1
|
Pinkham MB, Herschtal A, Hong AM, Chua MST, Scolyer RA, Cumming S, Pullar A, Nobes J, Barker CA, Guadagnolo BA, Fogarty GB, Burmeister BH, Foote MC. Randomized Trial of Postoperative Radiation Therapy After Wide Excision of Neurotropic Melanoma of the Head and Neck (RTN2 Trial 01.09). Ann Surg Oncol 2024; 31:6088-6096. [PMID: 38851639 PMCID: PMC11300506 DOI: 10.1245/s10434-024-15569-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/21/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Cutaneous neurotropic melanoma (NM) of the head and neck (H&N) is prone to local relapse, possibly due to difficulties widely excising the tumor. This trial assessed radiation therapy (RT) to the primary site after local excision. METHODS Participants from 15 international centers were randomized to observation or RT. The participants were required to have microscopically negative excision margins 5 mm wide or wider and no evidence of disease elsewhere. The primary outcome was time to local relapse. The secondary outcomes included time to any recurrence, overall survival (OS), and toxicity. RESULTS The trial ceased prematurely due to slow recruitment and the COVID-19 pandemic. During 2009-2020, 50 participants were randomized: 23 to observation and 27 to RT. The most common NM subsites were scalp (32%), midface (22%), and lip (20%). The median depth of invasion was 5 mm, and desmoplasia observed in 69%. The median duration from randomization to last contact was 4.8 years. Four participants (8%) experienced local relapse as a first recurrence during the study period: 3 in the observation arm and 1 in the RT arm (hazard ratio [HR] 0.29; 95% confidence interval [CI] 0.03-2.76; p = 0.279). No statistically significant difference in time to any relapse or OS was observed. More than 6 months after randomization, grade 3 or greater toxicity was experienced by 10% of the participants in the observation arm and 12.5% of the participants in the RT arm of the study. CONCLUSION Due to low accrual, the role of adjuvant RT for cutaneous NM of the H&N excised with microscopically negative margins 5 mm wide or wider remains undefined. Its routine use cannot be recommended. Local relapse might be less common than previously anticipated based on retrospective reports.
Collapse
Affiliation(s)
- Mark B Pinkham
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia.
- University of Queensland, Brisbane, Australia.
| | - A Herschtal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A M Hong
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Genesiscare, Mater Hospital, North Sydney, Australia
| | - M S-T Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - R A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - S Cumming
- Melanoma and Skin Cancer Research Centre, Monash University, Melbourne, Australia
| | - A Pullar
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
| | - J Nobes
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
| | - C A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - B A Guadagnolo
- Department of Radiation Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | | | - B H Burmeister
- University of Queensland, Brisbane, Australia
- GenesisCare Fraser Coast, Hervey Bay, Australia
| | - M C Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| |
Collapse
|
2
|
Bliley R, Avant A, Medina TM, Lanning RM. Radiation and Melanoma: Where Are We Now? Curr Oncol Rep 2024; 26:904-914. [PMID: 38822928 DOI: 10.1007/s11912-024-01557-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE OF REVIEW This review summarizes the current role of radiotherapy for the treatment of cutaneous melanoma in the definitive, adjuvant, and palliative settings, and combinations with immunotherapy and targeted therapies. RECENT FINDINGS Definitive radiotherapy may be considered for lentigo maligna if surgery would be disfiguring. High risk, resected melanoma may be treated with adjuvant radiotherapy, but the role is poorly defined since the advent of effective systemic therapies. For patients with metastatic disease, immunotherapy and targeted therapies can be delivered safely in tandem with radiotherapy to improve outcomes. Radiotherapy and modern systemic therapies act in concert to improve outcomes, especially in the metastatic setting. Further prospective data is needed to guide the use of definitive radiotherapy for lentigo maligna and adjuvant radiotherapy for high-risk melanoma in the immunotherapy era. Current evidence does not support an abscopal response or at least identify the conditions necessary to reliably produce one with combinations of radiation and immunotherapy.
Collapse
Affiliation(s)
- Roy Bliley
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam Avant
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Theresa M Medina
- Department of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan M Lanning
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
3
|
Shannon AB, Zager JS, Perez MC. Clinical Characteristics and Special Considerations in the Management of Rare Melanoma Subtypes. Cancers (Basel) 2024; 16:2395. [PMID: 39001457 PMCID: PMC11240680 DOI: 10.3390/cancers16132395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Rare histologic subtypes of melanoma, including acral, mucosal, uveal, and desmoplastic melanomas, only make up 5% of all diagnosed melanomas and are often underrepresented in large, randomized trials. Recent advancements in systemic therapy have shown marked improvement in pathologic response rates, improving progression-free and overall survival among cutaneous melanoma patients, but there are limited data to demonstrate improved survival among rarer subtypes of melanoma. Acral melanoma has a poor response to immunotherapy and is associated with worse survival. Mucosal melanoma has a large variability in its presentation, a poor prognosis, and a low mutational burden. Uveal melanoma is associated with a high rate of liver metastasis; recent adoption of infusion and perfusion therapies has demonstrated improved survival among these patients. Desmoplastic melanoma, a high-risk cutaneous melanoma, is associated with high locoregional recurrence rates and mutational burden, suggesting this melanoma may have enhanced response to immunotherapy. While these variants of melanoma represent distinct disease entities, this review highlights the clinicopathologic characteristics and treatment recommendations for each of these rare melanomas and highlights the utility of modern therapies for each of them.
Collapse
Affiliation(s)
- Adrienne B Shannon
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Matthew C Perez
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| |
Collapse
|
4
|
Yu H, Zhu L, Zhang J, Zheng S, Ming WK, Ip CC, Jiang Y, Chen W, Wu S, Lyu J, Deng L. Joinpoint regression analysis of recent trends in desmoplastic malignant melanoma incidence and mortality: 15-year multicentre retrospective study. Arch Dermatol Res 2024; 316:273. [PMID: 38796649 DOI: 10.1007/s00403-024-02928-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 02/18/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Recent data reveal a marked rise in the detection and mortality rates of Desmoplastic Malignant Melanoma (DMM). This trend underscores the imperative for an in-depth analysis of DMM's epidemiology, which is crucial for the formulation of precise medical and public health strategies. This investigation seeks to elucidate the variations in the incidence and mortality of DMM over a 15-year period (2005-2019). METHODS Data on DMM patients was sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Both incidence and incidence-based mortality rates (IBM) were directly extracted from the SEER database. Joinpoint regression was used to analyze and calculate the average annual percent change (AAPC) and its 95% confidence interval (CI). RESULTS Between 2005 and 2019, 3,384 DMM cases were identified, boasting an age-adjusted incidence rate of 36.3 cases per 1000,000 person-years (95% CI 3.51-3.76) and an IBM of 1.65cases per 1000,000 person-years (95% CI 1.57-1.74). Of these, 2,353 were males (69.53%) and 1,031 were females (30.47%). There were 1894 patients (55.97%) who were over 70 years old. Predominantly, DMM lesions manifested in exposed areas: Limbs (955, 28.22%), Face (906, 26.77%), and Scalp and Neck (865, 25.56%). The incidence of DMM increased significantly at a rate of APC = 0.9% during 2005-2019, while the incidence-based mortality showed a significant upward trend (APC = 7%) during 2005-2012, and slowly increasing trend (APC = 0.6%) during 2012-2019. In contrast to the modest upward trajectory in female incidence and mortality, male incidence initially surged, later declining, while male mortality peaked and stabilized post-2012. The primary sites for incidence and mortality were chronically sun-exposed areas: Face, Scalp and Neck, and Limbs. CONCLUSIONS In recent years, the incidence and incidence-based mortality of DMM have significantly increased. Each subgroup analysis has different trends, and these trends can provide better support for our exploration of DMM.
Collapse
Affiliation(s)
- Hai Yu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Linna Zhu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Jinrong Zhang
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Suzheng Zheng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
| | | | - Yuzhen Jiang
- Royal Free Hospital & University College London, London, UK
| | - Wenhui Chen
- Shanghai Aige Medical Beauty Clinic Co., Ltd. (Agge), Shanghai, China
| | - Shi Wu
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, Guangdong, China.
- Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China.
| | - Liehua Deng
- Department of Dermatology, The First Affiliated Hospital of Jinan University & Jinan University Institute of Dermatology, Guangzhou, 510630, Guangdong, China.
- Department of Dermatology, The Fifth Affiliated Hospital of Jinan University, Heyuan, China.
| |
Collapse
|
5
|
Guadagnolo BA, Baldini EH. Are We Ready for Life in the Fast Lane? A Critical Review of Preoperative Hypofractionated Radiotherapy for Localized Soft Tissue Sarcoma. Semin Radiat Oncol 2024; 34:180-194. [PMID: 38508783 DOI: 10.1016/j.semradonc.2023.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
This critical review aims to summarize the relevant published data regarding hypofractionation regimens for preoperative radiation therapy (RT) prior to surgery for soft tissue sarcoma (STS) of the extremity or superficial trunk. We identified peer-reviewed publications using a PubMed search on the MeSH headings of "soft tissue sarcoma" AND "hypofractionated radiation therapy." To obtain complication data on similar anatomical radiotherapeutic scenarios we also searched "hypofractionated radiation therapy" AND "melanoma" as well as "hypofractionated radiation therapy" AND "breast cancer." We then used reference lists from relevant articles to obtain additional pertinent publications. We also incorporated relevant abstracts presented at international sarcoma meetings and relevant clinical trials as listed on the ClinicalTrials.gov website. Detailed data are presented and contextualized for ultra-hypofractionated and moderately hypofractionated regimens with respect to local control, wound complications, and amputation rates. Comparative data are also presented for late toxicities including: fibrosis, joint limitation, edema, skin integrity, and bone fracture or necrosis. These data are compared to a standard regimen of 50 Gy in 25 daily fractions delivered over 5 weeks. This analysis supports the continued use of a standard regimen for preoperative RT for STS of 25 × 2 Gy over 5 weeks without concurrent chemotherapy. Use of concurrent chemotherapy with preoperative RT for STS should be reserved for well-designed clinical trials. A randomized trial of ultra-hypofractionated and moderately hypofractionated pre op RT for STS is warranted, but it is critical for the primary endpoint (or co-primary endpoint) to be late toxicity to: bone, soft tissue, joint, and skin.
Collapse
Affiliation(s)
| | - Elizabeth H Baldini
- Department of Radiation Oncology, Dana Farber/Brigham Women's Hospital, Boston, MA
| |
Collapse
|
6
|
Ran NA, Veerabagu S, Miller CJ, Elenitsas R, Chu EY, Krausz AE. Local Recurrence Rates After Excision of Desmoplastic Melanoma: A Systematic Review and Meta-Analysis. Dermatol Surg 2023; 49:330-337. [PMID: 36857167 DOI: 10.1097/dss.0000000000003699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Few prospective studies have evaluated local recurrence rates (LRR) after excision of desmoplastic melanoma (DM); however, several retrospective studies have reported high LRR. OBJECTIVE To determine LRR after excision of DM and evaluate factors affecting LRR. MATERIALS AND METHODS Systematic review of the PubMed, Embase, and Web of Science databases was performed to identify studies reporting local recurrence after excision of DM with conventional wide local excision (WLE), Mohs micrographic surgery (MMS), or staged excision (SE). Meta-analysis was performed to calculate summary LRR and pooled risk ratios (RR). RESULTS Literature search identified 4 studies evaluating MMS or SE (total n = 61 DM). 53 studies assessed WLE ( n = 3,080) and were analyzed quantitatively. The overall LRR after WLE of DM was 21% (95% CI, 0.16-0.28; n = 2,308). Local recurrence rate was higher with positive/unknown histologic excision margins (49%, 95% CI, 0.25-0.74; n = 91) versus negative histologic margins (11%, 95% CI, 0.07-0.17; n = 1,075; [ p < .01]). Neurotropism was also associated with increased LRR (RR, 1.79; 95% CI, 1.34-2.38, p < .01; n = 644). CONCLUSION DM has high LRR after WLE. Local recurrence risk was greatest with positive excision margins, indicating the importance of achieving negative microscopic margins. Greater study of MMS and SE for DM is required.
Collapse
Affiliation(s)
- Nina A Ran
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Christopher J Miller
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rosalie Elenitsas
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Y Chu
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aimee E Krausz
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
7
|
King ALO, Lee V, Yu B, Mirza FN, Zogg CK, Yang DX, Tran T, Leventhal J, An Y. Factors associated with the use of adjuvant radiation therapy in stage III melanoma. Front Oncol 2023; 13:1005930. [PMID: 36816935 PMCID: PMC9929351 DOI: 10.3389/fonc.2023.1005930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023] Open
Abstract
Objective The role of radiation therapy (RT) in melanoma has historically been limited to palliative care, with surgery as the primary treatment modality. However, adjuvant RT can be a powerful tool in certain cases and its application in melanoma has been increasingly explored in recent years. The aim of this study is to explore national patterns of care and associations surrounding the use of adjuvant RT for stage III melanoma. Methods The National Cancer Data Base (NCDB) was used to identify patients who were diagnosed with stage III melanoma between 2004 and 2014. Exclusion criteria included those with distant metastatic disease, in-situ histology, no confirmed positive nodes, palliative intent therapy, and dosing regimens inconsistent with National Comprehensive Cancer Network (NCCN) guidelines for adjuvant RT in melanoma. Patients treated with and without adjuvant RT were compared and factors associated with use of adjuvant RT were identified using multivariable logistic regression analyses. Results A total of 7,758 cases of stage III melanoma were analyzed, of which 11.7% received adjuvant RT. The mean age of the overall cohort was 58.5 years, and the majority of patients were male (64.7%), white (96.6%), on private insurance (51.3%), and presented to a non-high-volume facility (90.3%). Multivariable regression analyses revealed that patients who present to the hospital in 2009-2014 as compared to 2004-2008 (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.36-1.92), had 4 or more positive nodes (OR 4.30, 95% CI 3.67-5.04), and had microscopic residual tumor (OR 2.11, 95% CI 1.46-3.04) were more likely to receive adjuvant RT. Factors that were negatively associated with receiving adjuvant RT included female gender (OR 0.72, 95% CI 0.61-0.85) and median income of at least $63,000 (OR 0.66, 95% CI 0.52-0.83). Conclusions This study demonstrates the rising use of RT for stage III melanoma in recent years and identifies demographic, social, clinical, and hospital-specific factors associated with patients receiving adjuvant RT. Further investigation is needed to explore disease benefits to improve guidance on the utilization of RT in melanoma.
Collapse
Affiliation(s)
- Amber L. O. King
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Victor Lee
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States
| | - Beverly Yu
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Fatima N. Mirza
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Cheryl K. Zogg
- Department of Surgery, Yale School of Medicine, New Haven, CT, United States
| | - Daniel X. Yang
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States
| | - Thuy Tran
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, CT, United States
| | - Jonathan Leventhal
- Department of Dermatology, Yale School of Medicine, New Haven, CT, United States
| | - Yi An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, United States
| |
Collapse
|
8
|
Sondak VK, Neves RI, Wuthrick EJ, Messina JL, Khushalani NI. Current and future approaches in the surgical management of T3b/T4 primary and locoregionally advanced melanoma. Cancer 2022; 128:3764-3771. [PMID: 36066835 DOI: 10.1002/cncr.34449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/25/2022] [Accepted: 07/14/2022] [Indexed: 11/08/2022]
Abstract
Currently accepted principles of surgical management-margin width, use of sentinel node biopsy, performance of radical node dissections for node-positive cases-and some aspects of postoperative management (use of radiation for desmoplastic melanoma primaries and for clinically node-positive disease) will change in the future with the potential widespread adoption of adjuvant and neoadjuvant therapies.
Collapse
Affiliation(s)
- Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Rogerio I Neves
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA.,Reconstructive and Plastic Surgery Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Evan J Wuthrick
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA.,Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Nikhil I Khushalani
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| |
Collapse
|
9
|
Hsu EJ, Parsons D, Chiu T, Godley AR, Sher DJ, Vo DT. 3D printed integrated bolus/headrest for radiation therapy for malignancies involving the posterior scalp and neck. 3D Print Med 2022; 8:22. [PMID: 35844030 PMCID: PMC9290275 DOI: 10.1186/s41205-022-00152-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Malignancies of the head and neck region, encompassing cutaneous, mucosal, and sarcomatous histologies, are complex entities to manage, comprising of coordination between surgery, radiation therapy, and systemic therapy. Malignancies of the posterior scalp are particular challenging to treat with radiation therapy, given its irregular contours and anatomy as well as the superficial location of the target volume. Bolus material is commonly used in radiation therapy to ensure that the dose to the skin and subcutaneous tissue is appropriate and adequate, accounting for the buildup effect of megavoltage photon treatment. The use of commercially available bolus material on the posterior scalp potentially creates air gaps between the bolus and posterior scalp. Case presentations In this report, we created and utilized a custom 3D-printed integrated bolus and headrest for 5 patients to irradiate malignancies involving the posterior scalp, including those with cutaneous squamous cell carcinoma, melanoma, malignant peripheral nerve sheath tumor, and dermal sarcoma. Treatment setup was consistently reproducible, and patients tolerated treatment well without any unexpected adverse effects. Conclusions We found that the use of this custom 3D-printed integrated bolus/headrest allowed for comfortable, consistent, and reproducible treatment set up while minimizing the risk of creating significant air gaps and should be considered in the radiotherapeutic management of patients with posterior scalp malignancies. Supplementary Information The online version contains supplementary material available at 10.1186/s41205-022-00152-w.
Collapse
Affiliation(s)
- Eric J Hsu
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - David Parsons
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Tsuicheng Chiu
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Andrew R Godley
- Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - David J Sher
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Dat T Vo
- Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
| |
Collapse
|
10
|
Stanisz H, Beutner C, Kretschmer L, Schuppe MC, Schnabel V, Schön MP, Mitteldorf C. Neuropathy as an early warning sign of desmoplastic neurotropic melanoma of the head. J Eur Acad Dermatol Venereol 2022; 36:e941-e943. [PMID: 35735996 DOI: 10.1111/jdv.18353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H Stanisz
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - C Beutner
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - L Kretschmer
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - M C Schuppe
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - V Schnabel
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - M P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - C Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
11
|
Boada Garcia A, Quer Pi-Sunyer A, Richarz N, Jaka-Moreno A. Actualización en el diagnóstico y manejo del melanoma desmoplásico. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:47-57. [DOI: 10.1016/j.ad.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/28/2022] Open
|
12
|
Boada A, Quer Pi-Sunyer A, Richarz N, Jaka-Moreno A. [Translated article] Update on the Diagnosis and Management of Desmoplastic Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
13
|
Boada A, Quer Pi-Sunyer A, Richarz N, Jaka-Moreno A. Update on the Diagnosis and Management of Desmoplastic Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
14
|
Lewis GD, Guzman AK, Haque W, McLellan BN, Teh BS. Comparison of Survival Outcomes With/Without Adjuvant Radiation Therapy in Desmoplastic Melanoma. Dermatol Surg 2021; 47:1333-1336. [PMID: 34537788 DOI: 10.1097/dss.0000000000003177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Desmoplastic melanoma (DM) is a rare variant of cutaneous melanoma with a high rate of local recurrence. Recent studies have indicated a potential benefit in local control with the addition of adjuvant radiotherapy (RT). OBJECTIVE This study sought to evaluate the outcomes of adjuvant RT for patients with DM. MATERIALS AND METHODS The National Cancer Database was queried (2004-2015) for patients with newly diagnosed, nonmetastatic DM. Patients were divided into 2 groups based on the adjuvant therapy they received: RT or observation. Statistics included multivariable logistic regression to determine factors predictive of receiving adjuvant RT, Kaplan-Meier analysis to evaluate overall survival (OS), and Cox proportional hazards modeling to determine variables associated with OS. RESULTS There was no difference in median OS between patients treated with RT when compared with patients observed (111.4 months vs 133.9 months, p = .1312). On multivariable analysis, older age, T stage ≥2, N stage ≥1, and no receipt of immunotherapy were associated with worse OS. CONCLUSION In this large study evaluating efficacy of adjuvant RT in DM, no overall survival benefit was observed among patients receiving adjuvant RT.
Collapse
Affiliation(s)
- Gary D Lewis
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Anthony K Guzman
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas
| | - Beth N McLellan
- Division of Dermatology, Department of Internal Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas
| |
Collapse
|
15
|
Dabestani PJ, Dawson AJ, Neumeister MW, Bradbury CM. Radiation Therapy for Local Cutaneous Melanoma. Clin Plast Surg 2021; 48:643-649. [PMID: 34503724 DOI: 10.1016/j.cps.2021.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
While primary treatment for melanoma consists of surgical resection and chemotherapeutics, radiation can be used as either definitive or adjuvant therapy in certain clinical scenarios. This chapter aims to explore the indications for primary definitive radiotherapy as well as adjuvant treatment following resection. Delivery, dose, fractionation, and toxicity of radiation treatment will be discussed. As our understanding of melanoma tumor biology increases, the role of radiotherapy may expand for more effective treatment of oligometastatic disease.
Collapse
Affiliation(s)
- Parinaz J Dabestani
- Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | | | - Michael W Neumeister
- Southern Illinois University School of Medicine, Institute for Plastic Surgery, 747 N. Rutledge St #3, Springfield, IL 62702, USA
| | - C Matthew Bradbury
- Springfield Clinic Cancer Center and Southern Illinois University School of Medicine, 900 N. 1st Street, Springfield, IL 62702, USA
| |
Collapse
|
16
|
Schuitevoerder D, Vining CC, Tseng J. Adjuvant Therapy for Cutaneous Melanoma. Surg Oncol Clin N Am 2021; 29:455-465. [PMID: 32482320 DOI: 10.1016/j.soc.2020.02.009] [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: 11/26/2022]
Abstract
This article presents the current data supporting adjuvant therapy for patients with cutaneous melanoma. With the recent development of novel immunotherapy agents as well as targeted therapy, there are strong data to support the use of these therapies in patients at high risk of developing recurrent or metastatic disease.
Collapse
Affiliation(s)
- Darryl Schuitevoerder
- Department of Surgery, University of Chicago, 5841 South Maryland Avenue # MC5094, Chicago, IL 60637, USA
| | - Charles C Vining
- Department of Surgery, University of Chicago, 5841 South Maryland Avenue # MC5094, Chicago, IL 60637, USA
| | - Jennifer Tseng
- Department of Surgery, University of Chicago, 5841 South Maryland Avenue # MC5094, Chicago, IL 60637, USA.
| |
Collapse
|
17
|
Fan Y, Xu M, Liang Y, Wu N, Wang F, Du Q, Bai Y, Liu Y. Desmoplastic Melanoma: A Clinicopathological Analysis of Three Cases in the Chinese Population. Onco Targets Ther 2021; 14:2651-2660. [PMID: 33883908 PMCID: PMC8055249 DOI: 10.2147/ott.s295716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/25/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate the clinicopathological characteristics and immunophenotype of desmoplastic melanoma (DM) in the Chinese population. Patients and Methods We report three cases of DM diagnosed by the Pathology Department of Shanghai Dermatology Hospital. We describe the clinical and pathological characteristics of the three cases and examine molecular markers used in the diagnosis of DM. Finally, we summarize the current literature in the DM field. Results Clinically, lesions in the three DM patients were characterized by non-pigmented nodules or papules. Microscopically, we observed an abundance of fibrous interstitium mixed with spindle cells exhibiting various degrees of atypia. Occasionally, these structures exhibited changes in lentigo maligna at the epidermal junction, accompanied by the presence of lymphoid follicular structures and neurophilic behavior. Diagnosis of DM was confirmed by immunohistochemical staining, which revealed high expression levels of S-100 and SOX-10. Melanocyte markers were focally positive or negative. Unlike DMs from other populations, our three patients were negative for WT-1 and P53. All three cases received surgical resection, which is the preferred treatment for DM, and none of the patients experienced recurrence. Conclusion DM in these Chinese patients was similar to that observed in other DM populations in terms of immunophenotype and clinical and histological features. A notable absence in p53 staining was observed in the three cases reported here, suggesting that p53 negativity should not exclude the diagnosis of DM in the Chinese population.
Collapse
Affiliation(s)
- Yaqi Fan
- Department of Pathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200050, People's Republic of China
| | - Mingyuan Xu
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Yulin Liang
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Nanhui Wu
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Feiyan Wang
- Shanghai Skin Disease Clinical College of Anhui Medical University, Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Qian Du
- Shanghai Skin Disease Hospital, Shanghai, 200443, People's Republic of China
| | - Yun Bai
- Department of Pathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200050, People's Republic of China
| | - Yeqiang Liu
- Department of Pathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, 200050, People's Republic of China
| |
Collapse
|
18
|
Hughes TM, Williams GJ, Gyorki DE, Kelly JW, Stretch JR, Varey AHR, Hong AM, Scolyer RA, Thompson JF. Desmoplastic melanoma: a review of its pathology and clinical behaviour, and of management recommendations in published guidelines. J Eur Acad Dermatol Venereol 2021; 35:1290-1298. [PMID: 33544941 DOI: 10.1111/jdv.17154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
Desmoplastic melanomas are uncommon. Their behaviour differs from that of other melanoma subtypes; therefore, management guidelines for non-desmoplastic melanomas may not be applicable. This review sought to examine all available evidence relating to the behaviour and management of desmoplastic melanomas, based on review of all relevant English-language publications, and to critically assess the recommendations for their management in current published melanoma management guidelines. Compared with other melanoma subtypes, patients with 'pure' desmoplastic melanomas (where ≥90% of the invasive melanoma is of desmoplastic melanoma subtype) have much lower rates of sentinel node positivity and distant metastasis. Local recurrence rates are higher for desmoplastic melanomas, but resection margins wider than those recommended for non-desmoplastic melanomas have not been shown to be of benefit. Adjuvant radiotherapy reduces the risk of local recurrence when a satisfactory histological clearance (≥8 mm) cannot be achieved. Of 29 published melanoma management guidelines identified, only 11 specified management for desmoplastic melanomas, while seven simply stated that the feature should be reported. Desmoplastic melanoma is a unique melanoma subtype with biology that differs from that of other melanoma subtypes. It requires specific management strategies but few current guidelines address these.
Collapse
Affiliation(s)
- T M Hughes
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Adventist Hospital, Sydney, NSW, Australia
| | - G J Williams
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - D E Gyorki
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - J W Kelly
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic., Australia
| | - J R Stretch
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Westmead Hospital, Sydney, NSW, Australia
| | - A M Hong
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - R A Scolyer
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia.,NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
19
|
Katipally R, Agrawal N, Juloori A. Radiation Therapy for Cutaneous Malignancies of the Head and Neck. Otolaryngol Clin North Am 2021; 54:307-327. [PMID: 33602518 DOI: 10.1016/j.otc.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Radiation therapy plays an integral role in the management of cutaneous malignancies of the head and neck. This article highlights the use of radiation therapy in the definitive and adjuvant setting for basal cell carcinoma, cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. Themes that emerge include the overall efficacy of radiation therapy as a local therapy, the relevance of cosmesis, functional outcomes, late toxicities as secondary end points, and the multitude of treatment modalities that are used.
Collapse
Affiliation(s)
- Rohan Katipally
- Department of Radiation and Cellular Oncology, Duchossois Center for Advanced Medicine, University of Chicago Medicine, 5758 South Maryland Avenue, MC 9006, Chicago, IL 60637, USA.
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Aditya Juloori
- Department of Radiation and Cellular Oncology, Duchossois Center for Advanced Medicine, University of Chicago Medicine, 5758 South Maryland Avenue, MC 9006, Chicago, IL 60637, USA
| |
Collapse
|
20
|
Desmoplastic melanoma: an updated clinical review and the emerging role of genetic markers and immunotherapies. Melanoma Res 2020; 30:429-432. [PMID: 32590412 DOI: 10.1097/cmr.0000000000000679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Desmoplastic melanoma (DM) is a rare and histopathologically as well as prognostically distinct subset of melanoma that arises in chronically sun-damaged skin. DM is typically and relatively indolent in nature with most cases not progressing to metastatic disease. DM has been managed with both radiation and surgical approaches. Medical options for the treatment of metastatic DM have traditionally been limited. Recent advances in immunotherapies have shown promising responses in DM ushering in a new class of treatment options. Additionally, with the advent of whole exome sequencing, the genetic make-up of DM has been further characterized creating new possibilities for future targeted therapies.
Collapse
|
21
|
Comparing survival outcomes in early stage desmoplastic melanoma with or without adjuvant radiation. Melanoma Res 2020; 29:413-419. [PMID: 30383720 DOI: 10.1097/cmr.0000000000000532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Desmoplastic melanoma (DM) due to its rare and locally aggressive nature, can be difficult to study and to treat effectively. Whether the optimal treatment approach for these tumors should include adjuvant radiation has been unclear in the literature. In this retrospective study of the National Cancer Database, 2390 patients with localized DM were included for analysis. 2082 were treated with wide local excision (WLE) and 308 were treated with wide local excision and adjuvant radiation therapy (WLE + RT). Overall survival (OS) in these groups was compared on crude and adjusted analyses utilizing Cox proportional hazards regression modeling. There was no difference in OS at 1, 3, and 5 years on initial analysis. Subsequent multivariate analysis and propensity score analysis showed a survival benefit in those treated with WLE + RT. Multivariate analysis demonstrated significantly decreased OS in cases of residual tumor following surgical excision. Adjuvant radiation was more likely to be performed for tumors on the head and neck, tumors with higher pathologic American Joint Committee on Cancer stage and T classifications, and tumors with positive surgical margins. This is the first study to demonstrate significantly improved OS in early-stage DM patients treated with WLE + RT compared to WLE alone.
Collapse
|
22
|
Jerjes W, Hamdoon Z, Hopper C. Desmoplastic neurotropic melanoma of the buccal sulcus invading the inferior alveolar nerve subjected to interstitial photodynamic therapy. Photodiagnosis Photodyn Ther 2020; 30:101601. [DOI: 10.1016/j.pdpdt.2019.101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
|
23
|
Cohen JV, Wang N, Venur VA, Hadfield MJ, Cahill DP, Oh K, Brastianos PK. Neurologic complications of melanoma. Cancer 2020; 126:477-486. [DOI: 10.1002/cncr.32619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 09/28/2019] [Accepted: 10/08/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Justine V. Cohen
- Division of Medical Oncology and Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Nancy Wang
- Division of Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Vyshak A. Venur
- Division of Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| | - Matthew J. Hadfield
- Division of Internal Medicine University of Connecticut Hartford Connecticut
| | - Daniel P. Cahill
- Division of Neurosurgery Massachusetts General Hospital Boston Massachusetts
| | - Kevin Oh
- Division of Radiation Oncology Massachusetts General Hospital Boston Massachusetts
| | - Priscilla K. Brastianos
- Division of Medical Oncology and Neuro‐Oncology Massachusetts General Hospital Cancer Center Boston Massachusetts
| |
Collapse
|
24
|
Haeger A, Alexander S, Vullings M, Kaiser FM, Veelken C, Flucke U, Koehl GE, Hirschberg M, Flentje M, Hoffman RM, Geissler EK, Kissler S, Friedl P. Collective cancer invasion forms an integrin-dependent radioresistant niche. J Exp Med 2020; 217:e20181184. [PMID: 31658985 PMCID: PMC7037234 DOI: 10.1084/jem.20181184] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 06/25/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
Cancer fatalities result from metastatic dissemination and therapy resistance, both processes that depend on signals from the tumor microenvironment. To identify how invasion and resistance programs cooperate, we used intravital microscopy of orthotopic sarcoma and melanoma xenografts. We demonstrate that these tumors invade collectively and that, specifically, cells within the invasion zone acquire increased resistance to radiotherapy, rapidly normalize DNA damage, and preferentially survive. Using a candidate-based approach to identify effectors of invasion-associated resistance, we targeted β1 and αVβ3/β5 integrins, essential extracellular matrix receptors in mesenchymal tumors, which mediate cancer progression and resistance. Combining radiotherapy with β1 or αV integrin monotargeting in invading tumors led to relapse and metastasis in 40-60% of the cohort, in line with recently failed clinical trials individually targeting integrins. However, when combined, anti-β1/αV integrin dual targeting achieved relapse-free radiosensitization and prevented metastatic escape. Collectively, invading cancer cells thus withstand radiotherapy and DNA damage by β1/αVβ3/β5 integrin cross-talk, but efficient radiosensitization can be achieved by multiple integrin targeting.
Collapse
Affiliation(s)
- Anna Haeger
- Department of Cell Biology, Radboudumc, Nijmegen, Netherlands
| | - Stephanie Alexander
- Department of Dermatology, Venerology, and Allergology, University of Würzburg, Germany
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
- Department of Genitourinary Oncology, MD Anderson Cancer Center, Houston, TX
| | - Manon Vullings
- Department of Cell Biology, Radboudumc, Nijmegen, Netherlands
| | - Fabian M.P. Kaiser
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
| | | | - Uta Flucke
- Department of Pathology, Radboudumc, Nijmegen, Netherlands
| | - Gudrun E. Koehl
- Department of Surgery, Section of Experimental Surgery, University Hospital Regensburg, University of Regensburg, Germany
| | - Markus Hirschberg
- Department of Dermatology, Venerology, and Allergology, University of Würzburg, Germany
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Würzburg, Germany
| | - Robert M. Hoffman
- Department of Surgery, University of California San Diego, San Diego, CA
- AntiCancer, Inc., San Diego, CA
| | - Edward K. Geissler
- Department of Surgery, Section of Experimental Surgery, University Hospital Regensburg, University of Regensburg, Germany
| | - Stephan Kissler
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
| | - Peter Friedl
- Department of Cell Biology, Radboudumc, Nijmegen, Netherlands
- Department of Dermatology, Venerology, and Allergology, University of Würzburg, Germany
- Rudolf Virchow Center for Experimental Biomedicine, University of Würzburg, Germany
- Department of Genitourinary Oncology, MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
25
|
DeWane ME, Kelsey A, Oliviero M, Rabinovitz H, Grant-Kels JM. Melanoma on chronically sun-damaged skin: Lentigo maligna and desmoplastic melanoma. J Am Acad Dermatol 2019; 81:823-833. [DOI: 10.1016/j.jaad.2019.03.066] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 02/01/2023]
|
26
|
Abstract
BACKGROUND Desmoplastic melanoma (DM) is a subvariant of spindle cell melanoma, accounting for less than 4% of all cutaneous melanomas. It occurs later in life and is associated with chronic sun exposure. Desmoplastic melanoma prognosis is considered more favorable than other variants, with lower rates of metastasis and higher survival. Recently, DM has been further subclassified into pure and mixed, calling into question surgical management and patient outcomes as well as viability of current nationwide databases without this distinction. METHODS We identified all patients with a histopathologic diagnosis of DM from the Cleveland Clinic electronic melanoma database (n = 58) from 1997 to 2013. Clinical and histopathologic data were collected. Comparison in clinical variables was performed between patients who had pure (n = 15) and mixed (n = 43) variants of DM. RESULTS There were no differences in age, sex, location of lesion, Breslow depth, ulceration, or regression. Patients with mixed DM were more likely to have lymphovascular invasion (P = 0.03) compared with pure DM. There was no difference in performance of sentinel lymph node biopsy (P = 0.25) or sentinel lymph node positivity (P = 0.31) between the 2 groups. Recurrence was present in 13.3% of pure and 30.2% of mixed patients. Overall, Kaplan-Meier 3-year survival was 75% for pure and 80% for mixed DM (P = 0.53). CONCLUSIONS Pure and mixed DMs seem to have similar clinical characteristics and outcomes. This indicates that analysis of national datasets without this subclassification remains viable.
Collapse
|
27
|
Ochoa CE, Joseph RW. Desmoplastic melanoma: a brief review and the efficacy of immunotherapy. Expert Rev Anticancer Ther 2019; 19:205-207. [PMID: 30686076 DOI: 10.1080/14737140.2019.1574573] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Cesar E Ochoa
- a Division of Hematology/Oncology, Department of Medicine , Mayo Clinic , Jacksonville , FL , USA
| | - Richard W Joseph
- a Division of Hematology/Oncology, Department of Medicine , Mayo Clinic , Jacksonville , FL , USA
| |
Collapse
|
28
|
|
29
|
Boer FL, Ten Eikelder MLG, Kapiteijn EH, Creutzberg CL, Galaal K, van Poelgeest MIE. Vulvar malignant melanoma: Pathogenesis, clinical behaviour and management: Review of the literature. Cancer Treat Rev 2018; 73:91-103. [PMID: 30685613 DOI: 10.1016/j.ctrv.2018.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/16/2023]
Abstract
Vulvar malignant melanoma (VMM) is a rare disease, accounting for 5% of all vulvar malignancies and is characterized by low survival and high recurrence rates. It is considered as a distinct entity of mucosal melanoma. Prognostic factors are higher age, advanced Breslow thickness, and lymph node involvement whilst central localization and ulceration status are still under debate. Surgery is the cornerstone for the treatment of primary VMM, however, it can be mutilating due to the anatomical location of the disease. Elective lymph node dissection is not part of standard care. The value of sentinel lymph node biopsy in VMM is still being studied. Radiation therapy and chemotherapy as adjuvant treatment do not benefit survival. Immunotherapy in cutaneous melanoma has shown promising results but clinical studies in VMM are scarce. In metastatic VMM, checkpoint inhibitors and in case of BRAF or KIT mutated metastatic VMM targeted therapy have shown clinical efficacy. In this review, we present an overview of clinical aspects, clinicopathological characteristics and its prognostic value and the latest view on (adjuvant) therapy and follow-up.
Collapse
Affiliation(s)
- Florine L Boer
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ellen H Kapiteijn
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Khadra Galaal
- Department of Gynaecology, Royal Cornwall Hospital NHS Trust, United Kingdom
| | | |
Collapse
|
30
|
Spillane A, Hong A, Fogarty G. Re-examining the role of adjuvant radiation therapy. J Surg Oncol 2018; 119:242-248. [PMID: 30554414 DOI: 10.1002/jso.25329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/23/2018] [Indexed: 11/08/2022]
Abstract
Previously important roles for adjuvant radiotherapy (RT) in melanoma patients included improved regional control after resection of high-risk nodal disease, to reduce local recurrence for desmoplastic, and other subtypes of melanoma with neurotropism, reducing in-brain relapse of brain metastases after surgery and other situations on a case-by-case basis. This review evaluates the integration of adjuvant RT into clinical practice at this time of rapidly evolving knowledge and improving outcomes from effective systemic therapy.
Collapse
Affiliation(s)
- Andrew Spillane
- Surgical Oncology, Northern Clinical School, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, Sydney, Australia.,Melanoma Unit, Mater Hospital, Sydney, Australia.,Royal North Shore Hospital, Sydney, Australia
| | - Angela Hong
- Surgical Oncology, Northern Clinical School, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, Sydney, Australia.,Melanoma Unit, Mater Hospital, Sydney, Australia.,Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia.,Radiation Oncology, GenesisCare, Mater Radiation Oncology, Sydney, Australia
| | - Gerald Fogarty
- Surgical Oncology, Northern Clinical School, The University of Sydney, Sydney, Australia.,Melanoma Institute Australia, Sydney, Australia.,Melanoma Unit, Mater Hospital, Sydney, Australia.,Radiation Oncology, St Vincents Hospital, Sydney, Australia.,Radiation Oncology, GenesisCare, Mater Radiation Oncology, Sydney, Australia
| |
Collapse
|
31
|
Nicolson NG, Han D. Desmoplastic melanoma. J Surg Oncol 2018; 119:208-215. [PMID: 30481377 DOI: 10.1002/jso.25317] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 11/11/2018] [Indexed: 12/12/2022]
Abstract
Desmoplastic melanoma (DM) is a rare melanoma variant that has unique biology and pathology compared with conventional melanoma (non-DM). Importantly, DM is classified into pure and mixed histologic subtypes, which have been correlated with outcomes. Management of DM broadly mirrors that of non-DM; however, there are unique considerations for DM that influence treatment approaches. This paper will provide a contemporary overview of this disease and will review the literature regarding the management of DM.
Collapse
Affiliation(s)
- Norman G Nicolson
- Department of Surgery, Section of Surgical Oncology, Yale School of Medicine, New Haven, Connecticut
| | - Dale Han
- Division of Surgical Oncology, Department of Surgery, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
32
|
Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2018; 80:208-250. [PMID: 30392755 DOI: 10.1016/j.jaad.2018.08.055] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
Collapse
Affiliation(s)
- Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona
| | - David E Elder
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Oliver J Wisco
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Toyin Lamina
- American Academy of Dermatology, Rosemont, Illinois
| |
Collapse
|
33
|
McKean MA, Amaria RN. Multidisciplinary treatment strategies in high-risk resectable melanoma: Role of adjuvant and neoadjuvant therapy. Cancer Treat Rev 2018; 70:144-153. [DOI: 10.1016/j.ctrv.2018.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022]
|
34
|
Śniegocka M, Podgórska E, Płonka PM, Elas M, Romanowska-Dixon B, Szczygieł M, Żmijewski MA, Cichorek M, Markiewicz A, Brożyna AA, Słominski AT, Urbańska K. Transplantable Melanomas in Hamsters and Gerbils as Models for Human Melanoma. Sensitization in Melanoma Radiotherapy-From Animal Models to Clinical Trials. Int J Mol Sci 2018; 19:E1048. [PMID: 29614755 PMCID: PMC5979283 DOI: 10.3390/ijms19041048] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022] Open
Abstract
The focus of the present review is to investigate the role of melanin in the radioprotection of melanoma and attempts to sensitize tumors to radiation by inhibiting melanogenesis. Early studies showed radical scavenging, oxygen consumption and adsorption as mechanisms of melanin radioprotection. Experimental models of melanoma in hamsters and in gerbils are described as well as their use in biochemical and radiobiological studies, including a spontaneously metastasizing ocular model. Some results from in vitro studies on the inhibition of melanogenesis are presented as well as radio-chelation therapy in experimental and clinical settings. In contrast to cutaneous melanoma, uveal melanoma is very successfully treated with radiation, both using photon and proton beams. We point out that the presence or lack of melanin pigmentation should be considered, when choosing therapeutic options, and that both the experimental and clinical data suggest that melanin could be a target for radiosensitizing melanoma cells to increase efficacy of radiotherapy against melanoma.
Collapse
Affiliation(s)
- Martyna Śniegocka
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Ewa Podgórska
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Przemysław M Płonka
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Martyna Elas
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology and Ocular Oncology, Medical College of Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Małgorzata Szczygieł
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Michał A Żmijewski
- Department of Histology, Medical University of Gdansk, 80-210 Gdańsk, Poland.
| | - Mirosława Cichorek
- Department of Embryology, Medical University of Gdansk, 80-210 Gdańsk, Poland.
| | - Anna Markiewicz
- Department of Ophthalmology and Ocular Oncology, Medical College of Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| | - Anna A Brożyna
- Department of Tumor Pathology and Pathomorphology, Faculty of Health Sciences, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland.
- Department of Dermatology, Comprehensive Cancer Center Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| | - Andrzej T Słominski
- Department of Dermatology, Comprehensive Cancer Center Cancer Chemoprevention Program, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
- VA Medical Center, Birmingham, AL 35294, USA.
| | - Krystyna Urbańska
- Department of Biophysics, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University in Kraków, 31-007 Kraków, Poland.
| |
Collapse
|
35
|
Namikawa K, Aung PP, Gershenwald JE, Milton DR, Prieto VG. Clinical impact of ulceration width, lymphovascular invasion, microscopic satellitosis, perineural invasion, and mitotic rate in patients undergoing sentinel lymph node biopsy for cutaneous melanoma: a retrospective observational study at a comprehensive cancer center. Cancer Med 2018; 7:583-593. [PMID: 29464914 PMCID: PMC5852363 DOI: 10.1002/cam4.1320] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/07/2017] [Accepted: 12/10/2017] [Indexed: 12/05/2022] Open
Abstract
The prognostic significance of the width of the ulceration in primary melanomas remains unclear, and there is a relative paucity of data for lymphovascular invasion (LVI), microscopic satellitosis (MS), perineural invasion (PNI), and mitotic rate when compared with other pathological elements currently required for reporting. To evaluate the prognostic importance of the ulceration width and other important pathologic measurements, a single-institutional retrospective study was conducted using records of cutaneous melanoma patients who underwent sentinel lymph node (SLN) biopsy at The University of Texas, MD Anderson Cancer Center between 2003 and 2008. We identified 1898 eligible patients with median tumor thickness of 1.25 mm and median follow-up of 6.7 years. By multivariable analyses, the strongest risk factor for SLN positivity was high tumor thickness followed by the presence of LVI. The pathologic measures with the strongest influence on recurrence-free survival (RFS) were tumor thickness and positive SLN status. Ulceration width and presence of MS were also significantly associated with RFS while PNI was not. Factors with the strongest influence on melanoma-specific survival (MSS) were positive SLN status and mitotic rate. In conclusion, SLN biopsy should probably be offered if the primary tumor has LVI. MS is an adverse prognostic factor for RFS, but its influence on outcome is modest. Ulceration width predicts RFS but loses its independent prognostic significance for MSS when adjusting for currently used clinicopathological factors. In view of its impact on MSS, mitotic rate should be recorded for cutaneous invasive melanomas across all T categories.
Collapse
Affiliation(s)
- Kenjiro Namikawa
- Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
- Department of Dermatologic OncologyNational Cancer Center HospitalTokyoJapan
| | - Phyu P. Aung
- Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Jeffrey E. Gershenwald
- Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Denái R. Milton
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexas
| | - Victor G. Prieto
- Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonTexas
| |
Collapse
|
36
|
Ow TJ, Grethlein SJ, Schmalbach CE. Do you know your guidelines? Diagnosis and management of cutaneous head and neck melanoma. Head Neck 2018; 40:875-885. [PMID: 29485688 DOI: 10.1002/hed.25074] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/06/2017] [Indexed: 01/09/2023] Open
Abstract
The following article is the next installment of the series "Do You Know Your Guidelines?" presented by the Education Committee of the American Head and Neck Society. Guidelines for the prevention, diagnosis, workup, and management of cutaneous melanoma are reviewed in an evidence-based fashion.
Collapse
Affiliation(s)
- Thomas J Ow
- Department of Otorhinolaryngology - Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Sara Jo Grethlein
- Department of Medicine, Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Cecelia E Schmalbach
- Department of Otolaryngology - Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | |
Collapse
|
37
|
Varey AHR, Goumas C, Hong AM, Mann GJ, Fogarty GB, Stretch JR, Saw RPM, Spillane AJ, Shannon KF, Lee KJ, Quinn MJ, Thompson JF, Scolyer RA. Neurotropic melanoma: an analysis of the clinicopathological features, management strategies and survival outcomes for 671 patients treated at a tertiary referral center. Mod Pathol 2017; 30:1538-1550. [PMID: 28731051 DOI: 10.1038/modpathol.2017.76] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/18/2017] [Accepted: 05/20/2017] [Indexed: 11/08/2022]
Abstract
Neurotropic cutaneous melanoma is a rare melanoma subtype that invades nerves and is often associated with desmoplastic melanoma. Limited data suggest that it has a greater propensity to recur locally, but it is unknown whether its behavior differs from that of other melanoma subtypes, including desmoplastic melanoma. We investigated clinicopathological predictors of outcome in a cohort of 671 patients with neurotropic melanoma to develop evidence-based management recommendations. Patients with primary neurotropic melanoma diagnosed from 1985 to 2013 were identified from the Melanoma Institute Australia database, along with a control cohort of 718 non-neurotropic melanoma patients. Features predictive of sentinel lymph node status, recurrence, melanoma-specific survival and response to adjuvant radiotherapy were sought. Neither local recurrence (hazard ratio: 1.28 (0.73-2.25) P=0.39) nor melanoma-specific survival (hazard ratio: 0.79 (0.55-1.15) P=0.22) were significantly affected by the presence of neurotropism on multivariate analysis. However, there was a markedly reduced likelihood of sentinel node positivity (hazard ratio: 0.61 (0.41-0.89) P=0.01) in neurotropic melanoma patients. Surgical margins ≥8mm halved the recurrence risk compared with <2 mm margins (hazard ratio: 0.46 (0.31-0.68) P<0.001). Additionally, in neurotropic melanoma patients with <8 mm margins, adjuvant radiotherapy halved the recurrence risk (hazard ratio: 0.48 (0.27-0.87) P=0.02). This, the largest study of neurotropic melanoma reported to date, has demonstrated that the presence of neurotropism does not alter the risk of melanoma recurrence or survival but does reduce the likelihood of sentinel node positivity. For successful treatment of neurotropic melanoma, adequate excision margins are of paramount importance. However, when adequate margins cannot be achieved, adjuvant radiotherapy reduces the risk of recurrence.
Collapse
Affiliation(s)
- Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Westmead Hospital, Westmead, NSW, Australia
| | - Chris Goumas
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
| | - Angela M Hong
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
| | - Gerald B Fogarty
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kenneth J Lee
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Michael J Quinn
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney, NSW, Australia
- Sydney Medical School, The University of Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| |
Collapse
|
38
|
Hwang JK, Kim KH, Kim JS, Ahn SJ, Kuh SU. Late-Developing Metastatic Malignant Melanoma in the Thoracic Spine Originating from Choroidal Melanoma. KOREAN JOURNAL OF SPINE 2017; 14:53-56. [PMID: 28704910 PMCID: PMC5518428 DOI: 10.14245/kjs.2017.14.2.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/05/2017] [Accepted: 06/07/2017] [Indexed: 12/20/2022]
Abstract
A 54-year-old woman visited Gangnam Severance Hospital for left side flank pain. She had a history of total removal of malignant melanoma on the left eye ball 20 years prior. No evaluation had been performed since then. A paravertebral mass at thoracic ninth level (T9) was discovered on spinal magnetic resonance imaging, and pathology confirmed malignant melanoma. Following positron emission tomography-computed tomography, no other metastasis was discovered. After removal of the paravertebral mass, palliative chemotherapy (dacabarzine + tamoxifene) was administered in 3 cycles over 2 months. Radiotherapy with simultaneous integrated boost technique was performed at 4,350 cGy total over 15 days, 290 cGy per delivery, and was administered with the first cycle of palliative chemotherapy. Despite this treatment, multiple metastases developed throughout her body 7 months later, and the patient is continuing chemotherapy.
Collapse
Affiliation(s)
- Jun Kyu Hwang
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Sup Kim
- Department of Pathology, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Uk Kuh
- Department of Neurosurgery, Gangnam Severance Hospital, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
39
|
Baker A, Camacho F, Andrews G, Mackley H. A retrospective analysis of the role of adjuvant radiotherapy in the treatment of cutaneous melanoma. Cancer Biol Ther 2016; 17:1030-1034. [PMID: 27636187 DOI: 10.1080/15384047.2016.1219811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Melanoma is a significant clinical problem, with rising rates of incidence. Surgery is the mainstay of treatment. The role of adjuvant radiotherapy in the control of locoregionally advanced cutaneous melanoma is controversial. A retrospective study of the Surveillance, Epidemiology, and End Results (SEER) database was performed. Patients with locoregionally confined cutaneous melanoma treated surgically between 2004 and 2009 were evaluated, with cancer-specific and all-cause mortality as primary end points. Propensity score matching was used to match 319 radiotherapy patients with 319 non-radiotherapy controls, stratifying by head and neck (HN) and non-head and neck (NHN) primary. Surgery was primarily by wide excision in both the radiotherapy (51.72%) and non-radiotherapy (53.91%) groups. The majority had nodal disease (82.13% vs. 82.44%). White (91.22% vs. 90.59%) males (70.21% vs. 68.96%) predominated. Average ages at diagnosis were 62.27 (SD 15.93) and 63.02 (SD 16.03). Using Cox proportional hazards models, radiation conferred decreased survival in all-cause (HR 1.44, p < 0.0003), and cancer specific mortality (HR 1.57, p < 0.0002) in combined analysis. The NHN group showed significantly decreased 6-year cancer specific survival (HR 2.05, p < 0.0001) for radiated patients. The HN group showed a non-significant hazard with radiotherapy (HR 1.19, p = 0.307). Meaningful differences not captured in the SEER database may exist between cohorts. Based on available SEER data, routine use of adjuvant radiotherapy should be viewed with caution and reserved for high-risk patients. Future trials evaluating patient quality of life may clarify the benefit of adjuvant radiotherapy in high-risk melanoma populations.
Collapse
Affiliation(s)
- Aaron Baker
- a The Pennsylvania State University, College of Medicine , Hershey , PA , USA
| | - Fabian Camacho
- b University of Virginia , Department of Public Health Sciences Administration , Charlottesville , VA , USA
| | - Genevieve Andrews
- a The Pennsylvania State University, College of Medicine , Hershey , PA , USA
| | - Heath Mackley
- a The Pennsylvania State University, College of Medicine , Hershey , PA , USA
| |
Collapse
|
40
|
Abstract
LEARNING OBJECTIVES After reading this article, the participant should be able to: 1. Discuss the initial management of cutaneous malignant melanoma with regard to diagnostic biopsy and currently accepted resection margins. 2. Be familiar with the management options for melanoma in specific situations such as subungual melanoma, auricular melanoma, and melanoma in the pregnant patient. 3. Discuss the differentiating characteristics of desmoplastic melanoma and its treatment options. 4. List the indications for sentinel lymph node biopsy and be aware of the ongoing trials and current literature. 5. Discuss the medical therapies available to patients with metastatic melanoma. SUMMARY Management of the melanoma patient is a complex and evolving subject. Plastic surgeons should be aware of the recent changes in the field. Excisional biopsy remains the gold standard for diagnosis, although there is no evidence that use of other biopsy types alters survival or recurrence. Wide local excisions should be carried out with margins as recommended by National Comprehensive Cancer Network guidelines according to lesion Breslow depth, with sentinel lymph node biopsy being offered to all medically suitable candidates with intermediate thickness melanomas (1.0 to 4.0 mm), and with sentinel lymph node biopsy being considered for high-risk lesions (ulceration and/or high mitotic figures) with melanomas of 0.75 to 1.0 mm. Melanomas diagnosed during pregnancy can be treated with preoperative lymphoscintigraphy and wide local excision under local anesthesia, with sentinel lymph node biopsy under general anesthesia delayed until after delivery. Management of desmoplastic melanoma is currently controversial with regard to the indications for sentinel lymph node biopsy and the efficacy of postoperative radiation therapy. Subungual and auricular melanoma have evolved from being treated by amputation of the involved appendage to less radical procedures-ear reconstruction is now attempted in the absence of gross invasion into the perichondrium, and subungual melanomas may be treated with wide local excision down to and including the periosteum, with immediate full-thickness skin grafting over bone. Although surgical treatment remains the current gold standard, recent advances in immunotherapy and targeted molecular therapy for metastatic melanoma show great promise for the development of medical therapies for melanoma.
Collapse
Affiliation(s)
- Sabrina N Pavri
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
| | - James Clune
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
| | - Stephan Ariyan
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
| | - Deepak Narayan
- New Haven, Conn
- From the Section of Plastic and Reconstructive Surgery, Yale University School of Medicine
| |
Collapse
|
41
|
Rule WG, Allred JB, Pockaj BA, Markovic SN, DiCaudo DJ, Erickson LA, Deming RL, Schild SE. Results of NCCTG N0275 (Alliance) - a phase II trial evaluating resection followed by adjuvant radiation therapy for patients with desmoplastic melanoma. Cancer Med 2016; 5:1890-6. [PMID: 27368067 PMCID: PMC4971918 DOI: 10.1002/cam4.783] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/07/2016] [Accepted: 04/23/2016] [Indexed: 11/06/2022] Open
Abstract
To examine, in a prospective fashion, the utilization and efficacy of adjuvant radiation therapy (RT) in patients with resected desmoplastic melanoma (DM). Adult patients with resected, margin‐negative, and nonmetastatic DM were eligible for this single‐arm prospective phase II study. Patients were to receive postoperative RT, 30 Gy in five fractions, to the operative bed with 2‐ to 3‐cm margins (depending on the tumor location). Nodal basin RT was not allowed. The primary study endpoint was the 2‐year local recurrence rate (LRR). Secondary endpoints included the incidence of regional and distant metastatic disease, progression‐free survival, overall survival (OS), and treatment‐related toxicity. Twenty patients with a single de novo DM lesion meeting trial eligibility criteria were enrolled and treated. The 2‐year LRR was 10%, with two patients demonstrating a LR within 2 years of completion of protocol therapy. No regional or distant failures occurred. OS at 2 and 5 years was 95 and 77%, respectively. There were no grade 3 or higher acute or late adverse events that were related to the protocol therapy. Adjuvant RT after wide local excision (WLE) for DM is efficacious and well tolerated. It should be considered for DM patients after margin‐negative WLE. Additional study is needed to further refine low‐risk patient populations that can potentially have adjuvant RT omitted as part of the treatment plan.
Collapse
Affiliation(s)
- William G Rule
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Jacob B Allred
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota
| | | | | | - David J DiCaudo
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Lori A Erickson
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, Minnesota
| | - Richard L Deming
- Department of Radiation Oncology, Mercy Cancer Center, Des Moines, Iowa
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| |
Collapse
|
42
|
Erkan S, Acharya AN, Savundra J, Lewis SB, Rajan GP. En Bloc Resection of Desmoplastic Neurotropic Melanoma with Perineural Invasion of the Intracranial Trigeminal and Intraparotid Facial Nerve: Case Report and Review of the Literature. J Neurol Surg Rep 2016; 77:e008-12. [PMID: 26929895 PMCID: PMC4726377 DOI: 10.1055/s-0035-1566254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/14/2015] [Indexed: 12/31/2022] Open
Abstract
Background Desmoplastic neurotropic melanoma (DNM) is a rare, highly malignant, and locally invasive form of cutaneous melanoma with a tendency for perineural invasion (PNI). Methods We report a case of a 61-year-old man presenting with right-sided trigeminal neuralgia and progressive facial paresis due to the PNI of the intracranial trigeminal nerve and the intraparotid facial nerve from DNM. We also present a review of the literature with six cases of DNM with PNI of the intracranial trigeminal nerve identified. Results The combined transtemporal-infratemporal fossa approach was performed to achieve total en bloc resection of the tumor mass followed by postoperative radiotherapy (PORT). After 24 months of follow-up, the patient remains disease free with no signs of recurrence on magnetic resonance imaging. Conclusion We recommend the en bloc resection of the tumor mass followed by PORT for the management of DNM with PNI. A high index of suspicion for PNI as a cause of cranial neuropathies is essential for the early detection and treatment of patients with known melanoma.
Collapse
Affiliation(s)
- Serkan Erkan
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Aanand N Acharya
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - James Savundra
- Department of Plastics Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Stephen B Lewis
- Perth Neurosurgery, Hollywood Medical Centre, Nedlands, Western Australia, Australia
| | - Gunesh P Rajan
- Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Skull Base Division, Otolaryngology, Head and Neck Surgery, University of Western Australia, Murdoch, Western Australia, Australia
| |
Collapse
|
43
|
Kan CE, Mansur DB. The role of radiation therapy in the management of cutaneous melanoma. Melanoma Manag 2016; 3:61-72. [PMID: 30190873 DOI: 10.2217/mmt.15.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 11/06/2015] [Indexed: 02/05/2023] Open
Abstract
The local treatment of cutaneous melanoma with surgical excision is well-established; however, the role of adjuvant radiation is not well-defined. Characteristics of the primary melanoma can indicate a higher local recurrence risk and thus warrant consideration of adjuvant treatment to the primary site. Management of the lymph node regions has been studied in some recent clinical trials, especially with the advent of sentinel lymph node procedures. We will review the indications for radiation to the primary site as well as lymph node regions based on the available data.
Collapse
Affiliation(s)
- Charlene E Kan
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, University Hospitals, Seidman Cancer Center, 11100 Euclid Avenue, Lerner Tower B-141, Cleveland, OH 44106, USA
| | - David B Mansur
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, University Hospitals, Seidman Cancer Center, 11100 Euclid Avenue, Lerner Tower B-141, Cleveland, OH 44106, USA
| |
Collapse
|
44
|
Oliver DE, Patel KR, Switchenko J, Parker D, Lawson DH, Delman KA, Kudchadkar RR, Khan MK. Roles of adjuvant and salvage radiotherapy for desmoplastic melanoma. Melanoma Res 2016; 26:35-41. [PMID: 26397051 PMCID: PMC4869869 DOI: 10.1097/cmr.0000000000000201] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Current guidelines are unclear as to the precise role of radiotherapy (RT) in patients with desmoplastic melanoma (DM). The purpose of this study was to evaluate our institutional outcomes in patients with DM, and to explore the roles of both adjuvant and salvage RT in these patients. We identified 100 patients with a histopathologic diagnosis of DM who received treatment at our institution from 2000 to 2014. Local control, distant metastasis-free survival, and overall survival (OS) were evaluated in the 95 patients managed surgically with or without adjuvant and/or salvage RT. The overall rate of local recurrence (LR) was 10%. There was no LR in either adjuvant or salvage RT cohort. Adjuvant RT did not significantly improve LR-free survival at 5 years (100 vs. 81%, P=0.59), despite the RT patients having worse pathological features. Four of seven (57%) salvage patients developed distant metastases, despite 100% local control. Adjuvant RT did not significantly impact 5-year overall survival (86 vs. 82%, P=0.43). RT shows a trend towards improved local control in both the adjuvant and salvage settings for patients with DM, and likely overcomes adverse risk factors after surgery in appropriately selected patients. Future prospective studies are needed to better address the optimal management for these patients.
Collapse
Affiliation(s)
- Daniel E. Oliver
- Emory University School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Kirtesh R. Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jeffrey Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Douglas Parker
- Department of Surgical Pathology and Dermatology, Emory University, Atlanta, Georgia, USA
| | - David H. Lawson
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Keith A. Delman
- Department of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Ragini R. Kudchadkar
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Mohammad K. Khan
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
45
|
Zuluaga-Sepúlveda MA, Arellano-Mendoza I, Ocampo-Candiani J. [Update on surgical treatment of primary and metastatic cutaneous melanoma]. CIR CIR 2015; 84:77-84. [PMID: 26277601 DOI: 10.1016/j.circir.2015.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/10/2014] [Indexed: 11/27/2022]
Abstract
Melanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes. This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy. Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy.
Collapse
Affiliation(s)
| | - Ivonne Arellano-Mendoza
- Servicio de Dermatología, Hospital General de México Dr. Eduardo Liceaga, México D.F., México
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Hospital Universitario Dr. José E. González, Monterrey, Nuevo LeónMéxico.
| |
Collapse
|
46
|
The Role of Regional Therapies for in-Transit Melanoma in the Era of Improved Systemic Options. Cancers (Basel) 2015; 7:1154-77. [PMID: 26140669 PMCID: PMC4586763 DOI: 10.3390/cancers7030830] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/17/2015] [Accepted: 06/24/2015] [Indexed: 12/21/2022] Open
Abstract
The incidence of melanoma has been increasing at a rapid rate, with 4%–11% of all melanoma recurrences presenting as in-transit disease. Treatments for in-transit melanoma of the extremity are varied and include surgical excision, lesional injection, regional techniques and systemic therapies. Excision to clear margins is preferred; however, in cases of widespread disease, this may not be practical. Historically, intralesional therapies were generally not curative and were often used for palliation or as adjuncts to other therapies, but recent advances in oncolytic viruses may change this paradigm. Radiation as a regional therapy can be quite locally toxic and is typically relegated to disease control and symptom relief in patients with limited treatment options. Regional therapies such as isolated limb perfusion and isolated limb infusion are older therapies, but offer the ability to treat bulky disease for curative intent with a high response rate. These techniques have their associated toxicities and can be technically challenging. Historically, systemic therapy with chemotherapies and biochemotherapies were relatively ineffective and highly toxic. With the advent of novel immunotherapeutic and targeted small molecule agents for the treatment of metastatic melanoma, the armamentarium against in-transit disease has expanded. Given the multitude of options, many different combinations and sequences of therapies can be offered to patients with in-transit extremity melanoma in the contemporary era. Reported response and survival rates of the varied treatments may offer valuable information regarding treatment decisions for patients with in-transit melanoma and provide rationale for these decisions.
Collapse
|
47
|
Zhou L, Yang K, Andl T, Wickett RR, Zhang Y. Perspective of Targeting Cancer-Associated Fibroblasts in Melanoma. J Cancer 2015; 6:717-26. [PMID: 26185533 PMCID: PMC4504107 DOI: 10.7150/jca.10865] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/04/2015] [Indexed: 12/23/2022] Open
Abstract
Melanoma is known as an exceptionally aggressive and treatment-resistant human cancer. Although a great deal of progress has been made in the past decade, including the development of immunotherapy using immune checkpoint inhibitors and targeted therapy using BRAF, MEK or KIT inhibitors, treatment for unresectable stage III, stage IV, and recurrent melanoma is still challenging with limited response rate, severe side effects and poor prognosis, highlighting an urgent need for discovering and designing more effective approaches to conquer melanoma. Melanoma is not only driven by malignant melanocytes, but also by the altered communication between neoplastic cells and non-malignant cell populations, including fibroblasts, endothelial and inflammatory cells, in the tumor stroma. Infiltrated and surrounding fibroblasts, also known as cancer-associated fibroblasts (CAFs), exhibit both phenotypical and physiological differences compared to normal dermal fibroblasts. They acquire properties of myofibroblasts, remodel the extracellular matrix (ECM) and architecture of the diseased tissue and secrete chemical factors, which all together promote the transformation process by encouraging tumor growth, angiogenesis, inflammation and metastasis and contribute to drug resistance. A number of in vitro and in vivo experiments have shown that stromal fibroblasts promote melanoma cell proliferation and they have been targeted to suppress tumor growth effectively. Evidently, a combination therapy co-targeting tumor cells and stromal fibroblasts may provide promising strategies to improve therapeutic outcomes and overcome treatment resistance. A significant benefit of targeting CAFs is that the approach aims to create a tumor-resistant environment that inhibits growth of melanomas carrying different genetic mutations. However, the origin of CAFs and precise mechanisms by which CAFs contribute to melanoma progression and drug resistance remain poorly understood. In this review, we discuss the origin, activation and heterogeneity of CAFs in the melanoma tumor microenvironment and examine the contributions of stromal fibroblasts at different stages of melanoma development. We also highlight the recent progression in dissecting and characterizing how local fibroblasts become reprogrammed and build a dynamic yet optimal microenvironment for tumors to develop and metastasize. In addition, we review key developments in ongoing preclinical studies and clinical applications targeting CAFs and tumor-stroma interactions for melanoma treatment.
Collapse
Affiliation(s)
- Linli Zhou
- 1. Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Kun Yang
- 1. Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Thomas Andl
- 2. Division of Dermatology, Department of Medicine, Vanderbilt University, Nashville, TN 37232-2600, USA
| | - R Randall Wickett
- 1. Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Yuhang Zhang
- 1. Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, Cincinnati, OH 45267, USA
| |
Collapse
|
48
|
The emerging role of radiotherapy for desmoplastic melanoma and implications for future research. Melanoma Res 2015; 25:95-102. [DOI: 10.1097/cmr.0000000000000139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
Abstract
Although melanoma is generally considered a relative radioresistant tumor, radiation therapy (RT) remains a valid and effective treatment option in definitive, adjuvant, and palliative settings. Definitive RT is generally only used in inoperable patients. Despite a high-quality clinical trial showing adjuvant RT following lymphadenectomy in node-positive melanoma patients prevents local and regional recurrence, the role of adjuvant RT in the treatment of melanoma remains controversial and is underused. RT is highly effective in providing symptom palliation for metastatic melanoma. RT combined with new systemic options, such as immunotherapy, holds promise and is being actively evaluated.
Collapse
Affiliation(s)
- Wenyin Shi
- Department of Radiation Oncology, Thomas Jefferson University, 111 South 11th Street, Suite G301, Philadelphia, PA 19107, USA.
| |
Collapse
|
50
|
Gorayski P, Burmeister B, Foote M. Radiotherapy for cutaneous melanoma: current and future applications. Future Oncol 2015; 11:525-34. [PMID: 25675130 DOI: 10.2217/fon.14.300] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cutaneous malignant melanoma remains a significant health burden worldwide despite advances in the management of locoregionally advanced and metastatic disease. Historically, the efficacy of radiation therapy (RT) has been questioned due to the perceived radioresistance of melanoma cancer cells in vitro. Nowadays, RT has limited indications for primary disease, but is used for high-risk nodal disease and in the palliative setting. This review article outlines the current role of RT for melanoma and its expanding role in oligometastatic disease scenarios as an alternative approach to surgery and highlights potential future applications to harness RT interaction with immunomodulatory targeted therapies.
Collapse
Affiliation(s)
- Peter Gorayski
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | | |
Collapse
|