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Keating S, Machchhar R, Jain U, Lipschutz J, Naronowicz G, Chaudhri M, Kanukuntla A. A Unique Case of High-Grade Dedifferentiated Melanoma Without a Known Primary Site. Cureus 2024; 16:e66951. [PMID: 39280375 PMCID: PMC11401614 DOI: 10.7759/cureus.66951] [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] [Accepted: 08/13/2024] [Indexed: 09/18/2024] Open
Abstract
Melanoma is a malignant neoplasm that arises in melanocytes, pigment-producing cells present primarily in the skin. However, not all malignant melanomas originate from the skin, and the other sites of origin include the uveal (eye) or mucosa (rectal or oral); it can have different patterns of mutations. While targeted therapies and immunotherapies have transformed the treatment of this disease in the metastatic setting, resistance mechanisms can still pose challenges for patients and their healthcare providers. We present a case of a male patient with metastatic melanoma and discuss its clinical presentation, diagnostic workup, treatment options, and outcomes. By exploring the complexities of this multifaceted disease process, clinicians and researchers can gain valuable insights into potential areas for improved management strategies. Ultimately, we should aim to deepen our understanding of melanoma and work towards better patient outcomes.
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Affiliation(s)
- Shawn Keating
- Internal Medicine, Hackensack Meridian Ocean Medical Center, Brick, USA
| | | | - Ujjwala Jain
- Internal Medicine, Ocean University Medical Center, Brick, USA
| | | | | | - Moiuz Chaudhri
- Internal Medicine, Ocean University Medical Center, Brick, USA
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Basilicata M, Terrano V, D’Aurelio A, Bruno G, Troiani T, Bollero P, Napolitano S. Oral Adverse Events Associated with BRAF and MEK Inhibitors in Melanoma Treatment: A Narrative Literature Review. Healthcare (Basel) 2024; 12:105. [PMID: 38201012 PMCID: PMC10778825 DOI: 10.3390/healthcare12010105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Melanoma cancer represents the most lethal type of skin cancer originating from the malignant transformation of melanocyte cells. Almost 50% of melanomas show the activation of BRAF mutations. The identification and characterization of BRAF mutations led to the development of specific drugs that radically changed the therapeutic approach to melanoma. METHODS We conducted a narrative review of the literature according to a written protocol before conducting the study. This article is based on previously conducted studies. We identified articles by searching electronic databases (Medline, Google Scholar and PubMed). We used a combination of "melanoma", "Braf-Mek inhibitors", " targeted therapy" and "oral side effects". RESULTS Eighteen studies were reported in this article showing the relationship between the use of targeted therapy in melanoma cancer and the development of oral side effects, such as mucositis, hyperkeratosis and cellular proliferation. CONCLUSION Targeted therapy plays an important role in the treatment of melanoma cancer, showing a notable increase in response rate, prolonged progression-free survival and overall survival in BRAF-mutated melanoma patients. Oral side effects represent a common finding over the course of treatment. However, these adverse effects can be easily managed in a multidisciplinary approach involving collaboration between medical oncologists and dental doctors.
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Affiliation(s)
- Michele Basilicata
- UOSD Special Care Dentistry, Department of Experimental Medicine and Surgery, University of Roma Tor Vergata, 00133 Rome, Italy; (M.B.); (A.D.); (P.B.)
- UniCamillus-Saint Camillus, International University of Health Sciences, 00131 Rome, Italy
| | - Vincenzo Terrano
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (V.T.); (T.T.); (S.N.)
| | - Alessandro D’Aurelio
- UOSD Special Care Dentistry, Department of Experimental Medicine and Surgery, University of Roma Tor Vergata, 00133 Rome, Italy; (M.B.); (A.D.); (P.B.)
| | - Giovanni Bruno
- Department of Neuroscience, University of Padua, 35121 Padova, Italy
- Department of Industrial Engineering, University of Tor Vergata, 00133 Rome, Italy
| | - Teresa Troiani
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (V.T.); (T.T.); (S.N.)
| | - Patrizio Bollero
- UOSD Special Care Dentistry, Department of Experimental Medicine and Surgery, University of Roma Tor Vergata, 00133 Rome, Italy; (M.B.); (A.D.); (P.B.)
| | - Stefania Napolitano
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Napoli, Italy; (V.T.); (T.T.); (S.N.)
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Salman P, de Melo AC, Rico-Restrepo M, Rodriguez J, Russi A, Schmerling RA, Zambrano A, Cinat G. Addressing the unmet needs of patients with BRAF-mutated melanoma in Latin America: Expert perspective. Front Oncol 2023; 13:1032300. [PMID: 36998456 PMCID: PMC10043339 DOI: 10.3389/fonc.2023.1032300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
Melanoma represents an increasing public health burden with extensive unmet needs in Latin America (LA). A mutation in the BRAF gene is present in approximately 50% of all melanomas in White populations and is a target of precision medicine, with the potential to dramatically improve patient outcomes. Thus, increased access to BRAF testing and therapy is LA must be explored. At a multi-day conference, a panel of Latin American experts in oncology and dermatology were provided with questions to address the barriers limiting access to testing for BRAF mutation in patients with melanoma in LA, who may be eligible for targeted therapy to improve their prognosis. During the conference, responses were discussed and edited until a consensus on addressing the barriers was achieved. Identified challenges included ignorance of BRAF-status implications, limited human and infrastructural resources, affordability and reimbursement, fragmented care delivery, pitfalls in the sample journey, and lack of local data. Despite the clear benefits of targeted therapies for BRAF-mutated melanoma in other regions, there is no clear path to prepare LA for a sustainable personalized medicine approach to this disease. Due to melanoma’s time-sensitive nature, LA must aim to provide early access to BRAF testing and consider mutational status within treatment decision making. To this end, recommendations are provided and include establishing multidisciplinary teams and melanoma referral centers and improving access to diagnosis and treatment.
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Affiliation(s)
- Pamela Salman
- Oncology Department, Oncovida Cancer Center, Santiago, Chile
- *Correspondence: Pamela Salman,
| | | | | | | | - Andrea Russi
- Departamento de Oncología, Hospital Universitario San Ignacio, Centro Javeriano de Oncología, Bogotá, Colombia
| | | | - Angela Zambrano
- Departamento de Oncología, Fundación Valle del Lili, Cali, Colombia
| | - Gabriela Cinat
- Instituto de Oncología Ángel Roffo, Universidad de Buenos Aires, Fundación CIDEA, Buenos Aires, Argentina
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Meevassana J, Anothaisatapon K, Subbalekha S, Kamolratanakul S, Siritientong T, Ruangritchankul K, Pungrasami P, Hamill KJ, Angsapatt A, Kitkumthorn N. BRAF V600E Immunohistochemistry Predicts Prognosis of Patients with Cutaneous Melanoma in Thai population. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4605. [PMID: 36299811 PMCID: PMC9592364 DOI: 10.1097/gox.0000000000004605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/26/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED The BRAF V600E mutation in the Thai population has been identified in a considerable percentage of people with cutaneous melanoma. The objectives of this study were to determine the prevalence of this mutation in cutaneous melanomas, conduct a clinicopathological association analysis with the BRAF V600E mutation, and develop a treatment strategy for patients with this mutation that would take advantage of the medications currently available to treat them. METHODS Anti-BRAF V600E (clone VE1) immunohistochemistry was performed on 50 pathological samples of cutaneous melanoma after excluding the samples with a low amount of pathologic tissue, a lack of clinical data' and poor follow-up. BRAF V600E expression DNA sequencing was performed to confirm the results of several cases. RESULTS Anti-BRAF V600E antibody positivity was noted in 56% (28/50) of cutaneous melanoma cases. DNA sequencing results were consistent with immunohistochemistry results. In cutaneous melanoma, the BRAF V600E mutation was significantly associated with adverse prognosis of patients, including reduced overall survival and disease-free survival. CONCLUSIONS An increased prevalence of the BRAF V600E mutation was determined in a collection of cutaneous melanomas in the Thai population, implying that BRAF-targeted therapy may be a promising strategy for patients with BRAF-mutated cutaneous melanoma. This study revealed an association between the clinicopathological aspects of cutaneous melanoma and overall survival, disease-free survival, and overall mortality. A treatment with anti-BRAF-targeted therapy, which incorporates the already available medications' is being researched and developed.
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Affiliation(s)
- Jiraroch Meevassana
- From the Center of Excellence in Burn and Wound care, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Surawish Subbalekha
- From the Center of Excellence in Burn and Wound care, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
| | - Supitcha Kamolratanakul
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Tippawan Siritientong
- From the Center of Excellence in Burn and Wound care, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | | | - Pornthep Pungrasami
- From the Center of Excellence in Burn and Wound care, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kevin J Hamill
- Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Apichai Angsapatt
- From the Center of Excellence in Burn and Wound care, Faculty of Medicine, Chulalongkorn, Bangkok, Thailand
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nakarin Kitkumthorn
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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The Effect of MDT Collaborative Nursing Combined with Hierarchical Nursing Management Model on the Quality of Life and Comfort of Patients with Gallbladder Stones Combined with Acute Cholecystitis after Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8696084. [PMID: 35734780 PMCID: PMC9208964 DOI: 10.1155/2022/8696084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/05/2022] [Accepted: 05/24/2022] [Indexed: 12/07/2022]
Abstract
Objective To explore the effect of MDT (multidisciplinary team) collaborative nursing combined with hierarchical nursing management mode on the quality of life and comfort of patients with gallbladder stones combined with acute cholecystitis after surgery. Methods A total of 120 patients with gallbladder stones and acute cholecystitis who were treated in our hospital from March 2019 to March 2021 were selected as prospective research objects. According to the order of care, they were divided into control group and observation group with 60 cases each. Among them, the control group implements a hierarchical nursing management model, and the observation group implements MDT collaborative nursing based on this and compares the impact of the two groups on patient's quality of life scores, daily self-care ability, nursing satisfaction, and comfort after nursing. Results Before nursing, the comparison of the quality of life score, nursing comfort, and nursing ability of the two groups of patients was not statistically significant (P > 0.05). After nursing, the mental vitality score, social interaction score, emotional restriction score, and mental status of the observation group were significantly higher than those of the control group. Statistics showed that the difference was statistically significant (P < 0.05). After nursing, the scores of social comfort, physical comfort, and psychological comfort of the observation group were significantly higher than those of the control group, and statistics showed that the difference was statistically significant (P < 0.05). The health knowledge level, self-care skills, self-care responsibility, and self-concept of the observation group after nursing were higher than those of the control group, while the score of depression and mood disorder was significantly lower than that of the control group. Statistics showed that this difference was statistically significant (P < 0.05). After nursing, patients in the observation group had higher operating technique scores, service attitude scores, health education scores, psychological intervention scores, and nursing quality scores than those of the control group. Statistics showed that the difference was statistically significant (P < 0.05). Conclusion MDT collaborative nursing combined with hierarchical nursing management mode can effectively improve the self-care ability of patients with gallbladder stones complicated with acute cholecystitis, effectively improve the quality of life of patients, and improve the satisfaction and comfort of patients with nursing care. The postnursing care of patients after inflammation has a certain reference value.
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Jaeger ZJ, Williams GA, Chen L, Mhlanga JC, Cornelius LA, Fields RC. 18 F-FDG positron emission tomography-computed tomography has a low positive predictive value for detecting occult recurrence in asymptomatic patients with high-risk Stages IIB, IIC, and IIIA melanoma. J Surg Oncol 2022; 125:525-534. [PMID: 34741547 PMCID: PMC8799500 DOI: 10.1002/jso.26737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/13/2021] [Accepted: 10/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES High recurrence rates of Stages II and IIIA melanoma make close follow-up essential, especially with new adjuvant therapies for metastatic disease. However, there are currently no consensus guidelines for routine imaging for Stages IIB, IIC, and IIIA melanoma. The study's aim is to determine the utility of 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting asymptomatic recurrence of melanoma after primary surgical resection. METHODS This retrospective cohort study included 158 patients with the American Joint Committee on Cancer 8th edition Stages IIB, IIC, or IIIA cutaneous melanoma who underwent an 18 F-FDG PET/CT from 2010 to 2020. We retrospectively analyzed clinical data after a median follow-up time of 39 months. RESULTS We calculated a positive predictive value (PPV) of 32% (95% confidence interval: 11%-53%) for 154 routine PET/CTs, including six true positives and 13 false positives (FPs). PPV was 33% for Stage IIB, 50% for Stage IIC, and 14% for Stage IIIA. FPs were mostly benign or inflammatory foci (75%), and some other malignancies were found (21%). CONCLUSIONS This cohort of patients imaged for high-risk melanoma demonstrated a high FP rate and low PPV. These findings suggest that routine surveillance with 18 F-FDG PET/CT may not be indicated for monitoring recurrence in this population.
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Affiliation(s)
| | - Gregory A. Williams
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine
- Alvin J. Siteman Comprehensive Cancer Center
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine
| | - Joyce C. Mhlanga
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine
| | - Lynn A. Cornelius
- Alvin J. Siteman Comprehensive Cancer Center
- Division of Dermatology, Department of Medicine, Washington University School of Medicine
| | - Ryan C. Fields
- Section of Surgical Oncology, Department of Surgery, Washington University School of Medicine
- Alvin J. Siteman Comprehensive Cancer Center
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