Management of thin melanoma

Management of thin melanoma Durham et al performed a study on a cohort of 510 patients affected by 512 lesions with Breslow tickness comprised between 0.75 and 0.99 mm. Their aim was to establish a correct treatment choice for the mentioned lesions. The authors concluded that the sentinel lymph node biopsy (SLNB) should be considered for patients of 45 years or less, with a Breslow thickness ≥0.85 mm, rounded to 0.9 mm, according to the AJCC 8th Edition, a mitotic rate>1 mm, and/or lesion ulceration. Conversely, they reported that thin melanomas (TMs) <0.85 mm thickness that are without high‐risk features may be treated with wide local excision (WLE).Primary melanomas evolve through three tumor progression steps. A typical melanocytes first proliferate above epidermal basement membrane, then invade the papillary dermis (invasive radial growth phase [RGP]), and subsequently develop the capacity to grow a tumor (vertical growth phase [VGP]). Following these histogenetic concepts, Roncati et al have classified TMs into three subtypes correlated with therapeutic implications: 1. Nontumorigenic microinvasive RGP TM, where the WLE is indicated: in fact, very small cellular nests (three or four cells) may be present distantly from the main lesion. These cells should be removed because they could develop the capacity to grow as a tumor (VGP). Anyway, the SLNB is not necessary, because the lesion is nontumorigenic itself; 2. Tumorigenic, early VGP, TM: the lesion is associated with a statistical chance for distant metastases: thus, both WLE and SLNB must be performed; and 3. Uncertain potentially tumorigenic TM, accompanied with a significant risk for metastases due to the presence of extensive regression which could contain a VGP clone. WLE and SLNB are recommended. By definition, the presence of mitoses is conclusive for early VGP TM displaying the capacity to develop metastases. Consequently, the SLNB should be always performed according to the histogenesis of the lesion. In conclusion, the guidelines to be followed for the management must be based only on the TM histogenetic classification.CONFLICTS OF INTERESTNone of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.AUTHORS’ CONTRIBURTIONSAll authors had full access to all the data in the study and the accuracy of the data analysis. TP contributed to the study concept and design, and drafted the article. FP contributed to the acquisition of data. All authors contributed to a critical revision of the article for important intellectual content, and they grave final approval of the version to be published.Teresa Pusiol MD, PhDFrancesco Piscioli MD, PhD1Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto (TN), ItalyCorrespondenceTeresa Pusiol, MD, PhD, Provincial Health Care Services, Istitute of Pathology, Santa Maria del Carmine Hospital, Rovereto (TN), Italy.Email teresa.pusiol@apss.tn.itREFERENCESDurham AB, Schwartz JL, Lowe L, et al. The natural history of thin melanoma and the utility of sentinel lymph node biopsy. J Surg Oncol. 2017;116:1185–1192.Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma of the skin. In: Amin BM, editor. (Editor in Chief) AJCC Cancer Staging Manual, Eight Edition. New York: Springer; 2016. pp. 563–585.Roncati L, Piscioli F, Pusiol T. The importance of mitotic rate reporting in primary cutaneous melanoma. J Surg Oncol. 2017;116:958–959.Roncati L, Piscioli F, Pusiol T. Surgical outcomes reflect the histological types of cutaneous malignant melanoma. J Eur Acad Dermatol Venereol. 2017;31:e279–e280.Roncati L, Piscioli F, Pusiol T. Current controversies on sentinel node biopsy in thin and thick cutaneous melanoma. Eur J Surg Oncol. 2017;43:506–507.Piscioli F, Pusiol T, Roncati L. Wisely choosing thin melanomas for sentinel lymph node biopsy. J Am Acad Dermatol. 2017;76:e25.Piscioli F, Pusiol T, Roncati L. Histopathological determination of thin melanomas at risk for metastasis. Melanoma Res. 2016;26:635.Piscioli F, Pusiol T, Roncati L. Higher predictive value of sentinel lymph node biopsy in patients with histological subcategoritation of thin melanoma. Int J Dermatol. 2017;56:e93–e94.Piscioli F, Pusiol T, Roncati L. Nowadays a histological sub‐typing of thin melanoma is demanded for a proper patient management. J Plast Reconstr Aesthet Surg. 2016;69:1563–1564. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Surgical Oncology Wiley

Management of thin melanoma

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© 2018 Wiley Periodicals, Inc.
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0022-4790
eISSN
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D.O.I.
10.1002/jso.24863
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Abstract

Durham et al performed a study on a cohort of 510 patients affected by 512 lesions with Breslow tickness comprised between 0.75 and 0.99 mm. Their aim was to establish a correct treatment choice for the mentioned lesions. The authors concluded that the sentinel lymph node biopsy (SLNB) should be considered for patients of 45 years or less, with a Breslow thickness ≥0.85 mm, rounded to 0.9 mm, according to the AJCC 8th Edition, a mitotic rate>1 mm, and/or lesion ulceration. Conversely, they reported that thin melanomas (TMs) <0.85 mm thickness that are without high‐risk features may be treated with wide local excision (WLE).Primary melanomas evolve through three tumor progression steps. A typical melanocytes first proliferate above epidermal basement membrane, then invade the papillary dermis (invasive radial growth phase [RGP]), and subsequently develop the capacity to grow a tumor (vertical growth phase [VGP]). Following these histogenetic concepts, Roncati et al have classified TMs into three subtypes correlated with therapeutic implications: 1. Nontumorigenic microinvasive RGP TM, where the WLE is indicated: in fact, very small cellular nests (three or four cells) may be present distantly from the main lesion. These cells should be removed because they could develop the capacity to grow as a tumor (VGP). Anyway, the SLNB is not necessary, because the lesion is nontumorigenic itself; 2. Tumorigenic, early VGP, TM: the lesion is associated with a statistical chance for distant metastases: thus, both WLE and SLNB must be performed; and 3. Uncertain potentially tumorigenic TM, accompanied with a significant risk for metastases due to the presence of extensive regression which could contain a VGP clone. WLE and SLNB are recommended. By definition, the presence of mitoses is conclusive for early VGP TM displaying the capacity to develop metastases. Consequently, the SLNB should be always performed according to the histogenesis of the lesion. In conclusion, the guidelines to be followed for the management must be based only on the TM histogenetic classification.CONFLICTS OF INTERESTNone of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.AUTHORS’ CONTRIBURTIONSAll authors had full access to all the data in the study and the accuracy of the data analysis. TP contributed to the study concept and design, and drafted the article. FP contributed to the acquisition of data. All authors contributed to a critical revision of the article for important intellectual content, and they grave final approval of the version to be published.Teresa Pusiol MD, PhDFrancesco Piscioli MD, PhD1Provincial Health Care Services, Institute of Pathology, Santa Maria del Carmine Hospital, Rovereto (TN), ItalyCorrespondenceTeresa Pusiol, MD, PhD, Provincial Health Care Services, Istitute of Pathology, Santa Maria del Carmine Hospital, Rovereto (TN), Italy.Email teresa.pusiol@apss.tn.itREFERENCESDurham AB, Schwartz JL, Lowe L, et al. The natural history of thin melanoma and the utility of sentinel lymph node biopsy. J Surg Oncol. 2017;116:1185–1192.Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma of the skin. In: Amin BM, editor. (Editor in Chief) AJCC Cancer Staging Manual, Eight Edition. New York: Springer; 2016. pp. 563–585.Roncati L, Piscioli F, Pusiol T. The importance of mitotic rate reporting in primary cutaneous melanoma. J Surg Oncol. 2017;116:958–959.Roncati L, Piscioli F, Pusiol T. Surgical outcomes reflect the histological types of cutaneous malignant melanoma. J Eur Acad Dermatol Venereol. 2017;31:e279–e280.Roncati L, Piscioli F, Pusiol T. Current controversies on sentinel node biopsy in thin and thick cutaneous melanoma. Eur J Surg Oncol. 2017;43:506–507.Piscioli F, Pusiol T, Roncati L. Wisely choosing thin melanomas for sentinel lymph node biopsy. J Am Acad Dermatol. 2017;76:e25.Piscioli F, Pusiol T, Roncati L. Histopathological determination of thin melanomas at risk for metastasis. Melanoma Res. 2016;26:635.Piscioli F, Pusiol T, Roncati L. Higher predictive value of sentinel lymph node biopsy in patients with histological subcategoritation of thin melanoma. Int J Dermatol. 2017;56:e93–e94.Piscioli F, Pusiol T, Roncati L. Nowadays a histological sub‐typing of thin melanoma is demanded for a proper patient management. J Plast Reconstr Aesthet Surg. 2016;69:1563–1564.

Journal

Journal of Surgical OncologyWiley

Published: Jan 1, 2018

References

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