Age-related variations observed in treatment of melanoma

Main Category: Melanoma / Skin Cancer
Article Date: 15 Aug 2013 - 2:00 PDT Current ratings for:
Age-related variations observed in treatment of melanoma

Age-related variations in the treatment of melanoma were observed in a study of melanoma and its management in the elderly compared to younger patients, according to a study by Dragos Ciocan, M.D., of the Unité d'Aide Méthodologique, Hopital Robert Debré, Reims, France, and colleagues.

Elderly people have the highest incidence of melanoma and life expectancy is increasing in most developed countries, according to the study background.

The study included 1,621 patients with stage I or stage II melanoma in 2004 and 2008. Questionnaires to physicians, a survey of cancer registries and pathology laboratories were used to obtain data for the study that was conducted in five regions in northeastern France.

Older patients had more frequent melanomas involving the head and neck (29.4 percent vs. 8.7 percent); thicker and more frequently ulcerated tumors; and diagnosis of the melanoma occurred more frequently in a general practice setting and less frequently in direct consultation with a dermatologist or regular screening for skin cancer. Time to definitive excision also was longer in older patients, and 16.8 percent of them, compared with 5 percent of the younger population, had insufficient margins. Adjuvant (auxiliary) therapy also was started less frequently in older patients and was prematurely stopped in a higher proportion of that population, according to the study results.

"Age-related variations are observed at every step of melanoma management. The most important concerns are access of elderly people to settings for early diagnosis and excision with appropriate margins," the authors conclude.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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JAMA Dermatol. Published August 14, 2013. doi:10.1001/jamadermatol.2013.706.

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Nonsentinel lymph node positivity appears to be significant prognostic factor in patients with melanoma

Main Category: Melanoma / Skin Cancer
Also Included In: Lymphology/Lymphedema
Article Date: 31 Jul 2013 - 13:00 PDT Current ratings for:
Nonsentinel lymph node positivity appears to be significant prognostic factor in patients with melanoma

Nonsentinel lymph node (NSLN) positivity appears to be a significant prognostic factor in patients with stage III melanoma, according to a study by Anna M. Leung M.D., of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California, and colleagues.

Regional lymph node metastasis in patients with primary cutaneous melanoma is the most important prognostic factor for tumor recurrence and survival. Sentinel lymph node (SLN) biopsy (a surgery that removes lymph node tissue to look for cancer) has become the one of the most important clinical tools in the staging of melanoma, according to the study background.

Among a total of 4,223 patients who underwent SLN biopsy from 1986 to 2012, a total of 329 had a tumor-positive SLN. Of these 329 patients, 250 (76 percent) had no additional positive nodes and 79 patients (24 percent) had a tumor-positive NSLN.

According to the study results, factors predictive of NSLN positivity included older age, greater Breslow thickness (the total vertical height of the melanoma, from the top of the area of deepest penetration into the skin), and ulceration. Median overall survival was 178 months for the SLN-only positive group and 42.2 months for the NSLN positive group (5-year overall survival, 72.3 percent and 46.4 percent, respectively). Median melanoma-specific survival (MSS) was not reached for the SLN-only positive group and was 60 months for the NSLN positive group (five-year MSS, 77.8 percent and 49.5 percent, respectively). NSLN positivity had a strong association with recurrence, shorter overall survival, and shorter MSS.

"We propose that, for the next iteration of the staging system, the committee performs an analysis of the independent prognostic impact of NSLN status," the authors write. "Should that analysis confirm the findings of our series and others, this sample, readily available data point should be included in the next staging system."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our melanoma / skin cancer section for the latest news on this subject.

JAMA Surgery. Published online July 31, 2013. doi:10.1001/jamasurg.2013.3044.

The study was funded in part by fellowship funding from the Harold McAlister Charitable Foundation and a grant from the National Cancer Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

JAMA Surgery

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'Nonsentinel lymph node positivity appears to be significant prognostic factor in patients with melanoma'

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Report describes malignant melanoma that developed on a pigmented skin lesion within a tattoo underlying laser removal

Main Category: Melanoma / Skin Cancer
Also Included In: Dermatology
Article Date: 31 Jul 2013 - 13:00 PDT Current ratings for:
Report describes malignant melanoma that developed on a pigmented skin lesion within a tattoo underlying laser removal

A case report from Germany describes a young man who developed malignant melanoma on a pre-existing nevus (skin lesion known as a mole or birthmark) within a tattoo during and between the phases of laser tattoo removal, according to a report by Laura Pohl, M.D., of Laserklinik Karlsruhe, Germany, and colleagues.

"Pigmented lesions in decorative tattoos cause diagnostic difficulties at a clinical and dermoscopic level. In cases of laser removal of tattoos, hidden suspicious nevi may be revealed gradually," the researchers stated.

In the case study, the researchers describe a malignant melanoma that developed on a preexisting nevus within a tattoo during and between the phases of laser removal. According to the authors, 16 other cases have been reported in the English literature of malignant melanoma developing in tattoos. Dermoscopic assessments on a regular basis during the period of tattoo removal are recommended.

"If any question about malignancy arises, we suggest an excision before treatment. In general, tattoos should never be placed on pigmented lesions; if they are, the tattoos should never be treated by laser," the authors conclude.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our melanoma / skin cancer section for the latest news on this subject.

JAMA Dermatol. Published July 31, 2013. doi:10.1001/jamadermatol.2013.4901.

Please see article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

JAMA Dermatology

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Dermatology, JAMA. "Report describes malignant melanoma that developed on a pigmented skin lesion within a tattoo underlying laser removal." Medical News Today. MediLexicon, Intl., 31 Jul. 2013. Web.
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'Report describes malignant melanoma that developed on a pigmented skin lesion within a tattoo underlying laser removal'

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