Risultati per: Raccomandazioni cliniche per il melanoma cutaneo

In Reply We appreciate the tremendous enthusiasm with which Drs He and Huang read our article highlighting the weak association between proxies for UV radiation exposure and melanoma incidence across US counties. Although this revelation may be surprising to some readers and could shatter long-standing perceptions for others, it is not a new finding. The meta-analytic relative risk for the strongest UV-related risk factor—sunburn history—is only 2.0. This relatively weak association is not recognized by the wider public because sun exposure and its association with melanoma are too often (and inappropriately) compared with smoking and lung cancer (relative risk, 10.0-20.0). Although UV radiation exposure may be a modifiable risk factor for melanoma, it is certainly not formidable.

This JAMA Patient Page describes melanoma, its risk factors, diagnosis, treatment, and prognosis.

New England Journal of Medicine, Volume 388, Issue 9, Page 859-860, March 2023.

New England Journal of Medicine, Volume 388, Issue 9, Page 813-823, March 2023.

This randomized clinical trial examines quality of life in patients with resected melanoma at high risk for relapse who were treated with adjuvant pembrolizumab vs standard of care with either ipilimumab or high-dose interferon α 2b.

This cohort study examines the association between tumor-infiltrating lymphocyte classification and disease progression among patients with metastatic primary cutaneous melanoma receiving checkpoint inhibitor therapy.

Comunicato del 30/01/2023 n°7

Terapie personalizzate, più efficaci in base al tipo di malattia

Objective
Although black patients are more likely to have advanced melanomas at diagnosis, with a 5-year survival rate among black patients of 70% compared with 92% for white patients, black people are generally not the focus of melanoma public health campaigns. We sought to explore awareness and perspectives of melanoma among black people to inform the development of relevant and valued public health messages to promote early detection of melanoma.

Design
Inductive thematic analysis of in-depth semistructured interviews.

Setting
Interviews were conducted with participants via video software or telephone in the USA.

Participants
Participants were adults from the USA who self-identified as African American or black. Recruitment flyers were posted around the San Francisco Bay Area and shared on our team Facebook page, with further participants identified through snowball sampling.

Results
We interviewed 26 participants from 10 different states. Overall, 12 were men and 14 were women, with a mean age of 43 years (range 18–85). We identified five key themes regarding melanoma awareness in black people: (1) lack of understanding of term ‘melanoma’ and features of skin cancer; (2) do not feel at risk of melanoma skin cancer; (3) surprise that melanoma can occur on palms, soles and nails; (4) skin cancer awareness messages do not apply to or include black people; and (5) Importance of relationship with healthcare and habits of utilisation.

Conclusions
Analysis of these in-depth semistructured interviews illuminate the pressing need for health information on melanoma designed specifically for black people. We highlight two key points for focused public health messaging: (1) melanoma skin cancer does occur in black people and (2) high-risk sites for melanoma in black people include the palms, soles and nail beds. Therefore, public health messages for black people and their healthcare providers may involve productively checking these body surface areas.

È LAP1 e aumento dei livelli è collegato a prognosi sfavorevole

In Reply We read with interest the Letter to the Editor written by Pham and Dalle in response to our prospective, multicenter randomized clinical trial that evaluated the hypothesis that reflectance confocal microscopy (RCM) reduces unnecessary lesion excision in equivocal lesions for the diagnosis of melanoma. We thank the editor for the opportunity to further clarify the inclusion criteria of our study.

This case report describes an ulcerated, erythematous, and hyperpigmented periurethral nodule with surrounding irregular macular hyperpigmentation.

To the Editor We read the work of Pellacani et al with great interest. They reported the effects of adjunct reflectance confocal microscopy (RCM) in equivocal lesions for the diagnosis of melanoma in a prospective, multicenter randomized clinical trial against standard therapeutic care, which comprised either immediate excision or digital dermoscopy follow-up (DDF) after clinical and dermoscopic evaluation. They showed that RCM halved the number needed to excise.

Introduction
The benefits of patient-reported feedback, using questionnaires that allow patients to report how they feel and function without any interpretation from healthcare professionals, are well established. However, patient-reported outcomes measures (PROMs) are not routinely collected in patients with melanoma in Australia. The aim of this study is to evaluate the feasibility and acceptability of implementing electronic PROMs (ePROMs) into routine care from the perspectives of patients with stage III melanoma and their treating clinical team.

Methods and analysis
A minimum of 50 patients and 5 clinicians will be recruited to this prospective, longitudinal pilot study (ePROMs-MELanoma). The study uses a mixed-methods approach (quantitative PROMs questionnaires and end-of-study surveys with qualitative interviews) and commenced in May 2021 in surgical and medical melanoma clinics at two sites in metropolitan Sydney, Australia. The primary outcomes are measures of feasibility and acceptability, comprising descriptive questionnaire completion statistics, and proportion of patients who reported that these PROMs were easy to complete and measured items they considered important. Clinician and clinic staff views will be canvassed on the appropriateness of these PROMs for their patients, change in referral practice and uptake and incorporation into routine practice. Secondary aims include measurement of improvements in patients’ emotional and physical health and well-being, and utility of real-time data capture and clinician feedback. All participants will complete the Distress Thermometer and EQ-5D-5L questionnaires in the clinic using a tablet computer at baseline and two to three subsequent follow-up appointments. Participants who report a score of 4 or higher on the Distress Thermometer will be triaged to complete an additional three questionnaires: the QLQ-C30, Depression, Anxiety and Stress Scale and Melanoma Concerns Questionnaire-28. Results will be generated in real time; patients with psychosocial distress or poor quality of life will discuss possible referral to appropriate allied health services with their clinician. Thematic analysis of interviews will be conducted.

Ethics and dissemination
Ethics approval obtained from St Vincent’s Hospital Human Research Ethics Committee on 19 September 2019 (2019/ETH10558), with amendments approved on 8 June 2022. Patient consent is obtained electronically prior to questionnaire commencement. Dissemination strategies will include publication in peer-reviewed journals and presentation at international conferences, tailored presentations for clinical societies and government bodies, organisational reporting through multidisciplinary meetings and research symposia for local clinicians and clinic staff, and more informal, lay reports and presentations for consumer melanoma representative bodies and patient participants and their families.

Trial registration number
ACTRN12620001149954.

New England Journal of Medicine, Volume 387, Issue 23, Page 2113-2125, December 2022.