Favourable prognostic role of regression of primary melanoma in AJCC stage I-II patients

Ribero, Simone; Osella‐Abate, Simona; Sanlorenzo, Martina; Savoia, Paola; Astrua, Chiara; Cavaliere, Giovanni; Tomasini, Carlo Francesco; Senetta, Rebecca; Macripò, Giuseppe; Bernengo, Maria Grazia; Quaglino, Pietro

doi:10.1111/bjd.12586

Cited by 57 publications

(67 citation statements)

References 25 publications

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“…7,72,[74][75][76]78,[100][101][102][103] On the other hand, additional studies have suggested that regression indicates a favorable outcome (Table 3). 3,[104][105][106][107][108] Thus, the prognostic significance of regression in primary melanoma has been controversial for many years. In the next section, we discuss some of the most relevant published studies with respect to melanoma recurrence, lymph node metastasis, and survival.…”

Section: Prognostic Significance Of Regression In Melanomamentioning

confidence: 99%

“…4 Only a few studies have reported an association between the presence of regression and better survival rates. 104,108 Notably, most of these studies compared the presence or absence of late-stage regression, while some of the remaining studies compared the extent of regression as focal, partial, or complete or the stage of regression as early vs late or active vs past, with or without an intermediate stage. Only rare studies have examined regression further by measuring the depth of regression-associated fibrosis; Sondergaard and Hou-Jensen 75 expanded their analysis of regression by assessing the horizontal width and depth of fibrosis.…”

Section: Association Between Regression and Survivalmentioning

confidence: 99%

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Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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Though not required currently for staging, regression is a histopathologic parameter typically reported upon diagnosis of an invasive primary cutaneous melanoma. The studies examining the prognostic significance of regression in patient outcome have yielded controversial findings; likely because the definition and assessment of regression have not been consistent, in addition to subjectivity of pathologists' interpretation. Regression is histologically characterized by variable decrease in the number of melanoma cells accompanied by the presence of a host response consisting of dermal fibrosis, inflammatory infiltrate, melanophages, ectatic blood vessels, epidermal attenuation, and/or apoptosis of keratinocytes or melanocytes; the relative extent of these features depends on the stage of the regression. However, the magnitudes to which these individual changes must be present to meet the threshold of histologic regression have not been well defined or agreed upon, and thus, the definition and classification of histologic regression in melanoma varies considerably among institutions and even among individual pathologists. In order to determine the clinical significance of histologic analysis of regression, there is a compelling need for a universal scheme to objectively define and assess histologic regression in primary cutaneous melanoma, so that the biologic and prognostic significance of this process may be completely understood.

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Section: Prognostic Significance Of Regression In Melanomamentioning

confidence: 99%

Section: Association Between Regression and Survivalmentioning

confidence: 99%

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Aung

Nagarajan

Prieto

2017

Laboratory Investigation

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“…Regression was described as playing a protective role for prognosis in a large group of early stage melanoma [35] . Histological regression can occur frequently in trunk melanoma compared to melanomas arising on other body areas [36] .…”

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confidence: 99%

Multiple Lymph Node Basin Drainage in Trunk Melanoma Is Not Associated with Survival of Sentinel Lymph Node-Positive Patients

Ribero

Abate

Pasquali³

et al. 2017

Dermatology

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Objectives: This study was aimed at investigating the prognostic role of multiple lymph node basin drainage (MLBD) in patients with positive sentinel lymph node (SLN) biopsy. Background: MLBD is frequently observed in patients with trunk melanoma undergoing SLN. The prognostic value of MLBD in SLN-positive patients is still debated. Methods: Retrospective data from 312 trunk melanoma patients with positive SLN biopsy (1991-2012) at 6 Italian referral centres were gathered in a multicentre database. MLBD was defined at preoperative lymphoscintigraphy. Clinical and pathological data were analysed for their association with disease-free interval (DFI) and disease-specific (DSS) survival. Results: MLBD was identified in 34.6% of patients (108/312) and was significantly associated with >1 positive SLN (37 vs. 15.2%; p < 0.001) and with >1 positive lymph node (LN) after complete lymph node dissection (CLND) (50.9 vs. 34.8%; p = 0.033). No differences were observed according to drainage pattern in patients who had negative and positive non-SLN at CLND. MLBD was not associated with either DFI or DSS. Multivariate analyses showed that tumour thickness, ulceration, and number of metastatic LNs were associated with worse DFI and DSS, while regression confirmed its protective role in survival. Conclusion: In positive SLN patients, MLBD has no association with survival, which is mainly related to American Joint Committee on Cancer (AJCC) prognostic factors. Since the overall number of positive LNs drives the prognosis, the importance of a CLND in all the positive basins is confirmed.

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“…It was also suggested that the same therapeutic approach should be followed for both of these entities [12] . Furthermore, histological regression has been described as a potential favorable feature of melanoma as it probably reflects an activation of the immune system [13] . On the other hand, discordant data are reported regarding the survival of patients with complete regressed primary cutaneous melanoma [14] .…”

Section: Discussionmentioning

confidence: 99%

Unknown Primary Melanoma: Worldwide Survey on Clinical Management

et al. 2016

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Background: How to deal with melanoma of unknown primary (MUP) origin is a debated topic in the literature. Objective: We performed a worldwide survey to inquire what clinical and investigational workup is performed as well as the physicians' perception of this disease. Methods: A questionnaire was sent via mail to clinicians involved in melanoma care from December 2015 to April 2016 using the International Dermoscopy Society website. Results: 119 physicians from 47 different countries answered the questionnaire. The most reported examination was skin examination followed by CT and/or PET scans. All the participants declared asking about previous excisions of skin lesions with 81% of them asking for a histopathological slide review of previous biopsies. Half of the participants checked for a possible vitiligo phenomenon that may explain regression of the primary lesion. BRAF, cKIT, and GNAQ mutations were screened by 32% of participants. The majority of participants (76%) applied the same treatment protocols for MUP as patients with known primary melanomas of the same AJCC stage. Conclusion: Strong heterogeneity was found between physicians dealing with MUP. Thus, a consensus document should be strongly encouraged.

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Favourable prognostic role of regression of primary melanoma in AJCC stage I-II patients

Abstract: We confirmed that regression alone should not be a reason to perform SLNB in thin melanoma and, on the contrary, it can be considered a favourable prognostic factor in patients with AJCC stage I-II melanoma.

Cited by 57 publications

References 25 publications

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Regression in primary cutaneous melanoma: etiopathogenesis and clinical significance

Multiple Lymph Node Basin Drainage in Trunk Melanoma Is Not Associated with Survival of Sentinel Lymph Node-Positive Patients

Unknown Primary Melanoma: Worldwide Survey on Clinical Management

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