Revisión sistemática

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Temozolomide for the treatment of metastatic melanoma: a systematic review.

Año 2007
Autores Quirt I , Verma S , Petrella T , Bak K , Charette M
Revista The oncologist
Enlaces Pubmed , DOI

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BACKGROUND:

This systematic review examines the role of temozolomide in patients with metastatic melanoma. Outcomes of interest include response rate, progression-free survival, overall survival, quality of life, and adverse effects.

METHODS:

The MEDLINE, EMBASE, and Cochrane Library databases were searched from 1980 through to 2005 using variations on the search terms: melanoma, clinical trial, random, temozolomide, temodal, and temodar. The American Society of Clinical Oncology Annual Meeting proceedings were searched from 1996 to 2005. Relevant articles and abstracts were selected and reviewed by two reviewers, and the reference lists from these sources were searched for additional trials.

RESULTS:

Two randomized phase III trials and three randomized phase II trials were located. In addition, 21 phase I or II trials investigating single-agent temozolomide, temozolomide plus interferon-alpha, and temozolomide plus thalidomide were reviewed. A direct comparison of temozolomide and dacarbazine demonstrated equal efficacy for response rates and overall survival; however, no significant difference was reported. A second phase III study comparing single-agent temozolomide with temozolomide combined with interferon-alpha indicated a significantly higher response rate for the combination treatment arm, but no difference in overall survival was noted. Further phase III studies are required to confirm whether there is a benefit associated with the combination of temozolomide and interferon-alpha or thalidomide.

CONCLUSION:

Our review of the available literature suggests that temozolomide demonstrates comparable activity to the current standard treatment, dacarbazine, with the additional benefit of being a convenient oral treatment that penetrates the blood-brain barrier.

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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

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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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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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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

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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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Microphthalmia transcription factor in the immunohistochemical diagnosis of metastatic melanoma: comparison with four other melanoma markers.

Año 2001
Revista The American journal of surgical pathology
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The diagnosis of metastatic malignant melanoma (MMM) may be difficult in surgical pathology, often complicated by the unpredictable spread of this tumor and its great variability on histologic evaluation. Traditionally used immunohistochemical markers on melanomas are insufficient because of either a relative lack of specificity (S100 protein) or variably reported sensitivity (HMB45). Information about some newer markers, such as tyrosinase (TYR) and Melan A, is more limited. Recently, based on the study of a small number of tumors, it was suggested that microphthalmia transcription factor (MITF) is 100% sensitive in the identification of metastatic melanoma. In the current study, we compared the diagnostic usefulness of MITF with that of four other markers in 266 cases of conventional metastatic melanomas from different sites, 33 cases of desmoplastic melanomas, and 1 case of melanoma with rhabdoid features. The specificity of MITF was evaluated by using a representative sample of control tumors. Microphthalmia transcription factor with nuclear positivity was seen in 235 of 266 cases of conventional MMM (88%), usually in more than 30% of tumor cells. However, some melanomas had only foci of MITF- and TYR-positive cells, whereas the majority of cells were generally S100 protein-positive. Only 1 of 30 desmoplastic melanomas (3%) had MITF-positive cells, representing epithelioid foci resembling conventional melanoma. Two cases had TYR in a similar pattern; all were HMB45-negative. One metastatic melanoma with rhabdoid features was negative for MITF and other markers except the S100 protein. Half of the S100 protein negative conventional melanomas (6 of 12) were MITF-positive, whereas 4 of 20 (20%) TYR-negative tumors had reactivity for MITF. The percentages of positive cases of MMM (10% or more tumor cells positive) diagnosed with the four other markers in descending order were 90% (S100 protein and TYR), 78% (melan-A), and 66% (HMB45). Microphthalmia transcription factor appeared to be specific, because significant reactivity was not found in 112 carcinomas, 20 lymphomas, 20 angiosarcomas, 20 fibrous histiocytomas, and 20 malignant peripheral nerve sheath tumors. However, positive nuclei were found focally among reactive histiocytes, especially in osteoclasts, epithelioid histiocytes, and sporadic other histiocytes. Microphthalmia transcription factor may be a valuable addition to the marker panel used in diagnosing melanoma, in combination with S100, TYR, and the other markers, but it is not present in cases of desmoplastic melanomas.

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Estudio primario

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

Traducción oficial
Año 2008
Revista Iatreia
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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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[Metastatic melanoma of unknown primary site].

Año 2001
Revista Annales de dermatologie et de vénéréologie
Enlaces Pubmed

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INTRODUCTION:

Melanomas of unknown primary site are rare. To establish their diagnosis the metastatic nature of the lesion must be confirmed clinically and histologically, the melanoid nature by histology and immunohistochemistry. Any primary melanoma must be eliminated by careful examination of the skin and mucosa, and the absence of past surgical excision of skin lesions must be confirmed. We studied the epidemiological, clinic and prognostic characteristics of 19 melanomas of unknown primary site in a series of 646 melanomas.

MATERIAL AND METHODS:

This retrospective study was conducted on a series of 646 melanomas recruited over a period of 14 years. The epidemiological (age, gender, phototype and family history of melanoma), clinical and prognostic parameters (relapse and global survival rate) were analyzed in 19 patients. Clinical and epidemiological data were compared with the 646 melanomas of the series. The prognostic parameters were compared with the melanomas of the series at the same stage.

RESULTS:

The melanomas with unknown primary site represented 2.94 p. 100 of our series and concerned 10 men and 9 women with a median age of 60 years. Eight patients presented stage III melanomas, according to MD Anderson's classification and 11 stage IV. Relapse after surgery was observed in 63 p. 100 of patients and 9 deceased during the observation period. In stage III patients the probability of survival after 2 years was of 51 p. 100 and for stage IV 34 p. 100.

DISCUSSION:

In our series the frequency of melanomas of unknown primary site is comparable to that observed in other studies. Compared to melanomas of known primary site, there was a preponderance in men and in slightly older patients. There was a majority of single glandular localizations and no particular site was preponderant. Survival of Stage III patients was comparable to that of melanomas of know primary site. However, for stage IV patients it appeared better, as has been noted in other series. Treatment of metastatic melanomas of unknown primary site should therefore be the same as that of classical forms. Whenever possible, surgery remains the first indication. Search for the primary site must be orientated by clinical examination including complete examination of the skin and mucosa (ENT, ophthalmologic and genito-urinary), eventually associated with paraclinical investigations, depending on the symptoms.

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Estudio primario

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[Melanoma of the female urethra].

Año 1983
Revista Zentralblatt für Gynäkologie
Enlaces Pubmed

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Case report of a 69-year-old woman with a melanoma of the urethra. Radical surgery was renounced in regard of the age. We performed local excision with inguinal lymphonodectomy only followed by chemotherapy with dacarbazine. A tumor of this localisation is rare. Approximately 45 cases have been described in the literature at present. The prognosis of the diseases is very poor.

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