Melanoma Management最新文献

Aim: To analyze trends in Utah melanoma diagnosis and study the impact of rurality.

Patients & methods: State-wide melanoma incidence was calculated using Surveillance, Epidemiology, and End Results data (2005-2013). A subset of 5199 patients treated in an integrated healthcare system was further stratified for urban or rural residence.

Results: Early-stage tumors accounted for most of the increase in melanoma incidence over time. Age-adjusted melanoma incidence rate was higher in rural counties (46.7 vs 39.4). Anatomic site and stage did not differ between rural and urban patients. Rural patients were more commonly diagnosed by a local primary care provider.

Conclusion: Rurality had an impact on melanoma diagnosis in the specialty and location of the diagnosing provider.

The introduction of immune checkpoint blockade (ICB) and BRAF-MEK inhibitors has substantially improved outcomes in patients with metastatic melanoma. However, several challenging factors may hinder the efficacy of ICB in patients with symptomatic intracranial metastatic melanoma who are immunosuppressed due to the use of steroids prior to the administration of ICB. This has resulted in the exclusion of patients treated with high dose steroid at baseline from the majority of ICB clinical trials. In addition, despite the high efficacy of BRAF-MEK inhibitors in BRAF-mutant intracranial metastatic melanoma, most tumors will eventually progress. This demonstrates a gap in addressing the best management in such patients. Here, we present a case demonstrating our approach in this patient population.

Aim: To present cases of recurred jejuno-jejunal intussusception and jejunal perforation due to melanoma.

Materials & methods: Case 1: A 43-year-old male under treatment for malignant melanoma was presented with abdominal pain and distention. Ten centimeter intussuscepted jejunum was resected. Second exploration was done due to failure to pass gas and stool. The reintussusception was detected and resection of reintussuscepted jejunum was performed. Case 2: A 63-year-old male was presented with abdominal pain. Abdomen computed tomography showed free air in the abdomen suggesting intestinal perforations. Perforated area at 80 cm in the jejunum sutured.

Conclusion: We present the seemingly first report of reintussusception of resected segment in a very short time. Surgeons should be aware of both intussusception and perforation in metastatic melanoma.

Aim: Primary gastric melanoma is a rare clinical presentation. The purpose of this review was to compare the 1-year survival in patients who underwent surgery with patients who did not receive treatment.

Patients & methods: A systematic search of databases for case reports and case series of primary gastric melanoma was conducted.

Results: The mean survival of patients was 22 months. One-year survival was 56.5% with surgery, rising to 66% with adjuvant therapy. Mean survival of the surgical group was 21.05 months (±20.2) versus 4.5 months (±3.61) in the nonsurgical group.

Conclusion: Primary gastric melanoma has a poor prognosis but early surgical intervention can have a significant impact on patient outcome. We reviewed the biology and clinical diagnosis of gastrointestinal melanoma and the current management options available.

Skin cutaneous melanoma is characterized by significant heterogeneity in its molecular, genomic and immunologic features. Whole transcriptome RNA sequencing data from The Cancer Genome Atlas of skin cutaneous melanoma (n = 328) was utilized. CIBERSORT was used to identify immune cell type composition, on which unsupervised hierarchical clustering was performed. Analysis of overall survival was performed using Kaplan-Meier estimates and multivariate Cox regression analyses. Membership in the lymphocyte:monocyte^low, monocyte^{hi gh} and M0^high cluster was an independently poor prognostic factor for survival (HR: 3.03; 95% CI: 1.12-8.20; p = 0.029) and correlated with decreased predicted response to immune checkpoint blockade. In conclusion, an M0-macrophage-enriched, lymphocyte-to-monocyte-ratio-low phenotype in the primary melanoma tumor site independently characterizes an aggressive phenotype that may differentially respond to treatment.

The neutrophil-to-lymphocyte ratio (NLR) is gaining traction as a biomarker with utility in a variety of malignancies including melanoma. Intact lymphocyte function is necessary for tumor surveillance and destruction, and neutrophils play a role in suppressing lymphocyte proliferation and in the induction of lymphocyte apoptosis. Early research in melanoma indicates that in high-risk localized melanoma, a high NLR is correlated with worse overall and disease-free survival. Similarly, in metastatic melanoma treated with both metastasectomy and immunotherapies, an elevated NLR is predictive of shortened overall survival and progression-free survival. Future studies incorporating NLR into more traditional melanoma prognostic markers while employing more granular outcomes, are needed to realize the full potential of NLR.