Expert recommendations on diagnostic-therapeutic management of melanoma patients

Rutkowski, Piotr; Wysocki, Piotr J.; Kozak, Katarzyna; Nasierowska‐Guttmejer, Anna; Jeziorski, Arkadiusz; Wysocki, Wojciech M.; Kalinka, Ewa; Świtaj, Tomasz; Kamińska‐Winciorek, Grażyna; Czarnecka, Anna; Koseła-Paterczyk, Hanna; Cybulska-Stopa, Bożena; Wiśniewski, Piotr; Szumera‐Ciećkiewicz, Anna; Zdzienicki, Marcin; Ziobro, Marek; Fijuth, Jacek; Kawecki, Andrzej; Tysarowski, Andrzej; Romanowska–Dixon, Bożena; Markiewicz, A.; Dedecjus, Marek; Kubiatowski, Tomasz; Dolecki, Kamil; Tchórzewska-Korba, Hanna; Rudnicka, Lidia; Owczarek, Witold; Krzakowski, Maciej

doi:10.5603/ocp.2021.0042

Cited by 7 publications

(5 citation statements)

References 124 publications

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“…Although there is no measured incidence in the literature, in the author's experience at a tertiary referral institution, true melanoma of unknown primary is seen extremely infrequently (less than monthly). Some authors theorize that some instances of MUP are partially regressed primary melanoma; however, this has not been substantiated [ 5 ]. This case also demonstrates that tumoral melanosis may be the presenting and residual sign of a preceding melanoma that has fully regressed.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Radiologic Imaging and Full Body Skin Examination in Patients With Melanoma of Unknown Primary

ShamaeiZadeh,

Campbell,

Comfere

2024

Cureus

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Although most melanomas have a cutaneous origin, melanomas are rarely discovered without an overt primary site and are found in the metastatic stage. This phenomenon is called melanoma of unknown primary (MUP), which was first recorded in 1963. Melanoma can also rarely present as tumoral melanosis, which has completely regressed. By definition, this does not have viable melanocytes and histologically presents as an infiltration of melanophages and melanin. A 71-year-old female presented for dermatologic evaluation after being found to have melanoma of unknown primary (MUP). The MUP, located in multiple lymph nodes of the left superior and inferior inguinal region, was found on preoperative imaging indicated for surgical management of endometrial carcinoma. After the biopsy, a positron emission tomographycomputed tomography (PET-CT) scan was performed to determine the extent of involvement, which noted focal uptake of the left heel of just medial to midline with an SUV max of 2.1. Based on the PET-CT findings, the patient was questioned about the lesion on her heel. She had suspected this was due to friction and stated it had been asymptomatic and present for years. This unique case demonstrates that combined total skin examination and whole-body radiologic imaging (preferably PET-CT) are both critical elements in the evaluation of MUP. Since melanoma of unknown primary is at least American Joint Committee on Cancer (AJCC) 8 Stage III (due to N1 status), imaging is reasonable in these patients.

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Section: Discussionmentioning

confidence: 99%

The Utility of Radiologic Imaging and Full Body Skin Examination in Patients With Melanoma of Unknown Primary

ShamaeiZadeh,

Campbell,

Comfere

2024

Cureus

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“…Due to the fact that CLND is associated with a high risk of complications and an increase in adverse events, limiting this approach to specific groups of patients and implementing it only when indicated will reduce the number of unnecessary operations [31]. We have observed changes in trends of surgical approach in SLNB-positive patients in Poland after introduction of Polish national guidelines [32][33][34], leading to eliminating CLND as well as a rapid increase in the use of systemic therapy in this population upon it becoming available. In accordance with those guidelines, the CLND might be performed in patients with a very high risk of extra-sentinel lymph node metastases, such as a large sentinel lymph node metastasis (larger than 1 mm metastasis), involvement of more than two sentinel lymph nodes with metastases or sentinel lymph node extracapsular infiltration.…”

Section: Discussionmentioning

confidence: 99%

The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study

Ziętek

Teterycz

Wierzbicki

et al. 2023

Cancers

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Background: In melanoma treatment, an approach following positive sentinel lymph node biopsy (SLNB) has been recently deescalated from completion lymph node dissection (CLND) to active surveillance based on phase III trials data. In this study, we aim to evaluate treatment strategies in SLNB-positive melanoma patients in real-world practice. Methods: Five-hundred-fifty-seven melanoma SLNB-positive patients from seven comprehensive cancer centers treated between 2017 and 2021 were included. Kaplan–Meier methods and the Cox Proportional-Hazards Model were used for analysis. Results: The median follow-up was 25 months. Between 2017 and 2021, the percentage of patients undergoing CLND decreased (88–41%), while the use of adjuvant treatment increased (11–51%). The 3-year OS and RFS rates were 77.9% and 59.6%, respectively. Adjuvant therapy prolonged RFS (HR:0.69, p = 0.036)), but CLND did not (HR:1.22, p = 0.272). There were no statistically significant differences in OS for either adjuvant systemic treatment or CLND. Lower progression risk was also found, and time-dependent hazard ratios estimation in patients treated with systemic adjuvant therapy was confirmed (HR:0.20, p = 0.002 for BRAF inhibitors and HR:0.50, p = 0.015 for anti-PD-1 inhibitors). Conclusions: Treatment of SLNB-positive melanoma patients is constantly evolving, and the role of surgery is currently rather limited. Whether CLND has been performed or not, in a group of SLNB-positive patients, adjuvant systemic treatment should be offered to all eligible patients.

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“…The sentinel lymph node is the first lymph node in the pathway of lymph outflow from the tumour focus. If melanoma metastasis in regional lymph nodes is confirmed by fine needle biopsy or histopathological examination, lymphadenectomy should be performed in the area of regional lymphatic run-off [15].…”

Section: Principles Of Treatmentmentioning

confidence: 99%

“…Depending on the clinical stage and the presence of the above-mentioned mutation, appropriate systemic therapy is selected -chemotherapy and/or immunotherapy, and in some cases, also radiotherapy. Patients with metastatic disease should be treated in specialized oncology centres [4,15,16].…”

Section: Principles Of Treatmentmentioning

confidence: 99%

Healthcare problems of a patient with melanoma of the skin cancer

Kamińska,

Bielak,

Ścirka

et al. 2024

Med Og Nauk Zdr.

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Expert recommendations on diagnostic-therapeutic management of melanoma patients

Cited by 7 publications

References 124 publications

The Utility of Radiologic Imaging and Full Body Skin Examination in Patients With Melanoma of Unknown Primary

The Utility of Radiologic Imaging and Full Body Skin Examination in Patients With Melanoma of Unknown Primary

The Current Treatment Trends and Survival Patterns in Melanoma Patients with Positive Sentinel Lymph Node Biopsy (SLNB): A Multicenter Nationwide Study

Healthcare problems of a patient with melanoma of the skin cancer

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