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Malekzadeh P, Brady MS. Adjuvant therapy for stage IIB + IIC melanoma. J Surg Oncol 2024; 129:91-96. [PMID: 38031847 DOI: 10.1002/jso.27534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Parisa Malekzadeh
- Department of Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary S Brady
- Department of Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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2
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Catalano O, Crisan D, Díaz CPG, Cavallieri F, Varelli C, Wortsman X. Ultrasound Assessment of Skin Tumors Local Recurrence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2439-2446. [PMID: 37195073 DOI: 10.1002/jum.16255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/16/2023] [Indexed: 05/18/2023]
Abstract
Skin cancer may recur at or around the surgical site despite wide excisions. Prompt clinical and sonographic detection of local recurrence is important since subjects with relapsing melanomas or nonmelanoma malignancies can be managed efficaciously, with a relevant impact on morbidity and survival. Ultrasound is being employed with increasing frequency in the assessment of skin tumors, but most of the published articles relate to initial pretherapeutic diagnosis and staging. This review aims to offer an illustrated guide to the sonographic evaluation of locally recurring skin cancer. We introduce the topic, then we provide some sonographic tips for patient follow-up, then we describe the ultrasound findings in case of local recurrence, illustrating the main mimickers, and finally, we mention the role of ultrasound in guiding diagnostic and therapeutic percutaneous procedures.
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Affiliation(s)
| | - Diana Crisan
- Clinic of Dermatology and Allergology, University Clinic, Ulm, Germany
| | | | | | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, Naples, Italy
| | - Ximena Wortsman
- Department of Dermatology, Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues Clinic, University of Chile and Pontifical Catholic University of Chile, Santiago, Chile
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3
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Peirano D, Donoso F, Vargas S, Hidalgo L, Agüero R, Uribe P, Mondaca S, Navarrete-Dechent C. Patterns of Recurrence of Cutaneous Melanoma: A Literature Review. Dermatol Pract Concept 2023; 13:dpc.1304a304. [PMID: 37992344 PMCID: PMC10656145 DOI: 10.5826/dpc.1304a304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/24/2023] Open
Abstract
The incidence of melanoma has been dramatically increasing over the last decades. Melanoma is considered to have a high metastatic potential and it can progress via lymphatic vessels or through hematogenous metastasis. Different patterns of recurrence have been described, namely, local, satellite, and in transit metastasis (LCIT), lymphatic metastasis, and systemic metastasis. With a more advanced melanoma stage at diagnosis, there is a higher risk for systemic metastasis in comparison to LCIT; in contrast, early-stage melanoma tends to recur more frequently as LCIT and less commonly as systematic metastasis. The aim of this review was to summarize the patterns of recurrence of cuta-neous melanoma, giving the clinician a practical summary for diagnosis, prognosis, and surveillance. There is a knowledge gap of the common patterns of recurrence that needs to be addressed to better identify patients at high risk of disease recurrence and personalize surveillance strategies as well as patient counseling.
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Affiliation(s)
- Dominga Peirano
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisca Donoso
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Vargas
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Leonel Hidalgo
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rosario Agüero
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Uribe
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastían Mondaca
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Medical Oncology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Navarrete-Dechent
- Department of Dermatology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Melanoma and Skin Cancer Unit, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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4
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Johnston L, Starkey S, Mukovozov I, Robertson L, Petrella T, Alhusayen R. Surveillance After a Previous Cutaneous Melanoma Diagnosis: A Scoping Review of Melanoma Follow-Up Guidelines. J Cutan Med Surg 2023; 27:516-525. [PMID: 37489919 PMCID: PMC10617001 DOI: 10.1177/12034754231188434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/30/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Cutaneous melanoma accounts for more than 70% of all skin cancer deaths. Follow-up surveillance is an integral part of melanoma patient care, to facilitate early detection of recurrences and subsequent primary melanomas. The purpose of this scoping review is to provide an overview of recently published melanoma surveillance guidelines from regional and national melanoma working groups. METHODS A systematic search for relevant studies in MEDLINE and Embase was conducted in September 2022 and was limited to publications from 2010 or later. RESULTS A total of 1047 articles were retrieved, and after abstract and full text review, 26 articles from 19 different organizations met inclusion criteria. Life-long annual skin surveillance with a physician was recommended by 53% (9/17) of guidelines. Routine laboratory investigations were recommended by 7/19 guidelines. Regional lymph node ultrasound was recommended by 9/16 guidelines, most often in stage IB or higher, and was optional in 7/16 for patients who met specific criteria. Surveillance with PET-CT or CT and MRI was recommended by 15 and 11 guidelines, respectively, most commonly in stage IIC or higher, with a variable frequency and total duration. Five out of 9 guidelines indicated a preference for skin surveillance to be completed with a dermatologist. CONCLUSION Guidelines were highly variable for many aspects of melanoma surveillance, which may be partly attributed to regional differences in healthcare workforce distribution and availability of imaging technologies. Further high-level studies are recommended to provide more evidence on the most effective clinical and imaging follow-up surveillance protocols.
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Affiliation(s)
- Leah Johnston
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Samantha Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Lynne Robertson
- Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Teresa Petrella
- Department of Medical Oncology, Odette Cancer Centre, Toronto, Canada
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Canada
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5
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Yan MK, Adler NR, Wolfe R, Pan Y, Chamberlain A, Kelly J, Yap K, Voskoboynik M, Haydon A, Shackleton M, Mar VJ. The role of surveillance imaging for resected high‐risk melanoma. Asia Pac J Clin Oncol 2022. [DOI: 10.1111/ajco.13913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Mabel K. Yan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Nikki R. Adler
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Yan Pan
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - Alexander Chamberlain
- Victorian Melanoma Service Alfred Health Melbourne Australia
- Central Clinical School Monash University Melbourne Australia
| | - John Kelly
- Victorian Melanoma Service Alfred Health Melbourne Australia
| | - Kenneth Yap
- Central Clinical School Monash University Melbourne Australia
- Department of Nuclear Medicine and PET Alfred Health Melbourne Australia
| | - Mark Voskoboynik
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Andrew Haydon
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Mark Shackleton
- Central Clinical School Monash University Melbourne Australia
- Department of Medical Oncology Alfred Health Melbourne Australia
| | - Victoria J. Mar
- Victorian Melanoma Service Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
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6
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Samlowski W, Silver MA, Hohlbauch A, Zhang S, Scherrer E, Fukunaga-Kalabis M, Krepler C, Jiang R. Real-world clinical outcomes of patients with stage IIB or IIC cutaneous melanoma treated at US community oncology clinics. Future Oncol 2022; 18:3755-3767. [PMID: 36346064 DOI: 10.2217/fon-2022-0508] [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: 11/10/2022] Open
Abstract
Aim: To describe clinical outcomes after complete surgical resection of stage IIB and IIC melanoma. Methods: Adult patients (n = 567) with stage IIB or IIC cutaneous melanoma initially diagnosed and completely resected from 2008-2017 were identified using data from a US community-based oncology network. Results: Median patient follow-up was 38.8 months from melanoma resection to death, last visit or data cut-off (31 December 2020). For stage IIB (n = 375; 66%), Kaplan-Meier median real-world recurrence-free survival (rwRFS) was 58.6 months (95% CI, 48.6-69.5). For stage IIC (n = 192; 34%), median rwRFS was 29.9 months (24.9-45.5). Overall, 44% of patients had melanoma recurrence or died; 30% developed distant metastases. Conclusion: Melanoma recurrence was common, highlighting the need for effective adjuvant therapy for stage IIB and IIC melanoma.
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Affiliation(s)
- Wolfram Samlowski
- Comprehensive Cancer Centers of Nevada, Las Vegas, NV 89148 USA/The US Oncology Network.,University of Nevada School of Medicine, Reno, NV 89557 USA.,University of Nevada Las Vegas, Las Vegas, NV 89102, USA
| | | | | | - Shujing Zhang
- Biostatistics & Research Decision Sciences, Merck & Co., Inc., Rahway, NJ 07065, USA
| | - Emilie Scherrer
- Center for Observational & Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA
| | | | | | - Ruixuan Jiang
- Center for Observational & Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ 07065, USA
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7
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Evaluating the effect of detection modalities in the Danish clinical follow-up program of cutaneous melanoma—a retrospective cohort study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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8
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van Pul KM, Notohardjo JCL, Fransen MF, Koster BD, Stam AGM, Chondronasiou D, Lougheed SM, Bakker J, Kandiah V, van den Tol MP, Jooss K, Vuylsteke RJCLM, van den Eertwegh AJM, de Gruijl TD. Local delivery of low-dose anti–CTLA-4 to the melanoma lymphatic basin leads to systemic T
reg
reduction and effector T cell activation. Sci Immunol 2022; 7:eabn8097. [DOI: 10.1126/sciimmunol.abn8097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Preclinical studies show that locoregional CTLA-4 blockade is equally effective in inducing tumor eradication as systemic delivery, without the added risk of immune-related side effects. This efficacy is related to access of the CTLA-4 blocking antibodies to tumor-draining lymph nodes (TDLNs). Local delivery of anti–CTLA-4 after surgical removal of primary melanoma, before sentinel lymph node biopsy (SLNB), provides a unique setting to clinically assess the role of TDLN in the biological efficacy of locoregional CTLA-4 blockade. Here, we have evaluated the safety, tolerability, and immunomodulatory effects in the SLN and peripheral blood of a single dose of tremelimumab [a fully human immunoglobulin gamma-2 (IgG2) mAb directed against CTLA-4] in a dose range of 2 to 20 mg, injected intradermally at the tumor excision site 1 week before SLNB in 13 patients with early-stage melanoma (phase 1 trial; NCT04274816). Intradermal delivery was safe and well tolerated and induced activation of migratory dendritic cell (DC) subsets in the SLN. It also induced profound and durable decreases in regulatory T cell (T
reg
) frequencies and activation of effector T cells in both SLN and peripheral blood. Moreover, systemic T cell responses against NY-ESO-1 or MART-1 were primed or boosted (
N
= 7), in association with T cell activation and central memory T cell differentiation. These findings indicate that local administration of anti–CTLA-4 may offer a safe and promising adjuvant treatment strategy for patients with early-stage melanoma. Moreover, our data demonstrate a central role for TDLN in the biological efficacy of CTLA-4 blockade and support TDLN-targeted delivery methods.
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Affiliation(s)
- Kim M. van Pul
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit, Surgical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Jessica C. L. Notohardjo
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Marieke F. Fransen
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit, Pulmonary Diseases, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Bas D. Koster
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Anita G. M. Stam
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Dafni Chondronasiou
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Sinéad M. Lougheed
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Joyce Bakker
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Vinitha Kandiah
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - M. Petrousjka van den Tol
- Amsterdam UMC location Vrije Universiteit, Surgical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | | | | | - Alfons J. M. van den Eertwegh
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
| | - Tanja D. de Gruijl
- Amsterdam UMC location Vrije Universiteit, Medical Oncology, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Cancer Center Amsterdam, Cancer Immunology, Amsterdam, Netherlands
- Amsterdam Institute for Infection and Immunology, Cancer Immunology, Amsterdam, Netherlands
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9
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Follow-up of primary melanoma patients with high risk of recurrence: recommendations based on evidence and consensus. Clin Transl Oncol 2022; 24:1515-1523. [PMID: 35349041 DOI: 10.1007/s12094-022-02822-x] [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: 10/15/2021] [Accepted: 02/27/2022] [Indexed: 10/18/2022]
Abstract
In spite of the good prognosis of patients with early-stage melanoma, there is a substantial proportion of them that develop local or distant relapses. With the introduction of targeted and immune therapies for advanced melanoma, including at the adjuvant setting, early detection of recurrent melanoma and/or second primary lesions is crucial to improve clinical outcomes. However, there is a lack of universal guidelines regarding both frequency of surveillance visits and diagnostic imaging and/or laboratory evaluations. In this article, a multidisciplinary expert panel recommends, after careful review of relevant data in the field, a consensus- and experience-based follow-up strategy for melanoma patients, taking into account prognostic factors and biomarkers and the high-risk periods and patterns of recurrence in each (sub) stage of the disease. Apart from the surveillance intensity, healthcare professionals should focus on patients' education to perform regular self-examinations of the skin and palpation of lymph nodes.
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10
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Utilization and survival benefit of adjuvant immunotherapy in resected high-risk stage II melanoma. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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11
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Newcomer K, Robbins KJ, Perone J, Hinojosa FL, Chen D, Jones S, Kaufman CK, Weiser R, Fields RC, Tyler DS. Malignant melanoma: evolving practice management in an era of increasingly effective systemic therapies. Curr Probl Surg 2022; 59:101030. [PMID: 35033317 PMCID: PMC9798450 DOI: 10.1016/j.cpsurg.2021.101030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/12/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Ken Newcomer
- Department of Surgery, Barnes-Jewish Hospital, Washington University, St. Louis, MO
| | | | - Jennifer Perone
- Department of Surgery, University of Texas Medical Branch, Galveston, TX
| | | | - David Chen
- e. Department of Medicine, Washington University, St. Louis, MO
| | - Susan Jones
- f. Department of Pediatrics, Washington University, St. Louis, MO
| | | | - Roi Weiser
- University of Texas Medical Branch, Galveston, TX
| | - Ryan C Fields
- Department of Surgery, Washington University, St. Louis, MO
| | - Douglas S Tyler
- Department of Surgery, University of Texas Medical Branch, Galveston, TX.
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12
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Helvind NM, Aros Mardones CA, Hölmich LR, Hendel HW, Bidstrup PE, Sørensen JA, Chakera AH. Routine PET-CT scans provide early and accurate recurrence detection in asymptomatic stage IIB-III melanoma patients. Eur J Surg Oncol 2021; 47:3020-3027. [PMID: 34120809 DOI: 10.1016/j.ejso.2021.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/18/2021] [Accepted: 06/02/2021] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION The use of routine imaging with 18F-FDG PET-CT (PET-CT) in melanoma surveillance is debated and evidence of its diagnostic value and yield in asymptomatic patients is limited. Denmark introduced nationwide routine surveillance with PET-CT in high-risk patients in 2016. The aim of this study was to examine the sensitivity, specificity, negative and positive predictive values, numbers-needed-to-scan and clinical impact of routine PET-CT in the surveillance of asymptomatic stage IIB-III melanoma patients. MATERIALS AND METHODS Data was retrieved from the population-based Danish Melanoma Database and patient records. All patients diagnosed with stage IIB-III melanoma at two University Hospitals in 2016 and 2017 were included. Patients underwent surveillance with clinical examinations and PET-CT scans at 6, 12, 24 and 36 months. RESULTS In 138 patients, 243 routine PET-CTs were performed within a median follow-up time of 17.7 months. Routine PET-CT detected recurrence at least once in 25 patients (18.1%), including distant recurrence in 19 patients (13.8%). Stage IIB patients had the lowest recurrence rate (11.1%). Numbers-needed-to-scan to detect one distant recurrence was 12.8 patients and median time-to-recurrence was 6.8 months. Sensitivity was 100%, specificity was 94.7% and negative and positive predictive values were 100% and 74.4%, respectively. False positive findings prompted 22 additional investigations (of which ten invasive) in 17 patients (12.3%). CONCLUSION Routine PET-CT has a high sensitivity and specificity when used in high-risk melanoma surveillance. Time-to-recurrence and stage-specific recurrence rates indicate high gain of early routine imaging at six months especially for stage IIC and III patients.
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Affiliation(s)
- Neel Maria Helvind
- Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Catalina Aurora Aros Mardones
- Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark.
| | - Lisbet Rosenkrantz Hölmich
- Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
| | - Helle Westergren Hendel
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark.
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society's Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark.
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense C, Denmark; Faculty of Health Sciences, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense C, Denmark.
| | - Annette Hougaard Chakera
- Department of Plastic Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls vej 1, 2730, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
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13
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Ravichandran S, Nath N, Jones DC, Li G, Suresh V, Brys AK, Hanks BA, Beasley GM, Salama AKS, Howard BA, Mosca PJ. The utility of initial staging PET-CT as a baseline scan for surveillance imaging in stage II and III melanoma. Surg Oncol 2020; 35:533-539. [PMID: 33161362 DOI: 10.1016/j.suronc.2020.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 10/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study evaluates the utility of whole-body PET-CT for the initial staging and subsequent surveillance imaging of patients with completely resected stage II and stage III melanoma. METHODS A single-center, retrospective review of patients who received perioperative whole-body PET-CT from January 1, 2005 to December 1, 2019 within three months of initial melanoma diagnosis was performed. RESULTS Of 258 total patients with completely resected melanoma who had a PET-CT within 3 months after their melanoma diagnosis, 113 had stage II and 145 had stage III melanoma. PET-CT detected distant metastasis in 3 (2.7%) of 113 stage II patients and 7 (4.8%) of 145 stage III patients. 179 of 258 patients had adequate follow-up time to determine whether they received surveillance cross-sectional imaging and whether they had a melanoma recurrence. 143 (79.9%) received subsequent surveillance imaging, 74 of whom developed a recurrence. In 64 (86.5%) of 74 cases, recurrence was detected by routine surveillance. 26 (34.2%) of 76 stage II and 65 (63.1%) of 103 stage III patients developed a recurrence. The median time to recurrence among the 179 patients for stage II and III was 16.3 and 13.0 months, respectively. CONCLUSIONS These findings indicate that baseline staging with whole-body PET-CT rarely provides information that changes initial management. Rather, the value of the initial PET-CT is as a baseline for subsequent surveillance scans. Therefore, it may be premature to discourage cross-sectional imaging for patients with stage II and III melanoma without supportive evidence or a reliable biomarker of recurrent disease.
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Affiliation(s)
- Surya Ravichandran
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Neel Nath
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - David C Jones
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Gabriel Li
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Visakha Suresh
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Adam K Brys
- Department of Dermatology, Duke University Medical Center, Durham, NC, USA
| | - Brent A Hanks
- Department of Medicine, Division of Medical Oncology and Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Georgia M Beasley
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - April K S Salama
- Department of Medicine, Division of Medical Oncology and Department of Pharmacology and Cancer Biology, Duke University Medical Center, Durham, NC, USA
| | - Brandon A Howard
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Paul J Mosca
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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14
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Bleicher J, Swords DS, Mali ME, McGuire L, Pahlkotter MK, Asare EA, Bowles TL, Hyngstrom JR. Recurrence patterns in patients with Stage II melanoma: The evolving role of routine imaging for surveillance. J Surg Oncol 2020; 122:1770-1777. [PMID: 33098702 DOI: 10.1002/jso.26214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The relatively recent availability of effective systemic therapies for metastatic melanoma necessitates reconsideration of current surveillance patterns. Evidence supporting surveillance guidelines for resected Stage II melanoma is lacking. Prior reports note routine imaging detects only 21% of recurrent disease. This study aims to define recurrence patterns for Stage II melanoma to inform future surveillance guidelines. METHODS This is a retrospective study of patients with Stage II melanoma. We analyzed risk factors for recurrence and methods of recurrence detection. We also assessed survival. Yearly hazards of recurrence were visualized. RESULTS With a median follow-up of 4.9 years, 158 per 580 patients (27.2%) recurred. Overall, most recurrences were patient-detected (60.7%) or imaging-detected (27.3%). Routine imaging was important in detecting recurrence in patients with distant recurrences (adjusted rate 43.1% vs. 9.4% for local/in-transit; p = .04) and with Stage IIC melanoma (42.5% vs. 18.5% for IIA; p = .01). Male patients also self-detected recurrent disease less than females (52.1% vs. 76.8%; p < .01). CONCLUSIONS Routine imaging surveillance played a larger role in detecting recurrent disease for select groups in this cohort than noted in prior studies. In an era of effective systemic therapy, routine imaging should be considered for detection of asymptomatic relapse for select, high-risk patient groups.
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Affiliation(s)
- Josh Bleicher
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Douglas S Swords
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Meghan E Mali
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Lauren McGuire
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Maranda K Pahlkotter
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Elliot A Asare
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Tawnya L Bowles
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - John R Hyngstrom
- Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
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15
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Loidi-Pascual L, Lecumberri-Biurrun MJ, Arozarena-Martinicorena I, Goñi-Gironés E, Yanguas-Bayona JI. Study of cutaneous melanoma recurrences after sentinel node biopsy: Patterns of dissemination and use of complementary test in follow-up. Eur J Cancer Care (Engl) 2020; 30:e13344. [PMID: 33089896 DOI: 10.1111/ecc.13344] [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: 11/05/2019] [Revised: 07/06/2020] [Accepted: 08/07/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the patterns of melanoma recurrence in the local population, including factors that may influence in this event and timing of relapse, and to determine the mode of detection of them. METHODS This is a retrospective cohort study of patients with melanoma who underwent sentinel lymph node biopsy at the Complejo Hospitalario de Navarra (Spain) from 2002 to 2012. The following data were collected of each patient: age, gender, date of diagnosis, location of melanoma, histological subtype, Breslow thickness, ulceration, mitosis, sentinel node status, AJCC 8th edition stage, site of first diagnosed metastasis, mode of relapse, date of first relapse and time of death. RESULTS Of 308 patients, 30% people suffered metastasis. The mean follow-up time was 68.63 months. 51.1% of relapses were locoregional and 48.9% haemato-visceral. Sentinel node status was the only variable associated with higher risk of haemato-visceral metastasis (p < 0.001). The mean time between diagnosis of melanoma and recurrence was 2.7 years. Most recurrences were detected by the patient himself or had any type of symptoms and were consequently selected for a complementary test. CONCLUSION It is important to follow-up all patients with diagnosis of cutaneous melanoma, essentially during the first 5 years after diagnosis.
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Affiliation(s)
| | | | | | - Elena Goñi-Gironés
- Nuclear Medicine Department, Complejo Hospitalario de Navarra, Pamplona, Spain
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16
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Bhurosy T, Heckman CJ, Riley M. Prevalence and correlates of skin self-examination behaviors among melanoma survivors: a systematic review. Transl Behav Med 2020; 10:1120-1133. [PMID: 33044529 DOI: 10.1093/tbm/ibaa003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Melanoma is the most common cause of skin cancer deaths, and individuals who have had melanoma have an increased risk of developing new melanomas. Doing regular self-examinations of skin enables one to detect thinner melanomas earlier when the disease is more treatable. The aim of this systematic review is to characterize and evaluate the existing literature on the prevalence and correlates of skin self-examination (SSE) behaviors among adult melanoma survivors in the USA and Canada. A computerized literature search was performed using PubMed, Google Scholar, and ScienceDirect. The inclusion criteria for the studies were: (a) reported results for adult melanoma survivors in the USA or Canada, (b) papers described empirical research, (c) assessed SSE and related behaviors, and (d) papers were published in a peer-reviewed journal in the past 20 years. Key phrases such as "skin self-examination/SSE in melanoma survivors in the United States" and "correlates of skin self-examination/SSE" were used. Based on the inclusion criteria, 30 studies were included in the systematic review. SSE prevalence varied depending on how SSE was defined. Demographics and factors (gender, education level, patient characteristics, partner assistance, and physician support) associated with SSE were identified. Findings of this review show evidence for the need to have a consistent way to assess SSE and suggest different types of correlates on which to focus in order to promote SSE and reduce the risk of melanoma recurrence in survivors. This systematic review and its protocol have been registered in the international database of prospectively registered systematic reviews in health and social care (PROSPERO; ID: 148878).
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Affiliation(s)
- Trishnee Bhurosy
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Carolyn J Heckman
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Mary Riley
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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17
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Association between subjective symptoms and obesity and postoperative recurrence in differentiated thyroid cancer: a matched-pair analysis. Sci Rep 2020; 10:3679. [PMID: 32111875 PMCID: PMC7048844 DOI: 10.1038/s41598-020-60276-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/20/2020] [Indexed: 11/08/2022] Open
Abstract
Several patients with thyroid cancer experience symptom distress after diagnosis and surgery. Data on the association between symptomatology and disease recurrence are limited. A retrospective review of a prospectively maintained database was performed, and 57 patients who had recurrence after operation of differentiated thyroid cancer were identified. Controlling for age, sex, surgery, and tumour stage, 114 patients without recurrent disease were selected by case-control matching. Subjective symptoms at follow-up visits were extracted from medical records and classified into three symptom clusters: pharyngolaryngeal, psychoneurological, and gastrointestinal. Compared to the control group, patients with recurrence had higher symptom totals in the pharyngolaryngeal (P < 0.001) and psychoneurological clusters (P = 0.005). Symptom score >3 yielded a sensitivity of 61.4% and a specificity of 80.7% to predict recurrence. Multivariate Cox regression analysis revealed that high symptom score (hazard ratio [HR] = 4.184), family history of thyroid cancer (HR = 2.463), and obesity (HR = 1.981) were independently associated with disease recurrence. Taken together, the likelihood of postoperative recurrence seemed to increase with high self-perceived symptom burden, family history, and obesity in patients with thyroid cancer. The results could be applied to the recurrence surveillance and symptomatic management of thyroid cancer post-operation.
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18
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Luke JJ, Ascierto PA, Carlino MS, Gershenwald JE, Grob JJ, Hauschild A, Kirkwood JM, Long GV, Mohr P, Robert C, Ross M, Scolyer RA, Yoon CH, Poklepovic A, Rutkowski P, Anderson JR, Ahsan S, Ibrahim N, M Eggermont AM. KEYNOTE-716: Phase III study of adjuvant pembrolizumab versus placebo in resected high-risk stage II melanoma. Future Oncol 2019; 16:4429-4438. [PMID: 31870188 DOI: 10.2217/fon-2019-0666] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Patients with high-risk stage II melanoma are at significant risk for recurrence after surgical resection. Adjuvant treatment options to lower the risk for distant metastases are limited. Although adjuvant IFN-α2b is associated with improved relapse-free survival in patients with high-risk melanoma, toxicity and limited overall survival benefits limit its use. Adjuvant treatment with the PD-1 inhibitor pembrolizumab significantly improved recurrence-free survival, compared with placebo, in patients with resected stage III melanoma in the Phase III KEYNOTE-054 trial; efficacy in patients with stage II disease has not been established. This article describes the design and rationale of KEYNOTE-716 (NCT03553836), a two-part, randomized, placebo-controlled, multicenter Phase III study of adjuvant pembrolizumab in patients with surgically resected high-risk stage II melanoma. Clinical trial registry & ID: ClinicalTrials.gov, NCT03553836.
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Affiliation(s)
- Jason J Luke
- Cancer Immunotherapeutics Center, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA
| | - Paolo A Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale," Naples, Italy
| | - Matteo S Carlino
- Department of Medical Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia.,Blacktown Cancer and Haematology Centre, Blacktown Hospital, Blacktown, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jean-Jacques Grob
- Department of Dermatology and Skin Cancers, Hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - Axel Hauschild
- Department of Dermatological Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - John M Kirkwood
- Cancer Immunotherapeutics Center, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA
| | - Georgina V Long
- Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Mater Hospital, North Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Peter Mohr
- Department of Dermatology, Elbe Kliniken Buxtehude, Buxtehude, Germany
| | - Caroline Robert
- Dermatology Unit, Department of Oncology, Gustave Roussy Cancer Centre, Villejuif, France.,Department of Medicine, Université Paris-Sud, Orsay, France
| | - Merrick Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Richard A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Charles H Yoon
- Department of Surgical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - Andrew Poklepovic
- Department of Internal Medicine, VCU Massey Cancer Center, Richmond, VA 23298, USA
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - James R Anderson
- Department of Clinical Oncology, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Sama Ahsan
- Department of Clinical Oncology, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Nageatte Ibrahim
- Department of Clinical Oncology, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Alexander M M Eggermont
- Dermatology Unit, Department of Oncology, Gustave Roussy Cancer Centre, Villejuif, France.,Department of Medical Oncology, Gustave Roussy Cancer Institute & Université Paris-Saclay, Paris, France
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19
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Abstract
Melanoma accounts for 7% of all cancers in adolescents ages 15-19 years but is an unexpected malignancy in younger children. The prevalence of malignant melanoma is very rare in children ages 1-4 years, but certain non-modifiable risk factors such as xeroderma pigmentosum, congenital melanocytic nevus syndrome and other inherited traits increase the risk for its development in these young children. Recent genomic studies have identified characteristics of pediatric melanoma that differ from conventional melanoma seen in adults. In this review the authors inform on the types of melanoma seen in children and adolescents, discuss similarities and differences in melanoma between children and adults, and discuss the role of imaging in the care of these children.
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Affiliation(s)
- Sue C Kaste
- Departments of Diagnostic Imaging and Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, MSN 220, Memphis, TN, 38105-3678, USA.
- Department of Radiology, University of Tennessee Health Science Center, Memphis, TN, USA.
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20
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Tas F, Erturk K. The course of stage III melanoma in accordance with the severity of node involvement. Curr Med Res Opin 2019; 35:1819-1824. [PMID: 31169423 DOI: 10.1080/03007995.2019.1628563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Pathological stage III melanoma patients have variable clinical presentation and outcome when divided by substages, and the number of metastatic lymph nodes is the most significant independent factor. We aimed to determine the clinical features and natural course of node positive melanoma, such as first relapse and final outcome, and other factors influencing them. Methods: A total of 362 node positive melanoma patients were included in the study and reviewed retrospectively. Results: Cases were as follows: N1 (56.6%); N2 (27.1%); and N3 (16.3%). Lymphovascular invasion was found significant among node positive subtypes; it was predominant in patients with involvement of two or more nodes (p < .05). The majority of the relapses were locoregional alone (43.4%) and distant alone (31.3%). The lung/pleura was the most frequently metastasized site (32.1%). Time to relapse was the longest for N1 (20.8 months) (p < .05). Five and 10 year relapse-free survival (RFS) rates were 40% and 38%, respectively. Nodular histopathology, ulcerated lesion and higher mitotic rates carried worse RFS for all patients and also for N1. Five- and 10 year overall survival (OS) rates were 49% and 40%, respectively. Older age, nodular histopathology, higher mitotic rates and relapse of disease (p = .001) were the independent variables that were inversely correlated with OS for all patients. Conclusion: Comparative analyses of node positive melanoma suggested that there was not only a remarkable heterogeneity in the recurrence and survival rates but also a distinctive pattern among independent prognostic indicators in accordance with the severity of nodal involvement.
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Affiliation(s)
- Faruk Tas
- Department of Medical Oncology, Institute of Oncology, University of Istanbul , Istanbul , Turkey
| | - Kayhan Erturk
- Department of Medical Oncology, Institute of Oncology, University of Istanbul , Istanbul , Turkey
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21
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Deckers EA, Hoekstra-Weebers JEHM, Damude S, Francken AB, Ter Meulen S, Bastiaannet E, Hoekstra HJ. The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB-IIC Patients-Results After 3 Years. Ann Surg Oncol 2019; 27:1407-1417. [PMID: 31535302 PMCID: PMC7138761 DOI: 10.1245/s10434-019-07825-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Indexed: 11/18/2022]
Abstract
Background This study compares well-being, recurrences, and deaths of early-stage cutaneous melanoma patients in follow-up, as recommended in the Dutch guideline, with that of patients in a stage-adjusted reduced follow-up schedule, 3 years after diagnosis, as well as costs. Methods Overall, 180 eligible pathological American Joint Committee on Cancer (AJCC) stage IB–IIC, sentinel node staged, melanoma patients (response rate = 87%, 48% male, median age 57 years), randomized into a conventional (CSG, n = 93) or experimental (ESG, n = 87) follow-up schedule group, completed patient-reported outcome measures (PROMs) at diagnosis (T1): State-Trait Anxiety Inventory–State version (STAI-S), Cancer Worry Scale (CWS), Impact of Event Scale (IES), and RAND-36 (Mental and Physical Component scales [PCS/MCS]). Three years later (T3), 110 patients (CSG, n = 56; ESG, n = 54) completed PROMs, while 42 declined (23%). Results Repeated measures analyses of variance (ANOVAs) showed a significant group effect on the IES (p = 0.001) in favor of the ESG, and on the RAND-36 PCS (p = 0.02) favoring the CSG. Mean IES and CWS scores decreased significantly over time, while those on the RAND-36 MCS and PCS increased. Effect sizes were small. Twenty-five patients developed a recurrence or second primary melanoma, of whom 13 patients died within 3 years. Cox proportional hazards models showed no differences between groups in recurrence-free survival (hazard ratio [HR] 0.71 [0.32–1.58]; p = 0.400) and disease-free survival (HR 1.24 [0.42–3.71]; p = 0.690). Costs per patient after 3 years (computed for 77.3% of patients) were 39% lower in the ESG. Conclusion These results seemingly support the notion that a stage-adjusted reduced follow-up schedule forms an appropriate, safe, and cost-effective alternative for pathological AJCC stage IB–IIC melanoma patients to the follow-up regimen as advised in the current melanoma guideline.
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Affiliation(s)
- Eric A Deckers
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Josette E H M Hoekstra-Weebers
- Wenckebach Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Samantha Damude
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sylvia Ter Meulen
- Skin-Melanoma Clinic, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Esther Bastiaannet
- Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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22
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Feigelson HS, Powers JD, Kumar M, Carroll NM, Pathy A, Ritzwoller DP. Melanoma incidence, recurrence, and mortality in an integrated healthcare system: A retrospective cohort study. Cancer Med 2019; 8:4508-4516. [PMID: 31215776 PMCID: PMC6675720 DOI: 10.1002/cam4.2252] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 01/13/2023] Open
Abstract
Background Numerous studies have examined melanoma incidence and survival, but studies on melanoma recurrence are limited. We examined melanoma incidence, recurrence, and mortality among members of Kaiser Permanente Colorado (KPCO) between January 1, 2000 and December 31, 2015. Methods Age‐adjusted incidence rates were computed to examine trends among KPCO members aged 21 years and older. Cox proportional hazards models were used to examine factors associated with recurrence and mortality. Results Our cohort included 1931 cases of invasive melanoma. Incidence rates increased over time and were higher than SEER rates; however, the increase was limited to early stage disease. In multivariable models, stage at initial diagnosis, gender, and age were associated with melanoma recurrence. Men were more likely to have a recurrence than women (adjusted hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.19‐2.43), and for each decade of increasing age, the adjusted HR = 1.20 (95% CI: 1.06‐1.37). Factors associated with all‐cause mortality included stage (HR = 12.87, 95% CI: 6.63‐24.99, for stage IV vs stage I), male gender (HR = 1.42, 95% CI: 1.12‐1.79), older age at diagnosis, lower socioeconomic status, and comorbidity index. For melanoma‐specific mortality, results were similar, with one exception: age was not associated with melanoma‐specific death (HR = 1.09, 95% CI: 0.94‐1.25, P = 0.253). Conclusions Data derived from an insured patient population, such as KPCO, have the potential to enhance our understanding of emerging trends in melanoma. This is the first population‐based study in the United States to examine patient characteristics associated with risk of recurrence. Men have an increased risk of both recurrence and death, and thus may benefit from more intensive follow‐up than women.
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Affiliation(s)
| | - John D Powers
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Mayanka Kumar
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Nikki M Carroll
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
| | - Arun Pathy
- Department of Dermatology, Kaiser Permanente Colorado, Aurora, Colorado
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado
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23
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Freeman M, Laks S. Surveillance imaging for metastasis in high-risk melanoma: importance in individualized patient care and survivorship. Melanoma Manag 2019; 6:MMT12. [PMID: 31236204 PMCID: PMC6582455 DOI: 10.2217/mmt-2019-0003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 04/01/2019] [Indexed: 12/29/2022] Open
Abstract
Most patients newly diagnosed with melanoma have early-stage disease considered of good prognosis. However, with a risk of recurrence, appropriate follow-up may include surveillance imaging for early relapse detection. Previously, surveillance imaging to detect recurrences was considered unjustified, given the lack of effective treatments. Now, systemic therapies have improved, and patients with low tumor burden may derive benefit from surveillance imaging. Despite this, controversy exists regarding the role of surveillance imaging in early-stage melanoma survivorship, in part reflected by the lack of consensus on specific imaging protocols and broad guidelines. This review discusses published evidence on surveillance imaging to detect metastasis in high-risk melanoma, the need for early recurrence detection and implications for value-based clinical decision-making, survivorship care and multidisciplinary patient management.
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Affiliation(s)
- Morganna Freeman
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA.,Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA 91010, USA
| | - Shachar Laks
- Department of Surgery, East Carolina University, Greenville, NC 27834, USA.,Department of Surgery, East Carolina University, Greenville, NC 27834, USA
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24
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Klapperich ME, Bowen GM, Grossman D. Current controversies in early-stage melanoma: Questions on management and surveillance. J Am Acad Dermatol 2019; 80:15-25. [PMID: 30553299 DOI: 10.1016/j.jaad.2018.03.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 12/24/2022]
Abstract
There are a number of controversies and uncertainties relating to the management and surveillance of patients with early-stage, localized (ie, stage 0, I, and II) cutaneous melanoma. While tumor stage is a critical predictor of clinical outcome and guides treatment, accurate determination of stage may be affected by the biopsy technique used and the method of sectioning before histologic review. A new molecular prognostic test is available but has not been formally incorporated into staging or treatment guidelines. There are no randomized controlled clinical trials to support guidelines for surveillance following the treatment of early-stage melanoma. In the second article in this continuing medical education series, we review the controversies and uncertainties relating to these issues. The questions we address are controversial because they speak to clinical scenarios for which there are no evidence-based guidelines or randomized clinical trials with the consequence of considerable variability in clinical practice. Our goal is to provide the clinician with up-to-date contextual knowledge to appreciate the multiple sides of each controversy and to suggest pathways to resolution.
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Affiliation(s)
- Marki E Klapperich
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Glen M Bowen
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.
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