BACKGROUND AND OBJECTIVE:

Our goal was to evaluate the different subtypes of mucosal melanoma and describe specific variables that predict outcomes.

METHODS:

Prospective review of two tertiary care center databases identified 76 mucosal melanoma patients; 73 with complete records were included. Demographic and clinical data were analyzed. Cox regression determined variables impacting recurrence and survival.

RESULTS:

In the 73 patients, the mean age was 64 years, and 74% were female. Sixty-seven percent presented with lymph node involvement, and 73% had ulcerated tumors. Major sites affected were nasal/palate/oral (36%), vulvar/vaginal/cervical (48%), and anorectal (15%). Mean overall and disease-free survival were 56.9 and 27.2 months. Variables associated with decreased survival included: lymphovascular invasion (HR17.70, P = 0.0093), Caucasian race (HR3.02, P = 0.0362), nasal/palate/oral sub-group (HR1.85, P = 0.026), Breslow thickness (HR1.23, P = 0.00004), T stage (HR1.34, P = 0.0075), M stage (HR3.03, P = 0.0039), and chemotherapy (HR3.13, P = 0.0002). The worst prognosis was seen in the nasal/palate/oral sub-group, with a median overall survival of 9.7 months and recurrence-free time of 4.5 months. This subtype also demonstrated high lymph node positivity, ulceration, and larger tumor size.

CONCLUSION:

The nasal, palate, oral subtype has the worst prognosis compared to other mucosal melanoma locations. Studies are ongoing to evaluate pathologic and genomic variables that may predict outcomes.

Eight cases of melanoma of the lower female urogenital tract are presented. The lesions were located 5 in the vulva, 2 in the vagina and 1 in the urethra. Patients had a mean age of 58.3 (range 43-80). Most of vulvar melanomas were polypoid and black, 3 of them arose in the major labium, 2 in clitoris area; histologically, four tumors were superficial spreading melanomas and one unclassifiable. Grossly, one vaginal melanoma was nodular, one polypoid, both were black and arose in the lower vagina. Urethral melanoma arose in the distal part of the organ. Prognosis of gynecological melanoma is severe, as 5 out of 8 patients died in 5-52 months.

BACKGROUND:

There is much evidence supporting the role of telomeres in cancer pathogenesis, however the studies that investigated the association between telomere length and skin cancer risk provided inconsistent results. To help clarify this issue, we performed a systematic review and meta-analysis of published papers on the association between peripheral leukocytes telomere length (PLTL) and the risk of cutaneous melanoma and non-melanoma skin cancer (NMSC).

METHODS:

We calculated summary relative risks (SRR) and 95% confidence intervals (95%CI) using random effect models with maximum likelihood estimates, and explored causes of between-studies heterogeneity of risk estimates.

RESULTS:

We included 1629 cutaneous melanoma and 1439 NMSC from eight independent studies published until March 2015. The SRR of cutaneous melanoma for those in the lowest (vs. highest) category of PLTL distribution was 0.25 (95% CI 0.09-0.67). The results were less clear for NMSC, with two studies reporting no association and one study showing an increase in risk for those in the lowest (vs. highest) category of PLTL distribution. For both cutaneous melanoma and NMSC, the between-studies heterogeneity was large, mainly due to inclusion of hospital-based case-control studies.

CONCLUSIONS:

Our meta-analysis shows evidence of an association between short PLTL and reduced risk for cutaneous melanoma.

Vitamin D is formed mainly in the skin upon exposure to sunlight and can as well be taken orally with food or through supplements. While sun exposure is a known risk factor for skin cancer development, vitamin D exerts anti-proliferative and pro-apoptotic effects on melanocytes and keratinocytes in vitro. To clarify the role of vitamin D in skin carcinogenesis, we performed a review of the literature and meta-analysis to evaluate the association of vitamin D serum levels and dietary intake with cutaneous melanoma (CM) and non-melanoma skin cancer (NMSC) risk and melanoma prognostic factors. Twenty papers were included for an overall 1420 CM and 2317 NMSC. The summary relative risks (SRRs) from random effects models for the association of highest versus lowest vitamin D serum levels was 1.46 (95% confidence interval (CI) 0.60-3.53) and 1.64 (95% CI 1.02-2.65) for CM and NMSC, respectively. The SRR for the highest versus lowest quintile of vitamin D intake was 0.86 (95% CI 0.63-1.13) for CM and 1.03 (95% CI 0.95-1.13) for NMSC. Data were suggestive of an inverse association between vitamin D blood levels and CM thickness at diagnosis. Further research is needed to investigate the effect of vitamin D on skin cancer risk in populations with different exposure to sunlight and dietary habits, and to evaluate whether vitamin D supplementation is effective in improving CM survival.

Skin cancer is the most common form of cancer in the US, and an important public health concern both in the US and throughout the world. Given high incidence rates among young adults and the large number of deaths, skin cancer has the potential to result in significant years of potential life lost (YPLL) and lost productivity. The purpose of this study was to systematically review the published literature on the YPLL and the value of productivity loss from morbidity and premature mortality resulting from melanoma and non-melanoma skin cancer (NMSC). Employing pre-defined search terms and inclusion/exclusion criteria, systematic searches were conducted in MEDLINE, EMBASE, CINAHL and Econlit. We selected studies that measured the societal burden of melanoma and NMSC - through estimating either the YPLL and/or the indirect costs. We identified 16 relevant studies meeting our criteria, six were from the US and ten were from other industrialized countries; ten of the studies reported results on YPLL, eight on mortality costs and five on morbidity costs. Some studies reported results in more than one category. From each eligible article and report, we extracted detailed information on the study population/country, study design, data analysis methods and study results. Data abstracted for each eligible study included estimated number of YPLL, YPLL per death and morbidity and mortality costs. The average number of YPLL per death was approximately 15 for melanoma and 10 for NMSC. We found the costs attributable to melanoma and NMSC ranged from $US39.2 million to $US28.9 million for morbidity and $US3.3 billion to $US1.0 billion for mortality, respectively. It is clear from the published literature that skin cancer leads to significant YPLL and indirect costs associated with premature mortality and morbidity. Prevention and early detection efforts are important in helping reduce the incidence of melanoma and NMSC, and the related deaths and productivity losses.

Melanoma is responsible for the greatest number of deaths caused by skin malignancies. The purpose of monitoring patients diagnosed with melanoma is to allow early detection of recurrence and any subsequent primary tumors. Several dermatological and oncological societies developed their own set of guidelines for the surveillance and management of melanoma patients depending on the stage of the disease. The object of this article is to provide a comprehensive, systematic overview that summarizes and interprets previous studies, to characterize current practices regarding progression of melanoma, division into stages of development, and subsequent surveillance. We have performed a systematic review search to December 2016 using the MEDLINE database and performed a manual search of selected references. We examined the staging system and the different surveillance programs for melanoma patients. Consistent recommendations with proven evidence are available for staging melanoma patients. Conversely, recommendations are more controversial for follow-up procedures. Given the inadequate number of randomized controlled trials, consensus on the best, universally-applicable follow-up procedure has not been reached and interpretation of the roles of imaging and laboratory tests, as well as of the appropriate frequency and duration of physical examinations, vary widely. Based on a universally-accepted staging system different surveillance procedures have been developed, which may be mainly classified in two groups: low- and high-intensity strategies.

OBJETIVO:

Evaluar la precisión diagnóstica y utilidad clínica de la dermatoscopia para la detección del melanoma como médico de familia.

CALIDAD DE LA EVIDENCIA:

En las bases de dato Ovid MEDLINE (1946 a junio de 2011), EMBASE, PubMed, Cochrane se realizaron búsquedas utilizando los siguientes términos: dermoscopia, dermatoscopia, microscopia epiluminiscencia, medicina familiar, medicina general, atención primaria de la salud, el melanoma, las neoplasias de la piel, y nevus pigmentados. Para ser incluidos, los estudios debían ser artículos de investigación primaria con médicos de familia como los sujetos y la formación y el uso de la dermatoscopia como la intervención. Cuatro artículos cumplieron todos los criterios de inclusión y proporcionaron evidencia de nivel I de acuerdo con la Canadian Task Force sobre la definición de salud preventiva.

MENSAJE PRINCIPAL:

Entre los médicos de familia, la dermoscopia tiene mayor sensibilidad para la detección del melanoma que a simple vista con el examen general, sin disminución de la especificidad. La dermoscopia también ayuda a aumentar la confianza de los médicos de la familia en su diagnóstico preliminar de las lesiones. Cuando se utiliza dermoscopia, en comparación con el examen a simple vista, hay una mayor probabilidad de que una lesión evaluada como maligna sea, de hecho, maligna y que una lesión evaluada como benigna sea de hecho benigna.

CONCLUSIÓN:

La dermoscopia ha demostrado ser una herramienta útil y bastante barata para la detección de melanoma en la práctica familiar. Esta técnica puede aumentar la confianza de los médicos de la familia en su exactitud de remisión a dermatólogos y puede ayudar en la reducción de biopsias innecesarias. Dermoscopia puede ser especialmente útil para examinar pacientes con alto riesgo de melanoma, como la actual guía práctica clínica canadiense recomienda una evaluación anual en estos individuos.

The objective of this review is to report and discuss the evidence for fully automated diagnostic instruments for cutaneous melanoma tested in a real-world clinical setting directly compared with human diagnosis. A systematic review was performed and articles excluded when studies did not report sensitivity or specificity for melanoma directly compared with humans on an independent test set. Only 3 instruments have had their diagnostic accuracy compared with a human diagnosis in the clinical field with a meaningful sample size that could allow some generalization with the wider clinical arena. Two of these instruments showed a significantly inferior specificity for the diagnosis of melanoma compared with specialists. In one of these studies, the sensitivity for diagnosis, although superior to the specialist diagnosis, did not reach statistical significance. In contrast, one instrument had an equivalent specificity and trended superior but not significantly for sensitivity for the diagnosis of melanoma. Other image based nonclinic studies and studies comparing clinical management as the endpoint rather than diagnosis are also reviewed.

A variety of estimates of the value and impact of physician skin examinations (PSEs) in screening for melanoma have been published. Although current melanoma screening guidelines vary, new evidence supports improved melanoma outcomes associated with PSEs. In this systematic review, we evaluated 5 observational studies of the impact of PSEs on melanoma thickness at diagnosis and melanoma mortality rates. Although definitive evidence from randomized controlled trials supporting improved health outcomes associated with PSEs is lacking, these well-designed observational studies have found PSEs to be correlated with thinner melanomas at diagnosis and reduced melanoma mortality rates.

BACKGROUND:

External ear melanoma accounts for only 1% of all cutaneous melanomas, and data on its optimal management and prognosis are limited.

AIM:

We aim to review the literature on external ear melanoma to guide surgeons in the treatment of this uncommon and peculiar pathology.

MATERIALS AND METHODS:

A systematic review of English language studies on ear melanoma published from 1993 to 2013 was performed using the PubMed electronic database. Data on epidemiology, oncological treatment (tumor resection and regional lymph nodes management), and reconstruction were extrapolated from selected papers.

RESULTS:

The total number of patients was 858 (30 studies). The helix was the most common location (57%); superficial spreading melanoma was the most common histopathological subtype (41%). The mean Breslow thickness was 2.01 mm, with 88% of stage I-II patients. Sentinel lymph node biopsy was performed in 45% of patients, with 8% of positive nodes. Available data on its prognosis are fragmentary and contrasting, but the Breslow thickness appears to be the main prognostic factor. There is a tendency towards reduced resection margins and preservation of the underlying perichondrium and cartilage. Local flaps are the most popular reconstructive option.

CONCLUSION:

To the best of our knowledge, this systematic review presents the largest data series on external ear melanoma. There is no general agreement on its surgical management, but a favorable prognosis seems to justify the tendency towards conservative treatments.