Journal of Clinical and Aesthetic Dermatology • Hot Topics in Melanoma November 2024 • Journal Watch

Analysis of calculated liver scores for long-term outcome in 423 patients with cutaneous melanoma

Abu Rached N, Reis MMDS, Stockfleth E, et al. Cancers (Basel). 2024;16(18):3217.

Summary. Among 423 patients with cutaneous melanoma, 159 (37.6%) experienced disease relapse at a median time of 88 months. The median time to melanoma-specific death was 99 months, and the melanoma-specific mortality rate was 27 percent. Liver scores were not associated with progression-free survival (PFS) or cutaneous melanoma-specific survival (CMSS) in the overall patient population. However, higher aspartate transaminase-to-platelet ratio index score was significantly associated with greater risk of melanoma-specific death and relapse in patients with Stage I to II disease.

The phenotypical characterization of dual-nature hybrid cells in uveal melanoma

Summary. Marcotte et al utilized immunohistochemistry with double labeling of melanocytic and panleukocytic markers (HMB45 and CD45, respectively) to identify dual-nature cells in uveal melanoma tumors. Twenty-six of 29 (90%) tumors contained HMB45+/CD45+ dual-nature cells. Among 28 tumors stained for HMB45 and CD8, 26 (93%) had HMB45+/CD8+ dual-nature cells. There was a significant, positive correlation between the number of CD8+ T cells and HMB45+/ CD8+ dual-nature cells. Seventeen of 24 (71%) tumors stained for HMB45 and CD68 contained HMB45+/CD68+ dual-nature cells; as with CD8+ T cells and HMB45+/CD8+ dualnature cells, expression of HMB45+/CD68+ dual-nature cells was significantly, positively correlated with CD68+ macrophage expression. In vitro fusion of uveal melanoma cells and immune cells was observed.

The HCV-melanoma paradox: first multi-cohort and molecular network analysis reveals lower incidence but worse outcomes-integrating clinical, real-world, and in silico data

Al Ageeli E, Abdulhakim JA, Hussein MH, et al. Medicina (Kaunas). 2024;60(9):1531.

Summary. Among patients with cutaneous melanoma, those without hepatitis C virus (HCV; n=113) had significantly lower rate of recurrence (39.8%), compared to patients with HCV (65.5%). The mortality rate was 65.5 percent for patients with HCV, compared to 23.0 percent for those without HCV; this difference was significant. Further analysis revealed a significantly lower risk of developing melanoma in individuals with HCV, but worse outcomes for patients with melanoma and HCV.

A novel tool for predicting the risk of cancer-specific early death in older patients with primary malignant melanoma of skin: a population-based analysis

Summary. Analyzing data from older patients with malignant melanoma in the Surveillance, Epidemiology, and End Results (SEER) database, Lei et al identified age, histology, tumor stage, liver metastasis, surgery, and radiotherapy as independent risk factors for early death. A nomogram was developed using these factors, and the area under the curve (AUC) of the training cohort (n=1,872) was 0.966. In the validation cohort (n=783), the AUC was 0.971. Decision curve analysis showed that the nomogram had high clinical applicability.

Pregnancy and survival-related outcomes of uveal melanoma treated with brachytherapy in women of reproductive age

Summary. Among female patients with uveal melanoma who received plaque brachytherapy (PBT), the rate of metastasis was not significantly different for pregnant patients following PBT (n=13) and nonpregnant patients (n=96), at 15.38 and 18.75 percent, respectively. The mortality rate also did not significantly differ (pregnancy group: 7.69%; nonpregnancy group: 12.5%). Metastasis-free survival (MFS) and overall survival (OS) were also similar between groups. All pregnancies were full-term, and there were no reported placental or infant metastases.

Durable local control with hypofractionated radiation therapy for unresectable or metastatic melanoma

Keatts SA, Salem AF, Swanson DM, et al. Clin Transl Radiat Oncol. 2024;49:100856.

Summary. In this study, Keatts et al assessed the efficacy of hypofractionated radiation therapy (HFRT) in the treatment of 53 unresectable or bulky metastatic melanoma tumors in 49 patients. Treatment response was recorded in 48 tumors (91%); 39 tumors (74%) shrank, six (11%) showed reduced 18F-fluoro- 2-deoxy-D-glucose (FDG) avidity, and three (6%) had stable disease. Ninety-eight percent of symptomatic patients experienced symptom improvement. While local control was high at one and two years, one- and two-year PFS were 33 percent, and median OS was 11.5 months.

Implications of tumor-positive sentinel lymph nodes in single vs. multiple nodal basins in melanoma

Summary. In a cohort of 1,915 patients with melanoma and tumor-positive sentinel lymph nodes (SLNs), most (78.4%) had only one tumor-positive SLN in one basin. Multiple tumor-positive SLNs in one basin were observed in 17.7 percent of patients, and 3.9 percent had multiple tumor-positive SLNs in multiple basins. Five-year disease-free survival (DFS), distant DFS (DDFS), and MSS were significantly improved in patients with one tumor-positive SLN, compared to those with multiple tumor-positive SLNs, regardless of number of basins involved. Involvement of multiple basins was also associated with poorer outcomes.

Treatment patterns and outcomes of patients with Stage III melanoma and positive sentinel lymph node biopsy: a real-life experience

Summary. In this retrospective study, researchers compared outcomes in patients Stage III melanoma and positive SLN biopsy (SLNB) with (n=88) or without (n=69) complete lymph node dissection (CLND). A significantly greater proportion of the no CLND group received adjuvant therapy, compared to the CLND group (97.1% vs. 75.0%). Relapse-free survival (RFS) and OS were similar between groups. Receipt of adjuvant therapy was associated with reduced risk of relapse.

Higher Nodal expression is often associated with poorer survival in patients diagnosed with melanoma and treated with anti-PD-1 therapy

Summary. In this pilot study, Gascard et al aimed to predict anti-programmed cell death protein 1 (PD-1) immunotherapy outcomes in advanced metastatic melanoma based on re-expression of Nodal, a transforming growth factor beta superfamily member. Patients with Nodal positivity in 45 percent or more of melanoma-antigen expressing tumor cells had a survival rate of 31.25 percent, compared to 77.78 percent for patients with Nodal positivity in less than 45 percent of cells. Treatment response was similar between groups. High Nodal positivity was almost significantly associated with OS (p=0.0503).

RESEARCH BITE—The 31-gene expression profile test informs sentinel lymph node biopsy decisions in patients with cutaneous melanoma: results of a prospective, multicenter study

Here, Yamamoto et al assessed the impact of 31-gene expression profile (31-GEP) testing on the decision to pursue or forego sentinel lymph node biopsy (SLNB) in patients with Stage T1 to T2 cutaneous melanoma. In 100 of 191 cases, 31-GEP testing influenced clinical decisions to forego SLNB. Seventy SLNBs were not performed. In the 30 cases where SLNB was performed despite the informed clinical decision to forego SLNB (largely because of patient preference), zero cases demonstrated SLNB positivity. The 31-GEP test impacted 63 clinical decisions to pursue SLNB. Fifty-eight SLNBs were performed with a positivity rate of 18.8 percent. With 31-GEP testing, the rate of SLNB was significantly reduced compared to the contemporary baseline rate (59.1% vs. 78.0%). Additionally, there was a significantly lower SLNB rate among patients with a low-risk (Class 1A) result, compared to the baseline rate (48.6% vs. 78.0%). SLNB performance was also significantly reduced in patients with Class 1A aged 55 years or older and those aged 65 years or older.

Source: Yamamoto M, Sickle-Santanello B, Beard T, et al. The 31-gene expression profile test informs sentinel lymph node biopsy decisions in patients with cutaneous melanoma: results of a prospective, multicenter study. Curr Med Res Opin. 2023;39(3):417–423.

RESEARCH BITE—Incomplete excision rate for lentigo maligna and associated risk factors

Among 380 patients with a total of 395 lentigo maligna lesions who underwent surgical excision, the incomplete excision rate (IER) was 16.7 percent (n=66). Most incompletely excised lesions were at the head and neck (92.4%); this location was associated with greater IER, compared to other anatomical areas. IER was significantly increased with the use of clinical margins under 5mm and in lesions with preoperative biopsies, compared to the use of a 5mm clinical margin and in lesions without preoperative biopsies (25.6% vs. 13.0% and 20.0% vs. 10.7%, respectively). Lesions excised by dermatologists exhibited a significantly lower IER than those excised by plastic surgeons. Only surgeon specialty maintained significance upon multivariate analysis.

Source: Modin M, Svensson H, Bergsten Wanders Y, et al. Incomplete excision rate for lentigo maligna and associated risk factors. Acta Derm Venereol. 2024;104:adv40535.