A incidência do melanoma cutâneo vem aumentando significativamente de 1:1500 em 1935 para cerca de 1:75 no ano 2000. Contudo, atribuído a um diagnóstico cada vez mais precoce, têm-se observado uma melhora da sobrevida em cinco anos com diminuição da taxa de mortalidade geral entre 70 a 80% desde a década de 30. É o câncer mais prevalente na faixa etária entre 25 e 35 anos nos EUA. O Brasil ocupa a 15º posição com relação à incidência do tumor no mundo. O estadiamento inicial é baseado na pesquisa de sinais e sintomas que podem indicar doença metastática. Especial atenção deve ser dada à palpação de linfonodos regionais. A espessura e a ulceração são os principais fatores de risco independentes, em pacientes com melanoma primário com linfonodos livres. Já naqueles com metástases linfonodais, a presença de ulceração, de metástase detectada macroscopicamente e o número de linfonodos acometidos, são os principais índices de impacto na sobrevida. Pacientes com metástases para o pulmão possuem melhor prognóstico no primeiro ano de sobrevida em comparação àqueles com metástases para outros órgãos. A dosagem de DHL é fator prognóstico poderoso, sendo incluída no último estadiamento publicado, em pacientes com estádio IV da doença. A pesquisa do linfonodo sentinela já é técnica incorporada à conduta de pacientes com melanoma com reconhecido impacto no estadiamento, prognóstico e programação terapêutica. Devido à falta de padronização para o tratamento do melanoma, muitos pacientes ainda evoluem com um prognóstico reservado devido a uma conduta inicial inadequada. Os tratamentos vêm mudando significativamente e a proposta deste trabalho visa apresentar uma revisão com ênfase nas condutas preconizadas para o melanoma.

Sentinel node mapping reduces surgical morbidity and allows the use of more accurate tumour staging techniques. Radionuclide studies are preferentially performed using small colloids, which have limited availability in our country. The possibility of using phytate for sentinel node mapping was raised because of the similarity between its biodistribution and that of nanocolloids in the reticulo-endothelial system. In this paper we evaluated the use of 99mTc-phytate for sentinel node mapping, correlating the histopathological results with the status of the rest of the lymph node chain in different malignant tumours. A total of 100 patients were studied. group 1 consisted of 62 patients with breast cancer, group 2 of 20 patients with melanoma and group 3 of 18 patients with vulvar carcinoma. Lymph node scintigraphy was carried out after injecting 99mTc-phytate subdermally, and the sentinel node projection was marked on the skin. After 18-24 h, intraoperative sentinel node localisation was performed using a gamma probe (combined with visual localisation using patent blue dye) in 75 patients, and lymph node dissection was then carried out. Radionuclide scintigraphy identified the sentinel node in 98% of all studies. Intraoperative detection using the gamma probe was equally efficient: group 1=93% (38/41), group 2=95% (18/19) and group 3=100% (15/15). The sentinel node was involved in 41%, 31% and 20% of cases in groups 1, 2 and 3, respectively. Among the patients with positive nodes, the sentinel node was the only one affected in 53% of group 1, 50% of group 2 and 67% of group 3 cases. The method's negative predictive value was 91% in group 1 and 100% in the other groups. One false-negative study occurred in a patient who had a multifocal tumour and an intraparenchymatous lymph node; another occurred in a patient with a macroscopically affected node found during surgery. There were no side-effects related to the 99mTc-phytate. It is concluded that scintigraphic and intraoperative sentinel node identification was satisfactorily performed using 99mTc-phytate. The results were comparable to those previously described in the literature using other radiopharmaceuticals. Easy availability and low cost justify the use of phytate in our practice.

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PURPOSE National epidemiologic data on melanoma are scarce in Brazil. The current work presents final demographic, clinical, and pathologic results from the Brazilian Melanoma Group database to detail how patients with melanoma present at diagnosis. METHODS The online database includes patients diagnosed between 1982 and 2015 and evaluated at their centers of origin between 2001 and 2016. The primary objective was to describe the demographic, clinical, and pathologic characteristics of the patients, and secondary objectives were to investigate the association between clinical and pathologic variables of interest. RESULTS A total of 1,596 patients were included. Median age was 52 years, 57% were women, and the majority were identified as white. Invasive melanoma was diagnosed in 1,297 patients, mostly localized, whereas 299 (19%) had in situ disease (TisN0M0). Only 165 patients had initial lymph node involvement. Fitzpatrick skin types I or II were slightly more frequent with in situ melanoma (73%) than with invasive disease (67%; P = .054). The median Breslow thickness was 0.95 mm, Clark levels 2 and 3 comprised nearly 70% of cases, and ulceration was present in 18% of patients. The mitotic rate was significantly associated with the presence of ulceration and both vascular and perineural invasion but not with margin positivity, whereas histologic regression was associated with both intratumoral and peritumoral inflammatory infiltrates. CONCLUSION Despite the limitations of an observational, registry-based study, the current results provide a general profile of patients with cutaneous melanoma in Brazil at the time of diagnosis.