Melanoma &amp; Nuclear Medicine: New Insights &amp; Advances

Perissinotti, Andrés; Rietbergen, Daphne D. D.; Vidal-Sicart, Sergi; Riera, A. Allende; Olmos, Renato A. Valdés

doi:10.2217/mmt-2017-0022

Cited by 25 publications

(19 citation statements)

References 154 publications

(151 reference statements)

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“…Potential negative impacts by proceeding directly to definitive WLE include failure to perform SLNB and failure to undertake a sufficient excision margin at WLE, when these would have been indicated with full knowledge of tumour depth. Whilst, the latter can be retrieved in many cases from further excision, the SLNB can no longer be performed with the same level of accuracy …”

Section: Discussionmentioning

confidence: 99%

Accuracy of partial biopsies in the management of cutaneous melanoma

et al. 2019

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Background: The recommended method for histopathological diagnosis of cutaneous melanoma is excisional biopsy, although partial biopsies (shave and punch) are often used. Following a partial biopsy, treatment guidelines recommend a narrow excisional biopsy to plan definitive management. There is limited evidence on the benefits of direct wide local excision (WLE) following diagnostic partial biopsies.Methods: Retrospective cohort study of cutaneous melanoma cases, from two tertiary referral centres from January 2013 to December 2015. Demographic and histopathological data, including tumour thickness (T-stage) from initial biopsy and subsequent excisions, were collected. Logistic regression was used to examine histopathological T-staging between biopsy and subsequent excisions (upstaging).Results: 2304 melanomas (2157 patients) were identified; 455 shave, 308 punch, 14 incisional and 1527 excisional biopsies. Out of 1527, 5 (<1%) excisional biopsies were upstaged from original biopsy T-stage to final WLE; compared to 28/455 (6%) for shave, 45/308 (15%) for punch and 2/14 (14%) for incisional biopsies. Histopathology upstaging were increased with punch (OR, 52.1; 95% CI, 20.5-132.4. P < 0.001) and shave biopsy (OR, 20.0; 95% CI, 7.7-52.0. P < 0.001) compared to excisional biopsy. Upstaging rates of 9.4% for desmoplastic (OR, 6.9; 95% CI, 2.4-19.7. P < 0.001) and 21.9% for acral lentiginous (OR, 18.4; 95% CI, 6.9-49.2. P < 0.001) melanomas were elevated compared to 1.4% for superficial spreading melanoma. Conclusions:In most cases, partial biopsy (particularly shave biopsy) can provide sufficient information to plan for definitive surgical melanoma management. Punch and incisional biopsies have elevated upstaging rates, a consideration in planning therapy. Partial biopsies of desmoplastic or acral lentiginous melanomas have high rates of upstaging and should have a complete excision prior to definitive treatment.

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Section: Discussionmentioning

confidence: 99%

Accuracy of partial biopsies in the management of cutaneous melanoma

et al. 2019

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“…While it is possible to perform SLNB in a delayed fashion, accuracy and therapeutic value may be reduced following wide excision and/or local tissue rearrangement of the primary site. 33 , 34 Inaccurate or delayed SLNB would be expected to lead to a higher risk of subsequent nodal recurrence, with potential loss of regional disease control, which represents one of the traditional reservations of surgical oncologists towards shave biopsy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis

et al. 2021

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Background Melanoma is the most lethal skin cancer. Excision biopsy is generally recommended for clinically suspicious pigmented lesions; however, a proportion of cutaneous melanomas are diagnosed by shave biopsy. A systematic review was undertaken to investigate the impact of shave biopsy on tumor staging, treatment recommendations, and prognosis. Methodology The MEDLINE, Embase, and Cochrane Library databases were searched for relevant articles. Data on deep margin status on shave biopsy, tumor upstaging, and additional treatments on wide local excision (WLE), disease recurrence, and survival effect were analyzed across studies. Results Fourteen articles from 2010 to 2020 were included. In total, 3713 patients had melanoma diagnosed on shave biopsy. Meta-analysis revealed a positive deep margin in 42.9% of shave biopsies. Following WLE, change in tumor stage was reported in 7.7% of patients. Additional treatment was recommended for 2.3% of patients in the form of either further WLE and/or sentinel lymph node biopsy. There was high heterogeneity across studies in all outcomes. Four studies reported survival, while no studies found any significant difference in disease-free or overall survival between shave biopsy and other biopsy modalities. Conclusions Just over 40% of melanomas diagnosed on shave biopsy report a positive deep margin; however, this translated into a change in tumor stage or treatment recommendations in relatively few patients (7.7% and 2.3%, respectively), with no impact on local recurrence or survival among the studies analyzed.

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“…Since the early 1990s, nuclear medicine (NM) has represented a valuable imaging approach for MM management due to the implementation of lymphoscintigraphy (LS) for the lymphatic mapping and sentinel node biopsy (SNB) [11]. Over the years, the contribution of NM has gained more and more consideration due to several technological improvements such as the use of portable imaging devices aiding the intraoperative detection of SN in difficult anatomical sites [12][13][14] or the utilization of hybrid imaging through single photon computed tomography (SPECT/CT) for an accurate localization of the scintigraphic data [15][16][17].…”

Section: Pet/ct With 18 F-fdg For Prognostication and Staging Of Mali...mentioning

confidence: 99%

The Role and Potential of 18F-FDG PET/CT in Malignant Melanoma: Prognostication, Monitoring Response to Targeted and Immunotherapy, and Radiomics

et al. 2022

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Novel therapeutic approaches, consisting of immune check-point inhibitors (ICIs) and molecularly targeted therapy, have thoroughly changed the clinical management of malignant melanoma (MM), the most frequent and deadly skin cancer. Since only 30–40% of MM patients respond to ICIs, imaging biomarkers suitable for the pre-therapeutic stratification and response assessment are warmly welcome. In this scenario, positron emission computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has been successfully utilized for advanced MM staging and therapy response evaluation. Furthermore, several PET-derived parameters (SUVmax, MTV, TLG) were particularly impactful for the prognostic evaluation of patients submitted to targeted and immunotherapy. In this review, we performed a web-based and desktop research on the clinical applications of 18F-FDG PET/CT in MM, with a particular emphasis on the various metabolic criteria developed for interpreting PET/CT scan in patients undergoing immunotherapy or targeted therapy or a combination of both. Furthermore, the emerging role of radiomics, a quantitative approach to medical imaging applying analysis methodology derived by the field of artificial intelligence, was examined in the peculiar context, putting a particular emphasis on the potential of this discipline to support clinicians in the delicate process of building patient-tailored pathways of care.

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Melanoma & Nuclear Medicine: New Insights & Advances

Cited by 25 publications

References 154 publications

Accuracy of partial biopsies in the management of cutaneous melanoma

Accuracy of partial biopsies in the management of cutaneous melanoma

Impact of Shave Biopsy on Diagnosis and Management of Cutaneous Melanoma: A Systematic Review and Meta-Analysis

The Role and Potential of 18F-FDG PET/CT in Malignant Melanoma: Prognostication, Monitoring Response to Targeted and Immunotherapy, and Radiomics

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