Changing biology of cutaneous melanoma

Perić, Barbara; Žgajnar, Janez; Bešič, Nikola; Hočevar, Marko

doi:10.1097/cmr.0b013e3282f94651

Cited by 6 publications

(4 citation statements)

References 16 publications

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“…3 The parietal pelvic fascia covers the sacral nerves and piriformis muscles, and continues to a fascia covering the ventral surface of the levator ani muscle (Fig 1). 3 The parietal pelvic fascia covers the sacral nerves and piriformis muscles, and continues to a fascia covering the ventral surface of the levator ani muscle (Fig 1).…”

Section: In Replymentioning

confidence: 99%

In Reply

Lee

Faries

Morton

2009

JCO

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IN REPLY:We thank Hocevar et al for their interest in our multivariate analysis of prognostic factors for patients with palpable metastatic melanoma in a single regional lymphatic basin. 1 We agree that decade of diagnosis is not a common prognostic factor for melanoma; its marginal significance in our study and its importance in the recent studies from Lasithiotakis et al 2 and Peric et al 3 thus are intriguing.However, because our study 1 focused on prognostic factors available for melanoma from an unknown primary (MUP), our findings probably should not be compared directly with any study involving a multivariate analysis that included important prognostic factors related to the primary tumor. In our study, status of the primary tumor referred to known primary melanoma versus MUP; primary tumor thickness, invasion, ulceration, and other prognostic characteristics of primary melanoma 4 were not included in the multivariate analysis. The significant covariates in our multivariate analysis were likely driven by the larger known primary melanoma cohort. In addition, our study population was a focused subset of patients with stage III melanoma with palpable nodal disease to a single nodal basin. Therefore, the significance for decade of diagnosis in this subset may not be a valid reflection of the population of patients with stage III melanoma.Hocevar et al hypothesize that melanoma has become less aggressive over time. This hypothesis cannot be discounted because none of the above-mentioned multivariate studies considered changes in and possible effects of tumor regression, mitotic rate, angiolymphatic invasion, and unidentified biologic markers. However, nonbiologic factors also must be considered in a chronologic analysis of melanoma survival, especially for a stage of disease with a 5-year overall survival rate of 24% to 70%. 5 For example, nodal tumor burden, a known prognostic factor, was not evaluated in the above studies. 2,3 Even if nodal tumor burden has decreased in recent years, is this decrease a result of the changing biology of melanoma, or is it due to earlier detection 6-8 because of increased awareness?Another unaccounted factor is the type of treatment received for stage III melanoma. Our study 1 included a cohort of patients with stage III melanoma who underwent regional lymphadenectomy for palpable nodal disease, but the studies of Lasithiotakis et al 2 and Peric et al 3 did not evaluate treatment. Although standard treatment for stage III melanoma has not changed for the last three decades, it may not be reasonable to assume that all patients underwent standard treatment. According to a recent study in the United States by Bilimoria et al, 9 only 50% of patients with sentinel node metastasis underwent complete lymph node dissection. Chronologic, demo-graphic, and geographic variations in practice patterns should be considered.Although the improved survival in more recent years could reflect a change in the biology of melanoma, other possible explanations cannot be discounted. Regardless of its ...

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Section: In Replymentioning

confidence: 99%

In Reply

Lee

Faries

Morton

2009

JCO

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“…3 Because treatment of patients with melanoma with regional metastases has unfortunately not changed in the last three decades, we believe that the disease itself has become less aggressive. Our group studied the entire Slovenian population of patients with melanoma using the Slovenian National Cancer Registry, and found that the most important independent predictor of survival among patients diagnosed with CM between 1983 and 1997 was time of diagnosis.…”

Section: Authors' Disclosures Of Potential Conflicts Of Interestmentioning

confidence: 99%

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Marks

Prosnitz

2009

JCO

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“…Concomitant with this, there has been a shift towards earlier diagnosis, with a consequent improvement in prognosis. This has been ascribed by numerous authors to improved public and professional education [1–4]. …”

Section: Introductionmentioning

confidence: 99%

The Determination of Melanoma Stage at Diagnosis

Lee

2010

Dermatology Research and Practice

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The rising proportion of melanomas diagnosed at an early pathologic stage is commonly ascribed to better public education. However in the US SEER program of cancer registration it has been found that the rates for in situ melanomas are closely related by a log linear relationship to the incidence of invasive melanomas and that this relationship is unrelated to calendar year or gender or patient age. This relationship is sufficiently strong to leave little room for other factors. The relationship may be different in populations with different melanoma rates and responses to them. It is suggested that the results are due to variations within populations of individual response to melanoma cell proliferation.

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Changing biology of cutaneous melanoma

Cited by 6 publications

References 16 publications

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The Determination of Melanoma Stage at Diagnosis

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