Spanish Multidisciplinary Melanoma Group (GEM) guidelines for the management of patients with advanced melanoma

Advanced melanoma is a relatively uncommon condition whose therapeutic management has undergone major changes over the past four years. The present article aims to establish recommendations for the management of these patients based on the best available evidence reached by consensus of a group of professionals familiar in the treatment of these patients. These professionals, belonging to Spanish Multidisciplinary Melanoma Group, reviewed the diagnostic process and the incorporation of newtechniques of molecular diagnosis of advanced disease; treatment and monitoring of stage III both as adjuvant locoregional treatments have been addressed, as well as new therapies for stage IV.We have reviewed the palliative treatment alternatives for disseminated disease, such as surgery, radiotherapy or non-cytotoxic systemic treatments. Finally, we have also reviewed the most relevant toxicities of new drugs and their management in clinical practice.     

A rational approach to melanoma follow-up in patients with primary cutaneous melanoma. Scottish Melanoma Group

From the Scottish Melanoma Group database for south-east Scotland we evaluated 5-year follow-up in patients with cutaneous malignant melanoma excised between 1979 and 1994 and devised an 'evidence-based' review protocol. Of the 1568 with stage I melanoma, 293 (19%) developed a recurrence, 32 had a second primary melanoma and 97 had an in-situ melanoma. The disease-free interval shortened progressively with increasing tumour thickness. Overall, 80% of recurrences were within the first 3 years, but a few patients (< 8%) had recurrences 5 or 10 years after the initial surgery. In-situ melanomas did not recur. Almost half (47%) the recurrences were noted first by the patient, and only 26% were detected first at a follow-up clinic. One hundred and thirty-nine patients (89%) were still under review when their recurrences were detected, and 102 (65%) had been seen within the previous 3 months. Questionnaires were completed by 120 patients: sun protection and avoidance, and mole examination were more likely after melanoma excision. We recommend 3-monthly review of patients with invasive lesions for the first 3 years. Thereafter, those with lesions >/= 1.0 mm need two further annual reviews. Patients with in-situ lesions should be reviewed once, to confirm adequate excision (0.5 cm margins) and to give appropriate education. Surveillance beyond 5 years is only justified if there are special risk factors.     

The Effect of the COVID-19 Lockdown on Melanoma Diagnosis in Italy

The coronavirus disease 2019 (COVID-19) pandemic has led to lockdowns for much of the world. In Italy, all health procedures not directly related to COVID-19 were reduced or suspended, thus limiting patient access to hospitals. Any delay in cancer treatment presents the additional risk of tumors progressing from being curable to incurable. Specifically, melanoma survival rate strictly depends on tumor thickness, which, in turn, is a function of time. To estimate the impact on melanoma progression caused by the reduction in dermatologic services during the COVID-19 lockdown, a retrospective observational cohort study was conducted. This study was designed to compare the clinical and histologic characteristics of the primary melanomas removed in the first 2 months after the end of the lockdown (May-July 2020) in 12 Italian centers characterized by different COVID-19 case frequencies. The control group was represented by the melanomas removed during the same period in the previous 3 years. Overall, 1,124 melanomas were considered: 237 as part of the study group and 887 from the control group (average, 295), with a 20% reduction. Breslow thickness, as well as high-risk histotypes and melanomas with vertical growth, increased for all melanomas. Ulcerated and high mitotic index melanomas increased, particularly in northern Italy. In Italy, the lockdown led to a significant worsening of melanoma severity, causing a staging jump, with a consequent worsening of outcomes.     

Exploring the implications of the first COVID-19 lockdown on patients with melanoma: a national survey

The impact of the COVID-19 pandemic upon care of malignant melanoma (MM) remains as yet poorly understood. We undertook a UK-wide national survey, in conjunction with a patient support group (Melanoma UK), to explore patient perceptions of the impact of the pandemic upon treatment and outpatient care of their MM. Our findings suggest that following the onset of COVID-19, a significant minority of treatments and appointments have been delayed, there has been a shift from face-to-face to virtual outpatient consultations and there may be a rise in psychological comorbidities in patients with MM. We would urge clinicians to consider mental health interventions as part of a holistic care package.     

Current guidelines in melanoma treatment. Melanoma Working Group of Gent and Bordet

This article focuses on the actual management of cutaneous melanoma, dealing both with established, internationally well-accepted standard procedures and interventions which are still being investigated. It wants to offer a global picture to the dermatologist of what is currently available in the therapeutic arsenal against melanoma.     

Tyrosinase activity in three types of the malignant melanoma: Superficial spreading melanoma,mentigo maligna melanoma and Nodular Melanoma

Summary Quantitative differences in the tyrosinase activity are found at the three types of malignant melanoma of Clark and Mihm by the combined 3,4-dihydroxyphenylalaninepremelanin-reaction. Only a very small activity is present in the junction nevus. In the superficial spreading melanoma the tyrosinase activity is clear, but limited. The lentigo maligna melanoma shows an increased pigmentation. The topmost activity after incubation however is present in the nodular melanoma.

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Zusammenfassung Bei den Typen des malignen Melanoms nach Clark u. Mihm wurden quantitative Unterschiede in der Tyrosinase-Aktivität mit der kombinierten 3,4-Dihydroxyphenylalanin-Praemelanin-Reaktion gefunden. Eine nur geringe Aktivität ist bei dem junktionalen Naevus vorhanden. Beim Superficial spreading melanoma ist die Tyrosinase-Aktivität deutlich, aber beschränkt. Das Lentigo maligna melanoma zeigt eine Zunahme der Pigmentierung nach Inkubation. Die stärkste Aktivität ist jedoch beim nodulären Melanom zu finden.

     

Determination of medical device-related pressure injury in COVID-19 patients: A prospective descriptive study

BackgroundCOVID-19 patients are at risk for the development of pressure injuries (PI).AimThe aim of this study was to determine the incidence of medical device-related pressure injury (MDRPI) in patients treated in the COVID-19 Intensive Care Unit (ICU)s.MethodsThe sample of the study consisted of 132 patients, and each with a maximum follow-up of 7 days. Data were collected in the COVID-19 ICU of a university hospital between January and May 2021 by using a Patient Characteristics Form, the MDRPI Follow-up Form, the Braden Pressure Ulcer Risk Assessment Scale, and the Pressure Ulcer Staging Form.ResultsOf the patients, 59.1% (n = 78) developed at least one MDRPI. MRDPI was observed in those with a mean age of 65.45 ± 2.462 years who were invasively ventilated (51.3%), enterally fed (46.2%), placed in the prone position (78.2%), and had a Braden score ≤12 (50%). The most common medical devices that caused MDRPIs included endotracheal tube (ET) (31.2% n = 44), non-invasive mechanical ventilation (NIVM) (23.4% n = 33), nasal high-flow (11.3% n = 16), nasogastric tube (10.6% n = 15), the ET connection (8.5% n = 12), respectively. The most common sites for pressure injuries were the nose (28.8% n = 34), mouth (25.8% n = 34), ear (12.9% n = 17), lip (9.1% n = 12), and cheek (8.3% n = 11). The most common gradings of MDRPIs were stage 2 (28.8% n = 38), stage 1 (19.7% n = 26), stage 3 (9.1% n = 12) mucous membrane injuries (12.9% n = 17) and suspected deep tissue injuries (9.1% n = 12), respectively. The time to PI was 3 days (25.7% n = 36).ConclusionsMDRPI was common among COVID-19 patients. It was found that the most common cause of pressure injury was ventilators, and PI developed in the mouth and lip sites most frequently in patients in prone position, stage 2 and suspected deep tissue damage was the most common grade. It is important to evaluate the skin in contact with medical devices in COVID-19 patients and to take the necessary interventions to prevent PI.     

Melanoma erysipeloides: inflammatory metastatic melanoma of the skin

We report a case of diffuse infiltration of the skin of the chest wall with metastatic melanoma. This developed as a direct extension from right axillary lymph nodes. Histology and immunohistochemistry showed invasion of dermal lymphatics with melanoma cells.     

COVID-19 in liver transplant patients: Impact and considerations

The coronavirus disease 2019 pandemic has significantly impacted liver transplantation worldwide, leading to major effects on the transplant process,including the pretransplant, perioperative, and post-transplant periods. It is believed that patients with chronic liver disease, especially those with cirrhosis,have a higher risk of complications from coronavirus disease 2019 infection compared to the general population. However, evaluation of coronavirus disease 2019 effects on liver transplant p...     

Virtual conferences and e-learning in dermatology during COVID-19 pandemic: Results of a web-based,global survey

During the pandemic, virtual conferences became the norm. We conducted a cross-sectional global study to assess dermatologists’ responses to virtual conference and e-learning program attendance, as well as to discuss the status of such events during the pandemic. This web-based, global survey included 733 dermatologists. Primary outcomes are percentages of responders answering questions. Assessment of the relationship between two categorical variables was performed with the chi-square test. A substantial percentage of responders were willing to attend a virtual meeting (70.6%) or webinar (80.2%), or to conduct a webinar (47.3%). Among participants who provided resident or fellow training before the pandemic, 38% responded that they did not have any teaching systems in place during the pandemic. Virtual conference attendance was significantly associated with video conference attendance before the pandemic, webinar attendance, teledermatology (TD) use during the pandemic, future TD use, having training systems in place for residents or fellows (P < .001 for each), and North American location of participant (P = .001). Webinar attendance was associated with North American location, conducting webinars (P < .001 for each), and future TD use (P = .024). This pandemic has had a profound effect on dermatology conferences and e-learning programs. Attending video conferences and webinars or other online training was associated with TD use and future use, which indicates that these technologies are all here to stay.     

Melanoma inhibitory activity in Brazilian patients with cutaneous melanoma

BACKGROUND:

Melanoma inhibitory activity is a protein secreted by melanoma cells and has been used as a tumor marker. Increased Melanoma inhibitory activity serum levels are related to metastatic disease or tumor recurrence. Currently there are no studies on Melanoma inhibitory activity and cutaneous melanoma involving Brazilian patients.

OBJECTIVE:

To evaluate the performance and feasibility of measuring Melanoma inhibitory activity levels in Brazilian patients with cutaneous melanoma.

METHODS:

Blood was obtained from ten patients with proved metastatic cutaneous melanoma (Group 1), 15 patients resected for cutaneous melanoma without metastasis (Group 2) and 5 healthy donors (Group 3). Melanoma inhibitory activity was measured using a commercially available ELISA kit.

RESULTS:

There was a statistically significant difference of Melanoma inhibitory activity levels between patients with and without metastasis (p=0.002), and between patients with metastasis and healthy donors (p=0.002). There was no difference between patients without metastasis and healthy donors (p=0.443).

CONCLUSION:

Melanoma inhibitory activity is a tumor marker for cutaneous melanoma and the Melanoma inhibitory activity-ELISA test can be easily performed. Patients with metastasis have increased Melanoma inhibitory activity serum levels when compared to patients without metastasis and healthy donors.