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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
Melanoma-associated emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Vidya Kharkar, M. R. L. Sujata
Clark levels relate the depth of invasion of melanoma cells to the different anatomic layers of the skin: level I is confined to the epidermis (in situ), level II invades the papillary dermis, level III fills the papillary dermis to the junction with the superficial reticular dermis, level IV invades the reticular dermis, and level V invades the fat. In the current staging system, the Clark level is used to distinguish between stage Ia and Ib lesions.
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
The characteristics of the 56 melanomas reviewed for this study were compared between the time periods 1990–2002 and 2003–2014 (Table 1). SLNB had been performed in 68% (n = 26) of the more recent cases, while SLNB had only been performed in one patient (5.6%) before 2003. SLNB was introduced in Finland in the early 2000s. Consequently, the tumours diagnosed in 2003–2014 were of slightly higher stage than tumours diagnosed earlier (p = 0.100). There were no differences in Clark level, Breslow thickness, ulceration, or mitotic rate between the two time periods (Table 1). Melanoma-related deaths appeared to be more frequent in the pre-2003 period. However, patients diagnosed 1990–2002 had a median follow-up time of 18.0 years (range 2.6 to 25.4) and those diagnosed 2003–2014 had a median follow-up time of 5.3 years (range 0.58 to 14.8). There was no significant difference in the relative risk of melanoma-related death before 2003 compared to the period after 2003 (HR 1.53, 95% CI 0.30 to 7.88, p = 0.611).
Impact of Non-Steroidal Anti-Inflammatory Drugs on Recurrence and Survival after Melanoma Surgery: A Cohort Study
Published in Cancer Investigation, 2020
Bruno Luís de Castro Araujo, Jadivan Leite de Oliveira, José Francisco Neto Rezende, Washington Silva Noguera, Andréia Cristina de Melo, Luiz Claudio Santos Thuler
Data on preoperative characteristics including sex, age, weight, formal education, skin colour, and American Society of Anesthesiologists (ASA) Physical Status Classification System were collected from medical records. Tumor information included the tumor location, histological subtype, tumor thickness (Breslow depth), Clark level, ulceration, mitosis rate, and regression were also collected. From the lymph node specimens, the presence and the number of affected nodes were documented. Tumor and lymph node information were used to perform the staging according to the 8th Edition of the American Joint Committee on Cancer (AJCC) staging manual (22). From anesthesia chart, anesthesia technique, metamizole, dexamethasone, and NSAIDs were extracted. Dates of locoregional recurrence, systemic recurrence, last follow-up, and death were also verified.
Malignant melanoma of the cecum and small intestine
Published in Baylor University Medical Center Proceedings, 2020
Christopher Tan, Teresa Yanchak, Jonathan Ramirez
The propensity of the primary melanoma to metastasize is dependent on Clark level. More than 70% of lesions involving the gastrointestinal tract are Clark level III–IV.7 Older studies have shown that metastasectomy can lead to survival benefits in stage IV metastatic melanoma.2,8,9 Even with the advent of novel immunotherapy treatment for malignant melanoma, it has been shown that metastasectomy in conjunction with immunotherapy is superior to either modality alone. In one study involving 393 patients with malignant melanoma and gastrointestinal metastases, median survival was 20.0 months with surgery plus immunotherapy (n = 160), 13.0 months with surgery alone (n = 111), 8.0 months with immunotherapy alone (n = 64), and only 5.0 months with neither treatment (n = 58) (P < 0.001).10 Therefore, resection of metastatic lesions in conjunction with immunotherapy should be explored as a treatment option for these patients. Our case was unique because multiple areas of the gastrointestinal tract were involved throughout our patient’s clinical course; his care required a wide spectrum of detection and treatment modalities, which ultimately resulted in an improved outcome.