The changing face of malignant melanoma

Reintgen, Christian; Shivers, Steven C.; Reintgen, Michael; Giuliano, Rosemary; Reintgen, Douglas S.

doi:10.1002/jso.21515

Cited by 10 publications

(7 citation statements)

References 10 publications

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“…This finding, too, is in line with recent international population studies. [5][6][7] The decrease in melanoma thickness is related to a sharp increase in the diagnoses of thin melanomas (which increased by 244 and 132% from 1985-1989 to 1995-1999 and from 1995-1999 to 2005-2009, respectively) compared with melanomas >2 mm in thickness (increases of 82 and 36%, respectively, in the same two periods) (Fig. 3).…”

Section: Discussionmentioning

confidence: 96%

“…Female prevalence is frequently observed in European studies whereas the gender ratio is often more equal in US studies. 5,7,9 We can speculate that this result may be due to different types of population, race and sun-exposure behaviour. When we analysed the data for associations between gender and mean lesion thickness we found that for lesions Յ2 mm thick, women were more prevalent than men; hence the diagnosis of thin lesions increased in time in the same manner for both sexes.…”

Section: Discussionmentioning

confidence: 97%

“…5 However, this finding is not matched by a proportional reduction in thick melanomas (>2 mm thick), as would be expected. [6][7][8] Certain studies have reported an increase in the absolute number of new thick lesions diagnosed. 9,10 There are even countries, like New Zealand, where despite public health campaigns and widespread pigmented lesion clinics, the thickness of melanomas at diagnosis increased from 0.60 mm in 1995 to 0.80 mm in 2004.…”

Section: Introductionmentioning

confidence: 99%

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A single centre melanoma thickness trend (1985–2009) in relation to skin areas accessible and non‐accessible to self‐inspection

Rubegni¹,

Rossi²,

Nami³

et al. 2011

Aust J Dermatology

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A single centre melanoma thickness trend (1985–2009) in relation to skin areas accessible and non‐accessible to self‐inspection

Rubegni¹,

Rossi²,

Nami³

et al. 2011

Aust J Dermatology

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“…34 Thin melanomas are generally associated with a good prognosis; however, survival is variable as 20% are associated with metastasis and 5% prove to be fatal. 35 Notably, recent studies have shown that nearly all the thin melanomas that develop metastases are ≥ 0.75 mm in thickness.…”

Section: Lymphatic Invasion and Metastasismentioning

confidence: 99%

Lymphatic invasion and angiotropism in primary cutaneous melanoma

Moy

Duncan

Kraft

2017

Laboratory Investigation

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Access of melanoma cells to the cutaneous vasculature either via lymphatic invasion or angiotropism is a proposed mechanism for metastasis. Lymphatic invasion is believed to be a mechanism by which melanoma cells can disseminate to regional lymph nodes and to distant sites and may be predictive of adverse outcomes. Although it can be detected on hematoxylin-and eosin-stained sections, sensitivity is markedly improved by immunohistochemistry for lymphatic endothelial cells. Multiple studies have reported a significant association between the presence of lymphatic invasion and sentinel lymph node metastasis and survival. More recently, extravascular migratory metastasis has been suggested as another means by which melanoma cells can spread. Angiotropism, the histopathologic correlate of extravascular migratory metastasis, has also been associated with melanoma metastasis and disease recurrence. Although lymphatic invasion and angiotropism are not currently part of routine melanoma reporting, the detection of these attributes using ancillary immunohistochemical stains may be useful in therapeutic planning for patients with melanoma.

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“…4 In the United States, Europe, and Australia, the majority of patients with newly diagnosed cutaneous melanomas have thin tumors. [5][6][7][8] Therefore, even though fewer than 10 % of patients with thin melanomas will eventually progress, this population constitutes a large number of individuals. It is clearly important to identify these higher-risk patients early in the course of their disease if possible, so that management plans appropriate for the biologic aggression of their tumors can be initiated.…”

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confidence: 99%

Can We Better Identify Thin Cutaneous Melanomas That are Likely to Metastasize and Cause Death?

2012

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Most patients with thin primary cutaneous melanomas (Breslow thickness B 1 mm) have an excellent outcome, and only a minority experience tumor recurrence and death due to melanoma. [1][2][3] For example, in the American Joint Committee on Cancer database, which contains information on a large number of patients treated at many international centers, the 10-year melanoma-specific survival for patients presenting with T1 melanomas (i.e., B 1.0 mm in thickness) was 92 %. 4 In the United States, Europe, and Australia, the majority of patients with newly diagnosed cutaneous melanomas have thin tumors.5-8 Therefore, even though fewer than 10 % of patients with thin melanomas will eventually progress, this population constitutes a large number of individuals. It is clearly important to identify these higher-risk patients early in the course of their disease if possible, so that management plans appropriate for the biologic aggression of their tumors can be initiated.How do we accurately identify these high-risk patients with thin melanomas? Previous studies found that increasing Breslow thickness and mitotic rate (MR) were significantly associated with a greater risk of recurrence and death in patients with thin melanomas, but the prognostic importance of other factors such as age, sex, anatomic location, ulceration, and regression has been less consistently demonstrated. 5,6,9,10 Two recent large studies have addressed this question. One was a population-based study and the other a single-center case-control study, and in both, determinants of prognosis in patients with thin melanomas were evaluated.11,12 The results of the two studies shed new light on this clinically important matter.The population-based study analyzed 26,736 patients with thin primary melanomas from the State Cancer Registry in Queensland, Australia, and found a 96 % survival rate after 20 years of follow-up. Increasing tumor thickness and level of invasion, increasing patient age, acral lentiginous and nodular histologic subtypes, male sex, and tumor location in the head/neck region were independently associated with melanoma-specific death. 11The case-control study, which analyzed patients with thin melanomas treated at Melanoma Institute Australia (MIA, formerly the Sydney Melanoma Unit), was designed to detect differences in clinical and pathologic parameters between two groups of patients with widely disparate outcomes.12 From the MIA database, which contains details of more than 35,000 patients, 5,628 patients with single thin primary melanomas diagnosed between 1983 and 2003 were identified. Patients who developed distant metastasis (n = 178) were compared with 178 sex-matched control patients who experienced no recurrence. After a median follow-up of 111 months, 140 (79 %) of the patients with distant metastases had died of melanoma. Factors that were independently associated with poorer distant metastasis-free and melanoma-specific survival were increasing Breslow thickness (0.51-0.75 mm and [0.75-1.00 mm, compared with B0.50 mm), increasing

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The changing face of malignant melanoma

Abstract: Even though there is an epidemic of malignant melanoma occurring in the United States, it appears that patients are being diagnosed earlier with thinner lesions that are capable of being cured with simple surgical techniques.

Cited by 10 publications

References 10 publications

A single centre melanoma thickness trend (1985–2009) in relation to skin areas accessible and non‐accessible to self‐inspection

A single centre melanoma thickness trend (1985–2009) in relation to skin areas accessible and non‐accessible to self‐inspection

Lymphatic invasion and angiotropism in primary cutaneous melanoma

Can We Better Identify Thin Cutaneous Melanomas That are Likely to Metastasize and Cause Death?

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