PHILADELPHIA--Lymphocytes are known to infiltrate melanoma lesions at the primary site, occasionally resulting in spontaneous regressions. Therefore, investigators in search of specific treatments for metastatic melanoma have turned to immunologic approaches, John Kirkwood, MD, said at the 12th Annual Toward 2000 Symposium at Fox Chase Cancer Center.
Treatment with Mohs micrographic surgery produces cure rates of 93% to 99% for the most common skin cancers, basal cell carcinomas and squamous cell carcinomas, Perry Robins, md, reported in The 1996 Skin Cancer Foundation Journal.
A controversial treatment for melanoma, elective lymph node dissection (ELND), has again been shown to provide important prognostic information, according to a study presented at the 65th Annual Meeting of the American Society of Plastic and Reconstructive Surgeons (ASPRS) held in Dallas, Texas. Although the retrospective study did not demonstrate that ELND makes a difference in patient survival, it indicated that the information gained from the removal and testing of the lymph nodes could be crucial in predicting the patient's prognosis.
The role of elective lymph node dissection in the treatment of patients with early-stage melanoma remains controversial. Some surgeons advocate the routine use of elective node dissection in patients with intermediate-thickness primary tumors, but the cost, morbidity, and low yield of tumor-positive lymph nodes associated with this approach make it less appealing than wide excision and observation. Multiple retrospective studies suggest a survival advantage as high as 25% for patients undergoing elective node dissection in the setting of clinically negative nodes, as opposed to delayed node dissection for clinically evident nodal metastases. Although two randomized prospective studies failed to demonstrate a survival advantage in patients undergoing elective node dissection, as compared with those having wide excision alone, both studies were criticized for their design [1,2].
Drs. North and Spellman concisely review the role of sentinel node biopsy in the management of patients with malignant melanoma and provide an excellent summary of the current state of this technique. A number of comments should be made about this review. These comments relate to (1) the technical aspects of the procedure and (2) its clinical indications.
The use of elective lymph node dissection for intermediate-thickness melanoma has remained controversial. The technique of sentinel node biopsy (intraoperative lymphatic mapping and selective lymphadenectomy) has been
BETHESDA, Md--Research supported by the National Institutes of Health and the National Cancer Institute has led to discovery of a tumor-suppressor gene involved in basal cell carcinoma.
Dr. Trimble's review of female genital tract melanomas provides a well-organized summary of the published information on these rare cancers. His inclusion of the two recent population-based samples from the United States and Sweden [1,2] is particularly useful because all of the available data on genital tract melanomas comes from long-term retrospective case reviews. The cited incidence rates calculated in the studies represent the first legitimate estimates of the incidence of these uncommon cancers.
Melanomas of the vulva and vagina comprise less than 2% of melanomas in women. Although their biologic behavior appears to be similar to that of cutaneous melanoma, vulvar and vaginal melanomas appear to have a
WASHINGTON--Final approval by the National Cancer Institute of the largest ever melanoma vaccine trial is near, John M. Kirkwood, MD, of the University of Pittsburgh, said at the American Association for Cancer Research (AACR) meeting. "I think before the summer is through, we should see this trial initiated," added Dr. Kirkwood, principal investigator for the study.
ASCO--A randomized ECOG study of patients with high-risk melanoma showed significant gains in overall and recurrence free survival for adjuvant high-dose interferon alfa-2b (Intron), but also showed that the high-dose regimen has significant side effects. However, a new quality of life analysis suggests that, for most patients, the benefits of interferon clearly offset its toxicity, Bernard Cole, PhD, of Brown University, said at an ASCO scientific session.
DURHAM, NC--A researcher at Duke Comprehensive Cancer Center has pioneered the use of CD-ROM technology to preserve a photographic record of the skin and to detect the earliest signs of melanoma.
Approximately three-fourths of all skin cancer-associated deaths are caused by melanoma. During 1973 to 1991, the incidence of melanoma increased approximately 4% each year. In addition, the incidence of melanoma is increasing faster than that of any other cancer. To characterize the distribution of deaths from melanoma in the United States, the CDC analyzed national mortality data for 1973 through 1992. This report by the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, summarizes the results of that analysis.
MADISON, NJ--Schering-Plough Corporation's Intron A for Injection (interferon alfa-2b, recombinant) has received FDA clearance for a new indication as adjuvant treatment to surgery in malignant melanoma patients at high risk for systemic recurrence.
University of Pittsburgh Cancer Institute (UPCI) investigators have begun vaccinating people with advanced melanoma using molecules that are overexpressed in melanoma cells.
BUENOS AIRES--The techniques of lymphatic mapping, sentinel lymph node biopsy, and polymerase chain reaction (PCR) determination of occult metastases promise to provide a more accurate staging of the melanoma patient with more conservative surgery. This could save the health-care industry dollars and save patients the morbidity and expense of complete node dissection, Douglas Reintgen, MD, said at the Sixth World Congress on Cancers of the Skin.
BUENOS AIRES--The surgical care of the melanoma patient is in flux because of new data showing that complete nodal staging can be obtained with the technique of lymphatic mapping and sentinel lymph node biopsy, said speakers at a plenary session at the Sixth World Congress on Cancers of the Skin.
BUENOS AIRES-Ultraviolet (UV) radiation contributes to skin cancer induction not only by transforming normal cells to cancer cells but also by impairing the host immune response to skin cancer, said Daniel Yarosh, PhD, president of Applied Genetics, Inc., Freeport, NY.
The history of systemic treatments for advanced cutaneous melanoma, which is reviewed thoroughly in the paper by Anderson et al, can best be characterized as a series of unrealized hopes.
The treatment of advanced cutaneous melanoma remains disappointing. Single-agent cytotoxic drugs usually produce response rates of less than 20%, though newer agents, particularly fotemustine and temozolomide, show some promise, especially in patients with brain metastases.
Anderson and colleagues present a comprehensive and factually accurate overview of systemic treatment for advanced melanoma. They correctly identify dacarbazine as the only single agent officially sanctioned for the treatment of metastatic melanoma. They further opine that "dacarbazine alone remains the standard of care for initial chemotherapy treatment of metastatic melanoma." With overall response rates of 10% to 20%, a complete response rate of less than 4%, and no evidence that treatment with dacarbazine improves survival over best palliative care, one questions whether or not dacarbazine would merit approval if reevaluated today.
Researchers at the John Wayne Cancer Institute at Saint John's Hospital in Los Angeles are studying a new blood test that
NEW YORK--Sunscreens represent the first line of defense against skin damage from the sun, and broad-spectrum products offer the best protection, Madhukar A. Pathak, MB, PhD, said at a media conference sponsored by the Skin Cancer Foundation.
NEW YORK--If the face is the area of the body most vulnerable to sun damage, the eyes are in need of special protection, Rene S. Rodriguez-Sains, MD, said at a media conference sponsored by the Skin Cancer Foundation. Malignancies of the eyes and periocular area are particularly serious because of their proximity to the brain and other vital structures, he said.
NEW YORK--A mollusk protein turned out to be the best carrier for a cancer vaccine being developed by Philip O. Livingston, MD, at Memorial Sloan-Kettering Cancer Center. This approach to augmenting the immunogenicity of the GM2 ganglioside tumor antigen is about to be tested in phase III randomized trials of melanoma patients who are free of detectable disease after surgery but are at high risk for recurrence.
