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Palacios-Diaz, Rodolfo David, Blanca de Unamuno-Bustos, Carlos Abril-Pérez, et al. "Multiple Primary Melanomas: Retrospective Review in a Tertiary Care Hospital." Journal of Clinical Medicine 11, no. 9 (2022): 2355. http://dx.doi.org/10.3390/jcm11092355.
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Multiple primary melanomas (MPM) refer to the occurrence of more than one synchronous or metachronous melanoma in the same individual. The aim of this study was to identify the frequency of MPM and describe the clinical and histopathologic characteristics of patients with MPM. An observational single-center retrospective study was designed based on a cohort of melanoma patients followed in a tertiary care hospital. Fifty-eight (8.9%) patients developed MPM. Most patients were men (65.5%) and the median age at the time of diagnosis of the first melanoma was 71 years old. The median time of diagnosis of the second melanoma from the first melanoma was 10.9 months, and 77.6% of second melanomas were diagnosed within the first 5 years. In total, 29 (50%) and 28 (48.3%) first and second melanomas were located in the trunk, respectively. Concordance of anatomic site between primary and subsequent melanoma was found in 46.6% of the patients. Proportion of in situ melanomas was increasingly higher in subsequent melanomas (from 36.21% of first melanomas to 100% of fifth melanomas). An increasing rate of melanomas with histological regression was observed within subsequent melanomas (from 60.3% of first melanomas to 80% of third melanomas). Our results support the importance of careful long-term follow-up with total body examination in melanoma patients.
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Bol, Kalijn Fredrike, Marco Donia, Steffen Heegaard, Jens Folke Kiilgaard, and Inge Marie Svane. "Genetic Biomarkers in Melanoma of the Ocular Region: What the Medical Oncologist Should Know." International Journal of Molecular Sciences 21, no. 15 (2020): 5231. http://dx.doi.org/10.3390/ijms21155231.
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Melanoma of the ocular region (ocular melanoma) comprises about 5% of all patients with melanoma and covers posterior uveal melanoma, iris melanoma, and conjunctival melanoma. The risk of metastasis is much higher in patients with ocular melanoma compared to a primary melanoma of the skin. The subtypes of ocular melanoma have distinct genetic features, which should be taken into consideration when making clinical decisions. Most relevant for current practice is the absence of BRAF mutations in posterior uveal melanoma, although present in some iris melanomas and conjunctival melanomas. In this review, we discuss the genetic biomarkers of the subtypes of ocular melanoma and their impacts on the clinical care of these patients.
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Gellrich, Frank Friedrich, Nadia Eberl, Julian Steininger, Friedegund Meier, Stefan Beissert, and Sarah Hobelsberger. "Comparison of Extended Skin Cancer Screening Using a Three-Step Advanced Imaging Programme vs. Standard-of-Care Examination in a High-Risk Melanoma Patient Cohort." Cancers 16, no. 12 (2024): 2204. http://dx.doi.org/10.3390/cancers16122204.
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Modern diagnostic procedures, such as three-dimensional total body photography (3D-TBP), digital dermoscopy (DD), and reflectance confocal microscopy (RCM), can improve melanoma diagnosis, particularly in high-risk patients. This study assessed the benefits of combining these advanced imaging techniques in a three-step programme in managing high-risk patients. This study included 410 high-risk melanoma patients who underwent a specialised imaging consultation in addition to their regular skin examinations in outpatient care. At each visit, the patients underwent a 3D-TBP, a DD for suspicious findings, and an RCM for unclear DD findings. The histological findings of excisions initiated based on imaging consultation and outpatient care were compared. Imaging consultation detected sixteen confirmed melanomas (eight invasive and eight in situ) in 39 excised pigmented lesions. Outpatient care examination detected seven confirmed melanomas (one invasive and six in situ) in 163 excised melanocytic lesions. The number needed to excise (NNE) in the imaging consultation was significantly lower than that in the outpatient care (2.4 vs. 23.3). The NNE was 2.6 for DD and 2.3 for RCM. DD, 3D-TBP, or RCM detected melanomas that were not detected by the other imaging methods. The three-step imaging programme improves melanoma detection and reduces the number of unnecessary excisions in high-risk patients.
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Truong, Thach-Giao, Kirun Chohan, Angeles Price, et al. "Early case ascertainment and prospective multidisciplinary review for management of new melanoma diagnoses within an integrated healthcare system: The Kaiser Permanente Northern California experience." Journal of Clinical Oncology 37, no. 15_suppl (2019): 6523. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6523.
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6523 Background: Appropriate surgical treatment of early-stage melanoma yields a high cure rate, but this management can be nuanced. In particular, surgical management, including sentinel lymph node biopsy (SLNB), of thin melanoma (≤1.0mm) is not well-defined. Methods: Biopsies with new melanoma diagnoses were identified electronically and manually reviewed. In a community oncology setting, we organized a review panel of physicians specialized in melanoma from dermatology, medical oncology, nuclear medicine, radiation oncology, and surgical subspecialties (oncology, plastics, head and neck). Patients were assigned to care pathways based on NCCN and ASCO guidelines, including guidance on SLNB for thin melanomas with high-risk features like lymphovascular invasion, high mitotic rate, positive deep margin, and ulceration. These recommendations were documented in the chart and communicated directly to the patients care team. Results: From 11/2016 through 10/2018, our multidisciplinary committee reviewed 3626 patients with new melanoma from 22 sites in our integrated, regional hospital system. Median age was 66 (range 19-99); 60% were male. cT2N0 tumors comprised 7%, cT3 3%, and cT4 2%. Thin melanomas ≤1.0mm represented 71% of cases, of which 34% were ≤0.5mm. SLNB was performed in 9.8% of thin melanomas, and 18% were positive, much higher than historical positive rates of 3-4%. Conclusions: Early case ascertainment and prospective multidisciplinary review in a community oncology setting resulted in increased identification of high-risk thin melanoma, and consequently increased identification of nodal disease through SLNB. Positive SLNB triggers important clinical decision-making regarding need for node dissection versus clinical surveillance, and need for adjuvant therapy, which have been shown to improve survival. This clinical practice structure improved risk-stratification and adherence to national guidelines. We plan to further study the impact of these improvements to melanoma care on disease-free survival and overall survival.
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Hilke, Franz J., Tobias Sinnberg, Axel Gschwind, et al. "Distinct Mutation Patterns Reveal Melanoma Subtypes and Influence Immunotherapy Response in Advanced Melanoma Patients." Cancers 12, no. 9 (2020): 2359. http://dx.doi.org/10.3390/cancers12092359.
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The detection of somatic driver mutations by next-generation sequencing (NGS) is becoming increasingly important in the care of advanced melanoma patients. In our study, we evaluated the NGS results of 82 melanoma patients from clinical routine in 2017. Besides determining the tumor mutational burden (TMB) and annotation of all genetic driver alterations, we investigated their potential as a predictor for resistance to immune checkpoint inhibitors (ICI) and as a distinguishing feature between melanoma subtypes. Melanomas of unknown primary had a similar mutation pattern and TMB to cutaneous melanoma, which hints at its cutaneous origin. Besides the typical hotspot mutation in BRAF and NRAS, we frequently observed CDKN2A deletions. Acral and mucosal melanomas were dominated by CNV alterations affecting PDGFRA, KIT, CDK4, RICTOR, CCND2 and CHEK2. Uveal melanoma often had somatic SNVs in GNA11/Q and amplification of MYC in all cases. A significantly higher incidence of BRAF V600 mutations and EGFR amplifications, PTEN and TP53 deletions was found in patients with disease progression while on ICI. Thus, NGS might help to characterize melanoma subtypes more precisely and to identify possible resistance mechanisms to ICI therapy. Nevertheless, NGS based studies, including larger cohorts, are needed to support potential genetic ICI resistance mechanisms.
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Spillane, John B., and Michael A. Henderson. "Improving care for patients with melanoma." ANZ Journal of Surgery 82, no. 1-2 (2012): 3–5. http://dx.doi.org/10.1111/j.1445-2197.2011.05961.x.
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Yamasaki, Alisa, Michael P. Wu, and Kevin S. Emerick. "Outcomes of Cartilage-Sparing Wide Local Excision for Primary Melanoma of the External Ear." OTO Open 4, no. 1 (2020): 2473974X2090312. http://dx.doi.org/10.1177/2473974x20903124.
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Objective To describe outcomes after cartilage-sparing wide local excision for primary melanoma of the external ear. Study Design Retrospective analysis of patients undergoing external ear melanoma excision using a cartilage-sparing approach at a university-based tertiary care center between 2010 and 2018. Setting University-based tertiary care center. Subject and Methods Chart review was performed for all patients over age 18 who were treated for melanoma of the external ear at Massachusetts Eye and Ear between 2010 and 2018. Patients with melanoma in situ or with melanomas in noncartilaginous areas of the ear (eg, lobule) were excluded. Results A total of 8 patients underwent cartilage-sparing excision. Sentinel lymph node biopsy was performed in 7 patients, with positive lymph nodes in 1 of 7 cases. Positive margins and local recurrence occurred in 1 of 8 (12.5%) patients during a mean (SD) follow-up time of 22.5 (15.1) months (SE, 5.3 months). No distant metastasis or death was observed. Conclusion Cartilage-sparing wide local excision for melanoma of the external ear is a surgical approach that enables surgeons to follow guideline-recommended oncologic excision margins but has the added benefit of improved postoperative aesthetic outcomes as well as reconstructive options through preservation of the auricular cartilage framework.
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Halpern, Allan C., and Sanjay K. Mandal. "Role of Dermatologists in Treating Melanoma." Journal of the National Comprehensive Cancer Network 4, no. 7 (2006): 695–702. http://dx.doi.org/10.6004/jnccn.2006.0059.
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Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.
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Varghese, Sruthy, Snigdha Pramanik, Rishika Prasad, et al. "Abstract PR06: The glutaminase inhibitor CB-839 potentiates antimelanoma activity of standard-of-care targeted therapies and immunotherapies." Cancer Research 80, no. 19_Supplement (2020): PR06. http://dx.doi.org/10.1158/1538-7445.mel2019-pr06.
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Abstract Nearly all metastatic melanoma patients who respond to targeted therapies will relapse with the disease within a year. Although more durable responses are seen with immune therapies, about half of the melanoma patients do not respond to them, and a significant number of responders eventually relapse. Most relapsed melanomas also exhibit post-treatment resistance to these treatments. Hence, there is a clear and present need to develop therapeutics that counteract resistance associated with relapse. We and others earlier showed that melanomas with elevated mitochondrial activity possess improved cellular rigor and are intrinsically resistant to the antitumor effects of BRAF and MEK inhibitors. In many other instances, melanomas that initially respond to these inhibitors acquire resistance by elevating mitochondrial activity. Mitochondrial activity is elevated in part by increased cellular uptake of glutamine, and its conversion to alpha-ketoglutarate in the TCA cycle, with glutaminase enzyme playing a rate-limiting role. In this study, we show that BRAFV600E-mutant melanomas with intrinsic or acquired resistance to MAPK pathway inhibitors have lower glucose uptake and increased glutamine uptake compared to those that are sensitive. Treatment of these resistant melanomas with single-agent glutaminase inhibitor, CB-839, moderately inhibited their growth. However, a more robust inhibition of their growth was achieved when CB-839 was combined with BRAF and MEK inhibitors. In addition, CB-839 increased the in vivo activity of tumor-infiltrating lymphocytes (TILs) in a mouse vaccine model and also enhanced the proapoptotic effect of human autologous patient-derived TILs on their cognate melanoma cells. Seahorse bioenergetics stress tests showed that CB-839 inhibited mitochondrial OxPhos in tumor cells to a greater extent than in activated TILs. Additional molecular studies are currently in progress. A recent clinical trial in melanoma patients showed that combination treatment with CB-839 and the immune checkpoint blocker, nivolumab, caused an objective response in three melanoma patients who had earlier progressed on treatment with immune checkpoint blockade. Our preclinical results complement this clinical finding and suggest that CB-839 combination could potentiate the efficacy of targeted and immune therapies in refractory melanomas. Citation Format: Sruthy Varghese, Snigdha Pramanik, Rishika Prasad, Hannah Hodges, Leila Williams, Weiyi Peng, Hussein Tawbi, Vashisht Yennu Nanda. The glutaminase inhibitor CB-839 potentiates antimelanoma activity of standard-of-care targeted therapies and immunotherapies [abstract]. In: Proceedings of the AACR Special Conference on Melanoma: From Biology to Target; 2019 Jan 15-18; Houston, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(19 Suppl):Abstract nr PR06.
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Kostner, Lisa, Sara Elisa Cerminara, Gustavo Santo Pedro Pamplona, et al. "Effects of COVID-19 Lockdown on Melanoma Diagnosis in Switzerland: Increased Tumor Thickness in Elderly Females and Shift towards Stage IV Melanoma during Lockdown." Cancers 14, no. 10 (2022): 2360. http://dx.doi.org/10.3390/cancers14102360.
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At the early stages of the COVID-19 outbreak in 2020, Switzerland was among the countries with the highest number of SARS-CoV2-infections per capita in the world. Lockdowns had a remarkable impact on primary care access and resulted in postponed cancer screenings. The aim of this study was to investigate the effects of the COVID-19 lockdown on the diagnosis of melanomas and stage of melanomas at diagnosis. In this retrospective, exploratory cohort study, 1240 patients with a new diagnosis of melanoma were analyzed at five tertiary care hospitals in German-speaking Switzerland over a period of two years and three months. We compared the pre-lockdown (01/FEB/19–15/MAR/20, n = 655) with the lockdown (16/MAR/20–22/JUN/20, n = 148) and post-lockdown period (23/JUN/20–30/APR/21, n = 437) by evaluating patients’ demographics and prognostic features using Breslow thickness, ulceration, subtype, and stages. We observed a short-term, two-week rise in melanoma diagnoses after the major lift of social lockdown restrictions. The difference of mean Breslow thicknesses was significantly greater in older females during the lockdown compared to the pre-lockdown (1.9 ± 1.3 mm, p = 0.03) and post-lockdown period (1.9 ± 1.3 mm, p = 0.048). Thickness increase was driven by nodular melanomas (2.9 ± 1.3 mm, p = 0.0021; resp. 2.6 ± 1.3 mm, p = 0.008). A proportional rise of advanced melanomas was observed during lockdown (p = 0.047). The findings provide clinically relevant insights into lockdown-related gender- and age-dependent effects on melanoma diagnosis. Our data highlight a stable course in new melanomas with a lower-than-expected increase in the post-lockdown period. The lockdown period led to a greater thickness in elderly women driven by nodular melanomas and a proportional shift towards stage IV melanoma. We intend to raise awareness for individual cancer care in future pandemic management strategies.
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Shah, Hemali, Paul Feustel, and Lindy Davis. "Survivorship care plans and adherence with surveillance schedule in patients with invasive melanoma." Journal of Clinical Oncology 39, no. 15_suppl (2021): e24079-e24079. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e24079.
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e24079 Background: Melanoma accounts for 5.5% of new cancer diagnoses in the United States, and the 5-year overall survival is 93%. Overall, 7% of patients develop a recurrence, and 4-8% develop a second primary melanoma. This study aimed to assess how the standards set by the American College of Surgeons Commission on Cancer (CoC) to provide survivorship care plans (SCP) to patients may improve adherence to surveillance visits. Methods: All patients treated for invasive melanoma at our institution between 8/2018-2/2020 were included. SCP containing stage, treatment summary, and surveillance plan were delivered in-person to patients and sent to primary providers and dermatologists as outlined by CoC Standards for Optimal Care. Psychosocial distress (PSD) screening was performed using the National Comprehensive Cancer Network Distress Thermometer, with scores > 4 requiring further evaluation by oncology social worker. SCP and PSD were provided during the initiation phase of our cancer care program, and half the patients received services. Surveillance adherence was determined from chart review. The two groups were compared by t-test for continuous or chi-square test for categorical variables. Multiple regression analysis with odds ratios were performed. Mann-Whitney analysis was performed to assess the impact of SCP on PSD. Results: Of 146 patients identified for our cohort, 73 received SCP and PSD screening. Stage IA was the most common diagnosis (44%), followed by IB (13%) and IIIC (9%). Ninety-eight patients (67%) were adherent to all surveillance visits, and 55 of these received SCPs. Most patients noted low distress without the need for further support (79%), and 12 (21%) scored ≥4, benefiting from emotional and financial support and appointment and health insurance navigation. High PSD score did not correlate with advanced stage. Reception of SCP (p = 0.036) and close distance to treating facility (p = 0.016) improved adherence to surveillance visits. For patients who did not receive SCP, likelihood to follow up decreased by a factor of 0.469 (95% CI 0.231 - 0.952). Sex, age, PSD score, and stage did not affect surveillance adherence (p = NS). There were 6 recurrences, of which 4 were physician-detected during surveillance, and 8 patients developed second primary melanomas, all physician-detected. Conclusions: Delivery of SCP, a component of which includes counseling regarding signs and symptoms of recurrence or possibility of second primary melanoma, leads to significantly higher rates of surveillance adherence. This was shown for all stages. Melanoma survivors require close clinical follow-up, as demonstrated by our study finding that even with patient education, most recurrences and all new primary melanomas were physician-detected. PSD among melanoma patients is common, and all patients regardless of stage should undergo screening, as even early-stage patients exhibited distress.
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Murchie, Peter, Rosalind Adam, Wei L. Khor, et al. "Impact of rurality on processes and outcomes in melanoma care: results from a whole-Scotland melanoma cohort in primary and secondary care." British Journal of General Practice 68, no. 673 (2018): e566-e575. http://dx.doi.org/10.3399/bjgp18x697901.
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BackgroundThose living in rural areas have poorer cancer outcomes, but current evidence on how rurality impacts melanoma care and survival is contradictory.AimTo investigate the impact of rurality on setting of melanoma excision and mortality in a whole-nation cohort.Design and settingAnalysis of linked routine healthcare data comprising every individual in Scotland diagnosed with melanoma, January 2005–December 2013, in primary and secondary care.MethodMultivariate binary logistic regression was used to explore the relationship between rurality and setting of melanoma excision; Cox proportional hazards regression between rurality and mortality was used, with adjustments for key confounders.ResultsIn total 9519 patients were included (54.3% [n = 5167] female, mean age 60.2 years [SD 17.5]). Of melanomas where setting of excision was known, 90.3% (n = 8598) were in secondary care and 8.1% (n = 771) in primary care. Odds of primary care excision increased with increasing rurality/remoteness. Compared with those in urban areas, those in the most remote rural locations had almost twice the odds of melanoma excision in primary care (adjusted odds ratio [aOR] 1.92; 95% confidence interval [CI] = 1.33 to 2.77). No significant association was found between urban or rural residency and all-cause mortality. Melanoma-specific mortality was significantly lower in individuals residing in accessible small towns than in large urban areas (adjusted hazards ratio [HR] 0.53; 95% CI = 0.33 to 0.87) with no trend towards poorer survival with increasing rurality.ConclusionPatients in Scottish rural locations were more likely to have a melanoma excised in primary care. However, those in rural areas did not have significantly increased mortality from melanoma. Together these findings suggest that current UK melanoma management guidelines could be revised to be more realistic by recognising the role of primary care in the prompt diagnosis and treatment of those in rural locations.
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Bilimoria, Karl Y., Charles M. Balch, Jeffrey D. Wayne, et al. "Health Care System and Socioeconomic Factors Associated With Variance in Use of Sentinel Lymph Node Biopsy for Melanoma in the United States." Journal of Clinical Oncology 27, no. 11 (2009): 1857–63. http://dx.doi.org/10.1200/jco.2008.18.7567.
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PurposeGuidelines recommend sentinel lymph node biopsy (SLNB) for patients with clinical stage IB/II melanomas, but not clinical stage IA melanoma. This study examines factors associated with SLNB use for clinically node-negative melanoma.MethodsPatients diagnosed with clinically node-negative invasive melanoma in 2004 and 2005 were identified from the National Cancer Data Base. Regression models were developed to assess the association of clinicopathologic (sex, age, race/ethnicity, comorbidities, T stage), socioeconomic (insurance status, educational level, income), and hospital (hospital type, geographic area) factors with SLNB use.ResultsA total of 16,598 patients were identified: 8,073 patients with clinical stage IA and 8,525 patients with clinical stage IB/II melanoma. For clinical stage IB/II melanoma, SLNB use was reported in 48.7% of patients. Patients with clinical stage IB/II melanoma were less likely to undergo SLNB if they were older than 75 years; had T1b tumors, no tumor ulceration, or head/neck or truncal lesions; were covered by Medicaid or Medicare; or lived in the Northeast, South, or West census regions. SLNB use was reported in 13.3% of patients with clinical stage IA melanoma and was more likely in patients who were younger than 56 years or lived in the Mountain or Pacific census regions. Patients treated at National Comprehensive Cancer Network–or National Cancer Institute–designated hospitals were most likely to undergo SLNB in adherence with national consensus guidelines.ConclusionSLNB use was associated with clinicopathologic factors but also with health system factors, including type of insurance, geographic area, and hospital type. These findings have implications for provider education and health policy.
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Pinto Torres, Simão, Teresa André, Emanuel Gouveia, Lívio Costa, and Maria José Passos. "Systemic Treatment of Metastatic Conjunctival Melanoma." Case Reports in Oncological Medicine 2017 (2017): 1–3. http://dx.doi.org/10.1155/2017/4623964.
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Conjunctival melanoma (CM) is an exceptionally rare tumor, with a propensity for local and distant recurrence, with the lungs, skin, liver, and brain being the most common sites of metastasis. Recent progress in systemic treatments, with checkpoint inhibitors and targeted therapies blocking BRAF and MEK, has redefined the standard of care of advanced unresectable and metastatic melanoma. Although most trials did not include patients with conjunctival melanoma, its close molecular and genetic relationship to cutaneous melanoma might suggest a similar response to these novel agents. The authors describe two uncommon cases of metastatic conjunctival melanomas with distinct genetic profiles and, as such, submitted to different systemic treatments.
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Mitchell, Janine, Peta Callaghan, Jackie Street, Susan Neuhaus, and Taryn Bessen. "The Experience of Melanoma Follow-Up Care: An Online Survey of Patients in Australia." Journal of Skin Cancer 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/429149.
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Investigating patients’ reports on the quality and consistency of melanoma follow-up care in Australia would assist in evaluating if this care is effective and meeting patients’ needs. The objective of this study was to obtain and explore the patients’ account of the technical and interpersonal aspects of melanoma follow-up care received. An online survey was conducted to acquire details of patients’ experience. Participants were patients treated in Australia for primary melanoma. Qualitative and quantitative data about patient perceptions of the nature and quality of their follow-up care were collected, including provision of melanoma specific information, psychosocial support, and imaging tests received. Inconsistencies were reported in the provision and quality of care received. Patient satisfaction was generally low and provision of reassurance from health professionals was construed as an essential element of quality of care. “Gaps” in follow-up care for melanoma patients were identified, particularly provision of adequate psychosocial support and patient education. Focus on strategies for greater consistency in the provision of support, information, and investigations received, may generate a cost dividend which could be reinvested in preventive and supportive care and benefit patient well-being.
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Ward, Andrew Joseph, James M. McLoughlin, and James M. Lewis. "Leveraging survivorship care to identify recurrent melanoma." Journal of Clinical Oncology 36, no. 7_suppl (2018): 181. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.181.
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181 Background: The University of Tennessee Medical Center in Knoxville, Tennessee is the regions only academic medical center. This includes the Cancer Institute, where in 2013 a division dedicated to melanoma and soft tissue tumors (MASTT) was created. Since 2013, the number of melanoma cases treated at UTMCK treated has increased in excess of 300%. One critical aspect of the MASTT service was to provide survivorship care to all patients treated. This has given MASTT a unique opportunity to determine how survivorship care has impacted detection of recurrence in melanoma. Methods: Tumor registry data was retrospectively reviewed from a prospectively maintained database. All melanoma patients treated from 2011 to 2015 were identified. This cohort was selected because all of these patients would have been eligible for survivorship care. These patients were then stratified into stage and sub-stage, recurrence status, stage at recurrence, and whether alive or dead. Median and range of time to recurrence were calculated as well. Results: A total of 758 patients were treated for melanoma between 2011 and 2015 at UTMCK by the MASTT service. From this overall sample, a total of 37 patients demonstrated recurrence (4.88% overall). Local recurrence was noted in 9 cases (1.2%), regional recurrence in 4 cases (0.53%) and distant in 15 cases (2.0%). Seven of the recurrent cases were not specified. Median time to recurrence was 12 months (6-40 months). Overall mortality rate for patients with recurrent melanoma was 18/37 (48.6%). Nationally, local recurrence rates are reported between 3 – 5%. Conclusions: A retrospective analysis of tumor registry data for melanoma patients treated at UTMCK CI by the MASTT service line shows that offering survivorship care to this population is beneficial in detecting recurrence. This is key in getting patients evaluated and established for immunotherapy and/or other treatment options at the earliest time of recurrence, which can potentially improve their response to treatment by.
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Rubin Fitzgerald, Sydney, Bailey Hanson, and Andrew Phillip Loehrer. "Creating a single point of referral and standardized care pathway for patients with melanoma to improve access to care." Journal of Clinical Oncology 40, no. 28_suppl (2022): 127. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.127.
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127 Background: Access to care is often a challenge for healthcare organizations especially as pressures on time increase and workforce availability decreases and is often complex to solve. In this quality improvement (QI) initiative, a team from a rural academic medical center deployed the Lean Six Sigma approach to develop a two-pronged method that reduced the median time to first visit for new melanoma patients. Methods: The project team deployed the Define, Measure, Analyze, Improve, and Control (DMAIC) processes to address access for melanoma patients after the healthcare organization set a goal that 55% of new specialty care patients be seen within 10 days. Define: Concern was raised by the melanoma clinical care team that the lack of a well-defined and standardized referral workflow for melanoma patients could delay patient care. Measure: Data from the electronic medical record (EMR) indicated that only 31% of incoming referrals were seen within 10 days, and the median number of days to first visit was 15, or 50% over the organizational standard. Analyze: Analysis found considerable waste in the existing referral system. First, untrained staff made referral and routing decisions, meaning patients could potentially be seen by inappropriate departments based on the assessment of those not specialized in melanoma care and treatment. This led to the second area of waste: rework. Every referral had to be reviewed by multiple staff in several departments to ensure the referral made was appropriate based on the characteristics of disease. This was a very labor-intensive processes that allowed too many patients to slip through the cracks of the system. Improve: Two interventions were deployed to address the identified waste. First, a centralized referral point for all melanomas monitored by the Program Coordinator. Second, a referral questionnaire developed by an interdisciplinary team to guide where routine cases should be referred. Early results show that the interventions had marked impact on the time to first appointment for all referrals, whether originating inside of the organization or out. After the intervention 54% of newly referred patients were seen within 10 days. Results: Control: A standard report was built to support the project team in monthly monitoring of the KPI, days from referral to patient seen. The report is monitored by a dedicated Program Coordinator who can escalate any issues during regular interdisciplinary care team meetings. Conclusions: Improvements in access can be achieved by adopting standard work that is targeted to reduce waste in the referral workflow. The model developed by this QI initiative is easily replicable and may be especially useful for interdisciplinary teams who provide care to complex diseases.[Table: see text]
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Switzer, Benjamin, David J. Savage, Rujul Parikh, et al. "The impact of interdisciplinary shared medical appointments in newly diagnosed early-stage melanoma patients: The Cleveland Clinic experience." Journal of Clinical Oncology 37, no. 27_suppl (2019): 230. http://dx.doi.org/10.1200/jco.2019.37.27_suppl.230.
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230 Background: Shared Medical Appointments (SMA) serve as a unique means of improving outcomes and patient satisfaction while reducing clinic wait times and healthcare costs. Early-stage melanoma survivors may benefit from a targeted SMA. This cohort exhibits high rates of psychosocial distress, with up to 30% warranting clinical intervention (Kasparian, 2013). Additionally,numerically more melanoma deaths are related to thin ( < 1mm) melanomas than those with thick ( > 4mm) on presentation (Whitehall et al, 2015). We hypothesized that an SMA targeting early-stage melanoma patients may reducepsychologic fear and stress, as well as improve patients’ melanoma-related knowledge and adherence to their individualized care plans. Methods: The Cleveland Clinic’s Early Stage Melanoma Survivorship SMA interdisciplinary care team focused on crucial survivorship and prevention techniques, in addition to targeting modifiable behaviors for patients to collaboratively explore (format introduced ASCO Quality 2018, abst 69). A retrospective chart review assessed for demographics, participation rates, changes in depression scores, follow-up show-rates, and post-SMA survey results. Results: Of 477 early stage melanoma patients seen during the time of SMA implementation (6/2018-4/2019), only 91 (19.1%) attended oncology follow-up appointments, and 34 (7.1%) participated in an SMA. Participants expressed high rates of satisfaction and improvement in melanoma-related knowledge, whileexhibiting a > 92% show rate in subsequent oncologic and dermatologic medical appointments compared to 74% and 73%, respectively, in the non-SMA group. No significant improvement in depression and anxiety scoring was noted in SMA vs. non-SMA groups. SMA attendance was notably higher in younger (mean age 56 vs 61) and female (56% vs 30%) patient cohorts without appreciable differences in social history, marital status, or socioeconomic region. Conclusions: Survivorship SMAs for early stage melanoma patients appear to exhibit high rates of patient satisfaction, improvement in clinical knowledge, and adherence to routine dermatology and oncology follow-up appointments.
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Lamprell, Klay, and Jeffrey Braithwaite. "When Patients Tell Their Own Stories: A Meta-Narrative Study of Web-Based Personalized Texts of 214 Melanoma Patients’ Journeys in Four Countries." Qualitative Health Research 28, no. 10 (2017): 1564–83. http://dx.doi.org/10.1177/1049732317742623.
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Malignant melanoma is an aggressive, recalcitrant disease. Its impact on people can be compounded by the physical and psychosocial consequences of medical management. Providing melanoma patients with patient-centered care that is effective, safe, and supportive throughout their journey requires knowledge of patients’ progressive experiences and evolving perspectives. With ethical approval, we undertook a meta-narrative study of 214 experiential accounts of melanoma collected from the personal story sections of melanoma and cancer support websites. Using a narrative approach, we qualitatively examined the care experiences represented in these accounts and identified needs for supportive care in a framework reflective of the personal patient journey. We differentiate these across three key periods: lead-up to diagnosis; diagnosis, treatment, and recovery; and posttreatment and recurrence, and provide a visual representation of the patient journey. This article contributes to the growing body of work that utilizes Internet content as sources of qualitative, experiential health care data.
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Wang, Ding, Jonathan Wang, Richard Krajenta, and Liping Zhu. "Single-institutional analysis of clinicopathologic features and overall survival (OS) in melanoma patients (pts)." Journal of Clinical Oncology 38, no. 15_suppl (2020): e14023-e14023. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e14023.
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e14023 Background: Melanoma is ranked 5th commonest malignancy in United States and SEER has projected 3,290 new skin melanoma cases in Michigan in 2020. Diagnosis of recurrent & metastatic melanoma has associated with poor prognosis and survival. Henry Ford Cancer Institute (HFCI) is a tertiary cancer care facility serves cancer patients from communities throughout metropolitan Detroit tri-county areas where a higher melanoma presentation (1.56%) in black pts than this group at national database (0.6%). A subgroup of white Michiganders travel to Southern sunshine states in winter months known as “snowbirds” have contributed to melanoma incidences in Michigan. We aim to review our institute tumor registry data to analyze the clinicopathological features, care pattern and correlated survival outcomes. Methods: We have identified adult melanoma pts through institute tumor registry between 2007 – 2017, who had demographics, initial diagnosis, recurrence, then death or last follow-up for overall survival (OS) outcome. Data were analyzed using IBM SPSS, R-statistical and log-rank test. Results: Of 1327 eligible pts, median age was 63, and 874 (65.86%) pts were invasive at onset diagnosis. 1298 (97.81%) pts were white, 23 (1.73%) pts were black. Slightly more females (55.54%) over males and overall 301 deaths (22.68%) were observed. 1277 pts with cutaneous melanoma had better 5- and 10-year (yr) OS at 78.14%, and 68.32% compared to 50 (3.77%) non-cutaneous pts at 13.31% and 8.87%, respectively. Black pts carried a poor 5-yr OS at 34.68% vs white at 76.4%. 116 (17.9%) pts presented with recurrences, had 5-yr OS at 34.58%. Of 121 (9.1%) pts who never had been disease-free, showed worse 5-yr OS at 15.87%, with trend of improvement since FDA-approval of immune checkpoint inhibitor therapies. Conclusions: We have analyzed our melanoma care pattern, experience and survival outcomes at 5-yr and/or 10-yr from a tertiary community cancer care facility. We have assessed our current practice benchmarks with plan to improve our care delivery by having built a multidisciplinary team, and launched Melanoma & Skin Cancer Clinical Care Pathway through Tumor Board to improve care access, to decrease care disparity, then to standardize quality of care including encouraging clinical trial enrollments which will enhance quality of melanoma care and survival outcomes of advanced and metastatic cases.
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Akers, Rachel, Alison Coogan, Laura Kasper, Vaishnavi Krishnan, Alan Tan, and Cristina O'Donoghue. "Melanoma disparities in urban vs rural communities in the era of immunotherapy: An NCDB analysis." Journal of Clinical Oncology 41, no. 16_suppl (2023): 9578. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.9578.
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9578 Background: Several barriers to care exist for melanoma patients including distance to specialty care, transportation, and cost. Additionally, differences in rural and urban melanoma incidence have not been fully investigated. Using a large nationwide database, we aim to investigate the relationship between urban and rural locations in stage of melanoma presentation and access to adjuvant systemic treatment. Methods: The National Cancer Database (NCDB) was queried for all adult patients (≥ 18 years old) with diagnosis of cutaneous melanoma from 1/1/2011 – 12/31/2020. For receipt of adjuvant immunotherapy, diagnosis from only 1/1/2017 - 12/31/2020 was analyzed. Demographic, socioeconomic, tumor-related, and treatment-related factors were analyzed using SPSS Statistics, with Chi-square analysis performed for categorical variables and ANOVA performed for continuous. Results: Between 2011 and 2020, 558,445 patient cases were identified and included in the analyses. The average age was 63.7 years, and patients predominantly identified as White (97.6%) and non-Hispanic (96.2%). Patients in urban areas were more likely to present with melanoma of the extremities (40.8% vs 36.2%, p < 0.001), while patients in rural areas presented with head and neck melanoma (26.2% vs 31.0%, p < 0.001). Additionally, patients in urban areas were more likely to have an early-stage melanoma (0, 1, or 2) melanoma (51.4% vs 48.5%, p < 0.001). Patients in rural areas traveled an average of 68 miles for care, in contrast to urban patients who traveled an average of 20 miles (p < 0.001). There was no significant difference when comparing receipt of immunotherapy for stage 3 or stage 4 patients. Conclusions: In rural areas, patients with melanoma tended to present with a higher portion of head and neck melanoma and of later stage. Rural patients also had to travel farther for care. However, these differences did not result in fewer patients in rural areas receiving immunotherapy for appropriate treatment. Further studies are needed to evaluate how these presentation differences influence care outcomes.
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Qianqi, Chen, Zhao Yan, Tang Yueqiang, Duan Jiangman, Fu Xiaohong, and Zhou Qiming. "Efficacy and safety of transarterial infusion of anti-PD-1 in the treatment of advanced or metastatic acral and mucosal melanomas." Cellular and Molecular Biology 67, no. 5 (2022): 263–68. http://dx.doi.org/10.14715/cmb/2021.67.5.36.
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This study aimed to evaluate the efficacy and safety of transarterial infusion of programmed cell death receptor-1 (PD-1) antibody therapy in advanced or metastatic acral and mucosal melanomas. Eleven patients with acral or mucosal melanoma were referred to the department of Internal Medicine-Oncology in Huazhong University of Science and Technology Union Shenzhen Hospital from January 2019 to August 2020. These patients received transarterial infusions of PD-1 antibody and intravenous infusions of albumin-bound paclitaxel. The median duration of follow-up was 8 months. The patients were treated with transarterial infusion of PD-1 antibody and intravenous infusion of albumin-bound paclitaxel. in study, We collected and recorded immunotherapy-related adverse events. The results showed that the response rate (RR) and the disease control rate (DCR) of the patients (seven with acral melanoma, four with mucosal melanoma) were 54.5 % and 90.9 %, respectively. No grade 3–4 adverse events or major complications were observed during the study. The median progression-free survival was 10 months. The transarterial infusion of PD-1 antibody has remission and control effects on acral and mucosal melanomas, which is important for the clinical care of these patients.
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Khushalani, Nikhil I., Thach-Giao Truong, and John F. Thompson. "Current Challenges in Access to Melanoma Care: A Multidisciplinary Perspective." American Society of Clinical Oncology Educational Book, no. 41 (June 2021): e295-e303. http://dx.doi.org/10.1200/edbk_320301.
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A diagnosis of melanoma requires multidisciplinary specialized care across all stages of disease. Although many important advances have been made for the treatment of melanoma for local and advanced disease, barriers to optimal care remain for many patients who live in areas without ready access to the expertise of a specialized melanoma center. In this article, we review some of the recent advances in the treatment of melanoma and the persistent challenges around the world that prevent the delivery of the best standard of care to patients living in the community. With the therapeutic landscape continuing to evolve and newer more complex drug therapies soon to be approved, it is important to recognize the many challenges that patients face and attempt to identify tools and policies that will help to improve treatment outcomes for their melanoma.
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Habgood, Emily, Christopher McCormack, Fiona M. Walter, and Jon D. Emery. "Patients’ Experiences of Using Skin Self-monitoring Apps With People at Higher Risk of Melanoma: Qualitative Study." JMIR Dermatology 4, no. 2 (2021): e22583. http://dx.doi.org/10.2196/22583.
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Background Melanoma is the fourth most commonly diagnosed cancer in Australia. Up to 75% of melanomas are first detected by patients or their family or friends. Many mobile apps for melanoma exist, including apps to encourage skin self-monitoring to improve the likelihood of early detection. Previous research in this area has focused on their development, diagnostic accuracy, or validation. Little is known about patients’ views and experiences of using these apps. Objective This study aims to understand patients’ views and experiences of using commercially available melanoma skin self-monitoring mobile apps for a period of 3 months. Methods This qualitative study was conducted in two populations: primary care (where the MelatoolsQ tool was used to identify patients who were at increased risk of melanoma) and secondary care (where patients had a previous diagnosis of melanoma, stages T0-T3a). Participants downloaded 2 of the 4 mobile apps for skin self-monitoring (SkinVision, UMSkinCheck, Mole Monitor, or MySkinPal) and were encouraged to use them for 3 months. After 3 months, a semistructured interview was conducted with participants to discuss their experiences of using the skin self-monitoring mobile apps. Results A total of 54 participants were recruited in the study, with 37% (20) of participants from primary care and 62% (34) from secondary care. Interviews were conducted with 34 participants when data saturation was reached. Most participants did not use the apps at all (n=12) or tried them once but did not continue (n=14). Only 8 participants used the apps to assist with skin self-monitoring for the entire duration of the study. Patients discussed the apps in the context of the importance of early detection and their current skin self-monitoring behaviors. A range of features of perceived quality of each app affected engagement to support skin self-monitoring. Participants described their skin self-monitoring routines and potential mismatches with the app reminders. They also described the technical and practical difficulties experienced when using the apps for skin self-monitoring. The app’s positioning within existing relationships with health care providers was crucial to understand the use of the apps. Conclusions This study of patients at increased risk of melanoma highlights several barriers to engagement with apps to support skin self-monitoring. The results highlight the wide-ranging and dynamic influences on engagement with mobile apps, which extend beyond app design and relate to broader contextual factors about skin self-monitoring routines and relationships with health care providers.
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Swearingen, Alyssa, Mary Gao, Pearl Ugwu-Dike, et al. "Disparities in the initial presentation of melanoma across two socioeconomically diverse New York City neighborhoods." Journal of Clinical Oncology 42, no. 16_suppl (2024): 1593. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.1593.
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1593 Background: Disparities in stage at diagnosis among melanoma patients are often seen between urban and rural communities, with patients in rural areas being diagnosed with more advanced tumors. Factors contributing to the disparities include decreased access to dermatologists in rural areas, and lower socioeconomic status (SES). We investigated urban disparities in melanoma T stage at diagnosis among patients residing in 2 New York City (NYC) neighborhoods of differing SES and receiving care within the NYU Langone Health System. The neighborhoods were: Upper East Side (UES) and Brighton Beach/Coney Island (BB/CI). Methods: We conducted a retrospective chart review (NYU IRB 23-01020) of melanoma patients (N=243) diagnosed from 2018-2022 using ICD-10-CM codes: C43 (malignant melanoma of skin); D03 (melanoma in situ); and Z85.820 (personal history of malignant melanoma of skin). For community-level data we used the American Academy of Dermatology’s “Find a Dermatologist” search function to locate member-dermatologists; New York State Cancer Registry data (2016-2020) to determine annual melanoma incidence; and the United States Census Bureau Public Use Microdata Areas to determine the proportion of Non-Hispanic Whites (NHW), income levels, and educational attainment. The distribution of T stages was compared using a chi-square test. A two-sample test was used to assess equality of proportions. Results: In UES, the annual melanoma incidence was 30.2/100,000 (95% CI: 27.4-33.2); NHW comprised 74.6% of the population; the median household income was $135,820; 78% attained education higher than high school; and there are 190 dermatologists within a 0.5-mile radius. In BB/CI the annual melanoma incidence was 14/100,000 (95% CI: 11.6-16.9); NHW comprised 55.1% of the population; the median household income was $43,118; 46% attained education higher than high school; and there is 1 dermatologist within a 0.5-mile radius. There are 15 dermatologists within a 3.0-mile radius. 155 and 88 patients met inclusion criteria in UES and BB/CI respectively. The distribution of T stages (i.e. Tis to T4) was significantly different between UES and BB/CI with higher proportions of advanced stage tumors in BB/CI (p=0.0002). Specifically, the proportion of (T2+T3+T4) tumors/total melanomas was 35/155 (23%) in UES; and 41/88(47%) in BB/CI (p<0.0001). For reference, the proportion of T2+T3+T4 melanomas in the United States is 30%. Conclusions: We identified substantial disparities in the initial presentation of melanoma in 2 NYC neighborhoods, with proportionately more advanced stage tumors in the community of low educational attainment, less access to dermatologic services, and lesser household income. Neighborhood-based approaches to uncover melanoma disparities can identify areas for community outreach and engagement efforts to improve melanoma awareness and access to dermatologic care.
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Cariti, Caterina, Martina Merli, Gianluca Avallone, et al. "Melanoma Management during the COVID-19 Pandemic Emergency: A Literature Review and Single-Center Experience." Cancers 13, no. 23 (2021): 6071. http://dx.doi.org/10.3390/cancers13236071.
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Background: The current COVID-19 pandemic has influenced the modus operandi of all fields of medicine, significantly impacting patients with oncological diseases and multiple comorbidities. Thus, in recent months, the establishment of melanoma management during the emergency has become a major area of interest. In addition to original articles, case reports and specific guidelines for the period have been developed. Purpose: This article aims to evaluate whether melanoma management has been changed by the outbreak of COVID-19, and if so, what the consequences are. We summarized the main issues concerning the screening of suspicious lesions, the diagnosis of primary melanoma, and the management of early-stage and advanced melanomas during the pandemic. Additionally, we report on the experience of our dermatological clinic in northern Italy. Methods: We performed a literature review evaluating articles on melanomas and COVID-19 published in the last two years on PubMed, as well as considering publications by major healthcare organizations. Concerning oncological practice in our center, we collected data on surgical and therapeutic procedures in patients with a melanoma performed during the first months of the pandemic. Conclusions: During the emergency period, the evaluation of suspicious skin lesions was ensured as much as possible. However, the reduced level of access to medical care led to a documented delay in the diagnosis of new melanomas. When detected, the management of early-stage and advanced melanomas was fully guaranteed, whereas the follow-up visits of disease-free patients have been postponed or replaced with a teleconsultation when possible.
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Palacios-Diaz, Rodolfo David, Blanca de Unamuno-Bustos, Mónica Pozuelo-Ruiz, Enrico Giorgio Morales-Tedone, Rosa Ballester-Sánchez, and Rafael Botella-Estrada. "Scalp Melanoma: A High-Risk Subset of Cutaneous Head and Neck Melanomas with Distinctive Clinicopathological Features." Journal of Clinical Medicine 12, no. 24 (2023): 7643. http://dx.doi.org/10.3390/jcm12247643.
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Scalp melanomas (SM) have been previously associated with poor overall and melanoma-specific survival rates. The aim of this study was to describe and compare the clinicopathological characteristics and survival outcomes of SM and non-scalp cutaneous head and neck melanoma (CHNM). An observational multi-center retrospective study was designed based on patients with CHNM followed in two tertiary care hospitals. A hundred and fifty-two patients had CHNM, of which 35 (23%) had SM. In comparison with non-scalp CHNM, SM were more frequently superficial spreading and nodular subtypes, had a thicker Breslow index median (2.1 mm vs. 0.85 mm), and a higher tumor mitotic rate (3 vs. 1 mitosis/mm2) (p < 0.05). SM had a higher risk of recurrence and a higher risk of melanoma-specific death (p < 0.05). In the multivariate analysis, scalp location was the only prognostic factor for recurrence, and tumor mitotic rate was the only prognostic factor for melanoma-specific survival. We encourage routinely examining the scalp in all patients, especially those with chronic sun damage.
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Olafimihan, Ayobami Gbenga, Inimfon Jackson, Jay Vakil, et al. "Trends, sociodemographic and hospital-level factors associated with inpatient palliative care utilization among malignant melanoma patients: A 5-year National Inpatient Sample (NIS) study." Journal of Clinical Oncology 41, no. 16_suppl (2023): e21526-e21526. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.e21526.
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e21526 Background: Palliative care improves the quality of life in cancer patients; however, there is no literature on specific factors that predict its use in patients with malignant melanoma. We explored the prevalence trends, and predictors of palliative care utilization among hospitalized patients with malignant melanoma. Methods: Retrospective analyses were conducted using the National Inpatient Sample (NIS) data collected between 2016 and 2020. Descriptive analyses and multivariable regression models were used to investigate the prevalence trends, and sociodemographic and hospital-level factors associated with palliative care utilization in hospitalized malignant melanoma patients. Results: Of the 9,760 hospitalizations with a diagnosis of malignant melanoma over the study duration, 14% utilized palliative care during their hospital stay. Overall, 9.2% of malignant melanoma patients used palliative care and were discharged alive. There was a stable trend of palliative care use over the 5-year period (14%). Compared to patients on Medicare, those on Medicaid were twice (adjusted odds ratio (AOR): 2.12; 95% confidence interval (CI): 1.263.64) more likely to utilize palliative care. Relative to other regions in the US, patients hospitalized in the West were 40% less likely to receive the service of the palliative team (AOR: 0.61; 95% CI: 0.38-0.96). Those admitted to teaching hospitals (AOR: 0.55; 95% CI: 0.40-0.77) had lower odds of having palliative care consultations when compared to non-teaching hospitals. Patients admitted to urban hospitals had 50% (AOR: 0.51; 95% CI: 0.270.98) lesser odds of getting palliative care when compared to their counterparts in rural hospitals. Individuals who were either discharged to a facility/with home health (AOR: 8.81; 95% CI: 5.8813.23) or died during hospitalization (AOR: 128.42; 95% CI: 72.10228.77) had higher odds of utilizing palliative care when compared to those with a routine discharge. Conclusions: The prevalence of palliative care utilization was low, and factors associated with utilization in our population were identified. Our findings emphasize the necessity to improve awareness among medical oncologists and primary inpatient teams on the importance of involving the palliative care service early in the management of hospitalized patients with malignant melanoma.
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Körner, Annett, and Kurt Fritzsche. "Psychosomatic services for melanoma patients in tertiary care." International Journal of Dermatology 51, no. 9 (2012): 1060–67. http://dx.doi.org/10.1111/j.1365-4632.2011.05228.x.
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Dunn, Cary L., and John A. Zitelli. "Standards of care for patients with malignant melanoma." Journal of the American Academy of Dermatology 43, no. 1 (2000): 155–56. http://dx.doi.org/10.1067/mjd.2000.105160.
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LoRusso, Patricia M., Aleksandar Sekulic, Jeffrey A. Sosman, et al. "Identifying treatment options for BRAFV600 wild-type metastatic melanoma: A SU2C/MRA genomics-enabled clinical trial." PLOS ONE 16, no. 4 (2021): e0248097. http://dx.doi.org/10.1371/journal.pone.0248097.
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Although combination BRAF and MEK inhibitors are highly effective for the 40–50% of cutaneous metastatic melanomas harboring BRAFV600 mutations, targeted agents have been ineffective for BRAFV600wild-type (wt) metastatic melanomas. The SU2C Genomics-Enabled Medicine for Melanoma Trial utilized a Simon two-stage optimal design to assess whether comprehensive genomic profiling improves selection of molecular-based therapies for BRAFV600wt metastatic melanoma patients who had progressed on standard-of-care therapy, which may include immunotherapy. Of the response-evaluable patients, binimetinib was selected for 20 patients randomized to the genomics-enabled arm, and nine were treated on the alternate treatment arm. Response rates for 27 patients treated with targeted recommendations included one (4%) partial response, 18 (67%) with stable disease, and eight (30%) with progressive disease. Post-trial genomic and protein pathway activation mapping identified additional drug classes that may be considered for future studies. Our results highlight the complexity and heterogeneity of metastatic melanomas, as well as how the lack of response in this trial may be associated with limitations including monotherapy drug selection and the dearth of available single and combination molecularly-driven therapies to treat BRAFV600wt metastatic melanomas.
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Petrovszki, Irén, Ildikó Csányi, Mónika Szűcs, et al. "A melanoma malignum korai felismerését befolyásoló tényezők." Orvosi Hetilap 157, no. 51 (2016): 2028–33. http://dx.doi.org/10.1556/650.2016.30610.
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Abstract: Introduction and aim: Melanoma is a highly aggressive tumour with often unpredictable outcome. Our aim with this study was to determine factors influencing early detection of melanoma. Method: We analyzed 139 questionnaires completed by patients diagnosed with melanoma. Results: We found that our patients are health-conscious regarding cardiovascular diseases and attend cancer screenings on recall. However, their knowledge about melanoma is insufficient. Most of them perform skin self-examination, but they do not know what to check. Melanoma is detected mostly by the patients themselves, but it takes more than one year to consult a doctor. Our study confirmed that patients’ attitude toward melanoma is an important factor influencing early detection. We found that physical examination and communication about skin cancer prevention is not part of the routine medical care. Conclusions: It is important to improve knowledge about melanoma among the general population and health care providers and to emphasize that early detection can save lives. Orv. Hetil., 2016, 157(51), 2028–2033.
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Michenko, A. V., O. V. Zhukova, M. N. Ostretsova, and O. L. Novozhilova. "Management of patients at high risk of developing skin melanoma: organizational and clinical aspects." Meditsinskiy sovet = Medical Council, no. 8 (June 7, 2021): 21–26. http://dx.doi.org/10.21518/2079-701x-2021-8-21-26.
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Early diagnosis of skin melanoma is one of the most reliable ways to improve the prognosis for the life of patients with this tumor. Organization of medical care for patients with a high risk of developing melanoma, together with the use of non-invasive diagnostic methods and teaching the patient the principles of prevention and early diagnosis of skin malignancies should improve the survival rates of patients with melanoma. The article discusses the experience of implementing the Organizational model of medical care for patients with skin neoplasms in Moscow, as well as the key rules for managing patients at risk of developing skin melanoma with special emphasis on recommendations to patients for regular self-examination of the skin, lifestyle correction and the use of photoprotective agents.
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Pitre, Lacey D., Geordie Linford, Gregory R. Pond, Elaine McWhirter, and Hsien Seow. "Is Access to Care Associated With Stage at Presentation and Survival for Melanoma Patients?" Journal of Cutaneous Medicine and Surgery 23, no. 6 (2019): 586–94. http://dx.doi.org/10.1177/1203475419870177.
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Background Melanoma incidence increases with socioeconomic status but the effect of rurality and access to primary care or dermatology on patient outcomes is unclear. Objectives The objectives of this study were to determine whether access to care, rurality, or socioeconomic status are associated with melanoma stage at presentation and prognosis. Methods Linked administrative databases from Ontario, Canada, were retrospectively analyzed to identify a population-based cohort of patients diagnosed with melanoma between 2004 and 2012. Rurality was assessed using the rural index of Ontario (RIO) score, and the number of visits to dermatology and primary care was used to evaluate access to care. Results We identified 18 776 melanoma patients, of whom 9591 had completed pathological staging. Patients with higher RIO scores, living further from a cancer center or in a rural community, were less likely to see a dermatologist in the year prior to diagnosis ( P < .001 for all). Patients seen by a dermatologist within 365 days prior to diagnosis were less likely to present with stage III or IV disease (odds ratio 0.63, P < .001) and had improved overall survival (hazard ratio [HR] for death 0.77, P < .001). There was a nonlinear association between number of family physician visits and melanoma prognosis, with patients who had 3 to 5 visits per year having the best overall survival (HR 0.88, P = .003). Conclusion Our findings strengthen the known association between access to dermatology and melanoma outcomes by linking individual patients’ prediagnosis access to care to pathological stage at diagnosis and overall survival.
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Cubitt, J. J., A. A. Khan, E. Royston, M. Rughani, M. R. Middleton, and P. G. Budny. "Melanoma in Buckinghamshire: Data from the Inception of the Skin Cancer Multidisciplinary Team." Journal of Skin Cancer 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/843282.
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Background.Melanoma incidence is increasing faster than any other cancer in the UK. The introduction of specialist skin cancer multidisciplinary teams intends to improve the provision of care to patients suffering from melanoma. This study aims to investigate the management and survival of patients diagnosed with melanoma around the time of inception of the regional skin cancer multidisciplinary team both to benchmark the service against published data and to enable future analysis of the impact of the specialisation of skin cancer care.Methods.All patients diagnosed with primary cutaneous melanoma between January 1, 2003 and December 3, 2005 were identified. Data on clinical and histopathological features, surgical procedures, complications, disease recurrence and 5-year survival were collected and analysed.Results.Two hundred and fourteen patients were included, 134 female and 80 males. Median Breslow thickness was 0.74 mm (0.7 mm female and 0.8 mm male). Overall 5-year survival was 88% (90% female and 85% male).Discussion.Melanoma incidence in Buckinghamshire is in keeping with published data. Basic demographics details concur with classic melanoma distribution and more recent trends, with increased percentage of superficial spreading and thin melanomas, leading to improved survival are reflected.
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Taylor, D. C., Z. Zhou, S. Haider, and D. Thompson. "Health-care utilization and cost for the treatment of melanoma in the six months following diagnosis." Journal of Clinical Oncology 24, no. 18_suppl (2006): 18005. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.18005.
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18005 Background: The objective of this study was to use a 5% sample of Medicare claims data to estimate health-care utilization and cost for the treatment of melanoma. Methods: Data for this study were obtained from national administrative Medicare files. Adult patients were selected for the analysis if they were newly diagnosed with melanoma between July 1, 1999 and June 30, 2001. Patients with diagnoses of other cancers prior to melanoma as well as those who did not have data available for at least six months of continuous follow-up were excluded from the analysis. Patients were identified as having Stage 0-II or Stage III-IV melanoma based on the absence or receipt, respectively, of lymph node dissection, chemotherapy, and/or radiation therapy. Study measures included the type, cost, and duration of melanoma treatment. Results: A total of 1,465 patients were identified for the study, including 1,291 with Stage 0-II melanoma and 174 with Stage III-IV melanoma. The mean age was 73.9 years, 54% were female. Overall, 98.3% of patients underwent a surgical procedure, 3.1% underwent chemotherapy, 2.3% had inpatient treatment, 1.2% received radiation, and 1.5% had home health treatment for melanoma in the first six months after diagnosis. Corresponding percentages by disease stage were 100%, 0%, 1.2%, 0%, and 0.9% for Stage 0-II patients, and 85.6%, 25.9%, 10.9%, 10.3%, and 6.3% for Stage III-IV patients. The average total six-month Medicare cost of care was $2,395 ($2,065 outpatient, $330 inpatient) per patient; the average per-patient cost of care was $1,402 ($1,292 outpatient, $110 inpatient) for Stage 0-II patients and was $9,756 ($7,800 outpatient, $1,956 inpatient) for Stage III-IV patients. Conclusions: Treatment costs for melanoma are substantial in the first six months following diagnosis, especially for those patients with Stage III-IV disease. No significant financial relationships to disclose.
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de Meza, Melissa Melanie, Rawa Ismail, Willeke Blokx, et al. "Is adjuvant treatment for melanoma in clinical practice comparable to trials? The first population-based results." Journal of Clinical Oncology 39, no. 15_suppl (2021): e21523-e21523. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e21523.
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e21523 Background: Little is known about the outcome of adjuvant therapy in melanoma patients beyond the clinical trial setting. The Dutch Melanoma treatment Registry (DMTR) is a population-based registry, set up in July 2013 to monitor the safety and quality of melanoma care. Since 2019, adjuvant treated melanoma patients have also been registered in the DMTR, following approval and reimbursement of adjuvant treatment in the Netherlands in December 2018. Methods: Analyses were performed on melanoma patients treated with adjuvant anti-PD1 therapy included in the DMTR between 01-07-2018 and 31-12-2019. Descriptive statistics were used to analyze patient-, and treatment characteristics, and death as well as relapse rates. Results: Six hundred and fifty-seven patients treated with adjuvant systemic therapy were included in the DMTR. The majority (94%) of these patients was treated with anti-PD1. Twenty percent of the anti-PD1-treated patients developed grade ≥3 toxicity. Of the 279 patients with a minimum follow-up of one year after start of anti-PD1, 170 (61%) prematurely discontinued therapy. Relapse and death occurred in respectively, 38% and 12% of patients within one year of follow-up. Relapse was significantly more frequent in older patients, with high Breslow thickness and ulcerated melanomas. Conclusions: These data show more frequent premature discontinuation of adjuvant anti-PD1 in daily clinical practice than reported in the registration trials. Moreover, incidence of severe toxicity, relapse and death during adjuvant treatment appears higher in the real-world setting.
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van Not, Olivier Jules, Jesper van Breeschoten, Alfonsus Johannes Maria van den Eertwegh, et al. "Dutch advanced melanoma care in times of COVID-19." Journal of Clinical Oncology 39, no. 15_suppl (2021): e21502-e21502. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e21502.
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e21502 Background: The COVID-19 pandemic COVID had a severe impact on medical care in The Netherlands. So far, few studies have investigated the influence of COVID-19 on advanced melanoma care nationwide. This study aims to investigate the impact of COVID-19 on the systemic treatment of unresectable stage III and IV advanced melanoma patients in the Netherlands. Methods: Data were obtained from the Dutch Melanoma Treatment Registry (DMTR), a population-based nationwide registry of all stage III and IV melanoma patients amenable for systemic treatment. We compared two patient groups dependent on the date of the first diagnosis of metastasis: during the first COVID-19 wave (March 15th 2020 until May 22nd 2020), and a control group during the same period one year earlier. Furthermore, we divided patients into three geographical regions within the Netherlands (north, middle and south). These regions were based on the maximum number of hospital admissions for COVID-19 patients during the first wave, using data from the National Intensive Care Evaluation (NICE). COVID-19 incidence was highest in the southern part of The Netherlands. We investigated baseline characteristics, type of systemic therapy, time from diagnosis of the irresectable stage III or IV melanoma until the start of systemic therapy, postponement of anti-PD-1 courses in patients actively being treated during the predefined time periods and progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier estimates. Results: During the first COVID-19 wave, 104 patients were diagnosed with advanced melanoma versus 166 patients during the control period in 2019. No significant differences were found in patient and tumor characteristics, type of systemic therapies or in the time from diagnosis until the start of systemic therapy, between the different periods. However, during the first wave, the time between diagnosis until the start of treatment was significantly longer in the southern regions as compared to the northern and middle regions (33 vs 9 and 15 days, p-value < 0.05). Anti-PD-1 antibody treatment courses were postponed in 79 patients (15.5%) during the first wave versus four patients (1.1%) in the control period. Significantly more patients had a postponed course in the south during the first wave compared to the middle and northern regions (30.2% vs 2.7% vs 16.7%, p-value < 0.001). With limited follow-up, thus far no significant differences in PFS and OS were found. Conclusions: Advanced melanoma care in the Netherlands was severely affected by the COVID-19 pandemic. In the south, where COVID-19 incidence was highest in the first wave, the start of systemic treatment for advanced melanoma was more often delayed, and treatment courses were more frequently postponed. Longer follow-up is needed to establish whether this has had an impact on patient outcome.
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Muñoz-Barba, Daniel, Manuel Sánchez-Díaz, Alejandro Molina-Leyva, Antonio Martínez-López, and Salvador Arias-Santiago. "Sexual Dysfunction in Melanoma Survivors: A Cross-Sectional Study on Prevalence and Associated Factors." Journal of Clinical Medicine 14, no. 14 (2025): 4891. https://doi.org/10.3390/jcm14144891.
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Background/Objectives: Melanoma is a skin cancer that can lead to a poor prognosis. Unlike other oncologic diseases, there is scarce evidence regarding sexual function in melanoma patients, as well as factors associated with sexual dysfunction (SD). The aim of this study was to evaluate SD in a cohort of melanoma patients, as well as to describe associated factors. Methods: A cross-sectional analysis was conducted in individuals diagnosed with melanoma. Data regarding sociodemographic characteristics, clinical stage of the disease, quality of life, and sexual functioning were obtained through the use of validated assessment tools. The duration of the study was from 1 January 2023 to 1 January 2024. Results: Seventy-five patients were included. The mean age was 52.70 ± 14.07 years, and 61.33% (46/75) were females. Melanomas at stages III or IV comprised 18.67% (14/75) of the sample. A negative impact of the melanoma on sexual function was reported by 29.33% (22/75) of patients, with low sexual desire being the most frequent cause. Female SD was associated with older age, shorter disease duration, greater depression rates, and visible scar location after melanoma surgery (p < 0.05). Male SD correlated with higher anxiety and depression rates and worse quality of life (p < 0.05). No association was found for melanoma stage in any case (p > 0.30). Conclusions: Melanoma patients may suffer from SD, which can be associated with mood status disturbances, poor quality of life, and older age. Since the most frequent causes of a negative impact on sexuality are a reduction in sexual desire and the side effects of melanoma surgery, patients should be specifically asked about sexuality to improve holistic care of the disease, irrespective of disease stage.
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Freiman, Anatoli, John Yu, Antoine Loutfi, and Beatrice Wang. "Impact of Melanoma Diagnosis on Sun-Awareness and Protection: Efficacy of Education Campaigns in a High-Risk Population." Journal of Cutaneous Medicine and Surgery 8, no. 5 (2004): 303–9. http://dx.doi.org/10.1177/120347540400800501.
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Background: Malignant melanoma is a significant cause of morbidity and mortality worldwide. Sun-awareness campaigns increase public knowledge but may not translate into behavioral changes in practice, which is particularly alarming when reported for individuals in high-risk groups. In particular, patients diagnosed with melanoma are at increased risk of developing subsequent primary melanomas compared with the general population. Objectives: The study was undertaken (1) to assess whether patients with known risk factors for developing melanoma had been exposed to preventative campaign messages prior to their diagnosis, (2) to quantify whether the diagnosis of melanoma changed sun-related attitudes and behavior, and (3) to assess the adequacy of sun-related advice given to patients with melanoma, as well as their compliance with the advice. Methods: Using an anonymous questionnaire, 217 patients previously diagnosed with melanoma were interviewed on the source and frequency of received sun-related advice, as well as on their knowledge, attitudes, and behavior toward sun protection before and after the diagnosis. Results: The number of patients who reported receiving sun-related advice after being diagnosed with melanoma increased by 36% (52% pre-vs. 88% postDiagnosis), with advice being given more frequently and more often by a physician (19% pre- vs. 49% postdiagnosis). Furthermore, sun-related attitudes and behavioral practices were positively altered. Yet, patients with known risk factors were not preferentially targeted for advice before their diagnosis. Conclusions: The diagnosis of melanoma leads to increased sunwareness and protection. While dermatologists should continue their efforts to promote and reinforce sun-awareness in patients with melanoma, additional emphasis on preventative targeting of high-risk individuals would be of marked benefit in decreasing the overall incidence of melanoma. Non-dermatologists, such as family physicians, can be key players in this preventative campign, and can be educated to recognize and educate patients at risk, as well as direct them to be followed under dermatology care.
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Olivia, Bass, and Koevary* Steven. "Uveal Melanoma: an Updated Review." Biomedical Research and Reviews (ISSN:2631-3944) 2, no. 2 (2019): 1–10. https://doi.org/10.5281/zenodo.7943557.
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<strong>Abstract</strong> This article reviews the epidemiology, pathophysiology, and treatment of uveal melanoma. Emphasis is placed on differential diagnosis and the genetics associated with tumor development and metastasis. The role of the <em>BRCA1</em>-associated protein 1 <em>(BAP1)</em> gene, a suggested uveal melanoma tumor suppressor gene, <em>EIF1AX</em>, a gene that encodes a protein that binds mRNA, among other genes, as well as the associated loss of chromosome 3 are discussed. While the treatment of primary uveal melanoma is generally successful, up to approximately 50% of patients ultimately develop metastatic disease; there is currently no FDA approved systemic therapy for metastatic uveal melanoma. The promising role of a variety of treatments is discussed, with emphasis on the immune checkpoint inhibitors. <strong>Epidemiology</strong> Melanomas develop from melanocytes that malignantly transform as a result of environmental or genetically induced changes in their DNA. While such transformation occurs most commonly in the skin, uveal melanoma represents 3-5% of all melanomas occurring in the United States and is the most frequent form of primary intraocular tumor in adults [1,2]; worldwide, the primary intraocular tumor is retinoblastoma with an incidence of 1:15,000 to 1:20,000 live births [3]. Approximately 85-90% of uveal melanomas develop from melanocytes in the choroid, 5-8% in the ciliary body, and 3-5% in the iris [1,4]. Unlike the pathogenesis of uveal melanoma, the malignant conversion of conjunctival melanocytes more closely approximates the development of cutaneous melanoma and is strongly associated with increased sun exposure [4]. In contrast to the rising incidence of cutaneous melanoma, the incidence of uveal melanoma has remained relatively stable at approximately 5 per million since the 1970s [1]. The distribution of uveal melanoma varies depending on sex, race, and geographic location [2]. Males were reported to have a significantly higher age-adjusted incidence of 5.9 per million compared to females, who had an average age-adjusted incidence of 4.5 per million [2,5,6]. Similarly, analysis of data from the European Cancer Registry-based study on survival and care of cancer patients (EUROCARE) in Europe, including 6,673 patients with uveal melanoma diagnosed from 1983 to 1994, revealed standardized incidence rates of 1.3–8.6 cases per million per year [7]. The US data were collected by the Surveillance and Epidemiology and End Result (SEER) program of the NIH which collects and provides reliable US population-based incidence data for a variety of cancers, including uveal melanoma [8]. In the US, there is a higher incidence of uveal melanoma in non-Hispanic whites (~6 per million) compared to Hispanics, Asians and blacks (~1.7, 0.4 and 0.3 per million, respectively) [2]. In contrast, cutaneous melanoma rates are 16 fold higher in whites than blacks [5]. Relative to uveal melanomas, conjunctival and mucosal melanoma rates are only about 2-3 fold higher in whites than blacks [9]. Overall, the rate of uveal melanoma in the US is lower in southern states, though the rate of iris and ciliary body melanomas are higher in southern and coastal states [5]. Uveal melanoma incidence appears to peak around the seventh or eighth decade. While, as mentioned, the incidence of uveal melanoma has remained relatively stable over the last decades [1,10], conjunctival melanomas were reported to have increased in incidence, especially among older white men, and while the incidence tended to rise in individuals 40-59 years of age, this increase was not statistically significant [11].
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Fabrini, Maria Grazia, Federica Genovesi-Ebert, Franco Perrone, et al. "A multimodal approach to eye melanoma: patterns of care and related complications." Oncology Reviews 3, no. 1 (2011): 41. http://dx.doi.org/10.4081/oncol.2009.41.
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We describe the results of multimodal treatment of uveal and conjunctival melanomas. A retrospective analysis was performed on 54 patients treated with a multimodal approach between 2003 and 2008 in a single institution. Main outcome measures were survival, enucleation rate, local tumor control, visual function preservation and complications associated with treatments. The median follow-up was 33.4 months. The 5-year overall survival was 95.3%, the local recurrence was 3.7% and the 5-year enucleation was 9.4%. Vision preservation was achieved in 84% of cases. Observed complications were cataract, retinal detachment, diplopia, glaucoma, retinopathy, optic neuropathy and scleral necrosis. A careful consideration of treatment of uveal melanoma in this study allowed us to obtain the survival rates and visual outcomes similar to previously published results, with a very small incidence of complications. the results must be interpreted in the light of recent findings on the genetic pattern of uveal melanoma.
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Ricci, Francesco, Alessio Caggiati, Vincenzo Ziparo, et al. "The integrated care pathway for melanoma: the Istituto Dermopatico dell’Immacolata experience in Rome." AboutOpen 6, no. 1 (2019): 39–47. http://dx.doi.org/10.33393/abtpn.2019.289.
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Introduction: The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care, placed in an appropriate timeframe, to support patients with specific conditions or symptoms. The aim of this paper is to define the ICP for patients with melanoma referring to the “Istituto Dermopatico dell’Immacolata-IRCCS di Roma e Villa Paola” (“Center”). Methods and results: A multidisciplinary group (oncologists, dermatologists, surgeons, pathologists etc.) was defined as well as a facilitator to act as a link between all experts. The first step of ICP development was a review of current practice for patients with melanoma referring to the Center. This first step had the scope to define the multidisciplinary process map (a “picture” of the care plan) for patients with melanoma. The process map defined: i) the activities performed during delivery of care to the patients, ii) the responsibilities for these activities and iii) potential problem areas or opportunities for improvements. The process map formed the basis of the final ICP document. Conclusion: The adoption of melanoma ICP will allow the multidisciplinary group to ensure that clinical guidelines and available evidence are incorporated into everyday practice. (Oncology, HTA & Market Access)
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Leong, Stanley P., Mehdi Nosrati, Max C. Wu, et al. "Preoperative and Intraoperative Identification of Sentinel Lymph Nodes in Melanoma Surgery." Cancers 16, no. 15 (2024): 2767. http://dx.doi.org/10.3390/cancers16152767.
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According to the American Joint Commission on Cancer (AJCC) 8th edition guidelines, SLN biopsy is recommended for primary melanomas with a Breslow thickness of at least 1 mm. Additionally, the National Comprehensive Cancer Network (NCCN) recommends that a SLN biopsy may be considered for melanoma patients with T1b lesions, which are 0.8–1 mm thick or less than 0.8 mm thick with ulceration. It can also be considered for T1a lesions that are less than 0.8 mm thick but have other adverse features, such as a high mitotic rate, lymphovascular invasion, or a positive deep margin. To reduce the false negative rate of melanoma SLN biopsy, we have introduced the intraoperative use of Sentinella, a gamma camera, to enhance the identification rate of SLNs beyond that of the traditional gamma hand-held probe. At the Center for Melanoma Research and Treatment at the California Pacific Medical Center, a multidisciplinary approach has been established to treat melanoma patients when the diagnosis of primary melanoma is made with a referral to our melanoma center. This comprehensive approach at the melanoma tumor board, including the efforts of pathologists, radiologists, dermatologists, surgical, medical and radiation oncologists, results in a consensus to deliver personalized and high-quality care for our melanoma patients. This multidisciplinary program for the management of melanoma can be duplicated for other types of cancer. This article consists of current knowledge to document the published methods of identification of sentinel lymph nodes. In addition, we have included new data as developed in our melanoma center as newly published materials in this article to demonstrate the utility of these methods in melanoma sentinel lymph node surgery. Informed consent has been waived by our IRB regarding the acquisition of clinical data as presented in this study.
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Fletcher, Kylie A., and Douglas B. Johnson. "Investigational Approaches for Treatment of Melanoma Patients Progressing After Standard of Care." Cancer Journal 30, no. 2 (2024): 126–31. http://dx.doi.org/10.1097/ppo.0000000000000702.
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Abstract The advent of effective immunotherapy, specifically cytotoxic T-lymphocyte associated protein 4 and programmed cell death 1 inhibitors, as well as targeted therapy including BRAF/MEK inhibitors, has dramatically changed the prognosis for metastatic melanoma patients. Up to 50% of patients may experience long-term survival currently. Despite these advances in melanoma treatment, many patients still progress and die of their disease. As such, there are many studies aimed at providing new treatment options for this population. Therapies currently under investigation include, but are not limited to, novel immunotherapies, targeted therapies, tumor-infiltrating lymphocytes and other cellular therapies, oncolytic viral therapy and other injectables, and fecal microbiota transplant. In this review, we discuss the emerging treatment options for metastatic melanoma patients who have progressed on standard of care treatments.
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Kumar, Sonali Vinay, Vinay Kumar, Natasha V. Kumar, Alok Sati, and Sandeepan Bandopadhyay. "A series of choroidal melanoma in young patients: insights from a tertiary care facility." International Journal of Clinical Trials 12, no. 2 (2025): 163–68. https://doi.org/10.18203/2349-3259.ijct20251212.
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Choroidal melanoma is rare in young individuals and often presents at a later stage due to low clinical suspicion. This case series describes a group of young patients, all under the age of 30 years, who presented with advanced choroidal melanoma requiring enucleation. A prospective observational study was conducted from January 2019 to December 2023 at a tertiary care center. Twelve young patients diagnosed with choroidal melanoma were assessed. Patient’s demography, clinical presentation, tumor characteristics and histopathological findings were noted. Histopathologically tumors were classified as epithelioid, mixed and spindle cell type. The treatment protocol was devised based on the size, extent of the lesion and any involvement of systemic system. There were 10 females and 02 males. The mean age of patients in the current study was 23±3.5 years. Right eye was involved in 05 patients and left eye was involved in 07 patients. All patients had advanced choroidal melanoma at the time of presentation at our center. The mean basal diameter of the tumor was 21±2 mm and thickness were 11±1.5 mm. Primary enucleation with implant was the most common treatment modality in all patients. Epithelioid cell type choroidal melanoma was the commonest histology pattern was found in the current study. No mortality or death occurred at the end of 02 years follow-up in any patient. This series highlights the aggressive nature of choroidal melanoma in young individuals when diagnosed at an advanced stage. It emphasizes the importance of early clinical suspicion, timely referral, and appropriate imaging in any atypical choroidal lesion in the young population.
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Ranjith, S., M. Muralee, A. Sajeed, et al. "Anorectal melanoma: experience from a tertiary cancer care centre in South India." Annals of The Royal College of Surgeons of England 100, no. 3 (2018): 185–89. http://dx.doi.org/10.1308/rcsann.2017.0184.
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Introduction Mucosal malignant melanoma of the anorectum is a rare and aggressive disease, in which early diagnosis is difficult. The prognosis remains extremely poor, irrespective of the treatment. We share our experience in treating this malignancy at our centre in South India. Methods This study describes a retrospective analysis of 31 cases of anorectal melanoma presented to our centre between January 2001 and December 2013. Results Twenty-two patients (71%) presented with metastasis and had a median overall survival of nine months. None of the 22 patients survived for two years. Nine patients (29%) had curative surgery, in the form of abdominoperineal resection (six patients), abdominoperineal resection with bilateral inguinal node dissection (one patient), abdominoperineal resection with liver resection (one patient) and posterior exenteration (one patient). In patients who underwent curative surgery, the median overall survival was 15 months and disease-free survival was nine months, with a two-year overall survival of 22%. Conclusions Anorectal melanoma is an aggressive disease with a poor prognosis. The majority of patients present with distant metastases. Prognosis depends on stage at presentation. Early diagnosis and surgical resection may improve the overall outcome. Newer modalities such as immunotherapy and targeted therapies such as anti-CTLA4 monoclonal antibody and anti-programmed cell death protein 1 monoclonal antibodies have radically changed the management of mucosal melanoma and may, in the future, improve the overall prognosis of anorectal melanoma.
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Thapa, Sushma, Arnab Ghosh, Dilasma Ghartimagar, Tillotama Prasad, Raghavan Narasimhan, and OP Talwar. "Clinico-pathological Study of Malignant Melanoma in A Tertiary Care Centre." Journal of Nepal Medical Association 56, no. 205 (2017): 132–36. http://dx.doi.org/10.31729/jnma.2888.
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Introduction: Malignant melanoma, which causes three fourth of all deaths related to skin cancer, is more common in Caucasian population compared to Asian population. There is no reliable information about malignant melanoma in Nepal hence an effort has been made to assess the clinical and pathological features of melanoma patients.
 Methods: This was a retrospective hospital based study done in the department of Pathology. All cases of malignant melanoma diagnosed on biopsy during a period of 13 years were retrieved, reviewed and collated.
 Results: We had 35 cases with age range from 15 to 84 years with the mean of 51.4 years and M: F of 1.3:1. The predominant site was lower extremities. Most cases were less than 3 cm. Majority of histologic subtypes were nodular melanoma 29 (82.8%) followed by mucosal lentiginous melanoma 3 (8.6%), superficial spreading melanoma 2 (5.7%) and acral lentiginous melanoma 1 (2.9%). Half (50%) of the excisional biopsies were at Clark’s level IV and 75% were at high Breslow thickness.
 Conclusions: The most frequent site in males and females were lower extremities and trunk respectively in contrast to Western studies where it is opposite. Nodular melanoma was the commonest histologic subtype while in other Asian studies and in Western studies majority were acral lentiginous melanoma and superficial spreading melanoma respectively. 
 Keywords: Breslow thickness; Clark’s level; malignant melanoma; nodular melanoma.
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Dunlop, Hayley Marie, Robert Connor Chick, Carson Karakis, et al. "Persistent poverty impacts survival and National Comprehensive Cancer Network guideline-concordant care for patients with melanoma." Journal of Clinical Oncology 42, no. 16_suppl (2024): 1598. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.1598.
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1598 Background: Based on guidelines from the National Comprehensive Cancer Network (NCCN), sentinel lymph node biopsy (SLNB) should be offered to patients with high-risk stage IB or stage II melanoma and adjuvant systemic therapy is recommended for patients with stage III disease. Persistent poverty census tracts are defined as areas where at least20% of residents were poor as measured by each of the 1980, 1990, 2000 censuses and 2007 American Community Survey 5-year average. The aim of this study was to describe the association between persistent poverty and adherence to NCCN guidelines and cancer-specific survival in patients with cutaneous melanoma. Methods: Patients diagnosed with melanoma from 2006-2018 were identified in Survival, Epidemiology, and End Results (SEER) Program registries. The analytic cohort was restricted to patients with superficial spreading melanoma, nodular melanoma, malignant melanoma with regression, lentigo malignant melanoma, and acral lentiginous melanoma. Patient demographics such as age, race, and ethnicity and tumor characteristics associated with stage at diagnosis were analyzed using adjusted regression analyses for patients of all melanoma stages. Demographics and tumor characteristics associated with receipt of SLNB were analyzed amongst pathologic stage IB and II cases, and demographics and tumor characteristics associated with receipt of adjuvant systemic therapy were analyzed amongst stage III cases. Kaplan-Meier curves and adjusted accelerated failure time models were used to examine disparities in cancer-specific survival. Results: Of 127,308 total patients, 3.13% (n=3994) lived in census tracts with persistent poverty. In adjusted analyses, persistent poverty was an independent predictor of later pathologic stage at diagnosis (OR 1.32 [95% CI 1.21-1.44] p<0.001). Persistent poverty was also associated with lower likelihood of receiving SLNB according to NCCN guidelines (OR 0.717 [SE 0.072] p<0.01) and with worse cancer-specific survival (HR 1.25 [1.06-1.47], p=0.008) when controlling for age, race, ethnicity, pathologic stage at diagnosis, and histology. In univariable models persistent poverty was associated with increased odds of receiving systemic therapy, but this relationship was not significant on multivariable analysis. Conclusions: Patients from areas with persistent poverty had a later pathologic stage at diagnosis, were less likely to receive a SLNB according to NCCN guidelines, and had worse cancer-specific survival. Efforts to better define and resolve disparities in the treatment and survival of patients with melanoma are warranted.
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Maul, Lara V., Dagmar Jamiolkowski, Rebecca A. Lapides, et al. "Health Economic Consequences Associated With COVID-19–Related Delay in Melanoma Diagnosis in Europe." JAMA Network Open 7, no. 2 (2024): e2356479. http://dx.doi.org/10.1001/jamanetworkopen.2023.56479.
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ImportanceThe COVID-19 pandemic resulted in delayed access to medical care. Restrictions to health care specialists, staff shortages, and fear of SARS-CoV-2 infection led to interruptions in routine care, such as early melanoma detection; however, premature mortality and economic burden associated with this postponement have not been studied yet.ObjectiveTo determine the premature mortality and economic costs associated with suspended melanoma screenings during COVID-19 pandemic lockdowns by estimating the total burden of delayed melanoma diagnoses for Europe.Design, Setting, and ParticipantsThis multicenter economic evaluation used population-based data from patients aged at least 18 years with invasive primary cutaneous melanomas stages I to IV according to the American Joint Committee on Cancer (AJCC) seventh and eighth editions, including melanomas of unknown primary (T0). Data were collected from January 2017 to December 2021 in Switzerland and from January 2019 to December 2021 in Hungary. Data were used to develop an estimation of melanoma upstaging rates in AJCC stages, which was verified with peripandemic data. Years of life lost (YLL) were calculated and were, together with cost data, used for financial estimations. The total financial burden was assessed through direct and indirect treatment costs. Models were building using data from 50 072 patients aged 18 years and older with invasive primary cutaneous melanomas stages I to IV according to the AJCC seventh and eighth edition, including melanomas of unknown primary (T0) from 2 European tertiary centers. Data from European cancer registries included patient-based direct and indirect cost data, country-level economic indicators, melanoma incidence, and population rates per country. Data were analyzed from July 2021 to September 2022.ExposureCOVID-19 lockdown-related delay of melanoma detection and consecutive public health and economic burden. As lockdown restrictions varied by country, lockdown scenario was defined as elimination of routine medical examinations and severely restricted access to follow-up examinations for at least 4 weeks.Main Outcomes and MeasuresPrimary outcomes were the total burden of a delay in melanoma diagnosis during COVID-19 lockdown periods, measured using the direct (in US$) and indirect (calculated as YLL plus years lost due to disability [YLD] and disability-adjusted life-years [DALYs]) costs for Europe. Secondary outcomes included estimation of upstaging rate, estimated YLD, YLL, and DALY for each European country, absolute direct and indirect treatment costs per European country, proportion of the relative direct and indirect treatment costs for the countries, and European health expenditure.ResultsThere were an estimated 111 464 (range, 52 454-295 051) YLL due to pandemic-associated delay in melanoma diagnosis in Europe, and estimated total additional costs were $7.65 (range, $3.60 to $20.25) billion. Indirect treatment costs were the main cost driver, accounting for 94.5% of total costs. Estimates for YLD in Europe resulted in 15 360 years for the 17% upstaging model, ranging from 7228 years (8% upstaging model) to 40 660 years (45% upstaging model). Together, YLL and YLD constitute the overall disease burden, ranging from 59 682 DALYs (8% upstaging model) to 335 711 DALYs (45% upstaging model), with 126 824 DALYs for the real-world 17% scenario.Conclusions and RelevanceThis economic analysis emphasizes the importance of continuing secondary skin cancer prevention measures during pandemics. Beyond the personal outcomes of a delayed melanoma diagnosis, the additional economic and public health consequences are underscored, emphasizing the need to include indirect economic costs in future decision-making processes. These estimates on DALYs and the associated financial losses complement previous studies highlighting the cost-effectiveness of screening for melanoma.