Trends in Melanoma Mortality in Brazil: A Registry-Based Study

Cutaneous Melanoma: An Overview of Physiological and Therapeutic Aspects and Biotechnological Use of Serine Protease Inhibitors

BACKGROUND

Metastatic melanoma stands out as the most lethal form of skin cancer because of its high propensity to spread and its remarkable resistance to treatment methods.

METHODS

In this review article, we address the incidence of melanoma worldwide and its staging phases. We thoroughly investigate the different melanomas and their associated risk factors. In addition, we underscore the principal therapeutic goals and pharmacological methods that are currently used in the treatment of melanoma.

RESULTS

The implementation of targeted therapies has contributed to improving the approach to patients. However, because of the emergence of resistance early in treatment, overall survival and progression-free periods continue to be limited.

CONCLUSIONS

We provide new insights into plant serine protease inhibitor therapeutics, supporting high-throughput drug screening soon, and seeking a complementary approach to explain crucial mechanisms associated with melanoma.

Acral Melanoma Incidence and Survival Trends in 1990-2020: A Nationwide, Population-based Study

Acral melanoma is a clinical subtype of melanoma with high mortality, on which research is limited in scope. This study aimed to assess incidence trends and melanoma-specific survival rates for acral melanoma in the Swedish population from 1990 to 2020.This cross-sectional study included patients with an acral melanoma diagnosis from 1990 to 2020 from the nationwide, population-based Swedish Melanoma Registry. Analyses on acral melanoma melanoma-specific survival rates were adjusted for age, sex, histopathological subtype, and tumour thickness. Clinicopathological features and melanoma-specific survival rates were compared between diagnostic periods: 1990-1999, 2000-2009, and 2010-2020, respectively. Changes in standardized incidence rates in 1996-2020 were evaluated separately for males and females. In total, 1,000 acral melanomas in 999 patients were included in the study. No significant yearly change in standardized incidence rates for either males or females was observed, even though the absolute number of cases increased. Factors such as male sex, age ≥ 70 years, and Breslow thickness > 1.0 were independently linked to lower melanoma-specific survival. The 5-year melanoma-specific survival across the studied period ranged from 75.8% to 77.9% for females, and from 62.4% to 71.7% for males.

Analysis of the dermoscopic features of excised melanomas and their relation with tumor thickness in a tertiary hospital in Brazil

BACKGROUND

Dermoscopy is a non-invasive, cost-effective tool useful in the assessment of pigmented lesions. The aim of this study was to analyze the dermoscopic features in excised melanomas in a tertiary hospital in Brazil and the influence of Breslow thickness on the dermoscopic features observed.

METHODS

An observational, cross-sectional study in which dermoscopic images of 43 melanomas were evaluated. The patients were divided into three groups: in situ, thin invasive melanoma (Breslow thickness <1 mm), and thick invasive melanoma (Breslow thickness ≥1 mm).

RESULTS

We studied 33 patients with 43 melanomas. Twenty-one (48.8%) were melanoma in situ, 16 (37.2%) were thin melanomas, and 6 (14%) were thick melanomas. The most frequent dermoscopic criteria observed in all cases were atypical pigment network, multiple colors (3 or more), asymmetrical blotches, and peripheral asymmetric dots and globules. There was a statistically significant difference in the three groups regarding the frequency of atypical vessels, white scar areas, blue-white veil, shiny white structures, and radial streaming. The group of invasive melanomas presented with a higher frequency and statistical significance (P < 0.05) of atypical vessels, white scar areas, blue-white veil, and shiny white structures when compared to in situ melanomas. The presence of radial streaming and blue-white veil was more frequent in thick invasive melanomas than in thin invasive melanomas. The presence of a higher number of structures was seen in invasive melanomas, with a median of 5 and 7.5 structures for thin and thick invasive tumors, respectively.

CONCLUSIONS

In line with prior data, we identified an association between invasive melanomas and structures linked to fibrosis and tumor vascularity. Specifically, we noted the presence of atypical vessels, scar-like white areas, a blue-white veil, and shiny white structures. Also, a higher number of dermoscopic structures was seen in invasive melanomas. In thicker melanomas, we observed additional findings, including a higher frequency of radial streaming and a blue-white veil.

Epidemiology of cutaneous melanoma in Blumenau, Santa Catarina state, Brazil from 1980 to 2019

BACKGROUND

The incidence and mortality of melanoma have increased in the last years in the Caucasian population. This 40-year study of melanoma incidence in Blumenau-SC shows the impact of primary prevention on the decrease of mortality.

OBJECTIVES

To classify cutaneous melanomas and evaluate their incidence in Blumenau from 1980 to 2019.

METHODOLOGY

This retrospective, descriptive and cross-sectional study collected 2,336 histopathological examinations of individuals living in the city, considering sex, age, primary location, histopathological type, invasion level (Clark), and tumor thickness (Breslow). The crude coefficients of annual incidence rates were calculated using the number of melanomas and the population estimated by the Brazilian Institute of Geography and Statistics between 1980 and 2019.

RESULTS

Melanoma incidence rates reached 44.26 cases/100,000 inhabitants/year and the rates by sex reached 52.87 in men and 46.73 cases in women per 100,000 inhabitants. The most affected age group was 70 years old and over, with 421 cases in men and 301 cases/100,000 inhabitants in women. Superficial spreading melanoma occurred in 64.5% of the cases, followed by nodular melanoma in 22.8%. Early diagnoses reached 1900% with Breslow < 0.5 mm.

STUDY LIMITATIONS

This study only covers histopathological reports with definitive diagnoses of cutaneous melanoma; therefore, the data are underestimated, consequently resulting in lower rates than in reality.

CONCLUSIONS

The incidence of cutaneous melanoma has increased fivefold between 1980 and 2009 and early diagnosis increased as a result of health education and primary prevention.

Evaluation of tumor load in sentinel lymph node in patients with cutaneous melanoma

INTRODUCTION

cutaneous melanoma (MC) is a malignant neoplasm derived from melanocytic cells with an aggressive behavior. It is usually associated with the multifactorial interaction of genetic susceptibility and environmental exposure, usually ultraviolet radiation. Despite advances in treatment, the disease remains relentless with poor prognosis. Sentinel lymph node (SLN) biopsy is a technique used to screen patients in need of lymph node dissection.

OBJECTIVES

to correlate the tumor burden in the SLN with the mortality of patients undergoing SLN biopsy.

METHODOLOGY

the medical records and histological slides of patients with MC who underwent SLN biopsy treated at HC-Unicamp from 2001 to 2021 were retrospectively analyzed. The positive SLN were measured according to the size of the tumor infiltration area, for analysis of the depth of invasion (DI), closest proximity to the capsule (CPC) and tumor burden (TB). For statistical analysis, associations between variables were analyzed using Fishers exact test, with post Bonferroni test and Wilcoxon test.

RESULTS

105 records of patients who underwent SLN biopsy of MC were identified. Of these, nine (8.6%) had positive SLN and 81 (77.1%) had negative SLN. The performed lymphadenectomies resulted in 55.6% (n=5) affected, 22.2% (n=2) without disease and 22.2% (n=2) were not performed. Mean CPC, TB, and DI were 0.14mm, 32.10mm and 2.33mm, respectively. Patients with T2 and T3 tumors were more likely to show the SLN affected (p=0.022). No patient with positive SLN died during follow-up.

CONCLUSION

patients who presented T3 staging are the ones who most presented positive SLN.

The effects of exposure to solar radiation on human health

This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.

The SRPK inhibitor N-(2-(piperidin-1-yl)-5-(trifluoromethyl)phenyl) isonicotinamide (SRPIN340) increases the immune response against metastatic melanoma in mice

Cancers have a strong relationship with immune cells in their microenvironment, which significantly influences tumor proliferation and progression. Thus, pharmacological strategies that stimulate the immune system to combat tumor cells are promising for better therapeutic efficacy. Deregulated expression of the splicing regulatory serine arginine protein kinases (mostly SRPK1 and SRPK2) has been found in different cancer types, leading to the expression of isoforms related to tumor growth and metastasis. The microenvironment of melanoma exhibits a strong presence of immune cells, which significantly influences tumor progression, and around 50% of cutaneous melanoma patients benefit from targeted immunotherapy. Here, we analyzed human malignant melanoma single-cell gene expression data and observed that SRPK1/2 overexpression correlates with immune system pathway alterations. In further analysis, we observed an increased presence of immune cells in biopsies from mice bearing metastatic melanoma treated with SRPIN340, a well-known SRPK1/2 pharmacological inhibitor. Local treatments increased the expression of proinflammatory cytokines at the tumor lesions and the activity of the spleen, accompanied by reduced pulmonary metastasis foci, edema formation, and alveolar congestion. In in vitro assays, SRPIN340 also potentiated immunological susceptibility, by increasing the expression of the antigen presenting MHCI and MHCII molecules and by increasing the ability of B16F10 cells to attract splenic cells in transwell assays. Taken together, these results reveal that the antimetastatic effect of SRPIN340 can also involve an increased immune response, which suggests additional functional clues for SRPKs in tumor biology.

Cancer Statistics over Time in Northwestern São Paulo State, Brazil: Incidence and Mortality

BACKGROUND

Population studies can serve as an essential source of information on cancer's etiology, and assessments of cancer trends over time can detect changes. This study aimed to provide statistics over time on cancer incidence and mortality in the Barretos Region, Brazil.

METHODS

Cancer incidence data were obtained from the population-based cancer registry of the Barretos Region, and mortality data were obtained from the Official Federal Database from 2002 to 2016. Age-standardized rates for incidence and mortality were calculated. Joinpoint Regression software was used to estimate the average annual percentage changes (AAPC).

RESULTS

Age-standardized rates of incidence increased significantly for colon cancer (AAPC: 2.2), rectum and rectosigmoid (AAPC: 2.4), liver (AAPC: 4.7), female breast (AAPC: 2.2), and thyroid cancer (AAPC: 3.8) but decreased for esophageal (AAPC: -3.2), stomach (AAPC: -4.2), lung (AAPC: -2.0), and ovarian cancer (AAPC: -5.6). The mortality increased for liver cancer (AAPC: 2.3) and decreased for pharyngeal cancer (AAPC: -5.8), stomach cancer (AAPC: -6.6), cervical uterine cancer (AAPC: -5.9), prostate cancer (AAPC: -2.4), and ovarian cancer (AAPC: -3.3).

CONCLUSIONS

We observed decreases in some cancers related to tobacco smoking and cervical and stomach cancers related to infectious agents, showing strong regional and national prevention programs' successes. But, we also observed rises in many cancer sites linked to lifestyle factors, such as breast or colorectal cancer, without a sign of declining mortality.

IMPACT

These results can impact and support cancer control program implementation and improvement at the community level and extrapolate to the state level and/or the whole country.