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van Veenendaal LM, van Akkooi ACJ, Verhoef C, Grünhagen DJ, Klop WMC, Valk GD, Tesselaar MET. Merkel cell carcinoma: Clinical outcome and prognostic factors in 351 patients. J Surg Oncol 2018; 117:1768-1775. [DOI: 10.1002/jso.25090] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Cees Verhoef
- Departement of Surgical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - Dirk Jan Grünhagen
- Departement of Surgical Oncology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - W. Martin C. Klop
- Departement of Head and Neck Surgery and Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
| | - Gerlof D. Valk
- Departement of Endocrine Oncology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Margot E. T. Tesselaar
- Departement of Medical Oncology; Netherlands Cancer Institute; Amsterdam The Netherlands
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52
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A cancer registry-based analysis on the non-white populations reveals a critical role of the female sex in early-onset melanoma. Cancer Causes Control 2018. [PMID: 29524010 DOI: 10.1007/s10552-018-1022-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Most melanoma studies have been performed in the white population who exhibits the highest incidence rate due to their skin sensitivity to UV radiation. Previous publications have shown that young women (approximately under the menopausal age) exhibit higher incidence rates than men of the same age, and the causes are mostly attributed to their sun behavior or indoor tanning. In our recent publications, we suggested that higher risk in younger women was due to pathophysiological factors, such as hormonal impact, and thus this higher risk in young women should be shared across ethnicities regardless of their skin color or UV behavior. METHODS A total of 13,208 non-white melanoma patients from SEER and 15,226 from WHO CI5-Plus were extracted for analysis. Age-specific incidence rates, female-to-male incidence rate ratios, and p values were calculated. RESULTS As observed in the white population, younger women and older men showed higher melanoma incidence rates than their peers of the other gender in all ethnic groups. The highest female-to-male incidence rate ratios were observed in the pubescent and reproductive ages. Previously this gender discrepancy in the white population was attributed to the preference of skin tanning in young females. There is no evidence to show that darker-skinned young females adopt a similar tanning preference. Thus the age-dependent gender difference in the risk of melanoma is shared across ethnic groups and is perhaps independent of UV behavior. CONCLUSIONS Our results highlight the importance of gender as one of the melanoma risk factors beyond traditional UV radiation, which warrants further investigation and may provide a base for an improved prevention strategy.
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Neutrophil-to-lymphocyte Ratio (NLR) as a predictor for recurrence in patients with stage III melanoma. Sci Rep 2018; 8:4044. [PMID: 29511262 PMCID: PMC5840418 DOI: 10.1038/s41598-018-22425-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/22/2018] [Indexed: 12/22/2022] Open
Abstract
Neutrophil-to-lymphocyte ratio is a strong predictor for overall survival and disease free survival in many cancers. Our study is the first investigation aiming to determine the predictive value of neutrophil-to-lymphocyte ratio on prognosis of patients with stage III melanoma. This retrospective study utilized a cohort of 107 patients with stage III melanoma treated at Huntsman Cancer Institute, University of Utah, from May 2002 to March 2016. The optimal cutoff of neutrophil-to-lymphocyte ratio was determined by the significance of log-rank tests. A total of 97 log-rank tests were conducted to find the optimal cutoff. Disease free survival was assessed using the Kaplan–Meier method, and univariable and multivariable Cox models were applied to evaluate the predictive value of neutrophil-to-lymphocyte ratio. 2.5 was identified as the optimal cutoff. Kaplan–Meier curve showed that the disease free survival rate of the low value group was significantly higher compared to that of high value group. After adjusting for confounders and other prognostic factors, the neutrophil-to-lymphocyte ratio ≥ 2.5 remained a strong predictor for disease recurrence in patients with stage III melanoma.
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54
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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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55
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Erturk K, Tas F. Effect of biology on the outcome of female melanoma patients. Mol Clin Oncol 2017; 7:1093-1100. [PMID: 29285381 DOI: 10.3892/mco.2017.1446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/06/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate plausible explanations for the favorable outcome of female melanoma patients and determine the effect of biology on this outcome. Data from 1,169 cutaneous melanoma patients were retrospectively analyzed. Cox proportional hazards models were used and the confounding factors on the survival difference were analyzed by a forward step multivariate modification method. The majority of the factors contributing to poor prognosis were significantly more pronounced in male melanoma patients. After the survival advantage of female patients (P=0.0001 on univariate analysis) was confounded (P=0.708 on multivariate analysis) following adjustment for the prognostic factors, two factors (neurotropism and vertical growth phase) were identified as the confounders, and this effect was attributed to the small number of patients in the groups of these two variables. The already known female advantage in melanoma survival was not affected by other prognostic factors, and female sex remained an independent predictor of good survival in melanoma. This sex-related independent survival advantage was attributed to a biological characteristic that has not yet been fully elucidated, but may be more closely associated with host-related rather than melanoma-related factors.
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Affiliation(s)
- Kayhan Erturk
- Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul 34093, Turkey
| | - Faruk Tas
- Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul 34093, Turkey
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56
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Crawford AB, Nessim C, Weaver J, van Walraven C. Wait Times for Melanoma Surgery: Is There an Association with Overall Survival? Ann Surg Oncol 2017; 25:265-270. [DOI: 10.1245/s10434-017-6146-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Indexed: 11/18/2022]
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57
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Vallone MG, Tell-Marti G, Potrony M, Rebollo-Morell A, Badenas C, Puig-Butille JA, Gimenez-Xavier P, Carrera C, Malvehy J, Puig S. Melanocortin 1 receptor (MC1R) polymorphisms' influence on size and dermoscopic features of nevi. Pigment Cell Melanoma Res 2017; 31:39-50. [PMID: 28950052 DOI: 10.1111/pcmr.12646] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/01/2017] [Indexed: 01/02/2023]
Abstract
The melanocortin 1 receptor (MC1R) is a highly polymorphic gene. The loss-of-function MC1R variants ("R") have been strongly associated with red hair color phenotype and an increased melanoma risk. We sequenced the MC1R gene in 175 healthy individuals to assess the influence of MC1R on nevus phenotype. We identified that MC1R variant carriers had larger nevi both on the back [p-value = .016, adjusted for multiple parameters (adj. p-value)] and on the upper limbs (adj. p-value = .007). Specifically, we identified a positive association between the "R" MC1R variants and visible vessels in nevi [p-value = .033, corrected using the FDR method for multiple comparisons (corrected p-value)], dots and globules in nevi (corrected p-value = .033), nevi with eccentric hyperpigmentation (corrected p-value = .033), a high degree of freckling (adj. p-value = .019), and an associative trend with presence of blue nevi (corrected p-value = .120). In conclusion, the MC1R gene appears to influence the nevus phenotype.
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Affiliation(s)
- María Gabriela Vallone
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Dermatology Department, Hospital Alemán, Buenos Aires, Argentina
| | - Gemma Tell-Marti
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Miriam Potrony
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Aida Rebollo-Morell
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Celia Badenas
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,Biochemical and Molecular Genetics Service, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Joan Anton Puig-Butille
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,Biochemical and Molecular Genetics Service, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain
| | - Pol Gimenez-Xavier
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Cristina Carrera
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain
| | - Josep Malvehy
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,Medicine Department, Universitat de Barcelona, Barcelona, Spain
| | - Susana Puig
- Dermatology Department, Melanoma Unit, Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,Medicine Department, Universitat de Barcelona, Barcelona, Spain
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58
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Thomson DR, Rughani MG, Kuo R, Cassell OCS. Sentinel node biopsy status is strongly predictive of survival in cutaneous melanoma: Extended follow-up of Oxford patients from 1998 to 2014. J Plast Reconstr Aesthet Surg 2017; 70:1397-1403. [PMID: 28625757 DOI: 10.1016/j.bjps.2017.05.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/02/2017] [Accepted: 05/10/2017] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Sentinel lymph node biopsy (SLNB) is widely used as a key investigatory tool for cutaneous melanoma, with results incorporated into the latest AJCC staging guidelines. We present the results of our extended follow-up of sentinel lymph node biopsy for melanoma over a sixteen-year period. METHODS Data were collected prospectively from June 1998 to December 2014 from a single tertiary skin cancer referral centre. Chi-squared analysis was used to analyse patient demographics and primary tumour pathology. Survival analysis was conducted using Cox regression models and Kaplan-Meier survival curves. RESULTS Over a sixteen-year period 1527 patients underwent SLNB in 1609 basins, with 2876 nodes harvested. 347 patients (23%) had a positive biopsy. The most common primary tumour sites for males was the back (32%); women had a significantly higher number of melanomas occurring on the lower and upper limbs (45% and 26% respectively) [all p < 0.0001, Chi-squared]. Mean follow-up time was 4.9 years. Patients with a positive SLNB at diagnosis were significantly more likely to die from melanoma (subhazard ratio 5.59, p = 0.000, 95% CI 3.59-8.69). Breslow thickness and ulceration were also significant predictors of melanoma-specific mortality. For patients with a primary Breslow >4.0 mm ten-year disease free survival was 52% for SLNB negative and 26% for SLNB positive patients. For Breslow thicknesses of 2.01-4 mm these values were 66% and 32% respectively. CONCLUSIONS Sentinel lymph node biopsy status is strongly predictive of survival across all thicknesses of primary cutaneous melanoma.
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Affiliation(s)
- David R Thomson
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
| | - Milap G Rughani
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
| | - Rachel Kuo
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
| | - Oliver C S Cassell
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
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Enninga EAL, Moser JC, Weaver AL, Markovic SN, Brewer JD, Leontovich AA, Hieken TJ, Shuster L, Kottschade LA, Olariu A, Mansfield AS, Dronca RS. Survival of cutaneous melanoma based on sex, age, and stage in the United States, 1992-2011. Cancer Med 2017; 6:2203-2212. [PMID: 28879661 PMCID: PMC5633552 DOI: 10.1002/cam4.1152] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/02/2017] [Accepted: 07/06/2017] [Indexed: 01/08/2023] Open
Abstract
Women diagnosed with cutaneous melanoma have a survival advantage compared to men, which has been hypothesized to be due to difference in behavior and/or biology (sex hormones). It remains controversial whether this advantage is dependent on age or stage of disease. We sought to compare melanoma-specific survival between females in pre, peri, and postmenopausal age groups to males in the same age group, adjusting for stage of disease. This is a retrospective population-based cohort study using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed from 1 January 1992 through 31 January 2011 with primary invasive cutaneous melanoma were included in our cohort. Melanoma-specific survival was the main outcome studied. Of the 106,511 subjects that were included, 45% were female. Females in all age groups (18-45, 46-54, and ≥55) with localized and regional disease, were less likely to die from melanoma compared to males in the same age group. Among patients with localized and regional disease, the relative risk of death due to melanoma increased with advancing age at diagnosis; this increase was more pronounced among females than males. In contrast, we observed no female survival advantage among patients with distant disease and no effect of age on relative risk of death from melanoma. Females with localized and regional melanoma have a decreased risk of death compared to males within all age groups. Our data show no differences in survival between men and women with metastatic melanoma, indicating that the influence of sex on survival is limited to early stage disease but not confined to pre or perimenopausal age groups.
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Affiliation(s)
- Elizabeth Ann L. Enninga
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Justin C. Moser
- Huntsman Cancer InstituteDivisions of Hematology and OncologyUniversity of Utah30 N 1900 ESalt Lake CityUtah84132France
| | - Amy L. Weaver
- Biomedical Statistics and InformaticsMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Svetomir N. Markovic
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Jerry D. Brewer
- Department of DermatologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Alexey A. Leontovich
- Biomedical Statistics and InformaticsMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Tina J. Hieken
- Department of SurgeryMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Lynne Shuster
- Huntsman Cancer InstituteDivisions of Hematology and OncologyUniversity of Utah30 N 1900 ESalt Lake CityUtah84132France
| | - Lisa A. Kottschade
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Ariadna Olariu
- Department of SurgeryNotre Dame des AydesNotre Dame des Aydes 11 Rue FranciadeBlois41000France
| | - Aaron S. Mansfield
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
| | - Roxana S. Dronca
- Department of OncologyDivision of Medical OncologyMayo Clinic200 1st Street SWRochesterMinnesota55905France
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60
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Trofymenko O, Zeitouni NC. Association of patient demographic characteristics with dermatofibrosarcoma protuberans tumour size at diagnosis in the U.S. National Cancer Database. Br J Dermatol 2017; 177:e103-e104. [PMID: 28144941 DOI: 10.1111/bjd.15357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- O Trofymenko
- College of Medicine, University of Arizona, Tucson, AZ, U.S.A
| | - N C Zeitouni
- Department of Dermatology, University of Arizona College of Medicine, Phoenix, AZ, U.S.A
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61
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Read T, Webber S, Tan J, Wagels M, Schaider H, Soyer HP, Smithers BM. Diphenylcyclopropenone for the treatment of cutaneous in-transit melanoma metastases - results of a prospective, non-randomized, single-centre study. J Eur Acad Dermatol Venereol 2017. [PMID: 28626861 DOI: 10.1111/jdv.14422] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current treatments for in-transit melanoma (ITM) metastases are frequently invasive and do not improve overall survival. Recently, there has been increasing investigation into the use of topical agents. Diphenylcyclopropenone or diphencyprone (DPCP) is a novel, topical therapy that has been reported to have immune-sensitizing properties useful in the treatment of ITM. OBJECTIVE To assess the clinical outcomes of patients treated within a prospective, non-randomized, non-comparative study using DPCP for cutaneous ITM metastases. METHODS A review was conducted assessing the outcomes of 58 patients prospectively treated using DPCP. Patients had satellite or in-transit disease (stage IIIB+), with all lesion morphology types included. The patients were treated through a single, specialized clinic with regular outpatient follow-up. DPCP was topically applied as an aqueous cream in 0.005-1% concentrations once to twice per week for up to 24-48 h of duration. To assess variables associated with response, a per-protocol statistical analysis was performed. RESULTS Fifty-four patients were treated who satisfied eligibility criteria for analysis. The overall response rates were as follows: complete response 22%, partial response 39%, stable disease 24% and progressive disease 15%. The mean time to complete response was 10.5 months, mean duration (disease-free interval) 12.3 months and recurrence rate in complete responders 41%. Lesion morphology was predictive of clinical benefit with a higher response in epidermotropic disease (P < 0.05). CONCLUSIONS DPCP provided a well-tolerated, convenient and efficacious treatment for cutaneous ITM metastases. Identifying patterns of response may assist treatment selection and improve patient-rated outcomes.
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Affiliation(s)
- T Read
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia.,School of Medicine, Griffith University, Gold Coast, Qld, Australia
| | - S Webber
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia
| | - J Tan
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia
| | - M Wagels
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - H Schaider
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Dermatology Research Centre, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - H P Soyer
- Department of Dermatology, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Dermatology Research Centre, School of Medicine, Translational Research Institute, The University of Queensland, Brisbane, Qld, Australia
| | - B M Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Queensland Health, Brisbane, Qld, Australia.,Discipline of Surgery, School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Abstract
Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States in the current year and compiles the most recent data on cancer incidence, mortality, and survival. Incidence data were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data were collected by the National Center for Health Statistics. In 2017, 1,688,780 new cancer cases and 600,920 cancer deaths are projected to occur in the United States. For all sites combined, the cancer incidence rate is 20% higher in men than in women, while the cancer death rate is 40% higher. However, sex disparities vary by cancer type. For example, thyroid cancer incidence rates are 3-fold higher in women than in men (21 vs 7 per 100,000 population), despite equivalent death rates (0.5 per 100,000 population), largely reflecting sex differences in the "epidemic of diagnosis." Over the past decade of available data, the overall cancer incidence rate (2004-2013) was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2005-2014) declined by about 1.5% annually in both men and women. From 1991 to 2014, the overall cancer death rate dropped 25%, translating to approximately 2,143,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. Although the cancer death rate was 15% higher in blacks than in whites in 2014, increasing access to care as a result of the Patient Protection and Affordable Care Act may expedite the narrowing racial gap; from 2010 to 2015, the proportion of blacks who were uninsured halved, from 21% to 11%, as it did for Hispanics (31% to 16%). Gains in coverage for traditionally underserved Americans will facilitate the broader application of existing cancer control knowledge across every segment of the population. CA Cancer J Clin 2017;67:7-30. © 2017 American Cancer Society.
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Affiliation(s)
- Rebecca L Siegel
- Strategic Director, Surveillance Information Services, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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63
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Zhang Y, Cartmel B, Choy CC, Molinaro AM, Leffell DJ, Bale AE, Mayne ST, Ferrucci LM. Body mass index, height and early-onset basal cell carcinoma in a case-control study. Cancer Epidemiol 2016; 46:66-72. [PMID: 28039770 DOI: 10.1016/j.canep.2016.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/30/2016] [Accepted: 12/14/2016] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Basal cell carcinoma (BCC) is the most common malignancy in the US. Body mass index (BMI) and height have been associated with a variety of cancer types, yet the evidence regarding BCC is limited. Therefore, we evaluated BMI and height in relation to early-onset BCC (under age 40) and explored the potential role of ultraviolet (UV) radiation exposure and estrogen-related exposures in the BMI-BCC relationship. METHODS BCC cases (n=377) were identified through a central dermatopathology facility in Connecticut. Control subjects (n=389) with benign skin conditions were randomly sampled from the same database and frequency matched to cases on age (median=36, interquartile range 33-39), gender, and biopsy site. Participants reported weight (usual adult and at age 18), adult height, sociodemographic, phenotypic, and medical characteristics, and prior UV exposures. We calculated multivariate odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional logistic regression models. RESULTS Adult BMI was inversely associated with early-onset BCC (obese vs. normal OR=0.43, 95% CI=0.26-0.71). A similar inverse association was present for BMI at age 18 (OR=0.54, 95% CI=0.34-0.85). Excluding UV exposures from the BMI models and including estrogen-related exposures among women only did not alter the association between BMI and BCC, indicating limited mediation or confounding. We did not observe an association between adult height and BCC (OR per cm=1.00, 95% CI=0.98-1.02). CONCLUSIONS We found a significant inverse association between BMI and early-onset BCC, but no association between height and BCC. This association was not explained by UV exposures or estrogen-related exposures in women.
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Affiliation(s)
- Yanchang Zhang
- Yale School of Public Health, New Haven, CT, 06520, United States
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, CT, 06520, United States; Yale Cancer Center, New Haven, CT, 06520, United States
| | - Courtney C Choy
- Yale School of Public Health, New Haven, CT, 06520, United States
| | - Annette M Molinaro
- UCSF Departments of Neurological Surgery and Epidemiology and Biostatistics, San Francisco, CA 94143, United States
| | - David J Leffell
- Yale Cancer Center, New Haven, CT, 06520, United States; Yale University School of Medicine, New Haven, CT 06520, United States
| | - Allen E Bale
- Yale Cancer Center, New Haven, CT, 06520, United States; Yale University School of Medicine, New Haven, CT 06520, United States
| | - Susan T Mayne
- Yale School of Public Health, New Haven, CT, 06520, United States; Yale Cancer Center, New Haven, CT, 06520, United States
| | - Leah M Ferrucci
- Yale School of Public Health, New Haven, CT, 06520, United States; Yale Cancer Center, New Haven, CT, 06520, United States.
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64
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Schoffer O, Schülein S, Arand G, Arnholdt H, Baaske D, Bargou RC, Becker N, Beckmann MW, Bodack Y, Böhme B, Bozkurt T, Breitsprecher R, Buchali A, Burger E, Burger U, Dommisch K, Elsner G, Fernschild K, Flintzer U, Funke U, Gerken M, Göbel H, Grobe N, Gumpp V, Heinzerling L, Kempfer LR, Kiani A, Klinkhammer-Schalke M, Klöcking S, Kreibich U, Knabner K, Kuhn P, Lutze S, Mäder U, Maisel T, Maschke J, Middeke M, Neubauer A, Niedostatek A, Opazo-Saez A, Peters C, Schell B, Schenkirsch G, Schmalenberg H, Schmidt P, Schneider C, Schubotz B, Seide A, Strecker P, Taubenheim S, Wackes M, Weiß S, Welke C, Werner C, Wittekind C, Wulff J, Zettl H, Klug SJ. Tumour stage distribution and survival of malignant melanoma in Germany 2002-2011. BMC Cancer 2016; 16:936. [PMID: 27919243 PMCID: PMC5139127 DOI: 10.1186/s12885-016-2963-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 11/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past two decades, there has been a rising trend in malignant melanoma incidence worldwide. In 2008, Germany introduced a nationwide skin cancer screening program starting at age 35. The aims of this study were to analyse the distribution of malignant melanoma tumour stages over time, as well as demographic and regional differences in stage distribution and survival of melanoma patients. METHODS Pooled data from 61 895 malignant melanoma patients diagnosed between 2002 and 2011 and documented in 28 German population-based and hospital-based clinical cancer registries were analysed using descriptive methods, joinpoint regression, logistic regression and relative survival. RESULTS The number of annually documented cases increased by 53.2% between 2002 (N = 4 779) and 2011 (N = 7 320). There was a statistically significant continuous positive trend in the proportion of stage UICC I cases diagnosed between 2002 and 2011, compared to a negative trend for stage UICC II. No trends were found for stages UICC III and IV respectively. Age (OR 0.97, 95% CI 0.97-0.97), sex (OR 1.18, 95% CI 1.11-1.25), date of diagnosis (OR 1.05, 95% CI 1.04-1.06), 'diagnosis during screening' (OR 3.24, 95% CI 2.50-4.19) and place of residence (OR 1.23, 95% CI 1.16-1.30) had a statistically significant influence on the tumour stage at diagnosis. The overall 5-year relative survival for invasive cases was 83.4% (95% CI 82.8-83.9%). CONCLUSIONS No distinct changes in the distribution of malignant melanoma tumour stages among those aged 35 and older were seen that could be directly attributed to the introduction of skin cancer screening in 2008.
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Affiliation(s)
- Olaf Schoffer
- Cancer Epidemiology, University Cancer Center, Technische Universität Dresden, Dresden, Germany. .,Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany.
| | - Stefanie Schülein
- Cancer Epidemiology, University Cancer Center, Technische Universität Dresden, Dresden, Germany.,Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
| | - Gerlinde Arand
- Onkologischer Schwerpunkt (OSP) Göppingen, Göppingen, Germany
| | | | | | | | - Nikolaus Becker
- National Centre for Tumour Diseases (NCT) Heidelberg, Heidelberg, Germany
| | | | - Yves Bodack
- Onkologische Qualitätssicherung (QS) in Westfalen-Lippe, Münster, Germany
| | - Beatrix Böhme
- Regional Clinical Cancer Registry Magdeburg, Magdeburg, Germany
| | | | | | - Andre Buchali
- Tumour Centre Brandenburg, Frankfurt (Oder), Germany
| | - Elke Burger
- Regional Clinical Cancer Registry Magdeburg, Magdeburg, Germany
| | | | | | - Gudrun Elsner
- Onkologischer Schwerpunkt (OSP) Göppingen, Göppingen, Germany
| | | | | | | | | | | | - Norbert Grobe
- Tumour Centre Neubrandenburg, Neubrandenburg, Germany
| | - Vera Gumpp
- Tumour Centre Freiburg/Comprehensive Cancer Centre Freiburg (CCCF), Freiburg im Breisgau, Germany
| | | | | | | | | | | | - Ute Kreibich
- Cancer Register of Southwest Saxony, Zwickau, Zwickau, Germany
| | | | - Peter Kuhn
- Tumour Centre Ulm/Comprehensive Cancer Centre Ulm (CCCU), Ulm, Germany
| | - Stine Lutze
- Tumour Centre Vorpommern, Greifswald, Germany
| | - Uwe Mäder
- Tumour Centre Würzburg, Würzburg, Germany
| | | | - Jan Maschke
- Tumour Centre Görlitz, Görlitz, Germany.,Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Martin Middeke
- Comprehensive Cancer Centre (CCC) Marburg, Marburg, Germany
| | | | | | | | - Christoph Peters
- Tumour Centre Freiburg/Comprehensive Cancer Centre Freiburg (CCCF), Freiburg im Breisgau, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - Claudia Welke
- Tumour Centre Ulm/Comprehensive Cancer Centre Ulm (CCCU), Ulm, Germany
| | - Carmen Werner
- Regional Clinical Cancer Registry Dresden, Dresden, Germany
| | | | - Jörg Wulff
- Cancer Register of Southwest Saxony, Zwickau, Zwickau, Germany
| | | | - Stefanie J Klug
- Cancer Epidemiology, University Cancer Center, Technische Universität Dresden, Dresden, Germany.,Epidemiology, Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
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65
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Wang Y, Ou Z, Sun Y, Yeh S, Wang X, Long J, Chang C. Androgen receptor promotes melanoma metastasis via altering the miRNA-539-3p/USP13/MITF/AXL signals. Oncogene 2016; 36:1644-1654. [PMID: 27869170 DOI: 10.1038/onc.2016.330] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 07/10/2015] [Accepted: 07/28/2016] [Indexed: 12/21/2022]
Abstract
Early studies demonstrated that male melanoma patients have worse survival than female patients, yet the detailed mechanisms for this gender difference remain unclear. We analyzed around 100 cases of human melanoma and found that androgen receptor (AR) positive melanoma patients have worse survival outcomes compared with AR-negative melanoma patients. Here we report that AR can have positive roles to increase melanoma cell invasion in multiple cell lines in vitro and a mouse model in vivo. Mechanism dissection suggest that AR increases melanoma cell invasion via modulating the MITF-AXL signals via altering the miRNA-539-3p/USP13 signaling to increase MITF protein degradation through a reduction of de-ubiquitination. Restoring MITF can reverse AR-enhanced melanoma cell invasion. Together, our results demonstrate that AR can promote melanoma metastasis via altering the miRNA-539-3p/USP13/MITF/AXL signal and targeting this newly identified signal with AR degradation enhancer ASC-J9 may help us to better suppress the melanoma metastasis.
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Affiliation(s)
- Y Wang
- Departments of Plastic Surgery, Xiangya Hospital, Central South University, Changsha, China.,George Whipple Lab for Cancer Research, Departments of Pathology and Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester NY, USA
| | - Z Ou
- Departments of Plastic Surgery, Xiangya Hospital, Central South University, Changsha, China.,George Whipple Lab for Cancer Research, Departments of Pathology and Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester NY, USA
| | - Y Sun
- George Whipple Lab for Cancer Research, Departments of Pathology and Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester NY, USA
| | - S Yeh
- George Whipple Lab for Cancer Research, Departments of Pathology and Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester NY, USA
| | - X Wang
- Departments of Plastic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - J Long
- Departments of Plastic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - C Chang
- George Whipple Lab for Cancer Research, Departments of Pathology and Urology, and The Wilmot Cancer Center, University of Rochester Medical Center, Rochester NY, USA.,Sex Hormone Research Center, China Medical University/Hospital, Taichung, Taiwan
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66
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Crocetti E, Fancelli L, Manneschi G, Caldarella A, Pimpinelli N, Chiarugi A, Nardini P, Buzzoni C. Melanoma survival: sex does matter, but we do not know how. Eur J Cancer Prev 2016; 25:404-9. [PMID: 26266895 DOI: 10.1097/cej.0000000000000190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The objective of this study was to provide further insights into the prognostic role of female sex in skin melanoma. The prognostic effect of sex in a population-based case series of 3900 skin melanomas in central Italy has been evaluated considering the possible confounding role of many demographic and clinical variables (age, period of diagnosis, Breslow's thickness, Clark level, ulceration, lymph node status, metastasis, histological type, skin site, and pathological T and N). Multiple imputations, according to chained equations, have been used for imputing incomplete values. A Cox proportional hazards model on the risk of death caused by melanoma was fitted. Univariate and multivariate effects of sex and of other variables were computed. The 5-year cause-specific survival was 87% (95% confidence interval: 86-89%) for women and 80% (78-82%) for men. Women had higher rates at any time since diagnosis. After adjustment for other confounders, women had a 34% reduced risk compared with men of dying from skin melanoma (hazard ratio=0.66, 95% confidence interval: 0.56-0.79). The present study confirmed a strong protective effect of female sex on skin melanoma mortality. The protective factor is still unknown.
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Affiliation(s)
- Emanuele Crocetti
- aClinical and Descriptive Epidemiology Unit bSecondary Prevention and Screening Unit, Melanoma Prevention Service, Institute for Cancer Study and Prevention (ISPO) cSurgery and Translational Medicine Department, Dermatology Division, University of Florence Medical School, Florence, Italy
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67
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Ipenburg NA, Nieweg OE, Uren RF, Thompson JF. Outcome of Melanoma Patients Who Did Not Proceed to Sentinel Node Biopsy After Preoperative Lymphoscintigraphy. Ann Surg Oncol 2016; 24:117-126. [PMID: 27480356 DOI: 10.1245/s10434-016-5458-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND At our institution, a planned sentinel node biopsy (SNB) procedure is occasionally canceled after preoperative lymphoscintigraphy. This study reports the frequency of this, the reasons, and the management and outcomes of these patients. METHODS All patients with clinically localized cutaneous melanoma treated at Melanoma Institute Australia between 2000 and 2009 whose planned SNB procedure was not undertaken after lymphoscintigraphy were included in this retrospective study. RESULTS Of the 3148 patients in whom the procedure had been planned, 203 patients (6.4 %) did not have a SNB. The main reason for not proceeding with SNB (in 84 % of cases) was the lymphoscintigraphic demonstration of multiple drainage fields and/or multiple sentinel nodes (SNs). Patients who did not proceed to SNB were significantly older than those who did, more often had melanomas of the head or neck, and had more SNs and more nodal drainage fields. Of the 203 patients, 181 (89 %) were followed with high-resolution ultrasound of their SNs, which identified 33 % of the nodal recurrences before they were clinically apparent. Patients whose SNB was canceled had significantly worse recurrence-free survival and regional node disease-free survival, but melanoma-specific survival was similar. Compared to SN-positive patients, node-positive patients without SNB had significantly more involved nodes when a delayed lymphadenectomy was performed, but melanoma-specific survival was not significantly different after a median follow-up of 42 months. CONCLUSIONS Lymphoscintigraphy with ultrasound follow-up of previously identified SNs is an acceptable management strategy for patients in whom a SNB procedure is likely to be challenging.
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Affiliation(s)
| | - Omgo E Nieweg
- Melanoma Institute Australia, North Sydney, NSW, Australia. .,Central Medical School, The University of Sydney, Sydney, NSW, Australia. .,The Mater Hospital, North Sydney and Royal Prince Alfred Hospital, Camperdown, Australia.
| | - Roger F Uren
- Central Medical School, The University of Sydney, Sydney, NSW, Australia.,Alfred Nuclear Medicine and Ultrasound, RPAH Medical Centre, Newtown, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, North Sydney, NSW, Australia.,Central Medical School, The University of Sydney, Sydney, NSW, Australia.,The Mater Hospital, North Sydney and Royal Prince Alfred Hospital, Camperdown, Australia
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68
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Guo H, Cheng Y, Martinka M, McElwee K. High LIFr expression stimulates melanoma cell migration and is associated with unfavorable prognosis in melanoma. Oncotarget 2016; 6:25484-98. [PMID: 26329521 PMCID: PMC4694846 DOI: 10.18632/oncotarget.4688] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022] Open
Abstract
Increased or decreased expression of LIF receptor (LIFr) has been reported in several human cancers, including skin cancer, but its role in melanoma is unknown. In this study, we investigated the expression pattern of LIFr in melanoma and assessed its prognostic value. Using tissue microarrays consisting of 441 melanomas and 96 nevi, we found that no normal nevi showed high LIFr expression. LIFr staining was significantly increased in primary melanoma compared to dysplastic nevi (P = 0.0003) and further increased in metastatic melanoma (P = 0.0000). Kaplan–Meier survival curve and univariate Cox regression analyses showed that increased expression of LIFr was correlated with poorer 5-year patient survival (overall survival, P = 0.0000; disease-specific survival, P = 0.0000). Multivariate Cox regression analyses indicated that increased LIFr expression was an independent prognostic marker for primary melanoma (P = 0.036). LIFr knockdown inhibited melanoma cell migration in wound healing assays and reduced stress fiber formation. LIFr knockdown correlated with STAT3 suppression, but not YAP, suggesting that LIFr activation might stimulate melanoma cell migration through the STAT3 pathway. Our data indicate that strong LIFr expression identifies potentially highly malignant melanocytic lesions at an early stage and LIFr may be a potential target for the development of early intervention therapeutics.
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Affiliation(s)
- Hongwei Guo
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Yabin Cheng
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Magdalena Martinka
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin McElwee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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69
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Mitchell B, Dhingra JK, Mahalingam M. BRAF and Epithelial-Mesenchymal Transition: Lessons From Papillary Thyroid Carcinoma and Primary Cutaneous Melanoma. Adv Anat Pathol 2016; 23:244-71. [PMID: 27145091 DOI: 10.1097/pap.0000000000000113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The increased prevalence of BRAF mutations in thyroid carcinoma and primary cutaneous melanoma (PCM) hint that dysregulation of BRAF might contribute to the noted association between PCM and thyroid carcinoma. A recent study evaluating the rate of BRAFV600E mutations among patients who had been diagnosed with primary papillary thyroid carcinoma (PTC) and PCM showed that patients with either PCM or PTC were at an increased risk of developing the other as a second primary malignant neoplasm. Furthermore, the authors noted that samples from patients suffering from both malignancies exhibited a higher rate of incidence of the BRAFV600E mutation, compared with patients not suffering from both malignancies. These studies support the hypothesis that the pathogenesis of these 2 malignancies might share a conserved molecular pattern associated with dysregulation of the BRAF protein. One mechanism through which BRAF might contribute to PCM and thyroid carcinoma progression is through induction of epithelial-mesenchymal transition (EMT). Specifically, the Snail/E-cadherin axis has been demonstrated as a pathway dysregulated by BRAF, leading to EMT in both malignancies. Our analysis focuses on the results of these recent investigations, and through a review of select molecules relevant to EMT, looks to provide a context by which to better understand the relevance and role of stromal-parenchymal signaling and the BRAF mutation in the pathogenesis of PTC and PCM.
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Affiliation(s)
- Brendon Mitchell
- *University of Florida College of Medicine, Gainesville, FL †Department of Otolaryngology, Tufts Medical center, Boston, MA ‡Dermatopathology Section, Department of Pathology and Laboratory Medicine, VA Consolidated Laboratories, West Roxbury, MA
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70
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Najita JS, Swetter SM, Geller AC, Gershenwald JE, Zelen M, Lee SJ. Sex Differences in Age at Primary Melanoma Diagnosis in a Population-Based Analysis (US Surveillance, Epidemiology, and End Results, 2005-2011). J Invest Dermatol 2016; 136:1894-1897. [PMID: 27251792 DOI: 10.1016/j.jid.2016.03.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/03/2016] [Accepted: 03/24/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Julie S Najita
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center and Cancer Institute, Stanford, California, USA; Dermatology Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Marvin Zelen
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sandra J Lee
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts, USA
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71
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Woolston A, Sintupisut N, Lu TP, Lai LC, Tsai MH, Chuang EY, Yeang CH. Putative effectors for prognosis in lung adenocarcinoma are ethnic and gender specific. Oncotarget 2016; 6:19483-99. [PMID: 26160836 PMCID: PMC4637300 DOI: 10.18632/oncotarget.4287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/09/2015] [Indexed: 01/13/2023] Open
Abstract
Lung adenocarcinoma possesses distinct patterns of EGFR/KRAS mutations between East Asian and Western, male and female patients. However, beyond the well-known EGFR/KRAS distinction, gender and ethnic specific molecular aberrations and their effects on prognosis remain largely unexplored. Association modules capture the dependency of an effector molecular aberration and target gene expressions. We established association modules from the copy number variation (CNV), DNA methylation and mRNA expression data of a Taiwanese female cohort. The inferred modules were validated in four external datasets of East Asian and Caucasian patients by examining the coherence of the target gene expressions and their associations with prognostic outcomes. Modules 1 (cis-acting effects with chromosome 7 CNV) and 3 (DNA methylations of UBIAD1 and VAV1) possessed significantly negative associations with survival times among two East Asian patient cohorts. Module 2 (cis-acting effects with chromosome 18 CNV) possessed significantly negative associations with survival times among the East Asian female subpopulation alone. By examining the genomic locations and functions of the target genes, we identified several putative effectors of the two cis-acting CNV modules: RAC1, EGFR, CDK5 and RALBP1. Furthermore, module 3 targets were enriched with genes involved in cell proliferation and division and hence were consistent with the negative associations with survival times. We demonstrated that association modules in lung adenocarcinoma with significant links of prognostic outcomes were ethnic and/or gender specific. This discovery has profound implications in diagnosis and treatment of lung adenocarcinoma and echoes the fundamental principles of the personalized medicine paradigm.
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Affiliation(s)
- Andrew Woolston
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | | | - Tzu-Pin Lu
- Department of Public Health, National Taiwan University, Taipei, Taiwan
| | - Liang-Chuan Lai
- Graduate Institute of Physiology, National Taiwan University, Taipei, Taiwan
| | - Mong-Hsun Tsai
- Institute of Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Eric Y Chuang
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
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72
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Gugger A, Barnhill RL, Seifert B, Dehler S, Moch H, Lugassy C, Marques-Maggio E, Rushing EJ, Mihic-Probst D. Cutaneous Melanoma with Brain Metastasis: Report of 193 Patients with New Observations. PLoS One 2016; 11:e0156115. [PMID: 27213536 PMCID: PMC4877095 DOI: 10.1371/journal.pone.0156115] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 05/08/2016] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Brain metastasis is a common endpoint in patients suffering from malignant melanoma. However, little is known about factors that predispose to brain metastases. OBJECTIVE We performed a retrospective clinical and pathological investigation of melanoma patients with brain metastases in order to better characterise this patient population. METHODS 193 melanoma patients with brain metastasis histologically diagnosed between 1990 and 2015 at the University Hospital Zurich were retrospectively identified and further specified for sex, age at diagnosis and detection of brain metastasis, and localisation. In addition, data were extracted regarding the subtype of primary melanoma, Breslow tumour thickness, Clark Level, mutation status, extent of metastatic spread and history of a second melanoma. RESULTS We found a significant male predominance (n = 126/193; 65%; p < 0.001). Breslow tumour thickness showed a wide range from 0.2 to 12.0 mm (n = 99; median 2.3 mm). 14 of 101 melanomas (14%) were classified as T1, thereof 11 (79%) were found in men. In 32 of 193 patients (17%), the primary melanoma was unknown. CONCLUSIONS Of special interest in our series is the high incidence of male predominance (79%) in cases of thin metastasing melanoma (14%), implicating genetic or epigenetic (hormonal) gender differences underlying tumour progression. Additionally, the high percentage of unknown primary melanoma (17%), at least partly representing completely regressed melanomas, indicates the importance of immune surveillance in melanoma progression.
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Affiliation(s)
- Alenka Gugger
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Raymond L. Barnhill
- Departments of Pathology and Translational Research, Institut Curie, Paris, France
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Silvia Dehler
- Cancer Registry Zurich and Zug, Institute of Surgical Pathology, University Hospital Zurich and Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Holger Moch
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Claire Lugassy
- Departments of Pathology and Translational Research, Institut Curie, Paris, France
| | | | | | - Daniela Mihic-Probst
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
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73
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Abstract
The incidence of many types of cancer arising in organs with non-reproductive functions is significantly higher in male populations than in female populations, with associated differences in survival. Occupational and/or behavioural factors are well-known underlying determinants. However, cellular and molecular differences between the two sexes are also likely to be important. In this Opinion article, we focus on the complex interplay that sex hormones and sex chromosomes can have in intrinsic control of cancer-initiating cell populations, the tumour microenvironment and systemic determinants of cancer development, such as the immune system and metabolism. A better appreciation of these differences between the two sexes could be of substantial value for cancer prevention as well as treatment.
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Affiliation(s)
- Andrea Clocchiatti
- Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129, USA
| | - Elisa Cora
- Department of Biochemistry, University of Lausanne, Epalinges, CH-1066, Switzerland
| | - Yosra Zhang
- Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129, USA; and the Department of Biochemistry, University of Lausanne, Epalinges, CH-1066, Switzerland
| | - G Paolo Dotto
- Cutaneous Biology Research Center, Massachusetts General Hospital, Charlestown, Massachusetts 02129, USA; and the Department of Biochemistry, University of Lausanne, Epalinges, CH-1066, Switzerland
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74
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Koskivuo I, Vihinen P, Mäki M, Talve L, Vahlberg T, Suominen E. Improved Survival in Male Melanoma Patients in the Era of Sentinel Node Biopsy. Scand J Surg 2016; 106:80-86. [PMID: 26929285 DOI: 10.1177/1457496916631852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Sentinel node biopsy is a standard method for nodal staging in patients with clinically localized cutaneous melanoma, but the survival advantage of sentinel node biopsy remains unsolved. The aim of this case-control study was to investigate the survival benefit of sentinel node biopsy. MATERIALS AND METHODS A total of 305 prospective melanoma patients undergoing sentinel node biopsy were compared with 616 retrospective control patients with clinically localized melanoma whom have not undergone sentinel node biopsy. Survival differences were calculated with the median follow-up time of 71 months in sentinel node biopsy patients and 74 months in control patients. Analyses were calculated overall and separately in males and females. RESULTS Overall, there were no differences in relapse-free survival or cancer-specific survival between sentinel node biopsy patients and control patients. Male sentinel node biopsy patients had significantly higher relapse-free survival ( P = 0.021) and cancer-specific survival ( P = 0.024) than control patients. In females, no differences were found. Cancer-specific survival rates at 5 years were 87.8% in sentinel node biopsy patients and 85.2% in controls overall with 88.3% in male sentinel node biopsy patients and 80.6% in male controls and 87.3% in female sentinel node biopsy patients and 89.8% in female controls. CONCLUSION Sentinel node biopsy did not improve survival in melanoma patients overall. While females had no differences in survival, males had significantly improved relapse-free survival and cancer-specific survival following sentinel node biopsy.
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Affiliation(s)
- I Koskivuo
- 1 Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - P Vihinen
- 2 Department of Oncology, Turku University Hospital, Turku, Finland
| | - M Mäki
- 3 Department of Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - L Talve
- 4 Department of Pathology, Turku University Hospital, Turku, Finland
| | - T Vahlberg
- 5 Department of Biostatistics, University of Turku, Turku, Finland
| | - E Suominen
- 1 Department of Plastic and General Surgery, Turku University Hospital and University of Turku, Turku, Finland
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75
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Abstract
The surgical management of melanoma has undergone considerable changes over the past several decades, as new strategies and treatments have become available. Surgeons play a pivotal role in all aspects of melanoma care: diagnostic, curative, and palliative. There is a high potential for cure in patients with early-stage melanoma and the selection of an appropriate operation is very important for this reason. Staging the nodal basin has become widespread since the adoption of sentinel lymph node biopsy (SLNB) for the management of melanoma. This operation provides the best prognostic information that is currently available for patients with melanoma. The surgeon plays a central role in the palliation of symptoms resulting from nodal disease and metastases, as melanoma has a propensity to spread to almost any site in the body.
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Affiliation(s)
- Vadim P Koshenkov
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA.
| | - Joe Broucek
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA
| | - Howard L Kaufman
- Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany St., Suite 3001, New Brunswick, NJ, 08901, USA
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Lee DY, Huynh KT, Teng A, Lau BJ, Vitug S, Lee JH, Stern SL, Foshag LJ, Faries MB. Predictors and Survival Impact of False-Negative Sentinel Nodes in Melanoma. Ann Surg Oncol 2015; 23:1012-8. [PMID: 26586498 DOI: 10.1245/s10434-015-4912-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND The status of the sentinel lymph node in melanoma is an important prognostic factor. The clinical predictors and implications of false-negative (FN) biopsy remain debatable. METHODS We compared patients with positive sentinel lymph node biopsy (SNB) [true positive (TP)] and negative SNB with and without regional recurrence [FN, true negative (TN)] from our prospective institutional database. RESULTS Among 2986 patients (84 FN, 494 TP, and 2408 TN; median follow-up 93 months), the incidence of FN-SNB was 2.8%. While calculated FN rate was 14.5% [84 FN/(494 TP + 84 FN) × 100], when we accounted for local/in-transit recurrence (LITR) this rate was 8.5% [46 FN/(494 TP + 46 FN) × 100 %]. On multivariate analysis, male gender (OR 2.0, 95% CI 1.1-3.6, p = 0.018), head/neck primaries (OR 2.5, 95% CI 1.3-4.8, p < 0.006), and LITR (OR 3.5, 95% CI 2.1-5.8, p < 0.001) were associated with FN-SNB. Melanoma-specific survival (MSS) for the FN group was similar to the TP group at 5 years (68 vs. 73%, p = 0.539). However, MSS declined more for the FN group with a longer follow up and was significantly worse at 10 years (44 vs. 64%, p < 0.001). On multivariate analysis, FN-SNB was a significant predictor of worse MSS in melanomas <4 mm in Breslow thickness (HR 1.6; 95% CI 1.1-2.5, p = 0.021). CONCLUSIONS Male gender, LITR, and head and neck tumors were associated with FN-SNB. FN-SNB was an independent predictor of worse MSS in melanomas <4 mm in thickness, but this survival difference did not become apparent until after 5 years of follow-up.
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Affiliation(s)
- David Y Lee
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Kelly T Huynh
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Annabelle Teng
- Department of Surgery, Mount Sinai, St-Luke's-Roosevelt Hospital Center, New York, NY, USA
| | - Briana J Lau
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Sarah Vitug
- Ochsner Clinical School, University of Queensland School of Medicine, Saint Lucia, QLD, Australia
| | - Ji-Hey Lee
- Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Stacey L Stern
- Department of Biostatistics, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Leland J Foshag
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA
| | - Mark B Faries
- Department of Surgical Oncology, The John Wayne Cancer Institute at Providence St. John's Health Center, Santa Monica, CA, USA.
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Majewski W, Stanienda K, Wicherska K, Ulczok R, Wydmanski J. Treatment Outcome and Prognostic Factors for Malignant Skin Melanoma Treated with Radical Surgery. Asian Pac J Cancer Prev 2015; 16:5709-14. [PMID: 26320440 DOI: 10.7314/apjcp.2015.16.14.5709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AIM To assess the treatment outcome in patients with malignant skin melanoma and prognostic factors for distant metastases (DM), disease-free survival (DFS) and overall survival (OS). MATERIALS AND METHODS A retrospective analysis was conducted on 113 patients with malignant skin melanoma (60 females, 53 males, average age-55 years) who were treated surgically. Primary treatment consisted of local excision. In 12 cases, it was accompanied by lymph node excision. In 93 (82%) cases, radicalization was necessary, which was either local only (19 cases) or accompanied by lymph node surgery/biopsy (74 cases). Possible prognostic factors such as Clark's stage and Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases (pN+), gender, tumor location and primary excision margins were considered. RESULTS In 51 (45%) cases, treatment failure occurred. The 5-year DM rate was 47%, the 5-year DFS was 38%, and the 5-year OS was 56%. In the univariate analysis, the important factors with respect to at least one endpoint included Clark's stage, Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases, gender and primary tumor localization. The presence of metastasic nodes was the most important prognostic factor, with a 5-year DM rates of 30% for pN(-) and 76% for pN(+) and a 5-year DFS and OS of 56% and 76% for pN(-) and 13% and 24% for pN(+), respectively. The average tumor dimension was independently significant for DFS and OS, with 5-year rates of 69% and 80% for ≤1 cm, 28% and 53% for 1-2 cm, and 18% and 30% for >2 cm, respectively. Tumor location was also significant for DM and OS, with 5-year rates of 69% vs 33% and 41% vs 66% for trunk vs other locations, respectively. CONCLUSIONS The natural course of a malignant skin melanoma treated radically is disadvantageous, with unsuccessful outcome in nearly half of the cases. Common clinical factors, such as Clark's tumor stage, Breslow's depth of invasion and the presence of metastatic nodes, have high prognostic significance. The size and location of the primary lesion may be considered independent prognostic factors. The most important negative prognostic factor is the presence of metastatic regional lymph nodes. Only one quarter of patients with metastases in lymph nodes survive 5 years from primary surgery.
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Affiliation(s)
- Wojciech Majewski
- Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland E-mail :
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Abstract
Differences across the sexes include epidemiological trends, distribution of clinical features and prognostic relevance in melanoma patients. The aims of this single-institution hospital-based cohort study were as follows: to assess the trends over time of the male/female ratio; to analyse the clinicopathologic features according to sex and their modifications following the introduction in 1999 of sentinel lymph node biopsy; to ascertain the metastatic pathways across sexes and the prognostic role of sex in the disease-free interval (DFI), disease-specific survival (DSS) and survival after recurrence. The patient population included 4310 stage I-II melanoma patients, diagnosed, treated and followed up in our institution from 1975. Patients were divided into two groups on the basis of the introduction of sentinel lymph node biopsy in 1999. A female prevalence was observed until 1999; thereafter, the male/female ratio approached 1 (period 1999-2003), with a subsequent increasing trend suggesting a potential male prevalence. Longer DFI and DSS were observed after 1999 and men showed greater improvement compared with women. In multivariate analyses, sex showed a lower impact on DFI and survival after recurrence following the introduction on sentinel lymph node biopsy. No sex-related differences in terms of DSS were observed before and after 1999 among patients with melanoma located on the trunk. However, among patients with primary lesions not located on the trunk, sex maintained a significant prognostic role in both groups. The results of this study suggest that in the last few years, the prognosis of men could have improved more than that in women. The changing surgical/therapeutic interventions can influence sex disparities in melanoma.
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79
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Marzagalli M, Casati L, Moretti RM, Montagnani Marelli M, Limonta P. Estrogen Receptor β Agonists Differentially Affect the Growth of Human Melanoma Cell Lines. PLoS One 2015. [PMID: 26225426 PMCID: PMC4520550 DOI: 10.1371/journal.pone.0134396] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background Cutaneous melanoma is an aggressive malignancy; its incidence is increasing worldwide and its prognosis remains poor. Clinical observations indicate that estrogen receptor β (ERβ) is expressed in melanoma tissues and its expression decreases with tumor progression, suggesting its tumor suppressive function. These experiments were performed to investigate the effects of ERβ activation on melanoma cell growth. Methods and Results Protein expression was analyzed by Western blot and immunofluorescence assays. Cell proliferation was assessed by counting the cells by hemocytometer. ERβ transcriptional activity was evaluated by gene reporter assay. Global DNA methylation was analyzed by restriction enzyme assay and ERβ isoforms were identified by qRT-PCR. We demonstrated that ERβ is expressed in a panel of human melanoma cell lines (BLM, WM115, A375, WM1552). In BLM (NRAS-mutant) cells, ERβ agonists significantly and specifically inhibited cell proliferation. ERβ activation triggered its cytoplasmic-to-nuclear translocation and transcriptional activity. Moreover, the antiproliferative activity of ERβ agonists was associated with an altered expression of G1-S transition-related proteins. In these cells, global DNA was found to be hypomethylated when compared to normal melanocytes; this DNA hypomethylation status was reverted by ERβ activation. ERβ agonists also decreased the proliferation of WM115 (BRAF V600D-mutant) cells, while they failed to reduce the growth of A375 and WM1552 (BRAF V600E-mutant) cells. Finally, we could observe that ERβ isoforms are expressed at different levels in the various cell lines. Specific oncogenic mutations or differential expression of receptor isoforms might be responsible for the different responses of cell lines to ERβ agonists. Conclusions Our results demonstrate that ERβ is expressed in melanoma cell lines and that ERβ agonists differentially regulate the proliferation of these cells. These data confirm the notion that melanoma is a heterogeneous tumor and that genetic profiling is mandatory for the development of effective personalized therapeutic approaches for melanoma patients.
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Affiliation(s)
- Monica Marzagalli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Lavinia Casati
- Department of Medical Biotechnologies and Translational Medicine, Università degli Studi di Milano, Milano, Italy
| | - Roberta M. Moretti
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Marina Montagnani Marelli
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
| | - Patrizia Limonta
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milano, Italy
- * E-mail:
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Retrospective Analysis of Clinicopathological Characteristics of Pregnancy Associated Melanoma. Pathol Oncol Res 2015; 21:1265-71. [DOI: 10.1007/s12253-015-9961-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/06/2015] [Indexed: 12/14/2022]
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81
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Stanelle EJ, Busam KJ, Rich BS, Christison-Lagay ER, Dunkel IJ, Marghoob AA, Halpern A, Coit DG, La Quaglia MP. Early-stage non-Spitzoid cutaneous melanoma in patients younger than 22 years of age at diagnosis: long-term follow-up and survival analysis. J Pediatr Surg 2015; 50:1019-23. [PMID: 25819019 PMCID: PMC4558908 DOI: 10.1016/j.jpedsurg.2015.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated prognostic factors among young patients with early stage melanoma, with particular attention to survival, recurrence, and development of a second primary melanoma. METHODS We retrospectively reviewed patients (age <22 years) with pathologically confirmed in-situ and stage 1 non-Spitzoid melanoma treated at our institution from 1980-2010, assessing demographics, clinical presentation, treatment, disease-specific survival, recurrence-free survival, and probability of developing a second primary melanoma. RESULTS One hundred patients with in-situ melanoma (n=16) or stage 1A (n=48) or 1B (n=36) melanoma were identified. Median age was 19.4 years (range, 11.2-21.9), and median follow-up was 7.6 years (range, 0.1-31.7). Median tumor thickness was 0.76 mm (range, 0.23-2.0). No lesions were ulcerated. All patients underwent wide local excision with negative margins, and 21 had a concomitant negative sentinel lymph node biopsy (SLNB). Sixteen patients developed recurrences, and 8 subsequently died of progressive melanoma. There were 2 non-melanoma-related deaths. Endpoints were 20-year overall survival (77.4%), melanoma-specific mortality (20.1%), recurrence rate (34.0%), and probability of developing a second primary melanoma (24.7%). Greater tumor depth and Clark level were associated with worse prognosis, but age, sex, and tumor mitotic rate were not correlated with recurrence or survival. CONCLUSION Among younger early-stage melanoma patients, greater lesion depth conferred higher recurrence risk and mortality. Our data did not define the role of sentinel lymph node biopsy in this group.
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Affiliation(s)
- Eric J Stanelle
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Klaus J Busam
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Barrie S Rich
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily R Christison-Lagay
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ashfaq A Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allan Halpern
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel G Coit
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael P La Quaglia
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Akman T, Oztop I, Unek IT, Koca D, Unal OU, Salman T, Yavuzsen T, Yilmaz AU, Somali I, Demir N, Ellidokuz H. Long-term outcomes and prognostic factors of high-risk malignant melanoma patients after surgery and adjuvant high-dose interferon treatment: a single-center experience. Chemotherapy 2015; 60:228-38. [PMID: 25870939 DOI: 10.1159/000371838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical excision constitutes an important part of the treatment of local advanced malignant melanoma. Due to the high recurrence risk, adjuvant high-dose interferon therapy is still the only therapy used in stage IIB and III high-risk melanoma patients. METHODS One hundred two high-risk malignant melanoma patients who received high-dose interferon-α-2b therapy were evaluated retrospectively. The clinicopathological features, survival times, and prognostic factors of the patients were determined. RESULTS The median disease-free and overall survival times were 25.2 and 60.8 months, respectively. Our findings revealed that male gender, advanced disease stage, lymph node involvement, lymphatic invasion, the presence of ulceration, and a high Clark level were significant negative prognostic factors. CONCLUSION In light of the favorable survival results obtained in this study, high-dose interferon treatment as adjuvant therapy for high-risk melanoma is still an efficient treatment and its possible side effects can be prevented by taking the necessary precautions.
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Affiliation(s)
- Tulay Akman
- Division of Medical Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
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83
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Sex disparities in melanoma outcomes: The role of biology. Arch Biochem Biophys 2014; 563:42-50. [DOI: 10.1016/j.abb.2014.06.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/16/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023]
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84
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Williams EL, Derek Ho MK, Halpern AC, Markowitz O, Siegel DM. Relationship between melanoma detection pattern and tumor thickness. Am J Prev Med 2014; 47:411-6. [PMID: 25073734 DOI: 10.1016/j.amepre.2014.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 04/12/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Melanoma tumor thickness remains the most important determinant of patient survival. Several large population-based studies have shown that full-body skin examinations (FBSE) improve melanoma mortality and others that FBSEs may detect melanomas at a thinner, more curable stage. PURPOSE To relate the detection method to lesion thickness at the time of diagnosis. METHODS A retrospective chart review of all cases of biopsy-proven primary cutaneous melanomas diagnosed from 2000 to 2012 at the Veterans Affairs Hospital in Brooklyn NY was conducted. Data were collected in 2012-2013 and analyzed in 2013. Main outcome measures include lesion thickness stratified by method of detection and probabilities of detecting thin lesions per method (using cut-offs of in situ and 0.75 mm). Secondary outcomes include interaction between method and body site or lesion diameter. RESULTS Sixty-three percent of melanomas were detected by FBSE and 59% of all melanomas were in situ. There was no statistically significant difference in thickness among the detection groups when a cut-off of in situ (Fisher's exact test, p=0.6148) or 0.75 mm was used (p=0.8910). A majority of lesions on the back were found by FBSE (68%). CONCLUSIONS FBSE was not shown to detect melanomas at a thinner stage. Prospective studies are needed to analyze the utility and efficacy of FBSEs in clinical practice.
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Affiliation(s)
| | - Man Kin Derek Ho
- State University of New York, Downstate Medical Center, Brooklyn
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center
| | - Orit Markowitz
- Department of Dermatology, Mount Sinai Medical Center, New York, New York
| | - Daniel M Siegel
- Department of Dermatology, Downstate Medical Center, Brooklyn
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Vilanova CMA, Lages RB, Ribeiro SM, Almeida IP, Santos LGD, Vieira SC. Epidemiological and histopathological profile of cutaneous melanoma at a center in northeastern Brazil from 2000 to 2010. An Bras Dermatol 2014; 88:545-53. [PMID: 24068125 PMCID: PMC3760929 DOI: 10.1590/abd1806-4841.20132036] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/14/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND While representing only 3-4% of malignant skin tumors, cutaneous melanoma is the
most aggressive and lethal. Statistical knowledge about the biological behavior of
this tumor is essential for guiding daily outpatient practice and aiding public
health policies. OBJECTIVES To analyze the profile of patients with cutaneous melanoma attending a pathology
department in Teresina (state of Piauí) between 2000 and 2010. METHODS Retrospective study of melanoma patients diagnosed between 2000 and 2010 in the
São Marcos Hospital in the city of Teresina. The pathology laboratory reports were
studied and all the statistical analyses performed using SPSS 19.0. RESULTS A total of 25 in situ, 199 invasive and 89 metastatic melanomas of unknown
primary site were observed. Histological types found were nodular (52.8%),
superficial spreading melanoma (18.6%), acral (10.6%) and lentigo maligna (9.5%).
In 144 (73.4%) cases the Breslow thickness was >1 mm. Metastasis was found in
28.6% of invasive melanomas and nodular melanoma, Clark IV/ V, Breslow > 1 mm,
mitotic index ≥ 6 and ulcerated lesions were more likely to metastasize. CONCLUSION Most melanomas presented Breslow> 1mm. The main factors associated with
metastasis were nodular type, Clark IV / V, Breslow> 1mm, mitotic index ≥ 6
and ulcerated lesions.
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86
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Burton AL, Egger ME, Quillo AR, Stromberg AJ, Hagendoorn L, Scoggins CR, Martin RC, McMasters KM, Callender GG. Prognostic factors in young women with cutaneous melanoma. Am J Surg 2014; 207:102-8. [DOI: 10.1016/j.amjsurg.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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de Giorgi V, Gori A, Gandini S, Papi F, Grazzini M, Rossari S, Simoni A, Maio V, Massi D. Oestrogen receptor beta and melanoma: a comparative study. Br J Dermatol 2013; 168:513-9. [PMID: 23013061 DOI: 10.1111/bjd.12056] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Oncological research has focused on evaluating oestrogen receptors (ERs) in oestrogen-related tumours, and understanding the potential role of ERs in the pathophysiology of cancer. OBJECTIVES To investigate the significance of oestrogen receptor beta (ERβ) in melanoma. METHODS We prospectively evaluated ERβ expression in malignant melanoma (MM) tissue and adjacent healthy skin by quantitative immunohistochemistry at the Department of Dermatology of the University of Florence, from 1998 to 2010. RESULTS ERβ was detected with varying staining intensity in the 66 malignant melanocytic lesions. After adjusting for age and sex, we found that ERβ expression was significantly lower in melanoma tissue compared with adjacent healthy skin (P < 0·0001). We also found significantly lower ERβ levels in thick melanoma tissue compared with thin melanoma tissue. In addition, there was a positive association between Breslow thickness and the difference of ERβ expression between healthy tissue and melanoma tissue (P = 0·0004). Consistent with sex differences in melanoma survival, men showed significantly lower levels of ERβ than women in both melanoma (P = 0·05) and healthy tissues (P = 0·02). CONCLUSIONS ERβ expression is inversely associated with Breslow thickness and is significantly influenced by sex in MM.
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Affiliation(s)
- V de Giorgi
- Department of Dermatology Department of Critical Care Medicine and Surgery, Division of Pathology, University of Florence, Florence, Italy.
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Jones EL, Jones TS, Pearlman NW, Gao D, Stovall R, Gajdos C, Kounalakis N, Gonzalez R, Lewis KD, Robinson WA, McCarter MD. Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result. JAMA Surg 2013; 148:456-61. [PMID: 23325294 DOI: 10.1001/jamasurg.2013.1335] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To analyze the predictors and patterns of recurrence of melanoma in patients with a negative sentinel lymph node biopsy result. DESIGN Retrospective chart review of a prospectively created database of patients with cutaneous melanoma. SETTING Tertiary university hospital. PATIENTS A total of 515 patients with melanoma underwent a sentinel lymph node biopsy without evidence of metastatic disease between 1996 and 2008. MAIN OUTCOME MEASURES Time to recurrence and overall survival. RESULTS Of 515 patients, 83 (16%) had a recurrence of melanoma at a median of 23 months during a median follow-up of 61 months (range, 1-154 months). Of these 83 patients, 21 had melanoma that metastasized in the studied nodal basin for an in-basin false-negative rate of 4.0%. Patients with recurrence had deeper primary lesions (mean thickness, 2.7 vs 1.8 mm; P < .01) that were more likely to be ulcerated (32.5% vs 13.5%; P < .001) than those without recurrence. The primary melanoma of patients with recurrence was more likely to be located in the head and neck region compared with all other locations combined (31.8% vs 11.7%; P < .001). Median survival following a recurrence was 21 months (range, 1-106 months). Favorable characteristics associated with lower risk of recurrence included younger age at diagnosis (mean, 49 vs 57 years) and female sex (9% vs 21% for males; P < .001). CONCLUSION Overall, recurrence of melanoma (16%) after a negative sentinel lymph node biopsy result was similar to that in previously reported studies with an in-basin false-negative rate of 4.0%. Lesions of the head and neck, the presence of ulceration, increasing Breslow thickness, older age, and male sex are associated with increased risk of recurrence, despite a negative sentinel lymph node biopsy result.
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Affiliation(s)
- Edward L Jones
- Department of Surgery, University of Colorado Denver, Aurora, CO 80045, USA
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89
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Metastatic Melanoma from Unknown Primary Presenting as Dorsal Midbrain Syndrome. Optom Vis Sci 2012; 89:e112-7. [DOI: 10.1097/opx.0b013e3182771698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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90
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Dobos J, Mohos A, Tóvári J, Rásó E, Lőrincz T, Zádori G, Tímár J, Ladányi A. Sex-dependent liver colonization of human melanoma in SCID mice--role of host defense mechanisms. Clin Exp Metastasis 2012. [PMID: 23203681 DOI: 10.1007/s10585-012-9554-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The possibility that endocrine factors may influence the clinical course of malignant melanoma is suggested by the superior survival data of women. In preclinical models we observed a higher rate of colony formation by human melanoma cells in male compared to female SCID mice, but only in the case of the liver and not in other organs. The gender difference could be seen at an early phase of colony formation. On the other hand, in our human melanoma cell lines we failed to detect steroid receptor protein expression, and treatment with sex hormones did not considerably influence their in vitro behavior. Investigating the possible contribution of host cells to the observed gender difference, we performed in vivo blocking experiments applying pretreatment of the animals with Kupffer cell inhibitor gadolinium chloride and the NK cell inhibitor anti-asialo GM1 antibody. While Kupffer cell blockade enhanced melanoma liver colonization equally in the two sexes, a more prominent increase was observed in female than in male mice in the case of NK cell inhibition. Further supporting the importance of NK cells in the lower liver colonization efficiency of melanoma cells in females, gender difference in colony formation was lost in NSG mice lacking NK activity. Although in humans no organ selectivity of gender difference in melanoma progression has been observed according to data in the literature, our results possibly indicate a contribution of natural host defense mechanisms to gender difference in survival of patients with melanoma or other tumor types as well.
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MESH Headings
- Animals
- Apoptosis
- Cell Adhesion
- Cell Proliferation
- Cytotoxicity, Immunologic/immunology
- Female
- Flow Cytometry
- G(M1) Ganglioside/pharmacology
- Gonadal Steroid Hormones/metabolism
- Humans
- Immunoenzyme Techniques
- Killer Cells, Natural/drug effects
- Killer Cells, Natural/immunology
- Killer Cells, Natural/pathology
- Kupffer Cells/drug effects
- Kupffer Cells/immunology
- Kupffer Cells/pathology
- Liver Neoplasms, Experimental/drug therapy
- Liver Neoplasms, Experimental/immunology
- Liver Neoplasms, Experimental/secondary
- Male
- Melanoma/drug therapy
- Melanoma/immunology
- Melanoma/pathology
- Mice
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, SCID
- Receptors, Steroid/metabolism
- Sex Factors
- Tumor Cells, Cultured
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Affiliation(s)
- Judit Dobos
- Department of Surgical and Molecular Pathology, National Institute of Oncology, 7-9. Ráth György u, Budapest 1122, Hungary
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Azarjana K, Ozola A, Ruklisa D, Cema I, Rivosh A, Azaryan A, Pjanova D. Melanoma epidemiology, prognosis and trends in Latvia. J Eur Acad Dermatol Venereol 2012; 27:1352-9. [PMID: 23106225 DOI: 10.1111/jdv.12007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma incidence and mortality rates are increasing worldwide within the white population. Clinical and histological factors have been usually used for the prognosis and assessment of the risk for melanoma. OBJECTIVES The aim of the study was to describe the clinical and histopathological features of the cutaneous melanoma (CM) in the Latvian population, to test the association between melanoma features and patient survival, and to assess the time trends for melanoma incidence. METHODS We undertook a descriptive, retrospective analysis of archive data of 984 melanoma patients treated at the largest oncological hospital of Latvia, Riga East University Hospital Latvian Oncology Centre (LOC), between 1998 and 2008. Cox proportional hazards model was used to analyse patient survival and autoregressive models were applied to detect trends in melanoma incidence over time for various categories of melanoma. RESULTS The study showed a significant ascending trend in melanoma incidence in Latvia during the time period from 1998 to 2008 (ß = 1.83, 95% CI = 1.15-2.91, P = 0.011). Nodular melanoma was the most common tumour subtype with a frequency of 39.2%. Ulceration was present in 45.2% of melanomas. The mean Breslow thickness was 6.0 mm (6.8 mm) and no significant decline in median Breslow thickness was observed during the study period (P = 0.609). A better overall prognosis was detected for females in comparison with males (HR = 1.49; 95% CI = 1.22-1.81; P < 0.001). CONCLUSIONS There is a steady increase in melanoma incidence in Latvia with the majority of melanomas diagnosed at late stages with poor prognosis for survival.
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Affiliation(s)
- K Azarjana
- Department of Oral Pathology, Riga Stradins University, Riga, LatviaLatvian Biomedical Research and Study Centre, Riga, LatviaGenetics Institute, University College London, London, UKRiga East University Hospital Latvian Oncology Centre, Riga, LatviaFaculty of Computing, University of Latvia, Riga, LatviaFaculty of Life Sciences, University of Vienna, Vienna, Austria
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92
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Egger ME, Callender GG, McMasters KM, Ross MI, Martin RCG, Edwards MJ, Urist MM, Noyes RD, Sussman JJ, Reintgen DS, Stromberg AJ, Scoggins CR. Diversity of stage III melanoma in the era of sentinel lymph node biopsy. Ann Surg Oncol 2012; 20:956-63. [PMID: 23064795 DOI: 10.1245/s10434-012-2701-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy for melanoma often detects minimal nodal tumor burden. Although all node-positive patients are considered stage III, there is controversy regarding the necessity of adjuvant therapy for all patients with tumor-positive SLN. METHODS Post hoc analysis was performed of a prospective multi-institutional study of patients with melanoma ≥ 1.0 mm Breslow thickness. All patients underwent SLN biopsy; completion lymphadenectomy was performed for patients with SLN metastasis. Kaplan-Meier analysis of disease-free survival (DFS) and overall survival (OS) was performed. Univariate and multivariate Cox regression analyses were performed. Classification and regression tree (CART) analysis also was performed. RESULTS A total of 509 patients with tumor-positive SLN were evaluated. Independent risk factors for worse OS included thickness, age, gender, presence of ulceration, and tumor-positive non-SLN (nodal metastasis found on completion lymphadenectomy). As the number of tumor-positive SLN and the total number of tumor-positive nodes (SLN and non-SLN) increased, DFS and OS worsened on Kaplan-Meier analysis. On CART analysis, the 5-year OS rates ranged from 84.9% (women with thickness < 2.1 mm, age < 59 years, no ulceration, and tumor-negative non-SLN) to 14.3% (men with thickness ≥ 2.1 mm, age ≥ 59 years, ulceration present, and tumor-positive non-SLN). Six distinct subgroups were identified with 5-year OS in excess of 70%. CONCLUSIONS Stage III melanoma in the era of SLN is associated with a very wide range of prognosis. CART analysis of prognostic factors allows discrimination of low-risk subgroups for which adjuvant therapy may not be warranted.
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Affiliation(s)
- Michael E Egger
- Department of Surgery, University of Louisville, Louisville, KY, USA
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93
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Egger ME, Dunki-Jacobs EM, Callender GG, Quillo AR, Scoggins CR, Martin RCG, Stromberg AJ, McMasters KM. Outcomes and prognostic factors in nodular melanomas. Surgery 2012; 152:652-9; discussion 659-60. [PMID: 22925134 DOI: 10.1016/j.surg.2012.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/05/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND The nodular subtype of cutaneous melanoma has a more pronounced vertical phase and less of a radial growth phase compared with other histologic subtypes. This study was performed to determine prognostic factors and outcomes for nodular melanomas. METHODS A post hoc analysis of a prospective clinical trial was performed in all patients with nodular histologic subtype. Univariate and multivariate analyses of factors associated with disease-free survival (DFS), overall survival (OS), and local and in-transit recurrence-free survival (LITRFS) were performed. Kaplan-Meier survival analyses were performed. RESULTS There were 736 patients available for analysis, and 189 (25.7%) were sentinel lymph node (SLN) positive. Breslow thickness of ≥2.3 mm, presence of ulceration, nonextremity tumor location, positive SLN, and non-SLN-positive status were independent risk factors for worse OS and DFS. Kaplan-Meier analysis demonstrated that ulceration predicted worse OS and DFS in all nodular melanoma patients, and in both SLN-positive and -negative subsets. The presence of ulceration and a positive SLN together predicted significantly worse DFS and OS. CONCLUSION The most important risk factors that determine prognosis in nodular melanomas are SLN status and ulceration. The presence of both a positive SLN and ulceration significantly affect DFS and OS, and to a lesser degree LITRFS.
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Affiliation(s)
- Michael E Egger
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY 40202, USA
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94
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Fridberg M, Jonsson L, Bergman J, Nodin B, Jirström K. Modifying effect of gender on the prognostic value of clinicopathological factors and Ki67 expression in melanoma: a population-based cohort study. Biol Sex Differ 2012; 3:16. [PMID: 22748166 PMCID: PMC3418558 DOI: 10.1186/2042-6410-3-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 07/02/2012] [Indexed: 11/24/2022] Open
Abstract
Background Malignant melanoma is the most deadly form of skin cancer. Female sex is known to have a protective effect on incidence, tumour characteristics, and mortality from melanoma. However, the potentially modifying effect of sex on the prognostic significance of clinicopathological and investigative factors is generally not taken into consideration in biomarker studies. In this study, we compared the sex-specific distribution and prognostic value of established tumour characteristics and Ki67 expression in 255 cases of incident primary melanoma in a prospective, population-based cohort study. Methods The study included 255 incident cases of melanoma, 132 females and 123 males, in the Malmö Diet and Cancer Study. Tumours from 226 (88.6%) cases had been assembled in tissue microarrays. Clinicopathological factors and immunohistochemical Ki67 expression were assessed and correlated with disease-free survival (DFS) and overall survival (OS) using Kaplan-Meier analysis, log rank test and univariable and multivariable Cox regression analyses, stratified for gender. Effect of gender on melanoma-specific survival (MSS) after first recurrence was also analysed. Results Women were significantly younger at diagnosis than men (p = 0.012). The most common tumour sites were the legs in women (37.5%) and the dorsal trunk in men (37.8%). Kaplan-Meier analysis revealed that tumour location had no prognostic impact in women, but in men, location to the frontal trunk was significantly associated with a reduced DFS compared with all other locations combined and location to the dorsal trunk was significantly associated with a prolonged OS. High Ki67 expression was significantly associated with a reduced DFS and OS in men but not in women, also when adjusted for other factors. In men, but not in women, ulceration was an independent prognostic factor for both DFS and OS. MSS after first local, regional or distant recurrence was significantly shorter for men than for women. Conclusions The results from this study demonstrate that the prognostic value of tumour location, Ki67 expression and ulceration in melanoma differs according to gender. These findings need to be validated in future studies, as they may help improve prognostication in patients with melanoma. Moreover, our findings demonstrate that sex-stratified analyses add valuable information to biomarker studies.
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Affiliation(s)
- Marie Fridberg
- Department of Clinical Sciences, Division of Pathology, Lund University, Skåne University Hospital, 221 85 Lund, Sweden.
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95
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Egger ME, Tabler BL, Dunki-Jacobs EM, Callender GG, Scoggins CR, Martin RCG, Quillo AR, Stromberg AJ, McMasters KM. Clinicopathologic and Survival Differences between Upper and Lower Extremity Melanomas. Am Surg 2012. [DOI: 10.1177/000313481207800718] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This analysis was performed to compare differences in clinicopathologic factors, sentinel lymph node (SLN) status, and survival between upper extremity (UE) and lower extremity (LE) melanoma patients. Post hoc analysis of a prospective clinical trial was performed of all patients with extremity melanomas with complete data. Survival was evaluated with Kaplan-Meier analysis. Univariate and multivariate analyses were performed. A total of 1115 patients aged 18 to 70 years with extremity melanomas ≥ 1.0 mm Breslow thickness were analyzed; all underwent SLN biopsy with completion lymphadenectomy for a tumor-positive SLN. Compared with UE patients, LE melanoma patients were younger, predominantly female, and had a higher rate of SLN metastasis. Kaplan-Meier analysis revealed worse 5-year disease-free survival (DFS) and worse local and in-transit recurrence-free survival in LE versus UE melanoma patients, but no difference in overall survival (OS). Subgroup analysis revealed that older patients (age > 51 years) with LE melanomas had worse DFS, local and in-transit recurrence-free-survival, and OS. LE tumor location was not an independent risk factor for OS or DFS. Compared with UE melanoma patients, those with LE melanomas have a greater risk of tumor-positive SLN and local/in-transit recurrence.
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Affiliation(s)
- Michael E. Egger
- University of Louisville, Department of Surgery, Louisville, Kentucky
| | | | | | | | | | | | - Amy R. Quillo
- University of Louisville, Department of Surgery, Louisville, Kentucky
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96
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Volkovova K, Bilanicova D, Bartonova A, Letašiová S, Dusinska M. Associations between environmental factors and incidence of cutaneous melanoma. Review. Environ Health 2012; 11 Suppl 1:S12. [PMID: 22759494 PMCID: PMC3388446 DOI: 10.1186/1476-069x-11-s1-s12] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Cutaneous melanoma is one of the most serious skin cancers. It is caused by neural crest-derived melanocytes - pigmented cells normally present in the epidermis and, sometimes, in the dermis. METHODS We performed a review of current knowledge on the risk factors of cutaneous melanoma. Relevant studies were identified using the PubMed, Science Direct, Medline, Scopus, Scholar Google and ISI Web of Knowledge databases. RESULTS Melanoma incurs a considerable public health burden owing to the worldwide dramatic rise in incidence since the mid-1960s. Ultraviolet radiation exposure is the predominant environmental risk factor. The role of geographical (latitude) and individual factors such as skin type, life style, vitamin D levels and antioxidant protection, sunburn, and exposure to other environmental factors possibly contributing to melanoma risk (such as cosmetics including sunscreen, photosensitising drugs, and exogenous hormones) are reviewed in this article. Recently, both rare high risk susceptibility genes and common polymorphic genes contributing to melanoma risk have been identified. CONCLUSIONS Cutaneous melanoma is a complex cancer with heterogeneous aetiology that continues to increase in incidence. Introduction of new biomarkers may help to elucidate the mechanism of pathogenesis and individual susceptibility to the disease, and make both prevention and treatment more effective.
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Affiliation(s)
| | - Dagmar Bilanicova
- Slovak Medical University, Bratislava, Slovakia
- University of Venice, Venice, Italy
| | | | | | - Maria Dusinska
- Slovak Medical University, Bratislava, Slovakia
- NILU - Norwegian Institute for Air Research, Oslo, Norway
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97
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Asgari MM, Brasky TM, White E. Association of vitamin A and carotenoid intake with melanoma risk in a large prospective cohort. J Invest Dermatol 2012; 132:1573-82. [PMID: 22377763 PMCID: PMC3352977 DOI: 10.1038/jid.2012.21] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Laboratory data suggest that intake of vitamin A and carotenoids may have chemopreventive benefits against melanoma, but epidemiological studies examining the association have yielded conflicting results. We examined whether dietary and supplemental vitamin A and carotenoid intake was associated with melanoma risk among 69,635 men and women who were participants of the VITamins And Lifestyle (VITAL) cohort study in western Washington. After an average of 5.84 years of follow-up, 566 incident melanomas were identified. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of melanoma associated with dietary, supplemental, and total vitamin A and carotenoid intake after adjusting for melanoma risk factors. Baseline use of individual retinol supplements was associated with a significant reduction in melanoma risk (HR: 0.60; 95% CI: 0.41-0.89). High-dose (>1,200 μg per day) supplemental retinol was also associated with reduced melanoma risk (HR: 0.74; 95% CI: 0.55-1.00), as compared with non-users. The reduction in melanoma risk was stronger in sun-exposed anatomic sites. There was no association of melanoma risk with dietary or total intake of vitamin A or carotenoids. Retinol supplementation may have a preventative role in melanoma among women.
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Affiliation(s)
- Maryam M Asgari
- Division of Research, Kaiser Permanente Northern California, Oakland, California 94612, USA.
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98
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Callender GG, Gershenwald JE, Egger ME, Scoggins CR, Martin RC, Schacherer CW, Edwards MJ, Urist MM, Ross MI, Stromberg AJ, McMasters KM. A Novel and Accurate Computer Model of Melanoma Prognosis for Patients Staged by Sentinel Lymph Node Biopsy: Comparison with the American Joint Committee on Cancer Model. J Am Coll Surg 2012; 214:608-17; discussion 617-9. [DOI: 10.1016/j.jamcollsurg.2011.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 12/29/2022]
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99
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Moreno M, Schmitt RL, Lang MG, Gheno V. Epidemiological profile of patients with cutaneous melanoma in a region of southern Brazil. J Skin Cancer 2012; 2012:917346. [PMID: 22548178 PMCID: PMC3321574 DOI: 10.1155/2012/917346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/20/2011] [Accepted: 12/29/2011] [Indexed: 02/05/2023] Open
Abstract
Cutaneous melanoma (CM) is responsible for 75% of deaths from malignant skin cancer. The incidence of CM in the southern region of Brazil, particularly in the western region of Santa Catarina, is possibly higher than estimated. In this study, the clinical and epidemiological profile of patients with CM treated in the western region of Santa Catarina was examined. A cross-sectional study was performed with patients diagnosed with CM from January 2002 to December 2009, from 78 counties of the western region of the state of Santa Catarina. Data were collected using a protocol adapted from the Brazilian Melanoma Group and 503 patients were evaluated. The incidence and prevalence of CM found in this region are much higher than those found elsewhere in the country. This fact is most likely due to the phenotypic characteristics of the population and the high incidence of UV radiation in this region due to its location in southern Brazil, as is the case in the countries of Oceania.
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Affiliation(s)
- Marcelo Moreno
- Universidade Comunitária da Região de Chapecó-Unochapecó, Avenida Senador Atílio Fontana, 591-E. Efapi, Caixa Postal 1141 89809-000, Chapecó, SC, Brazil
| | - Ricardo Ludwig Schmitt
- Universidade Comunitária da Região de Chapecó-Unochapecó, Avenida Senador Atílio Fontana, 591-E. Efapi, Caixa Postal 1141 89809-000, Chapecó, SC, Brazil
| | - Maria Gabriela Lang
- Universidade Comunitária da Região de Chapecó-Unochapecó, Avenida Senador Atílio Fontana, 591-E. Efapi, Caixa Postal 1141 89809-000, Chapecó, SC, Brazil
| | - Vanessa Gheno
- Universidade Comunitária da Região de Chapecó-Unochapecó, Avenida Senador Atílio Fontana, 591-E. Efapi, Caixa Postal 1141 89809-000, Chapecó, SC, Brazil
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100
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Mervic L. Time course and pattern of metastasis of cutaneous melanoma differ between men and women. PLoS One 2012; 7:e32955. [PMID: 22412958 PMCID: PMC3295777 DOI: 10.1371/journal.pone.0032955] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/02/2012] [Indexed: 11/18/2022] Open
Abstract
Background This study identified sex differences in progression of cutaneous melanoma. Methodology/Principal Findings Of 7,338 patients who were diagnosed as an invasive primary CM without clinically detectable metastases from 1976 to 2008 at the University of Tuebingen in Germany, 1,078 developed subsequent metastases during follow up. The metastatic pathways were defined in these patients and analyzed using the Kaplan-Meier method. Multivariate survival analysis was performed using Cox modeling. In 18.7% of men and 29.2% of women (P<0.001) the first metastasis following diagnosis of primary tumor was locoregional as satellite/in-transit metastasis. The majority of men (54.0%) and women (47.6%, P = 0.035) exhibited direct regional lymph node metastasis. Direct distant metastasis from the stage of the primary tumor was observed in 27.3% of men and 23.2% of women (P = 0.13). Site of first metastasis was the most important prognostic factor of survival after recurrence in multivariate analysis (HR:1.3; 95% CI: 1.0–1.6 for metastasis to the regional lymph nodes vs. satellite/in-transit recurrence, and HR:5.5; 95% CI: 4.2–7.1 for distant metastasis vs. satellite/in-transit recurrence, P<0.001). Median time to distant metastasis was 40.5 months (IQR, 58.75) in women and 33 months (IQR, 44.25) in men (P = 0.002). Five-year survival after distant recurrence probability was 5.2% (95% CI: 1.4–2.5) for men compared with 15.3% (95% CI: 11.1–19.5; P = 0.008) for women. Conclusions/Significance Both, the pattern of metastatic spread with more locoregional metastasis in women, and the time course with retracted metastasis in women contributed to the more favorable outcome of women. Furthermore, the total rate of metastasis is increased in men. Interestingly, there is also a much more favorable long term survival of women after development of distant metastasis. It remains a matter of debate and of future research, whether hormonal or immunologic factors may be responsible for these sex differences.
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Affiliation(s)
- Liljana Mervic
- Department of Dermatology, Center of Dermatooncology, University of Tüebingen, Germany.
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