Primary cutaneous melanoma: an 18-year study

The Risk of Melanoma due to Exposure to Sun and Solarium Use in Poland: A Large-Scale, Hospital Based Case - Control Study

OBJECTIVE

The incidence of skin cancer is constantly growing, it is considered a serious problem of public health. Most cases of skin cancer are caused by a combination of non-modifiable genetic, and modifiable environmental risk factors. The study objective was to analyse the correlation between pigmentation traits, excessive sunlight exposure, solarium use and the risk of melanoma development.

METHODS

The study included 480 patients diagnosed with melanoma and 400 within the control group. Subjects diagnosed with the melanoma confirmed by histopathology were invited to take part in the study. The research was based on a clinical, direct, individual, structured, in-depth and focused interview.

RESULTS

The mean age of the study subjects was 44.3 ± 7.86, while in the control group 59.5 (7.93) Most frequently, melanoma was located on the upper extremities (64%). A family history of neoplastic diseases was found in 55% of the patients. The assessment of sunburns showed that only 15%  of the respondents never experienced sunburn, 49% of the study subjects never used solarium. Among patients with multiple sunburns, the risk of developing skin cancer was 1.27 (AOR = 1,27; 95% CI, 1.07-1.55) compared with non-sunburns subjects.

CONCLUSIONS

Risky behaviours including excessive exposure to UV radiation, both natural and artificial, are of special significance in women with fair complexion and fair hair. Indoor tanning is a probable factor of increased skin cancer incidence in younger women, as compared to men.

Re-excision within a radius of 2 cm in patients with melanoma of the skin - sufficient for local oncological radicalness

Introduction

Malignant melanoma is one of the most malignant tumours in the human body. Radical re-excision of the tumour bed is a principal part of its surgical treatment. We aim to test the hypothesis that the re-excision with a 2 cm margin in all directions to the scar from the previous biopsy of the primary tumour provides sufficient local control in patients with this disease.

Material and methods

This is a prospective descriptive study using STROBE methods, including all 151 patients with malignant melanoma of the skin, diagnosed and treated at the Department of Plastic, Reconstructive, and Aesthetic Surgery, Dr Georgi Stranski University Hospital, Medical University of Pleven, Bulgaria, in the period 2012-2016. Twenty-one cases were omitted from the study during the observation period due to lack of sufficient data. The re-excision was mainly within 2 cm margins in all directions to the scar from the previous biopsy of the primary tumour.

Results

Data of all 130 patients with malignant skin melanoma, diagnosed and treated at our single large centre, were prospectively registered and analysed. These were 67 male and 63 female patients with a mean age at diagnosis of 61.6 years (range: 17-91 years). Using the re-excision within 2 cm margins, we identified only 1 (0.77%) patient with a histologically confirmed residual tumour in the re-excised flap. Local recurrence was observed in 13 (10%) patients.

Conclusions

Re-excision with a 2 cm margin is sufficient to achieve local surgical radicalness in the treatment of this disease without compromising oncological survival.

Ethnic disparity in primary cutaneous CD30+ T-cell lymphoproliferative disorders: an analysis of 1496 cases from the US National Cancer Database

Primary cutaneous CD30⁺ T cell lymphoproliferative disorders (PCLPD), the second most common type of primary cutaneous T cell lymphomas, accounts for approximately 25-30% of cutaneous T-cell lymphoma cases. However, only small retrospective studies have been reported. We aimed to identify prognostic factors and evaluate the overall survival (OS) of patients with PCLPD stratified by ethnicity. We identified 1496 patients diagnosed with PCLPD between 2004 and 2014 in the US National Cancer Database. Chi-square test and anova were used to evaluate differences in demographic and disease characteristics, socioeconomic factors and treatments received. OS was evaluated with the log-rank test, Cox proportional hazard regression analysis, and propensity score matching. The study included 1267 Caucasians, 153 African Americans (AA), 43 Asians, and 33 of other/unknown ethnicity. Older age, higher Charlson-Deyo score, higher clinical stage and receipt of chemotherapy were predictors of shorter OS. Primary disease site on a lower extremity was associated with shorter OS, while a head and neck location was associated with longer OS. AA patients had shorter OS when compared to Caucasian patients on multivariate analysis. This ethnic disparity persisted on propensity-score matched analysis and after matching Caucasian and AA patients on demographic and disease characteristics, socioeconomic factors and treatments received, and age and gender-matched relative survival analyses.

Epidemiological and histopathological aspects of primary cutaneous melanoma in residents of Joinville, 2003-2014

BACKGROUND

The worldwide incidence of cutaneous melanoma (CM) has been continuously increasing over the last decades. Primary and secondary prevention, with attention to risk factors and early diagnosis, remain the cornerstone for reducing the burden of cutaneous melanoma. Detailed information with respect to clinical and pathological data on cutaneous melanoma is scarce in Brazil.

OBJECTIVE

The purpose of our study was to analyze epidemiological and pathological characteristics of primary cutaneous melanoma in Joinville, southern Brazil.

METHODS

Observational, cross-sectional, retrospective study in which 893 reports of primary cutaneous melanoma from the local population were analyzed in the period 2003-2014. The study was approved by the local Ethics and Research Committee.

RESULTS

We observed a female predominance of cutaneous melanoma (56.3%). The age standardized incidence rate of primary cutaneous melanoma for the world population in the period 2003-06 was 11.8 per 100,000 population (CI 95%, 10.3-13.4), and 17.5 (CI 95%, 15.7-19.3) in 2011-14, revealing a significant increase of 48.3% (p < 0,05). Six and a half percent of patients had multiple cutaneous melanomas (mean 2.2 years and a maximum of 10.0 years between diagnoses). We observed significant differences between the location head/neck and cutaneous melanoma in situ, lower limb with Breslow depth S III and upper limb with Breslow depth S I. The comparison of the characteristics of cutaneous melanoma in the elderly and non-elderly (< 60 years old) showed significant differences with respect to all the variables studied.

STUDY LIMITATIONS

Using secondary data source.

CONCLUSION

Joinville has high incidence coefficients for Brazilian standards, showing an increase in the incidence of cutaneous melanoma.

Folate-conjugated immunoglobulin targets melanoma tumor cells for NK cell effector functions

The folate receptor (FR) is overexpressed on the vascular side of cancerous cells including those of the breast, ovaries, testes, and cervix. We hypothesized that a folate-conjugated immunoglobulin (F-IgG) would bind to the FR that is overexpressed on melanoma tumor cells to target these cells for lysis by natural killer (NK) cells. Folate receptor expression was confirmed in the Mel-39 (human melanoma) cell line by flow cytometry and immunoblot analysis using KB (human oral epithelial) and F01 (human melanoma) as a positive and a negative control, respectively. FR-positive and FR-negative cell lines were treated with F-IgG or control immunoglobulin G in the presence or absence of cytokines to determine NK cell ability to lyse FR-positive cell lines. NK cell activation was significantly upregulated and lysis of Mel 39 tumor cells increased following treatment with F-IgG compared with control immunoglobulin G at all effector : target (E : T) ratios (P<0.01). This trend further increased by NK cell stimulation with the activating cytokine interleukin-12. NK cell production of cytokines such as interferon-gamma, macrophage inflammatory protein 1α, and regulated on activation normal T-cell expressed and secreted (RANTES) was also significantly increased in response to costimulation with interleukin-12 stimulation and F-IgG-coated Mel 39 target cells compared with controls (P<0.01). In contrast, F-IgG did not bind to the FR-negative cell line F01 and had no significant effect on NK cell lysis or cytokine production. This research indicates the potential use of F-IgG for its ability to induce an immune response from NK cells against FR-positive melanoma tumor cells, which can be further increased by the addition of cytokines.

Nevus-associated melanomas: clinicopathologic features

OBJECTIVES

The clinical significance of nevus-associated melanoma compared with de novo melanomas remains controversial. It has been suggested that nevus-associated melanomas have a higher Breslow thickness and therefore worse prognosis. Over a 10-year period, this study evaluated the incidence of nevus-associated melanoma and its prognostic significance related to clinicopathologic features.

METHODS

Cross-sectional study from 1995 through 2004 in a dermatopathology referral center. With available data, we evaluated sex, primary location, histologic subtype, Breslow thickness, Clark level, presence of ulceration, associated lesion, and histologic subtype of the associated lesion.

RESULTS

Of 135,653 pathologic records from skin biopsy specimens over a 10-year period, 1,190 melanoma records were selected. Nevus-associated melanomas corresponded to 390 (32.8%) melanomas, with thin melanomas having a nevus 1.52 times the association observed with thick melanomas (>1.01 mm; 95% confidence interval, 1.16-1.99; P < .001). Superficial spreading melanoma was the most frequent, while no lentigo maligna melanoma was associated with nevi. The median Breslow thickness of nevus-associated melanomas was lower than that of de novo melanomas.

CONCLUSIONS

Nevus-associated melanomas, which represent one-third of the melanomas in southeast Brazil, are associated with intermittent sun exposure, superficial spreading melanomas, and lower Breslow thickness. This is one of the largest series describing nevus-associated melanomas in Latin America.

Immune-related biomarkers for diagnosis/prognosis and therapy monitoring of cutaneous melanoma

Skin melanoma, a life-threatening disease, has a recently reported worldwide increase in incidence, despite primary prevention. Skin melanoma statistics emphasize the need for finding markers related to the immune response of the host. The mechanisms that are able to over-power the local immune surveillance comprise molecules that can be valuable markers for diagnosis and prognosis. This article summarizes the immune markers that can monitor the disease stage and evaluate the efficacy of therapeutic interventions. Recent data regarding immunotherapy are presented in the context of tumor escape from immune surveillance and the immune molecules that are both targets and a means of monitoring. Perspectives for developing immune interventions for skin melanoma management and the position of tissue or soluble immune markers as a diagnostic/prognostic panel are evaluated. State-of-the-art technology is emphasized for developing immune molecular signatures for a complex characterization of the patient's immunological status.