At 6 months, overall survival was 84% (95% confidence interval [CI], 78 to 89) in the vemurafenib group and 64% (95% CI, 56 to 73) in the dacarbazine group. In the interim analysis for overall survival and final analysis for progression-free survival, vemurafenib was associated with a relative reduction of 63% in the risk of death and of 74% in the risk of either death or disease progression, as compared with dacarbazine (P<0.001 for both comparisons). After review of the interim analysis by an independent data and safety monitoring board, crossover from dacarbazine to vemurafenib was recommended. Response rates were 48% for vemurafenib and 5% for dacarbazine. Common adverse events associated with vemurafenib were arthralgia, rash, fatigue, alopecia, keratoacanthoma or squamous-cell carcinoma, photosensitivity, nausea, and diarrhea; 38% of patients required dose modification because of toxic effects. Conclusions Vemurafenib produced improved rates of overall and progression-free survival in patients with previously untreated melanoma with the BRAF V600E mutation. (Funded by Hoffmann–La Roche; BRIM-3 ClinicalTrials.gov number, NCT01006980.)

/pdf/improved-survival-with-vemurafenib-in-melanoma-with-braf-4rigjjinh0.pdf

Improved Survival with Vemurafenib in Melanoma with BRAF V600E Mutation

https://air.unimi.it/bitstream/2434/566817/2/3768.full.pdf

WHO-EORTC classification for cutaneous lymphomas.

/pdf/nccn-clinical-practice-guidelines-in-oncology-hepatobiliary-1kpacqqvi8.pdf

NCCN clinical practice guidelines in oncology: hepatobiliary cancers.

EXECUTIVE SUMMARYSoft-tissue infections are common, generally of mild tomodest severity, and are easily treated with a variety ofagents. An etiologic diagnosis of simple cellulitis is fre-quently difﬁcult and generally unnecessary for patientswith mild signs and symptoms of illness. Clinical as-sessment of the severity of infection is crucial, and sev-eral classiﬁcation schemes and algorithms have beenproposed to guide the clinician [1]. However, mostclinical assessments have been developed from eitherretrospective studies or from an author’s own “clinicalexperience,” illustrating the need for prospectivestudieswith deﬁned measurements of severity coupled to man-agement issues and outcomes.Until then, it is the recommendation of this com-mittee that patients with soft-tissue infection accom-panied by signs and symptoms of systemic toxicity (e.g.,fever or hypothermia, tachycardia [heart rate,

/pdf/practice-guidelines-for-the-diagnosis-and-management-of-skin-4b42oom5lk.pdf

Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections

A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.

/pdf/practice-guidelines-for-the-diagnosis-and-management-of-skin-3yst6uf27k.pdf

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America

e21008Background: Information on the role and type of radiotherapy in melanoma pts treated with anti-PD1 is limited. We report a cohort of advanced melanoma pts having received simultaneous hypofra...

Efficacy of combined hypofractionated radiotherapy and anti-PD-1 monotherapy in patients with melanoma.

Epithelial and melanotic skin tumors. Melanomas

Le prurit est un motif frequent de consultation en dermatologie. Il est associe a la plupart des dermatoses, mais il peut aussi etre isole et revelateur d’une pathologie extracutanee. Ainsi, la cause d’un prurit est de diagnostic facile lorsque son mode d’installation est rapide et contemporain d’une eruption cutanee comme lors d’une urticaire ou d’une varicelle par exemple. En revanche, le diagnostic etiologique peut etre plus difficile quand le prurit est d’evolution chronique, sans lesions cutanees specifiques, traduisant une maladie interne. Il importe alors d’orienter la demarche diagnostique par l’examen clinique et les investigations complementaires, sans sombrer dans les travers d’un bilan exhaustif systematique. Le prurit est une sensation limitee a la peau et ne concerne pas les muqueuses. La physiopathologie est complexe et mal resolue. La liste des pathologies associees a un prurit est longue. L’analyse critique de la litterature est difficile car elle comporte peu d’etudes prospectives ou controlees. Le but de cet article n’est pas de lister toutes les pathologies rapportees comme prurigineuses mais de proposer une strategie au clinicien pour pouvoir resoudre la plupart des situations de prurit auxquelles il peut etre confronte. La recherche de la cause d’un prurit est une demarche necessaire. En effet, le prurit peut etre revelateur de pathologies dermatologiques ou internes pour lesquelles le diagnostic a des implications therapeutiques. La demarche diagnostique doit etre systematique en recherchant tout d’abord des arguments cliniques et para-cliniques pour une dermatose specifique puis en recherchant une cause interne extracutanee. Le diagnostic de prurigo chronique ou de prurit sine materia sont des diagnostics d’exclusion. La negativite des recherches etiologiques doit conduire a la surveillance du malade avec reevaluation reguliere. Cette demarche diagnostique est aussi un acte therapeutique puisque le traitement de la pathologie a l’origine du prurit est a meme de guerir ce symptome. Toutefois, cette demarche n’est pas toujours suffisante a la guerison du prurit. Dans les cas ou la prise en charge de la pathologie causale ne suffit pas a traiter le prurit (comme la cholestase ou l’insuffisance renale chronique), ou dans les cas ou la recherche d’une etiologie est negative, il importe de s’aider de traitements dits symptomatiques. les soins locaux comportent les emollients, les agents keratolytiques en cas de lichenification. Les dermocorticoides de classe I ou II sont surtout efficaces sur des lesions eczematisees et peu sur celles de prurigo. Les antihistaminiques systemiques peuvent aider a la prise en charge surtout lorsqu’ils sont sedatifs mais ne sont pas une solution en l’absence d’allergie de type I. La phototherapie (PUVA ou UVB) est proposee dans certaines formes de prurigo rebelles (sujet VIH, insuffisants renaux, prurit de la cholestase). Les antagonistes morphiniques (naltrexone, nalmefene) semblent etre efficaces dans le prurit de l’insuffisance renale chronique ou de la cholestase en agissant sur les opioides centraux circulants [40] mais aussi dans d’autres types de prurit [41]. Les traitements locaux specifiques du prurit agissant sur la liberation de substance P (capsaicine) ou antihistaminiques (doxepine) sont aussi prometteurs [42]. Ainsi, la prise en charge d’un prurit est un vrai challenge medical diagnostique et therapeutique qui fait appel a une concertation pluridisciplinaire entre le dermatologue et les autres specialistes internistes.

Stratégie diagnostique devant un prurit

[Lyell's syndrome].

8591 Background: V, a selective BRAF inhibitor, significantly improves OS in BRAF mutated mM. ATU is an exceptional measure making available drugs that have not yet been granted a Marketing Authori...

Philippe Saiag

Papers

Efficacy of combined hypofractionated radiotherapy and anti-PD-1 monotherapy in patients with melanoma.

Epithelial and melanotic skin tumors. Melanomas

Stratégie diagnostique devant un prurit

[Lyell's syndrome].

Vemurafenib (V) in BRAF V600E metastatic melanoma (mM): Analysis of 507 patients (pts) enrolled in the French temporary authorization for use (ATU).