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Synthetic Compounds vs. Phytochemicals for the Treatment of Human Cutaneous Malignant Melanoma
Published in Namrita Lall, Medicinal Plants for Cosmetics, Health and Diseases, 2022
Jacqueline Maphutha, Namrita Lall
Levels three to five characterize a more aggressive form of malignant melanoma, wherein the dissection of lymph nodes and adjuvants would be accompanied with chemotherapy, radiation therapy, targeted therapies and immunotherapies. Breslow’s depth is similar to the Clark scale, as they both describe how deeply the melanoma has penetrated the skin; however, the prognosis of melanoma in this system is based on the depth of the tumor in the skin, which is measured in millimeters (mm). The characteristics of each stage are as follows (Davis, Shalin, and Tackett, 2019).
Malignant Neoplasms
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Mark Biro, Vesna Petronic-Rosic
Melanoma staging is determined according to the American Joint Committee on Cancer (AJCC) staging system. The AJCC staging system uses the TNM scale, where T corresponds to tumor thickness, also known as Breslow’s depth, N corresponds to nodal involvement, and M corresponds to sites of metastatic disease (Tables 21.7 and 21.8). Breslow’s depth is the most important staging characteristic and is measured from the granular layer to the deepest part of the melanoma. Presence of tumor ulceration increases the grade of the tumor. Depending on the stage of melanoma at the time of diagnosis, patients may require sentinel lymph node biopsy. If further metastatic evaluation is warranted, computer-assisted tomography (CAT) scan with contrast of the chest, abdomen, and pelvis or total body positron emission tomography may be completed. If there are findings suggestive of brain involvement, a brain MRI is recommended.
Cutaneous Malignant Melanoma
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
Younger, female patients with extremity stage I and II melanoma have a more favorable prognosis. Patients with melanoma of increasing Breslow depth (thickness), along with ulceration, diminished lymphoid response, evidence of tumor regression, microscopic satellites, lymphovascular invasion, and non–spindle-cell type tumors, have a poorer prognosis.
Near-infrared photoimmunotherapy for the treatment of skin disorders
Published in Expert Opinion on Biological Therapy, 2022
Irene Russo, Laura Fagotto, Anna Colombo, Emma Sartor, Roberto Luisetto, Mauro Alaibac
The four major subtypes of invasive cutaneous melanoma are: superficial spreading melanoma (the most common), nodular melanoma, lentigo maligna melanoma, and acral lentiginous melanoma. Uncommon variants of melanoma include amelanotic, desmoplastic, and spitzoid melanoma [56–60]. Histologically, melanoma displays two growth phases: in the horizontal or radial growth phase, which is not identifiable in nodular melanomas, tumor cells are confined to the epidermis, while in the vertical growth-phase tumor cells infiltrate the dermis and can metastasize [57]. The thickness of the tumor (Breslow depth) measured on histological samples correlates with the prognosis and the likelihood of metastasis of an invasive melanoma in the vertical growth phase [61]. Risk for metastasis also increases with ulceration, microsatellites, high mitotic rate, lymphovascular invasion, and either absent or minimum tumor-infiltrating lymphocytes [57].
Non-radical primary diagnostic biopsies affect survival in cutaneous head and neck melanoma
Published in Acta Oto-Laryngologica, 2021
Lennart Greiff, Ingela Skogvall-Svensson, Ana Carneiro, Anna Hafström
Partial, non-radical primary biopsies (including non-clear margins in EBs intended to be ‘radical’) emerged as risk factors for insufficient control of disease and poor survival in our study. Furthermore, positive or narrow histopathological margins remained as an independent negative prognostic factor for MSS in the multivariate analyses. The accuracy of this finding was strengthened by the observation that only deeper Breslow and ulceration remained as other independent negative prognostic factors for MSS in the analysis. Both Breslow thickness and ulceration of the primary tumor are established strong prognostic factors for MSS. Thus, ‘non-radicality’ in the initial diagnostic procedure portended a worse outcome when controlling for Breslow depth and ulceration as well as for the other significant prognostic factors in the univariate analyses, i.e. age, diameter of primary lesion, and residual invasive melanoma in the WLE specimen. Similar to our findings, Austin et al. found that a radical biopsy was an independent factor influencing MSS. However, Breslow and ulceration did not remain as prognostic factors in their study [11]. Taken together, the above findings indicate that the associations between non-radical biopsies and poor outcome cannot be explained by the correlation with tumor thickness or ulceration. Considering this, an option may be to aim for macroscopic EB margins greater than the recommended 1–3 mm [1–3] or at least implementing the higher span, i.e. 3 mm, to improve the ability to reach microscopic radicality.
Invited Brief Commentary: Sentinel Lymph Node Status is a Main Prognostic Parameter Needful for the Correct Staging of Patients with Melanoma Thicker than 4 mm: Single Institutional Experience and Literature Meta-analysis
Published in Journal of Investigative Surgery, 2019
One of the values of the current study is the stress the authors put on the heterogeneity of T4 patients-this is a truly diverse group of melanoma patients, and SLN biopsy is an important tool to help the clinician better risk-stratify a given individual. As mentioned above, patients with T4 melanomas who are SLN− can have a fairly good prognosis. This conclusion was consistent across the present study,1 our study,5 and the meta-analysis.1 In the current era of personalized medicine, it is incumbent on the provider to deliver to the patient the clearest and most inclusive available picture of the risk presented by their melanoma, to aid the patient and provider in making shared decisions regarding not just treatment, but also follow-up. The National Comprehensive Cancer Network (NCCN) recommends follow-up for melanoma patients based on their individual risk.7 Beside SLN status, other available risk determination tools include the on-line American Joint Committee on Cancer (AJCC) Melanoma Risk-Prediction Tool (which uses a combination of histologic and demographic factors),8 cross-sectional imaging,9 and genetic expression profile testing.10,11 Taken together, all of these items give the patient and provider a much clearer picture of the potential outcome of a given melanoma, far beyond the mere fact that the tumor is greater than 4 mm in Breslow depth.