Comparison of clinicopathological features and treatment outcomes for cutaneous melanomas of the head and neck and melanomas arising at other sites: implications for systemic therapy.

BACKGROUND: Melanoma is increasingly recognized as a heterogeneous disease, with conflicting evidence regarding whether cutaneous head and neck melanoma (CHNM) represents a distinct entity. OBJECTIVE: Comparison of clinicopathological features and treatment outcomes of CHNM and cutaneous melanomas of other sites (CMOS). METHODS: Patients with CHNM and CMOS diagnosed between 2000-2018 were included. Locoregional control (LRC), distant metastasis-free survival (DMFS), melanoma-specific survival (MSS), and overall survival (OS) were described using the Kaplan-Meier method. Cox regression analyses were performed to examine associations between prognostic factors and outcomes. Additional analyses of survival from time of stage IV disease diagnosis were undertaken, stratified by receipt of BRAF-targeted therapy and immune checkpoint inhibitor (ICI) immunotherapy. RESULTS: Of 3007 CHNM and 10637 CMOS patients, CHNM had more adverse pathological features (median age 65.9 vs. 58.5, p<0.001, median Breslow thickness 1.7mm vs. 1.2mm, p<0.001, ulceration 21.2% vs. 18.2%, p<0.001). CHNM had worse LRC (HR 1.17, p<0.001) and DMFS (HR 1.25, p<0.001) but there were no significant differences in MSS or OS. Amongst stage IV patients who received ICI, CHNM had better MSS (HR 0.56, p=0.001) and OS (HR 0.57, p<0.001) on multivariable analyses. LIMITATIONS: Retrospective study, offset by prospective data collection. CONCLUSION: CHNM is associated with a distinct clinicopathological and prognostic profile.

Development and validation of risk calculators for people with "thin" melanomas on their skin to predict the likelihood that their cancer will return: a plain language summary of publication.

WHAT IS THIS SUMMARY ABOUT?: This is a summary of an article describing the development of risk calculators for use in people who develop a type of melanoma on their skin called "thin" melanoma to predict the likelihood that their cancer will return. The article was originally published in the Journal of Clinical Oncology in 2021. HOW WERE THE CALCULATORS DEVELOPED?: Calculations were performed to predict the chance of people with thin melanomas surviving without their melanoma recurring. Three graphical prediction calculators (called nomograms) were developed, along with easy-to-use online calculators using the same underlying calculation methods. The model was developed using data for 25,930 Dutch people diagnosed with thin melanomas (called the "development set"). To test its ability to predict melanoma recurrence, it was then compared with data for 2,968 Australian people with melanoma (the "validation set"). The calculators developed in the Dutch patients were found to accurately predict the risk of melanoma recurring for people with melanoma in the Australian "validation" group. WHAT DO THE RESULTS MEAN?: The calculators provide estimates of the risk of the melanoma returning for people with thin melanomas. The easy-to-use online calculators are freely available on a smartphone, tablet or computer, and will assist in providing accurate estimates of recurrence risks for individuals with thin melanomas, allowing more intensive follow-up of those whose predicted risk of their melanoma returning is high.

Vasopressors improve outcomes in autologous free tissue transfer: A systematic review and meta-analysis.

BACKGROUND: Vasopressor use in patients undergoing autologous free tissue transfer is generally discouraged by surgeons perioperatively. This stems from concerns about the increased risk of flap failure with their use. The aim of this systematic review was to investigate the evidence and quantify any harm or benefits associated with vasopressor use. METHODS: A systematic review of the literature was undertaken using OVID Medline to search 13 databases. The search strategy used Boolean operators, text word searches, truncation symbols, and adjacency searching. Terms such as "free flap," "free tissue graft," and "free tissue transfer" were used along with a list of appropriate vasopressors. The primary outcome was free flap failure, on which a meta-analysis was performed. RESULT: The search initially identified 1029 unique articles, which after title and abstract screening was reduced to 112, of which 15 remained after full-text screening for inclusion in the review and analysis. We analyzed data from 8427 flaps, with 6695 having received a vasopressor. Meta-analysis demonstrated that vasopressor use reduced the relative risk (RR) of free flap failure (RR: 0.70; 95% CI: 0.50-0.97; p = 0.03) but did not affect rates of other adverse events (RR: 0.81; 95% CI: 0.63-1.05; p = 0.11). CONCLUSION: Vasopressor use appears beneficial for autologous free tissue transfer, with evidence that it reduced the risk of flap failure without impacting the rates of other adverse events. The use of vasopressors should, therefore, be encouraged on a case-by-case basis, depending upon the general physiological needs of the patient.