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Melanoma: HELP
Articles by Joao Pedreira Duprat Neto
Based on 18 articles published since 2008
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Between 2008 and 2019, J. P. Duprat Neto wrote the following 18 articles about Melanoma.
 
+ Citations + Abstracts
1 Guideline Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II. 2016

Castro, Luiz Guilherme Martins / Bakos, Renato Marchiori / Duprat Neto, João Pedreira / Bittencourt, Flávia Vasques / Di Giacomo, Thais Helena Bello / Serpa, Sérgio Schrader / Messina, Maria Cristina de Lorenzo / Loureiro, Walter Refkalefsky / Macarenco, Ricardo Silvestre e Silva / Stolf, Hamilton Ometto / Gontijo, Gabriel. ·Hospital Israelita Albert Einstein, SP, Brazil. · Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. · Departamento de Câncer de Pele, A. C. Camargo Cancer Center, São Paulo, SP, Brazil. · Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. · Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil. · Universidade Estadual do Pará, Belém, PA, Brazil. · Universidade Estadual Paulista "Júlio de Mesquita Filho", Botucatu, SP, Brazil. ·An Bras Dermatol · Pubmed #26982779.

ABSTRACT: The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?

2 Guideline Guidelines of the Brazilian Dermatology Society for diagnosis, treatment and follow up of primary cutaneous melanoma--Part I. 2015

Castro, Luiz Guilherme Martins / Messina, Maria Cristina / Loureiro, Walter / Macarenco, Ricardo Silvestre / Duprat Neto, João Pedreira / Di Giacomo, Thais Helena Bello / Bittencourt, Flávia Vasques / Bakos, Renato Marchiori / Serpa, Sérgio Schrader / Stolf, Hamilton Ometto / Gontijo, Gabriel. ·Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. · Universidade Estadual do Pará, Belém, SP, Brazil. · Departamento de Câncer de Pele, A. C. Camargo Cancer Center, São Paulo, SP, Brazil. · Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. · Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. · Universidade Estácio de Sá, Rio de Janeiro, RJ, Brazil. · Universidade Estadual Paulista, Botucatu, SP, Brazil. ·An Bras Dermatol · Pubmed #26734867.

ABSTRACT: The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In the first part, the following clinical questions were answered: 1) The use of dermoscopy for diagnosis of primary cutaneous melanoma brings benefits for patients when compared with clinical examination? 2) Does dermoscopy favor diagnosis of nail apparatus melanoma? 3) Is there a prognostic difference when incisional or excisional biopsies are used? 4) Does revision by a pathologist trained in melanoma contribute to diagnosis and treatment of primary cutaneous melanoma? What margins should be used to treat lentigo maligna melanoma and melanoma in situ?

3 Review Atypical mole syndrome and dysplastic nevi: identification of populations at risk for developing melanoma - review article. 2011

Silva, Juliana Hypólito / Sá, B C de / Avila, Alexandre Leon Ribeiro de / Landman, Gilles / Duprat Neto, João Pedreira. ·Oncology School Celestino Bourroul, Hospital AC Camargo, São Paulo, SP, Brazil. ·Clinics (Sao Paulo) · Pubmed #21552679.

ABSTRACT: Atypical Mole Syndrome is the most important phenotypic risk factor for developing cutaneous melanoma, a malignancy that accounts for about 80% of deaths from skin cancer. Because the diagnosis of melanoma at an early stage is of great prognostic relevance, the identification of Atypical Mole Syndrome carriers is essential, as well as the creation of recommended preventative measures that must be taken by these patients.

4 Clinical Trial Isolated limb infusion with hyperthermia and chemotherapy for advanced limb malignancy: factors influencing toxicity. 2014

Duprat Neto, João Pedreira / Mauro, Ana Carolina C / Molina, Andre S / Nishinari, Kenji / Zurstrassen, Charles E / Costa, Odon F / Belfort, Francisco A / Facure, Luciana / Fregnani, José H. ·Department of Skin Oncology, Hospital do Câncer A.C. Camargo, São Paulo, Brazil. ·ANZ J Surg · Pubmed #22998400.

ABSTRACT: BACKGROUND: The isolated limb infusion (ILI) technique is a simpler and less invasive alternative to isolated limb perfusion, which allows regional administration of high-dose chemotherapy to patients with advanced melanoma and other malignancies restricted to a limb. METHODS: Patients from two institutions, treated by ILI between 1998 and 2009 for extensive disease restricted to a limb, were included. The cohort included 31 patients with melanoma who presented with in-transit metastases or an extensive primary lesion, one patient with squamous cell carcinoma and another with epithelioid sarcoma not suitable for local surgical treatment. RESULTS: A complete response was achieved in 26.3% of patients and a partial response in 52.6%. Toxicity was assessed according to the Wieberdink limb toxicity scale. Grade II toxicity was noted in 39.5% of patients, grade III in 50% and grade IV in 10.5%. Toxicity was correlated with the results of a number of clinical and laboratory tests. The toxicity of melphalan and actinomycin D was dose-dependent. For melphalan, the relationship between toxicity and mean dose was as follows: grade II--34.7 mg; grades III and IV--47.5 mg (P = 0.012). The relationship between toxicity and maximum serum creatine phosphokinase (CPK) was as follows: grade II--431.5 U/L; grades III and IV--3228 U/L (P = 0.010). CONCLUSION: Toxicity after ILI is dose-dependent and serum CPK correlates with toxicity.

5 Article Validation of a Nomogram for Non-sentinel Node Positivity in Melanoma Patients, and Its Clinical Implications: A Brazilian-Dutch Study. 2019

Bertolli, Eduardo / Franke, Viola / Calsavara, Vinicius Fernando / de Macedo, Mariana Petaccia / Pinto, Clovis Antonio Lopes / van Houdt, Winan J / Wouters, Michel W J M / Duprat Neto, Joao Pedreira / van Akkooi, Alexander C J. ·Skin Cancer Department, AC Camargo Cancer Center, São Paulo, SP, Brazil. ebertolli@hotmail.com. · Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. ebertolli@hotmail.com. · Department of Surgical Oncology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. · Epidemiology and Statistics Department, AC Camargo Cancer Center, São Paulo, SP, Brazil. · Department of Pathology, AC Camargo Cancer Center, São Paulo, SP, Brazil. · Skin Cancer Department, AC Camargo Cancer Center, São Paulo, SP, Brazil. ·Ann Surg Oncol · Pubmed #30456681.

ABSTRACT: BACKGROUND: Non-sentinel node (NSN) positivity impacts the prognosis of melanoma patients; however, the benefits of completion lymph node dissection in patients with positive sentinel nodes (SNs) are limited. OBJECTIVE: We aimed to present a predictive nomogram for NSN positivity in melanoma patients with a positive SN biopsy. METHODS: This retrospective analysis from patients who underwent SN biopsy in a Brazilian institution from 2000 to 2015 was used for the construction and internal validation of the nomogram. This nomogram was then externally validated in a cohort of Dutch patients. RESULTS: The Brazilian cohort comprised 1213 patients, with a mean follow-up of 5.11 years. Breslow thickness (odds ratio [OR] 1.170, 95% confidence interval [CI] 1.043-1.314]; p = 0.008), number of positive SNs (OR 1.092, 95% CI 1.034-1.153; p = 0.001), and largest diameter of the metastatic deposit (OR 3.217, 95% CI 1.551-6.674; p = 0.002) were statistically significant for NSN positivity. Internal validation was performed using a bootstrapping technique. A good performance was observed (Brier score 0.097) and an excellent power of discrimination was achieved (area under the curve [AUC] 0.822). The nomogram was then applied to the Dutch cohort, and its overall performance (Brier score 0.085), calibration (Hosmer-Lemeshow goodness-of-fit test; p = 0.198), and discriminatory power (AUC 0.752, 95% CI 0.615-0.890) were all adequate. CONCLUSIONS: We presented a nomogram for assessing NSN probability that should not only be used for surgical considerations but also for risk stratification and clinical decisions. Internal validation has shown that this is an adequate model, while external validation increases the model's reliability and suggests that it can be globally incorporated.

6 Article A nomogram to identify high-risk melanoma patients with a negative sentinel lymph node biopsy. 2019

Bertolli, Eduardo / de Macedo, Mariana Petaccia / Calsavara, Vinícius Fernando / Pinto, Clovis Antonio Lopes / Duprat Neto, João Pedreira. ·Skin Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil. Electronic address: ebertolli@hotmail.com. · Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil. · Epidemiology and Statistics Department, AC Camargo Cancer Center, São Paulo, Brazil. · Skin Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil. ·J Am Acad Dermatol · Pubmed #30395920.

ABSTRACT: BACKGROUND: Melanoma patients with negative nodes after sentinel lymph node biopsy are a heterogeneous group. Current guidelines fail to adequately stratify surveillance and treatment for this group. Also, there is scarce data on adjuvant treatments for these patients. OBJECTIVE: To create a nomogram including clinical and pathologic characteristics capable of evaluating the risk for recurrence of primary melanoma patients with negative sentinel lymph node biopsies (SLNBs). METHODS: We used a retrospective cohort of patients who underwent SLNB during 2000-2015 at a single institution. RESULTS: Our cohort comprised 1213 patients. Among these patients, 967 (79.7%) had a negative SLNB, and mean follow-up was 59.67 months. There were 133 recurrences (13.8%); 45 (33.8%) presented with nodal recurrence, and 35 (26.3%) recurred where a SLNB was performed. Breslow thickness, ulceration, and microsatellitosis were found to be predictive of risk for recurrence at 1, 2, 5, and 10 years. LIMITATION: Single center analysis. CONCLUSION: We created a predictive nomogram for melanoma patients with negative SLNBs. This nomogram is easy to use and identifies high-risk patients who should have more strict surveillance and be considered for adjuvant treatment.

7 Article Diphencyprone as a therapeutic option in cutaneous metastasis of melanoma. A single-institution experience. 2018

Gibbons, Ivana Lameiras / Sonagli, Marina / Bertolli, Eduardo / Macedo, Mariana Petaccia de / Pinto, Clovis Antonio Lopes / Duprat Neto, João Pedreira. ·Skin Cancer Center, A.C. Camargo Cancer Center, São Paulo, SP, Brazil, Brazil. · Oncology Residency Training Program, A.C. Camargo Cancer Center, São Paulo, SP, Brazil. · Department of Pathology, A.C. Camargo Cancer Center, São Paulo, SP, Brazil. ·An Bras Dermatol · Pubmed #29723355.

ABSTRACT: Diphencyprone has been reported as a local immunotherapy for cutaneous melanoma metastases. We aim to report cases of melanoma patients treated with diphencyprone in a single Brazilian institution and highlight their outcomes. Since 2012, we have treated 16 melanoma patients with cutaneous metastases with topical diphencyprone. To date, we have had 37.5% of complete response, 25% of partial responses, and 31.25% patients without any response. Treatment was well tolerated and local toxicity was easily controlled. We believe topical diphencyprone is a feasible treatment that can be another option for treating melanoma patients, especially in cases of in-transit or extensive disease.

8 Article In transit sentinel node drainage as a prognostic factor for patients with cutaneous melanoma. 2018

Brandão, Paulo H D M / Bertolli, Eduardo / Doria-Filho, Eduardo / Santos Filho, Ivan D A O / de Macedo, Mariana P / Pinto, Clovis A L / Duprat Neto, João P. ·Surgical Oncology Medical Residence Program, AC Camargo Cancer Center, São Paulo, Brazil. · Skin Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil. · Pathology, AC Camargo Cancer Center, São Paulo, Brazil. ·J Surg Oncol · Pubmed #29484669.

ABSTRACT: BACKGROUND: Minor basin or in transit node drainage can be found in patients with cutaneous melanoma who undergo sentinel node biopsy. Its clinical impact is still unclear. Our objective is to evaluate clinical outcomes in patients who presented with in transit sentinel node (ITN) drainage. MATERIAL AND METHODS: Retrospective analysis of patients who underwent sentinel node biopsy (SNB) in a single Brazilian institution between 2000 and 2015. RESULTS: Our cohort comprised 1223 SNB. There were 64 patients (5.2%) with ITN. Melanoma of the limbs (OR 10.61, P < 0.0001) and acral subtype (OR 3.49, P < 0.0001) were associated with ITN drainage. Among these 64 patients, 14 (21.9%) had a positive SNB. The ITN was positive for metastases in five patients, four in a popliteal basin and one on the trunk. Regarding completion node dissection (CND), two patients had positive non-sentinel nodes (NSN), both in major basins. In patients who developed recurrence, time to recurrence was shorter (mean time 18 vs 31.4 months, P = 0.001) and time to death was shorter (mean time 31.6 vs 40 months, P = 0.039) in those who had ITN drainage. CONCLUSION: ITN drainage was associated with earlier recurrences and deaths from melanoma.

9 Article Osteogenic Melanoma With Desmin Expression. 2017

Trevisan, Flávia / Tregnago, Aline C / Lopes Pinto, Clóvis A / Urvanegia, Ana C M / Morbeck, Diogo L / Bertolli, Eduardo / Riva Neto, Floriano R / Duprat Neto, João P / de Macedo, Mariana P. ·*Department of Dermatology, Hospital de Clinicas da UFPR, Curitiba, Brazil; Departments of †Anatomic Pathology, and ‡Skin Cancer, A. C. Camargo Cancer Center, São Paulo, Brazil. ·Am J Dermatopathol · Pubmed #27655122.

ABSTRACT: BACKGROUND: Osteogenic differentiation is rarely seen in melanomas, when it occurs it is mainly in acral lesions. METHODS: We report a case of an osteogenic melanoma in a 49-year-old woman who presented with a pigmented lesion in the subungueal region of her left hallux. The lesion was ulcerated and infiltrated until the deep dermis without bone involvement. RESULTS: The tumor was composed of pleomorphic atypical epithelioid and fusiform cells disposed in nests or cords, with vesicular nuclei and prominent central nucleoli. Focal lentiginous proliferation of large atypical melanocytes was present along the dermoepidermal junction. Areas of osteoid matrix focally mineralized were disposed in trabeculae, and there were islands of neoplastic cells. Immunohistochemistry revealed strong expression of S-100 protein and, unexpectedly, of desmin. Focal expression of Melan-A, microphthalmia transcription factor, and HMB-45 is also revealed. Mutations in BRAF and NRAS genes were not present. The patient was submitted to an amputation of the left hallux with negative sentinel lymph node. CONCLUSION: The importance of recognizing osteogenic melanoma is based on difficulties for histologic recognition and its differentials diagnosis.

10 Article Characterization of individuals at high risk of developing melanoma in Latin America: bases for genetic counseling in melanoma. 2016

Puig, Susana / Potrony, Miriam / Cuellar, Francisco / Puig-Butille, Joan Anton / Carrera, Cristina / Aguilera, Paula / Nagore, Eduardo / Garcia-Casado, Zaida / Requena, Celia / Kumar, Rajiv / Landman, Gilles / Costa Soares de Sá, Bianca / Gargantini Rezze, Gisele / Facure, Luciana / de Avila, Alexandre Leon Ribeiro / Achatz, Maria Isabel / Carraro, Dirce Maria / Duprat Neto, João Pedreira / Grazziotin, Thais C / Bonamigo, Renan R / Rey, Maria Carolina W / Balestrini, Claudia / Morales, Enrique / Molgo, Montserrat / Bakos, Renato Marchiori / Ashton-Prolla, Patricia / Giugliani, Roberto / Larre Borges, Alejandra / Barquet, Virginia / Pérez, Javiera / Martínez, Miguel / Cabo, Horacio / Cohen Sabban, Emilia / Latorre, Clara / Carlos-Ortega, Blanca / Salas-Alanis, Julio C / Gonzalez, Roger / Olazaran, Zulema / Malvehy, Josep / Badenas, Celia. ·Melanoma Unit, Dermatology Department, Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain. · Centro Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain. · Departament de Medicina, Universitat de Barcelona, Barcelona, Spain. · Consejo Nacional de Ciencia y Tecnología (CONACYT), Ciudad de México, México. · Melanoma Unit, Biochemistry and Molecular Genetics Department, Hospital Clínic & IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain. · Department of Dermatology, Instituto Valenciano de Oncologia, Valencia, Spain. · Universidad Católica de Valencia, Valencia, Spain. · Molecular Biology Unit, Instituto Valenciano de Oncologia, Valencia, Spain. · Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany. · Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil. · International Research Center, AC Camargo Cancer Center, São Paulo, Brazil. · Dermatology Department and Post-Graduation Program of Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil. · Servicio de Dermatología, Hospital Dr. Sótero del Río, Santiago de Chile, Chile. · Servicio de Dermatología, Hospital San Juan de Dios, Santiago, Chile. · Pontificia Universidad Católica de Chile, Santiago de Chile, Chile. · Department of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. · Unidad de Lesiones Pigmentadas, Cátedra de Dermatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay. · Instituto de Investigaciones Medicas "A Lanari," Universidad de Buenos Aires, Buenos Aires, Argentina. · Consultorio Dermatológico Drs. Cohen Sabban y Cabo, Buenos Aires, Argentina. · Hospital Especialidades Centro Medico Nacional La Raza, Mexico, DF, Mexico. · Departamento de Ciencias Básicas, Escuela de Medicina Universidad de Monterrey, Monterrey, Mexico. · Departamento de Introducción a la Clínica, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico. · Servicio de Dermatología, Hospital Universitario "Dr. José Eleuterio González," Monterrey, Mexico. ·Genet Med · Pubmed #26681309.

ABSTRACT: PURPOSE: CDKN2A is the main high-risk melanoma-susceptibility gene, but it has been poorly assessed in Latin America. We sought to analyze CDKN2A and MC1R in patients from Latin America with familial and sporadic multiple primary melanoma (SMP) and compare the data with those for patients from Spain to establish bases for melanoma genetic counseling in Latin America. METHODS: CDKN2A and MC1R were sequenced in 186 Latin American patients from Argentina, Brazil, Chile, Mexico, and Uruguay, and in 904 Spanish patients. Clinical and phenotypic data were obtained. RESULTS: Overall, 24 and 14% of melanoma-prone families in Latin America and Spain, respectively, had mutations in CDKN2A. Latin American families had CDKN2A mutations more frequently (P = 0.014) than Spanish ones. Of patients with SMP, 10% of those from Latin America and 8.5% of those from Spain had mutations in CDKN2A (P = 0.623). The most recurrent CDKN2A mutations were c.-34G>T and p.G101W. Latin American patients had fairer hair (P = 0.016) and skin (P < 0.001) and a higher prevalence of MC1R variants (P = 0.003) compared with Spanish patients. CONCLUSION: The inclusion criteria for genetic counseling of melanoma in Latin America may be the same criteria used in Spain, as suggested in areas with low to medium incidence, SMP with at least two melanomas, or families with at least two cases among first- or second-degree relatives.Genet Med 18 7, 727-736.

11 Article Metastatic area ratio can help predict nonsentinel node positivity in melanoma patients. 2016

Bertolli, Eduardo / Macedo, Mariana Petaccia de / Pinto, Clovis Antonio Lopes / Damascena, Aline Santos / Molina, André Sapata / Duprat Neto, João Pedreira. ·Departments of aSkin Cancer bPathology cInternational Center for Research, AC Camargo Cancer Center, São Paulo, Brazil. ·Melanoma Res · Pubmed #26397049.

ABSTRACT: Several studies suggest that melanoma patients with a positive sentinel node biopsy (SNB) can avoid having complete nodal dissection on the basis of pathological features of the node. The aim of the study was to determine the value of metastatic area ratio as a predictive factor for nonsentinel node (NSN) positivity. A retrospective analysis was carried out of melanoma patients who underwent SNB in a single institution between 2000 and 2010. A total of 697 patients were evaluated. In 155 patients (22.2%), the SNB was positive; 146 lymphadenectomies were performed, and 23 patients in whom this was performed (15.8%) had positive NSN. In multivariate analyses, Breslow thickness of more than 2 mm, perinodal vascular invasion, and metastatic area ratio were significantly related to NSN positivity in the complete nodal dissection. Metastatic area ratio of a positive SNB can be valuable in predicting the risk of NSN positivity.

12 Article Vemurafenib and cutaneous adverse events--report of five cases. 2015

Silva, Giselle de Barros / Mendes, Adriana Pessoa / de Macedo, Mariana Petaccia / Pinto, Clóvis Antônio Lopes / Gibbons, Ivana Lameiras / Duprat Neto, João Pedreira. ·AC Camargo Cancer Center, SP, BR. ·An Bras Dermatol · Pubmed #26312729.

ABSTRACT: Vemurafenib is a selective inhibitor of V600E-mutant BRAF protein used to treat metastatic and unresectable melanoma. Clinical trials have shown increased overall survival and progression-free survival in patients treated with Vemurafenib. However, cutaneous adverse events are common during treatment. We report fi ve cases of metastatic melanoma with BRAF V600E positivity, treated with Vemurafenib and its cutaneous adverse events. Dermatologists and oncologists need to be aware of possible skin changes caused by this medication, which is increasingly employed in melanoma treatment. Monitoring of patients during therapy is important for early treatment of adverse cutaneous cutaneous adverse events, improvement in quality of life and adherence to treatment.

13 Article Popliteal sentinel lymph node involvement in melanoma patients. 2015

Bertolli, Eduardo / Bevilacqua, José Luiz Barbosa / Molina, André Sapata / de Macedo, Mariana Petaccia / Pinto, Clovis Antonio Lopes / Duprat Neto, João Pedreira. ·Skin Cancer Department, AC Camargo Cancer Center, São Paulo/SP, Brazil. · Breast Cancer Department, AC Camargo Cancer Center, São Paulo, Brazil. · Pathology Department, AC Camargo Cancer Center, São Paulo, Brazil. ·J Surg Oncol · Pubmed #26227662.

ABSTRACT: BACKGROUND: Sentinel lymph nodes (SLN) in popliteal basins are rare, and there is controversy in literature regarding their origin, management, and outcomes. OBJECTIVES: To correlate clinical and pathological features of popliteal basin drainage and analyze the impact of popliteal lymph node drainage on survival. MATERIALS AND METHODS: Retrospective analysis of SLN biopsies performed at a single institution between 2000 and 2010. RESULTS: SLN biopsies were performed in 254 patients with melanoma in lower limbs, 247 of which were evaluated. In this group, there were 59 patients (24%) with a positive SLN. Twenty-seven cases (11%) presented with popliteal drainage, one of which lacked concurrent groin drainage. Among these 27 patients, three (11%) had popliteal metastasis, one of which had exclusive involvement of this basin. Popliteal drainage was associated with worse 5-year disease-free survival (DFS) (P = 0.028) but not 5-year overall survival (OS) (P = 0.219) in univariate analysis. In multivariate analysis, Breslow thickness, mitotic index, and positive SLN were prognostic factors for DFS. Only mitotic index correlated significantly with OS (P = 0.044). CONCLUSIONS: Popliteal drainage seems to be associated with worse prognostic features of the primary tumor.

14 Article Evaluation of melanoma features and their relationship with nodal disease: the importance of the pathological report. 2015

Bertolli, Eduardo / de Macedo, Mariana Petaccia / Pinto, Clóvis Antonio Lopes / Damascena, Aline Santos / Molina, André Sapata / Ueno, Patrícia Sayuri / Duprat Neto, João Pedreira. ·Skin Cancer Department, AC Camargo Cancer Center, São Paulo, SP - Brazil. ·Tumori · Pubmed #25983100.

ABSTRACT: BACKGROUND: The pathological features of melanoma biopsies can provide significant prognostic information that can help the surgeon evaluate the risk of nodal disease. The aim of this study was to attempt to determine the relationship between pathological features of primary melanoma and nodal disease, by sentinel node biopsy (SNB) and complete node dissection (CND). METHODS: A retrospective analysis was completed of patients who underwent SNB at AC Camargo Cancer Center, São Paulo, Brazil, between 2000 and 2010. RESULTS: A total of 697 patients were evaluated. By univariate analysis, it was found that histology, Clark level, Breslow depth, mitotic index, ulceration, regression, lymphatic and perineural invasion and satellitosis were significantly associated with SNB positivity. In the multivariate analysis, it was found that Breslow depth, mitotic index, ulceration, regression, lymphatic invasion and satellitosis were significant factors. In patients with a positive SNB, the primary tumor site, Clark level and Breslow depth greater than 2 mm were significantly related to non-sentinel node (NSN) positivity by univariate analysis. By multivariate analysis, Breslow depth greater than 2 mm was the only primary tumor feature that was significantly related (p = 0.038). CONCLUSIONS: The indication of SNB should not be based solely on Breslow depth and ulceration or mitotic index. A complete evaluation of the pathological report should improve the identification of high-risk patients.

15 Article Association of melanoma with intraepithelial neoplasia of the pancreas in three patients. 2014

Fidalgo, Felipe / Gomes, Elimar Elias / Moredo Facure, Luciana / Da Silva, Felipe Carneiro / Carraro, Dirce Maria / de Sá, Bianca Costa Soares / Duprat Neto, João Pedreira / Krepischi, Ana Cristina Victorino. ·International Research Center, AC Camargo Cancer Center, São Paulo, Brazil. · Department of Skin Cancer, AC Camargo Cancer Center, São Paulo, Brazil. · International Research Center, AC Camargo Cancer Center, São Paulo, Brazil; Department of Genetics and Evolutionary Biology, University of São Paulo, Brazil. Electronic address: ana.krepischi@gmail.com. ·Exp Mol Pathol · Pubmed #24984283.

ABSTRACT: Melanoma and pancreatic cancer are two low frequency types of cancer. In this study, three patients who developed both melanoma and intraepithelial neoplasia of the pancreas were tested for CDKN2A mutations and deletions, and investigated for rare germline copy number variations (CNVs). The three patients were negative for CDKN2A point mutations and intragenic deletions. One of these patients carried two large (>300 kb) germline CNVs, both genomic duplications affecting coding sequences that are not copy number variable in the population. A second patient exhibited loss of the entire Y chromosome, an event probably coincidental related to his advanced age (79 years-old). Our data pinpoint that rare germline CNVs harboring genes can contribute to the cancer predisposition of melanoma and intraepithelial neoplasia of the pancreas.

16 Article Isolated limb perfusion with hyperthermia and chemotherapy: predictive factors for regional toxicity. 2012

Duprat Neto, João Pedreira / Oliveira, Fernanda / Bertolli, Eduardo / Molina, Andre Sapata / Nishinari, Kenji / Facure, Luciana / Fregnani, Jose Humberto. ·Hospital do Câncer AC Camargo, São Paulo, SP, Brazil. jduprat@uol.com.br ·Clinics (Sao Paulo) · Pubmed #22473404.

ABSTRACT: OBJECTIVE: Isolated limb perfusion combined with melphalan is an accepted treatment for obtaining locoregional control in advanced melanoma of the extremities and other malignant neoplasias restricted to the limb. This study aims to examine the factors associated with toxicity caused by the regional method. We considered the technical aspects of severe complications associated with the procedure in an attempt to diminish the patient morbidity that occurs during the learning curve. METHODS: We conducted a retrospective analysis of the records of patients who underwent perfusion at the AC Camargo Hospital in São Paulo, Brazil between January 2000 and January 2009. The Wieberdink scale was applied to classify local toxicity and its relation to clinical and laboratory variables. RESULTS: Fifty-eight perfusions were performed in 55 patients. Most patients (86.2%) presented a toxicity level between I and III. Grade V toxicity was seen in five cases (8.6%), four of which occurred in the first 2 years. Creatine phosphokinase, an important predictive factor for toxicity, had an average value of 231.8 for toxicity grades I-III and 1286.2 for toxicity grades IV-V (p = 0.001). There was a relationship between the melphalan dose and toxicity, which was 77 mg (25 to 130 mg) for toxicity grades I-II and 93.5 mg (45 to 120 mg) for toxicity grades IV-V (p = 0.0204). CONCLUSION: It is possible to prevent the toxicity associated with melphalan by adjusting the dose according to the patient's body weight (especially for women and obese patients) and the creatine phosphokinase values in the postoperative period.

17 Article Mathematical model to predict risk for lymphoedema after treatment of cutaneous melanoma. 2011

Campanholi, L L / Duprat Neto, J P / Fregnani, J H T G. ·AC Camargo Hospital, São Paulo, Brazil. larissalcm@yahoo.com.br ·Int J Surg · Pubmed #21276878.

ABSTRACT: AIM: To evaluate risk factors for lymphoedema development in the upper and lower limbs and to propose a model that predicts risk of lymphoedema after lymphadenectomy. PATIENTS: We studied 84 patients who had undergone radical lymphadenectomies for cutaneous melanoma from 1990 to 2008. METHODS: The patients included underwent an evaluation that consisted of measurement of limb volume using perimetry, application of the manually acquired perimetric data to the truncated-cone formula, and data from medical records. RESULTS: Using multivariate analysis, we obtained the following risk factors for the development of lymphoedema: reconstruction with graft (p = 0.013), Breslow depth >4mm (p = 0.029), ilioinguinal lymphadenectomy (p = 0.037) and wound infection (p = 0.036). We assigned points to each factor as dictated by the value of the regression coefficient, as follows: infection (1 point), ilioinguinal lymphadenectomy and Breslow >4mm (2 points each) and reconstruction with graft (3 points). The mathematical model for predicting lymphoedema risk in the limb ipsilateral to the lymphadenectomy was based on risk groups, defined by score: low risk = 0 point (for which we calculated an 8.3% chance of developing lymphoedema), intermediate risk = 1-2 points (26.8%), high risk = 3 points (52.9%) and very high risk = 4 or more points (88.9%). CONCLUSIONS: This study identified a melanoma thickness >4mm, graft reconstruction, ilioinguinal lymphadenectomy and infection as risk factors for lymphoedema. From these factors, we constructed a mathematical model that successfully predicted risk of post-lymphadenectomy lymphoedema. The combined presence of these risk factors increased the chance of developing lymphoedema.

18 Article Proteins involved in pRb and p53 pathways are differentially expressed in thin and thick superficial spreading melanomas. 2009

de Sá, Bianca Costa Soares / Fugimori, Melissa Lissae / Ribeiro, Karina de Cássia Braga / Duprat Neto, João Pedreira / Neves, Rogério Izar / Landman, Gilles. ·Department of Skin Oncology, Hospital AC Camargo, São Paulo, Brazil. bianca.sa@terra.com.br ·Melanoma Res · Pubmed #19369901.

ABSTRACT: Cutaneous melanoma is one of the leading causes of cancer-related death. Malignant transformation of epidermal melanocytes is a multifactorial process involving cell cycle and death control pathways. The purpose of this study was to analyze the immunohistochemical expression of cell-cycle-related and apoptosis-related proteins in cutaneous superficial spreading melanomas using the tissue microarray technique to further understand tumor development. A total of 20 samples of in-situ melanomas and 44 melanomas 1.0 mm) and metastases lost p16 expression in 100% of the cases and in-situ and thin melanomas (loss of p16 expression was a constant feature in primary and metastatic melanomas. Cyclin D1 expression seems to be related to initial phases of melanoma development. An increase in p21 expression could represent a cell cycle control in proliferating cells with reduced p16 and/or increased nuclear Cdk4 expression.