1113 Distance between primary melanoma site and the brain strongly affects brain metastasis-free survival, head-neck location as the main predictor for early onset of brain metastases

Gorka, Eszter; Czirbesz, Kata; Fabó, Dániel; Liszkay, G.

doi:10.1016/s0959-8049(16)30495-6

Cited by 4 publications

(4 citation statements)

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“…Analyzing the baseline characteristics of the cohort, we observed that patients who developed central nervous system (CNS) metastases initially exhibited unfavorable tumor features: specifically, a median Breslow index exceeding a median of 3 mm, with over half presenting ulceration, aligning with findings from prior studies [ 2 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. Notably, microsatellites were also seen in our study to be more prevalent in patients who subsequently developed CNS metastasis, occurring in 8.7% of cases vs. 2.3% in the control group.…”

Section: Discussionsupporting

confidence: 78%

Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases—A Cohort Study

Serra,

Abarzua-Araya,

Arance

et al. 2024

Cancers

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Background: Melanoma is the cancer with the highest risk of dissemination to the central nervous system (CNS), one of the leading causes of mortality from this cancer. Objective: To identify patients at higher risk of developing CNS metastases and to evaluate associated prognostic factors. Methods: A cohort study (1998–2023) assessed patients who developed CNS melanoma metastases. Multivariate logistic regression was used to identify predictive factors at melanoma diagnosis for CNS metastasis. Cox regression analysis evaluated the CNS-independent metastasis-related variables impacting survival. Results: Out of 4718 patients, 380 (8.05%) developed CNS metastases. Multivariate logistic regression showed that a higher Breslow index, mitotic rate ≥ 1 mm2, ulceration, and microscopic satellitosis were significant risk factors for CNS metastasis development. Higher patient age and the location of the primary tumor in the upper or lower extremities were protective factors. In survival analysis, post-CNS metastasis, symptomatic disease, prior non-CNS metastases, CNS debut with multiple metastases, elevated LDH levels, and leptomeningeal involvement correlated with poorer survival. Conclusion: Predictive factors in the primary tumor independently associated with brain metastases include microscopic satellitosis, ulceration, higher Breslow index, and trunk location. Prognostic factors for lower survival in CNS disease include symptomatic disease, multiple CNS metastases, and previous metastases from different sites.

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Section: Discussionsupporting

confidence: 78%

Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases—A Cohort Study

Serra,

Abarzua-Araya,

Arance

et al. 2024

Cancers

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“…The brain and lungs were the most common sites of distant metastasis and showed a poor prognosis, which was comparable in terms of frequency and biological aggressiveness to thicker melanomas [32]. All of the patients with distant metastasis received systemic therapy in both metastatic and adjuvant settings.…”

Section: Discussionmentioning

confidence: 99%

Dermoscopy as a Tool for Identifying Potentially Metastatic Thin Melanoma: A Clinical–Dermoscopic and Histopathological Case–Control Study

De Giorgi,

Silvestri,

Cecchi

et al. 2024

Cancers

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Despite being early-stage tumors, thin cutaneous melanomas contribute significantly to mortality and have a rising incidence. A retrospective case–control study was performed to identify clinical–dermoscopic and histopathological variables linked to local and distant metastases in melanomas ≤0.8 mm. Data from 1 January 2000 to 22 June 2022 were analyzed from two Italian skin cancer referral centers. Sixteen patients with ≤0.8 mm melanomas developing metastases were studied compared to controls without metastases over 5 years. Statistical analysis involved Pearson’s chi-squared test or Fisher’s exact test. Of the 1396 cases, 1.1% progressed. The median diagnosis age was 49 (range 28–83), with 56.3% men and 43.7% women. The torso was the primary tumor site (43.7%). Clinically, lesions were pigmented (>10 mm diameter: 73.3%, ≥3 colors: 80%). Dermoscopically, the common features were white patches (73.3%), atypical vascular patterns (66.5%), blue-gray areas (60%) and absent pigment networks (60%). Histopathologically, all cases had adverse features like regression (87.4%), dermal mitoses (50%), a vertical growth phase (62.5%) and ulceration (12.5%). These findings were statistically significant compared to controls (p < 0.05). In ≤0.8 mm melanomas, specific clinical–dermoscopic traits might indicate higher metastatic potential when paired with adverse histopathological features.

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“…It is commonly reported that scalp melanomas have a higher incidence of brain metastasis and a poorer overall prognosis compared with cutaneous melanomas occurring at other body sites [1,[4][5][6]14,15]. Previous studies have indicated not only a higher incidence of brain metastasis but also a shorter time to development of brain metastasis for scalp primary melanomas compared with other head and neck subsites [1,8]. However, it has been controversial whether this is due to anatomical factors, unique biology, or delays in diagnosis and treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Several anatomical factors have been suggested to favor or facilitate brain metastasis from primary scalp melanomas. For example, it has been postulated that the rich lymphovascular supply of the head and neck regions and its proximity to the brain may contribute to the increased incidence of brain metastases for primary melanomas arising in this region [5,7,8]. However, these broad anatomical concepts do not account for the higher propensity of scalp melanomas to metastasize to the brain compared with the rest of the head and neck region, suggesting that other features of scalp melanomas may be involved.…”

Section: Introductionmentioning

confidence: 99%

Lack of association between anatomical sites of scalp melanomas and brain metastases does not support direct vascular spread

Yip

Choksi

et al. 2022

Melanoma Research

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1113 Distance between primary melanoma site and the brain strongly affects brain metastasis-free survival, head-neck location as the main predictor for early onset of brain metastases

Cited by 4 publications

References 0 publications

Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases—A Cohort Study

Predictive and Prognostic Factors in Melanoma Central Nervous System Metastases—A Cohort Study

Dermoscopy as a Tool for Identifying Potentially Metastatic Thin Melanoma: A Clinical–Dermoscopic and Histopathological Case–Control Study

Lack of association between anatomical sites of scalp melanomas and brain metastases does not support direct vascular spread

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