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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.
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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
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2
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Tsiogka A, Rubin AI, Gregoriou S, Soulaidopoulos S, Belyayeva H, Rigopoulos D. Prevalence of subungual melanoma in patients with cutaneous malignant melanoma: A systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2024; 38:77-83. [PMID: 37644688 DOI: 10.1111/jdv.19482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Subungual melanoma (SUM) is a rare type of cutaneous malignant melanoma (CMM) associated with poor prognosis, while data regarding its prevalence are scarce. OBJECTIVES We sought to provide a comprehensive systematic review and meta-analysis of the prevalence rates of SUM among all types of CMM, considering certain demographic and clinical characteristics. METHODS The MEDLINE electronic database was searched systematically to identify eligible studies providing prevalence rate estimates of SUM in patients with CMM. Included studies were further analysed to estimate the relative prevalences of SUM according to study design, study years, geographical region and sex distribution. RESULTS Twenty-eight studies met the inclusion criteria. The overall SUM prevalence was 1.9% (95% CI [1.5%-2.3%]). The prevalence of SUM did not differ significantly between population- and hospital-based studies and remained stable over time. However, it was found to be significantly higher in Asians compared to patients of other geographical regions as well as in studies with more men than women compared to those with female preponderance (p < 0.001). CONCLUSIONS In all, the overall SUM prevalence among all subtypes of CMM was estimated at 1.9%, without significant changes over time, and was found to exhibit significant variability between subgroups of different geographical regions.
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Affiliation(s)
- Aikaterini Tsiogka
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Adam I Rubin
- Department of Dermatology, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stamatios Gregoriou
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Helena Belyayeva
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Rigopoulos
- Faculty of Medicine, First Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece
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3
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Zhang S, Wang Y, Fang K, Jia Q, Zhang H, Qu T. Slow Mohs micrographic surgery for nail apparatus melanoma in situ. Int J Dermatol 2023; 62:1170-1175. [PMID: 37350436 DOI: 10.1111/ijd.16748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Nail apparatus melanoma is a malignant tumor with a high incidence in Chinese melanoma patients. Slow Mohs micrographic surgery is an emerging technique for treating nail apparatus melanoma in situ (NAMIS). OBJECTIVE This study evaluated the efficacy and safety of slow Mohs micrographic surgery for treating NAMIS. METHODS Patients were enrolled in this retrospective study and treated in a single center from October 1, 2016, to June 30, 2022. Each patient underwent standard slow Mohs micrographic surgery, and follow-up was regularly conducted at clinics. RESULTS Ten patients were enrolled in the study. Two patients underwent one Mohs stage, seven underwent two Mohs stages, and one underwent seven Mohs stages. The resection margin ranged from 5 to 25 mm. No severe complications were reported in the treatment, and recurrence of NAMIS was not observed during the follow-up period. CONCLUSION Slow Mohs micrographic surgery is a valuable surgical method to treat NAMIS that preserves digit function and can be well tolerated by patients.
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Affiliation(s)
- Shu Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Yuanzhuo Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Kai Fang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Qiannan Jia
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Hanlin Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
| | - Tao Qu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College Hospital, Wangfujing, Dongcheng District, Beijing, 100730, China
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Das De S, Tan KB, Ho SAJE, Athanasian EA, Puhaindran ME. Pigmented Nail Lesions: When to Observe, When to Biopsy, When to Widely Excise, and When to Amputate? J Hand Surg Am 2022; 47:988-997. [PMID: 36050195 DOI: 10.1016/j.jhsa.2022.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 05/07/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023]
Abstract
Pigmented nail lesions are challenging problems. The differential diagnosis is broad and ranges from common self-limiting conditions, such as subungual hematoma and infection, to potentially fatal conditions, such as subungual melanoma. Clinical assessment and adjuncts, such as dermoscopy and imaging, are usually insufficient to establish a diagnosis, and a nail bed biopsy is often required. However, this is not an innocuous procedure and may result in permanent nail deformity. In addition, subjecting every patient with nail pigmentation to a biopsy will result in an unacceptably high rate of negative test results. Furthermore, histopathologic diagnosis of subungual melanoma remains challenging for several reasons. Once the diagnosis of subungual melanoma is established, the definitive treatment is controversial because the existing guidelines have largely been adapted from those for cutaneous melanoma. This review presents an approach to the diagnosis and management of pigmented subungual lesions and subungual melanoma, in particular, on the basis of the latest available evidence.
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Affiliation(s)
- Soumen Das De
- Department of Hand & Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
| | - Kong Bing Tan
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Sue-Ann Ju Ee Ho
- Division of Dermatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | | | - Mark E Puhaindran
- Department of Hand & Reconstructive Microsurgery, National University Hospital, Singapore, Singapore.
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Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML. Skin Cancer in People of Color: A Systematic Review. Am J Clin Dermatol 2022; 23:137-151. [PMID: 34902111 DOI: 10.1007/s40257-021-00662-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES In this study, we assess incidence, risk factors, clinical characteristics, histopathology, treatment, and survival for skin malignancies in people of color as defined by the SOCS, by systematically reviewing the literature. METHODS An electronic literature search of the PubMed, EMBASE, and MEDLINE databases was performed. Articles published from 1 January 1990 through 12 December 2020 were included in the search. RESULTS We identified 2666 publications potentially meeting the study criteria. Titles and abstracts of these studies were reviewed and 2353 were excluded. The full text of 313 articles were evaluated and 251 were included in this review. CONCLUSION Differences in incidence, patterns, treatment, and survival exist among people of color for cutaneous malignancies. Further research and initiatives are needed to account for and mitigate these differences.
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Affiliation(s)
- George A Zakhem
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Akshay N Pulavarty
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA
| | - Jenna C Lester
- University of California San Francisco, San Francisco, CA, USA
| | - Mary L Stevenson
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 222 East 41st Street, 24th Floor, New York, NY, 10017, USA.
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Abstract
SUMMARY Nail unit squamous cell carcinoma and melanoma are the most common malignancies of the nail apparatus. Compared to their cutaneous counterparts, they are diagnosed later and perceived as more aggressive. This may result in overzealous management, including radiographic imaging with poor sensitivity and specificity, interventional nodal staging by sentinel lymph node biopsy, amputation over digit-sparing tumor resections, and elaborate reconstructions after tumor extirpation. In this review article, the authors evaluate the evidence behind several misconceptions in nail malignancy management and provide evidence-based guidance for more conservative care.
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Bernardes SS, Ferreira I, Elder DE, Nobre AB, Martínez‐Said H, Adams DJ, Robles‐Espinoza CD, Possik PA. More than just acral melanoma: the controversies of defining the disease. J Pathol Clin Res 2021; 7:531-541. [PMID: 34213090 PMCID: PMC8503895 DOI: 10.1002/cjp2.233] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/13/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Abstract
Acral melanoma (AM) is a malignant cutaneous melanocytic tumour specifically located on the palms, soles, and nail apparatus, which are areas of glabrous (hairless) skin. Acral lentiginous melanoma, a subtype of AM, represents a histopathological subtype diagnosis of cutaneous melanoma with unique morphological and structural features. Despite clear definitions, the misuse of these terms and the inconsistency in reporting the histopathological features of AM cases have become a major obstacle to the study of the disease. In this review, we discuss the epidemiology, histopathological features, prognosis, and genetic profile of AM, highlighting the differences observed when histopathological subtypes are considered. The increasing global effort to characterise AM cases from ethnically diverse populations would benefit greatly from a more consistent classification of the disease.
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Affiliation(s)
- Sara S Bernardes
- Program of Immunology and Tumour BiologyBrazilian National Cancer InstituteRio de JaneiroBrazil
- Tissue Microenvironment Laboratory, Department of General PathologyFederal University of Minas GeraisBelo HorizonteBrazil
| | - Ingrid Ferreira
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
- Université Libre de BruxellesBrusselsBelgium
| | - David E Elder
- Division of Anatomic PathologyHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Aretha B Nobre
- Division of PathologyBrazilian National Cancer InstituteRio de JaneiroBrazil
- Serviço de Patologia, Maternidade EscolaUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
| | - Héctor Martínez‐Said
- Servicio de Piel y Partes BlandasInstituto Nacional de CancerologíaCiudad de MéxicoMexico
| | - David J Adams
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
| | - Carla Daniela Robles‐Espinoza
- Experimental Cancer GeneticsWellcome Sanger InstituteHinxtonUK
- Laboratorio Internacional de Investigación sobre el Genoma HumanoUniversidad Nacional Autónoma de MéxicoSantiago de QuerétaroMexico
| | - Patricia A Possik
- Program of Immunology and Tumour BiologyBrazilian National Cancer InstituteRio de JaneiroBrazil
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Bian SX, Hwang L, Hwang J, Ragab O, In GK, Peng D, Lin E. Acral lentiginous melanoma-Population, treatment, and survival using the NCDB from 2004 to 2015. Pigment Cell Melanoma Res 2021; 34:1049-1061. [PMID: 34273249 PMCID: PMC8599631 DOI: 10.1111/pcmr.12999] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 12/27/2022]
Abstract
Acral lentiginous melanoma (ALM) is a rare histological subtype of cutaneous malignant melanoma that typically presents on the palms and soles. To characterize the demographic and treatment characteristics of ALM, we used the National Cancer Database (NCDB) to describe a large multi-institutional cohort of ALM patients, consisting of 4,796 ALM patients from 2004 to 2015. ALM was more likely to be diagnosed at a later stage overall compared with non-ALM cutaneous melanomas, and more likely to be thicker, ulcerated, lymph node positive, and have lymphovascular invasion and positive margins. When stratified by stage, ALM had worse survival compared with non-ALM patients, most notably in stage III patients with 5-year survival of 47.5% versus 56.7%, respectively (p < .001). In ALM patients, older age, male sex, higher comorbidity burden, increased tumor thickness and ulceration, positive lymph nodes, and positive metastasis were independently associated with lower 5-year survival. Multimodality therapy, defined as surgery in addition to systemic therapy and/or radiation therapy, was associated with higher survival in stage III patients but not in other stages. These results call for further investigation into possible treatment intensification in the ALM population in the future.
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Affiliation(s)
- Shelly X Bian
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA
| | - Lindsay Hwang
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Hwang
- Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Omar Ragab
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA, USA
| | - Gino K In
- Department of Medicine, Division of Oncology, University of Southern California, Los Angeles, CA, USA
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - David Peng
- Department of Dermatology, University of Southern California, Los Angeles, CA, USA
| | - Eugene Lin
- Department of Medicine, Division of Nephrology, University of Southern California, Los Angeles, CA, USA
- Leonard D Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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Susok L, Gambichler T. Caucasians with acral lentiginous melanoma have the same outcome as patients with stage- and limb-matched superficial spreading melanoma. J Cancer Res Clin Oncol 2021; 148:497-502. [PMID: 33856527 PMCID: PMC8800911 DOI: 10.1007/s00432-021-03630-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Acral lentiginous melanoma (ALM), a relatively rare subtype of cutaneous melanoma, has been reported to have a worse prognosis than other melanomas. We aimed to assess clinical findings in Caucasian ALM patients and compare the data with a matched cohort of superficial spreading melanoma (SSM) patients. METHODS We studied 63 patients with ALM and 63 randomly stage- and limb-matched patients with SSM (non-ALM). In both cohorts, guideline-adjusted diagnosis, treatment and follow-up were performed. RESULTS We did not observe differences in prognostic factors (e.g., tumor thickness, ulceration) between the two cohorts. Both in ALM and non-ALM patients positive sentinel lymph node was a significant independent predictor for disease relapse and melanoma-specific death. However, disease relapse and melanoma-specific death rates did not significantly differ between ALM and non-ALM patients. An overall 5-year melanoma-specific survival of 82.5% and 81% was observed in ALM and non-ALM patients, respectively. CONCLUSIONS Our data confirm that patients with ALM have no worse outcome than non-ALM patients when correcting for significant prognostic factors. Hence, the reportedly high rates of fatal ALM cases should not be ascribed to pathobiological differences between ALM and non-ALM but are most likely are a consequence of a delay in diagnosis and thus advanced stage of ALM.
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Affiliation(s)
- Laura Susok
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Thilo Gambichler
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
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Abstract
Nail unit melanoma is an uncommon form of melanoma with worse prognosis compared with nonacral cutaneous melanoma. Nail unit melanoma is often diagnosed at a late stage. Clinical and dermoscopic features may suggest a diagnosis of nail unit melanoma, but confirmation requires histologic analysis. Like the clinical diagnosis, histopathologic diagnosis of nail unit melanoma is also difficult. The surgical management of nail unit melanoma has evolved from aggressive amputations to digit-sparing approaches. This article reviews the clinical presentation, diagnosis, and surgical treatment of nail unit melanoma to promote early diagnosis and rational surgery.
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Borkowska AM, Szumera-Ciećkiewicz A, Spałek MJ, Teterycz P, Czarnecka AM, Rutkowski PŁ. Clinicopathological Features and Prognostic Factors of Primary Acral Melanomas in Caucasians. J Clin Med 2020; 9:jcm9092996. [PMID: 32948014 PMCID: PMC7563150 DOI: 10.3390/jcm9092996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Cutaneous melanomas located on the acral part of extremities (hand and foot melanoma; HFM) comprise a rare group within all melanomas in Caucasians. HFM is associated with a poor prognosis. We aimed to evaluate clinicopathological features, long-term outcomes, and prognostic factors in primary HFM in Caucasians. Methods: Medical records of all consecutive patients treated between 1997 and 2014 were revised. Patients were diagnosed with primary cutaneous melanoma at I-II clinical stage, and sentinel lymph node biopsy was conducted. The analysis was performed to define the clinicopathological factors influencing outcomes in the HFM and subungual cohort. Among 2537 consecutive patients diagnosed with primary cutaneous melanoma, 247 cases of HFM (9.7%) were found, with a median follow-up time of 7.8 years. Results: Median primary tumor Breslow thickness in subungual melanomas and HFMs was 4.0 mm and 3.3 mm, respectively, significantly higher than in the entire population (median 2.2 mm; p < 0.01). In the HFM group, 37.6% of tumors were ulcerated. Metastases to sentinel lymph node (SLN) were found in 28.3% of HFMs. The 10-year overall survival rate in the HFM group and subungual melanomas was 48.1% and 49.3%, respectively, compared to 63.0% in non-HFM melanomas. Conclusions: Our results confirm that patients with HFMs display worse overall survival compared to the entire melanoma population, with male gender and positive SLN biopsy status acting as independent negative prognostic factors.
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Affiliation(s)
- Aneta M. Borkowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.J.S.); (P.T.); (A.M.C.)
- Correspondence: (A.M.B.); (P.Ł.R.); Tel.: +48-22-5462184 (P.Ł.R.); Fax: +48-22-6439791 (P.Ł.R.)
| | - Anna Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland;
- Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, 02-776 Warsaw, Poland
| | - Mateusz J. Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.J.S.); (P.T.); (A.M.C.)
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.J.S.); (P.T.); (A.M.C.)
| | - Anna M. Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.J.S.); (P.T.); (A.M.C.)
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Piotr Ł. Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland; (M.J.S.); (P.T.); (A.M.C.)
- Correspondence: (A.M.B.); (P.Ł.R.); Tel.: +48-22-5462184 (P.Ł.R.); Fax: +48-22-6439791 (P.Ł.R.)
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12
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Huang K, Fan J, Misra S. Acral Lentiginous Melanoma: Incidence and Survival in the United States, 2006-2015, an Analysis of the SEER Registry. J Surg Res 2020; 251:329-339. [PMID: 32208196 DOI: 10.1016/j.jss.2020.02.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/13/2020] [Accepted: 02/16/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acral lentiginous melanoma (ALM) is one of the four major subtypes in cutaneous malignant melanoma (CMM). We aimed to study the incidence and survival of ALM in the United States in recent 10 y and compare the survival between ALM and nonacral CMM. In the meantime, racial disparity and prognostic factors associated with survival were investigated. METHODS All the cases of ALM registered in the Surveillance, Epidemiology, and End Results registry from 2006 to 2015 were retrieved, including non-Hispanic whites (NHW), black Americans (blacks), Asian/Pacific Islanders, and Hispanic whites. Age-adjusted incidence was calculated. Clinicopathologic data, including age, gender, race, geographic location, Breslow thickness, ulceration, pathologic staging, sentinel lymph node status, and surgical approach, were collected and analyzed. Melanoma-specific survival (MSS) was analyzed in patients with ALM and CMM. The Kaplan-Meier method was used to estimate the influence of clinicopathologic data on ALM MSS. Only cases with complete staging and active follow-up were included in prognostic factor analysis. RESULTS A total of 1724 ALM and 87,442 nonacral CMM patients were included in the study. For ALM patients, the age-adjusted incidence rate was 2.0 per million person-years. The proportion of ALM among all melanoma subtypes was greatest in blacks (32.6%). The 5-y MSS rates of ALM were lower than CMM overall (80.6% versus 93.0%, P < 0.001, respectively). When controlled by stage, the difference was significant in patients diagnosed at stages I and III. ALM 5-y MSS rates were highest (84.3%) in NHW, intermediate in Asian/Pacific Islanders (76.6%), Hispanic white (72.0%), and lowest in blacks (66.9%). Blacks were elderly, male predominant, located in East and Middle American, and had thicker, more ulcerated, advanced disease as compared with NHWs. When controlled by stage, survival difference was significant between NHWs and blacks in stage I (P = 0.004) and stage III (P = 0.005) patients. Gender, race, sentinel lymph node status, and pathologic stage were identified as independent risk factors in multivariate analysis. CONCLUSIONS The incidence of ALM has been steady in recent 10 y and more prevalent in aged people. ALM is associated with a worse prognosis than CMM. Black Americans have the worst prognosis, and survival difference is significant between NHW and blacks.
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Affiliation(s)
- Kai Huang
- General Surgery, Brandon Regional Hospital, HCA West FL Division/USF Health Consortium, Brandon, Florida
| | - Ji Fan
- General Surgery, Brandon Regional Hospital, HCA West FL Division/USF Health Consortium, Brandon, Florida
| | - Subhasis Misra
- General Surgery, Brandon Regional Hospital, HCA West FL Division/USF Health Consortium, Brandon, Florida.
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13
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Wei X, Wu D, Li H, Zhang R, Chen Y, Yao H, Chi Z, Sheng X, Cui C, Bai X, Qi Z, Li K, Lan S, Chen L, Guo R, Yao X, Mao L, Lian B, Kong Y, Dai J, Tang B, Yan X, Wang X, Li S, Zhou L, Balch CM, Si L, Guo J. The Clinicopathological and Survival Profiles Comparison Across Primary Sites in Acral Melanoma. Ann Surg Oncol 2020; 27:3478-3485. [PMID: 32253677 PMCID: PMC7410855 DOI: 10.1245/s10434-020-08418-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Indexed: 01/10/2023]
Abstract
Background The clinicopathological and survival profiles across primary sites in acral melanoma (AM) are still controversial and unclear. Methods This is a multi-center retrospective study. Clinicopathological data of AM patients diagnosed between 1 January 2000 and 31 December 2017 from 6 large tertiary hospitals in China were extracted. Chi square tests were used to compare basic characteristics between primary sites of sole, palm and nail bed. Melanoma-specific survival (MSS) differences based on primary sites were compared by log-rank tests and multivariate Cox regressions were used to identify prognostic factors for MSS. Results In total, 1157 AM patients were included. The sole group had a more advanced initial stage, deeper Breslow thickness, higher recurrence rate and distant metastases risk (all P < 0.05). The proportion of age < 65 years and ulceration were statistically lower in nail bed and palm groups, respectively. A total of 294 patients underwent sentinel lymph node biopsy and rates of positive SLN status had no statistical difference across primary sites. Among 701 patients with genetic profiles, the mutational frequency of BRAF, C-KIT, and PDGFRA were similar except for NRAS (higher in sole group, P = 0.0102). The median MSS of sole, nail bed and palm patients were 65.0 months, 112.0 months, and not reached, respectively (log-rank P = 0.0053). In multivariate analyses, primary site, initial stage, ulceration and recurrence were the prognostic factors for MSS in overall population, but the statistical significance varied over primary sites. Conclusions Substantial clinicopathological and survival heterogeneities exist across different primary sites in the AM population. Sole melanoma has worse prognosis compared with palm and nail bed subtypes.
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Affiliation(s)
- Xiaoting Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Di Wu
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Hang Li
- Department of Dermatology, National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Rui Zhang
- Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Yu Chen
- Department of Medical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Hong Yao
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhihong Chi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xinan Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Chuanliang Cui
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xue Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Zhonghui Qi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Ke Li
- Department of Cancer Biotherapy Center, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shijie Lan
- Cancer Center, The First Hospital of Jilin University, Changchun, China
| | - Lizhu Chen
- Department of Medical Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Rui Guo
- Department of Colorectal Surgery, Liaoning Cancer Hospital and Institute, Cancer Hospital of China Medical University, Shenyang, China
| | - Xinyu Yao
- Department of Dermatology, National Clinical Research Center for Skin and Immune Diseases, Peking University First Hospital, Beijing, China
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Bin Lian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Yan Kong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Jie Dai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Bixia Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xieqiao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Siming Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Li Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China
| | - Charles M Balch
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China.
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital and Institute, Haidian District, Beijing, China.
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Kwon MR, Choi SH, Jang KT, Kim JH, Mun GH, Lee J, Lee DY. Acral malignant melanoma; emphasis on the primary metastasis and the usefulness of preoperative ultrasound for sentinel lymph node metastasis. Sci Rep 2019; 9:15894. [PMID: 31685847 PMCID: PMC6828697 DOI: 10.1038/s41598-019-52180-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 10/02/2019] [Indexed: 11/10/2022] Open
Abstract
This study aimed to evaluate the most common primary metastatic location of acral malignant melanoma and to evaluate the usefulness of preoperative ultrasound for sentinel lymph node metastasis. Ninety-eight Korean acral malignant melanoma patients were enrolled. Acral malignant melanoma was present in 76 lower limbs and in 22 upper limbs. The most common origin location was the sole (33.7%). The most common location of primary metastasis was loco-regional recurrence (22/34, 64.7%). The sensitivity, specificity, positive predictive value, and negative predictive value of preoperative sentinel lymph node ultrasound was 29.1%, 94.6%, 63.6%, and 80.5%, respectively. We postulate the unusefulness of preoperative ultrasound for sentinel lymph node metastasis in acral malignant melanoma.
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Affiliation(s)
- Mi-Ri Kwon
- Department of Radiology, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sang-Hee Choi
- Department of Radiology, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Kee-Taek Jang
- Department of Pathology, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jung-Han Kim
- Division of Endocrine Surgery, Department of Surgery, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Goo-Hyun Mun
- Department of Plastic surgery, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jeeyun Lee
- Division of Hematology/Oncology, Department of Medicine, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung medical center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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15
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Si L, Zhang X, Shu Y, Pan H, Wu D, Liu J, Lou F, Mao L, Wang X, Wen X, Gu Y, Zhu L, Lan S, Cai X, Diede SJ, Zhou Y, Ge J, Li J, Wu H, Guo J. A Phase Ib Study of Pembrolizumab as Second-Line Therapy for Chinese Patients With Advanced or Metastatic Melanoma (KEYNOTE-151). Transl Oncol 2019; 12:828-835. [PMID: 30981094 PMCID: PMC6458446 DOI: 10.1016/j.tranon.2019.02.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pembrolizumab shows robust antitumor activity and favorable safety in metastatic melanoma. KEYNOTE-151 evaluated pembrolizumab in Chinese patients, who have more aggressive melanoma subtypes than other populations. METHODS Chinese patients aged ≥18years with advanced melanoma previously treated with one line of therapy received pembrolizumab 2 mg/kg every 3 weeks for 35 cycles or until confirmed disease progression, intolerable toxicity, or study withdrawal. Primary end points were objective response rate (ORR) per RECIST v1.1 by blinded independent central review and safety. Key secondary end points included duration of response (DOR) and progression-free survival (PFS) per RECIST v1.1 and overall survival (OS). RESULTS Median age was 52 years (N=103); 37.9% had acral and 14.6% had mucosal melanoma. Median follow-up was 7.9months at data cutoff (December 27, 2017). ORR was 16.7% (95% CI, 10.0-25.3%) (1 complete, 16 partial responses). Disease control rate was 38.2%. ORR was 15.8% for acral, 13.3% for mucosal melanoma. Median DOR was 8.4months; 65.6% of patients had response duration ≥6months. Median PFS was 2.8months (95% CI, 2.7-3.5months); 6-month rate was 20.4%. Median OS was 12.1months (95% CI, 9.6months-not reached); 6-month rate, 75.7%; 12-month rate, 50.6%. Treatment-related AEs (TRAEs) occurred in 87 (84.5%) patients; 9 (8.7%) experienced grade 3/4 TRAE and 2 (1.9%) discontinued because of TRAE; none died. Two deaths occurred that were unrelated to treatment. CONCLUSIONS Pembrolizumab was well tolerated and provided clinically meaningful antitumor activity as second-line therapy in Chinese patients with advanced melanoma.
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Affiliation(s)
- Lu Si
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
| | - Xiaoshi Zhang
- Sun Yat-sen University Cancer Centre, 651 Dongfeng E Rd, Yuexiu Qu, Guangzhou Shi, Guangdong Sheng, Guangzhou, China.
| | - Yongqian Shu
- Jiangsu Province Hospital, 300 Guangzhou Rd, Gulou Qu, Nanjing, Shi, 210029, Jiangsu Sheng, China.
| | - Hongming Pan
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun E Rd, XinCheng ShangQuan, Jianggan Qu, Hangzhou Shi, Zhejiang Sheng, 310016, Zhejiang, China.
| | - Di Wu
- The First Hospital of Jilin University, 3808 Jiefang Rd, HongQiJie, Chaoyang Qu, Changchun Shi, Jilin Sheng, 130021, Jilin, China.
| | - Jiwei Liu
- The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Xigang Qu, Dalian, Shi, 116011, Liaoning Sheng, China.
| | - Fang Lou
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qingchun E Rd, XinCheng ShangQuan, Jianggan Qu, Hangzhou Shi, Zhejiang Sheng, 310016, Zhejiang, China.
| | - Lili Mao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
| | - Xuan Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
| | - Xizhi Wen
- Sun Yat-sen University Cancer Centre, 651 Dongfeng E Rd, Yuexiu Qu, Guangzhou Shi, Guangdong Sheng, Guangzhou, China.
| | - Yanhong Gu
- Jiangsu Province Hospital, 300 Guangzhou Rd, Gulou Qu, Nanjing, Shi, 210029, Jiangsu Sheng, China.
| | - Lingjun Zhu
- Jiangsu Province Hospital, 300 Guangzhou Rd, Gulou Qu, Nanjing, Shi, 210029, Jiangsu Sheng, China; The First Hospital of Jilin University, 3808 Jiefang Rd, HongQiJie, Chaoyang Qu, Changchun Shi, Jilin Sheng, 130021, Jilin, China.
| | - Shijie Lan
- The First Hospital of Jilin University, 3808 Jiefang Rd, HongQiJie, Chaoyang Qu, Changchun Shi, Jilin Sheng, 130021, Jilin, China.
| | - Xin Cai
- The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Xigang Qu, Dalian, Shi, 116011, Liaoning Sheng, China.
| | - Scott J Diede
- Merck & Co. Inc., 2000 Galloping Hill Rd, 07033, Kenilworth, NJ, USA.
| | - Yu Zhou
- MSD, Building A, Headquarters Park Phase 2, 1582 Gumei Road, Xuhui District, 200233, Shanghai, China.
| | - Jun Ge
- MSD, Building A, Headquarters Park Phase 2, 1582 Gumei Road, Xuhui District, 200233, Shanghai, China.
| | - Jianfeng Li
- MSD, One Merck Campus Beijing, 100012, Beijing, Beijing, China.
| | - Haiyan Wu
- MSD, One Merck Campus Beijing, 100012, Beijing, Beijing, China.
| | - Jun Guo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Kidney Cancer and Melanoma, Peking University Cancer Hospital & Institute, 52# Fucheng Road, Haidian District, 100142, Beijing, China.
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16
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Functional Surgery for Malignant Subungual Tumors: A Case Series and Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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17
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Cirugía funcional en tumores malignos subungueales. Serie de casos y revisión de la literatura. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:712-721. [DOI: 10.1016/j.ad.2018.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/01/2018] [Accepted: 05/23/2018] [Indexed: 11/20/2022] Open
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18
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Acral melanoma: a retrospective cohort from the Brazilian National Cancer Institute (INCA). Melanoma Res 2018; 28:458-464. [DOI: 10.1097/cmr.0000000000000476] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Nunes LF, Mendes GLQ, Koifman RJ. Subungual melanoma: A retrospective cohort of 157 cases from Brazilian National Cancer Institute. J Surg Oncol 2018; 118:1142-1149. [DOI: 10.1002/jso.25242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/27/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Luiz Fernando Nunes
- Brazilian National Cancer Institute; Rio de Janeiro Brazil-Connective Bone Tissue Section
| | - Gélcio L. Q. Mendes
- Brazilian National Cancer Institute; Rio de Janeiro Brazil-Connective Bone Tissue Section
| | - Rosalina J. Koifman
- Department of Epidemiology and Quantitative Methods in Health; National School of Public Health, Oswaldo Cruz Foundation; Rio de Janeiro Brazil
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20
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Lino-Silva LS, Zepeda-Najar C, Salcedo-Hernández RA, Martínez-Said H. Acral Lentiginous Melanoma: Survival Analysis of 715 Cases. J Cutan Med Surg 2018; 23:38-43. [DOI: 10.1177/1203475418800943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Acral lentiginous melanoma (ALM) is an aggressive variant of melanoma; the incidence, prevalence, and prognosis differ among populations. We analyzed clinicopathological features and survival in Hispanics, a population with high ALM prevalence. Material and Methods: From 1144 patients with melanoma, we analyzed 715 ALMs and 429 non-ALMs from the National Referral Cancer Centre and compared survival. Results: Of the ALM group, 62.8% were female; the median age was 58 years. The mean Breslow thickness was 3.56 ± 7.16 mm. ALM patients showed an estimated 5-year disease-specific survival (DSS) of 53.3%, 52.7%, and 40.8% for stage I, II, and III, respectively. For non-ALM patients, the DSS rates were 66%, 60.8%, and 48.4% for stage I, II, and III disease, respectively. Overall, the 1-, 3-, and 5-year DSS rates for patients with ALM were 85.1%, 59.4%, and 46.3%, respectively; for non-ALM patients, they were 81.3%, 64.8%, and 55.7%, respectively ( P = .168). In the multivariate analysis, factors associated with decreased DSS were high Breslow thickness, recurrence, ulceration, male sex, and advanced stage. Conclusions: The 1-, 3-, and 5-year DSS rates of patients with ALM were not statistically different from those of non-ALM patients. In addition to known adverse prognostic factors, male sex was also associated with worse survival.
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Affiliation(s)
| | - César Zepeda-Najar
- Surgical Oncology, Hospital Ángeles Tijuana, Tijuana, Baja California Norte, Mexico
| | | | - Héctor Martínez-Said
- Surgical Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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21
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Seo JW, Ha SM, Song KH. Feasibility of IMP-3 as an Invasiveness Marker for Acral Lentiginous Melanoma. Ann Dermatol 2018; 30:496-499. [PMID: 30065600 PMCID: PMC6029947 DOI: 10.5021/ad.2018.30.4.496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/30/2017] [Accepted: 09/12/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jeong-Wan Seo
- Department of Dermatology, Dong-A University, College of Medicine, Busan, Korea
| | - Seung-Min Ha
- Department of Dermatology, Dong-A University, College of Medicine, Busan, Korea
| | - Ki-Hoon Song
- Department of Dermatology, Dong-A University, College of Medicine, Busan, Korea
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22
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Ozdemir F, Errico MA, Yaman B, Karaarslan I. Acral lentiginous melanoma in the Turkish population and a new dermoscopic clue for the diagnosis. Dermatol Pract Concept 2018; 8:140-148. [PMID: 29785333 PMCID: PMC5955083 DOI: 10.5826/dpc.0802a14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/07/2018] [Indexed: 11/19/2022] Open
Abstract
Background The incidence of acral lentiginous melanoma (ALM) in the white population is low. Dermoscopy enhances diagnosis of ALM; however, diagnostic accuracy may sometimes be poor due to the considerable proportion of amelanotic ALM variants. Objectives To calculate the proportion of ALM among all melanoma subtypes and to determine the frequency of dermoscopic features of ALM in the Turkish population. Methods Out of 612 melanomas, there were 70 cases of ALM, of which 46 showed sufficient image quality for retrospective study of dermoscopic features. Data from patients and their lesions was classified according to clinical features and histopathologic parameters. The dermoscopic variables evaluated were based on pertinent literature on dermoscopy of acral melanocytic neoplasms. Results The prevalence of ALM among all melanoma subtypes was 11.4%. Parallel-ridge pattern (PRP) was detected in 60.8% of cases and irregular diffuse pigmentation (IDP) in 28.3%. The ALMs were amelanotic in 24%, showing an atypical vascular pattern in all cases; a new dermoscopic pattern, named “vascularized parallel-ridge pattern” (VPRP), was detected in 13% of ALMs. Irregular lines were observed in 81.8% of subungual melanomas and were often associated with a multicolored background. Conclusions ALM has site-specific dermoscopic patterns, with PRP being the most prevalent pattern. The newly described VPRP pattern may be an additional clue for ALM diagnosis, especially in thin amelanotic melanomas.
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Affiliation(s)
- Fezal Ozdemir
- Ege University, Medical Faculty, Dermato-Oncology Unit, Department of Dermatology, Izmir, Turkey
| | - Micol A Errico
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Banu Yaman
- Ege University, Medical Faculty, Department of Pathology, Izmir, Turkey
| | - Isil Karaarslan
- Ege University, Medical Faculty, Dermato-Oncology Unit, Department of Dermatology, Izmir, Turkey
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23
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Seo JW, Ha SM, Song KH. Insulin-like growth factor-2 mRNA-binding protein 3 as a novel prognostic biomarker for acral lentiginous melanoma. Br J Dermatol 2018; 178:e268-e270. [PMID: 29048737 DOI: 10.1111/bjd.16077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- J W Seo
- Department of Dermatology, College of Medicine, Dong-A University, Dong Dae Sin-Dong, Seo-gu, Busan, 602-715, Republic of Korea
| | - S M Ha
- Pungsan Public Health Center Branch, Jeonbuk, Republic of Korea
| | - K H Song
- Department of Dermatology, College of Medicine, Dong-A University, Dong Dae Sin-Dong, Seo-gu, Busan, 602-715, Republic of Korea
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24
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Castaneda CA, Torres-Cabala C, Castillo M, Villegas V, Casavilca S, Cano L, Sanchez J, Dunstan J, Calderon G, De La Cruz M, Cotrina JM, Gomez HL, Galvez R, Abugattas J. Tumor infiltrating lymphocytes in acral lentiginous melanoma: a study of a large cohort of cases from Latin America. Clin Transl Oncol 2017; 19:1478-1488. [PMID: 28577153 DOI: 10.1007/s12094-017-1685-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Acral lentiginous melanoma (ALM) is a poor prognosis subtype and is the most prevalent in non-Caucasian populations. The presence of tumor infiltrating lymphocytes (TILs) has been associated with poor prognosis in melanoma. A large cohort of ALM cases was studied to determine status of TIL and its association with outcome. METHODS All patients with cutaneous melanoma presenting from 2005 to 2012 at Instituto Nacional de Enfermedades Neoplasicas in Peru were retrospectively identified. Clinicopathological information was obtained from the medical charts. A prospective evaluation of TIL was performed. Analysis of association between ALM and clinicopathological features including TIL as well as survival analysis compared the outcome of ALM to whole group and extremity NALM was performed. RESULTS 537 ALM from a total of 824 cutaneous melanoma cases were studied. Older age (p = 0.022), higher Breslow (p = 0.008) and ulceration (p < 0.001) were found to be more frequent in ALM. Acral had worse overall survival (OS) compared with the whole group (p = 0.04). Clinical stage (CS) I-II patients had a median OS of 5.3 (95% CI 4.3-6.2) for ALM and 9.2 (95% CI 5.0-7.0) for extremity NALM (p = 0.016). Grade 0 (absence of TIL), I, II and III were found in 7.5, 34.5, 32.1, and 25.9%, respectively. Lower TIL grade was associated with larger tumor size (p = 0.003), higher Breslow (p = 0.001), higher Clark level (p = 0.007), higher CS (p = 0.002), extremity location (p = 0.048), histological subtype ALM (p = 0.024) and better OS (p = 0.001). CONCLUSIONS ALM is highly prevalent in Peru and carries poor outcome. Lower TIL levels were associated with poor outcome and ALM.
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Affiliation(s)
- C A Castaneda
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru.
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru.
| | - C Torres-Cabala
- Departments of Pathology and Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - M Castillo
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - V Villegas
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - S Casavilca
- Pathology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - L Cano
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Sanchez
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Dunstan
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - G Calderon
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - M De La Cruz
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J M Cotrina
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - H L Gomez
- Medical Oncology Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - R Galvez
- Research Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
| | - J Abugattas
- Breast Cancer Surgery Department, Instituto Nacional de Enfermedades Neoplasicas, Av. Angamos Este 2520, Surquillo, 15038, Lima, Peru
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A prognostic model for resectable acral melanoma patients on the basis of preoperative inflammatory markers. Melanoma Res 2017; 27:469-476. [DOI: 10.1097/cmr.0000000000000365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Berk-Krauss J, Stein J. The role of access to care in acral lentiginous melanoma survival. Br J Dermatol 2017; 177:341-342. [DOI: 10.1111/bjd.15713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- J. Berk-Krauss
- The Ronald O. Perelman Department of Dermatology; New York University School of Medicine; 11th Floor, 240 East 38th Street New York NY 10016 U.S.A
- Yale University School of Medicine; New Haven CT U.S.A
| | - J.A. Stein
- The Ronald O. Perelman Department of Dermatology; New York University School of Medicine; 11th Floor, 240 East 38th Street New York NY 10016 U.S.A
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Asgari M, Shen L, Sokil M, Yeh I, Jorgenson E. Prognostic factors and survival in acral lentiginous melanoma. Br J Dermatol 2017; 177:428-435. [DOI: 10.1111/bjd.15600] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- M.M. Asgari
- Department of Dermatology; Massachusetts General Hospital, and Harvard Medical School; Boston MA U.S.A
- Division of Research; Kaiser Permanente Northern California; Oakland CA U.S.A
| | - L. Shen
- Division of Research; Kaiser Permanente Northern California; Oakland CA U.S.A
| | - M.M. Sokil
- Division of Research; Kaiser Permanente Northern California; Oakland CA U.S.A
| | - I. Yeh
- Departments of Pathology and Dermatology; University of California at San Francisco; San Francisco CA U.S.A
| | - E. Jorgenson
- Division of Research; Kaiser Permanente Northern California; Oakland CA U.S.A
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Surgical excision margin for primary acral melanoma. J Surg Oncol 2016; 114:933-939. [DOI: 10.1002/jso.24442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/02/2016] [Indexed: 11/07/2022]
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Abstract
The etiology and pathogenesis of lentiginous acral melanomas are poorly understood. Recent studies have postulated that DNA repair mechanisms and cell growth pathways are involved in the development of melanoma, particularly changes in the MAPK pathways (RAS, BRAF, MEK 1/2, and ERK 1/2). The aim of this study is to assess the status of the MAP kinase pathways in the pathogenesis of acral melanomas. The authors examined the components of the RAS–RAF–MEK–ERK cascades by immunohistochemistry in a series of 16 primary acral melanomas by tissue microarray. The expression of MAP kinase cascade proteins changed in most cases. The authors observed that 57.14% of cases were BRAF positive and that 61.53%, 71.42%, and 71.42% of cases were positive for MEK2, ERK1, and ERK2, respectively; RAS was not expressed in 92.31%, and all cases were negative for MEK1. The absence of RAS and positivity for MEK2, ERK1, and ERK2 were most seen in invasive cases with high thickness. These aspects of the MAPK pathway require further examination in acral melanomas between different populations. Nevertheless, the results highlight significant alterations in the MAP kinase cascades that are related to histological indicators of prognosis in primary acral melanomas.
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Lazar A, Abimelec P, Dumontier C. Full Thickness Skin Graft for Nail Unit Reconstruction. ACTA ACUST UNITED AC 2016; 30:194-8. [PMID: 15757774 DOI: 10.1016/j.jhsb.2004.11.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2002] [Accepted: 11/05/2004] [Indexed: 11/30/2022]
Abstract
A retrospective study of 13 patients assessed the use of a full thickness skin graft for nail unit reconstruction after total nail unit removal for nail bed malignancies. No failures of the graft were observed and no patient had recurrence of the malignant tumour at 4 year follow-up. Full thickness skin grafting is a simple procedure which provides a good cosmetic outcome and does not produce significant donor site morbidity.
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Affiliation(s)
- A Lazar
- Institut de la Main, 6 square Jouvenet, and Hôpital Saint Antoine, 184 Rue du Faubourg Saint Antoine, Paris, France
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Acral Melanoma in Chinese: A Clinicopathological and Prognostic Study of 142 cases. Sci Rep 2016; 6:31432. [PMID: 27545198 PMCID: PMC4992860 DOI: 10.1038/srep31432] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/19/2016] [Indexed: 01/09/2023] Open
Abstract
Acral melanoma (AM), as a peculiar subgroup of melanoma, is rare in Caucasians but has higher incidence in Asians. Large series of study on AM with clinicopathological features and prognostic factors is still limited, especially in Asian population. We retrospectively collected clinical, pathological and follow-up data of 142 AM cases. All patients were Chinese, with the age ranging from 24 to 87 years (mean 62.0; median 62.0). The Breslow thickness of primary lesions ranged from 0.6 to 16.3 mm (mean 4.9; median 3.7). 85.9% of the patients had acral lentiginous histologic subtype. Plantar was the most frequently involved site, followed by heels. Statistically, duration of the lesion before diagnosis (≤2.5 years), Breslow thickness >4.0 mm (T4), high mitotic index (>15 mm−2), presence of vascular invasion, regional lymph node metastasis at diagnosis and pathologic stage (II/III/IV) were found to be independent prognostic factors in both univariate and multivariate analyses. The prognosis of AM in Chinese is extremely poor. Our 5- and 10-year disease-specific survival (DSS) rates were 53.3% and 27.4%, respectively. Therefore, AM in Asians represents a more biologically aggressive melanoma subtype and is thought to carry a worse prognosis when compared with other races or cutaneous melanomas in other anatomic sites.
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Lino-Silva LS, Domínguez-Rodríguez JA, Aguilar-Romero JM, Martínez-Said H, Salcedo-Hernández RA, García-Pérez L, Herrera-Gómez Á, Cuellar-Hubbe M. Melanoma in Mexico: Clinicopathologic Features in a Population with Predominance of Acral Lentiginous Subtype. Ann Surg Oncol 2016; 23:4189-4194. [PMID: 27401447 DOI: 10.1245/s10434-016-5394-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to analyze the clinicopathologic features of melanoma in México as the demographics of melanoma are not well known in Mexican and Latin American people. MATERIALS AND METHODS A total of 1219 patients with cutaneous melanoma were analyzed through a retrospective database collected from a cancer referral institute, and the results were compared with developed countries. RESULTS Median age was 57 years, and 713 (58.5 %) were females. The most common melanoma subtype was acral lentiginous melanoma (ALM), which was observed in 538 (44.1 %) patients. Median Breslow thickness was 5.2 mm. Among 837 patients with complete data, the 5-year disease-specific survival (DSS) was 52.3 %. Factors associated with worse DSS on univariate analysis were Breslow thickness (p < 0.001), recurrence (p < 0.001), ulceration (p < 0.001), positive margin (p < 0.001), ALM (p = 0.001), and male sex (p = 0.001). Multivariate analysis demonstrated Breslow thickness [hazard ratio (HR) 1.45, 95 % confidence interval (CI) 1.27-1.65; p < 0.001], positive margin (HR 1.25, 95 % CI 1.03-1.57; p = 0.018), recurrence (HR 9.56, 95 % CI 6.89-9.87; p = 0.002), ALM (HR 8.07, 95 % CI 6.77-8.95; p = 0.004), and male sex (HR 1.33, 95 % CI 1.06-1.68; p = 0.013) as independent risk factors for DSS. CONCLUSION Our patients had worse prognosis compared with data from the US Surveillance, Epidemiology, and End Results database. We found male sex and ALM as independent risk factors for worse survival, in addition to known risk factors.
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Affiliation(s)
- Leonardo S Lino-Silva
- Department of Anatomic Pathology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
| | | | - José M Aguilar-Romero
- Department of Surgical Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Héctor Martínez-Said
- Department of Surgical Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rosa A Salcedo-Hernández
- Department of Surgical Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | - Ángel Herrera-Gómez
- Department of Surgical Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Mario Cuellar-Hubbe
- Department of Surgical Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
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Sondermann W, Zimmer L, Schadendorf D, Roesch A, Klode J, Dissemond J. Initial misdiagnosis of melanoma located on the foot is associated with poorer prognosis. Medicine (Baltimore) 2016; 95:e4332. [PMID: 27442685 PMCID: PMC5265802 DOI: 10.1097/md.0000000000004332] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Acral melanoma has been reported to be associated with poorer outcomes than melanoma occurring on other cutaneous sites. It has been suggested that part of this disparity in outcomes may be related to delay in diagnosis. Therefore, we have analyzed the rate of misdiagnoses in patients with melanoma located on the foot and have characterized the influence on the clinical course and survival of the patients. A prospective, computerized melanoma database at the Skin Cancer Center of the University Hospital Essen, Germany was used to identify patients with histologically confirmed melanoma located on the foot between 2002 and July 2013 for subsequent analysis. A cohort of 151 patients diagnosed with primary melanoma located on the foot was identified. One hundred seven patients qualified for subsequent analysis. Forty-two patients were male (39.3%) and 65 (60.7%) were female; the mean age at first diagnosis was 61.6 years (median 66 years). The youngest patient was 19 years, the oldest 88 years old.Of the 107 patients analyzed, 32 (30%) were initially misdiagnosed. Misdiagnoses included chronic wounds, nevi, hematoma, fungal infections, warts, and paronychia. Misdiagnosis caused a median delay in diagnosis of 9 months. The 5-year disease-free survival rate (47.8% vs 72.7%) and the 5-year overall survival rate (63.5% vs 88.4%) were statistically significant lower in the misdiagnosis cohort.The awareness of potentially overlooked melanoma located on the foot has to increase among physicians.To improve early detection and, thus, the prognosis of patients with melanoma located on the foot, taking a biopsy from any suspicious lesion should be taken into consideration as soon as possible.
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Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venerology and Allergology, University School of Medicine Essen-Duisburg, Essen, Germany
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Sheen YS, Liao YH, Lin MH, Chiu HC, Jee SH, Liau JY, Chang YL, Chu CY. Insulin-Like Growth Factor II mRNA-Binding Protein 3 Expression Correlates with Poor Prognosis in Acral Lentiginous Melanoma. PLoS One 2016; 11:e0147431. [PMID: 26796627 PMCID: PMC4721868 DOI: 10.1371/journal.pone.0147431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/04/2016] [Indexed: 12/21/2022] Open
Abstract
Insulin-like growth factor-II mRNA-binding protein 3 (IMP-3) is an RNA-binding protein expressed in multiple cancers, including melanomas. However, the expression of IMP-3 has not been investigated in acral lentiginous melanoma (ALM). This study sought to elucidate its prognostic value in ALMs. IMP-3 expression was studied in 93 patients diagnosed with ALM via immunohistochemistry. Univariate and multivariate analyses for survival were performed, according to clinical and histologic parameters, using the Cox proportional hazard model. Survival curves were graphed using the Kaplan-Meier method. IMP-3 was over-expressed in 70 out of 93 tumors (75.3%). IMP-3 expression correlated with thick and high-stage tumor and predicted poorer overall, melanoma-specific, recurrence-free and distant metastasis-free survivals (P = 0.002, 0.006, 0.008 and 0.012, respectively). Further analysis showed that patients with tumor thickness ≤ 4.0 mm and positive IMP-3 expression had a significantly worse melanoma-specific survival than those without IMP-3 expression (P = 0.048). IMP-3 (hazard ratio 3.67, 95% confidence intervals 1.35-9.97, P = 0.011) was confirmed to be an independent prognostic factor for melanoma-specific survival in multivariate survival analysis. Positive IMP-3 expression was an important prognostic factor for ALMs.
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Affiliation(s)
- Yi-Shuan Sheen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Hsien Lin
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hisn-Chu, Taiwan
| | - Hsien-Ching Chiu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shiou-Hwa Jee
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jau-Yu Liau
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yih-Leong Chang
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Haenssle HA, Hoffmann S, Buhl T, Emmert S, Schön MP, Bertsch HP, Rosenberger A. Assessment of melanoma histotypes and associated patient related factors: basis for a predictive statistical model. J Dtsch Dermatol Ges 2015; 13:37-45. [PMID: 25640492 DOI: 10.1111/ddg.12561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Certain melanoma histotypes carry a worse prognosis than others. We aimed to identify patient related factors associated with specific melanoma histotypes. PATIENTS AND METHODS Single center study including 347 melanoma patients, prospectively assessed for 22 variables leading to a database of more than 7,600 features. RESULTS Melanomas were histologically categorized as superficial spreading (SSM, 70.6%), nodular (NM; 12.7%), acrolentiginous (ALM; 4.0%), lentigo maligna (LMM; 3.8%), or unclassified melanoma (UCM; 8.9%). Well recognized melanoma risk indicators (i. e. many atypical nevi, freckles, previous melanoma), were significantly associated with SSM and LMM histotypes. NM and ALM patients carried significantly less common and/or atypical nevi. NM were mostly self-detected or detected by relatives. In contrast, SSM, LMM, and ALM were most frequently detected by dermatologists. NM and UCM were preferentially located on poorly observable sites, SSM on the lower limbs, ALM on plantar sites, and LMM on the head and neck. ALM and LMM patients were significantly older than other patients. A multinomial logistic model was designed to predict a certain melanoma histotype (overall accuracy 81%), which could be helpful to focus the attention of clinicians or may be integrated into fully automated diagnostic algorithms. CONCLUSIONS Melanoma histotypes show significant differences regarding patients' characteristics.
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Affiliation(s)
- Holger A Haenssle
- Clinic of Dermatology, Venerology and Allergology; University Medical Center, Ruprecht-Karls-University Heidelberg, Germany; Clinic of Dermatology, Venerology and Allergology; University Medical Center, Georg-August-University Goettingen, Germany
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Lee WJ, Lee JH, Won CH, Chang SE, Choi JH, Moon KC, Lee MW. Nail apparatus melanoma: A comparative, clinicoprognostic study of the initial clinical and morphological characteristics of 49 patients. J Am Acad Dermatol 2015; 73:213-20. [DOI: 10.1016/j.jaad.2015.04.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/09/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
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Haenssle HA, Hoffmann S, Buhl T, Emmert S, Schön MP, Bertsch HP, Rosenberger A. Subtypen des malignen Melanoms und assoziierte patientenbezogene Faktoren: Grundlage für ein prädiktives statistisches Modell. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.12561_suppl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Holger A. Haenssle
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Ruprecht-Karls-Universität Heidelberg
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Georg-August-Universität Göttingen
| | - Saskia Hoffmann
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Georg-August-Universität Göttingen
| | - Timo Buhl
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Georg-August-Universität Göttingen
| | - Steffen Emmert
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Georg-August-Universität Göttingen
| | - Michael P. Schön
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Georg-August-Universität Göttingen
| | - Hans Peter Bertsch
- Klinik für Dermatologie; Venerologie und Allergologie; Universitätsklinikum der Georg-August-Universität Göttingen
| | - Albert Rosenberger
- Institut für genetische Epidemiologie; Universitätsklinikum der Georg-August-Universität Göttingen
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Gumaste PV, Fleming NH, Silva I, Shapiro RL, Berman RS, Zhong J, Osman I, Stein JA. Analysis of recurrence patterns in acral versus nonacral melanoma: should histologic subtype influence treatment guidelines? J Natl Compr Canc Netw 2014; 12:1706-12. [PMID: 25505211 PMCID: PMC4469335 DOI: 10.6004/jnccn.2014.0172] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Current surgical treatment of primary melanoma is uniform for all histosubtypes, although certain types of melanoma, such as acral lentiginous melanoma (ALM), have a worse prognosis. No study has explored the effectiveness of standard melanoma treatment guidelines for managing ALM compared with nonacral melanoma (NAM). Study subjects were identified from a prospectively enrolled database of patients with primary melanoma at New York University. Patients with ALM were matched to those with NAM (1:3) by gender and melanoma stage, including substage (ALM, 61; NAM, 183). All patients received standard-of-care treatment. Recurrence and survival outcomes in both cohorts were compared. ALM histologic subtype was an independent negative predictor of recurrence-free survival (hazard ratio [HR], 2.24; P=.001) and melanoma-specific survival (HR, 2.58; P=.001) compared with NAM. Recurrence was significantly more common in patients with ALM than in those with NAM (49% vs 30%; P=.007). For tumors less than 2 mm in thickness, a significantly higher recurrence rate was seen with ALM versus NAM (P=.048). No significant difference was seen in recurrence for tumors greater than 2 mm (P=.12). Notably, the rate of locoregional recurrence was nearly double for ALM compared with NAM (P=.001). The data presented herein reveal a high rate of locoregional failure in ALM compared with NAM when controlling for AJCC stage. These results raise the question of whether ALM may require more aggressive surgical treatment than nonacral cutaneous melanomas of equal thickness, particularly in tumors less than 2 mm thick. Larger multicenter trials are necessary for further conclusions.
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Affiliation(s)
- Priyanka V. Gumaste
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Nathaniel H. Fleming
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Ines Silva
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Richard L. Shapiro
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Russell S. Berman
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Judy Zhong
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
| | - Iman Osman
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Jennifer A. Stein
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, New York, New York
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
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Cho K, Jung ST. Treatment outcomes of advanced stage malignant melanoma in hand and foot after amputation in Korean patients. Clin Orthop Surg 2013; 5:314-20. [PMID: 24340152 PMCID: PMC3858086 DOI: 10.4055/cios.2013.5.4.314] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 01/14/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A retrospective study was conducted to review the overall survival and treatment outcomes of high grade melanoma in the extremity to explore the clinical features of malignant melanoma of the hand and foot, and the therapeutic efficacies and survival rate after amputation. METHODS The clinical data of 30 patients with malignant melanoma of the hand and foot (confirmed by pathological examination), who were admitted and treated in our hospital between 2001 and 2010, were analyzed retrospectively. We analyzed variables affecting overall and disease-free survival. RESULTS Thirty patients (18 men and 12 women) treated with an amputation procedure for malignant melanoma in the hand or foot constituted the study cohort. The average age of the patients at the time of diagnosis was 58.7 years. Univariate analysis for overall melanoma survival revealed that diagnosis at over 70 years of age, postoperative lymph node metastasis, and location of the tumor were significant prognostic factors. And on the Kaplan-Meier survival curve, old age, American Joint Committee on Cancer stage and postoperative lymph node metastasis showed statistically significant differences in the 5-year survival rate. Also, amputation with aggressive lymph node dissection showed improved long term survival in advanced stage melanoma. CONCLUSIONS In Korean melanoma patients, for the treatment of high grade melanomas in the extremities after amputation, early diagnosis and postoperative follow-up for evaluation of lymph node metastasis are critical factors for long-term survival. And by performing lymph node dissection during amputation, we may improve the survival rate in advanced stage melanoma patients.
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Affiliation(s)
- Kyujin Cho
- Department of Orthopaedics, Chonnam National University Hospital, Gwangju, Korea
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Alexandrescu DT, Maslin B, Kauffman CL, Ichim TE, Dasanu CA. Malignant Melanoma in Pigmented Skin: Does the Current Interventional Model Fit a Different Clinical, Histologic, and Molecular Entity? Dermatol Surg 2013; 39:1291-303. [DOI: 10.1111/dsu.12251] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Bello DM, Chou JF, Panageas KS, Brady MS, Coit DG, Carvajal RD, Ariyan CE. Prognosis of acral melanoma: a series of 281 patients. Ann Surg Oncol 2013; 20:3618-25. [PMID: 23838913 DOI: 10.1245/s10434-013-3089-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Acral melanoma (AM) is an unusual malignancy with poor survival. This study defines a cohort of patients, treated at a single institution, and the factors associated with survival and comparison with nonacral cutaneous melanoma (NACM). METHODS All patients with AM presenting from 1995 to 2010 were identified from a prospectively maintained database. Analysis of clinicopathologic features of AM associated with disease-specific survival (DSS) was performed. A stratified, stage-matched survival analysis compared the outcome of 281 acral to 843 extremity NACM patients. RESULTS A total of 281 AM patients (170 volar, 111 subungual) were identified. Pathologic stage (p < 0.001), ulceration (p < 0.001), Breslow thickness (p < 0.001), and a positive sentinel lymph node (p < 0.001) were found to be poor prognostic indicators associated with DSS. In stage-matched analysis, AM had a worse DSS compared with NACM (hazard ratio 1.8; 95 % CI 1.2-2.7; p < 0.01). CONCLUSIONS This study represents the largest, single-institution series describing the characteristics and outcomes of AM. AM tumors exhibit aggressive histopathologic features associated with a poorer survival outcome. AM patients have an inferior survival than extremity NACM when matched for stage, perhaps reflecting inherent alterations in tumor biology. This warrants further investigation into the differences between acral and cutaneous melanoma.
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Affiliation(s)
- Danielle M Bello
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Proietto G, Giaculli E, De Biasio F, Guarneri GF, Rampino Cordaro E, Parodi PC. Conservative surgical treatment of a thin acral lentiginous melanoma of the thumb with no recurrences: a case report. Dermatol Ther 2013; 26:260-2. [DOI: 10.1111/j.1529-8019.2013.01550.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Gianluca Proietto
- Department of Dermatology; “G. D'Annunzio” University of Chieti; Chieti; Italy
| | - E. Giaculli
- Department of Dermatology; “G. D'Annunzio” University of Chieti; Chieti; Italy
| | - F. De Biasio
- Department of Plastic Reconstructive Surgery; University of Udine; Udine; Italy
| | - G. F. Guarneri
- Department of Plastic Reconstructive Surgery; University of Udine; Udine; Italy
| | - E. Rampino Cordaro
- Department of Plastic Reconstructive Surgery; University of Udine; Udine; Italy
| | - P. C. Parodi
- Department of Plastic Reconstructive Surgery; University of Udine; Udine; Italy
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Egger ME, McMasters KM, Callender GG, Quillo AR, Martin RCG, Stromberg AJ, Scoggins CR. Unique prognostic factors in acral lentiginous melanoma. Am J Surg 2012; 204:874-9; discussion 879-80. [PMID: 23022254 DOI: 10.1016/j.amjsurg.2012.05.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/19/2012] [Accepted: 05/22/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was performed to identify clinicopathologic factors associated with survival in acral lentiginous melanoma. METHODS A post hoc analysis of a prospective clinical trial and local database was performed in all patients with acral lentiginous melanomas. Multivariate analyses of factors associated with a tumor-positive sentinel lymph node (SLN) biopsy, disease-free survival (DFS), overall survival (OS), and local and in-transit recurrence-free survival (LITRFS) were performed. Kaplan-Meier survival analyses were performed. RESULTS Eighty-five patients were identified. Age younger than 59 years and Breslow thickness (BT) of 2.0 mm or greater were independent risk factors for a positive SLN. SLN status was the only independent risk factor for DFS and LITRFS on multivariate analysis. A BT of 2.0 mm or greater was the only independent risk factor for OS. SLN status distinguished differences in DFS, OS, and LITRFS on Kaplan-Meier analysis. CONCLUSIONS SLN status is the dominant factor for recurrence and survival in acral lentiginous melanoma. BT and ulceration are less important in this histologic subtype.
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Affiliation(s)
- Michael E Egger
- Department of Surgery, Division of Surgical Oncology, University of Louisville, 315 East Broadway, Suite 303, Louisville, KY 40202, USA
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Durbec F, Martin L, Derancourt C, Grange F. Melanoma of the hand and foot: epidemiological, prognostic and genetic features. A systematic review. Br J Dermatol 2012; 166:727-39. [DOI: 10.1111/j.1365-2133.2011.10772.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Rashid OM, Schaum JC, Wolfe LG, Brinster NK, Neifeld JP. Prognostic variables and surgical management of foot melanoma: review of a 25-year institutional experience. ISRN DERMATOLOGY 2011; 2011:384729. [PMID: 22363851 PMCID: PMC3262538 DOI: 10.5402/2011/384729] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 05/15/2011] [Indexed: 12/02/2022]
Abstract
Introduction. Cutaneous foot melanoma is rare, challenging to manage, and not adequately examined in the literature. This study evaluated the prognostic variables and surgical management of foot melanoma. Materials and Methods. Foot melanoma cases managed at an academic center from 1985 to 2010 were retrospectively reviewed. Results. 46 patients were identified with a broad range of demographic characteristics. Overall recurrence was 32.6%: 19% acral lentiginous, 57% nodular, 66% superficial spreading, 30% melanoma unspecified, 50% severely atypical; 53% ulcerated, 23% nonulcerated; 29% on the dorsum of the foot, 17% heel, 60% ankle, 22% toe, 50% plantar; 0% <1 mm thick, 47% 1–4 mm, 33% >4 mm. 13 had positive nodes, 4 (31%) of whom recurred. Prognostic factors and recurrence did not correlate, and survival was 96% with a median followup of 91 months. Conclusions. Aggressive management of foot melanoma may result in excellent long-term survival even following disease recurrence.
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Affiliation(s)
- Omar M Rashid
- Department of Surgery, Virginia Commonwealth University and the Massey Cancer Center, Richmond, VA 23298-0645, USA
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Lee CS, Lee J, Choi JJ, Yang WI, Yoon JS, Lee SY, Lee SC. Cytogenetics and prognosis for uveal melanoma in Korean patients. Acta Ophthalmol 2011; 89:e310-4. [PMID: 21310015 DOI: 10.1111/j.1755-3768.2010.02099.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the rate of mortality for uveal melanoma in the Korean population and assess whether it correlates with cytogenetic data, and clinical and histopathological factors. METHODS A retrospective review of medical files from 33 uveal melanoma patients who underwent enucleation at Yonsei University, Seoul, Korea, between January, 1994 and December, 2009 was performed. Dual-colour fluorescence in situ hybridization was performed using centromeric probes for chromosome 3 and 8 in archived patient tissues. RESULTS The mean age of patients was 53.2 years (range; 29-78), and the mean largest basal diameter was 11.8 mm (range; 6.0-18.1). Of the 20 tissue blocks with available cytogenetic data, there was monosomy 3 in seven (35%) and polysomy 8 in four (20%). The presence of monosomy 3 (p < 0.001), polysomy 8 (p < 0.001), ciliary body involvement (p < 0.001), a mitotic rate ≥5/40 high-power fields (p = 0.006), closed extravascular matrix loop (p = 0.025), large basal tumour diameter (p = 0.029) and epithelioid cellularity (p = 0.038) predicted melanoma-related mortality. The median time from enucleation to liver metastasis was 16 months (range; 10-70), and the median survival after metastasis was 5 months (range; 1-9). The Kaplan--Meier survival curve estimated the metastatic death rate to be 22% for 5 years and 30% for 10 years. CONCLUSIONS Korean patients with uveal melanoma are younger and appear to exhibit no worse prognosis than Caucasian. Cytogenetic abnormality of chromosome 3 and 8 highly predicted metastatic death.
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Robinson JK, Joshi KM, Ortiz S, Kundu RV. Melanoma knowledge, perception, and awareness in ethnic minorities in Chicago: recommendations regarding education. Psychooncology 2011; 20:313-20. [PMID: 20878831 DOI: 10.1002/pon.1736] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess the level of melanoma awareness and risk perception among ethnic minorities and to identify ways to enhance the relevance of melanoma educational materials for ethnic minorities. METHODS Twelve focus groups composed of participants from a single ethnicity [African-American (n=40), Hispanic (n=40), and Asian (n=40)], participated in a 2 h discussion on melanoma and skin cancer and commented on an educational brochure by the American Cancer Society and reacted to photographs of melanoma on ethnic skin. Participants also evaluated the ability to sunburn and tan and the skin cancer risk of images of celebrities before and after the discussion. Additionally, participants assessed the skin tone of celebrities as very fair, fair, olive, light brown, dark brown, and very dark. The audiotape recordings of the 12 focus groups were transcribed and analyzed with the Non-numerical Unstructured Data Indexing Searching and Theorizing software for common themes. RESULTS The common themes were (1) lack of relevance of skin cancer to ethnic people, (2) understanding of skin cancer risk terminology is based on personal experience and what is acquired from the media, and (3) sources of health information for ethnic minorities are fragmented and physicians are not the primary source of information. Celebrity images representing the six skin tones were selected. CONCLUSIONS Relevance of melanoma education to ethnic people may be improved by using 'melanoma skin cancer', photographs of early melanoma in people with dark skin, and providing guidance on how to inspect hands and feet for suspicious moles.
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Affiliation(s)
- June K Robinson
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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