Comorbidity in Small Cell Lung Cancer: Prognostic Impacts of Hypertension/Coronary Artery Disease, Diabetes Mellitus, and Chronic Obstructive Pulmonary Disease.

Comorbidity, the most important components of which are hypertension/coronary artery disease (HTN/CAD), diabetes mellitus (DM), and chronic obstructive pulmonary disease (COPD), is frequently encountered in small cell lung cancer (SCLC) patients. We aimed to assess the possible impacts of these major comorbidities on the prognoses of SCLC patients. A total of 378 SCLC patients were analyzed retrospectively. We did not ascertain the effect of comorbidity on survival in SCLC patients in general; and similarly, the presence of HTN/CAD and COPD did not adversely affect the outcome. However, lower survival rates were observed in patients with SCLC coexisting with DM.

Ulceration vs. Mitosis in Cutaneous Melanoma: Which Is Superior for Predicting Prognosis Across Clinical Stages?

Ulceration and high mitosis are considered among the major unfavorable prognostic factors in the survival of cutaneous melanoma patients. The aim of this study was to investigate the clinical significance of these parameters and to compare them to see which one is superior to predicting prognosis across all clinical stages of melanoma. A total of 1,074 melanomas were analyzed retrospectively. Tumor ulceration was found to be limited to the local stage for predicting survival, whereas, mitosis maintained its prognostic strength for predicting survival across all clinical stages. Furthermore, no survival differences were observed between ulceration and mitosis across clinical stages.

Major Histotypes in Skin Melanoma: Nodular and Acral Lentiginous Melanomas Are Poor Prognostic Factors for Relapse and Survival.

ABSTRACT: The histological subtype is not considered one of the major prognostic factors in melanoma, yet it is known to have an impact on survival. The aim of this study was to investigate the clinical significance of histological subtypes and the possible impacts of clinicopathological factors on the course of melanoma patients of all stages. A total of 1017 cutaneous melanoma patients were analyzed retrospectively. Four major melanoma histotypes that were studied in this study were as follows: (1) superficial spreading melanoma (SSM), (2) nodular melanoma (NM), (3) acral lentiginous melanoma (ALM), and (4) lentigo maligna melanoma (LMM). Unlike SSMs and LMMs, there were statistically significant correlations between NMs and ALMs and most aggressive histopathological prognostic indicators, such as higher Clark level ( P = 0.0001), thick Breslow depth ( P = 0.0001), presence of ulceration ( P = 0.0001), and lymphovascular invasion ( P = 0.0001). Furthermore, NMs and ALMs were also associated with advanced clinical stages, that is, node involvement and metastasis. Relapse rates for nonmetastatic melanomas were higher in NMs (39.6%) and ALMs (35.3%) than in SSMs (24.3%) and LMMs (10.3%) ( P = 0.0001). Additionally, 5-year relapse-free survival rates were 90.5%, 70.5%, 55.7%, and 50.5% in LMMs, SSMs, ALMs, and NMs, respectively ( P = 0.0001). Moreover, 5-year overall survival rates plummeted from 84.3% in LMMs to 74.8%, 64.3%, and 46% in SSMs, ALMs, and NMs, respectively ( P = 0.0001). In conclusion, we observed that the histologic subtype was an independent predictor for relapse and outcome for cutaneous melanoma patients. Both NM and ALM had unfavorable prognoses, and they were associated with known poor pathological and clinical indicators.

Successful Treatment of a 92-Year-Old Classic Kaposi's Sarcoma Man With Ultra-Low Dose Oral Etoposide.

INTRODUCTION: Because classic Kaposi's sarcoma (CKS) is currently regarded as a low-grade vascular malignancy, it has been usually known as indolent clinical course. The slow-growing neoplasms are usually asymptomatic and rarely systematically progressive. Although CKS is a chronic disease which is rarely life-threatening, systemic therapy may be necessary in some patients with symptomatic skin or visceral involvement. CASE REPORT: In this report, we presented a 92-year-old CKS man with widespread and symptomatic skin lesions. MANAGEMENT AND OUTCOME: Patient was treated successfully with ultra-low dose oral etoposide; 50 mg/day for 7 days. Cycles were repeated in every 21 days. There was a dramatic regression in all lesions at the end of treatment; only skin colorations were persisted instead of palpable nodular lesions. Moreover, no serious hematological and non-hematological adverse events were observed. DISCUSSION: Fragile advanced CKS patients with advanced age and/or comorbitidies need to be considered to optimize outcomes. Treatment with single-agent oral chemotherapy, oral ultra-low dose etoposide, may be one of the effective treatment styles.

Complementary and alternative medicine (CAM) in Turkish cutaneous melanoma patients: A prospective study from tertiary cancer center.

BACKGROUND: Only a few studies assessed the prevalence and the predictors of complementary and alternative medicine (CAM) use specifically in melanoma patients. The aim of this study was to assess the extent of CAM use in Turkish melanoma patients. OBJECTIVE: To assess the extent of CAM use and to compare sociodemographic and clinical characteristics between users and non-users in melanoma patients. METHODS: One hundred melanoma patients who were seen in outpatient clinics were included in a survey using questionnaire on CAM use. RESULTS: Twenty-seven patients used at least one type of CAM, the majority of which were herbs (73%). Turmeric (curcumin) was the most popular herb that was used alone or in conjunction with various other herbs (41%). Living in rural areas was significantly associated with CAM use (p = 0.02). The most common reason for CAM use was intent to cure of the disease (52%). The primary source of information about CAM was a close friend or a family contact (44%). CAMs were generally used together with conventional anticancer treatment modalities (64%) and they were ingested on a regular base (72%). CAMs could easily be acquired at regular herbal stores (88%). The patients experienced almost no adverse effects with CAM use; and most cases (71%) had confidence in CAM. About half of the patients consulted with their physicians about CAM use. CONCLUSION: Minority, nearly one fourth of the melanoma cases used at least one type of CAM, the majority of which were herbs and turmeric (curcumin) was the most popular agent.

Serum 25-Hydroxyvitamin D Level Is Not Associated with Duration and Activity of Disease in Melanoma Patients.

Preclinical and epidemiological studies showed the association between 25-hydroxyvitamin D (vitamin D) and cancer development. The aim of the study was to evaluate serum vitamin D levels of melanoma patients and compare them with other malignancies and healthy controls. A total of 87 cutaneous melanoma patients from a tertiary cancer center were included in the study. Vitamin D levels were measured with electrochemiluminescence binding assay. There were no differences between serum vitamin D levels of melanoma patients, other malignancies and healthy controls (median values: 18.8, 14.3, and 24.5 ng/ml, respectively, p > 0.05). Vitamin D deficiency (<20 ng/ml) was found in 56% of melanoma patients and 42% of healthy controls; however serum vitamin D levels in only 16% of both melanoma patients and healthy controls were sufficient (>30 ng/ml) (p > 0.05). Furthermore, no difference regarding serum vitamin D levels was found between melanoma and other malignancies. Age, gender and clinical stage were not found statistically correlated with serum vitamin D levels. Similarly, serum vitamin D level was not associated with disease duration and presence or absence of active disease. In conclusion, there was no difference between serum vitamin D levels of melanoma patients and healthy controls and it was also not associated with duration and activity of disease.

Multiple combinations of melanocytic and vascular endothelial markers enhance the detection rate of lymphovascular invasion in cutaneous melanoma.

BACKGROUND: Lymphovascular invasion (LVI) is believed to be the mechanism by which melanoma cells can disseminate to regional lymph nodes and distant sites and may be predictive of adverse outcome. Lymphovascular invasion often difficult to detect on hematoxylin-eosin (HE) stained sections, are readily identified with dual immunohistochemistry (IHC) for melanocytic and vascular markers. METHODS: A total of 100 primary cutaneous malignant melanoma cases that had a Breslow thickness of 1-4 mm and lacked LVI by conventional HE assessment were included. We compared the LVI detection rates of double staining for CD31/S100 and CD34/S100, and D2-40/S100, and examined the association of LVI with clinical outcomes. RESULTS: The dual immunohistochemical positivity for CD31/S100, CD34/S100, and D2-40/S100 were 40(40%), 17(17%) and 35(35%), respectively. On multivariate analysis, LVI was an independent predictor of SLN status. Multivariate analysis revealed that LVI and male gender were independent risk factors for overall survival. CONCLUSIONS: The recognition of LVI is improved by dual IHC and predicts SLN metastasis. The detection of LVI using dual IHC, especially by a combination of CD31/S100 and D2-40/S100 is a useful step that inclusion should be recommended in basic evaluation parameters for cutaneous melanoma.

Mitotic rate in node-positive stage III melanoma: it might be as important a prognostic factor as node number.

BACKGROUND: Stage III melanoma is a heterogenous disease, and the number of tumor-involved lymph nodes is the most significantly unfavorable prognostic indicator for relapse and outcome. The aim of this study is to investigate the possible effects of the various clinicopathological factors on the course of node-positive stage III disease. METHODS: A total of 389 node-positive stage III cutaneous melanomas were included in the study and analyzed retrospectively. All underwent pathological nodal staging by sentinel lymph node biopsy or elective lymph node dissection. RESULTS: The group was male-dominant (59%) and the median age was 50 years. The largest group of patients was N1 (n = 221, 56.8%) followed by N2 (n = 105, 27.0%) and N3 (n = 63, 16.2%). N1 melanomas were less frequently associated with relapses than melanomas with multiple lymph node metastases (P = 0.05). The 5-year relapse-free survival rate was 37.9%. The melanomas with multiple lymph nodes metastases (P = 0.01), higher mitotic rate (P = 0.005) and ulceration (P = 0.02) had worse RFS. In the multivariate analysis only the significances of the N2-N3 stage (P = 0.016) and higher mitosis (P = 0.012) persisted. The severe lymph node metastasis (N2-N3) was associated with a higher mortality rate in comparison with the single nodal involvement (P = 0.05). The 5-year overall survival rate was 52.1%. Presence of relapse (P = 0.0001), higher mitotic rate (P = 0.03) and N2-N3 stage (P = 0.04) were inversely correlated with the overall survival. When relapse was included in the multivariate analysis, it was the only significant prognostic factor on survival (P = 0.0001), whereas mitosis became the only significant factor on survival with the exclusion of relapse from the multivariate analysis (P = 0.031). CONCLUSION: In node-positive stage III melanoma, tumor mitotic rate might be just as significant a prognostic indicator as the metastatic lymph node number.

Primary tumour ulceration in cutaneous melanoma: its role on TNM stages.

BACKGROUND: Tumour ulceration has unfavourable prognostic factor in stage I-II melanoma. The aim of this study was to question whether tumour ulceration might predict relapse and survival in melanomas of all stages. METHODS: A total of 911 melanoma patients were analysed. RESULTS: The 5-year relapse-free survival rates were 50.0% for ulcerated melanomas and 75.8% for all non-ulcerated melanomas (P = 0.0001). Ulcerated melanomas had lower relapse-free survival rates than non-ulcerated melanomas in all T-stages (P = 0.0001). The relapse-free survival rates were statistically significant for T1 (P = 0.02), T3 (P = 0.01) and T4 (P = 0.004); however, T2 (P = 0.07). There were significant differences between ulcerated melanomas and non-ulcerated melanomas regarding relapse-free survival rates for both N0 (P = 0.0001) and N1 (P = 0.01) patients; poor relapse-free survival rates were found to be in association with ulcerated melanomas (P = 0.06 for N1, P = 0.04 for N2 and P = 0.8 for N3 disease). The 5- year overall survival rates were 55.3 and 81.5% for ulcerated melanomas and non-ulcerated melanomas, respectively (P = 0.0001). Ulcerated melanomas had lower overall survival rates than non-ulcerated melanomas in all T-stages; they were statistically significant for T1 (P = 0.01), T2 (P = 0.03) and T4 (P = 0.006), but not for T3 (P = 0.3). Ulceration predicted poor survival in N0 patients; however, it was not found significant although its overall survival rate was lower in node-positive patients (P = 0.09), and ulceration was a significantly poor prognostic factor only for N3 patients (P = 0.03), but not for N1 (P = 0.9) and N2 patients (P = 0.2). Furthermore, non-metastatic patients with ulcerated melanomas survived significantly less (P = 0.0001), but there were no differences in survivals between ulcerated melanoma and non-ulcerated melanoma metastatic melanoma patients (P = 0.1). CONCLUSION: Primary tumour ulceration has been considered as a poor prognostic factor in local melanomas, but it might also have a potential for predicting survival in loco-regional and advanced melanomas.

Efficacy and tolerability of vismodegib treatment in locally advanced and metastatic basal cell carcinoma: Retrospective real-life data.

The study aims to evaluate the vismodegib treatment in local advanced (laBCC) and metastatic (mBCC) basal cell carcinoma. The data of 29 patients were retrospectively reviewed. The clinical and histopathological features of the patients and adverse events of vismodegib were recorded. Overall survival (OS) and progression-free survival (PFS) were evaluated with Kaplan-Meier analysis. The median follow-up period was 17 months (range: 1.6-57.3), and the median age at diagnosis 73 years (range: 39-88). The most common disease location was head and neck (86.2%), and the most common non-skin sites of disease were lymph nodes (13.8%), bone (13.8%), lung (6.9%), and brain (6.9%). Three (10.3%) patients had Gorlin's syndrome. The number of metastatic patients was 5 (17.2%). With vismodegib treatment, the complete response rate was 27.6%, partial response 55.2%, and stable response 10.3%. Treatment responses were most frequently seen within 2 months from the beginning of vismodegib. The median OS was 43.3 ± 9.0 months (25.6-61.1) for all patients. The median PFS in the laBCC was 15.7 ± 1.8 months (12.2-19.3), and 12.1 ± 4.6 months (2.9-21.2) in the mBCC. In the univariable analysis for the OS, only the treatment after the vismodegib was statistically significant, showing chemotherapy was better comparing to no treatment or surgery. The most common adverse events were fatigue-58.6%, muscle spasms-48.3%, alopecia-13.8%, and weight loss-13.8%. This real-life data study shows that vismodegib treatment in locally advanced and metastatic BCC was well tolerated and effective.

Single-agent temozolomide may be an effective option for late adjuvant therapy in patients with melanoma.

BACKGROUND: Late adjuvant therapy is the term to define the treatment administered following complete resection of metastatic or relapsed disease. OBJECTIVE: To assess the efficacy of single-agent temozolomide, a standard agent is used for metastatic melanoma in late adjuvant chemotherapy for cutaneous melanoma. METHODS: Twenty-seven adult cutaneous melanoma patients whose relapses were completely resected were included in this study. Temozolomide was administered as follows: peroral, 200 mg/m2 once daily for five consecutive days of a 28-day treatment cycle for six cycles. RESULTS: The median age was 55 years and men were predominant (74%). Median follow-up time was 23.6 months (range, 3.6-122.6 months). Any type of relapse occurred in 14 (51.9%) patients, and five patients relapsed while on chemotherapy. Almost all relapses (n = 13, 93%) occurred within the first two years of follow-up. The relapse rates were found 37.4 and 49.1% in the first and second years of follow-up, respectively. Moreover, after fifth year of onset of chemotherapy, relapse rate was found only 51.9%. The median relapse-free survival (RFS) was 12.9 months, and 1-, 2-, 3-, and 5-year RFS rates were 60, 46, 39, and 39%, respectively. The estimated median overall survival was 23.6 months. All patients survived first year (n = 27, 100%), and the overall survival rates for 2, 3, and 5 years were 81, 48, and 48%, respectively. CONCLUSION: Single-agent temozolomide may be a rational and prudent option for late adjuvant therapy in melanoma patients if/when novel therapies, such as targeting and immune therapies, are not accessible or available.

Seasons influence diagnosis and outcome of cutaneous melanoma.

The effects of season changes on the diagnosis of cutaneous melanoma have already been concluded; however, its clinical significance has yet to be defined. The aim of this study was to assess the effects of seasons on both the diagnosis and outcome of melanoma. A total of 1258 adult Caucasian Turkish cutaneous melanoma patients who had been treated and followed up in a single tertiary cancer referral center were included in the study. The most frequently affected season was summer (29%) followed by spring (26.6%), autumn (23.1%), and winter (21.3%). Similarly, rate of the patients diagnosed in July compared to January was significantly higher (11% vs 6%). Most of the clinicopathological characteristics were not correlated with seasons. The 5-year overall survival rate was significantly higher for patients diagnosed in August (81%) than other months, and especially January (47%) (P = .002 and P = .0001, respectively). Similarly, the patients of July (65%) survived longer than those of January (P = .02). Furthermore, similar favorable outcomes for summer (70%) compared to other seasons and winter (51%) were shown (P = .005 and P = .001, respectively). In conclusion, there are seasonal fluctuations in diagnosis of melanoma with a peak in summer, and those diagnosed in summer have favorable survival outcomes.

BRAF V600E mutation as a prognostic factor in cutaneous melanoma patients.

The prognostic significance of BRAF mutations in the natural course of melanoma is controversial. The aim of study was to assess the prognostic significance of BRAF V600E mutation in cutaneous melanoma patients. A total of 151 melanomas were included in the study. BRAF V600E mutation was detected using the real-time PCR. BRAF V600E mutation rate was 51%. BRAF mutation rate was higher for young patients (61.4%) and upper limbs (63.2%), trunk (59.3%) and head and neck (59.2%) were the most frequently afflicted sites in BRAF-mutant patients, whereas lower limbs were mostly affected in BRAF-wild patients (77.8%). Likewise, acral melanomas rarely harbored BRAF mutation (17.1%). The disease-free survivals regarding the entire and Stage III cohorts were longer in the BRAF-mutant group than in the BRAF-wild group (p = .006 and p = .004, respectively), whereas Stage I-II patients had no survival differences between BRAF statuses (p = .2). Likewise, BRAF-mutant patients had better overall survival (OS) time compared to BRAF-wild patients in all stages (p = .01), in Stage III (p = .01), and in Stage IV patients (p = .001). However, no differences between BRAF statuses were observed in Stage I-II melanomas (p = .3). In conclusion, BRAF V600E-mutant melanomas show favorable prognostic impact on both disease-free and OSs in all staged melanomas except local disease.

Distichiasis in association with entropion in metastatic HER2-positive breast cancer treated by pertuzumab, trastuzumab, and docetaxel combination chemotherapy.

We report the first case of distichiasis combined with entropion in a HER2-positive metastatic breast cancer patient treated by pertuzumab, trastuzumab, and docetaxel combination therapy. After 7 months, she had ocular complaints including pain, irritation, burning, dryness, and redness in her both eyes. Ophthalmologic examination revealed distichiasis and a mild entropion involving her lower eyelids bilaterally. She remained free of symptom and in complete response to maintenance chemotherapy.

Lymph node ratio has impact on relapse and outcome in patients with stage III melanoma.

BACKGROUND: Even though both the involvement of regional lymph nodes and the number of metastatic lymph nodes are regarded as major determinants of survival in cutaneous melanoma, the extent of node dissection has been analyzed as an independent prognostic indicator in only a few studies. This study aims to determine how the lymph node ratio (NR) (ratio of positive nodes to total nodes removed) might predict the disease relapse and survival in node-positive melanoma. MATERIALS AND METHODS: A total of 317 patients with stage III primary melanoma were included in the study and reviewed retrospectively. All patients had nodal staging (N) by radical lymph node dissection. Patients were divided into three groups based on NR1 ≤ 10%, NR2 10-25%, and NR3 > 25%. RESULTS: The median age was 50 years (range 16-86) and men were predominant (59.3%). The majority of the patients had thicker Breslow depth (> 2 mm) (83.3%), higher mitotic rate (> 2/mm2) (64.1%) and ulcerated lesions (69.4%). The median number of positive nodes was 1 (range 1-32). The largest group was N1 (52.4%), which was followed by N2 (29.6%) and N3 (18%). The ratios of patients were 37.5%, 35.3%, and 27.1% in NR1, NR2, and NR3, respectively. The median number of excised lymph nodes was 13 (range 1-73). For all patients the estimated 5-and 10-year relapse-free survival (RFS) rates were 41% and 39%, respectively; and the estimated 5-and 10-year overall survival (OS) rates were 51% and 42%, respectively. Nodular histopathology, ulcerated lesions, higher mitotic rates, and higher node substages were the independent variables that were inversely correlated with survival for all patients; and NR was one of the significant prognostic factors and strongest predictors of relapse and survival (p = 0.03 and p = 0.01, respectively). CONCLUSION: Our results suggest that, apart from the conventional nodal status, NR is an independent prognostic factor-regarding both RFS and OS in stage III cutaneous melanoma.

Number of Excised Lymph Nodes Has No Impact on Relapse and Survival in Patients With Stage III Melanoma.

BACKGROUND: Even though both the involvement of regional lymph nodes and the number of metastatic lymph nodes are regarded as major determinants of survival in cutaneous melanoma, the extent of node dissection has been analyzed as an independent prognostic indicator in only a few studies. This study aims to determine how the extent of lymph node excision (EN) might predict the disease relapse and survival in melanoma. METHODS: A total of 317 patients with stage III melanoma were included in the study and reviewed retrospectively. The patients were divided into 2 groups based on the number of the excised lymph nodes: EN1 for fewer than 10 and EN2 for 10 or more lymph nodes removed. RESULTS: The median number of positive nodes was 1 (range, 1-32). The largest group was N1 (52.4%), which was followed by N2 (29.6%) and N3 (18%). The median number of EN was 13 (range, 1-73). The patients were allocated to EN1 and EN2 as follows: 31.9% and 68.1%, respectively. The rates of EN2 patients were 62.2%, 72.2%, and 78.2% in N1, N2, and N3, respectively. For all patients, the estimated 5- and 10-year relapse-free survival rates were 41% and 39%, respectively; and the estimated 5- and 10-year overall survival rates were 51% and 42%, respectively. Extension of lymph node excision was found to be not prognostic for relapse and survival (P = 0.55 and P = 0.88, respectively). CONCLUSIONS: Extension of lymph node excision has no impact on relapse and survival of stage III cutaneous melanomas.

Cheek Cutaneous Melanomas: A Review of 98 Cases.

BACKGROUND: Most head and neck melanomas occur on the face, with the cheek being the most frequently affected site. So far, small numbers of researches on cheek melanomas have yielded insufficient and controversial results. In this trial, we aimed to define the histopathological and clinical features specific to cheek melanomas and to compare them with other head and neck melanomas by using a large group of patients from a single tertiary center. PATIENTS AND METHODS: A total of 98 cheek melanomas and 183 other (noncheek) head and neck melanoma cases were analyzed retrospectively. RESULTS: The median age was 62 years and malar/zygomatic was the mostly affected site (78.6%). The cheek melanomas developed more frequently in females (61.2%) and most of them were associated with lentigo maligna histopathological subtype (49.2%) and early-stage disease (stage 0-II) (77.6%). The cheek melanomas were found more significantly associated with older patients (P = 0.05), females (P = 0.0001), lentigo maligna subtype (P = 0.0001), lower vertical growth phase (P = 0.03), and early-stage of disease (P = 0.0001) compared with other lesions that developed other sites. Furthermore, they were associated with lower relapse rates (18.6% vs 39.5%, P = 0.0001) and the 5-year recurrence-free survival rate of cheek melanomas was 80% (P = 0.002). Moreover, the 5-year overall survival rate of cheek melanomas was 62%, and they were found to be associated with a favorable overall survival (P = 0.004). CONCLUSIONS: Cheek melanomas are associated with lower relapse rates and favorable outcomes compared with other (noncheek) head and neck melanomas.

Anemia in Cutaneous Malignant Melanoma: Low Blood Hemoglobin Level is Associated with Nodal Involvement, Metastatic Disease, and Worse Survival.

Anemia is common in cancer patients and also affects survival. However, its clinical role and prognostic significance remains unknown in cutaneous melanoma patients (CMPs). The aim of this study was to determine the clinical significance of blood hemoglobin levels in CMPs. Of 446 CMPs were enrolled into this study and were investigated retrospectively. The median value of hemoglobin levels was 13.4 g/dL (7.9-17.4 g/dL). The female patients (P < 0.001) and those with nodular histology (P = 0.040), elevated erythrocyte sedimentation rate (P < 0.001), higher serum lactate dehydrogenase (P < 0.001), lymph node involvement (P = 0.018), and metastatic disease (P < 0.001) had more likely low hemoglobin concentrations compared with other CMPs. However, serum hemoglobin levels were not significantly associated with age, anatomic localization, and various pathological features including Breslow depth, mitotic rate, and ulceration. We found that hemoglobin levels were significantly associated with outcome; the patients with low hemoglobin concentrations had worse survival than other CMPs (P < 0.001). On multivariate analyses, however, hemoglobin level lost its significance, thus, it was not found independently associated with the outcome. In conclusion, low blood hemoglobin concentration is associated with nodal involvement and metastatic disease. Although anemia in diagnosis was not an independent prognostic factor for survival in CMPs, it was associated with poor prognostic factors.

Acral Lentiginous Melanoma Is Associated with Certain Poor Prognostic Histopathological Factors but May Not be Correlated with Nodal Involvement, Recurrence, and a Worse Survival.

BACKGROUND/AIMS: Acral lentiginous melanoma (ALM) is a small subtype of melanoma affecting Caucasians far more often than other ethnic groups, such as blacks, Hispanics, and Asians. Only a few studies have yielded controversial results on ALM so far. The aim of this study was to define the histopathological and clinical expressions of ALM and to compare them with those of non-ALM in a large group of Turkish patients from a single referral institution. METHODS: One hundred two ALM patients were analyzed retrospectively. RESULTS: The median age of the patients was 58 years. The lower limbs (the thigh and leg as well as the foot) were predominantly affected (78%) and cases were mostly nonungual (89%). ALM were found more frequently in females (p = 0.04). They were ulcerated (p = 0.0001), they were associated with neurotropism (p = 0.0001), they lacked the BRAF mutation (p = 0.03), and they less often coexisted with a preceding melanocytic nevus (p = 0.0001). No correlations were found between ALM and either nodal involvement or distant metastasis. The recurrence-free survival and overall survival rates for ALM patients were similar to those of patients with other histopathologies. The 5-year recurrence-free survival and 5-year overall survival rates for ALM patients were 58.7 and 59%, respectively. CONCLUSION: Although ALM is associated with some aggressive histopathological factors, it may not correlated with nodal involvement, recurrence, or poor survival.

Tumor Infiltrating Lymphocytes (TILs) May be Only an Independent Predictor of Nodal Involvement but not for Recurrence and Survival in Cutaneous Melanoma Patients.

Tumor infiltrating lymphocytes (TILs) invade and disrupt melanoma cells and their clinical roles remain controversial. In this study, we aimed to determine the clinical significance of the TILs status in cutaneous melanoma patients (CMPs). Of 750 CMPs enrolled into this study 486 (64.8%) had lesions with TILs. The patients with TILs more likely had nodular histology, presence of histological regression, and absence of regional lymph node involvement. However, its presence was not associated with outcome. In conclusion, presence of TILs may be only an independent predictor for absence of nodal involvement but it is not associated with recurrence and survival in CMPs.