Risultati per: Melanoma cutaneo

Circulation, Volume 148, Issue Suppl_1, Page A17445-A17445, November 6, 2023. Introduction:Metastatic tumors to the heart can have varied clinical presentations depending on location. We present a case of right atrial (RA) metastatic melanoma with near obstruction of the tricuspid valve resulting in significant hypoxia.Case Presentation:A 34-year-old man with a history of retinoblastoma and astrocytoma presented to the emergency department with 2 weeks of progressively worsening shortness of breath. On examination he was hypoxic and in respiratory distress. Computed tomography of the chest with contrast showed a large hypoattenuating homogeneous mass in the RA that protruded into the right ventricle and extended to the superior and inferior vena cavae. Transthoracic echocardiography (TTE) showed a large (9.1 x 4.6 cm) echodensity filling the RA and almost completely obstructing the tricuspid valve. Due to worsening hypoxia, the patient underwent palliative surgical resection of the mass. Intraoperatively, the mass was densely adherent to all walls of the RA. Surgical pathology identified the mass as metastatic malignant melanoma. The patient was started on pembrolizumab and discharged home in stable condition. At his 1-month follow-up, his symptoms had improved and he had returned to work.Discussion:Metastases to the heart are more common than primary cardiac tumors. Left-sided cardiac masses are commonly benign, whereas right-sided masses raise suspicion for metastatic disease. Melanoma, lymphoma, leukemia, and breast and lung cancers commonly metastasize to the heart. The size of the RA mass in this patient was significant enough to cause hypoxia and near occlusion of the tricuspid valve. Successful palliative resection of the mass resulted in a large improvement in symptoms.Conclusion:As the incidence of malignant melanoma increases, clinicians need to have a high index of suspicion for cardiac metastasis. Early identification of cardiac metastasis is critical as these cases can often be associated with poor prognosis.

Circulation, Volume 148, Issue Suppl_1, Page A16756-A16756, November 6, 2023. Introduction:Melanoma is the fifth most common cancer diagnosis in the United States. With recent advances in treatment modalities, including immune checkpoint inhibitors (ICIs), targeted therapies, there has been improvement in survival among melanoma patients. However, increasing resistance and treatment related adverse effects (TrAEs) are being reported including cardiovascular side effects.Objectives:To evaluate the trend of cardiovascular specific death rate among patients with melanoma.Methods:We used Surveillance, Epidemiology, and End Results (SEER) Program database 17 registries from 2000 to 2019 and SEER*Stat Version 8.4.1 software to analyze the data using the rate session. Joinpoint software, version 4.7.1.0 was used to create log-linear time trends annually.Results:Our study included 301,632 patients with melanoma from 2005 to 2019. The annual percentage change (APC) of melanoma was 0.46% (95% CI -1.45 to 1.07, p >0.05) annually from 2005 to 2011 and 3.33% (95% CI 1.79 to 4.27, p0.05) annually from 2014 to 2019. Melanoma specific mortality rate increased annually by 2.03 % (95% CI 0.78 to 3.94, P

This cohort study compares costs, survival, and time toxicity among patients with melanoma in 2007 to 2012 vs 2018 to 2019.

This diagnostic study builds synthetic data sets for diagnosing melanoma and melanocytic nevus with artificial intelligence (AI) using unstandardized photographs on the internet.

The challenging task of skin cancer classification via artificial intelligence (AI) is a combined effort of dermatologists, patients, and the machine-learning community. A classifier in this case is a software based on AI that assigns skin photographs to categories (ie, benign or malignant).

This retrospective cohort study estimates stage-specific recurrence and melanoma-specific mortality rates, estimates absolute stage-specific risks of recurrence and mortality, and describes stage-specific recurrence patterns in Danish patients.

New England Journal of Medicine, Ahead of Print.

A 7 anni dalla diagnosi, in pazienti con metastasi cerebrali 

Objective
This study aimed to construct prognostic models to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with primary gastrointestinal melanoma (PGIM).

Design
An observational and retrospective study.

Setting
Data were obtained from the Surveillance, Epidemiology and End Results (SEER) programme database, encompassing a broad geographical and demographic spectrum of patients across the USA.

Participants
A total of 991 patients diagnosed with PGIM were included in this study.

Methods
A total of 991 patients with PGIM were selected from the SEER database. They were further divided into a training cohort and a validation cohort. Independent prognostic factors were identified by Cox regression analysis. Two prognostic models were constructed based on the results of multivariable Cox regression analysis. The concordance index (C-index) and area under the time-dependent receiver operating characteristic curve (time-dependent AUC) were used to evaluate the discriminative ability. Calibration curves were plotted to evaluate the agreement between the probability as predicted by the models and the actual probability. Risk stratification was developed given the model.

Results
By the multivariable Cox regression analysis, we identified four independent risk factors (age, stage, lymph node density and surgery) for OS, and three independent risk factors (stage, lymph node density and surgery) for CSS, which were used to construct prognostic models. C-index, time-dependent AUC, calibration curves and Kaplan-Meier curves of risk stratification indicated that these two models had good discriminative ability, predictive ability as well as clinical value.

Conclusions
The prognostic models of OS and CSS had satisfactory accuracy and were of clinical value in evaluating the prognosis of patients with PGIM.

The gut contains approximately 100 trillion commensal microorganisms, including viruses, archaea, bacteria, and unicellular eukaryotes that influence the development and function of the human neurological, immunological, and digestive systems from birth through adulthood. These collective microbes and their genes comprise the gut microbiome, which has gained clinical interest in many specialties as a diagnostic and potential therapeutic tool for several diseases and malignant neoplasms. The bacterial component of the gut microbiome is the most well-characterized and can be studied in a culture-independent manner using 16S ribosomal RNA sequencing. Alpha diversity describes the richness (number of unique species) in a single sample. Beta diversity describes differences between population samples. Dysbiosis describes a deviation from normal composition or metabolic activity.

This randomized clinical trial presents the final 5-year follow-up results of neoadjuvant talimogene laherparepvec (T-VEC) plus surgery in patients with advanced melanoma.

This cohort study estimates the prevalence and describes tumor types of melanoma-astrocytoma syndrome.

This case-control study compares differences in the fecal microbiota—including overall diversity, composition, and putative function—between control participants and patients with melanoma and between patients with early- and late-stage melanoma.

This case report describes a patient in their 60s with metastatic colon cancer who developed multiple new dark nevi within 2 months of initiating encorafenib and panitumumab therapy.

This meta-analysis investigates the efficacy and safety of nivolumab plus ipilimumab vs nivolumab alone in the treatment of advanced cancers other than melanoma.

Objectives
To identify prognostic models for melanoma survival, recurrence and metastasis among American Joint Committee on Cancer stage I and II patients postsurgery; and evaluate model performance, including overall survival (OS) prediction.

Design
Systematic review and narrative synthesis.

Data sources
Searched MEDLINE, Embase, CINAHL, Cochrane Library, Science Citation Index and grey literature sources including cancer and guideline websites from 2000 to September 2021.

Eligibility criteria
Included studies on risk prediction models for stage I and II melanoma in adults ≥18 years. Outcomes included OS, recurrence, metastases and model performance. No language or country of publication restrictions were applied.

Data extraction and synthesis
Two pairs of reviewers independently screened studies, extracted data and assessed the risk of bias using the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist and the Prediction study Risk of Bias Assessment Tool. Heterogeneous predictors prevented statistical synthesis.

Results
From 28 967 records, 15 studies reporting 20 models were included; 8 (stage I), 2 (stage II), 7 (stages I–II) and 7 (stages not reported), but were clearly applicable to early stages. Clinicopathological predictors per model ranged from 3–10. The most common were: ulceration, Breslow thickness/depth, sociodemographic status and site. Where reported, discriminatory values were ≥0.7. Calibration measures showed good matches between predicted and observed rates. None of the studies assessed clinical usefulness of the models. Risk of bias was high in eight models, unclear in nine and low in three. Seven models were internally and externally cross-validated, six models were externally validated and eight models were internally validated.

Conclusions
All models are effective in their predictive performance, however the low quality of the evidence raises concern as to whether current follow-up recommendations following surgical treatment is adequate. Future models should incorporate biomarkers for improved accuracy.

PROSPERO registration number
CRD42018086784.