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Ghiasvand R, Green AC, Veierød MB, Robsahm TE. Incidence and Factors Associated With Second Primary Invasive Melanoma in Norway. JAMA Dermatol 2024; 160:402-408. [PMID: 38416466 PMCID: PMC10902780 DOI: 10.1001/jamadermatol.2023.6251] [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: 10/04/2023] [Accepted: 12/17/2023] [Indexed: 02/29/2024]
Abstract
Importance Patients diagnosed with a primary melanoma are at high risk of subsequent melanomas. Understanding the risk of second primary invasive melanoma and associated factors is crucial to optimize patient follow-up. Objective To assess the incidence rate of second primary invasive melanoma and time between the first and second primary invasive melanoma in the Norwegian population. Design, Setting, and Participants This population-based cohort study included data from deidentified records of all invasive melanomas diagnosed in Norway in 2008 to 2020, obtained from the Cancer Registry of Norway. Data were from adults aged 18 years or older diagnosed with a first primary melanoma. Data analysis was performed from March to August 2023. Main Outcomes and Measures The main outcome was the incidence rate of second primary invasive melanoma at least 30 days after the first. Accelerated failure time models were fitted to examine potential associations with patient and tumor characteristics. Median time between first and second primary melanomas and 95% CIs were calculated. The likelihood of, and median interval for, second primary melanomas on the same or different site as the first primary were calculated. Results A total of 19 196 individuals aged 18 years or older were diagnosed with a first primary melanoma. The mean (SD) age at diagnosis of the first primary melanoma was 62 (16) years (range, 18-104 years), and 9763 (51%) were female. The incidence rate in the year following diagnosis was 16.8 (95% CI, 14.9-18.7) per 1000 person-years, which decreased to 7.3 (95% CI, 6.0-8.6) during the second year and stabilized thereafter. Median time between first and second primaries decreased with advancing age and was 37 months (95% CI, 8-49) in patients younger than 40 years, 18 (95% CI, 13-24) in patients aged 50 to 59 years, and 11 (95% CI, 7-18) in patients aged 80 years or older. The second primary was on the same site as their first primary for 47% (359 patients), and on a different site for 53% (407 patients). The median interval until second melanoma on the same site as the initial melanoma was 12 (95% CI, 7-19) months in men and 22 (95% CI, 11-35) months in women. Conclusions and Relevance Older age and male sex were associated with an increased risk, suggesting that increased surveillance intensity may be considered for men, especially those older than 50 years, for at least 3 years after their initial diagnosis, regardless of the characteristics of their first invasive melanoma.
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Affiliation(s)
- Reza Ghiasvand
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Adele C. Green
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Cancer Research UK Manchester Institute, University of Manchester, Manchester, United Kingdom
| | - Marit B. Veierød
- Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Trude E. Robsahm
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Institute for Cancer Research, Oslo University Hospital, Oslo, Norway
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Smith J, Cust AE, Lo SN. Risk factors for subsequent primary melanoma in patients with previous melanoma: a systematic review and meta-analysis. Br J Dermatol 2024; 190:174-183. [PMID: 37562043 DOI: 10.1093/bjd/ljad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Compared with the general population, people with a previous melanoma are at increased risk of developing another primary melanoma. Understanding the risk factors associated with multiple primary melanomas can inform patient education and tailored surveillance. OBJECTIVES To examine the risk factors for subsequent primary melanoma in people with a previous melanoma, by conducting a systematic review and meta-analysis of the available data. METHODS A systematic literature search was conducted in CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase and MEDLINE. Studies that reported a risk estimate or raw frequencies and conducted between 1982 and August 2022 were included. Adjusted risk estimates were prioritized over univariable risk estimates. PRISMA reporting guidelines were followed. Random effects meta-analysis was conducted to derive pooled estimates. Quality assessment was conducted by two researchers using the Newcastle-Ottawa scale. GRADE was used to rate the certainty and quality of the evidence. RESULTS Data from 27 studies involving 413 181 participants were pooled and analysed. Risk factors assessed included age and sex, environmental, lifestyle, phenotypic, genetic and histopathological factors, and there was wide variation in how they were categorized and analysed. Independent risk factors identified from pooled analyses included male sex [hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.40-1.53], increasing age per 10 years (HR 1.19, 95% CI 1.14-1.24), light skin colour (HR 1.44, 95% CI 1.23-1.70), family history [odds ratio (OR) 1.79, 95% CI 1.25-2.56], CDKN2A mutation (OR 5.29, 95% CI 2.70-10.37), a high or moderate naevus count [OR 2.63 (95% CI 1.61-4.30) and OR 1.64 (95% CI 1.07-2.51), respectively], one or more atypical naevi (OR 3.01, 95% CI 1.52-5.97), first lesions occurring on the head or neck, lentigo maligna subtype (HR 1.16, 95% CI 1.15-1.17), other subtype (HR 1.14, 95% CI 1.03-1.27) and inadequate sun protection (HR 1.85, 95% CI 0.98-3.50). Based on the GRADE criteria, there was high to very low confidence in the pooled effect estimates. CONCLUSIONS This meta-analysis identified several consistent, independent risk factors for the development of subsequent primary melanoma. These findings will help stratify the risk of subsequent melanoma, tailor skin-check schedules and inform patient education.
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Affiliation(s)
- Juliet Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia
- Sydney School of Public Health
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- Melanoma Institute Australia
- Sydney School of Public Health
| | - Serigne N Lo
- Melanoma Institute Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Leachman SA, Latour E, Detweiler-Bedell B, Detweiler-Bedell JB, Zell A, Wenzel E, Stoos E, Nelson JH, Wiedrick J, Berry EG, Lange J, Etzioni R, Lapidus JA. Melanoma literacy among the general population of three western US states. Pigment Cell Melanoma Res 2023; 36:481-500. [PMID: 37574711 DOI: 10.1111/pcmr.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/10/2023] [Accepted: 06/06/2023] [Indexed: 08/15/2023]
Abstract
Melanoma is a significant cause of cancer death, despite being detectable without specialized or invasive technologies. Understanding barriers to preventive behaviors such as skin self-examination (SSE) could help to define interventions for increasing the frequency of early detection. To determine melanoma knowledge and beliefs across three high-incidence US states, 15,000 surveys were sent to a population-representative sample. We aimed to assess (1) melanoma literacy (i.e., knowledge about melanoma risks, attitudes, and preventive behaviors) and (2) self-reported SSE and its association with melanoma literacy, self-efficacy, and belief in the benefits of SSE. Of 2326 respondents, only 21.2% provided responses indicating high knowledge of melanoma, and 62.8% reported performing an SSE at any time in their lives. Only 38.3% and 7.3% reported being "fairly" or "very" confident about doing SSE, respectively. SSE performance among respondents was most strongly associated with higher melanoma knowledge, higher self-efficacy, and personal history of melanoma. Melanoma literacy among survey respondents was modest, with greater literacy associated with a higher likelihood of reported preventive behavior. This assessment establishes a baseline and provides guidance for public health campaigns designed to increase prevention and early detection of this lethal cancer.
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Affiliation(s)
- Sancy A Leachman
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Emile Latour
- Biostatistics Shared Resource, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Adrienne Zell
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Wenzel
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Stoos
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jacob H Nelson
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jack Wiedrick
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health, Portland, Oregon, USA
| | - Elizabeth G Berry
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Jane Lange
- Melanoma & Skin Cancer Program, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- Center for Early Detection Advanced Research, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Group Health Research Institute, Seattle, Washington, USA
| | - Jodi A Lapidus
- Oregon Clinical and Translational Research Institute (OCTRI), Oregon Health & Science University, Portland, Oregon, USA
- Biostatistics and Design Program, Oregon Health & Science University, Portland, Oregon, USA
- Oregon Health & Science University-Portland State University (OHSU-PSU) School of Public Health, Portland, Oregon, USA
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4
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Lallas A. Which patients with melanoma are a priority for monitoring to detect new primary melanoma? Br J Dermatol 2023; 189:e3. [PMID: 37067919 DOI: 10.1093/bjd/ljad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Aimilios Lallas
- First Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece
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KUSHNIR-GRINBAUM D, KRAUSZ J, RAHAL N, APEL-SARID L, ZIV M. Risk of Melanoma in Patients with Basal Cell Carcinoma: A Population-based Cohort Study. Acta Derm Venereol 2023; 103:adv00841. [PMID: 36600530 PMCID: PMC9885282 DOI: 10.2340/actadv.v103.4402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/16/2022] [Indexed: 01/06/2023] Open
Abstract
Basal cell carcinoma is the most prevalent cancer in Caucasians worldwide. The aim of this study was to examine the overall risk of melanoma among patients diagnosed with basal cell carcinoma. This population-based retrospective cohort study included data from January 2010 to December 2018 from the databases of the Clalit Health Maintenance Organization and 2 major pathology laboratories in North District, Israel. The incidence and hazard ratio of melanoma in patients with a diagnosis of basal cell carcinoma were determined. Of 466,700 participants, 51% were women and the mean (standard deviation) follow-up was 6.7 (2.9; range 1-9) years. A total of 3,338 patients were diagnosed with basal cell carcinoma during the study period, 82 of whom subsequently developed melanoma. Patients with basal cell carcinoma had a significantly higher incidence of melanoma than patients without basal cell carcinoma (2.46% vs 0.37%; p < 0.0001). Univariate Cox regression analysis revealed a hazard ratio of 6.6 (95% confidence interval: 3.6-12.1; p < 0.0001) for melanoma in patients with a diagnosis of basal cell carcinoma. In conclusion, a diagnosis of basal cell carcinoma confers a significant risk of melanoma.
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Affiliation(s)
| | | | - Nader RAHAL
- Dermatology Department, Emek Medical Center, Afula,Clalit Health Maintenance Service North District, Ness-Ziona
| | - Liat APEL-SARID
- Patho-Lab Diagnostics, Assuta Medical Centers, Nof-Hagallil, Israel
| | - Michael ZIV
- Dermatology Department, Emek Medical Center, Afula
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Bellinato F, Rosina P, Tonin B, Gisondi P, Girolomoni G. Predictors of subsequent primary melanoma: a case-control study. Arch Dermatol Res 2022; 314:881-885. [PMID: 34825952 DOI: 10.1007/s00403-021-02309-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/18/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
Patients with history of malignant melanoma (MM) are at risk of developing subsequent primary MM (SPM). Predictors of SPM may be helpful to identify patients at higher risk. The objective of the study is to investigate the phenotypic traits, indirect actinic exposure features and pathological variables associated with the risk of development of SPM. A ten-year retrospective case-control study was undertaken involving patients following MM excision who underwent regular video-dermoscopic examination at 4-6-month intervals for the first 5 years, followed by annual dermoscopic examination for the following five years. Patients with only one primary cutaneous MM were compared with those who developed at least one SPM. A total of 577 patients were included, 309 (53.6%) men and 268 (46.5%) women (mean age, 55 ± 15 years), comprising 450 patients with single melanoma and 127 with at least one SPM. The median time span to the SPM was 30 (IQR 12-53) months. Compared to the first melanoma, SPM were thinner, mean Breslow 0.56 ± 0.64 mm vs 1.37 ± 1.83 mm (p < 0.001); in situ MM prevalence 12% vs 36% (p < 0.001). 36 % of the patients with SPM developed it in the anatomical site of the previous melanoma. At multivariate analysis, having numerous naevi (i.e. 10-50 nevi) OR = 2.88 (95% CI 1.32-6.28, previous dysplastic naevi excisions OR = 2.51 (95% CI 1.53-4.12), solar lentigo OR = 2.68 (95% CI 1.67-4.31) and actinic keratosis OR = 3.09 (95% CI 1.64-4.31) were associated with an increased risk of SPM. These features may identify persons at increased risk of developing SPM.
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Affiliation(s)
- Francesco Bellinato
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Paolo Rosina
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Beatrice Tonin
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Piazzale A. Stefani 1, 37126, Verona, Italy
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Akhtar S, Levin A, Rajabi-Estarabadi A, Nouri K. Cells to Surgery Quiz: August 2021. J Invest Dermatol 2021. [PMID: 34303471 DOI: 10.1016/j.jid.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Shifa Akhtar
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adam Levin
- Island Dermatology, Newport Beach, California, USA
| | - Ali Rajabi-Estarabadi
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Keyvan Nouri
- Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA.
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Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20-22 February 2020. ACTA ACUST UNITED AC 2021; 28:2040-2051. [PMID: 34072050 PMCID: PMC8161801 DOI: 10.3390/curroncol28030189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/29/2022]
Abstract
Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online voting process was undertaken at the 13th and 14th annual Canadian Melanoma Conferences (CMC) to collect expert opinions relating to “who, what, where, and when” HRS should be conducted. Initial opinions were gathered via audience participation software and used as the basis for a second iterative questionnaire distributed online to attendees from the 13th CMC and to identified melanoma specialists from across Canada. A third questionnaire was disseminated in a similar fashion to conduct a final vote on HRS that could be implemented. Results: The majority of respondents from the first two iterative surveys agreed on stages IIB to IV as high risk. Surveillance should be conducted by an appropriate specialist, irrespective of association to a cancer centre. Frequency and modality of surveillance favoured biannual visits and Positron Emission Tomography Computed Tomography (PET/CT) with brain magnetic resonance imaging (MRI) among the systemic imaging modalities available. No consensus was initially reached regarding the frequency of systemic imaging and ultrasound of nodal basins (US). The third iterative survey resolved major areas of disagreement. A 5-year surveillance schedule was voted on with 92% of conference members in agreement. Conclusion: This final recommendation was established following 92% overall agreement among the 2020 CMC attendees.
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Williams GJ, Webster AC, Thompson JF. Organ transplantation and outcomes in patients with a past history of melanoma: A systematic review and meta-analysis. Clin Transplant 2021; 35:e14287. [PMID: 33720403 DOI: 10.1111/ctr.14287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The incidence of melanoma is steadily rising around the world. There is uncertainty about the safety of solid organ transplantation in patients with a prior history of melanoma. AIM To review studies reporting patients with a history of melanoma before solid organ transplantation. METHODS Electronic searches of Medline, Embase, and the Cochrane library up to March 2020. All study designs, in any language and without sample size restriction, were eligible for inclusion. Risk of bias was assessed using established tools, and meta-analysis was performed using a random-effects model. RESULTS We identified 41 studies reporting 703 100 transplant recipients and 1692 had pre-transplantation melanomas. Risk of death, expressed as a hazard ratio, in patients with pre-transplantation melanoma relative to those without prior melanoma, was 1.32 (95% CI: 1.09-1.59). After transplantation, 13.1% of patients with pre-transplantation melanoma developed new or recurrent melanoma (IQR: 4.8%-18.2%). CONCLUSIONS Around 1-in-400 transplant recipients had a prior history of melanoma. This was associated with a greater than 1-in-10 risk of new or recurrent melanoma after transplantation and an increased risk of death. A 5-year waiting time between a melanoma diagnosis and transplantation has been recommended based on historic registry data, but very little additional information is available to justify or revise this.
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Affiliation(s)
| | - Angela C Webster
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Tang Z, Tong X, Huang J, Liu L, Wang D, Yang S. Research progress of keratinocyte-programmed cell death in UV-induced Skin photodamage. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2021; 37:442-448. [PMID: 33738849 DOI: 10.1111/phpp.12679] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/06/2021] [Accepted: 03/14/2021] [Indexed: 01/11/2023]
Abstract
Programmed cell death (PCD) is a basic component of life and an important terminal path for cells. A variety of biological events are associated with PCD, including the conservation of tissue homeostasis and removal of harmful cells. Overexposure of the skin to UV radiation causes skin photodamage. Keratinocytes are the first line of defence against ultraviolet radiation. During UV radiation, the keratinocyte can undergo four modes of PCD: apoptosis, pyroptosis, necroptosis and autophagy. The molecular mechanisms of these four modes of PCD have been widely studied as potential therapeutic targets for the prevention of UV-induced skin inflammation, ageing and skin cancer. In this review, we summarize the role of keratinocyte PCD in the pathogenesis of UV-induced skin photodamage. This article will provide new research directions for the design of intervention strategies for the treatment and prevention of skin photodamage.
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Affiliation(s)
- Ziting Tang
- Department of Dermatology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoliang Tong
- Department of Dermatology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinhua Huang
- Department of Dermatology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Lulu Liu
- Department of Dermatology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Dan Wang
- Department of Dermatology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Shengbo Yang
- Department of Dermatology, the Third Xiangya Hospital, Central South University, Changsha, China
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Karapetyan L, Yang X, Wang H, Sander CA, Moyer A, Wilson M, Karunamurthy A, Kirkwood JM. Indoor tanning exposure in association with multiple primary melanoma. Cancer 2021; 127:560-568. [PMID: 33170961 DOI: 10.1002/cncr.33307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with primary cutaneous melanoma are at increased risk for subsequent new primary melanomas. Indoor tanning is a recognized risk factor for melanoma. This study was aimed at determining the association between indoor tanning and the occurrence of multiple primary melanoma. METHODS This was a retrospective case-control study of cases with multiple primary melanoma and sex-matched controls with single primary melanoma retrieved at a 1:2 ratio from the Biological Sample and Nevus Bank of the Melanoma Center of the University of Pittsburgh Cancer Institute. Logistic regression models were used to examine the association between multiple primary melanoma and risk factors. RESULTS In total, 330 patients (39.1% men) with a median age of 51 years were enrolled. Compared with patients who had a single primary melanoma, patients with multiple melanomas were younger at the diagnosis of their first primary melanoma and were more likely to be discovered at stage 0 or I and to have had indoor tanning exposure, a family history of melanoma, atypical moles, dysplastic nevi, and a Breslow thickness less than 1 mm. Compared with patients' first melanomas, subsequent melanomas were more likely to be thinner or in situ. The estimated probability of the locus for the second primary being the same as that for the first primary melanoma was 34%. In a multivariate analysis after adjustments for age, a family history of melanoma, the presence of atypical and dysplastic nevi, and recreational sun exposure, indoor tanning remained significantly associated with the occurrence of multiple primary melanoma (odds ratio, 2.75; 95% confidence interval, 1.07-7.08; P = .0356). CONCLUSIONS Indoor tanning is associated with an increased risk of second primary melanoma. Subsequent melanomas are more likely to be thin or in situ and to occur in different anatomic locations.
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Affiliation(s)
- Lilit Karapetyan
- Department of Medicine, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Xi Yang
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Hong Wang
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Cindy A Sander
- Department of Medicine, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ashley Moyer
- Department of Medicine, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Melissa Wilson
- Department of Medicine, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - John M Kirkwood
- Department of Medicine, Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Ungureanu L, Zboraș I, Vasilovici A, Vesa Ș, Cosgarea I, Cosgarea R, Șenilă S. Multiple primary melanomas: Our experience. Exp Ther Med 2020; 21:88. [PMID: 33363599 PMCID: PMC7725020 DOI: 10.3892/etm.2020.9520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 01/28/2023] Open
Abstract
Patients with melanoma have an increased risk of having other neoplasms, and particularly other melanomas and non-melanoma skin cancers. The study aimed to describe multiple primary melanomas in a large medical university centre from Romania (Cluj-Napoca) from 2004 to 2020. Out of 699 patients with melanoma included in the study, 26 (3.71%) developed multiple tumours. The 26 patients developed a total of 59 melanomas, corresponding to a mean of 2.3 melanomas per patient. The site and histological subtype of the first and second melanomas were not consistent. The proportion of subsequent melanomas that were in situ (51.5%) or thin melanomas (<1 mm, 24.2%) was higher compared with first melanomas (7.7%, respectively 11.5%). The median and mean time to diagnosis was 2.75 months, respectively, 28.09 months. In total, 76.92% of second melanomas were detected within three years, but we were able to document a subsequent melanoma more than ten years after the first diagnosis. The study highlights the importance of follow-up in patients diagnosed with melanoma, not only in the first years after the primary diagnoses but for the entire life.
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Affiliation(s)
- Loredana Ungureanu
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Iulia Zboraș
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Alina Vasilovici
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Ștefan Vesa
- Department of Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, Toxicology and Clinical Pharmacology, 400012 Cluj-Napoca, Romania
| | - Ioana Cosgarea
- Institute of Cellular Medicine, University of Newcastle, Newcastle upon Tyne NE2 4HH, UK
| | - Rodica Cosgarea
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Simona Șenilă
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
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Survival in patients with multiple primary melanomas: Systematic review and meta-analysis. J Am Acad Dermatol 2020; 83:1406-1414. [DOI: 10.1016/j.jaad.2020.03.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/09/2020] [Accepted: 03/24/2020] [Indexed: 01/12/2023]
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14
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Pastor-Tomás N, Martínez-Franco A, Bañuls J, Peñalver JC, Traves V, García-Casado Z, Requena C, Kumar R, Nagore E. Risk factors for the development of a second melanoma in patients with cutaneous melanoma. J Eur Acad Dermatol Venereol 2020; 34:2295-2302. [PMID: 32163215 DOI: 10.1111/jdv.16341] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/25/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cutaneous melanoma patients have an increased risk of developing other neoplasms, especially cutaneous neoplasms and other melanomas. Identifying factors associated with an increased risk might be useful in the development of melanoma guidelines. OBJECTIVES To identify risk factors related to the development of a second primary melanoma in a series of patients diagnosed with sporadic melanoma and to establish the estimated incidence rate. METHODS A longitudinal study based on prospective follow-up information of patients diagnosed with sporadic cutaneous melanoma at our centre from 2000 to 2015 was performed. Cumulative incidence was estimated based on competing risk models, and the association of characteristics with the risk of a second melanoma was performed by Cox proportional hazard models. RESULTS Out of 1447 patients included in the study, after a median follow-up of 61 months, 55 patients (3.8%) developed a second melanoma. Fair hair colour, more than 100 common melanocytic nevi and the presence of more than 50 cherry angiomas were independently associated with the development of a second melanoma. The site and the histological subtype of the first and second melanomas were not consistent. The second melanomas were thinner than the first ones. CONCLUSIONS Fair-haired and multiple-nevi patients might benefit from more intensive prevention measures. The finding of cherry angiomas as a risk factor suggests that these lesions could be markers of skin sun damage in the setting of certain degree of genetic susceptibility.
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Affiliation(s)
- N Pastor-Tomás
- Department of Dermatology, Hospital General Universitario de Elda, Alicante, Spain.,Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - A Martínez-Franco
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain
| | - J Bañuls
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain.,Departament of Medicina Clínica, Universidad Miguel Hernández. Sant Joan D'Alacant, Alicante, Spain
| | - J C Peñalver
- Department of Thoracic Surgery, Instituto Valenciano de Oncología, València, Spain
| | - V Traves
- Department of Pathology, Instituto Valenciano de Oncología, València, Spain
| | - Z García-Casado
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, València, Spain
| | - C Requena
- Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
| | - R Kumar
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - E Nagore
- School of Medicine, Universidad Católica de Valencia San Vicente Mártir, València, Spain.,Department of Dermatology, Instituto Valenciano de Oncología, València, Spain
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15
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Cust AE, Badcock C, Smith J, Thomas NE, Haydu LE, Armstrong BK, Law MH, Thompson JF, Kanetsky PA, Begg CB, Shi Y, Kricker A, Orlow I, Sharma A, Yoo S, Leong SF, Berwick M, Ollila DW, Lo S. A risk prediction model for the development of subsequent primary melanoma in a population-based cohort. Br J Dermatol 2020; 182:1148-1157. [PMID: 31520533 PMCID: PMC7069770 DOI: 10.1111/bjd.18524] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Guidelines for follow-up of patients with melanoma are based on limited evidence. OBJECTIVES To guide skin surveillance, we developed a risk prediction model for subsequent primary melanomas, using demographic, phenotypical, histopathological, sun exposure and genomic risk factors. METHODS Using Cox regression frailty models, we analysed data for 2613 primary melanomas from 1266 patients recruited to the population-based Genes, Environment and Melanoma study in New South Wales, Australia, with a median of 14 years' follow-up via the cancer registry. Discrimination and calibration were assessed. RESULTS The median time to diagnosis of a subsequent primary melanoma decreased with each new primary melanoma. The final model included 12 risk factors. Harrell's C-statistic was 0·73 [95% confidence interval (CI) 0·68-0·77], 0·65 (95% CI 0·62-0·68) and 0·65 (95% CI 0·61-0·69) for predicting second, third and fourth primary melanomas, respectively. The risk of a subsequent primary melanoma was 4·75 times higher (95% CI 3·87-5·82) for the highest vs. the lowest quintile of the risk score. The mean absolute risk of a subsequent primary melanoma within 5 years was 8·0 ± SD 4.1% after the first primary melanoma, and 46·8 ± 15·0% after the second, but varied substantially by risk score. CONCLUSIONS The risk of developing a subsequent primary melanoma varies considerably between individuals and is particularly high for those with two or more primary melanomas. The risk prediction model and its associated nomograms enable estimation of the absolute risk of subsequent primary melanoma, on the basis of on an individual's risk factors, and can be used to tailor surveillance intensity, communicate risk and provide patient education. What's already known about this topic? Current guidelines for the frequency and length of follow-up to detect new primary melanomas in patients with one or more previous primary melanomas are based on limited evidence. People with one or more primary melanomas have, on average, a higher risk of developing another primary invasive melanoma, compared with the general population, but an accurate way of estimating individual risk is needed. What does this study add? We provide a comprehensive risk prediction model for subsequent primary melanomas, using data from 1266 participants with melanoma (2613 primary melanomas), over a median 14 years' follow-up. The model includes 12 risk factors comprising demographic, phenotypical, histopathological and genomic factors, and sun exposure. It enables estimation of the absolute risk of subsequent primary melanomas, and can be used to tailor surveillance intensity, communicate individual risk and provide patient education.
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Affiliation(s)
- A E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - C Badcock
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - J Smith
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - N E Thomas
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, U.S.A
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, U.S.A
| | - L E Haydu
- University of Texas MD Anderson Cancer Center, Houston, TX, U.S.A
| | - B K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - M H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - P A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, U.S.A
| | - C B Begg
- Department of Dermatology, University of North Carolina, Chapel Hill, NC, U.S.A
| | - Y Shi
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, U.S.A
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, U.S.A
| | - A Kricker
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - I Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - A Sharma
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S Yoo
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - S F Leong
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, U.S.A
| | - M Berwick
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, NM, U.S.A
| | - D W Ollila
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC, U.S.A
- Department of Surgery, University of North Carolina, Chapel Hill, NC, U.S.A
| | - S Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
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16
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Villani A, Fabbrocini G, Costa C, Greco V, Scalvenzi M. Second primary melanoma: incidence rate and risk factors. J Eur Acad Dermatol Venereol 2020; 34:e623-e624. [PMID: 32314450 DOI: 10.1111/jdv.16500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Villani
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Federico II, Naples, Italy
| | - G Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Federico II, Naples, Italy
| | - C Costa
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Federico II, Naples, Italy
| | - V Greco
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Federico II, Naples, Italy
| | - M Scalvenzi
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Federico II, Naples, Italy
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17
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McMeniman EK, Duffy DL, Jagirdar K, Lee KJ, Peach E, McInerney-Leo AM, De'Ambrosis B, Rayner JE, Smithers BM, Soyer HP, Sturm RA. The interplay of sun damage and genetic risk in Australian multiple and single primary melanoma cases and controls. Br J Dermatol 2020; 183:357-366. [PMID: 31794051 DOI: 10.1111/bjd.18777] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Skin phenotype, host genotype and ultraviolet (UV) damage play a role in the development of melanoma. OBJECTIVES To ascertain whether the level of UV damage at the site of melanomas was associated with genetic polymorphisms. METHODS Deep phenotyping was performed on 1244 individuals; 281 with multiple primary melanomas (MPMs), 304 with single primary melanoma (SPM) and 659 convenience controls. Genotype data was generated using the Illumina CoreExome microarray platform, assaying over 500 000 single-nucleotide polymorphisms. A subset of variants were combined to assess a polygenic risk score (PRS) for melanoma. RESULTS Most MPM cases were diagnosed in patients aged > 40 years, in sites with visible chronic UV damage. Women and those diagnosed at age ≤ 40 years were less likely to have perilesional UV damage. Patients with MPM had higher frequencies of MITF E318K, MC1R R-alleles and the ASIP risk haplotype. Individuals who had melanoma in a visibly UV-damaged site were more likely to carry MC1R rs75570604 [odds ratio (OR) 2·5], 9q31.2 rs10816595 (OR 1·4) and MTAP rs869329 (OR 1·4). These same alleles were more common in patients with MPM who were diagnosed at age ≤ 40 years. The mean PRS was significantly higher in MPM than in SPM and controls. Naevus count was comparable in early-onset MPM cases and those diagnosed at age > 40 years. CONCLUSIONS Our cohort demonstrated higher frequencies of previously reported alleles associated with melanoma. MPM melanomas more commonly occur in UV-damaged areas, and these individuals are more likely to carry MC1R red hair colour alleles. Awareness of the interplay of genetic vulnerability with UV damage can stratify risk and guide recommendations for melanoma screening. What's already known about this topic? Skin phenotype, host genotype and ultraviolet (UV) damage all play a role in melanoma development. One of the main risk factors is a personal history of melanoma; second and subsequent primary melanomas account for over 20% of all melanomas registered in Queensland. Multiple loci are associated with melanoma risk, including many low-penetrance loci, which may have a cumulatively significant risk. Population-wide screening programmes for melanoma are not yet economically viable. What does this study add? Patients diagnosed with melanoma at age ≤ 40 years were more likely than older patients to have melanomas in non-UV-damaged sites. Patients with multiple melanomas had higher frequencies of MITF E318K, MC1R R-alleles, and the ASIP extended risk haplotype than patients with single melanoma. CDKN2A, MC1R and MTAP variants were more frequent in patients who developed melanomas at a younger age, but also in those whose melanomas were all on visibly UV-damaged sites. What is the translational message? Incorporating these genetic findings into the known risk factors of skin phenotype and visible UV damage may allow for a more customized and economically feasible approach to early detection of melanoma, particularly in younger patients. Plain language summary available online.
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Affiliation(s)
- E K McMeniman
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D L Duffy
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K Jagirdar
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - K J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - E Peach
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - A M McInerney-Leo
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B De'Ambrosis
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,South East Dermatology, Annerley Square, Annerley, Brisbane, Queensland, Australia
| | - J E Rayner
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - B M Smithers
- Queensland Melanoma Project, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - R A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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18
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Lallas A, Apalla Z, Kyrgidis A, Papageorgiou C, Boukovinas I, Bobos M, Efthimiopoulos G, Nikolaidou C, Moutsoudis A, Gkentsidi T, Lallas K, Lazaridou E, Sotiriou E, Vakirlis E, Ioannides D. Second primary melanomas in a cohort of 977 melanoma patients within the first 5 years of monitoring. J Am Acad Dermatol 2020; 82:398-406. [DOI: 10.1016/j.jaad.2019.08.074] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/15/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022]
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19
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Comment on: "Second primary melanomas in a cohort of 977 melanoma patients within the first 5 years of monitoring". J Am Acad Dermatol 2019; 82:e107. [PMID: 31706936 DOI: 10.1016/j.jaad.2019.10.075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 10/03/2019] [Indexed: 11/21/2022]
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20
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Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, Guild V, Grant-Kels JM, Halpern AC, Johnson TM, Sober AJ, Thompson JA, Wisco OJ, Wyatt S, Hu S, Lamina T. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol 2018; 80:208-250. [PMID: 30392755 DOI: 10.1016/j.jaad.2018.08.055] [Citation(s) in RCA: 318] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 12/12/2022]
Abstract
The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.
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Affiliation(s)
- Susan M Swetter
- Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
| | - Hensin Tsao
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts
| | - Christopher K Bichakjian
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Clara Curiel-Lewandrowski
- Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona
| | - David E Elder
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | | | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
| | - Allan C Halpern
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Timothy M Johnson
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Arthur J Sober
- Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John A Thompson
- Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington
| | - Oliver J Wisco
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon
| | | | - Shasa Hu
- Department of Dermatology, University of Miami Health System, Miami, Florida
| | - Toyin Lamina
- American Academy of Dermatology, Rosemont, Illinois
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21
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Grossman D, Farnham JM, Hyngstrom J, Klapperich ME, Secrest AM, Empey S, Bowen GM, Wada D, Andtbacka RHI, Grossmann K, Bowles TL, Cannon-Albright LA. Similar survival of patients with multiple versus single primary melanomas based on Utah Surveillance, Epidemiology, and End Results data (1973-2011). J Am Acad Dermatol 2018; 79:238-244. [PMID: 29499295 PMCID: PMC6754624 DOI: 10.1016/j.jaad.2018.02.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/31/2017] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Survival data are mixed comparing patients with multiple primary melanomas (MPM) to those with single primary melanomas (SPM). OBJECTIVES We compared MPM versus SPM patient survival using a matching method that avoids potential biases associated with other analytic approaches. METHODS Records of 14,138 individuals obtained from the Surveillance, Epidemiology, and End Results registry of all melanomas diagnosed or treated in Utah between 1973 and 2011 were reviewed. A single matched control patient was selected randomly from the SPM cohort for each MPM patient, with the restriction that they survived at least as long as the interval between the first and second diagnoses for the matched MPM patient. RESULTS Survival curves (n = 887 for both MPM and SPM groups) without covariates showed a significant survival disadvantage for MPM patients (chi-squared 39.29, P < .001). However, a multivariate Cox proportional hazards model showed no significant survival difference (hazard ratio 1.07, P = .55). Restricting the multivariate analysis to invasive melanomas also showed no significant survival difference (hazard ratio 0.99, P = .96). LIMITATIONS Breslow depth, ulceration status, and specific cause of death were not available for all patients. CONCLUSIONS Patients with MPM had similar survival times as patients with SPM.
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Affiliation(s)
- Douglas Grossman
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Department of Oncological Sciences, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah.
| | - James M Farnham
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - John Hyngstrom
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Marki E Klapperich
- University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Aaron M Secrest
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Sarah Empey
- Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Glen M Bowen
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - David Wada
- Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Robert H I Andtbacka
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Kenneth Grossmann
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Tawnya L Bowles
- Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Lisa A Cannon-Albright
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah; Huntsman Cancer Institute, University of Utah Health Sciences Center, Salt Lake City, Utah; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah
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22
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Adler NR, McLean CA, Wolfe R, Kelly JW, McArthur GA, Haydon A, Tra T, Cummings N, Mar VJ. Concordance of somatic mutational profile in multiple primary melanomas. Pigment Cell Melanoma Res 2018; 31:592-603. [PMID: 29603877 DOI: 10.1111/pcmr.12702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/12/2018] [Indexed: 12/16/2022]
Abstract
This study aimed to determine the frequency and concordance of BRAF and NRAS mutation in tumours arising in patients with multiple primary melanoma (MPM). Patients with MPM managed at one of three tertiary referral centres in Melbourne, Australia, from 2010 to 2015 were included. Incident and subsequent melanomas underwent mutation testing. Cohen's kappa (κ) coefficient assessed agreement between incident and subsequent primary melanomas for both BRAF and NRAS mutation status (mutant versus wild-type). Mutation testing of at least two primary tumours from 64 patients was conducted. There was poor agreement for both BRAF and NRAS mutation status between incident and subsequent melanomas (κ = 0.10, 95% CI -0.10 to 0.42; κ = 0.06, 95% CI -0.10 to 0.57, respectively). In view of the low concordance in BRAF mutation status between incident and subsequent melanomas, mutational analysis of metastatic tissue, rather than of a primary melanoma, in patients with MPM should be used to guide targeted therapy.
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Affiliation(s)
- Nikki R Adler
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Catriona A McLean
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic., Australia.,Department of Anatomical Pathology, Alfred Hospital, Melbourne, Vic., Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - John W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic., Australia
| | - Grant A McArthur
- Divisions of Research and Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic., Australia
| | - Andrew Haydon
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic., Australia.,Department of Medical Oncology, Alfred Hospital, Melbourne, Vic., Australia
| | - Thien Tra
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Vic., Australia
| | - Nicholas Cummings
- Department of Anatomical Pathology, Alfred Hospital, Melbourne, Vic., Australia
| | - Victoria J Mar
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Skin and Cancer Foundation Inc., Carlton, Vic., Australia
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23
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Pellegrini C, Di Nardo L, Cipolloni G, Martorelli C, De Padova M, Antonini A, Maturo MG, Del Regno L, Strafella S, Micantonio T, Leocata P, Peris K, Fargnoli MC. Heterogeneity of BRAF, NRAS, and TERT Promoter Mutational Status in Multiple Melanomas and Association with MC1R Genotype. J Mol Diagn 2018; 20:110-122. [DOI: 10.1016/j.jmoldx.2017.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022] Open
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24
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van der Leest R, Hollestein L, Liu L, Nijsten T, de Vries E. Risks of different skin tumour combinations after a first melanoma, squamous cell carcinoma and basal cell carcinoma in Dutch population-based cohorts: 1989-2009. J Eur Acad Dermatol Venereol 2017; 32:382-389. [DOI: 10.1111/jdv.14587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/05/2017] [Indexed: 11/27/2022]
Affiliation(s)
- R.J.T. van der Leest
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - L.M. Hollestein
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Department of Research; Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht The Netherlands
| | - L. Liu
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Statistics; European Organization for Research and Treatment of Cancer (EORTC); Brussels Belgium
| | - T. Nijsten
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
| | - E. de Vries
- Department of Dermatology; Erasmus MC Cancer Institute; Rotterdam The Netherlands
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Clinical Epidemiology and Biostatistics; Faculty of Medicine; Pontificia Universidad Javeriana; Bogotá Colombia
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25
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Schuurman M, de Waal A, Thijs E, van Rossum M, Kiemeney L, Aben K. Risk factors for second primary melanoma among Dutch patients with melanoma. Br J Dermatol 2017; 176:971-978. [DOI: 10.1111/bjd.15024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M.S. Schuurman
- Netherlands Comprehensive Cancer Organisation (IKNL); PO Box 19079 3501 DB Utrecht the Netherlands
| | - A.C. de Waal
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - E.J.M. Thijs
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
| | - M.M. van Rossum
- Department of Dermatology; Radboud University Medical Center; Nijmegen the Netherlands
| | - L.A.L.M. Kiemeney
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
- Department of Urology; Radboud University Medical Center; Nijmegen the Netherlands
| | - K.K.H. Aben
- Netherlands Comprehensive Cancer Organisation (IKNL); PO Box 19079 3501 DB Utrecht the Netherlands
- Department of Health Evidence; Radboud University Medical Center; Nijmegen the Netherlands
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Jones MS, Torisu-Itakura H, Flaherty DC, Schoellhammer HF, Lee J, Sim MS, Faries MB. Second Primary Melanoma: Risk Factors, Histopathologic Features, Survival, and Implications for Follow-Up. Am Surg 2016; 82:1009-1013. [PMID: 27779995 PMCID: PMC5555365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The impact on survival of a second primary melanoma (SPM) is unclear. We used our melanoma center's database to examine clinicopathologic risk factors and outcomes of stage 0 to IV cutaneous melanoma in patients with one versus two primaries. Among 12,325 patients with primary melanoma, 969 (7.86%) developed SPM. SPMs were significantly thinner than autologous primary melanomas (P = 0.01), and 451 SPM patients had better overall and melanoma-specific survival than 451 prognostically matched non-SPM patients (P < 0.0001 and 0.0001, respectively) at a median follow-up of 142.37 months. Patients with cutaneous melanoma are at high risk for development of SPM, but the development of SPM does not seem to impair survival.
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Affiliation(s)
- Maris S Jones
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA
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Jones MS, Torisu-Itakura H, Flaherty DC, Schoellhammer HF, Lee J, Sim MS, Faries MB. Second Primary Melanoma: Risk Factors, Histopathologic Features, Survival, and Implications for Follow-Up. Am Surg 2016. [DOI: 10.1177/000313481608201034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The impact on survival of a second primary melanoma (SPM) is unclear. We used our melanoma center's database to examine clinicopathologic risk factors and outcomes of stage 0 to IV cutaneous melanoma in patients with one versus two primaries. Among 12,325 patients with primary melanoma, 969 (7.86%) developed SPM. SPMs were significantly thinner than autologous primary melanomas ( P = 0.01), and 451 SPM patients had better overall and melanoma-specific survival than 451 prognostically matched non-SPM patients ( P < 0.0001 and 0.0001, respectively) at a median follow-up of 142.37 months. Patients with cutaneous melanoma are at high risk for development of SPM, but the development of SPM does not seem to impair survival.
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Affiliation(s)
- Maris S. Jones
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Hitoe Torisu-Itakura
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Devin C. Flaherty
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Hans F. Schoellhammer
- John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
| | - Jihey Lee
- Department of Biostatistics, Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California; and
| | - Myung-Shim Sim
- Department of Biostatistics, Division of Surgical Oncology, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California; and
| | - Mark B. Faries
- Department of Melanoma Research, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California
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28
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Krajewski AC, Hart DR, Hieken TJ. Multiple primary melanoma in the elderly. Am J Surg 2015; 211:84-8. [PMID: 26303880 DOI: 10.1016/j.amjsurg.2015.05.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 05/24/2015] [Accepted: 05/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few data exist regarding surveillance for multiple primary melanoma (MPM) in elderly patients or whether the incidence and risk factors are the same as for younger patients. Thus, we studied the frequency and characteristics of MPM in the elderly melanoma patients. METHODS From our prospective melanoma registry, we studied 222 consecutive patients aged 65 years or older at their initial melanoma diagnosis. Mean follow-up was 65 ± 3 months. RESULTS Median age was 76 years. Twenty-two patients (10%) developed a second primary melanoma and 8 (4%) of 3 or more primaries. 82% of second primaries (18 of 22) were the same or thinner than the index melanoma, yet 50% of third primary melanomas (4 out of 8) were thicker. Only prior dysplastic nevi (P <. 0001) were a significant risk factor for MPM. CONCLUSIONS These data suggest elderly melanoma patients have a significant risk of MPM that warrants careful surveillance to facilitate prompt detection and treatment. Patients with dysplastic nevi merit special scrutiny.
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Affiliation(s)
- Adam C Krajewski
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Donna R Hart
- Department of Surgery, NorthShore University HealthSystem Skokie Hospital, 9600 Gross Point Road, Skokie, IL 60076, USA; Rush University Medical Center, 1653 Congress Parkway, Chicago, IL 60612, USA; Rush Medical College, 600 South Paulina Street, Chicago, IL 60612, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Surgery, NorthShore University HealthSystem Skokie Hospital, 9600 Gross Point Road, Skokie, IL 60076, USA; Rush University Medical Center, 1653 Congress Parkway, Chicago, IL 60612, USA; Rush Medical College, 600 South Paulina Street, Chicago, IL 60612, USA.
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29
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Stanelle EJ, Busam KJ, Rich BS, Christison-Lagay ER, Dunkel IJ, Marghoob AA, Halpern A, Coit DG, La Quaglia MP. Early-stage non-Spitzoid cutaneous melanoma in patients younger than 22 years of age at diagnosis: long-term follow-up and survival analysis. J Pediatr Surg 2015; 50:1019-23. [PMID: 25819019 PMCID: PMC4558908 DOI: 10.1016/j.jpedsurg.2015.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluated prognostic factors among young patients with early stage melanoma, with particular attention to survival, recurrence, and development of a second primary melanoma. METHODS We retrospectively reviewed patients (age <22 years) with pathologically confirmed in-situ and stage 1 non-Spitzoid melanoma treated at our institution from 1980-2010, assessing demographics, clinical presentation, treatment, disease-specific survival, recurrence-free survival, and probability of developing a second primary melanoma. RESULTS One hundred patients with in-situ melanoma (n=16) or stage 1A (n=48) or 1B (n=36) melanoma were identified. Median age was 19.4 years (range, 11.2-21.9), and median follow-up was 7.6 years (range, 0.1-31.7). Median tumor thickness was 0.76 mm (range, 0.23-2.0). No lesions were ulcerated. All patients underwent wide local excision with negative margins, and 21 had a concomitant negative sentinel lymph node biopsy (SLNB). Sixteen patients developed recurrences, and 8 subsequently died of progressive melanoma. There were 2 non-melanoma-related deaths. Endpoints were 20-year overall survival (77.4%), melanoma-specific mortality (20.1%), recurrence rate (34.0%), and probability of developing a second primary melanoma (24.7%). Greater tumor depth and Clark level were associated with worse prognosis, but age, sex, and tumor mitotic rate were not correlated with recurrence or survival. CONCLUSION Among younger early-stage melanoma patients, greater lesion depth conferred higher recurrence risk and mortality. Our data did not define the role of sentinel lymph node biopsy in this group.
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Affiliation(s)
- Eric J Stanelle
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Klaus J Busam
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Barrie S Rich
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily R Christison-Lagay
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ashfaq A Marghoob
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Allan Halpern
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel G Coit
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael P La Quaglia
- Pediatric Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Pomerantz H, Huang D, Weinstock MA. Risk of subsequent melanoma after melanoma in situ and invasive melanoma: a population-based study from 1973 to 2011. J Am Acad Dermatol 2015; 72:794-800. [PMID: 25769192 DOI: 10.1016/j.jaad.2015.02.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/26/2015] [Accepted: 02/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with melanoma in situ are at an increased risk of subsequent melanoma compared with the general population, but the risk of subsequent melanoma after initial melanoma in situ versus after initial invasive melanoma is not known. OBJECTIVE We sought to compare the risk of subsequent melanoma in the cohort whose first cancer was melanoma in situ to the risk in the cohort whose first cancer was invasive melanoma. METHODS In this cohort study, we identified individuals whose first cancer was either melanoma in situ or invasive melanoma from the Surveillance, Epidemiology, and End Results (SEER) program between 1973 and 2011 and used Cox proportional hazards models for comparison. RESULTS Compared with the invasive melanoma cohort, the melanoma in situ cohort was more likely to develop subsequent melanoma of any stage after 2 years, subsequent invasive melanoma after 10 years, and subsequent melanoma in situ at all the time points (P < .001, P = .003, P < .001, respectively). LIMITATIONS Underreporting of melanomas, particularly melanoma in situ cases, and missing cases of subsequent melanomas as a result of patient migration from the SEER registry areas could affect results. CONCLUSION Given the increased long-term risk of subsequent melanoma in the melanoma in situ cohort, the patients with melanoma in situ diagnosis may benefit from a long-term surveillance for subsequent melanomas.
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Affiliation(s)
- Hyemin Pomerantz
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Brown University, Providence, Rhode Island.
| | - David Huang
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Brown University, Providence, Rhode Island
| | - Martin A Weinstock
- Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Brown University, Providence, Rhode Island; Department of Epidemiology, Brown University, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island
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31
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Palmieri G, Colombino M, Casula M, Budroni M, Manca A, Sini MC, Lissia A, Stanganelli I, Ascierto PA, Cossu A. Epidemiological and genetic factors underlying melanoma development in Italy. Melanoma Manag 2015; 2:149-163. [PMID: 30190844 PMCID: PMC6094587 DOI: 10.2217/mmt.15.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Among human cancers, melanoma remains one of the malignancies with an ever-growing incidence in white populations. Recent advances in biological and immunological therapeutic approaches as well as increased efforts for secondary prevention are contributing to improve the survival rates. It is likely that a significant fall in mortality rates for melanoma will be achieved by further increase of the early detection through a more accurate selection of the higher-risk individuals (i.e., carriers of predisposing genetic alterations). A similar scenario occurs in Italy. In the present review, we have considered data on incidence, survival and mortality rates of melanoma in Italian population, including evaluation of the main risk factors and genetic mutations underlying disease susceptibility.
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Affiliation(s)
- Giuseppe Palmieri
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Maria Colombino
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Milena Casula
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Mario Budroni
- Department of Pathology, Hospital-University Health Unit (AOU), Sassari, Italy
| | - Antonella Manca
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Maria Cristina Sini
- Institute of Biomolecular Chemistry, National Research Council (CNR), Sassari, Italy
| | - Amelia Lissia
- Department of Pathology, Hospital-University Health Unit (AOU), Sassari, Italy
| | - Ignazio Stanganelli
- Skin Cancer Unit, Istituto Scientifico Romagnolo Tumori (IRST), Meldola, Italy
| | - Paolo A Ascierto
- Istituto Nazionale Tumori (INT), Fondazione G. Pascale, Naples, Italy
| | - Antonio Cossu
- Department of Pathology, Hospital-University Health Unit (AOU), Sassari, Italy
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32
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Rowe CJ, Law MH, Palmer JM, MacGregor S, Hayward NK, Khosrotehrani K. Survival outcomes in patients with multiple primary melanomas. J Eur Acad Dermatol Venereol 2015; 29:2120-7. [PMID: 25864459 DOI: 10.1111/jdv.13144] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND A substantial number of melanoma patients will develop multiple primary melanomas (MPM). Currently, little is known about the impact of MPM on survival. OBJECTIVE We aimed to determine whether melanoma survival is worse for patients with MPM compared to those with a single invasive primary melanoma (SPM). MATERIALS AND METHODS A cohort study was conducted. Patients were sourced from an Australian population, with follow-up information collected retrospectively from registry data. Melanoma-specific survival analysis was performed to find associated variables after adjustment for known prognostic factors, using four different models, each selecting a different index melanoma lesion. RESULTS 1068 stage I and II melanoma patients were followed up for a median of 24.4 years. MPM was found in 17.8% of the cohort (190 patients), more likely among males and older age groups. Other clinicopathological parameters were similar between the MPM and SPM (878 patients) cohorts. After adjustment for age, sex and Breslow thickness, MPM was a hazard for death from melanoma, across all models, reaching significance when considering the last invasive lesion as the index melanoma (HR = 2.76, P = 0.017). CONCLUSION Patients with multiple invasive lesions seem more at risk of death from melanoma, independent of known prognostic factors.
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Affiliation(s)
- C J Rowe
- UQ Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Qld, Australia.,Oncogenomics, QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - M H Law
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - J M Palmer
- Oncogenomics, QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - S MacGregor
- Statistical Genetics, QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - N K Hayward
- Oncogenomics, QIMR Berghofer Medical Research Institute, Herston, Qld, Australia
| | - K Khosrotehrani
- UQ Diamantina Institute, Translational Research Institute, The University of Queensland, Woolloongabba, Qld, Australia.,The University of Queensland Centre for Clinical Research, Herston, Qld, Australia
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van der Leest R, Flohil S, Arends L, de Vries E, Nijsten T. Risk of subsequent cutaneous malignancy in patients with prior melanoma: a systematic review and meta-analysis. J Eur Acad Dermatol Venereol 2014; 29:1053-62. [DOI: 10.1111/jdv.12887] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- R.J.T. van der Leest
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - S.C. Flohil
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - L.R. Arends
- Department of Biostatistics; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Pedagogical and Educational Sciences; Erasmus University Rotterdam; Rotterdam The Netherlands
- Institute of Psychology; Erasmus University Rotterdam; Rotterdam The Netherlands
| | - E. de Vries
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
- Department of Public Health; Erasmus MC University Medical Center; Rotterdam The Netherlands
| | - T. Nijsten
- Department of Dermatology; Erasmus MC University Medical Center; Rotterdam The Netherlands
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Screening, early detection, education, and trends for melanoma: current status (2007-2013) and future directions: Part II. Screening, education, and future directions. J Am Acad Dermatol 2014; 71:611.e1-611.e10; quiz 621-2. [PMID: 25219717 DOI: 10.1016/j.jaad.2014.05.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 05/15/2014] [Accepted: 05/21/2014] [Indexed: 11/22/2022]
Abstract
New evidence has accumulated over the past several years that supports improved melanoma outcomes associated with both clinician and patient screening. Population-based and workplace studies conducted in Australia and the Unites States, respectively, have shown decreases in the incidence of thick melanoma and overall melanoma mortality, and a year-long statewide screening program in Germany has shown a nearly 50% reduction in mortality 5 years after the screening ended. Current melanoma screening guidelines in the United States are inconsistent among various organizations, and therefore rates of both physician and patient skin examinations are low. As policymaking organizations update national screening recommendations in the United States, the latest research reviewed in part II of this continuing medical education article should be considered to establish the most effective recommendations. Patient and provider education will be necessary to ensure that appropriate patients receive recommended screening.
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Robsahm TE, Karagas MR, Rees JR, Syse A. New malignancies after squamous cell carcinoma and melanomas: a population-based study from Norway. BMC Cancer 2014; 14:210. [PMID: 24645632 PMCID: PMC3994878 DOI: 10.1186/1471-2407-14-210] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 03/06/2014] [Indexed: 11/10/2022] Open
Abstract
Background Skin cancer survivors experience an increased risk for subsequent malignancies but the associated risk factors are poorly understood. This study examined the risk of a new primary cancer following an initial skin cancer and assessed risk factors associated with second primary cancers. Methods All invasive cutaneous malignant melanomas (CMM, N = 28 069) and squamous cell carcinomas (SCC, N = 24 620) diagnosed in Norway during 1955–2008 were included. Rates of new primary cancers in skin cancer survivors were compared to rates of primary malignancies in the general population using standardized incidence ratios (SIR). Discrete-time logistic regression models were applied to individual-level data to estimate cancer risk among those with and without a prior skin cancer, accounting for residential region, education, income, parenthood, marital status and parental cancer status, using a 20% random sample of the entire Norwegian population as reference. Further analyses of the skin cancer cohort were undertaken to determine risk factors related to subsequent cancers. Results During follow-up, 9608 new primary cancers occurred after an initial skin cancer. SIR analyses showed 50% and 90% increased risks for any cancer after CMM and SCC, respectively (p < 0.01). The logistic regression model suggested even stronger increase after SCC (130%). The highest risk was seen for subsequent skin cancers, but several non-skin cancers were also diagnosed in excess: oral, lung, colon, breast, prostate, thyroid, leukemia, lymphoma and central nervous system. Factors that were associated with increased risk of subsequent cancers include male sex, older age, lower residential latitude, being married and low education and income. Parental cancer did not increase the risk of a subsequent cancer after SCC, but was a significant predictor among younger CMM survivors. Conclusions Our results provide information on shared environmental and genetic risk factors for first and later cancers and may help to identify individuals at high risk for subsequent cancers, which will be important as skin cancer incidence continues to rise.
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Affiliation(s)
- Trude E Robsahm
- Cancer Registry of Norway, PB 5313 Majorstuen, N-0304 Oslo, Norway.
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36
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Kang SG, Kim CH, Tark MS, Choi CY, Wee SY, Kim JW, Jeen YM. Second primary mucosal malignant melanoma in hypopharynx. J Craniofac Surg 2014; 25:492-4. [PMID: 24514893 DOI: 10.1097/scs.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary mucosal melanomas of the head and neck are rare. In addition, second primary mucosal melanoma following primary cutaneous malignant melanomas is very rare. We report a second primary mucosal melanoma. A 76-year-old woman, who had a previously cutaneous malignant melanoma of the left foot, visited with a complaint of a foreign body sensation of the throat. Endoscopy revealed a black mass at the left piriform sinus of the hypopharynx. After wide surgical excision of the lesion and reconstruction with a radial forearm free flap, the histopathology was confirmed to be a second primary mucosal malignant melanoma of the hypopharynx. Five months postoperatively, masses were palpated in the neck, and metastasis was diagnosed. The patient was treated with adjuvant chemotherapy and radiotherapy. Eight months postoperatively, computed tomography scans showed other metastatic masses in the liver, spleen, both adrenal glands, soft tissues of the abdominal wall, and both lungs. After that, the patient died 9 months postoperatively. We report a rare case of second primary mucosal malignant melanoma of the hypopharynx. Although rare, this case shows that a detailed examination of the hypopharynx and the head and neck should be a part of the follow-up examination in all cutaneous malignant melanoma patients.
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Affiliation(s)
- Sang Gue Kang
- From the Departments of *Plastic and Reconstructive Surgery, †Otolaryngology-Head and Neck Surgery, and ‡Pathology, Soonchunhyang University College of Medicine, Seoul, Korea
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Shiau CJ, Thompson JF, Scolyer RA. Controversies and evolving concepts in the diagnosis, classification and management of lentigo maligna. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/edm.13.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Walls AC, Han J, Li T, Qureshi AA. Host risk factors, ultraviolet index of residence, and incident malignant melanoma in situ among US women and men. Am J Epidemiol 2013; 177:997-1005. [PMID: 23579556 PMCID: PMC4023296 DOI: 10.1093/aje/kws335] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 07/23/2012] [Indexed: 11/14/2022] Open
Abstract
The incidences of malignant melanoma in situ (MMIS) and invasive malignant melanoma are rising in the United States, but few studies have examined risk factors for MMIS. We evaluated the risk of MMIS according to the host phenotype and the ultraviolet index of the state of residence. Prospective data were collected via biennial questionnaires from 250,151 women and men aged ≥20 years in the Nurses' Health Study (1980-2008), the Nurses' Health Study 2 (1989-2009), and the Health Professionals Follow-up Study (1986-2008). During 7,144,820 person-years of follow-up, 888 incident MMIS lesions occurred, representing 33% of all incident malignant melanoma. Meta-analysis across the cohorts demonstrated that the presence of multiple nevi on the extremities conferred the highest relative risk for MMIS (relative risk = 3.18, 95% confidence interval: 2.59, 3.90). Family history of melanoma, number of severe sunburns, sunburn susceptibility, hair color, and Fitzpatrick skin types I, II, and III were significantly associated with an increased risk of MMIS. Conversely, the ultraviolet index of the state of residence at birth, at age 15 years, and at age 30 years was not associated with increased risk of MMIS. Continued study of MMIS and associated risk factors will help identify persons who are most at risk and elucidate the role of MMIS within the spectrum of cutaneous melanoma.
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Affiliation(s)
| | | | | | - Abrar A. Qureshi
- Correspondence to Dr. Abrar A. Qureshi, Department of Dermatology, 221L, Brigham and Women's Hospital, Longwood Avenue, Boston, MA 02115 (e-mail: )
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Fearfield L, Newton-Bishop J, Sinha R, Edmonds K, Gore M, Larkin J. Second primary melanomas on treatment with vemurafenib: reply from the authors. Br J Dermatol 2013; 168:888-9. [DOI: 10.1111/bjd.12094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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van der Leest R, Liu L, Coebergh J, Neumann H, Mooi W, Nijsten T, de Vries E. Risk of second primary
in situ
and invasive melanoma in a Dutch population‐based cohort: 1989–2008. Br J Dermatol 2012; 167:1321-30. [DOI: 10.1111/j.1365-2133.2012.11123.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - L. Liu
- Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - J.W.W. Coebergh
- Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Netherlands Cancer Registry, Utrecht, the Netherlands
| | | | - W.J. Mooi
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - E. de Vries
- Departments of Dermatology
- Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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41
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Jung G, Weinstock M. Clinicopathological comparisons of index and second primary melanomas in paediatric and adult populations. Br J Dermatol 2012; 167:882-7. [DOI: 10.1111/j.1365-2133.2012.11097.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Targeted inhibition of BRAF kinase: opportunities and challenges for therapeutics in melanoma. Biosci Rep 2012; 32:25-33. [PMID: 21981139 DOI: 10.1042/bsr20110068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Malignant melanoma is the most aggressive form of skin cancer and its incidence has increased dramatically in the last two decades. Even with a high rate of success in the treatment of early stages of this malignancy, currently there are no effective strategies for the treatment of advanced metastatic melanoma. Much effort has been put into the use of different target-specific drugs, among which BRAF kinase-specific small-molecule inhibitors have rendered promising results as therapeutic agents in metastatic melanoma. Nonetheless, some side effects, such as development of SCC (squamous cell carcinoma), as well as tumour resistance and recurrence, are common limitations of this therapeutic strategy. The use of combination treatments in which different regulatory pathways or the immunological response are targeted seems to be a promising tool for the future success of melanoma therapeutics.
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Hwa C, Price LS, Belitskaya-Levy I, Ma MW, Shapiro RL, Berman RS, Kamino H, Darvishian F, Osman I, Stein JA. Single versus multiple primary melanomas: old questions and new answers. Cancer 2012; 118:4184-92. [PMID: 22246969 DOI: 10.1002/cncr.27407] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 12/06/2011] [Accepted: 12/13/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND In patients with multiple primary melanomas (MPM), mean tumor thickness tends to decrease from the first melanoma to the second melanoma, and prognosis may be improved compared with the prognosis for patients who have a single primary melanoma (SPM). In this study, the authors compared the clinicopathologic features of patients with MPM and SPM to better characterize the differences between these 2 groups and to determine whether or not there is an inherent difference in tumor aggression. METHODS In total, 788 patients with melanoma who were enrolled prospectively in the Interdisciplinary Melanoma Cooperative Group database from 2002 to 2008 were studied. Patients with SPM and with MPM were compared with regard to clinical and primary melanoma characteristics. RESULTS Of 788 patients with melanoma, 61 patients (7.7%) had 2 or more primary melanomas. The incidence of developing a second primary melanoma 1 year and 5 years after initial melanoma diagnosis was 4.1% and 8.7%, respectively, and most of the risk accumulated within the first year. The incidence of MPM was greater in patients aged ≥60 years than in those aged ≤60 years. The absence or presence of mitosis and other tumor characteristics did not differ significantly between patients with SPM and patients with MPM (P = .61). CONCLUSIONS No difference was observed in the presence or absence of mitoses, a marker of tumor proliferation, in SPM and MPM. Because it has been demonstrated that the presence of mitosis is a powerful prognostic marker, the current findings suggested that the tumors behave similarly in patients with SPM and patients with MPM. The authors concluded that differences in tumor thickness and prognosis between SPM and MPM more likely are caused by factors other than tumor biology, such as increased surveillance.
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Affiliation(s)
- Charlotte Hwa
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
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Melanozytäre Nävi. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2425-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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