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Kontogiannis V, Coughlan D, Javanbakht M, Kunonga P, Beyer F, Richmond C, Bryant A, Bajwa D, Ellis RA, Vale L. Optimal Surveillance Strategies for Early-Stage Cutaneous Melanoma Post Primary Tumor Excision: An Economic Evaluation. MDM Policy Pract 2022; 7:23814683211069988. [PMID: 35024448 PMCID: PMC8743969 DOI: 10.1177/23814683211069988] [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] [Indexed: 11/28/2022] Open
Abstract
Background. Consensus on standardized active surveillance or follow-up care by clinicians is lacking leading to considerable variation in practice across countries. An important structural modelling consideration is that self-examination by patients and their partners can detect melanoma recurrence outside of active surveillance regimes. Objectives. To identify candidate melanoma surveillance strategies for American Joint Committee on Cancer (AJCC) stage I disease and compare them with the current recommended practice in a cost-utility analysis framework. Methods. In consultation with UK clinical experts, a microsimulation model was built in TreeAge Pro 2019 R1.0 (Williamstown, MA, USA) to evaluate surveillance strategies for AJCC stage IA and IB melanoma patients separately. The model incorporated patient behaviors such as self-detection and emergency visits to examine suspicious lesions. A National Health Service (NHS) perspective was taken. Model input parameters were taken from the literature and where data were not available, local expert opinion was sought. Probabilistic sensitivity analysis, one-way sensitivity analysis on pertinent parameters and value of information was performed. Results. In the base-case probabilistic sensitivity analysis, less intensive surveillance strategies for AJCC stage IA and IB had lower total lifetime costs than the current National Institute for Health and Care Excellence (NICE) recommended strategy with similar effectiveness in terms of quality-adjusted life years and thereby likely to be cost-effective. Many strategies had similar effectiveness due to the relatively low chance of recurrence and the high rate of self-detection. Sensitivity and scenario analyses did not change these findings. Conclusions. Our model findings suggest that less resource intensive surveillance may be cost-effective compared with the current NICE surveillance guidelines. However, to advocate convincingly for changes, better evidence is required.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Luke Vale
- Population Health Sciences Institute
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2
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Mitotic Rate as a Prognostic Factor in Melanoma: Implications for Disease Management. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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3
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Bois MC, Morgado-Carrasco D, Barba PJ, Puig S. Mitotic rate as a prognostic factor in melanoma and implications in patient management. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00181-2. [PMID: 33992620 DOI: 10.1016/j.ad.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/28/2020] [Accepted: 05/23/2020] [Indexed: 10/21/2022] Open
Affiliation(s)
- Marina Clara Bois
- Dermatology Department, Hospital General de Agudos Dr. Cosme Argerich, Buenos Aires, Argentina
| | - Daniel Morgado-Carrasco
- Dermatology Department, Melanoma Group IDIBAPS, Hospital Clínic de Barcelona, Universitat de Barcelona, España.
| | - Paula Johana Barba
- Dermatology Department, HIGA Prof. Dr. Rodolfo Rossi, La Plata, Argentina
| | - Susana Puig
- Dermatology Department, Melanoma Group IDIBAPS, Hospital Clínic de Barcelona, Universitat de Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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Dessinioti C, Geller AC, Whiteman DC, Garbe C, Grob JJ, Kelly JW, Scolyer RA, Rawson RV, Lallas A, Pellacani G, Stratigos AJ. Not all melanomas are created equal: a review and call for more research into nodular melanoma. Br J Dermatol 2021; 185:700-710. [PMID: 33864261 DOI: 10.1111/bjd.20388] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/23/2022]
Abstract
Among the histogenic subtypes of melanoma, nodular melanoma (NM) is the major contributor for thicker and fatal melanomas and it has been associated with melanoma-specific death in thin tumours, highlighting an important subgroup of 'aggressive thin' melanomas. This review provides a synthesis of the distinct characteristics of NM, with respect to epidemiology and risk factors, clinical presentation, histopathology, molecular and dermoscopic aspects, and screening practices. The real challenges are to find better biomarkers of aggressiveness and to know whether the control of such aggressive melanomas can be influenced by targeted interventions such as early detection, drug interventions and preventive strategies.
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Affiliation(s)
- C Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - A C Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - D C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - C Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - J J Grob
- Department of Dermatology and Skin Cancers, APHM Timone Hospital Aix-Marseille University, Marseille, France
| | - J W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia
| | - R A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - R V Rawson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
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5
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Gualdi G, Panarese F, Meogrossi G, Marchioni M, De Tursi M, Di Marino P, Angelucci D, Amatetti M, Proietto G, Di Nicola M, Amerio P. Speed rate (SR) as a new dynamic index of melanoma behavior. Pigment Cell Melanoma Res 2020; 33:709-718. [PMID: 32406598 DOI: 10.1111/pcmr.12890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 01/25/2023]
Abstract
Melanomas are skin tumors that show a variety of biological behavior. Some develop very fast and some other grow extremely slow, with metastasis appearing, eventually, many years after the diagnosis. The number of mitoses in primary melanoma has been related to a more aggressive tumor and may have a potential as predictive factor for cutaneous melanoma survival. However, tumor mitotic rate is a static measure and in multivariate analysis on tumor survival, it has scored less than other tumor characteristics. We tried to evolve tumor mitotic rate from a static parameter to a time-dependent one. Similar to the already described growth rate (GR), we propose the speed rate (SR). SR is defined as the ratio of tumor mitotic rate to time to melanoma development. A prospective series of 345 patients with melanoma was investigated for the role of SR as predictive factor for sentinel lymph node (SLN) positivity and tumor progression. We calculated the best threshold for SR and GR to predict the risk of recurrence. Melanoma clinical and histological characteristics as well as GR were correlated in a multivariated analysis with SR. SR values >0.2 mitoses/month were associated with negative prognostic factors such as ulceration (82.8%), SLN positivity (80%), progression (82.8%), and death (85.7%). The association of GR > 0.3 mm/months and SR > 0.2 mitoses/month had a significant predictive value in terms of SLN positivity, progression, and recurrence-free survival. We propose SR as a new "dynamic" predictor of histological SLN positivity and melanoma recurrence risk. We think that he association with this new feature with GR may be helpful in improving the accuracy of predicted clinical outcome of patient especially with thin melanomas.
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Affiliation(s)
- Giulio Gualdi
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Fabrizio Panarese
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Giovanna Meogrossi
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Michele Marchioni
- Biostatistic, Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Michele De Tursi
- Oncologi Clinic, Department of Medical, Oral Sciences and Biotechnologies University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Pietro Di Marino
- Oncologi Clinic, Department of Medical, Oral Sciences and Biotechnologies University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Domenico Angelucci
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Massimo Amatetti
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Gianluca Proietto
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Marta Di Nicola
- Biostatistic, Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio Chieti-Pescara, Chieti, Italy
| | - Paolo Amerio
- Dermatologic Clinic, Department of Medicine and Aging Science, University G D'Annunzio Chieti-Pescara, Chieti, Italy
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Dessinioti C, Dimou N, Geller AC, Stergiopoulou A, Lo S, Keim U, Gershenwald JE, Haydu LE, Ribero S, Quaglino P, Puig S, Malvehy J, Kandolf-Sekulovic L, Radevic T, Kaufmann R, Meister L, Nagore E, Traves V, Champsas GG, Plaka M, Dreno B, Varey E, Ramirez DM, Dummer R, Mangana J, Hauschild A, Egberts F, Peris K, Del Regno L, Forsea AM, Zurac SA, Vieira R, Brinca A, Zalaudek I, Deinlein T, Linos E, Evangelou E, Thompson JF, Scolyer RA, Garbe C, Stratigos AJ. Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers. J Natl Cancer Inst 2020; 111:1314-1322. [PMID: 30863861 DOI: 10.1093/jnci/djz034] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/26/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nodular melanoma (NM) is more likely to be fatal compared with other melanoma subtypes, an effect attributed to its greater Breslow thickness. METHODS Clinicopathological features of NM and superficial spreading melanoma (SSM) diagnosed in 17 centers in Europe (n = 15), the United States, and Australia between 2006 and 2015, were analyzed by multivariable logistic regression analysis, with emphasis on thin (T1 ≤ 1.0 mm) melanomas. Cox analysis assessed melanoma-specific survival. All statistical tests were two sided. RESULTS In all, 20 132 melanomas (NM: 5062, SSM: 15 070) were included. Compared with T1 SSM, T1 NM was less likely to have regression (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.29 to 0.72) or nevus remnants histologically (OR = 0.60, 95% CI = 0.42 to 0.85), and more likely to have mitoses (OR = 1.97, 95% CI = 1.33 to 2.93) and regional metastasis (OR = 1.77, 95% CI = 1.02 to 3.05). T1 NM had a higher mitotic rate than T1 SSM (adjusted geometric mean = 2.2, 95% CI = 1.9 to 2.5 vs 1.6, 95% CI = 1.5 to 1.7 per mm2, P < .001). Cox multivariable analysis showed a higher risk for melanoma-specific death for NM compared with SSM for T1 (HR = 2.10, 95% CI = 1.24 to 3.56) and T2 melanomas (HR = 1.30, 95% CI = 1.01 to 1.68), and after accounting for center heterogeneity, the difference was statistically significant only for T1 (HR = 2.20, 95% CI = 1.28 to 3.78). The NM subtype did not confer increased risk within each stratum (among localized tumors or cases with regional metastasis). CONCLUSIONS T1 NM (compared with T1 SSM) was associated with a constellation of aggressive characteristics that may confer a worse prognosis. Our results indicate NM is a high-risk melanoma subtype that should be considered for inclusion in future prognostic classifications of melanoma.
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Mahamat-Saleh Y, Hughes MCB, Miura K, Malt MK, von Schuckmann L, Khosrotehrani K, Smithers BM, Green AC. Patterns of Omega-3 and Omega-6 Fatty Acid Dietary Intake and Melanoma Thickness at Diagnosis. Cancer Epidemiol Biomarkers Prev 2020; 29:1647-1653. [PMID: 32430338 DOI: 10.1158/1055-9965.epi-20-0319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/05/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Experimental evidence suggests that dietary intakes of omega-3 and omega-6 polyunsaturated fatty acids have divergent effects on melanoma growth, but epidemiologic evidence on their combined effect is lacking. METHODS In 634 Australian patients with primary melanoma, we assessed prediagnosis consumption of 39 food groups by food frequency questionnaires completed within 2 months of diagnosis. We derived, by reduced rank regression, dietary patterns that explained variability in selected omega-3 and omega-6 fatty acid intakes. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between tertiles of dietary patterns and melanoma thickness >2 mm versus ≤2 mm were estimated using Poisson regression. RESULTS Overall omega-3 fatty acid intakes were low. Two major fatty acid dietary patterns were identified: "meat, fish, and fat," positively correlated with intakes of all fatty acids; and "fish, low-meat, and low-fat," positively correlated with long-chain omega-3 fatty acid intake, and inversely with medium-chain omega-3 and omega-6 fatty acid intakes. Prevalence of thick melanomas was significantly higher in those in the highest compared with lowest tertile of the "meat, fish, and fat" pattern (PR, 1.40; 95% CI, 1.01-1.94), especially those with serious comorbidity (PR, 1.83; 95% CI, 1.15-2.92) or a family history (PR, 2.32; 95% CI, 1.00-5.35). The "fish, low-meat, and low-fat" pattern was not associated with melanoma thickness. CONCLUSIONS People with high meat, fish, and fat intakes, who thus consumed relatively high levels of omega-3 and high omega-6 fatty acid intakes, are more likely to be diagnosed with thick than thin melanomas. IMPACT High omega-3 and omega-6 fatty acid intakes may contribute to patients' presentation with thick melanomas.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Centre for Research in Epidemiology and Population Health (CESP) - School of Medicine, Universite Paris Sud - School of Medicine, Universite Versailles Saint-Quentin-en-Yvelines (UVSQ); INSERM French National Institute for Health and Medical Research, Universite Paris Saclay, Villejuif, France.,Gustave Roussy, Villejuif, France
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Kyoko Miura
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maryrose K Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lena von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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8
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von Schuckmann LA, Khosrotehrani K, Ghiasvand R, Hughes MCB, van der Pols JC, Malt M, Smithers BM, Green AC. Statins may reduce disease recurrence in patients with ulcerated primary melanoma. Br J Dermatol 2020; 183:1049-1055. [PMID: 32133622 DOI: 10.1111/bjd.19012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Statins may restrict the cellular functions required for melanoma growth and metastasis. OBJECTIVES To determine whether long-term statin use commenced before diagnosis of a primary melanoma is associated with reduced risk of melanoma recurrence. METHODS We prospectively followed a cohort of patients newly diagnosed between 2010 and 2014 with localized tumour-stage T1b to T4b melanoma in Queensland, Australia. We used Cox regression analyses to examine associations between long-term statin use and melanoma recurrence for the entire cohort, and then separately by sex and by presence of ulceration, due to evidence of effect modification. RESULTS Among 700 patients diagnosed with stage T1b to T4b primary melanoma (mean age 62 years, 59% male, 28% with ulcerated tumours), 94 patients (13%) developed melanoma recurrence within 2 years. Long-term statin users (n = 204, 29%) had a significantly lower risk of disease recurrence than nonusers [adjusted hazard ratio (HRadj ) 0·55, 95% confidence Interval (CI) 0·32-0·97] regardless of statin subtype or potency. Compared with nonusers of statins, risk of recurrence was significantly decreased in male statin users (HRadj 0·39, 95% CI 0·19-0·79) but not in female statin users (HRadj 0·82, 95% CI 0·29-2·27) and in statin users with ulcerated (HRadj 0·17, 95% CI 0·05-0·52) but not nonulcerated (HRadj 0·91, 95% CI 0·46-1·81) primary melanoma. CONCLUSIONS Statins commenced before melanoma diagnosis may reduce the risk of melanoma recurrence, especially in men and in those with ulcerated tumours. Clinical trial evaluation of the potential role of statins in improving the prognosis of high-risk melanoma is warranted.
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Affiliation(s)
- L A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - K Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - R Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - M C B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - J C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - M Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - B M Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - A C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,CRUK Manchester and Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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9
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Theile H, Moore J, Dunn N, Cossio D, Forristal CE, Green AC, Smithers BM. Regional nodal metastasis and 5-year survival in patients with thin melanoma in Queensland: a population-based study. ANZ J Surg 2020; 90:503-507. [PMID: 32162780 DOI: 10.1111/ans.15804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/16/2019] [Accepted: 02/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Optimal management of regional lymph nodes for thin cutaneous melanoma is uncertain. We evaluated regional lymph node involvement and 5-year melanoma-specific survival (MSS) in patients with thin (≤1 mm) primary melanoma. METHODS Patients with a melanoma, American Joint Committee on Cancer Staging 8th Edition pT1a (<0.8 mm) or pT1b (ulceration; and/or 0.8-1.0 mm), diagnosed during 2001-2015 were identified from the Queensland Oncology Repository. We extracted demographic, pathology and clinical details, including sentinel lymph node biopsy (SLNB), regional nodal dissection and nodal recurrence. Poisson regression was used to assess recurrence risk in patients who did not undergo SLNB. The 5-year MSS was calculated using the Kaplan-Maier method with Cox regression to compare survival outcomes according to SLNB performance. RESULTS Of the 27 824 eligible patients, 240 (0.9%) underwent SLNB. One hundred and seventy-eight patients (0.6%) without SLNB had nodal recurrence. Of the 4848 patients with a pT1b lesion, 166 (3.4%) had SLNB with 12 (7.2%) positive; of the remainder, 99 (2.1%) had clinical recurrence. Risk of recurrence was higher in males, nodular subtype and T1b lesions and lower if patients were aged >60 years. The 5-year MSS was similar for observed and SLNB cohorts (99.66% versus 98.92%) but worse for T1b lesions (98.90%) and clinical nodal recurrence (66.89%). CONCLUSION Overall prognosis for T1 melanoma is excellent with nodal involvement being rare. However, the American Joint Committee on Cancer 8th Edition T1b melanoma correlates with significantly worse 5-year MSS and increased regional nodal recurrence (notably for 0.8-1.0 mm lesions with ulceration). Further characterization of high-risk groups for nodal positivity that impacts patient outcome is needed for the pT1 melanoma cohort.
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Affiliation(s)
- Harrison Theile
- Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Julie Moore
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Nathan Dunn
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Danica Cossio
- Queensland Cancer Control Analysis Team, Cancer Alliance Queensland, Brisbane, Queensland, Australia
| | - Catherine E Forristal
- Queensland Melanoma Collaborative, Brisbane, Queensland, Australia.,Mater Research Institute, Brisbane, Queensland, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester Institute, University of Manchester, Manchester, UK
| | - B Mark Smithers
- Discipline of Surgery, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Queensland Melanoma Collaborative, Brisbane, Queensland, Australia.,Mater Research Institute, Brisbane, Queensland, Australia
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10
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von Schuckmann LA, Hughes MCB, Ghiasvand R, Malt M, van der Pols JC, Beesley VL, Khosrotehrani K, Smithers BM, Green AC. Risk of Melanoma Recurrence After Diagnosis of a High-Risk Primary Tumor. JAMA Dermatol 2020; 155:688-693. [PMID: 31042258 DOI: 10.1001/jamadermatol.2019.0440] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance With emerging new systemic treatments for metastatic melanoma, early detection of disease recurrence is increasingly important. Objective To investigate the risk of melanoma recurrence in patients with a localized melanoma at a high risk of metastasis. Design, Setting, and Participants A total of 1254 patients with newly diagnosed, histologically confirmed tumor category T1b to T4b melanoma in Queensland, Australia, were recruited prospectively between October 1, 2010, and October 1, 2014, for participation in a cohort study. Data analysis was conducted from February 8, 2018, to February 20, 2019. We used Cox proportional hazards regression analysis to examine associations between patient and tumor factors and melanoma recurrence. Exposures Disease-free survival (DFS) by melanoma tumor category defined by the 7th vs 8th editions of the AJCC Cancer Staging Manual (AJCC 7 vs AJCC 8). Main Outcomes and Measures Melanoma recurrences were self-reported through follow-up questionnaires administered every 6 months and confirmed by histologic or imaging findings. Results Of 1254 patients recruited, 825 individuals (65.8%) agreed to participate. Thirty-six were found to be ineligible after providing consent and a further 89 patients were excluded after reclassifying tumors using AJCC 8, leaving 700 participants with high-risk primary melanoma (mean [SD] age, 62.2 [13.5] years; 410 [58.6%] men). Independent predictors of recurrence were head or neck site of primary tumor, ulceration, thickness, and mitotic rate greater than 3/mm2 (hazard ratio, 2.36; 95% CI, 1.19-4.71). Ninety-four patients (13.4%) developed a recurrence within 2 years of diagnosis: 66 tumors (70.2%) were locoregional, and 28 tumors (29.8%) developed at distant sites. After surgery for locoregional disease, 37 of 64 patients (57.8%) remained disease free at 2 years, 7 patients (10.9%) developed new locoregional recurrence, and 20 patients (31.3%), developed distant disease. Two-year DFS was similar when comparing AJCC 7 and AJCC 8, for T1b (AJCC 7, 253 [93.3% DFS]; AJCC 8, 242 [93.0% DFS]) and T4b (AJCC 7 and AJCC 8, 50 [68.0% DFS] category tumors in both editions. Patients with T2a to T4a tumors who did not have a sentinel lymph node biopsy (SLNB) at diagnosis had lower DFS than patients with the same tumor category and a negative SLNB (T2a: 136 [91.1%; 95% CI, 86.4-95.9] vs 96 [96.9%; 95 % CI, 93.4-100.0]; T4a: 33 [78.8%; 95% CI, 64.8-92.7] vs 6 [83.3; 95% CI, 53.5-100.0]). Conclusions and Relevance These findings suggest that 13.4% of patients with a high-risk primary melanoma will experience disease recurrence within 2 years. Head or neck location of initial tumor, SLNB positivity, and signs of rapid tumor growth may be associated with primary melanoma recurrence.
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Affiliation(s)
- Lena A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Reza Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Maryrose Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Jolieke C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | - Vanessa L Beesley
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia
| | - Adele C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia.,Cancer Research UK Manchester, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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11
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Gaudy-Marqueste C. Quoi de neuf en oncodermatologie ? Ann Dermatol Venereol 2019; 146:12S39-12S45. [DOI: 10.1016/s0151-9638(20)30105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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