1
|
Wagner NB, Knierim SM, Luttermann F, Metzler G, Yazdi AS, Bauer J, Gassenmaier M, Forschner A, Leiter U, Amaral T, Garbe C, Eigentler TK, Forchhammer S, Flatz L. Histopathologic regression in patients with primary cutaneous melanoma undergoing sentinel lymph node biopsy is associated with favorable survival and, after metastasis, with improved progression-free survival on immune checkpoint inhibitor therapy: A single-institutional cohort study. J Am Acad Dermatol 2024; 90:739-748. [PMID: 38043594 DOI: 10.1016/j.jaad.2023.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/01/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Histopathologic regression of cutaneous melanoma is considered a favorable prognostic factor, but its significance in clinical practice remains controversial. OBJECTIVE To investigate the prognostic importance of regression in patients with primary cutaneous melanoma undergoing sentinel lymph node (SLN) biopsy and to assess its significance in patients progressing to an unresectable stage requiring systemic therapy. METHODS We retrospectively reviewed patients with newly diagnosed melanoma undergoing SLN biopsy between 2010 and 2015 and available information on histopathologic regression (n = 1179). Survival data and associations of clinical variables with SLN status were assessed. RESULTS Patients with regressive melanoma showed favorable relapse-free (hazard ratio [HR], 0.52; P = .00013), distant metastasis-free (HR, 0.56; P = .0020), and melanoma-specific survival (HR, 0.35; P = .00053). Regression was associated with negative SLN (odds ratio, 0.48; P = .0077). In patients who progressed to an unresectable stage, regression was associated with favorable progression-free survival under immune checkpoint inhibition (HR, 0.43; P = .031) but not under targeted therapy (HR, 1.14; P = .73) or chemotherapy (HR, 3.65; P = .0095). LIMITATIONS Retrospective, single-institutional design. CONCLUSIONS Regression of cutaneous melanoma is associated with improved prognosis in patients eligible for SLN biopsy as well as in patients with unresectable disease receiving systemic therapy with immune checkpoint inhibitors.
Collapse
Affiliation(s)
- Nikolaus B Wagner
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
| | - Sarah M Knierim
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Felix Luttermann
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Gisela Metzler
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Center for Dermatohistopathology and Oral Pathology, Tuebingen/Wuerzburg, Tuebingen, Germany
| | - Amir S Yazdi
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Department of Dermatology and Allergology, RWTH University Hospital Aachen, Aachen, Germany
| | - Jürgen Bauer
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Maximilian Gassenmaier
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; MVZ Dermatopathology, Friedrichshafen/Bodensee PartG, Friedrichshafen, Germany
| | - Andrea Forschner
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Ulrike Leiter
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Teresa Amaral
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Claus Garbe
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Thomas K Eigentler
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany; Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Forchhammer
- Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Lukas Flatz
- Department of Dermatology, Venereology and Allergology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Department of Dermatology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| |
Collapse
|
2
|
Histological regression in melanoma: impact on sentinel lymph node status and survival. Mod Pathol 2021; 34:1999-2008. [PMID: 34247192 DOI: 10.1038/s41379-021-00870-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/08/2022]
Abstract
Regression in melanoma is an immunological phenomenon that results in partial or complete replacement of the tumor with variably vascular fibrous tissue, often accompanied by pigment-laden macrophages and chronic inflammation. In some cases, tumor-infiltrating lymphocytes (TILs) may represent the earliest phase of this process. The prognostic significance of regression has long been a matter of debate, with inconsistent findings reported in the literature to date. This study sought to determine whether regression in primary cutaneous melanomas predicted sentinel lymph node (SLN) status and survival outcomes in a large cohort of patients managed at a single centre. Clinical and pathological parameters for 8,693 consecutive cases were retrieved. Associations between regression and SLN status, overall survival (OS), melanoma-specific survival (MSS) and recurrence-free survival (RFS) were investigated using logistic and Cox regression. Histological evidence of regression was present in 1958 cases (22.5%). Regression was significantly associated with lower Breslow thickness, lower mitotic rate, and absence of ulceration (p < 0.0001). Multivariable analysis showed that regression in combination with TILs independently predicted a negative SLN biopsy (OR 0.33; 95% C.I. 0.20-0.52; p < 0.0001). Patients whose tumors showed both regression and TILs had the highest 10-year OS (65%, 95% C.I. 59-71%), MSS (85%, 95% C.I. 81-89%), and RFS (60%, 95% C.I. 54-66%). On multivariable analyses, the concurrent presence of regression and TILs independently predicted the lowest risk of death from melanoma (HR 0.69; 95% C.I. 0.51-0.94; p = 0.0003) as well as the lowest rate of disease recurrence (HR 0.71; 95% C.I. 0.58-0.85; p < 0.0001). However, in contrast, in the subgroup analysis of Stage III patients, the presence of regression predicted the lowest OS and RFS, with MSS showing a similar trend. Overall, these findings indicate a prognostically favorable role of regression in primary cutaneous melanoma. However, in Stage III melanoma patients, regression may be a marker of more aggressive disease.
Collapse
|
3
|
Sohng C, Sim HB, Kim JY, Lim Y, Han MH, Lee H, Ahn BC, Huh S, Lee SJ. Sentinel lymph node biopsy in acral melanoma: A Korean single-center experience with 107 patients (2006-2018). Asia Pac J Clin Oncol 2021; 17:115-122. [PMID: 33079454 DOI: 10.1111/ajco.13425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sentinel lymph node biopsy (SLNB) of primary cutaneous melanoma as an important staging method has not been popularly undertaken in Korea and only a few studies with small patient numbers have been published. AIM We examined the clinical feasibility and overall outcomes of SLNB in acral melanoma (AM) of Korean in Kyungpook National University Hospital (KNUH) over the past 13 years. METHODS SLNB in AM patients during 2006-2018 were analyzed retrospectively for sentinel lymph node (SLN) harvesting rate, positivity rate, positivity-relevant overall survival (OS) and disease-free survival (DFS), and its side effects. RESULTS A total of 109 AM patients who underwent SLNB were enrolled. Harvested nodes were identified from 107 patients and SLN harvesting rate was 98.2%. The mean Breslow thickness (±standard deviation) was 3.38 ± 3.03 mm, and the proportion of ulcerated melanomas was 64%. Twenty-two (20.6%) had a tumor-positive SLN and, among them, 82% (18/22) underwent immediate complete lymph node dissection (CLND). The metastasis-positive nodal basin after CLND was detected in 16.7% of cases (3/18). Tumor-negative SLN cohorts showed significantly better OS and DFS than tumor-positive ones (P = 0.006 and P < 0.001 for each). Two side effects, one seroma and one lymphocele, were observed without major sequelae. CONCLUSION SLNB, crucial management of melanoma, proved its efficacy to predict patients' prognosis and could be performed successfully and safely in Korean AM patients by interdisciplinary cooperation between dermatology and other surgical departments. SLN(-) showed significantly better OS and DFS than SLN(+). Significant risk factors for DFS were Breslow thickness, the presence of ulceration and the presence of SLN metastasis. SLNB should be encouraged in order to stage melanoma accurately and direct the proper management in Korean AM.
Collapse
Affiliation(s)
- Chihyeon Sohng
- Department of Dermatology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Hyun Bo Sim
- Park and Lee Dermatologic Clinic, Daegu, South Korea
| | - Jun Young Kim
- Department of Dermatology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Yangsoo Lim
- Department of Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Man Hoon Han
- Department of Pathology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Hoseok Lee
- Department of Radiology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Byeong-Cheol Ahn
- Department of Dermatology, Nuclear Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung Huh
- Department of Surgery, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Seok-Jong Lee
- Department of Dermatology, School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| |
Collapse
|
4
|
Kim E, Obermeyer I, Rubin N, Khariwala SS. Prognostic significance of regression and mitotic rate in head and neck cutaneous melanoma. Laryngoscope Investig Otolaryngol 2020; 6:109-115. [PMID: 33614938 PMCID: PMC7883603 DOI: 10.1002/lio2.509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/28/2022] Open
Abstract
Importance While regression is a commonly reported microscopic feature of melanoma, its prognostic significance is unclear. Objective To examine the impact of regression on sentinel node status and the likelihood of recurrence in primary cutaneous melanoma of the head and neck. Design Retrospective analysis of 191 adults who underwent surgical management for primary cutaneous melanoma of the head and neck between May 2002 and March 2019. Setting Tertiary academic center. Participants Patients appropriate for the study were identified by the Academic Health Center Information Exchange using a list of current procedural terminology codes. One hundred and ninety‐one cases of invasive melanoma of the head and neck were included from 830 patients identified. Clinical features assessed for each patient included age, sex, location of primary lesion, date of diagnosis, and current disease status (alive with or without disease). Histologic features assessed were histological melanoma subtype (nodular vs non‐nodular), Breslow thickness, Clark level, presence/absence of ulceration, mitotic rate per square millimeter, and regression. If applicable, sentinel lymph node biopsy (SLNB) status, date of recurrence, interval treatments, and date of death related to melanoma were recorded. Exclusion criteria included melanoma outside the anatomic parameters of head and neck, ocular or choroidal melanoma, mucosal melanoma, metastatic melanoma to the head or neck with no known primary tumor, melanoma of the head or neck with no surgical intervention, and non‐melanoma skin cancers of the head and neck. Intervention/Exposure Surgery for cutaneous melanoma of the head and neck. Main Outcome(s) and Measure(s) The association between presence of regression and Breslow thickness, sentinel node status, and recurrence. Results Of the 191 patients identified, 30.9% were female and 69.1% were male with a mean age at diagnosis of 62.6 (range 20‐97) years. Mean Breslow thickness was 1.2 mm in those with regression and 2.0 mm in those without regression. In patients with regression, 17.6% had a positive sentinel node, and 13.0% experienced a recurrence. In patients without regression, 26.5% had a positive sentinel node, and 31.4% experienced a recurrence. When adjusted for other factors above, regression was not associated with positive sentinel node (odds ratio [OR] = 0.59, 95% confidence interval [CI] = 0.13‐2.00) or recurrence (OR = 0.33, CI = 0.07‐1.01). Mitotic rate >2 was associated with recurrence (OR = 2.71, CI = 1.11‐6.75, P = .03). Conclusions and Relevance Patients with presence of regression had thinner melanomas and trended toward decreased rates of sentinel node positivity and recurrence, suggesting regression may not be a negative prognostic indicator in patients with cutaneous melanoma of the head and neck.
Collapse
Affiliation(s)
- Elizabeth Kim
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Isaac Obermeyer
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center University of Minnesota Minneapolis Minnesota USA
| | - Samir S Khariwala
- Department of Otolaryngology-Head and Neck Surgery University of Minnesota Minneapolis Minnesota USA
| |
Collapse
|
5
|
Min KW, Choe JY, Kwon MJ, Lee HK, Kang HS, Nam ES, Cho SJ, Park HR, Min SK, Seo J, Kim YJ, Kim NY, Kim HY. BRAF and NRAS mutations and antitumor immunity in Korean malignant melanomas and their prognostic relevance: Gene set enrichment analysis and CIBERSORT analysis. Pathol Res Pract 2019; 215:152671. [DOI: 10.1016/j.prp.2019.152671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
|
6
|
Gardner LJ, Strunck JL, Wu YP, Grossman D. Current controversies in early-stage melanoma: Questions on incidence, screening, and histologic regression. J Am Acad Dermatol 2019; 80:1-12. [PMID: 30553298 DOI: 10.1016/j.jaad.2018.03.053] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 02/03/2023]
Abstract
In the first article in this continuing medical education series we review controversies and uncertainties relating to the epidemiology and initial diagnosis of localized cutaneous melanoma (ie, stage 0, I, or II). Many of these issues are unsettled because of conflicting evidence. Melanoma incidence appears to be increasing, yet its basis has not been fully explained. Despite the advantages of early detection, the US Preventive Services Task Force does not recommend skin screening for the general population. Occasionally, biopsy specimens of melanoma will show histologic regression, but the prognostic importance of this phenomenon is uncertain. Some practitioners recommend obtaining a sentinel lymph node biopsy specimen for thin melanomas showing regression, although this histologic finding is not part of the staging system for thin melanomas. Our goal is to provide the clinician who cares for patients with (or at risk for) melanoma with up-to-date contextual knowledge to appreciate the multiple sides of each controversy so that they will be better informed to discuss these issues with their patients and their families.
Collapse
Affiliation(s)
| | | | - Yelena P Wu
- 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
| | - Douglas Grossman
- 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.
| |
Collapse
|
7
|
Vertical Growth Phase as a Prognostic Factor for Sentinel Lymph Node Positivity in Thin Melanomas: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2018; 141:1529-1540. [PMID: 29579032 DOI: 10.1097/prs.0000000000004395] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The 2010 American Joint Committee on Cancer guidelines recommended consideration of sentinel lymph node biopsy for thin melanoma (Breslow thickness <1.0 mm) with aggressive pathologic features such as ulceration and/or high mitotic rate. The therapeutic benefit of biopsy-based treatment remains controversial. The authors conducted a meta-analysis to estimate the risk and outcomes of sentinel lymph node positivity in thin melanoma, and examined established and potential novel predictors of positivity. METHODS Three databases were searched by two independent reviewers for sentinel lymph node positivity in patients with thin melanoma. Study heterogeneity, publication bias, and quality were assessed. Data collected included age, sex, Breslow thickness, mitotic rate, ulceration, regression, Clark level, tumor-infiltrating lymphocytes, and vertical growth phase. Positivity was estimated using a random effects model. Association of positivity and clinicopathologic features was investigated using meta-regression. RESULTS Ninety-three studies were identified representing 35,276 patients with thin melanoma who underwent sentinel lymph node biopsy. Of these patients, 952 had a positive sentinel lymph node biopsy, for an event rate of 5.1 percent (95 percent CI, 4.1 to 6.3 percent). Significant associations were identified between positivity and Breslow thickness greater than 0.75 mm but less than 1.0 mm, mitotic rate, ulceration, and Clark level greater than IV. Seven studies reported on vertical growth phase, which was strongly associated with positivity (OR, 4.3; 95 percent CI, 2.5 to 7.7). CONCLUSIONS To date, this is the largest meta-analysis to examine predictors of sentinel lymph node biopsy positivity in patients with thin melanoma. Vertical growth phase had a strong association with biopsy positivity, providing support for its inclusion in standardized pathologic reporting.
Collapse
|
8
|
Wong SL, Faries MB, Kennedy EB, Agarwala SS, Akhurst TJ, Ariyan C, Balch CM, Berman BS, Cochran A, Delman KA, Gorman M, Kirkwood JM, Moncrieff MD, Zager JS, Lyman GH. Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. Ann Surg Oncol 2017; 25:356-377. [PMID: 29236202 DOI: 10.1245/s10434-017-6267-7] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. METHODS An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. RESULTS Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. RECOMMENDATIONS Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.
Collapse
Affiliation(s)
- Sandra L Wong
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mark B Faries
- The Angeles Clinic and Research Institute, Santa Monica, CA, USA
| | - Erin B Kennedy
- American Society of Clinical Oncology, Alexandria, VA, USA.
| | | | | | | | | | | | - Alistair Cochran
- Los Angeles Center for Health Services, University of California, Los Angeles, CA, USA
| | | | | | - John M Kirkwood
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | | | - Jonathan S Zager
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
9
|
Wong SL, Faries MB, Kennedy EB, Agarwala SS, Akhurst TJ, Ariyan C, Balch CM, Berman BS, Cochran A, Delman KA, Gorman M, Kirkwood JM, Moncrieff MD, Zager JS, Lyman GH. Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. J Clin Oncol 2017; 36:399-413. [PMID: 29232171 DOI: 10.1200/jco.2017.75.7724] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or < 0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. Additional information is available at www.asco.org/melanoma-guidelines and www.asco.org/guidelineswiki .
Collapse
Affiliation(s)
- Sandra L Wong
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark B Faries
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Erin B Kennedy
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sanjiv S Agarwala
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Timothy J Akhurst
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Charlotte Ariyan
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Charles M Balch
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Barry S Berman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Alistair Cochran
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Keith A Delman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mark Gorman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John M Kirkwood
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marc D Moncrieff
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jonathan S Zager
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Gary H Lyman
- Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica; Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Sanjiv S. Agarwala, St Luke's Cancer Center, Easton; John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA; Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia; Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY; Charles M. Balch, MD Anderson Cancer Center, Houston, TX; Barry S. Berman, Broward Health, Fort Lauderdale; Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Keith A. Delman, Emory University, Atlanta, GA; Mark Gorman, Silver Spring, MD; Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom; and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
10
|
Falkenius J, Johansson H, Tuominen R, Frostvik Stolt M, Hansson J, Egyhazi Brage S. Presence of immune cells, low tumor proliferation and wild type BRAF mutation status is associated with a favourable clinical outcome in stage III cutaneous melanoma. BMC Cancer 2017; 17:584. [PMID: 28851300 PMCID: PMC5576332 DOI: 10.1186/s12885-017-3577-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 08/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The variable prognosis in stage III cutaneous melanoma is partially due to unknown prognostic factors. Improved prognostic tools are required to define patients with an increased risk of developing metastatic disease who might benefit from adjuvant therapies. The aim was to examine if cellular immune markers in association with tumor proliferation rate and BRAF mutation status have an impact on prognosis in stage III melanoma. METHODS We have used two sets of case series with stage III disease: 23 patients with short survival (≤ 13 months) and 19 patients with long survival (≥ 60 months). Lymph node metastases were analyzed for Ki67, CD8 and FOXP3 protein expression using immunohistochemistry. BRAF mutation status was analyzed in a previous study on the same samples. RESULTS Low tumor proliferation rate was significantly associated with a better prognosis (p = 0.013). Presence of FOXP3+ T cells was not correlated to adverse clinical outcome. A highly significant trend for a longer survival was found in the presence of an increasing number of markers; CD8+ and FOXP3+ T cells, low tumor proliferation and BRAF wildtype status (p = 0.003). Presence of at least three of these four markers was found to be an independent favorable prognostic factor (OR 19.4, 95% CI 1.9-197, p = 0.012), when adjusting for ulceration and number of lymph node metastases. Proliferation alone remained significant in multivariate analyses (OR 26.1, 95% CI 2.0-344, p = 0.013) but with a wider confidence interval. This panel still remained independent when also adjusting for a previously identified prognostic glycolytic-pigment panel. CONCLUSIONS We have demonstrated that presence of immune cells in association with tumor proliferation and BRAF mutation status may further contribute to identify stage III melanoma patients with high risk of relapse.
Collapse
Affiliation(s)
- Johan Falkenius
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, 171 76 Solna, Stockholm Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, 171 76 Solna, Stockholm Sweden
| | - Rainer Tuominen
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, 171 76 Solna, Stockholm Sweden
| | - Marianne Frostvik Stolt
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, 171 76 Solna, Stockholm Sweden
| | - Johan Hansson
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, 171 76 Solna, Stockholm Sweden
| | - Suzanne Egyhazi Brage
- Department of Oncology-Pathology, Karolinska Institutet, Cancer Center Karolinska, Karolinska University Hospital, 171 76 Solna, Stockholm Sweden
| |
Collapse
|
11
|
Aung PP, Nagarajan P, Prieto VG. Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance. J Transl Med 2017; 97:657-668. [PMID: 28240749 DOI: 10.1038/labinvest.2017.8] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 12/18/2022] Open
Abstract
Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists' interpretation. Regression is histologically characterized by variable decrease in the number of melanoma cells accompanied by the presence of a host response consisting of dermal fibrosis, inflammatory infiltrate, melanophages, ectatic blood vessels, epidermal attenuation, and/or apoptosis of keratinocytes or melanocytes; the relative extent of these features depends on the stage of the regression. However, the magnitudes to which these individual changes must be present to meet the threshold of histologic regression have not been well defined or agreed upon, and thus, the definition and classification of histologic regression in melanoma varies considerably among institutions and even among individual pathologists. In order to determine the clinical significance of histologic analysis of regression, there is a compelling need for a universal scheme to objectively define and assess histologic regression in primary cutaneous melanoma, so that the biologic and prognostic significance of this process may be completely understood.Laboratory Investigation advance online publication, 27 February 2017; doi:10.1038/labinvest.2017.8.
Collapse
Affiliation(s)
- Phyu P Aung
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priyadharsini Nagarajan
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor G Prieto
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
12
|
Mikkelsen J, Hagen Wagenblast AL, Behrendt N, Lock-Andersen J. Melanoma in situ with in-transit metastases. JPRAS Open 2017. [DOI: 10.1016/j.jpra.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
13
|
|
14
|
Abstract
OBJECTIVE The purpose of this study was to assess regional recurrence rates of patients who underwent sentinel lymph node biopsy (SLNB) using radiocolloid guidance alone. BACKGROUND Isosulfan blue dye is commonly used along with Tc99-labeled radiocolloid localization in SLNB for melanoma. Blue dye has, however, been associated with allergic reactions, long-term staining of skin, and increased cost. We hypothesized that the rate of regional recurrence when SLNB is performed with radiocolloid alone would be comparable to established reports using both radiocolloid and blue dye. METHODS A prospectively collected database was retrospectively queried for patients who underwent SLNB for melanoma during the years 2005 through 2008. Data collected included patient demographics, primary lesion characteristics, operative details, and recurrence. The primary outcome was the rate of recurrence within the biopsied basin after negative SLNB's performed without isosulfan blue dye. RESULTS In 215 patients, 279 nodal basins were identified. All patients underwent successful radiocolloid localization, and positive sentinel nodes were found in 40 patients (18.6%). Six of 175 patients with a negative SLNB developed a regional node recurrence as the first site of metastasis (3.4%). Among all 215 patients, 44 experienced recurrence of any kind (20.5%). Higher mitotic rate and Breslow depth were significantly associated with likelihood of recurrence. CONCLUSIONS Success rates, node positivity rates, and rates of regional recurrence after SLNB for melanoma using radiocolloid alone are acceptable and similar to those of prior reports using blue dye plus radiocolloid.
Collapse
|
15
|
Maurichi A, Miceli R, Camerini T, Mariani L, Patuzzo R, Ruggeri R, Gallino G, Tolomio E, Tragni G, Valeri B, Anichini A, Mortarini R, Moglia D, Pellacani G, Bassoli S, Longo C, Quaglino P, Pimpinelli N, Borgognoni L, Bergamaschi D, Harwood C, Zoras O, Santinami M. Prediction of survival in patients with thin melanoma: results from a multi-institution study. J Clin Oncol 2014; 32:2479-85. [PMID: 25002727 DOI: 10.1200/jco.2013.54.2340] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Cutaneous melanoma incidence is increasing. Most new cases are thin (≤ 1 mm) with favorable prognoses, but survival is nonetheless variable. Our aim was to investigate new prognostic factors and construct a nomogram for predicting survival in individual patients. PATIENTS AND METHODS Data from 2,243 patients with thin melanoma were retrieved from prospectively maintained databases at six centers. Kaplan-Meier survival and crude cumulative incidences of recurrence were estimated, and competing risks were taken into account. Multivariable Cox regression was used to investigate survival predictors. RESULTS Median follow-up was 124 months (interquartile range, 106 to 157 months); 12-year overall survival was 85.3% (95% CI, 83.4% to 87.2%). Median times to local, regional, and distant recurrence were 79, 78, and 107 months, respectively. Relapse was significantly related to age, Breslow thickness, mitotic rate (MR), ulceration, lymphovascular invasion (LVI), and regression; incidence was lower and subgroup differences were less marked for distant metastasis than for regional relapse. The worst prognosis categories were age older than 60 years, Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, presence of LVI, and regression ≥ 50%. Breslow thickness more than 0.75 mm, MR ≥ 1, presence of ulceration, and LVI (all P = .001) were significantly associated with sentinel node positivity. Age, MR, ulceration, LVI, regression, and sentinel node status were independent predictors of survival and were used to construct a nomogram to predict 12-year overall survival. The nomogram was well calibrated and had good discriminative ability (adjusted Harrell C statistic, 0.88). CONCLUSION Our findings suggest including LVI and regression as new prognostic factors in the melanoma staging system. The nomogram appears useful for risk stratification in clinical management and for recruiting patients to clinical trials.
Collapse
Affiliation(s)
- Andrea Maurichi
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece.
| | - Rosalba Miceli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Tiziana Camerini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Luigi Mariani
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberto Patuzzo
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberta Ruggeri
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Gianfranco Gallino
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Elena Tolomio
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Gabrina Tragni
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Barbara Valeri
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Andrea Anichini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Roberta Mortarini
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Daniele Moglia
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Giovanni Pellacani
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Sara Bassoli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Caterina Longo
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Pietro Quaglino
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Nicola Pimpinelli
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Lorenzo Borgognoni
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Daniele Bergamaschi
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Catherine Harwood
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Odysseas Zoras
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| | - Mario Santinami
- Andrea Maurichi, Rosalba Miceli, Tiziana Camerini, Luigi Mariani, Roberto Patuzzo, Roberta Ruggeri, Gianfranco Gallino, Elena Tolomio, Gabrina Tragni, Barbara Valeri, Andrea Anichini, Roberta Mortarini, Daniele Moglia, Mario Santinami, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Nazionale dei Tumori, Milan; Giovanni Pellacani, Sara Bassoli, Caterina Longo, University Hospital of Modena and Skin Cancer Unit IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia; Pietro Quaglino, University Hospital of Turin, Turin; Nicola Pimpinelli, Lorenzo Borgognoni, University Hospital of Florence and Istituto Tumori Toscano, S. Maria Annunziata Hospital, Florence, Italy; Daniele Bergamaschi, Catherine Harwood, Queen Mary University of London, London, United Kingdom; and Odysseas Zoras, University Hospital of Heraklion, Crete, Greece
| |
Collapse
|
16
|
Kupferman ME, Kubik MW, Bradford CR, Civantos FJ, Devaney KO, Medina JE, Rinaldo A, Stoeckli SJ, Takes RP, Ferlito A. The role of sentinel lymph node biopsy for thin cutaneous melanomas of the head and neck. Am J Otolaryngol 2014; 35:226-32. [PMID: 24439782 DOI: 10.1016/j.amjoto.2013.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
From 18% to 35% of cutaneous melanomas are located in the head and neck, and nearly 70% are thin (Breslow thickness ≤ 1 mm). Sentinel lymph node biopsy (SLNB) has an established role in staging of intermediate-thickness melanomas, however its use in thin melanomas remains controversial. In this article, we review the literature regarding risk factors for occult nodal metastasis in thin cutaneous melanoma of the head and neck (CMHN). Based on the current literature, we recommend SLNB for all lesions with Breslow thickness ≥ 0.75 mm, particularly when accompanied by adverse features including mitotic rate ≥ 1 per mm(2), ulceration, and extensive regression. SLNB should also be strongly considered in younger patients (e.g. < 40 years old), especially in the presence of additional adverse features. All patients who do not proceed with sentinel lymph node biopsy must be carefully followed to monitor for regional relapse.
Collapse
Affiliation(s)
- Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Mark W Kubik
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Francisco J Civantos
- Department of Otolaryngology-Head and Neck Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | | | - Jesus E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Sandro J Stoeckli
- Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | | |
Collapse
|
17
|
Chu VH, Tetzlaff MT, Torres-Cabala CA, Prieto VG, Bassett R, Gershenwald JE, McLemore MS, Ivan D, Wang WL(B, Ross MI, Curry JL. Impact of the 2009 (7th edition) AJCC melanoma staging system in the classification of thin cutaneous melanomas. BIOMED RESEARCH INTERNATIONAL 2013; 2013:898719. [PMID: 24369020 PMCID: PMC3866827 DOI: 10.1155/2013/898719] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 10/23/2013] [Accepted: 10/28/2013] [Indexed: 11/17/2022]
Abstract
CONTEXT The 7th (2009) edition of the AJCC melanoma staging system incorporates tumor (Breslow) thickness, MR, and ulceration in stratifying T1 primary melanomas. Compared to the prior 6th (2001) edition, MR has replaced CL for thin melanomas. OBJECTIVE We sought to identify and report differences of the classification of thin melanomas as well as outcome of SLNB in patients according to the 6th and 7th editions at our institution. RESULTS 106 patients were identified with thin melanomas verified by wide excision. 31 of 106 thin melanomas were reclassified according to the 7th edition of the AJCC. Of those 31, 15 CL II/III patients (6th edition T1a) were reclassified as T1b based on the presence of mitoses while 16 CL IV patients (6th edition T1b) were categorized as T1a based on the absence of mitoses. 26/31 reclassified patients underwent SLNB, and all were negative. Patients with thin melanoma and a +SLNB (N = 3) were all classified as T1b according to both staging systems. CONCLUSIONS In our experience, 29% of thin melanomas were reclassified according to the 7th edition with similar proportions of patients re-distributed as T1a (14%) and T1b (15%). Cases with +SLN corresponded with T1b lesions in both 6th and 7th editions.
Collapse
Affiliation(s)
- Vicki H. Chu
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Michael T. Tetzlaff
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Carlos A. Torres-Cabala
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Victor G. Prieto
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Roland Bassett
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey E. Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michael S. McLemore
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Doina Ivan
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Wei-Lien (Billy) Wang
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Merrick I. Ross
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jonathan L. Curry
- Section of Dermatopathology, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
18
|
Kraft Rovere R, Pires de Souza ME, Fernanda Hilgert S, Rodrigues Chamse Ddine Y, Silva de Lima A. Melanoma metastasis to the gastric mucosa preceded by guillain-barré as a paraneoplastic syndrome. GASTROINTESTINAL CANCER RESEARCH : GCR 2013; 6:150-151. [PMID: 24312689 PMCID: PMC3849897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Rodrigo Kraft Rovere
- Department of Internal Medicine and Medical Oncology Hospital Santo Antonio Blumenau, Santa Catarina, Brazil
| | | | - Sara Fernanda Hilgert
- Department of Internal Medicine and Medical Oncology Hospital Santo Antonio Blumenau, Santa Catarina, Brazil
| | | | | |
Collapse
|