Revisión sistemática

No clasificado

Telomere length and the risk of cutaneous melanoma and non-melanoma skin cancer: a review of the literature and meta-analysis.

Año 2015
Revista Journal of dermatological science
Enlaces Pubmed , DOI

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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.

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Revisión sistemática

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Treatment and outcomes of anorectal melanoma.

Año 2011
Autores Heeney A , Mulsow J , Hyland JM
Revista The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
Enlaces Pubmed , DOI

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INTRODUCTION:

anorectal melanoma is an uncommon disease constituting less than 3% of all melanomas. Due to its rarity, there are a lack of randomized control trials regarding appropriate management and current evidence is based mainly on retrospective studies.

METHODS:

in view of the controversial surgical treatment of anorectal melanoma, we review the most published literature in an attempt to elucidate its typical clinical features along with current thinking with respect to management approaches to this aggressive disease. Using the keywords "anorectal" and "malignant melanoma", a medline search of all articles in English was performed and the relevant articles procured. Additional references were retrieved by cross reference from key articles.

RESULTS:

anorectal melanoma affects the elderly with a slight preponderance for females. It commonly presents disguised as benign disease with local bleeding or suspicion for haemorrhoidal disease. There is no convincing evidence to indicate that radical resection of primary anorectal melanoma is associated with improvement in local control or survival, and local excision is an acceptable treatment option.

CONCLUSION:

optimum management depends on several factors and the therapeutic goals should be to lengthen survival and preserve quality-of-life. Given that wide local excision is a more limited intervention with comparable survival it should be considered as the initial treatment choice. Unfortunately prognosis for patients with this disease remains poor despite choice of treatment strategy with overall five year disease-free survival less than twenty percent in most studies.

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Revisión sistemática

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La dermatoscopia para la detección de melanoma en la práctica familiar.

Traducción colaborativa
Año 2012
Autores Herschorn A
Revista Canadian family physician Médecin de famille canadien
Enlaces Pubmed , PMC

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Este artículo incluye 4 Estudios primarios 4 Estudios primarios (4 referencias)

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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.

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Revisión sistemática

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Automated diagnostic instruments for cutaneous melanoma.

Año 2008
Autores Vestergaard ME , Menzies SW
Revista Seminars in cutaneous medicine and surgery
Enlaces Pubmed , DOI

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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.

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Revisión sistemática

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Ipilimumab: a novel treatment for metastatic melanoma.

Año 2011
Autores Culver ME , Gatesman ML , Mancl EE , Lowe DK
Revista The Annals of pharmacotherapy
Enlaces Pubmed , DOI

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OBJECTIVE:

To review the mechanism of action, pharmacokinetics, efficacy, safety, drug interactions, dosing, and economic considerations of ipilimumab.

DATA SOURCES:

A literature search using MEDLINE (1966-November 2010) was performed using the terms ipilimumab, metastatic melanoma, MDX-010, and MDX-101. Additional data were obtained from meeting abstracts, bibliographies, and media releases.

STUDY SELECTION AND DATA EXTRACTION:

English-language articles identified from the data sources were reviewed. Selected studies evaluated the pharmacology, pharmacokinetics, efficacy, and safety of ipilimumab for the treatment of metastatic melanoma.

DATA SYNTHESIS:

The incidence of melanoma in the US is increasing faster than any other type of cancer in men and more than any other type of cancer, except lung cancer, in women. For patients with metastatic melanoma, systemic therapies are limited by low response rates, short durations of response, and a 5-year survival rate <10%. Ipilimumab, a novel CTLA-4 inhibitor, is under investigation for the treatment of metastatic melanoma. Results of a randomized, controlled Phase 3 trial showed a first-ever overall survival benefit for patients with previously treated metastatic melanoma who received ipilimumab compared with the controls. The majority of adverse events reported with ipilimumab administration are considered to be low-grade immune-related events involving the skin and intestine and can be managed medically. Nonetheless, 10-17% of patients have immune-related adverse events of grade 3 or higher severity, with 2-3% of these events resulting in death.

CONCLUSIONS:

Ipilimumab is a novel CTLA-4 inhibitor that has been evaluated for the treatment of metastatic melanoma. On March 25, 2011, the Food and Drug Administration approved ipilimumab, making it the first agent indicated for unresectable or metastatic melanoma in more than a decade.

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Revisión sistemática

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Desmoplastic malignant melanoma: a systematic review.

Año 2005
Autores Lens MB , Newton-Bishop JA , Boon AP
Revista The British journal of dermatology
Enlaces Pubmed , DOI

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BACKGROUND:

Desmoplastic melanoma (DM) is an uncommonly encountered type of malignant melanoma. The clinical appearance of DM can be highly variable and thus, diagnosis of this tumour is difficult and very often may mislead the physician.

OBJECTIVES:

To make a critical review of the contemporary literature on DM, to pool the data from published studies and to evaluate the clinical and morphological characteristics of this neoplasm.

METHODS:

All studies or reports on DM including 10 or more participants with reported clinical and histological characteristics of the tumour were included.

RESULTS:

In the 17 studies that met the inclusion criteria a total of 856 patients with DM was reported. There was a male predilection, with a male/female ratio of almost 2 : 1 (63% of the lesions were diagnosed in males). The head and neck were the most common sites of DM for both sexes (53.2%). The data confirmed that DM usually has an advanced Breslow thickness at the time of presentation. Histopathological diagnosis of DM is sometimes difficult and the absence of pigmentation is probably the major cause for failure to recognize DM histologically. The pooled data from included studies showed that the incidence of nodal metastasis is lower in patients with DM than in patients with other forms of cutaneous melanoma.

CONCLUSIONS:

Prompt definitive surgical excision is the treatment of choice for DM. Improved knowledge of the clinical behaviour and histological features of DM is important for more effective management of patients with DM.

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Estudio primario

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[Melanoma of the lower female urogenital tract (gynecological melanoma)].

Año 1991
Autores Urso C , Taddei GL
Revista Pathologica
Enlaces Pubmed

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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.

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Revisión sistemática

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Vitamin D and melanoma and non-melanoma skin cancer risk and prognosis: a comprehensive review and meta-analysis.

Año 2014
Revista European journal of cancer (Oxford, England : 1990)
Enlaces Pubmed , DOI

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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.

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Estudio primario

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Sentinel lymph node biopsy in cutaneous melanoma: the WHO Melanoma Program experience.

Año 2000
Revista Annals of surgical oncology
Enlaces Pubmed

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BACKGROUND:

We report the experience of the World Health Organization (WHO) Melanoma Program concerning sentinel lymph node (SLN) biopsy for detecting patients with occult regional nodal metastases to submit to selective regional node dissection.

METHODS:

From February 1994 to August 1998, in 12 centers of the WHO Melanoma Program, 892 SLN biopsies were performed in 829 patients with clinical stage I melanoma (male: 370; female: 459; median age: 50 years old). The location of the primary melanoma was as follows: trunk 35%; lower limbs, 45%; upper limbs, 18%; and head and neck, 2%. Blue dye injection for SLN identification was performed in all cases; preoperative lymphoscintigraphy was done in 440 patients, and an intra-operative probe for a radio-guided biopsy was used in 141 cases. Overall, the SLN identification rate was 88%. In 68% of the patients, only one SLN was identified, whereas two and three or more SLN were detected in 24% and 8% of the remaining cases, respectively.

RESULTS:

Overall SLN positivity rate was 18%. Intra-operative frozen section examination was performed in 39% of the cases and was helpful in detecting occult localizations only in 47% of the positive SLNs. Distribution of positive cases by primary thickness was as follows: < 1mm: 2%; 1-1.99 mm: 7%; 2-2.99 mm: 13%; and > or = 3 mm: 31%. Positive nonsentinel lymph nodes were found in 22% of cases with positive SLN submitted for selective dissection. No complications due to the procedure were registered. Of 710 patients who were evaluated, 40 (6%) presented a regional nodal relapse after a negative SLN biopsy and underwent a delayed therapeutic dissection. From the 710 enrolled cases, 638 (88.5%) were alive without evidence of disease at the time of this writing. A multivariate analysis showed SLN status as one of the most significant prognostic factors (P = .000) along with thickness (P = .001) and ulceration (P = .015) of primary tumor.

CONCLUSIONS:

These data confirm the feasibility and safety of the SLN technique for selecting patients to submit to a radical node dissection. The data represent the basis for a future trial by the WHO Melanoma Program in this field to evaluate the most appropriate surgical approach for treating patients with occult regional nodal metastases.

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Resumen estructurado de revisiones sistemáticas

No clasificado

Ipilimumab para pacientes con melanoma metastásico [Ipilimumab for patients with metastatic melanoma]

Año 2014
Revista HTA Database
Enlaces
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RECORD STATUS:

This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database.

CITATION:

Pichon Riviere A, Augustovski F, Garcia Marti S, Glujovsky D, Alcaraz A, Lopez A, Bardach A, Ciapponi A, Rey-Ares L, Caccavo F. Ipilimumab para pacientes con melanoma metastásico. [Ipilimumab for patients with metastatic melanoma] Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS). Informe de Respuesta Rápida N° 265. 2012

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