1
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Zhang YC, Lu CD, Li QY, Shi JN, Shi J, Yang M. Association between glycemic traits and melanoma: a mendelian randomization analysis. Front Genet 2023; 14:1260367. [PMID: 38179409 PMCID: PMC10765500 DOI: 10.3389/fgene.2023.1260367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
Background: The causation of Glycemic Traits and risks of Melanoma remains unknown. We used Mendelian Randomization (MR) to assess the links between Glycemic Traits and Melanoma. Method: Pooled data from Genome-Wide Association Studies (GWAS) were utilized to examine the relationships that exist between Fasting Insulin (n = 26), 2-h Glucose (n = 10), Fasting Glucose (n = 47), HbA1c (n = 68), and Type-2 Diabetes (n = 105) and Melanoma. We evaluated the correlation of these variations with melanoma risk using Two-Samples MR. Result: In the IVW model, Fasting Glucose (OR = 0.99, 95%CI = 0.993-0.998, p < 0.05, IVW), Type-2 Diabetes (OR = 0.998, 95%CI = 0.998-0.999, p < 0.01, IVW) and HbA1c (OR = 0.19, 95%CI = 0.0415-0.8788, p < 0.05, IVW) was causally associated with a lower risk of Melanoma. In all models analyzed, there was no apparent causal relationship between Fasting Insulin and Melanoma risk. There was no obvious causal difference in the IVW analysis of 2-h Glucose and Melanoma, but its p < 0.05 in MR Egger (OR = 0.99, 95%CI = 0.9883-0.9984, p < 0.05, MR Egger), and the direction was consistent in other MR analyses, suggesting that there may be a causal relationship. Conclusion: The results of this study suggest that a higher risk of Fasting Glucose, Type-2 Diabetes, 2-h Glucose, and HbA1c may be associated with a lower risk of Melanoma. However, no causal relationship between fasting insulin and melanoma was found. These results suggest that pharmacological or lifestyle interventions that regulate plasma glucose levels in the body may be beneficial in the prevention of melanoma.
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Affiliation(s)
- Yun-Chao Zhang
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cen-Di Lu
- Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Quan-Yao Li
- Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jin-Na Shi
- Department of General Practice, KangQiao Campus of the Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Jun Shi
- Department of Traditional Chinese Medicine, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Min Yang
- Department of Oncology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Xinhua Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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2
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De Giorgi V, Magnaterra E, Zuccaro B, Magi S, Magliulo M, Medri M, Mazzoni L, Venturi F, Silvestri F, Tomassini GM, Gola M, Tramontana M, Berti S, Stanganelli I, Stingeni L, Covarelli P. Is Pediatric Melanoma Really That Different from Adult Melanoma? A Multicenter Epidemiological, Clinical and Dermoscopic Study. Cancers (Basel) 2023; 15:cancers15061835. [PMID: 36980721 PMCID: PMC10046848 DOI: 10.3390/cancers15061835] [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: 02/05/2023] [Revised: 02/26/2023] [Accepted: 03/11/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To improve the diagnostic accuracy and optimal management of pediatric melanomas. METHODS We conducted a retrospective descriptive, multicenter study of the epidemiological, clinical, and dermoscopic characteristics of histopathologically proven melanomas diagnosed in patients less than 18 years old. Data on sociodemographic variables, clinical and dermoscopic characteristics, histopathology, local extension, therapy and follow-up, lymph node staging, and outcome were collected from the databases of three Italian dermatology units. We performed a clinical evaluation of the morphological characteristics of each assessed melanoma, using both classic ABCDE criteria and the modified ABCDE algorithm for pediatric melanoma to evaluate which of the two algorithms best suited our series. RESULTS The study population consisted of 39 patients with a histologically confirmed diagnosis of pediatric melanoma. Comparing classic ABCDE criteria with the modified ABCDE algorithm for pediatric melanomas, the modified pediatric ABCDE algorithm was less sensitive than the conventional criteria. Dermoscopically, the most frequent finding was the presence of irregular streaks/pseudopods (74.4%). When evaluating the total number of different suspicious dermoscopy criteria per lesion, 64.1% of the lesion assessments recognized two dermoscopic characteristics, 20.5% identified three, and 15.4% documented four or more assessments. CONCLUSIONS Contrary to what has always been described in the literature, from a clinical point of view, about 95% of our cases presented in a pigmented and non-amelanotic form, and these data must be underlined in the various prevention campaigns where pediatric melanoma is currently associated with a more frequently amelanotic form. All the pediatric melanomas analyzed presented at least two dermoscopic criteria of melanoma, suggesting that this could be a key for the dermoscopic diagnosis of suspected pediatric melanoma, making it possible to reach an early diagnosis even in this age group.
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Affiliation(s)
- Vincenzo De Giorgi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
- Cancer Research "Attilia Pofferi" Foundation, 51100 Pistoia, Italy
| | - Elisabetta Magnaterra
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Biancamaria Zuccaro
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
| | - Manfredi Magliulo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Matelda Medri
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
| | - Federico Venturi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Flavia Silvestri
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Gian Marco Tomassini
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
| | - Massimo Gola
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
| | - Samantha Berti
- Section of Dermatology, Department of Health Sciences, University of Florence, 50121 Florence, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo per lo Studio dei Tumori "Dino Amadori" (IRST) IRCCS, 47014 Meldola, Italy
- Dermatology Unit, Department Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
| | - Piero Covarelli
- Surgical Oncology Section, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy
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3
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Roccuzzo G, Moirano G, Fava P, Maule M, Ribero S, Quaglino P. Obesity and immune-checkpoint inhibitors in advanced melanoma: A meta-analysis of survival outcomes from clinical studies. Semin Cancer Biol 2023; 91:27-34. [PMID: 36871633 DOI: 10.1016/j.semcancer.2023.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Obesity is a chronic inflammatory condition that has been associated with different types of cancer. However, its role in melanoma incidence, progression, and response to immune-checkpoint-inhibitors (ICI) is still controversial. On the one hand, increased levels of lipids and adipokines can promote tumor proliferation and several genes associated with fatty acid metabolism have been found to be upregulated in melanomas. On the other hand, immunotherapy seems to be more effective in obese animal models, presumably due to an increase in CD8 + and subsequent decrease in PD-1 + T-cells in the tumor microenvironment. In humans, several studies have investigated the role of BMI (body mass index) and other adiposity-related parameters as potential prognostic markers of survival in advanced melanoma patients treated with ICI. The aim of this research has been to systematically review the scientific literature on studies evaluating the relationship between overweight/obesity and survival outcomes in patients with advanced melanoma treated with ICI and to perform a meta-analysis on those sharing common characteristics. After screening 1070 records identified through a literature search, 18 articles assessing the role of BMI-related exposure in relation to survival outcomes in ICI-treated patients with advanced melanoma were included in our review. In the meta-analysis of the association between overweight (defined as BMI>25 or BMI 25-30), overall survival (OS), and progression free survival (PFS), 7 studies were included, yielding a summary HR of 0.87 (95% CI: 0.74-1.03) and 0.96 (95% CI: 0.86-1.08), respectively. Our results show that, despite few suggestive findings, the use of BMI as a valuable predictor of melanoma patients' survival in terms of PFS and OS should not be currently recommended, due to the limited evidence available.
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Affiliation(s)
- Gabriele Roccuzzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, 10126 Torino, Italy; Postgraduate School in Biostatistics, Department of Public Health and Pediatrics, University of Turin, 10126 Torino, Italy
| | - Paolo Fava
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy
| | - Milena Maule
- Cancer Epidemiology Unit and CPO-Piemonte, Department of Medical Sciences, University of Torino, 10126 Torino, Italy
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, Turin 10126, Torino, Italy
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4
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Montal E, Lumaquin D, Ma Y, Suresh S, White RM. Modeling the effects of genetic- and diet-induced obesity on melanoma progression in zebrafish. Dis Model Mech 2023; 16:285858. [PMID: 36472402 PMCID: PMC9884122 DOI: 10.1242/dmm.049671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022] Open
Abstract
Obesity is a rising concern and associated with an increase in numerous cancers, often in a sex-specific manner. Preclinical models are needed to deconvolute the intersection between obesity, sex and melanoma. Here, we generated a zebrafish system that can be used as a platform for studying these factors. We studied how germline overexpression of Agrp along with a high-fat diet affects melanomas dependent on BRAFV600E and loss of p53. This revealed an increase in tumor incidence and area in male, but not female, obese fish, consistent with the clinical literature. We then determined whether this was further affected by additional somatic mutations in the clinically relevant genes rb1 or ptena/b. We found that the male obesogenic effect on melanoma was present with tumors generated with BRAF;p53;Rb1 but not BRAF;p53;Pten. These data indicate that both germline (Agrp) and somatic (BRAF, Rb1) mutations contribute to obesity-related effects in melanoma. Given the rapid genetic tools available in the zebrafish, this provides a high-throughput system to dissect the interactions of genetics, diet, sex and host factors in obesity-related cancers.
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Affiliation(s)
- Emily Montal
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Dianne Lumaquin
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY 10065, USA
| | - Yilun Ma
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA,Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY 10065, USA
| | - Shruthy Suresh
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Richard M. White
- Cancer Biology and Genetics Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA,Author for correspondence ()
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5
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Cosci I, Grande G, Di Nisio A, Rocca MS, Del Fiore P, Benna C, Mocellin S, Ferlin A. Cutaneous Melanoma and Hormones: Focus on Sex Differences and the Testis. Int J Mol Sci 2022; 24:ijms24010599. [PMID: 36614041 PMCID: PMC9820190 DOI: 10.3390/ijms24010599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/24/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Cutaneous melanoma, the most aggressive type of skin cancer, remains one the most represented forms of cancer in the United States and European countries, representing, in Australia, the primary cause of cancer-related deaths. Recently, many studies have shown that sex disparities previously observed in most cancers are particularly accentuated in melanoma, where male sex is consistently associated with an increased risk of disease progression and a higher mortality rate. The causes of these sex differences rely on biological mechanisms related to sex hormones, immune homeostasis and oxidative processes. The development of newer therapies, such as immune checkpoint inhibitors (ICIs) (i.e., anti-PD-1 and anti-CTLA-4 monoclonal antibodies) has dramatically changed the treatment landscape of metastatic melanoma patients, though ICIs can interfere with the immune response and lead to inflammatory immune-related adverse events (irAEs). Recently, some studies have shown a potential adverse influence of this immunotherapy treatment also on male fertility and testicular function. However, while many anticancer drugs are known to cause defects in spermatogenesis, the effects of ICIs therapy remain largely unknown. Notwithstanding the scarce and conflicting information available on this topic, the American Society of Clinical Oncology guidelines recommend sperm cryopreservation in males undergoing ICIs. As investigations regarding the long-term outcomes of anticancer immunotherapy on the male reproductive system are still in their infancy, this review aims to support and spur future research in order to understand a potential gonadotoxic effect of ICIs on testicular function, spermatogenesis and male fertility.
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Affiliation(s)
- Ilaria Cosci
- Veneto Institute of Oncology IOV-IRCCS, 35128 Padova, Italy
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
| | - Andrea Di Nisio
- Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Maria Santa Rocca
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
| | - Paolo Del Fiore
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
| | - Clara Benna
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
- Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35128 Padova, Italy
| | - Simone Mocellin
- Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy
- Department of Surgical, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, 35128 Padova, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, University Hospital of Padova, 35128 Padova, Italy
- Department of Medicine, University of Padova, 35128 Padova, Italy
- Correspondence: ; Tel.: +39-049-8212723
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6
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Bechmann N, Calsina B, Richter S, Pietzsch J. Therapeutic Potential of Nitric Oxide‒Releasing Selective Estrogen Receptor Modulators in Malignant Melanoma. J Invest Dermatol 2022; 142:2217-2227. [PMID: 34990694 DOI: 10.1016/j.jid.2021.12.028] [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] [Received: 04/05/2021] [Revised: 11/19/2021] [Accepted: 12/13/2021] [Indexed: 10/24/2022]
Abstract
Malignant melanoma has a steadily increasing incidence, but treatment options are still limited, and the prognosis for patients, especially for men, is poor. To investigate whether targeting estrogen receptor (ER) signaling is a valid therapeutic approach, we retrospectively analyzed ER gene expression profiles in 448 patients with melanoma. High ERα gene (ESR1) expression was associated with improved overall survival (hazard ratio = 0.881; 95% confidence interval = 0.793-0.979; P = 0.018) and increased with tumor stage, whereas ERβ gene (ESR2) expression did not change with tumor progression. This seemingly protective function of ERα led us to speculate that specific targeting of ERβ has a therapeutic benefit in malignant melanoma. An ERβ-selective ER modulator with nitric oxide‒releasing moiety (nitric oxide‒releasing selective ER modulator 4d [NO-SERM 4d]) significantly reduced the prometastatic behavior of two melanoma cell lines (A2058 and MEL-JUSO). Epithelial‒mesenchymal transition in melanoma is consistent with a switch from E- to N-cadherin expression, mediating the invasive phenotype. NO-SERM 4d reduced N-cadherin expression and impaired spheroid formation in A2058 cells. In addition, the growth of A2058 spheroids was significantly reduced, confirming the antitumorigenic potential of NO-SERM 4d. Targeting ERβ signaling combined with targeted nitric oxide release represents a promising therapeutic approach in malignant melanoma that has the potential to prevent metastatic spread and reduce tumor growth.
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Affiliation(s)
- Nicole Bechmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, School of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Medicine III, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Department of Experimental Diabetology (DIAB), German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Nuthetal, Germany; German Center for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Bruna Calsina
- Hereditary Endocrine Cancer Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain; Hereditary Endocrine Cancer Group, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Susan Richter
- Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, School of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Jens Pietzsch
- Department of Radiopharmaceutical and Chemical Biology, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum, Dresden-Rossendorf, Dresden, Germany; Faculty of Chemistry and Food Chemistry, School of Science, Technische Universität Dresden, Dresden, Germany
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7
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Safety of combining dabrafenib plus trametinib in elderly BRAF V600 mutation-positive advanced melanoma patients: real-world data analysis of Spanish patients (ELDERLYMEL). Melanoma Res 2022; 32:343-352. [PMID: 35762583 DOI: 10.1097/cmr.0000000000000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Efficacy and safety of dabrafenib and trametinib in metastatic melanoma have been demonstrated in two-phase III and one-phase I/II clinical trials. However, patients at least 75 years old (y.o.) were largely underrepresented. Additionally, the safety profile of dabrafenib and trametinib based on age is unknown. ELDERLYMEL is a retrospective noninterventional multicenter study, describing the effectiveness and safety of at least 75 y.o. patients compared with less than 75 y.o. patients with advanced BRAF V600-mutated melanoma treated with dabrafenib plus trametinib or dabrafenib monotherapy. A total of 159 patients were included, 130 less than 75 y.o. and 29 at least 75 y.o. Clinical features were similar between the groups, except in the number of comorbidities, number of metastatic sites, Eastern Cooperative Oncology Group (ECOG) performance status, and BRAF V600-mutation type. Five patients per group received dabrafenib monotherapy. There were no differences in adverse events (AEs) rate or grade between the groups. However, AE profiles were different between the groups, being pyrexia infrequent in patients at least 75 y.o. (13.8% vs. 42.3%; P = 0.005). Dabrafenib and trametinib dose intensities were lower in at least 75 y.o. patients (P = 0.018 and P = 0.020), but there were no differences in effectiveness between the groups. Finally, in a multivariate analysis, sex (female) was the only variable independently associated with an increased risk of AE grade ≥3. Data from the ELDERLYMEL study demonstrate that dabrafenib plus trametinib is safe and effective in at least 75 y.o. patients with advanced BRAF V600-mutated melanoma without increasing toxicity. Additionally, we describe a different safety profile depending on age and sex.
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8
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Dakup PP, Greer AJ, Gaddameedhi S. Let's talk about sex: a biological variable in immune response against melanoma. Pigment Cell Melanoma Res 2022; 35:268-279. [PMID: 35076986 PMCID: PMC9305920 DOI: 10.1111/pcmr.13028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/13/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
As science culture gravitates toward a more holistic inclusion of both males and females in research design, the outlining of sex differences and their respective intersections with disease physiology and pathophysiology should see reciprocal expansion. Melanoma skin cancer, for example, has observed a female advantage in incidence, mortality, and overall survival since the early 1970s. The exact biological mechanism of this trend, however, is unclear and further complicated by a layering of clinical variables such as skin phototype, age, and body mass index. In this perspective, we highlight epidemiological evidence of sex differences in melanoma and summarize the landscape of their potential origin. Among several biological hallmarks, we make a note of sex‐specific immune profiles—along with divergent hormonal regulation, social practices, DNA damage and oxidative stress responses, body composition, genetic variants, and X‐chromosome expression—as probable drivers of disparity in melanoma initiation and progression. This review further focuses the conversation of sex as an influencing factor in melanoma development and its potential implication for disease management and treatment strategies.
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Affiliation(s)
- Panshak P Dakup
- Department of Biological Sciences, North Carolina State University, Raleigh, 27606.,Present affiliation: Integrative Omics Group, Biological Sciences Division, Pacific Northwest National Laboratory, Richland
| | - Adam J Greer
- Department of Biological Sciences, North Carolina State University, Raleigh, 27606
| | - Shobhan Gaddameedhi
- Department of Biological Sciences, North Carolina State University, Raleigh, 27606.,Center for Human Health and the Environment, North Carolina State University, Raleigh, 27606
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9
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Chen P, Li B, Ou-Yang L. Role of estrogen receptors in health and disease. Front Endocrinol (Lausanne) 2022; 13:839005. [PMID: 36060947 PMCID: PMC9433670 DOI: 10.3389/fendo.2022.839005] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/26/2022] [Indexed: 12/14/2022] Open
Abstract
Estrogen receptors (ERs) regulate multiple complex physiological processes in humans. Abnormal ER signaling may result in various disorders, including reproductive system-related disorders (endometriosis, and breast, ovarian, and prostate cancer), bone-related abnormalities, lung cancer, cardiovascular disease, gastrointestinal disease, urogenital tract disease, neurodegenerative disorders, and cutaneous melanoma. ER alpha (ERα), ER beta (ERβ), and novel G-protein-coupled estrogen receptor 1 (GPER1) have been identified as the most prominent ERs. This review provides an overview of ERα, ERβ, and GPER1, as well as their functions in health and disease. Furthermore, the potential clinical applications and challenges are discussed.
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Affiliation(s)
| | - Bo Li
- *Correspondence: Bo Li, libo‐‐
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10
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Molecular Proof of a Clinical Concept: Expression of Estrogen Alpha-, Beta-Receptors and G Protein-Coupled Estrogen Receptor 1 (GPER) in Histologically Assessed Common Nevi, Dysplastic Nevi and Melanomas. Medicina (B Aires) 2021; 57:medicina57111228. [PMID: 34833446 PMCID: PMC8621316 DOI: 10.3390/medicina57111228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: Epidemiologic data show significant differences in melanoma incidence and outcomes between sexes. The role of hormonal receptors in the pathogenesis of melanocytic lesions remains unclear, thus we performed this study aiming to assess estrogen receptors expression in different melanocytic lesions. Materials and Methods: We performed a cross-sectional study that included 73 consecutively excised melanocytic lesions. Estrogen receptor alpha (ERα), beta (ERβ), and G-protein coupled estrogen receptor (GPER) expression was analyzed in melanocytes and keratinocytes of common nevi, dysplastic nevi, melanoma, healthy skin margin, and in sebaceous and sweat gland cells. Results: ERβ expression was higher in dysplastic nevi margin melanocytes compared to common nevi (p = 0.046) and in dysplastic nevi keratinocytes compared to melanoma keratinocytes (p = 0.021). ERβ expression was significantly higher in margin melanocytes compared to melanoma melanocytes (p = 0.009). No difference in ERβ expression was shown between melanocytes of three types of lesions. GPER expression was higher in nuclei and cytoplasm of dysplastic nevi (p = 0.02 and p = 0.036 respectively) and at the margin compared to melanoma. GPER expression was lower in sebaceous glands of tissue surrounding common nevi (p = 0.025) compared to dysplastic nevi. GPER expression was higher in skin margin tissue melanocytes (p = 0.016 nuclear, p = 0.029 cytoplasmic) compared to melanoma melanocytes. There were no differences in ERα expression between the melanocytic lesions. Conclusion: Further large-scale studies are warranted to investigate the potential role of ERβ and GPER in the pathogenesis of melanocytic lesions.
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11
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Sex-Based Differences in the Tumor Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1329:499-533. [PMID: 34664253 DOI: 10.1007/978-3-030-73119-9_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Cancers are heterogeneous multifactorial diseases consisting of a major public health issue worldwide. Sex disparities are evidenced in cancer incidence, mortality, expression of prognosis factor, response to treatment, and survival. For both sexes, an interplay of intrinsic and environmental factors influences cancer cells and tumor microenvironment (TME) components. The TME cumulates both supportive and communicative functions, contributing to cancer development, progression, and metastasis dissemination. The frontline topics of this chapter are focused on the contribution of sex, via steroid hormones, such as estrogens and androgens, on the following components of the TME: cancer-associated fibroblasts (CAFs), extracellular matrix (ECM), blood and lymphatic endothelial cells, and immunity/inflammatory system.
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12
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The Sex-Related Interplay between TME and Cancer: On the Critical Role of Estrogen, MicroRNAs and Autophagy. Cancers (Basel) 2021; 13:cancers13133287. [PMID: 34209162 PMCID: PMC8267629 DOI: 10.3390/cancers13133287] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/17/2021] [Accepted: 06/25/2021] [Indexed: 01/18/2023] Open
Abstract
The interplay between cancer cells and the tumor microenvironment (TME) has a fundamental role in tumor progression and response to therapy. The plethora of components constituting the TME, such as stroma, fibroblasts, endothelial and immune cells, as well as macromolecules, e.g., hormones and cytokines, and epigenetic factors, such as microRNAs, can modulate the survival or death of cancer cells. Actually, the TME can stimulate the genetically regulated programs that the cell puts in place under stress: apoptosis or, of interest here, autophagy. However, the implication of autophagy in tumor growth appears still undefined. Autophagy mainly represents a cyto-protective mechanism that allows cell survival but, in certain circumstances, also leads to the blocking of cell cycle progression, possibly leading to cell death. Since significant sex/gender differences in the incidence, progression and response to cancer therapy have been widely described in the literature, in this review, we analyzed the roles played by key components of the TME, e.g., estrogen and microRNAs, on autophagy regulation from a sex/gender-based perspective. We focused our attention on four paradigmatic and different forms of cancers-colon cancer, melanoma, lymphoma, and lung cancer-concluding that sex-specific differences may exert a significant impact on TME/cancer interaction and, thus, tumor growth.
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13
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Caroppo F, Tadiotto Cicogna G, Messina F, Alaibac M. Association between melanoma and exposure to sex hormones in puberty: A possible window of susceptibility (Review). Mol Clin Oncol 2021; 14:66. [PMID: 33680457 DOI: 10.3892/mco.2021.2228] [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] [Received: 07/18/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Abstract
The risk factors for melanoma in adolescents are similar to those in adults; however, it remains unclear whether these risk factors are also associated with melanoma in children. Epidemiological studies in the literature have reported a logarithmic increase in melanoma incidence after the age of 10 years. This may, in part, reflect the acute and chronic exposure to solar ultraviolet (UV) radiation during childhood. However, it appears unlikely that the cumulative exposure to UV radiation alone could explain such a sharp increase in melanoma incidence at the beginning of adolescence. It has been suggested that circulating sex hormones, the levels of which increase during puberty, may play a role in melanoma initiation and progression in predisposed individuals through binding to specific sex steroid receptors. The association between a longer cumulative exposure to sex hormones and the risk of melanoma may be supported by the reported epidemiological association between melanoma and several other sex hormone-related types of cancer, such as breast and prostate cancer, in which the enhanced exposure to androgens and estrogens was found to be directly associated with pubertal onset. Therefore, determining the association between pubertal onset and melanoma development may improve the current understanding of melanoma pathophysiology.
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Affiliation(s)
- Francesca Caroppo
- Dermatology Unit, Department of Medicine, University of Padova, I-35128 Padova, Italy
| | | | - Francesco Messina
- Dermatology Unit, Department of Medicine, University of Padova, I-35128 Padova, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, I-35128 Padova, Italy
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14
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Bellenghi M, Puglisi R, Pontecorvi G, De Feo A, Carè A, Mattia G. Sex and Gender Disparities in Melanoma. Cancers (Basel) 2020; 12:E1819. [PMID: 32645881 PMCID: PMC7408637 DOI: 10.3390/cancers12071819] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 07/03/2020] [Indexed: 12/19/2022] Open
Abstract
Worldwide, the total incidence of cutaneous melanoma is higher in men than in women, with some differences related to ethnicity and age and, above all, sex and gender. Differences exist in respect to the anatomic localization of melanoma, in that it is more frequent on the trunk in men and on the lower limbs in women. A debated issue is if-and to what extent-melanoma development can be attributed to gender-specific behaviors or to biologically intrinsic differences. In the search for factors responsible for the divergences, a pivotal role of sex hormones has been observed, although conflicting results indicate the involvement of other mechanisms. The presence on the X chromosome of numerous miRNAs and coding genes playing immunological roles represents another important factor, whose relevance can be even increased by the incomplete X chromosome random inactivation. Considering the known advantages of the female immune system, a different cancer immune surveillance efficacy was suggested to explain some sex disparities. Indeed, the complexity of this picture emerged when the recently developed immunotherapies unexpectedly showed better improvements in men than in women. Altogether, these data support the necessity of further studies, which consider enrolling a balanced number of men and women in clinical trials to better understand the differences and obtain actual gender-equitable healthcare.
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Affiliation(s)
- Maria Bellenghi
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Rossella Puglisi
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Giada Pontecorvi
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Alessandra De Feo
- Laboratory of Experimental Oncology, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Alessandra Carè
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
| | - Gianfranco Mattia
- Center for Gender-specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.B.); (R.P.); (G.P.); (G.M.)
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15
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The Melanoma and Breast Cancer Association: An Overview of their 'Second Primary Cancers' and the Epidemiological, Genetic and Biological correlations. Crit Rev Oncol Hematol 2020; 152:102989. [PMID: 32485529 DOI: 10.1016/j.critrevonc.2020.102989] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/22/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022] Open
Abstract
This study reviews the relevant epidemiological studies associating cutaneous melanoma and breast carcinomas and provides an overview of the possible genetic, biological and bias factors that underpin this relationship. Standardised incidence ratio (SIR) for primary cutaneous melanoma after breast carcinoma ranged from 1.16 to 5.13 and ranged from 1.03 to 4.10 for primary breast carcinoma after cutaneous melanoma. Epidemiological studies highlight age, gender and use of radiotherapy and chemotherapy as potential risk factors for second primary cancers (SPCs). Mutations in BRCA2, CDKN2A, CDK4 and BAP1 may partly underlie any SPC association. The impact of socio-cultural factors and surveillance bias may be attributed to the findings of SPC partially or entirely. In conclusion, this study has highlighted the association between breast carcinoma and melanoma and identified various factors for further research and the optimised management of patients with both cancers.
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16
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17
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Hieken TJ, Glasgow AE, Enninga EAL, Kottschade LA, Dronca RS, Markovic SN, Block MS, Habermann EB. Sex-Based Differences in Melanoma Survival in a Contemporary Patient Cohort. J Womens Health (Larchmt) 2020; 29:1160-1167. [PMID: 32105561 DOI: 10.1089/jwh.2019.7851] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: A female survival advantage in cutaneous melanoma has been long recognized. However, whether this extends across all age groups, with risk stratification using the latest prognostic staging system or in the current era of efficacious systemic therapies is unknown. Therefore, we evaluated whether sex-based differences in melanoma survival persisted within a recent population-based patient cohort with consideration of these factors. Materials and Methods: We identified stage II-IV cutaneous melanoma patients from 2010 to 2014 Surveillance, Epidemiology, and End Results cancer registries data. We recalculated stage per American Joint Committee on Cancer 8th edition guidelines. Cancer-specific survival (CSS) was estimated by using the Kaplan-Meier method and multivariable Cox proportional hazards regression. Results: Of 16,807 patients (39.8% female), 8,990 were stage II, 4,826 stage III, and 2,991 stage IV at diagnosis. Unadjusted 3-/5-year CSS estimates for females versus males were 64.2% versus 59.7%, and 53.5% versus 49.9%, respectively, p ≤ 0.0001. Five-year CSS varied within each stage and across age strata of <45, 45 - 59, and ≥60 years. Within each stage, females <45 had better CSS than all other sex/age groups (p < 0.0001). In multivariable analysis of stage II/III patients, female sex, younger age, and lower mitotic index retained favorable CSS prognostic significance (p < 0.001). Conclusions: Sex-based differences in melanoma survival persist in a contemporary patient cohort staged with the latest prognostic system. These data may guide decision marking regarding adjuvant therapy, highlight the importance of including sex as a pre-specified clinical trial variable, and suggest that investigation of underlying biologic mechanisms may drive discovery of biomarkers and therapeutic targets to improve patient care.
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Affiliation(s)
- Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy E Glasgow
- Department of Robert D. and Patricia E. Kern for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Roxana S Dronca
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matthew S Block
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth B Habermann
- Department of Robert D. and Patricia E. Kern for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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18
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Liu M, Du Y, Li H, Wang L, Ponikwicka-Tyszko D, Lebiedzinska W, Pilaszewicz-Puza A, Liu H, Zhou L, Fan H, Wang M, You H, Wolczynnski S, Rahman N, Guo YD, Li X. Cyanidin-3-o-Glucoside Pharmacologically Inhibits Tumorigenesis via Estrogen Receptor β in Melanoma Mice. Front Oncol 2019; 9:1110. [PMID: 31696058 PMCID: PMC6817467 DOI: 10.3389/fonc.2019.01110] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 10/07/2019] [Indexed: 01/25/2023] Open
Abstract
Expression patterns of estrogen receptors [ERα, ERβ, and G-protein associated ER (GPER)] in melanoma and skin may suggest their differential roles in carcinogenesis. Phytoestrogenic compound cyanidin-3-o-glucoside (C3G) has been shown to inhibit the growth and metastatic potential of melanoma, although the underlying molecular mechanism remains unclear. The aim of this study was to clarify the mechanism of action of C3G in melanoma in vitro and in vivo, as well as to characterize the functional expressions of ERs in melanoma. In normal skin or melanoma (n = 20/each), no ERα protein was detectable, whereas expression of ERβ was high in skin but weak focal or negative in melanoma; and finally high expression of GPER in all skin vs. 50% melanoma tissues (10/20) was found. These results correspond with our analysis of the melanoma survival rates (SRs) from Human Protein Atlas and The Cancer Genome Atlas GDC (362 patients), where low ERβ expression in melanoma correlate with a poor relapse-free survival, and no correlations were observed between SRs and ERα or GPER expression in melanoma. Furthermore, we demonstrated that C3G treatment arrested the cell cycle at the G2/M phase by targeting cyclin B1 (CCNB1) and promoted apoptosis via ERβ in both mouse and human melanoma cell lines, and inhibited melanoma cell growth in vivo. Our study suggested that C3G elicits an agonistic effect toward ERβ signaling enhancement, which may serve as a potential novel therapeutic and preventive approach for melanoma.
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Affiliation(s)
- Mei Liu
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.,State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China.,Department of Pathology, Chinese PLA General Hospital, Beijing, China
| | - Yaqi Du
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.,State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Haiwen Li
- State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Li Wang
- State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Donata Ponikwicka-Tyszko
- Department of Biology and Pathology of Human Reproduction, Institute of Animal Reproduction and Food Research, Polish Academy of Sciences, Olsztyn, Poland
| | - Weronika Lebiedzinska
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
| | - Agata Pilaszewicz-Puza
- Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland
| | - Huijiao Liu
- State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Lijun Zhou
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.,State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Hanlu Fan
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.,State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Mingming Wang
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.,State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Hua You
- State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China.,Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
| | - Slawomir Wolczynnski
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland
| | - Nafis Rahman
- Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland.,Institute of Biomedicine, University of Turku, Turku, Finland
| | - Yang-Dong Guo
- State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China
| | - Xiangdong Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health, China Agricultural University, Beijing, China.,State Key Laboratory of the Agro-Biotechnology, College of Horticultural Science, China Agricultural University, Beijing, China.,Department of Reproduction and Gynecological Endocrinology, Medical University of Bialystok, Bialystok, Poland.,Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
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19
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Innate immune cell infiltration in melanoma metastases affects survival and is associated with BRAFV600E mutation status. Melanoma Res 2019; 29:30-37. [PMID: 30299387 DOI: 10.1097/cmr.0000000000000515] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about the infiltrative pattern of innate immune cells in primary melanoma compared with their paired metastases and in BRAF-mutated tumors. Therefore, our aim was to characterize the inflammatory microenvironment in primary ulcerated and nonulcerated melanomas and paired metastases, to investigate the relation between inflammation and BRAF mutation in primary melanoma and paired metastases, and to evaluate the effect of the analyzed biomarkers on melanoma-specific survival. A total of 385 primary tumors and 96 paired metastases were stained with immunohistochemistry for BRAF, CD163+ macrophages, CD123+ plasmacytoid dendritic cells, CD66b+ neutrophils, and E-cadherin and estimated using objective computer-assisted image analysis. BRAF was semiquantitatively scored as either present or absent. In metastases of nonulcerated melanomas, we observed higher neutrophil (P=0.02) and macrophage (P=0.01) numbers. In the metastases of ulcerated melanomas, we found a higher number of macrophages (P<0.0001). Increase in the neutrophil numbers in the metastases was associated with poor patient survival after first relapse (hazard ratio=1.19, 95% confidence interval: 1.03-1.38, P=0.02). BRAF-positive primary tumors (P=0.02) and metastases (P=0.01) exhibited increased plasmacytoid dendritic cell numbers compared with BRAF-negative tumors. Lastly, primary melanomas in men had higher neutrophil numbers than women (P≤0.0001), and men had worse melanoma-specific survival (hazard ratio=1.52, 95% confidence interval: 1.04-2.21, P=0.03). Our data show that melanoma metastases are densely infiltrated with neutrophils, which affects survival. Our results also highlight the importance of recognizing the presence of inflammatory cells in the metastases as a prognostic marker, and that they may potentially be used to improve the precision of immunotherapy and BRAF targeted therapy.
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20
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Abstract
PURPOSE OF REVIEW The goal of this review has been to elucidate the sex differences in cancer incidence and mortality in cutaneous melanoma. We have evaluated biological and behavioral research to determine where the critical questions exist. RECENT FINDINGS The most recent findings, through 2015, are exploratory in nature but seem to indicate that the differences are more likely due to biological variations rather than behavioral. While behavioral studies do show that women are more likely than men to seek health care and practice healthy behaviors, these differences are not sufficiently strong to explain the variation in incidence and mortality in cutaneous melanoma. Evolved differences in the immune systems of females and the role of sex steroid hormones in immunomodulation are two promising avenues for research. Studies in mice demonstrate that the newer immunotherapies are more effective in females and sex steroid hormones, such as estrogen receptor beta are inversely associated with tumor aggressiveness while testosterone increases it. SUMMARY Our analysis indicates that biological factors need to be investigated more thoroughly to understand the variation in incidence and mortality in cutaneous melanoma. Such understanding could lead to reducing incidence and mortality for both males and females (male incidence is 27.4 per 100,000; female 16.8 per 100,000; male mortality is 3.9 per 100,000; female mortality 1.6 per 100,000). It is most likely that behavioral differences between the sexes cannot account for the preponderance of male mortality. In addition to the important role of genetic factors, it is critical to evaluate further additional biological factors and their interactions with genetics and behavior.
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Affiliation(s)
| | - Li Luo
- University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine
| | - Marianne Berwick
- University of New Mexico Comprehensive Cancer Center, Department of Internal Medicine and Department of Dermatology
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21
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Lira FE, Podlipnik S, Potrony M, Tell-Martí G, Calbet-Llopart N, Barreiro A, Carrera C, Malvehy J, Puig S. Inherited MC1R variants in patients with melanoma are associated with better survival in women. Br J Dermatol 2019; 182:138-146. [PMID: 31016712 PMCID: PMC6973087 DOI: 10.1111/bjd.18024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2019] [Indexed: 01/01/2023]
Abstract
Background Women have a better melanoma prognosis, and fairer skin/hair colour. The presence of inherited MC1R variants has been associated with a better melanoma prognosis, but its interaction with sex is unknown. Objectives To evaluate the relationship between germline MC1R status and survival, and determine any association with sex. Methods This was a cohort study including 1341 patients with melanoma from the Melanoma Unit of the Hospital Clinic of Barcelona, between January 1996 and April 2018. We examined known sex‐related prognosis factors as they relate to features of melanoma and evaluated the sex‐specific role of MC1R in overall and melanoma‐specific survival. Hazard ratios (HRs) were calculated using univariate and multivariate Cox logistic regression. Results Men showed lower overall survival than women (P < 0·001) and the presence of inherited MC1R variants was not associated with better survival in our cohort. However, in women the presence of MC1R variants was associated with better overall survival in the multivariate analysis [HR 0·57, 95% confidence interval (CI) 0·38–0·85; P = 0·006] but not in men [HR 1·26, 95% CI 0·89–1·79; P = 0·185 (P‐value for interaction 0·004)]. Analysis performed for melanoma‐specific survival showed the same level of significance. Conclusions Inherited MC1R variants are associated with improved overall survival in women with melanoma but not in men. Intrinsic sex‐dependent features can modify the role of specific genes in melanoma prognosis. We believe that survival studies of patients with melanoma should include analysis by sex and MC1R genotype. What's already known about this topic? Inherited MC1R variants have been associated with a better melanoma prognosis, but their interaction with sex is unknown.
What does this study add? MC1R variants are related to better overall survival and melanoma‐specific survival in women but not in men.
What is the translational message? These differences between the sexes could imply future changes in melanoma follow‐up and treatment strategies. This provides a basis for understanding the interaction between sex‐related genes and germline variants in cancer.
https://www.bjdonline.com/article/ Linked Editorial:https://doi.org/10.1111/bjd.18555
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Affiliation(s)
- F E Lira
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - S Podlipnik
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - M Potrony
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - G Tell-Martí
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - N Calbet-Llopart
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - A Barreiro
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - C Carrera
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - J Malvehy
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - S Puig
- Dermatology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
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22
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Deli T, Orosz M, Jakab A. Hormone Replacement Therapy in Cancer Survivors - Review of the Literature. Pathol Oncol Res 2019; 26:63-78. [PMID: 30617760 PMCID: PMC7109141 DOI: 10.1007/s12253-018-00569-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 12/18/2018] [Indexed: 12/17/2022]
Abstract
Rapid advance in oncology leads to increasing survival of oncologic patients. More and more of them live long enough to reach either the natural age of menopause or, as a side effect of their oncotherapy, experience the cessation of gonadal function, leading to premature ovarian insufficiency, with disturbing vasomotor symtoms and long-term negative cardiovascular and skeletal effects. Thus, an ever increasing number of cancer survivors search endocrinologic help in the form of hormone replacement therapy (HRT). The misinterpretation of the WHI (Women's Health Initiative) Study has lead to an irrational fear of female hormone replacement, both by the general population and medical professionals. It has seemed the logical and safe conclusion to many physicians to avoid HRT, supposing that this attitude definitely causes no harm, whereas the decision of prescribing estrogen alone or with progestins might bear oncologic and thromboembolic risks and may even lead to litigation in case of a potentially related complication. However, it was known even before the WHI results that premature menopause and hypogonadism decreases the life expectancy of women by years through its skeletal and cardiovascular effects, and this negative effect correlates with the length of the hypoestrogenaemic period. Therefore, the denial of HRT also needs to be supported by evidence and should be weighed againts the risks of HRT. Yet, the oncologic risk of HRT is extremely difficult to assess. In this work we review the latest evidence from in vitro experiments to clinical studies, regarding HRT in survivors of gynecologic and non-gynecologic cancers. Based on our literature research, we group tumours regarding the oncologic risk of properly chosen female hormone replacement therapy in cancer survivors as follows: ’HRT is advanageous’ (e.g. endometrial cancer type I, cervical adenocarcinoma, haematologic malignancies, local cutaneous malignant melanoma, colorectal cancer, hepatocellular cancer); ’HRT is neutral’ (e.g. BRCA 1/2 mutation carriers without cancer, endometrial cancer type II, uterinal carcinosarcoma and adenosarcoma, certain types of ovarian cancer, cervical, vaginal and vulvar squamous cell carcinoma, prolactinoma, kidney cancer, pancreatic cancer, thyroid cancer); ’HRT is relatively contraindicated’ for various reasons (e.g. leiomyosarcoma, certain types of ovarian tumours, brain tumours, advanced metastatic malignant melanoma, lung cancer, gastric cancer, bladder cancer); ’HRT is diasadvantageous and thus contraindicated’ (e.g. breast cancer, endometrial stroma sarcoma, meningioma, glioma, hormone receptor positive gastric and bladder cancer).
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Affiliation(s)
- Tamás Deli
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Mónika Orosz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Attila Jakab
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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23
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Berk-Krauss J, Bieber AK, Criscito MC, Grant-Kels JM, Driscoll MS, Keltz M, Pomeranz MK, Martires KJ, Liebman TN, Stein JA. Melanoma risk after in vitro fertilization: A review of the literature. J Am Acad Dermatol 2018; 79:1133-1140.e3. [DOI: 10.1016/j.jaad.2018.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 07/02/2018] [Accepted: 07/07/2018] [Indexed: 01/07/2023]
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24
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De Giorgi V, Gori A, Greco A, Savarese I, Alfaioli B, Grazzini M, Rossari S, Papi F, Scarfi F, Janowska A, D’Errico A, Salvati L, Covarelli P, Gandini S. Sun-Protection Behavior, Pubertal Development and Menarche: Factors Influencing the Melanocytic Nevi Development—The Results of an Observational Study of 1,512 Children. J Invest Dermatol 2018; 138:2144-2151. [DOI: 10.1016/j.jid.2018.02.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 11/29/2022]
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25
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Li B, Wang Y, Xu Y, Liu H, Bloomer W, Zhu D, Amos CI, Fang S, Lee JE, Li X, Han J, Wei Q. Genetic variants in RORA and DNMT1 associated with cutaneous melanoma survival. Int J Cancer 2018; 142:2303-2312. [PMID: 29313974 PMCID: PMC5893376 DOI: 10.1002/ijc.31243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
Cutaneous melanoma (CM) is considered as a steroid hormone-related malignancy. However, few studies have evaluated the roles of genetic variants encoding steroid hormone receptor genes and their related regulators (SHR-related genes) in CM-specific survival (CMSS). Here, we performed a pathway-based analysis to evaluate genetic variants of 191 SHR-related genes in 858 CMSS patients using a dataset from a genome-wide association study (GWAS) from The University of Texas MD Anderson Cancer Center (MDACC), and then validated the results in an additional dataset of 409 patients from the Harvard GWAS. Using multivariate Cox proportional hazards regression analysis, we identified three-independent SNPs (RORA rs782917 G > A, RORA rs17204952 C > T and DNMT1 rs7253062 G > A) as predictors of CMSS, with a variant-allele attributed hazards ratio (HR) and 95% confidence interval of 1.62 (1.25-2.09), 1.60 (1.20-2.13) and 1.52 (1.20-1.94), respectively. Combined analysis of risk genotypes of these three SNPs revealed a decreased CMSS in a dose-response manner as the number of risk genotypes increased (ptrend < 0.001); however, no improvement in the prediction model was observed (area under the curve [AUC] = 79.6-80.8%, p = 0.656), when these risk genotypes were added to the model containing clinical variables. Our findings suggest that genetic variants of RORA and DNMT1 may be promising biomarkers for CMSS, but these results needed to be validated in future larger studies.
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Affiliation(s)
- Bo Li
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, PR China
| | - Yanru Wang
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yinghui Xu
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, PR China
| | - Hongliang Liu
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Wendy Bloomer
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Dakai Zhu
- Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Christopher I. Amos
- Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Shenying Fang
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey E. Lee
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Xin Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jiali Han
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
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26
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McQuade JL, Daniel CR, Hess KR, Mak C, Wang DY, Rai RR, Park JJ, Haydu LE, Spencer C, Wongchenko M, Lane S, Lee DY, Kaper M, McKean M, Beckermann KE, Rubinstein SM, Rooney I, Musib L, Budha N, Hsu J, Nowicki TS, Avila A, Haas T, Puligandla M, Lee S, Fang S, Wargo JA, Gershenwald JE, Lee JE, Hwu P, Chapman PB, Sosman JA, Schadendorf D, Grob JJ, Flaherty KT, Walker D, Yan Y, McKenna E, Legos JJ, Carlino MS, Ribas A, Kirkwood JM, Long GV, Johnson DB, Menzies AM, Davies MA. Association of body-mass index and outcomes in patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy: a retrospective, multicohort analysis. Lancet Oncol 2018; 19:310-322. [PMID: 29449192 PMCID: PMC5840029 DOI: 10.1016/s1470-2045(18)30078-0] [Citation(s) in RCA: 440] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Obesity has been linked to increased mortality in several cancer types; however, the relation between obesity and survival outcomes in metastatic melanoma is unknown. The aim of this study was to examine the association between body-mass index (BMI) and progression-free survival or overall survival in patients with metastatic melanoma who received targeted therapy, immunotherapy, or chemotherapy. METHODS This retrospective study analysed independent cohorts of patients with metastatic melanoma assigned to treatment with targeted therapy, immunotherapy, or chemotherapy in randomised clinical trials and one retrospective study of patients treated with immunotherapy. Patients were classified according to BMI, following the WHO definitions, as underweight, normal, overweight, or obese. Patients without BMI and underweight patients were excluded. The primary outcomes were the associations between BMI and progression-free survival or overall survival, stratified by treatment type and sex. We did multivariable analyses in the independent cohorts, and combined adjusted hazard ratios in a mixed-effects meta-analysis to provide a precise estimate of the association between BMI and survival outcomes; heterogeneity was assessed with meta-regression analyses. Analyses were done on the predefined intention-to-treat population in the randomised controlled trials and on all patients included in the retrospective study. FINDINGS The six cohorts consisted of a total of 2046 patients with metastatic melanoma treated with targeted therapy, immunotherapy, or chemotherapy between Aug 8, 2006, and Jan 15, 2016. 1918 patients were included in the analysis. Two cohorts containing patients from randomised controlled trials treated with targeted therapy (dabrafenib plus trametinib [n=599] and vemurafenib plus cobimetinib [n=240]), two cohorts containing patients treated with immunotherapy (one randomised controlled trial of ipilimumab plus dacarbazine [n=207] and a retrospective cohort treated with pembrolizumab, nivolumab, or atezolizumab [n=331]), and two cohorts containing patients treated with chemotherapy (two randomised controlled trials of dacarbazine [n=320 and n=221]) were classified according to BMI as normal (694 [36%] patients), overweight (711 [37%]), or obese (513 [27%]). In the pooled analysis, obesity, compared with normal BMI, was associated with improved survival in patients with metastatic melanoma (average adjusted hazard ratio [HR] 0·77 [95% CI 0·66-0·90] for progression-free survival and 0·74 [0·58-0·95] for overall survival). The survival benefit associated with obesity was restricted to patients treated with targeted therapy (HR 0·72 [0·57-0·91] for progression-free survival and 0·60 [0·45-0·79] for overall survival) and immunotherapy (HR 0·75 [0·56-1·00] and 0·64 [0·47-0·86]). No associations were observed with chemotherapy (HR 0·87 [0·65-1·17, pinteraction=0·61] for progression-free survival and 1·03 [0·80-1·34, pinteraction=0·01] for overall survival). The association of BMI with overall survival for patients treated with targeted and immune therapies differed by sex, with inverse associations in men (HR 0·53 [0·40-0·70]), but no associations observed in women (HR 0·85 [0·61-1·18, pinteraction=0·03]). INTERPRETATION Our results suggest that in patients with metastatic melanoma, obesity is associated with improved progression-free survival and overall survival compared with those outcomes in patients with normal BMI, and that this association is mainly seen in male patients treated with targeted or immune therapy. These results have implications for the design of future clinical trials for patients with metastatic melanoma and the magnitude of the benefit found supports further investigation of the underlying mechanism of these associations. FUNDING ASCO/CCF Young Investigator Award, ASCO/CCF Career Development Award, MD Anderson Cancer Center (MDACC) Melanoma Moonshot Program, MDACC Melanoma SPORE, and the Dr Miriam and Sheldon G Adelson Medical Research Foundation.
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Affiliation(s)
- Jennifer L. McQuade
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Carrie R. Daniel
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Kenneth R. Hess
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Carmen Mak
- Independent Statistical Consultant, Westfield, NJ, USA 07091
| | - Daniel Y. Wang
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Rajat R. Rai
- Melanoma Institute Australia and The University of Sydney; 40 Rocklands Rd, North Sydney 2060, NSW, Australia
| | - John J. Park
- Crown Princess Mary Cancer Centre, Westmead Hospital, 166-174 Hawkesbury Rd, Westmead NSW 2145, Sydney, Australia
| | - Lauren E. Haydu
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Christine Spencer
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | | | - Stephen Lane
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, USA 07936
| | - Dung-Yang Lee
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, USA 07936
| | - Mathilde Kaper
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, USA 07936
| | - Meredith McKean
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Kathryn E Beckermann
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Samuel M. Rubinstein
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Isabelle Rooney
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Luna Musib
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Nageshwar Budha
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jessie Hsu
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Theodore S. Nowicki
- University of California Los Angeles Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | | | - Tomas Haas
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, USA 07936
| | - Maneka Puligandla
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
| | - Sandra Lee
- Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
| | - Shenying Fang
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Jennifer A. Wargo
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Jeffrey E Gershenwald
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Jeffrey E. Lee
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Patrick Hwu
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
| | - Paul B. Chapman
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jeffrey A. Sosman
- Northwestern University, 675 N. Saint Clair St., Galter Pavilion, Chicago, IL 60611, USA
| | - Dirk Schadendorf
- University Hospital Essen & German Cancer Consortium, Hufelandstraße 55, 45147, Essen, Germany
| | - Jean-Jacques Grob
- Centre Hospitalo-Universitaire Timone, Aix Marseille University, 264 Rue St Pierre, 13885 Marseille CEDEX 05, France
| | - Keith T. Flaherty
- Massachusetts General Hospital Cancer Center, 55 Fruit Street, Boston, MA, USA 02114
| | - Dana Walker
- Bristol-Myers Squibb, 345 Park Ave, New York, NY 10154, USA
| | - Yibing Yan
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Edward McKenna
- Genentech, Inc., 1 DNA Way, South San Francisco, CA 94080, USA
| | - Jeffrey J. Legos
- Novartis Pharmaceuticals Corporation, 1 Health Plaza, East Hanover, NJ, USA 07936
| | - Matteo S. Carlino
- Melanoma Institute Australia and The University of Sydney; 40 Rocklands Rd, North Sydney 2060, NSW, Australia,Crown Princess Mary Cancer Centre, Westmead Hospital, 166-174 Hawkesbury Rd, Westmead NSW 2145, Sydney, Australia
| | - Antoni Ribas
- University of California Los Angeles Medical Center, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
| | - John M. Kirkwood
- Hillman University of Pittsburgh Medical Center Cancer Center, 5117 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Georgina V. Long
- Melanoma Institute Australia and The University of Sydney; 40 Rocklands Rd, North Sydney 2060, NSW, Australia,Royal North Shore and Mater Hospitals Reserve Rd, St Leonards NSW 2065, Australia
| | - Douglas B. Johnson
- Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Alexander M Menzies
- Melanoma Institute Australia and The University of Sydney; 40 Rocklands Rd, North Sydney 2060, NSW, Australia,Royal North Shore and Mater Hospitals Reserve Rd, St Leonards NSW 2065, Australia
| | - Michael A. Davies
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA 77030
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27
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Tchernev G, Dzhelyatova GA, Wollina U, Lozev I, Lotti T. Medium Sized Congenital Melanocytic Nevus with Suspected Progression to Melanoma during Pregnancy: What's the Best for the Patient? Open Access Maced J Med Sci 2018; 6:143-145. [PMID: 29484013 PMCID: PMC5816287 DOI: 10.3889/oamjms.2018.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/17/2017] [Accepted: 09/24/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Congenital melanocytic nevi (CMN) are pigmented skin lesions usually present at birth. Rare varieties can develop and become clinically very large. Although they are benign nevomelanocytic neoplasms, all CMN may be precursors of the melanoma, regardless of their size. Individual risk of malignant transformation of melanocyte is determined by simultaneous action of exogenous and endogenous factors. The major exogenous risk factor is ultraviolet radiation. Leading roles among the endogenous factors are attributed to skin phenotype, gene mutation, sex hormones and their significance. CASE REPORT: We present a case of a 27 – year - old pregnant female patient with a congenital melanocytic nevus, which increased significantly in size, during her pregnancy. Estrogen levels increase during pregnancy and clinical evidence has suggested that melanocytes are estrogen - responsive. Nevi in a pregnant patient would exhibit increased expression of estrogen receptor β (ERβ) and thus enhanced the potential to respond to altered estrogen levels. CONCLUSION: All pigmented skin lesions should be carefully observed during pregnancy by a dermatologist due to the increased risk of malignant transformation, associated with the endocrine dependence. All lesions with visible changes should be removed surgically with appropriative anaesthesia.
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Affiliation(s)
- Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.,"Onkoderma"- Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | | | - Uwe Wollina
- Städtisches Klinikum Dresden - Department of Dermatology and Allergology, Dresden, Sachsen, Germany
| | - Ilia Lozev
- Medical Institute of Ministry of Interior Department of General, Vascular and Abdominal Surgery, Sofia, Bulgaria
| | - Torello Lotti
- University G. Marconi of Rome - Dermatology and Venereology, Rome, Italy
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28
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Enninga EAL, Moser JC, Weaver AL, Markovic SN, Brewer JD, Leontovich AA, Hieken TJ, Shuster L, Kottschade LA, Olariu A, Mansfield AS, Dronca RS. Survival of cutaneous melanoma based on sex, age, and stage in the United States, 1992-2011. Cancer Med 2017; 6:2203-2212. [PMID: 28879661 PMCID: PMC5633552 DOI: 10.1002/cam4.1152] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/02/2017] [Accepted: 07/06/2017] [Indexed: 01/08/2023] Open
Abstract
Women diagnosed with cutaneous melanoma have a survival advantage compared to men, which has been hypothesized to be due to difference in behavior and/or biology (sex hormones). It remains controversial whether this advantage is dependent on age or stage of disease. We sought to compare melanoma-specific survival between females in pre, peri, and postmenopausal age groups to males in the same age group, adjusting for stage of disease. This is a retrospective population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed from 1 January 1992 through 31 January 2011 with primary invasive cutaneous melanoma were included in our cohort. Melanoma-specific survival was the main outcome studied. Of the 106,511 subjects that were included, 45% were female. Females in all age groups (18-45, 46-54, and ≥55) with localized and regional disease, were less likely to die from melanoma compared to males in the same age group. Among patients with localized and regional disease, the relative risk of death due to melanoma increased with advancing age at diagnosis; this increase was more pronounced among females than males. In contrast, we observed no female survival advantage among patients with distant disease and no effect of age on relative risk of death from melanoma. Females with localized and regional melanoma have a decreased risk of death compared to males within all age groups. Our data show no differences in survival between men and women with metastatic melanoma, indicating that the influence of sex on survival is limited to early stage disease but not confined to pre or perimenopausal age groups.
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Affiliation(s)
- Elizabeth Ann L. Enninga
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Justin C. Moser
- Huntsman Cancer InstituteDivisions of Hematology and OncologyUniversity of Utah30 N 1900 ESalt Lake CityUtah84132France
| | - Amy L. Weaver
- Biomedical Statistics and InformaticsMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Svetomir N. Markovic
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Jerry D. Brewer
- Department of DermatologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Alexey A. Leontovich
- Biomedical Statistics and InformaticsMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Tina J. Hieken
- Department of SurgeryMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Lynne Shuster
- Huntsman Cancer InstituteDivisions of Hematology and OncologyUniversity of Utah30 N 1900 ESalt Lake CityUtah84132France
| | - Lisa A. Kottschade
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Ariadna Olariu
- Department of SurgeryNotre Dame des AydesNotre Dame des Aydes 11 Rue FranciadeBlois41000France
| | - Aaron S. Mansfield
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Roxana S. Dronca
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
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29
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Fábián M, Rencz F, Krenács T, Brodszky V, Hársing J, Németh K, Balogh P, Kárpáti S. Expression of G protein-coupled oestrogen receptor in melanoma and in pregnancy-associated melanoma. J Eur Acad Dermatol Venereol 2017; 31:1453-1461. [PMID: 28467693 DOI: 10.1111/jdv.14304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/29/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The hormone sensitivity of melanoma and the role of 'classical' oestrogen receptor (ER) α and β in tumour progression have been intensively studied with rather contradictory results. The presence of 'non-classical' G protein-coupled oestrogen receptor (GPER) has not been investigated on human melanoma tissues. OBJECTIVE To analyse the expression of GPER, ERα and ERβ in pregnancy-associated (PAM) and in non-pregnancy-associated (NPAM) melanomas in correlation with traditional prognostic markers and disease-free survival (DFS). METHODS Receptor protein levels were tested using immunohistochemistry in 81 formalin-fixed paraffin-embedded melanoma tissues. PAMs (n = 38) were compared with age- and Breslow thickness-matched cases (n = 43) including non-pregnant women (NPAM-W) (n = 22) and men (NPAM-M) (n = 21). The association between receptor expression and DFS was analysed by uni- and multivariate Cox proportional hazards regression. RESULTS G protein-coupled oestrogen receptor was detected both in PAMs and NPAMs. In 39 of the 41 (95.1%) GPER-positive melanomas, GPER and ERβ were co-expressed. GPER/ERβ-positive melanomas were significantly more common in PAM compared to NPAM (P = 0.0001) with no significant difference between genders (P = 0.4383). In PAMs, the distribution of GPER and ERβ was similar (78.4% vs. 81.6%; P = 0.8504), while in NPAM, ERβ was the representative ER (60.5% vs. 27.9%; P = 0.0010) without gender difference (59.1% vs. 61.9%). GPER-/ERβ-positive melanomas were associated with lower Breslow thickness, lower mitotic rate and higher presence of peritumoral lymphocyte infiltration (PLI) compared to GPER-/ERβ-negative cases (P = 0.0156, P = 0.0036 and P = 0.0001) predicting a better DFS (HR = 0.785, 95% CI 0.582-1.058). Despite the significantly higher frequency of GPER and ERβ expression in PAM, no significant difference was found in DFS between PAM and NPAM. All but one case failed to show ERα expression. CONCLUSIONS The presence of GPER and its simultaneous expression with ERβ can serve as a new prognostic indicator in a significant subpopulation of melanoma patients.
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Affiliation(s)
- M Fábián
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - T Krenács
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary.,MTA-SE Tumour Progression Research Group, Budapest, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - J Hársing
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - K Németh
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - P Balogh
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - S Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
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30
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Gori A, Savarese I, D'Errico A, Grazzini M, Papi F, Maio V, Covarelli P, Massi D, Gandini S, De Giorgi V. Estrogen receptor (ER)β expression and worse outcome from melanoma in pregnant and perimenopausal women. J Am Acad Dermatol 2016; 75:e117. [PMID: 27543235 DOI: 10.1016/j.jaad.2016.02.1245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Alessia Gori
- Cancer Research "Attilia Pofferi" Foundation, Pistoia, Italy
| | - Imma Savarese
- Department of Dermatology, University of Florence, Florence, Italy
| | | | - Marta Grazzini
- Department of Dermatology, University of Florence, Florence, Italy
| | - Federica Papi
- Department of Dermatology, University of Florence, Florence, Italy
| | - Vincenza Maio
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy
| | - Piero Covarelli
- Department of Surgery, University of Perugia, Perugia, Italy
| | - Daniela Massi
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy
| | - Sara Gandini
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Vincenzo De Giorgi
- Cancer Research "Attilia Pofferi" Foundation, Pistoia, Italy; Department of Dermatology, University of Florence, Florence, Italy.
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31
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Kreicher KL, Honda KS, Kurlander DE, Bordeaux JS. Hormone receptor expression in patients with dermatofibrosarcoma protuberans. J Am Acad Dermatol 2016; 75:1205-1209. [PMID: 27542587 DOI: 10.1016/j.jaad.2016.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/01/2016] [Accepted: 07/08/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma for which the exact etiology is unknown. Case reports exist of DFSP appearing and growing rapidly during pregnancy, suggesting a hormonal role. OBJECTIVE Our goal was to determine the expression of estrogen receptors (ERs) and progesterone receptors (PRs) in patients with DFSP. METHODS Archived formalin-fixed, paraffin-embedded tissue from patients with DFSP in the past 20 years at a single institution were analyzed for ER and PR using immunohistochemistry. A semiquantitative scoring method was used to evaluate the expression as positive or negative. Analysis was used to determine whether there was an association between receptor positivity and tumor site, age at diagnosis, sex, race, or disease recurrence. RESULTS Forty-four patients with DFSP were included in the study. Tumors were 22.7% ER+/PR+, 34.1% ER+/PR-, 9.1% ER-/PR+, and 34.1% ER-/PR-. There was no significant association between expression of ER and PR and sex, age at diagnosis, race, or tumor location. Loss of receptor expression was observed in all recurrent tumors. LIMITATIONS This study is limited by a lack of follow-up and a new scoring system. CONCLUSIONS The data presented warrant additional study to determine hormone receptor function and the potential efficacy of antihormone therapies for the treatment of patients with DFSP.
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Affiliation(s)
- Kathryn L Kreicher
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
| | - Kord S Honda
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Pathology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - David E Kurlander
- Department of Plastic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy S Bordeaux
- Department of Dermatology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
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32
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Kuhle CL, Kapoor E, Sood R, Thielen JM, Jatoi A, Faubion SS. Menopausal hormone therapy in cancer survivors: A narrative review of the literature. Maturitas 2016; 92:86-96. [PMID: 27621244 DOI: 10.1016/j.maturitas.2016.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 12/25/2022]
Abstract
Decision making regarding the use of menopausal hormone therapy (MHT) for the treatment of bothersome menopausal symptoms in a cancer survivor can be complex, and includes assessment of its impact on disease-free or overall survival. Estrogen receptors are present in several cancer types, but this does not always result in estrogen-mediated tumor proliferation and adverse cancer-related outcomes. Estrogen may even be protective against certain cancers. Menopausal hormone therapy is associated with an increased risk of recurrence and mortality after diagnosis of some cancer types, but not others. We provide a narrative review of the medical literature regarding the risk of cancer recurrence and associated mortality with initiation of MHT after the diagnosis of breast, gynecologic, lung, colorectal, hematologic cancers, and melanoma. Menopausal hormone therapy may be considered for management of bothersome menopausal symptoms in women with some cancer types (e.g., colorectal and hematologic cancer, localized melanoma, and most cervical, vulvar and vaginal cancers), while nonhormonal treatment options may be preferred for others (e.g., breast cancer). In women with other cancer types, recommendations are less straightforward, and the use of MHT must be individualized.
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Affiliation(s)
- Carol L Kuhle
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States.
| | - Ekta Kapoor
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States; Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Richa Sood
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jacqueline M Thielen
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Aminah Jatoi
- Division of Medical Oncology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Stephanie S Faubion
- Women's Health Clinic, Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
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Marzagalli M, Montagnani Marelli M, Casati L, Fontana F, Moretti RM, Limonta P. Estrogen Receptor β in Melanoma: From Molecular Insights to Potential Clinical Utility. Front Endocrinol (Lausanne) 2016; 7:140. [PMID: 27833586 PMCID: PMC5080294 DOI: 10.3389/fendo.2016.00140] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/12/2016] [Indexed: 12/14/2022] Open
Abstract
Cutaneous melanoma is an aggressive tumor; its incidence has been reported to increase fast in the past decades. Melanoma is a heterogeneous tumor, with most patients harboring mutations in the BRAF or NRAS oncogenes, leading to the overactivation of the MAPK/ERK and PI3K/Akt pathways. The current therapeutic approaches are based on therapies targeting mutated BRAF and the downstream pathway, and on monoclonal antibodies against the immune checkpoint blockade. However, treatment resistance and side effects are common events of these therapeutic strategies. Increasing evidence supports that melanoma is a hormone-related cancer. Melanoma incidence is higher in males than in females, and females have a significant survival advantage over men. Estrogens exert their effects through estrogen receptors (ERα and ERβ) that affect cancer growth in an opposite way: ERα is associated with a proliferative action and ERβ with an anticancer effect. ERβ is the predominant ER in melanoma, and its expression decreases in melanoma progression, supporting its role as a tumor suppressor. Thus, ERβ is now considered as an effective molecular target for melanoma treatment. 17β-estradiol was reported to inhibit melanoma cells proliferation; however, clinical trials did not provide the expected survival benefits. In vitro studies demonstrate that ERβ ligands inhibit the proliferation of melanoma cells harboring the NRAS (but not the BRAF) mutation, suggesting that ERβ activation might impair melanoma development through the inhibition of the PI3K/Akt pathway. These data suggest that ERβ agonists might be considered as an effective treatment strategy, in combination with MAPK inhibitors, for NRAS mutant melanomas. In an era of personalized medicine, pretreatment evaluation of the expression of ER isoforms together with the concurrent oncogenic mutations should be considered before selecting the most appropriate therapeutic intervention. Natural compounds that specifically bind to ERβ have been identified. These phytoestrogens decrease the proliferation of melanoma cells. Importantly, these effects are unrelated to the oncogenic mutations of melanomas, suggesting that, in addition to their ERβ activating function, these compounds might impair melanoma development through additional mechanisms. A better identification of the role of ERβ in melanoma development will help increase the therapeutic options for this aggressive pathology.
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Affiliation(s)
- Monica Marzagalli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Marina Montagnani Marelli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Lavinia Casati
- Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Fabrizio Fontana
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Roberta Manuela Moretti
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Patrizia Limonta
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
- *Correspondence: Patrizia Limonta,
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Mitkov M, Joseph R, Copland J. Steroid hormone influence on melanomagenesis. Mol Cell Endocrinol 2015; 417:94-102. [PMID: 26415591 DOI: 10.1016/j.mce.2015.09.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/22/2015] [Indexed: 01/07/2023]
Abstract
Disparities in the prognosis and incidence of melanoma between male and female patients have led clinicians to explore the influence of steroid hormones on the development and progression of this malignancy. A better understanding of the disparities of melanoma behavior between sexes and ages could lead to improved prevention and treatment options. There are multiple themes in the literature that unify the physiologic functions of estrogen and androgen receptors; herein we discuss and map their pathways. Overall, it is important to understand that the differences in melanoma behavior between the sexes are multifactorial and likely involve interactions between the immune system, endocrine system, and environment, namely UV-radiation. Melanoma deserves a spot among hormone-sensitive tumors, and if tamoxifen is re-introduced for future therapy, tissue ratios of estrogen receptors should be obtained beforehand to assess their therapeutic predictive value. Because androgens, estrogens, and their receptors are involved in signaling of commonly mutated melanoma pathways, potential synergistic properties of the recently developed molecular kinase inhibitors that target those pathways may exist.
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Affiliation(s)
- Mario Mitkov
- Mayo Clinic Department of Dermatology, Jacksonville, FL, USA; Creighton University School of Medicine, Omaha, NE, USA.
| | - Richard Joseph
- Mayo Clinic Department of Oncology, Jacksonville, FL, USA
| | - John Copland
- Mayo Clinic Department of Cancer Biology, Jacksonville, FL, USA
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Khosrotehrani K, Dasgupta P, Byrom L, Youlden DR, Baade PD, Green AC. Melanoma survival is superior in females across all tumour stages but is influenced by age. Arch Dermatol Res 2015; 307:731-40. [PMID: 26103951 DOI: 10.1007/s00403-015-1585-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 05/31/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Abstract
Among patients with invasive melanoma, females are known to have higher survival than males globally. However, this survival advantage has not been explored in thin melanomas, the most common form of the disease. In addition, it is unclear if this advantage is true across all age groups. We aimed to compare melanoma survival between males and females by clinical stage and within age groups. Melanomas from 1995 to 2008 were extracted from the Queensland Cancer Registry and the Surveillance, Epidemiology, and End Results (SEER) Program, and melanoma-specific deaths were ascertained up to 2011. Flexible parametric survival models compared survival between groups. The Queensland cohort of 28,979 patients experienced 1712 melanoma deaths and the SEER cohort of 57,402 patients included 6929 melanoma deaths. Survival rates were in favour of females across nearly all tumour stages, including thin invasive tumours in both cohorts after adjusting for demographic and clinical factors [odds ratio (OR) death female:male for stage I melanoma = 0.64 in Queensland; and OR = 0.79 in the US, both P < 0.001]. The sex influence on survival interacted with age categories. In particular, the survival advantage was inconsistent in females with stage I melanoma aged under 60. Females with melanoma have a survival advantage over males including in stage I melanomas. However, this advantage is dependent on age at diagnosis, suggesting an underlying biological mechanism influenced by age that exists from the very early stages of the disease.
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Affiliation(s)
- Kiarash Khosrotehrani
- The University of Queensland Centre for Clinical Research, Royal Brisbane Hospital Building 71/918, Herston, Brisbane, QLD, 4029, Australia.
- UQ Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, QLD, Australia.
| | - Paramita Dasgupta
- Cancer Council Queensland, PO Box 201, Spring Hill, QLD, 4004, Australia
| | - Lisa Byrom
- The University of Queensland Centre for Clinical Research, Royal Brisbane Hospital Building 71/918, Herston, Brisbane, QLD, 4029, Australia
- UQ Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, QLD, Australia
| | - Danny R Youlden
- Cancer Council Queensland, PO Box 201, Spring Hill, QLD, 4004, Australia
| | - Peter D Baade
- Cancer Council Queensland, PO Box 201, Spring Hill, QLD, 4004, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Adele C Green
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, 4029, Australia
- Manchester Academic Health Sciences Centre, CRUK Manchester Institute and Institute of Inflammation and Repair, University of Manchester, Manchester, UK
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Hieken TJ, Carter JM, Hawse JR, Hoskin TL, Bois M, Frost M, Hartmann LC, Radisky DC, Visscher DW, Degnim AC. ERβ expression and breast cancer risk prediction for women with atypias. Cancer Prev Res (Phila) 2015; 8:1084-92. [PMID: 26276747 DOI: 10.1158/1940-6207.capr-15-0198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Abstract
Estrogen receptor (ER) β is highly expressed in normal breast epithelium and a putative tumor suppressor. Atypical hyperplasia substantially increases breast cancer risk, but identification of biomarkers to further improve risk stratification is needed. We evaluated ERβ expression in breast tissues from women with atypical hyperplasia and association with subsequent breast cancer risk. ERβ expression was examined by immunohistochemistry in a well-characterized 171-women cohort with atypical hyperplasia diagnosed 1967-1991. Nuclear ERβ percent and intensity was scored in the atypia and adjacent normal lobules. An ERβ sum score (percent + intensity) was calculated and grouped as low, moderate, or high. Competing risks regression was used to assess associations of ERβ expression with breast cancer risk. After 15-year median follow-up, 36 women developed breast cancer. ERβ expression was lower in atypia lobules in than normal lobules, by percent staining and intensity (both P < 0.001). Higher ERβ expression in the atypia or normal lobules, evaluated by percent staining, intensity or sum score, decreased the risk of subsequent breast cancer by 2-fold (P = 0.04) and 2.5-fold (P = 0.006). High normal lobule ERβ expression conferred the strongest protective effect in premenopausal women: the 20-year cumulative incidence of breast cancer was 0% for women younger than 45 years with high versus 31% for low-moderate ERβ expression (P = 0.0008). High ERβ expression was associated with a significantly decreased risk of breast cancer in women with atypical hyperplasia. These data suggest that ERβ may be a useful biomarker for risk stratification and a novel therapeutic target for breast cancer risk reduction.
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Affiliation(s)
- Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, Minnesota.
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - John R Hawse
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Tanya L Hoskin
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Melanie Bois
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Marlene Frost
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Derek C Radisky
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Jacksonville, Florida
| | - Daniel W Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Marzagalli M, Casati L, Moretti RM, Montagnani Marelli M, Limonta P. Estrogen Receptor β Agonists Differentially Affect the Growth of Human Melanoma Cell Lines. PLoS One 2015. [PMID: 26225426 PMCID: PMC4520550 DOI: 10.1371/journal.pone.0134396] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Cutaneous melanoma is an aggressive malignancy; its incidence is increasing worldwide and its prognosis remains poor. Clinical observations indicate that estrogen receptor β (ERβ) is expressed in melanoma tissues and its expression decreases with tumor progression, suggesting its tumor suppressive function. These experiments were performed to investigate the effects of ERβ activation on melanoma cell growth. Methods and Results Protein expression was analyzed by Western blot and immunofluorescence assays. Cell proliferation was assessed by counting the cells by hemocytometer. ERβ transcriptional activity was evaluated by gene reporter assay. Global DNA methylation was analyzed by restriction enzyme assay and ERβ isoforms were identified by qRT-PCR. We demonstrated that ERβ is expressed in a panel of human melanoma cell lines (BLM, WM115, A375, WM1552). In BLM (NRAS-mutant) cells, ERβ agonists significantly and specifically inhibited cell proliferation. ERβ activation triggered its cytoplasmic-to-nuclear translocation and transcriptional activity. Moreover, the antiproliferative activity of ERβ agonists was associated with an altered expression of G1-S transition-related proteins. In these cells, global DNA was found to be hypomethylated when compared to normal melanocytes; this DNA hypomethylation status was reverted by ERβ activation. ERβ agonists also decreased the proliferation of WM115 (BRAF V600D-mutant) cells, while they failed to reduce the growth of A375 and WM1552 (BRAF V600E-mutant) cells. Finally, we could observe that ERβ isoforms are expressed at different levels in the various cell lines. Specific oncogenic mutations or differential expression of receptor isoforms might be responsible for the different responses of cell lines to ERβ agonists. Conclusions Our results demonstrate that ERβ is expressed in melanoma cell lines and that ERβ agonists differentially regulate the proliferation of these cells. These data confirm the notion that melanoma is a heterogeneous tumor and that genetic profiling is mandatory for the development of effective personalized therapeutic approaches for melanoma patients.
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Affiliation(s)
- Monica Marzagalli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Lavinia Casati
- Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Roberta M. Moretti
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Marina Montagnani Marelli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Patrizia Limonta
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
- * E-mail:
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Auriemma M, Di Nicola M, Varrati S, Carbone A, Pamio A, Capo A, Tracanna M, Castigliego AP, Tiboni GM, Amerio P. Mole modifications following controlled ovarian stimulation for assisted reproduction technologies. J Eur Acad Dermatol Venereol 2015; 29:1913-7. [PMID: 25879151 DOI: 10.1111/jdv.13065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The role of estrogens on moles biology remains undefined although estrogenic receptors have been found on melanocytes. It has been postulated that supraphysiological estrogen levels could promote the progression of moles to melanoma. Women undergoing controlled ovarian stimulation (COS) for assisted reproductive technologies (ART) are exposed to high levels of estrogens, produced by the ovary in response to exogenous gonadotropin administration. The aim of this study is to assess whether COS for ART may have an impact on mole structure and/or characteristics. METHODS Women undergoing to ART for various infertility conditions were included in the study. Personal and clinical data were collected. Dermatoscopic features and scores (total dermoscopy score--TDS) were statistically compared before COS and after a 6-month follow-up period. Statistical correlation was performed between estradiol, FSH blood levels and relative variation in moles dimensions. RESULTS A total of 46 patients were included in the study. One hundred and seventy-five melanocytic lesions from 31 patients were evaluated at both time points. Although statistically significant differences were found in mole dimension and TDS between the two time points, these differences had no relevance in the clinical setting not suggesting the need for mole excision. Moreover, the only statistically significant correlation with estradiol blood concentration on hCG administration day was found with one-axis dimensional variation. CONCLUSIONS To our knowledge this is the first work to evaluate the effect of COS on moles. The obtained results do not support a causal relation between the supraphysiological hormone levels stimulation and worsening of clinical and dermoscopical features of moles. Further study is needed to clarify whether estrogens plays a role in melanoma.
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Affiliation(s)
- M Auriemma
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - M Di Nicola
- Department of Experimental and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - S Varrati
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - A Carbone
- L'Immacolata Hospital, Catholic University of the Sacred Heart, Celano (AQ), Italy
| | - A Pamio
- Department of Medicine and Aging Science, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - A Capo
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - M Tracanna
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - A P Castigliego
- Department of Medicine and Aging Science, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - G M Tiboni
- Department of Medicine and Aging Science, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - P Amerio
- Department of Medicine and Aging Science and Dermatologic Clinic, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italy
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Is oestrogen an important player in melanoma progression? Contemp Oncol (Pozn) 2014; 18:302-6. [PMID: 25477750 PMCID: PMC4248054 DOI: 10.5114/wo.2014.43938] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/20/2013] [Accepted: 10/16/2013] [Indexed: 02/03/2023] Open
Abstract
The oestrogen-dependent regulation of cell behaviour is realised by stimulation of specific oestrogen receptors. The classical oestrogen receptors ERα and ERβ are transcription factors, and they modulate expression of hormonally regulated genes, while the third one, GPER, is thought to be responsible for the observed rapid, non-genomic cellular response. Oestrogen dependency is attributed to a number of cancers, including breast, ovarian and endometrial cancer; however, there is still growing evidence that melanoma should also be cited as a hormonally dependent tumour. This comes from the observations of gender-related differences in melanoma progression and reports concerning the history of the malignant course of melanomas during pregnancy. Although, the observations of oestrogen regulation of melanoma progression are controversial, the effect of oestrogen should not be neglected, as the skin possesses its own hormonal microenvironment. This aspect of melanoma progression should be taken under careful consideration as it may offer new therapeutic possibilities.
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40
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Piérard GE, Hermanns-Lê T, Piérard SL, Dewalque L, Charlier C, Piérard-Franchimont C, Delvenne P. In vivo skin fluorescence imaging in young Caucasian adults with early malignant melanomas. Clin Cosmet Investig Dermatol 2014; 7:225-30. [PMID: 25187731 PMCID: PMC4149332 DOI: 10.2147/ccid.s66929] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Human cutaneous malignant melanoma (CMM) is an aggressive cancer showing a dramatic worldwide increase in incidence over the past few decades. The most prominent relative epidemiological increase has been disclosed in young women. The aim of the study was to assess the effects of chronic sun exposures in order to rate the extend of melanocytic stimulations in the vicinity of CMM. Methods The study was designed to evaluate the melanin distribution and density using ultraviolet light illumination. The present study was performed on surgical excision specimens of thin CMM lesion removed from the upper limbs of 55 Caucasian adults (37 women and 18 men). Two control groups comprised 23 men and 21 women of similar ages who had medium-size congenital melanocytic nevi, also present on the upper limbs. The peritumoral skin was scrutinized using a Visioscan® VC98 device, revealing the faint mosaic melanoderma (FMM) pattern that grossly indicates early signs of chronic photodamage in epidermal melanin units. Results The median extent of relative FMM was significantly higher in the CMM male group. By contrast, the CMM female group showed a reverse bimodal distribution in FMM size. Only 12/37 (32.5%) of the CMM female group had an increased FMM size, whereas 25/37 (67.5%) of females with CMM had a global FMM extent in the normal range, relative to the controls. Conclusion Thin CMM supervening in young women appear unrelated to repeat photoexposure. Other mechanisms are possibly involved.
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Affiliation(s)
- Gérald E Piérard
- Laboratory of Skin Bioengineering and Imaging (LABIC), Department of Clinical Sciences, Liège University, Liège, Belgium
| | - Trinh Hermanns-Lê
- Department of Dermatopathology, Unilab Lg, University Hospital of Liège, Liège, Belgium
| | - Sébastien L Piérard
- INTELSIG Laboratory, Montefiore Institute, University of Liège, Liège, Belgium
| | - Lucas Dewalque
- Department of Clinical, Forensic and Environmental Toxicology, University Hospital of Liège, Liège, Belgium
| | - Corinne Charlier
- Department of Clinical, Forensic and Environmental Toxicology, University Hospital of Liège, Liège, Belgium
| | | | - Philippe Delvenne
- Department of Dermatopathology, Unilab Lg, University Hospital of Liège, Liège, Belgium
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Hermanns-Lê T, Piérard S. Streamlining cutaneous melanomas in young women of the Belgian Mosan region. BIOMED RESEARCH INTERNATIONAL 2014; 2014:320767. [PMID: 24716193 PMCID: PMC3955611 DOI: 10.1155/2014/320767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 01/24/2014] [Indexed: 02/01/2023]
Abstract
Sporadic cutaneous melanoma (SCM) has shown a dramatic increase in incidence in Caucasian populations over the past few decades. A particular epidemiological increase was reported in women during their childbearing age. In the Belgian Mosan region, a progressive unremitting increase in SCM incidence was noticed in young women for the past 35 years. The vast majority of these SCMs were of the superficial type without any obvious relationship with a large number of melanocytic nevi or with signs of frequent and intense sunlight exposures as disclosed by the extent in the mosaic subclinical melanoderma. A series of investigations pointed to a possible relationship linking the development of some SCM to the women hormonal status including the effect of hormonal disruptors. These aspects remain, however, unsettled and controversial. It is possible to differentiate and clearly quantify the SCM shape, size, scalloped border, and variegated pigmentation using computerized morphometry as well as fractal and multifractal methods.
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Affiliation(s)
- Trinh Hermanns-Lê
- Department of Dermatopathology, Unilab Lg, University Hospital of Liège, 4000 Liège, Belgium
- Dermatology Unit, Diagnostic Centre, 4800 Verviers, Belgium
| | - Sébastien Piérard
- INTELSIG Laboratory, Montefiore Institute, University of Liège, 4000 Liège, Belgium
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Burton AL, Egger ME, Quillo AR, Stromberg AJ, Hagendoorn L, Scoggins CR, Martin RC, McMasters KM, Callender GG. Prognostic factors in young women with cutaneous melanoma. Am J Surg 2014; 207:102-8. [DOI: 10.1016/j.amjsurg.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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Sexual dysfunction in women with cancer. Fertil Steril 2013; 100:916-21. [DOI: 10.1016/j.fertnstert.2013.08.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/28/2013] [Accepted: 08/08/2013] [Indexed: 11/18/2022]
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