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, 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

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