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Kfir U, Ronen O. Intraparotid Sentinel Lymph Node Dissection for Melanoma: A Systematic Review and Meta-Analysis. Ann Surg Oncol 2024:10.1245/s10434-024-15668-0. [PMID: 38954096 DOI: 10.1245/s10434-024-15668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Surgical management of head and neck cutaneous melanoma (HNCM) has evolved tremendously since sentinel lymph node biopsy (SLNB) has become the prominent tool of prognosis and staging. This meta-analysis aimed to evaluate the safety and efficiency of intraparotid SLNB compared with a more extensive surgery of superficial parotidectomy (SP). METHODS The electronic database of PubMed and Scopus were searched for publications until 10 March 2022. In addition, the study included data of patients from our institution who underwent cherry-picking procedures. Pooled estimates were calculated using the random-effects model. Heterogeneity was calculated using the I2 test. RESULTS The pooled result regarding the rate of SLNB excision success was 97 % (95 % confidence interval [CI], 0.95-0.99; p < 0.0001), and the pooled probability of a positive SLNB result was 16 % (95 % CI 0.12-0.20; p < 0.0001). Failure of SLNB had pooled results of 4 % (95 % CI 0.02-0.06; p < 0.0009). For SP, no study examining N0 HNCM patients has met the authors' inclusion criteria. Cherry-picking SLNB had temporary and permanent facial nerve paralysis relative risks (RRs) of 0.12 (95 % CI 0.06-0.27; p < 0.0001) and 0.46 (95 % CI 0.17-1.22; p < 0.0001), respectively, compared with historical data from four weighted meta-analyses of SP. CONCLUSIONS The data from this study suggest that intraparotid SLNB performed for N0 HNCM patients is a safe and reliable procedure, with very low complication rates. Failure of the procedure did not exceed 4 %. Therefore, intraparotid SLNB may be superior to an extensive surgery such as SP and should be examined in future prospective trials.
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Affiliation(s)
- Uriel Kfir
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ohad Ronen
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, 221001, Nahariya, Israel.
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White HW, Naveed AB, Campbell BR, Lee YJ, Baik FM, Topf M, Rosenthal EL, Hom ME. Infrared Fluorescence-guided Surgery for Tumor and Metastatic Lymph Node Detection in Head and Neck Cancer. Radiol Imaging Cancer 2024; 6:e230178. [PMID: 38940689 DOI: 10.1148/rycan.230178] [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] [Indexed: 06/29/2024]
Abstract
In patients with head and neck cancer (HNC), surgical removal of cancerous tissue presents the best overall survival rate. However, failure to obtain negative margins during resection has remained a steady concern over the past 3 decades. The need for improved tumor removal and margin assessment presents an ongoing concern for the field. While near-infrared agents have long been used in imaging, investigation of these agents for use in HNC imaging has dramatically expanded in the past decade. Targeted tracers for use in primary and metastatic lymph node detection are of particular interest, with panitumumab-IRDye800 as a major candidate in current studies. This review aims to provide an overview of intraoperative near-infrared fluorescence-guided surgery techniques used in the clinical detection of malignant tissue and sentinel lymph nodes in HNC, highlighting current applications, limitations, and future directions for use of this technology within the field. Keywords: Molecular Imaging-Cancer, Fluorescence © RSNA, 2024.
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Affiliation(s)
- Haley W White
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Abdullah Bin Naveed
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Benjamin R Campbell
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Yu-Jin Lee
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Fred M Baik
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Michael Topf
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Eben L Rosenthal
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
| | - Marisa E Hom
- From the University of Michigan School of Medicine, Ann Arbor, Mich (H.W.W.); Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 2220 Pierce Ave, PRB 754, Nashville, TN 37232 (A.B.N., B.R.C., M.T., E.L.R., M.E.H.); and Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, Calif (Y.J.L., F.M.B.)
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Baecher H, Gerken M, Knoedler L, Knoedler S, Alfertshofer M, Klinkhammer-Schalke M, Berneburg M, Drexler K, Haferkamp S. Complete lymph node dissection in cutaneous melanoma patients with positive sentinel lymph node: Outcome and predictors in a retrospective cohort study over 16 years. J Plast Reconstr Aesthet Surg 2024; 92:33-47. [PMID: 38489985 DOI: 10.1016/j.bjps.2024.02.056] [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: 12/04/2023] [Revised: 01/29/2024] [Accepted: 02/22/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND In melanoma treatment, complete lymph node dissection (CLND) has been considered the therapeutic gold standard in patients with positive sentinel lymph node biopsy (SLNB). This long-held approach was revised in 2017, with recent evidence questioning the therapeutic benefit of CLND in malignant melanoma (MM) therapy. In this study, we aimed to fill this knowledge gap by retrospectively analyzing the impact of CLND on MM patients' survival. METHODS We retrospectively analyzed the multi-center population-based Clinical Cancer Registry at the Tumor Center Regensburg (TUDOK) database (2004-2020) to identify patients who had been diagnosed with SLN-positive MM and underwent (non)invasive management thereof. Patient cohorts were subdivided according to the treatment received (CLND and waiving CLND). Primary outcomes included overall survival (OS), recurrence-free survival (RFS), and cumulative recurrence rate. RESULTS We identified 1143 MM patients, of whom 126 (11.0%) had positive SLN status. CLND was waived in the majority of SLN-positive MM cases (n = 71; 56.3%), with 55 (43.7%) patients undergoing CLND. Univariable and multivariable Cox regression revealed no significant advantage for CLND patients compared to non-CLND patients in OS (HR=0.970, p = 0.915 and HR=1.295, p = 0.479, respectively), RFS (HR=1.050, p = 0.849 and HR=1.220, p = 0.544, respectively), and cumulative recurrence rate (HR=1.234, p = 0.441 and HR=1.220, p = 0.544), respectively). CONCLUSION We found that CLND had no significant impact on patient survival and MM recurrence rate, thus corroborating the validity of current clinical guidelines.
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Affiliation(s)
- Helena Baecher
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Michael Gerken
- Bavarian Cancer Registry, Regional Centre Regensburg, Bavarian Health and Food Safety Authority, 93053 Regensburg, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Samuel Knoedler
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, Institute for Quality Management and Health Services Research, University of Regensburg, 93053 Regensburg, Germany
| | - Mark Berneburg
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Sebastian Haferkamp
- Department of Dermatology, University Hospital Regensburg, 93053 Regensburg, Germany.
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Schwantes IR, Sutton T, Behrens S, Fowler G, Han G, Vetto JT, Han D. Metastasectomy for metastatic melanoma in the era of effective systemic therapy. Am J Surg 2024; 231:65-69. [PMID: 37308347 DOI: 10.1016/j.amjsurg.2023.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/13/2023] [Accepted: 04/30/2023] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Effective systemic therapy (EST) in patients with metachronous metastatic melanoma (MMM) improves survival and alters surgical decision-making. Surgical metastasectomy is another treatment option, however, it is unclear if metastasectomy confers survival benefit. This study seeks to identify any survival benefit associated with surgical management of MMM. METHODS Patients with MMM from 2009 to 2021 were grouped by receipt of metastasectomy and treatment era (pre-versus post-EST). Overall survival (OS) was calculated from date of metastasis and evaluated with Kaplan-Meier analysis. RESULTS Our dataset identified 226 patients with MMM; 32% were diagnosed pre-EST. On Kaplan-Meier analysis, OS was improved for patients undergoing treatment post-versus pre-EST (p < 0.001). In the post-EST era, metastasectomy was associated with an increase in OS compared to no resection (p = 0.022). CONCLUSIONS In the post-EST group, EST paired with metastasectomy was associated with improved OS compared to the pre-EST group, suggesting persistent evidence of a survival benefit from metastasectomy.
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Affiliation(s)
- Issac R Schwantes
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Thomas Sutton
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Shay Behrens
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Graham Fowler
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Gang Han
- Texas A&M University, Department of Epidemiology and Biostatistics. School of Public Health, College Station, TX, USA
| | - John T Vetto
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University, Division of Surgical Oncology-Knight Cancer Institute, Portland, OR, USA.
| | - Dale Han
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA; Oregon Health & Science University, Division of Surgical Oncology-Knight Cancer Institute, Portland, OR, USA
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Augustin RC, Luke JJ. Rapidly Evolving Pre- and Post-surgical Systemic Treatment of Melanoma. Am J Clin Dermatol 2024; 25:421-434. [PMID: 38409643 DOI: 10.1007/s40257-024-00852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/28/2024]
Abstract
With the development of effective BRAF-targeted and immune-checkpoint immunotherapies for metastatic melanoma, clinical trials are moving these treatments into earlier adjuvant and perioperative settings. BRAF-targeted therapy is a standard of care in resected stage III-IV melanoma, while anti-programmed death-1 (PD1) immunotherapy is now a standard of care option in resected stage IIB through IV disease. With both modalities, recurrence-free survival and distant-metastasis-free survival are improved by a relative 35-50%, yet no improvement in overall survival has been demonstrated. Neoadjuvant anti-PD1 therapy improves event-free survival by approximately an absolute 23%, although improvements in overall survival have yet to be demonstrated. Understanding which patients are most likely to recur and which are most likely to benefit from treatment is now the highest priority question in the field. Biomarker analyses, such as gene expression profiling of the primary lesion and circulating DNA, are preliminarily exciting as potential biomarkers, though each has drawbacks. As in the setting of metastatic disease, markers that inform positive outcomes include interferon-γ gene expression, PD-L1, and high tumor mutational burden, while negative predictors of outcome include circulating factors such as lactate dehydrogenase, interleukin-8, and C-reactive protein. Integrating and validating these markers into clinically relevant models is thus a high priority. Melanoma therapeutics continues to advance with combination adjuvant approaches now investigating anti-PD1 with lymphocyte activation gene 3 (LAG3), T-cell immunoreceptor with Ig and ITIM domains (TIGIT), and individualized neoantigen therapies. How this progress will be integrated into the management of a unique patient to reduce recurrence, limit toxicity, and avoid over-treatment will dominate clinical research and patient care over the next decade.
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Affiliation(s)
- Ryan C Augustin
- UPMC Hillman Cancer Center, 5150 Centre Ave. Room 1.27C, Pittsburgh, PA, 15232, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Jason J Luke
- UPMC Hillman Cancer Center, 5150 Centre Ave. Room 1.27C, Pittsburgh, PA, 15232, USA.
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Yalcin CE, Melenkis S, Demir L, Okur FT, Sagir MS, Ercan A. Investigation of prognostic factors for non-sentinel lymph node metastasis in patients undergoing sentinel lymph node biopsy for cutaneous malignant melanoma: Experience from a reference centre in Turkey. J Plast Reconstr Aesthet Surg 2024; 91:167-172. [PMID: 38417393 DOI: 10.1016/j.bjps.2024.01.043] [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: 10/26/2023] [Revised: 12/14/2023] [Accepted: 01/29/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND In the light of the results of recent randomised controlled trials regarding the role of nodal observation and completion lymph node dissection (CLND), studies from different populations are needed. The aim of our study was to present our experience with sentinel lymph node biopsy (SLNB) and CLND and the clinical and histopathological factors associated with a positive non-sentinel node. METHODS In this single-centre, retrospective study, we reviewed histopathological reports of patients with primary cutaneous melanoma who underwent SLNB and CLND over a period of 7 years. The primary outcomes were the positivity rates of SLNBs and CLNDs. Secondary outcomes were metastatic tumour burden in positive sentinel nodes and presence of perinodal invasion. RESULTS Among the 110 participants who underwent SLNB (53 females, 57 males), the mean Breslow thickness of the primary tumour was 4.1 (0.3-41) mm. Ulceration appeared in 62.7% of lesions. The SLNBs were positive in 38 patients (34.5%), with 35 (92.1%) undergoing CLND, among which 9 (25.7%) showed metaNBstasis. Positive SLNB was linked to a higher Breslow thickness (p = 0.022), whereas CLND results lacked such an association (p = 0.76). Perinodal invasion (p = 0.006) and sentinel lymph node metastasis exceeding 1 mm (p = 0.017) was associated with a higher probability of non-sentinel node metastasis. CONCLUSION To adapt the results of the new cohort study on SLNB and melanoma to different populations, studies with different patient groups highlighting the problems and suggested solutions are needed.
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Affiliation(s)
- Can E Yalcin
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul 34700, Turkey
| | - Serkan Melenkis
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul 34700, Turkey
| | - Levent Demir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul 34700, Turkey
| | - Furkan T Okur
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul 34700, Turkey
| | - Melih S Sagir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul 34700, Turkey
| | - Alp Ercan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Cerrahpasa Medical Faculty, Istanbul University, Cerrahpasa, Istanbul 34700, Turkey.
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Benesch MGK, Skitzki JJ. Impact of anesthesia choice in cutaneous melanoma surgery. Melanoma Res 2024; 34:16-21. [PMID: 37924527 PMCID: PMC10842619 DOI: 10.1097/cmr.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Invasive cutaneous melanoma is the most lethal skin cancer, but fortunately, the vast majority can be surgically treated with wide local excision, and sometimes additionally with sentinel or index lymph node biopsy for prognostication. Melanomas are particularly immunogenic malignancies, and preclinical studies have demonstrated that use of volatile anesthetics and opioids, unlike local agents, can suppress the immune system during the perioperative period. Immunosuppression has implications for creating a potentially favorable microenvironment for the survival and propagation of residual melanoma cells or micro-metastases, which could lead to disease relapse, both in the local tumor bed and distally. Results from observational clinical studies are mixed, but the literature would suggest that patients are at risk of decreased melanoma-specific survival after undergoing general anesthesia compared to regional anesthesia and spinal blocks. With the safety of close observation now established rather than automatic completion or total lymph node dissection for patients with either a positive sentinel lymph node biopsy or significant clinical response to neoadjuvant immunotherapy after index node sampling, the indications for definitive surgery with local or regional anesthesia have increased tremendously in recent years. Therefore, cutaneous melanoma patients might benefit from avoidance of general anesthesia and other perioperative drugs that suppress cell-mediated immunity if the option to circumvent systemic anesthesia agents is feasible.
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Affiliation(s)
- Matthew G K Benesch
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Huynh J, Leiter U, Garbe C, Shiderova G, Walter V, Eigentler T, Scheu A, Häfner HM, Schnabl SM. Sentinel lymph node biopsy for lentigo maligna melanoma under local anaesthesia. J Eur Acad Dermatol Venereol 2024; 38:84-92. [PMID: 37611257 DOI: 10.1111/jdv.19456] [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: 02/02/2023] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Lentigo maligna melanoma is mainly localized in the head and neck region in elderly patients. Due to its slow horizontal growth, it has a good prognosis compared to other melanoma subtypes, but specific data are rare. OBJECTIVES The aim of this study was to investigate sentinel lymph node biopsy in lentigo maligna melanoma under local anaesthesia and to discuss the benefit. METHODS Investigation of patients with lentigo maligna melanoma and tumour thickness ≥1 mm treated at the Department of Dermatology, University Medical Centre Tuebingen, between January 2008 and October 2019. RESULTS In total, 204 patients (126 SLNB, 78 non-SLNB) with a median age of 75.7 years (SLNB: 73.3 years, non-SLNB: 79.7 years) could be included. Sixteen of 126 (12.7%) sentinel lymph nodes were positive. Five-year overall survival was 87.9% (88.5% SLNB; 87.4% non-SLNB) and 5-year distant metastasis-free survival was 85.8% (85.4% SLNB; 86.7% non-SLNB). There was no significant difference for distant metastasis-free survival (p = 0.861) and overall survival (p = 0.247) between patients with and without sentinel lymph node biopsy. CONCLUSIONS Sentinel lymph node biopsy in lentigo maligna melanoma under local anaesthesia is a safe and simple method, even in very old patients. However, LMM has a very good 5-year overall survival. In high-risk patients with high tumour thickness and/or ulceration, adjuvant immunotherapy can now be offered without the need to perform this procedure.
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Affiliation(s)
- Julia Huynh
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Leiter
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Claus Garbe
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Galina Shiderova
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Vincent Walter
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
| | - Thomas Eigentler
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Scheu
- Department of Dermatology, University of Tuebingen, Tübingen, Germany
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Elshot YS, Bruijn TVM, Ouwerkerk W, Jaspars LH, van de Wiel BA, Zupan-Kajcovski B, de Rie MA, Bekkenk MW, Balm AJM, Klop WMC. The limited value of sentinel lymph node biopsy in lentigo maligna melanoma: A nomogram based on the results of 29 years of the nationwide dutch pathology registry (PALGA). EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107053. [PMID: 37778193 DOI: 10.1016/j.ejso.2023.107053] [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: 05/08/2023] [Revised: 08/10/2023] [Accepted: 09/06/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Lentigo maligna melanoma (LMM) predominantly presents in the head and neck of the elderly. The value of sentinel lymph node biopsy (SLNB) for LMM patients remains to be determined, as the reported average yield of positive lymph nodes is less than 10%. In this nationwide cohort study, we wanted to identify LMM patients with an increased risk of SLNB-positivity. METHODS LMM with an SLNB indication according to the 8th AJCC melanoma guidelines were retrospectively identified from the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA). A penalized (LASSO) logistic regression analysis was performed to determine the optimal combination of clinicopathological factors to predict a positive SLNB. RESULTS Between 1991 and 2020, 1989 LMM patients met our inclusion criteria. SLNB was performed in 16.7% (n = 333) and was positive in 7.5% (25/333). The false-negative rate was 21.9%. Clinically detectable regional lymph node (LN) metastases were found in 1.3% (n = 25). Clinicopathological characteristics best predictive for SLNB-positivity (Odds ratio; 95% CI) were age (0.95; 0.91-0.99), ulceration 1.59 (0.44-4.83), T4-stage (1.81; 0.43-6.2), male sex (1.97; 0.79-5.27), (lymph)angioinvasion (5.07; 0.94-23.31), and microsatellites (7.23; 1.56-32.7) (C-statistic 0.75). During follow-up, regional LN recurrences were detected in 4.2% (83/1989) of patients, of which the majority (74/83) had no evidence of regional LN metastases at baseline. CONCLUSION Our findings confirm the limited SLNB-positivity in LMM patients. Based on the identified high-risk clinicopathological features, a nomogram was developed to predict the risk of a positive SLNB.
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Affiliation(s)
- Yannick S Elshot
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands; Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Tristan V M Bruijn
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands; Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Wouter Ouwerkerk
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute, Cancer Center, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Lies H Jaspars
- Department of Pathology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Bart A van de Wiel
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, Netherlands
| | - Biljana Zupan-Kajcovski
- Department of Dermatology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, the Netherlands
| | - Menno A de Rie
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Marcel W Bekkenk
- Department of Dermatology, Amsterdam UMC, Univ. of Amsterdam, Postbus 22660, 1100 DD, Amsterdam, the Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Univ. of Amsterdam, the Netherlands
| | - W Martin C Klop
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Postbus 90203, 1006 BE, Amsterdam, Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam UMC, Univ. of Amsterdam, the Netherlands
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Ji H, Hu C, Yang X, Liu Y, Ji G, Ge S, Wang X, Wang M. Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Signal Transduct Target Ther 2023; 8:367. [PMID: 37752146 PMCID: PMC10522642 DOI: 10.1038/s41392-023-01576-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Lymph nodes (LNs) are important hubs for metastatic cell arrest and growth, immune modulation, and secondary dissemination to distant sites through a series of mechanisms, and it has been proved that lymph node metastasis (LNM) is an essential prognostic indicator in many different types of cancer. Therefore, it is important for oncologists to understand the mechanisms of tumor cells to metastasize to LNs, as well as how LNM affects the prognosis and therapy of patients with cancer in order to provide patients with accurate disease assessment and effective treatment strategies. In recent years, with the updates in both basic and clinical studies on LNM and the application of advanced medical technologies, much progress has been made in the understanding of the mechanisms of LNM and the strategies for diagnosis and treatment of LNM. In this review, current knowledge of the anatomical and physiological characteristics of LNs, as well as the molecular mechanisms of LNM, are described. The clinical significance of LNM in different anatomical sites is summarized, including the roles of LNM playing in staging, prognostic prediction, and treatment selection for patients with various types of cancers. And the novel exploration and academic disputes of strategies for recognition, diagnosis, and therapeutic interventions of metastatic LNs are also discussed.
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Affiliation(s)
- Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xuhui Yang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuanhao Liu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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11
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Li AT, Law J, Ch'ng S, Scolyer RA, Thompson JF, Lo SN, Varey AHR. External validation in an Australian population of the EORTC-DeCOG nomogram predicting recurrence, distant metastasis and overall mortality in melanoma patients with positive sentinel lymph nodes. Eur J Cancer 2023; 189:112901. [PMID: 37263897 DOI: 10.1016/j.ejca.2023.04.017] [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: 12/15/2022] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Calculating an accurate prognosis for melanoma patients who have a positive sentinel node (SN) biopsy is important both for them and for their treating doctors to guide decision-making, particularly when adjuvant systemic therapy is being considered. The recently published EORTC-DeCOG nomograms aim to provide this via an online portal that predicts 5-year rates for recurrence, distant metastasis and overall mortality. The present study provides external validation of these nomograms. METHODS/MATERIALS De-identified data from patients with a positive SN biopsy between 2003 and 2015 were extracted from the prospectively maintained Melanoma Institute Australia (MIA) research database. ROC-curves with C-statistics, regression co-efficients and Decision Curve Net Benefit analyses were performed using the integrated private validation portal on the nomograms' hosting platform (Evidencio). RESULTS Complete data were available for 352 patients. The respective C-statistics for recurrence, distant metastasis and overall mortality nomogram validations were 0.68, 0.69 and 0.66. CONCLUSION The performance of the nomograms in predicting recurrence and distant metastasis was similar in the MIA and the development populations, suggesting that they are robust. However, the overall mortality nomogram performance was significantly poorer in the MIA population (C-statistic 0.66) than in the original EORTC-DeCOG derivation cohort (C-statistic 0.70) and may therefore be less reliable for clinical use.
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Affiliation(s)
- Andrew T Li
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Jenaleen Law
- Department of Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia; Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia; Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia; Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia; Department of Plastic & Reconstructive Surgery, Westmead Hospital, Sydney, NSW, Australia.
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12
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Rosales JA, Palacios CA, Fernandez Trokhimtchouk T, Flores LF, Morillo Cox Á, Crespo Martinez JK, German M. Video-Assisted Endoscopic Inguinal Lymph Node Dissection for Acral Melanoma. Cureus 2023; 15:e40136. [PMID: 37425577 PMCID: PMC10329480 DOI: 10.7759/cureus.40136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
This article discusses acral melanoma, a rare subtype of melanoma often presented at the later stages of the disease and is, thus, associated with poor survival rates, especially in patients with a lower socioeconomic status. Surgical resection is the primary treatment option for localized acral melanoma, while amputation is often necessary for tumors on the digits or the midfoot. Lymphadenectomy may be necessary for patients with regional lymph node involvement; however, the therapeutic role of dissection remains controversial. Here, we present the case of a 68-year-old man with acral melanoma who underwent a Lisfranc amputation and endoscopic groin lymph node dissection for ganglionic metastasis. In Ecuador, this is the first reported case of endoscopic groin lymphadenectomy for regional lymph node metastasis secondary to acral melanoma. The discussion explores the role of sentinel lymph node biopsy and the completion of lymph node dissection in managing regional lymph nodes in melanoma patients. This case study aims to contribute to the growing knowledge on acral melanoma, assess the need for better patient care, and analyze the role of minimally invasive techniques for inguinal lymph node dissections.
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Affiliation(s)
- Jose A Rosales
- General Surgery, Universidad Internacional del Ecuador/Axxis Hospital, Quito, ECU
| | | | | | - Luis F Flores
- General Surgery, Universidad Internacional del Ecuador/Axxis Hospital, Quito, ECU
| | - Álvaro Morillo Cox
- General Surgery, Universidad Internacional del Ecuador/Axxis Hospital, Quito, ECU
| | | | - Melissa German
- Surgical Oncology, Hospital Carlos Andrade Marín, Quito, ECU
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13
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Ziętek M, Teterycz P, Wierzbicki J, Jankowski M, Las-Jankowska M, Zegarski W, Piekarski J, Nejc D, Drucis K, Cybulska-Stopa B, Łobaziewicz W, Galwas K, Kamińska-Winciorek G, Zdzienicki M, Sryukina T, Ziobro A, Kluz A, Czarnecka AM, Rutkowski P. The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study. Cancers (Basel) 2023; 15:2667. [PMID: 37345002 DOI: 10.3390/cancers15102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In melanoma treatment, an approach following positive sentinel lymph node biopsy (SLNB) has been recently deescalated from completion lymph node dissection (CLND) to active surveillance based on phase III trials data. In this study, we aim to evaluate treatment strategies in SLNB-positive melanoma patients in real-world practice. METHODS Five-hundred-fifty-seven melanoma SLNB-positive patients from seven comprehensive cancer centers treated between 2017 and 2021 were included. Kaplan-Meier methods and the Cox Proportional-Hazards Model were used for analysis. RESULTS The median follow-up was 25 months. Between 2017 and 2021, the percentage of patients undergoing CLND decreased (88-41%), while the use of adjuvant treatment increased (11-51%). The 3-year OS and RFS rates were 77.9% and 59.6%, respectively. Adjuvant therapy prolonged RFS (HR:0.69, p = 0.036)), but CLND did not (HR:1.22, p = 0.272). There were no statistically significant differences in OS for either adjuvant systemic treatment or CLND. Lower progression risk was also found, and time-dependent hazard ratios estimation in patients treated with systemic adjuvant therapy was confirmed (HR:0.20, p = 0.002 for BRAF inhibitors and HR:0.50, p = 0.015 for anti-PD-1 inhibitors). CONCLUSIONS Treatment of SLNB-positive melanoma patients is constantly evolving, and the role of surgery is currently rather limited. Whether CLND has been performed or not, in a group of SLNB-positive patients, adjuvant systemic treatment should be offered to all eligible patients.
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Affiliation(s)
- Marcin Ziętek
- Department of Oncology, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland
| | - Paweł Teterycz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Department of Computational Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Jędrzej Wierzbicki
- Department of Surgical Oncology, Lower Silesian Oncology, Pulmonology and Hematology Center, 53-413 Wroclaw, Poland
- Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, 53-114 Wroclaw, Poland
| | - Michał Jankowski
- Chair of Surgical Oncology, Collegium Medicum Nicolaus Copernicus University, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland
| | - Manuela Las-Jankowska
- Chair of Surgical Oncology, Collegium Medicum Nicolaus Copernicus University, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland
| | - Wojciech Zegarski
- Chair of Surgical Oncology, Collegium Medicum Nicolaus Copernicus University, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, 85-796 Bydgoszcz, Poland
| | - Janusz Piekarski
- Department of Surgical Oncology, Medical University of Lodz, 90-419 Lodz, Poland
| | - Dariusz Nejc
- Department of Surgical Oncology, Medical University of Lodz, 90-419 Lodz, Poland
- Nicolaus Copernicus Multidisciplinary Center for Oncology and Traumatology, 93-513 Lodz, Poland
| | - Kamil Drucis
- Department of Surgical Oncology, Gdansk Medical University, 80-210 Gdansk, Poland
| | - Bożena Cybulska-Stopa
- Department of Clinical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Cracow, Poland
| | - Wojciech Łobaziewicz
- Department of Surgical Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, 31-115 Cracow, Poland
| | - Katarzyna Galwas
- 2nd Department of Radiotherapy and Chemotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Grażyna Kamińska-Winciorek
- Department of Bone Marrow Transplantation and Onco-Hematology, Skin Cancer and Melanoma Team, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Marcin Zdzienicki
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
| | - Tatsiana Sryukina
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna Ziobro
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Agnieszka Kluz
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Anna M Czarnecka
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
- Department of Experimental Pharmacology, Mossakowski Medical Research Centers, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Piotr Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, 02-781 Warsaw, Poland
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Li N, Zhou X, Zhu H, Wang F, Guo R, Zhang Y, Song Y, Zhai S, Xie Q, Liu J, Li Z, Yang Z. 99mTc-Rituximab sentinel lymph node mapping and biopsy, the effective technique avoids axillary dissection and predicts prognosis in 533 cutaneous melanoma. Ann Nucl Med 2023; 37:189-197. [PMID: 36586034 DOI: 10.1007/s12149-022-01815-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate the efficiency of a novel lymph node radiotracer 99mTc-rituximab in sentinel lymph node (SLN) lymphoscintigraphy and SLN biopsy (SLNB), and the influence of SLNB results on the prognosis of cutaneous malignant melanoma (CMM) patients. METHODS A retrospective study was performed on 533 patients with CMM who underwent lymphoscintigraphy and SLNB. All patients received a preoperative peritumoral injection of 11.1-18.5 MBq of 99mTc-rituximab 0.5 to 1 h before lymphoscintigraphy and SLNB. RESULTS The detection rate of lymphoscintigraphy and SLNB was both 99.81% (532/533), and the average number of detected SLNs was 2.1 (range 1 to 8) and 2.7 (range 1 to 11) per patient, respectively. 12.1% SLNs and 22.2% patients were found metastatic, with an average of 1.5 (range 1 to 5) metastatic SLNs per patient. The SLN metastatic rates were different in patients with different Breslow thickness, Clark levels, ulceration, mitotic counts, and HMB45 expression (p < 0.05). Ninety patients were proceeded with the regional lymph node dissection (RLND) after SLNB, and the sensitivity, specificity and accuracy of SLNB in metastatic diagnosis is 97.4, 100 and 96.7%, respectively. And SLNs with metastases was an independent prognostic factor for OS and PFS by multivariate prognostic analyses (HR was 5.9 and 4.3, p < 0.001). For patients with metastatic SLNs, the non-SLNs with metastasis and non-SLNs without metastasis in RLND, and observation groups showed different mean PFS as 14.9, 24.8 and 25.5 months (p = 0.018), but no statistically significant difference existed in the OS. CONCLUSION The novel radiotracer 99mTc-rituximab could identify SLNs specifically in SLN lymphoscintigraphy and SLNB in CMM patients, and the pathology obtained from SLNB rather than from RLND better indicated the staging and long-term prognosis.
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Affiliation(s)
- Nan Li
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
| | - Xin Zhou
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Hua Zhu
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Fei Wang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Rui Guo
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yufei Song
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Shizhen Zhai
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Qing Xie
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Jiayong Liu
- Department of Bone and Soft Tissue Tumor, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Zhongwu Li
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Zhi Yang
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), NMPA Key Laboratory for Research and Evaluation of Radiopharmaceuticals (National Medical Products Administration), Department of Nuclear Medicine, Peking University Cancer Hospital and Institute, Beijing, 100142, China.
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15
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Hussain Z, Heaton MJ, Snelling AP, Nobes JP, Gray G, Garioch JJ, Moncrieff MD. Risk Stratification of Sentinel Node Metastasis Disease Burden and Phenotype in Stage III Melanoma Patients. Ann Surg Oncol 2023; 30:1808-1819. [PMID: 36445500 PMCID: PMC9908720 DOI: 10.1245/s10434-022-12804-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/27/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, all patients with American Joint Committee on Cancer (AJCC) pT2b-pT4b melanomas and a positive sentinel node biopsy are now considered for adjuvant systemic therapy without consideration of the burden of disease in the metastatic nodes. METHODS This was a retrospective cohort analysis of 1377 pT1-pT4b melanoma patients treated at an academic cancer center. Standard variables regarding patient, primary tumor, and sentinel node characteristics, in addition to sentinel node metastasis maximum tumor deposit size (MTDS) in millimeters and extracapsular spread (ECS) status, were analyzed for predicting disease-specific survival (DSS). RESULTS The incidence of SN+ was 17.3% (238/1377) and ECS was 10.5% (25/238). Increasing AJCC N stage was associated with worse DSS. There was no difference in DSS between the IIIB and IIIC groups. Subgroup analyses showed that the optimal MTDS cut-point was 0.7 mm for the pT1b-pT4a SN+ subgroups, but there was no cut-point for the pT4b SN+ subgroup. Patients with MTDS <0.7 mm and no ECS had similar survival outcomes as the N0 patients with the same T stage. Nodal risk categories were developed using the 0.7 mm MTDS cut-point and ECS status. The incidence of low-risk disease, according to the new nodal risk model, was 22.3% (53/238) in the stage III cohort, with 49% (26/53) in the pT2b-pT3a and pT3b-pT4a subgroups and none in the pT4b subgroup. Similar outcomes were observed for overall and distant metastasis-free survival. CONCLUSION We propose a more granular classification system, based on tumor burden and ECS status in the sentinel node, that identifies low-risk patients in the AJCC IIIB and IIIC subgroups who may otherwise be observed.
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Affiliation(s)
- Zahra Hussain
- Department of Plastic Surgery and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Martin J Heaton
- Department of Plastic Surgery and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Andrew P Snelling
- Department of Plastic Surgery and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jenny P Nobes
- Department of Oncology, Norfolk and Norwich University Hospital, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Gill Gray
- Department of Oncology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Jennifer J Garioch
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Marc D Moncrieff
- Department of Plastic Surgery and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK.
- Norwich Medical School, University of East Anglia, Norwich, UK.
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16
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Allard-Coutu A, Dobson V, Schmitz E, Shah H, Nessim C. The Evolution of the Sentinel Node Biopsy in Melanoma. Life (Basel) 2023; 13:life13020489. [PMID: 36836846 PMCID: PMC9966203 DOI: 10.3390/life13020489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.
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Affiliation(s)
- Alexandra Allard-Coutu
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | | | - Erika Schmitz
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Hely Shah
- Department of Medical Oncology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Carolyn Nessim
- Department of General Surgery, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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17
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Rodríguez-Jiménez P, Reymundo-Jiménez A, Delgado-Jiménez Y, Gallo E, Navarro R, Vargas E, Castillo V, Hernández I, Torres E, Rodríguez-Campo F, Tejera-Vaquerizo A. Sentinel Lymph Node Biopsy in Elderly Melanoma Patients: A Real Practice Cohort. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:462-466. [PMID: 36750157 DOI: 10.1016/j.ad.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/23/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- P Rodríguez-Jiménez
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain.
| | - A Reymundo-Jiménez
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - Y Delgado-Jiménez
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - E Gallo
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - R Navarro
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - E Vargas
- Department of Dermatology, Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | - V Castillo
- Department of Nuclear Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - I Hernández
- Department of Nuclear Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - E Torres
- Department of General Surgery, Hospital Universitario de La Princesa, Madrid, Spain
| | - F Rodríguez-Campo
- Department of Oral and Maxillofacial Surgery, Hospital Universitario de La Princesa, Madrid, Spain
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18
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Clinical Trials in Melanoma: Margins, Lymph Nodes, Targeted and Immunotherapy. Surg Oncol Clin N Am 2023; 32:47-63. [PMID: 36410921 DOI: 10.1016/j.soc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multiple randomized controlled trials have influenced the current standard of care for patients with cutaneous melanoma. Since the development of targeted and immune therapy, studies of adjuvant therapy for patients with resected stage III/IV melanoma have led to the approval of combined B-raf proto-oncogene (BRAF) and mitogen-activated protein kinase kinase inhibitors for patients with a BRAF mutation, and cytotoxic T-lymphocyte associated protein-4 or antiprogrammed cell death-1 therapy for patients without a BRAF mutation. This article discusses the details of the trials that have influenced these treatment decisions, in addition to discussing ongoing trials and possible future directions.
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Moncrieff MD, Lo SN, Scolyer RA, Heaton MJ, Nobes JP, Snelling AP, Carr MJ, Nessim C, Wade R, Peach AH, Kisyova R, Mason J, Wilson ED, Nolan G, Pritchard Jones R, Johansson I, Olofsson Bagge R, Wright LJ, Patel NG, Sondak VK, Thompson JF, Zager JS. Clinical Outcomes and Risk Stratification of Early-Stage Melanoma Micrometastases From an International Multicenter Study: Implications for the Management of American Joint Committee on Cancer IIIA Disease. J Clin Oncol 2022; 40:3940-3951. [PMID: 35849790 DOI: 10.1200/jco.21.02488] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/04/2022] [Accepted: 06/17/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Indications for offering adjuvant systemic therapy for patients with early-stage melanomas with low disease burden sentinel node (SN) micrometastases, namely, American Joint Committee on Cancer (AJCC; eighth edition) stage IIIA disease, are presently controversial. The current study sought to identify high-risk SN-positive AJCC stage IIIA patients who are more likely to derive benefit from adjuvant systemic therapy. METHODS Patients were recruited from an intercontinental (Australia/Europe/North America) consortium of nine high-volume cancer centers. All were adult patients with pathologic stage pT1b/pT2a primary cutaneous melanomas who underwent SN biopsy between 2005 and 2020. Patient data, primary tumor and SN characteristics, and survival outcomes were analyzed. RESULTS Three thousand six hundred seven patients were included. The median follow-up was 34 months. Pairwise disease comparison demonstrated no significant survival difference between N1a and N2a subgroups. Survival analysis identified a SN tumor deposit maximum dimension of 0.3 mm as the optimal cut point for stratifying survival. Five-year disease-specific survival rates were 80.3% and 94.1% for patients with SN metastatic tumor deposits ≥ 0.3 mm and < 0.3 mm, respectively (hazard ratio, 1.26 [1.11 to 1.44]; P < .0001). Similar findings were seen for overall disease-free and distant metastasis-free survival. There were no survival differences between the AJCC IB patients and low-risk (< 0.3 mm) AJCC IIIA patients. The newly identified high-risk (≥ 0.3 mm) subgroup comprised 271 (66.4%) of the AJCC IIIA cohort, whereas only 142 (34.8%) patients had SN tumor deposits > 1 mm in maximum dimension. CONCLUSION Patients with AJCC IIIA melanoma with SN tumor deposits ≥ 0.3 mm in maximum dimension are at higher risk of disease progression and may benefit from adjuvant systemic therapy or enrollment into a clinical trial. Patients with SN deposits < 0.3 mm in maximum dimension can be managed similar to their SN-negative, AJCC IB counterparts, thereby avoiding regular radiological surveillance and more intensive follow-up.
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Affiliation(s)
- Marc D Moncrieff
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Serigne N Lo
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard A Scolyer
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- NSW Health Pathology, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Martin J Heaton
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Jenny P Nobes
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | - Andrew P Snelling
- Norfolk and Norwich University Hospital NHS Trust, Norwich, United Kingdom
| | | | - Carolyn Nessim
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryckie Wade
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - A Howard Peach
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rumi Kisyova
- North Bristol Hospital NHS Trust, Bristol, United Kingdom
| | - Jennifer Mason
- North Bristol Hospital NHS Trust, Bristol, United Kingdom
| | - Ewan D Wilson
- North Bristol Hospital NHS Trust, Bristol, United Kingdom
| | - Grant Nolan
- St Helens and Knowsley NHS Teaching Hospitals Trust, Liverpool, United Kingdom
| | | | - Iva Johansson
- Sahlgrenska Centre for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Centre for Cancer Research, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lucie J Wright
- United Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Nakul G Patel
- United Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - John F Thompson
- Melanoma Institute of Australia, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Ziętek M, Wierzbicki J, Pawlak E, Maciejczyk A, Matkowski R. Introduction of a pilot program to measure and improve the clinical care of melanoma patients in the Lower Silesian Voivodeship in Poland: a report of 20 months experience. BMC Cancer 2022; 22:1207. [PMID: 36419046 PMCID: PMC9684787 DOI: 10.1186/s12885-022-10253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/31/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND In recent years, benchmarking and assessment methods to improve the quality of care have become increasingly important. Such approaches allow for a uniform assessment, comparisons between centers or over time, and the identification of weaknesses. In this study, the results of a 20-month pilot program to assess, monitor and improve the quality of care in melanoma patients primarily treated surgically are presented. METHODS The pilot program started in May 2020 at the Lower Silesian Oncology, Pulmonology and Hematology Center (LSOPHC) in Wroclaw, Poland (Lower Silesian Voivodeship, southwestern province of Poland with a population of 2,9 million). The program involved the introduction of a synoptic histopathological protocol, medical coordinators, and a set of measures to assess oncological care. In total, 11 Skin Cancer Unit (SCU) measures were introduced to analyze clinical outcomes, diagnostic quality, and duration. Data from 352 patients covered by the program were analyzed. In addition, the completeness of diagnostics from external sites was compared to our own results. Furthermore, the timeliness of the initial diagnostic tests and in-depth diagnostics were assessed and compared to the timeliness before implementation of the pilot program. RESULTS The introduced measures assessed the mortality related to oncological treatment, the rate of complications, advanced stages of melanoma, the completeness and duration of diagnostics, the involved nodes after lymphadenectomy, and melanoma screening. During the study period, the timeliness of the initial diagnostics was maintained at 87.8%, and the timeliness of the in-depth diagnostics at 89.5%. Compared to a similar period before the program, these values were 36.1% and 67.5%, respectively. CONCLUSION The introduced measures seem to be effective and practical tools for benchmarking clinical and diagnostic aspects. They also allowed for a sensitive assessment of individual issues and indicated sensitive points. Furthermore, the actions undertaken in this pilot program allowed for a shortening of the duration of diagnostics.
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Affiliation(s)
- Marcin Ziętek
- grid.4495.c0000 0001 1090 049XDepartment of Oncology, Wrocław Medical University, 12 Hirszfeld Square, 53-413 Wrocław, Poland ,grid.500476.00000 0004 0620 4055Dolnośląskie Centrum Onkologii, Pulmonologii i Hematologii (Lower Silesian Oncology, Pulmonology and Hematology Center), 12 Hirszfeld Square, 53-413 Wrocław, Poland
| | - Jędrzej Wierzbicki
- grid.500476.00000 0004 0620 4055Dolnośląskie Centrum Onkologii, Pulmonologii i Hematologii (Lower Silesian Oncology, Pulmonology and Hematology Center), 12 Hirszfeld Square, 53-413 Wrocław, Poland ,grid.413454.30000 0001 1958 0162Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Rudolf Weigl 12 Street, 53-413 Wroclaw, Poland
| | - Edyta Pawlak
- grid.413454.30000 0001 1958 0162Laboratory of Immunopathology, Department of Experimental Therapy, Hirszfeld Institute of Immunology & Experimental Therapy, Polish Academy of Sciences, Rudolf Weigl 12 Street, 53-413 Wroclaw, Poland
| | - Adam Maciejczyk
- grid.4495.c0000 0001 1090 049XDepartment of Oncology, Wrocław Medical University, 12 Hirszfeld Square, 53-413 Wrocław, Poland ,grid.500476.00000 0004 0620 4055Dolnośląskie Centrum Onkologii, Pulmonologii i Hematologii (Lower Silesian Oncology, Pulmonology and Hematology Center), 12 Hirszfeld Square, 53-413 Wrocław, Poland
| | - Rafał Matkowski
- grid.4495.c0000 0001 1090 049XDepartment of Oncology, Wrocław Medical University, 12 Hirszfeld Square, 53-413 Wrocław, Poland ,grid.500476.00000 0004 0620 4055Dolnośląskie Centrum Onkologii, Pulmonologii i Hematologii (Lower Silesian Oncology, Pulmonology and Hematology Center), 12 Hirszfeld Square, 53-413 Wrocław, Poland
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21
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Sentinel Lymph Node Biopsy in Cutaneous Melanoma, a Clinical Point of View. Medicina (B Aires) 2022; 58:medicina58111589. [DOI: 10.3390/medicina58111589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/28/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a surgical procedure that has been used in patients with cutaneous melanoma for nearly 30 years. It is used for both staging and regional disease control with minimum morbidity, as proven by numerous worldwide prospective studies. It has been incorporated in the recommendations of national and professional guidelines. In this article, we provide a summary of the general information on SLNB in the clinical guidelines for the management of cutaneous malignant melanoma (American Association of Dermatology, European Society of Medical Oncology, National Comprehensive Cancer Network, and Cancer Council Australia) and review the most relevant literature to provide an update on the existing recommendations for SLNB.
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22
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Hirshoren N, abd el Qadir N, Weinberger JM, Eliashar R, Ben‐Haim S. Sentinel Lymph Node Identification in Cutaneous Head & Neck Cancer - Lymphoscintigraphy Late Phase. Laryngoscope 2022; 132:2164-2168. [PMID: 35199860 PMCID: PMC9790693 DOI: 10.1002/lary.30076] [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: 01/11/2022] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Sentinel node (SN) biopsy following lymphoscintography is recommended for high-risk cutaneous malignancies. Herein, we investigate different lymphoscintography phases, focusing on the importance of the late static phase and the resultant discovery of distal echelon solitary positive sentinel nodes that would otherwise have been overlooked. METHODS In this retrospective cohort study, conducted in a tertiary referral medical center, we assessed SN localization and time from tracer injection to SN identification on lymphoscintigraphy. Findings on scan were compared with SN found in the surgical field, and with the final pathological investigation. RESULTS Seventy-three patients, undergoing SN biopsy for head and neck skin malignancies, were investigated. Most patients were male (n = 50). The average age was 65.7 (±15.7) years and the average follow-up time was 29.1 (±22.4) months. Overall, 101 SNs were histologically investigated, demonstrating 7 positive SN. Eleven patients (15%) benefited from the late lymphoscintigraphy phase. In four studies, an SN was identified only in the late static phase, one of which was positive for the disease. In seven patients, SN was identified in the early phase with additional, different, SN on the late phase, one of which was positive for the disease. Comparing the yield (positive SNs) of early versus late phases, demonstrated the same importance (p = 0.275). CONCLUSIONS The late lymphoscintigraphy phase has a crucial role in high-risk HN cutaneous cancer. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2164-2168, 2022.
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Affiliation(s)
- Nir Hirshoren
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Narmeen abd el Qadir
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Jeffrey M. Weinberger
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Ron Eliashar
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Simona Ben‐Haim
- Department of Biophysics and Nuclear MedicineHadassah Medical Center and Hebrew UniversityJerusalemIsrael,Institute of Nuclear MedicineUniversity College London and UCL Hospitals, NHS TrustLondonUK
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Rhodin KE, Fimbres DP, Burner DN, Hollander S, O’Connor MH, Beasley GM. Melanoma lymph node metastases - moving beyond quantity in clinical trial design and contemporary practice. Front Oncol 2022; 12:1021057. [PMID: 36411863 PMCID: PMC9675405 DOI: 10.3389/fonc.2022.1021057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/29/2022] [Indexed: 09/10/2023] Open
Abstract
The presence of lymph node metastases is a well-studied prognostic factor for cutaneous melanoma. Characterization of melanoma lymph node metastases and their association with survival in multiple, large observational studies has led to recognition of the following high-risk features: quantity of lymph node metastases (number of nodes), size of the nodal tumor deposit (in mm), and extracapsular extension. Despite increasing utilization of these features in the design of randomized clinical trials, in addition to their role in contemporary clinical decision-making, current staging systems lag behind, only accounting for the quantity of lymph nodes with metastases. Herein, we review the prognostic role of melanoma lymph node metastases and their high-risk features, current reporting standards, how such features have been utilized in practice-changing trials, and best practices for future clinical trial design and clinical decision-making.
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Affiliation(s)
- Kristen E. Rhodin
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | | | | | - Shayna Hollander
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Margaret H. O’Connor
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
| | - Georgia M. Beasley
- Department of Surgery, Duke University Medical Center, Durham, NC, United States
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24
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Sharon CE, Straker RJ, Li EH, Karakousis GC, Miura JT. National Practice Patterns in the Management of the Regional Lymph Node Basin After Positive Sentinel Lymph Node Biopsy for Cutaneous Melanoma. Ann Surg Oncol 2022; 29:8456-8464. [PMID: 36006494 DOI: 10.1245/s10434-022-12364-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immediate completion lymph node dissection (CLND) for patients with sentinel lymph node (SLN) metastasis from cutaneous melanoma has been replaced largely by ultrasound nodal surveillance since the publication of two landmark trials in 2016 and 2017. National practice patterns of CLND remain poorly characterized. METHODS Patients with a diagnosis of cutaneous melanoma in 2016 and 2018 without clinical nodal disease who underwent sentinel lymph node biopsy (SLNB) were identified from the National Cancer Database (NCDB). Characteristics associated with CLND were analyzed by uni- and multivariate logistic regression. Overall survival (OS) was estimated using Kaplan-Meier and Cox proportional hazards regression analyses. RESULTS Of the 3517 patients included in the study, 1405 had disease diagnosed in 2016. The patients with cutaneous melanoma diagnosed in 2016 had a median age of 60 years and a tumor thickness of 2.3 mm compared to 62 years and 2.4 mm, respectively, for the patients with cutaneous melanoma diagnosed in 2018. According to the NCDB, 40 % (n = 559) of the patients underwent CLND in 2016 compared with 6 % (n = 132) in 2018. The factors associated with receipt of CLND in 2018 included younger age (odds ratio [OR], 0.97; 95 % confidence interval [CI], 0.95-0.99; p = 0.001), rural residence (OR, 3.96; 95 % CI, 1.50-10.49; p = 0.006), head/neck tumor location (OR, 1.88; 95 % CI, 1.10-3.23; p = 0.021), and more than one positive SLN (OR, 1.80; 95 % CI, 1.17-2.76; p = 0.007). The 5-year OS did not differ between the patients who received SLNB only and those who underwent CLND (hazard ratio [HR], 0.93; p = 0.54). CONCLUSION The rates of CLND have decreased nationally. However, patients with head/neck primary tumors who live in rural locations are more likely to undergo CLND, highlighting populations for which treatment may be non-uniform with national practice patterns.
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Affiliation(s)
- Cimarron E Sharon
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, Philadelphia, 19104, PA, USA.
| | - Richard J Straker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, Philadelphia, 19104, PA, USA
| | - Eric H Li
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, Philadelphia, 19104, PA, USA
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Maloney 4, Philadelphia, 19104, PA, USA
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25
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Chandra SR, Singu S, Foster J. Principles of Surgery in Head and Neck Cutaneous Melanoma. Oral Maxillofac Surg Clin North Am 2022; 34:251-262. [PMID: 35428503 DOI: 10.1016/j.coms.2021.11.006] [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] [Indexed: 11/18/2022]
Abstract
Surgical management of head and neck melanoma starts from the primary biopsy of the cutaneous site by a narrow excision with a 1 to 3 mm margins. The margin should include the whole breadth and sufficient depth of the lesion. The key is not to transect the lesion. With the advent of molecular testing, gene expression profiling, and immunotherapies, the surgical management of advanced melanoma has changed. Sentinel lymph node biopsy is an essential armamentarium for T2a and higher staging/greater than 1 mm thick and advance stage disease. Molecular pathogenesis and cancer immunology are recognized in the recent treatment protocols along with surgery in advanced stages of melanoma.
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Affiliation(s)
- Srinivasa Rama Chandra
- Oral and Maxillofacial Surgery, Oregon Health & Sciences University, 3181 SW Sam Jackson Park, Portland, OR 97239, USA.
| | - Sravani Singu
- University of Nebaraska Medical Center, College of Medicine, Omaha, NE 68198, USA
| | - Jason Foster
- Division of Surgical Oncology, University of Nebraska Medical Center, 986345 Nebraska Medical Center, Omaha, NE 68198-6345, USA
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Williams A, Hamilton O, Likar C, Thomay A, Garland-Kledzik M. "The Benefit Of Positron Emission Tomography/Computed Tomography In Stage I And Stage II Melanomas With High-Risk Decisiondx-Melanoma Scores". Am Surg 2022; 88:1446-1451. [PMID: 35321583 DOI: 10.1177/00031348221081760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Early detection of melanoma is instrumental as the 5-year survival decreases from 93.3% to <50% when metastases are present.1-3 Distinguishing which patients require closer follow-up can be difficult for melanoma patients. Developments by Castle Biosciences' (Friendswood, TX) DecisionDx-Melanoma (DDx-M) use 31 melanoma associated genes to stratify melanomas into 4 classes with 1A having lowest risk of morbidity and mortality and 2B the highest.5 We assessed the benefit of providing additional 18FDG-PET-CT and brain MRI to genetically high-risk patients who may have otherwise been overlooked. METHODS 297 patients at our institution had biopsies sent for DDx-M between 2014 and 2021. Patients found to have Class 2 melanomas received additional screening with yearly 18FDG-PET-CT scans and brain MRIs. Patients with Class 2 DDx-M scores and negative SLNB were included in the study. 66 met inclusion criteria and received imaging. RESULTS Within 3 years of follow-up, 8/66 (12.1%) patients had metastases detected by 18FDG-PET-CT scans. No patients with stage IA or IB went on to develop metastases. DISCUSSION 18FDG-PET-CT scans detect metastases in < 3% of the time when all stage I and II patients are scanned; however, by using DDx-M in our screening protocols, we achieved a detection rate of 12.1%.6,7 These patients went on to receive treatment and would have otherwise progressed undetected, leading to higher morbidity and mortality. CONCLUSION We suggest all patients with initial stage II or above melanomas receive a DDx-M score and those with class 2 receive yearly 18FDG-PET-CT/brain MRI imaging.
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Affiliation(s)
- Andrew Williams
- 12355West Virginia University School of Medicine, Morgantown, WV, USA
| | - Owen Hamilton
- 12355West Virginia University School of Medicine, Morgantown, WV, USA
| | - Carly Likar
- 12355West Virginia University School of Medicine, Morgantown, WV, USA
| | - Alan Thomay
- 12355West Virginia University School of Medicine, Morgantown, WV, USA
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Sentinel node in melanoma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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28
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Amabile S, Roccuzzo G, Pala V, Tonella L, Rubatto M, Merli M, Fava P, Ribero S, Fierro MT, Queirolo P, Quaglino P. Clinical Significance of Distant Metastasis-Free Survival (DMFS) in Melanoma: A Narrative Review from Adjuvant Clinical Trials. J Clin Med 2021; 10:jcm10235475. [PMID: 34884176 PMCID: PMC8658595 DOI: 10.3390/jcm10235475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Cutaneous melanoma is the most dangerous skin cancer, with high death rates in advanced stages. To assess the impact of each treatment on patient outcomes, most studies use relapse-free survival (RFS) as a primary endpoint and distant metastasis-free survival (DMFS) as a secondary endpoint. The aim of this narrative review of the main adjuvant studies for resected stage III/IV melanoma, with a specific focus on DMFS, is to evaluate DMFS trends and their potential association with RFS, identify which treatments are possibly associated with better outcomes in terms of DMFS and their potential predictive factors, and discuss DMFS trends in terms of patient management in daily practice. We outline the impact of each available treatment option on DMFS and RFS according to the years of follow-up and compare data from different studies. Overall, the trends of DMFS closely follow those of RFS, with most patients relapsing at visceral rather than regional sites. As it captures the burden of patients who develop distant relapse, DMFS could be considered a primary endpoint, in addition to RFS, in adjuvant trials, identifying patients whose relapse is associated with a worse prognosis and who may need further systemic treatment.
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Affiliation(s)
- Simone Amabile
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Gabriele Roccuzzo
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
- Correspondence: ; Tel.: +39-01-1633-5843
| | - Valentina Pala
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Luca Tonella
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Marco Rubatto
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Martina Merli
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Paolo Fava
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Simone Ribero
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Maria Teresa Fierro
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, European Institute of Oncology (IEO), European Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 20141 Milan, Italy;
| | - Pietro Quaglino
- Section of Dermatology, Department of Medical Sciences, University of Turin, 10126 Torino, Italy; (S.A.); (V.P.); (L.T.); (M.R.); (M.M.); (P.F.); (S.R.); (M.T.F.); (P.Q.)
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Moncrieff M, Pywell S, Snelling A, Gray M, Newman D, Beadsmoore C, Pawaroo D, Heaton M. Effectiveness of SPECT/CT Imaging for Sentinel Node Biopsy Staging of Primary Cutaneous Melanoma and Patient Outcomes. Ann Surg Oncol 2021; 29:767-775. [PMID: 34704182 PMCID: PMC8724187 DOI: 10.1245/s10434-021-10911-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023]
Abstract
Purpose Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging. Methods SNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed. Results A total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB. Conclusions This large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.
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Affiliation(s)
- Marc Moncrieff
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK. .,Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Sarah Pywell
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK
| | - Andrew Snelling
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK
| | - Matthew Gray
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - David Newman
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - Clare Beadsmoore
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - Davina Pawaroo
- Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation, Norwich, UK
| | - Martin Heaton
- Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital NHS Trust, Norwich, NR4 7UY, UK
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Prognostic factors and population-based analysis of melanoma with sentinel lymph node biopsy. Sci Rep 2021; 11:20524. [PMID: 34654890 PMCID: PMC8521595 DOI: 10.1038/s41598-021-99950-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
Cutaneous malignant melanoma is a rare but fatal disease in East Asia. Despite its increasing incidence, a general lack of awareness about the disease was noted. This study aims to provide population-based prognostic analysis of melanoma with sentinel lymph node biopsy (SLNB) in Taiwan. We conducted this retrospective cohort study using the data from Taiwan National Health Insurance Research Database during 1997–2013. The study cohort contains 3284 patients. The 5-year survival rates of patients undergoing SLNB and not undergoing SLNB were 45.5% and 33.6%. In multivariate analysis, age ≥ 80 years [adjusted hazard ratio (aHR) = 2.15] and male (aHR = 1.19) were associated with a poorer prognosis, while high social economic status (SES) (aHR = 0.69) and undergoing SLNB (aHR = 0.84) were good prognostic factors. Old age and low SES were associated with lower percentages of patients undergoing SLNB (P < 0.001). E-value analysis suggested robustness to unmeasured confounding. In conclusion, undergoing SLNB was associated with a better prognosis. The poor prognosis of old age and low SES may be due to decreased percentages of patients undergoing SLNB. Therefore, we recommend that SLNB should be performed on patients, especially in old age or low SES, who are candidates for SLNB according to current guidelines to achieve maximal survival.
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Marchetti MA, Bartlett EK. Sentinel Lymph Node Biopsy in Cutaneous Melanoma-Where Do We Stand? JAMA Dermatol 2021; 157:1159-1160. [PMID: 34406334 DOI: 10.1001/jamadermatol.2021.3048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Michael A Marchetti
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 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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Sarver M, Brown MC, Rhodin KE, Salama AKS, Beasley GM. Predictive factors of neoadjuvant immune checkpoint blockade in melanoma. Hum Vaccin Immunother 2021; 18:1943987. [PMID: 34254900 PMCID: PMC9122309 DOI: 10.1080/21645515.2021.1943987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This review describes the current body of literature and ongoing clinical trials examining neoadjuvant immune checkpoint inhibitors (ICI) for patients with resectable stage III and IV melanoma. Based on prior success in treating metastatic melanoma and as adjuvant therapy, ICIs are being explored in the neoadjuvant setting. There have been initial trials and there are many ongoing trials examining neoadjuvant ICI. Herein, we will review the clinical feasibility and efficacy of various neoadjuvant ICI regimens, explore pathologic and cellular responses, and present factors associated with predictive tumor response.
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Affiliation(s)
| | - Michael C Brown
- Department of Neurosurgery, Duke University, Durham, NC, USA
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Hamilton A, Jayaratne P, Zonta M. Metastatic Merkel cell carcinoma and malignant melanoma in a single sentinel lymph node. SAGE Open Med Case Rep 2021; 9:2050313X211023685. [PMID: 34188934 PMCID: PMC8212377 DOI: 10.1177/2050313x211023685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 05/18/2021] [Indexed: 12/21/2022] Open
Abstract
Merkel cell carcinoma (MCC) and malignant melanoma are aggressive skin cancers that
usually arise in sun-exposed parts of the body. This report describes an 85-year-old man
who underwent a wide local excision and sentinel lymph node biopsy for primary MCC and was
subsequently found to have metastatic MCC and malignant melanoma within the left inguinal
sentinel lymph node. Dual diagnoses of aggressive cutaneous carcinomas, although rare, may
become more common in regions of high ultraviolet exposure and an ageing population.
Currently, there are no guidelines for treating synchronous MCC and melanoma, however,
immunotherapy with PD-1 inhibitors and anti-CTLA-4 receptor antagonists have shown
therapeutic effect against these two cancers and should be considered in treatment
planning.
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Affiliation(s)
| | - Prasad Jayaratne
- Sullivan Nicolaides Pathology, Mater Hospital Pimlico, Townsville, QLD, Australia
| | - Mark Zonta
- North Queensland Minimally Invasive Surgery, Mater Hospital Pimlico, Townsville, QLD, Australia
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Narang J, Hue JJ, Bingmer K, Hardacre JM, Winter JM, Ocuin LM, Ammori JB, Mangla A, Bordeaux J, Rothermel LD. Sentinel lymph node biopsy guideline concordance in melanoma: Analysis of the National Cancer Database. J Surg Oncol 2021; 124:669-678. [PMID: 34109633 DOI: 10.1002/jso.26565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES This study investigated the impact of treating facility type on guideline-concordant sentinel lymph node biopsy (SLNB) management in T1a* (defined as a Breslow depth <0.76 mm without ulceration or mitoses) and T2/T3 melanoma. METHODS This was a retrospective cohort study utilizing the National Cancer Database from 2012 to 2016. RESULTS Our cohort included 109,432 patients. For T1a* melanomas, 85% of patients received guideline-concordant SLNB management at community and academic facilities versus 75% of patients at integrated network facilities (p < .001). Over 83% of patients with T2/T3 melanoma treated at an academic facility received guideline-concordant SLNB management versus 77% treated at a community facility (p < .001). Adjusting for demographic and clinical factors, integrated (adjusted odds ratio, aOR = 0.54), and comprehensive community (aOR = 0.74) facilities were less likely to provide guideline-concordant SLNB management in patients with T1a* melanoma compared to academic facilities. Community facilities (aOR = 0.72) were less likely to provide guideline-concordant SLNB management in patients with T2/T3 melanoma compared to academic facilities. CONCLUSION Academic facilities provide the highest rate of guideline-concordant sentinel lymph node management. Comparatively, community programs may underutilize SLNB in T2/T3 disease, while integrated and comprehensive community facilities may over-utilize SLNB in T1a* disease.
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Affiliation(s)
- Jatin Narang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jonathan J Hue
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Jordan M Winter
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lee M Ocuin
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ankit Mangla
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeremy Bordeaux
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Lallas A. Melanoma: update on dermatoscopy, artificial intelligence for diagnosis, histopathology, genetics, surgery and systemic medical treatment. Ital J Dermatol Venerol 2021; 156:271-273. [PMID: 33982544 DOI: 10.23736/s2784-8671.21.06955-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Aimilios Lallas
- School of Medicine, First Department of Dermatology, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece -
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Lymph node dissections in cutaneous malignancy: Where are we now? A review of 10 years' experience at a tertiary centre. J Plast Reconstr Aesthet Surg 2021; 74:2993-2998. [PMID: 34053906 DOI: 10.1016/j.bjps.2021.03.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
The surgical management of cutaneous malignancies has evolved over recent years with the introduction of novel medical therapies and an increasing emphasis upon early adjuvant systemic therapy. As such, completion lymph node dissection (cLND) is now no longer recommended following a positive sentinel lymph node biopsy (SLNB) in melanoma. We evaluated our ten-year practice at a regional tertiary centre, assessing the change in lymph node dissection (LND) caseload volume, anatomical distribution, and indication for the procedure. A retrospective search was carried out of all LNDs performed by the Plastic Surgery department at Cambridge University Hospitals NHS Trust, UK from 1 January 2010 to 31 December 2019. Case notes were retrospectively analysed for each procedure, with the site and pathology recorded. A total of 491 LNDs were performed over the 10-year period. Surgical volume peaked in 2015 with 67 cases, followed by a decline to 41 cases in 2019. The number of neck dissections increased over the decade, as well as the proportion of cases due to macroscopic nodal disease. We sub-analysed the number of LNDs in three contiguous 18-month intervals, corresponding to changes in practice due to evidence from the DeCOG and MSLT-II Trials. We found a 41.67% reduction in LNDs caseload between July 2018-Dec 2019, compared to a similar period prior to trial evidence (July 2015-Dec 2016) (p=0.0.14). In summary, the surgical volume of LNDs has decreased significantly since 2018, reflecting emerging evidence and changes to national guidelines. This will require ongoing monitoring for workforce planning and surgical training.
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Namin AW, Oudin EM, Tassone PT, Galloway TLI, Dooley LM, Zitsch RP. Treatment of Cutaneous Melanoma of the Head and Neck With Wide Local Excision Versus Mohs. Laryngoscope 2021; 131:2490-2496. [PMID: 33844289 DOI: 10.1002/lary.29570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/25/2021] [Accepted: 04/05/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Determine if Mohs micrographic surgery (MMS) is associated with improved overall survival compared to wide local excision (WLE) when treating cutaneous melanoma of the head and neck (CMHN) and to report the proportion of patients treated with MMS versus WLE who also underwent sentinel lymph node biopsy (SLNB). METHODS Retrospective cohort study of the National Cancer Database (NCDB) analyzing the overall survival of patients diagnosed with T1 to T4 CMHN between 2004 and 2016 who were treated with either WLE or MMS. RESULTS On multivariable analysis, treatment with WLE versus MMS was not significantly associated with overall survival (HR, 1.094; 95% CI, 0.997-1.201). On multivariable analysis, lower Charlson-Deyo score (HR, 0.489; 95% CI, 0.427-0.560), negative margins (HR, 0.754; 95% CI, 0.705-0.807), and N0 classification (HR 0.698; 95% CI, 0.668-0.730) were associated with improved overall survival. Seventy-seven percent of patients treated with MMS did not undergo SLNB, while 45% of patients treated with WLE did not undergo SLNB (P < .001). CONCLUSIONS No difference in overall survival between MMS and WLE when treating CMHN. Patients treated with MMS were significantly less likely to undergo SLNB, suggesting an opportunity for enhancement of multidisciplinary care. LEVEL OF EVIDENCE 4 Laryngoscope, 2021.
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Affiliation(s)
- Arya W Namin
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Edouard M Oudin
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Patrick T Tassone
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Tabitha L I Galloway
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Laura M Dooley
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Robert P Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
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Breit S, Foley E, Ablah E, Okut H, Mammen J. Recent Evolution in the Management of Lymph Node Metastases in Melanoma. Kans J Med 2021; 14:64-72. [PMID: 33763181 PMCID: PMC7984741 DOI: 10.17161/kjm.vol1414674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/15/2020] [Indexed: 02/03/2023] Open
Abstract
Introduction Based upon two large randomized international clinical trials (German Dermatologic Cooperative Oncology Group (DeCOG-SLT) and Multicenter Selective Lymphadenectomy Trial II (MSLT-II)) published in 2016 and 2017, respectively, active surveillance has been demonstrated to have equivalent survival outcomes to completion lymphadenectomy (CLND) for a subset of patients who have microscopic lymph node disease. In this study, the changes in national practice patterns were examined regarding the utilization of CLND after positive sentinel lymph node biopsy (SLNB). Methods Using the National Cancer Database, CLND utilization was examined in SLN-positive patients diagnosed with melanoma between 2012 and 2016. A hierarchal logistical regression model with hospital-level random intercepts was constructed to examine the factors associated with SLNB followed by observation vs. SLNB with CLND. Results Of the 148,982 patients identified, 43% (n = 63,358) underwent SLNB and 10.3% (n = 6,551) had a SLNB with microscopic disease. CLND was performed for 57% (n = 2,817) of these patients. Patients were more likely to undergo CLND if they were ≤ 55 years of age (OR, 1.454; p ≤ 0.0001), ages 56 - 65 (OR, 1.127; p = 0.026), Charlson Deyo Score = 0 (OR, 2.088; p = 0.043), or were diagnosed with melanoma in 2012 (OR, 2.259, p ≤ 0.0001). Conclusions The utilization of CLND among patients with microscopic nodal melanoma was significantly lower in 2016 compared to 2012. Younger age, lack of comorbidities, and primary tumor location on the trunk or head/neck were associated with higher utilization of CLND.
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Affiliation(s)
- Shelby Breit
- University of Kansas School of Medicine-Salina, Salina, KS
| | - Elise Foley
- University of Kansas School of Medicine-Salina, Salina, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Hayrettin Okut
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS.,Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Joshua Mammen
- University of Kansas School of Medicine-Kansas City, Department of Surgery, Kansas City, KS
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Featherston C, Nardi WS, Tomé FR, Quildrian SD. Role of sentinel lymph node biopsy for cutaneous melanoma in elderly patients: preliminary results in a Latin-American population. Ecancermedicalscience 2021; 15:1167. [PMID: 33680081 PMCID: PMC7929767 DOI: 10.3332/ecancer.2021.1167] [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: 07/24/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction In melanoma, lymph node status constitutes the most important prognostic factor among patients with locoregional disease. It has been postulated that elderly patients present less metastatic involvement in sentinel lymph node (SLN). Our objective was to analyse the results and evolution of patients ≥ 70 years-old with cutaneous melanoma in whom sentinel lymph node biopsy (SLNB) was carried out. Methods Retrospective analysis of 194 patients with primary CM who had a SLNB between 2005 and 2020 was included. Demographic and tumour data, SLN status, recurrence rate, morbidity and evolution were evaluated. Patients were divided into two groups according to age: Group 1 (<70 years old) and Group 2 (≥70 years old). Results One hundred and fifty patients were included in Group 1 and 44 patients in Group 2. Median Breslow thickness was 1.7 mm in Group 1 and of 2 mm in Group 2 (p = 0.015).Forty-seven patients had positive SLNB; 38 (25%) belonged to Group 1 and 9 (20.5%) to Group 2 (p = 0.55). Recurrence was found in 34 patients: 25 belonging to Group 1 and 9 corresponding to Group 2 (p = 0.65). Morbidity was of 4% in Group 1 and 9% in Group 2 (p = 0.23). With an average follow-up of 30.6 months, 5-year overall survival was of 87% in Group 1 and of 63% in Group 2 (p = 0.04). Conclusion Advanced age was not associated with differences regarding positivity of SLN and recurrence but difference in overall survival was observed. According to our results and the low morbidity rate, we consider SLNB should not be omitted in such age group, since it improves staging and gives the possibility to evaluate adjuvant treatment.
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Affiliation(s)
- Carola Featherston
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Walter Sebastián Nardi
- Sarcoma and Melanoma Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Florencia Rocio Tomé
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
| | - Sergio Damian Quildrian
- Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina.,Sarcoma and Melanoma Unit, Department of General Surgery, British Hospital of Buenos Aires, Perdriel 74, CABA, 1280AEB, Buenos Aires, Argentina
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Kretschmer L, Mitteldorf C, Hellriegel S, Leha A, Fichtner A, Ströbel P, Schön MP, Bremmer F. The sentinel node invasion level (SNIL) as a prognostic parameter in melanoma. Mod Pathol 2021; 34:1839-1849. [PMID: 34131294 PMCID: PMC8443441 DOI: 10.1038/s41379-021-00835-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022]
Abstract
Sentinel lymph node (SN) tumor burden is becoming increasingly important and is likely to be included in future N classifications in melanoma. Our aim was to investigate the prognostic significance of melanoma infiltration of various anatomically defined lymph node substructures. This retrospective cohort study included 1250 consecutive patients with SN biopsy. The pathology protocol required description of metastatic infiltration of each of the following lymph node substructures: intracapsular lymph vessels, subcapsular and transverse sinuses, cortex, paracortex, medulla, and capsule. Within the SN with the highest tumor burden, the SN invasion level (SNIL) was defined as follows: SNIL 1 = melanoma cells confined to intracapsular lymph vessels, subcapsular or transverse sinuses; SNIL 2 = melanoma infiltrating the cortex or paracortex; SNIL 3 = melanoma infiltrating the medulla or capsule. We classified 338 SN-positive patients according to the non-metric SNIL. Using Kaplan-Meier estimates and Cox models, recurrence-free survival (RFS), melanoma-specific survival (MSS) and nodal basin recurrence rates were analyzed. The median follow-up time was 75 months. The SNIL divided the SN-positive population into three groups with significantly different RFS, MSS, and nodal basin recurrence probabilities. The MSS of patients with SNIL 1 was virtually identical to that of SN-negative patients, whereas outgrowth of the metastasis from the parenchyma into the fibrous capsule or the medulla of the lymph node indicated a very poor prognosis. Thus, the SNIL may help to better assess the benefit-risk ratio of adjuvant therapies in patients with different SN metastasis patterns.
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Affiliation(s)
- Lutz Kretschmer
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany.
| | - Christina Mitteldorf
- grid.411984.10000 0001 0482 5331Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Simin Hellriegel
- grid.411984.10000 0001 0482 5331Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Andreas Leha
- grid.411984.10000 0001 0482 5331Department of Medical Statistics, University Medical Center, Göttingen, Germany
| | - Alexander Fichtner
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Philipp Ströbel
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center, Göttingen, Germany
| | - Michael P. Schön
- grid.411984.10000 0001 0482 5331Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Felix Bremmer
- grid.411984.10000 0001 0482 5331Institute of Pathology, University Medical Center, Göttingen, Germany
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Peric B, Milicevic S, Perhavec A, Hocevar M, Zgajnar J. Completely resected stage III melanoma controversy - 15 years of national tertiary centre experience. Radiol Oncol 2020; 55:50-56. [PMID: 33885234 PMCID: PMC7877267 DOI: 10.2478/raon-2020-0056] [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: 05/28/2020] [Accepted: 07/24/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Two prospective randomized studies analysing cutaneous melanoma (CM) patients with sentinel lymph node (SLN) metastases and rapid development of systemic adjuvant therapy have changed our approach to stage III CM treatment. The aim of this study was to compare results of retrospective survival analysis of stage III CM patients' treatment from Slovenian national CM register to leading international clinical guidelines. PATIENTS AND METHODS Since 2000, all Slovenian CM patients with primary tumour ≥ TIb are treated at the Institute of Oncology Ljubljana and data are prospectively collected into a national CM registry. A retrospective analysis of 2426 sentinel lymph node (SLN) biopsies and 789 lymphadenectomies performed until 2015 was conducted using Kaplan-Meier survival curves and log-rank tests. RESULTS Positive SLN was found in 519/2426 (21.4%) of patients and completion dissection (CLND) was performed in 455 patients. The 5-year overall survival (OS) of CLND group was 58% vs. 47% of metachronous metastases group (MLNM) (p = 0.003). The 5-year OS of patients with lymph node (LN) metastases and unknown primary site (UPM) was 45% vs. 21% of patients with synchronous LN metastasis. Patients with SLN tumour burden < 0.3 mm had 5-year OS similar to SLN negative patients (86% vs. 85%; p = 0.926). The 5-year OS of patients with burden > 1.0 mm was similar to the MLNM group (49% vs. 47%; p = 0.280). CONCLUSIONS Stage III melanoma patients is a heterogeneous group with significant OS differences. CLND after positive SLNB might still remain a method of treatment for selected patients with stage III.
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Affiliation(s)
- Barbara Peric
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Sara Milicevic
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Andraz Perhavec
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marko Hocevar
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Janez Zgajnar
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Lee RM, Delman KA, Lowe MC. Management of Melanoma Patients with Positive Nodes. Adv Surg 2020; 54:191-204. [PMID: 32713430 DOI: 10.1016/j.yasu.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel M Lee
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365 Clifton Road, Building B, 4th Floor, Atlanta, GA 30322, USA
| | - Keith A Delman
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1364 Clifton Road Northeast, Room H127, Atlanta, GA 30322, USA
| | - Michael C Lowe
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365 Clifton Road, Building B, 4th Floor, Atlanta, GA 30322, USA.
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Spagnolo F, Croce E, Boutros A, Tanda E, Cecchi F, Mascherini M, Solari N, Cafiero F, Queirolo P. Neoadjuvant treatments in patients with high-risk resectable stage III/IV melanoma. Expert Rev Anticancer Ther 2020; 20:403-413. [PMID: 32326767 DOI: 10.1080/14737140.2020.1760847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: In recent years, the introduction of targeted therapy and immunotherapy into clinical practice has radically changed the management of advanced melanoma. More recently, these treatments also became the standard of care in the adjuvant setting. However, high-risk resectable stage III melanoma (i.e. with clinically detected regional lymph node involvement and/or satellites/in transit metastases) still has a high risk of relapse, even after adjuvant treatment, suggesting that the activity of immunotherapy and targeted therapy may play a relevant role in a neoadjuvant setting.Area covered: In this review, we discuss the results of the main clinical trials conducted in the neoadjuvant setting for patients with resectable stage III and stage IV melanoma, with a focus on the hot topics and a look at the future perspectives of the field.Expert opinion: The long-term effects of immunotherapy and the high response rate of targeted therapy provided the strong rationale to start neoadjuvant clinical trials for patients with resectable stage III and oligometastatic stage IV melanoma. Neoadjuvant therapy may play an important role not only for its possible impact on overall survival, but also as a predictive biological marker to allow for a more accurate personalization of adjuvant treatments.
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Affiliation(s)
- Francesco Spagnolo
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elena Croce
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Boutros
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Enrica Tanda
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Cecchi
- Medical Oncology 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit 1, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Nicola Solari
- Surgical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ferdinando Cafiero
- Surgical Oncology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma, Sarcoma, and Rare Tumors, IEO, European Institute of Oncology IRCCS, Milano, Italy
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Bello DM, Faries MB. ASO Author Reflections: The Past, Present, and Future of Managing Melanoma Lymph Node Metastases: What the Trials Tell Us. Ann Surg Oncol 2019; 27:735-736. [PMID: 31788753 DOI: 10.1245/s10434-019-08013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Indexed: 11/18/2022]
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