Multimarker reverse transcriptase-polymerase chain reaction assay in lymphatic drainage and sentinel node tumor burden

Nonvisualized sentinel node on preoperative lymphoscintigraphy in primary cutaneous melanoma: an 11-year retrospective survey

BACKGROUND

Sentinel lymph node (SLN) biopsy in cutaneous melanoma patients evaluates the regional draining basin for occult micrometastatic disease. Occasionally, nonidentification of SLN impairs the acquisition of this important prognostic factor.

OBJECTIVES

To investigate the outcomes of melanoma patients with negative lymphoscintigraphic findings and patients who underwent SLN biopsy from 2004 to 2015 ( n  = 1200) were retrospectively reviewed for tumor characteristics and clinical outcomes.

METHODS

Patients with nonvisualized lymph nodes (NV group) who underwent only preoperative lymphoscintigraphy were separated and compared with a cohort drawn from all melanoma patients who completed the surgical procedure within the same period (V group).

RESULTS

A negative lymphoscintigraphic scan was observed in 38 cases (3.2% of all patients). The NV group showed a significantly older age (median 66.0 vs. 48.3 years; P  < 0.0001). Head and neck melanomas were more frequent in the NV group compared to the control group (25.1 vs. 7.8%; P  = 0.009). Tumor characteristics such as ulceration and Breslow thickness do not influence the lymphoscintigraphy result. No differences were found in overall survival (OS) and disease-free survival (DFS) between the groups.

CONCLUSIONS

The nonvisualization of regional lymph nodes by lymphoscintigraphy is more frequent in older patients with head and neck melanomas. From the clinical point of view, no specific recommendation emerged for patients' management because the nonvisualization of the SLN did not show a significant influence on DFS and OS rates. However, lack of knowledge of lymph node status suggests performing a tighter follow-up eventually by ultrasound evaluation of all potential lymph node drainage basins.

Tumor-associated factors are enriched in lymphatic exudate compared to plasma in metastatic melanoma patients

Liquid biopsies allow monitoring of cancer progression and detection of relapse, but reliable biomarkers in melanoma are lacking. Because secreted factors preferentially drain to lymphatic vessels before dilution in the blood, we hypothesized that lymph should be vastly enriched in cancer biomarkers. We characterized postoperative lymphatic exudate and plasma of metastatic melanoma patients after lymphadenectomy and found a dramatic enrichment in lymphatic exudate of tumor-derived factors and especially extracellular vesicles containing melanoma-associated proteins and miRNAs, with unique protein signatures reflecting early versus advanced metastatic spread. Furthermore, lymphatic exudate was enriched in memory T cells, including tumor-reactive CD137+ and stem cell-like types. In mice, lymph vessels were the major route of extracellular vesicle transport from tumors to the systemic circulation. We suggest that lymphatic exudate provides a rich source of tumor-derived factors for enabling the discovery of novel biomarkers that may reflect disease stage and therapeutic response.

Cancer Education in Poland: Current Status and Suggestions for Improvement

In this article, we want to describe the opportunities we experienced though involvement with the AACE and EACE to improve cancer education in poland from our points of view as fifth-year medicine students. By participating in the annual meeting of the EACE that our university (Wroclaw ) hosted and also the ESMI-ESO course on medical oncology for medical students, we were able to improve our doctor- patient skills and deepen our knowledge caring for cancer patients. In our opinion in the obligatory medical curriculum in Poland, the curricular offerings in oncology should be better coordinated and there is too little attention to the teaching of the so called "soft skills" for future doctors. Over the course our studies, we are taught a great deal about the biology, diagnosis and symptomatology of cancer; however, we are not exposed very much to issues of communication between the doctor and the oncology patient, or appropriate strategies to pass information about the diagnosis and prognosis. Therefore, we feel that it is important for the future for students to learn more about such topics. Many do this in informal, extracurricular ways as there is much interest to learn about such topics and we will discuss several useful tools. In this review, we would like to summarize the current state of oncology education in Poland and our hopes for improving the current state and to emphasize how inspiring it was for us to participate in an international cancer education meeting where we could discuss good ideas from all over the world and bring them home to Poland.