Melanoma Management最新文献

The treatment of malignant melanoma has changed beyond recognition in the last 7 years. Where previously single agent dacarbazine was often the only treatment used for advanced disease, now there are potentially multiple lines of treatment, based on immunotherapy and targeted treatment options, either as monotherapy or in combination. In this brave new world the question arises, does chemotherapy still have any relevance in the modern management of melanoma? In this review, we summarize the various chemotherapeutic options that have been trialled in melanoma to date, and discuss the role chemotherapy may still play in treating melanoma, potentially in combination with more novel agents, or in certain subtypes of melanoma.

Primary malignant melanoma originating in the small bowel is very rare. We report the case of primary malignant melanoma of the small bowel with secondary intussusception in a 51-year-old female with no prior history of cutaneous melanoma. The patient was admitted to the hospital for clinical bowel obstruction after 6 months of varying symptoms of antecedent syncopal events secondary to profound anemia due to iron deficiency followed later by vomiting, abdominal pain and weight loss. A CT scan showed intussusception and she underwent a small bowel resection. Diagnosis of malignant melanoma was confirmed post-operatively following immunohistochemistry. The patient history and postoperative investigation excluded the existence of a primary lesion elsewhere. Our case represents an aggressive primary small bowel melanoma presenting as intussusception.

Dr Smalley earned his PhD in Pharmacology from the University of Cambridge, UK, in 2001. He worked as a post-doctoral fellow in the Oncology Department of University College London, the Institute of Cancer Research, Fulham Road and the Wistar Institute, PA, USA. Currently, Dr Smalley is a Professor in the Departments of Tumor Biology and Cutaneous Oncology at the Moffitt Cancer Center, FL, USA. He is also currently the Donald A Adam Endowed Chair in Melanoma Research and is the Director of the Melanoma and Skin Cancers Center of Excellence. The lab of Dr Smalley focuses upon the development of targeted therapy strategies for melanoma and is currently funded by the NCI, the pharmaceutical industry and a number of philanthropic sources. Dr Smalley's work is highly translational in nature and work from his lab has led to the initiation of a number of clinical trials. To date, Dr Smalley has published over 120 papers in top peer-reviewed journals including Cancer Research, Cancer Discovery, Cancer Cell, New England Journal of Medicine, the Proceedings of the National Academy of Sciences, the Lancet, Gastroenterology and Clinical Cancer Research. He currently sits on the editorial boards of Clinical Cancer Research, Biochemical Pharmacology, Drugs, Melanoma Research and the American Journal of Clinical Dermatology and is the Associate Editor of Pharmacological Research. Dr Smalley is a charter member of the Basic Mechanisms of Cancer Therapeutics Study Section for the NCI/NIH and has served on many other peer review panels for the Department of Defense, the state of Texas and numerous melanoma research foundations. He has also fulfilled advisory roles with the University of Pennsylvania, the University of Pittsburgh and a number of pharmaceutical companies. Dr Smalley has been a visiting professor at the University of Sao Paulo, Brazil in 2011 and in 2014 received a Science Without Borders Scholarship from the Brazilian Government.

Imogen Cheese speaks to Sebastian Dennis-Beron, Commissioning Editor: Imogen was diagnosed with melanoma in June 2013 (currently stage 2C no evidence of disease monitored under Professor Mark Middleton at Oxford) and has since created and writes a website blog (www.melanomarollercoaster.co.uk) as well as founded the melanoma patient conference in 2015. As an impartial event, the patient conference brings together all stakeholders involved in melanoma diagnosis, treatment and care; this includes clinicians, charities and crucially, people living and dying with melanoma. This means the only end goal for the conference are the ongoing needs of patients and families. Imogen's blog has a readership of over 2000 people - many of whom are melanoma patients in the UK. She is prolific in her contact with these patients on social media and as a result of her blog, she has been asked to represent melanoma patients in the UK as their advocacy representative at numerous conferences and events across Europe (including ECC2015 and the MPNE annual events in Brussels). Patients reach out to Imogen on a daily basis asking for support and seeking a means to improve their knowledge and obtain access to better care and information on the latest drugs and trials in the UK. She is a member of the Melanoma Patient Network Europe and speaks daily to over 300 patients on an online support group on social media. Imogen was invited by the British Skin Foundation to support them in establishing a skin cancer specific arm of their charity called ITTakes7 and has worked directly with Melanoma UK on various projects for patient interaction and information gathering. She is connected with Cancer Research UK as a patient representative with the ECMC network and involved with the Oxford hospitals as an advisor for their public engagement and planning. Imogen can be found on twitter at @MelanomaBlog.

Melanocytic lesions of acral sites are common, with an estimated prevalence of 28-36% in the USA. While the majority of these lesions are benign, differentiation from acral melanoma (AM) is often challenging. AM is a unique subtype of melanoma, with distinct molecular characteristics that are thought to contribute to its high rate of locoregional recurrence and worse prognosis. The advent of dermoscopy has since improved the diagnostic accuracy of AM, resulting in earlier detection and arguably improved survival. Additionally, the identification of unique genomic amplifications in AM invites the potential for future AM-specific targeted therapies. Herein, we discuss the importance of dermoscopy in the diagnosis of acral melanocytic lesions and review the treatment strategies for AM.

Management of melanoma includes wide excision with adequate margins and lymph node biopsy depending on the depth of the lesion, with subsequent completion lymphadenectomy for positive sentinel node. Locally advanced disease can be approached in several different ways depending on a variety of patient and disease-specific factors. These include surgical resection, isolated limb perfusion and infusion and intralesional injection therapy such as talimogene laherparepvec, IL-2 and Bacille Calmette-Guerin. Ongoing controversy exists regarding the utility of completion lymphadenectomy, and trials such as MSLT-2 will attempt to shed light on this issue. The future of melanoma management will likely focus on expanding the use of immunotherapy, allowing for narrower surgical margins, particularly in sensitive anatomic areas, and limiting the number of completion lymphadenectomies.