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Buja A, Rugge M, Cozzolino C, Dossi F, Zorzi M, Vecchiato A, de Luca G, Del Fiore P, Tropea S, dall’Olmo L, Rossi CR, Boccuzzo G, Mocellin S. Could the mitotic count improve personalized prognosis in melanoma patients? PLoS One 2024; 19:e0302309. [PMID: 38626072 PMCID: PMC11020877 DOI: 10.1371/journal.pone.0302309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/28/2024] [Indexed: 04/18/2024] Open
Abstract
A number of studies have indicated that the mitotic rate may be a predictive factor for poor prognosis in melanoma patients. The aim of this study was to investigate whether the mitotic rate is associated with other prognostic clinical and anatomopathological characteristics. After adjusting for other anatomopathological characteristics, we then verified the prognostic value of the number of mitoses, determining in which population subgroup this variable may have greater prognostic significance on 3-year mortality. The Veneto Cancer Registry (Registro Tumori del Veneto-RTV), a high-resolution population-based dataset covering the regional population of approximately 4.9 million residents, served as the clinical data source for the analysis. Inclusion criteria included all incident cases of invasive cutaneous malignant melanoma recorded in the RTV in 2015 (1,050 cases) and 2017 (1,205 cases) for which the number of mitoses was available. Mitotic classes were represented by Kaplan-Meier curves for short-term overall survival. Cox regression calculated hazard ratios in multivariable models to evaluate the independent prognostic role of different mitotic rate cut-offs. The results indicate that the mitotic rate is associated with other survival prognostic factors: the variables comprising the TNM stage (e.g., tumor thickness, ulceration, lymph node status and presence of metastasis) and the characteristics that are not included in the TNM stage (e.g., age, site of tumor, type of morphology, growth pattern and TIL). Moreover, this study demonstrated that, even after adjusting for these prognostic factors, mitoses per mm2 are associated with higher mortality, particularly in T2 patients. In conclusion, these findings revealed the need to include the mitotic rate in the histological diagnosis because it correlates with the prognosis as an independent factor. The mitotic rate can be used to develop a personalized medicine approach in the treatment and follow-up monitoring of melanoma patients.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Rugge
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
- Department of Medicine—DIMED, Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Claudia Cozzolino
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Francesca Dossi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel Zorzi
- Veneto Tumor Registry, Azienda Zero, Padova, Italy
| | - Antonella Vecchiato
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Giuseppe de Luca
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Directorate General, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Saveria Tropea
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
| | - Luigi dall’Olmo
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
| | - Carlo Riccardo Rossi
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
| | | | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology—DISCOG, University of Padova, Padova, Italy
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2
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Dedeilia A, Lwin T, Li S, Tarantino G, Tunsiricharoengul S, Lawless A, Sharova T, Liu D, Boland GM, Cohen S. Factors Affecting Recurrence and Survival for Patients with High-Risk Stage II Melanoma. Ann Surg Oncol 2024; 31:2713-2726. [PMID: 38158497 PMCID: PMC10908640 DOI: 10.1245/s10434-023-14724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND In the current era of effective adjuvant therapies and de-escalation of surgery, distinguishing which patients with high-risk stage II melanoma are at increased risk of recurrence after excision of the primary lesion is essential to determining appropriate treatment and surveillance plans. METHODS A single-center retrospective study analyzed patients with stage IIB or IIC melanoma. Demographic and tumor data were collected, and genomic analysis of formalin-fixed, paraffin-embedded tissue samples was performed via an internal next-generation sequencing (NGS) platform (SNaPshot). The end points examined were relapse-free survival (RFS), distant metastasis-free survival (DMFS), overall survival (OS), and melanoma-specific survival (MSS). Uni- and multivariable Cox regressions were performed to calculate the hazard ratios. RESULTS The study included 92 patients with a median age of 69 years and a male/female ratio of 2:1. A Breslow depth greater than 4 mm, a higher mitotic rate, an advanced T stage, and a KIT mutation had a negative impact on RFS. A primary lesion in the head and neck, a mitotic rate exceeding 10 mitoses per mm2, a CDH1 mutation, or a KIT mutation was significantly associated with a shorter DMFS. Overall survival was significantly lower with older age at diagnosis and a higher mitotic rate. An older age at diagnosis also had a negative impact on MSS. CONCLUSION Traditional histopathologic factors and specific tumor mutations displayed a significant correlation with disease recurrence and survival for patients with high-risk stage II melanoma. This study supported the use of genomic testing of high-risk stage II melanomas for prognostic prediction and risk stratification.
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Affiliation(s)
- Aikaterini Dedeilia
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Thinzar Lwin
- Division of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Siming Li
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Giuseppe Tarantino
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Aleigha Lawless
- Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Tatyana Sharova
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David Liu
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Center for Immuno-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Genevieve M Boland
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Sonia Cohen
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
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3
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De Smedt J, Aura C, Van Kelst S, Janssen L, Marasigan V, Boecxstaens V, Stas M, Bogaerts K, Belmans A, Cleynen I, Vanderschueren D, Vandenberghe K, Bechter O, Nikkels A, Strobbe T, Emri G, Lambrechts D, Garmyn M. Clinical and genetic determinants of vitamin D receptor expression in cutaneous melanoma patients. Melanoma Res 2024; 34:125-133. [PMID: 38348498 PMCID: PMC10906192 DOI: 10.1097/cmr.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/02/2023] [Indexed: 03/02/2024]
Abstract
Decrease of vitamin D receptor (VDR) expression is observed in melanocytic naevi and melanoma compared to normal skin. Little is known about factors influencing VDR expression in cutaneous melanoma (CM). We investigated the correlation of VDR expression in CM with 25-hydroxy vitamin D (25OHD) levels, demographic/clinical parameters, genetic variants of VDR and pathology of the primary tumor. Demographic/clinical parameters were recorded in 407 prospectively recruited CM patients of a multi-center controlled study (ViDMe trial). We determined VDR expression both in the nucleus and in the cytoplasm by semi-quantitative assessment in CM tissue using histochemistry in 279 patients, expressed in percentages and histoscore (H-score). Genomic DNA from 332 patients was extracted to genotype thirteen VDR single nucleotide polymorphisms (SNPs) using TaqMan. VDR expression in CM tissue from 279 patients was correlated with clinical/demographic parameters and 25OHD levels (univariable and multivariable analysis), VDR SNPs (univariable analysis) and pathology parameters of primary CM tissue (univariable analysis). Cytoplasmic VDR expression was increased in patients who stated to have a high sun exposure during their life compared to patients with low sun exposure (p H-score,univariable : 0.001, p H-score,multivariable : 0.004). The A allele of the genetic VDR polymorphism Fok1 was associated with a higher expression of the VDR in the cytoplasm (p cytoplasmic, univariable : 0.001 and p H-score, univariable : 0.02). In the primary tumor, presence of mitosis (p nucleus,%, univariable : 0.002) and perineural invasion (p nucleus,%,univariable : 0.03) were significantly associated with low nuclear VDR expression. ClinicalTrials.gov Identifier: NCT01748448.
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Affiliation(s)
- Julie De Smedt
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
| | - Claudia Aura
- Conway Institute of Biomolecular and Biomedical Research, Pathology, University College Dublin, Dublin
| | - Sofie Van Kelst
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
| | - Laudine Janssen
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
| | - Vivien Marasigan
- Department of Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
| | - Veerle Boecxstaens
- Oncological and Vascular Access Surgery, Department of Surgical Oncology
| | - Marguerite Stas
- Oncological and Vascular Access Surgery, Department of Surgical Oncology
| | - Kris Bogaerts
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat)
| | - Ann Belmans
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat)
| | - Isabelle Cleynen
- Laboratory for Complex Genetics, Department of Human Genetics, KU Leuven
| | - Dirk Vanderschueren
- Clinical and Experimental Endocrinology, Department of Chronical Illness and Metabolism, KU Leuven, UZ Leuven
| | | | - Oliver Bechter
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, UZ Leuven, Leuven
| | - Arjen Nikkels
- Department of Dermatology, CHU Sart Tilman, University of Liège, Liège
| | - Tinne Strobbe
- Department of Dermatology, Imeldaziekenhuis, Bonheiden, Belgium
| | - Gabriella Emri
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dieter Lambrechts
- Laboratory for Translational Genetics, Department of Oncology, KU Leuven
- Center for Cancer Biology (VIB), Leuven, Belgium
| | - Marjan Garmyn
- Laboratory of Dermatology, Department of Oncology, KU Leuven, UZ Leuven, Leuven, Belgium
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Hawryluk EB, Moustafa D, Barry KK, Bahrani E, Reusch DB, Brahmbhatt M, Chen L, Coughlin CC, Gerami P, Haddock E, Hook K, Humphrey SR, Kao PC, Kruse LL, Lawley LP, Mansour D, Marghoob AA, Nguyen J, Phung TL, Pope E, Raisanen T, Robinson S, Rogers T, Schmidt B, Tran G, Travis K, Wolner Z, London WB, Eichenfield LF, Huang J. Risk factors and outcomes of melanoma in children and adolescents: A retrospective multicenter study. J Am Acad Dermatol 2024; 90:716-726. [PMID: 38040338 DOI: 10.1016/j.jaad.2023.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/04/2023] [Accepted: 10/26/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Pediatric melanoma presents with distinct clinical features compared to adult disease. OBJECTIVE Characterize risk factors and negative outcomes in pediatric melanoma. METHODS Multicenter retrospective study of patients under 20 years diagnosed with melanoma between January 1, 1995 and June 30, 2015 from 11 academic medical centers. RESULTS Melanoma was diagnosed in 317 patients, 73% of whom were diagnosed in adolescence (age ≥11). Spitzoid (31%) and superficial spreading (26%) subtypes were most common and 11% of cases arose from congenital nevi. Sentinel lymph node biopsy was performed in 68% of cases and positive in 46%. Fatality was observed in 7% of cases. Adolescent patients with melanoma were more likely to have family history of melanoma (P = .046) compared to controls. LIMITATIONS Retrospective nature, cohort size, control selection, and potential referral bias. CONCLUSION Pediatric melanoma has diverse clinical presentations. Better understanding of these cases and outcomes may facilitate improved risk stratification of pediatric melanoma.
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Affiliation(s)
- Elena B Hawryluk
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Danna Moustafa
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kelly K Barry
- Tufts University School of Medicine, Boston, Massachusetts
| | - Eman Bahrani
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Diana B Reusch
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Meera Brahmbhatt
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Lily Chen
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Carrie C Coughlin
- Division of Dermatology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ellen Haddock
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California
| | - Kristen Hook
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Stephen R Humphrey
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Pei-Chi Kao
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lacey L Kruse
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Danny Mansour
- Division of Pediatric Dermatology, The Hospital for Sick Children, Toronto, Canada; Temerity Faculty of Medicine and University of Toronto, Toronto, Canada
| | - Ashfaq A Marghoob
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Julie Nguyen
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Thuy L Phung
- Department of Pathology, University of South Alabama, Mobile, Alabama
| | - Elena Pope
- Division of Pediatric Dermatology, The Hospital for Sick Children, Toronto, Canada; Temerity Faculty of Medicine and University of Toronto, Toronto, Canada
| | - Tom Raisanen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Sarah Robinson
- Department of Dermatology, Tufts Medical Center, Boston, Massachusetts
| | - Tova Rogers
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Birgitta Schmidt
- Harvard Medical School, Boston, Massachusetts; Department of Pathology, Boston Children's Hospital, Boston, Massachusetts
| | - Gary Tran
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kate Travis
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Zachary Wolner
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Wendy B London
- Harvard Medical School, Boston, Massachusetts; Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego, California; Departments of Dermatology and Pediatrics, University of California, San Diego, San Diego, California
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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5
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Kesmodel SB, Kronenfeld JP, Zhao W, Koru-Sengul T, Goel N, Weingrad DN, Hernandez-Aya L, Lutzky J, Feun L, Garland-Kledzik M, Crystal JS. Omission of Completion Lymph Node Dissection in Sentinel Node Biopsy Positive Head and Neck Cutaneous Melanoma Patients. Ann Surg Oncol 2023; 30:7671-7685. [PMID: 37639029 PMCID: PMC10883719 DOI: 10.1245/s10434-023-14036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Recent studies evaluating patients with a positive sentinel lymph node biopsy (SLNB+) show no melanoma-specific survival difference between patients undergoing lymph node basin surveillance and completion lymph node dissection (CLND). This has been broadly applied, despite underrepresentation of head and neck (HN) cutaneous melanoma patients. We evaluated whether this was upheld in the HN melanoma cohort. METHODS Patients with HN melanoma with a SLNB+ were selected from the National Cancer Database (NCDB) from 2012 to 2019. Overall survival (OS) of patients who underwent SLNB only versus SLNB + CLND were compared. Subgroup analyses were performed based on pathologic N (pN) and receipt of immunotherapy. Adjusted hazard ratio (aHR) and 95% confidence interval (CI) were calculated. RESULTS Analysis of 634 patients with multivariable Cox regression showed no difference in OS in SLNB only versus SLNB + CLND cohorts (hazard ratio [HR] 1.13; 95% confidence interval [CI] 0.71-1.81; p = 0.610). Charlson-Deyo score (CDS) 1 versus 0 (HR 1.70; 95% CI 1.10-2.63; p = 0.016), pN2+ versus pN1 (HR 1.74; 95% CI 1.23-2.45; p = 0.002), and lymphovascular invasion (LVI) versus no (HR 2.07; 95% CI 1.34-3.19; p = 0.001) were associated with worse prognosis. Subgroup analysis by pN showed no OS benefit for CLND in either pN1 (HR 1.04; 95% CI 0.51-2.10; p = 0.922) or pN2+ (HR 1.31; 95% CI 0.67-2.57; p = 0.427) patients or in patients who received immunotherapy (HR 1.32; 95% CI 0.54-3.22; p = 0.549). CONCLUSIONS This study of SLNB + HN melanoma patients showed no OS difference in SLNB only versus SLNB + CLND. Further studies need to be performed to better define the role of CLND.
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Affiliation(s)
- Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Joshua P Kronenfeld
- DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Daniel N Weingrad
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Leonel Hernandez-Aya
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jose Lutzky
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Lynn Feun
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Mary Garland-Kledzik
- Division of Surgical Oncology, Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Jessica S Crystal
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
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6
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Țăpoi DA, Derewicz D, Gheorghișan-Gălățeanu AA, Dumitru AV, Ciongariu AM, Costache M. The Impact of Clinical and Histopathological Factors on Disease Progression and Survival in Thick Cutaneous Melanomas. Biomedicines 2023; 11:2616. [PMID: 37892990 PMCID: PMC10604442 DOI: 10.3390/biomedicines11102616] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
Thick cutaneous melanomas (Breslow depth > 4 mm) are locally advanced tumors, generally associated with poor prognosis. Nevertheless, these tumors sometimes display unpredictable behavior. This study aims to analyze clinical and histopathological features that can influence the prognosis of thick melanomas. This is a retrospective study on 94 thick primary cutaneous melanomas diagnosed between 2012 and 2018 that were followed-up for at least five years to assess disease progression and survival. We evaluated the age, gender, tumor location, histological subtype, Breslow depth, Clark level, resection margins, mitotic index, the presence/absence of ulceration, necrosis, regression, microsatellites, neurotropism, lymphovascular invasion, and the pattern of tumor-infiltrating lymphocytes, and their association with disease progression and survival. By conducting univariate analysis, we found that progression-free survival (PFS) was significantly associated with female gender, the superficial spreading melanoma (SSM) subtype, mitotic index, necrosis, microsatellites, and perineural invasion. Overall survival (OS) was significantly associated with female gender, Breslow depth, SSM subtype, necrosis, microsatellites, and perineural invasion. Through multivariate Cox proportional hazards regression, we found that the only factors associated with PFS were Breslow depth, necrosis, microsatellites, and perineural invasion, while the factors associated with OS were Breslow depth, necrosis, microsatellites, and perineural invasion. Certain histopathological features such as Breslow depth, necrosis, microsatellites, and perineural invasion could explain differences in disease evolution. This is one of the first studies to demonstrate an association between necrosis and perineural invasion and outcomes in patients with thick melanomas. By identifying high-risk patients, personalized therapy can be provided for improved prognosis.
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Affiliation(s)
- Dana Antonia Țăpoi
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Diana Derewicz
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Department of Pediatric Hematology and Oncology, Marie Sklodowska Curie Clinical Emergency Hospital, 041447 Bucharest, Romania
| | - Ancuța-Augustina Gheorghișan-Gălățeanu
- Department of Cellular and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- C.I. Parhon National Institute of Endocrinology, 011863 Bucharest, Romania
| | - Adrian Vasile Dumitru
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Ana Maria Ciongariu
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (D.A.Ț.); (A.M.C.); (M.C.)
- Department of Pathology, University Emergency Hospital, 050098 Bucharest, Romania
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7
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Vița O, Jurescu A, Văduva A, Cornea R, Cornianu M, Tăban S, Szilagyi D, Micșescu C, Natarâș B, Dema A. Invasive Cutaneous Melanoma: Evaluating the Prognostic Significance of Some Parameters Associated with Lymph Node Metastases. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1241. [PMID: 37512052 PMCID: PMC10385614 DOI: 10.3390/medicina59071241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: This study aimed to assess the clinical-pathological profile of patients with invasive cutaneous melanomas and to identify the parameters with a prognostic role in the lymph nodal spread of this malignant tumor. Materials and Methods: We performed a retrospective study on patients with invasive cutaneous melanomas who underwent surgery in the "Pius Brînzeu" County Clinical Emergency Hospital from Timișoara, Romania, and were evaluated for the status of loco-regional lymph nodes. We selected and analyzed some parameters searching for their relationship with lymph node metastases. Results: We identified 79 patients with invasive cutaneous melanomas (29 men and 50 women, mean age 59.36 years). A percentage of 58.3% of melanomas had Breslow tumor thickness >2 mm; 69.6% of melanomas showed a Clark level IV-V. Tumor ulceration was present in 59.5% of melanomas. A mitotic rate of ≥5 mitoses/mm2 was observed in 48.1% of melanomas. Tumor-infiltrating lymphocytes (TILs), non-brisk, were present in 59.5% of cases and 22.8% of patients had satellite/in-transit metastasis (SINTM). Tumor regression was identified in 44.3% of cases. Lymph nodes metastases were found in 43.1% of patients. Statistical analysis showed that lymph node metastases were more frequent in melanomas with Breslow thickness >2 mm (p = 0.0002), high Clark level (p = 0.0026), mitotic rate >5 mitoses/mm2 (p = 0.0044), ulceration (p = 0.0107), lymphovascular invasion (p = 0.0182), SINTM (p = 0.0302), and non-brisk TILs (p = 0.0302). Conclusions: The Breslow thickness >2 mm, high Clark level, high mitotic rate and ulceration are the most important prognostic factors for lymph nodal spread in cutaneous melanomas. However, some melanomas without these clinical-pathological features can have an unexpected, aggressive evolution, which entails the necessity of close and prolonged clinical follow-up of patients, including those with lesions considered without risk.
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Affiliation(s)
- Octavia Vița
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Aura Jurescu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Adrian Văduva
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Remus Cornea
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Marioara Cornianu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Sorina Tăban
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Diana Szilagyi
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Cristian Micșescu
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Bianca Natarâș
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
| | - Alis Dema
- Department of Microscopic Morphology-Morphopatology, ANAPATMOL Research Center, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
- Department of Pathology, "Pius Brînzeu" County Clinical Emergency Hospital, 300723 Timișoara, Romania
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Prognostic role of microsatellites in melanoma and implications in the American Joint Committee on Cancer classification system: A cohort study. J Am Acad Dermatol 2023; 88:338-347. [PMID: 36265824 DOI: 10.1016/j.jaad.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is limited information on microsatellite survival outcomes in patients with melanoma. OBJECTIVE To evaluate survival outcomes in patients with microsatellites, assess their role within stage III stratification of the American Joint Committee on Cancer classification, and assess the results of sentinel lymph node biopsies in patients with microsatellites. METHODS A retrospective bicenter cohort study from 1998 to 2019 included patients with a diagnosis of invasive cutaneous melanoma. RESULTS Of a total of 5216 patients, 108 (2.1%) had microsatellites at initial staging. Survival analysis showed that microsatellites were an independent risk factor with decreased overall survival (OS), melanoma-specific survival (MSS), and disease-free survival, with hazard ratios of 1.57, 1.76, and 1.76, respectively. Stratified analysis in patients with stage III melanoma showed a 5-year OS of 35% (95% CI, 17.3%-73.4%) and a MSS of 45% (95% CI, 23.1-87.5) for patients with stage IIIB melanoma with microsatellites. LIMITATIONS Retrospective design of the study. CONCLUSION Microsatellites were associated with other adverse melanoma prognostic factors. A multivariate Cox regression analysis showed that they are an independent risk factor for worse OS, MSS, and disease-free survival. Patients with stage IIIB melanoma with microsatellites had worse OS and MSS, whereas patients with stage IIIC melanoma had worse OS but not MSS.
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Ly CL, Blaha O, Wei W, Galan A, Kluger H, Ariyan S, Olino K, Clune JE. Predictive accuracy of elevated mitotic rate on lymph node positivity and recurrence in thin melanomas. Front Oncol 2023; 12:1077226. [PMID: 36686728 PMCID: PMC9853390 DOI: 10.3389/fonc.2022.1077226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Background Mitotic rate (MR) is considered an important prognostic factor for melanoma but is not currently used for staging because its nuanced effect is not yet well-delineated. We sought to determine if T category-specific MR is predictive of sentinel lymph node (SLN) positivity, recurrence, and melanoma-specific mortality (MSM). Methods A retrospective review of patients with primary cutaneous melanoma from 1994 to 2020 at a single academic center was performed. Patient demographics and tumor characteristics were recorded. MR was considered elevated for each AJCC8-defined T category if it was ≥2 mitoses/mm2 for T1, ≥4 mitoses/mm2 for T2, ≥6 mitoses/mm2 for T3, or ≥7 mitoses/mm2 for T4. Statistical analysis was performed to assess the predictive accuracy of MR on selected outcomes while controlling for ulceration. Results Data from 2,984 patients with complete records were analyzed. Along with Breslow thickness and ulceration, elevated MR was associated with higher risk of MSM (HR 1.816, P=0.0001). There was no difference among patients with ulcerated T1 or T2 tumors regardless of MR, but those with non-ulcerated T1 or T2 tumors and elevated MR were more likely to have positive SLNs (P<0.0001 and P=0.0043, respectively) and recurrence (P=0.0007 and P=0.0004, respectively) compared to counterparts with low MR. There were no notable differences for T3 or T4 tumors based on MR. Conclusions Elevated MR is associated with SLN positivity and recurrence in thin melanomas, independent of ulceration. SLN biopsy should therefore be strongly considered for patients with non-ulcerated lesions <0.8 mm thick if the MR is ≥2 mitoses/mm2.
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Affiliation(s)
- Catherine L. Ly
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Ondrej Blaha
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
| | - Wei Wei
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
| | - Anjela Galan
- Departments of Dermatology and Pathology, Yale School of Medicine, New Haven, CT, United States
| | - Harriet Kluger
- Division of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Stephan Ariyan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Kelly Olino
- Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - James E. Clune
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States,*Correspondence: James E. Clune,
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10
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Chu PY, Chen YF, Li CY, Wang TH, Chiu YJ, Ma H. Influencing factors associated with lymph node status in patients with cutaneous melanoma: An Asian population study. J Chin Med Assoc 2023; 86:72-79. [PMID: 36083686 DOI: 10.1097/jcma.0000000000000809] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Sentinel lymph node (SLN) status is the predominant prognostic factor in patients diagnosed with clinically localized melanoma. The significance of completion lymph node dissection in patients with SLN metastasis is debatable. Not many studies have been conducted on acrallentiginous melanoma (ALM). This study aimed to characterize the prognostic factors of nodal positive ALM and confirm whether ALM patients can undergo the same treatment strategy as non-ALM patients in the Asian population. METHODS This is a retrospective review of patients who underwent surgery for cutaneous melanoma (CM) at Taipei Veterans General Hospital between January 1993 and December 2019. We investigated the risk factors for lymph node status. The association between clinicopathological factors and lymph node status of ALM and non-ALM patients was analyzed. Outcomes of completion lymph node dissection (CLND) performed following sentinel lymph node biopsy (SLNB) in the CM and ALM groups were compared. RESULTS A total of 197 patients were included in this study. ALM was the most common histological subtype, accounting for 66.5% of all the cases. Patients in the CM and ALM subgroups with metastatic SLN ( p = 0.012) or lymph nodes ( p < 0.001 and p = 0.001) exhibited higher mortality rate. Multivariate analysis showed that patients with clinical presentation of T4 category tumor ( p = 0.012) and lymphovascular invasion ( p = 0.012) had a significantly higher risk of positive lymph nodes. The overall survival of patients with lymph nodes metastasis was not associated with the performance of CLND. CONCLUSION Patients in the CM or ALM subgroups with metastatic SLNs or lymph nodes exhibited significantly poorer overall survival. Advanced Breslow thickness and lymphovascular invasion were independent predictive factors for CM and ALM patients with positive lymph node status. There was no significant difference in survival between CM and ALM patients following SLNB, regardless of CLND being performed.
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Affiliation(s)
- Po-Yu Chu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
| | - Yi-Fan Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tien-Hsiang Wang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan, ROC
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11
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Tissue Biomarkers Predicting Lymph Node Status in Cutaneous Melanoma. Int J Mol Sci 2022; 24:ijms24010144. [PMID: 36613587 PMCID: PMC9820052 DOI: 10.3390/ijms24010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Cutaneous melanoma is a severe neoplasm that shows early invasiveness of the lymph nodes draining the primary site, with increased risk of distant metastases and recurrence. The tissue biomarker identification could be a new frontier to predict the risk of early lymph node invasiveness, especially in cases considered by current guidelines to be at low risk of lymph node involvement and not requiring evaluation of the sentinel lymph node (SLN). For this reason, we present a narrative review of the literature, seeking to provide an overview of current tissue biomarkers, particularly vascular endothelium growth factors (VEGF), Tetraspanin CD9, lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1), D2-40, and gene expression profile test (31-GEP). Among these, 31-GEP seems to be able to provide a distinction between low or high risk for positive SLN classes. VEGF receptor-3 and CD9 expression may be independent predictors of positive SLN. Lastly, LYVE-1 and D2-40 allow an easier assessment of lymph vascular invasion, which can be considered a good predictor of SLN status. In conclusion, biomarkers to assess the lymph node status of cutaneous melanoma patients may play an important role in those cases where the clinician is in doubt whether or not to perform SLN biopsy.
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12
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Hodson M, Feustel P, Davis L. Sentinel lymph node biopsy in desmoplastic melanoma - the percent desmoplastic component matters: A systematic review. J Plast Reconstr Aesthet Surg 2022; 75:4441-4449. [PMID: 36283925 DOI: 10.1016/j.bjps.2022.08.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/28/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Desmoplastic melanoma (DM) is a less common form of cutaneous melanoma that has been described for decades; however, controversy remains regarding the management and use of sentinel lymph node biopsy (SLNB). The purpose of this study is to identify whether SLNB is indicated in all cases of DM, including the pure subtype. METHODS A systematic review was conducted using PubMed (with access to MEDLINE) along with the Cochrane Central Register of Controlled Trials from 2001 to 2019. Case series and case-control studies were included. RESULTS Eighteen studies were included for a total population of 3,914 patients. SLNB was performed in 2229 patients. The percentage of positive SLNB results was 8.5%. However, patients with pure DM (>90% desmoplastic component) were found to have a significantly lower rate of occult metastatic node positivity when compared with that of mixed DM (4.9% and 14.8%, respectively). CONCLUSIONS Our findings underscore the importance of the pathologist reporting percentage of desmoplastic component in melanoma. SLNB should be strongly considered for patients with mixed DM. However, the low rate of occult metastatic node positivity in pure DM is beneath the threshold for using SLNB as a staging procedure. SUMMARY Previous studies have suggested that desmoplastic melanoma is less likely to metastasize to regional lymph nodes when compared with conventional melanoma. This review suggests that it is imperative to distinguish the histologic subtype of desmoplastic melanoma to determine if staging procedure is indicated.
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Affiliation(s)
| | - Paul Feustel
- Albany Medical College, Albany, NY, United States
| | - Lindy Davis
- Division of Surgical Oncology, Department of Surgery, Albany Medical Center, 43 New Scotland Ave, Albany, NY 12208, United States.
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Straker RJ, Taylor LA, Neuwirth MG, Sinnamon AJ, Shannon AB, Abbott J, Miura JT, Chu EY, Xu X, Karakousis GC. Optimizing Detection of Lymphatic Invasion in Primary Cutaneous Melanoma With the Use of D2-40 and a Paired Melanocytic Marker. Am J Dermatopathol 2022; 44:21-27. [PMID: 34231497 PMCID: PMC8671172 DOI: 10.1097/dad.0000000000002018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
ABSTRACT Dual immunohistochemical (IHC) staining with D2-40 and S100 improves detection of lymphatic invasion (LI) in primary cutaneous melanoma. However, limited data exist evaluating this technique using other melanocytic markers, and thus, the optimal marker for detection of LI is unestablished. To address this knowledge gap, a case-control study was performed comparing melanoma specimens from 22 patients with known lymphatic spread (LS) with a control group of 11 patients without LS. Specimens underwent dual IHC staining with D2-40 and MART-1, SOX-10, and S100 to evaluate for LI. Receiver operating characteristic analysis was used to estimate each stain's accuracy for detection of LI. The LS group was more likely to be ≥65 years (P = 0.04), have a tumor thickness of ≥1 mm (P < 0.01), and have ulcerated tumors (P = 0.02). Detection of LI with D2-40/MART-1 significantly correlated with LS (P = 0.03), and the D2-40/MART-1 stain was most accurate for LI based on receiver operating characteristic curve analysis (area under the curve [AUC] 0.705) in comparison with D2-40/SOX-10 (AUC 0.575) and D2-40/S100 (AUC 0.633). These findings suggest that MART-1 may be the optimal melanocytic marker to combine with D2-40 for detection of LI in melanoma. Further studies are needed to determine the utility of routinely performing these stains for histopathologic analysis of melanoma.
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Affiliation(s)
- Richard J. Straker
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Laura A. Taylor
- Department of Dermatology, University of Louisville, Louisville, KY
| | | | | | - Adrienne B. Shannon
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - James Abbott
- Department of Dermatology, University of Utah, Salt Lake City, UT
| | - John T. Miura
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Emily Y. Chu
- Department of Dermatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Giorgos C. Karakousis
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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Association of Melanoma-Risk Variants with Primary Melanoma Tumor Prognostic Characteristics and Melanoma-Specific Survival in the GEM Study. Curr Oncol 2021; 28:4756-4771. [PMID: 34898573 PMCID: PMC8628692 DOI: 10.3390/curroncol28060401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/11/2021] [Accepted: 11/10/2021] [Indexed: 12/15/2022] Open
Abstract
Genome-wide association studies (GWAS) and candidate pathway studies have identified low-penetrant genetic variants associated with cutaneous melanoma. We investigated the association of melanoma-risk variants with primary melanoma tumor prognostic characteristics and melanoma-specific survival. The Genes, Environment, and Melanoma Study enrolled 3285 European origin participants with incident invasive primary melanoma. For each of 47 melanoma-risk single nucleotide polymorphisms (SNPs), we used linear and logistic regression modeling to estimate, respectively, the per allele mean changes in log of Breslow thickness and odds ratios for presence of ulceration, mitoses, and tumor-infiltrating lymphocytes (TILs). We also used Cox proportional hazards regression modeling to estimate the per allele hazard ratios for melanoma-specific survival. Passing the false discovery threshold (p = 0.0026) were associations of IRF4 rs12203592 and CCND1 rs1485993 with log of Breslow thickness, and association of TERT rs2242652 with presence of mitoses. IRF4 rs12203592 also had nominal associations (p < 0.05) with presence of mitoses and melanoma-specific survival, as well as a borderline association (p = 0.07) with ulceration. CCND1 rs1485993 also had a borderline association with presence of mitoses (p = 0.06). MX2 rs45430 had nominal associations with log of Breslow thickness, presence of mitoses, and melanoma-specific survival. Our study indicates that further research investigating the associations of these genetic variants with underlying biologic pathways related to tumor progression is warranted.
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Loss of miR-1469 expression mediates melanoma cell migration and invasion. PLoS One 2021; 16:e0256629. [PMID: 34469478 PMCID: PMC8409617 DOI: 10.1371/journal.pone.0256629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/12/2021] [Indexed: 11/19/2022] Open
Abstract
Tumor ulceration is considered one of the most prognostically significant findings in primary cutaneous melanoma, associated with decreased disease-free and overall survival. However, the unique features associated with ulcerated melanoma that contribute to a poor prognosis in affected patients remain poorly defined. microRNAs are small, non-coding RNAs that function to inhibit expression of specific gene targets, therefore altering the functions of cells in which they are expressed. miR-1469 is a novel miR with significantly decreased expression in ulcerated melanoma tissue relative to non-ulcerated tumors. We hypothesized that loss of miR-1469 expression in melanoma contributes to altered tumor cell functions mediating disease progression. Transfection of a miR-1469 mimic resulted in a significant reduction in the migratory and invasive capacity of the CHL1 and MEL39 melanoma cell lines (>58.1% reduction, p < 0.0332), as well as the invasive capacity of the A375 melanoma cell line (>50% reduction, p < 0.0021). Expression of myeloid cell leukemia-1 (MCL1), a miR-1469 target gene, was reduced in the A375 and MEL39 cell lines by immunoblot. No significant differences in viability, resistance to apoptotic stimuli, or proliferation were observed following transfection. These findings together demonstrate how migration and invasion are specific functions through which miR-1469 expression in melanoma cells can contribute to the differences in disease progression associated with tumor ulceration.
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Chu PY, Chen YF, Li CY, Yang JS, King YA, Chiu YJ, Ma H. Factors influencing locoregional recurrence and distant metastasis in Asian patients with cutaneous melanoma after surgery: A retrospective analysis in a tertiary hospital in Taiwan. J Chin Med Assoc 2021; 84:870-876. [PMID: 34282077 DOI: 10.1097/jcma.0000000000000586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The goal of this study was to investigate the prognostic factors for locoregional recurrence and metastasis in patients with cutaneous melanoma (CM) who underwent surgery, especially in the acral lentiginous melanoma (ALM) subtype. METHODS This study was a retrospective review of patients who underwent surgery for CM at Taipei Veterans General Hospital between 2000 and 2018. We investigated the risk factors for locoregional and distant metastases. The association between clinicopathological factors and locoregional recurrence and distant metastasis of the CM and ALM subtypes was analyzed. In addition, the outcomes between the ALM and non-ALM groups were compared. RESULTS A total of 161 patients were included in the analysis. The most common histological subtype was ALM. The overall locoregional recurrence rate of CM was 13.0% and the distant metastasis rate was 42.9%, whereas that of the ALM subtype was 12.5% and 45.5%, respectively. In patients with CM, male sex, tumor with lymphovascular invasion, and positive lymph node status were the prognostic factors for both locoregional recurrence and distant metastasis. Among the patients with ALM, positive lymph node status was significantly associated with both locoregional recurrence and distant metastasis. CONCLUSION In this cohort, factors influencing locoregional recurrence and distant metastasis were similar between the ALM and non-ALM groups. The above-recommended surgical margin did not show any benefit in either the CM or the ALM subtype. ALM can be handled using the same surgical strategy as CM in the Asian population.
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Affiliation(s)
- Po-Yu Chu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
| | - Yi-Fan Chen
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jai-Sing Yang
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Yih-An King
- Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan, ROC
| | - Yu-Jen Chiu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsu Ma
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan, ROC
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Wainstein AJA, Duprat Neto JP, Enokihara MY, Brechtbühl ER, Riccardi F, Landman G, de Melo AC, de Lima Vazquez V, Munhoz RR, Dunshee De Abranches Oliveira Santos Filho I, Bertolli E, Drummond-Lage AP, Costa Soares de Sá B, Botelho L, Higino Steck J, Belfort FA, Maia M, Bakos RM, Gomes EE, Schmerling R, Cavarsan F. Demographic, Clinical, and Pathologic Features of Patients With Cutaneous Melanoma: Final Analysis of the Brazilian Melanoma Group Database. JCO Glob Oncol 2021; 6:575-582. [PMID: 32293941 PMCID: PMC7193775 DOI: 10.1200/jgo.20.00005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE National epidemiologic data on melanoma are scarce in Brazil. The current work presents final demographic, clinical, and pathologic results from the Brazilian Melanoma Group database to detail how patients with melanoma present at diagnosis. METHODS The online database includes patients diagnosed between 1982 and 2015 and evaluated at their centers of origin between 2001 and 2016. The primary objective was to describe the demographic, clinical, and pathologic characteristics of the patients, and secondary objectives were to investigate the association between clinical and pathologic variables of interest. RESULTS A total of 1,596 patients were included. Median age was 52 years, 57% were women, and the majority were identified as white. Invasive melanoma was diagnosed in 1,297 patients, mostly localized, whereas 299 (19%) had in situ disease (TisN0M0). Only 165 patients had initial lymph node involvement. Fitzpatrick skin types I or II were slightly more frequent with in situ melanoma (73%) than with invasive disease (67%; P = .054). The median Breslow thickness was 0.95 mm, Clark levels 2 and 3 comprised nearly 70% of cases, and ulceration was present in 18% of patients. The mitotic rate was significantly associated with the presence of ulceration and both vascular and perineural invasion but not with margin positivity, whereas histologic regression was associated with both intratumoral and peritumoral inflammatory infiltrates. CONCLUSION Despite the limitations of an observational, registry-based study, the current results provide a general profile of patients with cutaneous melanoma in Brazil at the time of diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marcus Maia
- Brazilian Melanoma Group, São Paulo, São Paulo, Brazil
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Mitra D, Ologun G, Keung EZ, Goepfert RP, Amaria RN, Ross MI, Gershenwald JE, Lucci A, Fisher SB, Davies MA, Lee JE, Bishop AJ, Farooqi AS, Wargo J, Guadagnolo BA. Nodal Recurrence is a Primary Driver of Early Relapse for Patients with Sentinel Lymph Node-Positive Melanoma in the Modern Therapeutic Era. Ann Surg Oncol 2021; 28:3480-3489. [PMID: 33856603 DOI: 10.1245/s10434-021-09804-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/23/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Management of patients with sentinel lymph node (SLN)-positive melanoma has changed dramatically over the last few years such that completion lymph node dissection (CLND) has become uncommon, and many patients receive adjuvant immunotherapy or targeted therapy. This study seeks to characterize patterns and predictors of early recurrence in this setting. PATIENTS AND METHODS All patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy (SLNB) between 3/2016 and 12/2019 were identified. The subset with a positive SLN who did not undergo CLND were examined for further analysis of outcomes and predictors of recurrence. RESULTS Overall, 215 patients with SLN-positive melanoma who did not have CLND were identified. Adjuvant systemic therapy was administered to 102 (47%), with 93% of this subset receiving immunotherapy (n = 95). Median follow-up from SLNB was 20 months (IQR 12-28.5 months), and 57 patients (27%) recurred during this time. The SLN basin was the most common site of recurrence (n = 38, 67% of recurrence), with isolated nodal recurrence being the most common first site of recurrent disease (n = 22, 39% of recurrence). On multivariable analysis, lymphovascular invasion (LVI) of the primary tumor, two or more involved nodes, and > 1 mm nodal deposit were independently associated with higher rates of nodal relapse. CONCLUSIONS Nodal recurrence is a primary driver of early disease relapse for patients with SLN-positive melanoma who do not undergo CLND in the era of effective adjuvant systemic therapy. LVI, ≥ 2 nodes, or > 1 mm nodal disease identifies patients at particularly high risk of nodal relapse.
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Affiliation(s)
- Devarati Mitra
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Gabriel Ologun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rodabe N Amaria
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Merrick I Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Anthony Lucci
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah B Fisher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Bishop
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahsan S Farooqi
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Wargo
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - B Ashleigh Guadagnolo
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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19
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Marsch AF, McKee RM, Werbel T, Ruo B, Hinds BR. The Relationship Between Epidermal Mitotic Density, Atypical Mitotic Figure Density, Breslow Depth, Ulceration, and Dermal Mitotic Rate in Cutaneous Melanoma: A Retrospective Cohort Study. Int J Surg Pathol 2021; 29:592-599. [PMID: 33624542 DOI: 10.1177/1066896921995985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Prognostic factors for melanoma include Breslow depth (BD), ulceration, and dermal mitotic rate (DMR). No studies have queried the effect of epidermal mitotic density (EMD) or atypical mitotic figure density (AMD) in an outcome-based assessment. Our objective was to determine if there is a relationship between EMD, AMD, BD, DMR, and ulceration and patient outcomes. This was a retrospective cohort study of 185 cases of thick and thin melanomas. Univariate and multivariate cause-specific regression analysis was performed. There was a positive correlation between EMD and BD (P = .0001). The difference between AMD in thick and thin melanomas was statistically significant. For every unit increase in EMD, patients had a 2.8-fold increase in the risk of distant metastasis; however, statistical significance was lost in the multivariate analysis. In adjusted analyses, ulceration, DMR, and BD were associated with outcomes. There were no statistically significant correlations between AMD and outcomes. This study is limited by its small sample size, diminution of the epidermis in some thick melanomas preventing EMD estimates, and reproducibility of mitotic figure counting. EMD and AMD do not seem to have any independent value in multivariate analyses for melanoma. Ulceration, BD, and DMR were significantly associated with outcomes and further solidify these known predictors of prognosis.
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Affiliation(s)
- Amanda F Marsch
- 8784Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Ryan M McKee
- UC San Diego School of Medicine, San Diego, La Jolla, CA, USA
| | | | - Bernice Ruo
- 8784Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Brian R Hinds
- 8784Department of Medicine, University of California San Diego, La Jolla, CA, USA
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20
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Tejera-Vaquerizo A, Fernández-Figueras MT, Santos-Briz A, Ríos-Martín JJ, Monteagudo C, Fernández-Flores A, Requena C, Traves V, Descalzo-Gallego MA, Rodríguez-Peralto JL. Protocol for the Histologic Diagnosis of Cutaneous Melanoma: Consensus Statement of the Spanish Society of Pathology and the Spanish Academy of Dermatology and Venereology (AEDV) for the National Cutaneous Melanoma Registry. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:32-43. [PMID: 33038295 PMCID: PMC7540207 DOI: 10.1016/j.ad.2020.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 11/26/2022] Open
Abstract
This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.
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Affiliation(s)
- A Tejera-Vaquerizo
- Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España; Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, España.
| | - M T Fernández-Figueras
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Grupo Quironsalud, Sant Cugat del Vallès, Barcelona, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España
| | - A Fernández-Flores
- Servicio de Anatomía Patológica, Hospital del Bierzo, Ponferrada, León, España; Servicio de Anatomía Patológica, Hospital de la Reina, Ponferrada, León, España
| | - C Requena
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
| | - V Traves
- Servicio de Anatomía Patológica, Instituto Valenciano de Oncología, Valencia, España
| | - M A Descalzo-Gallego
- Unidad de Investigación, Fundación Academia Española de Dermatología y Venereología, Madrid, España
| | - J L Rodríguez-Peralto
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
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21
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Wang D, Xu T, Zhu H, Dong J, Fu L. Primary malignant melanomas of the female lower genital tract: clinicopathological characteristics and management. Am J Cancer Res 2020; 10:4017-4037. [PMID: 33414983 PMCID: PMC7783736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023] Open
Abstract
The female lower genital tract melanomas mainly include vulvar, vaginal and cervical melanoma. There is little clinical data on the melanomas thus making them highly lethal with their prognosis being worse than for cutaneous melanoma and other gynecological malignancies. Surgery is still the primary treatment for gynecological melanomas with wide local resection (WLE) of tumors with adequate margins being preferred for early-stage vulvar melanoma while complete resection of the primary tumor is the standard treatment for early-stage cervical and vaginal melanoma. Sentinel lymph node biopsy seems to avoid unnecessary complete regional lymphadenectomy. However, it should be chosen cautiously. Recently discovered molecular changes have provided new hopes for effective systemic treatment of female genital tract melanomas. In this review, we summarize the pathogenesis and clinicopathological characteristics of these rare melanomas with particular emphasis on new therapies and clinical management methods that may affect prognosis. The review aims to provide a viable direction for clinicians to diagnose and treat female lower genital tract melanomas.
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Affiliation(s)
- Dongying Wang
- Department of Obstetrics and Gynecology, Second Hospital of Jilin UniversityChangchun, Jilin, P. R. China
| | - Tianmin Xu
- Department of Obstetrics and Gynecology, Second Hospital of Jilin UniversityChangchun, Jilin, P. R. China
| | - He Zhu
- Department of Obstetrics and Gynecology, Second Hospital of Jilin UniversityChangchun, Jilin, P. R. China
| | - Junxue Dong
- Department of Obstetrics and Gynecology, Second Hospital of Jilin UniversityChangchun, Jilin, P. R. China
- Department of Molecular Biology, Max Planck Institute for Infection BiologyBerlin, Germany
| | - Li Fu
- Department of Obstetrics and Gynecology, Second Hospital of Jilin UniversityChangchun, Jilin, P. R. China
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22
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Yi LG, Melson G, Belote K, Flowers R. Lymphovascular invasion of malignant melanoma presenting as gray streaks on dermoscopy. JAAD Case Rep 2020; 6:1258-1260. [PMID: 33294558 PMCID: PMC7700981 DOI: 10.1016/j.jdcr.2020.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lauren G. Yi
- Correspondence to: Lauren G. Yi, BS, 1215 Lee St, Charlottesville, VA 22908.
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23
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Hawryluk EB, Moustafa D, Bartenstein D, Brahmbhatt M, Cordoro K, Gardner L, Gauthier A, Grossman D, Gupta D, Hunt RD, Jen M, Kao PC, Kruse LL, Lawley LP, London WB, Mansour D, O'Haver JA, Phung T, Pope E, Price HN, Rogers T, Shah SD, Wolner Z, Huang J, Marghoob AA. A retrospective multicenter study of fatal pediatric melanoma. J Am Acad Dermatol 2020; 83:1274-1281. [DOI: 10.1016/j.jaad.2020.06.1010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
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24
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Mei C, Song PY, Zhang W, Zhou HH, Li X, Liu ZQ. Aberrant RNA Splicing Events Driven by Mutations of RNA-Binding Proteins as Indicators for Skin Cutaneous Melanoma Prognosis. Front Oncol 2020; 10:568469. [PMID: 33178596 PMCID: PMC7593665 DOI: 10.3389/fonc.2020.568469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/14/2020] [Indexed: 12/29/2022] Open
Abstract
The worldwide incidence of skin cutaneous melanoma (SKCM) is increasing at a more rapid rate than other tumors. Aberrant alternative splicing (AS) is found to be common in cancer; however, how this process contributes to cancer prognosis still remains largely unknown. Mutations in RNA-binding proteins (RBPs) may trigger great changes in the splicing process. In this study, we comprehensively analyzed DNA and RNA sequencing data and clinical information of SKCM patients, together with widespread changes in splicing patterns induced by RBP mutations. We screened mRNA expression-related and prognosis-related mutations in RBPs and investigated the potential affections of RBP mutations on splicing patterns. Mutations in 853 RBPs were demonstrated to be correlated with splicing aberrations (p < 0.01). Functional enrichment analysis revealed that these alternative splicing events (ASEs) may participate in tumor progress by regulating the modification process, cell-cycle checkpoint, metabolic pathways, MAPK signaling, PI3K-Akt signaling, and other important pathways in cancer. We also constructed a prediction model based on overall survival-related AS events (OS-ASEs) affected by RBP mutations, which exhibited a good predict efficiency with the area under the curve of 0.989. Our work highlights the importance of RBP mutations in splicing alterations and provides effective biomarkers for prediction of prognosis of SKCM.
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Affiliation(s)
- Chao Mei
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Key Laboratory of Biological Nanotechnology of National Health Commission, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Engineering Research Center for Applied Technology of Pharmacogenomics of Ministry of Education, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Pei-Yuan Song
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Key Laboratory of Biological Nanotechnology of National Health Commission, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Engineering Research Center for Applied Technology of Pharmacogenomics of Ministry of Education, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Wei Zhang
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Key Laboratory of Biological Nanotechnology of National Health Commission, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Engineering Research Center for Applied Technology of Pharmacogenomics of Ministry of Education, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Hong-Hao Zhou
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Key Laboratory of Biological Nanotechnology of National Health Commission, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Engineering Research Center for Applied Technology of Pharmacogenomics of Ministry of Education, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Xi Li
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Key Laboratory of Biological Nanotechnology of National Health Commission, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Engineering Research Center for Applied Technology of Pharmacogenomics of Ministry of Education, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Zhao-Qian Liu
- Department of Clinical Pharmacology, Hunan Key Laboratory of Pharmacogenetics, Key Laboratory of Biological Nanotechnology of National Health Commission, and National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Engineering Research Center for Applied Technology of Pharmacogenomics of Ministry of Education, Institute of Clinical Pharmacology, Central South University, Changsha, China
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25
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Avilés-Izquierdo JA, Nieto-Benito LM, Lázaro-Ochaita P, Escat-Cortés JL, Marquez-Rodas I, Mercader-Cidoncha E. Prognostic significance of sentinel node biopsy status in cutaneous melanoma: a 21-years prospective study from a single institution. Clin Transl Oncol 2020; 22:1611-1618. [PMID: 32065344 DOI: 10.1007/s12094-020-02306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/18/2020] [Indexed: 11/29/2022]
Abstract
AIM To analyze the accuracy of the sentinel lymphatic node biopsy (SLNB) and to investigate predictive factors for sentinel node (SN) status and prognostic factors for recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with melanoma. MATERIAL AND METHODS Between June 1997 and June 2017, 440 consecutive patients, who underwent SLNB by a single surgical team, were prospectively included. Descriptive and survival analysis were performed. RESULTS 119 of 440 patients (26%) had positive SN. SLNB's false-negative rate was 6.3%. Breslow thickness, Clark´s level, ulceration and histological subtype were statistically significant predictive factors of SN metastases. In a multivariate analysis, positive SN (HR = 2.21, p = 0.01), deeper Breslow thickness (HR = 2.05, p = 0.013), male gender (RR = 2.05, p = 0.02), and higher Clark's level (HR = 2.30, p = 0.043) were significantly associated with decreased RFS; and positive SN (HR = 2.58, p < 0.001), deeper Breslow thickness (HR = 2.57, p = 0.006) and male gender (HR = 1.93, p = 0.006) were associated with lower DSS. CONCLUSION SLNB is a reliable and reproducible procedure with high sensitivity (93.7%). Positive SN metastases, Breslow thickness and male gender were statistically associated with poorer outcomes. Male gender was an independent prognostic factor of tumor thickness or SN status.
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Affiliation(s)
- J A Avilés-Izquierdo
- Dermatology Department, Hospital Universitario Gregorio Marañón, C/Dr Esquerdo No. 46, 28007, Madrid, Spain
| | - L M Nieto-Benito
- Dermatology Department, Hospital Universitario Gregorio Marañón, C/Dr Esquerdo No. 46, 28007, Madrid, Spain
| | - P Lázaro-Ochaita
- Dermatology Department, Hospital Universitario Gregorio Marañón, C/Dr Esquerdo No. 46, 28007, Madrid, Spain
| | - J L Escat-Cortés
- General and Digestive Surgery Department, Hospital Universitario Gregorio Marañón, C/Dr Esquerdo No. 46, 28007, Madrid, Spain
| | - I Marquez-Rodas
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, C/Dr Esquerdo No. 46, 28007, Madrid, Spain
| | - E Mercader-Cidoncha
- General and Digestive Surgery Department, Hospital Universitario Gregorio Marañón, C/Dr Esquerdo No. 46, 28007, Madrid, Spain.
- Instituto Investigación Sanitaria Gregorio Marañón, Hospital Universitario Gregorio Marañón, C/Dr Esquerdo No. 46, 28007, Madrid, Spain.
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26
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Wilkinson MJ, Gyorki DE. Extent of ulceration in cutaneous melanoma: is this biomarker ready for primetime? Br J Dermatol 2020; 184:192-193. [PMID: 32729117 DOI: 10.1111/bjd.19386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M J Wilkinson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - D E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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27
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Portelli F, Galli F, Cattaneo L, Cossa M, De Giorgi V, Forte G, Fraternali Orcioni G, Gianatti A, Indini A, Labianca A, Maurichi A, Merelli B, Montesco MC, Occelli M, Patuzzo R, Piazzalunga D, Pigozzo J, Quaglino P, Ribero S, Salvatori R, Saraggi D, Sena P, Senetta R, Valeri B, Tanaka M, Fukayama M, Palmieri G, Mandalà M, Massi D. The prognostic impact of the extent of ulceration in patients with clinical stage I-II melanoma: a multicentre study of the Italian Melanoma Intergroup (IMI). Br J Dermatol 2020; 184:281-288. [PMID: 32282932 DOI: 10.1111/bjd.19120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The presence of ulceration has been recognized as an adverse prognostic factor in primary cutaneous melanoma (PCM). OBJECTIVES To investigate whether the extent of ulceration (EoU) predicts relapse-free survival (RFS) and overall survival (OS) in PCM. MATERIALS AND METHODS We retrieved data for 477 patients with ulcerated PCM from databases of the Italian Melanoma Intergroup. Univariate and multivariable Cox proportional hazard models were used to assess the independent prognostic impact of EoU. RESULTS A significant interaction emerged between Breslow thickness (BT) and EoU, considering both RFS (P < 0·0001) and OS (P = 0·0006). At multivariable analysis, a significant negative impact of EoU on RFS [hazard ratio (HR) (1-mm increase) 1·26, 95% confidence interval (CI) 1·08-1·48, P = 0·0047] and OS [HR (1-mm increase) 1·25, 95% CI 1·05-1·48, P = 0·0120] was found in patients with BT ≤ 2 mm, after adjusting for BT, age, tumour-infiltrating lymphocytes, sentinel lymph node status and mitotic rate. No impact of EoU was found in patients with 2·01-4 mm and > 4 mm BT. CONCLUSIONS This study demonstrates that EoU has an independent prognostic impact in PCM and should be recorded as a required element in pathology reports.
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Affiliation(s)
- F Portelli
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - F Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - L Cattaneo
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Units of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M Cossa
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - V De Giorgi
- Department of Dermatology, University of Florence, Italy
| | - G Forte
- Anatomia e Istologia Patologica, Azienda Ospedaliera Santa Croce e Carle di Cuneo SC, Cuneo, Italy
| | - G Fraternali Orcioni
- Anatomia e Istologia Patologica, Azienda Ospedaliera Santa Croce e Carle di Cuneo SC, Cuneo, Italy
| | - A Gianatti
- Units of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Indini
- Units of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Labianca
- Units of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Maurichi
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - B Merelli
- Units of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - M C Montesco
- Pathological Anatomy and Histology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Occelli
- Oncologia, Azienda Ospedaliera Santa Croce e Carle di Cuneo SC, Cuneo, Italy
| | - R Patuzzo
- Melanoma and Sarcoma Unit, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - D Piazzalunga
- Units of Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - J Pigozzo
- Melanoma and Esophageal Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - P Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy
| | - S Ribero
- Dermatologic Clinic, Department of Medical Sciences, University of Turin Medical School, Turin, Italy
| | - R Salvatori
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - D Saraggi
- Pathological Anatomy and Histology, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.,Department of Pathology, Azienda ULSS8 Berica-San Bortolo Hospital, Vicenza, Italy
| | - P Sena
- Units of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - R Senetta
- Pathology Division, Department of Oncology, University of Turin, Turin, Italy
| | - B Valeri
- Department of Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | | | | | - G Palmieri
- Unit of Cancer Genetics, ICB-CNR, Sassari, Italy
| | - M Mandalà
- Units of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - D Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
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28
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Gualdi G, Panarese F, Meogrossi G, Marchioni M, De Tursi M, Di Marino P, Angelucci D, Amatetti M, Proietto G, Di Nicola M, Amerio P. Speed rate (SR) as a new dynamic index of melanoma behavior. Pigment Cell Melanoma Res 2020; 33:709-718. [PMID: 32406598 DOI: 10.1111/pcmr.12890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 01/25/2023]
Abstract
Melanomas are skin tumors that show a variety of biological behavior. Some develop very fast and some other grow extremely slow, with metastasis appearing, eventually, many years after the diagnosis. The number of mitoses in primary melanoma has been related to a more aggressive tumor and may have a potential as predictive factor for cutaneous melanoma survival. However, tumor mitotic rate is a static measure and in multivariate analysis on tumor survival, it has scored less than other tumor characteristics. We tried to evolve tumor mitotic rate from a static parameter to a time-dependent one. Similar to the already described growth rate (GR), we propose the speed rate (SR). SR is defined as the ratio of tumor mitotic rate to time to melanoma development. A prospective series of 345 patients with melanoma was investigated for the role of SR as predictive factor for sentinel lymph node (SLN) positivity and tumor progression. We calculated the best threshold for SR and GR to predict the risk of recurrence. Melanoma clinical and histological characteristics as well as GR were correlated in a multivariated analysis with SR. SR values >0.2 mitoses/month were associated with negative prognostic factors such as ulceration (82.8%), SLN positivity (80%), progression (82.8%), and death (85.7%). The association of GR > 0.3 mm/months and SR > 0.2 mitoses/month had a significant predictive value in terms of SLN positivity, progression, and recurrence-free survival. We propose SR as a new "dynamic" predictor of histological SLN positivity and melanoma recurrence risk. We think that he association with this new feature with GR may be helpful in improving the accuracy of predicted clinical outcome of patient especially with thin melanomas.
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Affiliation(s)
- Giulio Gualdi
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Fabrizio Panarese
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Giovanna Meogrossi
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Michele Marchioni
- Biostatistic, Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Michele De Tursi
- Oncologi Clinic, Department of Medical, Oral Sciences and Biotechnologies University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Pietro Di Marino
- Oncologi Clinic, Department of Medical, Oral Sciences and Biotechnologies University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Domenico Angelucci
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Massimo Amatetti
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Gianluca Proietto
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Biostatistic, Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Paolo Amerio
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
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Han D, Han G, Duque MT, Morrison S, Leong SP, Kashani-Sabet M, Vetto J, White R, Schneebaum S, Pockaj B, Mozzillo N, Sondak VK, Zager JS. Sentinel Lymph Node Biopsy Is Prognostic in Thickest Melanoma Cases and Should Be Performed for Thick Melanomas. Ann Surg Oncol 2020; 28:1007-1016. [PMID: 32524460 DOI: 10.1245/s10434-020-08706-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) is recommended for intermediate thickness melanoma, but for thick melanoma, guidelines are less definitive about the use of SLNB in this population. We present a study on thick melanoma evaluating for prognostic factors. PATIENTS AND METHODS The Sentinel Lymph Node Working Group database was queried for thick (> 4 mm) melanoma cases that had a SLNB from 1993 to 2018. Clinicopathologic characteristics were correlated with SLN status and melanoma-specific survival (MSS). RESULTS There were 1235 patients. Median follow-up was 28 months. Median thickness was 5.9 mm, with 956, 175, and 104 cases presenting thickness > 4-8, > 8-12, and > 12 mm, respectively. SLN metastases were seen in 439 of 1235 (35.5%) cases and in 33.9%, 40.6%, and 42.3% of melanomas > 4-8, > 8-12, and > 12 mm, respectively. In each thickness group, MSS was significantly worse for SLN-positive compared with SLN-negative cases (all P < 0.005). Multivariable analysis showed that SLN metastasis, male gender, increasing thickness, lymphovascular invasion, and microsatellitosis significantly predicted worse MSS for melanomas > 4-8 mm, with SLN metastasis showing the greatest risk (HR 2.17, 95% CI 1.64-2.87, P < 0.0001). For melanomas > 8 mm, only SLN metastasis significantly predicted MSS (> 8-12 mm: HR 3.93, 95% CI 2.00-7.73, P < 0.0001; > 12 mm: HR 3.58, 95% CI 1.56-8.22, p < 0.0027). CONCLUSIONS Thick melanoma patients with SLN metastasis have significantly worse MSS compared with SLN-negative patients, even in the thickest cases, and SLN status is the most powerful and/or only predictor of MSS. Given these results, SLNB shows important prognostic value in this population and is indicated for clinically localized thick melanoma.
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Affiliation(s)
- Dale Han
- Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA.
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Monica T Duque
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Steven Morrison
- Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Stanley P Leong
- California Pacific Medical Center and Research Institute, San Francisco, CA, USA
| | | | - John Vetto
- Division of Surgical Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Richard White
- Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | | | | | - Nicola Mozzillo
- Instituto Tumori Napoli Fondazione G. Pascale, Naples, Italy
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MacDonald S, Siever J, Baliski C. Performance of models predicting residual lymph node disease in melanoma patients following sentinel lymph node biopsy. Am J Surg 2020; 219:750-755. [PMID: 32222274 DOI: 10.1016/j.amjsurg.2020.02.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Among melanoma patients with a tumor-positive sentinel node biopsy (SNB), approximately 20% harbor disease in non-sentinel nodes (nSN), as determined by a completion lymph node dissection (CLND). CLND lacks a survival benefit and has high morbidity. This study assesses predictive factors for nSN metastasis and validates five models predicting nSN metastasis. METHODS Patients with invasive melanoma were identified from the BC Cancer Agency (2005-2015). Clinicopathological data were collected from 296 patients who underwent a CLND after a positive SNB. Multivariate analysis was completed to assess predictive variables in the study population. Five models were externally validated using overall model performance (Brier score [calibration and discrimination]) and discrimination (area under the ROC curve [AUC]). RESULTS Seventy-three patients had nSN metastasis at the time of CLND. The variable most predictive of nSN involvement was lymphovascular invasion (odds ratio [OR] 3.99; 95% confidence interval [CI] 1.67-9.54; p = 0.002). The highest discrimination was Lee et al. (2004) (AUC 0.68 [95% CI 0.61-0.75]), Rossi et al. (2018) (AUC 0.68 [95% CI 0.57-0.77]), and Bertolli et al. (2019) (AUC 0.68 [95% CI 0.60-0.75]). Rossi et al. (2018) had the lowest overall model performance (Brier score 0.44). Rossi et al. (2018) and Bertolli et al. (2019) had the ability to stratify patients to a risk of nSN involvement up to 99% and 95%, respectively. CONCLUSION Bertolli et al. (2019) had amongst the highest overall model performance, was the most clinically meaningful and is recommended as the preferred model for predicting nSN metastasis.
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Affiliation(s)
- Sandra MacDonald
- BC Cancer-Sindi Ahluwalia Hawkins Centre, Dept. of Surgical Oncology, 399 Royal Ave, Kelowna, BC, V1Y 5L3, Canada; University of British Columbia Southern Medical Program, 2312 Pandosy Street, Kelowna, BC, V1Y 1T3, Canada.
| | - Jodi Siever
- University of British Columbia Southern Medical Program, 2312 Pandosy Street, Kelowna, BC, V1Y 1T3, Canada.
| | - Christopher Baliski
- BC Cancer-Sindi Ahluwalia Hawkins Centre, Dept. of Surgical Oncology, 399 Royal Ave, Kelowna, BC, V1Y 5L3, Canada.
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31
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Hirshoren N, Yoeli R, Cohen JE, Weinberger JM, Kaplan N, Merims S, Peretz T, Lotem M. Checkpoint inhibitors: Better outcomes among advanced cutaneous head and neck melanoma patients. PLoS One 2020; 15:e0231038. [PMID: 32282861 PMCID: PMC7153888 DOI: 10.1371/journal.pone.0231038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/13/2020] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE The aim of this study was to investigate if the treatment outcomes of checkpoint inhibitors (CPI) in patients with advanced-stage skin head and neck melanoma (HNM) differs from outcomes in patients with non-HNM. DESIGN A retrospective cohort study of patients with unresectable AJCC stage III and stage IV, who received CPI between 2010 and 2017. PARTICIPANTS Overall, 122 unresectable AJCC stage III and metastatic stage IV melanoma adult patients were treated with CPI during the study period (consecutive patients). The HNM group of patients was comparable with limbs and trunk melanoma group except different distant metastatic (M1a/b/c/d) pattern (p = 0.025). MAIN OUTCOMES Comparison of overall survival and clinical response to CPI in patients with advanced-stage skin melanoma of the head and neck with non-HNM. RESULTS We analyzed 38 patients with melanoma arising in the head and neck skin regions, 33 with melanoma of limbs and 51 with trunk melanoma. Most of the head and neck patients were men (89.5%), the average age of melanoma diagnosis was 61.4±16.7 years (range 16.4-85.6). More than a third of HNM group of patients (36.8%) were 70 years and older. Overall response rate (ORR) to CPI was 50% (CR 31.6% and PR 18.4%) in the head and neck study group of patients, compared to an ORR of 36.3% and 23.5% in melanoma of the limbs and of the trunk, respectively (p = 0.03). The median overall survival of HNM group of patients was 60.2±6.3 months, CI 95% [47.7-72.7], 63% were alive at 30 months, reaching a plateau. Whereas, the median survival time of limbs and trunk melanoma were 51.2 and 53.4 months, which did not reach significance. CONCLUSIONS AND RELEVANCE Response rate to CPI is significantly improved in patients with melanoma of the head and neck and they have a trend towards improved, long standing, overall survival.
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Affiliation(s)
- Nir Hirshoren
- Department of Otolaryngology / Head & Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Roni Yoeli
- Department of Otolaryngology / Head & Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Jonathan E Cohen
- Sharett Institute of Oncology, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
- The Faculty of Medicine, The Wohl institute for Translational Medicine, Hadassah Medical Center, Hadassah Hebrew-University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jeffrey M Weinberger
- Department of Otolaryngology / Head & Neck Surgery, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Nadia Kaplan
- Radiology department, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Sharon Merims
- Sharett Institute of Oncology, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
| | - Michal Lotem
- Sharett Institute of Oncology, Hadassah Hebrew-University Medical Center, Jerusalem, Israel
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Cohen JV, Wang N, Venur VA, Hadfield MJ, Cahill DP, Oh K, Brastianos PK. Neurologic complications of melanoma. Cancer 2020; 126:477-486. [DOI: 10.1002/cncr.32619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/28/2019] [Accepted: 10/08/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Justine V. Cohen
- Division of Medical Oncology and Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Nancy Wang
- Division of Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Vyshak A. Venur
- Division of Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Matthew J. Hadfield
- Division of Internal Medicine University of Connecticut Hartford Connecticut
| | - Daniel P. Cahill
- Division of Neurosurgery Massachusetts General Hospital Boston Massachusetts
| | - Kevin Oh
- Division of Radiation Oncology Massachusetts General Hospital Boston Massachusetts
| | - Priscilla K. Brastianos
- Division of Medical Oncology and Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
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Tian J, Yang Y, Li MY, Zhang Y. A novel RNA sequencing-based prognostic nomogram to predict survival for patients with cutaneous melanoma: Clinical trial/experimental study. Medicine (Baltimore) 2020; 99:e18868. [PMID: 32011509 PMCID: PMC7220347 DOI: 10.1097/md.0000000000018868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/10/2019] [Accepted: 12/21/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Plenty of evidence has suggested that long non-coding RNAs (lncRNAs) have played a vital part may act as prognostic biomarkers in a variety of cancers. The aim of this study was to screen survival-related lncRNAs and to construct a lncRNA-based prognostic model in patients with cutaneous melanoma (CM). METHODS We obtained lncRNAs expression profiles and clinicopathological data from the Cancer Genome Atlas (TCGA) and the Genotype-Tissue Expression (GTEx) databases. A lncRNA-based prognostic model was established in training set. The established prognostic model was evaluated, and validated in the validation set. Then, a prognostic nomogram combining the lncRNA-based risk score and clinicopathological characteristics was developed in training set, and assessed in the validation set. The accuracy of the model was evaluated by the discrimination and calibration plots. RESULTS A total of 212 lncRNAs were identified to be differentially expressed in CM. After univariate analysis, LASSO penalized regression analysis, and multivariate analysis, 3 lncRNAs were used to construct risk score model. The proposed risk score model could divide patients into high-risk and low-risk groups with significantly different survival in both training set and validation set. The ROC curve showed good performance in survival prediction in both sets. Furthermore, the nomogram for predicting 3-, 5-, and 10-year OS was established based on lncRNA-based risk score and clinicopathologic factors. The prognostic accuracy of the risk model was confirmed by the discrimination and calibration plots in both training set and validation set. CONCLUSIONS We established a novel three lncRNA-based risk score model and nomogram to predict overall survival of CM. The proposed nomogram may provide information for individualized treatment in CM patients.
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Affiliation(s)
- Jun Tian
- Department of Dermatology, Shanxi Provincial People's Hospital, Xi’an
| | - Ye Yang
- Department of Dermatology, 63600 Hospital of PLA, Lanzhou
| | - Meng-Yang Li
- Department of Hepatobiliary Surgery, The Fourth Medical Center, Chinese PAL General Hospital, Beijing
| | - Yuan Zhang
- Department of Oncology, Shanxi Provincial People's Hospital, Xi’an, China
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34
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Namikawa K, Aung PP, Milton DR, Tetzlaff MT, Torres-Cabala CA, Curry JL, Nagarajan P, Ivan D, Ross M, Gershenwald JE, Prieto VG. Correlation of Tumor Burden in Sentinel Lymph Nodes with Tumor Burden in Nonsentinel Lymph Nodes and Survival in Cutaneous Melanoma. Clin Cancer Res 2019; 25:7585-7593. [PMID: 31570567 DOI: 10.1158/1078-0432.ccr-19-1194] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/02/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE In patients with cutaneous melanoma, metastasis in a nonsentinel lymph node (non-SLN) is a strong independent adverse prognostic factor. However, patients with a tumor-involved SLN no longer routinely undergo completion lymph node dissection (CLND). We hypothesized that SLN tumor burden may predict non-SLN tumor burden. EXPERIMENTAL DESIGN We compared tumor burden parameters between SLN and non-SLN in patients with cutaneous melanoma who underwent SLN biopsy with a positive SLN during 2003 to 2008 at The University of Texas MD Anderson Cancer Center. RESULTS We identified 336 eligible patients with a positive SLN. Of these, 308 (92%) underwent CLND, and 35 (10%) had non-SLN metastasis. The median follow-up time was 6.0 years. For patients with maximum diameter of tumor in the SLN ≤2.0 mm, >2.0-5.0 mm, and >5.0 mm, non-SLN metastasis was detected in 5 of 200 patients (3%), 10 of 63 patients (16%), and 20 of 57 patients (35%), and the mean maximum diameters of the non-SLN tumor deposits were 0.09, 1.56, and 2.71 mm, respectively (P < 0.0001). The percentage of patients with both subcapsular and intraparenchymal non-SLN tumor was higher for patients with SLN tumor in both locations than for patients with SLN tumor in only one location (P < 0.0001). Extranodal extension in a non-SLN was more common in patients with extranodal extension in an SLN (P = 0.003). CONCLUSIONS In patients with cutaneous melanoma who undergo CLND, SLN tumor burden predicts non-SLN tumor burden. SLN tumor burden parameters provide accurate prognostic stratification independent of non-SLN status and should be considered for incorporation into future staging systems and integrated risk models.
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Affiliation(s)
- Kenjiro Namikawa
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos A Torres-Cabala
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Curry
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Doina Ivan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Merrick Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Abstract
Melanoma is an aggressive malignancy arising from melanocytes in the skin and rarely in extracutaneous sites. The understanding of pathology of melanoma has evolved over the years, with the initial classifications based on the clinical and microscopic features to the current use of immunohistochemistry and genetic sequencing. The depth of invasion and lymph node metastasis are still the most important prognostic features of melanoma. Other important prognostic features include ulceration, lymphovascular invasion, mitosis, and tumor-infiltrating lymphocytes. This article reviews the pathology of melanoma and its precursor lesions, along with the recent advances in pathologic diagnosis of melanoma.
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Affiliation(s)
- Asmita Chopra
- Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Room A-422, Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
| | - Rohit Sharma
- Department of Surgery, Marshfield Medical Center, 1000 North Oak Avenue, Marshfield, WI 54449, USA
| | - Uma N M Rao
- Department of Pathology, University of Pittsburgh School of Medicine, Section of Bone/Soft Tissue, Melanoma Pathology, UPMC Presbyterian Shadyside, Room WG2.9, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
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36
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Piñero-Madrona A, Ruiz-Merino G, Cerezuela Fuentes P, Martínez-Barba E, Rodríguez-López JN, Cabezas-Herrera J. Mitotic rate as an important prognostic factor in cutaneous malignant melanoma. Clin Transl Oncol 2019; 21:1348-1356. [PMID: 30783917 DOI: 10.1007/s12094-019-02064-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 02/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Recently, the quantification of mitoses in cutaneous melanoma has been discharged from the main prognostic variables of the TNM classification. OBJECTIVE To investigate the prognostic value of the presence of mitoses in primary cutaneous melanoma and to establish the number of mitoses per mm2 that may have prognostic significance. METHODS A retrospective observational study was performed on 141 patients treated for cutaneous melanoma, who were assessed by the same pathologist, and who had a minimum follow-up of 2 years. Clinical, epidemiological, histopathological and follow-up variables were gathered and compared with the number of mitoses to distinguish the significance of differences by means of univariate, multivariate, and survival analyses. RESULTS The cut-off level related to a better sensitivity and specificity was 1.50 mitoses per mm2. The presence of two or more mitoses/mm2 showed a better relationship with prognostic variables and both the overall and disease-free survival than the presence of 1 or more mitoses/mm2. This happens especially in melanomas thicker than 0.8 mm and it could affect the staging in cases with Breslow between 1 and 2 mm. CONCLUSIONS A mitotic rate of two or more mitoses per mm2 in cutaneous melanoma should be considered as a more accurate prognostic factor than one or more mitoses per mm2, particularly in tumors equal or greater than 0.8 mm in thickness.
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Affiliation(s)
- A Piñero-Madrona
- Department of Surgery, Hospital Clínico Universitario "Virgen de La Arrixaca", Instituto Murciano de Investigación Biosanitaria (IMIB), El Palmar, 30120, Murcia, Spain.
| | - G Ruiz-Merino
- Department of Statistics, Hospital Clínico Universitario "Virgen de La Arrixaca", Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - P Cerezuela Fuentes
- Department of Oncology, Hospital Clínico Universitario "Virgen de La Arrixaca", Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - E Martínez-Barba
- Department of Pathology, Hospital Clínico Universitario "Virgen de La Arrixaca", Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - J N Rodríguez-López
- Department of Molecular Research, Hospital Clínico Universitario "Virgen de La Arrixaca", Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
| | - J Cabezas-Herrera
- Department of Molecular Research, Hospital Clínico Universitario "Virgen de La Arrixaca", Instituto Murciano de Investigación Biosanitaria (IMIB), Murcia, Spain
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Hyams DM, Cook RW, Buzaid AC. Identification of risk in cutaneous melanoma patients: Prognostic and predictive markers. J Surg Oncol 2019; 119:175-186. [PMID: 30548543 PMCID: PMC6590387 DOI: 10.1002/jso.25319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/15/2018] [Indexed: 12/23/2022]
Abstract
New therapeutic modalities for melanoma promise benefit in selected individuals. Efficacy appears greater in patients with lower tumor burden, suggesting an important role for risk-stratified surveillance. Robust predictive markers might permit optimization of agent to patient, while low-risk prognostic markers might guide more conservative management. This review evaluates protein, gene, and multiplexed marker panels that may contribute to better risk assessment and improved management of patients with cutaneous melanoma.
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Affiliation(s)
- David M. Hyams
- Desert Surgical Oncology, Eisenhower Medical CenterRancho MirageCalifornia
| | - Robert W. Cook
- R&D and Medical Affairs, Castle Biosciences, IncFriendswoodTexas
| | - Antonio C. Buzaid
- Oncology Center, Hospital Israelita Albert EinsteinSão PauloBrazil
- Centro Oncológico Antonio Ermírio de Moraes, Beneficência Portuguesa de São PauloSão PauloBrazil
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