Browsing by Author "Carrera, Cristina"

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    Expert Agreement on the Presence and Spatial Localization of Melanocytic Features in Dermoscopy
    (2024) Liopyris, Konstantinos; Navarrete-Dechent, Cristian; Marchetti, Michael A.; Rotemberg, Veronica; Apalla, Zoe; Argenziano, Giuseppe; Blum, Andreas; Braun, Ralph P.; Carrera, Cristina; Codella, Noel C. F.; Combalia, Marc; Dusza, Stephen W.; Gutman, David A.; Helba, Brian; Hofmann-Wellenhof, Rainer; Jaimes, Natalia; Kittler, Harald; Kose, Kivanc; Lallas, Aimilios; Longo, Caterina; Malvehy, Josep; Menzies, Scott; Nelson, Kelly C.; Paoli, John; Puig, Susana; Rabinovitz, Harold S.; Rishpon, Ayelet; Russo, Teresa; Scope, Alon; Soyer, H. Peter; Stein, Jennifer A.; Stolz, Willhelm; Sgouros, Dimitrios; Stratigos, Alexander J.; Swanson, David L.; Thomas, Luc; Tschandl, Philipp; Zalaudek, Iris; Weber, Jochen; Halpern, Allan C.; Marghoob, Ashfaq A.
    Dermoscopy aids in melanoma detection; however, agreement on dermoscopic features, including those of high clinical relevance, remains poor. In this study, we attempted to evaluate agreement among experts on exemplar images not only for the presence of melanocytic-specific features but also for spatial localization. This was a cross-sectional, multicenter, observational study. Dermoscopy images exhibiting at least 1 of 31 melanocytic-specific features were submitted by 25 world experts as exemplars. Using a web-based platform that allows for image markup of specific contrast-defined regions (superpixels), 20 expert readers annotated 248 dermoscopic images in collections of 62 images. Each collection was reviewed by five independent readers. A total of 4,507 feature observations were performed. Good-to-excellent agreement was found for 14 of 31 features (45.2%), with eight achieving excellent agreement (Gwet's AC >0.75) and seven of them being melanomaspecific features. These features were peppering/granularity (0.91), shiny white streaks (0.89), typical pigment network (0.83), blotch irregular (0.82), negative network (0.81), irregular globules (0.78), dotted vessels (0.77), and blue-whitish veil (0.76). By utilizing an exemplar dataset, a good-to-excellent agreement was found for 14 features that have previously been shown useful in discriminating nevi from melanoma. All images are public (www.isic-archive.com) and can be used for education, scientific communication, and machine learning experiments.
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    Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases-A Cohort Study
    (2024) Serra, Estefania; Abarzua-Araya, Alvaro; Arance, Ana; Martin-Huertas, Roberto; Aya, Francisco; Olondo, Maria Lourdes; Rizo-Potau, Daniel; Malvehy, Josep; Puig, Susana; Carrera, Cristina; Podlipnik, Sebastian
    Simple Summary We conducted a study at the Melanoma Unit of the Hospital Clinic of Barcelona to investigate brain metastases in patients with cutaneous melanoma. We collected data from patients diagnosed between January 1998 and September 2023. Patients with melanoma in situ or those with prior lung or breast cancer were excluded. Our aim was to identify factors associated with the development and survival outcomes of brain metastases. We analyzed patient demographics, tumor characteristics, and survival data. The diagnosis of brain metastases was confirmed using imaging techniques, and biopsies were performed when feasible. Our study followed strict guidelines for reporting observational studies. We found that younger age and larger primary tumor thickness increased the risk of developing brain metastases. Additionally, the presence of ulceration and microscopic satellitosis in the primary tumor were associated with a higher risk. Melanomas located on the trunk had a higher risk compared to those on the extremities. Patients with brain metastases had a median survival of around six months. Neurological symptoms and leptomeningeal involvement were associated with poorer survival outcomes. Higher number of brain lesions and elevated levels of lactate dehydrogenase (LDH) also predicted worse survival. Our findings highlight the importance of early detection and monitoring of melanoma patients, especially those at higher risk of brain metastases. Understanding these factors can aid in personalized treatment approaches and improving patient outcomes.Abstract Background: Melanoma is the cancer with the highest risk of dissemination to the central nervous system (CNS), one of the leading causes of mortality from this cancer. Objective: To identify patients at higher risk of developing CNS metastases and to evaluate associated prognostic factors. Methods: A cohort study (1998-2023) assessed patients who developed CNS melanoma metastases. Multivariate logistic regression was used to identify predictive factors at melanoma diagnosis for CNS metastasis. Cox regression analysis evaluated the CNS-independent metastasis-related variables impacting survival. Results: Out of 4718 patients, 380 (8.05%) developed CNS metastases. Multivariate logistic regression showed that a higher Breslow index, mitotic rate >= 1 mm2, ulceration, and microscopic satellitosis were significant risk factors for CNS metastasis development. Higher patient age and the location of the primary tumor in the upper or lower extremities were protective factors. In survival analysis, post-CNS metastasis, symptomatic disease, prior non-CNS metastases, CNS debut with multiple metastases, elevated LDH levels, and leptomeningeal involvement correlated with poorer survival. Conclusion: Predictive factors in the primary tumor independently associated with brain metastases include microscopic satellitosis, ulceration, higher Breslow index, and trunk location. Prognostic factors for lower survival in CNS disease include symptomatic disease, multiple CNS metastases, and previous metastases from different sites.