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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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3
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Abstract
This 'What's new in oncodermatology?' addresses the developments in 2017 on the epidemiology and management of skin cancers. We observe a constant increase in carcinomas, risk factors for squamous cell carcinoma, especially in transplant recipients where skin cancer mortality is important. Among epidemiological developments in melanoma are increased mortality despite screening, occupational exposure to UV, second melanoma and higher risk after carcinoma. New classifications that should be considered are AJCC8 for melanoma and carcinoma. In a near future artificial intelligence could change skin cancer screening practices through deep learning. For the sentinel lymph node, there is no interest in systematic lymphadenectomy that does not improve survival. Radiation therapy is essential for the prognosis of Merkel's carcinoma, and Mohs' surgery can be of interest. In metastatic melanoma, results on immunotherapy and targeted treatments include duration, dose, combinations, and the study of resistance mechanisms. The great novelty is immunotherapy or targeted therapy as an adjuvant treatment, giving an improvement in survival without relapse.
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Affiliation(s)
- C Lebbé
- AP-HP dermatologie, INSERM U976, université Paris 7-Diderot, hôpital Saint-Louis, Paris, France.
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