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Maurichi A, Barretta F, Patuzzo R, Sala L, Miceli R, Gallino G, Mattavelli I, Leva A, Simonotti N, Taglione B, Cossa M, Belotti A, Valeri B, Cortinovis U, Santinami M. Association of Excision Margin Size With Local Recurrence and Survival in Patients With T1a Melanoma at Critical Structures. JAMA Dermatol 2023; 159:587-595. [PMID: 37043209 PMCID: PMC10099098 DOI: 10.1001/jamadermatol.2023.0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/16/2023] [Indexed: 04/13/2023]
Abstract
Importance Melanoma guidelines recommend surgical excision with 10-mm margins for T1 melanoma. However, this procedure may be problematic at sites close to critical structures such as the scalp, face, external genitalia, acral, periumbilical, and perineal areas. Objective To compare outcomes of wide (10-mm margins) vs narrow (5-mm margins) excision in patients with T1a melanoma near critical structures. Design, Setting, and Participants This cohort study was a retrospective comparison of 1341 consecutive patients aged 18 years or older from the National Cancer Institute of Milan, Italy, diagnosed between 2001 and 2020 with T1a cutaneous melanoma close to critical structures who accepted wide excision vs narrow excision. Exposures Local recurrence and melanoma-specific mortality (MSM) rates with 5-mm vs 10-mm excision margins. Main Outcomes and Measures The primary aim of the study was to ascertain whether a narrower (5-mm) vs wider (10-mm) excision margin was associated with local recurrence and MSM. The secondary aim was to compare the need for reconstructive surgery in the groups defined by excision margin width. Between April 28 and August 7, 2022, associations were assessed by weighted Cox and Fine-Gray univariable and multivariable models. Results A total of 1179 patients met the inclusion criteria (median [IQR] age, 50.0 [39.5-63.0] years; female, 610 [51.7%]; male, 569 [49.3%]). Six hundred twenty-six patients (53.1%) received a wide excision (434 [69.3%] with linear repair and 192 [30.7%] with flap or graft reconstruction) and 553 (46.9%) received a narrow excision (491 [88.8%] with linear repair and 62 [11.2%] with flap or graft reconstruction). The weighted 10-year MSM was 1.8% (95% CI, 0.8%-4.2%) in the wide group and 4.2% (95% CI, 2.2%-7.9%) in the narrow group; the weighted 10-year local recurrence rate was 5.7% (95% CI, 3.9%-8.3%) in the wide group and 6.7% (95% CI, 4.7%-9.5%) in the narrow group. Breslow thickness greater than 0.4 mm (subdistribution hazard ratio [sHR] for 0.6 vs 0.4 mm, 2.42; 95% CI, 1.59-3.68; P < .001) and mitotic rate greater than 1/mm2 (sHR for a single increment, 3.35; 95% CI, 2.59-4.32; P < .001) were associated with worse MSM. Multivariable analysis showed that acral lentiginous melanoma, lentigo maligna melanoma, and increasing Breslow thickness were associated with a higher incidence of local recurrence. Conclusions and Relevance The study's findings suggest that local excision with 5-mm margins for T1a melanoma may not be associated with an increased risk of local recurrence. Breslow thickness greater than 0.4 mm, mitotic rate greater than 1/mm2, and acral lentiginous melanoma and lentigo maligna melanoma subtypes were associated with a higher risk of recurrence. These findings may be useful for future melanoma treatment guidelines.
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Affiliation(s)
- Andrea Maurichi
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Francesco Barretta
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Roberto Patuzzo
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Laura Sala
- Plastic and Reconstructive Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Rosalba Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Gianfranco Gallino
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Mattavelli
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Andrea Leva
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Nicolò Simonotti
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Bianca Taglione
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mara Cossa
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Alessia Belotti
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Barbara Valeri
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Umberto Cortinovis
- Plastic and Reconstructive Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Mario Santinami
- Melanoma Surgical Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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2
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Bladen JC, Malhotra R, Litwin A. Long-term outcomes of margin-controlled excision for eyelid melanoma. Eye (Lond) 2023; 37:1009-1013. [PMID: 36828958 PMCID: PMC10049999 DOI: 10.1038/s41433-023-02428-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES To provide evidence for long-term outcomes for margin-controlled excision of eyelid melanoma. METHODS Retrospective single-centre observational case series of patients treated for eyelid melanoma between 2007 and 2016, with a minimum of 5-year follow-up. Tumour excision involved rush-paraffin en face horizontal sections and delayed repair (Slow Mohs; SM). RESULTS Twenty-two cases were seen with a survival of 91% (two deaths from nodular and lentigo maligna melanoma) and seven with melanoma in situ (MIS). Invasive melanoma includes eight lentigo maligna melanoma, four nodular, two amelanotic and one desmoplastic. Mean Breslow thickness was 6 mm for invasive (range 0.5-26). Mean excision margin for MIS was 3 mm (range 2-5 mm) and for invasive was 5 mm (range 2-10). Further excisions were performed in nine (41%); two went on to recur. Local recurrence was 36%; six invasive (27%) at a mean of 24 months (range 1.5-5 years) and two for MIS at a mean of 15 months (range 1-1.5 years). Imaging occurred for suspected advanced disease. Sentinel node biopsy was not performed. Advanced melanoma therapy was performed in two cases. No vitamin D testing occurred. CONCLUSIONS Survival rates are in line with 90% overall survival in the UK. Prescriptive excision margins are not applicable in the periocular region and margin-controlled excision with a delayed repair is recommended, but patients need to know further excision may be needed to obtain clearance. Evidence recommending vitamin D therapy needs to be put into clinical practice. In addition, upstaging of MIS occurred advocating excision rather than observation of MIS. More studies are needed to determine the best management of eyelid melanoma.
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Affiliation(s)
- John C Bladen
- Corneoplastic department, Queen Victoria Hospital, East Grinstead, UK
| | - Raman Malhotra
- Corneoplastic department, Queen Victoria Hospital, East Grinstead, UK
| | - Andre Litwin
- Corneoplastic department, Queen Victoria Hospital, East Grinstead, UK.
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3
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Toia F, Cajozzo M, Rosatti F, Di Lorenzo S, Rinaldi G, Mazzucco W, Cordova A. Effectiveness of clinical and instrumental follow-up for cutaneous melanoma. Surg Oncol 2022; 44:101821. [PMID: 35947885 DOI: 10.1016/j.suronc.2022.101821] [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: 03/24/2022] [Revised: 07/05/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Follow-up guidelines for melanoma greatly differ in the methods of screening for recurrence, and timing and duration of the follow up, with many areas of controversy and a lack of general consensus. The aims of this study are to present our protocol and case series for follow up and to summarize and discuss current literature on melanoma follow-up guidelines/recommendations in different countries. METHODS We retrospectively reviewed 539 patients operated for melanoma between 2004 and 2013 at the same Institution. Data on the diagnostic role of the different clinical and instrumental detection methods were adjusted for sex, age at diagnosis, staging and evaluated by Fisher's exact test and multivariate analysis. Recommendations from the literature were summarized and discussed. RESULTS Local recurrences and second melanoma were always identified through physical examination, irrespectively of melanoma staging. Regional metastases were most often identified through physical examination and ultrasound, being more frequent in stage II and III, while distant metastases were most often identified through CT scans. Surveillance follow-up schedules vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Similarities and controversies in the different follow-up protocols are presented and discussed. CONCLUSION Our clinical series showed that physical examination is very powerful in identifying local recurrences and second melanomas. Physical examination and ultrasound are equally powerful in identifying regional metastases, and alternating them over time could allow to reduce the number of follow-up visits. CT scans, differently from chest x-ray, showed a high power in identifying distant metastases. Surveillance follow-up schedules in the literature vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Standard protocols are desirable for a better evaluation of results.
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Affiliation(s)
- Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Marta Cajozzo
- Plastic and Maxillofacial Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fernando Rosatti
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy.
| | - Sara Di Lorenzo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Gaetana Rinaldi
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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Cabrera CI, Li S, Conic R, Gastman BR. The National Cancer Database: Survival Between Head and Neck Melanoma and Melanoma of Other Regions. Otolaryngol Head Neck Surg 2021; 167:286-297. [PMID: 34699278 DOI: 10.1177/01945998211053204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Primary site is considered an important prognostic factor for cutaneous malignant melanoma (CMM); however, opinions vary regarding its influence on survival. This study compares overall survival between head and neck melanoma (HNM) and melanoma of other regions (MOR), as well as between melanoma of the scalp and neck (MSN) and melanoma of other head regions (MOHR). STUDY DESIGN Level III retrospective cohort study. SETTING Patients from Commission on Cancer-accredited cancer programs affiliated to the National Cancer Database (NCDB). METHODS Patients with HNM (MSN and MOHR included) and MOR, stages I to IV (n = 39,754), and their linked survival data using the NCDB were identified. Survival was analyzed using propensity score matching methods. RESULTS After matching using propensity scores, allowing this observational study to mimic a randomized controlled trial, subjects with HNM showed a 22% increased mortality when compared to MOR (P < .01). Among those with HNM, hazard was not proportional over time. Overall, subjects with MSN in the first 3.5 years of follow-up (75% of subjects) showed a 15% increased mortality when compared to MOHR (P < .01); however, after 3.5 years, no difference in survival was noted (P = .5). CONCLUSION Patients with HNM showed a higher mortality when compared to MOR. The risk of death of primary sites within the head and neck varies over time, showing a higher risk of mortality for scalp and neck during the first 3.5 years of follow-up. This increased risk was not evident after the 3.5-year threshold. Further research is needed to evaluate additional patient factors or differences in treatment approaches.
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Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shawn Li
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rosalynn Conic
- University of Maryland Medical Center, Department of Surgery, Baltimore, Maryland, USA
| | - Brian R Gastman
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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5
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Spoerl S, Spanier G, Reiter E, Gerken M, Haferkamp S, Grosse J, Drexler K, Ettl T, Klinkhammer-Schalke M, Fischer R, Spoerl S, Reichert TE, Klingelhöffer C. Head and neck melanoma: outcome and predictors in a population-based cohort study. Head Face Med 2021; 17:45. [PMID: 34686191 PMCID: PMC8532308 DOI: 10.1186/s13005-021-00295-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/05/2021] [Indexed: 02/09/2023] Open
Abstract
Background To evaluate predictive clinico-pathological characteristics on outcome in head and neck melanoma (HNM) in a population-based study with particular emphasis on the prognostic effect of sentinel lymph node biopsy (SLNB), Charlson comorbidity index (CCI) and distinct tumor localisations. Methods Here we primarily describe a retrospective multicenter population-based cohort study with 402 patients having undergone resection with curative intent of HNM between 2010 and 2017. SLNB was used in the diagnosis of 79 HNM patients. Outcome was analyzed, focusing on SLNB, CCI as well as tumor localisation. Overall survival (OAS) und recurrence free survival (RFS) was examined by uni- and multivariate analysis. Results Histopathologically verified lymph node metastasis according to SLNB was associated with impaired RFS in HNM patients (p = 0.004). Especially in higher tumor stages, the sole implementation of SLNB improved survival significantly in the present cohort (p = 0.042). With most of the HNM being located in the face, melanoma of the scalp and neck could be linked to deteriorated patient’s outcome in uni- as well as multivariate analysis (p = 0.021, p = 0.004). Conclusions SLNB is a useful tool in predicting development of distant metastasis after HNM resection with curative intent. Especially in higher tumor stages, performing a SLNB ameliorated survival of HNM patients. Additionally, CCI as well as a distinct tumor localisations in HNM were identified as important risk factors in our population-based cohort study.
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Affiliation(s)
- Steffen Spoerl
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - Gerrit Spanier
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany.
| | - Elena Reiter
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Michael Gerken
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Jirka Grosse
- Department of Nuclear Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany
| | - Tobias Ettl
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center - Institute for Quality Management and Health Services Research, University of Regensburg, Regensburg, Germany
| | - René Fischer
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Silvia Spoerl
- Department of Internal Medicine 5 - Hematology/Oncology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Torsten E Reichert
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
| | - Christoph Klingelhöffer
- Department of Cranio-Maxillofacial Surgery, University Hospital Regensburg, D-93042, Regensburg, Germany
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Melanoma In Situ: A Critical Review and Re-Evaluation of Current Excision Margin Recommendations. Adv Ther 2021; 38:3506-3530. [PMID: 34047915 PMCID: PMC8280024 DOI: 10.1007/s12325-021-01783-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/07/2021] [Indexed: 11/02/2022]
Abstract
Most international clinical guidelines recommend 5-10 mm clinical margins for excision of melanoma in situ (MIS). While the evidence supporting this is weak, these guidelines are generally consistent. However, as a result of the high incidence of subclinical extension of MIS, especially of the lentigo maligna (LM) subtype, wider margins will often be needed to achieve complete histologic clearance. In this review, we assessed all available contemporary evidence on clearance margins for MIS. No randomized trials were identified and the 31 non-randomized studies were largely retrospective reviews of single-surgeon or single-institution experiences using Mohs micrographic surgery (MMS) for LM or staged excision (SE) for treatment of MIS on the head/neck and/or LM specifically. The available data challenge the adequacy of current international guidelines as they consistently demonstrate the need for clinical margins > 5 mm and often > 10 mm. For LM, any MIS on the head/neck, and/or ≥ 3 cm in diameter, all may require wider clinical margins because of the higher likelihood of subclinical spread. Histologic clearance should be confirmed prior to undertaking complex reconstruction. However, it is not clear whether wider margins are necessary for all MIS subtypes. Indeed, it seems that this is unlikely to be the case. Until optimal surgical margins can be better defined in a randomized trial setting, ideally controlling for MIS subtype and including correlation with histologic excision margins, techniques such as preliminary border mapping of large, ill-defined lesions and, most importantly, sound clinical judgement will be needed when planning surgical clearance margins for the treatment of MIS.
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Hughes TM, Williams GJ, Gyorki DE, Kelly JW, Stretch JR, Varey AHR, Hong AM, Scolyer RA, Thompson JF. Desmoplastic melanoma: a review of its pathology and clinical behaviour, and of management recommendations in published guidelines. J Eur Acad Dermatol Venereol 2021; 35:1290-1298. [PMID: 33544941 DOI: 10.1111/jdv.17154] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 12/15/2022]
Abstract
Desmoplastic melanomas are uncommon. Their behaviour differs from that of other melanoma subtypes; therefore, management guidelines for non-desmoplastic melanomas may not be applicable. This review sought to examine all available evidence relating to the behaviour and management of desmoplastic melanomas, based on review of all relevant English-language publications, and to critically assess the recommendations for their management in current published melanoma management guidelines. Compared with other melanoma subtypes, patients with 'pure' desmoplastic melanomas (where ≥90% of the invasive melanoma is of desmoplastic melanoma subtype) have much lower rates of sentinel node positivity and distant metastasis. Local recurrence rates are higher for desmoplastic melanomas, but resection margins wider than those recommended for non-desmoplastic melanomas have not been shown to be of benefit. Adjuvant radiotherapy reduces the risk of local recurrence when a satisfactory histological clearance (≥8 mm) cannot be achieved. Of 29 published melanoma management guidelines identified, only 11 specified management for desmoplastic melanomas, while seven simply stated that the feature should be reported. Desmoplastic melanoma is a unique melanoma subtype with biology that differs from that of other melanoma subtypes. It requires specific management strategies but few current guidelines address these.
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Affiliation(s)
- T M Hughes
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Adventist Hospital, Sydney, NSW, Australia
| | - G J Williams
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - D E Gyorki
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - J W Kelly
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic., Australia
| | - J R Stretch
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - A H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Westmead Hospital, Sydney, NSW, Australia
| | - A M Hong
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - R A Scolyer
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia.,NSW Health Pathology, Sydney, NSW, Australia
| | - J F Thompson
- Cancer Council Australia Melanoma Guidelines Working Party, Sydney, NSW, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
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8
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Skanjeti A, Dhomps A, Paschetta C, Tordo J, Delgado Bolton RC, Giammarile F. Lymphoscintigraphy for Sentinel Node Mapping in Head and Neck Cancer. Semin Nucl Med 2020; 51:39-49. [PMID: 33246538 DOI: 10.1053/j.semnuclmed.2020.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this comprehensive review is to describe and analyze the role of the sentinel node mapping in head and neck cancers. For this purpose, head and neck neoplasms have been categorized in cutaneous malignancies and neoplasms of the upper aerodigestive tract. A concise description of lymphatic drainage will be the "prelude" for each section, as well as the description of the injection techniques, when specific. Concisely, the attention has been focused on detection rate of the sentinel node by lymphoscintigraphy for each cancer, and for those patients in which the sentinel lymph node has been identified, true-positives rates, false-negative rates, and overall accuracy has been pointed out. Overall, in cutaneous neoplasms of the head and neck, the detection rate is higher than 90%, however the false-negative rate is still an issue, in particular in melanoma, inducing the need for newer developments. In fact, new tracers and techniques are already available, while prospective multicenter trials exploring the outcome impact are needed in the near future. For the upper aerodigestive tract and in particular oral cavity and oropharynx, sentinel lymph node identification by lymphoscintigraphy allows avoiding unnecessary neck dissection and/or node irradiation. Even in this case, the main limit remains the risk of false-negative rates. While, for patients affected by laryngeal and hypopharyngeal cancers the data seem very limited and, although the feasibility has been demonstrated, performances of this lymphoscintigraphy still need to be confirmed by multicenter studies.
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Affiliation(s)
- Andrea Skanjeti
- Nuclear Medicine Department, Hospices Civils de Lyon and Université Claude Bernard Lyon 1, Lyon, France
| | - Anthony Dhomps
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France
| | | | - Jérémie Tordo
- Nuclear Medicine Department, Hospices Civils de Lyon, Lyon, France
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria; Centre Léon Bérard, Lyon, France.
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Hoskin P. Head and neck cancer. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1201/9781315267081-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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10
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Han AY, Dhanjani S, Pettijohn K, Patel PB, John MAS. Optimal resection margin for head and neck cutaneous melanoma. Laryngoscope 2019; 129:1386-1394. [PMID: 30408184 DOI: 10.1002/lary.27465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/28/2018] [Accepted: 07/02/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS The objective of this study was to examine the difference between a narrow (between 1 and 2 cm) and a wide (>2 cm) margin in the surgical resection of head and neck cutaneous melanoma. STUDY DESIGN Population-based cohort analysis. METHODS The Surveillance, Epidemiology, and End Results database was employed to identify patients who had cutaneous melanoma of the head and neck from 2004 to 2014. Outcome measures were overall survival (OS) and disease-specific survival (DSS). RESULTS Among the total of 3,583 cases of cutaneous melanoma of the head and neck with known resection margins, 2,641 individuals had narrow resection margins, and 942 patients had wide margins. Most of the tumors presented in the skin of the scalp and neck, followed by the face, external ear, and other areas. The 5-year and 10-year Kaplan-Meier OS probabilities for narrow and wide margins were 65% and 66%, respectively, compared with 49% and 48%, respectively. The DSS probabilities exhibited similar trends between the two groups at these time points. In the Cox regression model, the patients who received narrow margins had similar OS (95% confidence interval [CI]: 0.918-1.217) and DSS (95% CI: 0.856-1.352) compared with the wide resection margin group, even when controlled for age, sex, T stage, and histology. CONCLUSIONS The survival of patients with cutaneous melanoma of the head and neck depends on age, depth of tumor invasion, and histology. Within the head and neck, a wider resection margin of >2 cm does not confer any additional survival benefit compared with a narrower margin. Future studies should examine whether wider surgical margins would confer survival benefit in local or recurrent melanoma. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1386-1394, 2019.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Suraj Dhanjani
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Kelly Pettijohn
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Pratik B Patel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles Medical Center, Los Angeles, California
- University of California, Los Angeles Head and Neck Cancer Program, University of California, Los Angeles Medical Center, Los Angeles, California, U.S.A
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11
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Surgery alone versus post-operative radiotherapy for sinonasal malignant melanoma: a meta-analysis. The Journal of Laryngology & Otology 2019; 132:1051-1060. [PMID: 30674363 DOI: 10.1017/s0022215118002189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Sinonasal malignant melanoma is a relatively rare malignancy with poor prognosis, and effective treatments remain elusive. This analysis aimed to explore whether post-operative radiotherapy conferred any survival advantages in patients with this disease when compared with surgery alone. METHODS Published studies were identified by searching four electronic databases. The endpoints evaluated were: rates of overall survival, disease-free survival and local control. RESULTS Twenty-eight studies including 1392 patients were identified. The results indicated that post-operative radiotherapy led to a significantly better three-year overall survival rate (p = 0.02), and suggested a borderline significant benefit for five-year overall survival (p = 0.05), when compared with surgery alone. However, no statistical advantage was found for disease-free survival, local control or one-year overall survival. CONCLUSION This meta-analysis indicated that adjuvant radiotherapy prolonged survival, but showed no benefit for disease-free survival or local control.
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Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluación de indicadores de estructura en la atención al paciente con cáncer de piel en los servicios de dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:807-812. [DOI: 10.1016/j.ad.2018.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/20/2018] [Accepted: 06/03/2018] [Indexed: 11/24/2022] Open
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Kueder-Pajares T, Descalzo M, García-Doval I, Ríos-Buceta L, Moreno-Ramírez D. Evaluation of Structure Indicators for Assessing Skin Cancer Quality of Care in Dermatology Departments. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2018.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Janz TA, Neskey DM, Nguyen SA, Lentsch EJ. Is imaging of the brain necessary at diagnosis for cutaneous head and neck melanomas? Am J Otolaryngol 2018; 39:631-635. [PMID: 29929862 DOI: 10.1016/j.amjoto.2018.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 06/03/2018] [Accepted: 06/06/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To evaluate the frequency of brain metastasis at the time of diagnosis for patients with cutaneous head and neck melanoma (CHNM). METHODS Patients in the Surveillance, Epidemiology, and End Results (SEER) database were included from 2010 to 2014 based on a diagnosis of CHNM using ICD O-3 histology codes and primary site location documentation. Patients were also included if they had a "yes" or "no" documented in the "Mets at Dx-Brain" category. RESULTS In this study, 46 out of 19,066 (0.2%) patients diagnosed with CHNM presented with brain metastasis at diagnosis. Of the 19,066 patients, 14,124 (74.1%) were male. Caucasian race was noted in 18,299 cases (96.0%). 16.8% of patients with AJCC 7 Stage IV/M1 CHNM had brain metastasis at the time of diagnosis as compared to 0% in Stage I-III/M0 lesions (p < .001). CONCLUSIONS AND RELEVANCE The 2018 NCCN guidelines recommend healthcare providers consider ordering a baseline brain MRI for patients with stage IIIC or greater melanoma. This study demonstrates the very low frequency of brain metastasis at time of diagnosis in patients with CHNM and supports the NCCN recommendations demonstrating that only very advanced stages of CHNM require baseline brain imaging.
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Kılıç S, Unsal AA, Chung SY, Samarrai R, Kılıç SS, Baredes S, Eloy JA. Geographic region: Does it matter in cutaneous melanoma of the head and neck? Laryngoscope 2017; 127:2763-2769. [PMID: 28581118 DOI: 10.1002/lary.26663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The head and neck are two of the most common locations for cutaneous melanoma. We present the first population-based analysis of geographic differences in anatomic subsite, clinicopathologic and demographical traits, histopathologic subtype, treatment modality, and disease-specific survival (DSS) of cutaneous head and neck melanoma (CHNM). STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results database was queried for cases of CHNM reported between 2000 and 2013. Patients were grouped into East, Midwest, South, and West regions of the United States. Overall incidence, demographic traits, primary tumor site, clinicopathologic traits, histopathologic subtype, treatment modality, and DSS were compared among regions. RESULTS There were 49,365 patients with CHNM identified. The West (4.60) and the South (4.42) had significantly higher incidence (per 100,000) than the East (3.84) and Midwest (3.65) (P < .05). DSS was significantly different among regions (P < .0066). The East (5 years: 89.4%, 10 years: 84.1%) had the highest DSS rate, and the South (5 years: 87.0%, 10 years: 81.8%) had the lowest DSS rate. The Midwest (5 years: 88.4%, 10 years: 84.3%) and West (5 years: 88.3%, 10 years: 83.5%) had intermediate DSS. On multivariate analysis, the South had an elevated hazard ratio (1.17, 95% confidence interval: 1.05-1.30) when compared to the West. CONCLUSIONS Geographic region may play a significant role in CHNM. Incidence is higher in the South and the West. Incidence, histologic subtype, treatment modality, and DSS vary among regions. DSS is lower in the South than the West, even after accounting for other major prognostic factors. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2763-2769, 2017.
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Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Aykut A Unsal
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Sei Y Chung
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Ruwaa Samarrai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Sarah S Kılıç
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
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