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Blessley-Redgrave N, Bowerman F, Dafydd H, Hemington-Gorse S, Boyce D. Malignant melanoma in the hand: current evidence and recommendations. J Hand Surg Eur Vol 2024; 49:831-842. [PMID: 38663875 DOI: 10.1177/17531934241245028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Malignant melanoma is the leading cause of death from skin cancer. In spite of significant advances in the management of melanoma with the advent of sentinel lymph node biopsy (SLNB) and adjuvant oncological therapies, the death rate continues to increase worldwide. Melanoma in the hand poses additional diagnostic and management challenges. Consequently, these tend to present at a later stage and are associated with a poorer prognosis. It is imperative that hand surgeons treat any pigmented hand lesion with suspicion to ensure rapid diagnosis and treatment. This article outlines the presentation of melanoma, and how to investigate suspicious pigmented lesions of the hand and digits. It guides hand surgeons in their approach to melanoma of the hand, outlining the multidisciplinary team approach as well as current standard surgical and reconstructive options to optimize outcomes.
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Affiliation(s)
| | - Frances Bowerman
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, Wales, UK
| | - Hywel Dafydd
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, Wales, UK
| | | | - Dean Boyce
- Welsh Centre for Burns & Plastic Surgery, Morriston Hospital, Swansea, Wales, UK
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2
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Jeun R, Iyer PC, Best C, Lavis V, Varghese JM, Yedururi S, Brady V, Glitza Oliva IC, Dadu R, Milton DR, Brock K, Thosani S. Clinical outcomes of immune checkpoint inhibitor diabetes mellitus at a comprehensive cancer center. Immunotherapy 2023; 15:417-428. [PMID: 37013834 PMCID: PMC10088048 DOI: 10.2217/imt-2021-0316] [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: 11/21/2021] [Accepted: 03/06/2023] [Indexed: 04/05/2023] Open
Abstract
Introduction: Immune checkpoint inhibitor-associated diabetes mellitus (ICI-DM) is a rare adverse event. In this study, we characterize clinical outcomes of patients with ICI-DM and evaluate survival impact of this complication on melanoma patients. Research design & methods: We conducted a retrospective review of 76 patients diagnosed with ICI-DM from April 2014 to December 2020. Results: 68% of patients presented in diabetic ketoacidosis, 16% had readmissions for hyperglycemia, and hypoglycemia occurred in 70% of patients after diagnosis. Development of ICI-DM did not impact overall survival or progression-free survival in melanoma patients. Conclusion: Development of ICI-DM is associated with long-term insulin dependence and pancreatic atrophy; the use of diabetes technology in this patient population can help improve glycemic control.
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Affiliation(s)
- Rebecca Jeun
- Department of Endocrinology, Diabetes & Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
| | - Priyanka C Iyer
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Conor Best
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Victor Lavis
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Jeena M Varghese
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Sireesha Yedururi
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Veronica Brady
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Denai R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kristy Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sonali Thosani
- Department of Endocrine Neoplasia & Hormonal Disorders, Unit 1461, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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Zamagni F, Bucchi L, Mancini S, Crocetti E, Dal Maso L, Ferretti S, Biggeri A, Villani S, Baldacchini F, Giuliani O, Ravaioli A, Vattiato R, Brustolin A, Candela G, Carone S, Carrozzi G, Cavallo R, Dinaro YM, Ferrante M, Iacovacci S, Mazzoleni G, Musolino A, Rizzello RV, Serraino D, Stracci F, Tumino R, Masini C, Ridolfi L, Palmieri G, Stanganelli I, Falcini F. The relative contribution of the decreasing trend in tumour thickness to the 2010s increase in net survival from cutaneous malignant melanoma in Italy: a population-based investigation. Br J Dermatol 2022; 187:52-63. [PMID: 35253204 PMCID: PMC9542017 DOI: 10.1111/bjd.21051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The long-term increase in survival from cutaneous malignant melanoma (CMM) is generally attributed to the decreasing trend in tumour thickness, the single most important prognostic factor. OBJECTIVES To determine the relative contribution of decreased tumour thickness to the favourable trend in survival from CMM in Italy. METHODS Eleven local cancer registries covering a population of 8 056 608 (13.4% of the Italian population in 2010) provided records for people with primary CMM registered between 2003 and 2017. Age-standardized 5-year net survival was calculated. Multivariate analysis of 5-year net survival was undertaken by calculating the relative excess risk (RER) of death. The relative contribution of the decrease in tumour thickness to the RER of death was evaluated using a forward stepwise flexible parametric survival model including the available prognostic factors. RESULTS Over the study period, tumour thickness was inversely associated with 5-year net survival and multivariate RER in both sexes. The median thickness was 0.90 mm in 2003-2007, 0.85 mm in 2008-2012 and 0.75 mm in 2013-2017 among male patients, and 0.78 mm, 0.77 mm and 0.68 mm among female patients, respectively. The 5-year net survival was 86.8%, 89.2% and 93.2% in male patients, and 91.4%, 92.0% and 93.4% in female patients, respectively. In 2013-2017, male patients exhibited the same survival as female patients despite having thicker lesions. For them, the increasing survival trend was more pronounced with increasing thickness, and the inclusion of thickness in the forward stepwise model made the RER in 2013-2017 vs. 2003-2007 increase from 0.64 [95% confidence interval (CI) 0.51-0.80] to 0.70 (95% CI 0.57-0.86). This indicates that the thickness trend accounted for less than 20% of the survival increase. For female patients, the results were not significant but, with multiple imputation of missing thickness values, the RER rose from 0.74 (95% CI 0.58-0.93) to 0.82 (95% CI 0.66-1.02) in 2013-2017. CONCLUSIONS For male patients in particular, decrease in tumour thickness accounted for a small part of the improvement in survival observed in 2013-2017. The introduction of targeted therapies and immune checkpoint inhibitors in 2013 is most likely to account for the remaining improvement.
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Affiliation(s)
- Federica Zamagni
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Lauro Bucchi
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Silvia Mancini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Emanuele Crocetti
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Luigino Dal Maso
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Stefano Ferretti
- Romagna Cancer Registry, Section of FerraraLocal Health Authority and University of FerraraFerraraItaly
| | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications G. ParentiUniversity of FlorenceFlorenceItaly
| | - Simona Villani
- Department of Public Health, Experimental and Forensic Medicine, Unit of Biostatistics and Clinical EpidemiologyUniversity of PaviaPaviaItaly
| | - Flavia Baldacchini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Orietta Giuliani
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Alessandra Ravaioli
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Rosa Vattiato
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Angelita Brustolin
- UOSD Epidemiologia e Registro Tumori (Dip. di Prevenzione ASL VT) c/o Cittadella della SaluteViterboItaly
| | - Giuseppa Candela
- Trapani Cancer Registry, Dipartimento di Prevenzione della SaluteServizio Sanitario Regionale Sicilia, Azienda Sanitaria Provinciale (ASP)TrapaniItaly
| | - Simona Carone
- Registro tumori di TarantoUnità operativa complessa di statistica ed epidemiologiaAzienda sanitaria locale TarantoItaly
| | - Giuliano Carrozzi
- Modena Cancer Registry, Public Health DepartmentLocal Health AuthorityModenaItaly
| | | | | | - Margherita Ferrante
- Integrated Cancer Registry of Catania‐Messina‐EnnaAzienda Ospedaliero‐Universitaria Policlinico ‘Rodolico‐San Marco’CataniaItaly
| | | | | | - Antonino Musolino
- Department of Medicine and SurgeryUniversity of Parma; Medical Oncology Unit and Cancer Registry, University Hospital of ParmaParmaItaly
| | - Roberto Vito Rizzello
- Trento Province Cancer Registry, Unit of Clinical EpidemiologyAzienda Provinciale per i Servizi Sanitari (APSS) TrentoItaly
| | - Diego Serraino
- Cancer Epidemiology UnitCentro di Riferimento Oncologico di Aviano (CRO) IRCCSAvianoItaly
| | - Fabrizio Stracci
- Department of Medicine and SurgeryUniversity of PerugiaPerugiaItaly
| | - Rosario Tumino
- Former Director Cancer RegistryProvincial Health Authority (ASP)RagusaItaly
| | - Carla Masini
- Unit of Oncological PharmacyIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Laura Ridolfi
- Immunotherapy, Cell Therapy and BiobankIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
| | - Giuseppe Palmieri
- Institute of Research on Genetics and Biomedicine (IRGB), National Research Council (CNR)SardegnaSassariItaly
| | - Ignazio Stanganelli
- Skin Cancer UnitIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Department of DermatologyUniversity of ParmaParmaItaly
| | - Fabio Falcini
- Romagna Cancer RegistryIRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) ‘Dino Amadori’MeldolaForlìItaly
- Cancer Prevention UnitLocal Health AuthorityForlìItaly
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Go CC, Kim DH, Go BC, McGeehan B, Briceño CA. Clinicopathologic Characteristics and Prognostic Factors Impacting Survival in Melanoma of the Eyelid. Am J Ophthalmol 2022; 234:71-80. [PMID: 34343490 DOI: 10.1016/j.ajo.2021.07.031] [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: 02/01/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine prognostic factors for survival in patients with melanoma of the eyelid. DESIGN Retrospective cohort study. METHODS This population-based study reviewed patients with primary melanoma of the eyelid diagnosed in the Surveillance, Epidemiology and End Results database between 1975 and 2016. The primary outcomes included survival rates estimated by Kaplan-Meier analysis and mortality hazard ratios (HRs) for overall survival and disease-specific survival (DSS). RESULTS The cohort consisted of 2257 patients with cutaneous melanoma of the eyelid, representing 1380 cases of melanoma in situ and 877 cases of invasive melanoma. For melanoma in situ and invasive melanoma respectively, at 5 years, the overall survival rates were 88.6% and 77.1%, while DSS rates were 99.4% and 91.0%. Cox regression analysis for eyelid melanoma indicated that for invasive melanoma, age at diagnosis ≥75 years (HR 2.17 [95% confidence interval {CI} 1.02-4.60]; P = .04), T4 staging (HR 8.45 [95% CI 2.96-25.31]; P < .001), lymph node involvement (HR 3.61 [95% CI 1.12-11.60]; P = .03), and nodular melanoma (HR 3.31 [95% CI 1.50-7.32]; P = .003) histologic subtype were associated with decreased rates of survival. Sex and tumor ulceration did not impact survival. CONCLUSIONS This study is the largest analysis to date that focuses on DSS for cutaneous melanoma of the eyelid. The most significant predictors for invasive melanoma survival are age ≥75 years at diagnosis, T4 staging, lymph node involvement, and the nodular melanoma histologic subtype. Patients with these attributes are at higher risk and should be counseled regarding prognosis.
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Clinical Study on the Increased Incidence of Nodular Melanoma Cases Compared to Superficial Melanoma. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:298-305. [PMID: 34765252 PMCID: PMC8551895 DOI: 10.12865/chsj.47.02.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/18/2021] [Indexed: 11/18/2022]
Abstract
Our study group was comprised of 67 patients with melanoma, admitted and operated in our clinic between 2010-2018. Only the patients with melanoma localized on the head, torso and upper limb were selected for our study. We attempted to establish a link between the clinical appearance, presence or absence of ulceration, presence or absence of regional lymphadenopathy or distant metastases, surgical technique, histopathological type, Clark level and Breslow depth, disease stage (TNM), adjuvant therapies and survival rates at 1, 3, 5 and 10 years.
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6
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Sohng C, Sim HB, Kim JY, Lim Y, Han MH, Lee H, Ahn BC, Huh S, Lee SJ. Sentinel lymph node biopsy in acral melanoma: A Korean single-center experience with 107 patients (2006-2018). Asia Pac J Clin Oncol 2021; 17:115-122. [PMID: 33079454 DOI: 10.1111/ajco.13425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) of primary cutaneous melanoma as an important staging method has not been popularly undertaken in Korea and only a few studies with small patient numbers have been published. AIM We examined the clinical feasibility and overall outcomes of SLNB in acral melanoma (AM) of Korean in Kyungpook National University Hospital (KNUH) over the past 13 years. METHODS SLNB in AM patients during 2006-2018 were analyzed retrospectively for sentinel lymph node (SLN) harvesting rate, positivity rate, positivity-relevant overall survival (OS) and disease-free survival (DFS), and its side effects. RESULTS A total of 109 AM patients who underwent SLNB were enrolled. Harvested nodes were identified from 107 patients and SLN harvesting rate was 98.2%. The mean Breslow thickness (±standard deviation) was 3.38 ± 3.03 mm, and the proportion of ulcerated melanomas was 64%. Twenty-two (20.6%) had a tumor-positive SLN and, among them, 82% (18/22) underwent immediate complete lymph node dissection (CLND). The metastasis-positive nodal basin after CLND was detected in 16.7% of cases (3/18). Tumor-negative SLN cohorts showed significantly better OS and DFS than tumor-positive ones (P = 0.006 and P < 0.001 for each). Two side effects, one seroma and one lymphocele, were observed without major sequelae. CONCLUSION SLNB, crucial management of melanoma, proved its efficacy to predict patients' prognosis and could be performed successfully and safely in Korean AM patients by interdisciplinary cooperation between dermatology and other surgical departments. SLN(-) showed significantly better OS and DFS than SLN(+). Significant risk factors for DFS were Breslow thickness, the presence of ulceration and the presence of SLN metastasis. SLNB should be encouraged in order to stage melanoma accurately and direct the proper management in Korean AM.
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Affiliation(s)
- Chihyeon Sohng
- Department of Dermatology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Hyun Bo Sim
- Park and Lee Dermatologic Clinic, Daegu, South Korea
| | - Jun Young Kim
- Department of Dermatology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Yangsoo Lim
- Department of Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Man Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Hoseok Lee
- Department of Radiology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Byeong-Cheol Ahn
- Department of Dermatology, Nuclear Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Seok-Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
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7
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Mahamat-Saleh Y, Hughes MCB, Miura K, Malt MK, von Schuckmann L, Khosrotehrani K, Smithers BM, Green AC. Patterns of Omega-3 and Omega-6 Fatty Acid Dietary Intake and Melanoma Thickness at Diagnosis. Cancer Epidemiol Biomarkers Prev 2020; 29:1647-1653. [PMID: 32430338 DOI: 10.1158/1055-9965.epi-20-0319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/05/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Experimental evidence suggests that dietary intakes of omega-3 and omega-6 polyunsaturated fatty acids have divergent effects on melanoma growth, but epidemiologic evidence on their combined effect is lacking. METHODS In 634 Australian patients with primary melanoma, we assessed prediagnosis consumption of 39 food groups by food frequency questionnaires completed within 2 months of diagnosis. We derived, by reduced rank regression, dietary patterns that explained variability in selected omega-3 and omega-6 fatty acid intakes. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between tertiles of dietary patterns and melanoma thickness >2 mm versus ≤2 mm were estimated using Poisson regression. RESULTS Overall omega-3 fatty acid intakes were low. Two major fatty acid dietary patterns were identified: "meat, fish, and fat," positively correlated with intakes of all fatty acids; and "fish, low-meat, and low-fat," positively correlated with long-chain omega-3 fatty acid intake, and inversely with medium-chain omega-3 and omega-6 fatty acid intakes. Prevalence of thick melanomas was significantly higher in those in the highest compared with lowest tertile of the "meat, fish, and fat" pattern (PR, 1.40; 95% CI, 1.01-1.94), especially those with serious comorbidity (PR, 1.83; 95% CI, 1.15-2.92) or a family history (PR, 2.32; 95% CI, 1.00-5.35). The "fish, low-meat, and low-fat" pattern was not associated with melanoma thickness. CONCLUSIONS People with high meat, fish, and fat intakes, who thus consumed relatively high levels of omega-3 and high omega-6 fatty acid intakes, are more likely to be diagnosed with thick than thin melanomas. IMPACT High omega-3 and omega-6 fatty acid intakes may contribute to patients' presentation with thick melanomas.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Centre for Research in Epidemiology and Population Health (CESP) - School of Medicine, Universite Paris Sud - School of Medicine, Universite Versailles Saint-Quentin-en-Yvelines (UVSQ); INSERM French National Institute for Health and Medical Research, Universite Paris Saclay, Villejuif, France.,Gustave Roussy, Villejuif, France
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Kyoko Miura
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maryrose K Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lena von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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Huang R, Liang J, Jiang F, Zhou F, Cheng N, Wang T, Lei B. MelanomaNet: An Effective Network for Melanoma Detection. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:1613-1616. [PMID: 31946205 DOI: 10.1109/embc.2019.8856947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Melanoma is one of the most deadly skin lesion, which often uses the skin dermoscopy to detect it. However, the low interclass variations between melanoma images make manual dermoscopic detection time-consuming and laborious. Therefore, an automatic recognition algorithm of skin image is highly desirable. However, the traditional methods still have the limitations (e.g., weak robustness and generalization ability). To meet the challenge, we propose an effective architecture based on residual - squeeze - and - excitation -Inception-v4 network (MelanomaNet) to detect melanoma. Specifically, Inception-v4 structure is utilized to get the rich spatial features and increase feature diversity. We also consider the relationship between feature channels by adding residual-squeeze-and-excitation (RSE) blocks in Inception- v4 network using the feature recalibration strategies. Finally, we use the support vector machine (SVM) as the classifier for the skin lesion classification. We evaluate our proposed method on the public available ISIC skin lesion challenge datasets in 2018 for training and evaluation. The experimental results show that the proposed method has achieved better performance over the state-of-the-arts methods.
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9
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Fernandes M, Barcelos D, Comodo AN, Guimarães DP, Lopes Carapeto FC, Cardili L, de Sousa Morães L, Cerutti Ap J, Landman Ap G. Acral Lentiginous Melanomas Harbour Intratumor Heterogeneity in BRAF Exon 15, With Mutations Distinct From V600E/V600K. Am J Dermatopathol 2019; 41:733-740. [PMID: 31021835 DOI: 10.1097/dad.0000000000001418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The choice of appropriate therapeutic strategies may be influenced by intratumor heterogeneity and makes cancer treatment considerably more challenging. We aimed to evaluate the heterogeneity of BRAF exon 15 mutations in different areas of acral lentiginous melanoma (ALM). The entire exon 15 was sequenced in 4 different areas of paraffin-embedded samples from 26 patients with ALM. A total of 26 of 49 cases of ≥1 mm in depth of ALM identified by clinical, anatomical, and pathological data fulfilled the inclusion and exclusion criteria for this study. Tumors had a mean Breslow depth of 7.2 mm and an average mitotic index of 3 mitosis/mm. Mutations distinct from the common V600E and V600K were detected in 31%, and intratumor heterogeneity was observed in 31% of samples. Interestingly, 63.5% of all mutations had been previously associated with cancer. Most (62.5%) of the missense BRAF exon 15 mutations found in the ALM samples examined here were deemed "detrimental" for protein function according to at least 2 functional prediction programs, and 3 mutations (37.5%) were predicted to be "neutral," with no effect on protein function. BRAF exon 15 mutations were detected frequently in ALM and displayed heterogeneity, a finding to be further investigated.
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Affiliation(s)
- Mariana Fernandes
- Department of Pathology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Denise Barcelos
- Department of Pathology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | - Leonardo Cardili
- Department of Pathology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Lais de Sousa Morães
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Janete Cerutti Ap
- Department of Morphology and Genetics, Federal University of São Paulo, São Paulo, Brazil
| | - Gilles Landman Ap
- Department of Pathology, Universidade Federal de São Paulo, São Paulo, Brazil
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10
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Pérez-Aldrete BM, Matildes-Mariscal JB, Gómez-Padilla F, Guevara-Gutiérrez E, Barrientos-García JG, Hernández-Peralta SL, Tlacuilo-Parra A. Cutaneous melanoma in patients from western Mexico: Clinical pathology characteristics and their relationship to prognosis. Australas J Dermatol 2019; 60:e298-e303. [PMID: 31016713 DOI: 10.1111/ajd.13054] [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: 09/17/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVE Melanoma is the third most frequent malignant neoplasm in skin. The majority of information available comes from studies performed in Caucasian populations. Our objective was to investigate the clinico-pathological characteristics in Mexican patients with cutaneous melanoma and the relationship these characteristics had to prognosis. METHODS A retrospective study included patients with a histopathological diagnosis of melanoma who were attended at a tertiary level Dermatology Institute over a 10-year period. Age, gender, anatomical location; histopathological subtype, Breslow thickness, Clark level; presence of ulceration, metastasis, anatomical-pathological stage and survival were investigated. To assess the data, descriptive statistics, chi-squared or the Fisher exact test and Kaplan-Meier curves were used. RESULTS There were 323 patients included. The overall survival rate was 77% with an average follow-up of 7 years. The lowest survival was statistically related to the following: higher age (>65 years), localisation in palms/soles, histopathological nodular subtype, presence of ulceration, Breslow thickness >4.0 mm, Clark level V, the presence of metastasis and stage IV disease. CONCLUSIONS Our results relay the characteristics and prognosis of patients with the diagnosis of cutaneous melanoma in western Mexico.
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Affiliation(s)
| | | | | | - Elizabeth Guevara-Gutiérrez
- Instituto Dermatologico de Jalisco "Dr. José Barba Rubio", Secretaria de Salud Jalisco, Zapopan, Jalisco, Mexico
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Li H, He X, Zhou F, Yu Z, Ni D, Chen S, Wang T, Lei B. Dense Deconvolutional Network for Skin Lesion Segmentation. IEEE J Biomed Health Inform 2018; 23:527-537. [PMID: 30047917 DOI: 10.1109/jbhi.2018.2859898] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Automatic delineation of skin lesion contours from dermoscopy images is a basic step in the process of diagnosis and treatment of skin lesions. However, it is a challenging task due to the high variation of appearances and sizes of skin lesions. In order to deal with such challenges, we propose a new dense deconvolutional network (DDN) for skin lesion segmentation based on residual learning. Specifically, the proposed network consists of dense deconvolutional layers (DDLs), chained residual pooling (CRP), and hierarchical supervision (HS). First, unlike traditional deconvolutional layers, DDLs are adopted to maintain the dimensions of the input and output images unchanged. The DDNs are trained in an end-to-end manner without the need of prior knowledge or complicated postprocessing procedures. Second, the CRP aims to capture rich contextual background information and to fuse multilevel features. By combining the local and global contextual information via multilevel feature fusion, the high-resolution prediction output is obtained. Third, HS is added to serve as an auxiliary loss and to refine the prediction mask. Extensive experiments based on the public ISBI 2016 and 2017 skin lesion challenge datasets demonstrate the superior segmentation results of our proposed method over the state-of-the-art methods.
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Glasner A, Levi A, Enk J, Isaacson B, Viukov S, Orlanski S, Scope A, Neuman T, Enk CD, Hanna JH, Sexl V, Jonjic S, Seliger B, Zitvogel L, Mandelboim O. NKp46 Receptor-Mediated Interferon-γ Production by Natural Killer Cells Increases Fibronectin 1 to Alter Tumor Architecture and Control Metastasis. Immunity 2018; 48:107-119.e4. [DOI: 10.1016/j.immuni.2017.12.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/15/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
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Pizzichetta MA, Massi D, Mandalà M, Queirolo P, Stanganelli I, De Giorgi V, Ghigliotti G, Cavicchini S, Quaglino P, Corradin MT, Rubegni P, Alaibac M, Astorino S, Ayala F, Magi S, Mazzoni L, Manganoni MA, Talamini R, Serraino D, Palmieri G. Clinicopathological predictors of recurrence in nodular and superficial spreading cutaneous melanoma: a multivariate analysis of 214 cases. J Transl Med 2017; 15:227. [PMID: 29115977 PMCID: PMC5688807 DOI: 10.1186/s12967-017-1332-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Nodular melanoma (NM) accounts for most thick melanomas and because of their frequent association with ulceration, fast growth rate and high mitotic rate, contribute substantially to melanoma-related mortality. In a multicentric series of 214 primary melanomas including 96 NM and 118 superficial spreading melanoma (SSM), histopathological features were examined with the aim to identify clinicopathological predictors of recurrence. METHODS All consecutive cases of histopathologically diagnosed primary invasive SSM and NM during the period 2005-2010, were retrieved from the 12 participating Italian Melanoma Intergroup (IMI) centers. Each center provided clinico-pathological data such as gender, age at diagnosis, anatomical site, histopathological conventional parameters, date of excision and first melanoma recurrence. RESULTS Results showed that NM subtype was significantly associated with Breslow thickness (BT) at multivariate analysis: [BT 1.01-2 mm (OR 7.22; 95% CI 2.73-19.05), BT 2.01-4 mm (OR 7.04; 95% CI 2.54-19.56), and BT > 4 mm (OR 51.78; 95% CI 5.65-474.86) (p < 0.0001)]. Furthermore, mitotic rate (MR) was significantly correlated with NM histotype: [(MR 3-5 mitoses/mm2 (OR 2.62; 95% CI 1.01-6.83) and MR > 5 mitoses/mm2 (OR 4.87; 95% CI 1.77-13.40) (p = 0.002)]. The risk of recurrence was not significantly associated with NM histotype while BT [BT 1.01-2.00 mm (HR 1.55; 95% CI 0.51-4.71), BT 2.01-4.00 mm (HR 2.42; 95% CI 0.89-6.54), BT > 4.00 mm. (HR 3.13; 95% CI 0.95-10.28) (p = 0.05)], mitotic rate [MR > 2 mitoses/mm2 (HR 2.34; 95% CI, 1.11-4.97) (p = 0.03)] and the positivity of lymph node sentinel biopsy (SNLB) (HR 2.60; 95% CI 1.19-5.68) (p = 0.007) were significantly associated with an increased risk of recurrence at multivariate analysis. CONCLUSIONS We found that NM subtype was significantly associated with higher BT and MR but it was not a prognostic factor since it did not significantly correlate with melanoma recurrence rate. Conversely, increased BT and MR as well as SNLB positivity were significantly associated with a higher risk of melanoma recurrence.
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Affiliation(s)
- Maria A. Pizzichetta
- Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano, Italy
| | - Daniela Massi
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Mario Mandalà
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Paola Queirolo
- Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | | | | | - Stefano Cavicchini
- Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
| | - Pietro Quaglino
- Dermatologic Clinic, Dept Medical Sciences, University of Torino, Turin, Italy
| | | | - Pietro Rubegni
- Department of Dermatology, University of Siena, Siena, Italy
| | - Mauro Alaibac
- Department of Dermatology, University of Padova, Padua, Italy
| | | | - Fabrizio Ayala
- National Cancer Institute, “Fondazione G. Pascale”-IRCCS, Naples, Italy
| | - Serena Magi
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | - Laura Mazzoni
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Parma, Parma, Italy
| | | | - Renato Talamini
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Diego Serraino
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy
| | - on behalf of the Italian Melanoma Intergroup (IMI)
- Division of Oncology B, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano, Italy
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
- Department of Medical Oncology, National Institute for Cancer Research, IRCCS San Martino, Genoa, Italy
- Skin Cancer Unit, Istituto Tumori Romagna (IRST), Meldola, Italy
- Department of Dermatology, University of Florence, Florence, Italy
- Clinic of Dermatology, IRCCS San Martino-IST, Genoa, Italy
- Department of Dermatology, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
- Dermatologic Clinic, Dept Medical Sciences, University of Torino, Turin, Italy
- Division of Dermatology, Pordenone Hospital, Pordenone, Italy
- Department of Dermatology, University of Siena, Siena, Italy
- Department of Dermatology, University of Padova, Padua, Italy
- Division of Dermatology, Celio Hospital, Rome, Italy
- National Cancer Institute, “Fondazione G. Pascale”-IRCCS, Naples, Italy
- Department of Dermatology, ASST degli Spedali Civili di Brescia, Brescia, Italy
- Unit of Epidemiology and Biostatistics, CRO Aviano National Cancer Institute, Aviano, Italy
- Unit of Cancer Genetics, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Sassari, Italy
- Department of Dermatology, University of Parma, Parma, Italy
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Zhang W, Li X, Song G, Luo D. Prognostic significance of LKB1 promoter methylation in cutaneous malignant melanoma. Oncol Lett 2017; 14:2075-2080. [PMID: 28781649 PMCID: PMC5530115 DOI: 10.3892/ol.2017.6431] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/13/2017] [Indexed: 11/07/2022] Open
Abstract
Liver kinase B1 (LKB1) loss is a common occurrence in various types of human cancer, and promoter methylation has been hypothesized to be a major mechanism of LKB1 inactivation. The association between LKB1 gene promoter methylation status and tumor progression in cutaneous malignant melanoma (CMM) remains unknown. In the present study, the methylation status of the LKB1 promoter region was examined in 57 human cutaneous malignant melanomas and 50 benign skin lesion controls by methylation-specific polymerase chain reaction. Consequently, 12 (12/57) melanoma tissues exhibited LKB1 promoter methylation, while only 2 (2/50) benign lesions presented with LKB1 hypermethylation. The frequency of LKB1 promoter methylation in melanoma was significantly increased compared with the benign controls (P<0.05). Additional statistical analysis demonstrated that hypermethylation of the LKB1 gene was correlated with Breslow's thickness, presence of ulceration and American Joint Committee on Cancer stage (P<0.05). Additionally, Kaplan-Meier analysis revealed that LKB1 hypermethylation was significantly associated with poorer survival (P<0.01). Multivariate COX regression analysis indicated that LKB1 promoter methylation was an independent prognostic factor for overall survival in patients with melanoma.
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Affiliation(s)
- Weiming Zhang
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Xiao Li
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Guoxin Song
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Dan Luo
- Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
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Guo H, Cheng Y, Martinka M, McElwee K. High LIFr expression stimulates melanoma cell migration and is associated with unfavorable prognosis in melanoma. Oncotarget 2016; 6:25484-98. [PMID: 26329521 PMCID: PMC4694846 DOI: 10.18632/oncotarget.4688] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022] Open
Abstract
Increased or decreased expression of LIF receptor (LIFr) has been reported in several human cancers, including skin cancer, but its role in melanoma is unknown. In this study, we investigated the expression pattern of LIFr in melanoma and assessed its prognostic value. Using tissue microarrays consisting of 441 melanomas and 96 nevi, we found that no normal nevi showed high LIFr expression. LIFr staining was significantly increased in primary melanoma compared to dysplastic nevi (P = 0.0003) and further increased in metastatic melanoma (P = 0.0000). Kaplan–Meier survival curve and univariate Cox regression analyses showed that increased expression of LIFr was correlated with poorer 5-year patient survival (overall survival, P = 0.0000; disease-specific survival, P = 0.0000). Multivariate Cox regression analyses indicated that increased LIFr expression was an independent prognostic marker for primary melanoma (P = 0.036). LIFr knockdown inhibited melanoma cell migration in wound healing assays and reduced stress fiber formation. LIFr knockdown correlated with STAT3 suppression, but not YAP, suggesting that LIFr activation might stimulate melanoma cell migration through the STAT3 pathway. Our data indicate that strong LIFr expression identifies potentially highly malignant melanocytic lesions at an early stage and LIFr may be a potential target for the development of early intervention therapeutics.
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Affiliation(s)
- Hongwei Guo
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada.,Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Yabin Cheng
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Magdalena Martinka
- Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin McElwee
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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Maria AG, Dillenburg-Pilla P, Reis RI, Floriano EM, Tefé-Silva C, Ramos SG, Pesquero JB, Nahmias C, Costa-Neto CM. Host kinin B1 receptor plays a protective role against melanoma progression. Sci Rep 2016; 6:22078. [PMID: 26898917 PMCID: PMC4761993 DOI: 10.1038/srep22078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/05/2016] [Indexed: 01/06/2023] Open
Abstract
Melanoma is a very aggressive tumor that arises from melanocytes. Late stage and widely spread diseases do not respond to standard therapeutic approaches. The kallikrein-kinin system (KKS) participates in biological processes such as vasodilatation, pain and inflammatory response. However, the role of KKS in tumor formation and progression is not completely understood. The role of the host kinin B1 receptor in melanoma development was evaluated using a syngeneic melanoma model. Primary tumors and metastasis were respectively induced by injecting B16F10 melanoma cells, which are derived from C57BL/6 mice, subcutaneously or in the tail vein in wild type C57BL/6 and B1 receptor knockout mice (B1−/−). Tumors developed in B1−/− mice presented unfavorable prognostic factors such as increased incidence of ulceration, higher levels of IL-10, higher activation of proliferative pathways such as ERK1/2 and Akt, and increased mitotic index. Furthermore, in the metastasis model, B1−/− mice developed larger metastatic colonies in the lung and lower CD8+immune effector cells when compared with WT animals. Altogether, our results provide evidences that B1−/− animals developed primary tumors with multiple features associated with poor prognosis and unfavorable metastatic onset, indicating that the B1 receptor may contribute to improve the host response against melanoma progression.
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Affiliation(s)
- Andrea G Maria
- Department of Biochemistry and Immunology; Ribeirão Preto Medical School - University of São Paulo, 14049-900, Ribeirão Preto, Brazil
| | - Patrícia Dillenburg-Pilla
- Department of Biochemistry and Immunology; Ribeirão Preto Medical School - University of São Paulo, 14049-900, Ribeirão Preto, Brazil
| | - Rosana I Reis
- Department of Biochemistry and Immunology; Ribeirão Preto Medical School - University of São Paulo, 14049-900, Ribeirão Preto, Brazil
| | - Elaine M Floriano
- Departament of Pathology, Ribeirão Preto Medical School - University of São Paulo, 14049-900, Ribeirão Preto, Brazil
| | - Cristiane Tefé-Silva
- Departament of Pathology, Ribeirão Preto Medical School - University of São Paulo, 14049-900, Ribeirão Preto, Brazil
| | - Simone G Ramos
- Departament of Pathology, Ribeirão Preto Medical School - University of São Paulo, 14049-900, Ribeirão Preto, Brazil
| | - João B Pesquero
- Department of Biophysics, Federal University of São Paulo, 04039-032, São Paulo, Brazil
| | - Clara Nahmias
- Inserm U981,Institut Gustave Roussy, 94800, Villejuif, France
| | - Claudio M Costa-Neto
- Department of Biochemistry and Immunology; Ribeirão Preto Medical School - University of São Paulo, 14049-900, Ribeirão Preto, Brazil
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Dellavedova L, Florimonte L, Carletto M, Maffioli LS. Missing sentinel lymph node in cutaneous melanoma. Indian J Nucl Med 2015; 30:158-61. [PMID: 25829738 PMCID: PMC4379679 DOI: 10.4103/0972-3919.152982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The American Society of Clinical Oncology guidelines recommend sentinel lymph node biopsy (SLNB) for all patients with melanoma tumors of intermediate thickness (between 1 and 4 mm). In case of patients with thick melanoma tumors (>4 mm), SLNB may be recommended as well, for staging purposes and to facilitate regional disease control. We report a case of an 82-year-old man, undergone excision of a cutaneous melanoma of the right thigh, which shows some limitation of SLNB in thick melanoma. Lymphoscintigraphy, performed as single-photon emission computed tomography/computed tomography (SPECT/CT), failed to identify the real sentinel lymph node, as tracer uptake was seen in A right inguinal node. Due to the presence on CT co-registered images of another suspicious node (with no radiopharmaceutical uptake) in the crural region, and considering the "high-risk" pathologic features of the removed primary lesion, a 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) staging scan was planned. PET/CT showed high metabolic activity in the suspected crural lymphadenopathy. Histopathology demonstrated massive invasion of the crural ("sentinel") node and no metastatic cells in the inguinal node. This report highlights both the higher accuracy of lymphoscintigraphy, when performed as SPECT/CT and the potential utility of 18F-FDG PET/CT in regional staging.
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Affiliation(s)
- Luca Dellavedova
- Department of Nuclear Medicine, A. O. Ospedale Civile di Legnano, Legnano, Italy ; Nuclear Medicine Residency, University of Milan, Milano, Italy
| | - Luigia Florimonte
- Department of Nuclear Medicine, IRCCS Cà Grande Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - Marco Carletto
- Department of Nuclear Medicine, A. O. Ospedale Civile di Legnano, Legnano, Italy
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Køstner AH, Ellegaard MBB, Christensen IJ, Bastholt L, Schmidt H. Fever and the use of paracetamol during IL-2-based immunotherapy in metastatic melanoma. Cancer Immunol Immunother 2015; 64:349-55. [PMID: 25445814 PMCID: PMC11029154 DOI: 10.1007/s00262-014-1637-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
Fever is frequently observed in conjunction with interleukin-2 (IL-2)-based immunotherapy. Traditionally, fever has been regarded as an undesirable side effect and treated with fever-lowering drugs. However, new insights in tumor immunology suggest that elevated temperature may facilitate a more effective antitumor immune response. The purpose of this retrospective study was to examine the potential role of the IL-2-induced fever in melanoma patients treated with or without paracetamol in two consecutive cohorts. One hundred and seventy-nine patients with metastatic melanoma treated with a modified decrescendo regimen of IL-2 and Interferon (IFN) between 2004 and 2010 were retrospectively studied. 87 patients treated before 2007 received paracetamol as part of the treatment schedule, and 92 patients treated after 2007 did not receive paracetamol routinely. Body temperature was analyzed as dichotomized and continuous variables and correlated to objective tumor response and overall survival using logistic regression and Cox proportional hazard analysis. Patients experiencing peak temperature of ≥ 39.5 °C had a median OS of 15.2 months compared to 8.7 months among patients with lower temperatures (P = 0.01). In the multivariate analysis, peak temperature of ≥ 39.5 °C (HR 0.53; P = 0.026) and high mean temperature (HR 0.56; P = 0.004) were independent prognostic factors for improved survival. We suggest high fever as a biomarker for improved survival in melanoma patients treated with IL-2/IFN. The routine use of fever-reducing drugs during immunotherapy can therefore be questioned. More studies are needed to evaluate the role of fever and the use of antipyretics during cytokine-based immunotherapy.
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Affiliation(s)
- Anne Helene Køstner
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000, Århus, Denmark,
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Baade PD, Royston P, Youl PH, Weinstock MA, Geller A, Aitken JF. Prognostic survival model for people diagnosed with invasive cutaneous melanoma. BMC Cancer 2015; 15:27. [PMID: 25637143 PMCID: PMC4328047 DOI: 10.1186/s12885-015-1024-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability of medical practitioners to communicate risk estimates effectively to patients diagnosed with melanoma relies on accurate information about prognostic factors and their impact on survival. This study reports the development of one of the few melanoma prognostic models, called the Melanoma Severity Index (MSI), based on population-based cancer registry data. METHODS Data from the Queensland Cancer Registry for people (20-89 years) diagnosed with a single invasive melanoma between 1995 and 2008 (n = 28,654; 1,700 melanoma deaths). Additional clinical information about metastasis, ulceration and positive lymph nodes was manually extracted from pathology forms. Flexible parametric survival models were combined with multivariable fractional polynomial for selecting variables and transformations of continuous variables. Multiple imputation was used for missing covariate values. RESULTS The MSI contained the variables thickness (transformed, explained 40.6% of variation in survival), body site (additional 1.9% in variation), metastasis (1.8%), positive nodes (0.7%), ulceration (1.3%), age (1.1%). Royston and Sauerbrei's D statistic (measure of discrimination) was 1.50 (95% CI = 1.44, 1.56) and the corresponding RD2 (measure of explained variation) was 0.47 (0.45, 0.49), demonstrating strong explanatory performance. The Harrell-C statistic was 0.88 (0.88, 0.89). Lacking an external validation dataset, we applied internal-external cross validation to demonstrate the consistency of the prognostic information across geographically-defined subsets of the cohort. CONCLUSIONS The MSI provides good ability to predict survival for melanoma patients. Beyond the immediate clinical use, the MSI may have important public health and research applications for evaluations of public health interventions aimed at reducing deaths from melanoma.
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Affiliation(s)
- Peter D Baade
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Queensland, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
- Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
| | - Patrick Royston
- MRC Clinical Trials Unit at University College London, London, UK.
| | - Philipa H Youl
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Queensland, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
- Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
| | - Martin A Weinstock
- Dermatoepidemiology Unit, V A Medical Center, Providence, RI, USA.
- Department of Dermatology, Rhode Island Hospital, Providence, RI, USA.
- Departments of Dermatology and Epidemiology, Brown University, Providence, RI, USA.
| | - Alan Geller
- Harvard School of Public Health, Harvard University, Boston, MA, USA.
| | - Joanne F Aitken
- Cancer Council Queensland, 553 Gregory Terrace, Fortitude Valley, Queensland, Australia.
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
- Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia.
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Jeon SY, Hong JW, Lee S, Oh SY, Hong YS, Kim KH, Song KH. Long-term survival analysis and clinical follow-up in acral lentiginous malignant melanoma undergoing sentinel lymph node biopsy in korean patients. Ann Dermatol 2014; 26:177-83. [PMID: 24882971 PMCID: PMC4037669 DOI: 10.5021/ad.2014.26.2.177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/10/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In cutaneous malignant melanoma (MM) with clinically uninvolved regional lymph nodes, sentinel lymph node (SLN) status is the most powerful indicator of both overall survival (OS) and disease-free survival (DFS). However, no studies on the long-term survival and clinical follow-up of Korean patients with acral lentiginous MM (ALM) undergoing SLN biopsy (SLNB) have been published. OBJECTIVE The purpose of this study was to investigate the clinical prognosis and long-term survival of Korean patients with ALM according to SLN status. METHODS Thirty-four ALM patients undergoing SLNB were included in this study. We evaluated clinical and histopathological follow-up data such as the stage of disease, treatment, recurrence, and metastasis, and analyzed OS and DFS according to SLN status. RESULTS The median follow-up time was 60.5 months (range 3~127 months). Positive SLNs were noted in 14 patients (41.2%). Patients with negative SLNs had better OS and DFS than those with positive SLNs (p<0.05). Increased Breslow thickness was associated with short OS and DFS (p<0.05), and female patients showed better DFS than male patients (p<0.05). CONCLUSION To our knowledge, this is the first study on the long-term survival and clinical follow-up of patients undergoing SLNB for ALM in Korea. Our findings show that SLN status is an important prognostic factor for predicting OS and DFS.
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Affiliation(s)
- Su-Young Jeon
- Department of Dermatology, Dong-A University College of Medicine, Busan, Korea
| | - Jin-Woo Hong
- Department of Dermatology, Dong-A University College of Medicine, Busan, Korea
| | - Suee Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Young-Seoub Hong
- Department of Pathology, Dong-A University College of Medicine, Busan, Korea
| | - Ki-Ho Kim
- 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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Cintolo JA, Gimotty P, Blair A, Guerry D, Elder DE, Hammond R, Elenitsas R, Xu X, Fraker D, Schuchter LM, Czerniecki BJ, Karakousis G. Local immune response predicts survival in patients with thick (t4) melanomas. Ann Surg Oncol 2013; 20:3610-7. [PMID: 23838911 DOI: 10.1245/s10434-013-3086-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Tumor infiltrating lymphocytes (TIL) and histological regression in primary melanoma are generally considered indicators of the local immune response but their roles as prognostic factors have been variably reported. We examined the prognostic role of these variables in patients with high risk (T4) primary melanomas in a large series of patients with long-term follow-up. METHODS From a prospectively maintained cohort of patients diagnosed between 1971 and 2004, 161 patients were retrospectively identified with primary thick melanomas (>4 mm), no clinical evidence of regional nodal disease (RND) at diagnosis and complete histopathologic data. Univariate and multivariate Cox regression models were performed to identify clinical and histopathologic predictors of disease-specific survival (DSS) and to identify subgroups with differential survival. RESULTS Factors significantly associated with decreased DSS by univariate analysis included male gender, age ≥ 60 years, axial anatomic location, presence of ulceration, RND, absence of TIL, and presence of regression. In the final multivariate model, TIL and regression, as interacting variables, and RND status remained significantly associated with DSS. In the presence of TIL, concomitant regression was associated with significantly worse survival (p ≤ 0.0001). In the absence of TIL, there was no effect of regression on survival (p = 0.324). CONCLUSIONS Primary TIL and regression status and RND status are independently associated with melanoma-specific survival in patients with T4 melanomas; presence of TIL in the primary melanoma with concomitant radial growth phase regression is associated with a poor prognosis and may reflect an ineffective local regional immune response.
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Affiliation(s)
- Jessica A Cintolo
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
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Protein and non-protein biomarkers in melanoma: a critical update. Amino Acids 2012; 43:2203-30. [DOI: 10.1007/s00726-012-1409-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/24/2012] [Indexed: 12/16/2022]
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