Resumen estructurado de revisiones sistemáticas

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Dermatoscopa Digital en el diagnostico de melanoma Digital dermoscopy in the diagnosis of melanoma

Año 2010
Revista HTA Database
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RECORD STATUS:

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CITATION:

Pichon Riviere A., Augustovski F., Garcia Marti S., Glujovsky D., Lopez A., Bardach A., Aruj P., Galante J.. Dermatoscopa Digital en el diagnostico de melanoma . Digital dermoscopy in the diagnosis of melanoma . Buenos Aires: Institute for Clinical Effectiveness and Health Policy (IECS). Informe de Respuesta Rapida No195. 2010

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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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Use of tamoxifen in the treatment of malignant melanoma.

Año 2003
Autores Lens MB , Reiman T , Husain AF
Revista Cancer
Enlaces Pubmed , DOI

Sin referencias

Este artículo está incluido en 1 Resumen estructurado de revisiones sistemáticas 0 Resúmenes estructurados de revisiones sistemáticas (1 referencia)

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BACKGROUND:

Tamoxifen has been used in the treatment of patients with metastatic malignant melanoma either as a single agent or, more commonly, in combination with other chemotherapeutic agents. The aim of the current study was to summarize the available clinical evidence on the role of the tamoxifen in different combination chemotherapy regimens because clinical studies including tamoxifen have produced inconclusive results.

METHODS:

The authors designed a systematic review and metaanalysis of published randomized controlled trials to assess the benefit of tamoxifen added to various single-agent or multiagent chemotherapy or biochemotherapy regimens.

RESULTS:

Six randomized trials met the inclusion criteria and were analyzed. These 6 trials involved a combined total of 912 patients. Of this number, 455 patients were randomized to receive tamoxifen added to chemotherapy or biochemotherapy regimens and 457 were randomized to receive chemotherapy or biochemotherapy without tamoxifen. The overall response rate was not improved significantly by the addition of tamoxifen to the chemotherapy regimen (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.75-1.82; test for overall effect: P = 0.14). The results were not statistically significant for complete response (OR, 0.64; 95% CI, 0.33-1.25; test for overall effect: P = 0.19).

CONCLUSIONS:

The current metaanalysis demonstrated that tamoxifen does not improve the overall response rate, complete response rate, or survival rate when administered along with combined chemotherapy regimens. Currently, the strength of evidence does not support the use of tamoxifen in combination with other systemic chemotherapy for the treatment of metastatic melanoma.

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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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Revisión sistemática

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Micrometástasis en el ganglio centinela en melanoma maligno

Traducción oficial
Año 2010
Autores Jaimovich, León
Revista Arch. argent. dermatol
Enlaces Virtual Health Library

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Este artículo no tiene resumen

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Revisión sistemática

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Cáncer de piel: melanoma. Revisión de la literatura

Traducción oficial
Año 2021
Revista Rev. Hosp. Clin. Univ. Chile
Enlaces Virtual Health Library

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Estudio primario

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Nodal staging in localized melanoma. The experience of the Brescia Melanoma Unit.

Año 2003
Revista British journal of plastic surgery
Enlaces Pubmed

Este artículo está incluido en 1 Revisión sistemática Revisiones sistemáticas (1 referencia)

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BACKGROUND AND OBJECTIVES:

We report our experience with patients affected by cutaneous melanoma undergoing sentinel node (SN) biopsy.

METHODS:

From November 1997 to October 2000 we performed 128 selective lymphadenectomies (SN biopsy) on 127 patients with cutaneous melanoma with Breslow thickness>1 mm or regression or ulceration. Age, sex, tumour location ad histology were recorded.

RESULTS:

Two hundred and thirty eight SNs were identified by lymphoscintigraphy in 167 lymphatic stations, 236 of them were identified intraoperatively using a gamma probe and patent blue V injection. Twenty-one patients had SNs with melanoma metastases (15.8%), 12 patients in the groin, eight patients in the axilla and one patient in the neck. After therapeutic lymphadenectomy eight more lymph nodes with metastases of melanoma were found in the specimens of three patients. After a follow-up ranging from 10 to 56 months the results are that 111 patients are free of disease. Ten patients died. Three patients have visceral metastases and are alive. One patient has developed two more melanomas. One patient was lost to follow-up.

CONCLUSIONS:

Our data confirm the clinical reliability of the SN technique in melanoma; for optimisation of the therapeutic strategy, this technique might be considered the standard method of nodal staging in the evaluation of melanoma patients.

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Estudio primario

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Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease.

Año 2012
Revista Gastroenterology
Enlaces Pubmed , DOI

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BACKGROUND & AIMS:

Patients with inflammatory bowel disease (IBD) are at risk for certain malignancies. We aimed to determine the risk of melanoma and nonmelanoma skin cancer (NMSC) in patients with IBD and how medications affect these risks.

METHODS:

We performed retrospective cohort and nested case-control studies using administrative data from the LifeLink Health Plan Claims Database from 1997 to 2009. The cohort comprised 108,579 patients with IBD, and each was matched to 4 individuals without IBD. The risk of melanoma and NMSC was evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazard ratio (HR) modeling. In nested case-control studies, patients with melanoma or NMSC were matched to 4 patients with IBD without melanoma or NMSC. Conditional logistic regression was used to determine associations between medications and both skin cancers.

RESULTS:

In the cohort, IBD was associated with an increased incidence of melanoma (IRR, 1.29; 95% confidence interval [CI], 1.09-1.53). Risk was greatest among individuals with Crohn's disease (IRR, 1.45; 95% CI, 1.13-1.85; adjusted HR, 1.28; 95% CI, 1.00-1.64). The incidence of NMSC also increased among patients with IBD (IRR, 1.46; 95% CI, 1.40-1.53) and was greatest among those with CD (IRR, 1.64; 95% CI, 1.54-1.74). In the nested case-control studies, therapy with biologics increased the risk of melanoma (odds ratio [OR], 1.88; 95% CI, 1.08-3.29). Patients who had been treated with thiopurines had an increased risk of NMSC (OR, 1.85; 95% CI, 1.66-2.05).

CONCLUSIONS:

Immunosuppression increases the risk of melanoma and NMSC among patients with IBD. The risk of melanoma is increased by use of biologics, and the risk of NMSC is increased by use of thiopurines. Patients with IBD should be counseled and monitored for skin cancer.

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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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Melanoma lentiginoso acral: una variante de melanoma maligno de especial interés en Colombia

Traducción oficial
Año 2008
Revista Iatreia
Enlaces Virtual Health Library

Este artículo no está incluido en ninguna revisión sistemática

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El melanoma lentiginoso acral (MLA) es una variante rápidamente progresiva del melanoma maligno (MM). Constituye el 5-10% de los MM y se presenta con mayor frecuencia en pacientes de raza negra, asiáticos y latinoamericanos. En Colombia, la frecuencia de MM se encuentra en aumento y el MLA es una de las variantes más comunes (14,7% de todos los melanomas). La edad promedio de presentación es de 58 años, con una tasa de supervivencia menor para las personas de raza negra, asociada al diagnóstico tardío. EL MLA se localiza en las plantas, palmas y regiones subungueales y en su etiopatología se ha descrito la presencia de mutaciones en varios genes: 9p21 p16: (67%), 11q13 (CCND1) (47%), 22q11-q13 (40%) y 5p15 (20%). El diagnóstico de MLA se ha fundamentado clásicamente en la histopatología; sin embargo, otros métodos como la dermatoscopia, la evaluación del ganglio centinela y la detección de alteraciones en las proteínas del ciclo celular pueden contribuir al diagnóstico precoz y a mejorar el pronóstico tanto del MLA como del MM en general.

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