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Tejera-Vaquerizo A, Cañueto J, Gómez-Tomás A, Santos-Juanes J, Ribero S, Avallone G, Jaka A, Ferrandiz-Pulido C, Toll A, Sanmartín O. Longitudinal Study of Different Progression Patterns in High-Risk Cutaneous Squamous Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:670-678. [PMID: 38554750 DOI: 10.1016/j.ad.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cutaneous squamous cell carcinoma (cSCC) is the second leading cause of skin cancer mortality in Europe. Few studies have analyzed the different pathways of this tumor progression in its natural history. The main objective of this study was to analyze the different metastatic and progression pathways and their temporal occurrence in the evolution of cSCC. MATERIAL AND METHOD We conducted a multicenter, retrospective, and observational study of consecutive high-risk sSCCs included in the SQUAMATA project. RESULTS A total of 222 out of the 1346 patients included relapsed. The most frequent route of progression was the lymphatic one (62.6%). A total of 20.2% of the cases with lymphatic progression developed distant metastases. Only 1 case (3.1%) of distant metastasis followed local recurrence without previous lymphatic metastasis. The median time to disease-related mortality was longer in patients who developed systemic metastases than in those who died of locoregional progression. CONCLUSIONS The mortality of patients with cSCC is mostly due to the regional progression of their lymphatic metastases. The appearance of distant metastases is practically always (96.9%) associated with previous lymphatic metastatic progression. Therefore, in the future, new studies will be needed to assess the regional management of cSCC in both surgical and adjuvant therapies.
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Affiliation(s)
- A Tejera-Vaquerizo
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, España; Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, España.
| | - J Cañueto
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - A Gómez-Tomás
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - J Santos-Juanes
- Servicio de Dermatología, Hospital Central de Asturias e Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, Universidad de Oviedo, Oviedo, España
| | - S Ribero
- Medical Sciences Department, Section of Dermatology, University of Turin, Turín, Italia
| | - G Avallone
- Medical Sciences Department, Section of Dermatology, University of Turin, Turín, Italia
| | - A Jaka
- Servicio de Dermatología, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació GermansTrias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España
| | - C Ferrandiz-Pulido
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - A Toll
- Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, España
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Tejera-Vaquerizo A, Cañueto J, Gómez-Tomás A, Santos-Juanes J, Ribero S, Avallone G, Jaka A, Ferrandiz-Pulido C, Toll A, Sanmartín O. [Translated article] Longitudinal Study of Different Progression Patterns in High-Risk Cutaneous Squamous Cell Carcinoma. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00437-X. [PMID: 38823771 DOI: 10.1016/j.ad.2024.05.016] [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: 09/15/2023] [Accepted: 03/11/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cutaneous squamous cell carcinoma (cSCC) is the second leading cause of skin cancer mortality in Europe. Few studies have analyzed the different pathways of this tumor progression in its natural history. The main objective of this study was to analyze the different metastatic and progression pathways and their temporal occurrence in the evolution of cSCC. MATERIAL AND METHOD We conducted a multicenter, retrospective, and observational study of consecutive high-risk sSCCs included in the SQUAMATA project. RESULTS A total of 222 out of the 1346 patients included relapsed. The most frequent route of progression was the lymphatic one (62.6%). A total of 20.2% of the cases with lymphatic progression developed distant metastases. Only 1 case (3.1%) of distant metastasis followed local recurrence without previous lymphatic metastasis. The median time to disease-related mortality was longer in patients who developed systemic metastases than in those who died of locoregional progression. CONCLUSIONS The mortality of patients with cSCC is mostly due to the regional progression of their lymphatic metastases. The appearance of distant metastases is practically always (96.9%) associated with previous lymphatic metastatic progression. Therefore, in the future, new studies will be needed to assess the regional management of cSCC in both surgical and adjuvant therapies.
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Affiliation(s)
- A Tejera-Vaquerizo
- Unidad de Oncología Cutánea, Hospital San Juan de Dios, Córdoba, Spain; Servicio de Dermatología, Instituto Dermatológico GlobalDerm, Palma del Río, Córdoba, Spain.
| | - J Cañueto
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Gómez-Tomás
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - J Santos-Juanes
- Servicio de Dermatología, Hospital Central de Asturias e Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, Universidad de Oviedo, Oviedo, Spain
| | - S Ribero
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - G Avallone
- Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
| | - A Jaka
- Servicio de Dermatología, Hospital Universitari Germans Trials i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - C Ferrandiz-Pulido
- Servicio de Dermatología, Hospital Universitari Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - A Toll
- Servicio de Dermatología, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - O Sanmartín
- Servicio de Dermatología, Instituto Valenciano de Oncología, Valencia, Spain
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Hsu CC, Lee TL, Lin MH, Liao YH, Liau JY, Sheen YS. Risk factors for lymphatic and hematogenous metastasis after diagnosis of cutaneous Melanoma in Taiwan. J Formos Med Assoc 2022; 121:1823-1831. [PMID: 35292188 DOI: 10.1016/j.jfma.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/06/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Risk factors of lymphatic and hematogenous metastasis in cutaneous melanoma remained unclear in Asian population. This study aimed to identify clinical and histopathological factors to predict metastatic pathways in cutaneous melanoma in Taiwan. METHODS A total of 247 patients diagnosed as stage I and II melanoma, followed at National Taiwan University Hospital were included in this retrospective study from 1980 to 2020. Kaplan-Meier curves and Cox proportional hazards regression were utilized to identify risk factors. RESULTS During a median follow-up of 143 months, 48 (19.4%) and 62 (25.1%) patients developed lymphatic and hematogenous metastasis respectively. In the univariate analysis, age> 70 years, greater Breslow thickness, ulceration, neurotropism, and NRAS mutation were significant risk factors for lymphatic metastasis in all subtypes of melanoma. Age >70 years, head and neck location, thickness, ulceration, higher mitotic rate, neurotropism, and NRAS mutation were significant predictors of hematogenous metastasis in all subtypes. In the multivariate analysis, greater thickness (HR for 2.0-4.0 mm, 4.5; p = .009 and HR for >4.0 mm, 5.7; p = .003) retained its significance as an independent risk factor for lymphatic metastasis in all subtypes of melanoma. Thickness (HR for >4.0 mm, 5.7; p < .001) and ulceration (HR, 2.5; p = .001) were independent risk factors for hematogenous metastasis. CONCLUSION Risk factors of metastasis not only differ between lymphatic and hematogenous pathways, but also differ between ethnics and melanoma subtypes. Better understanding the behavior of cutaneous melanoma may help guide further treatments and follow-up plans.
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Affiliation(s)
- Che-Chia Hsu
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tung-Lin Lee
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsin-chu, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jau-Yu Liau
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Shuan Sheen
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Pizarro Á. Sentinel Lymph Node Biopsy in Melanoma Does Have Therapeutic Utility. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pizarro Á. Sentinel Lymph Node Biopsy in Melanoma Does Have Therapeutic Utility. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:536-537. [PMID: 32507284 DOI: 10.1016/j.ad.2019.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/22/2019] [Indexed: 01/14/2023] Open
Affiliation(s)
- Á Pizarro
- Unidad de Prevención y Diagnóstico Precoz de Melanoma, Clínica Dermatológica Internacional, Madrid, España.
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Calomarde-Rees L, García-Calatayud R, Requena Caballero C, Manrique-Silva E, Traves V, García-Casado Z, Soriano V, Kumar R, Nagore E. Risk Factors for Lymphatic and Hematogenous Dissemination in Patients With Stages I to II Cutaneous Melanoma. JAMA Dermatol 2020; 155:679-687. [PMID: 31042264 DOI: 10.1001/jamadermatol.2019.0069] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance The lymphatic and the hematogenous pathways have been proposed for disease progression in cutaneous melanoma, but association with recurrence has not been studied separately to date. Objective To identify the risk factors associated with lymphatic and hematogenous metastasis. Design, Setting, and Participants This retrospective cohort study included 1177 patients with malignant melanoma treated at Instituto Valenciano de Oncología, València, Spain. Data were retrieved from the melanoma database from January 1, 2000, through December 31, 2015, and analyzed from June 1 to 30, 2018. Exposure Malignant melanoma at stages I to II. Main Outcomes and Measures Analyses of survival free of lymphatic and hematogenous metastasis were performed using Kaplan-Meier curves and Cox proportional hazards regression. Results For the 1177 patients included in the study analysis (51.1% women; median age at diagnosis, 55 years [interquartile range, 42-68 years), median follow-up was 75 months (interquartile range, 33-121 months); 108 (9.2%) developed lymphatic metastasis, and 108 (9.2%) developed hematogenous metastasis. In the multivariate analysis, being older than 55 years (hazard ratio [HR], 1.9; 95% CI, 1.2-3.1), tumor in the head/neck (HR, 1.7; 95% CI, 1.0-2.9) and acral locations (HR, 2.4; 95% CI, 1.3-4.5), greater Breslow thickness (HR for >4.00 mm, 5.4; 95% CI, 2.4-12.4), and presence of vascular invasion (HR, 3.2; 95% CI, 0.9-10.6) were associated with lymphatic spreading. Hematogenous metastasis was associated with greater Breslow thickness (HR for >4.00 mm, 10.4; 95% CI, 3.6-29.7), the absence of regression (HR, 0.1; 95% CI, 0.0-1.0), TERT promoter mutations (HR, 2.9; 95% CI, 1.5-5.7), and BRAF mutations (HR, 1.9; 95% CI, 1.1-3.6). Conclusions and Relevance Risk factors associated with lymphatic and hematogenous metastasis differ. Follow-up and adjuvant treatment strategies may therefore need to be adapted to individual clinical, histopathologic, and molecular characteristics.
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Affiliation(s)
| | | | | | | | - Víctor Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Zaida García-Casado
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, València, Spain
| | - Virtudes Soriano
- Department of Medical Oncology, Instituto Valenciano de Oncología, València, Spain
| | - Rajiv Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Eduardo Nagore
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain.,School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
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Pizarro Á. Lymphadenectomy After a Positive Sentinel Lymph Node Biopsy in Melanoma: A Paradigm Shift. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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8
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Pizarro Á. Lymphadenectomy After a Positive Sentinel Lymph Node Biopsy in Melanoma: A Paradigm Shift. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:298-302. [PMID: 29496198 DOI: 10.1016/j.ad.2018.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/13/2018] [Accepted: 01/21/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- Á Pizarro
- Unidad de Prevención y Diagnóstico Precoz de Melanoma, Clínica Dermatológica Internacional, Madrid, España.
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Adler NR, Haydon A, McLean CA, Kelly JW, Mar VJ. Metastatic pathways in patients with cutaneous melanoma. Pigment Cell Melanoma Res 2016; 30:13-27. [PMID: 27900851 DOI: 10.1111/pcmr.12544] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/15/2016] [Indexed: 12/21/2022]
Abstract
Metastasis represents the end product of an elaborate biological process, which is determined by a complex interplay between metastatic tumour cells, host factors and homoeostatic mechanisms. Cutaneous melanoma can metastasize haematogenously or lymphogenously. The three predominant models that endeavour to explain the patterns of melanoma progression are the stepwise spread model, the simultaneous spread model and the model of differential spread. The time course to the development of metastases differs between the different metastatic routes. There are several clinical and histopathological risk factors for the different metastatic pathways. In particular, patient sex and the anatomical location of the primary tumour influence patterns of disease progression. There is limited existing evidence regarding the relationship between tumour mutation status, other diagnostic and prognostic biomarkers and the metastatic pathways of primary cutaneous melanoma. This knowledge gap needs to be addressed to better identify patients at high risk of disease recurrence and personalize surveillance strategies.
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Affiliation(s)
- Nikki R Adler
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Vic, Australia
| | - Andrew Haydon
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic, Australia.,Department of Medical Oncology, Alfred Hospital, Melbourne, Vic, Australia
| | - Catriona A McLean
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Vic, Australia
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic, Australia
| | - Victoria J Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic, Australia.,School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Vic, Australia.,Skin and Cancer Foundation, Carlton, Vic, Australia
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