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Shemer M, Shimonovitz M, Furer R, Abu-Abeid A, Dayan D, Schneebaum S, Miodovnik M, Nizri E. Long-term outcomes and patterns of recurrence in patients with thin melanoma and a negative sentinel lymph node biopsy: a single-center experience. Melanoma Res 2024:00008390-990000000-00156. [PMID: 38874499 DOI: 10.1097/cmr.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
The majority of patients diagnosed with melanoma have thin melanomas (≤1 mm). Data on the rate and pattern of recurrence after a negative sentinel lymph node biopsy (SLNB) are sparse. We retrospectively searched our institutional database and retrieved the records of patients with thin melanomas who underwent an SLNB with negative results. We analyzed patterns of recurrence, time to recurrence, and mode of diagnosis. Thirteen of the 198 patients with thin melanomas and negative SLNB results had tumor recurrence (6.5%): two local in transit (15.4%), three regional (21.3%), and eight distant (61.5%). Distant recurrences tended to occur later than local or regional ones [median disease-free survival = 50 months (95% confidence interval: 36.1-63.9) vs. 34 and 15 months (95% confidence interval: 5.4-24.6), P = 0.005, respectively]. The percentage of patients with tumor thickness ≥0.8 mm was higher among those who sustained recurrence (84.6 vs. 64.9% for no recurrence, P = 0.04). The majority of patients with recurrence were not being followed up when diagnosed (69%), and they are presented because of clinical symptoms. Patients with recurrence had lower survival compared with those without recurrence (median: 118 months vs. ongoing survival, P < 0.001, respectively). Melanoma recurrence in patients with thin melanomas and negative SLNBs is rare, tends to be distant, and negatively affects prognosis. Recurrence tends to occur in patients with melanoma thickness ≥0.8 mm. Further studies are needed to identify patients with high recurrence risk and determine optimal follow-up protocols.
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Affiliation(s)
- Maayan Shemer
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Michal Shimonovitz
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rozalin Furer
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Adam Abu-Abeid
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
| | - Danit Dayan
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
| | - Schlomo Schneebaum
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Mor Miodovnik
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eran Nizri
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery B
- Melanoma Center, Institute of Oncology, Tel-Aviv Sourasky Medical Center, affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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2
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Rios-Duarte JA, Diaz-Valencia AC, Combariza G, Feles M, Peña-Silva RA. Comprehensive analysis of clinical images contributions for melanoma classification using convolutional neural networks. Skin Res Technol 2024; 30:e13607. [PMID: 38742379 DOI: 10.1111/srt.13607] [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: 10/11/2023] [Accepted: 01/19/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Timely diagnosis plays a critical role in determining melanoma prognosis, prompting the development of deep learning models to aid clinicians. Questions persist regarding the efficacy of clinical images alone or in conjunction with dermoscopy images for model training. This study aims to compare the classification performance for melanoma of three types of CNN models: those trained on clinical images, dermoscopy images, and a combination of paired clinical and dermoscopy images from the same lesion. MATERIALS AND METHODS We divided 914 image pairs into training, validation, and test sets. Models were built using pre-trained Inception-ResNetV2 convolutional layers for feature extraction, followed by binary classification. Training comprised 20 models per CNN type using sets of random hyperparameters. Best models were chosen based on validation AUC-ROC. RESULTS Significant AUC-ROC differences were found between clinical versus dermoscopy models (0.661 vs. 0.869, p < 0.001) and clinical versus clinical + dermoscopy models (0.661 vs. 0.822, p = 0.001). Significant sensitivity differences were found between clinical and dermoscopy models (0.513 vs. 0.799, p = 0.01), dermoscopy versus clinical + dermoscopy models (0.799 vs. 1.000, p = 0.02), and clinical versus clinical + dermoscopy models (0.513 vs. 1.000, p < 0.001). Significant specificity differences were found between dermoscopy versus clinical + dermoscopy models (0.800 vs. 0.288, p < 0.001) and clinical versus clinical + dermoscopy models (0.650 vs. 0.288, p < 0.001). CONCLUSION CNN models trained on dermoscopy images outperformed those relying solely on clinical images under our study conditions. The potential advantages of incorporating paired clinical and dermoscopy images for CNN-based melanoma classification appear less clear based on our findings.
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Affiliation(s)
| | | | - Germán Combariza
- Department of Mathematics, Universidad Externado de Colombia, Bogotá, Colombia
| | - Miguel Feles
- Department of Mathematics, Universidad Externado de Colombia, Bogotá, Colombia
| | - Ricardo A Peña-Silva
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Lown Scholars Program, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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3
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Lee KJ, Soyer HP, Stark MS. The Skin Molecular Ecosystem Holds the Key to Nevogenesis and Melanomagenesis. J Invest Dermatol 2024; 144:456-465. [PMID: 37921715 DOI: 10.1016/j.jid.2023.09.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023]
Abstract
Early detection of melanoma is critical to good patient outcomes, but we still know little about the mechanisms of early melanoma development. Normal epidermis has many of the sequence variants and genetic architecture disruptions found in both benign nevi, melanomas, and other skin cancers, yet continues to behave more or less normally. One hypothesis is that many melanocytes in this context are "tumor competent" but are regulated by the microenvironment provided by the surrounding keratinocytes to inhibit progress to nevi or melanoma. There is evidence of accumulating disorder in several measures of the genomic and epigenomic landscape from normal skin through nevi to melanoma that may be key to promoting nevogenesis and melanomagenesis.
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Affiliation(s)
- Katie J Lee
- Frazer Institute, the University of Queensland, Dermatology Research Centre, Queensland, Australia.
| | - H Peter Soyer
- Frazer Institute, the University of Queensland, Dermatology Research Centre, Queensland, Australia; Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Mitchell S Stark
- Frazer Institute, the University of Queensland, Dermatology Research Centre, Queensland, Australia
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4
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Al-Sadek T, Yusuf N. Ultraviolet Radiation Biological and Medical Implications. Curr Issues Mol Biol 2024; 46:1924-1942. [PMID: 38534742 DOI: 10.3390/cimb46030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
Ultraviolet (UV) radiation plays a crucial role in the development of melanoma and non-melanoma skin cancers. The types of UV radiation are differentiated by wavelength: UVA (315 to 400 nm), UVB (280 to 320 nm), and UVC (100 to 280 nm). UV radiation can cause direct DNA damage in the forms of cyclobutane pyrimidine dimers (CPDs) and 6-4 photoproducts (6-4PPs). In addition, UV radiation can also cause DNA damage indirectly through photosensitization reactions caused by reactive oxygen species (ROS), which manifest as 8-hydroxy-2'-deoxyguanine (8-OHdG). Both direct and indirect DNA damage can lead to mutations in genes that promote the development of skin cancers. The development of melanoma is largely influenced by the signaling of the melanocortin one receptor (MC1R), which plays an essential role in the synthesis of melanin in the skin. UV-induced mutations in the BRAF and NRAS genes are also significant risk factors in melanoma development. UV radiation plays a significant role in basal cell carcinoma (BCC) development by causing mutations in the Hedgehog (Hh) pathway, which dysregulates cell proliferation and survival. UV radiation can also induce the development of squamous cell carcinoma via mutations in the TP53 gene and upregulation of MMPs in the stroma layer of the skin.
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Affiliation(s)
- Tarek Al-Sadek
- Department of Dermatology, UAB Heersink School of Medicine, Birmingham, AL 35294, USA
| | - Nabiha Yusuf
- Department of Dermatology, UAB Heersink School of Medicine, Birmingham, AL 35294, USA
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5
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Manneschi G, Caldarella A, Caini S, Checchi S, Intrieri T, Chiarugi A, Nardini P, Masala G. The Burden of Thin Melanomas in Tuscany, Italy, 1985-2017: Age- and Sex-Specific Temporal Trends in Incidence and Mortality. Cancers (Basel) 2024; 16:536. [PMID: 38339287 PMCID: PMC10854552 DOI: 10.3390/cancers16030536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
A steady increase in the incidence and mortality burden correlated to thin melanomas (≤1 mm) has been reported in recent years in some international studies, but there is currently a paucity of data from the Mediterranean area. We aimed to describe the epidemiological characteristics of thin melanoma in Tuscany, Central Italy. A total of 6002 first cutaneous invasive melanomas occurring from 1985 to 2017 were selected for analysis; data were retrieved from the local population-based cancer registry. The standardized incidence rate was 15.0 per 100,000 in the population, higher among men than women (16.5 vs. 14.1). Incidence rates tended to increase over time across all age group-specific population strata, with annual percent changes moderately higher among men (+8.0%) than women (+6.9%), especially among the elderly. Among both sexes and in each age group, the trend toward increasing incidence rates was particularly strong for thin melanomas. Survival was better among women than men across all categories of thickness. Approximately 15% of deaths occurred among patients with thin lesions, with no major temporal changes in recent years. This study contributes to an improved understanding of melanoma epidemiology in Tuscany and underscores the need for primary prevention strategies tackling the growing burden of thin melanomas.
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Affiliation(s)
- Gianfranco Manneschi
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
| | - Adele Caldarella
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy
| | - Saverio Checchi
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, 50144 Florence, Italy;
| | - Teresa Intrieri
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
| | - Alessandra Chiarugi
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), 50139 Florence, Italy; (A.C.); (P.N.)
| | - Paolo Nardini
- Screening and Secondary Prevention Unit, Institute for Cancer Research, Prevention and Oncological Network (ISPRO), 50139 Florence, Italy; (A.C.); (P.N.)
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy; (G.M.); (A.C.); (T.I.); (G.M.)
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6
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Sladojevic J, Dotlic J, Gazibara T, Matkovic S, Maksimovic N. Longitudinal evaluation of health-related quality of life after removal of high-risk melanoma in a setting where adjuvant therapy is not available. Arch Dermatol Res 2023; 316:27. [PMID: 38060051 DOI: 10.1007/s00403-023-02766-4] [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: 01/26/2023] [Revised: 08/07/2023] [Accepted: 10/05/2023] [Indexed: 12/08/2023]
Abstract
To evaluate health-related quality of life (HRQoL) of people with a high-risk skin melanoma after completion of the primary surgical treatment over time, as well as, to identify factors associated with better HRQoL at the beginning and at the end of follow-up. The study included subjects with histopathologically confirmed high-risk skin melanoma in clinical stages IIC, IIIA, IIIB, and IIIC, in whom clinical and radiographic signs of the disease were not confirmed after primary surgical treatment. The HRQoL was evaluated using Short Form-36 (SF-36) after completion of primary surgical treatment (start of follow-up) and after 6 to 12 months (end of follow-up). A total of 71 people completed SF-36 at both points in time. There were no significant differences between the initial and the follow-up total HRQoL score (t = 1.118; p = 0.267). At the start of follow-up, having fewer depressive symptoms, better functional status and lower vitamin D serum levels were associated with a better total HRQoL score. At the end of follow-up, having lower Breslow depth and being employed at the start of follow-up, having fewer depressive symptoms and lower C-reactive protein (CRP) serum levels at follow-up, and not developing metastases over follow-up were associated with a higher total HRQoL scores. The HRQoL of people with high-risk melanoma did not change in the year following the complete removal of the tumor. However, presence of depressive symptoms and metastases seem to have the strongest impact on poorer quality of life after surgery.
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Affiliation(s)
| | - Jelena Dotlic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Obstetrics and Gynecology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, 11000, Belgrade, Serbia
| | - Suzana Matkovic
- Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Natasa Maksimovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, 11000, Belgrade, Serbia.
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7
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Tan SX, Chong S, Rowe C, Claeson M, Dight J, Zhou C, Rodero MP, Malt M, Smithers BM, Green AC, Khosrotehrani K. pSTAT5 is associated with improved survival in patients with thick or ulcerated primary cutaneous melanoma. Melanoma Res 2023; 33:506-513. [PMID: 37890182 DOI: 10.1097/cmr.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Identifying prognostic biomarkers to predict clinical outcomes in stage I and II cutaneous melanomas could guide the clinical application of adjuvant and neoadjuvant therapies. We aimed to investigate the prognostic value of phosphorylated signal transducer and activator of transcription 5 (pSTAT5) as a biomarker in early-stage melanoma. This study evaluated all initially staged Ib and II melanoma patients undergoing sentinel node biopsy at a tertiary centre in Brisbane, Australia between 1994 and 2007, with survival data collected from the Queensland Cancer Registry. Primary melanoma tissue from 189 patients was analysed for pSTAT5 level through immunohistochemistry. Cox regression modelling, with adjustment for sex, age, ulceration, anatomical location, and Breslow depth, was applied to determine the association between pSTAT5 detection and melanoma-specific survival. Median duration of follow-up was 7.4 years. High pSTAT5 detection was associated with ulceration and increased tumour thickness. However, multivariate analysis indicated that high pSTAT5 detection was associated with improved melanoma-specific survival (hazard ratio: 0.15, 95% confidence interval: 0.03-0.67) as compared to low pSTAT5 detection. This association persisted when pSTAT5 detection was limited to immune infiltrate or the vasculature, as well as when sentinel node positivity was accounted for. In this cohort, staining for high-pSTAT5 tumours identified a subset of melanoma patients with increased survival outcomes as compared to low-pSTAT5 tumours, despite the former having higher-risk clinicopathological characteristics at diagnosis. pSTAT5 is likely an indicator of local immune activation, and its detection could represent a useful tool to stratify the risk of melanoma progression.
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Affiliation(s)
- Samuel X Tan
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Sharene Chong
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Casey Rowe
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Magdalena Claeson
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Population Health, QIMR Berghofer Medical Research Institute
| | - James Dight
- Frazer Institute, University of Queensland, Brisbane, Australia
| | - Chenhao Zhou
- Frazer Institute, University of Queensland, Brisbane, Australia
| | | | - Maryrose Malt
- Department of Population Health, QIMR Berghofer Medical Research Institute
| | - B Mark Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Adele C Green
- Department of Population Health, QIMR Berghofer Medical Research Institute
- Cancer Research UK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kiarash Khosrotehrani
- Frazer Institute, University of Queensland, Brisbane, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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8
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Claeson M, Tan SX, Lambie D, Brown S, Walsh MD, Baade PD, Pandeya N, Whitehead KJ, Soyer HP, Smithers BM, Whiteman DC, Khosrotehrani K. The association between BRAF-V600E mutations and death from thin (≤1.00 mm) melanomas: A nested case-case study from Queensland, Australia. J Eur Acad Dermatol Venereol 2023; 37:e1168-e1172. [PMID: 37147869 DOI: 10.1111/jdv.19173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Affiliation(s)
- M Claeson
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S X Tan
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - D Lambie
- Anatomical Pathology, Princess Alexandra Hospital, Pathology Queensland, Brisbane, Queensland, Australia
- University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - S Brown
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
| | - M D Walsh
- Histopathology Department, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - P D Baade
- Cancer Council Queensland, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Centre for Data Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - N Pandeya
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K J Whitehead
- Histopathology Department, Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia
| | - H P Soyer
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B M Smithers
- Queensland Melanoma Project, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - D C Whiteman
- Department of Population Health, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - K Khosrotehrani
- Dermatology Research Centre, Experimental Dermatology Group, University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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9
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Vergara IA, Stark MS. One step closer to improving melanoma diagnosis and prognosis with liquid biopsies. Br J Dermatol 2023; 189:255-259. [PMID: 37279556 DOI: 10.1093/bjd/ljad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/03/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Ismael A Vergara
- Melanoma Institute Australia
- Faculty of Medicine and Health
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Mitchell S Stark
- Frazer Institute, The University of Queensland, Dermatology Research Centre, Brisbane, QLD 4102, Australia
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10
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Patel VR, Roberson ML, Pignone MP, Adamson AS. Risk of Mortality After a Diagnosis of Melanoma In Situ. JAMA Dermatol 2023; 159:703-710. [PMID: 37285145 PMCID: PMC10248809 DOI: 10.1001/jamadermatol.2023.1494] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/06/2023] [Indexed: 06/08/2023]
Abstract
Importance The incidence of melanoma in situ (MIS) is increasing more rapidly than any invasive or in situ cancer in the US. Although more than half of melanomas diagnosed are MIS, information about long-term prognosis following a diagnosis of MIS remains unknown. Objective To evaluate mortality and factors associated with mortality after a diagnosis of MIS. Design, Setting, and Participants This population-based cohort study of adults with a diagnosis of first primary MIS from 2000 to 2018 included data from the US Surveillance, Epidemiology, and End Results Program, which were analyzed from July to September 2022. Main Outcomes and Measures Mortality after a diagnosis of MIS was evaluated using 15-year melanoma-specific survival, 15-year relative survival (ie, compared with similar individuals without MIS), and standardized mortality ratios (SMRs). Cox regression was used to estimate hazard ratios (HRs) for death by demographic and clinical characteristics. Results Among 137 872 patients with a first-and-only MIS, the mean (SD) age at diagnosis was 61.9 (16.5) years (64 027 women [46.4%]; 239 [0.2%] American Indian or Alaska Native, 606 [0.4%] Asian, 344 [0.2%] Black, 3348 [2.4%] Hispanic, and 133 335 [96.7%] White individuals). Mean (range) follow-up was 6.6 (0-18.9) years. The 15-year melanoma-specific survival was 98.4% (95% CI, 98.3%-98.5%), whereas the 15-year relative survival was 112.4% (95% CI, 112.0%-112.8%). The melanoma-specific SMR was 1.89 (95% CI, 1.77-2.02); however, the all-cause SMR was 0.68 (95% CI, 0.67-0.7). Risk of melanoma-specific mortality was higher for older patients (7.4% for those 80 years or older vs 1.4% for those aged 60-69 years; adjusted HR, 8.2; 95% CI, 6.7-10.0) and patients with acral lentiginous histology results (3.3% for acral lentiginous vs 0.9% for superficial spreading; HR, 5.3; 95% CI, 2.3-12.3). Of patients with primary MIS, 6751 (4.3%) experienced a second primary invasive melanoma and 11 628 (7.4%) experienced a second primary MIS. Compared with patients without a subsequent melanoma, the risk of melanoma-specific mortality was increased for those with a second primary invasive melanoma (adjusted HR, 4.1; 95% CI, 3.6-4.6) and was decreased for those with a second primary MIS (adjusted HR, 0.7; 95% CI, 0.6-0.9). Conclusions and relevance The results of this cohort study suggest that patients with a diagnosis of MIS have an increased but low risk of melanoma-specific mortality and live longer than people in the general population, suggesting that there is significant detection of low-risk disease among health-seeking individuals. Factors associated with death following MIS include older age (≥80 years) and subsequent primary invasive melanoma.
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Affiliation(s)
- Vishal R. Patel
- Dell Medical School, The University of Texas at Austin, Austin
| | - Mya L. Roberson
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
- Associate Editor, JAMA Dermatology
| | - Michael P. Pignone
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin
| | - Adewole S. Adamson
- Associate Editor, JAMA Dermatology
- Web Editor, JAMA Dermatology
- Division of Dermatology, Dell Medical School, The University of Texas at Austin, Austin
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11
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Fidanzi C, Bevilacqua M, D'Erme AM, Morganti R, Viacava P, Manzo Margiotta F, Romanelli M, Dini V, Janowska A, Bagnoni G. Mitotic rate as a predictive factor for positive sentinel lymph nodes in pT1 and pT2 melanomas. J Plast Reconstr Aesthet Surg 2023; 83:215-220. [PMID: 37279633 DOI: 10.1016/j.bjps.2023.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/06/2023] [Accepted: 04/26/2023] [Indexed: 06/08/2023]
Abstract
Sentinel lymph node biopsy is a crucial step in the management of patients affected by melanoma. The decision whether to perform it or not is based on different histological parameters, but the mitotic rate is no longer considered a prognostic variable after the release of the 8th edition of the American Joint Committee on Cancer (AJCC) guidelines. Our objective was to investigate the risk factors that increase the chance for sentinel lymph node positivity in melanomas with a Breslow thickness of less than 2.00 mm, including the mitotic count. A retrospective single-center study was performed on a homogenous cohort of 408 patients treated for cutaneous melanoma. Histological and clinical features were gathered and correlated with the increased risk for sentinel lymph node positivity by means of univariate and multivariate analyses. A statistically significant correlation between a high mitotic index and a positive sentinel lymph node was found in pT1 and pT2 patients, suggesting that in the case of pT1a melanoma with a high number of mitoses, a discussion about whether a sentinel lymph node biopsy is required should be done.
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Affiliation(s)
| | | | - Angelo Massimiliano D'Erme
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
| | - Riccardo Morganti
- Statistical Support to Clinical Trials Department, University of Pisa, Pisa, Italy
| | - Paolo Viacava
- Unit of Pathology, Hospital of Livorno, Livorno, Italy
| | | | | | | | | | - Giovanni Bagnoni
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) and Unit of Dermatology, Livorno Hospital, Livorno, Italy
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12
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Li X, Li Z, Yi X, Gao X, Yang Z, Huang X, Ma S, Ma T, Deng Z, Shang L, Jian Z. A population-based cohort study for presence of ulceration among cutaneous malignant melanoma subgroups of patients. Front Oncol 2022; 12:929600. [PMID: 36408152 PMCID: PMC9666370 DOI: 10.3389/fonc.2022.929600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Observational studies suggest that ulceration is considered to be a negative prognostic factor for cutaneous melanoma. However, the impact of ulceration over different subgroups (e.g. AJCC Stage, thickness level) are controversial and its true causal effect on survival is lack of studies in the view of treating ulceration as an exposure. OBJECTIVE To explore the true causal effect of ulceration on melanoma's survival by adopting a combination of methods to discover proper adjustment set and confirming its correctness through a variety of means. METHODS A minimal sufficient adjustment set (MSAS) was found using directed acyclic graphs (DAG) to adjust the effect of causality. Sensitivity analysis was conducted to diagnose potential confounders in addition to MSAS. Cox models were built to analyze the causality in-depth and the model was validated using a novel method. Lastly, stratified effects of ulceration were examined to illustrate its impact within subgroups. RESULTS Hazard ratio (HR) of ulceration after adjustment by MSAS variables was 1.99 (95% CI=1.88-2.09). The sensitivity analysis of propensity score matching and E-value both demonstrated that variables other than MSAS do not have great influence on ulceration and MSS relationship. The HR of ulceration in AJCC Stage, thickness level, invasion level and tumor extension were all monotonically decreased from 5.76 to 1.57, 4.03 to 1.78, 2.75 to 1.78 and 2.65 to 1.71 respectively. CONCLUSION Ulceration in all subgroups were shown to have a significantly negative impact on MSS and its magnitude of effect was monotonically decreased as the disease progressed. The true effect of ulceration can be adjusted by MSAS and its correctness was validated through a variety of approaches.
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Affiliation(s)
- Xinrui Li
- School of Medicine, Northwest University, Xi’an, Shaanxi, China,Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zichao Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xiaowei Yi
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xianchun Gao
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhe Yang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Xingning Huang
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Sijie Ma
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Tianyuan Ma
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Ziyi Deng
- College of Basic Medicine, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Lei Shang
- Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, Shaanxi, China,*Correspondence: Lei Shang, ; Zhe Jian,
| | - Zhe Jian
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China,*Correspondence: Lei Shang, ; Zhe Jian,
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13
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Di Carlo V, Stiller CA, Eisemann N, Bordoni A, Matz M, Curado MP, Daubisse‐Marliac L, Valkov M, Bulliard J, Morrison D, Johnson C, Girardi F, Marcos‐Gragera R, Šekerija M, Larønningen S, Sirri E, Coleman MP, Allemani C. Does the morphology of cutaneous melanoma help to explain the international differences in survival? Results from 1 578 482 adults diagnosed during 2000-2014 in 59 countries (CONCORD-3). Br J Dermatol 2022; 187:364-380. [PMID: 35347700 PMCID: PMC9542891 DOI: 10.1111/bjd.21274] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/18/2022] [Accepted: 03/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND CONCORD-3 highlighted wide disparities in population-based 5-year net survival for cutaneous melanoma during 2000-2014. Clinical evidence suggests marked international differences in the proportion of lethal acral and nodular subtypes of cutaneous melanoma. OBJECTIVES We aimed to assess whether the differences in morphology may explain global variation in survival. METHODS Patients with melanoma were grouped into the following seven morphological categories: malignant melanoma, not otherwise specified (International Classification of Diseases for Oncology, third revision morphology code 8720), superficial spreading melanoma (8743), lentigo maligna melanoma (8742), nodular melanoma (8721), acral lentiginous melanoma (8744), desmoplastic melanoma (8745) and other morphologies (8722-8723, 8726-8727, 8730, 8740-8741, 8746, 8761, 8770-8774, 8780). We estimated net survival using the nonparametric Pohar Perme estimator, correcting for background mortality by single year of age, sex and calendar year in each country or region. All-ages survival estimates were standardized using the International Cancer Survival Standard weights. We fitted a flexible parametric model to estimate the effect of morphology on the hazard of death. RESULTS Worldwide, the proportion of nodular melanoma ranged between 7% and 13%. Acral lentiginous melanoma accounted for less than 2% of all registrations but was more common in Asia (6%) and Central and South America (7%). Overall, 36% of tumours were classified as superficial spreading melanoma. During 2010-2014, age-standardized 5-year net survival for superficial spreading melanoma was 95% or higher in Oceania, North America and most European countries, but was only 71% in Taiwan. Survival for acral lentiginous melanoma ranged between 66% and 95%. Nodular melanoma had the poorest prognosis in all countries. The multivariable analysis of data from registries with complete information on stage and morphology found that sex, age and stage at diagnosis only partially explain the higher risk of death for nodular and acral lentiginous subtypes. CONCLUSIONS This study provides the broadest picture of distribution and population-based survival trends for the main morphological subtypes of cutaneous melanoma in 59 countries. The poorer prognosis for nodular and acral lentiginous melanomas, more frequent in Asia and Latin America, suggests the need for health policies aimed at specific populations to improve awareness, early diagnosis and access to treatment. What is already known about this topic? The histopathological features of cutaneous melanoma vary markedly worldwide. The proportion of melanomas with the more aggressive acral lentiginous or nodular histological subtypes is higher in populations with predominantly dark skin than in populations with predominantly fair skin. What does this study add? We aimed to assess the extent to which these differences in morphology may explain international variation in survival when all histological subtypes are combined. This study provides, for the first time, international comparisons of population-based survival at 5 years for the main histological subtypes of melanoma for over 1.5 million adults diagnosed during 2000-2014. This study highlights the less favourable distribution of histological subtypes in Asia and Central and South America, and the poorer prognosis for nodular and acral lentiginous melanomas. We found that later stage at diagnosis does not fully explain the higher excess risk of death for nodular and acral lentiginous melanoma compared with superficial spreading melanoma.
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Affiliation(s)
- Veronica Di Carlo
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | | | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of LübeckRatzeburger Allee160 23538LübeckGermany
| | - Andrea Bordoni
- Ticino Cancer Registry, Dipartimento Sanità e SocialitàDivisione della Salute PubblicaVia Ciseri10 6600LocarnoSwitzerland
| | - Melissa Matz
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
| | - Maria P. Curado
- Goiânia Cancer Registry, Group of Epidemiology and Statistics on CancerAC Camargo Cancer CenterRua Tamandaré 753 ‐ LiberdadeSP01525‐001São PauloBrazil
| | - Laetitia Daubisse‐Marliac
- Tarn Cancer RegistryInstitut Universitaire du Cancer Toulouse – Oncopole Institut C. Regaud1 Avenue Irène Joliot‐Curie31059ToulouseFrance
| | - Mikhail Valkov
- Northern State Medical UniversityProspekt Troitskiy51 163000ArkhangelskRussian Federation
| | - Jean‐Luc Bulliard
- Centre for Primary Care and Public Health (Unisanté)University of LausanneLausanneSwitzerland
- Neuchâtel and Jura Tumour RegistryNeuchâtelSwitzerland
| | - David Morrison
- Scottish Cancer RegistryGyle Square, 1 South Gyle CrescentEH12 9EBEdinburghUK
| | - Chris Johnson
- Cancer Data Registry of Idaho, 615 North 7th StreetID83701‐1278BoiseUSA
| | - Fabio Girardi
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
- Division of Medical Oncology 2Veneto Institute of Oncology IOV‐IRCCSVia Gattamelata64 35128PadovaItaly
| | - Rafael Marcos‐Gragera
- Epidemiology Unit and Girona Cancer RegistryCatalan Institute of Oncology (ICO), IDIBGI, Oncology Coordination Plan, Department of Health Government of Catalonia17004GironaSpain
- University of Girona (UdG)17004GironaSpain
- CIBER of Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Mario Šekerija
- Croatian National Cancer RegistryCroatian Institute of Public HealthRockefeller Street7 10000ZagrebCroatia
| | | | - Eunice Sirri
- Epidemiological Cancer Registry of Lower SaxonyOffis Caree GmbHIndustriestr92 6121OldenburgGermany
| | - Michel P. Coleman
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
- Cancer DivisionUniversity College London Hospitals NHS Foundation TrustEuston RoadWC1H 8NJLondonUK
| | - Claudia Allemani
- Cancer Survival GroupLondon School of Hygiene and Tropical MedicineKeppel StreetWC1E 7HTLondonUK
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Chiru MR, Hindocha S, Burova E, Bejan GC, Manea LM, Ghilencea LN. Management of the Two-Week Wait Pathway for Skin Cancer Patients, before and during the Pandemic: Is Virtual Consultation an Option? J Pers Med 2022; 12:jpm12081258. [PMID: 36013205 PMCID: PMC9410100 DOI: 10.3390/jpm12081258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/20/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Although telemedicine emerged more than 100 years ago, the recent pandemic underlined the role of remote assessment of different diseases. The diagnoses of cutaneous conditions, especially malignant lesions, have placed significant stress on the fast-track pathway for general practitioners (GPs), dermatologists, and plastic surgeons. The aim of the study was to compare (pre- and during the pandemic) the ability of professionals to face the challenge. Methods: The study was composed of 1943 consecutive patients (mean age 61.9 ± 18.3, 53.8% female) assessed by GPs, face-to-face (988 patients, 50.8%, between October 2019 and March 2020) and by virtual (video/photo) visits (955 patients, 49.2%, between March 2020 and October 2020) for skin lesions, and referred to secondary care via the two-week wait pathway for suspected skin malignancy. Results: The two groups had similar primary skin malignancies identification rates (24.3% vs. 22.1%, p = 0.25). The virtual visits identified squamous cell carcinoma (SCC) better than face-to-face consultations (p = 0.04), but identified basal cell carcinoma less-well (BCC, p = 0.02), whereas malignant melanoma (MM) was equally identified in the two groups (p = 0.13). There was no difference in the median breach time (days) of the two-week wait pathway (12, IQR = 6 vs. 12, IQR = 5, p = 0.16) in the two groups. Virtual assessments (by GPs) of skin lesions suspected of malignancy, and referred via the two-week wait pathway, increased the probability of diagnosing SCC by 42.9% (p = 0.03), while for malignant melanomas, face-to-face and virtual consultations were alike (p = 0.12). Conclusions: The equivalent outcomes in the management of skin cancers (SCC, MM) via the two-week pathway through virtual consultations and face-to-face appointments underline the role of telemedicine as a reliable alternative to face-to-face assessments.
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Affiliation(s)
- Maria-Roxana Chiru
- Department of Plastic Surgery, Bedford Hospital NHS Foundation Trust, Bedford MK42 9DJ, UK;
- Correspondence: (M.-R.C.); (L.-N.G.)
| | - Sandip Hindocha
- Department of Plastic Surgery, Bedford Hospital NHS Foundation Trust, Bedford MK42 9DJ, UK;
| | - Ekaterina Burova
- Department of Dermatology, Bedford Hospital NHS Foundation Trust, Bedford MK42 9DJ, UK;
| | - Gabriel-Cristian Bejan
- Department 5 of Internal Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania;
| | - Laura-Maria Manea
- Department of Internal Medicine and Cardiology, Coltea University Hospital, 030171 Bucharest, Romania;
| | - Liviu-Nicolae Ghilencea
- Department 5 of Internal Medicine, Carol Davila University of Medicine and Pharmacy, 020022 Bucharest, Romania;
- Correspondence: (M.-R.C.); (L.-N.G.)
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15
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Gene Identification and Potential Drug Therapy for Drug-Resistant Melanoma with Bioinformatics and Deep Learning Technology. DISEASE MARKERS 2022; 2022:2461055. [PMID: 35915735 PMCID: PMC9338845 DOI: 10.1155/2022/2461055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/17/2022]
Abstract
Background. Melanomas are skin malignant tumors that arise from melanocytes which are primarily treated with surgery, chemotherapy, targeted therapy, immunotherapy, radiation therapy, etc. Targeted therapy is a promising approach to treating advanced melanomas, but resistance always occurs. This study is aimed at identifying the potential target genes and candidate drugs for drug-resistant melanoma effectively with computational methods. Methods. Identification of genes associated with drug-resistant melanomas was conducted using the text mining tool pubmed2ensembl. Further gene screening was carried out by GO and KEGG pathway enrichment analyses. The PPI network was constructed using STRING database and Cytoscape. GEPIA was used to perform the survival analysis and conduct the Kaplan-Meier curve. Drugs targeted at these genes were selected in Pharmaprojects. The binding affinity scores of drug-target interactions were predicted by DeepPurpose. Results. A total of 433 genes were found associated with drug-resistant melanomas by text mining. The most statistically differential functional enriched pathways of GO and KEGG analyses contained 348 genes, and 27 hub genes were further screened out by MCODE in Cytoscape. Six genes were identified with statistical differences after survival analysis and literature review. 16 candidate drugs targeted at hub genes were found by Pharmaprojects under our restrictions. Finally, 11 ERBB2-targeted drugs with top affinity scores were predicted by DeepPurpose, including 10 ERBB2 kinase inhibitors and 1 antibody-drug conjugate. Conclusion. Text mining and bioinformatics are valuable methods for gene identification in drug discovery. DeepPurpose is an efficient and operative deep learning tool for predicting the DTI and selecting the candidate drugs.
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16
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Basset-Seguin N, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Forsea AM, Grob JJ, Höller C, Kaufmann R, Kelleners-Smeets N, Lallas A, Lebbé C, Lytvynenko B, Malvehy J, Moreno-Ramirez D, Nathan P, Pellacani G, Saiag P, Stratigos AJ, Van Akkooi ACJ, Vieira R, Zalaudek I, Lorigan P. European consensus-based interdisciplinary guideline for melanoma. Part 1: Diagnostics: Update 2022. Eur J Cancer 2022; 170:236-255. [PMID: 35570085 DOI: 10.1016/j.ejca.2022.03.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 01/02/2023]
Abstract
Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multi-disciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed with dermatoscopy. If a melanoma is suspected, a histopathological examination is always required. Sequential digital dermatoscopy and full body photography can be used in high-risk patients to improve the detection of early melanoma. Where available, confocal reflectance microscopy can also improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the American Joint Committee on Cancer classification. Thin melanomas up to 0.8 mm tumor thickness do not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC onwards whole-body examinations with computed tomography (CT) or positron emission tomography CT (PET-CT) in combination with brain magnetic resonance imaging are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to define the frequency and extent of examinations. A stage-based follow-up scheme is proposed which, according to the experience of the guideline group, covers the optimal requirements, but further studies may be considered. This guideline is valid until the end of 2024.
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Affiliation(s)
- Claus Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.
| | - Teresa Amaral
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Ketty Peris
- Institute of Dermatology, Università Cattolica, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicole Basset-Seguin
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Lars Bastholt
- Department of Oncology, Odense University Hospital, Denmark
| | - Veronique Bataille
- Twin Research and Genetic Epidemiology Unit, School of Basic & Medical Biosciences, King's College London, London, SE1 7EH, UK
| | - Veronique Del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Brigitte Dréno
- Dermatology Department, CHU Nantes, CIC 1413, CRCINA, University Nantes, Nantes, France
| | - Maria C Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ana-Maria Forsea
- Dermatology Department, Elias University Hospital, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
| | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- Université Paris Cite, AP-HP Department of Dermatology INSERM U 976 Hôpital Saint Louis Paris France
| | - Bohdan Lytvynenko
- Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Paul Nathan
- Mount-Vernon Cancer Centre, Northwood United Kingdom
| | | | - Philippe Saiag
- University Department of Dermatology, Université de Versailles-Saint Quentin en Yvelines, APHP, Boulogne, France
| | - Alexander J Stratigos
- 1st Department of Dermatology, University of Athens School of Medicine, Andreas Sygros Hospital, Athens, Greece
| | - Alexander C J Van Akkooi
- Melanoma Institute Australia, The University of Sydney, Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Ricardo Vieira
- Department of Dermatology and Venereology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Paul Lorigan
- The University of Manchester, Oxford Rd, Manchester, M13 9PL, UK
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17
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Mandalà M, Rutkowski P, Galli F, Patuzzo R, De Giorgi V, Rulli E, Gianatti A, Valeri B, Merelli B, Szumera-Ciećkiewicz A, Massi D, Maurichi A, Teterycz P, Santinami M. Acral lentiginous melanoma histotype predicts outcome in clinical stage I-II melanoma patients: an International multicenter study. ESMO Open 2022; 7:100469. [PMID: 35421840 PMCID: PMC9271470 DOI: 10.1016/j.esmoop.2022.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 03/03/2022] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the American Joint Committee on Cancer (AJCC) classification, acral lentiginous melanoma (ALM) histotype ALM is not included as an independent prognostic factor; in small series its negative prognostic impact on disease-free survival (DFS) and overall survival (OS) has been linked to the greater Breslow thickness (BT). PATIENTS AND METHODS The study was carried out at four referral melanoma centers (three Italian and one Polish). Clinical consecutive patients with stage I-II melanoma, who were diagnosed, treated, and followed up between January 1998 and March 2018 in annotated specific databases were included. RESULTS Overall, 6734 were evaluable, 4349 with superficial spreading melanoma (SSM), 2132 with nodular melanoma (NM), and 253 with ALM. At univariable analysis, a statistically significant worse DFS [hazard ratio (HR) 2.72, 95% confidence interval (CI) 2.24-3.30; P < 0.001] and OS (HR 2.67, 95% CI 2.15-3.32; P < 0.001) were found in patients with ALM compared with SSM. Similarly, the NM histotype was associated with a worse prognosis compared with the SSM histotype (DFS: HR 2.29, 95% CI 2.08-2.52; P < 0.001 and OS: HR 2.21, 95% CI 1.99-2.46; P < 0.001). At multivariable analysis, after adjusting for age, sex, BT, ulceration, and the sentinel lymph node status, a statistically significant worse DFS [adjusted HR (aHR; ALM versus SSM) 1.25, 95% CI 1.02-1.52; P = 0.028] was confirmed for patients with ALM. For patients with NM, instead, no impact of histology was found in terms of DFS [aHR (NM versus SSM) 1.04, 95% CI 0.93-1.15; P = 0.513] and OS [aHR (NM versus SSM) 0.96, 95% CI 0.86-1.08; P = 0.548]. CONCLUSIONS ALM is associated with a worse long-term DFS. Our results could have important clinical implications for patients' stratification in future clinical trials and the incorporation of ALM histotype in the new AJCC classification as an independent prognostic factor.
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Affiliation(s)
- M Mandalà
- Department of Medicine and Surgery, University of Perugia, Unit of Medical Oncology, Perugia, Italy.
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - F Galli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - R Patuzzo
- Melanoma and Sarcoma Unit, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - V De Giorgi
- Department of Dermatology, University of Florence, Firenze, Italy
| | - E Rulli
- Methodology for Clinical Research Laboratory, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - A Gianatti
- Unit of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - B Valeri
- Department of Pathology and Laboratory Medicine, IRCCS Fondazione Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - B Merelli
- Unit of Medical Oncology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Szumera-Ciećkiewicz
- Department of Pathology and Laboratory Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland; Diagnostic Hematology Department, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - D Massi
- Section of Pathology, Department of Health Sciences, University of Florence, Firenze, Italy
| | - A Maurichi
- Melanoma and Sarcoma Unit, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
| | - P Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - M Santinami
- Melanoma and Sarcoma Unit, Department of Surgery, IRCCS Fondazione Istituto Nazionale dei Tumori, Milan, Italy
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18
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Bunnell AM, Nedrud SM, Fernandes RP. Classification and Staging of Melanoma in the Head and Neck. Oral Maxillofac Surg Clin North Am 2022; 34:221-234. [PMID: 35491079 DOI: 10.1016/j.coms.2021.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The rates of melanoma continue to rise, with recent estimates have shown that 18% to 22% of new melanoma cases occur within the head and neck in the United States each year. The mainstay of treatment of nonmetastatic primary melanomas of the head and neck includes the surgical resection and management of regional disease as indicated. Thorough knowledge of the classification and staging of melanoma is paramount to evaluate prognosis, determine the appropriate surgical intervention, and assess eligibility for adjuvant therapy and clinic trials. The traditional clinicopathologic classification of melanoma is based on morphologic aspects of the growth phase and distinguishes 4 of the most common subtypes as defined by the World Health Organization: superficial spreading, nodular, acral lentiginous, and lentigo maligna melanoma. The data used to derive the AJCC TNM Categories are based on superficial spreading melanoma and nodular subtypes. Melanoma is diagnosed histopathologically following initial biopsy that will assist with classifying the tumor to guide treatment. Classification is based on tumor thickness and ulceration (T stage, Breslow Staging), Regional Lymph Node Involvement (N Stage), and presence of metastasis (M Stage). Tumor thickness (Breslow thickness) and ulceration are 2 independent prognostic factors that have been shown to be the strongest predictors of survival and outcome. Clark level of invasion and mitotic rate are no longer incorporated into the current AJCC staging system, but still have shown to be important prognostic factors for cutaneous melanoma. For patients with metastatic (Stage IV) disease Lactate Dehydrogenase remains an independent predictor of survival. The Maxillofacial surgeon must remain up to date on the most current management strategies in this patient population. Classification systems and staging provide the foundation for clinical decision making and prognostication for the Maxillofacial surgeon when caring for these patients.
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Affiliation(s)
- Anthony M Bunnell
- Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA.
| | - Stacey M Nedrud
- Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA
| | - Rui P Fernandes
- Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine,- Jacksonville 653-1 West 8th, Street, Jacksonville, FL 32209, USA
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Hu D, Liu Z, Chen S, Huang Y, Zeng W, Wei W, Zhang C, Zhou L, Chen D, Wu Y, Guo L. Assessment of the Novel, Practical, and Prognosis-Relevant TNM Staging System for Stage I-III Cutaneous Melanoma. Front Oncol 2022; 12:738298. [PMID: 35574383 PMCID: PMC9104117 DOI: 10.3389/fonc.2022.738298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background The clinical TNM staging system does not differ between the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging manual. A more practical TNM staging system for patients with stage I-III cutaneous melanoma are needed. Methods Data were accessed from the Surveillance, Epidemiology, and End Results (SEER) open database. We divided the patients into 32 groups based on the T and N categories. The Kaplan-Meier survival curves and treatment guidelines were used to proposed a new TNM staging system. Cox proportional hazards model and 1000-person-years were used to verify accuracy. Results This retrospective study included 68 861 patients from 2010 to 2015. The new proposed staging system was as follows: stage IA, T1aN0M0; stage IB, T1b/T2aN0M0; stage IIA, T3-4aN0M0 and T2bN0M0; stage IIB, T1-4aN1-2M0 and T3-4bN0M0; and stage III, T1-4aN3M0 and T1-4bN1-3M0. Hazard ratios for the new stages IB, IIA, IIB, and III, with stage IA as reference, were 4.311 (95% confidence interval [CI]: 3.217-5.778), 8.993 (95% CI: 6.637-12.186), 13.179 (95% CI: 9.435-18.407), and 20.693 (95% CI: 13.655-31.356), respectively (all p-values < 0.001). Cancer-specific mortality rates per 1000-person-years were 0.812 (95% CI: 0.674-0.978), 6.612 (95% CI: 5.936-7.364), 22.228 (95% CI: 20.128-24.547), 50.863 (95% CI: 47.472-54.496) and 120.318 (95% CI: 112.596-128.570) for stages IA, IB, IIA, IIB and III, respectively. Conclusion We developed a more practical and prognosis-relevant staging system than that of the 8th edition AJCC manual for patients with stage I-III cutaneous melanoma. Treatments using this new model would improve the quality of life and survival rates of patients with melanoma.
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Affiliation(s)
- Di Hu
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zeming Liu
- Department of Plastic Surgery and Cosmetic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sichao Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yihui Huang
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Zeng
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Wei
- Department of Pediatrics, St John Hospital and Medical Center, Detroit, MI, United States
| | - Chao Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Zhou
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Danyang Chen
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yiping Wu
- Department of Plastic Surgery and Cosmetic, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Liang Guo, ; Yiping Wu,
| | - Liang Guo
- Department of Plastic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- *Correspondence: Liang Guo, ; Yiping Wu,
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20
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Hughes MCB, Malt M, Khosrotehrani K, Smithers BM, Green AC. Diet quality is associated with primary melanoma thickness. J Eur Acad Dermatol Venereol 2022; 36:1745-1750. [PMID: 35462440 PMCID: PMC9544655 DOI: 10.1111/jdv.18174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- MCB Hughes
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
| | - M Malt
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
| | - K Khosrotehrani
- Experimental Dermatology Group The University of Queensland Diamantina Institute Brisbane Australia
- Department of Dermatology, Princess Alexandra Hospital Brisbane Australia
| | - BM Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital The University of Queensland Australia
| | - AC Green
- Population Health Department QIMR Berghofer Medical Research Institute Brisbane Australia
- CRUK Manchester Institute and Faculty of Biology, Medicine and Health University of Manchester Manchester UK
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21
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Ferhatoglu F, Erturk K, Faruk T. Cutaneous melanoma survival rates of the elderly are not worse than those of the young, yet they have some specific differences. J Cancer Res Ther 2022; 19:S0. [PMID: 37147952 DOI: 10.4103/jcrt.jcrt_815_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction The incidence of cutaneous melanoma among the elderly has increased significantly. Unfavorable survival rates are associated with insufficient patient managements and poor prognostic features in the elderly. We aimed to compare elderly (≥75 years) and younger (<75 years) patients with cutaneous melanoma to determine the differences and the prognostic significance of age. Materials and Methods The retrospective data of 117 elderly and 232 younger patients with cutaneous melanoma were compared. Results The median age of the elderly patients was 78 years (75-104), and 51.3% of the patients were female. Of the patients, 14.5% were in the metastatic stages. Clinicopathologic factors such as extremity melanomas (P = 0.01), Clark levels IV-V (P = 0.04), ulceration (P = 0.009), and neurotropism (P = 0.03) were significantly more common in elderly patients. However, BRAF mutation was significantly more common in younger patients (P = 0.003). Overall survival (OS) and recurrence-free survival (RFS) rates of both the groups were similar. Lymph node involvement (P < 0.005), distant metastasis (P < 0.005), and relapse of disease (P = 0.02) were associated with poor OS in elderly patients. Tumor-infiltrating lymphocytes was associated with prolonged RFS (P = 0.05), while extremity melanomas (P = 0.01), lymphovascular invasion (P = 0.006), and lymph node involvement (P < 0.005) had negative impact on RFS. Conclusions Although elderly patients with cutaneous melanoma had different clinicopathologic features in our series, their survival rates are similar to those of younger patients, which shows that age alone is inadequate to determine the prognosis. Disease stage and a comprehensive geriatric assessment might assist to determine appropriate management.
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22
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Zheng G, Chattopadhyay S, Sundquist K, Sundquist J, Försti A, Hemminki A, Hemminki K. Types of second primary cancer influence overall survival in cutaneous melanoma. BMC Cancer 2021; 21:1123. [PMID: 34663263 PMCID: PMC8524825 DOI: 10.1186/s12885-021-08845-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Favorable survival in malignant cutaneous melanoma (melanoma) has increased the likelihood of second primary cancer (SPC). We assess the influence of patient characteristics at diagnosis of first melanoma and the type of SPC (second melanoma and other SPC) on overall survival. METHODS We used the Swedish Cancer Registry data to assess overall survival in melanoma for the period 1990 to 2015. Kaplan-Meier curves were plotted and hazard ratios (HRs) were estimated with Cox regression models by considering SPC diagnosis as a time-dependent variable. RESULTS A total of 46,726 patients were diagnosed with melanoma, and 15.3% of them developed SPC, among which, two thirds were other SPCs. Second melanomas were diagnosed early (31% during the first year) compared to non-melanoma SPCs (9.5%). Survival for women with second melanoma or other SPC (56 and 21% alive after 25 years of follow-up, respectively) exceeded the male rates (21 and 10%, respectively) but all these figures were lower than for females (60% alive) or males (48%) without SPC. Time dependent analysis showed vastly increased HRs for cancer types that are fatal also as first cancers, but SPC-specific HRs remained relatively uniform, irrespective of SPC diagnosed soon or late after first melanoma. In early-onset melanoma, SPC diagnosis after 10 years may not negatively influence overall survival. CONCLUSIONS As the overall survival of patients with many types of SPCs is unfavorable, advice about health lifestyle should benefit smoking patients and early detection methods may be recommended for SPCs of the breast, prostate and colorectum.
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Affiliation(s)
- Guoqiao Zheng
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
| | - Subhayan Chattopadhyay
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Asta Försti
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
- Hopp Children's Cancer Center (KiTZ), 69120, Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
- Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - Kari Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
- Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden.
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic.
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, D-69120, Heidelberg, Germany.
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23
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Soria X, Vilardell F, Maiques Ó, Barceló C, Sisó P, de la Rosa I, Velasco A, Cuevas D, Santacana M, Gatius S, Matías-Guiu X, Rodrigo A, Macià A, Martí RM. BRAFV600E Mutant Allele Frequency (MAF) Influences Melanoma Clinicopathologic Characteristics. Cancers (Basel) 2021; 13:5073. [PMID: 34680222 PMCID: PMC8533792 DOI: 10.3390/cancers13205073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Cutaneous melanoma shows high variability regarding clinicopathological presentation, evolution and prognosis. METHODS Next generation sequencing was performed to analyze hotspot mutations in different areas of primary melanomas (MMp) and their paired metastases. Clinicopathological features were evaluated depending on the degree of variation of the BRAFV600E mutant allele frequency (MAF) in MMp. RESULTS In our cohort of 14 superficial spreading, 10 nodular melanomas and 52 metastases, 17/24 (71%) melanomas had a BRAFV600E mutation and 5/24 (21%) had a NRASQ61 mutation. We observed a high variation of BRAFV600E MAF (H-BRAFV600E) in 7/17 (41%) MMp. The H-BRAFV600E MMp were all located on the trunk, had lower Breslow and mitotic indexes and predominantly, a first nodal metastasis. Regions with spindled tumor cells (Spin) and high lymphocytic infiltrate (HInf) were more frequent in the H-BRAFV600E patients (4/7; 57%), whereas regions with epithelial tumor cells (Epit) and low lymphocytic infiltrate (LInf) were predominant (6/10; 60%) and exclusive in the low BRAFV600E MAF variation tumors (L-BRAFV600E). The H-BRAFV600E/Spin/HInf MMp patients had better prognostic features and nodal first metastasis. CONCLUSIONS The H-BRAFV600E MMp were located on the trunk, had better prognostic characteristics, such as lower Breslow and mitotic indexes as well as high lymphocytic infiltrate.
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Affiliation(s)
- Xavier Soria
- Department of Dermatology, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain;
| | - Felip Vilardell
- Department of Pathology and Molecular Genetics, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain; (F.V.); (A.V.); (D.C.); (M.S.); (S.G.); (X.M.-G.)
| | - Óscar Maiques
- Tumour Microenvironment, Barts Cancer Institute, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Carla Barceló
- Oncological Pathology Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (C.B.); (P.S.); (I.d.l.R.)
| | - Pol Sisó
- Oncological Pathology Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (C.B.); (P.S.); (I.d.l.R.)
| | - Inés de la Rosa
- Oncological Pathology Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), 25198 Lleida, Spain; (C.B.); (P.S.); (I.d.l.R.)
| | - Ana Velasco
- Department of Pathology and Molecular Genetics, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain; (F.V.); (A.V.); (D.C.); (M.S.); (S.G.); (X.M.-G.)
- Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Dolors Cuevas
- Department of Pathology and Molecular Genetics, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain; (F.V.); (A.V.); (D.C.); (M.S.); (S.G.); (X.M.-G.)
- Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Maria Santacana
- Department of Pathology and Molecular Genetics, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain; (F.V.); (A.V.); (D.C.); (M.S.); (S.G.); (X.M.-G.)
- Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Sònia Gatius
- Department of Pathology and Molecular Genetics, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain; (F.V.); (A.V.); (D.C.); (M.S.); (S.G.); (X.M.-G.)
- Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Xavier Matías-Guiu
- Department of Pathology and Molecular Genetics, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain; (F.V.); (A.V.); (D.C.); (M.S.); (S.G.); (X.M.-G.)
- Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Alberto Rodrigo
- Department of Medical Oncology, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain;
| | - Anna Macià
- Unitat de Farmacologia- Department of Experimental Medicine, Universitat de Lleida, 25198 Lleida, Spain;
| | - Rosa M. Martí
- Department of Dermatology, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, 25198 Lleida, Spain;
- Centre of Biomedical Research on Cancer (CIBERONC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
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24
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Ryder-Burbidge C, Diaz RL, Barr RD, Gupta S, Nathan PC, McKillop SJ, Fidler-Benaoudia MM. The Burden of Late Effects and Related Risk Factors in Adolescent and Young Adult Cancer Survivors: A Scoping Review. Cancers (Basel) 2021; 13:cancers13194870. [PMID: 34638350 PMCID: PMC8508204 DOI: 10.3390/cancers13194870] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary It is unclear what the risk of negative health outcomes is after cancer during adolescence and young adulthood. We conducted a review to understand the risk of second cancers, chronic conditions, and death in adolescent and young adult (AYA) cancer survivors and found factors that increase the risk. In total, 652 studies were identified, of which 106 were included in the review: 23 for second cancers, 34 for chronic conditions, and 54 for deaths. The number of included studies increased over time, from four studies in 2010 to 17 in 2020. The studies found that AYA cancer survivors are at an increased risk of second cancers, chronic conditions, and deaths. In particular, the following factors increased risk: radiation exposure for second cancers; younger attained age and earlier calendar period of diagnosis for chronic conditions; and non-Hispanic Black or Hispanic, low socioeconomic status, and earlier calendar period of diagnosis for deaths. Abstract Risk factors associated with late effects in survivors of adolescent and young adult (AYA) cancer are poorly understood. We conducted a systematic scoping review to identify cohort studies published in English from 2010–2020 that included: (1) cancer survivors who were AYAs (age 15–39 years) at diagnosis and (2) outcomes of subsequent malignant neoplasms (SMNs), chronic conditions, and/or late mortality (>5 years postdiagnosis). There were 652 abstracts identified and, ultimately, 106 unique studies were included, of which 23, 34, and 54 studies related to the risk of SMNs, chronic conditions, and mortality, respectively. Studies investigating late effects among survivors of any primary cancer reported that AYA cancer survivors were at higher risk of SMN, chronic conditions, and all-cause mortality compared to controls. There was an indication that the following factors increased risk: radiation exposure (n = 3) for SMNs; younger attained age (n = 4) and earlier calendar period of diagnosis (n = 3) for chronic conditions; and non-Hispanic Black or Hispanic (n = 5), low socioeconomic status (n = 3), and earlier calendar period of diagnosis (n = 4) for late mortality. More studies including the full AYA age spectrum, treatment data, and results stratified by age, sex, and cancer type are needed to advance knowledge about late effects in AYA cancer survivors.
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Affiliation(s)
- Charlotte Ryder-Burbidge
- Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Department of Cancer Epidemiology and Prevention Research, 5th Floor, BOX ACB, 2210-2 St. SW, Calgary, AB T2S 3C3, Canada; (C.R.-B.); (R.L.D.)
| | - Ruth L. Diaz
- Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Department of Cancer Epidemiology and Prevention Research, 5th Floor, BOX ACB, 2210-2 St. SW, Calgary, AB T2S 3C3, Canada; (C.R.-B.); (R.L.D.)
| | - Ronald D. Barr
- Health Sciences Centre 3A, Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada;
| | - Sumit Gupta
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; (S.G.); (P.C.N.)
| | - Paul C. Nathan
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada; (S.G.); (P.C.N.)
| | - Sarah J. McKillop
- Department of Pediatrics, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AL T6G 1C9, Canada;
| | - Miranda M. Fidler-Benaoudia
- Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, Department of Cancer Epidemiology and Prevention Research, 5th Floor, BOX ACB, 2210-2 St. SW, Calgary, AB T2S 3C3, Canada; (C.R.-B.); (R.L.D.)
- Departments of Oncology and Community Health Sciences, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4, Canada
- Correspondence:
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25
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Guitera P, Menzies SW, Coates E, Azzi A, Fernandez-Penas P, Lilleyman A, Badcock C, Schmid H, Watts CG, Collgros H, Liu R, van Kemenade C, Mann GJ, Cust AE. Efficiency of Detecting New Primary Melanoma Among Individuals Treated in a High-risk Clinic for Skin Surveillance. JAMA Dermatol 2021; 157:521-530. [PMID: 33729464 DOI: 10.1001/jamadermatol.2020.5651] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance A previous single-center study observed fewer excisions, lower health care costs, thinner melanomas, and better quality of life when surveillance of high-risk patients was conducted in a melanoma dermatology clinic with a structured surveillance protocol involving full-body examinations every 6 months aided by total-body photography (TBP) and sequential digital dermoscopy imaging (SDDI). Objective To examine longer-term sustainability and expansion of the surveillance program to numerous practices, including a primary care skin cancer clinic setting. Design, Setting, and Participants This prospective cohort study recruited 593 participants assessed from 2012 to 2018 as having very high risk of melanoma, with a median of 2.9 years of follow-up (interquartile range, 1.9-3.3 years), from 4 melanoma high-risk clinics (3 dermatology clinics and 1 primary care skin cancer clinic) in New South Wales, Australia. Data analyses were conducted from February to September 2020. Exposures Six-month full-body examination with the aid of TBP and SDDI. For equivocal lesions, the clinician performed SDDI at 3 or 6 months. Main Outcomes and Measures All suspect monitored or excised lesions were recorded, and pathology reports obtained. Outcomes included the incidence and characteristics of new lesions and the association of diagnostic aids with rates of new melanoma detection. Results Among 593 participants, 340 (57.3%) were men, and the median age at baseline was 58 years (interquartile range, 47-66 years). There were 1513 lesions excised during follow-up, including 171 primary melanomas. The overall benign to malignant excision ratio, including keratinocyte carcinomas, was 0.8:1.0; the benign melanocytic to melanoma excision ratio was 2.4:1.0; and the melanoma in situ to invasive melanoma ratio was 2.2:1.0. The excision ratios were similar across the 4 centers. The risk of developing a new melanoma was 9.0% annually in the first 2 years and increased with time, particularly for those with multiple primary melanomas. The thicker melanomas (>1-mm Breslow thickness; 7 of 171 melanomas [4.1%]) were mostly desmoplastic or nodular (4 of 7), self-detected (2 of 7), or clinician detected without the aid of TBP (3 of 7). Overall, new melanomas were most likely to be detected by a clinician with the aid of TBP (54 of 171 [31.6%]) followed by digital dermoscopy monitoring (50 of 171 [29.2%]). Conclusions and Relevance The structured surveillance program for high-risk patients may be implemented at a larger scale given the present cohort study findings suggesting the sustainability and replication of results in numerous settings, including a primary care skin cancer clinic.
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Affiliation(s)
- Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Scott W Menzies
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Elliot Coates
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Pablo Fernandez-Penas
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Alister Lilleyman
- Newcastle Skin Check, Newcastle, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - Caro Badcock
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helen Schmid
- Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia
| | - Caroline G Watts
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Helena Collgros
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rose Liu
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Dermatology, Westmead Clinical School, The University of Sydney, Sydney, Australia
| | | | - Graham J Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Westmead Institute for Medical Research, The University of Sydney, Sydney, Australia.,The John Curtin School of Medical Research, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Anne E Cust
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, Australia
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26
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Nie J, Li Y, Shen X, Liu Y, Shi H, Lu Y. Nodular malignant melanoma in vulvar skin without pigmentation: a case report. BMC WOMENS HEALTH 2021; 21:289. [PMID: 34362374 PMCID: PMC8349019 DOI: 10.1186/s12905-021-01422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
Background Polypoid nodule growing without apparent pigmentation on the vulvar skin usually reminds us of the diagnostic pitfall, which is commonly and mistakenly diagnosed as other types of tumors. Although there are several manifestations of amelanotic melanoma are known, these malignancies are usually pigmented because they are derived from melanocytes containing melanin. However, amelanotic melanomas are easily misdiagnosed or their diagnoses were commonly delayed due to lack of pigmentation. Therefore, a solitary polypoid nodule is worth noting and further reporting. Particularly, the clinical characteristics and outcomes of the solitary polypoid nodule are rare in Asian patients. Case presentation
We presented an interesting case of a 33-year-old female with a solitary polypoid nodule without apparent pigmentation on her vulvar skin. Her medical history was unclear, no ulcer was seen in the lesion area, and dermatoscopy was indicated a possible tumorous change, which has caught the attention of clinicians, and then further examined by the pathologist. The final diagnosis was nodular malignant melanoma (NM) (Breslow thickness 9.5mm, Clark level 4). Conclusions Hence, though reviewing this case record, the relevant literature and NM-related materials, we suggest that the combination of skin imaging technology and histopathological examination could provide us a better understanding and reduce the possibility of misdiagnosis in clinic practice.
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Affiliation(s)
- Jing Nie
- Department of Dermatology, Chengdu Second People's Hospital, No.165 Caoshi Street, Qingyang District, Chengdu, 610000, Sichuan Province, China.
| | - Yan Li
- Department of Dermatology, Chengdu Second People's Hospital, No.165 Caoshi Street, Qingyang District, Chengdu, 610000, Sichuan Province, China
| | - Xue Shen
- Department of Dermatology, Chengdu Second People's Hospital, No.165 Caoshi Street, Qingyang District, Chengdu, 610000, Sichuan Province, China
| | - Yan Liu
- Department of Dermatology, Chengdu Second People's Hospital, No.165 Caoshi Street, Qingyang District, Chengdu, 610000, Sichuan Province, China
| | - Haipeng Shi
- Department of Pathology, Chengdu Second People's Hospital, Chengdu, China
| | - Yonghong Lu
- Department of Dermatology, Chengdu Second People's Hospital, No.165 Caoshi Street, Qingyang District, Chengdu, 610000, Sichuan Province, China
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27
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Sacchetto L, Rosso S, Comber H, Bouchardy C, Broganelli P, Galceran J, Hackl M, Katalinic A, Louwman M, Robsahm TE, Tryggvadottir L, Tumino R, Van Eycken E, Walsh PM, Zadnik V, Zanetti R. Skin melanoma deaths within 1 or 3 years from diagnosis in Europe. Int J Cancer 2021; 148:2898-2905. [PMID: 33497469 DOI: 10.1002/ijc.33479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/20/2020] [Accepted: 01/04/2021] [Indexed: 01/03/2023]
Abstract
The steep increase in incidence of cutaneous malignant melanoma in white populations mainly applies to thin lesions with good survival suggesting overdiagnosis. Based on population-based cancer registries (CRs), we have investigated changes in aggressive melanoma, selecting only cases who died within 1 or 3 years after diagnosis in 11 European countries between 1995 and 2012. Trends in fatal cases were analysed by period of diagnosis, sex, tumour thickness, histologic subtype of the lesion, tumour site and CR with a multivariate generalised linear mixed effects model, where geographical area was considered as a random effect. We collected data on 123 360 invasive melanomas, with 5133 fatal cases at 1 year (4%) and 12 330 (10%) at 3 years. The number of fatal cases showed a 16% decrease at 1 year and 8% at 3 years between the first (1995-2000) and the last (2007-2012) period. The highest proportion of fatal cases was seen for men, older age (≥65 years), thick lesions (>1 mm), nodular melanoma, melanoma on the trunk and for poorly documented cases, lacking information about thickness and histologic subtype. The mixed-effects model showed a remarkable variability among European countries. The majority of registries showed a decreasing trend in fatal cases, but a few registries showed an opposite pattern. Trends in fatal melanoma cases, highlighting real changes in risk not related to overdiagnosis, showed a decrease in most European countries, with a few exceptions. Stronger efforts for early detection could lead to a more efficient treatment of melanoma in general.
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Affiliation(s)
- Lidia Sacchetto
- Piedmont Cancer Registry, Turin, Italy
- Department of Mathematical Sciences, Politecnico di Torino, Turin, Italy
- Department of Mathematics, Università degli Studi di Torino, Turin, Italy
| | | | | | | | - Paolo Broganelli
- A.O.U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Jaume Galceran
- Servei d'Epidemiologia i Prevenció del Càncer, Hospital Universitari Sant Joan de Reus, ISSPV, Tarragona Cancer Registry, Reus, Spain
| | - Monika Hackl
- Austrian National Cancer Registry, Wien, Austria
| | - Alexander Katalinic
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Marieke Louwman
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Trude E Robsahm
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Laufey Tryggvadottir
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
- Faculty of Medicine, BMC, Laeknagardur, University of Iceland, Reykjavik, Iceland
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), Ragusa, Italy
| | | | | | - Vesna Zadnik
- Cancer Registry of Republic of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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28
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Subramanian S, Han G, Olson N, Leong SP, Kashani-Sabet M, White RL, Zager JS, Sondak VK, Messina JL, Pockaj B, Kosiorek HE, Vetto J, Fowler G, Schneebaum S, Han D. Regression is significantly associated with outcomes for patients with melanoma. Surgery 2021; 170:1487-1494. [PMID: 34120749 DOI: 10.1016/j.surg.2021.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/13/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The prognostic significance of regression in melanoma is debated. We present a large multicenter study correlating regression with sentinel lymph node metastasis and melanoma-specific survival. METHODS The Sentinel Lymph Node Working Group database was reviewed from 1993 to 2018. Patients with known regression and sentinel lymph node status were included. Clinicopathologic factors were correlated with regression, sentinel lymph node status, and melanoma-specific survival. RESULTS There were 4,790 patients; median follow-up was 39.6 months. Regression was present in 1,081 (22.6%) cases, and 798 (16.7%) patients had sentinel lymph node metastases. On multivariable analysis, male sex, truncal tumors, and decreasing thickness were significantly associated with regression (P < .05), whereas head/neck or leg tumors had lower rates of regression (P < .05). Regression was significantly correlated with a decreased risk of sentinel lymph node disease on multivariable analysis (odds ratio 0.68, 95% confidence interval 0.54-0.85; P = .0008). Multivariable analysis also showed that increasing age, male sex, increasing thickness, ulceration, lymphovascular invasion, microsatellitosis, and sentinel lymph node metastasis were significantly (P < .05) associated with worse melanoma-specific survival, while regression was significantly associated with better melanoma-specific survival (hazard ratio 0.75, 95% confidence interval 0.57-0.99; P = .043). CONCLUSION This large study shows that regression is significantly associated with better outcomes in patients with melanoma and is correlated with a lower risk of sentinel lymph node metastasis and a better melanoma-specific survival.
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Affiliation(s)
- Sarayu Subramanian
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR. https://twitter.com/dr_Sarayu
| | - Gang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A & M University, College Station, TX
| | - Natalie Olson
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A & M University, College Station, TX
| | - Stanley P Leong
- California Pacific Medical Center and Research Institute, San Francisco, CA
| | | | - Richard L White
- Levine Cancer Institute, Carolinas Medical Center, Atrium Health, Charlotte, NC
| | | | | | | | | | | | - John Vetto
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR
| | - Graham Fowler
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR
| | | | - Dale Han
- Division of Surgical Oncology, Oregon Health & Science University, Portland, OR.
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29
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Scatena C, Murtas D, Tomei S. Cutaneous Melanoma Classification: The Importance of High-Throughput Genomic Technologies. Front Oncol 2021; 11:635488. [PMID: 34123788 PMCID: PMC8193952 DOI: 10.3389/fonc.2021.635488] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/30/2021] [Indexed: 02/06/2023] Open
Abstract
Cutaneous melanoma is an aggressive tumor responsible for 90% of mortality related to skin cancer. In the recent years, the discovery of driving mutations in melanoma has led to better treatment approaches. The last decade has seen a genomic revolution in the field of cancer. Such genomic revolution has led to the production of an unprecedented mole of data. High-throughput genomic technologies have facilitated the genomic, transcriptomic and epigenomic profiling of several cancers, including melanoma. Nevertheless, there are a number of newer genomic technologies that have not yet been employed in large studies. In this article we describe the current classification of cutaneous melanoma, we review the current knowledge of the main genetic alterations of cutaneous melanoma and their related impact on targeted therapies, and we describe the most recent high-throughput genomic technologies, highlighting their advantages and disadvantages. We hope that the current review will also help scientists to identify the most suitable technology to address melanoma-related relevant questions. The translation of this knowledge and all actual advancements into the clinical practice will be helpful in better defining the different molecular subsets of melanoma patients and provide new tools to address relevant questions on disease management. Genomic technologies might indeed allow to better predict the biological - and, subsequently, clinical - behavior for each subset of melanoma patients as well as to even identify all molecular changes in tumor cell populations during disease evolution toward a real achievement of a personalized medicine.
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Affiliation(s)
- Cristian Scatena
- Division of Pathology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniela Murtas
- Department of Biomedical Sciences, Section of Cytomorphology, University of Cagliari, Cagliari, Italy
| | - Sara Tomei
- Omics Core, Integrated Genomics Services, Research Department, Sidra Medicine, Doha, Qatar
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30
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Garbarino F, Pampena R, Lai M, Pereira AR, Piana S, Cesinaro AM, Cinotti E, Fiorani D, Ciardo S, Farnetani F, Chester J, Pellacani G, Guitera P, Longo C. Flat scalp melanoma dermoscopic and reflectance confocal microscopy features correspond to histopathologic type and lesion location. J Eur Acad Dermatol Venereol 2021; 35:1670-1677. [PMID: 33960517 PMCID: PMC8361774 DOI: 10.1111/jdv.17313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
Background Dermoscopy and Reflectance Confocal Microscopy (RCM) features of scalp melanoma according to lesion location and histopathology have not been fully investigated. Objectives To reveal dermoscopic and RCM features of scalp melanoma according to lesion location and histopathology. Methods We retrospectively retrieved images of suspicious, atypical excised, flat melanocytic lesions of the scalp, assessed on dermoscopy and RCM at five centres, from June 2007 to April 2020. Lesions were classified according to histopathological diagnoses of nevi, lentigo maligna melanoma (LM/LMM) or superficial spreading melanoma (SSM). Clinical, dermoscopic and RCM images were evaluated; LM/LMM and SSM subtypes were compared through multivariate analysis. Results Two hundred forty‐seven lesions were included. In situ melanomas were mostly LM (81.3%), while invasive melanomas were mostly SSM (75.8%). Male sex, baldness and chronic sun‐damaged skin were associated with all types of melanomas and in particular with LM/LMM. LMs were mostly located in the vertex area and SSM in the frontal (OR: 8.8; P < 0.05, CI 95%) and temporal (OR: 16.7; P < 0.005, CI 95%) areas. The dermoscopy presence of pseudo‐network, pigmented rhomboidal structures, obliterated hair follicles and annular–granular pattern were associated with LM diagnoses, whereas bluish‐white veil was more typical of SSM. Observations on RCM of atypical roundish and dendritic cells in the epidermis were associated with SSM (42.4%) and dendritic cells with LM (62.5%) diagnoses. Folliculotropism on RCM was confirmed as a typical sign of LM. Conclusions Flat scalp melanomas reveal specific dermoscopic and RCM features according to histopathologic type and scalp location.
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Affiliation(s)
- F Garbarino
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - R Pampena
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - M Lai
- Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - A R Pereira
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - S Piana
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - A M Cesinaro
- Department of Pathology, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Modena, Italy
| | - E Cinotti
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - D Fiorani
- Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Siena, Italy
| | - S Ciardo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - F Farnetani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - J Chester
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - G Pellacani
- Department of Dermatology, University of La Sapienza, Roma, Italy
| | - P Guitera
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.,Melanoma Institute Australia, Sydney, NSW, Australia
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
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31
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Budden T, Gaudy-Marqueste C, Porter A, Kay E, Gurung S, Earnshaw CH, Roeck K, Craig S, Traves V, Krutmann J, Muller P, Motta L, Zanivan S, Malliri A, Furney SJ, Nagore E, Virós A. Ultraviolet light-induced collagen degradation inhibits melanoma invasion. Nat Commun 2021; 12:2742. [PMID: 33980846 PMCID: PMC8115293 DOI: 10.1038/s41467-021-22953-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/08/2021] [Indexed: 01/26/2023] Open
Abstract
Ultraviolet radiation (UVR) damages the dermis and fibroblasts; and increases melanoma incidence. Fibroblasts and their matrix contribute to cancer, so we studied how UVR modifies dermal fibroblast function, the extracellular matrix (ECM) and melanoma invasion. We confirmed UVR-damaged fibroblasts persistently upregulate collagen-cleaving matrix metalloprotein-1 (MMP1) expression, reducing local collagen (COL1A1), and COL1A1 degradation by MMP1 decreased melanoma invasion. Conversely, inhibiting ECM degradation and MMP1 expression restored melanoma invasion. Primary cutaneous melanomas of aged humans show more cancer cells invade as single cells at the invasive front of melanomas expressing and depositing more collagen, and collagen and single melanoma cell invasion are robust predictors of poor melanoma-specific survival. Thus, primary melanomas arising over collagen-degraded skin are less invasive, and reduced invasion improves survival. However, melanoma-associated fibroblasts can restore invasion by increasing collagen synthesis. Finally, high COL1A1 gene expression is a biomarker of poor outcome across a range of primary cancers.
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Affiliation(s)
- Timothy Budden
- Skin Cancer and Ageing Lab, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | | | - Andrew Porter
- Cell Signalling Group, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, Manchester, UK
| | - Emily Kay
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Beatson Institute, Glasgow, UK
| | - Shilpa Gurung
- Skin Cancer and Ageing Lab, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Charles H Earnshaw
- Skin Cancer and Ageing Lab, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Katharina Roeck
- Skin Cancer and Ageing Lab, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Sarah Craig
- Skin Cancer and Ageing Lab, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Víctor Traves
- Department of Dermatology, Institut Valencià Oncologia, Valencia, Spain
| | - Jean Krutmann
- IUF - Leibniz Research Institute of Environmental Medicine, Düsseldorf, Germany
- Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Patricia Muller
- Tumour Suppressors Lab, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK
| | - Luisa Motta
- Department of Histopathology, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - Sara Zanivan
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- CRUK Beatson Institute, Glasgow, UK
| | - Angeliki Malliri
- Cell Signalling Group, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, Manchester, UK
| | - Simon J Furney
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, Royal College of Surgeons in, Ireland, Dublin, Ireland
- Centre for Systems Medicine, Royal College of Surgeons in Ireland Dublin, Dublin, Ireland
| | - Eduardo Nagore
- Department of Dermatology, Institut Valencià Oncologia, Valencia, Spain
| | - Amaya Virós
- Skin Cancer and Ageing Lab, Cancer Research UK Manchester Institute, The University of Manchester, Manchester, UK.
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32
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Ackermann DM, Smit AK, Janda M, van Kemenade CH, Dieng M, Morton RL, Turner RM, Cust AE, Irwig L, Hersch JK, Guitera P, Soyer HP, Mar V, Saw RPM, Low D, Low C, Drabarek D, Espinoza D, Emery J, Murchie P, Thompson JF, Scolyer RA, Azzi A, Lilleyman A, Bell KJL. Can patient-led surveillance detect subsequent new primary or recurrent melanomas and reduce the need for routinely scheduled follow-up? A protocol for the MEL-SELF randomised controlled trial. Trials 2021; 22:324. [PMID: 33947444 PMCID: PMC8096155 DOI: 10.1186/s13063-021-05231-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/27/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Most subsequent new primary or recurrent melanomas might be self-detected if patients are trained to systematically self-examine their skin and have access to timely medical review (patient-led surveillance). Routinely scheduled clinic visits (clinician-led surveillance) is resource-intensive and has not been shown to improve health outcomes; fewer visits may be possible if patient-led surveillance is shown to be safe and effective. The MEL-SELF trial is a randomised controlled trial comparing patient-led surveillance with clinician-led surveillance in people who have been previously treated for localised melanoma. METHODS Stage 0/I/II melanoma patients (n = 600) from dermatology, surgical, or general practice clinics in NSW Australia, will be randomised (1:1) to the intervention (patient-led surveillance, n = 300) or control (usual care, n = 300). Patients in the intervention will undergo a second randomisation 1:1 to polarised (n = 150) or non-polarised (n = 150) dermatoscope. Patient-led surveillance comprises an educational booklet, skin self-examination (SSE) instructional videos; 3-monthly email/SMS reminders to perform SSE; patient-performed dermoscopy with teledermatologist feedback; clinical review of positive teledermoscopy through fast-tracked unscheduled clinic visits; and routinely scheduled clinic visits following each clinician's usual practice. Clinician-led surveillance comprises an educational booklet and routinely scheduled clinic visits following each clinician's usual practice. The primary outcome, measured at 12 months, is the proportion of participants diagnosed with a subsequent new primary or recurrent melanoma at an unscheduled clinic visit. Secondary outcomes include time from randomisation to diagnosis (of a subsequent new primary or recurrent melanoma and of a new keratinocyte cancer), clinicopathological characteristics of subsequent new primary or recurrent melanomas (including AJCC stage), psychological outcomes, and healthcare use. A nested qualitative study will include interviews with patients and clinicians, and a costing study we will compare costs from a societal perspective. We will compare the technical performance of two different models of dermatoscope (polarised vs non-polarised). DISCUSSION The findings from this study may inform guidance on evidence-based follow-up care, that maximises early detection of subsequent new primary or recurrent melanoma and patient wellbeing, while minimising costs to patients, health systems, and society. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000176864 . Registered on 18 February 2021.
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Affiliation(s)
- Deonna M Ackermann
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Amelia K Smit
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Cathelijne H van Kemenade
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mbathio Dieng
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Rachael L Morton
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Anne E Cust
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Les Irwig
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jolyn K Hersch
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Pascale Guitera
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Australia
- Department of Dermatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Victoria Mar
- Victorian Melanoma Service, Alfred Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Division of Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | - Dorothy Drabarek
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Jon Emery
- Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Peter Murchie
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Division of Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia
| | - Anthony Azzi
- Newcastle Skin Check, Newcastle, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Alister Lilleyman
- Newcastle Skin Check, Newcastle, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Katy J L Bell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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33
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Dessinioti C, Geller AC, Whiteman DC, Garbe C, Grob JJ, Kelly JW, Scolyer RA, Rawson RV, Lallas A, Pellacani G, Stratigos AJ. Not all melanomas are created equal: a review and call for more research into nodular melanoma. Br J Dermatol 2021; 185:700-710. [PMID: 33864261 DOI: 10.1111/bjd.20388] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 12/23/2022]
Abstract
Among the histogenic subtypes of melanoma, nodular melanoma (NM) is the major contributor for thicker and fatal melanomas and it has been associated with melanoma-specific death in thin tumours, highlighting an important subgroup of 'aggressive thin' melanomas. This review provides a synthesis of the distinct characteristics of NM, with respect to epidemiology and risk factors, clinical presentation, histopathology, molecular and dermoscopic aspects, and screening practices. The real challenges are to find better biomarkers of aggressiveness and to know whether the control of such aggressive melanomas can be influenced by targeted interventions such as early detection, drug interventions and preventive strategies.
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Affiliation(s)
- C Dessinioti
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - A C Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - D C Whiteman
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - C Garbe
- Center for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - J J Grob
- Department of Dermatology and Skin Cancers, APHM Timone Hospital Aix-Marseille University, Marseille, France
| | - J W Kelly
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Australia
| | - R A Scolyer
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - R V Rawson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - A J Stratigos
- First Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
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34
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El Sharouni MA, Ahmed T, Varey AHR, Elias SG, Witkamp AJ, Sigurdsson V, Suijkerbuijk KPM, van Diest PJ, Scolyer RA, van Gils CH, Thompson JF, Blokx WAM, Lo SN. Development and Validation of Nomograms to Predict Local, Regional, and Distant Recurrence in Patients With Thin (T1) Melanomas. J Clin Oncol 2021; 39:1243-1252. [PMID: 33600211 DOI: 10.1200/jco.20.02446] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although the prognosis of patients with thin primary cutaneous melanomas (T1, ≤ 1.0 mm) is generally excellent, some develop recurrence. We sought to develop and validate a model predicting recurrences in patients with thin melanomas. METHODS A Dutch population-based cohort (n = 25,930, development set) and a cohort from an Australian melanoma treatment center (n = 2,968, validation set) were analyzed (median follow-up 6.7 and 12.0 years, respectively). Multivariable Cox models were generated for local, regional, and distant recurrence-free survival (RFS). Discrimination was assessed using Harrell's C-statistic for each outcome. Each nomogram performance was evaluated using calibration plots defining low-risk and high-risk groups as the lowest and top 5% of the nomogram risk score, respectively. The nomograms' C-statistics were compared with those of a model including the current American Joint Committee on Cancer staging parameters (T-stage and sentinel node status). RESULTS Local, regional, and distant recurrences were found in 209 (0.8%), 503 (1.9%), and 203 (0.8%) Dutch patients, respectively, and 23 (0.8%), 61 (2.1%), and 75 (2.5%) Australian patients, respectively. C-statistics of 0.79 (95% CI, 0.75 to 0.82) for local RFS, 0.77 (95% CI, 0.75 to 0.78) for regional RFS, and 0.80 (95% CI, 0.77 to 0.83) for distant RFS were obtained for the development model. External validation showed C-statistics of 0.80 (95% CI, 0.69 to 0.90), 0.76 (95% CI, 0.70 to 0.82), and 0.74 (95% CI, 0.69 to 0.80), respectively. Calibration plots showed a good match between predicted and observed rates. Using the nomogram, the C-statistic was increased by 9%-12% for the development cohort and by 11%-15% for the validation cohort, compared with a model including only T-stage and sentinel node status. CONCLUSION Most patients with thin melanomas have an excellent prognosis, but some develop recurrence. The presented nomograms can accurately identify a subgroup at high risk. An online calculator is available at www.melanomarisk.org.au.
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Affiliation(s)
- Mary-Ann El Sharouni
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tasnia Ahmed
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - Arjen J Witkamp
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Vigfús Sigurdsson
- Department of Dermatology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Karijn P M Suijkerbuijk
- Department of Medical Oncology, University Medical Center Cancer Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Oncology and Diagnostic Pathology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, New South Wales, Australia
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Willeke A M Blokx
- Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Coroiu A, Moran C, Davine JA, Brophy K, Bergeron C, Tsao H, Körner A, Swetter SM, Geller AC. Patient-identified early clinical warning signs of nodular melanoma: a qualitative study. BMC Cancer 2021; 21:371. [PMID: 33827477 PMCID: PMC8028760 DOI: 10.1186/s12885-021-08072-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nodular (NM) and superficial spreading melanoma (SSM) show different disease trajectories, with more rapid development in NM and fewer opportunities for early detection often resulting in worse outcomes. Our study described the patient-identified early signs of thin NM via comparisons to thin (≤ 2 mm) SSM and thick (> 2 mm) NM. METHODS We conducted semi-structured interviews with NM and SSM patients and analyzed the data using thematic analysis. RESULTS We enrolled 34 NM and 32 SSM patients. Melanoma early signs uniquely identified by patients with thin NM included white, blue or black coloration, "dot-like" size, fast changes in shape and color observed over 2 weeks, elevation and texture or "puffiness" over 6-12 months, and the sensation that the mole "did not feel right". Early signs reported by both thin NM and thin SSM patients included round or oblong shape, "jagged" border, pink/red, brown/reddish or dark coloration, "elevated like a pimple" or "tiny bump", fast color darkening, diameter growth, and border irregularity, and mole feeling "really itchy". CONCLUSIONS We found evidence that early signs of NM can be self-identified, which has important implications for the earlier detection of this most aggressive type of melanoma by both health professionals and patients.
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Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA.
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Jessica A Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
| | - Kyla Brophy
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Hensin Tsao
- Harvard Medical School, Boston, USA
- Department of Dermatology, Massachusetts General Hospital, Boston, USA
| | - Annett Körner
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Susan M Swetter
- Department of Dermatology, Pigmented Lesion and Melanoma Program, Stanford University Medical Center, Stanford, USA
- Dermatology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, West Wing 4th floor, 403G, Boston, MA, 02215, USA
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36
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Allais BS, Beatson M, Wang H, Shahbazi S, Bijelic L, Jang S, Venna S. Five-year survival in patients with nodular and superficial spreading melanomas in the US population. J Am Acad Dermatol 2021; 84:1015-1022. [PMID: 33253834 DOI: 10.1016/j.jaad.2020.11.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 11/03/2020] [Accepted: 11/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although superficial spreading melanomas (SSM) are diagnosed as thinner lesions, nodular melanomas (NM) have a more rapid growth rate and are biologically more aggressive compared with other histologic subtypes. OBJECTIVE To determine the difference in 5-year relative survival in patients with NM and SSM at the same Breslow depth and TNM stage. METHODS A population-based cross-sectional analysis compared the 5-year relative survival of patients with NM and SSM using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)∗Stat software (version 8.2.1-8.3.5). Chi-square tests compared the proportions, and Kaplan-Meier method with Z-score compared 5-year relative survival. RESULTS For patients receiving a diagnosis between 2004 and 2009, 5-year relative survival was lower in NM compared with SSM (53.7% vs 87.3%; Z score, -41.35; P < .001). Similarly, for patients receiving a diagnosis between 2010 and 2015, 5-year relative survival was lower in NM compared with SSM (61.5% vs 89.7%; Z score, -2.7078; P < .01). Subgroup analyses showed inferior survival in NM in T1b, and survival differences remained significant after excluding patients with nodal or distant metastases. CONCLUSIONS Five-year relative survival is worse in NM compared with SSM especially in T1b, T2a, and T2b melanomas. Melanoma subtype should be taken into consideration when making treatment recommendations.
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Affiliation(s)
- Blair S Allais
- Washington University Department of Dermatology, Washington, DC.
| | - Meghan Beatson
- Memorial Sloan Kettering Cancer Center Department of Medicine, New York, NY
| | - Hongkun Wang
- Georgetown University Departments of Biostatistics, Bioinformatics, and Biomathematics, Washington, DC
| | | | - Lana Bijelic
- Hospital de Sant Joan Despi Moises Broggi, Barcelona, Spain
| | - Sekwon Jang
- University of Virginia School of Medicine, Charlottesville, VA; Inova Melanoma and Skin Cancer Center, Inova Schar Cancer Institute, Fairfax, VA
| | - Suraj Venna
- University of Virginia School of Medicine, Charlottesville, VA; Inova Melanoma and Skin Cancer Center, Inova Schar Cancer Institute, Fairfax, VA
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Susok L, Stücker M, Bechara FG, Stockfleth E, Gambichler T. Multivariate analysis of prognostic factors in patients with nodular melanoma. J Cancer Res Clin Oncol 2021; 147:2759-2764. [PMID: 33630139 PMCID: PMC8310843 DOI: 10.1007/s00432-021-03562-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Nodular melanoma (NM) is associated with worse disease outcome when compared to superficial spreading melanoma (SSM). We aimed to perform a single-center analysis of prognostic factors in patients with NM and compare the data with SSM patients. METHODS We studied 228 patients with NN and 396 patients with SSM. Patients with in situ melanomas or stage IV at diagnosis were not included in the study. Data were analyzed using the Mann-Whitney test, Chi-square test, Kaplan-Meier curves including the log-rank test, and logistic regression model. RESULTS When compared to patients with SSM, patients with NM had less likely lower Clark level, higher tumor thickness, less likely tumor regression, more often ulcerated tumors, and less likely a history of precursor lesions such as a nevus. Within a 5-year follow-up we observed significantly more disease relapses and deaths in NM patients than in SSM patients. On multivariate analysis, disease relapse in NM patients was independently predicted by tumor thickness and positive SLNB, whereas melanoma-specific death of NM patients was independently predicted by male sex and tumor thickness. Histologic regression also remained in the logistic regression model as a significant independent negative predictor of NM death. CONCLUSIONS We did not observe that NM subtype was per se a significant independent predictor for disease relapse or melanoma-specific death. Among the well-known prognostic factors such as tumor thickness and male sex, NM is also associated with other unfavorable factors such as absence of regression.
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Affiliation(s)
- L Susok
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - M Stücker
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - F G Bechara
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - E Stockfleth
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany
| | - T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstraße 56, 44791, Bochum, Germany.
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Lee KJ, Janda M, Stark MS, Sturm RA, Soyer HP. On Naevi and Melanomas: Two Sides of the Same Coin? Front Med (Lausanne) 2021; 8:635316. [PMID: 33681261 PMCID: PMC7933521 DOI: 10.3389/fmed.2021.635316] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/01/2021] [Indexed: 12/13/2022] Open
Abstract
Benign naevi are closely linked to melanoma, as risk factors, simulators, or sites of melanoma formation. There is a heavy genetic overlap between the two lesions, a shared environmental influence of ultraviolet radiation, and many similar cellular features, yet naevi remain locally situated while melanomas spread from their primary site and may progress systemically to distal organs. Untangling the overlapping contributors and predictors of naevi and melanoma is an ongoing area of research and should eventually lead to more personalized prevention and treatment strategies, through the development of melanoma risk stratification tools and early detection of evolving melanomas. This will be achieved through a range of complementary strategies: risk-adjusted primary prevention counseling; the use of lesion imaging technologies such as sequential 3D total body photography and consumer-performed lesion imaging; artificial intelligence deep phenotyping and clinical assistance; a better understanding of genetic drivers of malignancy, risk variants, clinical genetics, and polygenic effects; and the interplay between genetics, phenotype and the environment.
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Affiliation(s)
- Katie J Lee
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Mitchell S Stark
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Richard A Sturm
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Hornung A, Steeb T, Wessely A, Brinker TJ, Breakell T, Erdmann M, Berking C, Heppt MV. The Value of Total Body Photography for the Early Detection of Melanoma: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1726. [PMID: 33578996 PMCID: PMC7916771 DOI: 10.3390/ijerph18041726] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
Early detection of melanoma is critical to reduce the mortality and morbidity rates of this tumor. Total body photography (TBP) may aid in the early detection of melanoma. To summarize the current evidence on TBP for the early detection of melanoma, we performed a systematic literature search in Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for eligible records up to 6th August 2020. Outcomes of interest included melanoma incidence, incisional and excisional biopsy rates, as well as the Breslow's index of detected tumors. Results from individual studies were described qualitatively. The risks of bias and applicability of the included studies was assessed using the QUADAS-2 checklist. In total, 14 studies published between 1997 and 2020 with an overall sample size of n = 12082 (range 100-4692) were included in the qualitative analysis. Individuals undergoing TBP showed a trend towards a lower Breslow's thickness and a higher proportion of in situ melanomas compared to those without TBP. The number needed to excise one melanoma varied from 3:1 to 14.3:1 and was better for lesions that arose de novo than for tracked ones. The included studies were judged to be of unclear methodological concern with specific deficiencies in the domains "flow and timing" and "reference standard". The use of TBP can improve the early detection of melanoma in high-risk populations. Future studies are warranted to reduce the heterogeneity of phenotypic risk factor definition and the technical implementation of TBP. Artificial intelligence-assisted analysis of images derived from 3-D TBP systems and digital dermoscopy may further improve the early detection of melanoma.
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Affiliation(s)
- Annkathrin Hornung
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Titus J. Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany;
| | - Thomas Breakell
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.H.); (T.S.); (A.W.); (T.B.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen—European Metropolitan Region of Nürnberg, 91054 Erlangen, Germany
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Validation of the “knowledge about melanoma early detection scale” in a sample of melanoma survivors. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01366-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gordon LG, Rodriguez-Acevedo AJ, Køster B, Guy GP, Sinclair C, Van Deventer E, Green AC. Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe. JAMA Dermatol 2020; 156:401-410. [PMID: 32074257 DOI: 10.1001/jamadermatol.2020.0001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Importance UV radiation emissions from indoor tanning devices are carcinogenic. Regulatory actions may be associated with reduced exposure of UV radiation at a population level. Objective To estimate the long-term health and economic consequences of banning indoor tanning devices or prohibiting their use by minors only in North America and Europe compared with ongoing current levels of use. Design, Setting, and Participants This economic analysis modeled data for individuals 12 to 35 years old in North America and Europe, who commonly engage in indoor tanning. A Markov cohort model was used with outcomes projected during the cohort's remaining life-years. Models were populated by extracting data from high-quality systematic reviews and meta-analyses, epidemiologic reports, and cancer registrations. Main Outcomes and Measures Main outcomes were numbers of melanomas and deaths from melanoma, numbers of keratinocyte carcinomas, life-years, and health care and productivity costs. Extensive sensitivity analyses were performed to assess the stability of results. Results In an estimated population of 110 932 523 in the United States and Canada and 141 970 492 in Europe, for the next generation of youths and young adults during their remaining lifespans, regulatory actions that ban indoor tanning devices could be expected to gain 423 000 life-years, avert 240 000 melanomas (-8.2%), and avert 7.3 million keratinocyte carcinomas (-7.8%) in North America and gain 460 000 life-years, avert 204 000 melanomas (-4.9%), and avert 2.4 million keratinocyte carcinomas (-4.4%) in Europe compared with ongoing current levels of use. Economic cost savings of US $31.1 billion in North America and €21.1 billion (US $15.9 billion) in Europe could occur. Skin cancers averted and cost savings after prohibiting indoor tanning by minors may be associated with one-third of the corresponding benefits of a total ban. Conclusions and Relevance Banning indoor tanning may be associated with reduced skin cancer burden and health care costs. Corresponding gains from prohibiting indoor tanning by minors only may be smaller.
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Affiliation(s)
- Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology School of Nursing, Brisbane, Queensland, Australia.,The University of Queensland School of Medicine, Brisbane, Queensland, Australia
| | - Astrid J Rodriguez-Acevedo
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | | | - Gery P Guy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Manchester Academic Health Science Centre, CRUK Manchester Institute and Faculty of Biology Medicine and Health, University of Manchester, Manchester, United Kingdom
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Xiao Y, Peng S, Hu Y, Zhang J, Cao X. Development and validation of prognostic nomogram in patients with nonmetastatic malignant melanoma: a SEER population-based study. Cancer Med 2020; 9:8562-8570. [PMID: 32941704 PMCID: PMC7666721 DOI: 10.1002/cam4.3318] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/25/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The condition of tumor recurrence and overall death can be worried in the progress of nonmetastatic malignant melanoma (NMMM). Our goal was to construct and validate a prognostic nomogram from a large population database, which is vital for physicians to predict the 3- and 5-year overall survival (OS) rates of patients with NMMM. METHODS According to the Surveillance, Epidemiology, and End Results (SEER) program, patients were collected and randomly assigned into the training and validation cohorts. Several independent risk factors were identified based on the methods of univariable and multivariable cox hazards regression and were incorporated to develop a nomogram. The concordance index (C-index), the area under the receiver operating characteristics (AUC) curve and calibration plot were confirmed to assess predictive power of the nomogram. Decision curve analysis (DCA) was performed to measure nomogram for the clinical practice. RESULTS A total of 66192 eligible patients, randomly assigned into 70% of training (n = 46 336) and 30% of validation cohorts (n = 19 856), were selected in this study. The selected independent factors were applied to develop a nomogram, and validated indexes indicated nomogram had a good discrimination ability. The C-index for OS rates was 0.817 (95% CI: 0.811-0.823) in training cohort and 0.817 (95% CI: 0.809-0.825) in validation cohort, respectively. The AUCs of 3- and 5-year OS rates were more than 0.79, and the calibration plots also showed a good power for the nomogram. DCA demonstrated that constructed nomogram can provide clinical net benefit. CONCLUSION We constructed a novel nomogram that more accurately and comprehensively predict OS with nonmetastatic malignant melanoma patients, which is vital for clinician to improve individual treatment, make reasonable clinical decisions, and set appropriate follow-up strategies.
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Affiliation(s)
- Yu Xiao
- The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Shanshan Peng
- The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Youhong Hu
- The Central Hospital of Xiaogan, Xiaogan, Hubei, China
| | - Jie Zhang
- The First Affiliated Hospital Of Nanchang University, Nanchang, Jiangxi, China
| | - Xianwei Cao
- The First Affiliated Hospital Of Nanchang University, Nanchang, Jiangxi, China
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Marchetti MA, Coit DG, Dusza SW, Yu A, McLean L, Hu Y, Nanda JK, Matsoukas K, Mancebo SE, Bartlett EK. Performance of Gene Expression Profile Tests for Prognosis in Patients With Localized Cutaneous Melanoma: A Systematic Review and Meta-analysis. JAMA Dermatol 2020; 156:953-962. [PMID: 32745161 PMCID: PMC7391179 DOI: 10.1001/jamadermatol.2020.1731] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/20/2020] [Indexed: 01/28/2023]
Abstract
Importance The performance of prognostic gene expression profile (GEP) tests for cutaneous melanoma is poorly characterized. Objective To systematically assess the performance of commercially available GEP tests in patients with American Joint Committee on Cancer (AJCC) stage I or stage II disease. Data Sources For this systematic review and meta-analysis, comprehensive searches of PubMed/MEDLINE, Embase, and Web of Science were conducted on December 12, 2019, for English-language studies of humans without date restrictions. Study Selection Two reviewers identified GEP external validation studies of patients with localized melanoma. After exclusion criteria were applied, 7 studies (8%; 5 assessing DecisionDx-Melanoma and 2 assessing MelaGenix) were included. Data Extraction and Synthesis Data were extracted using an adaptation of the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies (CHARMS-PF). When feasible, meta-analysis using random-effects models was performed. Risk of bias and level of evidence were assessed with the Quality in Prognosis Studies tool and an adaptation of Grading of Recommendations Assessment, Development, and Evaluation. Main Outcomes and Measures Proportion of patients with or without melanoma recurrence correctly classified by the GEP test as being at high or low risk. Results In the 7 included studies, a total of 1450 study participants contributed data (age and sex unknown). The performance of both GEP tests varied by AJCC stage. Of patients tested with DecisionDx-Melanoma, 623 had stage I disease (6 true-positive [TP], 15 false-negative, 61 false-positive, and 541 true-negative [TN] results) and 212 had stage II disease (59 TP, 13 FN, 78 FP, and 62 TN results). Among patients with recurrence, DecisionDx-Melanoma correctly classified 29% with stage I disease and 82% with stage II disease. Among patients without recurrence, the test correctly classified 90% with stage I disease and 44% with stage II disease. Of patients tested with MelaGenix, 88 had stage I disease (7 TP, 15 FN, 15 FP, and 51 TN results) and 245 had stage II disease (59 TP, 19 FN, 95 FP, and 72 TN results). Among patients with recurrence, MelaGenix correctly classified 32% with stage I disease and 76% with stage II disease. Among patients without recurrence, the test correctly classified 77% with stage I disease and 43% with stage II disease. Conclusions and Relevance The prognostic ability of GEP tests among patients with localized melanoma varied by AJCC stage and appeared to be poor at correctly identifying recurrence in patients with stage I disease, suggesting limited potential for clinical utility in these patients.
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Affiliation(s)
- Michael A. Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Dermatology, Weill Medical College of Cornell University, New York, New York
| | - Daniel G. Coit
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W. Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashley Yu
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - LaToya McLean
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yinin Hu
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Japbani K. Nanda
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Silvia E. Mancebo
- Department of Dermatology, Weill Medical College of Cornell University, New York, New York
- Department of Dermatology, New York-Presbyterian Hospital, New York, New York
| | - Edmund K. Bartlett
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Keung EZ, Gershenwald JE. Clinicopathological Features, Staging, and Current Approaches to Treatment in High-Risk Resectable Melanoma. J Natl Cancer Inst 2020; 112:875-885. [PMID: 32061122 PMCID: PMC7492771 DOI: 10.1093/jnci/djaa012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 12/06/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022] Open
Abstract
The incidence of melanoma in the United States has been increasing over the past several decades. Prognosis largely depends on disease stage, with 5-year melanoma-specific survival ranging from as high as 99% in patients with stage I disease to less than 10% for some patients with stage IV (distant metastatic) disease. Fortunately, in the last 5-10 years, there have been remarkable treatment advances for patients with high-risk resectable melanoma, including approval of targeted and immune checkpoint blockade therapies. In addition, results of recent clinical trials have confirmed the importance of sentinel lymph node biopsy and continue to refine the approach to regional lymph node basin management. Lastly, the melanoma staging system was revised in the eighth edition AJCC Cancer Staging Manual, which was implemented on January 1, 2018. Here we discuss these changes and the clinicopathological features that confer high risk for locoregional and distant disease relapse and poor survival. Implications regarding the management of melanoma in the metastatic and adjuvant settings are discussed, as are future directions for neoadjuvant therapies.
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Affiliation(s)
- Emily Z Keung
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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45
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Dessinioti C, Dimou N, Geller AC, Stergiopoulou A, Lo S, Keim U, Gershenwald JE, Haydu LE, Ribero S, Quaglino P, Puig S, Malvehy J, Kandolf-Sekulovic L, Radevic T, Kaufmann R, Meister L, Nagore E, Traves V, Champsas GG, Plaka M, Dreno B, Varey E, Ramirez DM, Dummer R, Mangana J, Hauschild A, Egberts F, Peris K, Del Regno L, Forsea AM, Zurac SA, Vieira R, Brinca A, Zalaudek I, Deinlein T, Linos E, Evangelou E, Thompson JF, Scolyer RA, Garbe C, Stratigos AJ. Distinct Clinicopathological and Prognostic Features of Thin Nodular Primary Melanomas: An International Study from 17 Centers. J Natl Cancer Inst 2020; 111:1314-1322. [PMID: 30863861 DOI: 10.1093/jnci/djz034] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/26/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Nodular melanoma (NM) is more likely to be fatal compared with other melanoma subtypes, an effect attributed to its greater Breslow thickness. METHODS Clinicopathological features of NM and superficial spreading melanoma (SSM) diagnosed in 17 centers in Europe (n = 15), the United States, and Australia between 2006 and 2015, were analyzed by multivariable logistic regression analysis, with emphasis on thin (T1 ≤ 1.0 mm) melanomas. Cox analysis assessed melanoma-specific survival. All statistical tests were two sided. RESULTS In all, 20 132 melanomas (NM: 5062, SSM: 15 070) were included. Compared with T1 SSM, T1 NM was less likely to have regression (odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.29 to 0.72) or nevus remnants histologically (OR = 0.60, 95% CI = 0.42 to 0.85), and more likely to have mitoses (OR = 1.97, 95% CI = 1.33 to 2.93) and regional metastasis (OR = 1.77, 95% CI = 1.02 to 3.05). T1 NM had a higher mitotic rate than T1 SSM (adjusted geometric mean = 2.2, 95% CI = 1.9 to 2.5 vs 1.6, 95% CI = 1.5 to 1.7 per mm2, P < .001). Cox multivariable analysis showed a higher risk for melanoma-specific death for NM compared with SSM for T1 (HR = 2.10, 95% CI = 1.24 to 3.56) and T2 melanomas (HR = 1.30, 95% CI = 1.01 to 1.68), and after accounting for center heterogeneity, the difference was statistically significant only for T1 (HR = 2.20, 95% CI = 1.28 to 3.78). The NM subtype did not confer increased risk within each stratum (among localized tumors or cases with regional metastasis). CONCLUSIONS T1 NM (compared with T1 SSM) was associated with a constellation of aggressive characteristics that may confer a worse prognosis. Our results indicate NM is a high-risk melanoma subtype that should be considered for inclusion in future prognostic classifications of melanoma.
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46
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Buja A, Rivera M, De Polo A, Zorzi M, Baracco M, Italiano I, Vecchiato A, Del Fiore P, Guzzinati S, Saia M, Baldo V, Rugge M, Rossi CR. Differences in direct costs of patients with stage I cutaneous melanoma: A real-world data analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:976-981. [PMID: 32146052 DOI: 10.1016/j.ejso.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/21/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clinical factors, such as tumor thickness, ulceration and growth phase have a role as prognostic factors for stage I melanoma. However, it is still under debate whether these variables influence the related direct costs. We aimed to investigate which clinical factors represent direct health care "cost drivers" for stage I melanoma. MATERIALS AND METHOD Analyses were conducted on a cohort of patients diagnosed with stage I melanoma. Differences in the costs incurred by different groups of patients were examined using Mann-Whitney or Kruskal-Wallis non-parametric tests. Log linear multivariate analysis was used to identify the clinical drivers of the total direct costs one and two years after diagnosis. The study was conducted from the perspective of Italy's National Health care System. RESULTS One year after diagnosis, patients whose melanomas had a Breslow thickness ≥0.8 mmin (compared with those with lower thickness) and a vertical growth phase (compared with those with radial growth) incurred higher costs for hospitalization, as well as higher overall costs. One year after their diagnosis, treatment of patients with stage I melanoma in the vertical growth phase costs 50% more (95% CI: 22-85%) than their counterparts with a radial growth pattern, resulting in an estimated absolute increase of € 256.23. Having a tumor thicker than 0.8 mm prompted an increase of 91% (95% CI: 43-155%) in the costs (€955.24 in absolute terms). CONCLUSION Our data indicate a heterogeneity in the direct costs of stage I melanoma patients during the first year after diagnosis, which can be partly explained by clinical prognostic factors, like tumor thickness and growth pattern.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy.
| | - Anna De Polo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy
| | | | - Mario Saia
- Veneto Regional Authority, Padova, Italy
| | - Vincenzo Baldo
- Department of Cardiologic, Vascular, and Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Italy
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47
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Mahamat-Saleh Y, Hughes MCB, Miura K, Malt MK, von Schuckmann L, Khosrotehrani K, Smithers BM, Green AC. Patterns of Omega-3 and Omega-6 Fatty Acid Dietary Intake and Melanoma Thickness at Diagnosis. Cancer Epidemiol Biomarkers Prev 2020; 29:1647-1653. [PMID: 32430338 DOI: 10.1158/1055-9965.epi-20-0319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/05/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Experimental evidence suggests that dietary intakes of omega-3 and omega-6 polyunsaturated fatty acids have divergent effects on melanoma growth, but epidemiologic evidence on their combined effect is lacking. METHODS In 634 Australian patients with primary melanoma, we assessed prediagnosis consumption of 39 food groups by food frequency questionnaires completed within 2 months of diagnosis. We derived, by reduced rank regression, dietary patterns that explained variability in selected omega-3 and omega-6 fatty acid intakes. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between tertiles of dietary patterns and melanoma thickness >2 mm versus ≤2 mm were estimated using Poisson regression. RESULTS Overall omega-3 fatty acid intakes were low. Two major fatty acid dietary patterns were identified: "meat, fish, and fat," positively correlated with intakes of all fatty acids; and "fish, low-meat, and low-fat," positively correlated with long-chain omega-3 fatty acid intake, and inversely with medium-chain omega-3 and omega-6 fatty acid intakes. Prevalence of thick melanomas was significantly higher in those in the highest compared with lowest tertile of the "meat, fish, and fat" pattern (PR, 1.40; 95% CI, 1.01-1.94), especially those with serious comorbidity (PR, 1.83; 95% CI, 1.15-2.92) or a family history (PR, 2.32; 95% CI, 1.00-5.35). The "fish, low-meat, and low-fat" pattern was not associated with melanoma thickness. CONCLUSIONS People with high meat, fish, and fat intakes, who thus consumed relatively high levels of omega-3 and high omega-6 fatty acid intakes, are more likely to be diagnosed with thick than thin melanomas. IMPACT High omega-3 and omega-6 fatty acid intakes may contribute to patients' presentation with thick melanomas.
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Affiliation(s)
- Yahya Mahamat-Saleh
- Centre for Research in Epidemiology and Population Health (CESP) - School of Medicine, Universite Paris Sud - School of Medicine, Universite Versailles Saint-Quentin-en-Yvelines (UVSQ); INSERM French National Institute for Health and Medical Research, Universite Paris Saclay, Villejuif, France.,Gustave Roussy, Villejuif, France
| | - Maria Celia B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.
| | - Kyoko Miura
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maryrose K Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Lena von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Kiarash Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - B Mark Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia.,CRUK Manchester and Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
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48
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Coroiu A, Moran C, Bergeron C, Thombs BD, Geller AC, Kingsland E, Körner A. Operationalization of skin self-examination in randomized controlled trials with individuals at increased risk for melanoma: A systematic review. PATIENT EDUCATION AND COUNSELING 2020; 103:1013-1026. [PMID: 31917011 DOI: 10.1016/j.pec.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/25/2019] [Accepted: 12/11/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate how skin self-examination was operationalized and the psychometric properties of the scales used to assess this behavior in randomized controlled trials (RCTs) testing interventions that promote SSE among individuals at increased risk for melanoma. METHOD Eight scientific databases (e.g., Medline, EMBASE, CINAHL, PsycINFO) and four trial registries (e.g., Clinicaltrials.gov, UK Clinical Trails Gateway) were searched from inception through April 2, 2019. Three reviewers carried out the selection of relevant trials and conducted data extraction. RESULTS The review identified 13 unique RCT's. The definition of skin self-exams, extrapolated from instructions provided to participants during the trials and reported in only 6/13 trials, included periodically checking the skin of the entire body, individually or with partners/mirrors, with or without tracking or monitoring tools, and using the ABCDE criteria to identify early signs of melanoma. There was variability in how skin self-examination behavior was measured with respect to item content, number of items, response format, and type of outcome variable used: continuous or binary). No validity evidence and minimal reliability evidence for the measures were identified. CONCLUSIONS AND PRACTICE IMPLICATIONS Future studies are needed to establish the psychometric properties of measures assessing skin self-examination.
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Affiliation(s)
- Adina Coroiu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada.
| | - Chelsea Moran
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Catherine Bergeron
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada
| | - Brett D Thombs
- Department of Educational and Counselling Psychology, McGill University, Montréal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada; Department of Psychiatry, McGill University, Montréal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada; Department of Medicine, McGill University, Montréal, Quebec, Canada; Department of Psychology, McGill University, Montréal, Quebec, Canada
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Emily Kingsland
- McGill Library and Archives, McGill University, Montréal, Canada
| | - Annett Körner
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada; Louise Granofsky Psychosocial Oncology Program, Segal Cancer Center, Montreal, Canada; Psychosocial Oncology Program, McGill University Health Centre, Montreal, Canada
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49
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Isaksson K, Mikiver R, Eriksson H, Lapins J, Nielsen K, Ingvar C, Lyth J. Survival in 31 670 patients with thin melanomas: a Swedish population-based study. Br J Dermatol 2020; 184:60-67. [PMID: 32133615 DOI: 10.1111/bjd.19015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND The incidence of cutaneous malignant melanoma (CMM) continues to increase in most countries worldwide and the majority are diagnosed with thin tumours (≤ 1 mm). OBJECTIVES The aim of the present study was to investigate the melanoma-specific survival (MSS) as well as conditional MSS (CMSS) in patients with thin CMM in Sweden. PATIENTS AND METHODS Clinical and histological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with thin CMM between 1990 and 2017. Patients were followed until the end of 2017. MSS as well as CMSS for different thickness groups were calculated using the Kaplan-Meier method and Cox regression analyses were used to calculate for survival differences between thickness groups. RESULTS There were 31 670 patients included for final analyses. The overall 10- and 20-year MSS for thin CMMs was 97% [95% confidence interval (CI) 97-97] and 95% (95% CI 95-96), respectively. From 0·7 mm and above, MSS decreased significantly with increasing thickness level. All thickness groups had an increased survival over time. The lowest CMSS was confirmed for men with 1·0 mm in thickness but their 10-year CMSS increased steadily over time. Women had overall better MSS as well as CMSS than men. However, the relation between MSS and CMSS was similar for both sexes. CONCLUSIONS MSS was confirmed as excellent for patients with thin CMMs in Sweden. Although we could show a decreased MSS for patients with 0·7 mm thickness and above, the long-term survival and, in addition, a very favourable CMSS for those patients do not support more extended follow-up programmes than the current recommendations in Sweden.
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Affiliation(s)
- K Isaksson
- Surgery, Lund University, Lund, Sweden.,Surgery, Skåne University Hospital, Lund, Sweden.,Department of Surgery, Kristianstad Central Hospital, Kristianstad, Sweden
| | - R Mikiver
- Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Regional Cancer Center South East, Region Östergötland, Linköping, Sweden
| | - H Eriksson
- Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.,Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - J Lapins
- Departments of Dermatology, Karolinska Institutet, Stockholm, Sweden.,Departments of Dermatology, Skin Cancer Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - K Nielsen
- Dermatology, Lund University, Lund, Sweden.,Departments of Dermatology, Skåne University Hospital, Lund, Sweden.,Department of Dermatology, Helsingborg Hospital, Helsingborg, Sweden
| | - C Ingvar
- Surgery, Lund University, Lund, Sweden.,Surgery, Skåne University Hospital, Lund, Sweden
| | - J Lyth
- Departments of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Research and Development Unit, Region Östergötland, Linköping, Sweden
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50
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von Schuckmann LA, Khosrotehrani K, Ghiasvand R, Hughes MCB, van der Pols JC, Malt M, Smithers BM, Green AC. Statins may reduce disease recurrence in patients with ulcerated primary melanoma. Br J Dermatol 2020; 183:1049-1055. [PMID: 32133622 DOI: 10.1111/bjd.19012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Statins may restrict the cellular functions required for melanoma growth and metastasis. OBJECTIVES To determine whether long-term statin use commenced before diagnosis of a primary melanoma is associated with reduced risk of melanoma recurrence. METHODS We prospectively followed a cohort of patients newly diagnosed between 2010 and 2014 with localized tumour-stage T1b to T4b melanoma in Queensland, Australia. We used Cox regression analyses to examine associations between long-term statin use and melanoma recurrence for the entire cohort, and then separately by sex and by presence of ulceration, due to evidence of effect modification. RESULTS Among 700 patients diagnosed with stage T1b to T4b primary melanoma (mean age 62 years, 59% male, 28% with ulcerated tumours), 94 patients (13%) developed melanoma recurrence within 2 years. Long-term statin users (n = 204, 29%) had a significantly lower risk of disease recurrence than nonusers [adjusted hazard ratio (HRadj ) 0·55, 95% confidence Interval (CI) 0·32-0·97] regardless of statin subtype or potency. Compared with nonusers of statins, risk of recurrence was significantly decreased in male statin users (HRadj 0·39, 95% CI 0·19-0·79) but not in female statin users (HRadj 0·82, 95% CI 0·29-2·27) and in statin users with ulcerated (HRadj 0·17, 95% CI 0·05-0·52) but not nonulcerated (HRadj 0·91, 95% CI 0·46-1·81) primary melanoma. CONCLUSIONS Statins commenced before melanoma diagnosis may reduce the risk of melanoma recurrence, especially in men and in those with ulcerated tumours. Clinical trial evaluation of the potential role of statins in improving the prognosis of high-risk melanoma is warranted.
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Affiliation(s)
- L A von Schuckmann
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - K Khosrotehrani
- Experimental Dermatology Group, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, QLD, Australia.,Department of Dermatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - R Ghiasvand
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - M C B Hughes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - J C van der Pols
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - M Malt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - B M Smithers
- Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - A C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.,CRUK Manchester and Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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