Mucosal melanomas, far fewer in number than melanomas of the skin, manifest a far more aggressive and more rapid life-consuming biologic course. This behavior attends melanomas at any mucosal site, upper aerodigestive tracts, anorectum, and male and female genital tracts. Prognostic factors for both groups of melanoma are similar, but most mucosal melanomas have reached the dangerous limits, e.g., depth of invasion or thickness of melanoma at the time of diagnosis. In general, the mucosal melanomas are also more refractory to therapeutic modalities. In part, this may be due to anatomic restrictions of site and the large size of tumor when first discovered. This review presents a contemporary assessment of melanomas at all of the major mucosal sites.

Forty-seven cases of mucosal malignant melanomas and the recent literature are reviewed. Twenty patients had head and neck mucosal malignant melanomas; 14 had vulvar and 7 vaginal melanomas. Included are also isolated cases of urethral, anal and esophageal melanoma. Mucosal malignant melanomas are more aggressive and behave differently from cutaneous melanomas. The pathologic description and leveling system known from cutaneous melanomas are not applicable in mucosal melanomas, and other prognostic factors such as depth of invasion seem more important. Extensive surgical procedures is the favored treatment when cure is intended whereas radiation, chemotherapy and immunotherapy currently serve mainly as palliative measures. The prognosis is generally grave. In this review, 5 of the 20 patients with head and neck tumors and 3 of the patients with vulvar tumors had 5 years cures, but later recurrences are not infrequent. Two patients are alive with metastatic disease whereas the rest died from primary or recurrent disease. The main problem in head and neck tumors was gaining control over the local disease process, whereas metastatic disease was less ominous and less frequent. This was different in vulvar melanomas, in which disseminated metastatic disease made the disease difficult to control in the majority of cases. The course of the 47 patients, the poor treatment results and the rarity of the disease show the need for centralized registration and management of mucosal malignant melanomas.

A system for the computerized analysis of images obtained from ELM has been developed to enhance the early recognition of malignant melanoma. As an initial step, the binary mask of the skin lesion is determined by several basic segmentation algorithms together with a fusion strategy. A set of features containing shape and radiometric features as well as local and global parameters is calculated to describe the malignancy of a lesion. Significant features are then selected from this set by application of statistical feature subset selection methods. The final kNN classification delivers a sensitivity of 87% with a specificity of 92%.

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.

RECORD STATUS:

None

CITATION:

Canadian Coordinating Office for Health Technology Assessment. Metastatic melanoma vaccines. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA). Emerging Drug List Issue 69. 2006

RECORD STATUS:

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

CITATION:

Dermoscopy for detection of melanoma. Lansdale: HAYES, Inc.. Healthcare Technology Brief Publication. 2007

PURPOSE:

To determine trends in incidence, treatment, and survival with primary uveal melanoma in the United States over a 36-year period from 1973 to 2008.

DESIGN:

Systematic review of existing databases.

PARTICIPANTS:

A total of 4070 patients with primary uveal melanoma (International Classification of Disease for Oncology [ICD-O-2] codes C69.3 [choroid], C69.4 [ciliary body and iris], and C69.2 [retina]) derived from the Surveillance, Epidemiology, and End Results (SEER) program database in the United States from 1973 to 2008.

METHODS:

The significance of trends in age-adjusted incidence, treatment, and 5-year relative survival rates were determined using chi-square testing and 95% confidence intervals (CIs).

MAIN OUTCOME MEASURES:

Age-adjusted incidence, form of treatment (surgery, radiation, or both), and 5-year relative survival rates.

RESULTS:

There were 4070 cases of uveal melanoma representing 3.1% of all recorded cases of melanoma. The majority of cases (98.3%) were reported by hospital inpatient/outpatient clinics. Histopathologic confirmation was available in 2804 cases (72.1% for all years). The mean age-adjusted incidence of uveal melanoma in the United States was 5.1 per million (95% CI, 4.8-5.3). The majority of cases (97.8%) occurred in the white population. There was a statistically significant variation of age-adjusted incidence between sexes (male = 5.8, 95% CI, 5.5-6.2; and female = 4.4, 95% CI, 4.2-4.7). A decreasing trend was observed in patients treated with surgery alone (93.8% for 1973-1975 vs. 28.3% for 2006-2008), whereas a corresponding increase was seen in those treated with radiation (1.8% for 1973-1975 vs. 62.5% for 2006-2008). No change in the 5-year relative survival rate (81.6%) was observed from 1973 to 2008.

CONCLUSIONS:

The age-adjusted incidence of uveal melanoma (5.1 per million) has remained unchanged from 1973 to 2008. Despite a shift toward more conservative treatments, survival has not improved during this time period.

ANTECEDENTES:

El melanoma cutáneo representa el 75% de las muertes por cáncer de piel. El tratamiento estándar es la escisión quirúrgica con un margen de seguridad a cierta distancia de los bordes del tumor primario. La finalidad del margen de seguridad es extraer el tumor primario completo y cualquier célula de melanoma que pudiera haberse diseminado en la piel circundante.

OBJETIVOS:

Evaluar los efectos de diferentes márgenes de escisión para el melanoma cutáneo primario.

MÉTODOS DE BÚSQUEDA:

En agosto de 2009 se realizaron búsquedas de ensayos aleatorios relevantes en el Registro Especializado del Grupo Cochrane de Piel (Cochrane Skin Group); el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL) (The Cochrane Library (número 3, 2009), en MEDLINE, EMBASE, LILACS y otras bases de datos incluida Ongoing Trials Registers.

CRITERIOS DE SELECCIÓN:

Se consideraron todos los ensayos controlados aleatorios (ECA) de escisión quirúrgica del melanoma que comparaban diferentes anchos de los márgenes de escisión.

OBTENCIÓN Y ANÁLISIS DE LOS DATOS:

Se evaluó la calidad del ensayo, y se extrajeron y analizaron los datos de supervivencia y recidiva. A partir de los ensayos incluidos, se recopiló información sobre los efectos adversos.

RESULTADOS PRINCIPALES:

Se identificaron cinco ensayos. Hubo 1633 participantes en el grupo margen de escisión estrecho y 1664 en el grupo margen de escisión amplio. La definición de margen estrecho varió de 1 a 2 cm; los márgenes amplios variaron de 3 a 5 cm. La mediana de seguimiento varió de cinco a 16 años.

CONCLUSIONES DE LOS AUTORES:

Esta revisión sistemática resume las pruebas con respecto al ancho de los márgenes de escisión para el melanoma cutáneo primario. Ninguno de los cinco ensayos publicados, ni el metanálisis, mostraron una diferencia estadísticamente significativa en la supervivencia general entre la escisión estrecha o amplia.

TEMAS DE SALUD:

BACKGROUND:

Recent developments in computer technology have raised expectations that fully automated diagnostic instruments will become available to diagnose cutaneous melanoma without the need of human expertise.

OBJECTIVES:

To critically review the contemporary literature on computer diagnosis of melanoma, evaluate the accuracy of such computer diagnosis, analyze the influence of study characteristics, and compare the accuracy of computer diagnosis of melanoma with human diagnosis.

METHODS:

Quantitative meta-analysis of published reports.

DATA SOURCES:

Eligible studies were identified by a MEDLINE search covering the period from January 1991 to March 2002, by manual searches of the reference lists of retrieved articles, and by direct communication with experts.

RESULTS:

Thirty studies with substantial differences in methodological quality were deemed eligible for meta-analysis. Five of these complied with the predetermined list of "good quality" requirements, but none met all methodological quality requirements. Ten of these studies compared the performance of computer diagnosis with human diagnosis. The diagnostic accuracy achieved with computer diagnosis was statistically not different from that of human diagnosis (log odds ratios, 3.36 vs 3.51; P =.80). The diagnostic performance of the computer diagnosis was better for studies that used dermoscopic images than for studies that used clinical images (log odds ratios, 4.2 vs 3.4; P =.08). Other study characteristics did not significantly influence the accuracy of the computer diagnosis.

CONCLUSIONS:

The computer diagnosis of melanoma is accurate under experimental conditions, but the practical value of automated diagnostic instruments under real-world conditions is currently unknown. We suggest minimum requirements for methodological quality in future experimental studies or, ideally, randomized controlled trials.

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.