[Diagnosis of melanoma]. / Diagnostic du mélanome.

Melanoma is a rare cancer but it is the cancer with the biggest increase of incidence, especially in caucasian populations. UV exposure and genetic predisposition are the two main risk factors. The diagnosis is often clinically suspected with the "ABCDE" rule. However, there are some diagnostic traps. Histological exam of the whole lesion will confirm diagnosis and guide the management. In case of localised melanoma, Breslow index is the best prognostic index. In case of metastatic melanoma, prognostic is dark. The AJCC classification stages patients in 4 groups according to their global survival.

Topical treatment of cutaneous metastases of malignant melanoma using combined imiquimod and 5-fluorouracil.

BACKGROUND: Despite multiple available options, the treatment of cutaneous melanoma metastases is often unsuccessful. Based on the hypothesis that imiquimod and 5-fluorouracil have synergistic antitumor properties, we used this topical combination to treat several patients. AIM: Our objective was to investigate the treatment combination in a small cohort of patients with surgically non-resectable melanoma metastases. METHODS: The lesions of 5 patients with multiple cutaneous metastases were treated topically, 5 days per week, with 5-fluorouracil in the morning and imiquimod at night. RESULTS: 45 lesions were treated. A clinical response was seen in 44 lesions, with a complete response in 19 lesions and a partial response in 25. Stable disease was confirmed in the 1 remaining lesion. No patients developed new lesions during treatment. However, one patient had a recurrence 6 months after treatment discontinuation, followed by a partial response when rechallenged. CONCLUSIONS: The imiquimod and 5-fluorouracil combination is effective. That patients did not develop new, distant lesions suggests the achievement of locoregional control, probably by the induction of antitumor immune response.

Oral metronomic cyclophosphamide in elderly with metastatic melanoma.

INTRODUCTION: In Western countries, the number of frail elderly people with metastatic melanoma (MM) keeps increasing. Conventional chemotherapy frequently induces imbalance in frail physiological cases. We propose to treat these patients with oral metronomic cyclophosphamide. PATIENTS AND METHODS: This retrospective study analyses the data of patients with unresectable MM who received 50 to 100 mg of cyclophosphamide a day, 3 weeks out of 4. Main evaluation criterion was safety. Secondary evaluation criteria were objective response rate and overall survival. RESULTS: Thirteen patients were included (median age: 80, 5 AJCC stage III and 8 AJCC stage IV). Clinical and biological safety were good, leading to long home staying and rare treatment discontinuations. Main toxicity observed was lymphopenia; no opportunist infection occurred. The control rate was 46%: one partial response and five stable diseases (median: 10 months). Survival after beginning of treatment ranged from 4 to 37 months (median: 8 months). DISCUSSION: Literature about MM in frail elderly is limited. Still, specific treatment is necessary. Cyclophosphamide in metronomic schema was well tolerated. The response rate was difficult to assess (small population) but several patients presented with long lasting stabilisation. The mechanisms of action of this treatment are original, associating antiangiogenic action and immunomodulation. CONCLUSION: Cyclophosphamide in metronomic schema showed good safety results for this frail population. Oral treatment enabled patients to stay at home longer and limited hospitalisation time. A larger controlled study will be necessary to confirm these encouraging results in elderly with MM, a classical chemoresistant tumor.