Melanoma Management最新文献

Subungual melanoma accounts for 1.9% of cutaneous melanomas. Amelanotic cases, comprising 15-25%, poses a significant diagnostic challenge because it can be misdiagnosed as other traumatic, inflammatory, or neoplastic conditions. This often leads to delayed diagnosis and subsequently, a poor prognosis. We present a case of an 83-year-old woman with a bleeding, painful and progressive lesion on the nail area of her right middle finger initially misdiagnosed as paronychia at a rural clinic four months ago. An incisional biopsy confirmed the diagnosis of amelanotic subungual melanoma. Amputation of the affected finger was performed successfully. Imaging studies showed no metastatic disease. This case underscores the importance of early recognition and management of subungual melanoma, particularly in remote rural areas, to optimize patient outcomes.

Aims: In treating patients with melanoma, the order in which therapy is administered, choosing between targeted therapy and immune checkpoint inhibition, has garnered growing interest.

Patients and methods: We conducted a retrospective, real-world analysis of patients with advanced melanoma undergoing immunotherapy or targeted therapy as first-line at a single center.

Results: A total of 88 patients diagnosed with melanoma were identified. At 7 years, in this cohort, 68.4% (95% CI: 55.9%-83.6%) of patients were alive. In all, 47 tumors harbored BRAF mutations; 10 patients who did not receive therapy were excluded from this subgroup. Of the 37 patients with a BRAF mutation, 29 received first-line targeted therapy and 8 received first-line immunotherapy. At 2 years, 28 (76%) patients were alive and 9 (24%) had died. Of the 28 survivors, 22 received first-line targeted therapy and 6 received first-line immunotherapy. In addition, 29 patients were administered a MEK inhibitor in first line. Of these, 66.4% (95% CI: 48.3-91.2) of patients were alive at 7 years.

Conclusions: There was no significant difference between survival and first-line immunotherapy or first-line targeted therapy. Additional studies are required to establish whether front-line immunotherapy is linked to more effective long-term disease control compared to first-line targeted therapy.

Aim: This study summarized the existing evidence on the outcomes and safety of anti-PD-1s, anti-PD-L1s and anti-CTLA-4s in pediatric patients with melanoma.Materials & methods: MEDLINE^® and Embase were searched from database inception to 01-12-2023.Results: Of 1537 records identified, 27 studies (k) of 64 patients were included. Most studies were case reports (k = 16). All studies used anti-PD-1s (nivolumab, pembrolizumab) alone or anti-CTLA-4s (ipilimumab). Survival outcomes (k = 7), response outcomes (k = 15) and adverse events (k = 16) varied. Safety profiles of anti-PD-1s and anti-CTLA-4s were broadly similar to that seen in adults.Conclusion: Despite scarce, heterogenous data, this review can be a reference for clinicians. Future clinical trials should include adolescents to grow the evidence base on immune checkpoint inhibitors in pediatric melanoma.

Background: Melanoma, the deadliest skin cancer, presents significant challenges globally. This study examines survival factors among patients treated at a high-complexity oncology center in Colombia's coffee-growing region. Methods: Records from 2010 to 2021 were analyzed, capturing socio-demographics, clinical variables and survival outcomes via Kaplan-Meier and Cox regression. Results: Among 766 patients, factors influencing survival included sex, TNM stage, diagnostic stage, ulceration, metastasis, Breslow thickness ≥1 mm and positive nodes. Age, ulceration, distant stage at diagnosis and Breslow thickness ≥1 mm were associated with mortality. Conclusion: Colombian melanoma patients exhibit lower survival rates compared with global trends. Key survival determinants align with international literature. Enhanced photoprotection and early detection initiatives are imperative.

Aim: This study determined the characteristics of patients with early-stage melanoma (IA-IIA) who later had stage IV recurrence.Patients & methods: We retrospectively examined 880 melanoma patients and identified those who progressed to stage IV disease from an initial early-stage (n = 50).Results: We observed a median latent period of 4 years between early-stage diagnosis and metastatic disease. More patients (54%) developed metastatic disease 4 years or later from the initial diagnosis. 34% had regular dermatology appointments, and 30% had regular oncology follow-up. Lung and brain were the most common metastatic sites.Conclusion: Long term monitoring beyond 4 years and a low threshold for performing symptom-guided imaging, particularly if pulmonary or neurologic symptoms occur, may be prudent after early-stage melanoma diagnosis.

Aim: Cutaneous melanocytic neoplasms with diagnostic and/or clinical ambiguity pose patient management challenges. Methods: Six randomized case scenarios with diagnostic/clinical uncertainty were described with/without a benign or malignant diagnostic gene expression profile (GEP) result. Results: Clinical impact was assessed by reporting the mean increase/decrease of management changes normalized to baseline (n = 32 dermatologists). Benign GEP results prompted clinicians to decrease surgical margins (84.2%). Malignant GEP results escalated surgical excision recommendations (100%). A majority (72.2%) reduced and nearly all (98.9%) increased follow-up frequency for benign or malignant GEP results, respectively. There was an overall increase in management plan confidence with GEP results. Conclusion: Diagnostic GEP tests help guide clinical decision-making in a variety of diagnostically ambiguous or clinicopathologically discordant scenarios.

Primary malignant melanoma of the genitourinary tract is extremely rare. We present two such cases in elderly Caucasian females. An 81-year-old female with urinary retention and polypoid urinary bladder mass and a 72-year-old female with gross hematuria and urethral caruncle. After thorough evaluation, they were both eventually diagnosed with primary urogenital melanoma (SOX10 and MART1-positive in tumor cells). In both cases, the presence of melanoma-in-situ and absence of primary melanoma in other sites were consistent with primary urogenital melanoma. Immunotherapy with PD-1 inhibitors and use of neoadjuvant and adjuvant treatment are promising, as treatment guidelines remain unclear and overall survival is low. Additional clinical reporting of primary urogenital melanomas can help in better understanding and ultimately treating it.

Aim: To identify distinct disulfidptosis-molecular subtypes and develop a novel prognostic signature.

Methods/materials: We integrated into this study multiple SKCM transcriptomic datasets from the Cancer Genome Atlas database and Gene Expression Omnibus dataset. The consensus clustering algorithm was applied to categorize SKCM patients into different DRG subtypes.

Results: Three distinct DRG subtypes were identified, which were correlated to different clinical outcomes and signaling pathways. Then, a disulfidptosis-relaed signature and nomogram were constructed, which could accurately predict the individual OS of patients with SKCM. The high-risk group was less sensitive to immunotherapy than the low-risk group.

Conclusion: The signature can assist healthcare professionals in making more accurate and individualized treatment choices for patients with SKCM.

Vulvo-vaginal melanomas are one of the rarest gynecological oncology diseases with a poor survival compared with other malignancies. The 5-year survival varies from 13% to 32.3%. Vulvo-vaginal melanomas involving the upper 2/3rds of the vagina are usually treated with total pelvic exenteration (TPE). TPE surgery carries a 50% risk of major complications and also morbidity associated with double stomas. Central pelvic compartment resection is a novel organ-sparing surgical approach entailing radical total laparoscopic hysterectomy, bilateral salpingo-oophrectomy, laparoscopic vaginectomy and vulvectomy to reduce morbidity compared with TPE. Permanent suprapubic catheters are used if there is urethral involvement but require quality of life studies to assess their long-term outcomes.

Aim: This study aimed to investigate the incidence of BRAF mutation in cutaneous melanoma in the Ukrainian population with respect to clinical and histopathological data.

Materials & methods: This single-center retrospective cohort study enrolled 299 primary CM with known BRAF status assessed by RT-PCR.

Results: The overall BRAF mutation rate was 56.5% in CM and demonstrated a link with the younger age (p < 0.001), anatomical site (p < 0.001) and histological type of CM (p = 0.022). BRAF-positive CM possessed a slightly higher mitotic rate (p = 0.015) and Breslow thickness (p = 0.028) but did not relate to tumor-infiltrating lymphocytes.

Conclusion: The high rate of BRAF mutations in CM patients in the Ukrainian cohort was associated with superficial spreading histology, higher depth of invasion and proliferation.