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Neoplasia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The majority of patients present with a change in the size and color of a preexisting nevus. More advanced melanomas may present with ulceration and bleeding. Excisional biopsy of the entire suspicious pigmented lesion is the diagnostic procedure of choice. Microscopic measurement of the actual tumor thickness, as outlined by Breslow, most accurately reflects the prognostic index and is of utmost importance in the clinical management of patients (219). The Clark level, which describes the anatomic level of invasion, should also be assessed. Following histopathologic evaluation of the biopsy, the patient should be clinically staged with a thorough history and complete physical examination. The most common clinical staging system defines stage I as local disease without clinically palpable regional lymph nodes, stage II as having suspiciously palpable regional lymph nodes, and stage III as having distant metastases (220). Further tests, such as serum liver function studies, or radionucleotide or computed tomography scans of the liver, bone, or brain, should be performed only for specific signs or symptoms suggesting metastatic disease.
Final Trial Report of Sentinel-Node Biopsy versus Nodal Observation in Melanoma
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The criteria for enrollment included patients with localised cutaneous melanoma, Clark level 3, or Breslow thickness of 1.00 mm or more. Patients were aged between 18 and 75 years of age and had to have an anticipated survival of 10 years or more at recruitment.5
Malignant tumors
Published in Archana Singal, Shekhar Neema, Piyush Kumar, Nail Disorders, 2019
The histogenetic type of melanoma—ALM, SSM or NM—is difficult to define in the nail. It is, however, not really important as the molecular genetic investigations have not shown differences among them, but among melanomas of different localizations. Clark level and Breslow thickness are also very difficult to ascertain. This is not only due to the fact that most biopsies are only partial, but that the nail anatomy itself is different from skin. The papillary and reticular dermis are not clearly separated, and there is no cutaneous fat between the distal matrix-nail bed and the periosteum.167 Clark level I is therefore intraepidermal, II is very superficial, III is invasion into the mid- to deep dermis, IV almost reaches the periosteum, and V is invasion to or into the bone. Measuring the vertical tumor thickness according to Breslow is challenging as there is normally no granular layer in the matrix and nail bed and the epithelium may be acanthotic and grossly thickened giving large numbers that do not really reflect the prognosis. Therefore, a division into melanomas thinner or thicker than 2.5 mm has been proposed; this gave statistically significant differences in survival after 5 years: 88% vs. 40%.166 Old age, ulceration, higher mitotic index, amelanotic tumor, and higher stage of disease are further negative prognostic factors.143
Increased incidence of melanoma in children and adolescents in Finland in 1990–2014: nationwide re-evaluation of histopathological characteristics
Published in Annals of Medicine, 2022
Emma K. Rousi, Roope A. Kallionpää, Roosa E. Kallionpää, Susanna M. Juteau, Lauri A. I. Talve, Micaela M. Hernberg, Pia P. Vihinen, Veli-Matti Kähäri, Ilkka O. Koskivuo
Spitzoid melanomas had been diagnosed at an average age of 14.5 years, while the mean age at the diagnosis of the other melanoma types was 17.4 years (p = 0.006; Table 2). Forty-nine percent of the Spitzoid melanomas were located in lower extremities, while this was the case in only 26% of the other melanomas (p = 0.153). Spitzoid melanomas were of higher stage and had higher Clark level compared to other melanomas, whereas there was no significant difference between the groups in Breslow thickness, ulceration, mitotic rate, or TILs (Table 2). The melanoma-specific Kaplan–Meier estimate of five-year survival after the diagnosis of Spitzoid melanoma was 94.5% (95% CI 87.4% to 100%), and the relative risk of death after melanoma diagnosis was not significantly different among those with Spitzoid melanoma compared to those with other melanoma types (HR 0.52, 95% CI 0.10 to 2.58). BRAF V600E -positivity was less frequent in Spitzoid melanomas compared to the other melanoma types (35.1% vs. 68.4%), while all five tumours positive for ALK were Spitzoid melanomas. SLNB was performed in 27/56 patients, out of which the result was positive in 11/20 (55%) patients with Spitzoid melanomas and 1/7 (14%) patients with other melanomas, but the difference was not statistically significant (p = 0.091).
Survival prediction in patients with cutaneous melanoma by tumour lymphangiogenesis
Published in Acta Clinica Belgica, 2020
Zorica Špirić, Milka Vještica, Mirela Erić
Cutaneous melanoma is a very aggressive and often lethal neoplasm with a constant increase of incidence, especially in younger patients. Clinical and histological characteristics affecting the course of a disease have been studied for several decades. Prediction of survival based on the melanoma thickness and ulceration varies in different studies. Lower survival is found in patients with thick melanoma, the presence of ulceration, a high mitotic rate and deeper Clark level of invasion. However, there are patients with thin melanoma who also develop recurrent disease, resulting in a death outcome [1,2].
Prognostic value of tumor-infiltrating lymphocytes in melanoma: a systematic review and meta-analysis
Published in OncoImmunology, 2019
Qiaofen Fu, Nan Chen, Chunlei Ge, Ruilei Li, Zhen Li, Baozhen Zeng, Chunyan Li, Ying Wang, Yuanbo Xue, Xin Song, Heng Li, Gaofeng Li
Despite the advances in global healthcare, malignant tumors remain a major threat to human health. Malignant melanoma is the most aggressive form of skin cancer with unpredictable behavior. Although multiple approaches have been used to treat melanoma, the mortality of melanoma patients has barely improved over the last decades.1–3 Thus, in addition to Breslow thickness, Clark level, Sentinel lymph node biopsy and serum LDH level, early prediction of the patient prognosis using biomarkers is also a powerful weapon against melanoma.