SLNB guidelines target melanoma staging

Hi all

This came out this week. This is pretty vague about changing prognosis and I will go back to the source

Ian

SLNB guidelines target melanoma staging

National report — Two oncology societies have teamed to issue their first evidence-based clinical practice guidelines for using sentinel lymph node biopsy (SLNB) to stage patients with newly diagnosed melanoma.

The American Society of Clinical Oncology and the Society for Surgical Oncology noted that recent studies suggest SLNB is used inconsistently, according to a news release. The guideline recommendations are based on a review of all available evidence and are meant to clarify which patients should receive the procedure.

The guideline recommendations are:

• SLNB is recommended for all patients with melanoma tumors of intermediate thickness (between 1 and 4 mm). Studies have shown that the technique is useful for identifying small nearby metastases in these patients, who account for about one-third of all melanoma cases.
• Evidence is insufficient to recommend routine SLNB for patients with melanoma tumors less than 1 mm. Thin melanomas are the most common form of melanoma and can usually be cured through surgical removal of the primary tumor.
• SLNB for patients with thick melanoma tumors (greater than 4 mm) may be recommended. Thick melanomas are more uncommon than the above two types, but are considered more likely to spread.
• Completion lymph node dissection is recommended for all patients with a positive SLNB. Complete removal of the remaining lymph nodes has been shown to prevent or limit further cancer spread in these patients.

The authors recommended clinicians discuss SLNB as part of a comprehensive treatment planning process with their melanoma patients.

The guidelines were published in Annals of Surgical Oncology.

Effect of adding a diagnostic aid to best practice to manage suspicious pigmented lesions in primary care: randomised controlled trial

This article was commented upon in 6 minutes:

Mole scanning device leads to over-referral

A mole scanning device does not improve the diagnosis of melanoma and results in more patients with benign lesions being referred for investigation and treatment, a GP study has found.

http://www.6minutes.com.au/news/latest-news/mole-scanning-device-leads-to-over-referral#comment-576728445

 

BMJ 2012; 345 doi: 10.1136/bmj.e4110 (Published 4 July 2012)

Abstract

Objectives To assess whether adding a novel computerised diagnostic tool, the MoleMate system (SIAscopy with primary care scoring algorithm), to current best practice results in more appropriate referrals of suspicious pigmented lesions to secondary care, and to assess its impact on clinicians and patients.

 

Design Randomised controlled trial.

Setting 15 general practices in eastern England.

Participants 1297 adults with pigmented skin lesions not immediately diagnosed as benign.

Interventions Patients were assessed by trained primary care clinicians using best practice (clinical history, naked eye examination, seven point checklist) either alone (control group) or with the MoleMate system (intervention group).

Main outcome measures Appropriateness of referral, defined as the proportion of referred lesions that were biopsied or monitored. Secondary outcomes related to the clinicians (diagnostic performance, confidence, learning effects) and patients (satisfaction, anxiety). Economic evaluation, diagnostic performance of the seven point checklist, and five year follow-up of melanoma incidence were also secondary outcomes and will be reported later.

Results 1297 participants with 1580 lesions were randomised: 643 participants with 788 lesions to the intervention group and 654 participants with 792 lesions to the control group. The appropriateness of referral did not differ significantly between the intervention or control groups: 56.8% (130/229) v 64.5% (111/172); difference −8.1% (95% confidence interval −18.0% to 1.8%). The proportion of benign lesions appropriately managed in primary care did not differ (intervention 99.6% v control 99.2%, P=0.46), neither did the percentage agreement with an expert decision to biopsy or monitor (intervention 98.5% v control 95.7%, P=0.26). The percentage agreement with expert assessment that the lesion was benign was significantly lower with MoleMate (intervention 84.4% v control 90.6%, P<0.001), and a higher proportion of lesions were referred (intervention 29.8% vcontrol 22.4%, P=0.001). Thirty six histologically confirmed melanomas were diagnosed: 18/18 were appropriately referred in the intervention group and 17/18 in the control group. Clinicians in both groups were confident, and there was no evidence of learning effects, and therefore contamination, between groups. Patients in the intervention group ranked their consultations higher for thoroughness and reassuring care, although anxiety scores were similar between the groups.

Conclusions We found no evidence that the MoleMate system improved appropriateness of referral. The systematic application of best practice guidelines alone was more accurate than the MoleMate system, and both performed better than reports of current practice. Therefore the systematic application of best practice guidelines (including the seven point checklist) should be the paradigm for management of suspicious skin lesions in primary care.

 

 

 

Coffee Skin Cancer: Caffeine Consumption Linked With Lower Risk Of Basal Cell Carcinoma

A new coffee study is showing us yet another health benefit of being a regular brew-drinker.

Researchers from Brigham and Women’s Hospital and Harvard Medical School have found that there seems to be a relationship between increased coffee intake (meaning the more, the better) and decreased risk of basal cell carcinoma — the most common skin cancer.

But researchers cautioned that if you aren’t an avid coffee drinker already, this study shouldn’t convince you to try to increase your coffee intake for the sake of protecting against skin cancer.

“However, our results add basal cell carcinoma to a list of conditions for which risk is decreased with increasing coffee consumption,” study researcher Jiali Han, Ph.D., an associate professor at Brigham and Women’s Hospital, Harvard Medical School in Boston and Harvard School of Public Health, said in a statement. “This list includes conditions with serious negative health consequences such as Type 2 diabetes and Parkinson’s disease.”

This year in the United States, there are expected to be more than 2,000,000 new cases of nonmelanoma skin cancer, according to the National Cancer Institute.

The Cancer Research study included analysis of 112,897 people who were in the Nurses’ Health Study and the Health Professionals Follow-up Study. Over a 20-year period, 22,786 people developed basal cell carcinoma.

Researchers not only found a link between increased coffee consumption and decreased skin cancer risk — for example, women who drank three or more cups of coffee a day had a lower risk of skin cancer than people who drank less than a cup of coffee a month — but also a link between overall increased caffeine consumption (like from coffee, soda, chocolate and tea) and decreased skin cancer risk. Meanwhile, there was no link between decaffeinated coffee consumption and risk of the skin cancer.

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In addition, there was no link was identified between increased coffee or caffeine consumption and squamous cell carcinoma or melanoma, which are two other kinds of skin cancer.

“These results really suggest that it is the caffeine in coffee that is responsible for the decreased risk of basal cell carcinoma associated with increasing coffee consumption,” Han said in the statement. “This would be consistent with published mouse data, which indicate caffeine can block skin tumor formation. However, more studies in different population cohorts and additional mechanistic studies will be needed before we can say this definitively.”

However, there is such a thing as too much caffeine. The Mayo Clinic says that consuming heavy amounts of caffeine each day (500 to 600 milligrams a day, or more) can lead to muscle tremors, insomnia, irritability, restlessness and even upset stomach. But the Mayo Clinic did note that getting about 200 to 300 milligrams of caffeine per day — that which is in about four cups of coffee — for adults is not a detriment to health.

Recently, a study of about 200,000 people in the journal CANCER showed that there may be a link between taking anti-inflammatory drugs and skin cancer risk.

Researchers from the Aarhus University Hospital in Denmark found that people in the study with more than two NSAID prescriptions had a 15 percent lower risk for squamous cell carcinoma, a kind of skin cancer, as well as a 13 percent lower risk for malignant melanoma, a deadly form of the cancer. This is compared with people who only filled two or fewer NSAID prescriptions.

The decreased skin cancer risk was especially pronounced when the people took them for at least seven years, and with “high-intensity use,” researchers said in the study.

Number of primary melanomas is an independent predictor of survival in patients with metastatic melanoma.

This is from the SMU. It  is interesting in the fact that the more primary melanomas one has, the better is the prognosis in patients with both early melanoma and metastatic melanoma. I did not know either.

regards

Ian

BACKGROUND:

A history of multiple primary melanomas (PMs) has been associated with improved survival in patients with early stage melanoma, but whether it also is correlated with survival in patients with metastatic melanoma is unknown. The authors sought to address the latter question in the current study.

METHODS:

Patients with metastatic melanoma diagnosed at the Melanoma Institute Australia between 1983 and 2008 were identified. Overall survival (OS) was calculated from date of first distant metastasis. Survival analysis was performed using the Kaplan-Meier method, log-rank tests, and multivariate Cox proportional hazards models.

RESULTS:

Of 2942 patients with metastatic melanoma, 2634 (89.5%) had 1 PM and 308 (10.5%) had >1 PM. Factors that were associated independently with shorter OS were site of metastasis, including the brain (hazard ratio [HR], 2.41; 95% confidence interval [CI], 2.07-2.81; P < .001) and nonlung viscera (HR, 1.92; 95% CI, 1.67-2.22; P < .001, vs lymph node/subcutaneous/soft tissue), age >60 years (HR, 1.23; 95% CI, 1.12-1.36; P < .001), shorter disease-free interval from PM to first distant metastasis (≤12 months vs >36 months: HR, 1.62; 95% CI, 1.39-1.89; P < .001), and fewer PMs (1 vs >1; HR, 1.26; 95% CI, 1.08-1.47; P = .004).

CONCLUSIONS:

A history of multiple PM was an independent predictor of improved survival for patients with metastatic melanoma. The results indicate that a history of multiple PMs should be incorporated into multivariate analyses of prognostic factors and treatment outcomes.

Cancer 2012 Jun 26. doi: 10.1002/cncr.27693. [Epub ahead of print]