1
|
Kesmodel SB, Kronenfeld JP, Zhao W, Koru-Sengul T, Goel N, Weingrad DN, Hernandez-Aya L, Lutzky J, Feun L, Garland-Kledzik M, Crystal JS. Omission of Completion Lymph Node Dissection in Sentinel Node Biopsy Positive Head and Neck Cutaneous Melanoma Patients. Ann Surg Oncol 2023; 30:7671-7685. [PMID: 37639029 PMCID: PMC10883719 DOI: 10.1245/s10434-023-14036-8] [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] [Received: 03/20/2023] [Accepted: 07/10/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Recent studies evaluating patients with a positive sentinel lymph node biopsy (SLNB+) show no melanoma-specific survival difference between patients undergoing lymph node basin surveillance and completion lymph node dissection (CLND). This has been broadly applied, despite underrepresentation of head and neck (HN) cutaneous melanoma patients. We evaluated whether this was upheld in the HN melanoma cohort. METHODS Patients with HN melanoma with a SLNB+ were selected from the National Cancer Database (NCDB) from 2012 to 2019. Overall survival (OS) of patients who underwent SLNB only versus SLNB + CLND were compared. Subgroup analyses were performed based on pathologic N (pN) and receipt of immunotherapy. Adjusted hazard ratio (aHR) and 95% confidence interval (CI) were calculated. RESULTS Analysis of 634 patients with multivariable Cox regression showed no difference in OS in SLNB only versus SLNB + CLND cohorts (hazard ratio [HR] 1.13; 95% confidence interval [CI] 0.71-1.81; p = 0.610). Charlson-Deyo score (CDS) 1 versus 0 (HR 1.70; 95% CI 1.10-2.63; p = 0.016), pN2+ versus pN1 (HR 1.74; 95% CI 1.23-2.45; p = 0.002), and lymphovascular invasion (LVI) versus no (HR 2.07; 95% CI 1.34-3.19; p = 0.001) were associated with worse prognosis. Subgroup analysis by pN showed no OS benefit for CLND in either pN1 (HR 1.04; 95% CI 0.51-2.10; p = 0.922) or pN2+ (HR 1.31; 95% CI 0.67-2.57; p = 0.427) patients or in patients who received immunotherapy (HR 1.32; 95% CI 0.54-3.22; p = 0.549). CONCLUSIONS This study of SLNB + HN melanoma patients showed no OS difference in SLNB only versus SLNB + CLND. Further studies need to be performed to better define the role of CLND.
Collapse
Affiliation(s)
- Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Joshua P Kronenfeld
- DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Wei Zhao
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Daniel N Weingrad
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Leonel Hernandez-Aya
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jose Lutzky
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Lynn Feun
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
- Division of Medical Oncology, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Mary Garland-Kledzik
- Division of Surgical Oncology, Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Jessica S Crystal
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
| |
Collapse
|
2
|
Yuan YC, Li Y, Pan Y, Gao B. Gastric metastasis from nodular malignant melanoma of the auricle with multigene aberrations: A rare case report and literature review. Oncol Lett 2023; 26:368. [PMID: 37559590 PMCID: PMC10407719 DOI: 10.3892/ol.2023.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/30/2023] [Indexed: 08/11/2023] Open
Abstract
Primary malignant melanoma (MM) of the external ear accounts for a low proportion of cases of cutaneous MM, and its incidence in non-white women is very low. The stomach is a rare metastatic site for MM. Gastric metastasis of MM of the external ear is extremely rare, and the associated gene alterations and mechanisms are poorly understood. The present report describes the case of a 58-year-old Asian woman who had a mass on the left auricle for 5 years and was diagnosed with nodular MM with the BRAF V600E mutation after surgical resection. Postoperative metastases to the stomach and descending duodenum appeared 1 year after resection. After 11 months of BRAF-targeted therapy and immunotherapy, the patient developed drug resistance and died from systemic metastases to the brain, lungs, liver, left adrenal gland and peritoneum. Genetic testing revealed additional aberrations in MYB, p16, MYC and PTEN. The clinical characteristics of MM of the external ear and gastric metastatic MM were also summarized through a retrospective literature review. Immunohistochemical staining is critical in the diagnosis of gastric metastasis from MM of the external ear. This disease often requires a multidisciplinary treatment approach, including surgery, targeted therapy and immunotherapy. The present study provides some genetic information about this rare disease and discusses appropriate treatment strategies. The findings of the present study suggests that the surgical margin size, tumor histological type and number of genetic aberrations may be closely associated with metastasis potential, therapeutic efficacy and patient outcome.
Collapse
Affiliation(s)
- Ya-Chen Yuan
- Department of Pathology, The First Affiliated Hospital of Dali University, Dali, Yunnan 671000, P.R. China
| | - Ying Li
- Department of Pathology, People's Hospital of Xiangyun County, Xiangyun, Yunnan 672100, P.R. China
| | - Yun Pan
- Department of Pathology, The First Affiliated Hospital of Dali University, Dali, Yunnan 671000, P.R. China
| | - Bo Gao
- Department of Pathology, The First Affiliated Hospital of Dali University, Dali, Yunnan 671000, P.R. China
| |
Collapse
|
3
|
Yoo H, Park S, Kim SW. Nodular type predominance of head and neck cutaneous malignant melanoma in Asian populations leads to poor outcome and low survival. Melanoma Res 2023; 33:326-331. [PMID: 37199704 DOI: 10.1097/cmr.0000000000000901] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Cutaneous malignant melanomas of the head and neck (HNM) are proposed to have notable histological and clinical differences from those at other sites (other melanoma); however, HNMs among Asians have remained poorly understood. This study aimed to investigate the clinicopathological features and prognostic factors of HNM in Asians. Asian melanoma patients who underwent surgical treatment from January 2003 to December 2020 were retrospectively reviewed. The clinicopathological features and risk factors for local recurrence, lymph node metastasis, and distant metastasis were analyzed. Among 230 patients, 28 (12.2%) were diagnosed with HNM, and 202 (87.8%) with other melanoma. The histologic subtype significantly differed as the nodular type was predominant in HNM whereas the acral lentiginous type was predominant in other melanoma ( P < 0.001). HNM was significantly associated with higher local recurrence ( P = 0.045), lymph node metastasis ( P = 0.048), distant metastasis ( P = 0.023), and lower 5-year disease-free survival ( P = 0.022) than other melanoma. Ulceration was the risk factor for lymph node metastasis based on multivariable analysis ( P = 0.013). A high proportion of HNM present as the nodular subtype in Asians, leading to poor outcomes and low survival. Therefore, more cautious surveillance, evaluation, and aggressive treatment are required.
Collapse
Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | |
Collapse
|
4
|
Franke V, Stahlie EHA, Klop WMC, Zuur CL, Berger DMS, van der Hiel B, van de Wiel BA, Wouters MWJM, van Houdt WJ, van Akkooi ACJ. Talimogene laherparepvec monotherapy for head and neck melanoma patients. Melanoma Res 2023; 33:66-70. [PMID: 36454284 DOI: 10.1097/cmr.0000000000000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Talimogene laherparepvec (T-VEC) is a modified herpes simplex virus, type 1, intralesionally administered in patients with stage IIIB/C-IVM1a unresectable melanoma. When surgery is not a treatment option in the head and neck region, T-VEC can be an elegant alternative to systemic immunotherapy. Ten patients with metastatic melanoma in the head and neck region started treatment with T-VEC monotherapy at the Netherlands Cancer Institute. We collected data on response, adverse events (AEs), and baseline characteristics. For response evaluation, we used clinical evaluation with photography, 3-monthly PET/computed tomography (PET/CT) using 18F-fluoro-2-D-deoxyglucose, and histological biopsies. Median age at baseline was 78.2 (35-97) years with a median follow-up of 11.6months. Of these 10 patients, 5 had a complete response (CR), 3 had a partial response, 1 had stable disease and 1 showed progressive disease (PD) as their best response. Best overall response rate (ORR) was 80%. Median progression-free survival was 10.8 months (95% confidence interval, 2.2-19.4). Grade 1 AEs occurred in all patients. Mostly, these consisted of fatigue, influenza-like symptoms, and injection site pain. PET-CT and histological biopsies proved to be clinically useful tools to evaluate treatment response for T-VEC monotherapy, confirming pCR or PD to stage IV disease requiring systemic treatment. ORR for T-VEC monotherapy for melanoma in the head and neck region at our institute was 80% with 50% achieving a CR. This realworld data demonstrates promising results and suggests T-VEC can be an alternative to systemic therapy in this select, mostly elderly patient population.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Bart A van de Wiel
- Pathology at the Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | | | | | - Alexander C J van Akkooi
- Department of Surgical Oncology/ Faculty Member Melanoma Institute Australia, The Poche Centre, Cammeraygal Land, Wollstonecraft, Australia
| |
Collapse
|
5
|
Andrieu C, McNamee N, Larkin AM, Maguire A, Menon R, Mueller-Eisert J, Horgan N, Kennedy S, Gullo G, Crown J, Walsh N. Clinical Impact of Immune Checkpoint Inhibitor (ICI) Response, DNA Damage Repair (DDR) Gene Mutations and Immune-Cell Infiltration in Metastatic Melanoma Subtypes. Med Sci (Basel) 2022; 10:26. [PMID: 35736346 PMCID: PMC9230974 DOI: 10.3390/medsci10020026] [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: 03/08/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022] Open
Abstract
Molecular and histopathological analysis of melanoma subtypes has revealed distinct epidemiological, genetic, and clinical features. However, immunotherapy for advanced metastatic melanoma patients does not differ based on subtype. Response to immune checkpoint inhibitors (ICI) has been shown to vary, therefore, predictive biomarkers are needed in the design of precision treatments. Targeted sequencing and histopathological analysis (CD8 and CD20 immunohistochemistry) were performed on subtypes of metastatic melanoma (cutaneous melanoma (CM, n = 10); head and neck melanoma (HNM, n = 7); uveal melanoma (UM, n = 4); acral lentiginous melanoma (AM, n = 1) and mucosal melanoma (MM, n = 1) treated with ICI). Progression-free survival (PFS) was significantly associated with high CD8 expression (p = 0.025) and mutations in DNA damage repair (DDR) pathway genes (p = 0.012) in all subtypes but not with CD20 expression. Our study identified that immune cell infiltration and DDR gene mutations may have an impact in response to ICI treatment in metastatic melanoma but differs among subtypes. Therefore, a comprehensive understanding of the immune infiltration cells' role and DDR gene mutations in metastatic melanoma may identify prognostic biomarkers.
Collapse
Affiliation(s)
- Charlotte Andrieu
- National Institute for Cellular Biotechnology, School of Biotechnology, Dublin City University, Glasnevin, D09 E432 Dublin, Ireland; (C.A.); (N.M.); (A.-M.L.); (A.M.)
| | - Niamh McNamee
- National Institute for Cellular Biotechnology, School of Biotechnology, Dublin City University, Glasnevin, D09 E432 Dublin, Ireland; (C.A.); (N.M.); (A.-M.L.); (A.M.)
| | - Anne-Marie Larkin
- National Institute for Cellular Biotechnology, School of Biotechnology, Dublin City University, Glasnevin, D09 E432 Dublin, Ireland; (C.A.); (N.M.); (A.-M.L.); (A.M.)
- Department of Life Sciences, Institute of Technology Sligo, F91 YW50 Sligo, Ireland
| | - Alanna Maguire
- National Institute for Cellular Biotechnology, School of Biotechnology, Dublin City University, Glasnevin, D09 E432 Dublin, Ireland; (C.A.); (N.M.); (A.-M.L.); (A.M.)
| | - Roopika Menon
- Siemens Healthcare Diagnostics Products GmbH, 50667 Cologne, Germany; (R.M.); (J.M.-E.)
| | - Judith Mueller-Eisert
- Siemens Healthcare Diagnostics Products GmbH, 50667 Cologne, Germany; (R.M.); (J.M.-E.)
| | - Noel Horgan
- Royal Victoria Eye and Ear Hospital, Adelaide Road, D02 XK51 Dublin, Ireland; (N.H.); (S.K.)
| | - Susan Kennedy
- Royal Victoria Eye and Ear Hospital, Adelaide Road, D02 XK51 Dublin, Ireland; (N.H.); (S.K.)
| | - Giuseppe Gullo
- Department of Medical Oncology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (G.G.); (J.C.)
| | - John Crown
- Department of Medical Oncology, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland; (G.G.); (J.C.)
| | - Naomi Walsh
- National Institute for Cellular Biotechnology, School of Biotechnology, Dublin City University, Glasnevin, D09 E432 Dublin, Ireland; (C.A.); (N.M.); (A.-M.L.); (A.M.)
| |
Collapse
|
6
|
Cabrera CI, Li S, Conic R, Gastman BR. The National Cancer Database: Survival Between Head and Neck Melanoma and Melanoma of Other Regions. Otolaryngol Head Neck Surg 2021; 167:286-297. [PMID: 34699278 DOI: 10.1177/01945998211053204] [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: 11/16/2022]
Abstract
OBJECTIVE Primary site is considered an important prognostic factor for cutaneous malignant melanoma (CMM); however, opinions vary regarding its influence on survival. This study compares overall survival between head and neck melanoma (HNM) and melanoma of other regions (MOR), as well as between melanoma of the scalp and neck (MSN) and melanoma of other head regions (MOHR). STUDY DESIGN Level III retrospective cohort study. SETTING Patients from Commission on Cancer-accredited cancer programs affiliated to the National Cancer Database (NCDB). METHODS Patients with HNM (MSN and MOHR included) and MOR, stages I to IV (n = 39,754), and their linked survival data using the NCDB were identified. Survival was analyzed using propensity score matching methods. RESULTS After matching using propensity scores, allowing this observational study to mimic a randomized controlled trial, subjects with HNM showed a 22% increased mortality when compared to MOR (P < .01). Among those with HNM, hazard was not proportional over time. Overall, subjects with MSN in the first 3.5 years of follow-up (75% of subjects) showed a 15% increased mortality when compared to MOHR (P < .01); however, after 3.5 years, no difference in survival was noted (P = .5). CONCLUSION Patients with HNM showed a higher mortality when compared to MOR. The risk of death of primary sites within the head and neck varies over time, showing a higher risk of mortality for scalp and neck during the first 3.5 years of follow-up. This increased risk was not evident after the 3.5-year threshold. Further research is needed to evaluate additional patient factors or differences in treatment approaches.
Collapse
Affiliation(s)
- Claudia I Cabrera
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Shawn Li
- Department of Otolaryngology-Head & Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Rosalynn Conic
- University of Maryland Medical Center, Department of Surgery, Baltimore, Maryland, USA
| | - Brian R Gastman
- Department of Dermatology and Plastic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
7
|
Gulliver W, Gulliver S, Power RJ, Penney M, Lane D. The Incidence of Cutaneous Malignant Melanoma in Eastern Newfoundland and Labrador, Canada, from 2007 to 2015. Dermatology 2021; 238:527-533. [PMID: 34610598 DOI: 10.1159/000519193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The incidence of cutaneous malignant melanoma continues to increase worldwide and in Canada. It is unclear whether the increase in incidence and clinical characteristic trends of cutaneous malignant melanoma are similar in the province of Newfoundland and Labrador. OBJECTIVE The objective of this study is to examine the incidence and trends of cutaneous malignant melanoma in Eastern Newfoundland and Labrador. METHODS Patients aged 18 years or older diagnosed with cutaneous malignant melanoma were identified from the Eastern Health Authority's Cancer Registry. The diagnosis was confirmed by a pathologist via histological subtype. Patients were excluded if the diagnosis was unspecified, a nonmelanoma skin cancer or if there was a recurrence in the same lesion location. In total 298 patients diagnosed with cutaneous malignant melanoma from 2007 to 2015 were included in the analysis. RESULTS The total incidence increased from 4.1 to 15.6 cases/100,000 person-years, which represents a 283.0% increase from 2007 to 2015. The largest increases in incidence were seen in males and patients aged from 60 to 79 years. The most common lesion anatomical locations were the trunk in males and the lower extremity in females. The majority of cases had a Breslow thickness below 1.0 mm. CONCLUSION The incidence of cutaneous malignant melanoma in Eastern Newfoundland and Labrador is increasing at a faster rate than in any other region in Canada. Health care providers should work to be aware of the clinical trends and risk factors associated with this disease to facilitate early detection and prevent morbidity.
Collapse
Affiliation(s)
- Wayne Gulliver
- Department of Dermatology, Discipline of Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
- Newlab Clinical Research Inc., St. John's, Newfoundland, Canada
| | | | - Rebecca J Power
- Newlab Clinical Research Inc., St. John's, Newfoundland, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - Michelle Penney
- Newlab Clinical Research Inc., St. John's, Newfoundland, Canada
| | - David Lane
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| |
Collapse
|
8
|
Wood RP, Heyworth JS, McCarthy NS, Mauguen A, Berwick M, Thomas NE, Millward MJ, Anton-Culver H, Cust AE, Dwyer T, Gallagher RP, Gruber SB, Kanetsky PA, Orlow I, Rosso S, Moses EK, Begg CB, Ward SV. Association of Known Melanoma Risk Factors with Primary Melanoma of the Scalp and Neck. Cancer Epidemiol Biomarkers Prev 2020; 29:2203-2210. [PMID: 32856602 DOI: 10.1158/1055-9965.epi-20-0595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/02/2020] [Accepted: 08/14/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Scalp and neck (SN) melanoma confers a worse prognosis than melanoma of other sites but little is known about its determinants. We aimed to identify associations between SN melanoma and known risk genes, phenotypic traits, and sun exposure patterns. METHODS Participants were cases from the Western Australian Melanoma Health Study (n = 1,200) and the Genes, Environment, and Melanoma Study (n = 3,280). Associations between risk factors and SN melanoma, compared with truncal and arm/leg melanoma, were investigated using binomial logistic regression. Facial melanoma was also compared with the trunk and extremities, to evaluate whether associations were subregion specific, or reflective of the whole head/neck region. RESULTS Compared with other sites, increased odds of SN and facial melanoma were observed in older individuals [SN: OR = 1.28, 95% confidence interval (CI) = 0.92-1.80, P trend = 0.016; Face: OR = 4.57, 95% CI = 3.34-6.35, P trend < 0.001] and those carrying IRF4-rs12203592*T (SN: OR = 1.35, 95% CI = 1.12-1.63, P trend = 0.002; Face: OR = 1.29, 95% CI = 1.10-1.50, P trend = 0.001). Decreased odds were observed for females (SN: OR = 0.49, 95% CI = 0.37-0.64, P < 0.001; Face: OR = 0.66, 95% CI = 0.53-0.82, P < 0.001) and the presence of nevi (SN: OR = 0.66, 95% CI = 0.49-0.89, P = 0.006; Face: OR = 0.65, 95% CI = 0.52-0.83, P < 0.001). CONCLUSIONS Differences observed between SN melanoma and other sites were also observed for facial melanoma. Factors previously associated with the broader head and neck region, notably older age, may be driven by the facial subregion. A novel finding was the association of IRF4-rs12203592 with both SN and facial melanoma. IMPACT Understanding the epidemiology of site-specific melanoma will enable tailored strategies for risk factor reduction and site-specific screening campaigns.
Collapse
Affiliation(s)
- Renee P Wood
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Jane S Heyworth
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Nina S McCarthy
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Audrey Mauguen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marianne Berwick
- Department of Internal Medicine, University of New Mexico Cancer Center, University of New Mexico, Albuquerque, New Mexico
| | - Nancy E Thomas
- Department of Dermatology, School of Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Michael J Millward
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Hoda Anton-Culver
- Department of Medicine, University of California, Irvine, California
| | - Anne E Cust
- Sydney School of Public Health and The Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
| | - Terence Dwyer
- George Institute for Global Health Research, University of Oxford, Oxford, United Kingdom
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Richard P Gallagher
- British Columbia Cancer Research Centre and Department of Dermatology and Skin Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen B Gruber
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, California
| | - Peter A Kanetsky
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Irene Orlow
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Eric K Moses
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Colin B Begg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarah V Ward
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
9
|
Pyle MP, Hoa M. Applications of single-cell sequencing for the field of otolaryngology: A contemporary review. Laryngoscope Investig Otolaryngol 2020; 5:404-431. [PMID: 32596483 PMCID: PMC7314468 DOI: 10.1002/lio2.388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 04/02/2020] [Accepted: 04/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Single-cell RNA sequencing (scRNA-Seq) is a new technique used to interrogate the transcriptome of individual cells within native tissues that have already resulted in key discoveries in auditory basic science research. Rapid advances in scRNA-Seq make it likely that it will soon be translated into clinical medicine. The goal of this review is to inspire the use of scRNA-Seq in otolaryngology by giving examples of how it can be applied to patient samples and how this information can be used clinically. METHODS Studies were selected based on the scientific quality and relevance to scRNA-Seq. In addition to mouse auditory system (inner ear including hair cells and supporting cells, spiral ganglion neurons, and inner ear organoids), recent studies using human primary cell samples are discussed. We also perform our own analysis on publicly available, published scRNA-Seq data from oral head and neck squamous cell carcinoma (HNSCC) samples to serve as an example of a clinically relevant application of scRNA-Seq. RESULTS Studies focusing on patient tissues show that scRNA-Seq reveals tissue heterogeneity and rare-cell types responsible for disease pathogenesis. The heterogeneity detected by scRNA-Seq can result in both the identification of known or novel disease biomarkers and drug targets. Our analysis of HNSCC data gives an example for how otolaryngologists can use scRNA-Seq for clinical use. CONCLUSIONS Although there are limitations to the translation of scRNA-Seq to the clinic, we show that its use in otolaryngology can give physicians insight into the tissue heterogeneity within their patient's diseased tissue giving them information on disease pathogenesis, novel disease biomarkers or druggable targets, and aid in selecting patient-specific drug cocktails.
Collapse
Affiliation(s)
- Madeline P. Pyle
- Division of Intramural Research, Section on Auditory Development and Restoration, National Institute on Deafness and Other Communication Disorders (NIDCD) Otolaryngology Surgeon‐Scientist ProgramNational Institutes of HealthBethesdaMarylandUSA
| | - Michael Hoa
- Division of Intramural Research, Section on Auditory Development and Restoration, National Institute on Deafness and Other Communication Disorders (NIDCD) Otolaryngology Surgeon‐Scientist ProgramNational Institutes of HealthBethesdaMarylandUSA
| |
Collapse
|
10
|
Ramachandran V, Loya A, Phan K. Association of Gender with Survival in Melanoma In Situ of the Head and Neck: A National Database Study. Cureus 2020; 12:e6924. [PMID: 32190477 PMCID: PMC7064266 DOI: 10.7759/cureus.6924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction While prior studies have addressed the gender-specific survival of malignant melanoma, such investigation is lacking for melanoma in situ (MIS) and for the sun-exposed head and neck areas. Understanding the role of patient characteristics on disease prognosis is essential in determining optimal patient treatment and follow-up. We conducted a retrospective cohort study of patients diagnosed with MIS of the head and neck to assess the association of gender with long-term survival. Methods First primary cases of MIS diagnosed between 1998 and 2015 were extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis adjusting for demographic, tumor, and treatment characteristics was used to evaluate all-cause and cancer-specific mortality risks. Results After adjusting for demographic, tumor, and treatment data, males demonstrated significantly poorer overall survival (hazard ratio [HR] 1.484; 95% confidence interval [CI] 1.332, 1.653; P<0.001) and cancer-specific survival (HR 1.571; 95% CI 1.056, 2.338; P=0.026) compared to their female counterparts. Conclusion Proposed reasons for these findings include gender-based hormonal influence on cancer growth and development, gender-specific health utilization behaviors, and gender-based cosmetic impact of cutaneous malignancies. These findings do have limitations, including its retrospective nature, possible upgrading of MIS diagnoses during the study period, miscoding, and inability to account of lifestyle/modifiable/environmental risk factors. Nevertheless, it suggests a gender-specific survival difference, which may be further investigated and considered as part of clinician awareness, influence patient counseling, and screening for such patients.
Collapse
Affiliation(s)
| | - Asad Loya
- Medicine, Baylor College of Medicine, Houston, USA
| | - Kevin Phan
- Dermatology, Liverpool Hospital, Sydney, AUS
| |
Collapse
|
11
|
Evaluation of residual tumors and recurrence rates of malignant melanoma and non-melanoma skin cancer of head and neck region. MARMARA MEDICAL JOURNAL 2019. [DOI: 10.5472/marumj.637558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
12
|
Heenatigala Palliyage G, Singh S, Ashby CR, Tiwari AK, Chauhan H. Pharmaceutical Topical Delivery of Poorly Soluble Polyphenols: Potential Role in Prevention and Treatment of Melanoma. AAPS PharmSciTech 2019; 20:250. [PMID: 31297635 DOI: 10.1208/s12249-019-1457-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 06/06/2019] [Indexed: 01/10/2023] Open
Abstract
Melanoma is regarded as the fifth and sixth most common cancer in men and women, respectively, and it is estimated that one person dies from melanoma every hour in the USA. Unfortunately, the treatment of melanoma is difficult because of its aggressive metastasis and resistance to treatment. The treatment of melanoma continues to be a challenging issue due to the limitations of available treatments such as a low response rate, severe adverse reactions, and significant toxicity. Natural polyphenols have attracted considerable attention from the scientific community due to their chemopreventive and chemotherapeutic efficacy. It has been suggested that poorly soluble polyphenols such as curcumin, resveratrol, quercetin, coumarin, and epigallocatechin-3-gallate may have significant benefits in the treatment of melanoma due to their antioxidant, anti-inflammatory, antiproliferative, and chemoprotective efficacies. The major obstacles for the use of polyphenolic compounds are low stability and poor bioavailability. Numerous nanoformulations, including solid lipid nanoparticles, polymeric nanoparticles, micelles, and liposomes, have been formulated to enhance the bioavailability and stability, as well as the therapeutic efficacy of polyphenols. This review will provide an overview of poorly soluble polyphenols that have been reported to have antimetastatic efficacy in melanomas.
Collapse
|
13
|
Pfau D, Tamaki A, Hoppe KR, Honda K, Rezaee R, Zender CA. Sentinel Node Biopsy in Young Patients with Atypical Melanocytic Tumors of the Head and Neck. OTO Open 2019; 3:2473974X19850752. [PMID: 31428727 PMCID: PMC6684149 DOI: 10.1177/2473974x19850752] [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: 02/25/2019] [Revised: 03/19/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
Objective To examine the diagnostic value of the sentinel lymph node biopsy in pediatric through young adult head and neck melanocytic tumors of unknown malignant potential. Study Design Retrospective case series. Setting Single academic institution. Subjects and Methods Demographics, histology, and outcomes were examined in 14 patients aged 4 to 24 years with head and neck melanocytic tumors of unknown malignant potential. Information on age at diagnosis, primary lesion characteristics, and sentinel lymph node biopsy were compared. Results Of 14 patients meeting criteria for head and neck melanocytic tumors of unknown malignant potential, 8 patients underwent sentinel lymph node biopsy (57%). Of those, 4 biopsies (50%) had positive sentinel nodes. All patients undergoing sentinel lymph node biopsy had primary lesions greater than 1 mm depth or mitotic rate of at least 1 mitosis per mm2. No patients had recurrence of their primary lesion at time of follow-up. Conclusion Our data show a high rate of node-positive sentinel lymph node biopsy for pediatric and young adult head and neck patients with melanocytic tumors of unknown malignant potential, supporting the value of sentinel lymph node biopsy in this population.
Collapse
Affiliation(s)
- David Pfau
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Akina Tamaki
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kathryn R Hoppe
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kord Honda
- Department of Dermatology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rod Rezaee
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Chad A Zender
- Ear, Nose, and Throat Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| |
Collapse
|
14
|
Nichita L, Zurac S, Bastian A, Stinga P, Nedelcu R, Brinzea A, Turcu G, Ion D, Jilaveanu L, Sticlaru L, Popp C, Cioplea M. Comparative analysis of CEACAM1 expression in thin melanomas with and without regression. Oncol Lett 2019; 17:4149-4154. [PMID: 30944609 PMCID: PMC6444332 DOI: 10.3892/ol.2019.10067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022] Open
Abstract
Carcinoembryonic antigen-related cell adhesion molecule 1 (CEACAM1) is a key molecule in several intracellular and intercellular signaling pathways, with multiple functional and structural roles. CEACAM1 expression in melanoma is often described in the invading part of the tumor and has been associated with increased melanoma cells invasion and migration. We studied CEACAM1 expression in regressing versus non-regressing thin melanomas, knowing that phenomenon of regression represents a valuable model for understanding tumor immunity. In melanoma, through homophilic interactions, CEACAM1 inhibits natural killer cell activity, inhibits effector functions of tumor infiltrating lymphocytes, such as cytotoxicity and interferon-γ release. We present a retrospective study including 53 consecutive cases of thin melanoma, 21 with regression and 32 without regression. Comparative analysis of CEACAM1 expression in regressed and non-regressed areas from melanomas with regression and in non-regressed melanomas was performed. We used three different clones of CEACAM1: AA 1-428, extracellular domain, rabbit; AA 1-428, mouse, clone 8B6E2F4; and AA 1-468, full length, mouse, clone 2F6. All three clones had similar reactivity. We identified membrane positivity of tumor cells in non-regressed melanomas and in non-regressed areas in melanomas with regression. Remaining tumor cells in regressed areas were mostly negative for CEACAM1. In non-regressed lesions, there was a stronger positivity of CEACAM1 in the deep invasive front. In thin melanomas, CEACAM1 overexpression is related with invasiveness, suggesting that CEACAM1-positive melanomas are more aggressive. Also, in areas of regression tumor cells lose CEACAM1 expression, probably correlated with the presence of natural killer cells.
Collapse
Affiliation(s)
- Luciana Nichita
- Department of Pathology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 010221 Bucharest, Romania.,Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Sabina Zurac
- Department of Pathology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 010221 Bucharest, Romania.,Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Alexandra Bastian
- Department of Pathology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 010221 Bucharest, Romania.,Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Patricia Stinga
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Roxana Nedelcu
- Department of Physiopathology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Alice Brinzea
- Department of Physiopathology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gabriela Turcu
- Department of Physiopathology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Dermatology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Daniela Ion
- Department of Physiopathology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Lucia Jilaveanu
- Department of Medicine, Section of Medical Oncology, Yale University School of Medicine, New Haven, CT 208028, USA
| | - Liana Sticlaru
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Cristiana Popp
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| | - Mirela Cioplea
- Department of Pathology, Colentina University Hospital, 020125 Bucharest, Romania
| |
Collapse
|
15
|
The rule of 10s versus the rule of 2s: High complication rates after conventional excision with postoperative margin assessment of specialty site versus trunk and proximal extremity melanomas. J Am Acad Dermatol 2018; 85:442-452. [PMID: 30447316 DOI: 10.1016/j.jaad.2018.11.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/25/2018] [Accepted: 11/03/2018] [Indexed: 01/01/2023]
Abstract
Specialty site melanomas on the head and neck, hands and feet, genitalia, and pretibial leg have higher rates of surgical complications after conventional excision with postoperative margin assessment (CE-POMA) compared with trunk and proximal extremity melanomas. The rule of 10s describes complication rates after CE-POMA of specialty site melanomas: ∼10% risk for upstaging, ∼10% risk for positive excision margins, ∼10% risk for local recurrence, and ∼10-fold increased likelihood of reconstruction with a flap or graft. Trunk and proximal extremity melanomas encounter these complications at a lower rate, according to the rule of 2s. Mohs micrographic surgery (MMS) with frozen section melanocytic immunostains (MMS-I) and slow Mohs with paraffin sections decrease complications of surgery of specialty site melanomas by detecting upstaging and confirming complete tumor removal with comprehensive microscopic margin assessment before reconstruction. This article reviews information important for counseling melanoma patients about surgical treatment options and for developing consensus guidelines with clear indications for MMS-I or slow Mohs.
Collapse
|
16
|
Ozao-Choy J, Nelson DW, Hiles J, Stern S, Yoon JL, Sim MS, Faries MB. The prognostic importance of scalp location in primary head and neck melanoma. J Surg Oncol 2017; 116:337-343. [PMID: 28543136 PMCID: PMC5533640 DOI: 10.1002/jso.24679] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 04/17/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES For patients with cutaneous melanoma, primary tumors located in the head and neck is associated with poor outcomes. The reason for this difference and whether it is applicable to all locations within the head and neck remains unclear. We hypothesized that scalp melanoma is uniquely distinguished from other anatomic sites and is independently responsible for the poor prognosis of head and neck melanoma. METHODS Query and analysis of a prospectively maintained melanoma database of all patients treated for primary cutaneous melanoma from 1971 to 2010. RESULTS Of 11 384 patients identified, 7% (n = 799) of lesions originated on the scalp. Scalp primaries were more often found in males and were associated with increased Breslow thickness and were more frequently ulcerated compared to all other anatomic sites (P = 0.0001). On multivariate analysis, scalp location was an independent predictor of worse melanoma-specific (HR 1.75; CI 1.50-2.04; P < 0.0001) and overall survival (HR 1.62; CI 1.41-1.86; P < 0.0001). CONCLUSIONS This, the largest series examining scalp melanoma, confirms that scalp location is independently responsible for the negative prognosis associated with head and neck melanoma. Although the pathophysiology of this difference remains to be determined, these data argue for more rigorous surveillance of this anatomic location.
Collapse
Affiliation(s)
- Junko Ozao-Choy
- John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA
| | - Daniel W. Nelson
- John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA
| | - Jason Hiles
- John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA
| | - Stacey Stern
- John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA
| | - Jeong Lim Yoon
- John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA
| | - Myung Shin Sim
- University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Mark B. Faries
- John Wayne Cancer Institute at Providence Saint John’s Health Center, Santa Monica, CA
| |
Collapse
|
17
|
|
18
|
Kılıç S, Unsal AA, Chung SY, Samarrai R, Kılıç SS, Baredes S, Eloy JA. Geographic region: Does it matter in cutaneous melanoma of the head and neck? Laryngoscope 2017; 127:2763-2769. [PMID: 28581118 DOI: 10.1002/lary.26663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS The head and neck are two of the most common locations for cutaneous melanoma. We present the first population-based analysis of geographic differences in anatomic subsite, clinicopathologic and demographical traits, histopathologic subtype, treatment modality, and disease-specific survival (DSS) of cutaneous head and neck melanoma (CHNM). STUDY DESIGN Retrospective database analysis. METHODS The Surveillance, Epidemiology, and End Results database was queried for cases of CHNM reported between 2000 and 2013. Patients were grouped into East, Midwest, South, and West regions of the United States. Overall incidence, demographic traits, primary tumor site, clinicopathologic traits, histopathologic subtype, treatment modality, and DSS were compared among regions. RESULTS There were 49,365 patients with CHNM identified. The West (4.60) and the South (4.42) had significantly higher incidence (per 100,000) than the East (3.84) and Midwest (3.65) (P < .05). DSS was significantly different among regions (P < .0066). The East (5 years: 89.4%, 10 years: 84.1%) had the highest DSS rate, and the South (5 years: 87.0%, 10 years: 81.8%) had the lowest DSS rate. The Midwest (5 years: 88.4%, 10 years: 84.3%) and West (5 years: 88.3%, 10 years: 83.5%) had intermediate DSS. On multivariate analysis, the South had an elevated hazard ratio (1.17, 95% confidence interval: 1.05-1.30) when compared to the West. CONCLUSIONS Geographic region may play a significant role in CHNM. Incidence is higher in the South and the West. Incidence, histologic subtype, treatment modality, and DSS vary among regions. DSS is lower in the South than the West, even after accounting for other major prognostic factors. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2763-2769, 2017.
Collapse
Affiliation(s)
- Suat Kılıç
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Aykut A Unsal
- Department of Otolaryngology and Facial Plastic Surgery, Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Sei Y Chung
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Ruwaa Samarrai
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Sarah S Kılıç
- Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| |
Collapse
|
19
|
Silverman N, Shinder R. What's New in Eyelid Tumors. Asia Pac J Ophthalmol (Phila) 2017; 6:143-152. [PMID: 28399340 DOI: 10.22608/apo.201701] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/03/2017] [Indexed: 11/08/2022] Open
Abstract
Eyelid malignancies represent between 5% and 10% of all skin cancers. Basal cell carcinoma is the most common, followed by squamous cell carcinoma, sebaceous cell carcinoma, Merkel cell carcinoma, and melanoma. The gold standard treatment for periocular epithelial malignancies is surgical excision. Given the constraints of the anatomy and function of the eyelids, excision with negative margins and reconstruction can be challenging. In cases of significant tissue invasion or metastasis, complete tumor removal may not be possible. This review examines the management of periocular skin cancer from diagnosis and staging, including the role of sentinel lymph node biopsy, to both surgical and nonsurgical treatment. The development of targeted drug therapy against specific genetic mutations in cutaneous malignancies has allowed for the treatment of specific cancer cells with less systemic toxicity than more traditional treatments.
Collapse
Affiliation(s)
- Nora Silverman
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Roman Shinder
- Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY
| |
Collapse
|
20
|
Pham Dang N, Cassier S, Mulliez A, Mansard S, DʼIncan M, Barthélémy I. Eight Years' Experience of Sentinel Lymph Node Biopsy in Melanoma Using Lymphoscintigraphy and Gamma Probe Detection After Radiocolloid Mapping. Dermatol Surg 2017; 43:287-292. [PMID: 27893540 DOI: 10.1097/dss.0000000000000961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Isosulfan blue dye peripheral injection is used in preoperative sentinel lymph node (SLN) identification alone or, to increase sensitivity, in conjunction with radiocolloid mapping. However, isosulfan blue dye has certain drawbacks and limitations. OBJECTIVE This study assesses the authors' experience of SLN biopsy using only radiocolloid tracer. MATERIALS AND METHODS Between 2000 and 2008, 218 patients underwent SLN biopsy with radiocolloid mapping, preoperative localization by lymphoscintigraphy and intraoperative confirmation by gamma probe in primary malignant cutaneous melanoma. RESULTS Mean Breslow index was 2.1 mm. The SLN biopsy success rate was above 98% at all sites and 87% in head and neck locations. The 5-year overall survival rate was 90% and that of 5-year disease-free survival was 80%. False-negative rate, with a mean follow-up time of 41 months, was 5.5%. CONCLUSION Sentinel lymph node biopsy can be successfully performed in patients with melanoma using only radiocolloid tracer without blue dye staining. In circumstances where blue dye cannot be used such as head and neck tumors, allergic reactions and pregnancy, radiocolloid tracer mapping alone is not a loss of chance for patients with melanoma.
Collapse
Affiliation(s)
- Nathalie Pham Dang
- *Department of Oral and Maxillofacial Surgery, NHE-CHU de Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France; †UMR Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, France; ‡Department of Biostatistics, DRCI-CHU de Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France; §Department of Dermatology, NHE-CHU de Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | | | | | | | | | | |
Collapse
|
21
|
Kadakia S, Chan D, Mourad M, Ducic Y. The Prognostic Value of Age, Sex, and Subsite in Cutaneous Head and Neck Melanoma: A Clinical Review of Recent Literature. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e5079. [PMID: 27703647 PMCID: PMC5038835 DOI: 10.17795/ijcp-5079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/21/2016] [Accepted: 06/05/2016] [Indexed: 12/29/2022]
Abstract
Context Cutaneous head and neck melanoma is a challenging disease owing to its aggressive nature and often times advanced stage at presentation. Age, sex, and subsite are three prognostic indicators which can be determined prior to treatment or testing, and can allow the practitioner to counsel the patient before initiating therapy. Evidence Acquisition A PubMed search was conducted utilizing various terms relating to the subject matter. Articles over the past 25 years were analyzed and appropriately selected for review. Results It appears that patients older than 65 have a decreased overall 5 year survival compared to their younger counterparts. Male patients have poorer prognosis compared to female patients as noted by the decreased overall survival, decreased disease specific survival, and shorter time to distant metastasis. Scalp subsite was most uniformly accepted as having the worst prognosis in the head and neck, and may even serve as an independent prognostic indicator. Conclusions Advanced age, male sex, and scalp subsite all portend poor prognosis in patients with cutaneous head and neck melanoma.
Collapse
Affiliation(s)
- Sameep Kadakia
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - David Chan
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery Associates, Dallas-Fort Worth, Texas
| | - Moustafa Mourad
- Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
| | - Yadranko Ducic
- Department of Otolaryngology-Head and Neck Surgery, Facial Plastic Surgery Associates, Dallas-Fort Worth, Texas
| |
Collapse
|
22
|
Costa Svedman F, Spanopoulos D, Taylor A, Amelio J, Hansson J. Surgical outcomes in patients with cutaneous malignant melanoma in Europe - a systematic literature review. J Eur Acad Dermatol Venereol 2016; 31:603-615. [DOI: 10.1111/jdv.13950] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/11/2016] [Indexed: 02/03/2023]
Affiliation(s)
- F. Costa Svedman
- Karolinska Institutet; Karolinska University Hospital Solna; Stockholm Sweden
| | - D. Spanopoulos
- Centre for Observational Research; Amgen Ltd; Uxbridge UK
| | - A. Taylor
- Centre for Observational Research; Amgen Ltd; Uxbridge UK
| | - J. Amelio
- Centre for Observational Research; Amgen Ltd; Uxbridge UK
| | - J. Hansson
- Karolinska Institutet; Karolinska University Hospital Solna; Stockholm Sweden
| |
Collapse
|
23
|
Andtbacka RHI, Agarwala SS, Ollila DW, Hallmeyer S, Milhem M, Amatruda T, Nemunaitis JJ, Harrington KJ, Chen L, Shilkrut M, Ross M, Kaufman HL. Cutaneous head and neck melanoma in OPTiM, a randomized phase 3 trial of talimogene laherparepvec versus granulocyte-macrophage colony-stimulating factor for the treatment of unresected stage IIIB/IIIC/IV melanoma. Head Neck 2016; 38:1752-1758. [PMID: 27407058 PMCID: PMC5129499 DOI: 10.1002/hed.24522] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/14/2016] [Accepted: 05/16/2016] [Indexed: 12/19/2022] Open
Abstract
Background Cutaneous head and neck melanoma has poor outcomes and limited treatment options. In OPTiM, a phase 3 study in patients with unresectable stage IIIB/IIIC/IV melanoma, intralesional administration of the oncolytic virus talimogene laherparepvec improved durable response rate (DRR; continuous response ≥6 months) compared with subcutaneous granulocyte‐macrophage colony‐stimulating factor (GM‐CSF). Methods Retrospective review of OPTiM identified patients with cutaneous head and neck melanoma given talimogene laherparepvec (n = 61) or GM‐CSF (n = 26). Outcomes were compared between talimogene laherparepvec and GM‐CSF treated patients with cutaneous head and neck melanoma. Results DRR was higher for talimogene laherparepvec–treated patients than for GM‐CSF treated patients (36.1% vs 3.8%; p = .001). A total of 29.5% of patients had a complete response with talimogene laherparepvec versus 0% with GM‐CSF. Among talimogene laherparepvec–treated patients with a response, the probability of still being in response after 12 months was 73%. Median overall survival (OS) was 25.2 months for GM‐CSF and had not been reached with talimogene laherparepvec. Conclusion Treatment with talimogene laherparepvec was associated with improved response and survival compared with GM‐CSF in patients with cutaneous head and neck melanoma. © 2016 Wiley Periodicals, Inc. Head Neck38: 1752–1758, 2016
Collapse
Affiliation(s)
| | - Sanjiv S Agarwala
- St. Luke's University Hospital and Temple University, Philadelphia, Pennsylvania
| | - David W Ollila
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | | | | | - Lisa Chen
- Amgen, Inc, Thousand Oaks, California
| | | | - Merrick Ross
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | |
Collapse
|
24
|
Akman T, Oztop I, Unek IT, Koca D, Unal OU, Salman T, Yavuzsen T, Yilmaz AU, Somali I, Demir N, Ellidokuz H. Long-term outcomes and prognostic factors of high-risk malignant melanoma patients after surgery and adjuvant high-dose interferon treatment: a single-center experience. Chemotherapy 2015; 60:228-38. [PMID: 25870939 DOI: 10.1159/000371838] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical excision constitutes an important part of the treatment of local advanced malignant melanoma. Due to the high recurrence risk, adjuvant high-dose interferon therapy is still the only therapy used in stage IIB and III high-risk melanoma patients. METHODS One hundred two high-risk malignant melanoma patients who received high-dose interferon-α-2b therapy were evaluated retrospectively. The clinicopathological features, survival times, and prognostic factors of the patients were determined. RESULTS The median disease-free and overall survival times were 25.2 and 60.8 months, respectively. Our findings revealed that male gender, advanced disease stage, lymph node involvement, lymphatic invasion, the presence of ulceration, and a high Clark level were significant negative prognostic factors. CONCLUSION In light of the favorable survival results obtained in this study, high-dose interferon treatment as adjuvant therapy for high-risk melanoma is still an efficient treatment and its possible side effects can be prevented by taking the necessary precautions.
Collapse
Affiliation(s)
- Tulay Akman
- Division of Medical Oncology, Tepecik Education and Research Hospital, Izmir, Turkey
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Metastases to the spleen are rare and are generally part of a multi-visceral metastatic disease. The most common sources of splenic metastases include breast, lung and colorectal malignancies as well as melanoma and ovarian carcinoma. Solitary splenic metastasis is very uncommon. We present a case of a 44-year-old man who presented at our department for gallstones symptoms. He had a past medical history of neck cutaneous melanoma (T3bN0M0--Stage IIb). He had not attended follow-up schedule for personal reasons. However, abdominal ultrasound revealed the presence of a solitary solid lesion in the spleen. Preoperative workup was completed with CT scan that confirmed the presence of a large splenic lesion with subcapsular fluid collection, also compatible with a post-traumatic lesion.Preoperative findings could not exclude malignancy and patient was therefore submitted to surgery. At laparoscopy, a condition of peritoneal melanosis was present. Splenectomy was carried out. Histological report confirmed the peritoneal melanosis and the diagnosis of metastatic spleen lesion from melanoma. Patient was observed, but died of metastatic disease 14 months after surgery. Splenic metastases are uncommon. Isolated metastases from melanoma are rare and could be found several months after primary diagnosis of melanoma. Surgery remains the most effective treatment, especially for metachronous disease, offering the best chance of long-term survival. Prognosis remains poor, as metachronous disease is indicative of aggressive widespread of the disease.
Collapse
Affiliation(s)
- Isabella Reccia
- From the Department of Surgery, Clinica Chirurgica, University of Cagliari, Policlinico Universitario di Monserrato, Sestu (CA), Italy (IR, AP, MP, AU)
| | | | | | | |
Collapse
|
26
|
Metastatic melanoma misdiagnosed as a temporomandibular disorder: a case report and review of the literature. J Am Dent Assoc 2014; 145:1052-7. [PMID: 25270704 DOI: 10.14219/jada.2014.63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Malignancies in the head and neck region are difficult to diagnose because of their deep location and presence of symptoms mimicking those of temporomandibular disorders or other orofacial pain disorders. CASE DESCRIPTION A 75-year-old woman reported experiencing right-sided jaw pain, temporal discomfort and paresthesia. She had undergone conservative therapy for temporomandibular joint disorder, which was unsuccessful. A magnetic resonance image of the midface revealed a mass on the base of the tongue along with possible metastatic lesions to the brain. Further investigation of the lesions revealed them to be metastatic melanoma. PRACTICAL IMPLICATIONS Patients with atypical symptoms of facial pain, including neurological signs, should undergo further investigation with advanced imaging to determine the source of the symptoms, which could include neoplasms.
Collapse
|
27
|
|
28
|
|
29
|
GIUDICE G, LEUZZI S, ROBUSTO F, RONGHI V, NACCHIERO E, GIARDINELLI G, DI GIOIA G, RAGUSA L, PASCONE M. Sentinel lymph node biopsy in head and neck melanoma*. G Chir 2014; 35:149-55. [PMID: 24979109 PMCID: PMC4321520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The purpose of this study is to evaluate prognosis and surgical management of head and neck melanoma (HNM) and the accuracy of sentinel lymph node biopsy (SLNB). PATIENTS AND METHODS All patients with a primary cutaneous melanoma treated starting from 01/07/1994 to 31/12/2012 in the department of Plastic and Reconstructive Surgery of Bari are included in a electronic clinical medical registry. Within the 90th day from excision of the primary lesion all patients with adverse prognostic features underwent SLNB. All patients with positive findings underwent lymphadenectomy. RESULTS out of 680 patients affected by melanoma, 84 (12.35%) had HNM. In the HNM cohort lymphoscintigraphy was performed in 57 patients, 15 of which (26.3%) were positive. The percentage of unfound sentinel lymph node was similar both to the HNM group (5,26%) and to patients with melanoma of different sites (OMS 4,92%). There was a recurrence of disease after negative SLNB (false negatives) only in 4 cases. Recurrence-free period and survival rate at 5 years were worse in HNM cohort. CONCLUSION SLNB of HNM has been for a long time contested due to its complex lymphatic anatomy, but recent studies agreed with this technique. Our experience showed that identification of sentinel lymph node in HNM cohort was possible in 98.25% of cases. Frequency of interval nodes is significantly higher in HNM group. The prognosis of HNM cohort is significantly shorter than OMS one. Finally, this procedure requires a multidisciplinary team in referral centers.
Collapse
Affiliation(s)
- G. GIUDICE
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| | - S. LEUZZI
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| | - F. ROBUSTO
- “Fondazione Mario Negri Sud”, Santa Maria Imbaro, Italy
| | - V. RONGHI
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| | - E. NACCHIERO
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| | - G. GIARDINELLI
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| | - G. DI GIOIA
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| | - L. RAGUSA
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| | - M. PASCONE
- Plastic and Reconstructive Surgery Department, University of Bari, Bari, Italy
| |
Collapse
|