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Clinical Study on the Increased Incidence of Nodular Melanoma Cases Compared to Superficial Melanoma. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:298-305. [PMID: 34765252 PMCID: PMC8551895 DOI: 10.12865/chsj.47.02.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
Our study group was comprised of 67 patients with melanoma, admitted and operated in our clinic between 2010-2018. Only the patients with melanoma localized on the head, torso and upper limb were selected for our study. We attempted to establish a link between the clinical appearance, presence or absence of ulceration, presence or absence of regional lymphadenopathy or distant metastases, surgical technique, histopathological type, Clark level and Breslow depth, disease stage (TNM), adjuvant therapies and survival rates at 1, 3, 5 and 10 years.
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Coroiu A, Moran C, Davine JA, Brophy K, Bergeron C, Tsao H, Körner A, Swetter SM, Geller AC. Patient-identified early clinical warning signs of nodular melanoma: a qualitative study. BMC Cancer 2021; 21:371. [PMID: 33827477 PMCID: PMC8028760 DOI: 10.1186/s12885-021-08072-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nodular (NM) and superficial spreading melanoma (SSM) show different disease trajectories, with more rapid development in NM and fewer opportunities for early detection often resulting in worse outcomes. Our study described the patient-identified early signs of thin NM via comparisons to thin (≤ 2 mm) SSM and thick (> 2 mm) NM. METHODS We conducted semi-structured interviews with NM and SSM patients and analyzed the data using thematic analysis. RESULTS We enrolled 34 NM and 32 SSM patients. Melanoma early signs uniquely identified by patients with thin NM included white, blue or black coloration, "dot-like" size, fast changes in shape and color observed over 2 weeks, elevation and texture or "puffiness" over 6-12 months, and the sensation that the mole "did not feel right". Early signs reported by both thin NM and thin SSM patients included round or oblong shape, "jagged" border, pink/red, brown/reddish or dark coloration, "elevated like a pimple" or "tiny bump", fast color darkening, diameter growth, and border irregularity, and mole feeling "really itchy". CONCLUSIONS We found evidence that early signs of NM can be self-identified, which has important implications for the earlier detection of this most aggressive type of melanoma by both health professionals and patients.
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Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA.
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
| | - Kyla Brophy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Hensin Tsao
- Harvard Medical School, Boston, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, USA
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Stanford, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
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Bono A, Tolomio E, Carbone A, Moglia D, Crippa F, Tomatis S, Santinami M. Small Nodular Melanoma: The Beginning of a Life-Threatening Lesion. A Clinical Study on 11 Cases. TUMORI JOURNAL 2018; 97:35-8. [DOI: 10.1177/030089161109700107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Because of its high thickness, nodular melanoma often bears a poor prognosis. Thus, an earlier diagnosis of this type of lesion while it is still thin would be an important step in secondary prevention. The principal aim of the present study was to better define the initial clinical features of nodular melanoma to allow an early diagnosis. A secondary aim was to establish the prognosis of this type of lesion. Methods We retrospectively studied and illustrated the clinical features of 11 small (≤6 mm maximum diameter) cutaneous nodular melanomas seen and treated during a 10-year period. Prognostic characteristics of the various lesions were also described. Results The results of the study help to describe a small nodular melanoma as a dark and/or pink/red raised lesion, which may be evenly or unevenly colored, with well-defined borders, that often appears de novo. A correct clinical diagnosis was made in 7 of the cases. During a median follow-up of 6 years, none of the patients had local or distant relapses. Conclusions Detection of small nodular melanoma is feasible by accurate visual inspection, provided that physicians are aware of this type of lesion and maintain the index of suspicion at a high level to bring about curative surgery. Free full text available at www.tumorionline.it
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Affiliation(s)
- Aldo Bono
- Day Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Elena Tolomio
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Antonino Carbone
- Unit of Pathology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Daniele Moglia
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Federica Crippa
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Stefano Tomatis
- Health Physics Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Mario Santinami
- Melanoma and Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
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Pizzichetta MA, Massi D, Mandalà M, Queirolo P, Stanganelli I, De Giorgi V, Ghigliotti G, Cavicchini S, Quaglino P, Corradin MT, Rubegni P, Alaibac M, Astorino S, Ayala F, Magi S, Mazzoni L, Manganoni MA, Talamini R, Serraino D, Palmieri G. Clinicopathological predictors of recurrence in nodular and superficial spreading cutaneous melanoma: a multivariate analysis of 214 cases. J Transl Med 2017; 15:227. [PMID: 29115977 PMCID: PMC5688807 DOI: 10.1186/s12967-017-1332-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nodular melanoma (NM) accounts for most thick melanomas and because of their frequent association with ulceration, fast growth rate and high mitotic rate, contribute substantially to melanoma-related mortality. In a multicentric series of 214 primary melanomas including 96 NM and 118 superficial spreading melanoma (SSM), histopathological features were examined with the aim to identify clinicopathological predictors of recurrence. METHODS All consecutive cases of histopathologically diagnosed primary invasive SSM and NM during the period 2005-2010, were retrieved from the 12 participating Italian Melanoma Intergroup (IMI) centers. Each center provided clinico-pathological data such as gender, age at diagnosis, anatomical site, histopathological conventional parameters, date of excision and first melanoma recurrence. RESULTS Results showed that NM subtype was significantly associated with Breslow thickness (BT) at multivariate analysis: [BT 1.01-2 mm (OR 7.22; 95% CI 2.73-19.05), BT 2.01-4 mm (OR 7.04; 95% CI 2.54-19.56), and BT > 4 mm (OR 51.78; 95% CI 5.65-474.86) (p < 0.0001)]. Furthermore, mitotic rate (MR) was significantly correlated with NM histotype: [(MR 3-5 mitoses/mm2 (OR 2.62; 95% CI 1.01-6.83) and MR > 5 mitoses/mm2 (OR 4.87; 95% CI 1.77-13.40) (p = 0.002)]. The risk of recurrence was not significantly associated with NM histotype while BT [BT 1.01-2.00 mm (HR 1.55; 95% CI 0.51-4.71), BT 2.01-4.00 mm (HR 2.42; 95% CI 0.89-6.54), BT > 4.00 mm. (HR 3.13; 95% CI 0.95-10.28) (p = 0.05)], mitotic rate [MR > 2 mitoses/mm2 (HR 2.34; 95% CI, 1.11-4.97) (p = 0.03)] and the positivity of lymph node sentinel biopsy (SNLB) (HR 2.60; 95% CI 1.19-5.68) (p = 0.007) were significantly associated with an increased risk of recurrence at multivariate analysis. CONCLUSIONS We found that NM subtype was significantly associated with higher BT and MR but it was not a prognostic factor since it did not significantly correlate with melanoma recurrence rate. Conversely, increased BT and MR as well as SNLB positivity were significantly associated with a higher risk of melanoma recurrence.
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Affiliation(s)
- Maria A. Pizzichetta
- Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano, Italy
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Mario Mandalà
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Queirolo
- Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | | | | | - Stefano Cavicchini
- Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Dept Medical Sciences, University of Torino, Turin, Italy
| | | | - Pietro Rubegni
- Department of Dermatology, University of Siena, Siena, Italy
| | - Mauro Alaibac
- Department of Dermatology, University of Padova, Padua, Italy
| | | | - Fabrizio Ayala
- National Cancer Institute, “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | | | - Renato Talamini
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Diego Serraino
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy
| | - on behalf of the Italian Melanoma Intergroup (IMI)
- Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano, Italy
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Florence, Florence, Italy
- Clinic of Dermatology, IRCCS San Martino-IST, Genoa, Italy
- Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
- Dermatologic Clinic, Dept Medical Sciences, University of Torino, Turin, Italy
- Division of Dermatology, Pordenone Hospital, Pordenone, Italy
- Department of Dermatology, University of Siena, Siena, Italy
- Department of Dermatology, University of Padova, Padua, Italy
- Division of Dermatology, Celio Hospital, Rome, Italy
- National Cancer Institute, “Fondazione G. Pascale”-IRCCS, Naples, Italy
- Department of Dermatology, ASST degli Spedali Civili di Brescia, Brescia, Italy
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy
- Department of Dermatology, University of Parma, Parma, Italy
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Rosendahl C, Hishon M, Cameron A, Barksdale S, Weedon D, Kittler H. Nodular melanoma: five consecutive cases in a general practice with polarized and non-polarized dermatoscopy and dermatopathology. Dermatol Pract Concept 2014; 4:69-75. [PMID: 24855580 PMCID: PMC4029260 DOI: 10.5826/dpc.0402a15] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 12/09/2013] [Indexed: 11/24/2022] Open
Abstract
Background: The incidence of nodular melanoma (NM) has been consistently described as at least 10–15% of total melanomas for over 15 years despite advances in diagnostic algorithms and medical technology. NMs are strongly correlated with faster rates of growth and poorer prognosis and thus provide clinicians with a challenge for early recognition. Objective: To evaluate diagnostic clues of consecutive histopathologically proven NMs in one general practice with particular emphasis on dermatoscopic characteristics and compare this to the published literature. Method: A retrospective observational study was performed of five consecutive histologically proven NM, from a total of 212 consecutive melanomas from a general practice in Brisbane, Queensland, Australia. Dermatoscopic images, both polarized and non-polarized, which appears to be a unique resource, and dermatopathologic slides were available for all lesions. Results: All of the NMs in this series were pigmented although one was hypomelanotic. Two of them were symmetrical. The most highly sensitive clues to NM were gray or blue structures and polarizing-specific white lines. Limitations: Due to the small number of NMs in this report no statistical significance can be attributed to the observational findings. Conclusion: This small series supports what is already known: that a significant proportion of NMs may be dermatoscopically symmetrical but that known clues to melanoma are frequently present. Nodular lesions, pigmented or non-pigmented, should be excised to exclude NM if there is any clue to malignancy, regardless of symmetry, unless a confident specific benign diagnosis can be made.
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Affiliation(s)
| | - Matthew Hishon
- School of Medicine, The University of Queensland, Australia
| | - Alan Cameron
- School of Medicine, The University of Queensland, Australia
| | | | - David Weedon
- Sullivan Nicolaides Pathology, Brisbane, Australia
| | - Harald Kittler
- Department of Dermatology and Venereology, Medical University of Vienna, Austria
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6
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Mar V, Roberts H, Wolfe R, English DR, Kelly JW. Nodular melanoma: A distinct clinical entity and the largest contributor to melanoma deaths in Victoria, Australia. J Am Acad Dermatol 2013. [DOI: 10.1016/j.jaad.2012.09.047] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Tsai S, Balch C, Lange J. Epidemiology and treatment of melanoma in elderly patients. Nat Rev Clin Oncol 2010; 7:148-52. [DOI: 10.1038/nrclinonc.2010.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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The anatomic distribution of melanoma and relationships with childhood nevus distribution in Colorado. Melanoma Res 2009; 19:252-9. [PMID: 19543126 DOI: 10.1097/cmr.0b013e32832e0b81] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The nature of the relationship between nevus development in childhood and later development of melanoma is unclear. Data on melanoma diagnoses by histologic type and anatomic site were obtained for 2351 white, non-Hispanics in Colorado from the Colorado Central Cancer Registry between 2000 and 2004. Nevus size and body site were ascertained during skin exams conducted in the summer of 2007 on 717 white, non-Hispanic children aged 8-9 years. Chi-square goodness-of-fit analysis was used to assess the association between the anatomic site distributions of nevi versus melanoma. Superficial spreading melanoma was the most frequent histology, followed by lentigo maligna melanoma. Nodular melanoma was the least common histology. For males, there was no significant difference between the distribution of medium-sized (> or =2 mm) nevi and the distribution of both superficial spreading and nodular melanomas. For females, there was no significant difference between the anatomic distribution of small-sized (<2 mm) nevi and the distribution of nodular melanoma, and there was marginal evidence for a difference between the distribution of medium-sized (> or =2 mm) nevi and the distribution of nodular melanoma. There was evidence for a difference between all of the nevus distributions and the distributions of superficial spreading and lentigo maligna melanoma in females. The similarities between the nevus and melanoma distributions are interesting findings, but it is difficult to interpret the significance of these findings based on the current state of knowledge of melanoma etiology.
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Geller AC, Elwood M, Swetter SM, Brooks DR, Aitken J, Youl PH, Demierre MF, Baade PD. Factors related to the presentation of thin and thick nodular melanoma from a population-based cancer registry in Queensland Australia. Cancer 2009; 115:1318-27. [DOI: 10.1002/cncr.24162] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Warycha MA, Christos PJ, Mazumdar M, Darvishian F, Shapiro RL, Berman RS, Pavlick AC, Kopf AW, Polsky D, Osman I. Changes in the presentation of nodular and superficial spreading melanomas over 35 years. Cancer 2009; 113:3341-8. [PMID: 18988292 DOI: 10.1002/cncr.23955] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nodular melanoma (NM) may be biologically aggressive compared with the more common superficial spreading melanoma (SSM), with recent data suggesting underlying genetic differences between these 2 subtypes. To better define the clinical behavior of NMs, the authors compared their clinical and histopathologic features to those of SSMs at their institution, a tertiary referral center, over 3 decades. METHODS A total of 1,684 patients diagnosed with 1,734 melanomas were prospectively enrolled. Of these, 1,143 patients (69% SSM, 11% NM, 20% other) were diagnosed between 1972 and 1982; 541 patients (54% SSM, 23% NM, 23% other) were diagnosed between 2002 and the present. Differences between the features of NM and SSM within each time period as well as changes over time were analyzed. RESULTS The authors found that SSMs are now diagnosed as thinner lesions (P < .0001) with a low incidence of histologic ulceration (P < .0001), whereas there was no significant change in the median tumor thickness or ulceration status of NMs over time (P = .10, P = .30, respectively). The median age at diagnosis of NM, however, did significantly increase over time (51 years to 63 years, P < .01). The median duration of NMs was reported to be only 5 months compared with 9 months in SSM patients. CONCLUSIONS The authors' data suggest that improvements have been made in the early detection of SSM but not NM. Modifications of current screening practices, including increased surveillance of high-risk patients with an emphasis on the "E" for "evolution" criterion of the ABCDE acronym used for early detection of melanoma, are thus warranted.
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Affiliation(s)
- Melanie A Warycha
- Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA
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Geller AC, Swetter SM, Brooks K, Demierre MF, Yaroch AL. Screening, early detection, and trends for melanoma: Current status (2000-2006) and future directions. J Am Acad Dermatol 2007; 57:555-72; quiz 573-6. [PMID: 17870429 DOI: 10.1016/j.jaad.2007.06.032] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 06/13/2007] [Accepted: 06/27/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED In the past 5 years, there have been notable strides toward the earlier recognition and discovery of melanoma, including new technologies to complement and augment the clinical examination and new insights to help clinicians recognize early melanoma. However, incidence and mortality rates throughout most of the developed world have risen over the past 25 years, while education and screening, potentially the best means for reducing the disease, continue to be severely underutilized. Much progress needs to be made to reach middle-aged and older men and persons of lower socioeconomic status who suffer a disproportionate burden of death from melanoma. Worldwide melanoma control must also be a priority, and comprehensive educational and screening programs should be directed to Northern Ireland and a number of Eastern European nations, whose 5-year survival rates range between 53% and 60%, mirroring those of the United States and Australia more than 40 years ago. LEARNING OBJECTIVE After completing this learning activity, participants should be aware of the most recent melanoma epidemiologic data, both in the United States and internationally; worldwide early detection and screening programs; clinical strategies to recognize and improve the detection of early melanoma; the latest technologies for early detection of melanoma; and public and professional education programs designed to enhance early detection.
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Affiliation(s)
- Alan C Geller
- Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Baumert J, Plewig G, Volkenandt M, Schmid-Wendtner MH. Factors associated with a high tumour thickness in patients with melanoma. Br J Dermatol 2007; 156:938-44. [PMID: 17381454 DOI: 10.1111/j.1365-2133.2007.07805.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prognosis of patients with melanoma is strongly associated with tumour thickness at time of diagnosis. Therefore, knowledge of patient characteristics and behaviour associated with a high tumour thickness is essential for the development and improvement of melanoma prevention campaigns. OBJECTIVES The present study aimed to identify sociodemographic, clinical and behavioural factors associated with high tumour thickness according to Breslow. METHODS The study population consisted of 217 patients with histologically proven primary invasive cutaneous melanomas seen at the Department of Dermatology and Allergology at the Ludwig-Maximilian-University Munich, Germany, between January 1999 and January 2001. Personal interviews were conducted by two physicians to obtain information on sociodemographic characteristics and on patients' knowledge of melanoma symptoms, sun behaviour, delay in diagnosis and related factors. Multivariate linear and logistic regression analysis with stepwise variable selection was used to identify risk groups with a high tumour thickness. To assess possible effect modifications, interaction terms were included in the regression analysis. RESULTS The median tumour thickness was 0.8 mm (interquartile range 0.5-1.6). Fifty-seven patients (26%) had tumour thickness >1.5 mm. In a multivariate linear regression analysis, patients living alone and patients with a low educational level showed a significantly greater tumour thickness. The relation of melanoma knowledge to tumour thickness was modified by the melanoma subtype: whereas lack of melanoma knowledge led to an increased tumour thickness for the subtypes superficial spreading melanoma, lentigo maligna melanoma and unspecified malignant melanoma, no significant effect was estimated for the subtypes nodular melanoma (NM) and acrolentiginous melanoma (ALM). Sex, age, self-detection of melanoma, patient delay and professional delay were not significantly associated with the tumour thickness in multivariate linear regression. Similar results were found in multivariate logistic regression. CONCLUSIONS An increased tumour thickness was found in subjects living alone and having a low educational level. These subjects should be targeted in future prevention campaigns in a more focused way. Further efforts are necessary to improve knowledge and earlier detection of melanoma subtypes NM and ALM.
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Affiliation(s)
- J Baumert
- Department of Dermatology and Allergology, Ludwig-Maximilian-University, Munich, Germany
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13
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Corrigan MA, Coffey JC, O'Sullivan MJ, Fogarty KM, Redmond HP. Sentinel lymph node biopsy: Is it possible to reduce false negative rates by excluding patients with nodular melanoma? Surgeon 2006; 4:153-7. [PMID: 16764200 DOI: 10.1016/s1479-666x(06)80085-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to review the outcome of sentinel lymph node biopsy (SLNB) in patients with melanoma and to delineate whether patients with nodular melanoma are more likely to develop nodal recurrence despite negative SLNB. METHODS Consecutive patients with cutaneous melanoma undergoing SLNB were identified from a departmental database between 1997 and 2005. Factors including demographic data, site, histological subtype, depth and outcome were examined. RESULTS Of 131 patients, 103 were node negative and eligible for study. The median age was 53 (16-82) years with 46 patients being male (45%) and 57 female (55%). Primary melanoma sites included lower limb (49; 48%), upper limb (29; 28%), head (12; 11%), trunk (7; 7%) and back (6; 6%). The median Breslow thickness was 2mm. Superficial spreading accounted for 43% of melanoma with nodular accounting for 42%. Median follow-up was 40 (3-90) months. Of 20 relapses, seven recurred in the same nodal basin, three were satellite recurrences, one recurred with both satellite and nodal lesions simultaneously, and nine experienced haematogenous spread. Of the eight patients who developed recurrence in the same nodal basin, four were of nodular histological subtype (p=NS). All of the three patients with satellite lesions had nodular melanoma histologically (p=0.02). When nodal and satellite recurrences were combined, eight of 11 were histologically nodular (p=0.01). CONCLUSIONS This study indicates that lymphatic recurrence occurs more often in SLNB negative patients with nodular melanoma. Further evaluation of the inclusion criteria for sentinel node biopsy is warranted.
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Affiliation(s)
- M A Corrigan
- Department of Academic Surgery, Cork University Hospital, Ireland.
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14
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Fisher NM, Schaffer JV, Berwick M, Bolognia JL. Breslow depth of cutaneous melanoma: impact of factors related to surveillance of the skin, including prior skin biopsies and family history of melanoma. J Am Acad Dermatol 2006; 53:393-406. [PMID: 16112344 DOI: 10.1016/j.jaad.2005.03.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Revised: 02/27/2005] [Accepted: 03/04/2005] [Indexed: 12/01/2022]
Abstract
BACKGROUND Because the early detection of cutaneous melanoma can dramatically improve survival, identification and surveillance of persons at risk have received much attention. OBJECTIVE Our purpose was to examine the influences of personal or family history, patterns of detection, and prior skin biopsies (considered to be a measurement of surveillance by medical personnel) on the Breslow depth of cutaneous melanomas. METHODS A retrospective cohort analysis of 218 patients with a history of at least one invasive cutaneous melanoma who visited the Yale Pigmented Lesion Clinic between January 1995 and January 1996 was performed. Data on patterns of detection, melanocytic nevi, and skin biopsies before and after the initial diagnosis of melanoma were collected, and patients with a family history of melanoma were compared with sporadic patients. RESULTS Initial melanomas discovered by dermatologists were more likely to be 0.75 mm or less in depth than those found by other physicians (P = .03). Although patients detected 45% of the initial primary melanomas (98/218), dermatologists discovered 80% of the second primary tumors (33/41; P = .001). A personal history of melanoma was predictive of a thinner Breslow depth (P = .01), but a family history of melanoma was not. Having a biopsy of any type or combination of types of skin lesion(s) performed in the 5 years, 2 years, or 1 year before the first diagnosis of melanoma did not predict a melanoma of thinner Breslow depth among either familial or sporadic patients. The mean number of skin biopsies performed per patient was 8 times higher in the 5-year period after (5.6) versus the 5-year period before (0.7) the initial diagnosis of melanoma, with a peak in the first year after the diagnosis (2.3 vs 0.25 in the prior year). In 27 patients, one or more skin biopsies were performed in the year before the initial diagnosis of melanoma; 41% of these biopsies (23/56) were of lesions in normally exposed sites (eg, the face, neck, and forearms) compared with 22% of the melanomas (6/27). LIMITATIONS Since an invasive melanoma (with the possible exception of a nodular melanoma) would likely have been present for at least a year, plausible explanations for why evidence of previous dermatologic care did not appear to result in earlier detection include performance of a limited rather than a total body skin examination as well as subtle clinical features of early melanomas. However, this study cannot give weight to these explanations because at the time new Pigmented Lesion Clinic patients were not routinely asked about previous total body skin examinations. CONCLUSIONS The disappointing trends seen in this study, with neither the well-established risk factor of a family history of melanoma nor previously having a skin biopsy predicting thinner melanomas, highlight the need to establish criteria defining the subset of patients for whom appropriate management requires periodic total body skin examination.
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Affiliation(s)
- Nina M Fisher
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut 06520, USA
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Chamberlain AJ, Fritschi L, Kelly JW. Nodular melanoma: patients' perceptions of presenting features and implications for earlier detection. J Am Acad Dermatol 2003; 48:694-701. [PMID: 12734497 DOI: 10.1067/mjd.2003.216] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The incidence of thick melanoma and related mortality is largely static despite advances in early detection during the last 20 years. Nodular melanoma (NM) accounts for the majority of thick lesions and is difficult to recognize in the early stages of its evolution. OBJECTIVE The purpose of this study was to identify historic or clinical features that may facilitate earlier detection of NM. METHODS A questionnaire was administered to 125 patients attending the Victorian Melanoma Service between 1998 and 2000 with superficial spreading melanoma or NM. Parameters were compared by tumor type and thickness. RESULTS NMs are more often symmetric, elevated, uniform in color, and nonpigmented. Color change is uncommon. CONCLUSION NM often fails to fulfill the ABCD diagnostic criteria. Biopsy after a set period of observation should aid differentiation from inflammatory lesions and enable earlier detection of this subtype.
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