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Olmedo D, Brotons-Seguí M, Del Toro C, González M, Requena C, Traves V, Pla A, Bolumar I, Moreno-Ramírez D, Nagore E. Use of Lymph Node Ultrasound Prior to Sentinel Lymph Node Biopsy in 384 Patients with Melanoma: A Cost-Effectiveness Analysis. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:931-938. [PMID: 28801012 DOI: 10.1016/j.ad.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 04/26/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Locoregional lymph node ultrasound is not typically included in guidelines as part of the staging process prior to sentinel lymph node biopsy (SLNB). The objective of the present study was to make a clinical and economic analysis of lymph node ultrasound prior to SLNB. MATERIALS AND METHODS We performed a retrospective study of 384 patients with clinical stage I-II primary melanoma who underwent locorregional lymph node ultrasound (with or without ultrasound-guided biopsy) prior to SLNB between 2004 and 2015. We evaluated the reliability and cost-effectiveness of the strategy. RESULTS Use of locorregional lymph node ultrasound avoided SLNB in 23 patients (6%). Ultrasound had a sensitivity of 46% and specificity of 76% for the detection of metastatic lymph nodes that were not clinically palpable. False negatives were significantly more common in patients aged over 60 years and in tumors with a thickness of less than 2mm. The staging process using SLNB and ultrasound with ultrasound-guided biopsy produced an increase of €16.30 in the unit price. Our cost-effectiveness analysis identified the staging protocol with ultrasound and SLNB as the dominant strategy, with a lower cost-effectiveness ratio than the alternative, consisting of SLNB alone (8,095.24 vs. €28,605.00). CONCLUSIONS Ultrasound with ultrasound-guided biopsy for the diagnostic staging of melanoma prior to SLNB is a useful and cost-effective tool. This procedure does not substitute SLNB, though it does allow to avoid SLNB in a not insignificant proportion of patients.
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Rachakonda S, Heidenreich B, Nagore E, Kumar R. Abstract 3408: Telomere length and TERT promoter mutations in cutaneous melanoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Telomeres at chromosomal ends are comprised of multiple short repeat sequences. In humans TTAGGG repeats account for telomere length ranging 10-15 kb. Telomere sequences are mainly double stranded that end in a single stranded G-rich tail of 150-200 nucleotides. Telomeres in somatic cells undergo gradual shortening due to inherent limitations of DNA replication and limited levels of specialized enzyme telomerase that adds the repeats at chromosomal ends to maintain homeostasis. We previously reported somatic mutations in the core promoter of the telomerase reverse transcriptase (TERT) gene that lead to increased transcription of catalytic subunit and tumor specific telomerase reactivation. Telomere length per se is associated with risk in different cancers. In this study, we measured leukocyte telomere length using real-time PCR in 1469 melanoma patients and compared with that in 1158 matched healthy controls. The melanoma patients had statistically significantly longer telomeres than matched controls (t-test; P 6X10^-10). Mendelian randomization, carried out using two polymorphisms represented by rs1317082 and rs7726159 that associated with telomere length in genome wide association studies, showed association between increased telomere length and melanoma risk with an odds ratio of 2.3 (95% confidence interval 1.8-2.8). When measured in blood tissues from a melanoma family with the germline -57A>C TERT promoter mutation, the carriers had longer telomeres (median 1.12) than the non-carriers (median 0.87). The TERT promoter mutations create binding motifs for E-twenty six (ETS) transcription factors and in stem cell the presence of the promoter mutations resulted in continued TERT expression and telomerase activity following differentiation into adult cells. Individuals with the germline TERT promoter mutations develop melanoma with an early age of onset and rapid progression to metastases; two individuals in the family who lived past median age of onset developed several other malignancies, besides melanoma. Thus, dysregulated telomerase leads to a severe phenotype. In an analogy, we hypothesize that association of longer rather than shorter telomeres with an increased risk of melanoma reflects stochastic increased telomerase levels due to common genetic variation. In contrast, the telomere length was shorter in tumors from unrelated melanoma patients with (121) than without (170) somatic TERT promoter mutations (P 1X10^-5), which reflects the selection of the mutations at telomere crisis. Thus, a dynamic but controlled system evolved around telomere homeostasis when dysregulated leads to an increased cancer risk and affects tumor progression.
Citation Format: Sivaramakirishna Rachakonda, Barbara Heidenreich, Eduardo Nagore, Rajiv Kumar. Telomere length and TERT promoter mutations in cutaneous melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3408. doi:10.1158/1538-7445.AM2017-3408
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Machado I, Llombart B, Cruz J, Traves V, Requena C, Nagore E, Parafioriti A, Monteagudo C, Llombart-Bosch A. Desmoplastic melanoma may mimic a cutaneous peripheral nerve sheath tumor: Report of 3 challenging cases. J Cutan Pathol 2017; 44:632-638. [DOI: 10.1111/cup.12949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2017] [Accepted: 04/08/2017] [Indexed: 12/01/2022]
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154
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Gilaberte Y, Moreno D, Arias-Santiago S, Nagore E. «Comentarios», más que una nueva sección de Actas. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:281. [DOI: 10.1016/j.ad.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Indexed: 11/26/2022] Open
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Requena C, Heidenreich B, Kumar R, Nagore E. TERTpromoter mutations are not always associated with poor prognosis in atypical spitzoid tumors. Pigment Cell Melanoma Res 2017; 30:265-268. [DOI: 10.1111/pcmr.12565] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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156
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Nagore E, Reyes-Garcia D, Heidenreich B, Garcia-Casado Z, Requena C, Kumar R. TERTpromoter mutations associate with MC1R variants in melanoma patients. Pigment Cell Melanoma Res 2017; 30:273-275. [DOI: 10.1111/pcmr.12567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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157
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Tejera-Vaquerizo A, Nagore E. Effect of time to sentinel lymph node biopsy on cutaneous melanoma survival: a matter of discussion. Am J Surg 2017; 213:204-205. [DOI: 10.1016/j.amjsurg.2016.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 11/25/2022]
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158
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Duarte A, Maia Silva J, Costa Pereira A, Nagore E, Picoto A, Correia O. Sunbed use among Portuguese beach goers: a crave group while waiting sunbeds to be abolished. J Eur Acad Dermatol Venereol 2016; 31:e294-e295. [DOI: 10.1111/jdv.14070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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159
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Hernández-Ostiz S, Pérez-Ramada M, Ortiz B, Requena C, Ribas G, Aznar E, Nagore E. 25-Hydroxyvitamin D in Patients With Melanoma and Factors Associated With Inadequate Levels. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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160
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Hernández-Ostiz S, Pérez-Ramada MD, Ortiz B, Requena C, Ribas G, Aznar E, Nagore E. 25-Hydroxyvitamin D in Patients With Melanoma and Factors Associated With Inadequate Levels. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:758-764. [PMID: 27418183 DOI: 10.1016/j.ad.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/11/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Patients with melanoma appear to take extreme sun-protection measures, which could influence 25-hydroxyvitamin D [25(OH)D] levels. The aim of this study was to measure 25(OH)D levels in patients with cutaneous melanoma and identify factors associated with inadequate levels. MATERIAL AND METHODS Over a period of 1 year, we prospectively measured serum 25(OH)D in patients with cutaneous melanoma and used logistic regression analysis to identify environmental, phenotypic, and genotypic factors that were associated with insufficient and deficient levels. RESULTS Of 215 patients analyzed, 8.8% had deficient 25(OH)D levels (<10ng/mL) and just 24.7% had normal levels. Insufficient levels (<30ng/mL) were associated with obesity (odds ratio [OR], 4.2; 95% confidence interval [CI], 1.3-13.3) and blood sampling in autumn/winter (OR, 2.1; 95% CI, 1.1-4). Deficient levels (<10ng/mL) were associated with obesity (OR, 7.1; 95% CI, 1.1-46.9), blood sampling in autumn/winter (OR, 9.0; 95% CI, 1.7-47.0), absence of freckles (OR, 5.4; 95% CI, 1.2-23.4), and, with marginal significance, the presence of fewer than 2 nonsynonymous melanocortin-1 receptor (MC1R) polymorphisms (OR, 5.0; 95% CI, 0.9-28.9). LIMITATIONS Some factors related to 25(OH)D levels, such as food, were not included in the analyses. CONCLUSIONS 25(OH)D levels should be monitored in patients with melanoma and the need for oral supplements should be contemplated where appropriate.
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Denisova E, Heidenreich B, Nagore E, Rachakonda PS, Hosen I, Akrap I, Traves V, García-Casado Z, López-Guerrero JA, Requena C, Sanmartin O, Serra-Guillén C, Llombart B, Guillén C, Ferrando J, Gimeno E, Nordheim A, Hemminki K, Kumar R. Frequent DPH3 promoter mutations in skin cancers. Oncotarget 2016; 6:35922-30. [PMID: 26416425 PMCID: PMC4742151 DOI: 10.18632/oncotarget.5771] [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] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/12/2015] [Indexed: 12/24/2022] Open
Abstract
Recent reports suggested frequent occurrence of cancer associated somatic mutations within regulatory elements of the genome. Based on initial exome sequencing of 21 melanomas, we report frequent somatic mutations in skin cancers in a bidirectional promoter of diphthamide biosynthesis 3 (DPH3) and oxidoreductase NAD-binding domain containing 1 (OXNAD1) genes. The UV-signature mutations occurred at sites adjacent and within a binding motif for E-twenty six/ternary complex factors (Ets/TCF), at -8 and -9 bp from DPH3 transcription start site. Follow up screening of 586 different skin lesions showed that the DPH3 promoter mutations were present in melanocytic nevi (2/114; 2%), melanoma (30/304; 10%), basal cell carcinoma of skin (BCC; 57/137; 42%) and squamous cell carcinoma of skin (SCC; 12/31; 39%). Reporter assays carried out in one melanoma cell line for DPH3 and OXNAD1 orientations showed statistically significant increased promoter activity due to -8/-9CC > TT tandem mutations; although, no effect of the mutations on DPH3 and OXNAD1 transcription in tumors was observed. The results from this study show occurrence of frequent somatic non-coding mutations adjacent to a pre-existing binding site for Ets transcription factors within the directional promoter of DPH3 and OXNAD1 genes in three major skin cancers. The detected mutations displayed typical UV signature; however, the functionality of the mutations remains to be determined.
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Duarte AF, Correia B, Picoto A, Costa Pereira A, Nagore E, Correia O. Behaviour towards sun exposure, skin self-examination and skin cancer knowledge of educators, health professionals and the general population - cross-sectional study. J Eur Acad Dermatol Venereol 2016; 31:e132-e135. [PMID: 27520118 DOI: 10.1111/jdv.13878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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163
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Rivas-Tolosa N, Sanmartín O, Traves V, Guillén C, Nagore E. Erythematous-violaceous macule on the chest in a patient with dysplastic nevus syndrome. J Am Acad Dermatol 2016; 75:e55-6. [PMID: 27444088 DOI: 10.1016/j.jaad.2016.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 01/19/2016] [Accepted: 01/22/2016] [Indexed: 11/26/2022]
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164
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Ribero S, Longo C, Dika E, Fortes C, Pasquali S, Nagore E, Glass D, Robert C, Eggermont AM, Testori A, Quaglino P, Nathan P, Argenziano G, Puig S, Bataille V. Pregnancy and melanoma: a European-wide survey to assess current management and a critical literature overview. J Eur Acad Dermatol Venereol 2016; 31:65-69. [PMID: 27231086 DOI: 10.1111/jdv.13722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 01/18/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Management of melanoma during pregnancy can be extremely challenging. The reported incidence of melanoma in pregnancy ranges from 2.8 to 5.0 per 100 000 pregnancies. There are no guidelines for the management of melanoma during pregnancy. METHODS The survey was designed to investigate the opinions of melanoma physicians on decision making in relation to pregnancy and melanoma. A clinical scenario-based survey on management of pregnancy in melanoma was distributed all over Europe via the membership of the EORTC and other European melanoma societies. RESULTS A total of 290 questionnaires were returned with a larger participation from southern Europe. A large heterogeneity was found for the answers given in the different clinical scenarios with 50% of the answers showing discordance, especially regarding sentinel lymph node biopsy during pregnancy. Discordant answers were also found for the counselling of women about a potential delay in getting pregnant after a high-risk melanoma (35% for a 2 year wait minimum vs. 57% no waiting needed), while for thin melanomas, as expected, there was more concordance with 70% of the physicians recommending no delay. Fifteen per cent of physicians recommended an abortion in stage II melanoma during the third month of pregnancy. Twenty per cent of the responders advised against hormonal replacement therapy in melanoma patients. CONCLUSIONS The management of melanoma during pregnancy varies widely in Europe. At present, there is a lack of consensus in Europe, which may lead to very important decisions in women with melanoma, and guidelines are needed.
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Soufir N, Benfodda M, Gazal S, Descamps V, Madjlessi N, Lebbe C, Basset-Seguin N, Archimbaud A, Opletalova K, Vuong V, Nicaise Bergere C, Massart-Manil S, Machuel B, Saiag P, Merrouche Y, Bensussan A, Nagore E, Kumar R, Grange F. Melapred: first susceptibility test to sporadic melanoma in daily dermatological practice. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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166
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Taylor NJ, Handorf EA, Mitra N, Avril MF, Azizi E, Bergman W, Bianchi-Scarrà G, Bishop DT, Bressac-de Paillerets B, Calista D, Cannon-Albright LA, Cuellar F, Cust AE, Demenais F, Elder DE, Friedman E, Gerdes AM, Ghiorzo P, Goldstein AM, Grazziotin TC, Hansson J, Hayward NK, Hocevar M, Höiom V, Holland EA, Ingvar C, Landi MT, Landman G, Larre-Borges A, Leachman SA, Mann GJ, Nagore E, Olsson H, Palmer J, Perić B, Pjanova D, Puig S, Schmid H, van der Stoep N, Tucker MA, Wadt KAW, Whitaker L, Yang XR, Newton Bishop JA, Gruis NA, Kanetsky PA. Phenotypic and Histopathological Tumor Characteristics According to CDKN2A Mutation Status among Affected Members of Melanoma Families. J Invest Dermatol 2016; 136:1066-1069. [PMID: 26827760 PMCID: PMC5287416 DOI: 10.1016/j.jid.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 12/20/2022]
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167
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Nagore E, Heidenreich B, Rachakonda S, Garcia-Casado Z, Requena C, Soriano V, Frank C, Traves V, Quecedo E, Sanjuan-Gimenez J, Hemminki K, Landi MT, Kumar R. TERT promoter mutations in melanoma survival. Int J Cancer 2016; 139:75-84. [PMID: 26875008 DOI: 10.1002/ijc.30042] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 12/20/2022]
Abstract
Despite advances in targeted therapies, the treatment of advanced melanoma remains an exercise in disease management, hence a need for biomarkers for identification of at-risk primary melanoma patients. In this study, we aimed to assess the prognostic value of TERT promoter mutations in primary melanomas. Tumors from 300 patients with stage I/II melanoma were sequenced for TERT promoter and BRAF/NRAS mutations. Cumulative curves were drawn for patients with and without mutations with progression-free and melanoma-specific survival as outcomes. Cox proportional hazard regression models were used to determine the effect of the mutations on survivals. Individually, presence of TERT promoter and BRAF/NRAS mutations associated with poor disease-free and melanoma-specific survival with modification of the effect by the rs2853669 polymorphism within the TERT promoter. Hazard ratio (HR) for simultaneous occurrence of TERT promoter and BRAF/NRAS mutations for disease-free survival was 2.3 (95% CI 1.2-4.4) and for melanoma-specific survival 5.8 (95% CI 1.9-18.3). The effect of the mutations on melanoma-specific survival in noncarriers of variant allele of the polymorphism was significant (HR 4.5, 95% CI 1.4-15.2) but could not be calculated for the carriers due to low number of events. The variant allele per se showed association with increased survival (HR 0.3, 95% CI 0.1-0.9). The data in this study provide preliminary evidence that TERT promoter mutations in combination with BRAF/NRAS mutations can be used to identify patients at risk of aggressive disease and the possibility of refinement of the classification with inclusion of the rs2853669 polymorphism within TERT promoter.
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Nagore E, Heidenreich B, Requena C, García-Casado Z, Martorell-Calatayud A, Pont-Sanjuan V, Jimenez-Sanchez AI, Kumar R. TERT promoter mutations associate with fast-growing melanoma. Pigment Cell Melanoma Res 2016; 29:236-8. [PMID: 26575949 DOI: 10.1111/pcmr.12441] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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169
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Gilaberte Y, Nagore E, Arias-Santiago S, Moreno D. A por el factor de impacto: ha llegado el momento. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:1-2. [DOI: 10.1016/j.ad.2015.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 11/17/2022] Open
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Espinosa P, Pfeiffer RM, García-Casado Z, Requena C, Landi MT, Kumar R, Nagore E. Risk factors for keratinocyte skin cancer in patients diagnosed with melanoma, a large retrospective study. Eur J Cancer 2015; 53:115-24. [PMID: 26702765 DOI: 10.1016/j.ejca.2015.10.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/02/2015] [Accepted: 10/23/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Melanoma survivors are at an increased risk of developing other malignancies, including keratinocyte skin cancer (KSC). While it is known that many risk factors for melanoma also impact risk of KSC in the general population, no previous study has investigated risk factors for KSC development in melanoma patients. OBJECTIVE We assessed associations of personal and clinical characteristics, including skin phenotype and variations in the melanocortin 1 receptor (MC1R) gene, with KSC risk in melanoma patients. PATIENTS AND METHODS We used prospective follow-up information on 1200 patients treated for melanoma at the Instituto Valenciano de Oncología, Spain, between 2000 and 2011. We computed hazard ratios and 95% confidence intervals (CIs) for the association of clinical, personal and genetic characteristics with risk of KSC, squamous cell carcinoma (SCC), or basal cell carcinoma (BCC) from Cox proportional hazard models. Five-year cumulative incidence based on competing risk models of SCC, BCC or KSC overall was computed using multivariate subdistribution hazard models. To assess predictive performance of the models, we computed areas under the receiver-operating characteristic curves (AUCs, discriminatory power) using cross-validation. RESULTS Median follow-up was 57.2 months; a KSC was detected in 163 patients (13.6%). In multivariable Cox models, age, sex, sunburns, chronic sun exposure, past personal history of non-melanoma skin cancer or other non-cutaneous neoplasia, and the MC1R variants p.D294H and p.R163Q were significantly associated with KSC risk. A cumulative incidence model including age, sex, personal history of KSC, and of other non-cutaneous neoplasia had an AUC of 0.76 (95% CI: 0.71-0.80). When p.D294H and p.R163Q variants were added to the model, the AUC increased to 0.81 (95% CI: 0.77-0.84) (p-value for difference <0.0001). CONCLUSIONS In addition to age, sex, skin characteristics, and sun exposure, p.R163Q and p.D294H MC1R variants significantly increased KSC risk among melanoma patients. Our findings may help identify patients who could benefit most from preventive measures.
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Ribero S, Davies JR, Glass D, Quaglino P, Newton Bishop JA, Nagore E, Puig S, Bataille V. Authors' reply to: High naevus counts confer a favourable prognosis in patients with melanoma. Int J Cancer 2015; 137:3008-9. [PMID: 26109292 DOI: 10.1002/ijc.29652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/11/2022]
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172
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Rivas-Tolosa N, Ortiz-Brugués A, Toledo-Pastrana T, Baradad M, Traves V, Soriano V, Sanmartín V, Requena C, Martí R, Nagore E. Local cryosurgery and imiquimod: A successful combination for the treatment of locoregional cutaneous metastasis of melanoma: A case series. J Dermatol 2015; 43:553-6. [PMID: 26660713 DOI: 10.1111/1346-8138.13197] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/25/2015] [Indexed: 11/30/2022]
Abstract
Locoregional cutaneous metastases of melanoma (LCMM) represent a therapeutic challenge. Many treatment options are available with varying results. The combination of cryotherapy and imiquimod, two treatments with a possible synergistic effect, has not yet been described for treating this disease. In this paper, we aimed to show the response of LCMM to cryotherapy combined with topical imiquimod 5%. A retrospective review of 20 patients diagnosed with LCMM and treated with cryotherapy combined with topical imiquimod 5% between November 2000 and May 2014 at three institutions was performed. The locoregional cutaneous response was evaluated. After a mean of five sessions, 13 patients (65%) responded to treatment, eight (40%) of these completely and five (25%) partially. Systemic disease progressed in 16 (80%) patients. Cryotherapy followed by topical imiquimod 5% is simple to apply, has minimal adverse effects and provides response rates similar to other, more complex treatment options.
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Rivas-Tolosa N, Requena C, Llombart B, Alcalá R, Serra-Guillén C, Calomarde L, Nagore E, Guillén C, Sanmartín O. Antimalarial Drugs for the Treatment of Oral Erosive Lichen Planus. Dermatology 2015; 232:86-90. [DOI: 10.1159/000439588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/20/2015] [Indexed: 11/19/2022] Open
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Raimondi S, Gandini S, Kanetsky PA, Hoiom V, Kumar R, Ghiorzo P, Debniak T, Misa RFD, Palmieri G, Han J, Landi MT, Dwyer T, Fargnoli MC, Branicki W, Gruis NA, Stratigos A, Ribas G, Council ML, Kayser M, Autier P, García-Borrón JC, Little J, Newton-Bishop J, Sera F, Nagore E. Abstract A38: Role of MC1R variants in childhood and adolescent melanoma. Cancer Prev Res (Phila) 2015. [DOI: 10.1158/1940-6215.prev-14-a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cutaneous melanoma (CM) is rare in children, representing 1-3% of all paediatric malignancies and occurring at a frequency of 0.3-0.4% before puberty. MC1R is a key gene for skin pigmentation and is highly polymorphic in Caucasians. MC1R gene variants are associated with CM in different populations, and with congenital melanocytic naevi in children. The aim of this study is to evaluate whether the prevalence of MC1R variants differed among sporadic childhood and adolescent CM cases compared to adult patients.
Data were gathered through the M-SKIP project, an international pooled-analysis on MC1R variants, skin cancer and phenotypic characteristics. CM cases with information on age at diagnosis were selected from the M-SKIP dataset and divided into three groups: childhood (age ≤14 years, N=13), adolescent (age 15 to 18 years, N=52) and adult (age > 18 years, N=7,696). The frequency of carrying specific MC1R variants as well as at least one MC1R variant were compared between childhood/adolescent and adult CM cases with Chi Square test.
The prevalence of any MC1R variant was lower in children (≤14 years, 63%) than in adolescents (15-18 years, 71%) or adults (>18 years, 75%), although overall the difference was not statistically significant. A higher prevalence of the MC1R V92M variant was found in childhood and adolescent compared to adult CM cases (23% vs 5%, p=0.06). In contrast, the MC1R R151C variant was found less frequently in childhood and adolescent than in adult cases (9% vs 18%, p=0.06). Looking at rare variants in 5,983 cases with MC1R sequenced, 3 (9%) carriers of MC1R ins86A were found among 32 childhood and adolescent patients, while only 44 (1%) carriers of the same variant were found among 5,951 adult cases (p<0.0001).
MC1R variants ins86A and V92M, but not R151C, may be specifically associated with childhood and adolescent melanoma. Further studies using a larger sample size is needed to validate the present findings.
Citation Format: Sara Raimondi, Sara Gandini, Peter A. Kanetsky, Veronica Hoiom, Rajiv Kumar, Paola Ghiorzo, Tadeusz Debniak, Ricardo Fernandez de Misa, Giuseppe Palmieri, Jiali Han, Maria Teresa Landi, Terry Dwyer, Maria Concetta Fargnoli, Wojciech Branicki, Nelleke A. Gruis, Alexander Stratigos, Gloria Ribas, M. Laurin Council, Manfred Kayser, Philippe Autier, Jose Carlos García-Borrón, Julian Little, Julia Newton-Bishop, Francesco Sera, Eduardo Nagore. Role of MC1R variants in childhood and adolescent melanoma. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A38.
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Ribero S, Davies JR, Requena C, Carrera C, Glass D, Rull R, Vidal‐Sicart S, Vilalta A, Alos L, Soriano V, Quaglino P, Traves V, Newton‐Bishop JA, Nagore E, Malvehy J, Puig S, Bataille V. High nevus counts confer a favorable prognosis in melanoma patients. Int J Cancer 2015; 137:1691-8. [PMID: 25809795 PMCID: PMC4503475 DOI: 10.1002/ijc.29525] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 03/06/2015] [Indexed: 01/31/2023]
Abstract
A high number of nevi is the most significant phenotypic risk factor for melanoma and is in part genetically determined. The number of nevi decreases from middle age onward but this senescence can be delayed in patients with melanoma. We investigated the effects of nevus number count on sentinel node status and melanoma survival in a large cohort of melanoma cases. Out of 2,184 melanoma cases, 684 (31.3%) had a high nevus count (>50). High nevus counts were associated with favorable prognostic factors such as lower Breslow thickness, less ulceration and lower mitotic rate, despite adjustment for age. Nevus count was not predictive of sentinel node status. The crude 5- and 10-year melanoma-specific survival rate was higher in melanomas cases with a high nevus count compared to those with a low nevus count (91.2 vs. 86.4% and 87.2 vs. 79%, respectively). The difference in survival remained significant after adjusting for all known melanoma prognostic factors (hazard ratio [HR] = 0.43, confidence interval [CI] = 0.21-0.89). The favorable prognostic value of a high nevus count was also seen within the positive sentinel node subgroup of patients (HR = 0.22, CI = 0.08-0.60). High nevus count is associated with a better melanoma survival, even in the subgroup of patients with positive sentinel lymph node. This suggests a different biological behavior of melanoma tumors in patients with an excess of nevi.
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