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Wagner NB, Knierim SM, Luttermann F, Metzler G, Yazdi AS, Bauer J, Gassenmaier M, Forschner A, Leiter U, Amaral T, Garbe C, Eigentler TK, Forchhammer S, Flatz L. Histopathologic regression in patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy is associated with favorable survival and, after metastasis, with improved progression-free survival on immune checkpoint inhibitor therapy: A single-institutional cohort study. J Am Acad Dermatol 2024; 90:739-748. [PMID: 38043594 DOI: 10.1016/j.jaad.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Histopathologic regression of cutaneous melanoma is considered a favorable prognostic factor, but its significance in clinical practice remains controversial. OBJECTIVE To investigate the prognostic importance of regression in patients with primary cutaneous melanoma undergoing sentinel lymph node (SLN) biopsy and to assess its significance in patients progressing to an unresectable stage requiring systemic therapy. METHODS We retrospectively reviewed patients with newly diagnosed melanoma undergoing SLN biopsy between 2010 and 2015 and available information on histopathologic regression (n = 1179). Survival data and associations of clinical variables with SLN status were assessed. RESULTS Patients with regressive melanoma showed favorable relapse-free (hazard ratio [HR], 0.52; P = .00013), distant metastasis-free (HR, 0.56; P = .0020), and melanoma-specific survival (HR, 0.35; P = .00053). Regression was associated with negative SLN (odds ratio, 0.48; P = .0077). In patients who progressed to an unresectable stage, regression was associated with favorable progression-free survival under immune checkpoint inhibition (HR, 0.43; P = .031) but not under targeted therapy (HR, 1.14; P = .73) or chemotherapy (HR, 3.65; P = .0095). LIMITATIONS Retrospective, single-institutional design. CONCLUSIONS Regression of cutaneous melanoma is associated with improved prognosis in patients eligible for SLN biopsy as well as in patients with unresectable disease receiving systemic therapy with immune checkpoint inhibitors.
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Affiliation(s)
- Nikolaus B Wagner
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
| | - Sarah M Knierim
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Felix Luttermann
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Gisela Metzler
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Center for Dermatohistopathology and Oral Pathology, Tuebingen/Wuerzburg, Tuebingen, Germany
| | - Amir S Yazdi
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Department of Dermatology and Allergology, RWTH University Hospital Aachen, Aachen, Germany
| | - Jürgen Bauer
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Maximilian Gassenmaier
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; MVZ Dermatopathology, Friedrichshafen/Bodensee PartG, Friedrichshafen, Germany
| | - Andrea Forschner
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Thomas K Eigentler
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Forchhammer
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Lukas Flatz
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
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2
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Urbanski A, Minnemann J, Mauch C, Schmidt T, Kreuzberg N, Schlaak M, Bruns CJ, Stippel DL, Wahba R. Oligometastatic disease and visceral resections in advanced malignant melanoma: a propensity-matched analysis. Langenbecks Arch Surg 2023; 408:53. [PMID: 36680624 PMCID: PMC9867670 DOI: 10.1007/s00423-023-02804-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/22/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Malignant melanoma is among the tumours with the highest increase in incidence of solid tumours in Germany. While most patients are diagnosed at an early stage and show a good prognosis, advanced stages of malignant melanoma are accompanied with a poor prognosis and limited treatment options. Comparable to other tumour entities, the resection of visceral metastases could lead to a better prognosis. Supplementary, the subgroup of oligometastatic patients might benefit from surgical therapy to a greater extent. METHODS This retrospective study analysed 351 patients treated between 2006 and 2017 at the University Hospital of Cologne. A total of 121 patients showed visceral metastases, with which we compared patients with a diffuse tumour spread to patients in an oligometastatic state. Furthermore, we evaluated the effect of visceral resection of oligometastatic, malignant melanoma. RESULTS Our analysis showed that patients with an oligometastatic malignant melanoma had a significantly better prognosis than patients with a diffuse pattern of metastases, if they showed visceral metastases. Furthermore, the resection of visceral metastases leads to a significant gain in median overall survival time (13.6 vs. 34.2 months) and in progression-free survival (9.6 vs. 3.8 months). CONCLUSION The resection of visceral metastases is a rational treatment option in advanced malignant melanoma. Although our study is limited by a small cohort of patients (n = 18), we believe that the resection of visceral metastases will be fundamental in the treatment of malignant melanoma. In particular, patients in an oligometastatic stage could be an eligible group for surgical treatment.
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Affiliation(s)
- Alexander Urbanski
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
| | - Julia Minnemann
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Cornelia Mauch
- Department of Dermatology and Venereology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Thomas Schmidt
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Nicole Kreuzberg
- Department of Dermatology and Venereology, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Max Schlaak
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlincorporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Dirk L Stippel
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Roger Wahba
- Department of General, Visceral, Cancer and Transplant Surgery, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
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3
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Joura MI, Koszorú K, Czintner D, Sárdy M. [Geriatric dermatology]. Z Gerontol Geriatr 2023; 56:35-41. [PMID: 34989815 PMCID: PMC9876847 DOI: 10.1007/s00391-021-02006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/26/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND With an ageing society the incidences of skin diseases increase. OBJECTIVE The most important skin diseases in geriatric patients are discussed. MATERIAL AND METHODS A literature search was conducted using the PubMed database and standard dermatological textbooks. RESULTS Skin diseases in geriatric patients are often more susceptible to external influences and can be affected by visceral diseases. Due to a delayed diagnosis, malignant skin diseases in geriatric patients are first diagnosed at a higher stage. CONCLUSION Physiological skin changes are to be treated with appropriate care. In the case of unclear skin changes, a timely dermatological check-up is to be done.
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Affiliation(s)
- Marie Isolde Joura
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität Budapest, Mária utca 41, 1085, Budapest, Ungarn.
| | - Kamilla Koszorú
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität Budapest, Mária utca 41, 1085, Budapest, Ungarn
| | - Dóra Czintner
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität Budapest, Mária utca 41, 1085, Budapest, Ungarn
| | - Miklós Sárdy
- Klinik für Dermatologie, Venerologie und Dermatoonkologie, Semmelweis Universität Budapest, Mária utca 41, 1085, Budapest, Ungarn
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4
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Brinker TJ, Kiehl L, Schmitt M, Jutzi TB, Krieghoff-Henning EI, Krahl D, Kutzner H, Gholam P, Haferkamp S, Klode J, Schadendorf D, Hekler A, Fröhling S, Kather JN, Haggenmüller S, von Kalle C, Heppt M, Hilke F, Ghoreschi K, Tiemann M, Wehkamp U, Hauschild A, Weichenthal M, Utikal JS. Deep learning approach to predict sentinel lymph node status directly from routine histology of primary melanoma tumours. Eur J Cancer 2021; 154:227-234. [PMID: 34298373 DOI: 10.1016/j.ejca.2021.05.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 12/28/2022]
Abstract
AIM Sentinel lymph node status is a central prognostic factor for melanomas. However, the surgical excision involves some risks for affected patients. In this study, we therefore aimed to develop a digital biomarker that can predict lymph node metastasis non-invasively from digitised H&E slides of primary melanoma tumours. METHODS A total of 415 H&E slides from primary melanoma tumours with known sentinel node (SN) status from three German university hospitals and one private pathological practice were digitised (150 SN positive/265 SN negative). Two hundred ninety-one slides were used to train artificial neural networks (ANNs). The remaining 124 slides were used to test the ability of the ANNs to predict sentinel status. ANNs were trained and/or tested on data sets that were matched or not matched between SN-positive and SN-negative cases for patient age, ulceration, and tumour thickness, factors that are known to correlate with lymph node status. RESULTS The best accuracy was achieved by an ANN that was trained and tested on unmatched cases (61.8% ± 0.2%) area under the receiver operating characteristic (AUROC). In contrast, ANNs that were trained and/or tested on matched cases achieved (55.0% ± 3.5%) AUROC or less. CONCLUSION Our results indicate that the image classifier can predict lymph node status to some, albeit so far not clinically relevant, extent. It may do so by mostly detecting equivalents of factors on histological slides that are already known to correlate with lymph node status. Our results provide a basis for future research with larger data cohorts.
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Affiliation(s)
- Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany.
| | - Lennard Kiehl
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Tanja B Jutzi
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Eva I Krieghoff-Henning
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Dieter Krahl
- Private Laboratory of Dermatohistopathology, Mönchhofstraße 52, 69120, Heidelberg, Germany
| | - Heinz Kutzner
- Dermatopathology Laboratory, Friedrichshafen, Germany
| | - Patrick Gholam
- Department of Dermatology, University Hospital Heidelberg, Heidelberg. Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Joachim Klode
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Stefan Fröhling
- Translational Medical Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany
| | - Jakob N Kather
- Translational Medical Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120, Heidelberg, Germany; Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Sarah Haggenmüller
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Christof von Kalle
- Department of Clinical-Translational Sciences, Charité University Medicine and Berlin Institute of Health (BIH), Berlin, Germany
| | - Markus Heppt
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - Franz Hilke
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Ulrike Wehkamp
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Axel Hauschild
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jochen S Utikal
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, Mannheim, Germany; Department of Dermatology, University Hospital (UKSH), Kiel, Germany
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5
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de la Fouchardiere A, Blokx W, van Kempen LC, Luzar B, Piperno-Neumann S, Puig S, Alos L, Calonje E, Massi D. ESP, EORTC, and EURACAN Expert Opinion: practical recommendations for the pathological diagnosis and clinical management of intermediate melanocytic tumors and rare related melanoma variants. Virchows Arch 2021; 479:3-11. [PMID: 33432480 DOI: 10.1007/s00428-020-03005-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 01/17/2023]
Abstract
The recent WHO classification of skin tumors has underscored the importance of acknowledging intermediate grade melanocytic proliferations. A multistep acquisition of oncogenic events drives the progressive transformation of nevi into melanomas. The various pathways described are modulated by the initial oncogenic drivers that define the common, blue, and Spitz nevi groups. Intermediate lesions are most often the result of a clonal evolution within such nevi. Based on this established classification, we have suggested for each pathway a practical diagnostic approach, benefiting from the recently developed molecular tools, both in the setting of general pathology labs and expert centers. Moreover, recommendations regarding the re-excision and clinical follow-up are given to support decision-making in multidisciplinary tumor boards.
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Affiliation(s)
| | - Willeke Blokx
- Department of Pathology, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center, Utrecht, The Netherlands
| | - Léon C van Kempen
- Faculty of Medical Sciences, University Medical Center Groningen, Department of Pathology & Medical Biology, University of Groningen, Groningen, The Netherlands
| | - Boštjan Luzar
- Institute of Pathology, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
| | - Sophie Piperno-Neumann
- Department of Medical Oncology, Institut Curie, 75005, Paris, France.,EURACAN network member (rare skin and eye melanoma domain), Leiden, The Netherlands
| | - Susana Puig
- Department of Dermatology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Llucia Alos
- Institut d'Investigació Biomèdica August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Department of Pathology, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | - Eduardo Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK.
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
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6
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Kretschmer L, Mitteldorf C, Hellriegel S, Leha A, Fichtner A, Ströbel P, Schön MP, Bremmer F. The sentinel node invasion level (SNIL) as a prognostic parameter in melanoma. Mod Pathol 2021; 34:1839-1849. [PMID: 34131294 PMCID: PMC8443441 DOI: 10.1038/s41379-021-00835-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022]
Abstract
Sentinel lymph node (SN) tumor burden is becoming increasingly important and is likely to be included in future N classifications in melanoma. Our aim was to investigate the prognostic significance of melanoma infiltration of various anatomically defined lymph node substructures. This retrospective cohort study included 1250 consecutive patients with SN biopsy. The pathology protocol required description of metastatic infiltration of each of the following lymph node substructures: intracapsular lymph vessels, subcapsular and transverse sinuses, cortex, paracortex, medulla, and capsule. Within the SN with the highest tumor burden, the SN invasion level (SNIL) was defined as follows: SNIL 1 = melanoma cells confined to intracapsular lymph vessels, subcapsular or transverse sinuses; SNIL 2 = melanoma infiltrating the cortex or paracortex; SNIL 3 = melanoma infiltrating the medulla or capsule. We classified 338 SN-positive patients according to the non-metric SNIL. Using Kaplan-Meier estimates and Cox models, recurrence-free survival (RFS), melanoma-specific survival (MSS) and nodal basin recurrence rates were analyzed. The median follow-up time was 75 months. The SNIL divided the SN-positive population into three groups with significantly different RFS, MSS, and nodal basin recurrence probabilities. The MSS of patients with SNIL 1 was virtually identical to that of SN-negative patients, whereas outgrowth of the metastasis from the parenchyma into the fibrous capsule or the medulla of the lymph node indicated a very poor prognosis. Thus, the SNIL may help to better assess the benefit-risk ratio of adjuvant therapies in patients with different SN metastasis patterns.
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Affiliation(s)
- Lutz Kretschmer
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany.
| | - Christina Mitteldorf
- grid.411984.10000 0001 0482 5331Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Simin Hellriegel
- grid.411984.10000 0001 0482 5331Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Andreas Leha
- grid.411984.10000 0001 0482 5331Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Alexander Fichtner
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Philipp Ströbel
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Michael P. Schön
- grid.411984.10000 0001 0482 5331Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Felix Bremmer
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center, Göttingen, Germany
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Weskott HP. Sonografische Lymphknotendiagnostik im Bereich der unteren Extremitäten. PHLEBOLOGIE 2020. [DOI: 10.1055/a-1247-5486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie Sonografie dient der Detektion und Charakterisierung tastbarer Resistenzen oder zufällig entdeckter Lymphknoten (LK) der unteren Extremitäten. Meist handelt es sich um chronisch entzündliche oder reaktive Lymphknoten ohne klinische Relevanz. Sie finden sich fast immer nur inguinal, während LK in der Kniekehle sehr selten auftreten. Für die Differenzialdiagnose kommt neben Anamnese und Klinik der B-Bild-Sonografie sowie der Gefäßarchitektur eine wegweisende Rolle zu. Wegen der unspezifischen sonografischen Befunde kann bei einem singulären LK nicht sicher zwischen entzündlichen und Lymphomerkrankungen unterschieden werden: So findet sich eine Rindenverdickung bei erhaltener Gefäßarchitektur sowohl bei Lymphomen als auch bei entzündlich-reaktiven LK. Eine US-gezielte Biopsie kann diagnostisch wegweisend sein. Eine metastatische Transformation geht sonografisch oft mit einer Zerstörung der LK-Architektur und des geordneten Gefäßbildes einher. Wichtig sind ferner die LK-Abgrenzbarkeit und die zentrale Ischämie in der farbkodierten und kontrastverstärkten Sonografie.
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8
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Persa OD, Mauch C. [What is new in the diagnosis and therapy of malignant melanoma?]. Dtsch Med Wochenschr 2020; 145:1754-1756. [PMID: 33254249 DOI: 10.1055/a-1012-2972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Melanoma incidence and mortality rates are increasing. The sentinel lymph node biopsy plays an important prognostic role and is pivotal for the decision to undergo an adjuvant therapy making it an important diagnostic tool. The lack of survival benefit in patients with sentinel lymph node-positive (SLN+) melanoma upon immediate complete lymphadenectomy (CLND) suggest a parallel and not stepwise development of lymph node metastasis and distant metastasis thus questioning the role of immediate CLND. These findings also suggest adjuvant therapy may play a more important role for SLN+ melanoma patients than CLND. Recently, the PD-1 inhibitor Nivolumab and Pembrolizumab as well as the BRAF/MEK inhibitor Dabrafenib and Trametinib were approved for the adjuvant therapy of stage III malignant melanoma. Another novelty in the therapy of malignant melanoma is the approval of the first oncolytic virus, Talimogene laherparepvec, for the treatment of unresectable stage III and IV (M1a) melanoma. Significant progress has also been made in the treatment of patients with cerebral melanoma metastasis since studies indicate that both BRAF/MEK inhibitors and the immunotherapy with CTLA4 and PD-1 inhibitors are efficient in this group of patients. With this wide range of possible systemic therapies for advanced melanoma further studies regarding therapy sequence, combinations between targeted therapies and immunotherapy as well as biomarkers for treatment response are needed to help guide physicians find the optimal therapy for patients with advanced malignant melanoma.
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Affiliation(s)
- Oana-Diana Persa
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Köln
| | - Cornelia Mauch
- Klinik und Poliklinik für Dermatologie und Venerologie, Uniklinik Köln, Köln
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9
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Steeb T, Wessely A, Alter M, Bayerl C, Bender A, Bruning G, Dabrowski E, Debus D, Devereux N, Dippel E, Drexler K, Dücker P, Dummer R, Emmert S, Elsner P, Enk A, Gebhardt C, Gesierich A, Goebeler M, Goerdt S, Goetze S, Gutzmer R, Haferkamp S, Hansel G, Hassel JC, Heinzerling L, Kähler KC, Kaume KM, Krapf W, Kreuzberg N, Lehmann P, Livingstone E, Löffler H, Loquai C, Mauch C, Mangana J, Meier F, Meissner M, Moritz RKC, Maul LV, Müller V, Mohr P, Navarini A, Van Nguyen A, Pfeiffer C, Pföhler C, Posch C, Richtig E, Rompel R, Sachse MM, Sauder S, Schadendorf D, Schatton K, Schulze HJ, Schultz E, Schilling B, Schmuth M, Simon JC, Streit M, Terheyden P, Thiem A, Tüting T, Welzel J, Weyandt G, Wesselmann U, Wollina U, Ziemer M, Zimmer L, Zutt M, Berking C, Schlaak M, Heppt MV. Patterns of care and follow-up care of patients with uveal melanoma in German-speaking countries: a multinational survey of the German Dermatologic Cooperative Oncology Group (DeCOG). J Cancer Res Clin Oncol 2020; 147:1763-1771. [PMID: 33219855 PMCID: PMC8076157 DOI: 10.1007/s00432-020-03450-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/31/2020] [Indexed: 12/22/2022]
Abstract
Purpose Uveal melanoma (UM) is an orphan cancer of high unmet medical need. Current patterns of care and surveillance remain unclear as they are situated in an interdisciplinary setting. Methods A questionnaire addressing the patterns of care and surveillance in the management of patients with uveal melanoma was distributed to 70 skin cancer centers in Austria, Germany and Switzerland. Frequency distributions of responses for each item of the questionnaire were calculated. Results 44 of 70 (62.9%) skin cancer centers completed the questionnaire. Thirty-nine hospitals were located in Germany (88.6%), three in Switzerland (6.8%) and two in Austria (4.5%). The majority (68.2%) represented university hospitals. Most patients with metastatic disease were treated in certified skin cancer centers (70.7%, 29/41). Besides, the majority of patients with UM were referred to the respective skin cancer center by ophthalmologists (87.2%, 34/39). Treatment and organization of follow-up of patients varied across the different centers. 35.1% (14/37) of the centers stated to not perform any screening measures. Conclusion Treatment patterns of patients with uveal melanoma in Germany, Austria and Switzerland remain extremely heterogeneous. A guideline for the treatment and surveillance is urgently needed.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Christiane Bayerl
- Department of Dermatology and Allergology, Skin Cancer Center Wiesbaden, Helios Dr. Horst Schmidt Clinics, Wiesbaden, Germany
| | - Armin Bender
- Department of Dermatology and Allergology, Philipps University Marburg, Marburg, Germany
| | - Guido Bruning
- Center for Venous and Dermatosurgery, Tabea Krankenhaus Hamburg, Hamburg, Germany
| | - Evelyn Dabrowski
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Dirk Debus
- Department of Dermatology, Paracelsus Medical University Nuremberg, City Hospital of Nuremberg, Nuremberg, Germany
| | - Nina Devereux
- Center for Venous and Dermatosurgery, Tabea Krankenhaus Hamburg, Hamburg, Germany
| | - Edgar Dippel
- Department of Dermatology, Ludwigshafen Medical Center, Ludwigshafen, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Pia Dücker
- Department of Dermatology, Hospital of Dortmund, Dortmund, Germany
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University Zurich, Zürich, Switzerland
| | - Steffen Emmert
- Department of Dermatology and Venereology, University Medical Center, Rostock, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital, Jena, Germany
| | - Alexander Enk
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoffer Gebhardt
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Gesierich
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Sergij Goerdt
- Department of Dermatology, Venerology and Allergology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Steven Goetze
- Department of Dermatology, University Hospital, Jena, Germany
| | - Ralf Gutzmer
- Department of Dermatology and Allergy, Hannover Medical School, Skin Cancer Center Hannover, Hannover, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Gesina Hansel
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Jessica C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Lucie Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany.,Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilians-University (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany
| | - Katharina C Kähler
- Department of Dermatology, Venereology and Allergology, University Medical Center of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Kjell M Kaume
- Department of Dermatology and Allergology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Wolfgang Krapf
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Nicole Kreuzberg
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - Percy Lehmann
- Department of Dermatology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Harald Löffler
- Department of Dermatology, SLK Hospital Heilbronn, Heilbronn, Germany
| | - Carmen Loquai
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Cornelia Mauch
- Department of Dermatology and Venerology, University of Cologne, Cologne, Germany
| | - Johanna Mangana
- Department of Dermatology, University Hospital Zurich, University Zurich, Zürich, Switzerland
| | - Friedegund Meier
- Department of Dermatology, University Hospital Dresden, Dresden, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany
| | - Rose K C Moritz
- Department of Dermatology and Venereology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Lara Valeska Maul
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Verena Müller
- Department of Dermatology, Venerology and Allergology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Mohr
- Department of Dermatology, Elbe-Kliniken, Buxtehude, Germany
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Ahn Van Nguyen
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christiane Pfeiffer
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany.,Department of Dermatology and Allergology, University Hospital Ulm, Ulm, Germany
| | - Claudia Pföhler
- Department of Dermatology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Posch
- Department of Dermatology and Allergy, School of Medicine, German Cancer Consortium (DKTK), Technical University of Munich, Munich, Germany
| | - Erika Richtig
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Rainer Rompel
- Department of Dermatology, Klinikum Kassel, Kassel, Germany
| | - Michael M Sachse
- Skin Cancer Center, Department of Dermatology, Allergology and Phlebology, Bremerhaven Reinkenheide, Bremerhaven, Germany
| | | | - Dirk Schadendorf
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Kerstin Schatton
- Medical Faculty, Department of Dermatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Joachim Schulze
- Department of Dermatology and Dermato-Histo-Pathology, Fachklinik Hornheide, Skin Cancer Centre, Münster, Germany
| | - Erwin Schultz
- Department of Dermatology, Paracelsus Medical University Nuremberg, City Hospital of Nuremberg, Nuremberg, Germany
| | - Bastian Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - Matthias Schmuth
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jan C Simon
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Markus Streit
- Department of Dermatology, Hospital Aarau, Aarau, Switzerland
| | | | - Alexander Thiem
- Department of Dermatology and Venereology, University Medical Center, Rostock, Germany
| | - Thomas Tüting
- Department of Dermatology, University Medical Center, Magdeburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Gerhard Weyandt
- Department of Dermatology and Allergology, Hospital Bayreuth, Bayreuth, Germany
| | - Ulrich Wesselmann
- Department of Dermatology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Markus Zutt
- Department of Dermatology and Allergology, Klinikum Bremen-Mitte, Bremen, Germany
| | - Carola Berking
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
| | - Max Schlaak
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilians-University (LMU), Frauenlobstr. 9-11, 80337, Munich, Germany.
| | - Markus V Heppt
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen, European Metropolitan Region of Nuremberg, Erlangen, Germany
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10
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Wagner NB, Luttermann F, Gassenmaier M, Forschner A, Leiter U, Garbe C, Eigentler TK. Absolute and relative differential blood count predicts survival of AJCC stage I-II melanoma patients scheduled for sentinel lymph node biopsy. Australas J Dermatol 2020; 61:e310-e318. [PMID: 32050042 DOI: 10.1111/ajd.13248] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/13/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND/OBJECTIVES Elevated neutrophil-to-lymphocyte ratio (NLR) in peripheral blood is associated with poor overall survival (OS) in metastatic melanoma patients receiving immunotherapy. However, the impact of peripheral blood cells in patients undergoing sentinel lymph node biopsy (SLNB) is still unclear. This study was intended to characterize the impact of peripheral blood leukocytic cells on overall survival (OS) in melanoma patients undergoing SLNB. METHODS A total of 1412 AJCC stage I-II melanoma patients scheduled for SLNB at a single institution in the period 2010-2015 with available perioperative blood tests were randomly assigned to two independent cohorts. Associations of peripheral blood leukocytes with OS were analysed using Kaplan-Meier estimator and multivariate Cox proportional hazards model. RESULTS NLR >4.26, absolute neutrophil count >5800/µL, relative neutrophil count >69.7% and relative lymphocyte count ≤ 17.5% were significantly associated with reduced OS in both cohorts. Absolute monocytes >810/µL, absolute eosinophils ≤200/µL, relative monocytes >6.6%, relative eosinophils ≤2.7% and relative basophils ≤0.6% were significantly associated with reduced OS in one cohort each. On multivariate analysis, a combined score including absolute levels of neutrophils, lymphocytes, monocytes and eosinophils was significantly associated with OS in both cohorts. The hazard ratio of patients with a risk score of 3-4 was 5.42 (95% confidence interval: 1.52-19.42, P = 0.0094) in cohort 1 and 9.42 (2.06-43.06, P = 0.0038) in cohort 2, respectively. CONCLUSIONS We conclude that peripheral blood leukocytes are independently associated with OS in stage I-II melanoma patients and should be considered as prognostic markers in these patients. Eosinophils and basophils deserve more attention in future investigations.
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Affiliation(s)
- Nikolaus B Wagner
- Department of Dermatology and Venereology, University Medical Center Tubingen, University Tubingen, Tubingen, Germany
| | - Felix Luttermann
- Department of Dermatology and Venereology, University Medical Center Tubingen, University Tubingen, Tubingen, Germany
| | - Maximilian Gassenmaier
- Department of Dermatology and Venereology, University Medical Center Tubingen, University Tubingen, Tubingen, Germany
| | - Andrea Forschner
- Department of Dermatology and Venereology, University Medical Center Tubingen, University Tubingen, Tubingen, Germany
| | - Ulrike Leiter
- Department of Dermatology and Venereology, University Medical Center Tubingen, University Tubingen, Tubingen, Germany
| | - Claus Garbe
- Department of Dermatology and Venereology, University Medical Center Tubingen, University Tubingen, Tubingen, Germany
| | - Thomas K Eigentler
- Department of Dermatology and Venereology, University Medical Center Tubingen, University Tubingen, Tubingen, Germany
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11
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Schweizer A, Fink C, Bertlich I, Toberer F, Mitteldorf C, Stolz W, Enk A, Kilian S, Haenssle HA. Differenzierung von kombinierten Nävi und Melanomen: Fallkontrollstudie mit komparativer Analyse der dermatoskopischen Merkmale. J Dtsch Dermatol Ges 2020; 18:111-118. [DOI: 10.1111/ddg.14019_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/08/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Anissa Schweizer
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karl Universität Heidelberg
| | - Christine Fink
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karl Universität Heidelberg
| | - Ines Bertlich
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karl Universität Heidelberg
| | - Ferdinand Toberer
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karl Universität Heidelberg
| | | | - Wilhelm Stolz
- Hautklinik München Klinik Thalkirchner Straße München
| | - Alexander Enk
- Universitäts‐Hautklinik Heidelberg Ruprecht‐Karl Universität Heidelberg
| | - Samuel Kilian
- Institut für Medizinische Biometrie und Informatik Ruprecht‐Karl Universität Heidelberg
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12
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Schweizer A, Fink C, Bertlich I, Toberer F, Mitteldorf C, Stolz W, Enk A, Kilian S, Haenssle HA. Differentiation of combined nevi and melanomas: Case-control study with comparative analysis of dermoscopic features. J Dtsch Dermatol Ges 2020; 18:111-118. [PMID: 31951105 DOI: 10.1111/ddg.14019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Combined nevi (CN) show two or more components of major nevus subtypes and simulate melanomas. We investigated a panel of dermoscopic features and three dermoscopic algorithms for differentiating CN from melanomas. PATIENTS AND METHODS Retrospective, blinded case-control study using dermoscopic images of 36 CN and 36 melanoma controls. Twenty-one dermoscopic features validated for the diagnosis of melanocytic lesions, the number of colors, and three dermoscopic algorithms were investigated (ABCD rule of dermoscopy, Menzies scoring method, 7-point checklist). RESULTS Five of seven features indicative of nevi were observed significantly more frequently in CN than in melanomas (all p < 0.05) and two were exclusively found in CN. Eleven out of 14 features indicative of melanomas were observed significantly more frequently in melanomas than in CN (all p < 0.03) and five were exclusively found in melanomas. The mean (± SD) number of colors in CN was lower than in melanomas (2.1 ± 0.6 versus 3.4 ± 0.7; p < 0.001). Among tested algorithms the ABCD rule of dermoscopy performed best (sensitivity 91.7 %, specificity 77.8 %). CONCLUSIONS The ABCD rule of dermoscopy differentiated CN from melanomas most efficiently. Additional knowledge of dermoscopic features to be expected exclusively in either CN or melanomas should help dermatologists to make a correct clinical diagnosis.
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Affiliation(s)
- Anissa Schweizer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Christine Fink
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ines Bertlich
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Ferdinand Toberer
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | | | - Wilhelm Stolz
- Department of Dermatology, Allergology and Environmental Medicine II, Thalkirchner Strasse Hospital, Munich, Germany
| | - Alexander Enk
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
| | - Samuel Kilian
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Holger A Haenssle
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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13
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Weber J, Glutsch V, Geissinger E, Haug L, Lock JF, Schneider F, Kneitz H, Goebeler M, Schilling B, Gesierich A. Neoadjuvant immunotherapy with combined ipilimumab and nivolumab in patients with melanoma with primary or in transit disease. Br J Dermatol 2019; 183:559-563. [PMID: 31773720 DOI: 10.1111/bjd.18739] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2019] [Indexed: 02/04/2023]
Abstract
The introduction of new therapeutic agents has revolutionized the treatment of metastatic melanoma. The approval of adjuvant anti-programmed death-1 monotherapy with nivolumab or pembrolizumab, and dabrafenib plus trametinib has recently set a new landmark in the treatment of stage III melanoma. Now, clinical trials have shown that immune checkpoint blockade can be performed in a neoadjuvant setting, an approach established as a standard therapeutic approach for other tumour entities such as breast cancer. Recent studies suggest that a pathological response achieved by neoadjuvant immunotherapy is associated with long-term tumour control and that short neoadjuvant application of checkpoint inhibitors may be superior to adjuvant therapy. Most recently, neoadjuvant ipilimumab plus nivolumab in stage III melanoma was reported. With two courses of dose-optimized ipilimumab (1 mg kg-1 ) combined with nivolumab (3 mg kg-1 ), pathological responses were observed in 77% of patients, while only 20% of patients experienced grade 3 or 4 adverse events. However, the neoadjuvant trials employing combined immune checkpoint blockade conducted so far have excluded patients with in transit metastases, a common finding in stage III melanoma. Here we report four patients with in transit metastases or an advanced primary tumour who have been treated with neoadjuvant ipilimumab plus nivolumab according to the OpACIN-neo trial scheme (arm B). All patients achieved radiological disease control and a pathological response. None of the patients has relapsed so far. Linked Comment: Blankenstein and van Akkooi. Br J Dermatol 2020; 183:421-422.
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Affiliation(s)
- J Weber
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - V Glutsch
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - E Geissinger
- Institute of Pathology, Julius-Maximilians-University, Würzburg, Germany
| | - L Haug
- Institute of Pathology, Julius-Maximilians-University, Würzburg, Germany
| | - J F Lock
- Department of General, Visceral, Transplant, Vascular and Paediatric Surgery, University Hospital Würzburg, Würzburg, Germany
| | - F Schneider
- Institute for Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - H Kneitz
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - M Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - B Schilling
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
| | - A Gesierich
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Würzburg, Germany
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14
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Persa OD, Knuever J, Rose A, Mauch C, Schlaak M. Predicting risk for seroma development after axillary or inguinal sentinel lymph node biopsy in melanoma patients. Int J Dermatol 2018; 58:185-189. [DOI: 10.1111/ijd.14247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/23/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Oana-Diana Persa
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Jana Knuever
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Anna Rose
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Cornelia Mauch
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Max Schlaak
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
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15
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Persa OD, Knuever J, Mauch C, Schlaak M. Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single-center retrospective analysis. J Dermatol 2018; 45:1191-1194. [DOI: 10.1111/1346-8138.14577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 06/27/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Oana-Diana Persa
- Department of Dermatology and Venereology; University of Cologne; Cologne Germany
| | - Jana Knuever
- Department of Dermatology and Venereology; University of Cologne; Cologne Germany
| | - Cornelia Mauch
- Department of Dermatology and Venereology; University of Cologne; Cologne Germany
| | - Max Schlaak
- Department of Dermatology and Venereology; University of Cologne; Cologne Germany
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16
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Wagner NB, Forschner A, Leiter U, Garbe C, Eigentler TK. S100B and LDH as early prognostic markers for response and overall survival in melanoma patients treated with anti-PD-1 or combined anti-PD-1 plus anti-CTLA-4 antibodies. Br J Cancer 2018; 119:339-346. [PMID: 29950611 PMCID: PMC6070917 DOI: 10.1038/s41416-018-0167-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 01/19/2023] Open
Abstract
Background Immunotherapy with PD-1 antibodies has greatly increased prognosis of patients with advanced melanoma. Identifying biomarkers that predict overall survival (OS) and response to immunotherapy is important. Methods OS and best overall response according to RECIST version 1.1 were analysed, and S100B and lactate dehydrogenase (LDH) serum levels were assessed retrospectively in 152 patients treated with anti-PD-1, and in 86 patients treated with anti-PD-1 plus anti-CTLA-4 antibodies at University Hospital Tuebingen, Germany. Results In the pembrolizumab group, patients with elevated baseline S100B or LDH exhibited significantly impaired OS compared with patients with normal S100B (1-year OS: 51.1% vs 83.1%, log-rank P < .0001) and normal LDH (1-year OS: 44.4% vs 80.8%, P = .00022), respectively. LDH increases of >25% and S100B increases of >145% compared to baseline were significantly associated with impaired OS (both P < .0001). In patients treated with ipilimumab and nivolumab, baseline S100B and increasing S100B levels of >145% as well as baseline LDH were associated with impaired OS (P < .0001, P = .00060, and P = .0050, respectively), whereas increasing LDH of >25% was not (P = .64). Conclusions S100B could serve as a strong baseline marker for OS in melanoma patients receiving anti-PD-1 therapy. Rising S100B levels during the first weeks of therapy could help guide treatment decisions.
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Affiliation(s)
- Nikolaus B Wagner
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany.
| | - Andrea Forschner
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
| | - Thomas K Eigentler
- Department of Dermatology, University Hospital Tuebingen, Liebermeisterstrasse 25, 72076, Tuebingen, Germany
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17
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Die Rolle der Viszeralchirurgie bei Oligometastasierung nichtgastrointestinaler Tumoren. Chirurg 2018; 89:523-528. [DOI: 10.1007/s00104-018-0647-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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18
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Nashan D, Dengler S. [Acute emergencies in oncology]. Hautarzt 2018. [PMID: 29516114 DOI: 10.1007/s00105-018-4141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The spectrum of dermato-oncological emergencies is multifaceted. They are particularly observed in cases with malignant melanoma due to the large number of patients and prolonged survival rates that are associated with new therapies for advanced disease. Dermato-oncological patients present to the hospital with symptoms like nausea and emesis, unexpected neurological deficits, various gastrointestinal problems, and even acute abdomen, acute breathlessness, or hemoptysis. Furthermore, emergencies can be caused by hematological problems like anemia and leukopenia. In addition to standardized care for medical emergencies, there are many other problems caused by metastases and/or therapeutic side effects that need interdisciplinary skills to optimize procedures and deliberate on surgical interventions, radiotherapy, and medical therapeutic choices with regard to the overall situation of the patient. The article deals with a spectrum of acute organ-specific emergencies, including recommendations for medical treatment and considerations for therapeutic decisions. Recommendations for supportive care in patients who are severely ill are summarized. In addition to stage-adapted pain therapy, supportive measures such as nutritional supplementation, the use of dronabinol in cases of loss of appetite, and antipruritic therapies are outlined. This article provides a succinct summary of the most frequently observed dermato-oncological emergencies with references to the respective detailed literature of associated medical societies and guidelines.
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Affiliation(s)
- D Nashan
- Hautklinik, Klinikum Do, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - S Dengler
- Hautklinik, Klinikum Do, Beurhausstr. 40, 44137, Dortmund, Deutschland.
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