Browsing by Author "Padeken, Michael"

We report a 14-year-old girl with a large speckled lentiginous naevus (SLN) on her left arm and shoulder. As the occurrence of melanoma within SLN has been described previously, long-term follow-up of atypical lesions by digital dermoscopy was started at the age of 4 years. To date, nine Spitz naevi and four dysplastic compound naevi have been excised due to dynamic changes over time. No melanoma has so far been detected. We critically discuss the possibility of an 'overtreatment' because of a high rate of physiological changes within SLN of children. In conclusion, we would like to encourage a close follow-up of large SLN whenever complete excision is not an option. In order to avoid unnecessary excisions triggered by subtle dynamic changes, a standard approach with overview images, conventional dermoscopy and early excision of lesions that are rated as suspicious for melanoma by established algorithms may be recommended.

Early detection of melanoma metastases is essential for effective treatment and may be crucial for the prevention of systemic metastases and patient survival. However, data demonstrating the reliability and accuracy of ultrasound examination for the detection of lymph node metastases, in addition to clinical examination, are rare. We have examined 433 melanoma patients with stage-dependent follow-up intervals of 3 to 12 months. One thousand three hundred and thirty-two paired clinical and nonblinded sonographic tests of the locoregional lymph node areas were performed. Lesions suspicious of melanoma metastases were examined histopathologically. Of note, sensitivity [0.9394 (95% confidence interval: 0.7977-0.9926)] and specificity [0.9808 (95% confidence interval: 0.9717-0.9875)] of combined clinical and sonographic investigations were significantly (P < 0.0001) higher than clinical results alone. Significant differences between clinical follow-up and sonographically assisted follow-up were found for American Joint Committee on Cancer 2002 melanoma stages I (P = 0.0389), III P = 0.0101), and IV (P = 0.0016). For stage II melanoma, a trend was detected (P = 0.0821). Lymph node metastases were detected sonographically in 1.73% of clinically metastasis-free investigations (n = 22). Our data suggest that high-frequency sonography should be part of all melanoma follow-up investigations, independent of melanoma type, melanoma stage, or lymph node biopsy status. Melanoma Res 21:457-463 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

Background: Nevus spilus (NS) defines a cafe-au-lait macule with superimposed maculopapular speckles. Although the cafe-au-lait macule often presents at birth, the darker pigmented speckles increase in number and size during a period of several years. The need for close follow-Lip of patients with NS is underlined by reports of several cases of cutaneous melanoma developing within Such lesions. Methods: We followed up 4 adult patients (3 male, one female; mean age 38 years) with Unilateral segmental NS of the thoracic or abdominal region. The NS was present at birth in all 4 patients. Follow-up by sequential digital dermatoscopy and digital overview images was scheduled every 6 to 12 months. Results: During surveillance (mean follow-up time, 8.1.5 years), 3 melanocytic lesions were excised. in one patient focal enlargement prompted excision of two dysplastic compound nevi. In another patient new black dots and focal peripheral hyperpign-lentation were detected by comparison with previous images. Histologic analysis confirmed the diagnosis of invasive melanoma (Breslow thickness, 0.6 mm). Limitations: This observational clinical study included a small number of patients. Sequential digital dermatoscopy of large NS in children may lead to Unnecessary excisions because of physiologic changes. Conclusion: We suggest close follow-up of patients with segmental NS whenever complete excision is not possible. In adults, follow-tip by digital dermatoscopy and excision of lesions with dynamic changes may assist in the early detection of melanoma. (J Am Acad Dermatol 2009;61:337-41.)