Approaches to Surgical Management of Anorectal Melanoma in the Pre- and Post-Immunotherapy Eras.
Abstract Background: Whilst revolutionary in cutaneous melanoma, immune checkpoint inhibitors have shown reduced efficacy in anorectal melanoma. Nevertheless, their emergence, and the possibility of improved outcomes, may have changed the surgical management paradigm. Objective: To review the surgical management of anorectal melanoma in pre- and post-immunotherapy eras. Design: A retrospective cohort study from the Melanoma Institute Australia Research Database. Settings: A quaternary melanoma referral center. Patients: Patients with anorectal melanoma from 1958 to 2021. Interventions: The use of abdominoperineal resection and wide local excision were compared in pre- and post-immunotherapy eras from first use in 2014. Main outcome measures: Type of surgery performed over time and [...]
Sentinel Node Biopsy in Melanoma Remains a Valuable Clinical Tool. Comment on Dixon et al. Primary Cutaneous Melanoma-Management in 2024. J. Clin. Med. 2024, 13, 1607.
Abstract Management of melanoma in 2024 requires at times complex decision making and a multidisciplinary approach. An article by Dixon and collaborators published in this Journal contained broad-reaching recommendations, some of which are in contradiction of accepted National and International Guidelines. This article seeks to highlight these points of contention and outline widely accepted standards of care that are considered best practice. Read Full Paper
Approaches to Surgical Management of Anorectal Melanoma in the Pre- and Post-Immunotherapy Eras.
Abstract Background: Whilst revolutionary in cutaneous melanoma, immune checkpoint inhibitors have shown reduced efficacy in anorectal melanoma. Nevertheless, their emergence, and the possibility of improved outcomes, may have changed the surgical management paradigm. Objective: To review the surgical management of anorectal melanoma in pre- and post-immunotherapy eras. Design: A retrospective cohort study from the Melanoma Institute Australia Research Database. Settings: A quaternary melanoma referral center. Patients: Patients with anorectal melanoma from 1958 to 2021. Interventions: The use of abdominoperineal resection and wide local excision were compared in pre- and post-immunotherapy eras from first use in 2014. Main outcome measures: Type of surgery performed over time and [...]
ASO Author Reflections: Is Sentinel Node Biopsy Still of Value for Patients with High-Risk Primary Melanomas Eligible for Adjuvant Immunotherapy?
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Clinical significance of intra-thoracic and intra-abdominal sentinel lymph nodes detected on lymphoscintigraphy in truncal melanoma patients.
Abstract Background: Although most melanomas drain to the more common major lymph node basins (axilla, groin, neck), rarely they drain to deep SLN locations such as intra-abdominal and intra-thoracic (including intercostal and internal mammary) sites, which pose a higher surgical risk and complexity for procurement. Our study is aimed at determining the rate of positivity and likelihood of recurrence in these nodal sites to guide management decisions for patients with truncal melanomas which drain to these 'deep' SLN locations. Methods: Retrospective data collected between May 2008 and May 2022 including all patients with truncal melanomas who underwent lymphoscintigraphy resulting in the [...]
Patient and Staff Experiences of Embedding Electronic Patient Reported Outcome Measures for Distress Screening and Quality of Life Assessment, Into Routine Melanoma Care: A Mixed-Methods Study
Abstract Objective: Patient reported outcome measures (PROMs) are commonly collected in melanoma research. However, they are not used to guide immediate clinical care in Australia. This study explored the views and experiences of patients with Stage III melanoma and clinic staff during implementation of an electronic Patient-Reported Outcome Measures in melanoma (ePROMs-MEL) pilot to assess distress and quality of life. Methods: A prospective mixed-methods study in specialist melanoma clinics in Sydney, Australia between May 2021 and February 2023. Forty-two post-ePROMs implementation surveys and 17 semi-structured interviews were undertaken among patients and staff (including oncologists, melanoma nurses and clinic managers). Survey responses [...]
Patient and Staff Experiences of Embedding Electronic Patient Reported Outcome Measures for Distress Screening and Quality of Life Assessment, Into Routine Melanoma Care: A Mixed-Methods Study.
Abstract Objective: Patient reported outcome measures (PROMs) are commonly collected in melanoma research. However, they are not used to guide immediate clinical care in Australia. This study explored the views and experiences of patients with Stage III melanoma and clinic staff during implementation of an electronic Patient-Reported Outcome Measures in melanoma (ePROMs-MEL) pilot to assess distress and quality of life. Methods: A prospective mixed-methods study in specialist melanoma clinics in Sydney, Australia between May 2021 and February 2023. Forty-two post-ePROMs implementation surveys and 17 semi-structured interviews were undertaken among patients and staff (including oncologists, melanoma nurses and clinic managers). Survey responses [...]
72MO Concurrent BRAF targeted therapy (TT) with dabrafenib and trametinib and anti-PD-1 agent pembrolizumab (PD1) increased B cell signalling and inflammatory pathways more effectively than when given sequentially or with anti-PD-1 alone
Background Long duration TT prior to immunotherapy(IO) is inferior to IO upfront for patients with advanced BRAFV600 mutant melanoma while short duration TT continues to be investigated. The previously presented results of the neoadjuvant(NA) NeoTrio clinical trial (NCT02858921) demonstrated concurrent TT with PD1 yielded the highest pathologic response rates compared to 1 week of TT followed by PD1 or PD1 alone, although durability of pathological response was better with PD1 alone. We sought to characterise longitudinal changes to the tumour microenvironment induced by treatment. Methods In NeoTrio, 60 patients with BRAFV600 mutant stage IIIB/C/D melanoma were randomised to 6 weeks of [...]
The Effect of Neoadjuvant Systemic Therapy on Surgical Outcomes After Lymph Node Dissections for Stage III Melanoma; An Australian Cohort
Abstract Background: Neoadjuvant systemic therapy (NAST) for patients with stage III melanoma achieves high major pathologic response rates and high recurrence-free survival rates. This study aimed to determine how NAST with targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) influences surgical outcomes after lymph node dissection in terms of complications, morbidity, and textbook outcomes. Methods: Patients who underwent a lymph node dissection after either NAST in a clinical trial or upfront surgery for stage III melanoma between 2014 and 2022 were identified from an institutional research database. Results: The study included 89 NAST-treated patients and 79 upfront surgery-treated patients. The rate of [...]
Synchronous collision metastasis of melanoma and squamous cell carcinoma in a parotid lymph node: a very rare occurrence and literature review
No abstract available Read Full Paper