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 [...]
Short-Term Effectiveness of a Stepped-Care Model to Address Fear of Cancer Recurrence in Patients With Early-Stage Melanoma.
Abstract Objective: To investigate the effectiveness of the Melanoma Care Programme when implemented into routine clinical practice coupled with fear of cancer recurrence (FCR) screening and a stepped-care model of intervention delivery. Methods: Using a Type-I hybrid effectiveness-implementation design, individuals with stage 0-II melanoma and a Fear of Cancer Recurrence Inventory FCR severity score of ≥ 13 were offered the Melanoma Care Programme. The programme included a psychoeducational booklet and 3 to 5 psychotherapeutic telehealth sessions with a clinical psychologist, timed around routine dermatological appointments. Multivariable linear mixed modelling was used to analyse the effect of the intervention at 1-week post-intervention [...]
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 [...]
Impact of an online risk prediction tool for sentinel node metastasis on clinical decision-making in melanoma care: A mixed methods study.
Abstract Background The decision to perform a sentinel lymph node biopsy (SLNB) procedure can be guided by risk prediction tools. We aimed to investigate the impact of an online risk prediction tool for sentinel node metastasis on clinical decision-making. Methods We conducted a mixed methods study using an online questionnaire and semi-structured interviews between April 2022 and March 2023. Australian clinicians and patients/carers who were using the Melanoma Institute Australia risk prediction tool were invited to participate. Results Sixty-one participants completed the questionnaire (52 clinicians including 36 general practitioners of whom 32 worked at skin cancer clinics; 14 surgeons; [...]
A comparison of isolated limb infusion/perfusion, immune checkpoint inhibitors, and intralesional therapy as first-line treatment for patients with melanoma in-transit metastases
Abstract Background: Isolated limb infusion and perfusion (ILI/ILP) has been a mainstay treatment for unresectable melanoma in-transit metastases (ITM), but increased use of immune checkpoint inhibitors (ICI) and intralesional therapy (talimogene laherparepvec [TVEC]) introduced several different management options. This study compares first-line ILI/ILP, ICI, and TVEC. Methods: Retrospective review from 12 international institutions included patients treated from 1990 to 2022 with first-line ILI/ILP, ICI, or TVEC for unresectable melanoma ITM. Results: A total of 551 patients were treated, with ILI/ILP (n = 356), ICI (n = 125), and TVEC (n = 70) with median follow-up of 5.5 years. Tumor burden was highest [...]
A comparison of isolated limb infusion/perfusion, immune checkpoint inhibitors, and intralesional therapy as first-line treatment for patients with melanoma in-transit metastases
Abstract Background: Isolated limb infusion and perfusion (ILI/ILP) has been a mainstay treatment for unresectable melanoma in-transit metastases (ITM), but increased use of immune checkpoint inhibitors (ICI) and intralesional therapy (talimogene laherparepvec [TVEC]) introduced several different management options. This study compares first-line ILI/ILP, ICI, and TVEC. Methods: Retrospective review from 12 international institutions included patients treated from 1990 to 2022 with first-line ILI/ILP, ICI, or TVEC for unresectable melanoma ITM. Results: A total of 551 patients were treated, with ILI/ILP (n = 356), ICI (n = 125), and TVEC (n = 70) with median follow-up of 5.5 years. Tumor burden was highest [...]
Outcomes for smokers who develop melanoma: a systematic review and meta-analysis.
Abstract Background: There is compelling evidence that the incidence of melanoma in cigarette smokers is substantially lower than in non-smokers. However, the risks of both recurrence and death appear to be higher in smokers if melanoma does develop. The magnitude of these increased risks is poorly documented. This systematic review aimed to analyse melanoma survival outcomes among smokers compared to never-smokers using published studies, and report the magnitude of any survival differences. Methods: Searches of Medline, Embase and Cochrane CENTRAL (to 11/03/2024) using terms for melanoma and smoking were conducted. Included studies were those reporting outcomes including disease severity at presentation, [...]
Effect of smoking on melanoma incidence: a systematic review with meta-analysis.
Abstract Background: There is a strong correlation between cigarette smoking and the development of many cancer types. It is therefore paradoxical that multiple reports have suggested a reduced incidence of melanoma in smokers. This study aimed to analyze all existing studies of melanoma incidence in smokers relative to nonsmokers. Methods: Searches of MEDLINE and Embase were conducted for studies reporting data on melanoma in smokers and never-smokers. No study design limitations or language restrictions were applied. The outcome examined was the association between smoking status and melanoma. Analyses focused on risk of melanoma in smokers and never-smokers generated from multivariable analyses, [...]
Variation in initial biopsy technique for primary melanoma diagnosis: A population-based cohort study in New South Wales, Australia.
Abstract Background: Factors associated with nonadherence to guideline-recommended complete excision of suspicious cutaneous lesions are unclear. Objective: The purpose of this study was to analyze patient, melanoma, and clinician factors associated with initial diagnostic biopsy type and determine whether unwarranted variation from guidelines occurred. Methods: This population-based, cohort study involved the analysis of data from questionnaires completed by clinicians who managed patients with newly diagnosed, histopathologically confirmed primary invasive cutaneous melanomas reported to the New South Wales Cancer Registry between 2006 and 2007. Results: Of the 2267 biopsies, complete excision was attempted in 69.1% of cases but histologically incomplete in 14.0%. Multivariable regression [...]