Risultati per: Raccomandazioni cliniche per il melanoma cutaneo

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.

This cohort study assesses the incidence rate of second primary invasive melanoma at least 30 days after the first based on data from deidentified records of all invasive melanomas diagnosed in 2008 to 2020, obtained from the Cancer Registry of Norway.

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.

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.

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

This diagnostic study investigates the performance of a privacy-preserving federated learning approach vs a classical centralized and ensemble learning approach for artificial intelligence–based melanoma diagnostics.

This case series identifies patient-level and tumor-level characteristics of melanoma in 48 Black patients at 2 tertiary care centers.

Basata sui linfociti estratti dal tumore, moltiplicati e reinfusi

Introduction
Inflammation is a hallmark of cancer and is involved in tumour growth and dissemination. However, the hallmarks of cancer are also the hallmarks of wound healing, and modulating the wound inflammatory response and immune contexture in relation to cancer surgery may represent effective targets of therapies.
Repurposing anti-inflammatory drugs in a cancer setting has gained increasing interest in recent years. Interestingly, the known and thoroughly tested antifibrinolytic drug tranexamic acid reduces the risk of bleeding, but it is also suggested to play important roles in anti-inflammatory pathways, improving wound healing and affecting anti-carcinogenic mechanisms.
As a novel approach, we will conduct a randomised controlled trial using perioperative treatment with tranexamic acid, aiming to prevent early relapses by >10% for patients with melanoma.

Methods and analysis
Design: investigator-initiated parallel, two-arm, randomised, blinded, Danish multicentre superiority trial.
Patients: ≥T2 b melanoma and eligible for sentinel lymph node biopsy (n=1204).
Project drug: tranexamic acid or placebo.
Treatment: before surgery (intravenous 15 mg/kg) and daily (peroral 1000 mg x 3) through postoperative day 4.
Primary outcome: relapse within 2 years after surgery.
Primary analysis: risk difference between the treatment arms (2 test).
Secondary outcomes: postoperative complications, adverse events and survival.
Inclusion period: summer 2023 to summer 2026.

Ethics and dissemination
The trial will be initiated during the summer of 2023 and is approved by the National Committee on Health Research Ethics, the Danish Medicine Agency, and registered under the Data Protection Act. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Patients included in the study will adhere to normal Danish treatment protocols and standards of care, and we expect only mild and temporary side effects. Positive and negative results will be published in peer-reviewed journals, with authorships adhering to the Vancouver rules.

Trial registration number
NCT05899465; ClinicalTrials.gov Identifier.

Introduction
Diagnosing invasive cutaneous melanoma (CM) can be challenging due to subjectivity in distinguishing equivocal nevi, melanoma in situ and thin CMs. The underlying molecular mechanisms of progression from nevus to melanoma must be better understood. Identifying biomarkers for treatment response, diagnostics and prognostics is crucial. Using biomedical data from biobanks and population-based healthcare data, translational research can improve patient care by implementing evidence-based findings. The BioMEL biobank is a prospective, multicentre, large-scale biomedical database on equivocal nevi and all stages of primary melanoma to metastases. Its purpose is to serve as a translational resource, enabling researchers to uncover objective molecular, genotypic, phenotypic and structural differences in nevi and all stages of melanoma. The main objective is to leverage BioMEL to significantly improve diagnostics, prognostics and therapy outcomes of patients with melanoma.

Methods and analysis
The BioMEL biobank contains biological samples, epidemiological information and medical data from adult patients who receive routine care for melanoma. BioMEL is focused on primary and metastatic melanoma, but equivocal pigmented lesions such as clinically atypical nevi and melanoma in situ are also included. BioMEL data are gathered by questionnaires, blood sampling, tumour imaging, tissue sampling, medical records and histopathological reports.

Ethics and dissemination
The BioMEL biobank project is approved by the national Swedish Ethical Review Authority (Dnr. 2013/101, 2013/339, 2020/00469, 2021/01432 and 2022/02421-02). The datasets generated are not publicly available due to regulations related to the ethical review authority.

Trial registration number
NCT05446155.

In the Navajo language, cancer is broadly described as łóód dóó nádzi híí, which translates directly as a “sore that does not heal.” Accurate determination of cancer incidence in a specified population is a critical first step toward addressing disease burden. Previous studies have shown that racial misclassification is a problem that hinders epidemiologic research in American Indian/Alaska Native populations and underestimates American Indian/Alaska Native cancer incidence. In this issue of JAMA Dermatology, Townsend et al use a method that corrects for racial misclassification among American Indian/Alaska Native patients with melanoma and show that the non-Hispanic American Indian/Alaska Native population has the second highest incidence of melanoma and a rising incidence of late-stage melanoma diagnoses. This melanoma incidence (10.7 per 100 000) is nearly double those previously published (4.5 to 5.5 per 100 000) behind non-Hispanic White patients (21.9 to 32.2 per 100 000). These findings suggest that previous studies may have overlooked American Indian/Alaska Native health disparities and underscore the importance of minimizing racial misclassification in this population.