are presented in various menus where they are options for a particular goal in a particular setting of CTCL. The best recognized clinical scenarios of CTCL are those recognized by the staging system: limited patch plaque (T1), disseminated patch plaque (T2), erythroderma (T4), and tumor (T3). Each phase of the disease will have the menu of therapy options presented for a given goal of management.

*For a PDF of the full article, click on the link to the left of this introduction.

Brian Poligone, MD, PhD, and Peter Heald, MD

In the management of patients with cutaneous T-cell lymphoma (CTCL), there are numerous distinct therapy options. Each of these therapies is discussed in terms of when to use it, what factors limit the success of the treatment, and what to expect. A menu is defined as a list of items from which to choose. The treatments for CTCL are presented in various menus where they are options for a particular goal in a particular setting of CTCL. The best recognized clinical scenarios of CTCL are those recognized by the staging system: limited patch plaque (T1), disseminated patch plaque (T2), erythroderma (T4), and tumor (T3). Each phase of the disease will have the menu of therapy options presented for a given goal of management.

*For a PDF of the full article, click on the link to the left of this introduction.

Brian Poligone, MD, PhD, and Peter Heald, MD

In the management of patients with cutaneous T-cell lymphoma (CTCL), there are numerous distinct therapy options. Each of these therapies is discussed in terms of when to use it, what factors limit the success of the treatment, and what to expect. A menu is defined as a list of items from which to choose. The treatments for CTCL are presented in various menus where they are options for a particular goal in a particular setting of CTCL. The best recognized clinical scenarios of CTCL are those recognized by the staging system: limited patch plaque (T1), disseminated patch plaque (T2), erythroderma (T4), and tumor (T3). Each phase of the disease will have the menu of therapy options presented for a given goal of management.

*For a PDF of the full article, click on the link to the left of this introduction.

Allison T. O’Donnell, MPH, and Caroline C. Kim, MD

The incidence of melanoma is on the rise, and early detection of disease is imperative to reduce mortality. Dermatologists are key players in the early detection of melanoma; however, some clinicians rely on their clinical examination without any additional diagnostic tools to make this important diagnosis. Certain patients, such as atypical nevus patients, have more complicated mole examinations, making the diagnosis of melanoma difficult, whereas some melanomas, such as amelanotic melanomas, can be diagnostically challenging. The goal of the clinician is to detect melanoma with the highest accuracy, while avoiding unnecessary biopsies. Using diagnostic melanoma tools as an adjunct to the clinical examination, dermatologists have the opportunity to increase both their sensitivity and specificity for melanoma detection. This article will review current imaging technologies and those in development for pigmented lesions, updating the clinician on basic principals of such modalities and clinical use of such technologies in practice.

*For a PDF of the full article, click on the link to the left of this introduction.

Allison T. O’Donnell, MPH, and Caroline C. Kim, MD

The incidence of melanoma is on the rise, and early detection of disease is imperative to reduce mortality. Dermatologists are key players in the early detection of melanoma; however, some clinicians rely on their clinical examination without any additional diagnostic tools to make this important diagnosis. Certain patients, such as atypical nevus patients, have more complicated mole examinations, making the diagnosis of melanoma difficult, whereas some melanomas, such as amelanotic melanomas, can be diagnostically challenging. The goal of the clinician is to detect melanoma with the highest accuracy, while avoiding unnecessary biopsies. Using diagnostic melanoma tools as an adjunct to the clinical examination, dermatologists have the opportunity to increase both their sensitivity and specificity for melanoma detection. This article will review current imaging technologies and those in development for pigmented lesions, updating the clinician on basic principals of such modalities and clinical use of such technologies in practice.

*For a PDF of the full article, click on the link to the left of this introduction.

Allison T. O’Donnell, MPH, and Caroline C. Kim, MD

The incidence of melanoma is on the rise, and early detection of disease is imperative to reduce mortality. Dermatologists are key players in the early detection of melanoma; however, some clinicians rely on their clinical examination without any additional diagnostic tools to make this important diagnosis. Certain patients, such as atypical nevus patients, have more complicated mole examinations, making the diagnosis of melanoma difficult, whereas some melanomas, such as amelanotic melanomas, can be diagnostically challenging. The goal of the clinician is to detect melanoma with the highest accuracy, while avoiding unnecessary biopsies. Using diagnostic melanoma tools as an adjunct to the clinical examination, dermatologists have the opportunity to increase both their sensitivity and specificity for melanoma detection. This article will review current imaging technologies and those in development for pigmented lesions, updating the clinician on basic principals of such modalities and clinical use of such technologies in practice.

*For a PDF of the full article, click on the link to the left of this introduction.

Michael Krathen, MD

The detection of cutaneous melanoma still largely relies on clinical suspicion, skin biopsy, and histopathologic evaluation. New technologies are being evaluated to bypass the skin biopsy in the detection of melanoma. The quest for reliable biomarkers, with respect to subclinical detection, prognosis, and predicting treatment response, is longstanding and ongoing. New therapies have been developed for metastatic disease, including targeted small molecule inhibitors as well as immune modulators.

*For a PDF of the full article, click on the link to the left of this introduction.

Michael Krathen, MD

The detection of cutaneous melanoma still largely relies on clinical suspicion, skin biopsy, and histopathologic evaluation. New technologies are being evaluated to bypass the skin biopsy in the detection of melanoma. The quest for reliable biomarkers, with respect to subclinical detection, prognosis, and predicting treatment response, is longstanding and ongoing. New therapies have been developed for metastatic disease, including targeted small molecule inhibitors as well as immune modulators.

*For a PDF of the full article, click on the link to the left of this introduction.

Michael Krathen, MD

The detection of cutaneous melanoma still largely relies on clinical suspicion, skin biopsy, and histopathologic evaluation. New technologies are being evaluated to bypass the skin biopsy in the detection of melanoma. The quest for reliable biomarkers, with respect to subclinical detection, prognosis, and predicting treatment response, is longstanding and ongoing. New therapies have been developed for metastatic disease, including targeted small molecule inhibitors as well as immune modulators.

*For a PDF of the full article, click on the link to the left of this introduction.

Vemurafenib, an oral inhibitor of some mutated forms of the BRAF serine threonine kinase, was recently approved for the treatment of patients with unresectable or metastatic melanoma with the BRAF V600E mutation as detected by an FDA- approved test. It is not recommended for use in patients with wild-type BRAF melanoma. The clinical trial supporting approval of vemurafenib (PLX4032) was performed in treatment-naïve patients with the V600E mutation as detected by the Cobas 4800 BRAF V600 Mutation Test. About 40%-60% of cutaneous melanomas have BRAF mutations that result in constitutive activation of downstream signaling through the MAPK pathway; about 90% of those carry the V600E mutation.

*For a PDF of the full article, click on the link to the left of this introduction.

Vemurafenib, an oral inhibitor of some mutated forms of the BRAF serine threonine kinase, was recently approved for the treatment of patients with unresectable or metastatic melanoma with the BRAF V600E mutation as detected by an FDA- approved test. It is not recommended for use in patients with wild-type BRAF melanoma. The clinical trial supporting approval of vemurafenib (PLX4032) was performed in treatment-naïve patients with the V600E mutation as detected by the Cobas 4800 BRAF V600 Mutation Test. About 40%-60% of cutaneous melanomas have BRAF mutations that result in constitutive activation of downstream signaling through the MAPK pathway; about 90% of those carry the V600E mutation.

*For a PDF of the full article, click on the link to the left of this introduction.

Vemurafenib, an oral inhibitor of some mutated forms of the BRAF serine threonine kinase, was recently approved for the treatment of patients with unresectable or metastatic melanoma with the BRAF V600E mutation as detected by an FDA- approved test. It is not recommended for use in patients with wild-type BRAF melanoma. The clinical trial supporting approval of vemurafenib (PLX4032) was performed in treatment-naïve patients with the V600E mutation as detected by the Cobas 4800 BRAF V600 Mutation Test. About 40%-60% of cutaneous melanomas have BRAF mutations that result in constitutive activation of downstream signaling through the MAPK pathway; about 90% of those carry the V600E mutation.

*For a PDF of the full article, click on the link to the left of this introduction.