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Vargas GM, Farooq MS, Karakousis GC. Adjuvant Therapy for High-Risk Stage II Melanoma: Current Paradigms in Management and Future Directions. Cancers (Basel) 2024; 16:2690. [PMID: 39123418 PMCID: PMC11312203 DOI: 10.3390/cancers16152690] [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: 06/18/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Melanoma is the fifth most common cancer in the United States and accounts for the majority of all skin cancer-related deaths, making it the most lethal cutaneous malignancy. Systemic adjuvant therapy for stage IIB-IV melanoma is now approved for patients who have undergone surgical resection, given the appreciable risk of recurrence and mortality in this patient population. Despite the lower stage, high-risk stage II melanoma (stage IIB/IIC) can often exhibit an even more aggressive course when compared to stage IIIA/IIIB disease, thus justifying consideration of adjuvant therapy in these patients. In this review, we highlight the current standard of practice for the treatment of stage IIB/C melanoma, with a focus on adjuvant therapies supported by published landmark clinical trials, including anti-PD-1 therapy. Notably, adjuvant therapies approved thus far in this patient population have demonstrated an improvement in recurrence-free survival, while their impact on overall survival is pending. Finally, this review highlights currently ongoing trials and future directions for research and treatment possibilities for high-risk clinical stage II melanoma.
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Affiliation(s)
| | | | - Giorgos C. Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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Vetto JT. Clinical and Imaging Follow-Up for High-Risk Cutaneous Melanoma: Current Evidence and Guidelines. Cancers (Basel) 2024; 16:2572. [PMID: 39061211 PMCID: PMC11274402 DOI: 10.3390/cancers16142572] [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: 06/06/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
The most recent (eighth) edition of the American Joint Committee on Cancer (AJCC) staging system divides invasive cutaneous melanoma into two broad groups: "low-risk" (stage IA-IIA) and "high-risk" (stage IIB-IV). While surveillance imaging for high-risk melanoma patients makes intuitive sense, supporting data are limited in that they are mostly respective and used varying methods, schedules, and endpoints. As a result, there is a lack of uniformity across different dermatologic and oncologic organizations regarding recommendations for follow-up, especially regarding imaging. That said, the bulk of retrospective and prospective data support imaging follow-up for high-risk patients. Currently, it seems that either positron emission tomography (PET) or whole-body computerized tomography (CT) are reasonable options for follow-up, with brain magnetic resonance imaging (MRI) preferred for the detection of brain metastases in patients who can undergo it. The current era of effective systemic therapies (ESTs), which can improve disease-free survival (DFS) and overall survival (OS) beyond lead-time bias, has emphasized the role of imaging in detecting various patterns of EST response and treatment relapse, as well as the importance of radiologic tumor burden.
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Affiliation(s)
- John T. Vetto
- Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR 97239, USA; ; Tel.: +1-503-494-5501
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
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3
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Briatico G, Brancaccio G, Moscarella E, Longo C, Borsari S, Ruggeri R, Docimo G, Argenziano G. Stage IIA Cutaneous Melanoma: Do Regional Ultrasound and CT scan Improve Detection of Relapses? A Multicenter Retrospective Observational Study. Dermatol Pract Concept 2024; 14:dpc.1403a155. [PMID: 39122509 PMCID: PMC11313639 DOI: 10.5826/dpc.1403a155] [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: 02/22/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Stage IIA cutaneous melanoma is typified by a Breslow thickness between 1.1 and 2.0 mm with ulceration or between 2.1 and 4.0 mm without ulceration. The role of radiological investigations in staging and follow-up of this intermediate-risk subgroup of patients is still debated. OBJECTIVES The aim of this study is to investigate the role of imaging procedures in the follow-up of stage IIA melanoma asymptomatic patients. METHODS Data were retrieved from two tertiary referral centers in Italy. Among patients with stage IIA melanoma, those who relapsed were investigated concerning type of detection (by patient or by doctor), and modality of detection (clinical examination, ultrasound, CT scan). In addition, false positive data were collected. RESULTS In total, 213 patients were retrieved, with 26 patients showing relapse (recurrence rate, 12.2%). The mean follow-up time was 3 years and the mean time to recurrence was 17.8 months. 21/26 (80.7%) recurrences were identified by the doctor and 5/26 (19.2%) by the patient (P < 0.05). Among those identified by the doctor, 16/21 (76,1%) were identified by radiological examinations. Nine out of 15 (60%) lymph node recurrences were detected by ultrasound and 6/7 (85.7%) distant metastases were detected by CT. The false positive rate was 7% (P < 0.05). CONCLUSIONS In our study the great majority of metastases were detected using imaging procedures. Given the new therapeutic options offered by targeted therapy and immunotherapy in relapsing patients, the role of radiological investigations in the follow-up of stage IIA patients should be reconsidered.
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Affiliation(s)
- Giulia Briatico
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | | | - Elvira Moscarella
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Caterina Longo
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
- Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Stefania Borsari
- Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Roberta Ruggeri
- Department of Dermatology, University of Modena, Reggio Emilia, Italy
- Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Skin Cancer Center, Reggio Emilia, Italy
| | - Giovanni Docimo
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Lee ST, Kovaleva N, Senko C, Kee D, Scott AM. Positron Emission Tomography/Computed Tomography Transformation of Oncology: Melanoma and Skin Malignancies. PET Clin 2024; 19:231-248. [PMID: 38233284 DOI: 10.1016/j.cpet.2023.12.009] [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] [Indexed: 01/19/2024]
Abstract
Skin cancers are the most common cancers, with melanoma resulting in the highest cause of death in this category. Accurate clinical, histologic, and imaging staging with fludeoxyglucose positron emission tomography (FDG PET) is most important to guide patient management. Whilst surgical excision with clear margins is the gold-standard treatment for primary cutaneous melanoma, targeted therapies have generated remarkable and rapid clinical responses in melanoma, for which FDG PET also plays an important role in assessment of treatment response and post-therapy surveillance. Non-FDG PET tracers, advanced PET technology, and PET radiomics may potentially change the landscape of the utilization of PET in the imaging of patients with cutaneous malignancies.
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Affiliation(s)
- Sze-Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Natalia Kovaleva
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia
| | - Clare Senko
- Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia; Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Australia
| | - Damien Kee
- Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia; Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, Australia; Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia; Olivia Newton-John Cancer Research Institute, and La Trobe University, Heidelberg, Australia.
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Fietz S, Diekmann E, de Vos L, Zarbl R, Hunecke A, Glosch AK, Färber M, Sirokay J, Hoffmann F, Fröhlich A, Franzen A, Strieth S, Landsberg J, Dietrich D. Circulating Cell-Free SHOX2 DNA Methylation Is a Predictive, Prognostic, and Monitoring Biomarker in Adjuvant and Palliative Anti-PD-1-Treated Melanoma. Clin Chem 2024; 70:516-527. [PMID: 38300881 DOI: 10.1093/clinchem/hvad230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/13/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND The majority of metastatic melanoma patients initially do not respond or acquire resistance to anti-programmed cell death 1 (PD-1) immunotherapy. Liquid biopsy biomarkers might provide useful early response information and allow for personalized treatment decisions. METHODS We prospectively assessed circulating cell-free SHOX2 DNA methylation (SHOX2 ccfDNAm) levels and their dynamic changes in blood plasma of melanoma patients by quantitative methylation-specific polymerase chain reaction. Patients were treated with either palliative (n = 42) or adjuvant (n = 55) anti-PD-1 immunotherapy. Moreover, we included n = 126 control patients without evidence of malignant disease. We analyzed SHOX2 ccfDNAm status prior to and 4 weeks after palliative treatment initiation with regard to outcome [objective response, progression-free survival (PFS), and overall survival (OS)]. In the adjuvant setting, we associated longitudinal SHOX2 ccfDNAm status with disease recurrence. RESULTS Sensitivity was 60% with 25/42 melanoma patients showing increased SHOX2 ccfDNAm levels, whereas specificity was 98% with 123/126 (P < 0.001) control patients having SHOX2 ccfDNAm levels below cut-off. Pretreatment SHOX2 ccfDNAm status did not correlate with outcome; however, SHOX2 ccfDNAm negativity 4 weeks after palliative treatment initiation was strongly associated with improved survival [PFS: hazard ratio (HR) = 0.25, P = 0.002; OS: HR = 0.12, P = 0.007]. Pretreatment positive patients who reached SHOX2 ccfDNAm clearance after 4 weeks of immunotherapy showed an exceptionally beneficial outcome. SHOX2 ccfDNAm testing allowed for an early detection of distant metastases in adjuvant-treated melanoma patients. CONCLUSIONS Our study suggests SHOX2 ccfDNAm to be an early predictor of outcome in anti-PD-1 treated melanoma patients. SHOX2 ccfDNAm testing may aid individualized treatment decision-making.
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Affiliation(s)
- Simon Fietz
- Department of Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Eric Diekmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Luka de Vos
- Department of Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Romina Zarbl
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Alina Hunecke
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Glosch
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Moritz Färber
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Judith Sirokay
- Department of Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Friederike Hoffmann
- Department of Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Anne Fröhlich
- Department of Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Alina Franzen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Sebastian Strieth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
| | - Jennifer Landsberg
- Department of Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Dimo Dietrich
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Bonn, Bonn, Germany
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Gjorup CA, Woodford R, Li I, Carlino MS, Ch'ng S, Chung D, Hsiao E, Lo SN, London K, Long GV, Menzies AM, Nieweg OE, Pennington TE, Rtshiladze MA, Saw RPM, Scolyer RA, Shannon KF, Spillane AJ, Stretch JR, Thompson JF, Varey AHR, van Akkooi ACJ. Role of Concurrent Ultrasound Surveillance of Sentinel Node-Positive Node Fields in Melanoma Patients Having Routine Cross-Sectional Imaging. Ann Surg Oncol 2024; 31:1857-1864. [PMID: 37966706 PMCID: PMC10838221 DOI: 10.1245/s10434-023-14526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE In sentinel node-positive (SN+ve) melanoma patients, active surveillance with regular ultrasound examination of the node field has become standard, rather than completion lymph node dissection (CLND). A proportion of these patients now receive adjuvant systemic therapy and have routine cross-sectional imaging (computed tomography [CT] or positron emission tomography [PET]/CT). The role of concurrent ultrasound (US) surveillance in these patients is unclear. The purpose of our study was to describe the modality of detection of nodal recurrence in SN+ve node fields. METHODS SN+ve melanoma patients who did not undergo CLND treated at a single institution from January 1, 2016 to December 31, 2020 were included. RESULTS A total of 225 SN+ve patients with a median follow-up of 23 months were included. Of these, 119 (53%) received adjuvant systemic therapy. Eighty (36%) developed a recurrence at any site; 24 (11%) recurred first in the SN+ve field, of which 12 (5%) were confirmed node field recurrence only at 2 months follow-up. The nodal recurrences were first detected by ultrasound in seven (3%), CT in seven (3%), and PET/CT in seven (3%) patients. All nodal recurrences evident on US were also evident on PET/CT and vice versa. CONCLUSIONS The high rate of recurrences outside the node field and the identification of all US-detected nodal recurrences on concurrent cross-sectional imaging modalities suggest that routine concurrent ultrasound surveillance of the node-positive field may be unnecessary for SN+ve melanoma patients having routine cross-sectional imaging.
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Affiliation(s)
- Caroline A Gjorup
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Isabel Li
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Blacktown Hospital, Blacktown, Australia
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
- Chris O'Brien Lifehouse Cancer Centre, Head and Neck Service, Camperdown, Australia
| | - David Chung
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Alfred Nuclear Medicine and Ultrasound, Newtown, Australia
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Edward Hsiao
- Mater Imaging, Mater Hospital, North Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kevin London
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Alfred Nuclear Medicine and Ultrasound, Newtown, Australia
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia
- Department of Medical Oncology, Mater Hospital, North Sydney, Australia
- Charles Perkin Centre, The University of Sydney, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Thomas E Pennington
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael A Rtshiladze
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkin Centre, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- NSW Health Pathology, Sydney, Australia
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Chris O'Brien Lifehouse Cancer Centre, Head and Neck Service, Camperdown, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
- Breast and Melanoma Surgery Unit, Royal North Shore Hospital, St Leonards, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Plastic Surgery, Westmead Hospital, Westmead, Australia
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia.
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Homburg S, Christensen CB, Pedersen M, Sørensen SG, Donia M, Svane IM, Hendel HW, Ellebaek E. Prospective Assessment of Fluorine-18-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography (FDG-PET/CT) for Early Identification of Checkpoint-Inhibitor-Induced Pseudoprogression. Cancers (Basel) 2024; 16:964. [PMID: 38473325 DOI: 10.3390/cancers16050964] [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: 02/03/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
The activity of immune checkpoint inhibitors (ICIs) in patients with metastatic melanoma is often monitored using fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scans. However, distinguishing disease progression (PD) from pseudoprogression (PsPD), where increased FDG uptake might reflect immune cell activity rather than tumor growth, remains a challenge. This prospective study compared the efficacy of dual-time point (DTP) FDG-PET/CT with modified response criteria (PERCIMT) in differentiating PsPD from PD. From July 2017-January 2021, 41 patients suspected to have PsPD on an evaluation scan were prospectively included (29 evaluable). A subsequent DTP FDG-PET/CT scan was conducted within 14 days, followed by a confirmatory FDG-PET/CT scan. Additionally, PERCIMT were applied. DTP FDG-PET/CT identified 24% with PsPD and 76% with PD. Applying PERCIMT criteria, 69% showed PsPD, while 31% had PD. On follow-up, 10 patients (34%) demonstrated confirmed PsPD, while 19 (66%) exhibited PD. The sensitivity and specificity of DTP FDG-PET/CT were 20% and 74%, respectively, and for PERCIMT this was 80% and 37%, respectively. Our findings suggest limited efficacy of DTP FDG-PET/CT in distinguishing PsPD from PD in ICI-treated patients with metastatic melanoma. The use of PERCIMT could complement clinical assessment and be incorporated in multidisciplinary team conferences for enhanced decision-making.
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Affiliation(s)
- Sif Homburg
- Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Charlotte Birk Christensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Magnus Pedersen
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Simon Grund Sørensen
- Department of Molecular Medicine, Aarhus University Hospital, 8000 Aarhus, Denmark
| | - Marco Donia
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Inge Marie Svane
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Helle Westergren Hendel
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
| | - Eva Ellebaek
- National Center for Cancer Immune Therapy (CCIT-DK), Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark
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Trac N, Chen Z, Oh HS, Jones L, Huang Y, Giblin J, Gross M, Sta Maria NS, Jacobs RE, Chung EJ. MRI Detection of Lymph Node Metastasis through Molecular Targeting of C-C Chemokine Receptor Type 2 and Monocyte Hitchhiking. ACS NANO 2024; 18:2091-2104. [PMID: 38212302 DOI: 10.1021/acsnano.3c09201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Biopsy is the clinical standard for diagnosing lymph node (LN) metastasis, but it is invasive and poses significant risk to patient health. Magnetic resonance imaging (MRI) has been utilized as a noninvasive alternative but is limited by low sensitivity, with only ∼35% of LN metastases detected, as clinical contrast agents cannot discriminate between healthy and metastatic LNs due to nonspecific accumulation. Nanoparticles targeted to the C-C chemokine receptor 2 (CCR2), a biomarker highly expressed in metastatic LNs, have the potential to guide the delivery of contrast agents, improving the sensitivity of MRI. Additionally, cancer cells in metastatic LNs produce monocyte chemotactic protein 1 (MCP1), which binds to CCR2+ inflammatory monocytes and stimulates their migration. Thus, the molecular targeting of CCR2 may enable nanoparticle hitchhiking onto monocytes, providing an additional mechanism for metastatic LN targeting and early detection. Hence, we developed micelles incorporating gadolinium (Gd) and peptides derived from the CCR2-binding motif of MCP1 (MCP1-Gd) and evaluated the potential of MCP1-Gd to detect LN metastasis. When incubated with migrating monocytes in vitro, MCP1-Gd transport across lymphatic endothelium increased 2-fold relative to nontargeting controls. After administration into mouse models with initial LN metastasis and recurrent LN metastasis, MCP1-Gd detected metastatic LNs by increasing MRI signal by 30-50% relative to healthy LNs. Furthermore, LN targeting was dependent on monocyte hitchhiking, as monocyte depletion decreased accumulation by >70%. Herein, we present a nanoparticle contrast agent for MRI detection of LN metastasis mediated by CCR2-targeting and demonstrate the potential of monocyte hitchhiking for enhanced nanoparticle delivery.
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Affiliation(s)
- Noah Trac
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Zixi Chen
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Hyun-Seok Oh
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Leila Jones
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Yi Huang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Joshua Giblin
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
| | - Mitchell Gross
- Lawrence J. Ellison Institute for Transformative Medicine, Los Angeles, California 90064, United States
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Naomi S Sta Maria
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute and Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Russell E Jacobs
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute and Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
| | - Eun Ji Chung
- Department of Biomedical Engineering, University of Southern California, Los Angeles, California 90089, United States
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, United States
- Division of Nephrology and Hypertension, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Department of Medicine, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Department of Medicine, Eli and Edythe Broad Center for Regenerative Medicine and Stem Cell Research, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, United States
- Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, California 90089, United States
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Dobbs TD, Jovic M, Ekakkaravichit N, Ali SR, Gibson JAG, Ibrahim N, Hemington-Gorse S, Whitaker IS. Service implications of the revised 2022 National Institute for Health and Care Excellence (NICE) follow-up guidelines for stage IA-IIC melanoma. Br J Surg 2024; 111:znad402. [PMID: 38271073 PMCID: PMC10810063 DOI: 10.1093/bjs/znad402] [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: 05/24/2023] [Revised: 10/08/2023] [Accepted: 11/12/2023] [Indexed: 01/27/2024]
Abstract
BACKGROUND The 2022 National Institute for Health and Care Excellence melanoma guideline update made significant changes to follow-up. The aim of this study was to assess the impact these changes will have on a national melanoma cohort over a 5-year follow-up interval. METHODS Anonymized, individual-level, population-scale, linkable primary and secondary care National Health Service data for an 18-year interval (2000-2018) in Wales, UK were analysed. These data were used to predict the number of patients over a 10-year interval (2020-2030) that would be diagnosed with melanoma. Follow-up schedules for the 2015 and 2022 National Institute for Health and Care Excellence melanoma guidelines were then used to calculate the number of clinician-led appointments, the number of radiological investigations, and the total healthcare cost between 2025 and 2030, corresponding to a 5-year patient follow-up interval, for those with stage IA-IIC melanoma. RESULTS Between 2025 and 2030 it is predicted that implementation of the 2022 guidelines would lead to 21 122 (range 19 194-23 083) fewer clinician-led appointments for patients with stage IA-IIC melanoma. However, there would be a significant increase in the number of radiological investigations (7812; range 7444-8189). These changes would lead to a €2.74 million (€1.87 million-€3.61 million) reduction in the total cost of follow-up over the interval 2025-2030. CONCLUSION Melanoma follow-up guideline changes will result in a substantial reduction in the number of clinical follow-up appointments, but a significant additional burden to radiological services. The overall cost of follow-up at a national level will be reduced.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Mathew Jovic
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | | | - Stephen R Ali
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - John A G Gibson
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | - Nader Ibrahim
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
| | | | - Iain S Whitaker
- Reconstructive Surgery and Regenerative Medicine Research Centre, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
- Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK
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10
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Zamani-Siahkali N, Mirshahvalad SA, Pirich C, Beheshti M. Diagnostic Performance of [ 18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients. Cancers (Basel) 2024; 16:215. [PMID: 38201642 PMCID: PMC10778455 DOI: 10.3390/cancers16010215] [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: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
We described the diagnostic performance of [18F]F-FDG-PET in malignant melanoma by conducting a comprehensive systematic review and meta-analysis of the existing literature. The study was designed following PRISMA-DTA. Original articles with adequate crude data for meta-analytic calculations that evaluated [18F]F-FDG-PET and compared it with a valid reference standard were considered eligible. The pooled measurements were calculated based on the data level (patient/lesion-based). Regarding sub-groups, diagnostic performances were calculated for local, regional and distant involvement. The bivariate model was employed to calculate sensitivity and specificity. The initial search resulted in 6678 studies. Finally, 100 entered the meta-analysis, containing 82 patient-based (10,403 patients) and 32 lesion-based (6188 lesions) datasets. At patient level, overall, [18F]F-FDG-PET had pooled sensitivity and specificity of 81% (95%CI: 73-87%) and 92% (95%CI: 90-94%), respectively. To detect regional lymph node metastasis, the pooled sensitivity and specificity were 56% (95%CI: 40-72%) and 97% (95%CI: 94-99%), respectively. To detect distant metastasis, they were 88% (95%CI: 81-93%) and 94% (95%CI: 91-96%), respectively. At lesion level, [18F]F-FDG-PET had a pooled sensitivity and specificity of 70% (95%CI: 57-80%) and 94% (95%CI: 88-97%), respectively. Thus, [18F]F-FDG-PET is a valuable diagnostic modality for melanoma assessment. It was accurate in various clinical scenarios. However, despite its high specificity, it showed low sensitivity in detecting regional lymph node metastasis and could not replace lymph node biopsy.
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Affiliation(s)
- Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran 1461884513, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
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11
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Fakhoury JW, Lara JB, Manwar R, Zafar M, Xu Q, Engel R, Tsoukas MM, Daveluy S, Mehregan D, Avanaki K. Photoacoustic imaging for cutaneous melanoma assessment: a comprehensive review. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:S11518. [PMID: 38223680 PMCID: PMC10785699 DOI: 10.1117/1.jbo.29.s1.s11518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
Significance Cutaneous melanoma (CM) has a high morbidity and mortality rate, but it can be cured if the primary lesion is detected and treated at an early stage. Imaging techniques such as photoacoustic (PA) imaging (PAI) have been studied and implemented to aid in the detection and diagnosis of CM. Aim Provide an overview of different PAI systems and applications for the study of CM, including the determination of tumor depth/thickness, cancer-related angiogenesis, metastases to lymph nodes, circulating tumor cells (CTCs), virtual histology, and studies using exogenous contrast agents. Approach A systematic review and classification of different PAI configurations was conducted based on their specific applications for melanoma detection. This review encompasses animal and preclinical studies, offering insights into the future potential of PAI in melanoma diagnosis in the clinic. Results PAI holds great clinical potential as a noninvasive technique for melanoma detection and disease management. PA microscopy has predominantly been used to image and study angiogenesis surrounding tumors and provide information on tumor characteristics. Additionally, PA tomography, with its increased penetration depth, has demonstrated its ability to assess melanoma thickness. Both modalities have shown promise in detecting metastases to lymph nodes and CTCs, and an all-optical implementation has been developed to perform virtual histology analyses. Animal and human studies have successfully shown the capability of PAI to detect, visualize, classify, and stage CM. Conclusions PAI is a promising technique for assessing the status of the skin without a surgical procedure. The capability of the modality to image microvasculature, visualize tumor boundaries, detect metastases in lymph nodes, perform fast and label-free histology, and identify CTCs could aid in the early diagnosis and classification of CM, including determination of metastatic status. In addition, it could be useful for monitoring treatment efficacy noninvasively.
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Affiliation(s)
- Joseph W. Fakhoury
- Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Juliana Benavides Lara
- University of Illinois at Chicago, Richard and Loan Hill Department of Bioengineering, Chicago, Illinois, United States
| | - Rayyan Manwar
- University of Illinois at Chicago, Richard and Loan Hill Department of Bioengineering, Chicago, Illinois, United States
| | - Mohsin Zafar
- University of Illinois at Chicago, Richard and Loan Hill Department of Bioengineering, Chicago, Illinois, United States
| | - Qiuyun Xu
- Wayne State University, Department of Biomedical Engineering, Detroit, Michigan, United States
| | - Ricardo Engel
- Wayne State University School of Medicine, Detroit, Michigan, United States
| | - Maria M. Tsoukas
- University of Illinois at Chicago, Department of Dermatology, Chicago, Illinois, United States
| | - Steven Daveluy
- Wayne State University School of Medicine, Department of Dermatology, Detroit, Michigan, United States
| | - Darius Mehregan
- Wayne State University School of Medicine, Department of Dermatology, Detroit, Michigan, United States
| | - Kamran Avanaki
- University of Illinois at Chicago, Richard and Loan Hill Department of Bioengineering, Chicago, Illinois, United States
- University of Illinois at Chicago, Department of Dermatology, Chicago, Illinois, United States
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12
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Novruzov F, Mehdi E, Orucova N, Aliyeva G, Valla F, Mammadzada H, Shahin D, Aliyev J. Controversies of [ 68Ga]Ga-FAPI-46 and 2-[ 18F]FDG findings in metastatic melanoma. Eur J Nucl Med Mol Imaging 2024; 51:609-610. [PMID: 37752270 DOI: 10.1007/s00259-023-06444-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Fuad Novruzov
- Nuclear Medicine Department, National Centre of Oncology, Baku, Azerbaijan.
| | - Elnur Mehdi
- Nuclear Medicine Department, National Centre of Oncology, Baku, Azerbaijan
| | - Nuriyya Orucova
- Nuclear Medicine Department, National Centre of Oncology, Baku, Azerbaijan
| | - Gunay Aliyeva
- Nuclear Medicine Department, National Centre of Oncology, Baku, Azerbaijan
| | | | | | - Davut Shahin
- Department of Pathology, Acibadem University Hospital, Istanbul, Turkey
| | - Jamil Aliyev
- Department of General Surgery, National Centre of Oncology, Baku, Azerbaijan
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13
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Khalid M, Sutterfield B, Minley K, Ottwell R, Abercrombie M, Heath C, Torgerson T, Hartwell M, Vassar M. The Reporting and Methodological Quality of Systematic Reviews Underpinning Clinical Practice Guidelines Focused on the Management of Cutaneous Melanoma: Cross-Sectional Analysis. JMIR DERMATOLOGY 2023; 6:e43821. [PMID: 38060306 PMCID: PMC10739238 DOI: 10.2196/43821] [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: 10/27/2022] [Revised: 03/28/2023] [Accepted: 09/15/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Clinical practice guidelines (CPGs) inform evidence-based decision-making in the clinical setting; however, systematic reviews (SRs) that inform these CPGs may vary in terms of reporting and methodological quality, which affects confidence in summary effect estimates. OBJECTIVE Our objective was to appraise the methodological and reporting quality of the SRs used in CPGs for cutaneous melanoma and evaluate differences in these outcomes between Cochrane and non-Cochrane reviews. METHODS We conducted a cross-sectional analysis by searching PubMed for cutaneous melanoma guidelines published between January 1, 2015, and May 21, 2021. Next, we extracted SRs composing these guidelines and appraised their reporting and methodological rigor using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklists. Lastly, we compared these outcomes between Cochrane and non-Cochrane SRs. All screening and data extraction occurred in a masked, duplicate fashion. RESULTS Of the SRs appraised, the mean completion rate was 66.5% (SD 12.29%) for the PRISMA checklist and 44.5% (SD 21.05%) for AMSTAR. The majority of SRs (19/50, 53%) were of critically low methodological quality, with no SRs being appraised as high quality. There was a statistically significant association (P<.001) between AMSTAR and PRISMA checklists. Cochrane SRs had higher PRISMA mean completion rates and higher methodological quality than non-Cochrane SRs. CONCLUSIONS SRs supporting CPGs focused on the management of cutaneous melanoma vary in reporting and methodological quality, with the majority of SRs being of low quality. Increasing adherence to PRISMA and AMSTAR checklists will likely increase the quality of SRs, thereby increasing the level of evidence supporting cutaneous melanoma CPGs.
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Affiliation(s)
- Mahnoor Khalid
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States
| | - Bethany Sutterfield
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Kirstien Minley
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Ryan Ottwell
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - McKenna Abercrombie
- Dermatology Residency, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Christopher Heath
- Dermatology Residency, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Trevor Torgerson
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Micah Hartwell
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
| | - Matt Vassar
- Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States
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14
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Min V, Petit A, Rome A, Andre N. Metastatic Melanoma in Young Child. J Pediatr Hematol Oncol 2023; 45:461-462. [PMID: 37027236 DOI: 10.1097/mph.0000000000002663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 02/15/2023] [Indexed: 04/08/2023]
Abstract
Pediatric melanoma is a rare cancer, especially in young children, and it remains a diagnostic challenge. We report a case of massively metastatic melanoma in young patient with an atypical clinical and biological presentation and with no risk factors.
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Affiliation(s)
- Victoria Min
- Department of Pediatric Oncology, La Timone University Hospital of Marseille, APHM
| | - Audrey Petit
- Department of Pediatric Oncology, La Timone University Hospital of Marseille, APHM
| | - Angélique Rome
- Department of Pediatric Oncology, La Timone University Hospital of Marseille, APHM
| | - Nicolas Andre
- Department of Pediatric Oncology, La Timone University Hospital of Marseille, APHM
- SMARTc Unit, CRCM Inserm 1068-CNRS UMR 7258, Aix-Marseille University, Marseille, France
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15
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Sachpekidis C, Stein-Thoeringer CK, Kopp-Schneider A, Weru V, Dimitrakopoulou-Strauss A, Hassel JC. Can physiologic colonic [ 18F]FDG uptake in PET/CT imaging predict response to immunotherapy in metastatic melanoma? Eur J Nucl Med Mol Imaging 2023; 50:3709-3722. [PMID: 37452874 PMCID: PMC10547632 DOI: 10.1007/s00259-023-06327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
AIM The development of biomarkers that can reliably and early predict response to immune checkpoint inhibitors (ICIs) is crucial in melanoma. In recent years, the gut microbiome has emerged as an important regulator of immunotherapy response, which may, moreover, serve as a surrogate marker and prognosticator in oncological patients under immunotherapy. Aim of the present study is to investigate if physiologic colonic [18F]FDG uptake in PET/CT before start of ICIs correlates with clinical outcome of metastatic melanoma patients. The relation between [18F]FDG uptake in lymphoid cell-rich organs and long-term patient outcome is also assessed. METHODOLOGY One hundred nineteen stage IV melanoma patients scheduled for immunotherapy with ipilimumab, applied either as monotherapy or in combination with nivolumab, underwent baseline [18F]FDG PET/CT. PET/CT data analysis consisted of standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) calculations in the colon as well as measurements of the colon-to-liver SUV ratios (CLRmean, CLRmax). Visual grading of colon uptake based on a four-point scale was also performed. Moreover, the spleen-to-liver SUV ratios (SLRmean, SLRmax) and the bone marrow-to-liver SUV ratios (BLRmean, BLRmax) were calculated. We also measured serum lipopolysaccharide (LPS) levels as a marker for bacterial translocation and surrogate for mucosal defense homeostasis. The results were correlated with patients' best clinical response, progression-free survival (PFS), and overall survival (OS) as well as clinical signs of colitis. RESULTS Median follow-up [95%CI] from the beginning of immunotherapy was 64.6 months [61.0-68.6 months]. Best response to treatment was progressive disease (PD) for 60 patients, stable disease (SD) for 37 patients, partial response (PR) for 18 patients, and complete response (CR) for 4 patients. Kaplan-Meier curves demonstrated a trend for longer PFS and OS in patients with lower colonic SUV and CLR values; however, no statistical significance for these parameters as prognostic factors was demonstrated. On the other hand, patients showing disease control as best response to treatment (SD, PR, CR) had significantly lower colonic MTV and TLG than those showing PD. With regard to lymphoid cell-rich organs, significantly lower baseline SLRmax and BLRmax were observed in patients responding with disease control than progression to treatment. Furthermore, patients with lower SLRmax and BLRmax values had a significantly longer OS when dichotomized at their median. In multivariate analysis, PET parameters that were found to significantly adversely correlate with patient survival were colonic MTV for PFS, colonic TLG for PFS, and BLRmax for PFS and OS. CONCLUSIONS Physiologic colonic [18F]FDG uptake in PET/CT, as assessed by means of SUV, before start of ipilimumab-based treatment does not seem to independently predict patient survival of metastatic melanoma. On the other hand, volumetric PET parameters, such as MTV and TLG, derived from the normal gut may identify patients showing disease control to immunotherapy and significantly correlate with PFS. Moreover, the investigation of glucose metabolism in the spleen and the bone marrow may offer prognostic information.
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Affiliation(s)
- Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany.
| | - Christoph K Stein-Thoeringer
- Laboratory of Translational, Microbiome Science, Internal Medicine I, University Clinic Tuebingen, Tuebingen, Germany
| | | | - Vivienn Weru
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antonia Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69210, Heidelberg, Germany
| | - Jessica C Hassel
- Department of Dermatology and National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
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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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Dai J, Wang H, Xu Y, Chen X, Tian R. Clinical application of AI-based PET images in oncological patients. Semin Cancer Biol 2023; 91:124-142. [PMID: 36906112 DOI: 10.1016/j.semcancer.2023.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023]
Abstract
Based on the advantages of revealing the functional status and molecular expression of tumor cells, positron emission tomography (PET) imaging has been performed in numerous types of malignant diseases for diagnosis and monitoring. However, insufficient image quality, the lack of a convincing evaluation tool and intra- and interobserver variation in human work are well-known limitations of nuclear medicine imaging and restrict its clinical application. Artificial intelligence (AI) has gained increasing interest in the field of medical imaging due to its powerful information collection and interpretation ability. The combination of AI and PET imaging potentially provides great assistance to physicians managing patients. Radiomics, an important branch of AI applied in medical imaging, can extract hundreds of abstract mathematical features of images for further analysis. In this review, an overview of the applications of AI in PET imaging is provided, focusing on image enhancement, tumor detection, response and prognosis prediction and correlation analyses with pathology or specific gene mutations in several types of tumors. Our aim is to describe recent clinical applications of AI-based PET imaging in malignant diseases and to focus on the description of possible future developments.
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Affiliation(s)
- Jiaona Dai
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hui Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuchao Xu
- School of Nuclear Science and Technology, University of South China, Hengyang City 421001, China
| | - Xiyang Chen
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
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18
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Challenges in the Complex Management of Neglected Cutaneous Melanomas in the Head and Neck Area: A Single Center Experience. J Clin Med 2023; 12:jcm12051910. [PMID: 36902697 PMCID: PMC10004111 DOI: 10.3390/jcm12051910] [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: 12/11/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Familiar controversies in the management of head and neck melanomas are more remarkable in locally advanced cases, and they represent a treatment challenge both surgically and oncologically. In our retrospective study, patients with surgically treated primary malignant melanoma of the head and neck region larger than 3 cm in diameter were included. Five patients met our inclusion criteria. In all cases, wide excision and immediate reconstruction were performed without sentinel lymph node biopsy. The defect on the scalp was covered by a split skin graft, with local flaps chosen for reconstruction on the face on an individual basis. After a 2-6 year follow-up, a good oncological, functional, and esthetic result was achieved. Our results show that in the case of large, locally advanced melanomas, surgical treatment still plays a crucial role that can provide long-term local control and support the effect of systemic treatment.
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Parvez E, Khosrow-Khavar F, Dumitra T, Nessim C, Bernard-Bédard É, Rivard J, Pravong V, Wang S, Gervais MK, Meterissian S, Dumitra S. Multicenter Adoption and Outcomes of Nodal Observation for Patients with Melanoma and Sentinel Lymph Node Metastases. Ann Surg Oncol 2023; 30:1195-1205. [PMID: 36282456 DOI: 10.1245/s10434-022-12695-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Following publication of the MSLT-II trial showing no survival benefit of completion lymphadenectomy (CLND) in patients with melanoma sentinel lymph node (SLN) metastases, it is expected that practice patterns have changed. The purpose of this study is to understand real-world practices and outcomes after publication of this landmark trial. PATIENTS AND METHODS Patients with truncal/extremity melanoma SLN metastases diagnosed between 2013 and 2019 at four academic cancer centers were included in this retrospective cohort study. Descriptive statistics, Cox proportional hazards model, and multivariable regression were used to characterize the cohort and identify predictors of CLND, harboring non-SLN (NSLN) metastases, and survival. RESULTS Results of 1176 patients undergoing SLN biopsy, 183 had SLN metastases. The number of patients who underwent CLND before versus after trial publication was 75.7.% versus 20.5% (HR 0.16, 95% CI 0.09-0.28). Of those undergoing nodal observation (NO), 92% had a first nodal-basin ultrasound, while 63% of patients had a fourth. In exploratory multivariable analyses, age ≥ 50 years was associated with lower rate of CLND (HR 0.58, 95% CI 0.36-0.92) and larger SLN deposit (> 1.0 mm) with increased rate of CLND (HR 1.87, 95% CI 1.17-3.00) in the complete cohort. Extracapsular extension was associated with increased risk of NSLN metastases (HR 12.43, 95% CI 2.48-62.31). Adjusted survival analysis demonstrated no difference in recurrence or mortality between patients treated with CLND versus NO at median 2.2-year follow-up. CONCLUSION Nodal observation was rapidly adopted into practice in patients with melanoma SLN metastases at four centers in Canada. Younger age and higher nodal burden were associated with increased use of CLND after trial publication. Ultrasound (US) surveillance decreased with time from SLNB. In our study, CLND was not associated with a decreased risk of recurrence or mortality.
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Affiliation(s)
- Elena Parvez
- Department of Surgery, Juravinski Hospital and Cancer Center, McMaster University, Hamilton, ON, Canada.
| | | | - Teodora Dumitra
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Carolyn Nessim
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada
| | | | - Justin Rivard
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Vera Pravong
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Sara Wang
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Mai-Kim Gervais
- Department of Surgery, University of Montreal, Montreal, QC, Canada
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Dobre EG, Surcel M, Constantin C, Ilie MA, Caruntu A, Caruntu C, Neagu M. Skin Cancer Pathobiology at a Glance: A Focus on Imaging Techniques and Their Potential for Improved Diagnosis and Surveillance in Clinical Cohorts. Int J Mol Sci 2023; 24:ijms24021079. [PMID: 36674595 PMCID: PMC9866322 DOI: 10.3390/ijms24021079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
Early diagnosis is essential for completely eradicating skin cancer and maximizing patients' clinical benefits. Emerging optical imaging modalities such as reflectance confocal microscopy (RCM), optical coherence tomography (OCT), magnetic resonance imaging (MRI), near-infrared (NIR) bioimaging, positron emission tomography (PET), and their combinations provide non-invasive imaging data that may help in the early detection of cutaneous tumors and surgical planning. Hence, they seem appropriate for observing dynamic processes such as blood flow, immune cell activation, and tumor energy metabolism, which may be relevant for disease evolution. This review discusses the latest technological and methodological advances in imaging techniques that may be applied for skin cancer detection and monitoring. In the first instance, we will describe the principle and prospective clinical applications of the most commonly used imaging techniques, highlighting the challenges and opportunities of their implementation in the clinical setting. We will also highlight how imaging techniques may complement the molecular and histological approaches in sharpening the non-invasive skin characterization, laying the ground for more personalized approaches in skin cancer patients.
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Affiliation(s)
- Elena-Georgiana Dobre
- Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095 Bucharest, Romania
| | - Mihaela Surcel
- Immunology Department, “Victor Babes” National Institute of Pathology, 050096 Bucharest, Romania
| | - Carolina Constantin
- Immunology Department, “Victor Babes” National Institute of Pathology, 050096 Bucharest, Romania
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | | | - Ana Caruntu
- Department of Oral and Maxillofacial Surgery, “Carol Davila” Central Military Emergency Hospital, 010825 Bucharest, Romania
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, “Titu Maiorescu” University, 031593 Bucharest, Romania
| | - Constantin Caruntu
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Dermatology, “Prof. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
- Correspondence:
| | - Monica Neagu
- Faculty of Biology, University of Bucharest, Splaiul Independentei 91-95, 050095 Bucharest, Romania
- Immunology Department, “Victor Babes” National Institute of Pathology, 050096 Bucharest, Romania
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
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21
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Qiu Y, Jiao H, Huang W, Chen Z, Yang Q, Wu S, Sun X, Kang L. 18F-FDG PET/CT imaging of primary malignant melanoma of rectum with liver metastases mimicking rectum cancer: case report and literature review. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2022; 12:188-194. [PMID: 36636232 PMCID: PMC9831859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/13/2022] [Indexed: 01/14/2023]
Abstract
Malignant melanoma (MM) is an aggressive malignant tumor, which mostly occurs on the skin, uvea, etc. The mucosal MM accounts for a small proportion of all MM and can occur in the digestive tract. Primary MM of the digestive tract is rare and can be found in the middle and lower third of the esophagus and the rectum containing melanocytes. Primary rectal MM often occurs in middle-aged and elderly women, with rapid progress and strong invasion. We report a case of a 61-year-old man diagnosed with primary malignant melanoma of the rectum with liver metastases mimicking rectum cancer. 18F-FDG PET/CT showed the rectal wall was markedly thickened with a high metabolic level (SUVmax 10.6) and the boundary between the lesions and the prostate was unclear. In addition, increased FDG uptake were found in multiple lymph nodes, lung, liver, and bones, suggesting metastasis. In this case, 18F-FDG PET/CT shows the advantage of evaluating the whole-body situation and provides valuable information for the diagnosis, tumor stage, evaluation of treatment efficacy, and prognosis of MM.
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22
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Weber P, Arnold A, Hohmann J. Comparison of 18F-FDG PET/CT and ultrasound in staging of patients with malignant melanoma. Medicine (Baltimore) 2022; 101:e31092. [PMID: 36281128 PMCID: PMC9592435 DOI: 10.1097/md.0000000000031092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To evaluate the sensitivity and specificity of 2-18fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and ultrasound (US) for staging patients with malignant melanoma. METHODS In total, 258 patients (112 men and 146 women; mean age, 61 ± 16years) met the primary inclusion criteria for malignant melanoma without further malignancy proven by histopathology. This was a retrospective study of the diagnostic accuracy. All data were obtained from the hospital's patient and radiology information system. Patients formed a consecutive series and were examined by 18F-FDG PET/CT and 176 additionally by US (US as a whole [wUS], peripheral lymph nodes [pUS], abdomen [aUS]), with a total of 584 18F-FDG PET/CT and 697 US. 18F-FDG PET/CT and US revealed 824 and 726 lesions, respectively. Per-patient, per-examination, and per-lesion analyses were also performed. The reference standards used were histopathology or resection of lesions, and follow-up controls using other imaging methods. RESULTS Significant differences (P < .05) were found in the per-examination for the sensitivity of 18F-FDG PET/CT (0.80) compared to wUS (0.63) and pUS (0.61), and the specificity of 18F-FDG PET/CT (0.96) compared to wUS (0.98) and aUS (0.99). In the PLA, there were significant differences in sensitivity and specificity for 18F-FDG PET/CT (0.83, 0.91) compared to wUS (0.61, 0.98), pUS (0.60, 0.98), and aUS (0.61, 0.99). CONCLUSION 18F-FDG PET/CT is preferable to US for detecting both lymph node and abdominal metastases.
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Affiliation(s)
- Philipp Weber
- Department of Radiology and Nuclear Medicine, University Hospital of Basel, Basel, Switzerland
- * Correspondence: Philipp Weber, MD, MSc, Department of Radiology and Nuclear Medicine, University Hospital of Basel, Petersgraben 4, CH-4031 Basel, Switzerland (e-mail: )
| | - Andreas Arnold
- Group Practice “Dermatology on the Rhine”, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Joachim Hohmann
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital of Winterthur, Winterthur, Switzerland
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23
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Lawless AK, Coker DJ, Lo SN, Ahmed T, Scolyer RA, Ch'ng S, Nieweg OE, Shannon K, Spillane A, Stretch JR, Thompson JF, Saw RPM. Clinicopathological Characteristics Predicting Further Recurrence and Survival Following Resection of In-Transit Melanoma Metastases. Ann Surg Oncol 2022; 29:7019-7028. [PMID: 35771368 PMCID: PMC9492704 DOI: 10.1245/s10434-022-11997-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/24/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND In-transit metastases (ITMs) affect approximately 4% of patients with cutaneous melanoma. This study sought to identify clinical and pathological characteristics that predict further recurrence and survival following resection of ITMs. PATIENTS AND METHODS Patients (n = 573) who underwent surgical resection of their first presentation of ITM following previous surgical treatment of an American Joint Committee on Cancer (AJCC) stage I-II melanoma between 1969 and 2017 were identified from an institutional database. Clinicopathological predictors of patterns of recurrence and survival following ITM resection were sought. RESULTS The median time of ITM development was 2.4 years after primary melanoma resection. ITMs were most frequently located on the lower limb (51.0%). The most common melanoma subtype associated with ITM development was nodular melanoma (44.1%). After surgical resection of a first ITM, 65.4% of patients experienced recurrent disease. Most recurrences were locoregional (44.7%), with distant metastasis occurring in 23.9% of patients. Lower limb ITMs were more frequently associated with subsequent ITMs [odds ratio (OR) 2.41, p = 0.0002], and the lowest risk of distant metastasis (p < 0.0001) compared with other primary sites. Primary melanomas and ITM on head and neck, as well as the presence of ulceration, were associated with worse survival. CONCLUSIONS Recurrence after surgical resection of a first ITM was common. Patterns of recurrence differed according to anatomical site; further ITM recurrences were more likely for lower limb ITMs, which were also associated with longer distant recurrence-free survival. Distant metastasis was more common for ITM on the head and neck, with worse survival.
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Affiliation(s)
- Anna K Lawless
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David J Coker
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kerwin Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Breast and Melanoma Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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24
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Montgomery KB, Broman KK. ASO Author Reflections: Challenges to Achieving Consistent Nodal Surveillance with Ultrasound in Melanoma. Ann Surg Oncol 2022; 29:5969-5970. [PMID: 35532829 PMCID: PMC11216219 DOI: 10.1245/s10434-022-11883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Kelsey B Montgomery
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Kristy K Broman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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25
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Montgomery KB, Correya TA, Broman KK. Real-World Adherence to Nodal Surveillance for Sentinel Lymph Node-Positive Melanoma. Ann Surg Oncol 2022; 29:5961-5968. [PMID: 35608800 PMCID: PMC10827327 DOI: 10.1245/s10434-022-11839-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/19/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with sentinel lymph node-positive (SLN+) melanoma are increasingly undergoing active nodal surveillance over completion lymph node dissection (CLND) since the Second Multicenter Selective Lymphadenectomy Trial (MSLT-II). Adherence to nodal surveillance in real-world practice remains unknown. METHODS In a retrospective cohort of SLN+ melanoma patients who underwent nodal surveillance at a single institution from July 2017 through April 2021, this study evaluated adherence to nodal surveillance ultrasound (US). Adherence to nodal US was compared with adherence to other surveillance methods based on receipt of adjuvant therapy. Early recurrence data were reported using descriptive statistics. RESULTS Among 109 SLN+ patients, 37 (34%) received US surveillance at recommended intervals. Of the 72 (66%) non-adherent patients, 16 were lost to follow-up, and 33 had planned follow-up at an outside institution without available records. More patients had a minimum of bi-annual clinic visits (83%) and cross-sectional imaging (53%) compared to those who were adherent with nodal US. The patients who received adjuvant therapy (60%) had fewer ultrasounds (p < 0.01) but more exams (p < 0.01) and a trend toward more cross-sectional imaging (p = 0.06). Of the overall cohort, 26 patients (24%) experienced recurrence at a median follow-up period of 15 months. Of these recurrences, 10 were limited to the SLN basin, and all of these isolated nodal recurrences were resectable. CONCLUSIONS Pragmatic challenges to real-world delivery of nodal surveillance remain after MSLT-II, and adjuvant therapy appears to be associated with a decreased likelihood of US adherence. Understanding US utility alongside cross-sectional imaging will be critical as increasingly more patients undergo nodal surveillance and adjuvant therapy.
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Affiliation(s)
- Kelsey B Montgomery
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Tanya A Correya
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristy K Broman
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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26
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Toia F, Cajozzo M, Rosatti F, Di Lorenzo S, Rinaldi G, Mazzucco W, Cordova A. Effectiveness of clinical and instrumental follow-up for cutaneous melanoma. Surg Oncol 2022; 44:101821. [PMID: 35947885 DOI: 10.1016/j.suronc.2022.101821] [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: 03/24/2022] [Revised: 07/05/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Follow-up guidelines for melanoma greatly differ in the methods of screening for recurrence, and timing and duration of the follow up, with many areas of controversy and a lack of general consensus. The aims of this study are to present our protocol and case series for follow up and to summarize and discuss current literature on melanoma follow-up guidelines/recommendations in different countries. METHODS We retrospectively reviewed 539 patients operated for melanoma between 2004 and 2013 at the same Institution. Data on the diagnostic role of the different clinical and instrumental detection methods were adjusted for sex, age at diagnosis, staging and evaluated by Fisher's exact test and multivariate analysis. Recommendations from the literature were summarized and discussed. RESULTS Local recurrences and second melanoma were always identified through physical examination, irrespectively of melanoma staging. Regional metastases were most often identified through physical examination and ultrasound, being more frequent in stage II and III, while distant metastases were most often identified through CT scans. Surveillance follow-up schedules vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Similarities and controversies in the different follow-up protocols are presented and discussed. CONCLUSION Our clinical series showed that physical examination is very powerful in identifying local recurrences and second melanomas. Physical examination and ultrasound are equally powerful in identifying regional metastases, and alternating them over time could allow to reduce the number of follow-up visits. CT scans, differently from chest x-ray, showed a high power in identifying distant metastases. Surveillance follow-up schedules in the literature vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Standard protocols are desirable for a better evaluation of results.
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Affiliation(s)
- Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Marta Cajozzo
- Plastic and Maxillofacial Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fernando Rosatti
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy.
| | - Sara Di Lorenzo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Gaetana Rinaldi
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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Granata V, Simonetti I, Fusco R, Setola SV, Izzo F, Scarpato L, Vanella V, Festino L, Simeone E, Ascierto PA, Petrillo A. Management of cutaneous melanoma: radiologists challenging and risk assessment. LA RADIOLOGIA MEDICA 2022; 127:899-911. [PMID: 35834109 DOI: 10.1007/s11547-022-01522-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023]
Abstract
Melanoma patient remains a challenging for the radiologist, due to the difficulty related to the management of a patient more often in an advanced stage of the disease. It is necessary to determine a stratification of risk, optimizing the means, with diagnostic tools that should be optimized in relation to the type of patient, and improving knowledge. Staging and risk assessment procedures are determined by disease presentation at diagnosis. Melanoma staging is a critical tool to assist clinical decision-making and prognostic assessment. It is used for clinical trial design, eligibility, stratification, and analysis. The current standard for regional lymph nodes staging is represented by the sentinel lymph node excision biopsy procedure. For staging of distant metastases, PET-CT has the highest sensitivity and diagnostic odds ratio. Similar trend is observed during melanoma surveillance. The advent of immunotherapy, which has improved patient outcome, however, has determined new issues for radiologists, partly due to atypical response patterns, partly due to adverse reactions that must be identified as soon as possible for the correct management of the patient. The main objectives of the new ir-criteria are to standardize the assessment between different trials. However, these ir-criteria do not take into account all cases of atypical response patterns, as hyperprogression or dissociated responses. None of these criteria has actually been uniformly adopted in routine. The immune-related adverse events (irAEs) can involve various organs from head to toe. It is crucial for radiologists to know the imaging appearances of this condition, to exclude recurrent or progressive disease and for pneumonitis, since it could be potentially life-threatening toxicity, resulting in pneumonitis-related deaths in early phase trials, to allow a proper patient management.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy.
| | - Igino Simonetti
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | | | - Sergio Venanzio Setola
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia",, Via Mariano Semmola, Naples, Italy
| | - Luigi Scarpato
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Vito Vanella
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Lucia Festino
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Ester Simeone
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Antonio Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
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Seyed Jafari SM, Mazinani M, Beutler-Minth V, Lamos C, Heverhagen JT, Hunger RE, Daneshvar K. Noncontrast-enhanced 3-Tesla MRI using surface coil as a complementary test for assessment of distribution and depth of locoregional cutaneous metastases of malignant melanoma. Melanoma Res 2022; 32:211-217. [PMID: 35579669 DOI: 10.1097/cmr.0000000000000828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Locoregional and distant metastases account for most cases of morbidity and mortality associated with melanoma. In addition, local recurrences of melanoma might be the onset of disseminated disease. Therefore, precise diagnosis and therapy are warranted to minimize morbidity and increase survival in a subset of patients. However, the correct distribution of the metastatic lesions on the skin is often difficult to estimate. We present the application of noncontrast-enhanced 3-Tesla MRI using surface coil to detect locoregional cutaneous metastases of malignant melanoma on the basis of the topographic assessment of skin lesions. Furthermore, in a systematic review, we summarize the current knowledge about application of MRI in assessment of location, distribution, and depth of cutaneous primary malignant melanoma. MRI might be applied to evaluate the location, distribution, size, and depth of the locoregional cutaneous metastasis of malignant melanoma to identify the optimal cost-effective treatment strategies and monitor their effects.
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Affiliation(s)
| | - Mona Mazinani
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Verena Beutler-Minth
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Keivan Daneshvar
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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29
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Höller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022. Eur J Cancer 2022; 170:236-255. [PMID: 35570085 DOI: 10.1016/j.ejca.2022.03.008] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.
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Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicole Basset-Seguin
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Bohdan Lytvynenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Paul Nathan
- Mount-Vernon Cancer Centre, Northwood United Kingdom
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- 1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alexander C J Van Akkooi
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paul Lorigan
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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Ulrich J, Maschke J, Winkelmann A, Schwürzer-Voit M, Jenderka KV. [Conventional ultrasound diagnostics in dermatology]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:563-574. [PMID: 35925205 DOI: 10.1007/s00105-022-05012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Abstract
The imaging of changes to the skin, the subcutis and especially the regional lymph nodes by high-resolution ultrasound is an integral part of routine dermatological diagnostics. This is mainly done with electronic scanners operating at frequencies between 7.5 and 20 MHz (conventional ultrasound diagnostics). In addition, there are very high-frequency ultrasound systems (frequencies up to 100 MHz) that are used for special scientific questions. Ultrasound diagnostics has a number of advantages over other cross-sectional imaging techniques but is more dependent than these on the individual experience of the examiner. Structured training and continuing education are therefore essential for ultrasound diagnostics, also in dermatology. The following overview describes the most important indications for conventional sonography in dermatology in addition to the physical, technical and administrative principles.
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Affiliation(s)
- Jens Ulrich
- Klinik für Dermatologie und Allergologie, Hautkrebszentrum Harz, Harzklinikum Dorothea Christiane Erxleben, Ditfurter Weg 24, 06484, Quedlinburg, Deutschland.
| | | | | | | | - Klaus-Vitold Jenderka
- Fachbereich Ingenieur- und Naturwissenschaften, Hochschule Merseburg, Merseburg, Deutschland
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18FDG PET Assessment of Therapeutic Response in Patients with Advanced or Metastatic Melanoma Treated with First-Line Immune Checkpoint Inhibitors. Cancers (Basel) 2022; 14:cancers14133190. [PMID: 35804963 PMCID: PMC9264956 DOI: 10.3390/cancers14133190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/21/2022] Open
Abstract
Simple Summary In a retrospective study of patients with advanced or metastatic melanoma treated with first-line immune checkpoint inhibitors, we investigated the value of metabolic criteria, PERCIST 5 (criteria used for conventional chemotherapy), and imPERCIST5 (criteria adapted for immunotherapy therapeutic evaluation). Responding patients according to both criteria had better overall survival than that of not-responding patients, with a 2 years OS of 91% versus 39%, respectively. Combining different approaches to assess response could help improve the confidence in the test aiming at evaluating the response to immunotherapy. Abstract Background: Immune checkpoint inhibitors (ICI) are currently the first-line treatment for patients with metastatic melanoma. We investigated the value of positron emission tomography (PET) response criteria to assess the therapeutic response to first-line ICI in this clinical context and explore the potential contribution of total tumor metabolic volume (TMTV) analysis. Methods: We conducted a retrospective study in patients treated with first-line ICI for advanced or metastatic melanoma, with 18F-FDG PET/CT performed at baseline and 3 months after starting treatment. Patients’ metabolic response was classified according to PERCIST5 and imPERCIST 5 criteria. TMTV was recorded for each examination. Results: Twenty-nine patients were included. The median overall survival (OS) was 51.2 months (IQR 13.6—not reached), and the OS rate at 2 years was 58.6%. Patients classified as responders (complete and partial response) had a 90.9% 2-year OS rate versus 38.9% for non-responders (stable disease and progressive disease) (p = 0.03), for PERCIST5 and imPERCIST 5 criteria. The median change in metabolic volume was 9.8% (IQR −59–+140%). No significant correlation between OS and changes in TMTV was found. Conclusion: The evaluation of response to immunotherapy using metabolic imaging with PERCIST5 and imPERCIST5 was significantly associated with OS in patients with advanced or metastatic melanoma.
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Simonetti I, Trovato P, Granata V, Picone C, Fusco R, Setola SV, Mattace Raso M, Caracò C, Ascierto PA, Sandomenico F, Petrillo A. Imaging Assessment of Interval Metastasis from Melanoma. J Pers Med 2022; 12:jpm12071033. [PMID: 35887530 PMCID: PMC9315548 DOI: 10.3390/jpm12071033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
Interval metastasis is a particular metastatic category of metastatic localizations in the lymph nodes in patients with melanoma. Interval nodes are generally located at nonregional lymphatic stations placed along the pathway of the spread of melanoma, such as the epitrochlear lymph node station, the popliteal fossa, and the retroareolar station. Imaging techniques for evaluation of patients with interval metastasis from melanoma diseases include ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), lymphoscintigraphy (LS), and positron emission tomography (PET). A literature review was conducted through a methodical search on the Pubmed and Embase databases. The evaluation of lymph node metastases represents a critical phase in the staging and follow-up of melanoma patients. Therefore, a thorough knowledge of the imaging methods available and the interactions between the clinician and the radiologist are essential for making the correct choice for individual patients, for a better management, and to improve treatment and survival.
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Affiliation(s)
- Igino Simonetti
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (I.S.); (C.P.); (S.V.S.); (M.M.R.); (A.P.)
| | - Piero Trovato
- Radiology Division, “ASL Napoli II Nord”, 33939 Naples, Italy;
| | - Vincenza Granata
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (I.S.); (C.P.); (S.V.S.); (M.M.R.); (A.P.)
- Correspondence:
| | - Carmine Picone
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (I.S.); (C.P.); (S.V.S.); (M.M.R.); (A.P.)
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Napoli, Italy;
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Sergio Venanzio Setola
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (I.S.); (C.P.); (S.V.S.); (M.M.R.); (A.P.)
| | - Mauro Mattace Raso
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (I.S.); (C.P.); (S.V.S.); (M.M.R.); (A.P.)
| | - Corrado Caracò
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (C.C.); (P.A.A.)
| | - Paolo A. Ascierto
- Melanoma, Cancer Immunotherapy and Development Therapeutics Unit, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy; (C.C.); (P.A.A.)
| | | | - Antonella Petrillo
- Radiology Division, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (I.S.); (C.P.); (S.V.S.); (M.M.R.); (A.P.)
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Andersen JAS, Spatzek AD, Vilstrup MH, Grupe P, Hess S, Holdgaard PC, Bastholt L, Gerke O, Hildebrandt MG. The diagnostic accuracy and clinical impact of FDG-PET/CT follow-up for patients on adjuvant immunotherapy for high-risk malignant melanoma. Eur J Nucl Med Mol Imaging 2022; 49:2342-2351. [PMID: 35129651 DOI: 10.1007/s00259-022-05704-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/23/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The benefit of FDG-PET/CT in follow-up of patients treated with adjuvant immunotherapy after resection of high-risk malignant melanoma (MM) is debated. This study evaluated the diagnostic accuracy and clinical impact of FDG-PET/CT for diagnosing MM recurrence during the first year after surgery. METHODS We retrospectively included 124 patients with resected high-risk MM, who received adjuvant immunotherapy and follow-up FDG-PET/CT. Clinical information and AJCC-8 stage was obtained from patients' medical records. Recurrence was verified by biopsy/progression on a subsequent scan leading to change of treatment. Non-recurrence was assumed when no metastases were observed until the subsequent follow-up scan. Incidence of recurrence, sensitivity, specificity, positive and negative predictive values (PPV and NPV) were outcome measures. RESULTS Incidence rate of MM recurrence was 0.27 [95% CI 0.17-0.37] per person-year during the first-year. Recurrence was detected in 13 patients (10%) at 3-month FDG-PET/CT, in 10 patients (8.1%) at 6 months, 1 patient (0.8%) at 9 months, 3 patients (2.4%) at 12 months. The overall sensitivity, specificity, PPV, and NPV were 97% [86-99], 82% [78-86], 39% [29-50], and 99% [98-99], respectively. The PPV trended towards higher values as disease stage increased. At the 3-month scan, the majority of actions derived from positive findings were surgery or earlier expedition of the subsequent follow-up scan. CONCLUSION The high rate of recurrence in patients with high-risk MM treated with adjuvant immunotherapy emphasizes the need for follow-up. The potential harm by a moderately low specificity reflecting a high number of false-positive results must be weighed against the benefit of early detection of recurrence.
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Affiliation(s)
- Jesper A S Andersen
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
| | - Anders D Spatzek
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Open Patient Data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark
| | - Mie H Vilstrup
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
| | - Peter Grupe
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Research Unit of Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Paw C Holdgaard
- Department of Nuclear Medicine, University Hospital Lillebaelt, Vejle, Denmark
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Research Unit of Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Malene G Hildebrandt
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark.
- Open Patient Data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, Research Unit of Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark.
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Dieng M, Lord SJ, Turner RM, Nieweg OE, Menzies AM, Saw RPM, Einstein AJ, Emmett L, Thompson JF, Lo SN, Morton RL. The Impact of Surveillance Imaging Frequency on the Detection of Distant Disease for Patients with Resected Stage III Melanoma. Ann Surg Oncol 2022; 29:2871-2881. [PMID: 35142966 PMCID: PMC8990943 DOI: 10.1245/s10434-021-11231-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 11/02/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND It is not known whether there is a survival benefit associated with more frequent surveillance imaging in patients with resected American Joint Committee on Cancer stage III melanoma. OBJECTIVE The aim of this study was to investigate distant disease-free survival (DDFS), melanoma-specific survival (MSS), post distant recurrence MSS (dMSS), and overall survival for patients with resected stage III melanoma undergoing regular computed tomography (CT) or positron emission tomography (PET)/CT surveillance imaging at different intervals. PATIENTS AND METHODS A closely followed longitudinal cohort of patients with resected stage IIIA-D disease treated at a tertiary referral center underwent 3- to 4-monthly, 6-monthly, or 12-monthly surveillance imaging between 2000 and 2017. Survival outcomes were estimated using the Kaplan-Meier method, and log-rank tests assessed the significance of survival differences between imaging frequency groups. RESULTS Of 473 patients (IIIA, 19%; IIIB, 31%; IIIC, 49%; IIID, 1%) 30% underwent 3- to 4-monthly imaging, 10% underwent 6-monthly imaging, and 60% underwent 12-monthly imaging. After a median follow-up of 6.2 years, distant recurrence was recorded in 252 patients (53%), with 40% detected by surveillance CT or PET/CT, 43% detected clinically, and 17% with another imaging modality. Median DDFS was 5.1 years (95% confidence interval 3.9-6.6). Among 139 IIIC patients who developed distant disease, the median dMSS was 4.4 months shorter in those who underwent 3- to 4-monthly imaging than those who underwent 12-monthly imaging. CONCLUSION Selecting patients at higher risk of distant recurrence for more frequent surveillance imaging yields a higher proportion of imaging-detected distant recurrences but is not associated with improved survival. A randomized comparison of low versus high frequency imaging is needed.
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Affiliation(s)
- Mbathio Dieng
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Robin M Turner
- Centre for Biostatistics, University of Otago, Dunedin, New Zealand
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital and Mater Hospitals, Sydney, NSW, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore and Mater Hospitals, Sydney, NSW, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital and Mater Hospitals, Sydney, NSW, Australia
| | - Andrew J Einstein
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY, USA
| | - Louise Emmett
- Department of Theranostics and Nuclear Medicine, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital and Mater Hospitals, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
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Filippi L, Bianconi F, Schillaci O, Spanu A, Palumbo B. The Role and Potential of 18F-FDG PET/CT in Malignant Melanoma: Prognostication, Monitoring Response to Targeted and Immunotherapy, and Radiomics. Diagnostics (Basel) 2022; 12:929. [PMID: 35453977 PMCID: PMC9028862 DOI: 10.3390/diagnostics12040929] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022] Open
Abstract
Novel therapeutic approaches, consisting of immune check-point inhibitors (ICIs) and molecularly targeted therapy, have thoroughly changed the clinical management of malignant melanoma (MM), the most frequent and deadly skin cancer. Since only 30-40% of MM patients respond to ICIs, imaging biomarkers suitable for the pre-therapeutic stratification and response assessment are warmly welcome. In this scenario, positron emission computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has been successfully utilized for advanced MM staging and therapy response evaluation. Furthermore, several PET-derived parameters (SUVmax, MTV, TLG) were particularly impactful for the prognostic evaluation of patients submitted to targeted and immunotherapy. In this review, we performed a web-based and desktop research on the clinical applications of 18F-FDG PET/CT in MM, with a particular emphasis on the various metabolic criteria developed for interpreting PET/CT scan in patients undergoing immunotherapy or targeted therapy or a combination of both. Furthermore, the emerging role of radiomics, a quantitative approach to medical imaging applying analysis methodology derived by the field of artificial intelligence, was examined in the peculiar context, putting a particular emphasis on the potential of this discipline to support clinicians in the delicate process of building patient-tailored pathways of care.
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Affiliation(s)
- Luca Filippi
- Nuclear Medicine Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
| | - Francesco Bianconi
- Department of Engineering, Università Degli Studi di Perugia, Via Goffredo Duranti 93, 06135 Perugia, Italy;
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Viale Oxford 81, 00133 Rome, Italy;
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy;
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery, Università Degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy;
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Yan MK, Adler NR, Pan Y, Chamberlain A, Kelly J, Yap K, Voskoboynik M, Haydon A, Shackleton M, Mar VJ. Yield of baseline imaging for distant metastases in high-risk primary melanoma. J Surg Oncol 2022; 125:1312-1317. [PMID: 35262187 DOI: 10.1002/jso.26846] [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: 12/18/2021] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The yield of baseline imaging in patients presenting with higher risk primary tumours, at least American Joint Committee on Cancer 8th edition stage IIC or III melanoma, is unclear. METHODS This retrospective study included patients referred to the Victorian Melanoma Service from January 2017 to April 2020, diagnosed with at least stage IIC or stage III melanoma. Patients with a T4b tumour and no sentinel lymph node biopsy were included as 'T4bNX'. RESULTS One hundred and sixty-four patients (median age 65 years) with baseline imaging (T4bNX: 19, IIC: 30, IIIA: 21, IIIB: 43, IIIC: 50, IIID: 1) were included. The majority were male (73%), and those with T4bNX melanoma tended to be older (median age 79 years). Distant metastases were detected in 21% (4/19) of T4bNX, 3% (1/30) of stage IIC, 0% (0/21) of stage IIIA, and 6% (6/94) of stages IIIB-D melanoma patients. All stage III patients with distant metastases had palpable lymphadenopathy a presentation. Two patients had brain metastases, both of whom had T4bNX melanoma and synchronous extra-cranial metastases. CONCLUSIONS Compared to stage IIC, baseline imaging detects higher rates of extra-cranial distant disease in stages IIIB-D and T4bNX melanoma. Intracranial imaging has greater yield in patients with distant extra-cranial disease.
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Affiliation(s)
- Mabel K Yan
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nikki R Adler
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yan Pan
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Alexander Chamberlain
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - John Kelly
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia
| | - Kenneth Yap
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Nuclear Medicine and PET, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Voskoboynik
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Andrew Haydon
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Mark Shackleton
- Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ferdinandus J, Zaremba A, Zimmer L, Umutlu L, Seifert R, Barbato F, Ugurel S, Chorti E, Grünwald V, Herrmann K, Schadendorf D, Fendler WP, Livingstone E. Metabolic imaging with FDG-PET and time to progression in patients discontinuing immune-checkpoint inhibition for metastatic melanoma. Cancer Imaging 2022; 22:11. [PMID: 35123578 PMCID: PMC8817553 DOI: 10.1186/s40644-022-00449-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/18/2022] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background
The optimal duration of immune checkpoint blockade (ICB) therapy is not well established. Active residual disease is considered prohibitive for treatment discontinuation and its detection by diagnostic CT imaging is limited. Here, we set out to determine the potential added value of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) to identify patients at higher risk of relapse following discontinuation of ICB in advanced melanoma.
Methods
Metastatic melanoma patients who discontinued ICB were identified retrospectively. Eligible patients received FDG-PET and diagnostic CT within four months of ICB discontinuation. We defined morphologic response using RECIST v1.1. Complete metabolic response (CMR) was defined as uptake in tumor lesions below background, whereas any site of residual, FDG-avid disease was rated as non-CMR. The primary endpoint was time to progression (TTP) after therapy discontinuation stratified by morphologic and metabolic imaging response using Kaplan–Meier estimates and log-rank test.
Results
Thiry-eight patients were eligible for this analysis. Median follow-up was 37.3 months since ICB discontinuation. Median TTP in the overall cohort was not reached. A greater proportion of patients were rated as CMR in PET (n = 34, 89.5%) as compared to complete response (CR) in CT (n = 13, 34.2%). Median TTP was reached in patients with non-CMR (12.7 months, 95%CI 4.4-not reached) but not for patients with CMR (log-rank: p < 0.001). All patients with complete response by CT had CMR by PET. In a subset of patients excluding those with complete response by CT, TTP remained significantly different between CMR and non-CMR (log-rank: p < 0.001).
Conclusion
Additional FDG-PET at time of discontinuation of ICB therapy helps identify melanoma patients with a low risk of recurrence and favourable prognosis compared to CT imaging alone. Results may have clinical relevance especially for patients with residual tumor burden.
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Marsavela G, McEvoy AC, Pereira MR, Reid AL, Al-Ogaili Z, Warburton L, Khattak MA, Abed A, Meniawy TM, Millward M, Ziman MR, Calapre L, Gray ES. Detection of clinical progression through plasma ctDNA in metastatic melanoma patients: a comparison to radiological progression. Br J Cancer 2022; 126:401-408. [PMID: 34373567 PMCID: PMC8810871 DOI: 10.1038/s41416-021-01507-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/28/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The validity of circulating tumour DNA (ctDNA) as an indicator of disease progression compared to medical imaging in patients with metastatic melanoma requires detailed evaluation. METHODS Here, we carried out a retrospective ctDNA analysis of 108 plasma samples collected at the time of disease progression. We also analysed a validation cohort of 66 metastatic melanoma patients monitored prospectively after response to systemic therapy. RESULTS ctDNA was detected in 62% of patients at the time of disease progression. For 67 patients that responded to treatment, the mean ctDNA level at progressive disease was significantly higher than at the time of response (P < 0.0001). However, only 30 of these 67 (45%) patients had a statistically significant increase in ctDNA by Poisson test. A validation cohort of 66 metastatic melanoma patients monitored prospectively indicated a 56% detection rate of ctDNA at progression, with only two cases showing increased ctDNA prior to radiological progression. Finally, a correlation between ctDNA levels and metabolic tumour burden was only observed in treatment naïve patients but not at the time of progression in a subgroup of patients failing BRAF inhibition (N = 15). CONCLUSIONS These results highlight the low efficacy of ctDNA to detect disease progression in melanoma when compared mainly to standard positron emission tomography imaging.
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Affiliation(s)
- Gabriela Marsavela
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Ashleigh C McEvoy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Michelle R Pereira
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Anna L Reid
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Zeyad Al-Ogaili
- Department of Molecular Imaging and Therapy Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Lydia Warburton
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Muhammad A Khattak
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Afaf Abed
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
| | - Tarek M Meniawy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Michael Millward
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Crawley, WA, Australia
| | - Melanie R Ziman
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Biomedical Science, University of Western Australia, Crawley, WA, Australia
| | - Leslie Calapre
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Elin S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia.
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Monowar Anjum M, Mohammed N, Li W, Jiang X. Privacy Preserving Collaborative Learning of Generalized Linear Mixed Model. J Biomed Inform 2022; 127:104008. [DOI: 10.1016/j.jbi.2022.104008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/08/2021] [Accepted: 01/30/2022] [Indexed: 12/01/2022]
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40
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Kontogiannis V, Coughlan D, Javanbakht M, Kunonga P, Beyer F, Richmond C, Bryant A, Bajwa D, Ellis RA, Vale L. Optimal Surveillance Strategies for Early-Stage Cutaneous Melanoma Post Primary Tumor Excision: An Economic Evaluation. MDM Policy Pract 2022; 7:23814683211069988. [PMID: 35024448 PMCID: PMC8743969 DOI: 10.1177/23814683211069988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background. Consensus on standardized active surveillance or follow-up care by clinicians is lacking leading to considerable variation in practice across countries. An important structural modelling consideration is that self-examination by patients and their partners can detect melanoma recurrence outside of active surveillance regimes. Objectives. To identify candidate melanoma surveillance strategies for American Joint Committee on Cancer (AJCC) stage I disease and compare them with the current recommended practice in a cost-utility analysis framework. Methods. In consultation with UK clinical experts, a microsimulation model was built in TreeAge Pro 2019 R1.0 (Williamstown, MA, USA) to evaluate surveillance strategies for AJCC stage IA and IB melanoma patients separately. The model incorporated patient behaviors such as self-detection and emergency visits to examine suspicious lesions. A National Health Service (NHS) perspective was taken. Model input parameters were taken from the literature and where data were not available, local expert opinion was sought. Probabilistic sensitivity analysis, one-way sensitivity analysis on pertinent parameters and value of information was performed. Results. In the base-case probabilistic sensitivity analysis, less intensive surveillance strategies for AJCC stage IA and IB had lower total lifetime costs than the current National Institute for Health and Care Excellence (NICE) recommended strategy with similar effectiveness in terms of quality-adjusted life years and thereby likely to be cost-effective. Many strategies had similar effectiveness due to the relatively low chance of recurrence and the high rate of self-detection. Sensitivity and scenario analyses did not change these findings. Conclusions. Our model findings suggest that less resource intensive surveillance may be cost-effective compared with the current NICE surveillance guidelines. However, to advocate convincingly for changes, better evidence is required.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luke Vale
- Population Health Sciences Institute
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41
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Baragilly M, Willis BH. On estimating a constrained bivariate random effects model for meta-analysis of test accuracy studies. Stat Methods Med Res 2022; 31:287-299. [PMID: 34994667 PMCID: PMC8829734 DOI: 10.1177/09622802211065157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tailored meta-analysis uses setting-specific knowledge for the test positive rate and disease prevalence to constrain the possible values for a test's sensitivity and specificity. The constrained region is used to select those studies relevant to the setting for meta-analysis using an unconstrained bivariate random effects model (BRM). However, sometimes there may be no studies to aggregate, or the summary estimate may lie outside the plausible or “applicable” region. Potentially these shortcomings may be overcome by incorporating the constraints in the BRM to produce a constrained model. Using a penalised likelihood approach we developed an optimisation algorithm based on co-ordinate ascent and Newton-Raphson iteration to fit a constrained bivariate random effects model (CBRM) for meta-analysis. Using numerical examples based on simulation studies and real datasets we compared its performance with the BRM in terms of bias, mean squared error and coverage probability. We also determined the ‘closeness’ of the estimates to their true values using the Euclidian and Mahalanobis distances. The CBRM produced estimates which in the majority of cases had lower absolute mean bias and greater coverage probability than the BRM. The estimated sensitivities and specificity for the CBRM were, in general, closer to the true values than the BRM. For the two real datasets, the CBRM produced estimates which were in the applicable region in contrast to the BRM. When combining setting-specific data with test accuracy meta-analysis, a constrained model is more likely to yield a plausible estimate for the sensitivity and specificity in the practice setting than an unconstrained model.
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Affiliation(s)
- Mohammed Baragilly
- Department of Mathematics, Insurance and Applied Statistics, 120637Helwan University, Egypt.,Institute of Applied Health Research, 1724University of Birmingham, UK
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42
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Alipour R, Iravani A, Hicks RJ. PET Imaging of Melanoma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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43
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Ruiz ES. Radiologic Imaging for High-Stage Cutaneous Squamous Cell Carcinomas. JAMA Dermatol 2021; 158:125-126. [PMID: 34964808 DOI: 10.1001/jamadermatol.2021.4989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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44
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Vale L, Kunonga P, Coughlan D, Kontogiannis V, Astin M, Beyer F, Richmond C, Wilson D, Bajwa D, Javanbakht M, Bryant A, Akor W, Craig D, Lovat P, Labus M, Nasr B, Cunliffe T, Hinde H, Shawgi M, Saleh D, Royle P, Steward P, Lucas R, Ellis R. Optimal surveillance strategies for patients with stage 1 cutaneous melanoma post primary tumour excision: three systematic reviews and an economic model. Health Technol Assess 2021; 25:1-178. [PMID: 34792018 DOI: 10.3310/hta25640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Malignant melanoma is the fifth most common cancer in the UK, with rates continuing to rise, resulting in considerable burden to patients and the NHS. OBJECTIVES The objectives were to evaluate the effectiveness and cost-effectiveness of current and alternative follow-up strategies for stage IA and IB melanoma. REVIEW METHODS Three systematic reviews were conducted. (1) The effectiveness of surveillance strategies. Outcomes were detection of new primaries, recurrences, metastases and survival. Risk of bias was assessed using the Cochrane Collaboration's Risk-of-Bias 2.0 tool. (2) Prediction models to stratify by risk of recurrence, metastases and survival. Model performance was assessed by study-reported measures of discrimination (e.g. D-statistic, Harrel's c-statistic), calibration (e.g. the Hosmer-Lemeshow 'goodness-of-fit' test) or overall performance (e.g. Brier score, R 2). Risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). (3) Diagnostic test accuracy of fine-needle biopsy and ultrasonography. Outcomes were detection of new primaries, recurrences, metastases and overall survival. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Review data and data from elsewhere were used to model the cost-effectiveness of alternative surveillance strategies and the value of further research. RESULTS (1) The surveillance review included one randomised controlled trial. There was no evidence of a difference in new primary or recurrence detected (risk ratio 0.75, 95% confidence interval 0.43 to 1.31). Risk of bias was considered to be of some concern. Certainty of the evidence was low. (2) Eleven risk prediction models were identified. Discrimination measures were reported for six models, with the area under the operating curve ranging from 0.59 to 0.88. Three models reported calibration measures, with coefficients of ≥ 0.88. Overall performance was reported by two models. In one, the Brier score was slightly better than the American Joint Committee on Cancer scheme score. The other reported an R 2 of 0.47 (95% confidence interval 0.45 to 0.49). All studies were judged to have a high risk of bias. (3) The diagnostic test accuracy review identified two studies. One study considered fine-needle biopsy and the other considered ultrasonography. The sensitivity and specificity for fine-needle biopsy were 0.94 (95% confidence interval 0.90 to 0.97) and 0.95 (95% confidence interval 0.90 to 0.97), respectively. For ultrasonography, sensitivity and specificity were 1.00 (95% confidence interval 0.03 to 1.00) and 0.99 (95% confidence interval 0.96 to 0.99), respectively. For the reference standards and flow and timing domains, the risk of bias was rated as being high for both studies. The cost-effectiveness results suggest that, over a lifetime, less intensive surveillance than recommended by the National Institute for Health and Care Excellence might be worthwhile. There was considerable uncertainty. Improving the diagnostic performance of cancer nurse specialists and introducing a risk prediction tool could be promising. Further research on transition probabilities between different stages of melanoma and on improving diagnostic accuracy would be of most value. LIMITATIONS Overall, few data of limited quality were available, and these related to earlier versions of the American Joint Committee on Cancer staging. Consequently, there was considerable uncertainty in the economic evaluation. CONCLUSIONS Despite adoption of rigorous methods, too few data are available to justify changes to the National Institute for Health and Care Excellence recommendations on surveillance. However, alternative strategies warrant further research, specifically on improving estimates of incidence, progression of recurrent disease; diagnostic accuracy and health-related quality of life; developing and evaluating risk stratification tools; and understanding patient preferences. STUDY REGISTRATION This study is registered as PROSPERO CRD42018086784. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol 25, No. 64. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Luke Vale
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Patience Kunonga
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Diarmuid Coughlan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Margaret Astin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dor Wilson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dalvir Bajwa
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mehdi Javanbakht
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Wanwuri Akor
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Dawn Craig
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Penny Lovat
- Institute of Translation and Clinical Studies, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Labus
- Business Development and Enterprise, Newcastle University, Newcastle upon Tyne, UK
| | - Batoul Nasr
- Dermatological Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Timothy Cunliffe
- Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Helena Hinde
- Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Mohamed Shawgi
- Radiology Department, James Cook University Hospital, Middlesbrough, UK
| | - Daniel Saleh
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pam Royle
- Patient representative, ITV Tyne Tees, Gateshead, UK
| | - Paul Steward
- Patient representative, Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Rachel Lucas
- Patient representative, Dermatology Department, James Cook University Hospital, Middlesbrough, UK
| | - Robert Ellis
- Institute of Translation and Clinical Studies, Newcastle University, Newcastle upon Tyne, UK.,South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Saleh M, Javadi S, Elsherif S, Patnana M, Sagebiel TL, Torres-Cabala C, Matei J, Bhosale P, Faria SC. Multimodality Imaging and Genetics of Primary Mucosal Melanomas and Response to Treatment. Radiographics 2021; 41:1954-1972. [PMID: 34678102 DOI: 10.1148/rg.2021210063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mucosal melanomas (MMs) are rare and aggressive tumors that arise from melanocytes in the mucosal tissues that line the respiratory, gastrointestinal, and urogenital tracts. Most MMs occur during the 6th and 7th decades of life. MMs may be asymptomatic but may also cause bleeding, pain, and itching, depending on the site of origin. Because of their asymptomatic or oligosymptomatic nature and the difficulty of visualizing them in some cases, they are often advanced tumors at patient presentation. MM staging varies depending on the site of the primary tumor. A simplified staging system allows classification of clinically localized disease as stage I, regional nodal involvement as stage II, and distant metastasis as stage III. MM differs genetically from its cutaneous counterparts. Common drivers in cutaneous melanoma such as B-raf proto-oncogene serine/threonine kinase (BRAF) have a lower mutation rate in MM, whereas mutations of other genes including the KIT proto-oncogene, receptor tyrosine kinase (KIT) and splicing factor 3b subunit 1 gene (SF3B1) are more common in MM. Complete resection is the best curative option. However, surgical intervention with wide local excision and negative margins may be difficult to attain because of the local anatomy and the extent of disease. In addition, despite aggressive surgical resection, most patients develop local recurrence and metastatic disease. Recent advances in the treatment of melanoma include immunotherapy and targeted therapy. Unfortunately, MMs have a relatively poor prognosis, with an overall 5-year survival rate of 25%. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mohammed Saleh
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sanaz Javadi
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Sherif Elsherif
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Madhavi Patnana
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Tara L Sagebiel
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Carlos Torres-Cabala
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Jane Matei
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Priya Bhosale
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
| | - Silvana C Faria
- From the Departments of Abdominal Imaging (M.S., S.J., M.P., T.L.S., P.B., S.C.F.), Pathology (C.T.C.), Dermatology (C.T.C.), and Melanoma Oncology (J.M.), The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030-4008; and Department of Radiology, The University of Florida College of Medicine, Jacksonville, Fla (S.E.)
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Iacullo J, Barriera-Silvestrini P, Knackstedt TJ. Dermatologic Follow-up and Assessment of Suspicious Lesions. Clin Plast Surg 2021; 48:617-629. [PMID: 34503722 DOI: 10.1016/j.cps.2021.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
As our knowledge and understanding of melanoma evolve, melanoma surveillance guidelines will reflect these findings. Currently, there is no consensus across international guidelines for melanoma follow-up. However, it is accepted that more aggressive surveillance is recommended for more advanced disease. When examining high-risk individuals, a systematic approach should be followed. Future considerations include the use of noninvasive imaging techniques, 'liquid biopsies,' and artificial intelligence to enhance detection of melanomas.
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Affiliation(s)
- Julie Iacullo
- Department of Dermatology, MetroHealth System, 2500 Metrohealth Drive, Cleveland, OH 44109, USA
| | | | - Thomas J Knackstedt
- Department of Dermatology, MetroHealth System, 2500 Metrohealth Drive, Cleveland, OH 44109, USA; Case Western Reserve University, School of Medicine, 2500 Metrohealth Drive, Cleveland, OH 44109, USA.
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47
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Papageorgiou C, Apalla Z, Manoli SM, Lallas K, Vakirlis E, Lallas A. Melanoma: Staging and Follow-Up. Dermatol Pract Concept 2021; 11:e2021162S. [PMID: 34447611 DOI: 10.5826/dpc.11s1a162s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Cancer staging is the process determining to which extent a cancer has spread and where it is located in the body. A thorough staging is of utmost importance, not only because it provides the most accurate prognostic estimation, but also because several crucial decisions, such as the treatment choice and the follow-up strategy, vary according to the tumor's stage. The current staging system for melanoma is based on the 8th edition of TNM classification issued by the American Joint Committee on Cancer (AJCC) in 2017. It includes a clinical and a pathological staging, both consisting of 5 stages (0-IV). The stage of a melanoma is determined by several factors, among which the Breslow thickness, the pathological presence or absence of ulceration in the primary tumor, the presence and the number of tumor-involved regional lymph nodes, the presence or absence of in-transit, satellite and/or microsatellite metastases, and the presence of distant metastases. Following melanoma diagnosis, an accurate medical workup, in line with the stage and the physical examination, should be performed. A continuous patient monitoring is fundamental to detect a potential relapse or a second primary melanoma and should be lifelong. However, there is still no universally adopted follow-up strategy program and different follow-up schemes have been suggested. Future prospective studies are needed to evaluate different follow-up protocols according to the adopted therapy, as novel recent therapies (targeted and immunotherapies) are being increasingly used. Key MessagesProper staging is of utmost importance because it provides accurate prognostic estimation. Several crucial decisions, such as the treatment choice and the follow up strategy, are based on the tumor stage.Physical examination during staging procedure and follow-up visits are important to avoid unnecessary imaging and laboratory tests that could increase the patients' anxiety. A personalized approach taking into consideration the patient's risk factors, is strongly recommended.Melanoma patients should be kept under surveillance lifelong due to an increased risk of developing a second primary melanoma and the risk of recurrence. Higher intensity follow-up strategies during the first 5 years are recommended due to higher rates of regional or distant relapse.
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Affiliation(s)
- Chryssoula Papageorgiou
- Second Dermatology Department, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Zoe Apalla
- Second Dermatology Department, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Sofia-Magdalini Manoli
- First Dermatology Department, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Konstantinos Lallas
- First Dermatology Department, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Efstratios Vakirlis
- First Dermatology Department, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Aimilios Lallas
- First Dermatology Department, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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48
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Wright CL, Miller ED, Contreras C, Knopp MV. Precision Nuclear Medicine: The Evolving Role of PET in Melanoma. Radiol Clin North Am 2021; 59:755-772. [PMID: 34392917 DOI: 10.1016/j.rcl.2021.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The clinical management of melanoma patients has been rapidly evolving with the introduction of new targeted immuno-oncology (IO) therapeutics. The current diagnostic paradigms for melanoma patients begins with the histopathologic confirmation of melanoma, initial staging of disease burden with imaging and surgical approaches, treatment monitoring during systemic cytotoxic chemotherapy or IO therapeutics, restaging after completion of adjuvant systemic, surgical, and/or external radiation therapy, and the detection of recurrent malignancy/metastatic disease following therapy. New and evolving imaging approaches with positron-emission tomography (PET) imaging technologies, imaging methodologies, image reconstruction, and image analytics will likely continue to improve tumor detection, tumor characterization, and diagnostic confidence, enabling novel precision nuclear medicine practices for managing melanoma patients. This review will examine current concepts and challenges with existing PET imaging diagnostics for melanoma patients and introduce exciting new opportunities for PET in the current era of IO therapeutics.
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Affiliation(s)
- Chadwick L Wright
- Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 460, Columbus, OH 43210, USA.
| | - Eric D Miller
- Department of Radiation Oncology, James Cancer Center, The Ohio State University Wexner Medical Center, 460 W. 10th Avenue, 2nd Floor, Columbus, OH 43210, USA
| | - Carlo Contreras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, 2050 Kenny Road, Tower 4th Floor, Columbus, OH 43221, USA
| | - Michael V Knopp
- Department of Radiology, Wright Center of Innovation in Biomedical Imaging, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 460, Columbus, OH 43210, USA
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49
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Broman KK, Bettampadi D, Pérez-Morales J, Sun J, Kirichenko D, Carr MJ, Eroglu Z, Tarhini AA, Khushalani N, Schabath MB, Sarnaik A, Sondak VK, Zager JS. Surveillance of Sentinel Node-Positive Melanoma Patients Who Receive Adjuvant Therapy Without Undergoing Completion Lymph Node Dissection. Ann Surg Oncol 2021; 28:6978-6985. [PMID: 34363118 DOI: 10.1245/s10434-021-10570-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Adjuvant therapy trials required completion lymph node dissection (CLND) for sentinel lymph node (SLN)-positive melanoma prior to systemic treatment, but nodal surveillance without CLND is now common. For patients receiving adjuvant therapy without CLND, patterns of recurrence are unknown and the value of regional nodal ultrasound alongside cross-sectional imaging is not well-defined. METHODS In a retrospective cohort of SLN-positive melanoma patients managed with nodal surveillance from June 2014 to June 2019, we evaluated the association between adjuvant treatment and location of first recurrence (locoregional, nodal, distant, or multisite) using Chi-square tests. We compared methods of recurrence detection and cost by surveillance intensity using Chi-square and Dunn's tests. RESULTS Among 177 nodal surveillance patients, 66 (37%) received adjuvant therapy. Median follow-up was 24 months, during which 48 patients (27%) recurred. Adjuvant treatment did not alter patterns of initial recurrence (p = 0.76). Adjuvant therapy recipients more often had both nodal ultrasound and cross-sectional imaging surveillance (p < 0.01). Among 13 isolated nodal recurrences, 85% were within the first year and 85% were detected by examination and/or ultrasound. Increasing surveillance intensity was not associated with recurrence detection rates but increased overall cost and cost per detected recurrence. CONCLUSION Regardless of adjuvant treatment, most nodal recurrences occurred in the first year and were initially detected clinically or by ultrasound. Findings support continued use of examination and nodal basin ultrasound in addition to any planned cross-sectional imaging surveillance.
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Affiliation(s)
- Kristy K Broman
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. .,University of South Florida Morsani College of Medicine, Tampa, FL, USA. .,University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | | | - James Sun
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Dennis Kirichenko
- University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Michael J Carr
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Zeynep Eroglu
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Ahmad A Tarhini
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Nikhil Khushalani
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Matthew B Schabath
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Amod Sarnaik
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Vernon K Sondak
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jonathan S Zager
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,University of South Florida Morsani College of Medicine, Tampa, FL, USA
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Comment on "Preoperative Ultrasound Assessment of Regional Lymph Nodes in Melanoma Patients Does Not Provide Reliable Nodal Staging: Results From a Large Multicenter Trial". Ann Surg 2021; 274:e103-e104. [PMID: 31850978 DOI: 10.1097/sla.0000000000003696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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