Resumen estructurado de revisiones sistemáticas

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Metastatic melanoma vaccines

Año 2006
Revista HTA Database
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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

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Resumen estructurado de revisiones sistemáticas

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Dermoscopy for detection of melanoma

Año 2009
Autores HAYES , Inc
Revista HTA Database
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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

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Revisión sistemática

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Uveal melanoma: trends in incidence, treatment, and survival.

Año 2011
Autores Singh AD , Turell ME , Topham AK
Revista Ophthalmology
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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.

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Revisión sistemática

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Risk of developing a subsequent nonmelanoma skin cancer in patients with a history of nonmelanoma skin cancer: a critical review of the literature and meta-analysis.

Año 2000
Autores Marcil I , Stern RS
Revista Archives of dermatology
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OBJECTIVE:

To assess the risk of developing a basal cell carcinoma (BCC), and/or a squamous cell carcinoma (SCC), and/or Bowen disease (SCC in situ) after a nonmelanoma skin cancer (NMSC) of a specific type.

DATA SOURCES:

Four electronic databases were searched from January 1, 1966, to October 21, 1999.

STUDY SELECTION:

We included all studies published in English, identified by standard search strategies, that provided original data quantifying the risk of an NMSC among persons with a previous NMSC.

DATA EXTRACTION:

For each study and separate histological type of index skin tumor and subsequent skin tumor (SCC, BCC, NMSC, or Bowen disease), we determined the 3-year cumulative risk and the incidence rate of second tumors per 100 000 person-years. In cases where more than 1 study was assessing the risk of one specific tumor type after another, we undertook a formal meta-analysis. We compared the incidence of a subsequent SCC after an index SCC and of a subsequent BCC after an index BCC with the incidence of the first occurrence of such tumors in the comparable general population.

DATA SYNTHESIS:

We identified and reviewed 17 studies that included data for 26 tumor combinations. Overall, the 3-year cumulative risk of a subsequent SCC after an index SCC is 18%, at least a 10-fold increase in incidence compared with the incidence of first tumors in a comparable general population. For BCCs, the 3-year cumulative risk is 44%, also at least a 10-fold increase in incidence compared with the rate in a comparable general population. The risk of developing a BCC in patients with a prior SCC is about equal to that risk among persons with a prior BCC, but the risk of developing an SCC in patients with a prior BCC is low (6%).

CONCLUSIONS:

Although these studies vary in their study type, location, and biases, their results are consistent. The risk of developing a subsequent skin cancer of a specific type depends on the type of prior NMSC and number of prior skin tumors of that type. Based on these findings, follow-up strategies for patients with BCC and SCC are suggested.

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Revisión sistemática

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Pathogenesis, diagnosis and management of primary melanoma of the colon.

Año 2011
Autores Khalid U , Saleem T , Imam AM , Khan MR
Revista World journal of surgical oncology
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BACKGROUND:

Melanomas within the alimentary tract are usually metastatic in origin. On the other hand, primary melanomas of the gastrointestinal tract are relatively uncommon. There are several published reports of melanomas occurring in the esophagus, stomach, small bowel, and anorectum. The occurrence of primary melanoma of the colon has, however, only been rarely reported. The optimum modus operandi for the management of primary colonic melanoma remains nebulous due to the limited number of reports in literature.

METHODS:

A comprehensive search of Medline, Cochrane and Highwire was performed using the following keywords: 'melanoma', 'malignant melanoma', 'primary melanoma', 'colon', 'gastrointestinal tract', 'alimentary tract', 'digestive tract', and 'large bowel'. All patients with primary melanoma localized to the colon were included in the review. Patients with metastatic melanomas to the gastrointestinal (GI) tract and primary melanomas localized to the GI tract in anatomic locations other than colon were excluded.

RESULTS:

There have been only 12 reported cases of primary melanoma of the colon to date. The average age of patients on presentation was 60.4 years without any significant gender predilection. Right colon (33%) and cecum (33%) were the most common sites for the occurrence of primary colonic melanoma while abdominal pain (58%) and weight loss (50%) were the most common presenting complaints. Colonoscopy is the most reliable diagnostic investigation and offers the additional advantage of obtaining tissue for diagnosis. S-100 and HMB-45 are highly sensitive and specific for the diagnosis of this malignancy. For primary colonic melanomas that have not metastasized to any distant parts of the body, surgical resection with wide margins appears to be the treatment of choice. Although the management was individualized in every case, most of the authors preferred traditional hemicolectomy as the favored surgical approach. Chemotherapeutic agents including interferons, cytokines, biological agents and radiation therapy for brain metastases have been reported as adjuvant and palliative options while considering malignant melanomas in general. The average recurrence-free interval was 2.59 years. Nine of the 12 reports documented follow-up in their patients. Two of these 9 (22.2%) patients died.

CONCLUSIONS:

Primary melanoma of the colon is a rare clinical entity. Whenever a seemingly primary melanoma is detected in an atypical location such as the colon, it is prudent to conduct a thorough clinical investigation to consider the possibility of metastatic disease. Further studies are needed to document the long term follow-up, survival advantage and safety of the management approaches employed in patients with primary colonic melanoma. Based on current data, surgical resection appears to be appropriate management for primary colonic melanomas; unless the disease has metastasized to distant sites where surgery may have a limited palliative role.

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Revisión sistemática

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Márgenes de la escisión quirúrgica para el melanoma cutáneo primario

Traducción oficial
Año 2009
Revista Cochrane Database of Systematic Reviews
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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:


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Revisión sistemática

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Accuracy of computer diagnosis of melanoma: a quantitative meta-analysis.

Año 2003
Revista Archives of dermatology
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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.

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Revisión sistemática

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Uveal melanoma among Finnish children and young adults.

Año 2014
Autores Al-Jamal RT , Kivelä T
Revista Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus
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PURPOSE:

To characterize uveal melanoma (UM) among children and young adults in a high-risk region for this cancer.

METHODS:

The medical records of consecutive patients <25 years of age with UM treated from 1962 to 2009 were retrospectively reviewed. The following data were collected: sex, tumor location and size, tumor node metastasis (TNM) stage, vision, and survival. We compared data with five previous series reporting 70 matching patients and combined them for meta-analysis of survival.

RESULTS:

Of 1,185 UM patients, 18 were eligible. UM frequency in patients <25 years of age was 1.3%; in those ≤20 years of age, 0.6%. Median follow-up time was longer than in the previous series combined (11.6 vs 5.4 years). Females outnumbered males 2:1. Median tumor thickness was higher in our series (8 vs 5 mm) and increased with age. Median tumor diameter was similar to previous series (12 mm). Of our patients, 83% were stage II; 17%, stage III. In previous series, 26% were stage I; 64%, stage II; and 10%, stage III. Survival was 76% at 5 and 10 years, compared to 98% in previous series. By meta-analysis, mortality increased with stage, age > 17 years, female sex, and if the ciliary body was involved.

CONCLUSIONS:

Tumor stage was higher than in other regions. Age >17 years, female sex, and tumor stage adversely influenced survival among patients <25 years of age with UM.

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Revisión sistemática

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Interferon alpha for the adjuvant treatment of cutaneous melanoma

Año 2013
Revista Cochrane Database of Systematic Reviews
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BACKGROUND:

Interferon alpha is the only agent approved for the postoperative adjuvant treatment of high-risk cutaneous melanoma. However, the survival advantage associated with this treatment is unclear, especially in terms of overall survival. Thus, adjuvant interferon is not universally considered a gold standard treatment by all oncologists.

OBJECTIVES:

To assess the disease-free survival and overall survival effects of interferon alpha as adjuvant treatment for people with high-risk cutaneous melanoma.

SEARCH METHODS:

We searched the following databases up to August 2012: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2012, issue 8), MEDLINE (from 2005), EMBASE (from 2010), AMED (from 1985), and LILACS (from 1982). We also searched trials databases in 2011, and proceedings of the ASCO annual meeting from 2000 to 2011. We checked the reference lists of selected articles for further references to relevant trials.

SELECTION CRITERIA:

We included only randomised controlled trials (RCTs) comparing interferon alpha to observation (or any other treatment) for the postoperative (adjuvant) treatment of patients with high-risk skin melanoma, that is, people with regional lymph node metastasis (American Joint Committee on Cancer (AJCC) TNM (tumour, lymph node, metastasis) stage III) undergoing radical lymph node dissection, or people without nodal disease but with primary tumour thickness greater than 1 mm (AJCC TNM stage II).

DATA COLLECTION AND ANALYSIS:

Two authors extracted data, and a third author independently verified the extracted data. The main outcome measure was the hazard ratio (HR), which is the ratio of the risk of the event occurring in the treatment arm (adjuvant interferon) compared to the control arm (no adjuvant interferon). The survival data were either entered directly into Review Manager (RevMan) or extrapolated from Kaplan-Meier plots and then entered into RevMan. Based on the presence of between-study heterogeneity, we applied a fixed-effect or random-effects model for calculating the pooled estimates of treatment efficacy.

MAIN RESULTS:

Eighteen RCTs enrolling a total of 10,499 participants were eligible for the review. The results from 17 of 18 of these RCTs, published between 1995 and 2011, were suitable for meta-analysis and allowed us to quantify the therapeutic efficacy of interferon in terms of disease-free survival (17 trials) and overall survival (15 trials). Adjuvant interferon was associated with significantly improved disease-free survival (HR (hazard ratio) = 0.83; 95% CI (confidence interval) 0.78 to 0.87, P value < 0.00001) and overall survival (HR = 0.91; 95% CI 0.85 to 0.97; P value = 0.003). We detected no significant between-study heterogeneity (disease-free survival: I² statistic = 16%, Q-test P value = 0.27; overall survival: I² statistic = 6%; Q-test P value = 0.38).
Considering that the 5-year overall survival rate for TNM stage II–III cutaneous melanoma is 60%, the number needed to treat (NNT) is 35 participants (95% CI = 21 to 108 participants) in order to prevent 1 death. The results of subgroup analysis failed to answer the question of whether some treatment features (i.e. dosage, duration) might have an impact on interferon efficacy or whether some participant subgroups (i.e. with or without lymph node positivity) might benefit differently from interferon adjuvant treatment.
Grade 3 and 4 toxicity was observed in a minority of participants: In some trials, no-one had fever or fatigue of Grade 3 severity, but in other trials, up to 8% had fever and up to 23% had fatigue of Grade 3 severity. Less than 1% of participants had fever and fatigue of Grade 4 severity. Although it impaired quality of life, toxicity disappeared after treatment discontinuation.

AUTHORS' CONCLUSIONS:

The results of this meta-analysis support the therapeutic efficacy of adjuvant interferon alpha for the treatment of people with high-risk (AJCC TNM stage II-III) cutaneous melanoma in terms of both disease-free survival and, though to a lower extent, overall survival. Interferon is also valid as a reference treatment in RCTs investigating new therapeutic agents for the adjuvant treatment of this participant population. Further investigation is required to select people who are most likely to benefit from this treatment.

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Estudio primario

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The causes of malignant melanoma: results from the West Australian Lions Melanoma Research Project.

Año 1986
Revista Recent results in cancer research. Fortschritte der Krebsforschung. Progrès dans les recherches sur le cancer
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