Josep Malvehy

Josep Malvehy
Hospital Clínic de Barcelona · Servicio de Dermatología

PHD MD Consultant Dermatologist.Hospital Clinic of Barcelona

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Introduction

Publications

Publications (171)
Article
Autoimmune bullous diseases (AIBDs) still represent a considerable a source of morbidity and mortality: early identification of a specific AIBD is often difficult due to overlapping clinical and/or laboratory features and time‐consuming invasive laboratory tests. We aimed to investigate the potential role of a new imaging technology, Line‐field con...
Article
Line‐field confocal optical coherence tomography (LC‐OCT) is a recently developed non‐invasive imaging technique able to combine the technical principles of conventional OCT (high in‐tissue penetration and visualization of the vertical plane) and reflectance confocal microscopy (high resolution).1‐3 Indeed, LC‐OCT provides tridimensional images of...
Article
Background Early diagnosis and subtype classification of basal cell carcinoma (BCC) are crucial to reduce morbidity and optimise treatment. Good accuracy in differentiating BCC from clinical imitators has been achieved with existing diagnostic strategies but lower performance in discriminating BCC subtypes. Line‐field confocal optical coherence tom...
Article
Introduction Les différentes structures de la peau peuvent être maintenant étudiées in vivo en fonction de la topographie grâce à la tomographie confocale à cohérence optique en ligne (LC-OCT, DAMAE Medical®, Paris, France). Cette nouvelle technologie optique d’imagerie cutanée non-invasive innovante permet la visualisation in vivo en temps réel de...
Article
Introduction La jonction dermo-épidermique (JDE) n’est pas similaire sur l’ensemble des différentes parties du corps à l’instar des autres constituant de la peau, du fait d’une spécialisation liée à la topographie et à la fonctionnalité attenante. La JDE a été évaluée initialement ex vivo au moyen des coupes histologiques, puis in vivo en microscop...
Article
Introduction La line-field optical coherence tomography (LC-OCT) est une nouvelle technique d’imagerie cutanée non invasive, innovante, permettant d’obtenir des images 3D, à résolution cellulaire, sur une profondeur de ∼500 μm. Son rôle dans l’aide au diagnostic in vivo du mélanome n’a pas encore été établi. L’objectif de cette étude est d’identifi...
Article
Introduction Le diagnostic précoce et la classification par sous-type du carcinome basocellulaire (CBC) sont essentiels pour réduire la morbidité et optimiser le traitement. Les stratégies actuelles de diagnostic (dermatoscopie et microscopie confocale) ont permis d’obtenir une bonne précision dans la différenciation du CBC des imitateurs cliniques...
Article
Background The lack of uniformity in the outcomes reported in clinical studies of the treatment of cutaneous squamous cell carcinoma (cSCC) complicates efforts to compare treatment effectiveness across trials. Objective To develop a core outcome set (COS), a minimum set of agreed‐upon outcomes to be measured in all clinical trials of a given disea...
Article
In ‘Biopsy Outperforms Reflectance Confocal Microscopy in Diagnosing and Subtyping Basal Cell Carcinoma: Results and Experiences from a Randomized Controlled Multicentre Trial’, the authors found that reflectance confocal microscopy (RCM) identifies basal cell carcinoma (BCC) with 99% sensitivity and, impressively, distinguishes superficial BCCs fr...
Article
Full-text available
Background The incidence of skin cancers has been increasing steadily over the last decades. Although there have been significant breakthroughs in the management of skin cancers with the introduction of novel diagnostic tools and innovative therapies, skin cancer mortality, morbidity and costs heavily burden the society. Objective Members of the E...
Article
Background Thin nodular melanoma (NM) often lacks conspicuous melanoma‐specific dermatoscopic criteria, and escapes clinical detection until it progresses to a thicker and more advanced tumor. Objective To investigate the dermatoscopic morphology of thin (≤2mm Breslow thickness) versus thick (>2mm) NM and to identify dermatoscopic predictors of it...
Article
Background MC1R polymorphisms interact with CDKN2A mutations modulating melanoma risk and contribute to a less suspicious clinical and dermoscopic appearance of melanomas. Different strategies, including dermoscopic comparative approach and digital monitoring, are used for the melanoma diagnosis in this context. Objective To analyse the diagnostic...
Article
Full-text available
Background Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non‐invasively improve treatment response assessment. Objectives To compar...
Article
Full-text available
Resumen Antecedentes La clasificación automática de imágenes es una rama prometedora del aprendizaje automático (de sus siglas en inglés Machine Learning [ML]), y es una herramienta útil en el diagnóstico de cáncer de piel. Sin embargo, poco se ha estudiado acerca de las limitaciones de su uso en la práctica clínica diaria. Objetivo Determinar la...
Article
The ex vivo confocal microscope is an imaging system designed to analyze freshly excised tissue using two diode lasers with different wavelengths. The technique can dramatically reduce margin analysis times and offers a sensitivity of 88% and a specificity of 89% relative to histopathology. A new technology has recently been developed that produces...
Article
The presence of regional metastasis is a predictor of worse survival in thick melanoma1 and is currently an indication for adjuvant therapy. Few studies have analyzed the prognostic role of clinical and pathologic variables in thick melanoma without metastatic lymph node involvement2‐4. The aim of this study was to identify them.
Article
Background Automated image classification is a promising branch of machine learning (ML) useful for skin cancer diagnosis, but little has been determined about its limitations for general usability in current clinical practice. Objective To determine limitations in the selection of skin cancer images for ML analysis, particularly in melanoma. Met...
Article
Full-text available
Confocal Microscopy (CM) with in vivo and ex vivo modalities has been used in the evaluation of skin cancer and other dermatological disorders. Recent developments in ex‐vivo CM allows for faster pathology assessment with greater accuracy by the visualisation of cellular and architectural details similar to standard pathology either in paraffin emb...
Article
皮肤镜检查是使用一种名为皮肤镜的手持放大设备进行检查的技术,可让医生看到裸眼不可见的皮肤内部结构。这有助于诊断皮肤疾病,并减少了对活检的需要(取下一小块皮肤在显微镜下检查)。 它主要用于皮肤肿瘤(例如皮肤癌)的诊断,但它也越来越多地用于其他皮肤疾病,尤其是炎症性和感染性皮肤疾病。在过去几年,发表了若干有关非肿瘤性(即非癌症)皮肤疾病的皮肤镜检查的文章,但不同研究中所用的术语(语言)极不一致。 本研究以国际皮肤镜学会的名义,邀请遍布世界各地的 37 位国际专家参加,旨在确定统一的术语和基本参数(医生应查看的内容),以在非肿瘤性皮肤疾病的皮肤镜检查中使用/评估。 通过使用标准化的一致程序(称为“改进的 DELPHI 方法”)实现了这一目标。作者确定了五个标准化的基本参数。对于每个参数,都选择了可...
Article
Full-text available
体外(指在体外进行)共聚焦显微镜检查是一种成像技术,它使科学家能够查看通过活检取下的皮肤样本(通过外科手术切除一份小组织样本)。它常用于诊断皮肤癌,包括基底细胞癌 (BCC)。 共有两种主要类型,荧光共聚焦显微镜 (FCM) 和反射共聚焦显微镜 (RCM),允许可视化组织样本中的不同结构。 FCM 需要将一种染色剂(一种染料)添加到样本中,并已在一种称为 Mohs 显微外科手术 (MMS) 的手术中用于 BCC 的分析。使用 MMS 进行检查时每次切除薄薄一层肿瘤,连带周围极小范围的健康皮肤,并且立即在显微镜下检查每一层。 在 RCM 中,光束聚焦于一小块皮肤上。由于细胞结构存在差异,不同量的光线被反射回来。这会形成皮肤区域的灰度图像,以便医生发现异常。 最近,开发了一种新的、更快的体外共聚...
Article
Dermoscopy is a technique using a handheld magnifying device called a dermatoscope that allows doctors to see structures in the skin that are not visible to the naked eye. This helps with the diagnosis of skin diseases and reduces the need for biopsies (removal of a small sample of skin to be examined under a microscope). Its main use is for skin t...
Article
Full-text available
Blood plasma contains DNA fragments from dying cells, called cell‐free circulating DNA (cfDNA). In cancer patients, a fraction of their blood cfDNA comes from dying tumour cells. Therefore, key genetic alterations (mutations) from tumours might be detected in plasma from cancer patients. The analysis of cfDNA is a promising tool for the treating ca...
Article
Ex vivo (meaning that it takes place outside the body) confocal microscopy is an imaging technique which allows scientists to look at samples of skin that have been removed by biopsy (where a small tissue sample is removed surgically), and it is often used to diagnose skin cancers including basal cell carcinomas (BCC). There are two main types, flu...
Article
血浆中含有垂死细胞的 DNA 片段,称为无细胞循环 DNA (cfDNA)。在癌症患者中,他们的血液 cfDNA 的一部分来自垂死的肿瘤细胞。因此,可以在癌症患者的血浆中检测到肿瘤的关键基因变异(突变)。 cfDNA 分析对于治疗癌症患者是一种有前景的工具,因为来自肿瘤的信息可能是从血液样本中获得的,从而避免了使用“侵入性”方法,例如组织活检(例如,通过手术采集样本)。 黑色素瘤是一种侵袭性皮肤癌。全世界每年有超过 250,000 例新确诊病例。在大约 50% 的黑色素瘤中检测到了 BRAF 基因 (BRAFV600E) 中的 p.V600E 突变。目前,对黑色素瘤患者血浆中 BRAFV600E 突变的分析可用于监测其疾病进展。 除肿瘤外,经常在皮肤上的痣中检测到 BRAFV600E 突变,...
Article
Sonidegib and vismodegib are hedgehog pathway inhibitors (HhIs) approved for the treatment of advanced basal cell carcinoma (BCC). Until recently, vismodegib was the only targeted treatment available for patients with locally advanced BCC (laBCC) in cases where surgery and radiotherapy are inappropriate. Sonidegib has recently been approved and now...
Article
Background: The role of S100B protein in detecting early melanoma relapses is controversial, since most metastasis occur within normal values of S100B. Objective: The aim of this study was to assess the performance of S100B in detecting early disease progression in high-risk melanoma patients. Methods: Retrospective cohort study including pati...
Article
Full-text available
The ex vivo confocal microscope is an imaging system designed to analyze freshly excised tissue using two diode lasers with different wavelengths. The technique can dramatically reduce margin analysis times and offers a sensitivity of 88% and a specificity of 89% relative to histopathology. A new technology has recently been developed that produces...
Article
Introduction La Line-Field Optical Cohérence Tomography (LC-OCT) est une nouvelle technique d’imagerie cutanée non-invasive, innovante, combinant la haute résolution de la microscopie confocale (MC) et une pénétration tissulaire importante de l’Optical Coherence Tomography (OCT) en un seul appareil. En effet la MC a une haute résolution (1 μm) mais...
Conference Paper
Full-text available
Background Melanoma is the most aggressive of common skin cancers. We aimed to create a polygenic risk score (PRS) and evaluate its capability to predict melanoma prognosis better than staging. Methods The cohort included 1126 melanoma patients (567 males, 559 females); 57%, 24% and 19% patients stage I, II and III at diagnosis, respectively. The...
Article
Melanoma is an aggressive type of skin cancer. Each year more than 250,000 new cases are diagnosed worldwide. If diagnosed at early stages, melanoma can be cured with relatively simple surgery. Globally, 20% of melanoma patients will die, but when diagnosed with thick (more advanced / later stage) tumours, the probability of dying increases by up t...
Article
黑色素瘤是一种侵袭性皮肤癌。全世界每年有超过 250,000 例新确诊病例。如果在早期诊断,黑色素瘤可以通过相对简单的手术治愈。在全球范围内,20% 的黑色素瘤患者将会死亡,但当被诊断为厚(更晚期/晚期)肿瘤时,死亡的可能性将增加高达 60%。提高生存率的最佳策略是提早诊断。识别处于危险中的人至关重要。大约 10% 的病例发生在家族环境中。这意味着这些个体有遗传性黑色素瘤的风险,而这可以通过特定基因的改变(突变)来解释。在一个已知突变的家族中,携带该突变的健康个体可以被纳入早期检测计划,从而能够在早期诊断出黑色素瘤。但是,在超过 70% 的家族中,造成这种风险的基因仍然未知。这项来自西班牙的研究旨在评估西班牙没有已知突变基因的、黑色素瘤易发家族中两个基因(POT1 和 TERT)突变的患病率...
Article
Background: Ex vivo confocal microscopy (CM) works under two modes, fluorescence and reflectance, allowing the visualization of different structures. Fluorescence CM (FCM) requires a contrast agent and has been used for the analysis of basal cell carcinomas (BCC) during Mohs surgery. Conversely, reflectance CM (RCM) is mostly used for in vivo diag...
Article
Background The p.V600E mutation in the BRAF gene (BRAFV600E) is the most frequent mutation in cutaneous melanoma and is a recurrent alteration found in common benign naevi. The analysis of cell‐free BRAFV600E mutation (cfBRAFV600E) in plasma has emerged as a biomarker for monitoring prognosis and treatment response in melanoma patients. Objectives...
Article
Background Over the last few years, several articles on dermoscopy of non‐neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies. Objective We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non‐neoplastic dermatoses through an expert consens...
Article
Full-text available
Patients treated with haematopoietic stem cell transplantation are at increased risk of cutaneous malignant neoplasms. There are no reports on the characteristics of melanocytic lesions in patients with chronic graft versus host disease and the value of recognizing these difficult lesions in high-risk patients. The objective of this study is to des...
Article
Full-text available
Background Females have a better melanoma prognosis and fairer skin and hair colour. The presence of inherited MC1R variants has been associated with a better melanoma prognosis, but its interaction with sex is unknown. Objectives To evaluate the relationship between germline MC1R status and survival and determine any association with gender. Met...
Article
Full-text available
Background The clinical and pathological features of primary melanoma are not sufficiently sensitive to accurately predict which patients are at a greater risk of relapse. Recently, a 31‐gene expression profile (DecisionDx‐Melanoma) test has shown promising results. Objectives To evaluate the early prognostic performance of a genetic signature in...
Article
Introduction Les lésions pigmentées posent parfois des incertitudes diagnostiques même avec l’aide d’un examen dermoscopique. Nous relatons 7 cas atypiques de carcinomes spinocellulaires in situ pigmentés (CSIP) et maladies de Bowen pigmentées (MBP) dont les diagnostics ont été rectifiés par un examen par en microscopie confocale (reflectance confo...
Article
Introduction L’examen du corps entier nu, est recommandé par la Haute Autorité de santé (HAS) lors de la réalisation d’un examen dermatologique, dans le cadre de la prise en charge ou du suivi de tumeurs cutanées næviques notamment. Toutefois, l’examen de la muqueuse génitale n’est habituellement pas réalisé. Nous avons voulu évaluer l’acceptation...
Article
Talimogene laherparepvec, a herpes simplex virus type 1-based intralesional oncolytic immunotherapy, is approved in Europe for the treatment of adults with unresectable stage IIIB-IVM1a melanoma, with no bone, brain, lung or other visceral disease. It has direct oncolytic effects in injected lesions, leading to the release of tumour-derived antigen...
Article
Background Germline mutations in telomere‐related genes such as POT1 and the TERT promoter predispose to familial melanoma. Objective To evaluate the prevalence of germline mutations in the POT1 gene and in the TERT promoter in a large cohort of Spanish melanoma‐prone families (at least two affected individuals in first‐ or second‐degree relatives...
Article
Full-text available
Introduction Teledermatology is the most advanced clinical specialty in telemedicine. The development of teledermatology in specific countries has not been studied in depth. Methods Our objective was to analyze teledermatology models in clinical practice in Spain. We paid special attention to organization, technical aspects, training, and the adva...
Article
Background Many follow‐up guidelines for high‐risk melanoma patients include expensive imaging studies, serum biomarkers, and regular visits to the dermatologist with little attention to cost‐effectiveness. Objectives To establish the cost‐effectiveness of chest‐abdomen‐pelvis CT‐scan and brain MRI in a follow‐up protocol for patients at high risk...
Article
New drugs against advanced melanoma have emerged during last decade. Target therapy and immunotherapy have changed the management of patients with metastatic disease. Along with its generalized use, drug toxicities have appeared and the skin is the target organ of a significant part of them. This revision summarizes the most common side effects and...
Article
Full-text available
Recent publication of the results of clinical trials in which lymph node dissection was not associated with any survival benefit in patients with sentinel node metastasis makes it necessary to reconsider the treatment of patients with melanoma. This article provides an update on the available evidence on the diverse factors (routes of metastatic sp...
Article
Introduction: Teledermatology is the most advanced clinical specialty in telemedicine. The development of teledermatology in specific countries has not been studied in depth. Methods: Our objective was to analyze teledermatology models in clinical practice in Spain. We paid special attention to organization, technical aspects, training, and the...
Article
Recent publication of the results of clinical trials in which lymph node dissection was not associated with any survival benefit in patients with sentinel node metastasis makes it necessary to reconsider the treatment of patients with melanoma. This article provides an update on the available evidence on the diverse factors (routes of metastatic sp...
Article
Actinic keratosis (AK) is caused by ultraviolet radiation exposure and is more likely to be subclinical than visible. AK can potentially progress to invasive squamous cell carcinoma (SCC).¹ All stages of AK and sometimes, invasive SCC² coexist in the “cancerization field” where further neoplastic changes can occur.³ The current clinical or histolog...
Article
Full-text available
Basal cell carcinoma (BCC) accounts for 80% of non-melanoma skin cancer. The identification of the histological subtype is crucial for the correct management of the tumor. In vivo reflectance confocal microscopy (RCM) is a novel technique that has demonstrated high sensitivity and specificity in the in vivo diagnosis of BCC. In an effort to determi...
Article
Full-text available
Background: Several dermoscopic and in vivo reflectance confocal microscopy (RCM) diagnostic criteria of lentigo maligna (LM)/lentigo maligna melanoma (LMM) have been identified. However, no study compared the diagnostic accuracy of these techniques. Objective: We evaluated the diagnostic accuracy of dermoscopy and RCM for LM/LMM using a holisti...
Article
We read with attention the recent paper by Stockfleth et al1 on the efficacy and safety of Ingenol Mebutate 0.015% gel (IngMb) vs. diclofenac sodium 3% gel (DS) for the treatment of actinic keratosis (AK). Regarding this interesting study, we would like to address some comments to the authors.In this study, the primary endpoint was complete clearan...
Article
Introduction: Different protocols have been used to follow up melanoma patients in stage I-II. However, there is no consensus on the complementary tests that should be requested or the appropriate intervals between visits. Our aim is to compare an ultrasound-based follow-up with a clinical follow-up. Patients and methods: Analysis of two prospec...
Article
Here we report a phase 1b clinical trial testing the impact of oncolytic virotherapy with talimogene laherparepvec on cytotoxic T cell infiltration and therapeutic efficacy of the anti-PD-1 antibody pembrolizumab. Twenty-one patients with advanced melanoma were treated with talimogene laherparepvec followed by combination therapy with pembrolizumab...
Article
Full-text available
Facial melanoma is difficult to diagnose and dermatoscopic features are often subtle. Dermatoscopic non-melanoma patterns may have a comparable diagnostic value. In this pilot study, facial lesions were collected retrospectively, resulting in a case set of 339 melanomas and 308 non-melanomas. Lesions were evaluated for the prevalence (> 50% of lesi...
Article
Full-text available
Talimogene laherparepvec is a herpes simplex virus-1-based intralesional oncolytic immunotherapy and is the first oncolytic virus to be approved in Europe. It is indicated for the treatment of adults with unresectable melanoma that is regionally or distantly metastatic (stage IIIB, IIIC, and IVM1a) with no bone, brain, lung, or other visceral disea...
Article
Herein we describe the usefulness of a successful combination of dermoscopy and in vivo RCM for the early diagnosis of 3 AM in 2 OCA patients OCA is a group of rare autosomal recessive disorders of pigmentation. It consists in the absence or reduction of melanin in the skin, hair, and eyes due to a partial or total deficit in the activity of tyrosi...
Article
Full-text available
Genome wide association studies (GWAS) have mapped multiple independent cancer susceptibility loci to chr5p15.33. Here, we show that fine-mapping of pancreatic and testicular cancer GWAS within one of these loci (Region 2 in CLPTM1L) focuses the signal to nine highly correlated SNPs. Of these, rs36115365-C associated with increased pancreatic and t...
Chapter
The diagnosis of LM by means of RCM has been explained with detail in Chapter 25. Briefly, six positive features have been identified to independently correlate with diagnosis of LM by means of discriminant analysis, corresponding to, in order of relevance: nonedged papillae, pagetoid round and large cells, nucleated cells within dermal papilla, th...
Article
Reflectance confocal microscopy (RCM) allows the evaluation with superb accuracy of some skin tumors before, during, and after treatment. In clinical trials RCM has been shown to provide useful information for evaluation of efficacy of topical or systemic medication. With the recent introduction of handheld RCM a fast examination of the tumor can b...
Article
Confocal microscopy is a modern imaging device that has been extensively applied in skin oncology. More specifically, for tumor margin assessment, it has been used in two modalities: reflectance mode (in vivo on skin patient) and fluorescence mode (on freshly excised specimen). Although in vivo reflectance confocal microscopy is an add-on tool for...