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Granata V, Simonetti I, Fusco R, Setola SV, Izzo F, Scarpato L, Vanella V, Festino L, Simeone E, Ascierto PA, Petrillo A. Management of cutaneous melanoma: radiologists challenging and risk assessment. LA RADIOLOGIA MEDICA 2022; 127:899-911. [PMID: 35834109 DOI: 10.1007/s11547-022-01522-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/27/2022] [Indexed: 02/07/2023]
Abstract
Melanoma patient remains a challenging for the radiologist, due to the difficulty related to the management of a patient more often in an advanced stage of the disease. It is necessary to determine a stratification of risk, optimizing the means, with diagnostic tools that should be optimized in relation to the type of patient, and improving knowledge. Staging and risk assessment procedures are determined by disease presentation at diagnosis. Melanoma staging is a critical tool to assist clinical decision-making and prognostic assessment. It is used for clinical trial design, eligibility, stratification, and analysis. The current standard for regional lymph nodes staging is represented by the sentinel lymph node excision biopsy procedure. For staging of distant metastases, PET-CT has the highest sensitivity and diagnostic odds ratio. Similar trend is observed during melanoma surveillance. The advent of immunotherapy, which has improved patient outcome, however, has determined new issues for radiologists, partly due to atypical response patterns, partly due to adverse reactions that must be identified as soon as possible for the correct management of the patient. The main objectives of the new ir-criteria are to standardize the assessment between different trials. However, these ir-criteria do not take into account all cases of atypical response patterns, as hyperprogression or dissociated responses. None of these criteria has actually been uniformly adopted in routine. The immune-related adverse events (irAEs) can involve various organs from head to toe. It is crucial for radiologists to know the imaging appearances of this condition, to exclude recurrent or progressive disease and for pneumonitis, since it could be potentially life-threatening toxicity, resulting in pneumonitis-related deaths in early phase trials, to allow a proper patient management.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy.
| | - Igino Simonetti
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | | | - Sergio Venanzio Setola
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgical Oncology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia",, Via Mariano Semmola, Naples, Italy
| | - Luigi Scarpato
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Vito Vanella
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Lucia Festino
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Ester Simeone
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Paolo Antonio Ascierto
- Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia", Via Mariano Semmola, Naples, Italy
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Whole-Body MRI for the Detection of Recurrence in Melanoma Patients at High Risk of Relapse. Cancers (Basel) 2021; 13:cancers13030442. [PMID: 33503861 PMCID: PMC7865287 DOI: 10.3390/cancers13030442] [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: 12/27/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: No standard protocol for surveillance for melanoma patients is established. Whole-body magnetic resonance imaging (whole-body MRI) is a safe and sensitive technique that avoids exposure to X-rays and contrast agents. This prospective study explores the use of whole-body MRI for the early detection of recurrences. Material and Methods: Patients with American Joint Committee on Cancer Staging Manual (seventh edition; AJCC-7) stages IIIb/c or -IV melanoma who were disease-free following resection of macrometastases (cohort A), or obtained a durable complete response (CR) or partial response (PR) following systemic therapy (cohort B), were included. All patients underwent whole-body MRI, including T1, Short Tau Inversion Recovery, and diffusion-weighted imaging, every 4 months the first 3 years of follow-up and every 6 months in the following 2 years. A total body skin examination was performed every 6 months. Results: From November 2014 to November 2019, 111 patients were included (four screen failures, cohort A: 68 patients; cohort B: 39 patients). The median follow-up was 32 months. Twenty-six patients were diagnosed with suspected lesions. Of these, 15 patients were diagnosed with a recurrence on MRI. Eleven suspected lesions were considered to be of non-neoplastic origin. In addition, nine patients detected a solitary subcutaneous metastasis during self-examination, and two patients presented in between MRIs with recurrences. The overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 58%, 98%, 58%, 98%, and 98%. Sensitivity and specificity for the detection of distant metastases was respectively 88% and 98%. No patient experienced a clinically meaningful (>grade 1) adverse event. Conclusions: Whole-body MRI for the surveillance of melanoma patients is a safe and sensitive technique sparing patients' cumulative exposure to X-rays and contrast media.
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Naeser Y, Helgadottir H, Brandberg Y, Hansson J, Bagge RO, Elander NO, Ingvar C, Isaksson K, Flygare P, Nilsson C, Jakobsson F, Del Val Munoz O, Valachis A, Jansson M, Sparring C, Ohlsson L, Dyrke U, Papantoniou D, Sundin A, Ullenhag GJ. TRIM study protocol - a prospective randomized multicenter Trial to assess the Role of Imaging during follow-up after radical surgery of stage IIB-C and III cutaneous malignant Melanoma. BMC Cancer 2020; 20:1197. [PMID: 33287744 PMCID: PMC7720485 DOI: 10.1186/s12885-020-07632-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of cutaneous malignant melanoma (CMM) is increasing worldwide. In Sweden, over 4600 cases were diagnosed in 2018. The prognosis after radical surgery varies considerably with tumor stage. In recent years, new treatment options have become available for metastatic CMM. Early onset of treatment seems to improve outcome, which suggests that early detection of recurrent disease should be beneficial. Consequently, in several countries imaging is a part of the routine follow-up program after surgery of high risk CMM. However, imaging has drawbacks, including resources required (costs, personnel, equipment) and the radiation exposure. Furthermore, many patients experience anxiety in waiting for the imaging results and investigations of irrelevant findings is another factor that also could cause worry and lead to decreased quality of life. Hence, the impact of imaging in this setting is important to address and no randomized study has previously been conducted. The Swedish national guidelines stipulate follow-up for 3 years by clinical examinations only. METHODS The TRIM study is a prospective randomized multicenter trial evaluating the potential benefit of imaging and blood tests during follow-up after radical surgery for high-risk CMM, compared to clinical examinations only. Primary endpoint is overall survival (OS) at 5 years. Secondary endpoints are survival from diagnosis of relapse and health-related quality of life (HRQoL). Eligible for inclusion are patients radically operated for CMM stage IIB-C or III with sufficient renal function for iv contrast-enhanced CT and who are expected to be fit for treatment in case of recurrence. The planned number of patients is > 1300. Patients are randomized to clinical examinations for 3 years +/- whole-body imaging with CT or FDG-PET/CT and laboratory tests including S100B protein and LDH. This academic study is supported by the Swedish Melanoma Study Group. DISCUSSION This is the first randomized prospective trial on the potential benefit of imaging as a part of the follow-up scheme after radical surgery for high-risk CMM. RESULTS The first patient was recruited in June 2017 and as of April 2020, almost 500 patients had been included at 19 centers in Sweden. TRIAL REGISTRATION ClinicalTrials.gov , NCT03116412 . Registered 17 April 2017, https://clinicaltrials.gov/ct2/show/study/NCT03116412.
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Affiliation(s)
- Ylva Naeser
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck laboratory, 75185, Uppsala, Sweden
- Department of Oncology, Uppsala University Hospital, entrance 101, 1tr, 75185, Uppsala, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital Solna, 17164, Solna, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Johan Hansson
- Department of Oncology, Karolinska University Hospital Solna, 17164, Solna, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nils O Elander
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
| | - Christian Ingvar
- Department of Surgery, Clinical Sciences, Lund University, BMC F12, 22184, Lund, Sweden
| | - Karolin Isaksson
- Department of Surgery, Central Hospital Kristianstad, 29133, Kristianstad, Sweden
- Department of Clinical Sciences, Surgery, Lund University, BMC F12, 22184, Lund, Sweden
| | - Petra Flygare
- Department of Oncology, Sundsvall County Hospital, Lasarettsgatan 21, 856 43, Sundsvall, Sweden
| | - Cecilia Nilsson
- Department of Oncology, Hospital of Västmanland Västerås, 72189, Västerås, Sweden
| | - Frida Jakobsson
- Department of Oncology, Örebro University Hospital, 70185, Örebro, Sweden
| | | | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden
| | - Malin Jansson
- Department of Surgical and perioperative sciences, Umeå University and Umeå University Hospital, 90185, Umeå, Sweden
| | - Charlotte Sparring
- Department of Dermatology, Skaraborg County Hospital, 54185, Skövde, Sweden
| | - Lars Ohlsson
- Department of Surgery, Karlstad County Hospital, Rosenborgsgatan 9, 65230, Karlstad, Sweden
| | - Ulf Dyrke
- Department of Surgery, Falun County Hospital, 79182, Falun, Sweden
| | | | - Anders Sundin
- Department of Surgical Sciences Radiology & Molecular Imaging, Uppsala University, 75185, Uppsala, Sweden
| | - Gustav J Ullenhag
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck laboratory, 75185, Uppsala, Sweden.
- Department of Oncology, Uppsala University Hospital, entrance 101, 1tr, 75185, Uppsala, Sweden.
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Michielin O, van Akkooi ACJ, Ascierto PA, Dummer R, Keilholz U. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol 2019; 30:1884-1901. [PMID: 31566661 DOI: 10.1093/annonc/mdz411] [Citation(s) in RCA: 343] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- O Michielin
- Department of Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - A C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - P A Ascierto
- Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Napoli, Italy
| | - R Dummer
- Department of Dermatology, Skin Cancer Centre, University Hospital Zürich, Zürich, Switzerland
| | - U Keilholz
- Charité Comprehensive Cancer Centre, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Voss RK, Woods TN, Cromwell KD, Nelson KC, Cormier JN. Improving outcomes in patients with melanoma: strategies to ensure an early diagnosis. PATIENT-RELATED OUTCOME MEASURES 2015; 6:229-42. [PMID: 26609248 PMCID: PMC4644158 DOI: 10.2147/prom.s69351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patients with thin, low-risk melanomas have an excellent long-term prognosis and higher quality of life than those who are diagnosed at later stages. From an economic standpoint, treatment of early stage melanoma consumes a fraction of the health care resources needed to treat advanced disease. Consequently, early diagnosis of melanoma is in the best interest of patients, payers, and health care systems. This review describes strategies to ensure that patients receive an early diagnosis through interventions ranging from better utilization of primary care clinics, to in vivo diagnostic technologies, to new "apps" available in the market. Strategies for screening those at high risk due to age, male sex, skin type, nevi, genetic mutations, or family history are discussed. Despite progress in identifying those at high risk for melanoma, there remains a lack of general consensus worldwide for best screening practices. Strategies to ensure early diagnosis of recurrent disease in those with a prior melanoma diagnosis are also reviewed. Variations in recurrence surveillance practices by type of provider and country are featured, with evidence demonstrating that various imaging studies, including ultrasound, computed tomography, positron emission tomography, and magnetic resonance imaging, provide only minimal gains in life expectancy, even for those with more advanced (stage III) disease. Because the majority of melanomas are attributable to ultraviolet radiation in the form of sunlight, primary prevention strategies, including sunscreen use and behavioral interventions, are reviewed. Recent international government regulation of tanning beds is described, as well as issues surrounding the continued use artificial ultraviolet sources among youth. Health care stakeholder strategies to minimize UV exposure are summarized. The recommendations encompass both specific behaviors and broad intervention targets (eg, individuals, social spheres, organizations, celebrities, governments).
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Affiliation(s)
- Rachel K Voss
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tessa N Woods
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly C Nelson
- Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Dummer R, Hauschild A, Lindenblatt N, Pentheroudakis G, Keilholz U. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v126-32. [PMID: 26314774 DOI: 10.1093/annonc/mdv297] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- R Dummer
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - N Lindenblatt
- Division of Plastic and Reconstructive Surgery, University Hospital Zürich, Zürich, Switzerland
| | | | - U Keilholz
- Charité Comprehensive Cancer Center, Charité-Universitätsmedizin, Berlin, Germany
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Rueth NM, Cromwell KD, Cormier JN. Long-term follow-up for melanoma patients: is there any evidence of a benefit? Surg Oncol Clin N Am 2015; 24:359-77. [PMID: 25769718 DOI: 10.1016/j.soc.2014.12.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
As the incidence of melanoma and the number of melanoma survivors continues to rise, optimal surveillance strategies are needed that balance the risks and benefits of screening in the context of contemporary resource use. Detection of recurrences has important implications for clinical management. Most current surveillance recommendations for melanoma survivors are based on low-level evidence with wide variations in practice patterns and an unknown clinical impact for the melanoma survivor.
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Affiliation(s)
- Natasha M Rueth
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA
| | - Kate D Cromwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA
| | - Janice N Cormier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1484, 1400 Holcombe Boulevard, Houston, TX 77230-1402, USA.
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Cutaneous melanoma: Medical specialists' opinions on follow-up and sentinel lymph node biopsy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:1276-83. [DOI: 10.1016/j.ejso.2014.02.240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/10/2014] [Accepted: 02/21/2014] [Indexed: 11/15/2022]
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9
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Davidson M, Lorigan P, Larkin J. High-risk cutaneous melanoma follow-up: time for more intensive surveillance? Melanoma Manag 2014; 1:7-10. [PMID: 30190803 DOI: 10.2217/mmt.14.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Michael Davidson
- Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.,The Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK
| | - Paul Lorigan
- The Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK.,The Christie Hospital, Wilmslow Road, Manchester, M20 4BX, UK
| | - James Larkin
- Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.,Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
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Speijers MJ, Francken AB, Hoekstra-Weebers JEHM, Bastiaannet E, Kruijff S, Hoekstra HJ. Optimal follow-up for melanoma. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.10.38] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Variability in melanoma post-treatment surveillance practices by country and physician specialty: a systematic review. Melanoma Res 2013; 22:376-85. [PMID: 22914178 DOI: 10.1097/cmr.0b013e328357d796] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
There are no evidence-based guidelines for the surveillance of patients with melanoma following surgical treatment. We carried out a systematic review to identify by country and physician specialty the current stage-specific surveillance practices for patients with melanoma. Three major medical indices, MEDLINE, the Cochrane Library database, and Scopus, were reviewed to identify articles published from January 1970 to October 2011 that included detailed information about the surveillance of patients with melanoma after the initial surgical treatment. Data on surveillance intervals and recommended evaluation were extracted and categorized by country and, when reported, physician specialty. One hundred and four articles from 10 countries and four physician specialties (dermatology, surgical oncology, medical oncology, and general practice) fulfilled the inclusion criteria, including 43 providing specific patient-level data. The articles showed a wide variation with respect to the surveillance intervals and recommended evaluations. The variation was greatest for patients with stage I disease, for whom the follow-up frequency ranged from one to six visits per year during years 1 and 2 after treatment. All four physician specialties agreed that for years 1-3, the follow-up frequency should be four times per year for all patients. For years 4 and 5, surgical oncologists recommended two follow-up visits per year, whereas general practitioners, dermatologists, and medical oncologists recommended four visits per year. Recommended imaging and laboratory evaluations were most intense in the UK and most minimalist in the Netherlands. Although general practitioners did not recommend routine laboratory or imaging tests for surveillance, all other specialties utilized both in their surveillance practice. Self skin-examination was recommended for surveillance in all countries and by all practitioner specialties. There are significant intercountry and interspecialty variations in the surveillance of patients with melanoma. As the number of melanoma survivors increases, it will be critical to examine the benefits and costs of various follow-up strategies to establish consensus guidelines for melanoma post-treatment surveillance.
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12
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Salama AKS, de Rosa N, Scheri RP, Pruitt SK, Herndon JE, Marcello J, Tyler DS, Abernethy AP. Hazard-rate analysis and patterns of recurrence in early stage melanoma: moving towards a rationally designed surveillance strategy. PLoS One 2013; 8:e57665. [PMID: 23516415 PMCID: PMC3596369 DOI: 10.1371/journal.pone.0057665] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 01/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND While curable at early stages, few treatment options exist for advanced melanoma. Currently, no consensus exists regarding the optimal surveillance strategy for patients after resection. The objectives of this study were to identify patterns of metastatic recurrence, to determine the influence of metastatic site on survival, and to identify high-risk periods for recurrence. METHODS A retrospective review of the Duke Melanoma Database from 1970 to 2004 was conducted that focused on patients who were initially diagnosed without metastatic disease. The time to first recurrence was computed from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. Metastatic sites were coded by the American Joint Committee on Cancer (AJCC) system including local skin, distant skin and nodes (M1a), lung (M1b), and other distant (M1c). RESULTS Of 11,615 patients initially diagnosed without metastatic disease, 4616 (40%) had at least one recurrence. Overall the risk of initial recurrence peaked at 12 months. The risk of initial recurrence at the local skin, distant skin, and nodes peaked at 8 months, and the risk at lung and other distant sites peaked at 24 months. Patients with a cutaneous or nodal recurrence had improved survival compared to other recurrence types. CONCLUSIONS The risk of developing recurrent melanoma peaked at one year, and the site of first recurrence had a significant impact on survival. Defining the timing and expected patterns of recurrence will be important in creating an optimized surveillance strategy for this patient population.
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Affiliation(s)
- April K. S. Salama
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Nicole de Rosa
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Randall P. Scheri
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Scott K. Pruitt
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - James E. Herndon
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Jennifer Marcello
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Douglas S. Tyler
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Amy P. Abernethy
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
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13
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Patients' perspectives of long-term follow-up for localised cutaneous melanoma. Eur J Surg Oncol 2013; 39:297-303. [DOI: 10.1016/j.ejso.2012.12.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 11/28/2012] [Accepted: 12/17/2012] [Indexed: 11/20/2022] Open
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14
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Dummer R, Hauschild A, Guggenheim M, Keilholz U, Pentheroudakis G. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 23 Suppl 7:vii86-91. [PMID: 22997461 DOI: 10.1093/annonc/mds229] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Dummer
- Dermatologische Klinik, UniversitätsSpital Zürich, CH-8091 Zürich, Switzerland
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Rychetnik L, McCaffery K, Morton RL, Thompson JF, Menzies SW, Irwig L. Follow-up of early stage melanoma: specialist clinician perspectives on the functions of follow-up and implications for extending follow-up intervals. J Surg Oncol 2012; 107:463-8. [PMID: 23090908 DOI: 10.1002/jso.23278] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/24/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is limited evidence on the relative effectiveness of different follow-up schedules for patients with AJCC stage I or II melanoma, but less frequent follow-up than is currently recommended has been proposed. OBJECTIVES To describe melanoma clinicians' perspectives on the functions of follow-up, factors that influence follow-up intervals, and important considerations for extending intervals. METHODS Qualitative interviews with 16 clinicians (surgical oncologists, dermatologists, melanoma unit physicians) who conduct follow-up at two of Australia's largest specialist centers. RESULTS Follow-up is conducted for early detection of recurrences or new primary melanomas, to manage patient anxiety, support patient self-care, and as part of shared care. Recommended intervals are based on guidelines but account for each patient's clinical risk profile, level of anxiety, patient education requirements, capacity to engage in skin self-examination, and how the clinician prefers to manage any suspicious lesions. CONCLUSIONS To revise guidelines and implement change it is important to understand the rationale underpinning existing practice. Extended follow-up intervals for early stage melanoma are more likely to be adopted after the first year when patients are less anxious and sufficiently prepared to conduct self-examination. Clinicians may retain existing schedules for highly anxious patients or those unable to examine themselves.
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Affiliation(s)
- Lucie Rychetnik
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, Sydney, Australia.
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Mansour D, Kejariwal D. It is never too late: ultra-late recurrence of melanoma with distant metastases. BMJ Case Rep 2012; 2012:bcr.01.2012.5474. [PMID: 22605581 DOI: 10.1136/bcr.01.2012.5474] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors present the case of a 73-year-old lady presenting with weight loss, personality changes, transient confusion and visual loss, 38 years after initial surgical excision of a melanoma of the neck. CT and MRI of the brain showed cerebral metastases and positron emission tomography (PET)-CT showed an additional fludeoxyglucose avid lesion in the lung, which was biopsied. Histology confirmed metastatic malignant melanoma. She declined whole brain radiotherapy in favour of best supportive care and died 4 months after diagnosis. Life-long vigilance among patients with previous melanoma and awareness among physicians are necessary if late recurrences are to be recognised early, and outcomes improved. New imaging techniques including PET-CT may be helpful in diagnosing and staging melanoma recurrence. Treatment options for patients presenting with distant metastases are limited and the prognosis remains poor.
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Affiliation(s)
- Dina Mansour
- Department of Medicine, University Hospital of North Durham, Durham, UK.
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Fields RC, Coit DG. Evidence-Based Follow-up for the Patient with Melanoma. Surg Oncol Clin N Am 2011; 20:181-200. [DOI: 10.1016/j.soc.2010.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Dummer R, Hauschild A, Guggenheim M, Jost L, Pentheroudakis G. Melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v194-7. [DOI: 10.1093/annonc/mdq188] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Francken AB, Hoekstra HJ. Follow-Up of Melanoma Patients: The Need for Evidence-Based Protocols. Ann Surg Oncol 2009; 16:804-5. [DOI: 10.1245/s10434-009-0318-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 11/20/2008] [Indexed: 11/18/2022]
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Meyers MO, Yeh JJ, Frank J, Long P, Deal AM, Amos KD, Ollila DW. Method of detection of initial recurrence of stage II/III cutaneous melanoma: analysis of the utility of follow-up staging. Ann Surg Oncol 2008; 16:941-7. [PMID: 19101766 DOI: 10.1245/s10434-008-0238-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2008] [Revised: 10/06/2008] [Accepted: 10/08/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND The follow-up of patients with cutaneous melanoma is controversial. Current recommendations suggest routine history and physical examination every 3 to 6 months for the first 3 years and correlate studies including laboratory tests and radiographic imaging. However, the utility of these recommendations are unclear. The purpose of this study was to determine the impact of routine imaging on the method of detection of first recurrence in patients with stage II and sentinel lymph node-positive stage III melanoma. METHODS We analyzed a prospective database of all cutaneous melanoma patients treated at our institution from 1997 to 2005 who had at least 2 years of follow-up. The method of detection of initial recurrence was analyzed. RESULTS One hundred eighteen patients with stage II (n = 83) or III (n = 35) melanoma who were followed for at least 2 years were identified. Forty-three of these patients developed recurrence (median time to recurrence, 14 months). Site of first recurrence was as follows: 4 local, 17 in transit, 7 regional lymph node, and 15 distant. Twenty-nine recurrences (67%) were either patient detected or symptomatic. Eleven (26%) were detected by the physician at routine follow-up. Only three (7%) were identified by imaging (two chest X-ray and one brain magnetic resonance imaging) in an otherwise asymptomatic patient. CONCLUSIONS Two-thirds of all initial recurrences of cutaneous melanoma were either detected by a patient or were symptomatic, with most of the remainder detected during routine physical examination. Routine imaging added little value in the detection of initial recurrence.
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Affiliation(s)
- Michael O Meyers
- Department of Surgery and The Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7213, USA.
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Morton RL, Craig JC, Thompson JF. The Role of Surveillance Chest X-Rays in the Follow-Up of High-Risk Melanoma Patients. Ann Surg Oncol 2008; 16:571-7. [DOI: 10.1245/s10434-008-0207-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 09/18/2008] [Accepted: 09/22/2008] [Indexed: 11/18/2022]
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Francken AB, Shaw HM, Thompson JF. Detection of second primary cutaneous melanomas. Eur J Surg Oncol 2008; 34:587-92. [PMID: 17681449 DOI: 10.1016/j.ejso.2007.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 06/18/2007] [Indexed: 10/23/2022] Open
Abstract
AIMS There have been few studies investigating the value of follow-up in the detection of second primary melanomas (SPMs) and there is scant information on the role of self-surveillance by the patient. The aim of this study was to assess the frequency of patient detection of both first primary melanomas (FPMs) and SPMs. PATIENTS AND METHODS Patients were interviewed to determine who detected their FPM and SPM (in situ or invasive). The associations between clinical and pathological factors and the person who identified the FPM and SPM were examined using multivariate analysis. RESULTS One hundred and twelve patients with a recently diagnosed SPM were treated at the Sydney Melanoma Unit (July 2001 to March 2003). Patients detected 59% of the FPMs as compared with 46% of the SPMs. Female gender, greater Breslow tumour thickness and younger age were significant predictors for a patient-detected FPM (Odds Ratio: 4.9 (Confidence Interval 1.5-16.0), 3.2 (1.65-6.04), and 0.9 (0.9-1.0), respectively). Greater tumour thickness and ready visibility of the lesion to the patient were predicting factors for patient detection of a SPM (Odds Ratio: 1.9 (Confidence Interval 1.1-3.3) and 3.6 (1.4-9.1), respectively). CONCLUSIONS A history of melanoma does not increase the ability of patients to detect new or thinner primary melanomas themselves. Therefore, patients may benefit from regular clinical review by clinicians, who play an important role in the detection of new melanomas.
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Affiliation(s)
- A B Francken
- Sydney Melanoma Unit, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales Australia
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