Our results demonstrate that MT may represent a suitable prognostic factor that can characterize the metastasising ability of CMM and the tumour-promoting host immune response.
BackgroundCurrently, no consensus on the use of blood tests for monitoring disease recurrence in patients with resected melanoma exists. The only meta-analysis conducted in 2008 found that elevated serum S100B levels were associated with significantly worse survival in melanoma patients. Serum LDH is an established prognostic factor in patients with advanced melanoma.ObjectiveTo compare the discriminative and prognostic ability of serum S100B with that of serum LDH in patients with melanoma.MethodsThis systematic review and meta-analysis were reported in accordance with the PRISMA Statement. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42019137138).ResultsA quantitative analysis of data from 6 eligible studies included 1,033 patients with cutaneous melanoma. The discriminative ability of serum S100B at identifying disease relapse [pooled Area Under the ROC (AUROC) 78.64 (95% CI 70.28; 87.01)] was significantly greater than the discriminative ability of serum LDH [AUROC 64.41 (95% CI 56.05; 7278)] (p=0.013). Ten eligible studies with 1,987 patients were included in the risk of death analysis. The prognostic performance of serum S100B [pooled estimate of adjusted hazard ratio (HR) 1.78 (95% CI 1.38; 2.29)] was independent but not superior to that of serum LDH [HR 1.60 (95% CI 1.36; 2.29)].LimitationsA relatively small number of articles were eligible and there was considerable heterogeneity across the included studies.ConclusionsSerum biomarkers may provide relevant information on melanoma patient status and should be further researched. Serum S100B is a valid marker for diagnosis of melanoma recurrence.Systematic Review RegistrationThe study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42019137138).
There is a great need for efficient and cost-effective melanoma screening, but this is not yet solved. Epidemiological studies on trends in melanoma incidence by tumour thickness, anatomical site and demographical data can help to improve public health efforts regarding earlier melanoma diagnosis. We aimed to study the trends in the incidence and characteristics of patients and their melanoma in North-East Hungary from 2000 to 2014. Data were obtained from a university hospital-based registry. A total of 1509 cutaneous invasive melanomas of 1464 patients were included in the study. A moderate but significant increase in incidence was observed in the region [average annual percentage change: 3.04 (0.07; 6.11); P = 0.045], with a breakpoint in 2007. From 2001 to 2007, the trend was increasing [APC: 9.84 (3.52; 16.55); P=0.006], but it stalled from 2007 [APC: −2.45 (−5.99; 1.23); P = 0.164]. However, in the age groups over the age of 60 years, where the standardised incidence was the highest, the incidence continued to rise. Furthermore, older age, male sex and trunk or lower extremity localization were found to be associated with thicker melanomas. Our results support that regular screening examination for melanoma would be desirable for people over the age of 60 years.
Anti-PD1 therapy (pembrolizumab and nivolumab) is one of the treatment options for metastatic melanoma. According to literature there are predictors such as the neutrophillymphocyte ratio, the level of which at the time of initiation of the therapy indicates well the probability of biological therapy effectiveness. In our study stage IV melanoma patients treated with biological therapy were followed from the beginning of therapy to the week 12 at the Department of Dermatology of the University of Debrecen. We analysed the correlations between laboratory values at the time of the beginning of biological therapy or later on, the likelihood that the outcome of the disease will be determined by a laboratory parameter or by an early change in laboratory parameters, and the influencing factors of the progressive disease outcome. Totally 70 patients with stage IV melanoma who were treated with biological therapy were followed from the beginning of therapy to the twelfth week. Based on the radiological imaging methods on the twelfth week the outcome of disease was divided into three categories: progressive disease, stable disease and partial or complete response. The investigated biomarkers were S100B, LDH and neutrophil-lymphocyte ratio. Repeated measures variance analysis were performed, which was supplemented with a Newman-Keuls post hoc test, furthermore, correlation, ROC analysis and multivariate logistic regression were used. The results showed that none of the biomarkers can be used to determine the outcome of the therapy at the beginning. According to our results, based on the baseline laboratory parameters, we can not predict the outcome of the treatment, so we can not rely solely on laboratory values in deciding whether or not biological therapy should be started.
The authors report a case of bullous pemphigoid (BP) that occurred during pembrolizumab therapy in a 67-year-old male patient with advanced melanoma. Following regression of BP blisters, they reintroduced anti-PD-1 treatment. Due to the flare-up of BP, immunotherapy was discontinued again and corticosteroid was restarted. As the BP lesions regressed, interestingly, new skin metastases developed, exactly where the blisters were. One year after discontinuation of anti-PD-1 treatment, considering the significant tumor progression, pembrolizumab was restarted. This induced tumor remission, while the added low-dose corticosteroid was able to prevent the recurrence of BP. The patient carries the BP-predisposing HLA-DQB1*03:01 allele. In conclusion, anti-PD-1 rechallenge may be considered in metastatic melanoma, even if restarting anti-PD-1 has previously caused the flare-up of BP symptoms.
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