Objective: The aim of this study is to investigate the risk factors associated with metastasis to various sites in melanoma, construct corresponding nomograms for predicting the risk of metastasis, and provide a reference for clinical practitioners in the diagnosis and treatment of this condition. Methods: Utilising SEER database data, we analysed 11,218 metastatic melanoma patients using logistic regression to identify metastasis determinants to bone, brain, liver, and lung, illustrated with a forest plot and developed an interactive nomogram for prediction. Additionally, we investigated prognostic factors for outcomes using the same statistical methods. Results: Our results indicate that histological behaviour, sex, race, marital status, tumour site, surgery at the primary site, postoperative lymph node dissection, and radiotherapy are independent predictors of brain metastasis; histological behaviour, sex, race, marital status, surgery at the primary site, radiotherapy, chemotherapy, Breslow thickness, and ulceration are independent predictors of bone metastasis; histological behaviour, race, marital status, tumour site, surgery at the primary site, postoperative lymph node dissection, chemotherapy, Breslow thickness, and ulceration are independent predictors of liver metastasis; and histological behaviour, age, sex, race, marital status, tumour site, surgery at the primary site, postoperative lymph node dissection, radiotherapy, chemotherapy, and ulceration are independent predictors of lung metastasis. We constructed interactive nomograms based on these factors to predict the probability of metastasis at different sites. Additionally, univariate and multivariate logistic regression analyses revealed that histological behaviour, age, sex, race, marital status, income, tumour size, tumour site, surgery at the primary site, radiotherapy, chemotherapy, Breslow thickness, and ulceration are factors influencing metastatic melanoma. Conclusions: This study has successfully established a nomogram for predicting metastatic melanoma. Among the factors influencing metastasis to various sites, histological behaviour, race, marital status, primary site surgery, and postoperative lymph node dissection were identified as common determinants. This suggests that these factors play a significant role in the metastasis of melanoma. Moreover, these factors also play a crucial role in affecting the prognosis. Therefore, in the clinical diagnosis and treatment process, it is imperative to consider these factors carefully and to analyse them according to the specific circumstances of different patients.
Calciphylaxis, also known as calcific uraemic arteriolopathy, is a rare cutaneous manifestation of systemic disease occurring in patients with chronic kidney disease. It typically presents as a painful necrotic and progressive skin ulcer of reticular pattern, mostly in the lower legs. It is a condition of substantial morbidity and mortality, with death most frequently due to sepsis. Although skin biopsy is a standard method to confirm the clinical diagnosis, non-invasive imaging often provides valuable clues. We report a case of extensive calciphylaxis in a lady with end-stage renal failure, where clinical radiography showed a typical net-like calcifications.
FFA has become an emerging cause of scarring alopecia and increasing cases have been described in the literature leading to its development in evidence-based management. With the growing evidence in the management of FFA, Finasteride is currently considered to be the most supported systemic treatment to stop the scarring process and to prevent irreversible hair loss. With the suitable patient population and careful patient education, Finasteride can be of great benefit in treating this disease which have an immense negative impact on the patient's quality of life.
Introduction: Acute and chronic graft-versus-host disease (GVHD) are multisystem disorders which are complications of haematopoietic stem cell transplant (HSCT). It is important to consider other differential diagnoses that may have similar clinical and histopathologic features as GVHD. Method: A retrospective analysis was conducted on adult patients from a single centre who developed GVHD after HSCT between January 2014 and June 2018. Results: Fourteen patients were included where 13 had acute GVHD and 1 had chronic GVHD. The median age was 35.0 years (IQR 26 to 44 years) while median onset of cutaneous symptoms for acute GVHD was 70 days (IQR 17.0 - 96.5 days). All cases had histopathological confirmation. For acute GVHD (n=13), classical presentation with generalised exanthem and perifollicular erythema is the commonest (84.6%, n=11), where 61.5% and 38.5% of patients had stage 2 and 3 extent of skin involvement, respectively (n=8, n=5). 76.9% (n=10) of patients with acute GVHD had other organs involvement, such as liver, eyes, and gut. Lerner's grade 2 was the most common histological grade for patients with acute GVHD (53.8%, n=7) followed by grade 1 (38.5%, n=5). One patient with chronic GVHD had lichen planus-like presentation. All patients had received various antibiotics within two months prior to onset. None of the skin biopsies showed significant eosinophilic infiltrates. Conclusion: Cutaneous manifestations of GVHD are among the earliest presenting complaints among patients who have undergone HSCT. Half of these patients only had skin GVHD without any other organs involvement. Hence, biopsy is important to confirm the diagnosis of GVHD along with clinical correlation.
