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Zhang Z, Imani S, Shasaltaneh MD, Hosseinifard H, Zou L, Fan Y, Wen Q. The role of vascular mimicry as a biomarker in malignant melanoma: a systematic review and meta-analysis. BMC Cancer 2019; 19:1134. [PMID: 31752759 PMCID: PMC6873453 DOI: 10.1186/s12885-019-6350-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vasculogenic mimicry (VM) a microvascular system consisting of non-endothelial cells that is newly formed by aggressive tumors, has been proposed as an important therapeutic target in malignant melanoma (MM). We performed a systematic literature review to evaluate the diagnostic and prognostic accuracy of VM status for overall survival of MM patients. METHODS The quality of the included studies was evaluated using the QUADAS-2 tool. Diagnostic capacity of VM variables, including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the area under summary receiver operating characteristic (SROC), were pooled using Meta-DiSc software. RESULTS A retrospective observational study was conducted based on twelve clinical studies including 978 clinically confirmed melanoma patients with proportion (P). VM+ melanoma cells were associated with poor prognosis in 38% of MM group (P = 0.35, 95% confidence intervals (CI): 0.27-0.42, p < 0.001). The pooled sensitivity and specificity were 0.82 (95% CI: 0.79-0.84) and 0.69 (95% CI: 0.66-0.71), respectively. Furthermore, the pooled PLR, NLR, and DOR were 2.56 (95% CI: 1.94-3.93), 0.17 (95% CI: 0.07-0.42), and 17.75 (95% CI: 5.30-59.44), respectively. Furthermore, the AUC of SROC was 0.63, indicating high reliability of VM status as a biomarker. Importantly, subgroup results suggested that VM+ status is a significantly accurate prognostic biomarker when diagnosed by the CD31-/PAS+ staining methods in Asian MM samples (p < 0.001). CONCLUSIONS Our findings support the potential of VM status of tumors as a promising prognostic biomarker and emphasize an effective adjuvant therapeutic strategy in the prognosis of Asian MM patients.
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Affiliation(s)
- Zhenhua Zhang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province 646000 People’s Republic of China
| | - Saber Imani
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province 646000 People’s Republic of China
| | | | - Hossein Hosseinifard
- Research Center for Evidence Based Medicine (RCEBM), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Linglin Zou
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province 646000 People’s Republic of China
| | - Yu Fan
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province 646000 People’s Republic of China
| | - Qinglian Wen
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province 646000 People’s Republic of China
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Iga N, Otsuka A, Hirata M, Kataoka TR, Irie H, Nakashima C, Matsushita S, Uchi H, Yamamoto Y, Funakoshi T, Fujisawa Y, Yoshino K, Fujimura T, Hata H, Ishida Y, Kabashima K. Variable indoleamine 2,3-dioxygenase expression in acral/mucosal melanoma and its possible link to immunotherapy. Cancer Sci 2019; 110:3434-3441. [PMID: 31509303 PMCID: PMC6824999 DOI: 10.1111/cas.14195] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/23/2019] [Accepted: 09/05/2019] [Indexed: 02/02/2023] Open
Abstract
Immune checkpoint inhibitors have improved the prognosis of advanced melanoma. Although anti-programmed death ligand-1 (PD-L1) is a well-studied biomarker for response to anti-programmed death-1 PD-1 therapy in melanoma, its clinical relevance remains unclear. It has been established that the high expression of indoleamine 2,3-dioxygenase (IDO) is correlated to a response to anti-CTLA-4 treatment in melanoma. However, it is still unknown whether the IDO expression is associated with response to anti-PD-1 therapy in advanced melanoma. In addition, acral and mucosal melanomas, which comprise a great proportion of all melanomas in Asians, are genetically different subtypes from cutaneous melanomas; however, they have not been independently analyzed due to their low frequency in Western countries. To evaluate the association of IDO and PD-L1 expression with response to anti-PD-1 antibody in acral and mucosal melanoma patients, we analyzed 32 Japanese patients with acral and mucosal melanomas treated with anti-PD-1 antibody from the perspective of IDO and PD-L1 expression levels by immunohistochemistry (IHC). Multivariate Cox regression models showed that the low expression of IDO in tumors was associated with poor progression-free survival (HR = 0.33, 95% CI = 0.13-0.81, P = 0.016), whereas PD-L1 expression on tumors was not associated with progression-free survival. Significantly lower expression of IDO in tumors was found in non-responders compared to responders. Assessment of the IDO expression could be useful for the identification of suitable candidates for anti-PD-1 therapy among acral and mucosal melanomas patients. Further validation study is needed to estimate the clinical utility of our findings.
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Affiliation(s)
- Natsuko Iga
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Atsushi Otsuka
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan
- Translational Research Department for Skin and Brain DiseasesKyoto University Graduate School of MedicineKyotoJapan
| | - Masahiro Hirata
- Department of Diagnostic PathologyKyoto University Graduate School of MedicineKyotoJapan
| | - Tatsuki R. Kataoka
- Department of Diagnostic PathologyKyoto University Graduate School of MedicineKyotoJapan
| | - Hiroyuki Irie
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Chisa Nakashima
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Shigeto Matsushita
- Department of Dermato‐Oncology/DermatologyNational Hospital Organization Kagoshima Medical CenterKagoshimaJapan
| | - Hiroshi Uchi
- Department of DermatologyKyusyu University Graduate School of MedicineFukuokaJapan
| | - Yuki Yamamoto
- Department of DermatologyWakayama Medical UniversityWakayamaJapan
| | - Takeru Funakoshi
- Department of DermatologyKeio University School of MedicineTokyoJapan
| | | | - Koji Yoshino
- Department of DermatologyTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
| | - Taku Fujimura
- Department of DermatologyTohoku University Graduate School of MedicineSendaiJapan
| | - Hiroo Hata
- Department of DermatologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Yoshihiro Ishida
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan
| | - Kenji Kabashima
- Department of DermatologyKyoto University Graduate School of MedicineKyotoJapan
- Singapore Immunology Network (SIgN) and Skin Research Institute of Singapore (SRIS)Agency for Science, Technology and Research (A*STAR)SingaporeSingapore
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53
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Si L, Zhang X, Shu Y, Pan H, Wu D, Liu J, Lou F, Mao L, Wang X, Wen X, Gu Y, Zhu L, Lan S, Cai X, Diede SJ, Zhou Y, Ge J, Li J, Wu H, Guo J. A Phase Ib Study of Pembrolizumab as Second-Line Therapy for Chinese Patients With Advanced or Metastatic Melanoma (KEYNOTE-151). Transl Oncol 2019; 12:828-835. [PMID: 30981094 PMCID: PMC6458446 DOI: 10.1016/j.tranon.2019.02.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pembrolizumab shows robust antitumor activity and favorable safety in metastatic melanoma. KEYNOTE-151 evaluated pembrolizumab in Chinese patients, who have more aggressive melanoma subtypes than other populations. METHODS Chinese patients aged ≥18years with advanced melanoma previously treated with one line of therapy received pembrolizumab 2 mg/kg every 3 weeks for 35 cycles or until confirmed disease progression, intolerable toxicity, or study withdrawal. Primary end points were objective response rate (ORR) per RECIST v1.1 by blinded independent central review and safety. Key secondary end points included duration of response (DOR) and progression-free survival (PFS) per RECIST v1.1 and overall survival (OS). RESULTS Median age was 52 years (N=103); 37.9% had acral and 14.6% had mucosal melanoma. Median follow-up was 7.9months at data cutoff (December 27, 2017). ORR was 16.7% (95% CI, 10.0-25.3%) (1 complete, 16 partial responses). Disease control rate was 38.2%. ORR was 15.8% for acral, 13.3% for mucosal melanoma. Median DOR was 8.4months; 65.6% of patients had response duration ≥6months. Median PFS was 2.8months (95% CI, 2.7-3.5months); 6-month rate was 20.4%. Median OS was 12.1months (95% CI, 9.6months-not reached); 6-month rate, 75.7%; 12-month rate, 50.6%. Treatment-related AEs (TRAEs) occurred in 87 (84.5%) patients; 9 (8.7%) experienced grade 3/4 TRAE and 2 (1.9%) discontinued because of TRAE; none died. Two deaths occurred that were unrelated to treatment. CONCLUSIONS Pembrolizumab was well tolerated and provided clinically meaningful antitumor activity as second-line therapy in Chinese patients with advanced melanoma.
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Affiliation(s)
- Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
| | - Xiaoshi Zhang
- Sun Yat-sen University Cancer Centre, 651 Dongfeng E Rd, Yuexiu Qu, Guangzhou Shi, Guangdong Sheng, Guangzhou, China.
| | - Yongqian Shu
- Jiangsu Province Hospital, 300 Guangzhou Rd, Gulou Qu, Nanjing, Shi, 210029, Jiangsu Sheng, China.
| | - Hongming Pan
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun E Rd, XinCheng ShangQuan, Jianggan Qu, Hangzhou Shi, Zhejiang Sheng, 310016, Zhejiang, China.
| | - Di Wu
- The First Hospital of Jilin University, 3808 Jiefang Rd, HongQiJie, Chaoyang Qu, Changchun Shi, Jilin Sheng, 130021, Jilin, China.
| | - Jiwei Liu
- The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Xigang Qu, Dalian, Shi, 116011, Liaoning Sheng, China.
| | - Fang Lou
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun E Rd, XinCheng ShangQuan, Jianggan Qu, Hangzhou Shi, Zhejiang Sheng, 310016, Zhejiang, China.
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
| | - Xizhi Wen
- Sun Yat-sen University Cancer Centre, 651 Dongfeng E Rd, Yuexiu Qu, Guangzhou Shi, Guangdong Sheng, Guangzhou, China.
| | - Yanhong Gu
- Jiangsu Province Hospital, 300 Guangzhou Rd, Gulou Qu, Nanjing, Shi, 210029, Jiangsu Sheng, China.
| | - Lingjun Zhu
- Jiangsu Province Hospital, 300 Guangzhou Rd, Gulou Qu, Nanjing, Shi, 210029, Jiangsu Sheng, China; The First Hospital of Jilin University, 3808 Jiefang Rd, HongQiJie, Chaoyang Qu, Changchun Shi, Jilin Sheng, 130021, Jilin, China.
| | - Shijie Lan
- The First Hospital of Jilin University, 3808 Jiefang Rd, HongQiJie, Chaoyang Qu, Changchun Shi, Jilin Sheng, 130021, Jilin, China.
| | - Xin Cai
- The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Xigang Qu, Dalian, Shi, 116011, Liaoning Sheng, China.
| | - Scott J Diede
- Merck & Co. Inc., 2000 Galloping Hill Rd, 07033, Kenilworth, NJ, USA.
| | - Yu Zhou
- MSD, Building A, Headquarters Park Phase 2, 1582 Gumei Road, Xuhui District, 200233, Shanghai, China.
| | - Jun Ge
- MSD, Building A, Headquarters Park Phase 2, 1582 Gumei Road, Xuhui District, 200233, Shanghai, China.
| | - Jianfeng Li
- MSD, One Merck Campus Beijing, 100012, Beijing, Beijing, China.
| | - Haiyan Wu
- MSD, One Merck Campus Beijing, 100012, Beijing, Beijing, China.
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
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Kim JE, Chung BY, Sim CY, Park AY, Lee JS, Whang KU, Park YL, Kim HO, Park CW, Lee SY. Clinicopathologic Features and Prognostic Factors of Primary Cutaneous Melanoma: a Multicenter Study in Korea. J Korean Med Sci 2019; 34:e126. [PMID: 31020815 PMCID: PMC6484177 DOI: 10.3346/jkms.2019.34.e126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Malignant melanoma is a cutaneous malignancy with a high mortality rate and high potential for metastases. Detailed information on the clinicopathologic characteristics and prognostic factors of cutaneous melanoma is currently limited in Korea. This study aimed to identify the epidemiological and clinicopathologic characteristics of primary cutaneous melanoma in Korean patients, and to assess which prognostic variables could influence both the development of metastases in primary cutaneous melanoma and overall survival (OS). METHODS A total of 261 patients diagnosed with primary cutaneous melanoma in seven medical centers between 1997 and 2017 were retrospectively investigated with regard to clinical presentation, localization of the tumor, histopathologic subtype, and survival time. RESULTS The nodular histologic subtype, ulceration, and Breslow thickness were significantly associated with the development of metastasis; and overweight and obesity (body mass index > 23) were significantly associated with increased Breslow thickness. The location of the metastases appeared to influence OS: brain metastases were associated with the highest risk of death, followed by gastrointestinal, lung, and extra-regional lymph node metastases. CONCLUSION In this study, tumor thickness, nodular histologic subtype, and ulceration predicted metastatic spread of primary cutaneous melanoma. In addition, OS was associated with the location of metastases. Obesity was related to the prognosis of primary cutaneous melanoma. Clinicians should bear these findings in mind when forming a diagnosis because of the risk of a poor prognosis.
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Affiliation(s)
- Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Bo Young Chung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Chang Yoon Sim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - A Young Park
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jong Suk Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kyu Uang Whang
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Hye One Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Sung Yul Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
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55
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Darmawan CC, Jo G, Montenegro SE, Kwak Y, Cheol L, Cho KH, Mun JH. Early detection of acral melanoma: A review of clinical, dermoscopic, histopathologic, and molecular characteristics. J Am Acad Dermatol 2019; 81:805-812. [PMID: 30731177 DOI: 10.1016/j.jaad.2019.01.081] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022]
Abstract
Acral lentiginous melanoma is a distinct subtype of melanoma on acral skin. Patient presentation at later stages and delayed diagnosis by physicians contribute to a worse associated prognosis and survival rate. Despite our progress in understanding the key features of this disease, the diagnosis of early-stage acral melanoma is still challenging. It is essential to integrate clinical, dermoscopic, and histologic findings in the diagnosis of acral lentiginous melanoma. In addition, molecular studies can be helpful. In this review, we have summarized our current understanding of this disease entity from articles that were published between 1969 and 2018. We have outlined clinical and dermoscopic features as well as pathologic and molecular findings regarding acral melanoma and have presented an algorithm for diagnosis. Understanding and integrating these characteristics may assist clinicians in the early detection of acral melanomas.
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Affiliation(s)
- Claudia C Darmawan
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Gwanghyun Jo
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Sara E Montenegro
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea
| | - Yoonjin Kwak
- Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - Lee Cheol
- Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea
| | - Kwang Hyun Cho
- Department of Dermatology, Mediplex Sejong Hospital, Incheon, Korea
| | - Je-Ho Mun
- Department of Dermatology, College of Medicine, Seoul National University, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University, Seoul, Korea.
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Lee WJ, Lee YJ, Shin HJ, Won CH, Chang SE, Choi JH, Lee MW. Clinicopathological significance of tumor-infiltrating lymphocytes and programmed death-1 expression in cutaneous melanoma: a comparative study on clinical subtypes. Melanoma Res 2018; 28:423-434. [PMID: 29634635 DOI: 10.1097/cmr.0000000000000449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Interactions between immune cells and tumor cells play an important role in tumor progression. We evaluated patterns of tumor-infiltrating lymphocytes (TILs) and programmed death-1 (PD-1) expression in acral and nonacral cutaneous melanoma, and determined their effects on clinicopathological characteristics and biologic responses. We identified 122 cases of cutaneous melanoma, of which 39 were cases of non-nail unit acral melanoma (NNUAM), 35 were cases of nail unit melanoma (NUM), and 48 were cases of nonacral melanoma. Clinicopathological features and survival outcomes were analyzed according to the scores for TILs and PD-1 expression in intratumoral and peritumoral compartments. The effects of the presence of TILs and PD-1 expression on various clinicopathological factors differed according to the clinical subtypes of cutaneous melanoma. The frequency of intratumoral TILs and PD-1 expression were lower in NUM than in the other two subtypes. The density of peritumoral PD-1 was significantly higher in NNUAM. In NUM and nonacral melanoma, a low density of intratumoral TILs and PD-1 was associated with a deeper Breslow thickness and the presence of a vertical growth phase. In NNUAM, a high density of peritumoral TILs and PD-1 was associated with a shallower Breslow thickness and less frequent extracutaneous dissemination. In NNUAM, a high density of peritumoral PD-1 was associated with a better prognosis. This study suggests that the effects of PD-1+ TILs on biological activity differ according to the clinical subtypes of cutaneous melanoma.
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Affiliation(s)
- Woo J Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Kim HJ, Seo JW, Roh MS, Lee JH, Song KH. Clinical features and prognosis of Asian patients with acral lentiginous melanoma who have nodal nevi in their sentinel lymph node biopsy specimen. J Am Acad Dermatol 2018; 79:706-713. [PMID: 29673774 DOI: 10.1016/j.jaad.2018.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/31/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nodal melanocytic nevi (NNs) encountered during sentinel lymph node biopsy (SLB) for malignant melanoma are usually difficult to distinguish from metastatic melanoma. However, NNs have not been well studied in acral lentiginous melanoma (ALM) in Asian populations. OBJECTIVE To investigate the clinical characteristics and significance of NNs in SLB specimens from patients with ALM. METHODS We retrospectively analyzed 84 patients with ALM who underwent SLB between June 2010 and July 2017. RESULTS Of the 84 patients with ALM, 9 (10.7%) had NNs in their SLB specimens. NNs were significantly more common in SLB specimens than in specimens not obtained by SLB. The presence of pre-existing melanocytic lesions was found to be associated with NNs (P < .001). The 5-year overall survival was significantly higher in patients with ALM with NNs than in patients with a positive SLB result (P = .047). Distant recurrence in patients with ALM with NNs was significantly lower than in patients a positive SLB result (P = .03). LIMITATIONS The small sample size, single-center study design, and retrospective nature of the study were the limitations. CONCLUSION In Asian populations, the prevalence of NNs in ALM is similar to that reported in Europe and the United States. The rates of distant recurrence and overall survival in patients with ALM who have NNs are similar to those of patients who do not have metastatic melanoma.
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Affiliation(s)
- Ho-Jin Kim
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Jeong-Wan Seo
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Mee-Sook Roh
- Department of Pathology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Ji-Hyun Lee
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Ki-Hoon Song
- Department of Dermatology, College of Medicine, Dong-A University, Busan, Republic of Korea.
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Lin Y, Wang F, Xing Q, Guo F, Wang M, Li Y. The biological effect and mechanism of the Wnt/β-catenin signaling pathway on malignant melanoma A375 cells. Exp Ther Med 2018; 16:2032-2037. [PMID: 30186436 DOI: 10.3892/etm.2018.6413] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 01/01/2018] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to determine the influence of the Wnt/β-catenin signaling pathway on the proliferation, invasion, migration and apoptosis of malignant melanoma (MM) A375 cells. β-catenin interfering lentivirus liquid (β-catenin-RNAi-LV) and empty vector lentivirus liquid (β-catenin-negative-LV) were used to infect A375 cells. Infected cells were obtained and marked as A375-RNA interference (A375-RNAi) or A375-negative, respectively. Western blotting was used to measure the expression of β-catenin in infected cells and uninfected cells were utilized as a control. An MTT assay was adopted to measure cell proliferation and the clone formation of cells was assessed. In addition, the Transwell method was used to detect cell invasion and migration in vitro and flow cytometry was utilized to determine cell apoptosis. Western blot analysis demonstrated that β-catenin was highly expressed in uninfected A375 cells but exhibited reduced expression in A375-RNAi cells. These results indicate that β-catenin expression is effectively silenced by β-catenin-RNAi-LV. The proliferative and clone forming abilities of A375-RNAi cells were impaired compared with A375-negative and A375 cells. Additionally, the apoptosis rate was increased and the invasion and migration of A375-RNAi cells was decreased. However, no significant differences were identified in the proliferation, clone formation, apoptosis rate, invasion and migration of A375-negative cells compared with A375 cells. Therefore, the current study demonstrated that the inhibition of β-catenin expression or activity inhibits cell proliferation and invasion and migration, further downregulating the expression of anti-apoptotic genes and accelerating cellular apoptosis.
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Affiliation(s)
- Yuxia Lin
- Department of Urology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Fangfei Wang
- Department of Urology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Qingfei Xing
- Department of Urology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Feng Guo
- Department of Urology, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Mengzhen Wang
- Department of Finance, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
| | - Yunjie Li
- Department of Equipment, Jinan Central Hospital, Jinan, Shandong 250013, P.R. China
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Seo JW, Ha SM, Song KH. Feasibility of IMP-3 as an Invasiveness Marker for Acral Lentiginous Melanoma. Ann Dermatol 2018; 30:496-499. [PMID: 30065600 PMCID: PMC6029947 DOI: 10.5021/ad.2018.30.4.496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jeong-Wan Seo
- Department of Dermatology, Dong-A University, College of Medicine, Busan, Korea
| | - Seung-Min Ha
- Department of Dermatology, Dong-A University, College of Medicine, Busan, Korea
| | - Ki-Hoon Song
- Department of Dermatology, Dong-A University, College of Medicine, Busan, Korea
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Abstract
OPINION STATEMENT Melanoma is one of the most aggressive malignant skin tumors and its incidence has been increasing worldwide in recent decades. Among the four subtypes, acral lentiginous melanoma (ALM) shows the highest incidence in Asian countries, whereas ALM comprises only 1% of all melanomas in white populations. Early clinical diagnosis of ALM is essential, but early ALM lesions are often difficult to diagnose because the pigmentation of the lesions sometimes follows the skin marking of the palms and soles, resulting in an asymmetrical appearance and an irregular border in both ALM and benign melanocytic nevus. To overcome this difficulty, dermoscopy was introduced, and determination of the patterns by this method is essential for accurate clinical diagnosis of ALM. Although recent clinical trials have demonstrated that immune checkpoint inhibitors and BRAF/MEK inhibitors showed significantly improved overall survival of patients with advanced melanoma, ALM may be less susceptible to immune checkpoint inhibitors because of the poor immune response to the tumor. Therefore, strategies for enhancing the immune response to the tumor cells may be required when we apply immune checkpoint inhibitors in advanced ALM. In this context, imiquimod, dacarbazine, or interferon are possible therapies that may enhance the effectiveness of the immune checkpoint inhibitors. In addition to being known to have poor immunogenicity, ALM is also known to have infrequent BRAF mutation. Therefore, the majority of ALM patients may not benefit from therapy with BRAF/MEK inhibitors. However, some ALMs have mutations such as KIT and NRAS mutations, and therefore, targeted therapies may improve the survival of ALM patients in the future.
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Affiliation(s)
- Yoshiyuki Nakamura
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yasuhiro Fujisawa
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Ozdemir F, Errico MA, Yaman B, Karaarslan I. Acral lentiginous melanoma in the Turkish population and a new dermoscopic clue for the diagnosis. Dermatol Pract Concept 2018; 8:140-148. [PMID: 29785333 PMCID: PMC5955083 DOI: 10.5826/dpc.0802a14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background The incidence of acral lentiginous melanoma (ALM) in the white population is low. Dermoscopy enhances diagnosis of ALM; however, diagnostic accuracy may sometimes be poor due to the considerable proportion of amelanotic ALM variants. Objectives To calculate the proportion of ALM among all melanoma subtypes and to determine the frequency of dermoscopic features of ALM in the Turkish population. Methods Out of 612 melanomas, there were 70 cases of ALM, of which 46 showed sufficient image quality for retrospective study of dermoscopic features. Data from patients and their lesions was classified according to clinical features and histopathologic parameters. The dermoscopic variables evaluated were based on pertinent literature on dermoscopy of acral melanocytic neoplasms. Results The prevalence of ALM among all melanoma subtypes was 11.4%. Parallel-ridge pattern (PRP) was detected in 60.8% of cases and irregular diffuse pigmentation (IDP) in 28.3%. The ALMs were amelanotic in 24%, showing an atypical vascular pattern in all cases; a new dermoscopic pattern, named “vascularized parallel-ridge pattern” (VPRP), was detected in 13% of ALMs. Irregular lines were observed in 81.8% of subungual melanomas and were often associated with a multicolored background. Conclusions ALM has site-specific dermoscopic patterns, with PRP being the most prevalent pattern. The newly described VPRP pattern may be an additional clue for ALM diagnosis, especially in thin amelanotic melanomas.
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Affiliation(s)
- Fezal Ozdemir
- Ege University, Medical Faculty, Dermato-Oncology Unit, Department of Dermatology, Izmir, Turkey
| | - Micol A Errico
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Banu Yaman
- Ege University, Medical Faculty, Department of Pathology, Izmir, Turkey
| | - Isil Karaarslan
- Ege University, Medical Faculty, Dermato-Oncology Unit, Department of Dermatology, Izmir, Turkey
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Teramoto Y, Keim U, Gesierich A, Schuler G, Fiedler E, Tüting T, Ulrich C, Wollina U, Hassel JC, Gutzmer R, Goerdt S, Zouboulis C, Leiter U, Eigentler TK, Garbe C. Acral lentiginous melanoma: a skin cancer with unfavourable prognostic features. A study of the German central malignant melanoma registry (CMMR) in 2050 patients. Br J Dermatol 2018; 178:443-451. [PMID: 28707317 DOI: 10.1111/bjd.15803] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is one of the four major subtypes in cutaneous melanoma (CM). Although ALM has a poorer prognosis than other CM subtypes, the prognostic factors associated with ALM have only been verified in small-sized cohorts because of the low incidence of ALM worldwide. OBJECTIVES To investigate the clinical characteristics of ALM and to evaluate their prognostic values based on a large dataset from the Central Malignant Melanoma Registry (CMMR) of the German Dermatologic Society. METHODS The Kaplan-Meier method was used to estimate the potential influence of clinical and histological parameters on ALM disease-specific survival (DSS) curves, which were compared using the log-rank test. A Cox proportional hazards model was used to identify independent prognostic factors for DSS. RESULTS In total, 2050 patients with ALM were identified from 58 949 patients with CM recorded by the CMMR with follow-up data. In multivariate analyses, age (P = 0·006), ulceration (P = 0·013), tumour thickness (P < 0·001) and tumour spread (P < 0·001) turned out to be significant prognostic factors for DSS in ALM whereas sex, nevus association and level of invasion were not independent factors. CONCLUSIONS ALM has the same prognostic factors as other subtypes of melanoma. Unfavourable prognosis probably derives from the delay in diagnosis in comparison with other melanoma subtypes.
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Affiliation(s)
- Y Teramoto
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
- Department of Skin Oncology/Dermatology, Comprehensive Cancer Centre, Saitama Medical University International Medical Centre, Saitama, Japan
| | - U Keim
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
- Central Malignant Melanoma Registry, University Hospital Tuebingen, Tuebingen, Germany
| | - A Gesierich
- Department of Dermatology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - G Schuler
- Department of Dermatology, University Hospital Erlangen, Erlangen, Germany
| | - E Fiedler
- Skin Cancer Centre, Department of Dermatology, University Hospital Halle, Halle, Germany
| | - T Tüting
- Department of Dermatology, University Hospital Magdeburg, Magdeburg, Germany
| | - C Ulrich
- Skin Cancer Centre, Department of Dermatology, Charité Berlin, Berlin, Germany
| | - U Wollina
- Department of Dermatology and Allergology, Hospital Dresden Friedrichsstadt, Dresden, Germany
| | - J C Hassel
- Department of Dermatology and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - R Gutzmer
- Skin Cancer Centre, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - S Goerdt
- Department of Dermatology, University Hospital Mannheim, Mannheim, Germany
| | - C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Centre, Medical University of Brandenburg, Dessau, Germany
| | - U Leiter
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - T K Eigentler
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
| | - C Garbe
- Division for Dermatooncology, Department of Dermatology, University Hospital Tuebingen, Tuebingen, Germany
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Cherobin ACFP, Wainstein AJA, Colosimo EA, Goulart EMA, Bittencourt FV. Prognostic factors for metastasis in cutaneous melanoma. An Bras Dermatol 2018; 93:19-26. [PMID: 29641692 PMCID: PMC5871357 DOI: 10.1590/abd1806-4841.20184779] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/04/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Melanoma is a malignant neoplasia that shows high mortality when diagnosed in advanced stages. Early identification of high-risk patients for the development of melanoma metastases is the main strategy to reduce mortality. OBJECTIVE To assess the influence of eight epidemiological and histopathologic features on the development of metastases in patients diagnosed with primary cutaneous melanoma. METHODS Our historical cohort comprised patients with invasive primary cutaneous melanoma seen between 1995 and 2012 at a public university hospital and a private oncologic surgery institution in Southeastern Brazil. The following variables were analyzed: gender, age, family history of melanoma, site of the primary tumor, clinical and histologic subtype, Breslow thickness, histologic ulceration and the mitotic index. Kaplan-Meier univariate test and multivariate Cox proportional hazard analysis were used to assess factors associated with disease-free survival. RESULTS Five hundred and fourteen patients were enrolled. The univariate analysis identified the following significant risk factors: gender, age, site of the tumor, clinical and histologic subtype, Breslow thickness, histologic ulceration and mitotic index. Multivariate analysis included 244 patients and detected four significant prognostic factors: male gender, nodular clinical and histologic subtype, Breslow thickness > 4mm, and histologic ulceration. The mitotic index was not included in this analysis. STUDY LIMITATIONS Small number of patients in multivariate analysis. CONCLUSIONS The following prognostic factors to the development of melanoma metastasis were identified in the study: male gender, nodular histologic subtype, Breslow thickness > 4mm and ulceration.
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Affiliation(s)
| | | | - Enrico Antônio Colosimo
- Department of Statistics, Institute of Exact Sciences, Universidade
Federal de Minas Gerais (ICEx-UFMG) - Belo Horizonte (MG), Brazil
| | - Eugênio Marcos Andrade Goulart
- Department of Pediatrics, Faculdade de Medicina da Universidade
Federal de Minas Gerais (UFMG) - Belo Horizonte (MG), Brazil
| | - Flávia Vasques Bittencourt
- Department of Dermatology, Hospital das Clínicas,
Universidade Federal de Minas Gerais (HC-UFMG) - Belo Horizonte (MG), Brazil
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64
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Clinical Patterns of Melanoma in Asians: 11-Year Experience in a Tertiary Referral Center. Ann Plast Surg 2017; 77 Suppl 1:S6-S11. [PMID: 26808749 DOI: 10.1097/sap.0000000000000731] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Malignant melanoma is a relatively common malignancy in the West, but has a significantly lower incidence in Asians. Stark contrast in clinicopathological characteristics and prognosis has been observed between the 2 populations, yet data are limited. Here, we evaluate 106 Asian patients from a tertiary referral center in Hong Kong during an 11-year period. The purpose of this study was to collectively review all types of melanomas to analyze the clinicopathological characteristics of this poorly understood condition in an Asian population. METHODS A total of 106 patients diagnosed with malignant melanoma from 2002 to 2012 were retrospectively reviewed. Demographics, clinical presentations, pathological subtypes, treatments, and survival outcomes were evaluated. RESULTS Cutaneous melanomas dominated with 46 (43.4%) cases, followed by mucosal (39.6%), ocular (9.4%), and melanomas of unknown primary (7.5%); 43.3% patients presented in stage I, 36.7% in stage II, 18.9% in stage III, and 1.1% in stage IV. Acral lentiginous melanoma was the commonest subtype of cutaneous melanomas (60.9%). When types of melanomas were reviewed collectively, the median overall survival, disease-specific survival, and recurrence-free survival were 37, 45, and 48 months, respectively. Cutaneous melanoma had the best median overall survival of 59 months, followed by ocular melanoma (58 months), mucosal melanoma (18 months), and melanoma of unknown primary (2 months). Similar patterns were observed for disease-specific survival and recurrence-free survival. CONCLUSIONS Melanoma among Asians remains poorly understood. There is a clear distinction in the clinical patterns between Asians and whites and the difference is not solely accounted for by the lower incidence of cutaneous melanoma. Certain subtypes, such as mucosal melanoma and is acral lentiginous melanoma, seemed to have disproportionately high incidences. Further studies are warranted to elucidate these observations. The poor survival outcomes reflected the need for better awareness and understanding of the condition by both the general public and the physicians.
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65
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Shim JH, Shin HT, Park J, Park JH, Lee JH, Yang JM, Kim DH, Jang KT, Lee DY. Mutational profiling of acral melanomas in Korean populations. Exp Dermatol 2017; 26:883-888. [DOI: 10.1111/exd.13321] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Joon Ho Shim
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Samsung Genome Institute; Samsung Medical Center; Seoul Korea
| | - Hyun-Tae Shin
- Samsung Genome Institute; Samsung Medical Center; Seoul Korea
| | - Jiho Park
- Department of Health Sciences and Technology; Samsung Advanced Institute for Health Sciences and Technology; Sungkyunkwan University; Seoul Korea
| | - Ji-Hye Park
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Jong-Hee Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
- Department of Medical Device Management & Research; Samsung Advanced Institute for Health Sciences and Technology; Sungkyunkwan University; Seoul Korea
| | - Jun-Mo Yang
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Duk-Hwan Kim
- Department of Molecular Cell Biology; Samsung Biomedical Research Institute; Sungkyunkwan University School of Medicine; Suwon Korea
| | - Kee-Taek Jang
- Department of Pathology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Dong-Youn Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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66
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Yamazaki N, Takenouchi T, Fujimoto M, Ihn H, Uchi H, Inozume T, Kiyohara Y, Uhara H, Nakagawa K, Furukawa H, Wada H, Noguchi K, Shimamoto T, Yokota K. Phase 1b study of pembrolizumab (MK-3475; anti-PD-1 monoclonal antibody) in Japanese patients with advanced melanoma (KEYNOTE-041). Cancer Chemother Pharmacol 2017; 79:651-660. [PMID: 28283736 PMCID: PMC5364262 DOI: 10.1007/s00280-016-3237-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/28/2016] [Indexed: 01/06/2023]
Abstract
PURPOSE This phase I b study evaluated the safety and anti-tumor activity of pembrolizumab in Japanese patients with advanced melanoma. METHODS Pembrolizumab (2 mg/kg) was given every 3 weeks (Q3W) for up to 2 years or until confirmed progression or unacceptable toxicity. The tumor response was assessed as per the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) by both investigator review and central review. RESULTS Forty-two patients with advanced melanoma received pembrolizumab. A primary cutaneous histology was observed in 34 patients (81.0%), while a primary mucosal histology was observed in 8 patients (19.0%). Thirty-four patients (81.0%) experienced treatment-related adverse events (AEs). The most common treatment-related AEs were pruritus, maculopapular rash, malaise, and hypothyroidism. Grade 3-5 treatment-related AEs occurred in 8 patients (19.0%). The only grade 3-5 treatment-related AE reported in at least two patients was anemia. There were two treatment-related deaths (unknown cause and cerebral hemorrhage). Among the 37 evaluable patients, the confirmed overall response rates (ORRs) determined by central review were 24.1% (95% CI 10.3-43.5) for cutaneous melanoma and 25.0% (95% CI 3.2-65.1) for mucosal melanoma. The responses were durable, and the median duration of response was not reached in either population. The median overall survival (OS) was not reached, with a 12-month OS of 82.7% for cutaneous melanoma and 51.4% for mucosal melanoma. CONCLUSION The safety profile of pembrolizumab in Japanese patients was similar to that reported in the previous clinical studies. Pembrolizumab provided promising anti-tumor activity in Japanese patients with advanced melanoma.
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Affiliation(s)
- Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Tatsuya Takenouchi
- Department of Dermatology, Niigata Cancer Center Hospital, Niigata, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Uchi
- Department of Dermatology, Kyushu University School of Medicine, Fukuoka, Japan
| | - Takashi Inozume
- Department of Dermatology, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Yoshio Kiyohara
- Department of Dermatology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hisashi Uhara
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Hiroshi Furukawa
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hidefumi Wada
- Department of Dermatology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | | | - Kenji Yokota
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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67
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Chang JWC, Guo J, Hung CY, Lu S, Shin SJ, Quek R, Ying A, Ho GF, Nguyen HS, Dhabhar B, Sriuranpong V, Tiambeng ML, Prayogo N, Yamazaki N. Sunrise in melanoma management: Time to focus on melanoma burden in Asia. Asia Pac J Clin Oncol 2017; 13:423-427. [PMID: 28198155 DOI: 10.1111/ajco.12670] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
- John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Immune-Oncology Center of Excellence, Chang-Gung Memorial Hospital, Taipei, Taiwan
| | - Jun Guo
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chia-Yen Hung
- Division of Hematology-Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Si Lu
- Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Sang Joon Shin
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Richard Quek
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Gwo Fuang Ho
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Huu Sau Nguyen
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | | | - Virote Sriuranpong
- Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | | | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
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68
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Kim YJ, Waller K, Keo V, Soum R, Gollogly JG. Clinical report. Acral melanoma in Cambodia: challenges associated with a rare and aggressive disease encountered in a developing country setting. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Melanoma is a highly malignant skin cancer. Acral lentiginous melanoma (ALM) is most common among Asians. The prevalence of ALM among melanoma cases in Cambodian is not known.
Objective: To describe the prevalence of ALM among cases of melanoma and the stage of disease at presentation to the health facilities and health providers.
Method: Electronic clinical records were obtained from Children’s Surgical Centre (CSC) database between January 2002 and April 2014. Types and stages melanoma at presentation were documented.
Result: A total of 10 out of 26 melanoma patients had ALM. Their average age at diagnosis was 65.3 years. Most primary lesions were located on the plantar or lateral surfaces of the foot. Most histopathological descriptions were consistent with ALM. Seventy percent had lymph node metastases.
Conclusion: A high proportion of ALM was found associated with trauma as a potential risk factor. Most frequency presented at a late stage of disease. Providers must be made aware of the disease and render appropriate management early for good outcome.
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Affiliation(s)
| | - Karen Waller
- Children’s Surgical Centre, Phnom Penh, Cambodia
| | - Vanna Keo
- Children’s Surgical Centre, Phnom Penh, Cambodia
| | - Ratha Soum
- Children’s Surgical Centre, Phnom Penh, Cambodia
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69
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Liu L, Zhang W, Gao T, Li C. Is UV an etiological factor of acral melanoma? JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2016; 26:539-545. [PMID: 26464096 DOI: 10.1038/jes.2015.60] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 07/29/2015] [Accepted: 08/13/2015] [Indexed: 06/05/2023]
Abstract
Ultraviolet (UV) radiation is a major environmental risk factor for melanoma, particularly among Caucasians. However, studies have generated conflicting results on the role of UV exposure in the development of acral melanoma, the most prevalent subtype of melanoma in non-Caucasians. In this review, we analyzed studies that have examined the relationship between acral melanoma and UV and show that acral melanoma has specific epidemiological and genetic characteristics, with a lower frequency or absence of UV-induced features. Therefore, we postulate that UV is probably not involved in the etiology of acral melanoma. However, further epidemiological and laboratory studies are required to fully address this controversial issue, which may lead to a better understanding of the pathogenesis and prevention of acral melanoma.
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Affiliation(s)
- Lin Liu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Weigang Zhang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chunying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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70
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Kim SY, Yun SJ. Cutaneous Melanoma in Asians. Chonnam Med J 2016; 52:185-93. [PMID: 27689028 PMCID: PMC5040767 DOI: 10.4068/cmj.2016.52.3.185] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/17/2016] [Accepted: 06/28/2016] [Indexed: 02/05/2023] Open
Abstract
Malignant melanoma is a rare disease in Asians but potentially the most aggressive form of skin cancer worldwide. It can occur in any melanocyte-containing anatomic site. Four main cutaneous melanoma subtypes are recognized: lentigo maligna melanoma, superficial spreading melanoma, acral lentiginous melanoma (ALM), and nodular melanoma. Generally, excessive exposure to ultraviolet (UV) radiation increases the risk of melanoma. The exception is ALM, which is the most common melanoma subtype in Asians and is not associated with UV radiation. ALM presents as dark brownish to black, irregular maculopatches, nodules, or ulcers on the palms, soles, and nails. The lesions may be misdiagnosed as more benign lesions, such as warts, ulcers, hematomas, foreign bodies, or fungal infections, especially in amelanotic acral melanomas where black pigments are absent. The aim of this brief review is to improve understanding and the rate of early detection thereby reducing mortality, especially regarding cutaneous melanoma in Asians.
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Affiliation(s)
- Sang Yub Kim
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
| | - Sook Jung Yun
- Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea
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71
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Acral Melanoma in Chinese: A Clinicopathological and Prognostic Study of 142 cases. Sci Rep 2016; 6:31432. [PMID: 27545198 PMCID: PMC4992860 DOI: 10.1038/srep31432] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/19/2016] [Indexed: 01/09/2023] Open
Abstract
Acral melanoma (AM), as a peculiar subgroup of melanoma, is rare in Caucasians but has higher incidence in Asians. Large series of study on AM with clinicopathological features and prognostic factors is still limited, especially in Asian population. We retrospectively collected clinical, pathological and follow-up data of 142 AM cases. All patients were Chinese, with the age ranging from 24 to 87 years (mean 62.0; median 62.0). The Breslow thickness of primary lesions ranged from 0.6 to 16.3 mm (mean 4.9; median 3.7). 85.9% of the patients had acral lentiginous histologic subtype. Plantar was the most frequently involved site, followed by heels. Statistically, duration of the lesion before diagnosis (≤2.5 years), Breslow thickness >4.0 mm (T4), high mitotic index (>15 mm−2), presence of vascular invasion, regional lymph node metastasis at diagnosis and pathologic stage (II/III/IV) were found to be independent prognostic factors in both univariate and multivariate analyses. The prognosis of AM in Chinese is extremely poor. Our 5- and 10-year disease-specific survival (DSS) rates were 53.3% and 27.4%, respectively. Therefore, AM in Asians represents a more biologically aggressive melanoma subtype and is thought to carry a worse prognosis when compared with other races or cutaneous melanomas in other anatomic sites.
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72
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Sondermann W, Zimmer L, Schadendorf D, Roesch A, Klode J, Dissemond J. Initial misdiagnosis of melanoma located on the foot is associated with poorer prognosis. Medicine (Baltimore) 2016; 95:e4332. [PMID: 27442685 PMCID: PMC5265802 DOI: 10.1097/md.0000000000004332] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Acral melanoma has been reported to be associated with poorer outcomes than melanoma occurring on other cutaneous sites. It has been suggested that part of this disparity in outcomes may be related to delay in diagnosis. Therefore, we have analyzed the rate of misdiagnoses in patients with melanoma located on the foot and have characterized the influence on the clinical course and survival of the patients. A prospective, computerized melanoma database at the Skin Cancer Center of the University Hospital Essen, Germany was used to identify patients with histologically confirmed melanoma located on the foot between 2002 and July 2013 for subsequent analysis. A cohort of 151 patients diagnosed with primary melanoma located on the foot was identified. One hundred seven patients qualified for subsequent analysis. Forty-two patients were male (39.3%) and 65 (60.7%) were female; the mean age at first diagnosis was 61.6 years (median 66 years). The youngest patient was 19 years, the oldest 88 years old.Of the 107 patients analyzed, 32 (30%) were initially misdiagnosed. Misdiagnoses included chronic wounds, nevi, hematoma, fungal infections, warts, and paronychia. Misdiagnosis caused a median delay in diagnosis of 9 months. The 5-year disease-free survival rate (47.8% vs 72.7%) and the 5-year overall survival rate (63.5% vs 88.4%) were statistically significant lower in the misdiagnosis cohort.The awareness of potentially overlooked melanoma located on the foot has to increase among physicians.To improve early detection and, thus, the prognosis of patients with melanoma located on the foot, taking a biopsy from any suspicious lesion should be taken into consideration as soon as possible.
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Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Essen, Germany
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Jung M, Lee J, Kim TM, Lee DH, Kang JH, Oh SY, Lee SJ, Shin SJ. Ipilimumab Real-World Efficacy and Safety in Korean Melanoma Patients from the Korean Named-Patient Program Cohort. Cancer Res Treat 2016; 49:44-53. [PMID: 27121719 PMCID: PMC5266404 DOI: 10.4143/crt.2016.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/06/2016] [Indexed: 12/28/2022] Open
Abstract
Purpose Ipilimumab improves survival in advanced melanoma patients. However, the efficacy and safety of ipilimumab has not been evaluated in Asian melanoma patients with a high frequency of mucosal and acral melanoma subtypes. Materials and Methods Advanced melanoma patients treated with 3 mg/kg ipilimumab in a Korean multicenter named-patient program (NPP) were evaluated between September 2014 and July 2015. Baseline characteristics and blood parameters including neutrophil to lymphocyte ratio (NLR) were assessed, and outcome and adverse events were evaluated according to subtypes. Results A total of 104 advanced melanoma patients were treated. The primary sites were acral (31.7%), mucosal (26%), cutaneous (26%), uveal (9.6%), and unknown (6.7%). Sixty-eight patients (65.4%) experienced adverse events, and the most common toxicity was skin rash (22.1%), 10 patients (9.6%) experienced adverse events of grade 3 or higher. The median progression-free survival (PFS) was 2.73 months (95% confidence interval, 2.67 to 2.85), and there was no difference in PFS according to subtypes. Poor performance status, liver metastasis, and NLR (≥ 5) were independent poor prognostic factors by multivariate analysis. Conclusion In the Korean NPP cohort, ipilimumab showed similar efficacy and tolerability compared to Western patients, regardless of subtypes. All subtypes should benefit from ipilimumab with consideration of performance status, liver metastasis, and NLR.
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Affiliation(s)
- Minkyu Jung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dae Ho Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Hyung Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Young Oh
- Department of Internal Medicine, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Soo Jung Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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Abstract
The malignant cell in melanoma is the melanocyte. Because melanocytes are located in the basal layer of the epidermis, melanoma is most commonly seen on the skin. However, melanoma can also arise on mucosal surfaces such as the oral cavity, the upper gastrointestinal mucosa, the genital mucosa, as well as the uveal tract of the eye and leptomeninges. Melanomas tend to be pigmented but can also present as pink or red lesions. They can mimic benign or other malignant skin lesions. This chapter presents the spectrum of typical and less typical presentations of melanoma, as well as patterns of spread. It is divided into (1) cutaneous lesions; (2) patterns of regional spread, (3) non-cutaneous lesions; and (4) distant metastases.
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Affiliation(s)
- Nour Kibbi
- Departments of Dermatology and Medicine, Yale University School of Medicine, New Haven, USA
| | - Harriet Kluger
- Departments of Dermatology and Medicine, Yale University School of Medicine, New Haven, USA.
| | - Jennifer Nam Choi
- Departments of Dermatology and Medicine, Yale University School of Medicine, New Haven, USA
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Kong Y, Si L, Li Y, Wu X, Xu X, Dai J, Tang H, Ma M, Chi Z, Sheng X, Cui C, Guo J. Analysis of mTOR Gene Aberrations in Melanoma Patients and Evaluation of Their Sensitivity to PI3K-AKT-mTOR Pathway Inhibitors. Clin Cancer Res 2015; 22:1018-27. [PMID: 26490311 DOI: 10.1158/1078-0432.ccr-15-1110] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Accepted: 09/26/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE mTOR is a validated target in cancer. It remains to be determined whether melanoma patients bearing mTOR mutation could be selected for treatment with PI3K-AKT-mTOR pathway inhibitors. EXPERIMENTAL DESIGN A total of 412 melanoma samples were included. Gene aberrations in all exons of mTOR were detected by Sanger sequencing and confirmed by using Agilent's SureSelect Target Enrichment System. HEK293T cells stably expressing mTOR mutants were constructed by using transcription activator-like effector nucleases technique. Function of mTOR mutants and in vitro sensitivity of gain-of-function mTOR mutations to PI3K-AKT-mTOR pathway inhibitors were analyzed. RESULTS The overall incidence of somatic nonsynonymous mutations of mTOR was 10.4% (43/412). mTOR nonsynonymous mutations were relatively more frequent in acral (11.0%) and mucosal (14.3%) melanomas than in chronic sun-induced damage (CSD; 6.7%) and non-CSD (3.4%) melanomas. Of the 43 cases with mTOR mutations, 41 different mutations were detected, affecting 25 different exons. The median survival time for melanoma patients with mTOR nonsynonymous mutation was significantly shorter than that for patients without mTOR nonsynonymous mutation (P = 0.028). Transient expression of mTOR mutants in HEK293T cells strongly activated the mTOR-p70S6K pathway. In HEK293T cells with stable expression of H1968Y or P2213S mTOR mutants, LY294002 and AZD5363 showed higher potency than temsirolimus or BYL719 in inhibiting the PI3K-AKT-mTOR pathway and cell proliferation. CONCLUSIONS mTOR nonsynonymous mutations are frequent in melanoma patients. mTOR nonsynonymous mutation may predict a worse prognosis of melanoma. Clinical trials with PI3K-AKT-mTOR pathway inhibitors may be beneficial for melanoma patients with specific mTOR mutations.
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Affiliation(s)
- Yan Kong
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lu Si
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yiqian Li
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaowen Wu
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xiaowei Xu
- Department of Pathology and Laboratory Medicine, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jie Dai
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Huan Tang
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Meng Ma
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhihong Chi
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xinan Sheng
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Chuanliang Cui
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jun Guo
- The Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China.
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Wu CF, Wang HM, Huang WK, Chang JWC. Efficacy and safety of bio-chemotherapy with dacarbazine plus interleukin-2 in patients with unresectable malignant melanoma. Asia Pac J Clin Oncol 2015; 11:314-8. [DOI: 10.1111/ajco.12404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Chun-Feng Wu
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - Wen-Kuan Huang
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology; Department of Internal Medicine; Chang Gung Memorial Hospital at Linkou; Taoyuan Taiwan
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Lee WJ, Lee JH, Won CH, Chang SE, Choi JH, Moon KC, Lee MW. Nail apparatus melanoma: A comparative, clinicoprognostic study of the initial clinical and morphological characteristics of 49 patients. J Am Acad Dermatol 2015; 73:213-20. [DOI: 10.1016/j.jaad.2015.04.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/09/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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Johnson DB, Peng C, Abramson RG, Ye F, Zhao S, Wolchok JD, Sosman JA, Carvajal RD, Ariyan CE. Clinical Activity of Ipilimumab in Acral Melanoma: A Retrospective Review. Oncologist 2015; 20:648-52. [PMID: 25964307 DOI: 10.1634/theoncologist.2014-0468] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/10/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Ipilimumab improves overall survival (OS) in advanced melanoma. Acral melanoma is an uncommon clinical subtype of this disease associated with poor prognosis. The clinical activity of ipilimumab has not been well-defined in advanced acral melanoma. METHODS We retrospectively reviewed the demographics, treatment history, and clinical outcomes for all patients with acral melanoma treated with ipilimumab from two academic centers between February 2006 and June 2013. Using Cox proportional hazards models, we assessed for factors that correlated with OS. RESULTS A total of 35 patients with acral melanoma received ipilimumab. Melanomas arose on volar surfaces (n = 28) and subungual sites (n = 7); stage M1c disease was present in 54%, and 45% had elevated serum lactate dehydrogenase (LDH). Best response by RECIST 1.1 criteria was complete response in 1 patient, partial response in 3, and stable disease (SD) in 4 for an objective response rate (ORR) of 11.4% and a clinical benefit rate (ORR + SD) at 24 weeks of 22.9%. Median progression-free survival was 2.5 months (95% confidence interval [CI]: 2.3-2.7 months); median OS was 16.7 months (95% CI: 10.9-22.5 months). Normal LDH and absolute lymphocyte count ≥1,000 at 7 weeks predicted longer OS. Immune-related adverse events (irAEs) were noted in 16 patients including 7 with grade 3/4 irAEs (20%). CONCLUSION Ipilimumab is clinically active in acral melanoma with similar ORR and OS compared with unselected melanoma populations. Ipilimumab remains a viable therapeutic option for patients with advanced acral melanoma. IMPLICATIONS FOR PRACTICE Ipilimumab is a commonly used immune therapy that improves survival in metastatic melanoma. The clinical activity of ipilimumab in certain rare melanoma subtypes, such as uveal or mucosal melanomas, is suboptimal. Acral melanoma is another unusual subtype of this disease that arises on the palms, soles, and nailbeds. In this study of 35 patients with acral melanoma from 2 centers, ipilimumab was found to have activity that appears equivalent to unselected melanoma (response rate of 11.4%, median overall survival of 16.7 months). Ipilimumab remains a viable treatment option for this melanoma subpopulation.
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Affiliation(s)
- Douglas B Johnson
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Chengwei Peng
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Richard G Abramson
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Fei Ye
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Shilin Zhao
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jedd D Wolchok
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Jeffrey A Sosman
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Richard D Carvajal
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
| | - Charlotte E Ariyan
- Department of Medicine, School of Medicine, Department of Radiology, Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Departments of Medicine and Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Medicine, Columbia University Medical Center, New York, New York, USA
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Wu CE, Hsieh CH, Chang CJ, Yeh JT, Kuo TT, Yang CH, Lo YF, Lin KJ, Lin YC, Chang JWC. Prognostic factors for Taiwanese patients with cutaneous melanoma undergoing sentinel lymph node biopsy. J Formos Med Assoc 2015; 114:415-21. [PMID: 23969039 DOI: 10.1016/j.jfma.2013.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 06/22/2013] [Accepted: 06/24/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/PURPOSE Sentinel lymph node biopsy (SLNB) is a standard procedure in the management of clinically node-negative melanoma. However, few studies have been performed on SLNB in Asia, which is an acral melanoma-prevalent area. This study evaluated the clinicopathologic prognostic factors of disease-free survival (DFS) and overall survival (OS) in Taiwanese patients with cutaneous melanoma who received wide excision and SLNB. The prognosis of patients with false-negative (FN) SLNB was also evaluated. METHODS Malignant melanoma cases were reviewed for 518 patients who were treated between January 2000 and December 2011. Of these patients, 127 patients with node-negative cutaneous melanoma who received successful SLNB were eligible for inclusion in the study. RESULTS The SLNB-positive rate was 34.6%. The median DFS was 51.5 months, and the median OS was 90.9 months at the median follow-up of 36.6 months. Multivariate analysis revealed that patients whose melanoma had a Breslow thickness greater than 2 mm had a significantly shorter DFS than patients whose melanoma had a Breslow thickness of 2 mm or less [hazard ratio (HR), 3.421; p = 0.005]. Independent prognostic factors of OS were a Breslow thickness greater than 2 mm (HR, 4.435; p = 0.002); nonacral melanoma (HR, 3.048; p = 0.001); and an age older than 65 years (HR, 2.819; p = 0.036). During the follow-up period, 13 of 83 SLN-negative patients developed a regional nodal recurrence. The SLNB failure rate was 15.7% and the FN rate was 22.8%. Compared to patients with a true-positive SLNB, patients with FN SLNB had a significantly shorter DFS (p = 0.001) but no significant difference in OS (p = 0.262). CONCLUSION Except for the pathologic subtypes, prognostic factors in Taiwan are similar to those used in other melanoma-prevalent countries. Identifying and closely monitoring patients at risk of nodal recurrence after a negative SLNB is important.
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Affiliation(s)
- Chiao-En Wu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Jen Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jiun-Ting Yeh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tseng-Tong Kuo
- Department of Pathology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chih-Hsun Yang
- Department of Dermatology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Division of Breast Surgery, Department of General Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kun-Ju Lin
- Department of Nuclear Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Gamsizkan M, Yilmaz I, Buyukbabani N, Demirkesen C, Demiriz M, Cetin ED, Ince U, Akalin T, Demirkan NC, Lebe B, Erdem O, Gokoz O, Sakiz D, Demireli PT, Astarci HM, Adim SB, Zemheri IE, Acikalin A, Yaman B, Aydin O, Bassorgun CI. A Retrospective Multicenter Evaluation of Cutaneous Melanomas in Turkey. Asian Pac J Cancer Prev 2015; 15:10451-6. [DOI: 10.7314/apjcp.2014.15.23.10451] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ito T, Wada M, Nagae K, Nakano-Nakamura M, Nakahara T, Hagihara A, Furue M, Uchi H. Acral lentiginous melanoma: who benefits from sentinel lymph node biopsy? J Am Acad Dermatol 2014; 72:71-7. [PMID: 25455840 DOI: 10.1016/j.jaad.2014.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 09/16/2014] [Accepted: 10/07/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are significant clinicopathological, genetic, and biological differences between acral lentiginous melanoma (ALM) and other types of melanoma. OBJECTIVE We sought to investigate the use of sentinel lymph node (SLN) biopsy for patients with ALM. METHODS This was a retrospective review of 116 patients with primary ALM. Melanoma-specific and disease-free survival were estimated using the Kaplan-Meier method, together with multivariate analyses using the Cox proportional hazards regression model. RESULTS All patients were Japanese (48 male and 68 female). Metastases in SLN were noted in 13 of 84 patients who underwent SLN biopsy. No patients with thin ALM (≤1 mm) and only 2 patients with nonulcerated ALM had tumor-positive SLN. Patients with positive SLN had significantly shorter melanoma-specific survival (5-year survival rate, 37.5% vs 84.3%; P < .0001) and disease-free survival (5-year survival, 37.5% vs 77.9%; P = .0024). Among patients with thick (>1 mm) ALM, the influence of SLN positivity on melanoma-specific survival was increased (5-year survival, 22.7% vs 80.8%; P = .0005). LIMITATIONS This was a retrospective study and had a small sample size. CONCLUSIONS SLN biopsy should be considered for patients with thick or ulcerated ALM. For patients with thin or nonulcerated ones, it may be of limited importance.
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Affiliation(s)
- Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Maiko Wada
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Konosuke Nagae
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Misa Nakano-Nakamura
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akihito Hagihara
- Department of Health Services Management and Policy, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Uchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Kim JH, Park JH, Lee DY. Site distribution of cutaneous melanoma in South Korea: a retrospective study at a single tertiary institution. Int J Dermatol 2014; 54:e38-9. [DOI: 10.1111/ijd.12572] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jun-Hwan Kim
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Ji-Ho Park
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Dong-Youn Lee
- Department of Dermatology; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
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Tsai MS, Chiu MW. Patient-reported frequency of acral surface inspection during skin examination in white and ethnic minority patients. J Am Acad Dermatol 2014; 71:249-55. [PMID: 24767730 DOI: 10.1016/j.jaad.2014.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/16/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acral lentiginous melanomas compose a higher proportion of melanomas and have a higher mortality in ethnic minorities than in whites. Early detection by acral surface inspection during skin examinations may lead to improved acral lentiginous melanoma outcomes. OBJECTIVE This study compared patient-reported frequencies of acral skin examinations in ethnic and white populations. METHODS Written surveys were collected from 1040 dermatology clinic patients. RESULTS More whites reported performing self-skin examinations than ethnic minorities (P < .01), but there was no difference in the rates of hand (P = .7) or foot (P = .87) inspection during self-skin examination between whites and ethnic minorities. More whites (77.5%) than ethnic minorities (38.9%) reported having undergone a full-body skin examination (FBSE) from a health care provider (P < .01). During their most recent FBSE by a health care provider, more whites than ethnic minorities reported having their hands examined (P = .02), but there was no difference in reported hand inspection (P = .06) at any previous FBSE or foot inspection at any (P = .07) or the most recent (P = .59) FBSE between whites and ethnic minorities. LIMITATIONS Single-center study using a new unvalidated survey is a limitation. CONCLUSION Whites were found to more frequently report self-skin examination and FBSE than ethnic minorities, but significant differences in reported acral examinations were not detected.
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Affiliation(s)
- Monica S Tsai
- Division of Dermatology, David Geffen School of Medicine at the University of California, Los Angeles, California
| | - Melvin W Chiu
- Division of Dermatology, David Geffen School of Medicine at the University of California, Los Angeles, California.
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Dai B, Cai X, Kong YY, Yang F, Shen XX, Wang LW, Kong JC. Analysis of KIT expression and gene mutation in human acral melanoma: with a comparison between primary tumors and corresponding metastases/recurrences. Hum Pathol 2013; 44:1472-8. [DOI: 10.1016/j.humpath.2013.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 01/08/2013] [Accepted: 01/09/2013] [Indexed: 10/27/2022]
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The benefit of a sentinel lymph node biopsy and adjuvant therapy in thick (>4 mm) melanoma. Melanoma Res 2012; 22:362-7. [DOI: 10.1097/cmr.0b013e328355e558] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Lee HY, Chay WY, Tang MBY, Chio MTW, Tan SH. Melanoma: Differences between Asian and Caucasian Patients. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2012. [DOI: 10.47102/annals-acadmedsg.v41n1p17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Cutaneous melanoma is rare in Asia and the clinical presentation and outcome of melanoma is not well described in Southeast Asia. In addition, it is unclear if ethnic variations exist between the various racial groups. The objective of our study is to present the clinical characteristics of melanoma in Singapore and to highlight ethnical differences between Asians and Caucasians living in Singapore. Materials and Methods: Data were retrospectively collected from 48 patients with histological confirmation of melanoma who were seen in both the National Skin Centre and National Cancer Centre of Singapore. Results: Acral lentiginous melanoma (ALM) was the most common subtype of melanoma in Singapore (50%). A higher proportion of non-ALM subtypes of melanoma compared to ALM were diagnosed at stage 1 (48% vs. 25%). The delay in diagnosis of ALM was 27 months compared to 12 months in other subtypes. Compared to Caucasians, there was a trend towards Asian patients being older, having a higher proportion of ALM and a longer delay to diagnosis. Conclusion: Geographical and ethnic variations in the clinical presentation of melanoma exist. Specially adapted programmes are necessary to increase awareness of the different clinical presentation of melanoma in Asia and to encourage examination of the palms and soles in order to reduce the delay in diagnosis.
Key words: Acral, Pigmented lesions, Singapore, Skin cancer
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Chi Z, Li S, Sheng X, Si L, Cui C, Han M, Guo J. Clinical presentation, histology, and prognoses of malignant melanoma in ethnic Chinese: a study of 522 consecutive cases. BMC Cancer 2011; 11:85. [PMID: 21349197 PMCID: PMC3056833 DOI: 10.1186/1471-2407-11-85] [Citation(s) in RCA: 238] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 02/25/2011] [Indexed: 01/23/2023] Open
Abstract
Background Malignant melanoma is a rare disease in Asia, and knowledge on its characteristics and clinical outcome in Asian patients is limited. The purpose of this observational study was to determine the clinical presentation and outcome of patients with melanoma in China. Methods A database was prospectively established for the purpose of this analysis. The elements of the database included basic demographic data of patients and prognosticators previously reported in literature, as well as follow-up data including clinical outcome after treatment. Medical record of all patients with pathologically diagnosed malignant melanoma consulted in our center since 2006 were retrieved and reviewed. No patient was excluded in this study. Statistical analyses including survival and multivariate analyses of factors associated with survival were respectively performed by Kaplan-Meier method and Cox proportional hazard model. Results A total of 522 consecutive and nonselected cases were evaluated. There were 218 cases (41.8%) of acral lentiginous melanoma (ALM), 118 (22.6%) of mucosal melanoma (MCM), 103 (19.7%) of nodular melanoma (NM), 33 (6.3%) of superficial spreading melanoma (SSM), and others were Lentigo maligna melanoma or unclassifiable disease. The proportion of patients with clinical stage I, II, III, and IV diseases were 6.1%, 55.9%, 25.1%, and 12.8%, respectively. Among the 357 cases of cutaneous melanoma, 234 patients (65.5%) had ulceration. The 5-year overall survival rate of all 522 patients was 41.6%, and the median survival time was 3.92 years (95% CI, 3.282 to 4.558). Five-year survival rates of patients with stage I, II, III, and IV diseases were 94.1%, 44.0%, 38.4% and 4.6% respectively (P < 0.001). Multivariate analysis revealed that clinical stage and the ulceration were two significant prognosticators for OS. In addition, extent of surgery and use of adjuvant therapy were significant prognosticators for DFS in patients with non-metastatic disease after definitive treatment. Pathological subtype was not a significant prognostic factor to predict wither OS or DFS. Conclusions Prognoses of patients with malignant melanoma diagnosed in China were suboptimal, and most patients were diagnosed with locally advanced disease (i.e., stage II or above). ALM and MCM are the two most commonly diagnosed pathological subtypes. Clinical staging and presence of ulceration was significantly associated with clinical outcome in terms of OS, while treatment strategy including extent of surgery and use of adjuvant therapy were significant predictors of DFS.
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Affiliation(s)
- Zhihong Chi
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Renal Cancer and Melanoma, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, China
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91
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Bristow IR, de Berker DA, Acland KM, Turner RJ, Bowling J. Clinical guidelines for the recognition of melanoma of the foot and nail unit. J Foot Ankle Res 2010; 3:25. [PMID: 21040565 PMCID: PMC2987777 DOI: 10.1186/1757-1146-3-25] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 11/01/2010] [Indexed: 01/07/2023] Open
Abstract
Malignant melanoma is a life threatening skin tumour which may arise on the foot. The prognosis for the condition is good when lesions are diagnosed and treated early. However, lesions arising on the soles and within the nail unit can be difficult to recognise leading to delays in diagnosis. These guidelines have been drafted to alert health care practitioners to the early signs of the disease so an early diagnosis can be sought.
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Affiliation(s)
- Ivan R Bristow
- School of Health Sciences, University of Southampton, SO17 1BJ, UK.
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92
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93
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Rex J, Paradelo C, Mangas C, Hilari JM, Fernández-Figueras MT, Ferrándiz C. Management of Primary Cutaneous Melanoma of the Hands and Feet. Dermatol Surg 2009; 35:1505-13. [DOI: 10.1111/j.1524-4725.2009.01265.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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94
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Immunotherapy with dendritic cells pulsed by autologous dactinomycin-induced melanoma apoptotic bodies for patients with malignant melanoma. Melanoma Res 2009; 19:309-15. [DOI: 10.1097/cmr.0b013e32832b2717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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95
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Lichte V, Breuninger H, Metzler G, Haefner H, Moehrle M. Acral lentiginous melanoma: conventional histology vs. three-dimensional histology. Br J Dermatol 2009; 160:591-9. [DOI: 10.1111/j.1365-2133.2008.08954.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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96
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A phase II study of fotemustine plus dacarbazine with dendritic cell vaccines as first-line therapy for Chinese patients with advanced acral lentiginous melanoma. Chin J Cancer Res 2009. [DOI: 10.1007/s11670-009-0013-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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97
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Shin S, Palis BE, Phillips JL, Stewart AK, Perry RR. Cutaneous melanoma in Asian-Americans. J Surg Oncol 2009; 99:114-8. [PMID: 19034932 DOI: 10.1002/jso.21195] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is little information available on melanoma in non-white populations. Our objective was to characterize melanoma in Asian-Americans (AsA) and compare patient demographics and tumor characteristics with the non-Hispanic White (NHW) population. METHODS 483,050 cutaneous melanoma patients diagnosed between 1986 and 2005 were identified using the National Cancer Data Base (NCDB); 1,237 were AsA, and 409,564 were NHW. Age, gender, site, histologic type, tumor thickness, AJCC stage, and survival were compared. RESULTS AsA were more likely to be diagnosed with acral lentiginous tumors (6.7%) than NHW (0.8%, P < 0.001). A greater proportion of AsA were diagnosed with T4 tumors (15.6%) than NHW (8.5%, P < 0.001). AsA presented with fewer early stage I-II tumors and more late stage III-IV tumors than NHW (P < 0.001). Survival was similar for AsA and NHW. CONCLUSIONS This is the largest study to date on melanoma in AsA. Compared to NHW, AsA are more likely to have acral lentinginous tumors, thick tumors, and higher stage. Despite this, their survival is similar to the NHW population.
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Affiliation(s)
- Susanna Shin
- Department of Surgery, Division of Surgical Oncology, Eastern Virginia Medical School, Norfolk, VA, USA
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98
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Bristow IR, Acland K. Acral lentiginous melanoma of the foot and ankle: A case series and review of the literature. J Foot Ankle Res 2008; 1:11. [PMID: 18822168 PMCID: PMC2553782 DOI: 10.1186/1757-1146-1-11] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 09/15/2008] [Indexed: 12/01/2022] Open
Abstract
Background Acral lentiginous melanoma (ALM) is an uncommon, cutaneous malignant tumour which may arise on the foot. Its relative rarity, atypical appearance and late presentation frequently serve as poor prognostic indicators. Methods At a tertiary skin tumour centre, a retrospective review was undertaken of all patients diagnosed with the tumour at the level of ankle or below. Results Over a six year period, 27 cases (20 female, 7 male) were identified with positive histology confirming the disease. The age ranged from 35–96 years of age (mean 62.7 years). The majority of the cohort were white (59%) with plantar lesions (62%). 33% of patients were initially were diagnosed incorrectly. The average time taken from the point of recognition, by the patient, to the lesion being correctly diagnosed was around 13.5 months. Conclusion Earlier diagnosis of ALM requires education at both a patient and practitioner level.
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Affiliation(s)
- Ivan R Bristow
- School of Health Sciences, University of Southampton, UK.
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99
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Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. Acral lentiginous melanoma: histopathological prognostic features of 121 cases. Br J Dermatol 2007; 157:311-8. [PMID: 17596173 DOI: 10.1111/j.1365-2133.2007.08031.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is the fourth histopathological subtype of malignant melanoma, accounting for < 10% of all melanomas in white-skinned populations. It is characterized by a lentiginous pattern of proliferation of the intraepidermal component of the tumour. Its individualization is still controversial, especially in regard of its prognostic value. OBJECTIVES To characterize better ALM from a pathological point of view and to assess the prognostic value of all histopathological features of ALM. METHODS We performed a review of all cases of ALM followed from 1996 to 2004 at the University Hospital Department of Dermatology, Lyon, France. We examined all haematoxylin, eosin and saffron-stained tissue sections of the primary lesions. Several pathological parameters of interest in melanoma were evaluated for disease-free and specific survival with the Kaplan-Meier method and the Cox proportional hazards regression model. RESULTS Representative histological material was available for 121 patients. The mean Breslow thickness was 2.5 mm (in situ-20 mm). Fifteen lesions (12%) were in situ, nine (7%) were at Clark level II, 35 (29%) at III, 40 (33%) IV and 22 (18%) V. Extension along adnexal structures was found in almost half of the ALMs (46%), without prognostic significance. Seventeen (14%) lesions showed no microscopic pigmentation. Remnants of pre-existing naevus were found in four (3%) melanomas. The width of the 36 (30%) ulcerated lesions ranged from 1 to 20 mm (mean 7.6). Ulceration and its width were both associated with a large tumour thickness (P < 0.01), a high level of invasion (P < 0.01), the presence of vascular invasion (P < 0.01) and the lack of pigment production (P < 0.01). Among the 99 ALMs which were in the vertical growth phase (VGP), 21 showed a high mitotic rate (> 6 mitoses mm(-2)). A high mitotic rate was found to be significantly associated with the presence of ulceration (P < 0.01). The presence of microscopic satellites was noted in 10 (10%) lesions. The uncommon presence of small cells (8%) in the VGP was statistically significantly (P < 0.01) associated with a worse prognosis compared with other cell types. Multivariate analysis identified mitotic rate (P < 0.01), microsatellites (P = 0.05), Clark level (P = 0.01) and gender (P = 0.03) as independent prognostic factors for disease-free survival. Only the presence of microsatellites (P = 0.02) and a high mitotic rate (P < 0.01) were independently correlated with specific survival in ALM. CONCLUSIONS This is a detailed pathological study of a large cohort with ALM, an uncommon subtype of melanoma. Mitotic activity appears to be of particular importance in predicting the outcome of ALM.
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Affiliation(s)
- A Phan
- Department of Dermatology, Hôtel Dieu, Claude Bernard University, 69288 Lyon cedex 02, France
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Phan A, Touzet S, Dalle S, Ronger-Savlé S, Balme B, Thomas L. Acral lentiginous melanoma: a clinicoprognostic study of 126 cases. Br J Dermatol 2007; 155:561-9. [PMID: 16911282 DOI: 10.1111/j.1365-2133.2006.07368.x] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although the histopathological subtype of melanoma has not been clearly proven to carry independent prognostic significance, acral lentiginous melanoma (ALM) seems to confer a poorer prognosis mainly because disease is often more advanced at the time of diagnosis. OBJECTIVES To investigate the distinctive epidemiological and clinical characteristics of ALM, a peculiar histological entity, and to identify prognostic factors. METHODS We performed a register-based review of cases from a single large referral centre, the University Hospital Department of Dermatology, Lyons, France. We reviewed patient demographics, the initial presentation of the lesion, and clinical outcome. ALM-specific and disease-free survival were estimated using the KaplanMeier method and compared using the log-rank test. A Cox model was used to identify prognostic factors. RESULTS One hundred and twenty-six patients were identified as having histopathology-proven ALM in our melanoma patient register from 1996 to 2004. There were 46 (37%) subungual ALM and 80 (63%) ALM on soles, palms and nonvolar sites. The mean age at diagnosis was 63 years. There were 44 (35%) men and 82 (65%) women, sex ratio M/F 1 : 1.86. The mean Breslow thickness was 2.51 mm (range: in situ to 20 mm). There was no evidence of overexposure to ultraviolet radiation, nor was there found a predisposing genetic trait. Only 16 (13%) patients recalled a history of trauma. Thirty-four ALM (28%) were unpigmented. The median ALM-specific and disease-free survival were 13.5 and 10.1 years, respectively. The 5-year survival rate was 76%. Multivariate analysis identified tumour thickness, male gender and amelanosis as independent clinical prognostic factors for both ALM-specific and disease-free survival. CONCLUSIONS Our study provides specific information on the clinical characteristics and outcome of this uncommon histological subtype of melanoma. However, the pathogenesis remains unknown. Breslow thickness, male gender and amelanosis were significantly associated with a poorer prognosis.
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Affiliation(s)
- A Phan
- Department of Dermatology, Hôtel Dieu, Claude Bernard University, 69288 Lyon cedex 02, France
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