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Abstract
Cutaneous melanoma is the major cause of mortality from all skin cancers. The treatment has been revolutionized in recent years by introduction of immunotherapy and targeted therapy for melanoma patients Stages III and IV. Therefore, the role of surgery in melanoma treatment needs to be redefined. In this narrative review, we will focus on surgery for diagnosis, treatment of primary tumor, and metastases in the era of new and effective medical treatment options. Neoadjuvant therapy is currently investigated in several trials. Surgery for treatment-resistant metastases is another field of interest. In conclusion, surgery remains a cornerstone for diagnosis and treatment of primary melanoma. Therapeutic lymphadenectomy has lost importance while surgery in sentinel lymph node diagnostics and metastasectomy are useful in a tailored individual approach of combined treatments. There is a trend to less invasive surgical procedures.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Municipal Hospital Dresden, Dresden, Germany
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2
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Morkavuk ŞB, Çulcu S, Esen E, Ünal AE. The diagnostic value of modified systemic ınflammation score in predicting post-operative outcomes of cutaneous melanoma patients who underwent ısolated limb perfusion. World J Surg Oncol 2021; 19:327. [PMID: 34781987 PMCID: PMC8594072 DOI: 10.1186/s12957-021-02437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022] Open
Abstract
Background In-transit metastasis is considered a locoregional disease in cutaneous melanoma (CM) patients. Isolated limb perfusion (ILP) is among the treatment options in selected cases. The aim of this study was to determine the success of pre- and post-perfusion mSIS values in predicting the potential complications and the prognosis of the disease by investigating the early and long-term results of mSIS values calculated before and after ILP in CM cases with in-transit metastases. Materials and methods Patients who underwent ILP within the period from 2014 to 2020 in our department were retrospectively scanned. A total of 20 patients were found to undergo ILP. The scores obtained from modified inflammation score (mSIS) were formulated according to albumin (Alb) and lymphocyte to monocyte ratio (LMR) scores. Results The mean follow-up time was 20.47 months. Complications requiring surgical intervention developed in three patients. According to the Wieberdink local toxicity classification, the majority (70%) of the patients were found to be grade II. Based on pre-perfusion mSIS values, 8 patients were classified as mSIS 0 while six patients were classified as mSIS 1 and 2. Based on post-perfusion mSIS values, 14 patients and one patient were classified as mSIS 2 (70%) and mSIS 0, respectively. Accordingly, univariate analysis showed that mSIS 1 and mSIS 2 were negative prognostic factors for mean survival in the pre-perfusion period (HR 0.162, 95% CI 0.036–0.729; p = 0.018 and HR: 0.223, 95% CI 0.049–1.019; p = 0.053) whereas albumin (Alb) and lymphocyte to monocyte ratio (LMR) were not independent prognostic factors for mean survival. Conclusion The mSIS values calculated in the pre-perfusion period can give an opinion about the OS of the patients whereas post-perfusion mSIS values may predict potential surgical complications and local toxicities.
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Affiliation(s)
| | - Serdar Çulcu
- Department of Surgical Oncology, Dr. Abdurrahman Yurtaslan Research and Training Hospital, Ankara, Turkey
| | - Ebru Esen
- Department of Surgical Oncology, Ankara Gülhane Research and Training Hospital, Ankara, Turkey
| | - Ali Ekrem Ünal
- Department of Surgical Oncology, Ankara University Faculty of Medicine, Ankara, Turkey
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3
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Wollina U, Brzezinski P. The value of metastasectomy in stage IV cutaneous melanoma. Wien Med Wochenschr 2018; 169:331-338. [PMID: 29511905 DOI: 10.1007/s10354-018-0630-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 02/13/2018] [Indexed: 12/27/2022]
Abstract
Cutaneous melanoma is an aggressive neoplasia of melanocytes. Prognosis is dependent on tumor stage. Stage IV melanoma is characterized by the occurrence of distant metastases. Response of metastases to classical chemotherapy is limited and toxicity of treatment is high. In recent years, new developments in immunotherapy and targeted therapies improved prognosis of stage IV melanoma patients with better tolerability of treatment. There is no dispute about surgical treatment of primary melanoma. But what is the value of metastasectomy in the era of new systemic treatments? This review aims to discuss available data for surgical removal of distant metastases for several organs and tissues. The available evidence suggests that for selected patients with possible complete resection of all tumor metastases, metastasectomy remains an effective treatment option with a benefit in overall survival.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Friedrichstraße 41, 01067, Dresden, Germany.
| | - Piotr Brzezinski
- Faculty of Mathematics and Natural Sciences, Institute of Biology and Environmental Protection, Pomeranian Academy, 76-200, Slupsk, Poland.,Department of Dermatology, 6th Military Support Unit, os. Ledowo 1N, 76-270, Ustka, Poland
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Wollina U, Tchernev G. Subungual Nail Pigmentation and Malalignment of the Great Toe Nail in a Cancer Patient - A Diagnostic Challenge. Open Access Maced J Med Sci 2017; 5:467-469. [PMID: 28785334 PMCID: PMC5535659 DOI: 10.3889/oamjms.2017.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 04/21/2017] [Accepted: 04/23/2017] [Indexed: 11/05/2022] Open
Abstract
Subungual pigmentation may have a variety of underlying pathologies, but clinicians should consider malignancies such as subungual melanoma or metastasis, even if they are not common. A delayed diagnosis can dramatically worsen the prognosis. Therefore, histologic examination is highly recommended. We present a 75-year-old female cancer patient presenting with subungual blackish pigmentation of the great toe nail for several years suspicious of a subungual melanoma even by dermoscopy. Nail avulsion and histological investigations excluded melanoma. The final diagnosis was subungual hematoma with growth malalignment of the great toe nail.
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Affiliation(s)
- Uwe Wollina
- Biological Department of Dermatology and Allergology, Municipal Hospital Dresden, Academic Teaching Hospital of the Technical University of Dresden, Friedrichstrasse 41, 01067 Dresden, Germany
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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Yu SJ, Long ZW. Effect of SOCS1 silencing on proliferation and apoptosis of melanoma cells: An in vivo and in vitro study. Tumour Biol 2017; 39:1010428317694315. [PMID: 28466787 DOI: 10.1177/1010428317694315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to investigate the effect of SOCS1 silencing on the proliferation and apoptosis of melanoma cells by in vivo and in vitro studies. Immunohistochemical staining was used to detect SOCS1 expression in melanoma tissues and pigmented nevi. Quantitative real-time polymerase chain reaction and western blotting were applied to detect the messenger RNA and protein expressions of SOCS1 in primary human melanocytes and malignant melanoma cell lines (A375, SK-MEL-5, M14, and MV3). Melanoma cells were assigned into mock, negative small interfering RNA, and SOCS1-small interfering RNA groups. The proliferation, cell cycle and apoptosis, and messenger RNA expression of SOCS1 in MV3 and A375 cells were detected using MTT assay, flow cytometry, and quantitative real-time polymerase chain reaction, respectively. The expressions of SOCS1 protein, extracellular signal-regulated kinase, and janus kinase signal transduction and activators of transcription signaling pathways-related proteins were detected using western blotting. After the establishment of subcutaneous xenograft tumor models in nude mice, the latent period, size, volume and growth speed of xenograft tumors in the mock, negative small interfering RNA, and SOCS1-small interfering RNA groups were examined and compared. The results indicated that positive expression rate of SOCS1 was higher in malignant melanoma tissues than in pigmented nevi. MV3 cells had the highest messenger RNA and protein expressions of SOCS1, followed by A357 cells. Compared with the mock and negative small interfering RNA groups, SOCS1-small interfering RNA group showed lower cell viability, elevated cell apoptosis, more cells in G0/G1 phase and less cells in S and G2/M phases, and decreased messenger RNA and protein expressions of SOCS1, p-ERK1/2, p-JAK2, p-STAT1, and p-STAT3. Compared with the mock and negative small interfering RNA groups, the SOCS1-small interfering RNA group showed longer latent period of tumor, smaller tumor size and volume, and smoother tumor growth curve. To conclude, SOCS1 silencing can inhibit proliferation and induce apoptosis of MV3 and A357 melanoma cells in vivo and in vitro by inhibiting extracellular signal-regulated kinase and janus kinase signal transduction and activators of transcription signaling pathways.
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Affiliation(s)
- Sheng-Jia Yu
- 1 Department of Gastric Cancer and Softtissue Sarcoma Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zi-Wen Long
- 1 Department of Gastric Cancer and Softtissue Sarcoma Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.,2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,3 Department of medicine, Shigatse people's hospital, Shigatse 857000, P.R China
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Cardiac Metastases of Malignant Melanoma. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2015. [DOI: 10.5812/rijm.3(2)2015.28077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chokoeva AA, Tchernev G, Philipov S, Cardoso JC, Zanardelli M, Lotti T. Wrong melanoma thickness measurement: check it or leave it? Int J Immunopathol Pharmacol 2014; 27:639-44. [PMID: 25572745 DOI: 10.1177/039463201402700421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cutaneous malignant melanoma (CMM) is one of the most aggressive forms of skin cancer, accounting for about 90% of deaths from cutaneous neoplasms, and its incidence has increased significantly in recent years. According to the 2012 European criteria for diagnosis and treatment of malignant melanoma, diagnosis should be based on the combination of clinical features, dermoscopic data and histological examination, preferably after excisional biopsy. Tumour thickness and other parameters for local staging according to the AJCC classification should be included in the pathology report. Although many factors influence the prognosis and course of the disease, it has been established in a number of studies that tumour thickness is the most important parameter. Therapy of malignant melanoma in its initial stages mostly consists of wide local excision with 1 to 2 cm margins, and sentinel lymph node biopsy that is usually performed in cases of tumours with a thickness greater than 1 mm. We present the case of a 58-year-old Bulgarian male with cutaneous superficial spreading malignant melanoma, in which, after complete excision, histological examination established an inaccurate tumour thickness (0.7 mm), with consequent inadequate staging and further management. After reassessment of the results in another institution (as well as their confirmation by two additional independent histopathology laboratories in our country 1.92 mm), in the National Oncological Hospital where the patient was initially evaluated, sentinel lymph node biopsy was not performed, contrary to the generally accepted European and World standards. With the present case we raise some current issues regarding diagnosis and therapy of Bulgarian patients (not only in the case presented) with malignant melanoma in the 21st century, and discuss the urgent need for external quality control procedures and standardization of the histopathologic reporting, which is of paramount importance in the staging and subsequent management of these patients.
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Affiliation(s)
- A A Chokoeva
- Onkoderma- Policlinic for Dermatology and Dermatologic Surgery, General Skobelev 26 Sofia, Bulgaria
| | - G Tchernev
- Policlinic for Dermatology and Venereology, Saint Kliment Ohridski University, Medical Faculty, University Hospital Lozenetz, Sofia, Bulgaria
| | - S Philipov
- Department of General and Clinical Pathology, Medical Faculty, Saint Kliment Ohridski University, Sofia, Bulgaria
| | - J C Cardoso
- Dermatology Department, University Hospital of Coimbra,Praceta Mota Pinto, Coimbra Portugal
| | - M Zanardelli
- Department of Neuroscience, Psychology, Drug Research and Child Health - Neurofarba - Pharmacology and Toxicology Section, University of Florence, Italy
| | - T Lotti
- University of Rome G. Marconi, Rome, Italy
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Abstract
Whereas thin melanomas have an excellent prognosis after sufficient surgical treatment, melanoma disease in advanced stages is still a therapeutic challenge. After decades of frustrating studies, new therapeutic strategies have come up in the past few years. On the one hand, increasing insights into the molecular aberrations in melanoma have led to specific “targeted” therapies to affect only the mutated tumor cells, as in many other types of cancers. Today there are few “targeted” substances which are already approved and successfully used for single or combination therapy, but many others are under development. While on the other hand, nonpersonalized strategy substances have been developed successfully inducing an immunologic tumor response. Both kinds of therapy have been found to result in an improvement not only of the response rate, but also of the overall survival in metastatic disease, which represents a milestone in melanoma therapy. However, using these therapies there is still much to learn regarding the effects, the side effects, and the limitations of these promising substances.
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Affiliation(s)
- Michael Tronnier
- Department of Dermatology, Klinikum Hildesheim GmbH, Hildesheim, Germany
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Wollina U, Steinbach F, Verma S, Tchernev G. Penile tumours: a review. J Eur Acad Dermatol Venereol 2014; 28:1267-76. [DOI: 10.1111/jdv.12491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 03/03/2014] [Indexed: 12/13/2022]
Affiliation(s)
- U. Wollina
- Department of Dermatology and Allergology; Academic Teaching Hospital Dresden-Friedrichstadt; Dresden Germany
| | - F. Steinbach
- Department of Urology; Academic Teaching Hospital Dresden-Friedrichstadt; Dresden Germany
| | - S. Verma
- Nirvana Clinic; Vadodara; Gujarat India
| | - G. Tchernev
- Policlinic for Dermatology and Venerology; Saint Kliment Ohridski University; University Hospital Lozenetz; Sofia Bulgaria
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Commentary on "changing age distribution of patients with melanoma". South Med J 2013; 106:673-4. [PMID: 24305525 DOI: 10.1097/smj.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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