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Shahid M, Davis S, Peters G, Loh D, McGuane J, Fergusson J. Hepatic resection for metastatic melanoma in the era of targeted therapy: A case report. Int J Surg Case Rep 2024; 121:110033. [PMID: 39018727 DOI: 10.1016/j.ijscr.2024.110033] [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: 05/25/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
INTRODUCTION While prognosis in metastatic melanoma has traditionally been poor, novel systemic therapies such as immunotherapy and targeted agents have improved overall survival (Steininger et al., 2021). These medications are generally well tolerated but can be associated with immune related adverse events (Remash et al., 2021). Hepatic metastatectomy is an important component of management, conferring a survival benefit over systemic therapy alone in appropriately selected patients (Medina et al., 2020). Gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI) has been demonstrated to have enhanced diagnostic accuracy compared with other imaging modalities for hepatic metastases (Freitas et al., 2021). The risk of tumour seeding associated fine-needle aspiration biopsy (FNAB) of hepatic lesions varies, with most studies reporting a low incidence (Maturen et al., 2006). PRESENTATION OF CASE In February 2020, a 75-year-old male underwent wide local excision and sentinel lymph node biopsy for stage IIA (T2B, N0, M0) melanoma. Routine surveillance without adjuvant systemic treatment was commenced. In July 2022, he presented with haemoptysis and was subsequently diagnosed with widespread metastatic disease on positive emission tomography (PET). After combination ipilimumab and nivolumab, PET scans in August 2023 revealed new liver lesions with disease response at all other metastatic sites. Following a multi-disciplinary team (MDT) discussion, the patient proceeded to hepatic metastatectomy. Histopathology demonstrated chronic necrotising granulomatous hepatitis. DISCUSSION This case reflects the challenges involved in investigation and management of hepatic metastases in melanoma. CONCLUSION Despite the accuracy of modern imaging, this case demonstrates the need for MDT consideration of liver biopsy in patients on anti-CTL4 treatment or with response to systemic treatment at extrahepatic sites.
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Affiliation(s)
- Monica Shahid
- The Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory, Australia; School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton, Canberra, Australian Capital Territory, Australia.
| | - Sean Davis
- The Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory, Australia; The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Geoffrey Peters
- The Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory, Australia; School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton, Canberra, Australian Capital Territory, Australia
| | - Daphne Loh
- The Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory, Australia; School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton, Canberra, Australian Capital Territory, Australia
| | - Jonathan McGuane
- The Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory, Australia; School of Medicine and Psychology, College of Health and Medicine, Australian National University, 54 Mills Road, Acton, Canberra, Australian Capital Territory, Australia
| | - James Fergusson
- The Canberra Hospital, Yamba Drive, Garran, Canberra, Australian Capital Territory, Australia
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Yan K, Zhang W, Song H, Xu X. Sphingolipid metabolism and regulated cell death in malignant melanoma. Apoptosis 2024:10.1007/s10495-024-02002-y. [PMID: 39068623 DOI: 10.1007/s10495-024-02002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2024] [Indexed: 07/30/2024]
Abstract
Malignant melanoma (MM) is a highly invasive and therapeutically resistant skin malignancy, posing a significant clinical challenge in its treatment. Programmed cell death plays a crucial role in the occurrence and progression of MM. Sphingolipids (SP), as a class of bioactive lipids, may be associated with many kinds of diseases. SPs regulate various forms of programmed cell death in tumors, including apoptosis, necroptosis, ferroptosis, and more. This review will delve into the mechanisms by which different types of SPs modulate various forms of programmed cell death in MM, such as their regulation of cell membrane permeability and signaling pathways, and how they influence the survival and death fate of MM cells. An in-depth exploration of the role of SPs in programmed cell death in MM aids in unraveling the molecular mechanisms of melanoma development and holds significant importance in developing novel therapeutic strategies.
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Affiliation(s)
- Kexin Yan
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Wei Zhang
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China
| | - Hao Song
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China.
| | - Xiulian Xu
- Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China.
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Cash CJ, Pearson JM, Milikowski C, Feun L, Ritch C, Möller MG. Management of intramuscular melanoma metastases to the psoas. BMJ Case Rep 2024; 17:e257500. [PMID: 38839419 DOI: 10.1136/bcr-2023-257500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
We detail a case of a woman in her 40s with isolated melanoma skeletal muscle metastasis (MSMM) to the right psoas muscle. This patient underwent R0 surgical resection through a novel pelvic approach. She received subsequent adjuvant immunotherapy with Braftovi/Mektov along with adjuvant radiation. She is currently disease free at 9 months post surgery. Here, we describe our novel surgical approach including description of the tumour pathology. We explain our multidisciplinary management of MSMM consisting of a multidisciplinary surgical approach by surgical oncology, gynecological oncology and urology as well as multidisciplinary medical management by oncology, radiation oncology and pathology. Finally, we discuss best current options for therapeutic management.
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Affiliation(s)
- Charles Joseph Cash
- Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph Matthew Pearson
- Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Clara Milikowski
- Department of Pathology and Laboratory Medicine, University of Miami School of Medicine, Miami, Florida, USA
| | - Lynn Feun
- Department of Hematology and Oncology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Chad Ritch
- Department of Urologic Oncology, University of Miami Miller School of Medicine, Miami, Flordia, USA
| | - Mecker G Möller
- University of Miami Miller School of Medicine, Miami, Florida, USA
- Surgical Oncology, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Meretsky CR, Schiuma AT. Comparative Analysis of Slow Mohs Surgery in Melanoma and Mohs Micrographic Surgery in Squamous Cell Carcinoma and Basal Cell Carcinoma. Cureus 2024; 16:e59693. [PMID: 38840983 PMCID: PMC11150169 DOI: 10.7759/cureus.59693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
Skin cancer is one of the most common types of cancer worldwide, and it can affect people of all ages, races, and genders. Mohs micrographic surgery (MMS), a specialized type of skin cancer surgery, boasts the highest cure rates for various types of skin malignancies. Slow Mohs surgery (SMS) is a methodical and meticulous approach to MMS that involves careful and deliberate examination of tissue samples to ensure the complete removal of skin cancer while preserving as much healthy tissue as possible. Both SMS and MMS have been indicated to be effective treatment options for skin cancer, depending on the type and stage of cancer. This case-control study analysis compares the efficacy of SMS for melanoma with that of MMS for squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). We analyzed data from the past two decades to assess recurrence rates and treatment-related complications. Our findings suggest that SMS for melanoma achieves comparable outcomes to MMS in SCC and BCC. Both approaches demonstrated similar cure rates and complication profiles. However, further prospective studies are necessary to solidify these findings and refine the specific role of SMS in melanoma therapy.
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Switzer B, Puzanov I, Skitzki JJ, Hamad L, Ernstoff MS. Managing Metastatic Melanoma in 2022: A Clinical Review. JCO Oncol Pract 2022; 18:335-351. [PMID: 35133862 PMCID: PMC9810138 DOI: 10.1200/op.21.00686] [Citation(s) in RCA: 87] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Cutaneous melanoma remains the most lethal of the primary cutaneous neoplasms, and although the incidence of primary melanoma continues to rise, the mortality from metastatic disease remains unchanged, in part through advances in treatment. Major developments in immunomodulatory and targeted therapies have provided robust improvements in response and survival trends that have transformed the clinical management of patients with metastatic melanoma. Additional advances in immunologic and cancer cell biology have contributed to further optimization in (1) risk stratification, (2) prognostication, (3) treatment, (4) toxicity management, and (5) surveillance approaches for patients with an advanced melanoma diagnosis. In this review, we provide a comprehensive overview of the historical and future advances regarding the translational and clinical implications of advanced melanoma and share multidisciplinary recommendations to aid clinicians in the navigation of current treatment approaches for a variety of patient cohorts.
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Affiliation(s)
- Benjamin Switzer
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Igor Puzanov
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Joseph J. Skitzki
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lamya Hamad
- Department of Pharmacy, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Marc S. Ernstoff
- ImmunoOncology Branch, Developmental Therapeutics Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, MD,Marc S. Ernstoff, MD, National Cancer Institute, Rockville, MD 20850; e-mail:
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Guan M, Zhu S, Li S. Recent Progress in Nanomedicine for Melanoma Theranostics With Emphasis on Combination Therapy. Front Bioeng Biotechnol 2021; 9:661214. [PMID: 33777924 PMCID: PMC7991305 DOI: 10.3389/fbioe.2021.661214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Melanoma is an aggressive type of skin cancer with increasing incidence and high mortality rates worldwide. However, there is still a lack of efficient and resolutive treatment strategies, particularly in clinical settings. Currently, nanomedicine, an emerging area in the medical field, is being widely investigated in small animal models to afford melanoma theranostics. However, several problems, such as tumor heterogeneity, and drug resistance treatment with a single therapy, remain unresolved. Previous reviews have primarily focused on monotherapy for melanoma in the context of nanomedicine. In this review article, we summarize the recent progress in the application of nanomedicine for melanoma treatment, with particular attention to combination therapy based on nanomedicine to achieve optimized therapeutic output for melanoma treatment. In addition, we also highlight the fluorescence-guided strategies for intraoperative melanoma detection, especially in the near-infrared imaging window with greatly improved imaging contrast and penetration depth.
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Affiliation(s)
- Mengqi Guan
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
| | - Shoujun Zhu
- Joint Laboratory of Opto-Functional Theranostics in Medicine and Chemistry, The First Hospital of Jilin University, Changchun, China.,State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun, China
| | - Shanshan Li
- Department of Dermatology and Venerology, The First Hospital of Jilin University, Changchun, China
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Liu S, Zhu Y, Cheng H, Zhong M, Hu Y, Li Q, Gao X. The efficacy and safety of combined ipilimumab and nivolumab versus ipilimumab in patients with Stage III/IV unresectable melanoma: A systematic review and meta-analysis. J Cancer Res Ther 2021; 17:1679-1688. [DOI: 10.4103/jcrt.jcrt_1669_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brachytherapy in a Single Dose of 10Gy as an "in situ" Vaccination. Int J Mol Sci 2020; 21:ijms21134585. [PMID: 32605154 PMCID: PMC7369911 DOI: 10.3390/ijms21134585] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy (RT) is one of the major methods of cancer treatment. RT destroys cancer cells, but also affects the tumor microenvironment (TME). The delicate balance between immunomodulation processes in TME is dependent, among other things, on a specific radiation dose. Despite many studies, the optimal dose has not been clearly determined. Here, we demonstrate that brachytherapy (contact radiotherapy) inhibits melanoma tumor growth in a dose-dependent manner. Doses of 10Gy and 15Gy cause the most effective tumor growth inhibition compared to the control group. Brachytherapy, at a single dose of ≥ 5Gy, resulted in reduced tumor blood vessel density. Only a dose of 10Gy had the greatest impact on changes in the levels of tumor-infiltrating immune cells. It most effectively reduced the accumulation of protumorogenic M2 tumor-associated macrophages and increased the infiltration of cytotoxic CD8+ T lymphocytes. To summarize, more knowledge about the effects of irradiation doses in anticancer therapy is needed. It may help in the optimization of RT treatment. Our results indicate that a single dose of 10Gy leads to the development of a robust immune response. It seems that it is able to convert a tumor microenvironment into an “in situ” vaccine and lead to a significant inhibition of tumor growth.
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