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Nethanel A, Kyprianou C, Barzilai A, Shapira-Frommer R, Shoham Y, Kornhaber R, Cleary M, Avinoam-Dar G, Grynberg S, Haik J, Debby A, Harats M. The Implications of a Dermatopathologist's Report on Melanoma Diagnosis and Treatment. Life (Basel) 2023; 13:1803. [PMID: 37763207 PMCID: PMC10532537 DOI: 10.3390/life13091803] [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: 05/29/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/29/2023] Open
Abstract
An accurate and comprehensive histopathology report is essential for cutaneous melanoma management, providing critical information for accurate staging and risk estimation and determining the optimal surgical approach. In many institutions, a review of melanoma biopsy specimens by expert dermatopathologists is considered a necessary step. This study examined these reviews to determine the critical primary histopathology Breslow score in which a histopathology review would be most beneficial. Histopathology reports of patients referred to our institute between January 2011 and September 2019 were compared with our in-house review conducted by an expert dermatopathologist. The review focused on assessing fundamental histologic and clinical prognostic features. A total of 177 specimens underwent histopathology review. Significant changes in the Breslow index were identified in 103 cases (58.2%). Notably, in many of these cases (73.2%), the revised Breslow was higher than the initially reported score. Consequently, the T-stage was modified in 51 lesions (28.8%). Substantial discordance rates were observed in Tis (57%), T1b (59%), T3a (67%) and T4a (50%) classifications. The revised histopathology reports resulted in alterations to the surgical plan in 15.3% of the cases. These findings emphasize the importance of having all routine pathologies of pigmented lesions referred to a dedicated cancer center and reviewed by an experienced dermatopathologist. This recommendation is particularly crucial in instances where the histopathology review can potentially alter the diagnosis and treatment plan, such as in melanoma in situ and thinner melanomas measuring 0.6-2.2 mm in thickness. Our study highlights the significant impact of histopathology reviews in cutaneous melanoma cases. The observed changes in Breslow scores and subsequent modifications in T-stage classification underline the need for thorough evaluation by an expert dermatopathologist, especially in cases of melanoma in situ and thin melanomas. Incorporating such reviews into routine practice within dedicated cancer centers can improve diagnostic accuracy and guide appropriate treatment decisions, ultimately leading to better patient outcomes.
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Affiliation(s)
- Asher Nethanel
- Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (R.S.-F.); (S.G.)
| | - Christofis Kyprianou
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (C.K.); (R.K.); (G.A.-D.); (J.H.); (M.H.)
| | - Aviv Barzilai
- Department of Dermatology, Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (A.B.)
| | - Ronnie Shapira-Frommer
- Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (R.S.-F.); (S.G.)
| | - Yaron Shoham
- Plastic Surgery Department, Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba 84105, Israel;
| | - Rachel Kornhaber
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (C.K.); (R.K.); (G.A.-D.); (J.H.); (M.H.)
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, NSW 2795, Australia
| | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences, Central Queensland University, Sydney, NSW 2000, Australia;
| | - Galit Avinoam-Dar
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (C.K.); (R.K.); (G.A.-D.); (J.H.); (M.H.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
| | - Shirly Grynberg
- Ella Lemelbaum Institute for Immuno-Oncology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (R.S.-F.); (S.G.)
| | - Josef Haik
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (C.K.); (R.K.); (G.A.-D.); (J.H.); (M.H.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Talpiot Leadership Program, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
- Institute for Health Research, University of Notre Dame, Fremantle, WA 6160, Australia
| | - Assaf Debby
- Department of Dermatology, Institute of Pathology, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (A.B.)
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel; (C.K.); (R.K.); (G.A.-D.); (J.H.); (M.H.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
- Talpiot Leadership Program, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
- Institute for Health Research, University of Notre Dame, Fremantle, WA 6160, Australia
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Baetz TD, Fletcher GG, Knight G, McWhirter E, Rajagopal S, Song X, Petrella TM. Systemic adjuvant therapy for adult patients at high risk for recurrent melanoma: A systematic review. Cancer Treat Rev 2020; 87:102032. [PMID: 32473511 DOI: 10.1016/j.ctrv.2020.102032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/27/2022]
Abstract
Cutaneous melanoma is typically treated with wide local excision and, when appropriate, a sentinel node biopsy. Many patients are cured with this approach but for patients who have cancers with high risk features there is a significant risk of local and distant relapse and death. Interferon-based adjuvant therapy was recommended in the past but had modest results with significant toxicity. Recently, new therapies (immune checkpoint inhibitors and targeted therapies) have been found to be effective in the treatment of patients with metastatic melanoma and many of these therapies have been evaluated and found to be effective in the adjuvant treatment of high risk patients with melanoma. This systematic review of adjuvant therapies for cutaneous and mucosal melanoma was conducted for Ontario Health (Cancer Care Ontario) as the basis of a clinical practice guideline to address the question of whether patients with completely resected melanoma should be considered for adjuvant systemic therapy and which adjuvant therapy should be used.
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Affiliation(s)
- Tara D Baetz
- Department of Oncology, Queen's University, Kingston, ON, Canada; Cancer Centre of Southeastern Ontario/Kingston General Hospital, Kingston, ON, Canada.
| | - Glenn G Fletcher
- Program in Evidence-Based Care, McMaster University, Hamilton, ON, Canada
| | - Gregory Knight
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Grand River Regional Cancer Centre, Kitchener, ON, Canada
| | - Elaine McWhirter
- Department of Oncology, McMaster University, Hamilton, ON, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada
| | | | - Xinni Song
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Teresa M Petrella
- University of Toronto, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Garbe C, Amaral T, Peris K, Hauschild A, Arenberger P, Bastholt L, Bataille V, Del Marmol V, Dréno B, Fargnoli MC, Grob JJ, Höller C, Kaufmann R, Lallas A, Lebbé C, Malvehy J, Middleton M, Moreno-Ramirez D, Pellacani G, Saiag P, Stratigos AJ, Vieira R, Zalaudek I, Eggermont AMM. European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment - Update 2019. Eur J Cancer 2019; 126:159-177. [PMID: 31866016 DOI: 10.1016/j.ejca.2019.11.015] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022]
Abstract
A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies in stage III/IV patients are primarily anti-PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
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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; Portuguese Air Force Health Care Direction, Lisbon, Portugal
| | - 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 Dermatovenerology, Third Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - 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
| | | | | | - Christoph Höller
- Department of Dermatology, Medical University of Vienna, Austria
| | - Roland Kaufmann
- Department of Dermatology, Venerology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbé
- APHP Department of Dermatology, INSERM U976, University Paris 7 Diderot, Saint-Louis University Hospital, Paris, France
| | - Josep Malvehy
- Melanoma Unit, Department of Dermatology, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Mark Middleton
- NIHR Biomedical Research Centre, University of Oxford, UK
| | - David Moreno-Ramirez
- Medical-&-Surgical Dermatology Service, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - 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
| | - 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
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