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Melanoma: HELP
Articles by Ralph Peter Braun
Based on 45 articles published since 2008

Between 2008 and 2019, R. P. Braun wrote the following 45 articles about Melanoma.
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial The Recognition Process in Dermoscopy: Analytic Approach vs Heuristic Approach. 2015

Scope, Alon / Braun, Ralph P. ·Department of Dermatology, Sheba Medical Center, Ramat Gan and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Department of Dermatology, University Hospital Zürich, Switzerland. ·JAMA Dermatol · Pubmed #25715053.

ABSTRACT: -- No abstract --

2 Editorial Remodeling of the dermoepidermal junction in superficial spreading melanoma: insights gained from correlation of dermoscopy, reflectance confocal microscopy, and histopathologic analysis. 2008

Scope, Alon / Zalaudek, Iris / Ferrara, Gerardo / Argenziano, Giuseppe / Braun, Ralph P / Marghoob, Ashfaq A. · ·Arch Dermatol · Pubmed #19075152.

ABSTRACT: -- No abstract --

3 Review Usefulness of dermoscopy to improve the clinical and histopathologic diagnosis of skin cancers. 2019

Yélamos, Oriol / Braun, Ralph P / Liopyris, Konstantinos / Wolner, Zachary J / Kerl, Katrin / Gerami, Pedram / Marghoob, Ashfaq A. ·Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain. Electronic address: oyelamos@gmail.com. · Department of Dermatology, University Hospital Zürich, Zürich, Switzerland. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York. · Department of Dermatology, Feinberg School of Medicine, The Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois. · Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York; Dermatology Service, Memorial Sloan Kettering Cancer Center, Hauppauge, New York. ·J Am Acad Dermatol · Pubmed #30321580.

ABSTRACT: Multiple studies have shown that dermoscopy increases the sensitivity and specificity for the detection of skin cancers compared with examination by the naked eye. Dermoscopy can also lead to the detection of thinner and smaller cancers. In addition, dermoscopy leads to the more precise selection of lesions requiring excision. In essence, dermoscopy helps clinicians differentiate benign from malignant lesions through the presence or absence of specific dermoscopic structures. Therefore, because most dermoscopic structures have direct histopathologic correlates, dermoscopy can allow the prediction of certain histologic findings present in skin cancers, thus helping select management and treatment options for select types of skin cancers. Visualizing dermoscopic structures in the ex vivo specimens can also be beneficial. It can improve the histologic diagnostic accuracy by targeted step-sectioning in areas of concern, which can be marked by the clinician before sending the specimen to the pathologist, or by the pathologist on the excised specimen in the laboratory. In addition, ex vivo dermoscopy can also be used to select tumor areas with genetic importance because some dermoscopic structures have been related to mutations with theragnostic relevance. In the second article in this continuing medical education series, we review the impact of dermoscopy on the diagnostic accuracy of skin cancer, how dermoscopy can affect the histopathologic examination, and which dermoscopic features may be more relevant in terms of histologic and genetic prediction.

4 Review Update on adjuvant melanoma therapy. 2018

Dimitriou, Florentia / Braun, Ralph Peter / Mangana, Joanna. ·Department of Dermatology, University Hospital Zurich. · Kein Division, University of Zurich, Zurich, Switzerland. ·Curr Opin Oncol · Pubmed #29256902.

ABSTRACT: PURPOSE OF REVIEW: We review the results from relevant clinical trials and discuss current strategies in the melanoma adjuvant setting. RECENT FINDINGS: The favorable therapeutic efficacy and the significant less toxicity of nivolumab compared with ipilimumab, fully substitutes today's approval of ipilimumab, regardless mutation status, whereas in BRAF-mutated patients, dabrafenib and trametinib seem to confirm their high efficacy also in adjuvant setting. The use of interferon is restricted to patients with ulcerated melanoma and countries with no access to the new drugs. SUMMARY: Systemic adjuvant treatment after complete disease resection in high-risk melanoma patients aims to increase relapse-free survival (RFS) and overall survival (OS). According to the eighth edition of melanoma classification of American Joint Committee on Cancer (AJCC), the prognosis in stage III patients is heterogeneous and depends not only on N (nodal) but also on T (tumor thickness) category criteria. Recent data from randomized, phase-3 clinical trials analyzing the use of adjuvant anti-programmed death-1 and targeted therapies ultimately affect the standard of care and change the landscape of the adjuvant treatment.

5 Review Electrical Impedance Spectroscopy in Skin Cancer Diagnosis. 2017

Braun, Ralph P / Mangana, Johanna / Goldinger, Simone / French, Lars / Dummer, Reinhard / Marghoob, Ashfaq A. ·Department of Dermatology, University Hospital Zürich, Gloriastr 31, 8091 Zürich, Switzerland. Electronic address: Ralph.Braun@usz.ch. · Department of Dermatology, University Hospital Zürich, Gloriastr 31, 8091 Zürich, Switzerland. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 275 York Avenue, New York, NY 10065, USA. ·Dermatol Clin · Pubmed #28886804.

ABSTRACT: Electrical impedance spectroscopy (EIS) is a noninvasive method that aims to help diagnose skin cancer. The EIS device consists of a handheld probe with a disposable electrode that is applied directly on the skin and uses electrical impendence differences to differentiate between normal and abnormal skin lesions. The EIS algorithm is best used on lesions that are deemed clinically or dermoscopically suspicious and has a high sensitivity in detecting malignant melanoma. The greatest usefulness of EIS is achieved in conjunction with a physician who has experience with this modality and excellent training in the clinical detection of suspicious lesions.

6 Review Critical aspects to achieve a high-quality melanoma clinic. 2017

Dummer, Reinhard / Ramelyte, Egle / Levesque, Mitch / Goldinger, Simone M / Braun, Ralph P. ·aDepartment of Dermatology, University Hospital of Zurich, Zurich, Switzerland bVilnius University, Centre of Dermatovenereology, Vilnius, Lithuania. ·Curr Opin Oncol · Pubmed #28027104.

ABSTRACT: PURPOSE OF REVIEW: With incidence of melanoma growing worldwide and new therapies prolonging the survival of patients with advanced disease, complex medical care is needed. RECENT FINDINGS: Best care of complicated melanoma cases is achieved in specialized referral centers. Aims to provide optimized melanoma therapy, best patient-reported treatment outcome, and successful clinical and translational research, necessitate a dedicated interdisciplinary team. SUMMARY: We report on critical aspects of the interaction between patients, medical care givers, clinical trial and biobanking teams, and emphasize the importance of interdisciplinary tumor boards. Specialized skin cancer nurses and local patient advocacy groups should be involved in patient care and could be the binding link between the patients and the treatment team.

7 Review The updated Swiss guidelines 2016 for the treatment and follow-up of cutaneous melanoma. 2016

Dummer, Reinhard / Siano, Marco / Hunger, Robert E / Lindenblatt, Nicole / Braun, Ralph / Michielin, Oliver / Mihic-Probst, Daniela / von Moos, Roger / Najafi, Yousef / Guckenberger, Merlin / Arnold, Andreas. ·Skin Cancer Centre, Dept. of Dermatology, University Hospital of Zurich, Switzerland. · Dept. of Oncology, Kantonalspital St. Gallen, Switzerland. · Skin Cancer Centre, Dept. of Dermatology, University of Bern, Inselspital, Bern, Switzerland. · Division of Plastic Surgery and Hand Surgery, University Hospital of Zurich, Switzerland. · Dept. of Oncology, University Hospital of Lausanne, Switzerland. · Dept. of surgical Pathology, University Hospital of Zurich, Switzerland. · Dept. of Oncology, Kantonalspital Chur, Switzerland. · Dept. Radiation Oncology, University Hospital of Zurich, Switzerland. · Dept. of Dermatology, University Hospital of Basel, Switzerland. ·Swiss Med Wkly · Pubmed #26901103.

ABSTRACT: Cutaneous melanoma is the most deadly cutaneous neoplasm. In order to guide treatment decisions and follow-up of melanoma patients, guidelines for the management of melanoma in Switzerland were inaugurated in 2001 and revised in 2006 and 2016. Recent data on surgical and medical treatments from randomised trials necessitated modification of the treatment and follow-up recommendations.

8 Review A clinico-dermoscopic approach for skin cancer screening: recommendations involving a survey of the International Dermoscopy Society. 2013

Argenziano, Giuseppe / Giacomel, Jason / Zalaudek, Iris / Blum, Andreas / Braun, Ralph P / Cabo, Horacio / Halpern, Allan / Hofmann-Wellenhof, Rainer / Malvehy, Josep / Marghoob, Ashfaq A / Menzies, Scott / Moscarella, Elvira / Pellacani, Giovanni / Puig, Susana / Rabinovitz, Harold / Saida, Toshiaki / Seidenari, Stefania / Soyer, H Peter / Stolz, Wilhelm / Thomas, Luc / Kittler, Harald. ·Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova IRCCS, Viale Risorgimento 80, Reggio Emilia 42100, Italy. Electronic address: g.argenziano@gmail.com. ·Dermatol Clin · Pubmed #24075542.

ABSTRACT: Dermoscopy is useful for skin cancer screening, but a detailed approach is required that integrates this tool into a rational clinical work flow. To investigate clinician perceptions and behavior in approaching patients with skin tumors, a survey was launched by electronic mail through the International Dermoscopy Society. After 4 months, the responses were analyzed and significant findings calculated. Considering the current approach of study participants in examining patients for skin cancer, an up-to-date system of triage is presented in this review, which aims to promote an improved diagnostic accuracy and more timely management of skin malignancy.

9 Review Dermoscopy for the pediatric dermatologist part III: dermoscopy of melanocytic lesions. 2013

Haliasos, Elena C / Kerner, Miryam / Jaimes, Natalia / Zalaudek, Iris / Malvehy, Josep / Hofmann-Wellenhof, Rainer / Braun, Ralph P / Marghoob, Ashfaq A. ·Department of Dermatology, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey, USA. ·Pediatr Dermatol · Pubmed #23252411.

ABSTRACT: Melanocytic nevi encompass a variety of lesions, including blue, Spitz, congenital, and acquired nevi. These nevi can occasionally manifest clinical morphologies resembling melanoma, and the presence of such nevi in children can elicit anxiety in patients, parents, and clinicians. Dermoscopy has been shown to increase the diagnostic accuracy for melanoma and to help differentiate melanoma from nevi, ultimately aiding in the decision-making process as to whether to perform a biopsy. Dermoscopy is the perfect instrument to use during the evaluation of pigmented skin lesions in children because it is painless and provides important information for the clinician that can assist in formulating appropriate management decisions. This review highlights the most common benign dermoscopic patterns encountered in nevi and discuss the 10 most common dermoscopic structures seen in melanomas. Lesions manifesting a benign dermoscopic pattern and lacking any melanoma-specific structures do not need to be excised and can safely be monitored. In contrast, melanomas will invariably deviate from the benign nevus patterns and will usually manifest at least 1 of the 10 melanoma-specific structures: atypical network, negative network, streaks, crystalline structures, atypical dots and globules, irregular blotch, blue-white veil, regression structures, peripheral brown structureless areas, and atypical vessels. It is important to be cognizant of the fact that melanomas in childhood usually do not manifest the clinical ABCD features. Instead, they are often symmetric, amelanotic, nodular lesions. Although the clinical appearance may not be alarming, with dermoscopy they will invariably manifest at least one melanoma-specific structure, the most common being atypical vascular structures and crystalline structures.

10 Review Clinical and dermoscopic characteristics of amelanotic melanomas that are not of the nodular subtype. 2012

Jaimes, N / Braun, R P / Thomas, L / Marghoob, A A. ·Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. ·J Eur Acad Dermatol Venereol · Pubmed #21585561.

ABSTRACT: BACKGROUND: Amelanotic melanomas remain challenging to diagnose. OBJECTIVE: To analyze and describe the clinical and dermoscopic characteristics of amelanotic melanomas that are not of the nodular subtype. PATIENTS/METHODS: We conducted a retrospective review of 20 consecutively diagnosed amelanotic melanomas. The clinical and dermoscopic images of pathologically confirmed amelanotic melanomas that were not of the nodular subtype were analyzed. In addition, the clinical diagnosis and the reasons why these lesions were biopsied were examined. RESULTS: All 20 amelanotic melanomas were erythematous and lacked any of the clinical ABCD features commonly attributed to melanoma. The lesions appeared clinically to be relatively symmetric with regular borders and manifesting a circular to oval morphology. Dermoscopically, all lesions manifested polymorphous vascular pattern. CONCLUSIONS: Amelanotic melanomas that are not of the nodular subtype often present as clinically symmetric erythematous lesions. Therefore, it is important to consider AMs in the differential diagnosis of isolated and persistent erythematous outlier lesions, even if they are symmetric in appearance. Additionally, the presence of a polymorphous vascular pattern seen with dermoscopy can facilitate in correctly identifying these melanomas.

11 Review Dermoscopy of benign and malignant neoplasms in the pediatric population. 2010

Haliasos, Helen C / Zalaudek, Iris / Malvehy, Josep / Lanschuetzer, Christoph / Hinter, Helmut / Hofmann-Wellenhof, Rainer / Braun, Ralph / Marghoob, Ashfaq A. ·Division of Dermatology, Medical University of Graz, Graz, Austria. ·Semin Cutan Med Surg · Pubmed #21277535.

ABSTRACT: Dermoscopy is a noninvasive technique that enables visualization of subsurface colors and structures within the skin that are imperceptible to the naked eye. The dermatoscope allows the physician to examine both the macroscopic and microscopic primary morphology of skin lesions, identify subtle clinical clues, confirm naked-eye clinical diagnoses, and monitor treatment progress while posing little threat to the young patient. Dermoscopic findings have been formulated into diagnostic criteria that assist experienced clinicians in differentiating benign and malignant neoplasms. In this review, clinical morphology of melanocytic nevi and melanoma in the pediatric population is examined and the relevant dermoscopic findings and histopathologic correlates that aid in the diagnosis and management of these lesions are described.

12 Review [Early diagnosis of skin cancer]. 2010

Kolm, Isabell / Hofbauer, Günther / Braun, Ralph P. ·Dermatologische Klinik, Universitätsspital Zürich, Gloriastrasse 31 CH, Zurich. ·Ther Umsch · Pubmed #20806172.

ABSTRACT: The skin is the most affected organ by cancer. The incidence rates of skin cancer are steadily increasing, both for melanoma and non-melanoma skin cancers (squamous cell carcinoma, basal cell carcinoma). Over 90 % of the death cases from skin cancers attribute to melanoma. Survival from melanoma is strongly related to tumour thickness. Therefore early detection is the most important step to improve prognosis. In the last years a number of new non invasive techniques for the early diagnosis of melanoma have been developed which are superior to the naked eye examination. In this overview article we present some non-invasive diagnostic techniques like total body photography, digital dermoscopy and confocal microscopy which in addition to dermoscopy assist the dermatologist in differentiating nevi from early melanomas.Non-melanoma skin cancer can be prevented by accurate sun protection. Early squamous cell carcinomas and basal cell carcinomas can be treated either invasively or non-invasively with excellent prognosis.

13 Review Dermoscopy patterns of nevi associated with melanoma. 2010

Kolm, I / French, L / Braun, R P. ·Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland. ·G Ital Dermatol Venereol · Pubmed #20197749.

ABSTRACT: It is well known that dermoscopy improves the diagnostic accuracy of pigmented skin lesions. Many dermoscopic criteria can be found both in nevi and in melanoma. For the correct interpretation of those criteria, formal training and clinical experience in dermoscopy is needed. This paper reviews the global and local dermoscopic features seen both in nevi and melanoma and focuses on the interpretation of those findings in order to differentiate between benign and malignant melanocytic skin tumors.

14 Review [Non-invasive techniques for the diagnosis of melanoma]. 2009

Kolm, I / French, L E / Braun, R P. ·Hautkrebsvorsorge-Sprechstunde, Dermatologische Klinik, Universitätsspital Zürich. ·Praxis (Bern 1994) · Pubmed #20013689.

ABSTRACT: In the last years a number of new non invasive techniques for the early diagnosis of melanoma have become very popular. In addition to dermoscopy, total body photography and digital dermoscopy frequently assist the dermatologist in differentiating nevi from early melanomas. A new promising technique for the non invasive diagnosis of melanoma might be confocal microscopy.

15 Review Congenital melanocytic naevi. 2009

Kovalyshyn, Ivanka / Braun, Ralph / Marghoob, Ashfaq. ·Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, USA. ·Australas J Dermatol · Pubmed #19916964.

ABSTRACT: Congenital melanocytic naevi, consisting of clusters of naevo-melanocytes, develop in utero. Although many congenital naevi are visible at birth, some may not become evident until later in life. The timing of naevo-melanocyte proliferation, senescence and melanogenesis may all contribute towards determining when a naevus will become clinically manifest on the skin. Besides the fact that congenital melanocytic naevi may be aesthetically displeasing, resulting in a multitude of psychosocial issues, they also increase the risk for developing cutaneous melanoma, leptomeningeal melanoma, neurocutaneous melanocytosis, malformations of the brain and, rarely, other tumours such as rhabdomyosarcoma and liposarcoma. Whereas the risk of developing malignancy in association with congenital naevi is dependent, to some extent, on the size of the naevus, the risk of developing neurocutaneous melanocytosis correlates best with the number of satellite naevi. Management of patients with congenital melanocytic naevi requires individualization, taking into account the naevus size and location, and the risk of developing cutaneous melanoma or neurocutaneous melanocytosis. When contemplating treatment options, it is important to set realistic expectations and to address the possible aesthetic and functional outcomes, while at the same time addressing the risk for developing cutaneous and/or extracutaneous melanoma.

16 Review Dermoscopy research--an update. 2009

Braun, Ralph P / Rabinovitz, H / Tzu, J E / Marghoob, A A. ·Skin Cancer Diagnosis and Prevention Centre, Department of Dermatology, University Hospital, Zürich, Switzerland. Ralph.Braun@usc.ch ·Semin Cutan Med Surg · Pubmed #19782940.

ABSTRACT: Dermoscopy increases the clinician's diagnostic accuracy by as much as 30% over that of unaided visual clinical inspection alone and has been confirmed in 3 separate evidence-based publications using a meta-analysis of the literature. It can be viewed as an in vivo bridge between clinical morphology and histopathology. This "bridge" has provided clinician researchers with many new insights into morphology and tumor biology. In this article, we provide the reader with an overview of the different aspects of dermoscopy as a research tool. We cover different aspects, such as the new equipment, new structures, the importance of blood vessels, etc.

17 Review Dermoscopy of superficial spreading melanoma. 2009

Obieta, M P / Braun, R P / Scope, A / Rabinovitz, H / Marghoob, A A. ·Dermatology Section, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA. ·G Ital Dermatol Venereol · Pubmed #19218911.

ABSTRACT: Knowledge and insights gained over the past few decades pertaining to the clinical and dermoscopic primary morphology of melanoma has greatly increased the authors' appreciation of the varied faces of this malignancy. This knowledge has improved their ability to detect early melanoma and may in part explain the observed increase in the percentage of thin melanomas being diagnosed today as compared to the past. The authors have previously published in this journal an article on the dermoscopic patterns of melanoma. In this review they will focus on specific dermoscopic structures that are frequently observed in the most common subtype of melanoma, the superficial spreading melanoma.

18 Clinical Trial Does the distribution pattern of brain metastases during BRAF inhibitor therapy reflect phenotype switching? 2017

Haueis, Silvia A / Kränzlin, Pascale / Mangana, Joanna / Cheng, Phil F / Urosevic-Maiwald, Mirjana / Braun, Ralph P / Levesque, Mitchell P / Dummer, Reinhard / Goldinger, Simone M. ·Department of Dermatology, University Hospital Zurich, Zurich, Switzerland. ·Melanoma Res · Pubmed #28099366.

ABSTRACT: Brain metastases (brain mets) are frequent in metastatic melanoma patients. The aim of this study was to investigate the morphology and progression pattern of brain mets in melanoma patients treated with BRAF inhibitors (BRAFi) compared with patients who did not receive targeted therapy (BRAFi group and control group). The number and size of brain mets were compared between a baseline and a comparative MRI at progression. The number of brain mets was grouped into seven number classes (N=1-4, N=5-10, N=11-20, N=21-30, N=31-40, N=41-50, and N>50) and its difference was reported as the change of class that occurred. The mean size of the newly developed lesions was determined by representative measurements and the evolution of three persisting target lesions was assessed on the basis of modified RECIST criteria. Of 96 patients studied, 42 were in the BRAFi group and 54 were in the control group. Patients under BRAFi treatment had a significantly greater increase in the number of brain mets, where the median change of class for the BRAFi compared with the control group was 2 versus 0 (P<0.01). The mean size of the new lesions was smaller in the BRAFi group. Pre-existing target lesions did not show any prominent or different patterns of how they evolved in either group. Brain mets in patients treated with BRAFi showed a progression pattern characterized by a high propensity to disseminate, which might reflect an in-vivo manifestation of phenotype switching in response to targeted therapy, with a predominance of the invasive/migratory tumor cell phenotype. Drivers of invasiveness may present promising targets for therapeutic interventions.

19 Clinical Trial Feasibility and Efficacy of Patient-Initiated Mobile Teledermoscopy for Short-term Monitoring of Clinically Atypical Nevi. 2015

Wu, Xinyuan / Oliveria, Susan A / Yagerman, Sarah / Chen, Lucy / DeFazio, Jennifer / Braun, Ralph / Marghoob, Ashfaq A. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Weill Cornell Medical College, New York, New York. · Memorial Sloan Kettering Cancer Center, New York, New York. · University Hospital Zürich, Zürich, Switzerland. ·JAMA Dermatol · Pubmed #25629626.

ABSTRACT: IMPORTANCE: Patient-driven mobile teledermoscopy may be applicable for monitoring of skin lesions. OBJECTIVE: To assess the feasibility, efficacy, and patient receptivity of teledermoscopy for short-term monitoring of clinically atypical nevi. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective cohort study performed at an institutional referral center in New York. Consecutive patients 18 years or older, with 1 or more clinically atypical nevi that required short-term monitoring and were accessible by a mobile imaging device were recruited for the study. All 34 patients consented to the study, and 29 completed follow-up. Dermoscopic images were obtained in the office-based setting by a dermatologist and with an iPhone by the patient at baseline and follow-up (3-4 months). Patients completed surveys that included questions about skincare awareness and attitudes toward teledermoscopy. Standard dermoscopic images were evaluated by the office-based dermatologist, and mobile dermoscopic images were sent via the Internet to a teledermatologist to evaluate image quality and presence of significant clinical lesion change. The decisions of the teledermatologist and office-based dermatologist were compared. MAIN OUTCOMES AND MEASURES: (1) Feasibility of using mobile dermatoscope by patients, (2) diagnostic concordance of teledermoscopy vs conventional office-based visit, and (3) patient receptivity to teledermoscopy for short-term monitoring of nevi. RESULTS: Of the 29 patients who completed the study, 28 (97%) were able to acquire baseline and follow-up images that were subsequently deemed evaluable by the teledermatologist. The diagnostic concordance between conventional office-based visits and teledermoscopy encounters was 0.87 (SE, 0.13) (κ statistic). In addition, patients reported high receptivity to teledermoscopy for short-term monitoring of nevi. CONCLUSIONS AND RELEVANCE: Results from this pilot study suggest that teledermoscopy is feasible and effective as a method for short-term monitoring of clinically atypical nevi. The implementation of teledermoscopy can potentially enhance patient convenience, optimize physician scheduling, and promote efficiency.

20 Article Sarcoid-like reactions in patients receiving modern melanoma treatment. 2018

Dimitriou, Florentia / Frauchiger, Anna L / Urosevic-Maiwald, Mirjana / Naegeli, Mirjam C / Goldinger, Simone M / Barysch, Marjam / Franzen, Daniel / Kamarachev, Jivko / Braun, Ralph / Dummer, Reinhard / Mangana, Joanna. ·Departments of Dermatology. · Pneumology, University Hospital Zurich, Zurich, Switzerland. ·Melanoma Res · Pubmed #29485531.

ABSTRACT: The development of cancer immunotherapy and targeted therapy has reached an important inflection point in the history of melanoma. Immune checkpoint inhibitors and kinase inhibitors are today's standard of care treatments in advanced melanoma patients. Treatment-related toxicities can be very intriguing and quite challenging. Sarcoidosis is a multisystemic granulomatous disease characterized by an aberrant immune response to unknown antigens, whereas sarcoid-like reactions (SLRs) refer to localized clinical features. We carried out a single-center observational study in patients with stage IIB-IV melanoma treated with BRAF/MEK inhibitors and immune checkpoint inhibitors. A description of the sarcoidosis-related manifestations was provided from patients' records. We observated eight cases of SLRs in a cohort of 200 patients. The clinical courses were characterized by a variety of symptoms, accompanied by cutaneous signs and extracutaneous manifestations such as bilateral, hilar lymphadenopathy. We identified a histologically granulomatous inflammation involving the skin, the lungs, and the lymph nodes. Two patients presented with cutaneous lesions only, and three patients had lung involvement only. Three patients achieved complete and partial response of the melanoma disease, and three patients had stable disease. Disease progression was documented in two patients. The reported immune-related adverse events were mild to severe and in most of the cases were continued without any treatment cessation. SLRs appear during treatment with both kinase and immune checkpoint inhibitors. Awareness of these can avoid misdiagnosis of disease progression and unnecessary treatment changes.

21 Article Differential Diagnosis of Seborrheic Keratosis: Clinical and Dermoscopic Features. 2017

Braun, Ralph P / Ludwig, Sabine / Marghoob, Ashfaq A. · ·J Drugs Dermatol · Pubmed #28915278.


Seborrheic keratosis (SK) is a benign epidermal keratinocytic tumor that is extremely common, particularly in individuals over the age of 50. Most individuals with SK will have more than one lesion and the presence of over 10 lesions in the same person is not uncommon. Although the clinical morphology of most SK with their stuck-on, symmetric, keratotic, and waxy appearance makes them easy to identify, many manifest a morphology resembling melanoma or squamous cell carcinoma. One can argue that such cases will ultimately not prove to be problematic since a simple biopsy will easily reveal their benign nature and eliminate any concerns. However, the cost and morbidity associated with the biopsy of benign lesions should not be underestimated. Methods to improve our in vivo ability to correctly identify SK will prove beneficial not only to the health care system in general but to the individual patient specifically. The issue of greater concern resides with skin cancers that mimic SK or when skin cancers arise in association with SK. Needless to say, in vivo methods to help identify malignancy and differentiate them from benign lesions would be welcomed by all. Fortunately, we do now have in vivo imaging methods such as dermoscopy that can improve the clinician's diagnostic accuracy. In this article, we summarize the current knowledge regarding the clinical and dermoscopic features of SK, and provide clues to aid in their diagnosis.

J Drugs Dermatol. 2017;16(9):835-842.


22 Article Multicenter, real-life experience with checkpoint inhibitors and targeted therapy agents in advanced melanoma patients in Switzerland. 2017

Mangana, Joanna / Cheng, Phil F / Kaufmann, Corina / Amann, Valerie C / Frauchiger, Anna L / Stögner, Viola / Held, Ulrike / von Moos, Roger / Michielin, Olivier / Braun, Ralph P / Levesque, Mitchell P / Goldinger, Simone M / Dummer, Reinhard. ·aDepartment of Dermatology, University Hospital Zurich bUniversity of Zurich cHorten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich dDepartment of Internal Medicine, Cantonal Hospital Aarau, Aarau eDepartment of Oncology, Cantonal Hospital Graubünden, Chur fService of Medical Oncology, Department of Oncology, University Hospital of Lausanne, Lausanne, Switzerland gUniversity of Vienna, Vienna, Austria. ·Melanoma Res · Pubmed #28509765.

ABSTRACT: Metastatic melanoma is a highly aggressive disease. Recent progress in immunotherapy (IT) and targeted therapy (TT) has led to significant improvements in response and survival rates in metastatic melanoma patients. The current project aims to determine the benefit of the introduction of these new therapies in advanced melanoma across several regions of Switzerland. This is a retrospective multicenter analysis of 395 advanced melanoma patients treated with standard chemotherapy, checkpoint inhibitors, and kinase inhibitors from January 2008 until December 2014. The 1-year survival was 69% (n=121) in patients treated with checkpoint inhibitors (IT), 50% in patients treated with TTs (n=113), 85% in the IT+TT group (n=66), and 38% in patients treated with standard chemotherapy (n=95). The median overall survival (mOS) from first systemic treatment in the entire study cohort was 16.9 months. mOS of patients treated either with checkpoint or kinase inhibitors (n=300, 14.6 months) between 2008 and 2014 was significantly improved (P<0.0001) compared with patients treated with standard chemotherapy in 2008-2009 (n=95, 7.4 months). mOS of 61 patients with brain metastases at stage IV was 8.1 versus 12.5 months for patients without at stage IV (n=334), therefore being significantly different (P=0.00065). Furthermore, a significant reduction in hospitalization duration compared with chemotherapy was noted. Treatment with checkpoint and kinase inhibitors beyond clinical trials significantly improves the mOS in real life and the results are consistent with published prospective trial data.

23 Article Incidence trends and clinical-pathological characteristics of invasive cutaneous melanoma from 1980 to 2010 in the Canton of Zurich, Switzerland. 2017

Minini, Remo / Rohrmann, Sabine / Braun, Ralph / Korol, Dimitri / Dehler, Silvia. ·aDivision of Cancer Epidemiology and Prevention, Epidemiology, Biostatistics and Prevention Institute bCancer Registry Zurich and Zug cDepartment of Dermatology, University Hospital Zurich, Zurich, Switzerland. ·Melanoma Res · Pubmed #27926588.

ABSTRACT: The aims of this paper are to describe the incidence trends of invasive cutaneous melanoma in the Canton of Zurich and to evaluate clinical and pathological factors such as cancer subtype, localization, age and Breslow thickness. A retrospective analysis was carried out with data from the population-based Cancer Registry of Zurich and Zug located in Zurich. A total of 8469 cases in 8034 different patients of invasive cutaneous melanoma were registered for the period 1980-2010 in the Canton of Zurich. Incidence trends were age standardized to the European standard population. Joinpoint regression was used to compute changes in incidence and mortality rates, measured as the annual percent change (APC). The most common subtypes of cutaneous melanoma were superficial spreading melanoma (SSM, 41.1%), followed by nodular melanoma (16.5%), lentigo maligna melanoma (13.5%), acral-lentiginous melanoma (5.0%) and other types of melanoma (2.8%); 21.1% were melanoma not otherwise specified. The trunk was the most frequent location (30.8%), followed by the lower limb and hip (26.4%) and the upper limb and shoulder (22.8%). Statistically significantly increasing incidence trends were observed for both men (APC=3.0%) and women (APC=2.1%). Incidences of SSM and melanoma not otherwise specified were the histological subtypes for which a significant increase in incidence was observed (APC for the period 1980-2010=3.2% for both). In terms of Breslow thickness, thin melanomas (0.01-1.00 mm) showed an increasing incidence. The incidence of melanoma increased in both men and women between 1980 and 2010. In terms of the different subtypes and Breslow thickness, increasing incidences of the SSM and of thin melanomas (0.01-1.00 mm) were observed. These observations are in agreement with other studies from Southern and Western Switzerland as well as other European countries and the USA.

24 Article Validity and Reliability of Dermoscopic Criteria Used to Differentiate Nevi From Melanoma: A Web-Based International Dermoscopy Society Study. 2016

Carrera, Cristina / Marchetti, Michael A / Dusza, Stephen W / Argenziano, Giuseppe / Braun, Ralph P / Halpern, Allan C / Jaimes, Natalia / Kittler, Harald J / Malvehy, Josep / Menzies, Scott W / Pellacani, Giovanni / Puig, Susana / Rabinovitz, Harold S / Scope, Alon / Soyer, H Peter / Stolz, Wilhelm / Hofmann-Wellenhof, Rainer / Zalaudek, Iris / Marghoob, Ashfaq A. ·Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York2Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. · Dermatology Unit, Second University of Naples, Naples, Italy. · Department of Dermatology, University Hospital Zürich, Zürich, Switzerland. · Dermatology Service, Aurora Skin Cancer Center, Universidad Pontificia Bolivariana, Medellín, Colombia. · Department of Dermatology, Medical University of Vienna, Vienna, Austria. · Melanoma Unit, Department of Dermatology, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Centro de Investigacion Biomedica en red de enfermedades raras, Barcelona, Spain. · Sydney Melanoma Diagnostic Centre, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, Australia8Discipline of Dermatology, The University of Sydney, New South Wales, Australia. · Center for Environmental, Genetic, and Nutritional Epidemiology, Department of Diagnostic, Clinical, and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy. · Skin and Cancer Associates, Plantation, Florida. · Department of Dermatology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. · Dermatology Research Centre, The University of Queensland, Brisbane, Queensland, Australia13School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia. · Clinic for Dermatology, Allergology, and Environmental Medicine, Klinik Thalkirchner Straße Städt, Klinikum München GmbH, Munich, Germany. · Department of Dermatology, Medical University of Graz, Graz, Austria. ·JAMA Dermatol · Pubmed #27074267.

ABSTRACT: IMPORTANCE: The comparative diagnostic performance of dermoscopic algorithms and their individual criteria are not well studied. OBJECTIVES: To analyze the discriminatory power and reliability of dermoscopic criteria used in melanoma detection and compare the diagnostic accuracy of existing algorithms. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective, observational study of 477 lesions (119 melanomas [24.9%] and 358 nevi [75.1%]), which were divided into 12 image sets that consisted of 39 or 40 images per set. A link on the International Dermoscopy Society website from January 1, 2011, through December 31, 2011, directed participants to the study website. Data analysis was performed from June 1, 2013, through May 31, 2015. Participants included physicians, residents, and medical students, and there were no specialty-type or experience-level restrictions. Participants were randomly assigned to evaluate 1 of the 12 image sets. MAIN OUTCOMES AND MEASURES: Associations with melanoma and intraclass correlation coefficients (ICCs) were evaluated for the presence of dermoscopic criteria. Diagnostic accuracy measures were estimated for the following algorithms: the ABCD rule, the Menzies method, the 7-point checklist, the 3-point checklist, chaos and clues, and CASH (color, architecture, symmetry, and homogeneity). RESULTS: A total of 240 participants registered, and 103 (42.9%) evaluated all images. The 110 participants (45.8%) who evaluated fewer than 20 lesions were excluded, resulting in data from 130 participants (54.2%), 121 (93.1%) of whom were regular dermoscopy users. Criteria associated with melanoma included marked architectural disorder (odds ratio [OR], 6.6; 95% CI, 5.6-7.8), pattern asymmetry (OR, 4.9; 95% CI, 4.1-5.8), nonorganized pattern (OR, 3.3; 95% CI, 2.9-3.7), border score of 6 (OR, 3.3; 95% CI, 2.5-4.3), and contour asymmetry (OR, 3.2; 95% CI, 2.7-3.7) (P < .001 for all). Most dermoscopic criteria had poor to fair interobserver agreement. Criteria that reached moderate levels of agreement included comma vessels (ICC, 0.44; 95% CI, 0.40-0.49), absence of vessels (ICC, 0.46; 95% CI, 0.42-0.51), dark brown color (ICC, 0.40; 95% CI, 0.35-0.44), and architectural disorder (ICC, 0.43; 95% CI, 0.39-0.48). The Menzies method had the highest sensitivity for melanoma diagnosis (95.1%) but the lowest specificity (24.8%) compared with any other method (P < .001). The ABCD rule had the highest specificity (59.4%). All methods had similar areas under the receiver operating characteristic curves. CONCLUSIONS AND RELEVANCE: Important dermoscopic criteria for melanoma recognition were revalidated by participants with varied experience. Six algorithms tested had similar but modest levels of diagnostic accuracy, and the interobserver agreement of most individual criteria was poor.

25 Article Prognostic relevance of lactate dehydrogenase and serum S100 levels in stage IV melanoma with known BRAF mutation status. 2016

Frauchiger, A L / Mangana, J / Rechsteiner, M / Moch, H / Seifert, B / Braun, R P / Dummer, R / Goldinger, S M. ·Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091, Zurich, Switzerland. · Department of Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland. · Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Zurich, Switzerland. ·Br J Dermatol · Pubmed #26659191.

ABSTRACT: BACKGROUND: Activating mutations of BRAF provide an important treatment target in patients with melanoma. The prognostic role of several biochemical markers in relation to mutation status is not clear. OBJECTIVES: To analyse the prognostic significance of BRAF mutation in patients with melanoma and correlate it to different markers. METHODS: In total, 162 patients with stage IV melanoma and known BRAF mutation status were included. Clinical, histopathological and laboratory information was collected and compared between patients with BRAF mutant (BRAFm) and wild-type (BRAFwt) melanoma at the time of first distant metastasis. RESULTS: In total, 88 patients (54%) had BRAFm melanoma (V600E/V600K). At the first distant metastasis, S100B levels in BRAFm patients were more frequently elevated (P = 0·01) and significantly higher (P = 0·02). Median overall survival (mOS) was significantly longer in BRAFwt patients with normal compared with patients with elevated S100B levels (P < 0·01). In BRAFm melanoma, elevated S100B levels showed no prognostic influence (P = 0·18). Elevated lactate dehydrogenase (LDH) levels had a significantly negative impact on mOS in both groups. mOS was increased for BRAFm patients treated with a BRAF inhibitor (BRAFi) compared with BRAFm patients not receiving BRAFi (P = 0·01). No difference in mOS between BRAFm patients who did not receive BRAFi treatment and BRAFwt patients was observed. CONCLUSIONS: Better mOS was observed in BRAFm patients treated with BRAFi. BRAFm patients not treated with BRAFi show similar survival curves to BRAFwt patients. Elevated LDH is a BRAF-independent prognostic parameter; S100B has prognostic significance in BRAFwt melanoma only.