RESUMEN
El paciente con melanoma avanzado, metastásico o de alto riesgo, cuenta con opciones de tratamiento sistémico, inmunoterapia y terapias dirigidas, que han mejorado significativamente su supervivencia. El 50% de los pacientes con melanoma presentan mutación del gen BRAF. La toma de decisiones en cuanto a la secuencia óptima de tratamiento sistémico debe tener en cuenta factores relacionados con el medicamento, factores clínicos del paciente, así como los propios del tumor. Aunque la combinación ipilimumab-nivolumab es la que proporciona mejores resultados de supervivencia en todos los pacientes, la toxicidad asociada y el perfil de las terapias diana las puede hacer recomendables como primera línea en pacientes en determinadas situaciones clínicas. El objetivo de esta revisión es proporcionar un algoritmo de toma de decisiones en cuanto a la primera línea de tratamiento sistémico, inmunoterapia vs. terapias dirigidas, en el paciente con melanoma avanzado con mutación BRAF (AU)
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma (AU)
Asunto(s)
Humanos , Inmunoterapia/métodos , Melanoma/tratamiento farmacológico , Melanoma/genética , Terapia Molecular Dirigida , Nivolumab/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/genética , MutaciónRESUMEN
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma (AU)
El paciente con melanoma avanzado, metastásico o de alto riesgo, cuenta con opciones de tratamiento sistémico, inmunoterapia y terapias dirigidas, que han mejorado significativamente su supervivencia. El 50% de los pacientes con melanoma presentan mutación del gen BRAF. La toma de decisiones en cuanto a la secuencia óptima de tratamiento sistémico debe tener en cuenta factores relacionados con el medicamento, factores clínicos del paciente, así como los propios del tumor. Aunque la combinación ipilimumab-nivolumab es la que proporciona mejores resultados de supervivencia en todos los pacientes, la toxicidad asociada y el perfil de las terapias diana las puede hacer recomendables como primera línea en pacientes en determinadas situaciones clínicas. El objetivo de esta revisión es proporcionar un algoritmo de toma de decisiones en cuanto a la primera línea de tratamiento sistémico, inmunoterapia vs. terapias dirigidas, en el paciente con melanoma avanzado con mutación BRAF (AU)
Asunto(s)
Humanos , Inmunoterapia/métodos , Melanoma/tratamiento farmacológico , Melanoma/genética , Terapia Molecular Dirigida , Nivolumab/uso terapéutico , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/genética , MutaciónRESUMEN
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma.
Asunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/tratamiento farmacológico , Melanoma/genética , Proteínas Proto-Oncogénicas B-raf/genética , Nivolumab/uso terapéutico , Nivolumab/genética , Inmunoterapia , Mutación , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/genética , Terapia Molecular DirigidaRESUMEN
Systemic treatment with immunotherapy or targeted therapy can significantly improve survival in patients with advanced (metastatic or high-risk) melanoma. Fifty percent of patients with melanoma have a BRAF mutation. Decisions on optimal sequencing of systemic treatments should take into account drug- and tumor-related factors and patient characteristics. Although the combination of ipilimumab and nivolumab is associated with the best survival outcomes, it is associated with significant toxicity. Targeted therapy may be a more favorable option in certain clinical situations. We review the literature on immunotherapy and targeted therapy in melanoma and present an algorithm for guiding decision-making on their use as first-line systemic treatments for advanced BRAF-mutated melanoma.
Asunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/tratamiento farmacológico , Melanoma/genética , Proteínas Proto-Oncogénicas B-raf/genética , Nivolumab/uso terapéutico , Nivolumab/genética , Inmunoterapia , Mutación , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/genética , Terapia Molecular Dirigida , Inhibidores de Proteínas Quinasas/uso terapéuticoAsunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/patología , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Metástasis Linfática , Biopsia del Ganglio Linfático Centinela , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Escisión del Ganglio Linfático , Pronóstico , Melanoma Cutáneo MalignoRESUMEN
Mitotic rate is no longer considered a staging criterion for thin melanoma in the 8th edition of the American Joint Committee on Cancer Staging Manual. The aim of this observational study was to identify prognostic factors for thin melanoma and predictors and prognostic significance of sentinel lymph node (SLN) involvement in a large multicenter cohort of patients with melanoma from nine tertiary care hospitals. A total of 4249 consecutive patients with thin melanoma diagnosed from January 1, 1998 to December 31, 2016 were included. The main outcomes were disease-free interval and melanoma-specific survival for the overall population and predictors of SLN metastasis (n = 1083). Associations between survival and SLN status and different clinical and pathologic variables (sex, age, tumor location, mitosis, ulceration, regression, lymphovascular invasion, histologic subtype, Clark level, and Breslow thickness) were analyzed by Cox proportional hazards regression and logistic regression. SLN status was the most important prognostic factor for melanoma-specific survival (hazard ratio, 13.8; 95% CI, 6.1-31.2; P < 0.001), followed by sex, ulceration, and Clark level for patients who underwent SLNB. A mitotic rate of >2 mitoses/mm2 was the only factor associated with a positive SLN biopsy (odds ratio, 2.9; 95% CI, 1.22-7; P = 0.01. SLN status is the most important prognostic factor in thin melanoma. A high mitotic rate is associated with metastatic SLN involvement. SLN biopsy should be discussed and recommended in patients with thin melanoma and a high mitotic rate.
Asunto(s)
Metástasis Linfática/diagnóstico , Melanoma/mortalidad , Ganglio Linfático Centinela/citología , Neoplasias Cutáneas/mortalidad , Adulto , Anciano , Femenino , Humanos , Metástasis Linfática/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Biopsia del Ganglio Linfático Centinela , Neoplasias Cutáneas/patología , Análisis de Supervivencia , Melanoma Cutáneo MalignoRESUMEN
BACKGROUND: Teledermatology (TD) provides efficient care for skin cancer patients. OBJECTIVE: To compare the clinical effectiveness of imiquimod 5% for the treatment of AK with in-person care and through TD. METHODS: Longitudinal prospective controlled study including patients with single AK diagnosed and treated at face-to-face visits (FTF group) or through teledermatology (TD group) with imiquimod 5% cream. The main outcome measures assessed were the complete and global response percentage (CR and GR) under per-protocol (PP) and intention-to-treat (ITT) analysis. RESULTS: A total of 157 patients were enrolled (FTF = 75, TD = 82). PP analysis showed CR in 66.7% of FTF patients and 65.6% in TD patients (P > 0.05). The ITT yielded CR in 64.0% and 51.2% in FTF visits and TD, respectively (P = 0.073). The analysis showed an advantage of FTF care against TD in achieving GR (84.0% vs. 70.7%; P = 0.036). Facial location and local adverse reactions were the only explanatory factors of complete response in the ITT approach. Treatment completion was found in 90.7% and 72.0% in the FTF and TD groups, respectively (P = 0.004). CONCLUSIONS: Improvements in patient counselling at the primary care centre are needed before the implementation of TD as a routine methodology for the management of AK.
Asunto(s)
Antineoplásicos/uso terapéutico , Imiquimod/uso terapéutico , Queratosis Actínica/tratamiento farmacológico , Cumplimiento de la Medicación , Visita a Consultorio Médico , Telemedicina , Administración Cutánea , Anciano , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Dermatosis Facial/tratamiento farmacológico , Femenino , Humanos , Imiquimod/administración & dosificación , Imiquimod/efectos adversos , Análisis de Intención de Tratar , Estudios Longitudinales , Masculino , Estudios ProspectivosAsunto(s)
Dermoscopía , Telemedicina , Humanos , Melanoma/diagnóstico , Enfermedades de la Piel/diagnósticoAsunto(s)
Antivirales/uso terapéutico , Condiloma Acuminado/tratamiento farmacológico , Citosina/análogos & derivados , Infecciones por VIH/complicaciones , Organofosfonatos/uso terapéutico , Enfermedades del Pene/tratamiento farmacológico , Adulto , Cidofovir , Condiloma Acuminado/etiología , Citosina/uso terapéutico , Humanos , Masculino , Enfermedades del Pene/etiologíaRESUMEN
No disponible
No disponible
Asunto(s)
Humanos , Masculino , Adulto , Condiloma Acuminado/complicaciones , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Nucleótidos de Desoxicitosina/uso terapéutico , Verrugas/tratamiento farmacológico , Papillomaviridae , Verrugas/epidemiología , Verrugas/terapia , Condiloma Acuminado/fisiopatología , Condiloma Acuminado/virologíaAsunto(s)
Dermis/patología , Melanocitos , Melanosis/patología , Adulto , Dorso/patología , Mama/patología , Femenino , Humanos , InmunohistoquímicaRESUMEN
BACKGROUND: The incidence of melanoma and its associated mortality has stabilized over the recent years, due in part to efforts directed at better prevention and detection of these lesions. We analysed the trends in the distribution of melanomas, mainly according to their thickness. METHODS: Data from the Dermatology Service of 'Virgen de la Victoria' University Hospital in Malaga (Spain) showed a total of 459 cases of melanoma between 1990 and 2005, both inclusive. The lesions were stratified according to year of diagnosis (1990-96 and 1997-2005), sex, age (0-49, > or = 50), thickness (0-0.99, 1.00-1.99, and > or = 2 mm) and the histological subtype [lentigo maligna melanoma (LMM), superficial spreading melanoma (SSM), nodular melanoma (NM) and acral lentiginous melanoma (ALM)]. Particular attention was given to the distribution of the groups according to thickness. RESULTS: The number of new cases rose by 92% between the two study periods (1990-1996 and 1997-2005). However, the number of new cases of thick melanoma remained almost constant over the two periods, being associated with persons over 50 years of age (65.1% vs. 64.3%), with men having half the cases (48.4% vs. 47%). The proportion of nodular melanomas within the group of thick melanomas was high in both periods (36.5% and 39.3%, respectively). CONCLUSIONS: This study shows that despite the large increase in new melanomas, the diagnosis of thick melanomas has remained constant, mainly in persons over the age 50 years, with a relative increase in men. New strategies and education programmes are, therefore, required for the early detection of this type of tumour to reduce its incidence in these patients.
Asunto(s)
Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Femenino , Humanos , Incidencia , Masculino , Tamizaje Masivo , Melanoma/diagnóstico , Melanoma/patología , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , España/epidemiologíaRESUMEN
INTRODUCTION: Compared with other tumors, melanoma has displayed one of the largest increases in incidence in recent years, and it is known to have a high metastatic potential. In cases of metastasis, approximately two-thirds of patients have lymph-node metastases and one-third develop systemic metastases. However, few studies have been reported that analyzed different metastatic patterns according to the natural history of melanoma. The main aim of this study was to analyze the different metastatic pathways and patterns and to assess the time course of development of metastases from cutaneous melanoma. MATERIAL AND METHODS: A retrospective study was performed in 575 patients with onset of primary melanoma between 1990 and 2004. During follow-up, 67 patients developed metastases. Different pathways for metastasis were established and evaluated. We identified 4 metastatic pathways according to the metastatic pattern during progression of the melanoma. The time course of metastases was also evaluated. Finally, we analyzed melanomas with local recurrence in terms of whether or not systemic progression occurred. RESULTS: Melanoma metastases first occurred in local lymph nodes in 55.2 % of the patients. Initial metastasis was systemic in 14.9 % of the patients. The anatomical location and tumor thickness influenced which metastatic pathway was followed. Distant metastases occurred after a mean of 25 months regardless of the pathway followed CONCLUSIONS: The development of distant metastases displays a constant time course and the time to onset is independent of the metastatic pathway. This observation may explain why sentinel lymph node biopsy has a limited impact on overall survival of melanoma patients.
Asunto(s)
Melanoma/secundario , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de TiempoRESUMEN
Introducción. El melanoma es uno de los tumores que más ha aumentado en las últimas décadas y posee un elevado potencial de diseminación. Cuando metastatiza, hasta en dos tercios de las ocasiones lo hace a los ganglios linfáticos regionales y aproximadamente en un tercio de los casos a nivel sistémico. Existen, sin embargo, pocos estudios en la literatura que hayan analizado los diferentes patrones metastásicos en el contexto de la historia natural del melanoma. El objetivo principal del presente estudio es analizar las diferentes vías y patrones metastásicos y el tiempo de evolución en el desarrollo de metástasis en el melanoma cutáneo. Material y métodos. Se realizó un estudio retrospectivo en una serie de 575 pacientes con melanoma primario como primera presentación entre los años 1990 y 2004. En el seguimiento, 67 pacientes desarrollaron metástasis. Se establecieron y evaluaron diferentes vías de diseminación. También se establecieron cuatro rutas de diseminación dependiendo del patrón de diseminación en la progresión del melanoma. Se evaluó el curso temporal de las metástasis. Por último, se analizaron aquellos melanomas con recurrencia locorregional comparando los melanomas con y sin progresión sistémica. Resultados. Las metástasis linfáticas regionales constituyen la primera vía de diseminación de los melanomas (55,2 %). Las metástasis sistémicas aparecieron como primera vía metastásica en el 14,9 % de los casos. La localización anatómica y el grosor tumoral influyen en las diferentes vías metastásicas. Las metástasis a distancia aparecieron con una media de 25 meses, independientemente de la ruta de diseminación. Conclusiones. La aparición de metástasis a distancia es un evento con un curso temporal constante. Surgen al mismo tiempo independientemente de la ruta metastásica del melanoma. Esto podría explicar el beneficio limitado de la biopsia del ganglio centinela sobre la supervivencia global de los pacientes con melanoma
Introduction. Compared with other tumors, melanoma has displayed one of the largest increases in incidence in recent years, and it is known to have a high metastatic potential. In cases of metastasis, approximately two-thirds of patients have lymph-node metastases and one-third develop systemic metastases. However, few studies have been reported that analyzed different metastatic patterns according to the natural history of melanoma. The main aim of this study was to analyze the different metastatic pathways and patterns and to assess the time course of development of metastases from cutaneous melanoma. Material and methods. A retrospective study was performed in 575 patients with onset of primary melanoma between 1990 and 2004. During follow-up, 67 patients developed metastases. Different pathways for metastasis were established and evaluated. We identified 4 metastatic pathways according to the metastatic pattern during progression of the melanoma. The time course of metastases was also evaluated. Finally, we analyzed melanomas with local recurrence in terms of whether or not systemic progression occurred. Results. Melanoma metastases first occurred in local lymph nodes in 55.2 % of the patients. Initial metastasis was systemic in 14.9 % of the patients. The anatomical location and tumor thickness influenced which metastatic pathway was followed. Distant metastases occurred after a mean of 25 months regardless of the pathway followed Conclusions. The development of distant metastases displays a constant time course and the time to onset is independent of the metastatic pathway. This observation may explain why sentinel lymph node biopsy has a limited impact on overall survival of melanoma patients