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1.
Dermatol Clin ; 41(1): 79-88, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36410985

RESUMO

Evidence supports the safety of Mohs micrographic surgery for melanoma. Because of its potential benefits to the patient in terms of very low-recurrence rates and same-day histologic confirmation of tumor removal with reconstruction of tumor-free margins of potentially smaller wounds, it should be one of the treatment options considered. The informed consent process for the patient should not be complete without a discussion of the attributes of Mohs surgery for melanoma.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Cirurgia de Mohs , Margens de Excisão , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Melanoma/cirurgia , Melanoma/patologia
2.
Dermatol Clin ; 41(1): 39-47, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36410982

RESUMO

Mohs micrographic surgery (MMS) is widely accepted as the gold standard for skin cancer cure, and properly trained surgeons who carry out this procedure are experts in the science and management of skin cancer. There are many potential pitfalls and challenges that a surgeon may encounter while carrying out MMS, and these can increase the likelihood of tumor recurrence and increased patient morbidity. With precise surgical technique, careful tissue handling, and laboratory processes that safeguard against errors, this procedure can provide excellent cure rates for most skin cancers, including melanoma, while maximizing tissue conservation in a low-cost outpatient clinical setting.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Cirurgia de Mohs/métodos , Recidiva Local de Neoplasia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Melanoma/cirurgia
3.
Neurol India ; 70(5): 2153-2155, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36352627

RESUMO

Meningeal melanocytoma is a rare benign tumor, most frequently located in the posterior fossa and spinal canal. Localized tumors present as leptomeningeal masses and range from well-differentiated melanocytomas to lesions of intermediate malignancy and overtly malignant melanomas. Spinal meningeal melanocytoma has a benign course and is amenable for gross total resection. The outcome is favorable following complete resection. Meningeal melanocytoma may occasionally be associated with histological benign leptomeningeal spread and aggressive clinical course in spite of the absence of malignant transformation. We report a case of intraspinal melanocytoma in a 57-year-old female, which clinically as well as radiologically mimicked other spinal lesions. The final diagnosis was confirmed on histopathology.


Assuntos
Melanoma , Neoplasias Meníngeas , Nevo Pigmentado , Neoplasias Cutâneas , Feminino , Adulto , Humanos , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Melanoma/diagnóstico , Melanoma/cirurgia , Melanoma/patologia
4.
Medicina (Kaunas) ; 58(11)2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36363546

RESUMO

Sentinel lymph node biopsy (SLNB) is a surgical procedure that has been used in patients with cutaneous melanoma for nearly 30 years. It is used for both staging and regional disease control with minimum morbidity, as proven by numerous worldwide prospective studies. It has been incorporated in the recommendations of national and professional guidelines. In this article, we provide a summary of the general information on SLNB in the clinical guidelines for the management of cutaneous malignant melanoma (American Association of Dermatology, European Society of Medical Oncology, National Comprehensive Cancer Network, and Cancer Council Australia) and review the most relevant literature to provide an update on the existing recommendations for SLNB.


Assuntos
Melanoma , Linfonodo Sentinela , Neoplasias Cutâneas , Humanos , Melanoma/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Estudos Prospectivos , Linfonodo Sentinela/patologia , Estadiamento de Neoplasias
6.
Zhonghua Zhong Liu Za Zhi ; 44(10): 1146-1154, 2022 Oct 23.
Artigo em Chinês | MEDLINE | ID: mdl-36319462

RESUMO

Objective: To analyze the clinical features and prognosis of patients with cutaneous melanoma. Methods: The clinical data and follow-up data of 125 patients with cutaneous malignant melanoma (CMM) treated in the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology between February 2008 and August 2019 were collected. Kaplan-Meier method and Log rank test were used for survival analysis, and Cox proportional risk regression model was used for impact factor analysis. Results: Among the 125 patients, 12 were stage Ⅰ, 62 were stage Ⅱ, 30 were stage Ⅲ, and 21 were stage Ⅳ; 76 were acral and 49 were non-acral. The median survival time was 44 months, and the 1-, 2-, and 5-year survival rates were 85.4%, 63.2% and 38.7%, respectively. Kaplan-Meier univariate survival analysis showed that Karnofsky performance status score, tumor stage, primary site, vascular infiltration, Ki-67, BRAF, lactate dehydrogenase (LDH), and surgical treatment were related to the prognosis of patients (P<0.05). The median overall survival (OS) time of patients receiving interferon treatment was 53 months, which was better than 40 months of patients not receiving interferon treatment, but the difference was not statistically significant (P=0.448). Among stage Ⅲ patients, the median OS time of patients receiving interferon therapy was 40 months, which was better than 17 months of patients not receiving interferon therapy (P=0.012). Among stage Ⅱ patients, the 1-, 2-, and 5-year survival rates of acral patients were 97.1%, 84.7%, and 65.8%, and the 1-, 2-, and 5-year survival rates of non-acral patients were 93.3%, 70.0% and 17.0%. The prognosis of patients with stage Ⅱ acral type was better than that of non-acral type (P=0.043). The median survival time of stage Ⅲ patients with acral type was 32 months, better than 17 months of non-acral type, but the difference was not statistical significance (P=0.164). The median survival time of acral type and non-acral type was 8 months and 11 months respectively (P=0.458). Cox multivariate analysis showed that tumor stage and preoperative LDH level were independent prognostic risk factors for cutaneous melanoma. Conclusions: Interferon treatment can improve the prognosis of patients with stage Ⅲ, and stage Ⅱ acral type patients have better prognosis than that of non-acral type patients. Tumor stage and preoperative LDH level were independent prognostic risk factors for cutaneous melanoma.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Melanoma/cirurgia , Neoplasias Cutâneas/patologia , Prognóstico , Interferons , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 101(41): e31174, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36253970

RESUMO

RATIONALE: Anorectal malignant melanoma regularly exhibits a biological aggressive behavior which is metastasizing to lung, bone, brain or other organs and tissues early in the course of the disease. Compared with melanoma in the other parts of the body, anorectal malignant melanoma is relatively rare. Metastatic to the breast tissue from anorectal malignant melanoma or from other extra-mammary tumors are very rare. PATIENT CONCERNS: We report the case of a 65-year-old female who suffering from anorectal malignant melanoma and implemented complete surgical resection. Two years later, a space-occupying lesion in the outer upper quadrant of the right breast was observed on a chest CT. DIAGNOSIS: The right breast was excised, and breast metastasis of anorectal malignant melanoma was histologically confirmed. INTERVENTIONS: Radical mastectomy of the right breast was performed, and no lymph nodes or other metastases were observed. OUTCOMES: The patient's operative course was uneventful. The patient completely recovered and transfers to the oncology department for further treatment. LESSON: The patient presented with an isolated breast tumor. Duo to Malignant melanoma could mimic many kind of poorly differentiated tumors, it is difficult to diagnose accurately, especially when it appears as an isolated mammary tumor. Because of the treatment measures and prognosis between malignant melanoma and breast cancer are entirely different.


Assuntos
Neoplasias da Mama , Melanoma , Segunda Neoplasia Primária , Neoplasias Cutâneas , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Mastectomia , Melanoma/diagnóstico , Melanoma/patologia , Melanoma/cirurgia , Segunda Neoplasia Primária/cirurgia , Neoplasias Cutâneas/patologia
8.
Lancet Oncol ; 23(11): 1378-1388, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36265502

RESUMO

BACKGROUND: Patients with stage IIB or IIC melanoma who undergo surgery alone are at a substantial risk for disease recurrence. Adjuvant pembrolizumab significantly improved recurrence-free survival versus placebo in stage IIB or IIC melanoma in the first interim analysis of the KEYNOTE-716 trial. Here, we report results from the secondary endpoint of distant metastasis-free survival (prespecified third interim analysis), and recurrence-free survival with longer follow-up. METHODS: KEYNOTE-716 is a multicentre, double-blind, placebo-controlled, crossover or rechallenge, randomised, phase 3 trial done at 160 academic medical centres and hospitals across 16 countries. Eligible patients were aged 12 years and older with newly-diagnosed, completely resected, and histologically confirmed stage IIB (T3b or T4a) or IIC (T4b) cutaneous melanoma; negative sentinel lymph node biopsy; and an Eastern Cooperative Oncology Group performance status of 0-1. Patients were randomly assigned (1:1) to receive either 200 mg of pembrolizumab (2 mg/kg up to a maximum of 200 mg in paediatric patients) or placebo, both intravenously, every 3 weeks for 17 cycles (part 1) or until disease recurrence or unacceptable toxicity. Eligible patients with disease recurrence could receive further treatment with pembrolizumab in the part 2 crossover or rechallenge phase. Randomisation was done using an interactive response technology system and stratified by T category and paediatric status. The primary endpoint was investigator-assessed recurrence-free survival (assessed here with longer follow-up), and we report the prespecified third interim analysis of distant metastasis-free survival (secondary endpoint). Efficacy analyses were done in the intention-to-treat population (all patients who were randomly assigned, according to assigned group) and safety was assessed in all patients who were randomly assigned and received at least one dose of trial treatment, according to the treatment received. KEYNOTE-716 is registered at ClinicalTrials.gov, NCT03553836, and has completed recruitment. FINDINGS: Between Sept 23, 2018, and Nov 4, 2020, 976 patients were randomly assigned to receive pembrolizumab (n=487) or placebo (n=489). At a median follow-up of 27·4 months (IQR 23·1-31·7), median distant metastasis-free survival was not reached (95% CI not reached [NR]-NR) in either group. Pembrolizumab significantly improved distant metastasis-free survival (hazard ratio [HR] 0·64, 95% CI 0·47-0·88, p=0·0029) versus placebo. Median recurrence-free survival was 37·2 months (95% CI NR-NR) in the pembrolizumab group and not reached in the placebo group (95% CI NR-NR). The risk of recurrence remained lower with pembrolizumab versus placebo (HR 0·64, 95% CI 0·50-0·84). The most common grade 3 or worse adverse events were hypertension (16 [3%] of 483 patients in the pembrolizumab group vs 17 [4%] of 486 patients in the placebo group), diarrhoea (eight [2%] vs one [<1%]), rash (seven [1%] vs two [<1%]), autoimmune hepatitis (seven [1%] vs two [<1%]), and increased lipase (six [1%] vs eight [2%]). Treatment-related serious adverse events occurred in 49 (10%) patients in the pembrolizumab group and 11 (2%) patients in the placebo group. No treatment-related deaths were reported. INTERPRETATION: Adjuvant pembrolizumab is an efficacious treatment option for resected stage IIB and IIC melanoma, with significant improvement in distant-metastasis free survival versus placebo and continued reduction in the risk of recurrence with an adverse event profile consistent with previous studies of pembrolizumab. The overall benefit-risk of pembrolizumab continues to be positive in the adjuvant setting. FUNDING: Merck Sharp & Dohme, a subsidiary of Merck & Co.


Assuntos
Melanoma , Neoplasias Cutâneas , Neoplasias Testiculares , Masculino , Humanos , Criança , Melanoma/tratamento farmacológico , Melanoma/cirurgia , Melanoma/patologia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Recidiva Local de Neoplasia/patologia , Anticorpos Monoclonais Humanizados/efeitos adversos , Método Duplo-Cego , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
10.
Nature ; 611(7934): 155-160, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36289334

RESUMO

Relatlimab and nivolumab combination immunotherapy improves progression-free survival over nivolumab monotherapy in patients with unresectable advanced melanoma1. We investigated this regimen in patients with resectable clinical stage III or oligometastatic stage IV melanoma (NCT02519322). Patients received two neoadjuvant doses (nivolumab 480 mg and relatlimab 160 mg intravenously every 4 weeks) followed by surgery, and then ten doses of adjuvant combination therapy. The primary end point was pathologic complete response (pCR) rate2. The combination resulted in 57% pCR rate and 70% overall pathologic response rate among 30 patients treated. The radiographic response rate using Response Evaluation Criteria in Solid Tumors 1.1 was 57%. No grade 3-4 immune-related adverse events were observed in the neoadjuvant setting. The 1- and 2-year recurrence-free survival rate was 100% and 92% for patients with any pathologic response, compared to 88% and 55% for patients who did not have a pathologic response (P = 0.005). Increased immune cell infiltration at baseline, and decrease in M2 macrophages during treatment, were associated with pathologic response. Our results indicate that neoadjuvant relatlimab and nivolumab induces a high pCR rate. Safety during neoadjuvant therapy is favourable compared to other combination immunotherapy regimens. These data, in combination with the results of the RELATIVITY-047 trial1, provide further confirmation of the efficacy and safety of this new immunotherapy regimen.


Assuntos
Melanoma , Terapia Neoadjuvante , Nivolumabe , Humanos , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Inibidores de Checkpoint Imunológico/efeitos adversos , Inibidores de Checkpoint Imunológico/uso terapêutico , Melanoma/tratamento farmacológico , Melanoma/patologia , Melanoma/cirurgia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Nivolumabe/efeitos adversos , Nivolumabe/uso terapêutico , Macrófagos/efeitos dos fármacos , Quimioterapia Combinada , Taxa de Sobrevida
11.
Gan To Kagaku Ryoho ; 49(10): 1160-1162, 2022 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-36281619

RESUMO

Malignant melanoma of the esophagus is extremely rare and has a poor prognosis. Recently, the efficacy of anti-PD-1 antibody alone or combined with the anti-CTLA-4 antibody has been demonstrated in patients with recurrent or unresectable mucosal malignant melanoma. In this report, we describe a case of postoperative recurrent malignant melanoma of the esophagus treated using combined anti-PD-1 and anti-CTLA-4 antibodies, which resulted in long-term survival. The patient was a 64-year-old man who developed liver metastasis and left mediastinal lymph node recurrence 1 year and 2 months after resection of Stage Ⅱ malignant melanoma of the middle thoracic esophagus. After 4 courses of nivolumab and ipilimumab combined therapy, maintenance therapy with nivolumab alone was continued, and the patient survived for 47 months. During the disease course, the neutrophil/lymphocyte ratio(NLR)and lymphocyte/monocyte ratio(LMR)show - ed a trend reflecting the tumor status. Additionally, sIL-2R/%Ly was monitored as a new biomarker and seemed to be useful for disease assessment.


Assuntos
Melanoma , Nivolumabe , Masculino , Humanos , Pessoa de Meia-Idade , Ipilimumab/uso terapêutico , Nivolumabe/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Melanoma/tratamento farmacológico , Melanoma/cirurgia , Melanoma/patologia , Esôfago/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
12.
Eur J Cancer ; 176: 207-217, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36202690

RESUMO

BACKGROUND: Adjuvant pembrolizumab significantly improved recurrence-free survival (RFS) versus placebo in resected stage IIB and IIC melanoma in the phase 3 KEYNOTE-716 study. Health-related quality of life (HRQoL) results are reported. METHODS: Patients were randomly assigned 1:1 to pembrolizumab 200 mg (2 mg/kg, patients ≥12 to <18 years) Q3W or placebo for ≤17 cycles or until disease recurrence, unacceptable toxicity, or withdrawal. Change from baseline in EORTC QLQ-C30 global health status (GHS)/quality of life (QoL) was a prespecified exploratory end point. Change in EORTC QLQ-C30 functioning, symptom, and single-item scales, and EQ-5D-5L visual analog scale (VAS) were also summarized. Primary analyses were performed at week 48 to ensure adequate completion/compliance. The HRQoL population comprised patients who received ≥1 dose of treatment and completed ≥1 assessment. RESULTS: The HRQoL population included 969 patients (pembrolizumab, n = 483; placebo, n = 486). Compliance at week 48 was ≥80% for both instruments. EORTC QLQ-C30 GHS/QoL, physical functioning, role functioning, and EQ-5D-5L VAS scores were stable from baseline to week 48 in both arms, with no clinically meaningful decline observed. Scores did not differ significantly between pembrolizumab and placebo. EORTC QLQ-C30 GHS/QoL, physical functioning, role functioning, and EQ-5D-5L VAS scores remained stable through week 96 in both arms. CONCLUSIONS: HRQoL was stable with adjuvant pembrolizumab, with no clinically meaningful decline observed. Change from baseline in HRQoL was similar between arms. These results, in conjunction with the improved RFS and manageable safety previously reported, support the use of adjuvant pembrolizumab for high-risk stage II melanoma.


Assuntos
Melanoma , Qualidade de Vida , Humanos , Recidiva Local de Neoplasia , Melanoma/tratamento farmacológico , Melanoma/cirurgia , Adjuvantes Imunológicos/uso terapêutico
13.
J Plast Reconstr Aesthet Surg ; 75(11): 4212-4220, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36182571

RESUMO

INTRODUCTION: Melanoma occurs most commonly in non-Hispanic White patients; however, Black and Hispanic patients experience greater morbidity and mortality. This study assesses how race and socioeconomic factors influence rates of reconstructive procedures and hospital-based outcomes in melanoma patients. METHODS: Data were extracted from the National Inpatient Sample database from the years 2010-2015. Patients with melanoma who underwent a reconstructive procedure were identified. Univariate and multivariate logistic regression analysis was used to identify the relationship between dependent variables and various patient/hospital components for patients undergoing reconstructive procedures. RESULTS: Black and Hispanic patients had a greater length of stay (LOS) than non-Hispanic White patients (OR: 2.252, p = 0.0307, and OR: 2.592, p = 0.0014), and Hispanic patients were less likely to receive more complex reconstructive procedures (OR: 0.449, p = 0.0487). Patients living in rural areas were less likely to receive complex reconstructive procedures than those in both urban teaching and non-teaching hospitals (OR: 3.313, p = 0.0135, and OR: 3.505, p = 0.0074). Pedicled or rotational flaps were less likely to be performed at medium- or large-sized hospitals (OR: 0.610, p = 0.0296, and OR: 0.496, p = 0.0002). CONCLUSION: Race and socioeconomic factors are important predictors of access to complex reconstructive procedures and hospital-based outcomes following extirpation in melanoma patients.


Assuntos
Melanoma , Brancos , Humanos , Estados Unidos/epidemiologia , Afro-Americanos , Hispânico ou Latino , Negros , Melanoma/cirurgia
14.
Can J Urol ; 29(5): 11323-11325, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36245204

RESUMO

Non-urothelial malignant ureteral obstruction (MUO) causes hydronephrosis, renal damage and infectious sequelae. The overall condition, symptoms, and plans for systemic therapy inform urologic intervention. In well-selected cases, there is a role for definitive reconstruction. We describe a robotic-assisted distal ureterectomy and reimplant for definitive repair of obstructive metastatic melanoma.


Assuntos
Melanoma , Procedimentos Cirúrgicos Robóticos , Ureter , Neoplasias Ureterais , Humanos , Melanoma/complicações , Melanoma/cirurgia , Ureter/cirurgia , Neoplasias Ureterais/complicações , Neoplasias Ureterais/patologia , Neoplasias Ureterais/cirurgia , Procedimentos Cirúrgicos Urológicos
15.
Biomed Res Int ; 2022: 5600450, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36212718

RESUMO

Axillary defect coverage is often challenging after radical excision of chronic inflammatory skin lesions, such as complicated epidermoid cysts and hidradenitis suppurativa. This retrospective case series aims to demonstrate our experience with axillary reconstruction using the modified keystone perforator island flap (KPIF) technique, emphasizing its tension-reducing effects. All patients who presented for axillary reconstruction after radical excision of chronic inflammatory skin lesions between May 2019 and December 2020 were identified using the medical record database. Eleven patients ranging in age from 17 to 71 years underwent modified KPIF axillary reconstruction. Four types of modifications (modified type II KPIF, omega variation closure, Sydney melanoma unit modification, and hemi-KPIF) were used. All defects (size range, 2.5 × 3 cm2 to 8 × 13 cm2) were successfully covered using these modified KPIF techniques. All flaps (size range, 3.5 × 3.5 cm2 to 11 × 30 cm2) fully survived without complications. All patients exhibited favorable functional outcomes, and no cases of recurrence or limitations in joint range of motion were observed during the follow-up period (range, 4-5 months). Modified KPIF techniques may represent a reliable, effective alternative reconstructive modality for managing axillary defects.


Assuntos
Melanoma , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Idoso , Axila/cirurgia , Humanos , Melanoma/cirurgia , Pessoa de Meia-Idade , Retalho Perfurante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Tidsskr Nor Laegeforen ; 142(15)2022 10 25.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-36286556

RESUMO

BACKGROUND: Histopathological assessment of melanoma and other melanocytic skin lesions can be difficult and can vary between pathologists. MATERIAL AND METHOD: Histopathological slides of 196 melanocytic skin lesions from 2009 and 2018-2019 were obtained from the archive of the Department of Pathology at Oslo University Hospital and classified into six diagnostic categories: 1) benign nevus, 2) irregular/dysplastic nevus, i.e. dysplastic nevus with moderate atypia, 3) nevus with severe atypia, i.e. dysplastic nevus with severe atypia, 4) melanoma in situ, 5) superficial spreading or lentiginous melanoma and 6) nodular melanoma. The slides were then examined independently and blindly by three experienced pathologists and categorised in the same way. Interobserver agreement was assessed with Cohen's kappa, and agreement with the original diagnosis was assessed by the proportion of assessments in the same diagnostic category. RESULTS: The kappa values for the assessments from the three pathologists ranged from 0.45 to 0.50. The proportion of reassessments in agreement with the original diagnostic category was 85.7 % (95 % CI 75.7 to 92.1), 29.2 % (19.9 to 40.5), 27.8 % (20.9 to 36.0), 78.3 % (70.4 to 84.5), 81.2 % (73.7 to 86.9) and 93.3 % (82.1 to 97.7), respectively, i.e. highest for nodular melanoma. The proportion of reassessments in which the diagnosis was more serious or less serious than the original diagnosis was higher and lower, respectively, for slides from 2009 than for slides from 2018-2019. INTERPRETATION: The differences between the pathologists' assessments and deviations from the original diagnoses can be explained by poorly reproducible diagnostic criteria, diagnostic entities with overlapping morphology and increasing awareness of early signs of malignancy. Some evolution in diagnostic practice cannot be ruled out.


Assuntos
Síndrome do Nevo Displásico , Melanoma , Nevo , Neoplasias Cutâneas , Humanos , Síndrome do Nevo Displásico/diagnóstico , Síndrome do Nevo Displásico/patologia , Melanoma/diagnóstico , Melanoma/cirurgia , Melanoma/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Nevo/diagnóstico , Nevo/cirurgia , Diagnóstico Diferencial
17.
Anticancer Res ; 42(11): 5507-5519, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36288873

RESUMO

BACKGROUND/AIM: The latest developments in oncological therapies for malignant melanoma, and the discovery that complete lymph node dissection offers no survival benefit, are changing the landscape of melanoma surgery. There is a need for more information on health-related quality of life (HRQoL) consequences of melanoma surgery. PATIENTS AND METHODS: This longitudinal cohort study was carried out from 2004 to 2009 in the Helsinki and Uusimaa Hospital District and patients were followed-up at 6, 12 and 24 months. The patients were asked to fill in the generic 15D questionnaire and the cancer-specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30). In addition, they were asked selected questions from the EORTC Item Library regarding upper and lower limb edema. RESULTS: A total of 169 (64.5%) patients with local or locally advanced melanoma referred for surgical treatment responded, of whom 161 were included in the final analysis. For the whole patient group, distress, depression and emotional function improved over time. Worse HRQoL in some of the dimensions were associated with female sex, skin transplant versus direct wound closure and complications 30 days or more after surgery, but none was associated with worse overall HRQoL. Postoperative complications, type of wound closure or lymph node surgery had no effect on overall HRQoL. Patient-reported limb edema was associated with worse overall HRQoL at baseline and during follow-up by both instruments. Patients reporting limb edema reported worse mobility and more pain throughout the study. CONCLUSION: Patient-reported limb edema, regardless of the cause, seems to be an important predictor of worse HRQoL among patients with melanoma.


Assuntos
Melanoma , Qualidade de Vida , Humanos , Feminino , Seguimentos , Estudos Longitudinais , Estudos Prospectivos , Melanoma/complicações , Melanoma/cirurgia , Melanoma/patologia , Inquéritos e Questionários , Edema/etiologia
18.
Rhinology ; 60(5): 347-356, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36184882

RESUMO

BACKGROUND: Sinonasal mucosal melanoma is an aggressive malignancy with a 5-year survival rate ranging from 20% to 39%. Despite the evolving surgical and radiotherapy techniques, and introduction of immune-checkpoint inhibitor therapy, overall survival rates remain poor. METHODOLOGY: A retrospective cohort study was conducted at the Hospital Clinic de Barcelona and the Hospital de la Santa Creu i Sant Pau between 1984 and 2020; primary outcome measures were 3 and 5-year melanoma-specific survival (MSS). Kaplan-Meier survival analysis and Cox proportional hazards model were performed to identify predictors of survival. RESULTS: Fifty patients were included, the mean age was 70.4, MSS at 3 and 5 years was 51.2%, and 29.5%, respectively. The median follow-up was 39.6 months during which 46% presented locoregional recurrence and 36%, metastasis. The univariate and multivariate analyses found as survival predictors the N category, the treatment received, the surgical margins and the mitotic index. CONCLUSIONS: We found an overall 5-year MSS of 29.5%. Those patients with intention-to-cure (stages III and IVa) treated by surgery that were N0 at diagnosis, with < 10 mitoses per HPF showed a 5-year MSS rate of 74.1%. More studies will be needed to adequately define the patients' profiles that will benefit from a better survival outcome.


Assuntos
Melanoma , Neoplasias dos Seios Paranasais , Idoso , Intervalo Livre de Doença , Humanos , Inibidores de Checkpoint Imunológico , Melanoma/cirurgia , Recidiva Local de Neoplasia/patologia , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/cirurgia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
19.
Lancet ; 400(10358): 1117-1129, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099927

RESUMO

BACKGROUND: The IMMUNED trial previously showed significant improvements in recurrence-free survival for adjuvant nivolumab plus ipilimumab as well as for adjuvant nivolumab alone in patients with stage IV melanoma with no evidence of disease after resection or radiotherapy. Here, we report the final analysis, including overall survival data. METHODS: IMMUNED was an investigator-sponsored, double-blind, placebo-controlled, three-arm, phase 2 trial conducted in 20 academic medical centres in Germany. Eligible patients were aged 18-80 years with stage IV melanoma with no evidence of disease after surgery or radiotherapy. Patients were randomly assigned (1:1:1) to either nivolumab plus ipilimumab (nivolumab 1 mg/kg plus ipilimumab 3 mg/kg every 3 weeks for four doses followed by nivolumab 3 mg/kg every 2 weeks), nivolumab monotherapy (nivolumab 3 mg/kg every 2 weeks), or matching placebo, for up to 1 year. The primary endpoint was recurrence-free survival in the intention-to-treat population. Secondary endpoints were time-to-recurrence, overall survival, progression-free survival or recurrence-free survival 2 (in patients in the placebo group who crossed over to nivolumab monotherapy after experiencing disease recurrence), and safety endpoints. This trial is registered on ClinicalTrials.gov (NCT02523313), and is complete. FINDINGS: Between Sept 2, 2015, and Nov 20, 2018, 175 patients were enrolled in the study, and 167 were randomly assigned to receive either nivolumab plus ipilimumab (n=56), nivolumab plus ipilimumab-matching placebo (n=59), or double placebo control (n=52). At a median follow-up of 49·2 months (IQR 34·9-58·1), 4-year recurrence-free survival was 64·2% (95% CI 49·2-75·9) in the nivolumab plus ipilimumab group, 31·4% (19·7-43·8) in the nivolumab alone group, and 15·0% (6·7-26·6) in the placebo group. The hazard ratio (HR) for recurrence for the nivolumab plus ipilimumab group versus placebo was 0·25 (97·5% CI 0·13-0·48; p<0·0001), and for the nivolumab group versus placebo was 0·60 (0·36-1·00; p=0·024). Median overall survival was not reached in any treatment group. The HR for overall survival was significantly in favour of the nivolumab plus ipilimumab group versus placebo (HR 0·41; 95% CI 0·17-0·99; p=0·040), but not for the nivolumab group versus placebo (HR 0·75; 0·36-1·56; p=0·44). 4-year overall survival was 83·8% (95% CI 68·8-91·9) in the nivolumab plus ipilimumab group, 72·6% (57·4-83·2) in the nivolumab alone group, and 63·1% (46·9-75·6) in the placebo group. The median progression-free survival or recurrence-free survival 2 of patients in the placebo group who crossed over to nivolumab monotherapy after experiencing disease recurrence was not reached (95% CI 21·2 months to not reached). Rates of grade 3-4 treatment-related adverse events remained largely unchanged compared with our previous report, occurring in 71% (95% CI 57-82) of the nivolumab plus ipilimumab group, and 29% (95% CI 17-42) of patients receiving nivolumab alone. There were no treatment-related deaths. INTERPRETATION: Both active regimens continued to show significantly improved recurrence-free survival compared with placebo in patients with stage IV melanoma with no evidence of disease who were at high risk of recurrence. Overall survival was significantly improved for patients receiving nivolumab plus ipilimumab compared with placebo. Use of subsequent anti-PD-1-based therapy was high in patients in the placebo group after recurrence and most likely impacted the overall survival comparison of nivolumab alone versus placebo. The recurrence-free and overall survival benefit of nivolumab plus ipilimumab over placebo reinforces the change of practice already initiated for the treatment of patients with stage IV melanoma with no evidence of disease. FUNDING: Bristol-Myers Squibb.


Assuntos
Melanoma , Nivolumabe , Adjuvantes Imunológicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Método Duplo-Cego , Humanos , Ipilimumab/efeitos adversos , Melanoma/tratamento farmacológico , Melanoma/patologia , Melanoma/cirurgia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Nivolumabe/efeitos adversos
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