Objective:To investigate whether vitamin D receptor gene(VDR)Bsm I-rs1544410 and Fok I-rs2228570 polymorphisms,smoking duration,and body mass index(BMI)are risk factors for cutaneous melanoma,especially metastatic mel...Objective:To investigate whether vitamin D receptor gene(VDR)Bsm I-rs1544410 and Fok I-rs2228570 polymorphisms,smoking duration,and body mass index(BMI)are risk factors for cutaneous melanoma,especially metastatic melanoma.Methods:We studied 120 cutaneous melanoma cases[68 stage I and II non-metastatic melanoma(NMet M)patients,plus 52Stage III and IV metastatic melanoma(Met M)patients],and 120 matching healthy controls from northeast Italy.VDR polymorphisms were measured by restriction fragment length polymorphism analysis.Absence or presence of Bsm I and Fok I restriction sites was denoted by"B"and"F"or by"b"and"f,"respectively.Results:VDR-Bsm I bb genotype was more frequent among Met M(32.7%)than among NMet M cases(13.2%),with odds ratio(OR)=3.18.Comparison of all melanoma patients vs healthy controls showed that the following biomarkers were at risk:≥20 years of smoking(OR=2.43);≥20 years of smoking combined with bb(OR=4.78),Bb+bb(OR=2.30),Ff(OR=3.04),and Ff+ff(OR=3.08);obesity(BMI>30Conclusions:Risk factors for cutaneous Met M include two VDR polymorphisms combined with smoking duration and obesity.Results suggest gene-environment implications in melanoma susceptibility and severity.Future studies in larger cohorts and in subjects with different genetic background are warranted to extend our findings.展开更多
AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. METHODS: Patients with the following characteristics were included in ...AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. METHODS: Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status(Eastern Cooperative Oncology Group) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion(ILI)], and to stop the out flow(venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration(HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of drug.RESULTS: Thirty seven ILI were done in 29 cases(31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro Hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients(38%) received infusion of melphalan alone, 7(24%) melphalan associated to mitomicin C and 7(24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients(10%) were complete responders and 16(56%) were partial responders; whereas 7 patients(24%) had stable disease, and 3(10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade(I and II) toxicity.CONCLUSION: ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and is effective in delaying progression.展开更多
Metastatic melanoma has long been considered to have a very poor prognosis and to be chemo-resistant. However, a subgroup of patients with metastatic melanoma presents remarkable responses to chemotherapeutic agents, ...Metastatic melanoma has long been considered to have a very poor prognosis and to be chemo-resistant. However, a subgroup of patients with metastatic melanoma presents remarkable responses to chemotherapeutic agents, even in the absence of a response to modern targeted therapies and immunotherapies; accordingly, determining predictive biomarkers of the response to chemotherapies for metastatic melanoma remains a priority to guide treatment in these patients. We report a case study of a patient with B-Raf proto-oncogene serine/threonine kinase-mutated metastatic melanoma harbouring many genetic mutations. The patient did not respond to prior targeted therapies or immunotherapies but experienced a dramatic objective radiological and clinical response to subsequent dacarbazine-based chemotherapy. In the era of targeted therapies and immunotherapies for metastatic melanoma, cytotoxic chemotherapies may still represent an interesting therapeutic weapon in a well-deined subgroup of patients presenting with speciic genetic and molecular features.展开更多
Background: Sentinel node (SLN) status is the most important prognostic factor for early-stage melanoma patients. It will influence follow-up and may change therapy. Positive SLNs present different degrees of involvem...Background: Sentinel node (SLN) status is the most important prognostic factor for early-stage melanoma patients. It will influence follow-up and may change therapy. Positive SLNs present different degrees of involvement so that subgroups of patients may have minimal SLN invasion. The aim of this study was to evaluate survival in subgroups with minimally involved SLNs and to compare them to negative SLN patients. Method: SLN biopsy was performed in 499 consecutive clinically N0 patients between 1997 and 2008. Following updated recommendations from the Melanoma Group of the European Organization of Research and Treatment of Cancer, degrees of SLN involvement were fully reassessed for two anatomopathological parameters: tumour burden according to Rotterdam criteria (1.0 mm) and microanatomic location according to Dewar (subcapsular, combined subcapsular and parenchymal, parenchymal, multifocal, or extensive). Minimally involved SLNs were defined as those with tumor burden <0.1 mm and/or subcapsular metastasis location. Kaplan-Meier and multivariable logistic regression analyses were performed. Results: Out of 499 clinically N0 patients, positive SLNs were found in 123 patients (24.7 percent). With a median follow-up of 52 months (range: 9 - 146), five-year disease-free (DFS), disease-specific survival (DSS) and overall survival (OS) were 88.1, 93.9 and 89.9 percent for negative SLN patients, respectively. In minimally involved SLNs, there were 21 with tumour burden <0.1 mm, and 52 with subcapsular metastasis. Five-year DFS, DSS and OS in these sub-groups were 79.6, 86.6 and 86.6 percent, then 57.3, 69.8 and 67.8 percent respectively. DFS univariable analysis of these sub-groups compared to negative SLNs showed: (HR1.89, 95 percent CI 0.75 - 4.79;p 0.175) and (HR 3.92, 95 percent CI 2.29 - 6.71;p < 0.0001) respectively. Minimally involved sub-groups were not predictive for NSLN negativity. Conclusion: Rotterdam’s tumour burden stratification is an easy and useful prognostic factor of melanoma survival. There was a展开更多
The small intestine is sometimes metastasized by malignant melanoma. While small intestinal involvement is asymptomatic or usually nonspecific, intussusception causing intestinal obstruction is very rare. Herein we re...The small intestine is sometimes metastasized by malignant melanoma. While small intestinal involvement is asymptomatic or usually nonspecific, intussusception causing intestinal obstruction is very rare. Herein we report the case of a 68-year-old man with small bowel intussusception due to metastatic malignant melanoma. Although he has been comprehensively treated with surgery, radiation, and immunotherapies, the disease rapidly progressed and consequently severe life-threatening intussusception developed on the small bowel. Because surgical resection of the obstructive melanoma lesions was successful, his quality of life was dramatically improved followed by the resumption of treatment with anti-PD-1. Several effective treatments for metastatic melanoma, including immune checkpoint inhibitors and targeted therapy, have been developed within the past decade. However, given the present case, surgical approaches to symptomatic metastatic melanoma lesions should still be considered as a treatment option for improving not only patients’ critical condition but also their survival.展开更多
Objective: To investigate the pattern of palliative surgeries and associated costs in patients with metastatic melanoma in the USA. Methods: This was a retrospective claims-based study of patients identified using adm...Objective: To investigate the pattern of palliative surgeries and associated costs in patients with metastatic melanoma in the USA. Methods: This was a retrospective claims-based study of patients identified using administrative claims from MarketScan®?databases among patients with metastatic melanoma diagnosed between 2005 and 2011. Patient characteristics, patterns and cost of surgery, and length of hospital stay were evaluated. Results: Of the 2399 patients identified, 888 (37.0%) underwent at least one surgical procedure either in the outpatient or inpatient setting. The subgroup of patients who underwent surgery included significantly more patients with distant skin metastases compared to the subgroup who did not receive surgery;whereas significantly more patients in the non-surgery group had brain or bone metastases. Surgery performed in the outpatient setting was predominantly on the skin, whereas surgery on the brain was generally performed in the inpatient setting. The mean cost of the surgical procedures performed in the outpatient setting was $3393 (median: $1419) per procedure, which varied according to the location of the metastasis. For surgical procedures that were performed in the inpatient setting, the mean length of stay in hospital due to surgery was 4.4 (± 5.1) days, at a mean cost of $37,649 (median: $28,067) per hospitalization. Conclusions: Surgery is prevalent and costly in patients with metastatic melanoma.展开更多
Introduction Melanoma is the fifth most common cancer in the United States.The estimated number of new cases of melanoma in 2012 is 76,250, with 9,180 melanoma-related death[1,2].Moreover,the incidence of melanoma is ...Introduction Melanoma is the fifth most common cancer in the United States.The estimated number of new cases of melanoma in 2012 is 76,250, with 9,180 melanoma-related death[1,2].Moreover,the incidence of melanoma is rising faster than any other cancer in man and second only to lung cancer in women[3].Although only 5% of patients had metastatic disease on diagnosis, the median overall survival (OS) is less than one-year and the twoyear survival rate is between 10~20%[4,5].Compared to the white population, Asian population is less prone to this condition because of the protective effect of melanin[6].The overall incidence of melanoma in China has not been reported.A recent single institution study in China reported 522 melanoma cases during only four years from 2006~2010[7].展开更多
BACKGROUND Dual checkpoint inhibition improves response rates in treatment naive patients with metastatic melanoma compared to monotherapy.However,it confers a higher rate of toxicity,including immune-related colitis....BACKGROUND Dual checkpoint inhibition improves response rates in treatment naive patients with metastatic melanoma compared to monotherapy.However,it confers a higher rate of toxicity,including immune-related colitis.Steroids may not resolve symptoms in all cases.The use of vedolizumab,a humanized monoclonal antibody againstα4β7 integrin has proven effective in cases refractory to standard treatment.CASE SUMMARY We report the case of a 27-year-old female with Stage IVd metastatic melanoma treated with ipilimumab and nivolumab.She developed severe colitis refractory to methylprednisolone,infliximab and mycophenolate mofetil but responded to vedolizumab.CONCLUSION This case report supports vedolizumab use in severe immune related colitis refractory to standard immunosuppression.展开更多
A 54-year-old man diagnosed with metastatic melanoma of the right inguinal node with occult primary developed liver and bone metastases. The combination of dabrafenib plus trametinib was initiated, and a complete resp...A 54-year-old man diagnosed with metastatic melanoma of the right inguinal node with occult primary developed liver and bone metastases. The combination of dabrafenib plus trametinib was initiated, and a complete response (CR) was achieved 24 months after starting treatment. One month later, the target therapy was discontinued at the patient’s decision, and he has remained free from progression for 21 months since discontinuation. To the extent of our knowledge, real-world data in Asian melanoma concerning the discontinuation of dabrafenib plus trametinib after achieving CR have not been published;therefore, our case is a meaningful one for considering to cease target drugs and to rescue their financial toxicity.展开更多
AIM: To analyze the correlation of treatment method with the outcome of all the hepatic metastatic mela-noma (HMM) patients from our hospital.METHODS: There were altogether nine cases of HMM that had been treated in ... AIM: To analyze the correlation of treatment method with the outcome of all the hepatic metastatic mela-noma (HMM) patients from our hospital.METHODS: There were altogether nine cases of HMM that had been treated in the PUMCH hospital during the past 25 years, from December 1984 to February 2010. All of the cases developed hepatic metastasis from primary cutaneous melanoma. A retrospective review was performed on all the cases in order to draw informative conclusion on diagnosis and treatment in correlation with the prognosis. Clinical features including symptoms, signs, blood test results, Bultrasound and computed tomography (CT) imaging characteristics, and pathological data were analyzed in each case individually. A simple comparison was made on case by case basis instead of performing statistical analysis since the case numbers are low and patients were much diversified in each item that has been analyzed. Literatures on this subject were reviewed in order to draw a safe conclusion and found to be supportive to our finding in a much broad scope. RESULTS: There are six males and three females whose ages ranged 39-74 years old with an average of 58.8. Patients were either with or without symptoms at the time of diagnosis. The liver function and tumor marker exam were normal in all but one patient. The incidence of HMM does not affect liver function and was not related to virus infection status in the liver. Most of these HMM patients were also accompanied by the metastases of other locations, including lung, abdominal cavity, and cervical lymph nodes. Ultra-sound examinations showed lesions ranging 2-12 cm in diameter, with noor low-echo peripheral areola. Doppler showed blood flow appeared inside some tumors as well as in the surrounding area. CT image demonstrated low density without uniformed lesions, characterized with calcification in periphery, and en-hanced in the arterial phase. Contrast phase showed heterogeneous enhancement, with a density higher than normal liver tissue, which was especially appar-e展开更多
糖蛋白非转移性黑色素瘤蛋白B(glycoprotein non-metastatic melanoma protein B,GPNMB)是一种I型跨膜蛋白,多富集在癌细胞表面,在巨噬细胞和小胶质细胞中呈高表达。GPNMB在肿瘤进展及免疫反应中发挥了重要作用,其胞外结构域与整合素相...糖蛋白非转移性黑色素瘤蛋白B(glycoprotein non-metastatic melanoma protein B,GPNMB)是一种I型跨膜蛋白,多富集在癌细胞表面,在巨噬细胞和小胶质细胞中呈高表达。GPNMB在肿瘤进展及免疫反应中发挥了重要作用,其胞外结构域与整合素相互作用,能促进免疫抑制,并能促进血管生成细胞募集到肿瘤微环境,从而影响肿瘤的免疫反应,有可能可作为免疫治疗及靶向治疗的潜在靶点。展开更多
Background Glycoprotein non-metastatic melanoma protein B （GPNMB） plays an important role in the pathogenesis of inflammatory and malignant diseases. We investigated the expression of GPNMB in benign and malignant s...Background Glycoprotein non-metastatic melanoma protein B （GPNMB） plays an important role in the pathogenesis of inflammatory and malignant diseases. We investigated the expression of GPNMB in benign and malignant skin diseases. Methods Tissue microarray was performed in the skin tissues of 102 cases including malignant melanoma （MM）, squamous cell carcinoma （SCC）, basal cell carcinoma （BCC）, and benign dermatosis. The expression of GPNMB in the tissues was detected by immunohistochemistry. Twenty cases of normal skin and adjacent neoplastic normal skin tissues were selected as controls. Results GPNMB was positively stained in skin malignancies （38/50, 76%）, which was significantly higher than that in the control and the benign skin tissues （P=0.001 and 〈0.001 respectively）. GPNMB was positively stained in MM （13/15, 87%） and SCC （16/20, 80%） （P 〈0.001）. Significant higher expression of GPNMB was observed in patients aged 〉65 years than those less than 65 years （n=11 and n=9 respectively, P=0.027）. No significant difference of the expression rates was observed between normal control and BCC; however, stronger intensity was detected in the latter. Negative or weak expression was observed in the controls. Conclusion Over-expression of GPNMB correlated strongly and might play an important role in the pathogenesis of MM and SCC.展开更多
Background and Objective: Malignant melanoma is the most aggressive skin cancer because it has very strong metastatic power. Endobuccal localization is very rare. Its discovery is often made in the late stage, which l...Background and Objective: Malignant melanoma is the most aggressive skin cancer because it has very strong metastatic power. Endobuccal localization is very rare. Its discovery is often made in the late stage, which leads to a consistently pessimistic diagnostic. We report a case of palatal melanoma at the metastatic stage. Case Report: A 43-year-old woman presented left lateral cervical swelling associated with dyspnea for 5 months. She had regularly taken chewing tobacco for 4 years and had developed blackish gums. The endobuccal examination showed a blackish non-haemorrhagic swelling of 5 cm of the long axis, located at the level of the palatal vault, associated with pigmentation in teeth 21, 22, and 23. The anatomopathological examination confirmed the melanoma. The spreading assessment revealed pleural and hepatic metastasis. The proposed treatment was palliative treatment. The patient died 2 months later. Conclusion: Melanoma of the oral mucosa is a very aggressive tumor. The scarcities of dental care among the Malagasy people exacerbate the delay in diagnosis. Its management is still challenging in Madagascar.展开更多
文摘Objective:To investigate whether vitamin D receptor gene(VDR)Bsm I-rs1544410 and Fok I-rs2228570 polymorphisms,smoking duration,and body mass index(BMI)are risk factors for cutaneous melanoma,especially metastatic melanoma.Methods:We studied 120 cutaneous melanoma cases[68 stage I and II non-metastatic melanoma(NMet M)patients,plus 52Stage III and IV metastatic melanoma(Met M)patients],and 120 matching healthy controls from northeast Italy.VDR polymorphisms were measured by restriction fragment length polymorphism analysis.Absence or presence of Bsm I and Fok I restriction sites was denoted by"B"and"F"or by"b"and"f,"respectively.Results:VDR-Bsm I bb genotype was more frequent among Met M(32.7%)than among NMet M cases(13.2%),with odds ratio(OR)=3.18.Comparison of all melanoma patients vs healthy controls showed that the following biomarkers were at risk:≥20 years of smoking(OR=2.43);≥20 years of smoking combined with bb(OR=4.78),Bb+bb(OR=2.30),Ff(OR=3.04),and Ff+ff(OR=3.08);obesity(BMI>30Conclusions:Risk factors for cutaneous Met M include two VDR polymorphisms combined with smoking duration and obesity.Results suggest gene-environment implications in melanoma susceptibility and severity.Future studies in larger cohorts and in subjects with different genetic background are warranted to extend our findings.
文摘AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. METHODS: Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status(Eastern Cooperative Oncology Group) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion(ILI)], and to stop the out flow(venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration(HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of drug.RESULTS: Thirty seven ILI were done in 29 cases(31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro Hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients(38%) received infusion of melphalan alone, 7(24%) melphalan associated to mitomicin C and 7(24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients(10%) were complete responders and 16(56%) were partial responders; whereas 7 patients(24%) had stable disease, and 3(10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade(I and II) toxicity.CONCLUSION: ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and is effective in delaying progression.
文摘Metastatic melanoma has long been considered to have a very poor prognosis and to be chemo-resistant. However, a subgroup of patients with metastatic melanoma presents remarkable responses to chemotherapeutic agents, even in the absence of a response to modern targeted therapies and immunotherapies; accordingly, determining predictive biomarkers of the response to chemotherapies for metastatic melanoma remains a priority to guide treatment in these patients. We report a case study of a patient with B-Raf proto-oncogene serine/threonine kinase-mutated metastatic melanoma harbouring many genetic mutations. The patient did not respond to prior targeted therapies or immunotherapies but experienced a dramatic objective radiological and clinical response to subsequent dacarbazine-based chemotherapy. In the era of targeted therapies and immunotherapies for metastatic melanoma, cytotoxic chemotherapies may still represent an interesting therapeutic weapon in a well-deined subgroup of patients presenting with speciic genetic and molecular features.
文摘Background: Sentinel node (SLN) status is the most important prognostic factor for early-stage melanoma patients. It will influence follow-up and may change therapy. Positive SLNs present different degrees of involvement so that subgroups of patients may have minimal SLN invasion. The aim of this study was to evaluate survival in subgroups with minimally involved SLNs and to compare them to negative SLN patients. Method: SLN biopsy was performed in 499 consecutive clinically N0 patients between 1997 and 2008. Following updated recommendations from the Melanoma Group of the European Organization of Research and Treatment of Cancer, degrees of SLN involvement were fully reassessed for two anatomopathological parameters: tumour burden according to Rotterdam criteria (1.0 mm) and microanatomic location according to Dewar (subcapsular, combined subcapsular and parenchymal, parenchymal, multifocal, or extensive). Minimally involved SLNs were defined as those with tumor burden <0.1 mm and/or subcapsular metastasis location. Kaplan-Meier and multivariable logistic regression analyses were performed. Results: Out of 499 clinically N0 patients, positive SLNs were found in 123 patients (24.7 percent). With a median follow-up of 52 months (range: 9 - 146), five-year disease-free (DFS), disease-specific survival (DSS) and overall survival (OS) were 88.1, 93.9 and 89.9 percent for negative SLN patients, respectively. In minimally involved SLNs, there were 21 with tumour burden <0.1 mm, and 52 with subcapsular metastasis. Five-year DFS, DSS and OS in these sub-groups were 79.6, 86.6 and 86.6 percent, then 57.3, 69.8 and 67.8 percent respectively. DFS univariable analysis of these sub-groups compared to negative SLNs showed: (HR1.89, 95 percent CI 0.75 - 4.79;p 0.175) and (HR 3.92, 95 percent CI 2.29 - 6.71;p < 0.0001) respectively. Minimally involved sub-groups were not predictive for NSLN negativity. Conclusion: Rotterdam’s tumour burden stratification is an easy and useful prognostic factor of melanoma survival. There was a
文摘The small intestine is sometimes metastasized by malignant melanoma. While small intestinal involvement is asymptomatic or usually nonspecific, intussusception causing intestinal obstruction is very rare. Herein we report the case of a 68-year-old man with small bowel intussusception due to metastatic malignant melanoma. Although he has been comprehensively treated with surgery, radiation, and immunotherapies, the disease rapidly progressed and consequently severe life-threatening intussusception developed on the small bowel. Because surgical resection of the obstructive melanoma lesions was successful, his quality of life was dramatically improved followed by the resumption of treatment with anti-PD-1. Several effective treatments for metastatic melanoma, including immune checkpoint inhibitors and targeted therapy, have been developed within the past decade. However, given the present case, surgical approaches to symptomatic metastatic melanoma lesions should still be considered as a treatment option for improving not only patients’ critical condition but also their survival.
文摘Objective: To investigate the pattern of palliative surgeries and associated costs in patients with metastatic melanoma in the USA. Methods: This was a retrospective claims-based study of patients identified using administrative claims from MarketScan®?databases among patients with metastatic melanoma diagnosed between 2005 and 2011. Patient characteristics, patterns and cost of surgery, and length of hospital stay were evaluated. Results: Of the 2399 patients identified, 888 (37.0%) underwent at least one surgical procedure either in the outpatient or inpatient setting. The subgroup of patients who underwent surgery included significantly more patients with distant skin metastases compared to the subgroup who did not receive surgery;whereas significantly more patients in the non-surgery group had brain or bone metastases. Surgery performed in the outpatient setting was predominantly on the skin, whereas surgery on the brain was generally performed in the inpatient setting. The mean cost of the surgical procedures performed in the outpatient setting was $3393 (median: $1419) per procedure, which varied according to the location of the metastasis. For surgical procedures that were performed in the inpatient setting, the mean length of stay in hospital due to surgery was 4.4 (± 5.1) days, at a mean cost of $37,649 (median: $28,067) per hospitalization. Conclusions: Surgery is prevalent and costly in patients with metastatic melanoma.
文摘Introduction Melanoma is the fifth most common cancer in the United States.The estimated number of new cases of melanoma in 2012 is 76,250, with 9,180 melanoma-related death[1,2].Moreover,the incidence of melanoma is rising faster than any other cancer in man and second only to lung cancer in women[3].Although only 5% of patients had metastatic disease on diagnosis, the median overall survival (OS) is less than one-year and the twoyear survival rate is between 10~20%[4,5].Compared to the white population, Asian population is less prone to this condition because of the protective effect of melanin[6].The overall incidence of melanoma in China has not been reported.A recent single institution study in China reported 522 melanoma cases during only four years from 2006~2010[7].
文摘BACKGROUND Dual checkpoint inhibition improves response rates in treatment naive patients with metastatic melanoma compared to monotherapy.However,it confers a higher rate of toxicity,including immune-related colitis.Steroids may not resolve symptoms in all cases.The use of vedolizumab,a humanized monoclonal antibody againstα4β7 integrin has proven effective in cases refractory to standard treatment.CASE SUMMARY We report the case of a 27-year-old female with Stage IVd metastatic melanoma treated with ipilimumab and nivolumab.She developed severe colitis refractory to methylprednisolone,infliximab and mycophenolate mofetil but responded to vedolizumab.CONCLUSION This case report supports vedolizumab use in severe immune related colitis refractory to standard immunosuppression.
文摘A 54-year-old man diagnosed with metastatic melanoma of the right inguinal node with occult primary developed liver and bone metastases. The combination of dabrafenib plus trametinib was initiated, and a complete response (CR) was achieved 24 months after starting treatment. One month later, the target therapy was discontinued at the patient’s decision, and he has remained free from progression for 21 months since discontinuation. To the extent of our knowledge, real-world data in Asian melanoma concerning the discontinuation of dabrafenib plus trametinib after achieving CR have not been published;therefore, our case is a meaningful one for considering to cease target drugs and to rescue their financial toxicity.
基金Supported by The National Natural Science Foundation of China, No. 30901453
文摘 AIM: To analyze the correlation of treatment method with the outcome of all the hepatic metastatic mela-noma (HMM) patients from our hospital.METHODS: There were altogether nine cases of HMM that had been treated in the PUMCH hospital during the past 25 years, from December 1984 to February 2010. All of the cases developed hepatic metastasis from primary cutaneous melanoma. A retrospective review was performed on all the cases in order to draw informative conclusion on diagnosis and treatment in correlation with the prognosis. Clinical features including symptoms, signs, blood test results, Bultrasound and computed tomography (CT) imaging characteristics, and pathological data were analyzed in each case individually. A simple comparison was made on case by case basis instead of performing statistical analysis since the case numbers are low and patients were much diversified in each item that has been analyzed. Literatures on this subject were reviewed in order to draw a safe conclusion and found to be supportive to our finding in a much broad scope. RESULTS: There are six males and three females whose ages ranged 39-74 years old with an average of 58.8. Patients were either with or without symptoms at the time of diagnosis. The liver function and tumor marker exam were normal in all but one patient. The incidence of HMM does not affect liver function and was not related to virus infection status in the liver. Most of these HMM patients were also accompanied by the metastases of other locations, including lung, abdominal cavity, and cervical lymph nodes. Ultra-sound examinations showed lesions ranging 2-12 cm in diameter, with noor low-echo peripheral areola. Doppler showed blood flow appeared inside some tumors as well as in the surrounding area. CT image demonstrated low density without uniformed lesions, characterized with calcification in periphery, and en-hanced in the arterial phase. Contrast phase showed heterogeneous enhancement, with a density higher than normal liver tissue, which was especially appar-e
文摘糖蛋白非转移性黑色素瘤蛋白B(glycoprotein non-metastatic melanoma protein B,GPNMB)是一种I型跨膜蛋白,多富集在癌细胞表面,在巨噬细胞和小胶质细胞中呈高表达。GPNMB在肿瘤进展及免疫反应中发挥了重要作用,其胞外结构域与整合素相互作用,能促进免疫抑制,并能促进血管生成细胞募集到肿瘤微环境,从而影响肿瘤的免疫反应,有可能可作为免疫治疗及靶向治疗的潜在靶点。
文摘Background Glycoprotein non-metastatic melanoma protein B （GPNMB） plays an important role in the pathogenesis of inflammatory and malignant diseases. We investigated the expression of GPNMB in benign and malignant skin diseases. Methods Tissue microarray was performed in the skin tissues of 102 cases including malignant melanoma （MM）, squamous cell carcinoma （SCC）, basal cell carcinoma （BCC）, and benign dermatosis. The expression of GPNMB in the tissues was detected by immunohistochemistry. Twenty cases of normal skin and adjacent neoplastic normal skin tissues were selected as controls. Results GPNMB was positively stained in skin malignancies （38/50, 76%）, which was significantly higher than that in the control and the benign skin tissues （P=0.001 and 〈0.001 respectively）. GPNMB was positively stained in MM （13/15, 87%） and SCC （16/20, 80%） （P 〈0.001）. Significant higher expression of GPNMB was observed in patients aged 〉65 years than those less than 65 years （n=11 and n=9 respectively, P=0.027）. No significant difference of the expression rates was observed between normal control and BCC; however, stronger intensity was detected in the latter. Negative or weak expression was observed in the controls. Conclusion Over-expression of GPNMB correlated strongly and might play an important role in the pathogenesis of MM and SCC.
文摘Background and Objective: Malignant melanoma is the most aggressive skin cancer because it has very strong metastatic power. Endobuccal localization is very rare. Its discovery is often made in the late stage, which leads to a consistently pessimistic diagnostic. We report a case of palatal melanoma at the metastatic stage. Case Report: A 43-year-old woman presented left lateral cervical swelling associated with dyspnea for 5 months. She had regularly taken chewing tobacco for 4 years and had developed blackish gums. The endobuccal examination showed a blackish non-haemorrhagic swelling of 5 cm of the long axis, located at the level of the palatal vault, associated with pigmentation in teeth 21, 22, and 23. The anatomopathological examination confirmed the melanoma. The spreading assessment revealed pleural and hepatic metastasis. The proposed treatment was palliative treatment. The patient died 2 months later. Conclusion: Melanoma of the oral mucosa is a very aggressive tumor. The scarcities of dental care among the Malagasy people exacerbate the delay in diagnosis. Its management is still challenging in Madagascar.
