Risultati per: Melanoma cutaneo

This case series investigates the recurrence rate of melanoma in situ treated with a 5-mm margin in low-risk body sites.

The recommendations for treating invasive melanoma have evolved dramatically during the past century. The surgical practices of radically wide margins and amputations were abandoned when evidence from randomized clinical trials (RCTs) showed that surgical margins as narrow as 1 cm were safe for most melanomas. In contrast, the recommendations for surgical margins for melanoma in situ (MIS) are not based on RCTs and exist with some controversy. The earliest recommendations of a 5-mm surgical margin for MIS was suggested by the National Institutes of Health by a panel of dermatologists in 1991 based on their experience rather than scientific evidence, and this became the recommended excision margin adopted by many national and international groups writing clinical guidelines. At the same time, the experience of Mohs surgeons and others looking carefully at the width of surgical margins necessary to achieve negative histologic margins led to a different conclusion. Multiple studies from various institutions showed that MIS often extends beyond a 5-mm clinical margin, and wider margins were necessary to avoid local recurrence and tumor progression. Although no RCTs were performed to my knowledge, the preponderance of evidence from these sources came to the same conclusion that margins wider than 5 mm for MIS are necessary to provide negative histologic margins in 97% of real-world lesions of MIS. However, the controversy continued about surgical margins for subgroups of MIS based on histology (MIS vs lentigo maligna), location (head and neck vs trunk and extremity), and other clinical parameters. Today, most clinical guidelines recommend a range of margins of 0.5 to 1 cm for all MIS, noting that the goal of excision is negative histologic margins.

This Viewpoint discusses use of anti–PD-1 monotherapy as the primary treatment option for patients with treatment-naive metastatic melanoma staining positive for PD-L1 over dual checkpoint inhibition therapy.

New England Journal of Medicine, Ahead of Print.

New England Journal of Medicine, Ahead of Print.

This case series describes a constellation of novel adverse reactions in 3 of 9 patients with uveal melanoma receiving treatment targeting activity of the Brahma-associated factor chromatin remodeling complex.

This qualitative and survey-based study uses interviews and surveys to understand the psychological well-being of survivors of localized cutaneous melanoma.

This pooled analysis of 6 clinical trials describes the safety and efficacy of different courses of immune checkpoint inhibitor treatment in a neoadjuvant setting among patients with high-risk resectable melanoma.

To the Editor Serritella and Shenoy conducted an interesting meta-analysis to assess the relative efficacy of nivolumab plus ipilimumab vs nivolumab for the treatment of advanced cancers other than melanoma. Based on 8 studies with 1727 patients (854 in the nivolumab plus ipilimumab group vs 873 in the nivolumab group), the authors concluded that patients in the combination therapy group did not show clinically meaningful overall survival or progression-free survival benefits compared to those in the monotherapy group. Furthermore, treatment-related higher-grade toxicity and discontinuation rates were substantially higher with the combination therapy. However, several methodological issues need to be clarified.

This Viewpoint reviews the evidence for immune checkpoint inhibitor use in the adjuvant setting, discusses the individual and societal risks, benefits, and costs associated with immune checkpoint inhibitors, and highlights the need for more targeted patient selection approaches.

In Reply I thank Pang and Sun for their comments on our meta-analysis. First, a statement on the key findings: with CheckMate 714 included (see Comment published along with article), the pooled overall survival (OS) and progression-free survival (PFS) hazard ratios (HRs) for nivolumab plus ipilimumab vs nivolumab alone were 0.98 (95% CI, 0.88-1.08) and 0.91 (95% CI, 0.83-1.00), respectively, with 5 of 9 studies having a numerically lower median OS. The combination was associated with substantially higher treatment-related discontinuations and high-grade adverse events. These numbers very strongly support the stated conclusions.

This retrospective cross-sectional study illustrates national-level trends in immunohistochemistry staining for the diagnosis of melanoma in older adult patients enrolled in Medicare.