1
|
Martínez Campayo N, Paradela de la Morena S, Pértega-Díaz S, Tejera Vaquerizo A, Fonseca E. Prognostic significance of sentinel lymph node biopsy in elderly with cutaneous melanoma: systematic review and meta-analysis. Int J Dermatol 2024; 63:873-880. [PMID: 38563446 DOI: 10.1111/ijd.17092] [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] [Received: 10/22/2023] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 04/04/2024]
Abstract
Sentinel lymph node biopsy is the most powerful prognostic indicator to date for cutaneous melanoma. Even though elderly patients have a lower incidence of sentinel node involvement, its results are still necessary for access to adjuvant therapies. This is highly relevant considering that the Western population shows an aging trend, and the incidence of melanoma has grown exponentially over the years, making elderly patients more likely to die from melanoma than younger ones. We performed a systematic review to investigate the prognostic significance of sentinel lymph node biopsy in elderly patients with melanoma. The systematic review was conducted following the PRISMA guidelines and registered in PROSPERO. The authors searched the Cochrane Database, EMBASE, PubMed, and WOS. Eligible studies for the systematic review were clinical trials, observational population studies, clinical or hospital-based cohort studies, and case-control studies. The meta-analysis was conducted using the R software program applying the meta package. Six reports were identified to meet the inclusion criteria. All studies were retrospective, non-randomized cohorts. The results obtained in this systematic review show a statistically significant influence of sentinel lymph node biopsy on disease-specific survival (HR = 2.87; 95% CI: 1.73-4.74) but also suggest that a positive result negatively impacts disease-free survival (HR = 3.41; 95% CI: 0.96-12.11). This meta-analysis shows that a positive sentinel lymph node biopsy does not imply differences in overall survival but significantly influences disease-specific survival and suggests an unfavorable impact on disease-free survival.
Collapse
Affiliation(s)
| | | | - Sonia Pértega-Díaz
- Department of Research, University Hospital of A Coruña, A Coruña, Spain
| | | | - Eduardo Fonseca
- Department of Dermatology, University Hospital of A Coruña, A Coruña, Spain
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Mattila KE, Vihinen H, Heervä E, Nuotio MS, Vihinen P. The impact of prognostic factors and comorbidities on survival in older adults with stage I - III cutaneous melanoma in Southwest Finland: A register study. J Geriatr Oncol 2024; 15:101701. [PMID: 38219332 DOI: 10.1016/j.jgo.2023.101701] [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: 09/13/2023] [Revised: 11/23/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Despite being diagnosed with thicker and more often ulcerated melanomas, cancer-specific survival (CSS) is not necessarily inferior in older adults with melanoma compared to younger patients. MATERIALS AND METHODS Our aim was to evaluate the impact of baseline melanoma-specific prognostic factors and comorbidities on recurrence-free survival (RFS), CSS, and overall survival (OS) in patients aged 70-79 (n = 474) and ≥ 80 years (n = 286) with resected stage I - III cutaneous melanoma in Southwest Finland between January 1, 2000 and December 31, 2020. Patients were restaged according to the 8th edition of TNM classification, and comorbidities were assessed using the Charlson Comorbidity Index (CCI). RESULTS Patients aged ≥80 years had thicker and more commonly ulcerated melanomas: 43.0%, 40.9%, and 16.1% of patients aged ≥80 and 56.5%, 25.3%, and 18.1% of patients aged 70-79 years were diagnosed with stage I, II, and III melanoma, respectively. Multiple comorbidities (CCI ≥2) were more common and sentinel lymph node biopsy less frequently performed in patients aged ≥80 years. RFS and CSS were similar in patients aged 70-79 years and ≥ 80 years: median RFS 13.8 years vs not reached, with the hazard ratio of melanoma recurrence or death from melanoma 1.25 (95% confidence interval [CI]: 0.91-1.71); median CSS was not reached, with the hazard ratio of death from melanoma 1.12 (95%CI: 0.81-1.75). The proportion of patients who were alive with melanoma recurrence or had died from melanoma was similar in both age groups. In multivariable analysis, higher pathological stage was the only independent risk factor for short RFS regardless of age group, sex, CCI, and tumor ulceration. Higher stage and male sex were associated with short CSS. Age ≥ 80 years, stage III disease, and CCI ≥ 2 were associated with short OS and female sex with long OS in multivariable analysis. DISCUSSION Pathological stage was the most influential factor determining RFS and CSS in older adults with resected stage I - III melanoma. Concerning OS, age ≥ 80 years, stage III disease, and multiple comorbidities had a significant negative impact.
Collapse
Affiliation(s)
- Kalle E Mattila
- Department of Oncology, Fican West Cancer Centre, University of Turku and Turku University Hospital, Finland; InFLAMES Research Flagship Center, University of Turku, Finland.
| | - Helmi Vihinen
- Department of Oncology, Fican West Cancer Centre, University of Turku and Turku University Hospital, Finland; Turku School of Economics, University of Turku, Finland
| | - Eetu Heervä
- InFLAMES Research Flagship Center, University of Turku, Finland
| | - Maria S Nuotio
- Department of Geriatric Medicine, University of Turku and Turku University Hospital, Finland
| | - Pia Vihinen
- Department of Oncology, Fican West Cancer Centre, University of Turku and Turku University Hospital, Finland
| |
Collapse
|
4
|
Zhang X, Lin Z, Li M, Gai Y, Zheng H, Fan L, Ruan W, Hu F, Chen J, Lan X. Melanin-targeted [ 18F]-PFPN PET imaging for prognosticating patients with melanoma. Eur J Nucl Med Mol Imaging 2023; 50:3062-3071. [PMID: 37191681 DOI: 10.1007/s00259-023-06258-5] [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: 03/21/2023] [Accepted: 04/30/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Positron emission tomography (PET) using [18F]-PFPN, a melanin-targeted imaging tracer, has excellent diagnostic performance in patients with melanoma. This study aimed to investigate its value in prognostication and determine predictors of progression-free survival (PFS) and overall survival (OS). METHODS We reviewed melanoma patients who underwent [18F]-PFPN and [18F]-FDG PET from February 2021 to July 2022. Clinical characteristics, follow-up data, and the following [18F]-PFPN PET parameters were recorded: maximum standardized uptake value (SUVmax), whole-body melanotic tumoral volume (WBMTV), and whole-body total lesion melanin (WBTLM). Receiver operating characteristic (ROC), Kaplan-Meier and Cox regression analyses were performed. RESULTS Seventy-six patients (47 men and 29 women; mean age, 57.99 ± 10.72 years) were included for analysis. Median follow-up was 12.0 months (range: 1-22 months). Eighteen patients died and 38 experienced progression. Median OS was 17.60 months (95% confidence interval, 15.89-19.31). In the ROC analysis, [18F]-PFPN PET parameters were superior to those of [18F]-FDG PET in prognosticating death and disease progression. PFS and OS were significantly better in patients with lower SUVmax, WBMTV, and WBTLM on [18F]-PFPN PET (log-rank, P < 0.05). In the univariate analyses, distant metastasis, SUVmax, WBMTV, and WBTLM were significantly associated with cumulative incidence of PFS and OS (P < 0.05). In the multivariate analysis, SUVmax was an independent predictor of PFS and OS. CONCLUSIONS [18F]-PFPN PET has a role in prognostication of melanoma patients. Patients with higher [18F]-PFPN SUVmax have worse prognosis. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT05645484. Registered 9 December, 2022, https://clinicaltrials.gov/ct2/show/NCT05645484?cond=The+Prognostic+Value+of+18F-PFPN+PET+Imaging+in+Patients+With+Malignant+Melanoma&draw=2&rank=1.
Collapse
Affiliation(s)
- Xiao Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Zhaoguo Lin
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Mengting Li
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Yongkang Gai
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Huaiyuan Zheng
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Li Fan
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Weiwei Ruan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Fan Hu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
- Hubei Key Laboratory of Molecular Imaging, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China
| | - Jing Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China.
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China.
- Hubei Key Laboratory of Molecular Imaging, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China.
- Key Laboratory of Biological Targeted Therapy, the Ministry of Education, No. 1277 Jiefang Ave, Wuhan, 430022, Hubei Province, China.
| |
Collapse
|
5
|
Featherston C, Nardi WS, Tomé FR, Quildrian SD. Role of sentinel lymph node biopsy for cutaneous melanoma in elderly patients: preliminary results in a Latin-American population. Ecancermedicalscience 2021; 15:1167. [PMID: 33680081 PMCID: PMC7929767 DOI: 10.3332/ecancer.2021.1167] [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: 07/24/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction In melanoma, lymph node status constitutes the most important prognostic factor among patients with locoregional disease. It has been postulated that elderly patients present less metastatic involvement in sentinel lymph node (SLN). Our objective was to analyse the results and evolution of patients ≥ 70 years-old with cutaneous melanoma in whom sentinel lymph node biopsy (SLNB) was carried out. Methods Retrospective analysis of 194 patients with primary CM who had a SLNB between 2005 and 2020 was included. Demographic and tumour data, SLN status, recurrence rate, morbidity and evolution were evaluated. Patients were divided into two groups according to age: Group 1 (<70 years old) and Group 2 (≥70 years old). Results One hundred and fifty patients were included in Group 1 and 44 patients in Group 2. Median Breslow thickness was 1.7 mm in Group 1 and of 2 mm in Group 2 (p = 0.015).Forty-seven patients had positive SLNB; 38 (25%) belonged to Group 1 and 9 (20.5%) to Group 2 (p = 0.55). Recurrence was found in 34 patients: 25 belonging to Group 1 and 9 corresponding to Group 2 (p = 0.65). Morbidity was of 4% in Group 1 and 9% in Group 2 (p = 0.23). With an average follow-up of 30.6 months, 5-year overall survival was of 87% in Group 1 and of 63% in Group 2 (p = 0.04). Conclusion Advanced age was not associated with differences regarding positivity of SLN and recurrence but difference in overall survival was observed. According to our results and the low morbidity rate, we consider SLNB should not be omitted in such age group, since it improves staging and gives the possibility to evaluate adjuvant treatment.
Collapse
Affiliation(s)
- Carola Featherston
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Walter Sebastián Nardi
- Sarcoma and Melanoma Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Florencia Rocio Tomé
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Sergio Damian Quildrian
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina.,Sarcoma and Melanoma Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| |
Collapse
|
6
|
Yang C, Liao F, Cao L. Web-based nomograms for predicting the prognosis of adolescent and young adult skin melanoma, a large population-based real-world analysis. Transl Cancer Res 2020; 9:7103-7112. [PMID: 35117315 PMCID: PMC8797661 DOI: 10.21037/tcr-20-1295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
Background Invasive cutaneous melanoma is one of the most common malignant diseases among adolescents and young adults (aged 15–40 years) in the United States. We aimed to develop web-based nomograms to precisely predict overall survival and cancer-specific survival in this group of patients with cutaneous melanoma. Methods We analyzed the overall and caner-specific death events in 19,887 patients who underwent surgical resection of cutaneous melanoma from Surveillance, Epidemiology and End Results database and developed web-based clinic-pathologic prediction models for overall survival and cancer specific survival based on Cox regression. C-statistics of Harrell and time-dependent Receiver Operating Characteristic Curve (ROC) were used to evaluate the prognostic accuracy of nomograms. Results Multivariate Cox regression model analysis suggested that age, sex, race, tumor location, Clark level, ulceration, thickness, and N stage were independently associated with both overall survival and cancer-specific survival in adolescent and young adult patients with cutaneous melanoma. The nomograms performed excellently in predicting overall survival and cancer-specific survival with C-index being 0.875 (95% CI: 0.847–0.903) and 0.901 (95% CI: 0.876–0.925), respectively. Time-dependent ROC verified that the prognostic accuracy of nomograms was better than that of American Joint Committee on Cancer staging system and other prognostic factors. Conclusions These user-friendly nomograms can precisely predict overall survival and cancer-specific survival in cutaneous melanoma patients treated with surgical resection, which may help to make individualized postoperative follow-up and therapeutic schemes.
Collapse
Affiliation(s)
- Chen Yang
- Department of Dermatology, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Fei Liao
- Department of Dermatology, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, China
| | - Li Cao
- Department of Dermatology, The Affiliated Suzhou Science & Technology Town Hospital of Nanjing Medical University, Suzhou, China
| |
Collapse
|
7
|
Predictive Value of the Age-Adjusted Charlson Comorbidity Index for Outcomes After Hepatic Resection of Hepatocellular Carcinoma. World J Surg 2020; 44:3901-3914. [PMID: 32651603 DOI: 10.1007/s00268-020-05686-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed to evaluate the impact of the age-adjusted Charlson comorbidity index (ACCI) on outcomes after hepatic resection for hepatocellular carcinoma (HCC). METHODS We assessed 763 patients who underwent hepatic resection for HCC. The ACCI scores were categorized as follows: ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7. RESULTS A multivariate analysis showed that the odds ratios for postoperative complications in ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 0.71 (p = 0.41) and 4.15 (p < 0.001), respectively. The hazard ratios for overall survival of ACCI = 6 and ACCI ≥ 7 groups, with reference to ACCI ≤ 5 group, were 1.52 (p = 0.023) and 2.45 (p < 0.001), respectively. The distribution of deaths due to HCC-related, liver-related, and other causes was 68.2%, 11.8%, and 20% in ACCI ≤ 5 group, 47.2%, 13.9%, and 38.9% in ACCI = 6 group, and 27.3%, 9.1%, and 63.6% in ACCI ≥ 7 group (p = 0.053; ACCI ≤ 5 vs. = 6, p = 0.19; ACCI = 6 vs. ≥ 7, p < 0.001; ACCI ≤ 5 vs. ≥ 7). In terms of the treatment for HCC recurrence in ACCI ≤ 5, ACCI = 6, and ACCI ≥ 7 groups, adaptation rate of surgical resection was 20.1%, 7.3%, and 11.1% and the rate of palliative therapy was 4.3%, 12.2%, and 22.2%, respectively. CONCLUSIONS The ACCI predicted the short-term and long-term outcomes after hepatic resection of HCC. These findings will help physicians establish a treatment strategy for HCC patients with comorbidities.
Collapse
|
8
|
Deckers EA, Louwman MW, Kruijff S, Hoekstra HJ. Increase of sentinel lymph node melanoma staging in The Netherlands; still room and need for further improvement. Melanoma Manag 2020; 7:MMT38. [PMID: 32399176 PMCID: PMC7212513 DOI: 10.2217/mmt-2019-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: To investigate implementation of the seventh American Joint Committee on Cancer melanoma staging with sentinel lymph node biopsy (SLNB) and associations with socioeconomic status (SES). Patients & methods: Data from The Netherlands Cancer Registry on patient and tumor characteristics were analyzed for all stage IB–II melanoma cases diagnosed 2010–2016, along with SES data from The Netherlands Institute for Social Research. Results: The proportion of SLNB-staged patients increased from 40% to 65% (p < 0.001). Multivariate analysis showed that being female, elderly, or having head-and-neck disease reduced the likelihood of SLNB staging. Conclusion: SLNB staging increased by 25% during the study period but lagged among elderly patients and those with head-and-neck melanoma. In The Netherlands, SES no longer affects SLNB staging performance.
Collapse
Affiliation(s)
- Eric A Deckers
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marieke Wj Louwman
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Schelto Kruijff
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harald J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
Schuurman MS, Hollestein LM, Bastiaannet E, Posthuma EF, van Akkooi AJ, Kukutsch NA, Aarts MJ, Wakkee M, Lemmens VE, Louwman MW. Melanoma in older patients: declining gap in survival between younger and older patients with melanoma. Acta Oncol 2020; 59:4-12. [PMID: 31347929 DOI: 10.1080/0284186x.2019.1643914] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Older people have the highest incidence of melanoma and the population in most Western countries is ageing. We evaluated how the gap in incidence and survival between younger and older patients has developed during the past decades.Material and methods: All patients diagnosed with cutaneous melanoma between 1989 and 2015 (n = 84,827) were identified from the Netherlands Cancer Registry. Elderly were defined as aged ≥70 years. Differences in patient and tumor characteristics were described, age-specific incidence rates were calculated, and relative survival (RS) and multivariable analyses estimating the Relative Excess Rate of dying (RER) were conductedResults: In older men, the melanoma age-standardized incidence increased from 18 to 103/100,000 person-years (py) between 1989 and 2015 and in older women from 23 to 70/100,000 py. In younger men and women, it increased from 8 to 21 and from 13 to 28/100,000 py, respectively. Median Breslow thickness declined from 1.8 to 1.1 mm and from 1.6 to 1.1 mm in older men and women (2003 versus 2015), and from 1.1 to 0.9 mm and 0.9 to 0.8 mm in younger men and women. In older men, 5-year RS increased from 67% (95% CI: 63%-72%) in 1989-1997 to 85% (95% CI: 83%-87%) in 2007-2015 and in older women from 81% (95% CI: 78%-85%) to 89% (95% CI: 87%-91%). In younger men and women, RS increased from 82% (95% CI: 81%-83%) to 90% (95% CI: 90%-91%) and from 92% (95% CI: 92%-93%) to 96% (95% CI: 95%-96%). After case-mix correction , older men and women no longer showed an improved survival over time (RER 2010-2015 versus 2003-2009: 0.97; 95% CI: 0.81-1.16 and 0.95; 95% CI: 0.79-1.16). Whereas in younger men and women survival remained improved (RER 0.75; 95% CI: 0.67-0.83 and 0.77; 95%CI: 0.67-0.89).Conclusion: The gap in melanoma incidence between younger and older people is increasing due to a strong increase in incidence in older adults. Disparities in survival are declining, related to a narrowing gap in Breslow thickness.
Collapse
Affiliation(s)
| | - Loes M. Hollestein
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther Bastiaannet
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Eduardus F.M. Posthuma
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Internal Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Alexander J.C. van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Nicole A. Kukutsch
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maureen J.B. Aarts
- Department of Medical Oncology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marlies Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Valery E.P.P. Lemmens
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | | |
Collapse
|
10
|
Shah S, Raskin L, Cohan D, Freeman M, Hamid O. Treatment patterns of malignant melanoma in the United States from 2011 to 2016: a retrospective cohort study. Curr Med Res Opin 2020; 36:63-72. [PMID: 31469305 DOI: 10.1080/03007995.2019.1662688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Since 2011, the approval of several new agents has improved treatment options for malignant melanoma. We describe treatment patterns for malignant melanoma in the United States from the MarketScan database from 2011 to 2016.Methods: Treatments used for patients aged >18 years diagnosed with malignant melanoma after January 1, 2011 and enrolled in the Truven MarketScan database were analyzed. Patient data were collected for the 12-month period from the date of the first melanoma diagnosis to either death, the pre-specified study end date (August 31, 2016), or date of termination of health insurance. Treatment patterns from 2011-2013 and 2014-2016 were analyzed according to agent, year of drug administration, and line of therapy.Results: From 2011 to 2016, use of cytokines (63.8; 13.3%) and chemotherapy (19.6; 12.9%) decreased, and use of checkpoint inhibitors increased (2.0; 49.9%). Checkpoint inhibitor use also increased across all lines of therapy from 2011-2013 and 2014-2016. Use of BRAF/MEK inhibitors remained relatively stable from 2011 to 2016 (6.5-12.5%); however, the use of vemurafenib monotherapy decreased (6.5; 0.8%), and treatment with combination regimens increased (0; 10.9%) from 2011-2016. BRAF/MEK inhibitor use only increased in the first line setting from 2011-2013 (9.7%) to 2014-2016 (11.2%).Conclusion: With the approval of immune checkpoint inhibitors, BRAF/MEK inhibitors, and targeted therapies, the therapeutic landscape for the treatment of metastatic melanoma has shifted dramatically away from cytokines and chemotherapy. Treatment patterns will likely continue to evolve as scientific advances are made.
Collapse
Affiliation(s)
- Shweta Shah
- Global Health Economics, Amgen Inc., Thousand Oaks, CA, USA
| | - Leon Raskin
- Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - David Cohan
- Medical Affairs, Amgen Inc., Thousand Oaks, CA, USA
| | | | - Omid Hamid
- The Angeles Clinic and Research Institute, Los Angeles, CA, USA
| |
Collapse
|
11
|
Abstract
In this article we provide a critical review of the evidence available for surgical management of the nodal basin in melanoma, with an aim to ensure an understanding of risks and benefits for all lymph node surgery offered to patients, and alternatives to surgical management where appropriate.
Collapse
Affiliation(s)
- Rogeh Habashi
- Department of Surgery, McMaster University, Hamilton General Hospital, 237 Barton Street East, 6 North, Hamilton, Ontario L8L 2X2, Canada
| | - Valerie Francescutti
- Department of Surgery, McMaster University, Hamilton General Hospital, 237 Barton Street East, 6 North, Hamilton, Ontario L8L 2X2, Canada.
| |
Collapse
|
12
|
Ipenburg NA, Thompson JF, Uren RF, Chung D, Nieweg OE. Focused Ultrasound Surveillance of Lymph Nodes Following Lymphoscintigraphy Without Sentinel Node Biopsy: A Useful and Safe Strategy in Elderly or Frail Melanoma Patients. Ann Surg Oncol 2019; 26:2855-2863. [PMID: 31240588 PMCID: PMC6682569 DOI: 10.1245/s10434-019-07505-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sentinel node (SN) biopsy (SNB) has become standard of care in clinically localized melanoma patients. Although it is minimally invasive, advanced age and/or comorbidities may render SNB inadvisable in some patients. Focused ultrasound follow-up of SNs identified by preoperative lymphoscintigraphy may be an alternative in these patients. This study examines the outcomes in patients managed in this way at a major melanoma treatment center. METHODS All patients with clinically localized cutaneous melanoma who underwent lymphoscintigraphy and in whom SNB was intentionally not performed due to advanced age and/or comorbidities were included. RESULTS Between 2000 and 2009, 160 patients (5.2% of the total) underwent lymphoscintigraphy without SNB because of advanced age and/or comorbidities. Compared with the 2945 patients who had a SNB, the 160 patients were older, had thicker melanomas that were more often located in the head and neck region, and had more SNs in more nodal regions. Of the 160 patients, 150 (94%) were followed with ultrasound examination of their SNs at each follow-up visit; this identified 33% of the nodal recurrences before they became clinically apparent. Compared with SN-positive patients who were treated by completion lymph node dissection, observed patients who developed nodal recurrence had more involved nodes when a delayed lymphadenectomy was performed. Melanoma-specific survival, recurrence-free survival, and distant recurrence-free survival rates were similar, while regional lymph node-free survival was worse. CONCLUSIONS Lymphoscintigraphy with focused ultrasound follow-up of SNs is a reasonable management alternative to SNB in patients who are elderly and/or have substantial comorbidities.
Collapse
Affiliation(s)
- Norbertus A Ipenburg
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, Netherlands.
- Melanoma Institute Australia, Wollstonecraft, North Sydney, NSW, Australia.
| | - John F Thompson
- Melanoma Institute Australia, Wollstonecraft, North Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Roger F Uren
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Alfred Nuclear Medicine and Ultrasound, RPAH Medical Centre, Sydney, NSW, Australia
| | - David Chung
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Alfred Nuclear Medicine and Ultrasound, RPAH Medical Centre, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, Wollstonecraft, North Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| |
Collapse
|
13
|
Prognostic factors for first-line therapy and overall survival of metastatic uveal melanoma: The Princess Margaret Cancer Centre experience. Melanoma Res 2019; 28:571-577. [PMID: 30067547 DOI: 10.1097/cmr.0000000000000468] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Metastatic uveal melanoma (MUM) has a poor prognosis, with no established standard of care. Delineation of prognostic factors in MUM patients may enable stratified treatment algorithms of stage-specific survival. Overall, 132 MUM patients who presented to a single tertiary institution in Toronto, Canada, over 12 years were identified and data (demographics, clinical status, radiographic images, and laboratory values) were extracted. Associations with systemic first-line treatment outcome 12 weeks after first-line treatment, time to progression (TTP), and overall survival (OS) were explored by univariate and multivariable analysis. Age, presence of liver metastases, and time from primary presentation to metastatic presentation were significant variables affecting first-line treatment outcomes. Age, Eastern Cooperative Oncology Group (ECOG) score, presence of liver metastases, liver metastasis size, neutrophil lymphocyte ratio, absolute neutrophil count, lactate dehydrogenase (LDH), alkaline phosphatase, time from primary presentation to metastatic presentation, and patients receiving surgery as the first-line treatment were significant variables affecting TTP. Age, ECOG score, presence of liver metastases, liver metastasis size, neutrophil lymphocyte ratio, absolute neutrophil count, LDH, and alkaline phosphatase were significant variables affecting OS. Patients who underwent surgery, chemotherapy, immunotherapy, liver-directed therapy, or targeted therapy had better OS compared with patients not receiving treatment with surgery, associated with a significantly better OS compared with all other therapies. Multivariable analysis showed increased age, absence of liver metastases, and absence of bone metastases to be associated with positive treatment outcomes. ECOG score of at least 1, increased LDH, and decreased time from primary to metastatic presentation would predict decreased TTP. Increased LDH, older age, and ECOG score of at least 1 were associated with decreased OS. These results identified prognostic markers and models thereof of treatment benefit and survival. Further validation in larger cohorts is required.
Collapse
|
14
|
He CB, Zhang Y, Cai ZY, Lin XJ. The impact of surgery in metastatic pancreatic neuroendocrine tumors: a competing risk analysis. Endocr Connect 2019; 8:239-251. [PMID: 30726772 PMCID: PMC6391902 DOI: 10.1530/ec-18-0485] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
Aim The role of surgery in the treatment of metastatic pancreatic neuroendocrine tumors (PNETs) was controversial. The objectives of this study were to illustrate the impact of surgery in improving the prognosis of patients with metastatic PNETs and build nomograms to predict overall survival (OS) and cancer-specific survival (CSS) based on a large population-based cohort. Methods Patients diagnosed with metastatic PNETs between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively collected. Nomograms for estimating OS and CSS were established based on Cox regression model and Fine and Grey's model. The precision of the nomograms was evaluated and compared using concordance index (C-index) and the area under receiver operating characteristic (ROC) curve (AUC). Results The study cohort included 1966 patients with metastatic PNETs. It was shown that the surgery provided survival benefit for all groups of patients with metastatic PNETs. In the whole study cohort, 1-, 2- and 3-year OS and CSS were 51.5, 37.1 and 29.4% and 53.0, 38.9 and 31.1%, respectively. The established nomograms were well calibrated, and had good discriminative ability, with C-indexes of 0.773 for OS prediction and 0.774 for CSS prediction. Conclusions Patients with metastatic PNETs could benefit from surgery when the surgery tolerance was acceptable. The established nomograms could stratify patients who were categorized as tumor-node-metastasis (TNM) IV stage into groups with diverse prognoses, showing better discrimination and calibration of the established nomograms, compared with 8th TNM stage system in predicting OS and CSS for patients with metastatic PNETs.
Collapse
Affiliation(s)
- Chao-bin He
- Department of Hepatobiliary and Pancreatic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China
| | - Zhi-yuan Cai
- Department of Hepatobiliary and Pancreatic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Xiao-jun Lin
- Department of Hepatobiliary and Pancreatic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China
- Correspondence should be addressed to X Lin:
| |
Collapse
|
15
|
Mishra K, Barnhill RL, Paddock LE, Fine JA, Berwick M. Histopathologic variables differentially affect melanoma survival by age at diagnosis. Pigment Cell Melanoma Res 2019; 32:593-600. [PMID: 30706692 DOI: 10.1111/pcmr.12770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/14/2018] [Accepted: 01/21/2019] [Indexed: 11/30/2022]
Abstract
We evaluated clinical, phenotypic, behavioral, and histopathologic variables in relationship to melanoma-specific survival by age at diagnosis among 650 population-based melanoma patients in Connecticut, with 20 years of follow-up. Only one variable, skin awareness, was significantly associated with melanoma mortality in both groups. The variables that differed between the age-groups were anatomic site, Breslow thickness, histologic subtype, mitoses, tumor-infiltrating lymphocytes (TILs), and solar elastosis. Head and neck melanoma, Breslow thickness, nodular melanoma, and solar elastosis were all significantly more likely to be associated with mortality among the older subjects; among the younger subjects, the presence of mitoses was associated with an increased probability of dying and TILs were associated with a reduced risk of mortality.
Collapse
Affiliation(s)
- Kriti Mishra
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | | | - Lisa E Paddock
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Marianne Berwick
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| |
Collapse
|
16
|
Martinez-Garcia MA, Campos-Rodriguez F, Nagore E, Martorell A, Rodriguez-Peralto JL, Riveiro-Falkenbach E, Hernandez L, Bañuls J, Arias E, Ortiz P, Cabriada V, Gardeazabal J, Montserrat JM, Carrera C, Corral J, Masa JF, de Terreros JG, Abad J, Boada A, Mediano O, de Eusebio E, Chiner E, Landete P, Mayos M, Fortuño A, Barbé F, Sánchez de la Torre M, Sanchez de la Torre A, Cano I, Gonzalez C, Pérez-Gil A, Gómez-García T, Cullen D, Somoza M, Formigón M, Aizpuru F, Navarro C, Selma-Ferrer MJ, Garcia-Ortega A, de Unamuno B, Almendros I, Farré R, Gozal D. Sleep-Disordered Breathing Is Independently Associated With Increased Aggressiveness of Cutaneous Melanoma: A Multicenter Observational Study in 443 Patients. Chest 2018; 154:1348-1358. [PMID: 30059679 DOI: 10.1016/j.chest.2018.07.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/22/2018] [Accepted: 07/10/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) has been associated with a greater incidence and mortality of cancer, although such findings are inconsistent. However, no large studies are currently available to investigate this association in patients with a specific type of cancer. This study seeks to assess potential relationships between SDB severity and aggressiveness markers of cutaneous melanoma. METHODS Four hundred and forty-three patients with a diagnosis of melanoma underwent a sleep study within 6 months of diagnosis. General demographics were collected, along with melanoma characteristics and polygraphic parameters consisting of the apnea-hypopnea index (AHI) and indices of both continuous and intermittent night-time oxyhemoglobin desaturation (DI4%). An exploration of independent relationships between SDB and various objective melanoma aggressiveness markers (Breslow index, presence of ulceration, presence of regression, mitotic index, stage of severity, damage to the sentinel lymph, and spreading of the melanoma) was performed. RESULTS Patients in the upper tertiles of AHI or DI4% were 1.94 (95% CI, 1.14-3.32; P = .022) and 1.93 (95% CI, 1.14-3.26; P = .013) times more likely, respectively, to present with aggressive melanoma (Breslow index > 1 mm) than those in the lowest tertiles of these sleep attributes after adjustment for age, sex, tumor location, and BMI. This association was particularly prominent among patients < 56 years of age with Breslow index > 2 mm. The presence of the additional markers of aggressiveness was also associated with higher AHI and DI4% values. CONCLUSIONS The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.
Collapse
Affiliation(s)
| | | | - Eduardo Nagore
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | | | | | | | - Luis Hernandez
- Respiratory Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Jose Bañuls
- Dermatology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | - Eva Arias
- Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pablo Ortiz
- Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Valentin Cabriada
- Respiratory Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain
| | - Jose Gardeazabal
- Dermatology Department, Hospital Universitario Cruces de Bilbao, Bilbao, Spain
| | - Josep Maria Montserrat
- Respiratory Department, Hospital Clinic-IDIBAPS, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Cristina Carrera
- Dermatology Department, Hospital Clinic-IDIBAPS, Barcelona, Spain
| | - Jaime Corral
- Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Juan Fernando Masa
- Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Javier Gomez de Terreros
- Respiratory Department, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Jorge Abad
- Respiratory Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain
| | - Adam Boada
- Dermatology Department, Hospital Universitario Germans Trials I Pujol, Barcelona, Spain
| | - Olga Mediano
- Respiratory Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Esther de Eusebio
- Dermatology Department, Hospital Universitario General de Guadalajara, Guadalajara, Spain
| | - Eusebi Chiner
- Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Pedro Landete
- Respiratory Department, Hospital Universitario San Juan de Alicante, Alicante, Spain
| | - Mercedes Mayos
- Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Ana Fortuño
- Respiratory Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Ferrán Barbé
- Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Manuel Sánchez de la Torre
- Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Alicia Sanchez de la Torre
- Respiratory Department, IRBLleida, Lleida, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Irene Cano
- Respiratory Department, Hospital Universitario de Getafe, Madrid, Spain
| | - Cristina Gonzalez
- Dermatology Department, Hospital Universitario de Getafe, Madrid, Spain
| | | | - Teresa Gómez-García
- Respiratory Department, Fundación Jimenez Diaz, Madrid, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Daniela Cullen
- Dermatology Department, Fundación Jimenez Diaz, Madrid, Spain
| | - Maria Somoza
- Respiratory Department, Consorcio Sanitario Terrassa, Barcelona, Spain
| | - Manuel Formigón
- Dermatology Department, Consorcio Sanitario Terrassa, Barcelona, Spain
| | - Felipe Aizpuru
- Biostatistical Service, BioAraba, Health Research Institute, OSI Araba University Hospital, Basque Health Service, University of the Basque Country, Bilbao, Spain
| | - Cristina Navarro
- Respiratory Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | - Blanca de Unamuno
- Dermatology Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Isaac Almendros
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Ramón Farré
- Unitat de Biofísica i Bioenginyeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain, and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; CIBERes, CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - David Gozal
- Department of Pediatrics, University of Chicago, Chicago, IL
| |
Collapse
|
17
|
Persa OD, Knuever J, Rose A, Mauch C, Schlaak M. Predicting risk for seroma development after axillary or inguinal sentinel lymph node biopsy in melanoma patients. Int J Dermatol 2018; 58:185-189. [DOI: 10.1111/ijd.14247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/23/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Oana-Diana Persa
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Jana Knuever
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Anna Rose
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Cornelia Mauch
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| | - Max Schlaak
- Department of Dermatology and Venereology; University Hospital of Cologne; Cologne Germany
| |
Collapse
|
18
|
Rees MJ, Liao H, Spillane J, Speakman D, McCormack C, Donahoe S, Pohl M, Webb A, Gyorki D, Henderson MA. Melanoma in the very elderly, management in patients 85years of age and over. J Geriatr Oncol 2018; 9:488-493. [PMID: 29398454 DOI: 10.1016/j.jgo.2018.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/05/2017] [Accepted: 01/04/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Melanoma treatment in the elderly can entail complex decision making. This study characterizes the presentation, management, and outcome of melanoma in the very elderly. METHOD Retrospective review of all patients in their 85th year or older presenting to a tertiary referral cancer centre between 2000 and 2012 with American Joint Committee on Cancer stages 0-II cutaneous melanoma. RESULTS 127 patients, 26 with in-situ disease and 101 with stages I-II disease, were included. For invasive primary disease, the median age was 87years (IRQ=86-89). Most patients had melanomas with poor prognoses at diagnosis: 49.5% were ulcerated, 68.3% mitotically active (mitotic rate≥1), and the median tumor thickness was 3.7mm (IQR=1.7-5.8). Nodular melanomas were the most frequent subtype (31.7%, 32/101). Only 66.3% received an excision margin≥10mm. Suboptimal excision margins were associated with increased risk of local recurrence (HR=6.87, 95% CI=5.53-8.20, p=0.0045) but not poorer disease specific survival (DSS, p=0.37) or overall survival (OS, p=0.19). Sentinel node biopsy (SNB) did not influence survival (DSS, p=0.39, OS, p=0.78). Median OS was 33months. Overall, one-third (34.7%) of patients died from causes other than melanoma during the follow up period. In patients aged ≥90 only 1 patient (4.3%) died from melanoma, while 10 patients (43.5%) died of other causes. CONCLUSIONS Older patients have thick, mitotically active and frequently ulcerated melanomas. An excision margin≥10mm should be considered to reduce risk of local recurrence. SNB did not impact on survival. With increasing age, patients will more commonly die of causes other than melanoma regardless of the extent of surgical care.
Collapse
Affiliation(s)
- Matthew J Rees
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - Henry Liao
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - John Spillane
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - David Speakman
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - Chris McCormack
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - Simon Donahoe
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - Miki Pohl
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - Angela Webb
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - David Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia
| | - Michael A Henderson
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne 3000, Victoria, Australia.
| |
Collapse
|
19
|
Garcovich S, Colloca G, Sollena P, Andrea B, Balducci L, Cho WC, Bernabei R, Peris K. Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology. Aging Dis 2017; 8:643-661. [PMID: 28966807 PMCID: PMC5614327 DOI: 10.14336/ad.2017.0503] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 05/03/2017] [Indexed: 12/16/2022] Open
Abstract
Skin cancer is a worldwide, emerging clinical need in the elderly white population, with a steady increase in incidence rates, morbidity and related medical costs. Skin cancer is a heterogeneous group of cancers comprising cutaneous melanoma and non-melanoma skin cancers (NMSC), which predominantly affect elderly patients, aged older than 65 years. Melanoma has distinct clinical presentations in the elderly patient and represents a challenging question in terms of clinical management. NMSC includes the basal cell carcinoma and cutaneous squamous cell carcinoma and presents a wide disease spectrum in the elderly population, ranging from low-risk to high-risk tumours, advanced and inoperable disease. Treatment decisions for NMSC are preferentially based on tumour characteristics, patient’s chronological age and physician’s preferences and operational settings. Several treatment options are available for NMSC, from surgery to non-invasive/medical therapies, but patient-based factors, such as geriatric comorbidities and patient’s life expectancy, do not frequently modulate treatment goals. In melanoma, age-related variations in clinical management are significant and may frequently lead to under-treatment, limiting access to advanced surgical and medical treatments. Clinical decision-making in the care of elderly skin cancer patient should ideally implement a geriatric assessment, prioritizing patient-based factors and efficiently differentiating fit from frail cancer patients. Current clinical practice guidelines for NMSC and melanoma only partially address geriatric aspects of cancer care, such as frailty, limited life-expectancy, geriatric comorbidities and treatment compliance. We review the recent evidence on the scope and problem of skin cancer in the elderly population as well as age-related variations in its clinical management, highlighting the potential role of a geriatric approach in optimizing dermato-oncological care.
Collapse
Affiliation(s)
- Simone Garcovich
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Colloca
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Pietro Sollena
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| | - Bellieni Andrea
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Lodovico Balducci
- 3Senior Adult Oncology Program, Moffitt Cancer Center, Tampa, FL, USA
| | - William C Cho
- 4Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | - Roberto Bernabei
- 2Department of Geriatrics, Policlinico A. Gemelli University Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Ketty Peris
- 1Institute of Dermatology, Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
20
|
|
21
|
Shen W, Sakamoto N, Yang L. Melanoma-specific mortality and competing mortality in patients with non-metastatic malignant melanoma: a population-based analysis. BMC Cancer 2016; 16:413. [PMID: 27389173 PMCID: PMC4936003 DOI: 10.1186/s12885-016-2438-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 06/27/2016] [Indexed: 12/05/2022] Open
Abstract
Background The objectives of this study were to evaluate and model the probability of melanoma-specific death and competing causes of death for patients with melanoma by competing risk analysis, and to build competing risk nomograms to provide individualized and accurate predictive tools. Methods Melanoma data were obtained from the Surveillance Epidemiology and End Results program. All patients diagnosed with primary non-metastatic melanoma during the years 2004–2007 were potentially eligible for inclusion. The cumulative incidence function (CIF) was used to describe the probability of melanoma mortality and competing risk mortality. We used Gray’s test to compare differences in CIF between groups. The proportional subdistribution hazard approach by Fine and Gray was used to model CIF. We built competing risk nomograms based on the models that we developed. Results The 5-year cumulative incidence of melanoma death was 7.1 %, and the cumulative incidence of other causes of death was 7.4 %. We identified that variables associated with an elevated probability of melanoma-specific mortality included older age, male sex, thick melanoma, ulcerated cancer, and positive lymph nodes. The nomograms were well calibrated. C-indexes were 0.85 and 0.83 for nomograms predicting the probability of melanoma mortality and competing risk mortality, which suggests good discriminative ability. Conclusions This large study cohort enabled us to build a reliable competing risk model and nomogram for predicting melanoma prognosis. Model performance proved to be good. This individualized predictive tool can be used in clinical practice to help treatment-related decision making.
Collapse
Affiliation(s)
- Weidong Shen
- Department of Otolaryngology - Head and Neck Surgery, Chinese PLA General Hospital, The Institute of Otolaryngology, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Naoko Sakamoto
- Department of Epidemiology Research, Toho University, 4-16-20, Omori-Nishi Ota-ku, Tokyo, 143-0015, Japan
| | - Limin Yang
- Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. .,Medical Support Center for Japan Environment and Children's Study, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| |
Collapse
|