Summarize the epidemiology of malignant melanoma

Describe the current challenges of accurately diagnosing and predicting the behavior of malignant melanoma

Evaluate current and emerging data surrounding outcomes using these technologies

Outline current guideline recommendations regarding the implementation of these GEP technologies

Advances in Diagnostic and Prognostic Testing in Cutaneous Melanoma: Online CME Activity

Cutaneous Melanoma

WEDNESDAY, March 26, 2025 (HealthDay News) -- Factors associated with advanced presentation of melanoma include age, gender, race/ethnicity, geographical location, and socioeconomic factors, according to a study published in the March issue of SKIN.Kennedy A. Sabharwal, from the University of Kentucky College of Medicine in Lexington, and colleagues examined risk factors associated with advanced presentation of melanoma in the United States. Stage III and IV melanomas were identified in the National Cancer Database from 2004 to 2015.A total of 477,914 patients met the inclusion criteria; 13.2 percent presented with an advanced stage. The researchers found that lower income, non-Hispanic White race, Medicaid/uninsured, greater distance to treatment centers, male gender, younger age, more medical comorbidities, and Southeast U.S. location were factors associated with advanced presentation, and associations were significant in a multivariate analysis."Patients, medical providers, epidemiologists, and government organizations should be aware of the factors associated with advanced presentations of melanoma," the authors write. "Ultimately, patients and providers stand to benefit, always with the goal for reduced time to diagnosis and treatment and decreased mortality for this curable disease."

Factors include lower income, non-Hispanic White race, Medicaid/uninsured, greater distance to treatment centers

Study IDs Factors Linked to Advanced Melanoma Presentation

FRIDAY, Dec. 13, 2024 (HealthDay News) -- Risk of 20-year melanoma-related death increases significantly for patients with primary tumors of 0.8 to 1.0 mm in thickness, according to a study published online Dec. 11 in JAMA Dermatology.Serigne N. Lo, Ph.D., from the University of Sydney, and colleagues assessed the relative effect of a 0.8-mm Breslow thickness threshold with respect to the incidence of both melanoma-related and nonmelanoma-related death. Analysis included registry data for 144,447 individuals diagnosed with thin invasive primary melanomas between 1982 and 2014.The researchers found that crude incidence rates of melanoma-related death 20 years after diagnosis were 6.3 percent for the whole cohort, 6.0 percent for tumors &lt;0.8 mm, and 12.0 percent for tumors 0.8 to 1.0 mm. The corresponding 20-year melanoma-specific survival rates were 91.9 percent overall and 94.2 and 87.8 percent, respectively, across tumor sizes. Tumor thickness of 0.8 to 1.0 mm was significantly associated with both a greater absolute risk of melanoma-related death (subdistribution hazard ratio, 2.92), as well as a greater rate of melanoma-related death (hazard ratio, 2.98), compared to thinner tumors (&lt;0.8 mm). There was no association seen between risk of death from nonmelanoma-related causes and Breslow thickness. "The findings of this large-scale population-based analysis suggest the separation of risk for patients with melanomas with a Breslow thickness above and below 0.8 mm," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2827348">Abstract/Full Text (subscription or payment may be required)</a>

Findings for primary tumors of 0.8 to 1.0 mm versus those &lt;0.8 mm

Thicker Melanoma Tumor Size Tied to Higher Risk of 20-Year Melanoma-Related Death

WEDNESDAY, Dec. 18, 2024 -- Patients who undergo blood or marrow transplant (BMT) have an increased risk for subsequent cutaneous malignant neoplasms, according to a study published online Dec. 18 in JAMA Dermatology.Kristy K. Broman, M.D., M.P.H., from the University of Alabama at Birmingham, and colleagues conducted a retrospective cohort study involving patients who underwent treatment at City of Hope, University of Minnesota, or University of Alabama at Birmingham from 1974 to 2014 and survived two years or longer and a comparison cohort of siblings to identify risk factors for subsequent cutaneous malignant neoplasms after BMT.The researchers found that among the 3,880 BMT survivors followed for a median of 9.5 years, 605 developed 778 distinct cutaneous neoplasms. For any cutaneous malignant neoplasm, the 30-year cumulative incidence was 27.4 percent. Compared with siblings, BMT survivors had considerably higher 70-year cumulative probabilities of basal cell carcinoma (18.1 versus 8.2 percent), squamous cell carcinoma (14.7 versus 4.2 percent), and melanoma (4.2 versus 2.4 percent). Among BMT survivors, age 50 years and older at BMT, male sex, pre-BMT monoclonal antibody exposure, allogeneic BMT with chronic graft-versus-host disease, post-BMT immunosuppression, and transplant at City of Hope were included as risk factors for subsequent cutaneous malignant neoplasms. Race and ethnicity other than non-Hispanic White were protective for basal and squamous cell carcinomas. Among those younger than 50 years at BMT, total body irradiation was associated with basal cell carcinoma risk. "These findings could inform targeted surveillance of BMT survivors," the authors write.

Risk factors for subsequent neoplasm risk include age 50 years and older at BMT, male sex, post-BMT immunosuppression

Cutaneous Malignant Neoplasm Risk Elevated After Blood or Marrow Transplant

WEDNESDAY, Dec. 4, 2024 -- Tumor upstaging occurs in 9.4 percent of cases of invasive melanoma and is associated with higher overall and melanoma-specific mortality, according to a study published online Nov. 21 in the Journal of the American Academy of Dermatology.Amanda Rosenthal, M.D., from the Kaiser Permanente Los Angeles Medical Center, and colleagues examined the frequency of tumor upstaging in invasive melanoma in a retrospective study using data from a statewide Surveillance Endpoints and End Results-affiliated cancer registry between 2014 and 2018. Factors associated with upstaging and overall/melanoma-specific mortality were assessed. The researchers found that 9.4 percent of 4,391 cases of invasive melanoma were upstaged. In a univariate analysis, significant risk factors included older age, male sex, non-White race, head/neck location, larger clinical size, incisional and/or punch biopsy method, and increasing time between biopsy and surgical excision. In a multivariable analysis, significant risk factors included head/neck location and higher pathologic T stage. In more than half of cases, tumor upstaging dictated a change in clinical management; only 37.4 percent fulfilled the recommendation for additional treatment. Higher overall (36.0 versus 19.5 percent) and melanoma-specific (9.0 versus 2.9 percent) mortality were seen for upstaged melanomas compared with nonupstaged tumors."Our study highlights the significant clinical and prognostic implications of melanoma upstaging, particularly as it relates to surgical management, postoperative care, and patient outcomes," the authors write. "The 9.4 percent upstaging rate observed in our cohort underscores the importance of obtaining an adequate initial biopsy when sampling lesions suspicious for melanoma."

Patients with upstaged tumors experience higher overall and melanoma-specific mortality than those with nonupstaged tumors &nbsp;

Tumor Upstaging Occurs in 9.4 Percent of Cases of Invasive Melanoma

TUESDAY, Nov. 26, 2024 (HealthDay News) -- Tumor characteristics differ significantly among pediatric and adolescent and young adult (AYA) patients with melanoma, with decreasing incidence rates seen among young patients with cutaneous melanoma, according to a study published online Nov. 15 in the Journal of the American Academy of Dermatology.Bianca E. Ituarte, from the University of Nebraska Medical Center in Omaha, and colleagues examined the incidence trends and melanoma presentations based on age, sex, race, and ethnicity using a large cohort of diagnoses from 1997 to 2020 in a retrospective cohort study completed using the National Childhood Cancer Registry for pediatric and AYA patients. The researchers found that for pediatric and AYA patients, the incidence rates were 1.74 and 62.05 per 1 million person-years, respectively. Overall, 62.3 percent of the cohort was female. Non-Hispanic White patients accounted for 87.5 percent of all diagnoses, with the incidence rates of melanoma significantly higher compared with all other racial and ethnic groups in pediatric and AYA patients. The most common of the specified histologic subtypes was superficial spreading. In pediatric patients, the most common location was the lower extremity compared with the trunk in AYA. In both pediatric and AYA groups, there were significant differences in the distributions of primary tumor location by sex and by race and ethnicity."While a melanoma diagnosis in this age group is rare, our data provide incidence rates by age, gender, race and ethnicity, and clinical presentation patterns that can help the clinician understand individuals who may be at risk," the authors write.One author disclosed ties to Castle Biosciences.<a target="_blank" rel="noopener noreferrer" href="https://Abstract/Full Text (subscription or payment may be required)">Abstract/Full Text (subscription or payment may be required)</a>

Significant differences seen in distributions of primary tumor location by sex, race/ethnicity for pediatric, AYA groups &nbsp;

Characteristics Differ for Melanomas in Children, Teens, Young Adults

WEDNESDAY, Nov. 20, 2024 -- There was an increase in the incidence of thicker melanomas among women older than 50 years during the COVID-19 pandemic, according to a research letter published online Nov. 16 in the Journal of the American Academy of Dermatology.Areeba Ahmed, M.D., from the Feinberg School of Medicine at Northwestern University in Chicago, and colleagues examined the influence of the pandemic on skin cancer incidence in a retrospective analysis of data from the Icelandic Cancer Registry. The sex- and age-standardized incidence rates per 100,000 person-years were calculated for basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma from 2016 to 2022.The researchers found that in the overall population, the incidence hierarchy was BBC &gt; SCC &gt; melanoma (78.50, 33.45, and 10.45 per 100,000 person-years, respectively). Across all cancer types, incidence rates for women consistently exceeded those for men; individuals aged 50 years and older had higher rates than younger populations. The relative incidence shifted to BCC &gt; melanoma &gt; SCC for women aged 50 years and younger (23.02, 5.39, and 3.59 per 100,000 person-years, respectively), while rates increased significantly for BCC and SCC, overtaking melanoma, in women older than 50 years (65.73, 33.30, and 6.88 per 100,000 person-years, respectively). During the pandemic years, melanoma incidence decreased significantly among women older than 50 years, followed by a rebound in 2021, accompanied by an increase in the incidence of melanoma &gt;1 mm in thickness (annual percentage change, 8.61)."While discussions about overdiagnosis in melanoma remain relevant, our findings suggest that reduced dermatology access may possibly lead to a downstream increase of thicker melanomas," the authors write.

Authors suggest reduced dermatology access led to a 'downstream increase of thicker melanoma'

Uptick Seen in Thicker Melanomas Among Women Older Than 50 During Pandemic 

THURSDAY, Nov. 7, 2024 (HealthDay News) -- From 1987 to 2016, there was a considerable increase in the incidence of cutaneous malignant melanoma (CMM) among the elderly in the United States, according to a study published online Oct. 28 in Cancer Screening and Prevention.Ruofei Du, Ph.D., from Shaanxi University of Chinese Medicine in Xianyang, and colleagues examined CMM incidence trends in the elderly U.S. population from 1987 to 2016 using data from the Surveillance, Epidemiology, and End Results database. The annual percent change was estimated, and trends in CMM incidence were analyzed.The study included 56,997 elderly CMM patients from eight Surveillance, Epidemiology, and End Results registries; 64.4 percent were men. The researchers found that from 2012 to 2016, the age-adjusted CMM incidence rate was 0.99 per 1,000, which marked a 2.8-fold increase from 1987 to 1991. With age and birth cohort, there was an increase in incidence rates, peaking at 1.53 and 0.59 per 1,000 men and women aged 85 years or older, respectively, during 2012 to 2016. A continuous increase was also seen in birth cohort effects."CMM remains a significant health concern, especially among older adults, necessitating continued efforts in prevention, early diagnosis, and research into targeted interventions," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.xiahepublishing.com/2835-3315/CSP-2024-00019">Abstract/Full Text</a>

Age-adjusted CMM incidence rate was 0.99 per 1,000 from 2012 to 2016, marking an increase from previous years

Cutaneous Malignant Melanoma Incidence Increasing Among the Elderly

WEDNESDAY, Oct. 30, 2024 -- A health care system employing filtering functions before biopsy of skin lesions can achieve a low benign-to-malignant ratio (BMR), according to a study published online Oct. 12 in the Journal of the European Academy of Dermatology &amp; Venereology.Gustav G. Nervil, from Copenhagen University Hospital in Denmark, and colleagues examined the number and costs of skin biopsies in Denmark over 15 years, focusing on benign and malignant skin lesions and melanomas. The BMR and number needed to biopsy (NNB) were determined, and the direct cost of benign skin lesion biopsies was estimated in the Cancer Pathway.A total of 4,481,207 biopsy samples were included from January 2007 to June 2022 from the Danish Pathology Data Bank; 151,988 of these from the Cancer Pathway were included in the primary analysis of BMR. The researchers found that from 2007 to 2021, there was a 39.1 percent increase in the number of biopsies. The overall BMR was 4.1:1 for malignancy, and NNB was 31.8 for melanoma. Among biopsies performed on clinical suspicion of malignancy or melanoma, the BMR was 1.5:1 and NNB was 2.8. In 2021, the cost of benign skin biopsies performed on suspicion of cancer or melanoma was €6.6 million, mainly in hospitals."A health care system that employs easy and swift access to filtering functions before biopsy of skin lesions can achieve a BMR as low as 1.5:1, NNB of 2.8, and an underdiagnosis rate of 1 in 161, but it carries a heavy toll on the public health care system," the authors write.

<div class="text-story-m_header-details__3D-Xf" style="-webkit-text-stroke-width:0px;box-sizing:border-box;color:rgb(51, 51, 51);font-family:Lato, -apple-system, BlinkMacSystemFont, &quot;Segoe UI&quot;, Roboto, Oxygen, Ubuntu, Cantarell, &quot;Fira Sans&quot;, &quot;Droid Sans&quot;, &quot;Helvetica Neue&quot;, sans-serif;font-size:16px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:400;grid-column:2 / 10;letter-spacing:normal;margin:var(--arrow-fs-huge) 0;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;"><div class="p-alt arr--sub-headline arrow-component subheadline-m_subheadline__3fd7z subheadline-m_dark__28u00" style="-webkit-box-orient:vertical;-webkit-font-smoothing:antialiased;-webkit-line-clamp:none;box-sizing:border-box;color:var(--arrow-c-mono4);display:-webkit-box;font-family:var(--arrow-typeface-primary);font-size:var(--arrow-fs-m);font-stretch:normal;font-weight:400;letter-spacing:normal;line-height:var(--arrow-lh-5);margin-bottom:var(--arrow-spacing-xs);overflow:hidden;padding-right:2px;text-rendering:optimizelegibility;" data-test-id="subheadline">Health care system in Denmark employing filtering function before biopsy achieved low benign-to-malignant ratio over 15 years, but at high cost</div></div>

Using Filtering Function Before Skin Biopsy Can Reduce Benign-to-Malignant Ratio

WEDNESDAY, Oct. 9, 2024 (HealthDay News) -- Patients with a first melanoma diagnosis have an increased risk for a second melanoma diagnosis, regardless of race and ethnicity, according to a research letter published online Oct. 9 in JAMA Dermatology.Shoshana Zhang, from Dell Medical School at the University of Texas at Austin, and colleagues examined the absolute risk of second primary melanoma across race and ethnicity using data from patients with a first primary cutaneous melanoma diagnosis from 2000 to 2019 identified from 17 Surveillance, Epidemiology, and End Results registries.A total of 546,756 patients with first primary diagnosis were identified: 0.2, 0.6, 0.4, 3.1, and 96 percent had American Indian or Alaska Native, Asian or Pacific Islander, Black, Hispanic, and White race and ethnicity, respectively. The researchers found that White patients had the highest absolute incidence of first and second primary melanoma (47.67 per 100,000 people and 1,457.40 per 100,000 person-years, respectively); under null and alternative hypotheses, the incidence rate of two primary melanomas was higher for Whites. Black patients had the highest relative risk of second primary melanoma compared with the general population, followed by Asian or Pacific Islander, Hispanic, American Indian or Alaska Native, and White patients (standardized incidence ratios, 264.39, 196.68, 62.71, 48.47, and 11.63, respectively). The highest absolute numbers of excess second primary melanomas per 100,000 person years was seen for White patients (1,332.07)."While we found elevated relative risks of second primary melanoma among racial and ethnic minority groups versus the general population, measures of absolute risk were far less substantial, illustrating that reporting only relative measures, as done previously, is potentially misleading," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2824564">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2824565">Editor's Note (subscription or payment may be required)</a>

Melanoma less common among racial and ethnic minorities, but they still have increased rate of second primary melanoma

Risk for Second Melanoma Up for Those With First Melanoma Diagnosis

WEDNESDAY, Oct. 16, 2024 -- Remote cutaneous confocal microscopy (CCM) has good diagnostic accuracy and can reduce the number of unnecessary biopsies, according to a study published online Oct. 8 in the Journal of the American Academy of Dermatology.Genevieve Ho, M.D., from University of Sydney, and colleagues examined the diagnostic accuracy and safety of a "store and forward" approach for remote-CCM in a prospective study involving lesions selected for biopsy for skin malignancy across five Australian tertiary dermatology centers. CCM, clinical, and dermoscopy images were acquired before biopsy and accessed for interpretation by CCM readers. Diagnosis with CCM was compared to results from histopathology.The researchers found that melanoma was the most common malignancy of the 201 lesions included (47.2 percent). Overall, 90 percent of the 89 lesions potentially "saved" from biopsy (44.8 percent) were truly benign lesions and 10.1 percent were missed malignant lesions of melanoma in situ and squamous cell carcinoma (seven and two patients, respectively). No invasive melanomas were missed. For detection of malignancy, sensitivity and specificity of remote-CCM were 89 and 64 percent, respectively."This study provides reliable estimates of diagnostic accuracy for remote CCM, particularly in high-risk settings. Remote-CCM can reduce the number of unnecessary biopsies by up to 40 percent whilst safely identifying and managing invasive melanomas," the authors write.Several authors disclosed ties to the pharmaceutical and dermatology industries.

Sensitivity of remote CCM was 89 percent, specificity was 64 percent for detection of malignancy&nbsp;

Remote Cutaneous Confocal Microscopy Has Good Diagnostic Accuracy for Skin Malignancy

THURSDAY, Sept. 19, 2024 (HealthDay News) -- For patients with advanced melanoma, there is a survival benefit for nivolumab plus ipilimumab and for nivolumab monotherapy compared with ipilimumab monotherapy, according to a study published online Sept. 15 in the New England Journal of Medicine to coincide with the annual meeting of the European Society for Medical Oncology, held from Sept. 13 to 17 in Barcelona, Spain.Jedd D. Wolchok, M.D., Ph.D., from the Sandra and Edward Meyer Cancer Center in New York City, and colleagues randomly assigned patients with previously untreated melanoma to receive nivolumab plus ipilimumab every three weeks for four doses followed by nivolumab every two weeks; nivolumab every two weeks plus placebo; or ipilimumab every three weeks for four doses plus placebo in a 1:1:1 ratio.The researchers found that median overall survival was 71.9, 36.9, and 19.9 months with nivolumab plus ipilimumab, nivolumab, and ipilimumab, respectively, with a minimum follow-up of 10 years. The hazard ratio for death was 0.53 and 0.63 for nivolumab plus ipilimumab and for nivolumab versus ipilimumab, respectively. Median melanoma-specific survival was &gt;120, 49.4, and 21.9 months with nivolumab plus ipilimumab, nivolumab, and ipilimumab, respectively. For patients alive and progression-free at three years, 10-year melanoma-specific survival was 96, 97, and 88 percent with nivolumab plus ipilimumab, nivolumab, and ipilimumab, respectively."These 10-year data underscore how immune checkpoint inhibitor therapy has helped to change the long-term prognosis for patients with advanced melanoma and highlight the potential for a cure in patients who have a response to this type of treatment," the authors write.Several authors disclosed ties to biopharmaceutical companies, including Bristol Myers Squibb, which manufactures nivolumab and funded the study.<a target="_blank" rel="noopener noreferrer" href="https://www.nejm.org/doi/full/10.1056/NEJMoa2407417">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://www.esmo.org/meeting-calendar/esmo-congress-2024">More Information</a>

Continued survival benefit seen for nivolumab plus ipilimumab and for nivolumab monotherapy versus ipilimumab monotherapy

Long-Term Survival Benefit Seen for Nivolumab in Advanced Melanoma

TUESDAY, Sept. 17, 2024 (HealthDay News) -- Melanoma rates differ for men and women, including in terms of ages of occurrence and locations of melanoma, according to a study published online June 17 in the Journal of Investigative Dermatology.Catherine M. Olsen, Ph.D., from the QIMR Berghofer Medical Research Institute in Brisbane, Australia, and colleagues analyzed long-term melanoma data (1982 to 2018) in three populations residing at high-, moderate-, and low-ambient sun exposures. Trends in the male-to-female incidence rate ratio (IRR) were compared by site and sex using age-period-cohort models.The researchers found that the incidence of melanoma was always highest on the trunk in men, while in women, incidence was historically highest on limbs, but recent increases in truncal melanoma were seen. In all populations, the IRR showed excess melanoma in women on the lower limb in most age groups. In contrast, a male excess of melanoma was seen on the trunk and head/neck (from about age 25 years and from about age 40 years, respectively), which increased with age. Among recent birth cohorts, turning points in incidence from high to low incidence were identified, with differences seen by population and site."These analyses of trends in melanoma incidence by body site reveal consistent patterns compatible with changing patterns of sun exposure together with some innate differences in site-specific susceptibility between the sexes," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://www.jidonline.org/article/S0022-202X(24)01500-8/fulltext">Abstract/Full Text</a>

Melanoma incidence highest on trunk in men; incidence historically highest on limbs in women, but recent increases seen in truncal melanoma

Study Looks at Sex Differences in Melanoma Incidence

WEDNESDAY, Sept. 18, 2024 -- Cutaneous head and neck melanoma (CHNM) has a distinct clinicopathological and prognostic profile relative to cutaneous melanomas of other sites (CMOS), according to a study published online Sept. 5 in the Journal of the American Academy of Dermatology.Andrew T. Li, M.B.B.S., from the Melanoma Institute Australia at The University of Sydney, and colleagues compared clinicopathological features and treatment outcomes of CHNM and CMOS among patients diagnosed between 2000 and 2008. Using the Kaplan-Meier method, locoregional control (LRC), distant metastasis-free survival (DMFS), melanoma-specific survival (MSS), and overall survival (OS) were described.The analyses included 3,007 CHNM patients and 10,637 CMOS patients. The researchers found that CHNM had more adverse pathological features than CMOS (median age, 65.9 versus 58.5 years; median Breslow thickness, 1.7 versus 1.2 mm; ulceration: 21.2 versus 18.2 percent). Worse LRC and DMFS were seen for CHNM (hazard ratios, 1.17 and 1.25, respectively), but no significant differences were seen in MSS or OS. In multivariable analyses, better MSS and OS were seen for CHNM among stage IV patients who received immune checkpoint inhibitors (hazard ratios, 0.56 and 0.57, respectively)."There are likely to be biological differences between CHNM and CMOS," the authors write. "Primary melanoma site should be considered in the multidisciplinary decision-making process when deciding whether to recommend immune checkpoint inhibitor therapy."Several authors disclosed ties to the pharmaceutical industry.

Worse locoregional control, distant metastasis-free survival seen for CHNM versus cutaneous melanoma of other sites

Cutaneous Head, Neck Melanoma Has Distinct Clinicopathological Profile

WEDNESDAY, Sept. 4, 2024 -- Veterans have higher prevalence and odds of skin cancer and melanoma, as well as psoriasis, compared with nonveterans, according to a study published online Sept. 4 in JAMA Dermatology.Shawheen J. Rezaei, from the Stanford University School of Medicine in California, and colleagues conducted a population-based cross-sectional study using nationally representative data from the National Health and Nutrition Examination Survey to compare the prevalence and odds of dermatologic conditions between veterans and nonveterans. Data were included for 61,307 participants: 54,554 nonveterans and 6,753 veterans.The researchers found that compared with nonveterans, veterans had a higher prevalence of any skin cancer history (9.0 versus 2.9 percent), as well as a higher prevalence of melanoma history (2.2 versus 0.6 percent). Veterans had higher odds of any skin cancer history and melanoma history compared with nonveterans (odds ratios, 1.72 and 2.27, respectively) after adjustment for demographic factors. Compared with nonveterans, veterans had a higher prevalence of a psoriasis diagnosis (4.5 versus 2.9 percent) and higher odds of a psoriasis diagnosis (odds ratio, 1.61)."Our findings contribute to evidence indicating greater risk of skin cancers among veterans using a single, population-based data source," the authors write. "Public health measures seeking to address veteran health care differences could emphasize primary preventive strategies to mitigate risk and early detection of dermatologic conditions through regular skin examinations."

Prevalence and odds of any skin cancer, melanoma, and psoriasis diagnosis higher compared with nonveterans

Prevalence, Odds of Skin Cancer, Melanoma Increased for Veterans

MONDAY, Aug. 12, 2024 (HealthDay News) -- A gene expression signature in peripheral CD4+ T-cells can predict severe immune-related adverse events (irAEs) among melanoma patients treated with ipilimumab/nivolumab, according to a study published online Aug. 8 in Clinical Cancer Research.Kelsey R. Monson, Ph.D., from the Perlmutter Cancer Center at NYU Langone Health in New York City, and colleagues examined postsurgical, pre-immune checkpoint inhibitor treatment peripheral CD4+ and CD8+ T-cells from melanoma patients in a clinical trial (CheckMate-915) treated with adjuvant nivolumab (130 patients) or ipilimumab/nivolumab (COMBO; 82 patients). Baseline differences associated with severe (grade 3 to 5) irAEs were tested and a predictive model was constructed.The researchers found significant enrichment of the spleen tyrosine kinase (SYK) pathway in peripheral CD4+ cells, which was associated with severe irAEs in COMBO-treated patients. Severe irAE COMBO patients were predicted by this gene-expression signature with 73 percent accuracy, independent of disease recurrence. The irAE predictive model that incorporated this gene-expression signature had 82 percent accuracy."Predictive information of this kind is critically important to oncologists and patients to help guide their immunotherapy decisions, to either minimize these side effects by taking additional precautions or choose alternative immunotherapies," Monson said in a statement.Several authors disclosed ties to the biopharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://aacrjournals.org/clincancerres/article-abstract/doi/10.1158/1078-0432.CCR-24-0900/746832/Tyrosine-protein-kinase-SYK-related-gene-signature">Abstract/Full Text (subscription or payment may be required)</a>

Gene expression signature predicts irAEs in melanoma patients treated with ipilimumab/nivolumab

Gene Expression Signature Predicts Immune-Related Adverse Events in Melanoma Patients

WEDNESDAY, July 10, 2024 -- Primary and relapsed cutaneous melanoma (CM) have distinct patterns of recurrence, according to a study published online July 8 in the International Journal of Cancer.Sebastian A. Wohlfeil, M.D., from Heidelberg University in Mannheim, Germany, and colleagues extracted data for patients with primary or relapsed CM (1,033 and 350, respectively) who received adjuvant therapies with nivolumab (N), pembrolizumab (P), or dabrafenib and trametinib (D + T) to examine whether adjuvant treatments influence patterns of recurrence. Progression-free survival (PFS), distant metastasis-free survival (DMFS), organ-specific DMFS, and overall survival (OS) were examined as end points.The researchers found that D + T indicated an improved PFS compared with P or N for primary cases (one-year PFS: 90.9 percent versus 81.0 and 83.8 percent, respectively; two-year PFS: 82.7 percent versus 73.9 and 75.2 percent, respectively). Significantly lower PFS and reduced DMFS were seen with immune checkpoint inhibitor (ICI) treatment instead of D + T for BRAF-mutated (mut) CM. NRAS-mut CM tended to perform worse than wild-type CM with ICI treatment; similar OS was seen between the groups. Compared with primary cases, relapsed cases showed reduced PFS, DMFS, and OS; no significant differences were seen between the subgroups. Increased recurrence was seen in primary and relapsed cases in NRAS-mut CM."These data show that adjuvant targeted therapy is superior to ICI in primary, BRAF-mut CM," the authors write. "Besides, NRAS-mut CM should be carefully monitored during adjuvant therapy, since these demonstrated increased melanoma recurrence in both primary and relapsed cases."Several authors disclosed financial ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1002/ijc.35078">Abstract/Full Text (subscription or payment may be required)</a>

Significantly lower progression-free survival, reduced distant metastasis-free survival seen for BRAF-mutated CM with immune checkpoint inhibitor

Distinct Recurrence Patterns Seen for Primary, Relapsed Cutaneous Melanoma

<div class="raw-html-embed">
 <mux-player playback-id="hicr6ZTHTJpURslBCEFjt01kR4nnp02eWL7g3fEoQb21E" env-key="ENV_KEY" metadata-video-title="Melanoma Monday: Transforming Lives Through Early Detection and Prevention" "=""></mux-player> 
</div>Dr Darrell Rigel, Dermsquared Senior Clinical Advisor, shares an important message about Melanoma Monday and how dermatology professionals can use this day to educate and support patientsFor dermatologists, the first Monday in May holds particular significance—it's Melanoma Monday, a day established by the American Academy of Dermatology Association (AAD) as part of their skin cancer awareness program.&nbsp;Learn more about how Melanoma Monday plays a vital role in promoting public health and how dermatologists can educate their patients to help lower mortality and morbidity from this disease.&nbsp;Raise awareness&nbsp;Melanoma Monday calls attention to the risk of melanoma and the critical need for awareness. This day provides a platform to educate patients about the risks associated with UV radiation and the importance of early detection.&nbsp;Promote prevention&nbsp;Prevention is the greatest tool against melanoma. Melanoma Monday amplifies the message of sun safety practices, urging individuals to embrace habits such as sunscreen application, wearing protective clothing, and limiting sun exposure.&nbsp;By discussing these measures with patients, dermatologists can empower them to proactively mitigate their risk of melanoma development.&nbsp;Encourage early detection&nbsp;Early detection is paramount in treating melanoma. Melanoma Monday underscores the importance of regular skin examinations and prompt consultation with dermatology professionals for any suspicious lesions.&nbsp;By emphasizing the significance of vigilance and prompt action, dermatologists can improve the likelihood of successful treatment outcomes.&nbsp;Support research and resources&nbsp;Melanoma Monday supports fundraising efforts directed towards advancing research for developing improved treatment modalities, preventive strategies, and providing vital resources and support networks for individuals and families impacted by melanoma.

The first Monday in May is Melanoma Monday—explore its role in advancing public health and how dermatologists can spread its message to their patients

Melanoma Monday: Transforming Lives Through Early Detection and Prevention

WEDNESDAY, April 10, 2024 -- For patients with primary invasive cutaneous melanoma, adherence to annual dermatology visits is low, but greater adherence is associated with reduced melanoma-specific mortality, according to a study published online Feb. 16 in the Journal of the American Academy of Dermatology.Yuanshen Huang, M.D., Ph.D., from Queen's University in Kingston, Ontario, Canada, and colleagues examined the level of adherence to annual dermatologic follow-up in patients with melanoma in a retrospective inception cohort analysis involving adults with primary invasive cutaneous melanoma from 2010 to 2013. Patients were followed until Dec. 31, 2018 (median follow-up, 5.0 years).The researchers observed variable adherence to dermatologic follow-up, with 28.0 percent of patients seeing a dermatologist at least annually. Predictors for adherence included younger age, female sex, higher income, greater access to dermatology care, stage 2/3 melanoma, prior keratinocyte carcinoma, fewer comorbidities, and any outpatient visit in the 12 months before melanoma diagnosis. Compared with lower levels of adherence, greater adherence to annual dermatology visits was associated with reduced melanoma-specific mortality (adjusted hazard ratio, 0.64)."Patients, health care providers, and policy-makers should explore opportunities to improve adherence within the constraints of health care systems," the authors write. "Further research is needed to confirm a causal association, determine the optimal frequency of follow-up, and address barriers to adherence."Two authors disclosed ties to the biopharmaceutical industry.

Greater adherence to annual dermatology visits leads to reduced melanoma-specific mortality

Low Adherence to Follow-Up Seen for Primary Invasive Melanoma

WEDNESDAY, Dec. 27, 2023 -- The incidence of invasive cutaneous melanoma among non-Hispanic American Indian/Alaska Native individuals is 10.7 per 100,000, according to a study published online Dec. 27 in JAMA Dermatology.Julie S. Townsend, from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues examined invasive cutaneous melanoma incidence rates and trends over time among non-Hispanic American Indian/Alaska Native people in a descriptive, observational, cross-sectional study. Trends were examined from 1999 to 2019 by demographic and clinical characteristics, such as age, sex, geographic region, histology, stage, and tumor site.The researchers found that 2,151 non-Hispanic American Indian/Alaska Native people received a diagnosis of incident cutaneous melanoma from 1999 to 2019 (rate, 10.7 per 100,000). The rates were higher among male than female individuals (13.0 versus 9.2) and for those aged 55 years and older versus those aged 15 to 39 years (24.2 versus 3.5). The highest rates were seen for men aged 55 years and older (34.5), and for men and women living in the Southern Plains (23.8 and 15.5, respectively) and Pacific Coast region (16.5 and 12.3, respectively). From 1999 to 2019, rates increased among women, among regional/distant stage tumors, and for people aged 55 years and older (average annual percent changes, 2.5, 2.5, and 2.8, respectively)."We applaud Townsend et al for their careful demonstration that misclassification of race among American Indian/Alaska Native people potentially underreports the burden of disease in the population, especially late-stage melanomas," write the authors of an accompanying editorial.Several authors disclosed ties to the pharmaceutical industry.

Incidence rates higher among men than women and for those aged 55 years or older versus age 15 to 39 years

Study Looks at Incidence of Melanoma Among Indigenous Americans

WEDNESDAY, Dec. 20, 2023 -- A proposed blending ensemble-based deep learning model (BEDLM-CMS) can be used for early diagnosis of cutaneous melanoma, according to a study published online Dec. 14 in Scientific Reports.Noting that the accuracy of the state-of-the-art computer-aided diagnosis systems is unsatisfactory and that the major drawback of medical imaging is the shortage of labeled data, Asghar Ali Shah, from Bahria University in Islamabad, Pakistan, and colleagues proposed a BEDLM-CMS to detect mutation of cutaneous melanoma by integrating long short-term memory (LSTM), bidirectional LSTM (BLSTM), and gated recurrent unit (GRU) architectures. The dataset included 2,608 human samples and 6,778 mutations with 75 types of genes. The genes that function as biomarkers for early diagnosis and prognosis most prominently were utilized; the most prominent features were extracted. Different DL models optimized through grid search techniques were applied to diagnose melanoma. Result validity was confirmed using several techniques.The researchers found that in the independent set test, BEDLM gave the highest accuracy of 97 percent compared with 94 and 93 percent, respectively, in the self-consistency test and tenfold cross-validation test. The accuracy rates of the self-consistency test, independent set test, and tenfold cross-validation test were 96, 94, and 92 percent, respectively, for LSTM; 93, 94, and 91 percent, respectively, for GRU; and 99, 98, and 93 percent, respectively, for BLSTM."In the future this technique can be used in identifying other life-threatening diseases and other deep learning models can be used for obtaining more accuracy and efficiency," the authors write.

BEDLM gave the highest accuracy in the independent set test compared with the self-consistency, tenfold cross-validation tests

Can an Ensemble-Based AI Model Detect Cutaneous Melanoma?

WEDNESDAY, Nov. 1, 2023 -- Patients with nonulcerated cutaneous melanoma tumors have better survival than those with incipiently ulcerated tumors in univariable analyses, but no differences are seen in adjusted analyses, according to a study published online Nov. 1 in JAMA Dermatology.Elizabeth C. Paver, M.B.B.S., from The University of Sydney, and colleagues examined the prognostic significance of incipient ulceration in cutaneous melanoma in a case-control study consisting of resected primary cutaneous melanomas diagnosed between 2005 and 2015. Slides were reviewed by pathologists experienced in the diagnosis of melanocytic lesions and were classified as cases (incipient ulceration) and controls (ulcerated or nonulcerated). The cohort consisted of 40 cases of incipiently ulcerated melanoma, 80 nonulcerated controls, and 80 ulcerated controls.The researchers found a significant difference in median Breslow thickness between cases and controls (2.8, 1.0, and 5.3 mm for incipient cases, nonulcerated, and ulcerated melanomas, respectively). The median tumor mitotic rate was 5.0, 1.0, and 9.0 per mm2 in incipiently ulcerated cases, nonulcerated controls, and ulcerated controls, respectively. Compared with patients with incipient ulceration, those with nonulcerated tumors had significantly better overall survival and recurrence-free survival (RFS; hazard ratios, 0.49 and 0.37, respectively). Compared with incipiently ulcerated cases, the RFS was significantly worse in ulcerated tumors (hazard ratio, 1.67). No significant differences were seen in clinical outcomes between cases and controls after adjustment for pathological factors."Moving forward, pathologists should comment on the presence of incipient ulceration in pathology reports of primary melanomas, so that related data on this feature can continue to be collected," the authors write.Several authors disclosed ties to the pharmaceutical industry.

Patients with nonulcerated tumors have better survival than incipiently ulcerated cases in univariable analysis

What Is the Prognostic Significance of Incipient Ulceration in Melanoma?

WEDNESDAY, Oct. 11, 2023 &nbsp;-- Nonvisibility of suspicious lesions by patients is associated with higher T-stage tumors, higher-risk stage lesions, and positive lymph nodes, according to a research letter published online Oct. 3 in the Journal of the American Academy of Dermatology.Emily Everdell, from Albany Medical College in New York, and colleagues conducted a retrospective analysis of patients diagnosed with invasive melanoma and treated surgically between Aug. 1, 2018, and Nov. 1, 2021, to examine whether the visibility of suspicious lesions by patients leads to earlier diagnosis of melanoma. Data were included for 382 patients: 53 and 47 percent had visible and nonvisible lesions, respectively.The researchers found that men were more likely to present at diagnosis with a nonvisible lesion than women (odds ratio, 1.55). Overall, 53, 23, 14, and 10 percent of patients were diagnosed with T1, T2, T3, and T4 lesions, respectively. Compared with those with visible lesions, patients with nonvisible lesions were significantly more likely to have T3 or T4 versus T1 or T2 tumors (odds ratio, 2.22). For patients with T4 lesions, 63 percent of the lesions were nonvisible. Sixteen percent of patients had positive nodes; 60 percent of these patients had nonvisible lesions (odds ratio, 1.87). Sixty-seven percent of patients diagnosed with high-risk stage lesions had lesions in nonvisible locations (odds ratio, 2.65). Features of regression were more likely in nonvisible lesions (odds ratio, 2.4)."These findings may identify patient nonvisibility as a risk factor for advanced melanoma," the authors write. "Our findings emphasize the importance of continued vigilance by dermatologists to perform full-body skin examinations, paying particularly close attention to nonvisible areas."

Patients with nonvisible lesions more likely to have T3 or T4 tumors, positive lymph nodes, higher-risk stage

How Does Lesion Visibility Affect Melanoma Prognosis?

WEDNESDAY, Sept. 6, 2023 -- The fecal microbiota profile differs significantly between patients with melanoma and healthy controls, and for those in early- and late-stage melanoma, according to a study published online Aug. 30 in JAMA Dermatology.Russell G. Witt, M.D., from the University of Texas MD Anderson Cancer Center in Houston, and colleagues characterized and compared gut microbiota profiles between healthy volunteers and patients with melanoma and between those with early- and late-stage melanoma in a single-site case-control study. Fecal samples were collected from systemic treatment-naive patients with stage I to IV melanoma and from healthy volunteers (38 patients with early-stage melanoma [29 with stage I or melanoma in situ and nine with stage II], 141 with late-stage melanoma [66 with stage III and 75 with stage IV], and 49 volunteers without melanoma). There were community differences observed between patients with melanoma and the volunteers.The researchers found that in a univariate analysis, patients with melanoma had a higher relative abundance of Fusobacterium (0.19 versus 0.003 percent; P &lt; 0.001), but after adjustment for covariates, the association was attenuated (P = 0.09). Patients with early- and late-stage melanoma had distinct microbiomes. Higher alpha diversity was seen in patients with early-stage melanoma (Inverse Simpson Index, 14.6 versus 10.8), and they had a higher abundance of the genus Roseburia in a univariate analysis (2.4 versus 1.2 percent); statistical significance was no longer seen after adjustment for covariates. Between the groups, multiple functional pathways were differentially enriched."Further investigation is needed to confirm these findings and determine whether modifying the gut microbiome could influence melanoma development and progression," the authors write. "The gut microbiome is a crucial piece of the puzzle in our health, therapy responses, and treatment outcomes. Witt et al. provide another piece of this puzzle by identifying key features of gut dysbiosis in patients with melanoma," Amrit K. Greene, M.D., and Amanda M. Nelson, Ph.D., of the Penn State College of Medicine in Hershey, Pennsylvania, write in a companion editorial.Several study authors disclosed ties to the pharmaceutical industry.

Differences also seen for microbiomes in those with early- and late-stage melanoma, including higher alpha diversity in early-stage

Fecal Microbiota Profile Differs for Melanoma, Healthy Controls

MONDAY, July 24, 2023 (HealthDay News) -- Patterns of melanoma presentation, disease severity, and mortality vary by race, according to a research letter published online July 11 in the Journal of the American Academy of Dermatology.Jennifer M. Fernandez, M.D., from University of Nebraska Medical Center in Omaha, and colleagues used the National Cancer Database to identify 205,125 cases of primary cutaneous invasive melanoma diagnosed between 2004 and 2018.The researchers found that primary site differed significantly by race: The most common primary site was the trunk for American Indian/Alaska Native (38.8 percent) and White (35.4 percent) individuals, while the most common primary site was the lower extremity for Black (50.7 percent), Asian (40.5 percent), and Hispanic (26.3 percent) individuals. In Black individuals, the most common histologic subtype was acral lentiginous melanoma versus superficial spreading melanoma in all other groups. Black patients most commonly had advanced disease (stage III or IV; 48.6 percent) versus White (21.1 percent) patients. White patients had the highest five-year overall survival rates at 75.1 percent compared with 51.7 percent for Black patients."Black race is consistently an independent predictor of increased mortality risk in melanoma, and this remained the case in our study which only included males, even after adjusting for stage at diagnosis and insurance status," the authors write.

Black patients face higher mortality with melanoma independent of insurance status and severity at diagnosis

Melanoma Presentation, Mortality Varies by Race

WEDNESDAY, July 26, 2023 -- In a large racial and ethnic minority (REM) cohort, the incidence and detection rates of melanoma are low, according to a research letter published online July 26 in JAMA Dermatology.Brandon Smith, from the Drexel University College of Medicine in Philadelphia, and colleagues examined melanoma incidence and presentation in a REM cohort of 60,680 self-reported Hispanic and Alaska Native, American Indian, Asian, Black, and Pacific Islander individuals, of whom 12,738 were screened for skin cancer and 47,942 were not.The researchers found that eight melanomas were diagnosed in REM patients (three and five in screened and unscreened participants, respectively). One melanoma was detected during a screening visit (number needed to screen &gt;12,000 in REM individuals), while three and four melanomas were identified by the patient or family and by health care professionals at visits for reasons other than skin cancer screening, respectively. For comparison, among 124,747 screened non-Hispanic White individuals, 334 melanomas were diagnosed, resulting in a number needed to screen of 373."These findings are congruent with updated guidelines stating the evidence is insufficient to support population-based skin cancer screening of asymptomatic adults without a history of malignant or premalignant skin lesions," the authors write.Several authors disclosed ties to the biopharmaceutical industry.

Number needed to screen >12,000 in racial and ethnic minority individuals compared with 373 in non-Hispanic Whites


Incidence, Detection of Melanoma Low in Racial, Ethnic Minorities

<a target="_blank" rel="noopener noreferrer" href="https://d18uhdhjoz8by6.cloudfront.net/fcpanp23_Castle_Bio_Poster_1_Hyams_The_31_GEP_combined_with_AJCC_36bad6b54d.pdf" download="fcpanp23_CastleBio_Poster_1_Hyams_The_31_GEP_combined_with_AJCC.pdf">Click here to view poster PDF</a>Although stage I-II melanomas are usually considered low risk, the majority of melanoma-associated deaths occur in patients diagnosed with these malignancies given the absolute number of cases and limitations of traditional staging systems. The 31-Gene Expression Profile (31-GEP) test is a prognostic assay that measures the level of expression of 31 genes in a melanoma to further stratify risk of recurrence, metastasis, and mortality. This poster presents data from a large (N=6301), unselected cohort from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program who were 31-GEP tested and had a negative sentinel lymph node biopsy. Within this cohort, patients with a Class 1A result had a 97.9% 5-year melanoma-specific survival (MSS) while those with a Class 1B/2A or Class 2B result had a 95.7% and 85.8% 5-year MSS, respectively.

In this poster presented at the 2023 Fall Clinical Dermatology Conference for PAs & NPs in Orlando, Hyams and colleagues explore use of the 31-GEP test to stratify risks in cutaneous melanoma

Featured Poster: Combining the 31-Gene Expression Profile Test for Cutaneous Melanoma with the American Joint Committee on Cancer Staging Identifies the Highest-Risk Patients with Stage I-II Disease

WEDNESDAY, June 7, 2023 -- Patients with melanoma in situ (MIS) have higher relative survival and lower all-cause mortality than the general population, according to a study published online June 7 in JAMA Dermatology.Vishal R. Patel, from Dell Medical School at the University of Texas at Austin, and colleagues examined mortality and factors associated with mortality after a diagnosis of MIS in a population-based cohort study. Data were included for 137,872 patients with a first and only MIS (mean age at diagnosis, 61.9 years); mean follow-up was 6.6 years.The researchers found that the 15-year melanoma-specific survival was 98.4 percent and the 15-year relative survival was 112.4 percent. Patients with MIS had a melanoma-specific standardized mortality ratio (SMR) of 1.89, while all-cause SMR was 0.68. Older patients had a higher risk for melanoma-specific mortality (7.4 percent for those aged 80 years and older versus 1.4 percent for those aged 60 to 69 years; hazard ratio, 8.2), as did those with acral lentiginous histology results (3.3 percent for acral lentiginous versus 0.9 percent for superficial spreading; hazard ratio, 5.3). Overall, 4.3 percent of those with primary MIS experienced a second primary invasive melanoma and 7.4 percent experienced a second primary MIS. The risk for melanoma-specific mortality was increased for those with a second primary invasive melanoma and was reduced for those with a second primary MIS compared with those without subsequent melanoma (adjusted hazard ratios, 4.1 and 0.7, respectively)."Patients with a diagnosis of MIS have an increased but low risk of melanoma-specific mortality and live longer than people in the general population, suggesting significant detection of low-risk disease among health-seeking individuals," the authors write.One author disclosed ties to Concert Genetics.

Researchers find 15-year relative survival to be 112.4 percent and all-cause standardized mortality ratio to be 0.68

What Is the Risk for Mortality After Diagnosis of Melanoma in Situ?

WEDNESDAY, May 3, 2023 (HealthDay News) -- A patient-centered methodology (PCM) approach outperforms conventional analysis for predicting which melanoma patients would have a positive result on sentinel lymph node biopsy (SLNB), according to a study published online April 19 in JAMA Network Open.James R. Miller III, Ph.D., from the California Pacific Medical Center and Research Institute in San Francisco, and colleagues conducted a hybrid prognostic study/decision analytical model among patients with melanoma who were eligible for SLNB at two melanoma centers in Australia and the United States. A comparison was conducted for the individualized probabilities of SLNB positivity generated by a PCM and those generated by conventional multiple logistic regression analysis examining 12 prognostic factors.The simulation included 2,349 patients eligible for SLNB who did not undergo the procedure. The researchers found that the PCM-generated probabilities achieved an area under the receiver operating characteristic curve (AUROC) of 0.803 and 0.826 for predicting SLNB positivity in the Australian and U.S. cohorts, respectively, which was higher than the corresponding AUROCs generated by conventional logistic regression analysis. A minimally acceptable PCM-generated probability of 8.7 percent elicited the same number of SLNBs as historically performed, with 29.3 percent positive, representing an improvement of 287 additional positive SLNBs (38.6 percent improvement). Adopting a PCM-generated minimum cutoff probability of 23.7 percent resulted in performing 1,815 fewer SLNBs than the actual experience (49.9 percent), yielding the same expected number of positive results, for a positivity rate of 42.7 percent."Beyond SLNB for melanoma, results of this hybrid prognostic study/decision analytical model study may have important implications for how guidelines are developed for selecting patients to undergo other useful medical procedures," the authors write.Several authors disclosed financial ties to the pharmaceutical industry.

Patient-centered methodology-generated probabilities better identify patients eligible for sentinel lymph node biopsy than those generated by conventional logistic regression analysis

New Model Helps ID Melanoma Patients With Lymph Node Involvement

<div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655060646"><div class="body-description"><div id="utm_campaign"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655327632"><div class="body-description"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655486016"><div class="body-description"><div class="body js-expandable clearfix js-listicle-body css-listicle-body-2655432920"><div class="body-description"><p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">MONDAY, April 24, 2023 (HealthDay News) -- For patients with advanced melanoma, treatment with anti-programmed cell death 1 (anti-PD-1) results in improved response rate and longer progression-free survival for those with normal vitamin D levels, according to a study published online April 24 in Cancer.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Lukasz Galus, M.D., from the Poznan University of Medical Sciences in Poland, and colleagues compared the effectiveness of anti-PD-1 therapy in patients with locally advanced, inoperable, or metastatic melanoma in relation to vitamin D levels. All patients received nivolumab or pembrolizumab as first-line therapy. The participants were divided into subgroups: 58 with reduced vitamin D levels, who did not receive supplementation or had ineffective supplementation, and 141 patients with normal vitamin D levels at baseline or obtained with supplementation.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">The researchers found that the response rate was 36.2 versus 56.0 percent in the group with low vitamin D levels and not supplemented compared with the group with normal baseline levels or a normal level obtained with supplementation. In these groups, progression-free survival was 5.75 and 11.25 months, respectively. In terms of overall survival, there was a trend toward improved survival for the group with normal vitamin D levels (27 versus 31.5 months).<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">"The authors' opinion is that assessment of vitamin D levels and appropriate vitamin D supplementation should be considered in every patient qualified for treatment with anti–PD‐1 immunotherapy," the authors write.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;">Several authors disclosed financial ties to the biopharmaceutical industry.<p style="-webkit-text-stroke-width:0px;background-color:rgb(255, 255, 255);color:rgb(90, 88, 88);font-family:&quot;Source Sans Pro&quot;, sans-serif;font-size:18px;font-style:normal;font-variant-caps:normal;font-variant-ligatures:normal;font-weight:100;letter-spacing:normal;margin-left:auto;margin-right:auto;margin-top:0px;max-width:980px;orphans:2;text-align:start;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;text-indent:0px;text-transform:none;white-space:normal;widows:2;word-spacing:0px;"><a class="rm-stats-tracked" style="color:rgb(50, 170, 236);overflow-wrap:break-word;text-decoration:none;" target="_blank" rel="noopener noreferrer" href="http://doi.wiley.com/10.1002/cncr.34718">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://consumer.healthday.com/u/physiciansbriefingstaff"><img style="max-width:150px;" src="https://assets.rbl.ms/23636171/origin.png" alt="HealthDay"></a></div></div></div></div></div></div></div></div></div>

Definition includes five domains of management of clinical symptoms, psychosocial elements, QoL, treatment, health care team support

Anti-PD-1 More Effective With Normal Vitamin D Levels in Melanoma

Refining Sentinel Lymph Node Biopsy Decisions: The Role of GEP Testing in Melanoma Care

Integrating GEP Testing Into Melanoma Management&nbsp;In this episode of Topical Conversations, Aaron Farberg, MD, and David Cotter, MD, PhD, discuss how gene expression profiling (GEP) is changing the landscape of melanoma management, particularly in guiding sentinel lymph node biopsy (SLNB) decisions. Highlighting new data from a prospective, multicenter study, they explore how the DecisionDx-Melanoma 31-GEP test helps reduce unnecessary SLNB procedures in patients with intermediate-risk melanoma, improving patient care and reducing health care costs.&nbsp;New Data to Guide SLNB Decision-Making&nbsp;Dr Farberg references the prospective analysis showing that integrating the 31-GEP test into clinical decision-making reduced unnecessary SLNBs by approximately 20% in patients with T1 to T2 melanomas. Notably, patients classified as low risk by the test who still underwent SLNB had no positive nodes, reinforcing the test’s reliability. Dr Cotter emphasizes that beyond cost savings, this approach minimizes patient anxiety and reduces the risks associated with unnecessary surgery.&nbsp;Playing the Odds: Balancing Risk and Patient Care&nbsp;Although up to 88% of SLNBs in patients with thin melanomas are negative, both experts stress that forgoing biopsies altogether would leave some patients at risk for undetected metastases. GEP testing provides an objective tool to help dermatologists identify the right patients for SLNB and subsequent imaging. Dr Cotter notes that for node-negative melanoma patients, melanoma-specific survival is approximately 85%, underscoring the need for vigilant follow-up in high-risk cases.&nbsp;Beyond SLNB: GEP for Postbiopsy Management&nbsp;Dr Farberg explains that the utility of GEP testing extends beyond initial biopsy decisions. For node-negative patients, GEP results can guide imaging protocols and ongoing surveillance. He adds that high-risk patients may benefit from additional imaging, such as computed tomography or ultrasound, to monitor for recurrence or metastasis.&nbsp;Augmenting Staging and Improving Specificity&nbsp;Rather than replacing traditional T staging, GEP testing enhances it. Dr Cotter explains that combining GEP results with standard staging maintains high positive and negative predictive values while improving specificity. This approach further reduces unnecessary SLNBs by approximately 20% to 30%.&nbsp;Accessible and Equitable Care&nbsp;Drs Farberg and Cotter also discuss the broader implications of GEP testing in improving access to quality care nationwide. GEP testing, which uses formalin-fixed, paraffin-embedded tissue samples, helps standardize melanoma care in both academic and community settings, including areas where access to SLNB or advanced oncology services may be limited.&nbsp;A Commitment to High-Quality Care&nbsp;In closing, both physicians affirm their commitment to using tools such as DecisionDx-Melanoma to provide the highest standard of care for melanoma patients, focusing on patient outcomes while leaving cost considerations to health care systems and payers.&nbsp;By integrating GEP testing into melanoma care pathways, dermatologists can refine SLNB decisions, personalize postbiopsy management, and reduce health care disparities across diverse patient populations.

What is the i31-SLNB algorithm, and how can it enhance SLNB guidance in melanoma management?

What is the DecisionDx Melanoma test, and how does it work?

What are the key clinical questions the DecisionDx Melanoma test helps answer?

Is the DecisionDx test appropriate for all patients with melanoma, or are there specific eligibility criteria?

How can the DecisionDx Melanoma test contribute to improved survival outcomes for patients?

How does the DecisionDx Melanoma test compare to other GEP tests, such as the CP-GEP test, in clinical accuracy and utility?

How can dermatologists explain the DecisionDx Melanoma test and its significance to their patients?

What are the challenges in diagnosing melanoma in patients with skin of color, and how can they be addressed?

How do you approach biopsying suspicious lesions, and what techniques yield the best diagnostic outcomes?

What clinical and pathological features most significantly impact melanoma prognosis?

Exploring the MyPath Melanoma Test for Guiding Management and Care Decisions in Patients with Ambiguous Lesions 

In this installment of Discourses in Dermatology, Aaron Farberg, MD, gives an in-depth overview of the MyPath Melanoma test, a gene expression profile (GEP) test designed to aid in the diagnosis of ambiguous cutaneous melanocytic lesions and inform patient management and treatment decisions.&nbsp;Dr Farberg explains the importance of ancillary testing, particularly in cases where there is a lack of clinicopathological correlation, and how the MyPath Melanoma test can provide objective information to help clinicians classify ambiguous lesions of unknown potential.&nbsp;He also details how to incorporate the test into clinical practice, gives an overview of the MyPath Melanoma report guide, and details the patient-focused financial assistance and insurance billing services available.&nbsp;Finally, he reviews the case of a 27-year-old woman with a high clinical concern for melanoma and atypical histopathology, detailing how the MyPath Melanoma test impacted diagnosis and clinical care in a real-world example.

Melanoma Update – What’s New in 2024

The incidence of invasive melanoma is rising, and Dr Darrell Rigel gave us the data we need to contextualize risk for our patients and ensure they receive the most up-to-date treatments. Importantly, in a pooled analysis with data from 2013-2019, 5-year survival rates were significantly worse for African-American patients with localized, regional, and distant melanoma diagnoses giving melanoma the largest racial disparity in survival difference. This trend is reflected in racial and ethnic minorities across other skin cancers and deserves clinical attention. &nbsp;However, the past decade has also seen advances in targeted therapies and immune checkpoint inhibitors, which likely account for demonstrated improvement in malignant melanoma survival in Italy between 2003 and 2017.&nbsp;Dr Rigel covered who is at risk, especially those subjected to childhood sunburns and frequent sunburns. A less obvious connection was found between those with a family history of melanoma and Parkinson’s disease after following 131,342 patients for many decades. Alcohol consumption also may be a risk factor. While risk factors may provide clinical indication that more information about a lesion is required, the diagnosis of malignant melanoma is not always straightforward and has been quoted to be as low as 65% accurate. Genomics has become an increasingly important tool alongside pathologic findings as atypical genomic data in markers such as PRAME and TERT reflect cellular atypia. Genomic data can further be harnessed to identify patients who are at a higher risk for developing metastatic disease and would benefit from sentinel lymph node biopsies. Dr Rigel walked us through how to understand results from DecisionDx and emphasized the importance of using genomics to optimize clinical care.&nbsp; The last portion of the presentation focused on what happens after diagnosis. In one study, over 3500 patients with sentinel lymph node metastases were randomized to get either immediate dissection or nodal observation with ultrasonography, and melanoma-specific survival at 3 years was similar between groups. Histopathologic regression in patients with metastatic melanoma getting sentinel lymph node biopsies or with metastases on immune checkpoint inhibitors was associated with better survival as was treatment with 2 complimentary immune checkpoint inhibitors, specifically adding relatlimab, a lymphocyte-activation gene 3 inhibitor, to nivolumab, the PD-1 inhibitor. One RCT comparing neoadjuvant-adjuvant and adjuvant-only pembrolizumab in advanced-stage metastatic melanoma demonstrated significantly longer overall survival in those who were treated with the PD1 inhibitor before and after surgery. Other factors that may impact survival are beta-blocker use, statin use, and estrogen levels. He concluded by discussing some exciting innovations like an mRNA vaccine for melanoma for those at high risk of recurrence, which was studied in a Phase 2b trial.&nbsp;

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Refining Sentinel Lymph Node Biopsy Decisions: The Role of GEP Testing in Melanoma Care

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What is the i31-SLNB algorithm, and how can it enhance SLNB guidance in melanoma management?

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