Variations in Management of Stage I to Stage III Cutaneous Melanoma

Grange, Florent; Vitry, Fabien; Granel‐Brocard, F.; Lipsker, Dan; Aubin, F.; Hédelin, Guy; Dalac, S.; Truchetet, F.; Michel, Catherine; Batard, Marie-Laure; Baury, Béatrice; Halna, Jean-Michel; Schmutz, J.‐L.; Delvincourt, C.; Reuter, G; Dalle, S.; Bernard, P.; Danzon, Arlette

doi:10.1001/archderm.144.5.629

Cited by 40 publications

(8 citation statements)

References 44 publications

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“…However, the current staging system only partly explains the variability in the prognosis of melanoma, and there remains unexplained heterogeneity within each stage. Additionally, despite the benefit of early detection of locoregional and distant metastases amenable to curative resection [3,5], there is no consensus on either the selection or timing of imaging studies and laboratory tests for use in follow-up [6]. This is in part due to the limited sensitivity and specificity of available imaging modalities and blood tests, coupled with considerable economic cost [7].…”

Section: Introductionmentioning

confidence: 99%

Serum microRNAs as biomarkers for recurrence in melanoma

et al. 2012

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BackgroundIdentification of melanoma patients at high risk for recurrence and monitoring for recurrence are critical for informed management decisions. We hypothesized that serum microRNAs (miRNAs) could provide prognostic information at the time of diagnosis unaccounted for by the current staging system and could be useful in detecting recurrence after resection.MethodsWe screened 355 miRNAs in sera from 80 melanoma patients at primary diagnosis (discovery cohort) using a unique quantitative reverse transcription-PCR (qRT-PCR) panel. Cox proportional hazard models and Kaplan-Meier recurrence-free survival (RFS) curves were used to identify a miRNA signature with prognostic potential adjusting for stage. We then tested the miRNA signature in an independent cohort of 50 primary melanoma patients (validation cohort). Logistic regression analysis was performed to determine if the miRNA signature can determine risk of recurrence in both cohorts. Selected miRNAs were measured longitudinally in subsets of patients pre-/post-operatively and pre-/post-recurrence.ResultsA signature of 5 miRNAs successfully classified melanoma patients into high and low recurrence risk groups with significant separation of RFS in both discovery and validation cohorts (p = 0.0036, p = 0.0093, respectively). Significant separation of RFS was maintained when a logistic model containing the same signature set was used to predict recurrence risk in both discovery and validation cohorts (p < 0.0001, p = 0.033, respectively). Longitudinal expression of 4 miRNAs in a subset of patients was dynamic, suggesting miRNAs can be associated with tumor burden.ConclusionOur data demonstrate that serum miRNAs can improve accuracy in identifying primary melanoma patients with high recurrence risk and in monitoring melanoma tumor burden over time.

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Section: Introductionmentioning

confidence: 99%

Serum microRNAs as biomarkers for recurrence in melanoma

et al. 2012

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“…The variability in recommendations likely reflects financial considerations and medical environment 9 . Costs can be quite considerable, particularly when imaging studies are included.…”

Section: Introductionmentioning

confidence: 99%

Plasma Markers for Identifying Patients with Metastatic Melanoma

Kluger

Hoyt

Bacchiocchi

et al. 2011

Clinical Cancer Research

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Purpose With the rising incidence of melanoma, more patients are undergoing surveillance for disease recurrence. Our purpose was to study levels of proteins that might be secreted in the blood of patients with metastatic melanoma that can be used for monitoring these individuals. Methods Genome-wide gene expression data were used to identify abundantly expressed genes in melanoma cells that encode for proteins likely to be present in the blood of cancer patients based on high expression levels in tumors. ELISA assays were employed to measure proteins in plasma of 216 individuals; 108 metastatic melanoma patients and 108 age- and gender-matched patients with resected stage I/II disease split into equal-sized training and test cohorts. Results Levels of seven markers, CEACAM, ICAM-1, osteopontin, MIA, GDF-15, TIMP-1 and S100B, were higher in patients with unresected stage IV disease than in patients with resected stage I/II disease. 81% of the stage I/II patients in the training set had no marker elevation, whereas 69% of the stage IV patients had elevation of at least one marker (p<0.0001). Receiver operating characteristic curves for the markers in combination in these two patient populations had an AUC of 0.79 in the training set, 0.8 in the test set. A CART model developed in the training set further improved the AUC in the test set to 0.898. Conclusions Plasma markers, particularly when assessed in combination, can be used to monitor patients for disease recurrence and can compliment currently used LDH and imaging studies; prospective validation is warranted.

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“…In France, in contrast with other countries, 2,4 current guidelines do not recommend routine SLNB and specify only that skilled teams performing clinical trials may offer it or that it may be offered as part of a protocol for patients with melanomas thicker than 1 mm or with ulceration. In a recent population‐based study of clinical practices covering five French geographical regions and 8.2 million inhabitants, we found that SLNB was performed in 34% of CMs thicker than 1 mm, with large disparities between regions 5 . Indeed, some centers routinely offer SLNB, whereas others do not, often as a result of personal preferences and convictions.…”

mentioning

confidence: 95%

“…In this context, consensus guidelines 1–4 and practices vary from one country to another and within each country between centers 5–10 . In France, in contrast with other countries, 2,4 current guidelines do not recommend routine SLNB and specify only that skilled teams performing clinical trials may offer it or that it may be offered as part of a protocol for patients with melanomas thicker than 1 mm or with ulceration.…”

mentioning

confidence: 99%