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Li D, Sun Y, Le J, Dian Y, Liu Y, Zeng F, Deng G, Lei S, Su J. Predictors of survival in immunotherapy-based treatments in advanced melanoma: a meta-analysis. Int J Dermatol 2024. [PMID: 39097932 DOI: 10.1111/ijd.17379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 06/19/2024] [Accepted: 06/30/2024] [Indexed: 08/06/2024]
Abstract
The introduction of immunotherapy-based strategies has significantly improved the prognosis for melanoma patients. Nevertheless, some patients still have dismal outcomes, emphasizing the significance of survival predictive indicators in immunotherapy-based approaches. We systematically searched randomized controlled clinical trials investigating dual immunotherapy or chemoimmunotherapy versus placebo or mono-immunotherapy or chemotherapy alone in advanced melanoma patients. R version 4.3.0. was employed to perform all analyses. A comprehensive analysis was conducted on a total of 13,809 patients with advanced melanoma from 19 randomized clinical trials. Immunotherapy-based strategies (alone or in combination) could significantly lengthen the overall survival(OS) and recurrence-free survival (RFS) compared with corresponding controls. Mono-immunotherapy improved RFS and OS in PD-L1 positive patients, in stage AJCC IIIC, and with 4 or more positive lymph nodes, compared with chemotherapy. Combined immunotherapy statistically improved RFS and OS in those aged < 65, with an Eastern Cooperative Oncology Group (ECOG) status of 0, and LDH ≤ ULN at baseline compared with single treatment alone. Our findings indicated that certain clinicopathological and molecular features could assist in choosing appropriate melanoma patients for immune-based treatments.
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Affiliation(s)
- Daishi Li
- Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hu Nan Key Laboratory of Aging Biology, Changsha, China
| | - Yuming Sun
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiayuan Le
- Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hu Nan Key Laboratory of Aging Biology, Changsha, China
| | - Yating Dian
- Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hu Nan Key Laboratory of Aging Biology, Changsha, China
| | - Yihuang Liu
- Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hu Nan Key Laboratory of Aging Biology, Changsha, China
| | - Furong Zeng
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guangtong Deng
- Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hu Nan Key Laboratory of Aging Biology, Changsha, China
| | - Shaorong Lei
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Su
- Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Hu Nan Key Laboratory of Aging Biology, Changsha, China
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Pelczar P, Kosteczko P, Wieczorek E, Kwieciński M, Kozłowska A, Gil-Kulik P. Melanoma in Pregnancy-Diagnosis, Treatment, and Consequences for Fetal Development and the Maintenance of Pregnancy. Cancers (Basel) 2024; 16:2173. [PMID: 38927879 PMCID: PMC11202133 DOI: 10.3390/cancers16122173] [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: 05/24/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Cutaneous malignant melanoma is one of the most common neoplasms among pregnancy-associated cancers (PACs). Risk factors include excessive exposure to ultraviolet radiation, the presence of benign and dysplastic nevi, and a patient or family history of melanoma. Self-examination and careful inspection of nevi are crucial, especially in the context of their progression over time. Physiological changes that occur during pregnancy, such as the darkening and enlargement of the nevi, delay the diagnosis of CMM. In the fetus, metastases are very rare, and if they do occur, they concern the placenta or fetal tissues. The choice of treatment is influenced by the cancer stage, symptoms, the time of termination of pregnancy, and the patient's decision. Essential procedures which are safe for the fetus are diagnostic biopsy, ultrasound, and the therapeutic excision of the lesion and the affected lymph nodes. Other imaging methods can be used with a safe radiation dose limit of 100 mGy. Immunotherapy and targeted treatments must be carefully considered, because of their possible adverse effects on the fetus. An interdisciplinary approach to the problem of melanoma during pregnancy is necessary, involving doctors of various specialties.
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Affiliation(s)
- Patrycja Pelczar
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Pola Kosteczko
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Ewelina Wieczorek
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Maciej Kwieciński
- Student Scientific Society of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland; (P.P.); (P.K.); (E.W.); (M.K.)
| | - Aleksandra Kozłowska
- Department of Radiotherapy, Medical University of Lublin, 13 Radziwillowska Str., 20-080 Lublin, Poland;
| | - Paulina Gil-Kulik
- Department of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Str., 20-080 Lublin, Poland
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Xie F, Agrawal S, Johnson EF, Wieland CN, Davis DMR, Theiler RN, Lehman JS. Updates on the dermatopathology of pregnancy-associated skin conditions. Hum Pathol 2023; 140:173-195. [PMID: 37209919 DOI: 10.1016/j.humpath.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023]
Abstract
Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.
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Affiliation(s)
- Fangyi Xie
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Shruti Agrawal
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Dawn Marie R Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Regan N Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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Kiuru M, Li Q, Zhu G, Terrell JR, Beroukhim K, Maverakis E, Keegan THM. Melanoma in women of childbearing age and in pregnancy in California, 1994-2015: a population-based cohort study. J Eur Acad Dermatol Venereol 2022; 36:2025-2035. [PMID: 35870141 PMCID: PMC9560982 DOI: 10.1111/jdv.18458] [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: 10/07/2021] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Melanoma is one of the most common malignancies during pregnancy. There is debate regarding the impact of pregnancy on the prognosis of melanoma. Recent large population-based studies from the United States are lacking. OBJECTIVES To determine the characteristics and survival of women with pregnancy-associated melanoma. METHODS This population-based, retrospective cohort study used California Cancer Registry data linked with state-wide hospitalization and ambulatory surgery data to identify 15-44-year-old female patients diagnosed with melanoma in 1994-2015, including pregnant patients. Multivariable logistic regression compared demographic and clinical characteristics between pregnant and non-pregnant women with melanoma. Multivariable cox proportional hazards regression models assessed melanoma-specific and overall survival. RESULTS We identified 13 108 patients, of which 1406 were pregnant. Pregnancy-associated melanoma was more frequent in Hispanic compared to non-Hispanic White women. Melanoma occurring post-partum was associated with greater tumour thickness (2.01-4.00 vs. 0.01-1.00 mm, odds ratio 1.75, 95% confidence interval: 1.03-2.98). There were otherwise no significant differences between pregnant and non-pregnant women. Worse survival was associated with Asian, Black and Native American race/ethnicity (vs. non-Hispanic White), lower neighbourhood socio-economic status, public insurance, tumour site, greater tumour thickness and lymph node involvement, but not pregnancy. CONCLUSIONS Melanoma occurring post-partum was associated with greater tumour thickness, but pregnancy status did not affect survival after melanoma. Race/ethnicity, socio-economic status and health insurance impacted survival, emphasizing the importance of reducing health disparities.
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Affiliation(s)
- M Kiuru
- Department of Dermatology, University of California Davis, Sacramento, California, USA
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Q Li
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
| | - G Zhu
- Department of Dermatology, University of California Davis, Sacramento, California, USA
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - J R Terrell
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - K Beroukhim
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - E Maverakis
- Department of Dermatology, University of California Davis, Sacramento, California, USA
| | - T H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT) and Division of Hematology and Oncology, University of California Davis, Sacramento, California, USA
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Hassel JC, Livingstone E, Allam JP, Behre HM, Bojunga J, Klein HH, Landsberg J, Nawroth F, Schüring A, Susok L, Thoms KM, Kiesel L, Berking C. Fertility preservation and management of pregnancy in melanoma patients requiring systemic therapy. ESMO Open 2021; 6:100248. [PMID: 34438241 PMCID: PMC8390524 DOI: 10.1016/j.esmoop.2021.100248] [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: 04/01/2021] [Revised: 07/21/2021] [Accepted: 07/27/2021] [Indexed: 01/09/2023] Open
Abstract
Melanoma is one of the most common cancers in adolescents and adults at fertile age, especially in women. With novel and more effective systemic therapies that began to profoundly change the dismal outcome of melanoma by prolonging overall survival, the wish for fertility preservation or even parenthood has to be considered for a growing portion of melanoma patients-from the patients' as well as from the physicians' perspective. The dual blockade of the mitogen-activated protein kinase pathway by B-Raf proto-oncogene serine/threonine kinase and mitogen-activated protein kinase inhibitors and the immune checkpoint inhibition by anti-programmed cell death protein 1 and anti-cytotoxic T-lymphocyte-associated protein-4 monoclonal antibodies constitute the current standard systemic approaches to combat locally advanced or metastatic melanoma. Here, the preclinical data and clinical evidence of these systemic therapies are reviewed in terms of their potential gonadotoxicity, teratogenicity, embryotoxicity and fetotoxicity. Recommendations for routine fertility and contraception counseling of melanoma patients at fertile age are provided in line with interdisciplinary recommendations for the diagnostic work-up of these patients and for fertility-protective measures. Differentiated recommendations for the systemic therapy in both the adjuvant and the advanced, metastatic treatment situation are given. In addition, the challenges of pregnancy during systemic melanoma therapy are discussed.
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Affiliation(s)
- J C Hassel
- Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany
| | - E Livingstone
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - J P Allam
- Department of Andrology, University Hospital Bonn, Bonn, Germany
| | - H M Behre
- Center for Reproductive Medicine and Andrology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - J Bojunga
- Department of Endocrinology, Diabetology and Nutrition Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - H H Klein
- Department of Internal Medicine, Endocrinology & Diabetology & Gastroenterology and Hepatology, BG University Hospital Bergmannsheil Bochum, Bochum, Germany
| | - J Landsberg
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany
| | - F Nawroth
- Center for Infertility, Prenatal Medicine, Endocrinology and Osteology, Amedes Medical Center MVZ Hamburg, Hamburg, Germany
| | - A Schüring
- Fertility Center MVZ KITZ Regensburg, Regensburg, Germany
| | - L Susok
- Department of Dermatology, University Hospital Bochum, Bochum, Germany
| | - K M Thoms
- Department of Dermatology, Venereology and Allergy, University Medical Center Goettingen, Goettingen, Germany
| | - L Kiesel
- Department of Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - C Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Comprehensive Cancer Center Erlangen EMN, Deutsches Zentrum Immuntherapie (DZI), Erlangen, Germany.
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Ziogas DC, Diamantopoulos P, Benopoulou O, Anastasopoulou A, Bafaloukos D, Stratigos AJ, Kirkwood JM, Gogas H. Prognosis and Management of BRAF V600E-Mutated Pregnancy-Associated Melanoma. Oncologist 2020; 25:e1209-e1220. [PMID: 32271498 DOI: 10.1634/theoncologist.2019-0747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/28/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Approximately one third of women who develop melanoma at childbearing age are diagnosed during gestation or the postpartum period, facing pregnancy-associated melanoma (PAM). However, only some retrospective studies with heterogeneous data have analyzed the impact of pregnancy on melanoma development, and no evidence exists about the behavior and the management of BRAF-mutated disease. SUBJECTS, MATERIALS, AND METHODS In order to better describe the evolution of BRAF V600E-mutated PAM, we present here all consecutive cases diagnosed in our site during the last 7 years, recording oncological, obstetrical, and perinatal parameters, as well as the therapeutic decisions for both melanoma and gestation. Based on our institutional experience, we weigh the current published evidence and discuss upcoming clinical considerations about the prognosis of PAM, the role of BRAF status, and the possible treatment options during pregnancy in localized or advanced/metastatic disease. Five women were diagnosed with newly metastatic or relapsed BRAF V600E-mutated PAM (four during gestation and one in the 1st year postpartum) between 2012 and 2019. All of them developed extensive metastatic disease with multiple organ involvement, and four developed brain metastases. All cases experienced melanoma progression in less than 6 months under targeted therapy and died soon independently of the followed sequence of treatments. All the neonates were delivered alive and healthy, but one developed melanoma earlier than the second year of life. RESULTS Reviewing the literature to confirm our unfavorable outcomes, no specific data on BRAF-mutated PAM were retrieved and current evidence still supports that the prognosis of PAM should be guided by the established risk factors, whereas the management of advanced/metastatic PAM should be evaluated on a case-by-case basis. CONCLUSION More data are required to ascertain whether BRAF-mutated profile adversely affects PAM outcome, although the clinicians should be aware to detect any potential melanoma lesion during pregnancy as soon as possible, treating it locally, regardless of its BRAF status. IMPLICATIONS FOR PRACTICE The prognosis and management of pregnancy-associated melanoma whether BRAF-mutated or wild type, is currently guided by the same parameters as in the nonpregnant condition. In this special nontrial subpopulation, BRAF-mutated status seems to have a detrimental effect on disease outcome, independently of the following treatments. In early stage melanoma, wide local excision with or without sentinel lymph node dissection may be curative at any trimester of gestation, while in advanced/metastatic setting, therapeutic strategy including immune-checkpoint or BRAF/MEK inhibitors, is more challenging, regardless of BRAF status, and should be based on an individualized decision in each case at a multidisciplinary level.
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Affiliation(s)
- Dimitrios C Ziogas
- First Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Panagiotis Diamantopoulos
- First Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Olga Benopoulou
- First Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | - Amalia Anastasopoulou
- First Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
| | | | - Alexander J Stratigos
- Department of Dermatology-Venereology, National and Kapodistrian University of Athens, School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - John M Kirkwood
- Division of Hematology/Oncology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Helen Gogas
- First Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Laiko General Hospital, Athens, Greece
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Carbone A, Persechino F, Paolino G, Cota C, Piemonte P, Franceschini C, Eibenschutz L, Ferrari A, Buccini P, Frascione P, Calvieri S, Ardigò M. Enlarging melanocytic lesions with peripheral globular pattern: a dermoscopic and confocal microscopy study. Ital J Dermatol Venerol 2019; 156:467-472. [PMID: 31760729 DOI: 10.23736/s2784-8671.19.06471-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Enlarging melanocytic lesions with peripheral globular pattern (EMLPGP) are a pitfall in dermoscopy. Our aim was to evaluate the meaning of EMLPGP and to assess the use of dermoscopy and reflectance confocal microscopy (RCM) in order to improve the clinical management of this subtype of melanocytic lesions. METHODS A total of 135 EMLPGP were recruited and, accordingly to the dermoscopy features, were removed; later, an expert dermoscopist reviewed the lesions blinded to histology. Moreover, a subgroup of 63 lesions who underwent also to RCM, were reviewed by an expert confocalist. RESULTS Patients had a median age of 41 years old and a female prevalence (61.5%). The main anatomic site was the trunk (86%). Histology of the 135 excised EMLPGP disclosed 116 nevi (86%; P<0.0001) and 19 melanomas (14%). On dermoscopy, statistical significance was detected for small globules that were observed in 106 cases (78.5%; P<0.0001), while globules distribution and color did not impact the diagnosis prediction, as well as age, sex or any other patient profile. Considering the RCM, atypical cytology and irregular architecture were detected in 100% of melanomas (P<0.0001). CONCLUSIONS Our study shows that EMLPGPs are detectable in every age and can be a pitfall in especially in high risk patients with an over-excision of lesions. The presence of peripheral globules should be evaluated considering the overall dermoscopic features. RCM can contribute significantly in the management of lesions trough the detection of cyto-architectural atypia. Therefore, RCM in combination with dermoscopy can optimize the reduction of harmless lesions.
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Affiliation(s)
- Anna Carbone
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy -
| | - Flavia Persechino
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
| | - Giovanni Paolino
- Department of Dermatology and Cosmetology, IRCCS San Raffaele Hospital, Milan, Italy.,Dermatology Clinic, Sapienza University, Rome, Italy
| | - Carlo Cota
- Dermatopathology Research Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Paolo Piemonte
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Chiara Franceschini
- Rare Disease Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Laura Eibenschutz
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Angela Ferrari
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pierluigi Buccini
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | - Pasquale Frascione
- Oncologic and Preventative Dermatology Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
| | | | - Marco Ardigò
- Rare Disease Unit, San Gallicano Dermatological Institute, IRCCS, Rome, Italy
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Decreased T-Cell Programmed Death Receptor-1 Expression in Pregnancy-Associated Melanoma. Am J Dermatopathol 2019; 41:180-187. [PMID: 30308543 DOI: 10.1097/dad.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Pregnancy depends on tolerance of an immunologically foreign fetus through type 1 T-cell suppression. Worse melanoma outcomes have been described within 1 year of childbirth. We assessed immunopathologic factors that may account for the observed negative impact of pregnancy on outcome. MATERIALS AND METHODS Women of child-bearing age with ≥24 months follow-up were identified from our Institutional Melanoma Registry. Women with available primary tumor blocks were compared [history of childbirth within 1 year of diagnosis (CB1Y) (n = 18) vs. nonpregnant age-matched controls (n = 13)]. Immunohistochemical staining with quantification of immune infiltrates: CD68 tumor-associated macrophages, CD3 tumor-infiltrating T cells, and PD-1 activated/exhausted T cells; and hematolymphangiogenesis: CD31/D2-40 blood vessels and D2-40 lymphatics was performed by 2 blinded dermatopathologists. RESULTS CB1Y tumors showed decreased CD3 tumor-infiltrating T cells (P < 0.05) with significantly reduced PD1 expression (P ≤ 0.05). The CD3:PD1 ratio was higher in CB1Y (P < 0.05). Other tested parameters did not significantly differ between the 2 groups. DISCUSSION As PD1 expression is induced during type 1 T-cell activation, these data suggest that immune ignorance or suppression may predominate in CB1Y. Further studies are required to identify interventions that may promote tumor-associated T-cell inflammation in such patients.
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Abstract
Melanoma is rapidly evolving because of advances in noninvasive diagnosis, targeted therapies, and improved prognostic methods. This article discusses what is new in melanoma risk factors, prevention, clinical management, and targeted treatment. The incidence continues to increase worldwide, whereas mortality is steadily improving. This trend reinforces the importance of dermatologists comprehensively understanding all aspects of melanoma. Further research is needed to continue making a material impact on outcomes for patients.
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Affiliation(s)
- Giselle Prado
- National Society for Cutaneous Medicine, 35 East 35th Street #208, New York, NY 10016, USA.
| | - Ryan M Svoboda
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
| | - Darrell S Rigel
- Department of Dermatology, NYU School of Medicine, 35 East 35th Street #208, New York, NY 10016, USA
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cAMP-mediated regulation of melanocyte genomic instability: A melanoma-preventive strategy. ADVANCES IN PROTEIN CHEMISTRY AND STRUCTURAL BIOLOGY 2018; 115:247-295. [PMID: 30798934 DOI: 10.1016/bs.apcsb.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Malignant melanoma of the skin is the leading cause of death from skin cancer and ranks fifth in cancer incidence among all cancers in the United States. While melanoma mortality has remained steady for the past several decades, melanoma incidence has been increasing, particularly among fair-skinned individuals. According to the American Cancer Society, nearly 10,000 people in the United States will die from melanoma this year. Individuals with dark skin complexion are protected damage generated by UV-light due to the high content of UV-blocking melanin pigment in their epidermis as well as better capacity for melanocytes to cope with UV damage. There is now ample evidence that suggests that the melanocortin 1 receptor (MC1R) is a major melanoma risk factor. Inherited loss-of-function mutations in MC1R are common in melanoma-prone persons, correlating with a less melanized skin complexion and poorer recovery from mutagenic photodamage. We and others are interested in the MC1R signaling pathway in melanocytes, its mechanisms of enhancing genomic stability and pharmacologic opportunities to reduce melanoma risk based on those insights. In this chapter, we review melanoma risk factors, the MC1R signaling pathway, and the relationship between MC1R signaling and DNA repair.
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Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2018; 80:208-250. [PMID: 30392755 DOI: 10.1016/j.jaad.2018.08.055] [Citation(s) in RCA: 328] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
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Affiliation(s)
- Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona
| | - David E Elder
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Oliver J Wisco
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Toyin Lamina
- American Academy of Dermatology, Rosemont, Illinois
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12
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Li B, Wang Y, Xu Y, Liu H, Bloomer W, Zhu D, Amos CI, Fang S, Lee JE, Li X, Han J, Wei Q. Genetic variants in RORA and DNMT1 associated with cutaneous melanoma survival. Int J Cancer 2018; 142:2303-2312. [PMID: 29313974 PMCID: PMC5893376 DOI: 10.1002/ijc.31243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
Cutaneous melanoma (CM) is considered as a steroid hormone-related malignancy. However, few studies have evaluated the roles of genetic variants encoding steroid hormone receptor genes and their related regulators (SHR-related genes) in CM-specific survival (CMSS). Here, we performed a pathway-based analysis to evaluate genetic variants of 191 SHR-related genes in 858 CMSS patients using a dataset from a genome-wide association study (GWAS) from The University of Texas MD Anderson Cancer Center (MDACC), and then validated the results in an additional dataset of 409 patients from the Harvard GWAS. Using multivariate Cox proportional hazards regression analysis, we identified three-independent SNPs (RORA rs782917 G > A, RORA rs17204952 C > T and DNMT1 rs7253062 G > A) as predictors of CMSS, with a variant-allele attributed hazards ratio (HR) and 95% confidence interval of 1.62 (1.25-2.09), 1.60 (1.20-2.13) and 1.52 (1.20-1.94), respectively. Combined analysis of risk genotypes of these three SNPs revealed a decreased CMSS in a dose-response manner as the number of risk genotypes increased (ptrend < 0.001); however, no improvement in the prediction model was observed (area under the curve [AUC] = 79.6-80.8%, p = 0.656), when these risk genotypes were added to the model containing clinical variables. Our findings suggest that genetic variants of RORA and DNMT1 may be promising biomarkers for CMSS, but these results needed to be validated in future larger studies.
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Affiliation(s)
- Bo Li
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110004, PR China
| | - Yanru Wang
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yinghui Xu
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Cancer Center, The First Hospital of Jilin University, Changchun, Jilin 130021, PR China
| | - Hongliang Liu
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Wendy Bloomer
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
| | - Dakai Zhu
- Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Christopher I. Amos
- Community and Family Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Shenying Fang
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey E. Lee
- Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Xin Li
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jiali Han
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Duke University School of Medicine, Durham, NC 27710, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA
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13
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Chen GL, Luo Y, Eriksson D, Meng X, Qian C, Bäuerle T, Chen XX, Schett G, Bozec A. High fat diet increases melanoma cell growth in the bone marrow by inducing osteopontin and interleukin 6. Oncotarget 2018; 7:26653-69. [PMID: 27049717 PMCID: PMC5042005 DOI: 10.18632/oncotarget.8474] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/07/2016] [Indexed: 01/08/2023] Open
Abstract
The impact of metabolic stress induced by obesity on the bone marrow melanoma niche is largely unknown. Here we employed diet induced obese mice model, where mice received high-fat (HFD) or normal diet (ND) for 6 weeks before challenge with B16F10 melanoma cells. Tumor size, bone loss and osteoclasts numbers were assessed histologically in the tibial bones. For defining the molecular pathway, osteopontin knock-out mice, interleukin 6 neutralizing antibody or Janus kinase 2 inhibition were carried out in the same model. Mechanistic studies such as adipocyte-melanoma co-cultures for defining adipocyte induced changes of tumor cell proliferation and expression profiles were also performed. As results, HFD enhanced melanoma burden in bone by increasing tumor area and osteoclast numbers. This process was associated with higher numbers of bone marrow adipocytes expressing IL-6 in direct vicinity to tumor cells. Inhibition of IL-6 or of downstream JAK2 blocked HFD-induced tumor progression. Furthermore, the phenotypic changes of melanoma cells triggered macrophage and osteoclast accumulation accompanied by increased osteopontin expression. Osteopontin triggered osteoclastogenesis and also exerted a positive feedback loop to tumor cells, which was abrogated in its absence. Metabolic stress by HFD promotes melanoma growth in the bone marrow by an increase in bone marrow adipocytes and IL-6-JAK2-osteopontin mediated activation of tumor cells and osteoclast differentiation.
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Affiliation(s)
- Guang-Liang Chen
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany.,Minhang District Central Hospital, Fudan University, Shanghai, China
| | - Yubin Luo
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Daniel Eriksson
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Xianyi Meng
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Cheng Qian
- Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tobias Bäuerle
- Institute of Radiology, University Medical Center Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Xiao-Xiang Chen
- Department of Rheumatology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Georg Schett
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Aline Bozec
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
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14
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Martires KJ, Pomeranz MK, Stein JA, Grant-Kels JM, Driscoll MS. Pregnancy-associated melanoma (PAMM): Is there truly a worse prognosis? Would not sound alarm bells just yet…. J Am Acad Dermatol 2017; 75:e77. [PMID: 27444098 DOI: 10.1016/j.jaad.2016.03.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Kathryn J Martires
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Miriam Keltz Pomeranz
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jennifer A Stein
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Marcia S Driscoll
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland
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15
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Al-Jamal RT, Mudhar HS, Currie Z, Rennie IG, Salvi SM. Conjunctival Melanoma during Pregnancy. Ocul Oncol Pathol 2017; 3:101-105. [PMID: 28868278 DOI: 10.1159/000452162] [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: 08/10/2016] [Revised: 09/26/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To describe the clinical and histopathological features of a conjunctival melanoma (CM) during early pregnancy. PROCEDURES A 37-year-old, 20-week pregnant primigravida was referred to the Sheffield Ocular Oncology Service with a rapidly growing lesion arising from the right superior conjunctival fornix, noted from the first trimester of pregnancy. This was associated with pain and bloody discharge. Incisional biopsy confirmed the clinical suspicion of invasive CM. She was treated by primary surgical excision and cryotherapy under local anaesthesia. RESULTS Histology of the excised specimen showed an invasive malignant melanoma with surrounding in situ conjunctival changes arising from a naevus. The melanoma was 10.5 mm thick, focally necrotic, and had a mitotic count of 11/mm2 focally. The patient responded well to surgical treatment. She gave birth to a healthy boy, and the placenta showed no evidence of metastatic melanoma. There has been no recurrence or distant metastasis during 5 years of follow-up. CONCLUSION CM during pregnancy is extremely rare. Because of possible transformation to malignant melanoma, we recommend close monitoring of females known to have pigmented conjunctival lesions of the conjunctiva during pregnancy.
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Affiliation(s)
- Rana'a T Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Hardeep Singh Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, UK
| | - Zanna Currie
- Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
| | - Ian G Rennie
- Academic Unit of Ophthalmology and Orthoptics, Department of Oncology, CR-UK/YCR Sheffield Cancer Research Centre, Medical School, University of Sheffield, Sheffield, UK
| | - Sachin M Salvi
- Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, UK
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16
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Richtig G, Byrom L, Kupsa R, Schaider H, Hofmann-Wellenhof R, Wolf IH, Soyer HP, Richtig E. Pregnancy as a driver for melanoma. Br J Dermatol 2017; 177:854-857. [PMID: 27718538 DOI: 10.1111/bjd.15124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 12/31/2022]
Abstract
Whether or not pregnancy favours the occurrence and growth of melanoma is a source of controversy in the literature. Several case reports have shown dramatic courses of diseases in pregnancy. We present a case of a 36-year-old woman with multiple naevi with one melanoma detected in 2009 in the first trimester and a second primary melanoma in 2010 in the third trimester of her pregnancy. Both lesions have been present for at least 5 years and have been interpreted as dysplastic naevi. Because of their growth during pregnancy they were removed. No metastatic disease has been found between 2010 and early 2017. This case shows the difficulty of detecting melanomas in pregnancy, particularly when they mimic dysplastic naevi in women with multiple naevi, who are at higher risk. Therefore, we suggest that pregnant women with numerous naevi should be precautious of any changes of their naevi in size, shape and colour. Every suspicious lesion should be either excised or documented/monitored carefully, for example with sequential digital dermoscopy imaging.
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Affiliation(s)
- G Richtig
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria.,Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria.,Dermatology Research Centre, The University of Queensland, School of Medicine, Translational Research Institute, Woolloongabba, QLD, Australia
| | - L Byrom
- Translational Research Institute, University of Queensland Diamantina Institute, The University of Queensland, Woolloongabba, QLD, Australia.,Experimental Dermatology Group, University of Queensland Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - R Kupsa
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
| | - H Schaider
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
| | - R Hofmann-Wellenhof
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
| | - I H Wolf
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
| | - H P Soyer
- Institute of Experimental and Clinical Pharmacology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria.,Department of Dermatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - E Richtig
- Department of Dermatology, Medical University of Graz, Auenbruggerplatz 8, A-8036, Graz, Austria
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17
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Fábián M, Rencz F, Krenács T, Brodszky V, Hársing J, Németh K, Balogh P, Kárpáti S. Expression of G protein-coupled oestrogen receptor in melanoma and in pregnancy-associated melanoma. J Eur Acad Dermatol Venereol 2017; 31:1453-1461. [PMID: 28467693 DOI: 10.1111/jdv.14304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/29/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The hormone sensitivity of melanoma and the role of 'classical' oestrogen receptor (ER) α and β in tumour progression have been intensively studied with rather contradictory results. The presence of 'non-classical' G protein-coupled oestrogen receptor (GPER) has not been investigated on human melanoma tissues. OBJECTIVE To analyse the expression of GPER, ERα and ERβ in pregnancy-associated (PAM) and in non-pregnancy-associated (NPAM) melanomas in correlation with traditional prognostic markers and disease-free survival (DFS). METHODS Receptor protein levels were tested using immunohistochemistry in 81 formalin-fixed paraffin-embedded melanoma tissues. PAMs (n = 38) were compared with age- and Breslow thickness-matched cases (n = 43) including non-pregnant women (NPAM-W) (n = 22) and men (NPAM-M) (n = 21). The association between receptor expression and DFS was analysed by uni- and multivariate Cox proportional hazards regression. RESULTS G protein-coupled oestrogen receptor was detected both in PAMs and NPAMs. In 39 of the 41 (95.1%) GPER-positive melanomas, GPER and ERβ were co-expressed. GPER/ERβ-positive melanomas were significantly more common in PAM compared to NPAM (P = 0.0001) with no significant difference between genders (P = 0.4383). In PAMs, the distribution of GPER and ERβ was similar (78.4% vs. 81.6%; P = 0.8504), while in NPAM, ERβ was the representative ER (60.5% vs. 27.9%; P = 0.0010) without gender difference (59.1% vs. 61.9%). GPER-/ERβ-positive melanomas were associated with lower Breslow thickness, lower mitotic rate and higher presence of peritumoral lymphocyte infiltration (PLI) compared to GPER-/ERβ-negative cases (P = 0.0156, P = 0.0036 and P = 0.0001) predicting a better DFS (HR = 0.785, 95% CI 0.582-1.058). Despite the significantly higher frequency of GPER and ERβ expression in PAM, no significant difference was found in DFS between PAM and NPAM. All but one case failed to show ERα expression. CONCLUSIONS The presence of GPER and its simultaneous expression with ERβ can serve as a new prognostic indicator in a significant subpopulation of melanoma patients.
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Affiliation(s)
- M Fábián
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary.,Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - T Krenács
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary.,MTA-SE Tumour Progression Research Group, Budapest, Hungary
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - J Hársing
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - K Németh
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - P Balogh
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - S Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
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18
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Is Pregnancy-Associated Melanoma Associated with Adverse Outcomes? J Am Coll Surg 2017; 225:149-158. [PMID: 28457692 DOI: 10.1016/j.jamcollsurg.2017.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Melanoma is the most common malignancy encountered during pregnancy. Conflicting data have led to ongoing confusion regarding pregnancy-associated melanoma (PAM) in the media and among the public. The objective of this study was to better characterize both the clinical presentation of PAM and its prognostic implications. STUDY DESIGN Female patients of reproductive age, with stage 0 to IV cutaneous melanoma, were identified from our prospectively maintained database. Clinical and histopathologic factors were analyzed with appropriate statistical methods. Univariable and then multivariable analysis were used on matched data to compare disease-free survival (DFS), overall survival (OS), and melanoma-specific survival (MSS) for stage 0-III PAMs vs non-PAMs. Kaplan-Meier survival curves were then plotted for OS and MSS and compared using the log-rank test. RESULTS The clinical presentation of melanoma was similar for PAM and non-PAM patients. There was no significant difference in recurrence between the 2 groups; for PAM patients, 38.5% of patients had recurrence, as compared with 36.6% of non-PAM patients (p = 0.641). For PAM patients, median follow-up was 14.6 years (range 0 to 42.6 years) and 11.1 years (0 to 48.5 years) for the non-PAM patients. No significant differences in DFS, MSS, or OS were identified on univariable or multivariable analysis for PAM vs non-PAM patients in stage 0/I/II and stage III cutaneous melanoma, respectively (p = 0.880 DFS, p = 0.219 OS, and p = 0.670 MSS). CONCLUSIONS We observed no difference in DFS, OS, or MSS between the 2 groups. Pregnant patients should be screened for melanoma in a similar manner to nonpregnant patients and should be counseled that their survival is not adversely affected by their pregnancy.
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19
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Todd SP, Driscoll MS. Prognosis for women diagnosed with melanoma during, before, or after pregnancy: Weighing the evidence. Int J Womens Dermatol 2017; 3:26-29. [PMID: 28492051 PMCID: PMC5419023 DOI: 10.1016/j.ijwd.2016.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/27/2016] [Indexed: 01/29/2023] Open
Abstract
Approximately one third of women who are diagnosed with malignant melanoma are of childbearing age. Therefore, it is not surprising that some studies have found malignant melanoma to be one of the most common malignancies diagnosed in pregnant women. The impact of pregnancy-related hormonal changes on melanoma development and progression remains controversial. Women undergo immunologic changes during pregnancy that may decrease tumor surveillance. Additionally, hormone receptors are found on some melanomas. Unfortunately, many of the past and even recent studies that have been published and are reviewed herein did not uniformly use appropriate control groups, account for confounding covariates, or employ appropriate statistical analysis, which makes it difficult to rely on the conclusions they reach. However, a review of the better controlled and preponderant studies demonstrates that pregnancy-associated melanomas are not associated with a poorer prognosis.
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Affiliation(s)
- Sarah P. Todd
- University of Maryland Medical Center, Department of Internal Medicine, Baltimore, MD
| | - Marcia S. Driscoll
- University of Maryland School of Medicine, Department of Dermatology, Baltimore, MD
- Corresponding author.
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20
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Abstract
Melanoma diagnosed during pregnancy is a rare clinical case presentation which must be mastered. In the absence of guidelines for this clinical challenge, we performed a review of the literature and provide a practical guideline on how to manage such rare clinical cases based on our clinical experience. Expecting mothers require adequate counselling and explanation of all therapeutic options as they take responsibility for more than their own lives. However, they should be guided through the process of diagnostic and therapeutic measures in a potentially life-threatening situation. Pregnancy itself is no reason to withhold any type of necessary melanoma surgery. Perioperative management, however, requires certain adjustments in order to comply with this special situation. If indicated, even adjuvant and palliative systemic therapy need to be given to the patient, but they also have to be adapted to the specific circumstances as data is still sparse, especially for the new first and second line therapies with antibodies and targeted molecules.
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Affiliation(s)
- L A Schneider
- Klinik für Dermatologie und Dermatochirurgie, Helios Klinik Rottweil, Krankenhausstr 30, 78628, Rottweil, Deutschland.
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21
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Khosrotehrani K, Olsen CM, Byrom L, Green AC. Melanoma during pregnancy: Level of evidence and principles of precaution. J Am Acad Dermatol 2016; 76:e29-e30. [PMID: 27986158 DOI: 10.1016/j.jaad.2016.08.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 08/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Kiarash Khosrotehrani
- Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, Australia; Center for Clinical Research, Experimental Dermatology Group, University of Queensland, Brisbane, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia.
| | - Catherine M Olsen
- School of Public Health, University of Queensland, Brisbane, Australia; QIMR (Queensland Institute of Medical Research) Berghofer Medical Research Institute, Brisbane, Australia
| | - Lisa Byrom
- Diamantina Institute, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Adele C Green
- QIMR (Queensland Institute of Medical Research) Berghofer Medical Research Institute, Brisbane, Australia; CRUK (Cancer Research United-Kingdom) Manchester Institute and Institute of Inflammation and Repair, University of Manchester, Manchester, United Kingdom
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22
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Driscoll MS, Martires K, Bieber AK, Pomeranz MK, Grant-Kels JM, Stein JA. Pregnancy and melanoma. J Am Acad Dermatol 2016; 75:669-678. [PMID: 27646737 DOI: 10.1016/j.jaad.2016.01.061] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/16/2022]
Abstract
Malignant melanoma is the most common malignancy during pregnancy, and is diagnosed during childbearing age in approximately one-third of women diagnosed with melanoma. The impact of hormonal changes during pregnancy and from iatrogenic hormones on melanoma is controversial. Women undergo immunologic changes during pregnancy that may decrease tumor surveillance. In addition, hormone receptors are found on some melanomas. In spite of these observations, the preponderance of evidence does not support a poorer prognosis for pregnancy-associated melanomas. There is also a lack of evidence that oral contraceptives or hormone replacement therapy worsens melanoma prognosis.
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Affiliation(s)
- Marcia S Driscoll
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Kathryn Martires
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Amy Kalowitz Bieber
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Miriam Keltz Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut, Farmington, Connecticut
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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23
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Walter JR, Xu S, Paller AS, Choi JN, Woodruff TK. Oncofertility considerations in adolescents and young adults given a diagnosis of melanoma: Fertility risk of Food and Drug Administration-approved systemic therapies. J Am Acad Dermatol 2016; 75:528-534. [PMID: 27543212 PMCID: PMC5142834 DOI: 10.1016/j.jaad.2016.04.031] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/06/2016] [Accepted: 04/09/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Melanoma is the most common cancer diagnosed for patients ages 25 to 29 years, the group with the highest birth rates in the United States. Oncofertility is a new field addressing the reproductive needs of patients with cancer facing fertility-threatening treatments. OBJECTIVE We sought to assess gender-specific fertility risk for Food and Drug Administration (FDA)-approved melanoma therapies with a new risk category system. METHODS We conducted a retrospective review of FDA, European Union, and Health Canada regulatory filings, along with previously published reports to grade fertility risk of systemic melanoma therapies. The proposed fertility risk category system is analogous to the FDA's A/B/C/D/X/N pregnancy-risk categories. RESULTS For female patients, 58% of treatments represent a fertility risk (Category C and D), 33% have unknown risk (Category N), and 1 therapy (vemurafenib) did not show animal ovarian toxicity (Category B). For male patients, 33% represented a fertility risk (Category C and D), 50% of treatments had unknown risk (Category N), and 17% did not show animal testicular toxicity (Category B). LIMITATIONS Data on fertility risk for melanoma therapies approved after 2009 are limited to preclinical animal studies. CONCLUSION Dermatologists have an opportunity to discuss fertility preservation, make appropriate referrals, and steward registries on reproductive outcomes for patients with melanoma.
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Affiliation(s)
- Jessica R. Walter
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Amy S. Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer N. Choi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Teresa K. Woodruff
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Women’s Health Research Institute, Northwestern University, Chicago, Illinois
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Gori A, Savarese I, D'Errico A, Grazzini M, Papi F, Maio V, Covarelli P, Massi D, Gandini S, De Giorgi V. Estrogen receptor (ER)β expression and worse outcome from melanoma in pregnant and perimenopausal women. J Am Acad Dermatol 2016; 75:e117. [PMID: 27543235 DOI: 10.1016/j.jaad.2016.02.1245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 02/08/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Alessia Gori
- Cancer Research "Attilia Pofferi" Foundation, Pistoia, Italy
| | - Imma Savarese
- Department of Dermatology, University of Florence, Florence, Italy
| | | | - Marta Grazzini
- Department of Dermatology, University of Florence, Florence, Italy
| | - Federica Papi
- Department of Dermatology, University of Florence, Florence, Italy
| | - Vincenza Maio
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy
| | - Piero Covarelli
- Department of Surgery, University of Perugia, Perugia, Italy
| | - Daniela Massi
- Department of Human Pathology and Oncology, University of Florence, Florence, Italy
| | - Sara Gandini
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Vincenzo De Giorgi
- Cancer Research "Attilia Pofferi" Foundation, Pistoia, Italy; Department of Dermatology, University of Florence, Florence, Italy.
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