An innovative approach for locally advanced stage III cutaneous melanoma

Abstract

Patients with advanced nodal melanoma are typically managed with a regional nodal dissection; however, they have a high rate of distant relapse after surgery. This study assesses the role of preoperative radiotherapy to assist with the regional control in this subset of patients. Patients who had histologically confirmed stage III malignant melanoma and were treated with preoperative radiotherapy between 2004 and 2011 were eligible. All patients were staged with computer tomography and most with [F]-fluorodeoxyglucose (FDG) PET. Patients received preoperative radiotherapy, followed by a planned regional dissection at 12-14 weeks from completion with assessment of clinical, radiological and pathological responses. The primary outcome measure was the 1-year actuarial in-field control. There were 12 patients, with nine having disease of the axilla. All patients received radiotherapy up to a median dose of 48 Gy in 20 fractions, with seven patients achieving a partial clinical response. Ten patients proceeded to surgery, with four patients developing minor wound complications. The FDG-PET response did not appear to correlate with the pathological response. The 1-year in-field control rate was 92% (95% confidence interval 54-99) and the 1-year relapse-free survival was 54% (95% confidence interval 21-78). For selected patients with high-volume regional disease, we have successfully used preoperative radiotherapy, followed by a nodal dissection. Whether this type of protocol is of value in a more general group of patients with high-volume regional disease is currently under investigation.

Localized sinonasal mucosal melanoma: Outcomes and associations with stage, radiotherapy, and positron emission tomography response

“…47,48 Decreased metabolic activity has been associated with a completed pathologic response in some cases of cutaneous melanoma. 49 The striking difference observed in survival in patients with a complete PET response after RT suggests that it may be an important prognostic indicator of potential for durable response in sinonasal mucosal melanoma. Further investigation into PET imaging in sinonasal mucosal melanoma is warranted in a more systematic and prospective approach.…”

Diphenylcyclopropenone for the treatment of cutaneous in‐transit melanoma metastases – results of a prospective, non‐randomized, single‐centre study

“…Left untreated ITM can rapidly progress, contributing to significant disease‐related morbidity and health‐related expenditure . Various modalities have been utilized to achieve durable treatment responses however without significant effects on overall survival . In cases of localized disease, complete histological excision is considered the gold standard.…”

Radiation-induced melanoma-associated leucoderma, systemic antimelanoma immunity and disease-free survival in a patient with advanced-stage melanoma: a case report and immunological analysis

“…Interestingly, recent studies have shown clear clinical benefit of adjuvant radiotherapy given pre-or postnodal dissection in patients with locally advanced melanoma. [7][8][9] In these studies, immunological parameters for defining the presence of antimelanoma immune responses were not determined in the treated patients. Moreover, radiation-induced MAL in patients with melanoma, coinciding with antimelanoma immunity, has not previously been studied.…”