scholarly journals Second Diagnostic Opinion by Experienced Dermatopathologists in the Setting of a Referral Regional Melanoma Unit Significantly Improves the Clinical Management of Patients With Cutaneous Melanoma

2021 ◽  
Vol 7 ◽  
Author(s):  
Andrea Ronchi ◽  
Francesca Pagliuca ◽  
Federica Zito Marino ◽  
Giuseppe Argenziano ◽  
Gabriella Brancaccio ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Clinical Management ◽  
Clinical Impact ◽  
Second Opinion ◽  
Multidisciplinary Teams ◽  
Histopathological Diagnosis ◽  
Diagnostic Agreement ◽  
Melanocytic Lesions ◽  
Melanoma Patients ◽  
Diagnostic Discrepancies

The diagnosis of cutaneous melanoma and melanocytic neoplasms in general is one of the most challenging fields in pathology, and the reported interobserver diagnostic agreement in the evaluation of melanocytic lesions is poor. Nevertheless, a correct histopathological diagnosis is crucial to ensure a good clinical management of the patients. The institution of multidisciplinary teams has recently modified the approach to the patients with cutaneous melanoma. Patients referred to a multidisciplinary melanoma unit after receiving a diagnosis of melanoma elsewhere are encouraged to have their histopathological diagnosis confirmed by a second opinion from the experienced pathologist of the team before any treatment is initiated. We performed a retrospective analysis on a series of 121 histopathological revisions required for melanocytic neoplasms in the context of a multidisciplinary team, in order to evaluate the effects of second diagnostic opinion (SDO) on the clinical management of the patients. We defined three types of diagnostic discrepancies between the first diagnosis and the second opinion, according to the greatness of their clinical impact. Overall, the incidence of diagnostic discrepancies of any type was quite high in our series (56%). Interestingly, the SDO determined relevant changes in the clinical management of the patients in 33 out of 121 (27.3%) cases. This study confirms that SDO by expert pathologists significantly affects the course of treatment of melanoma patients and helps improving the diagnostic accuracy and clinical outcome.

Importance of the Second Opinion in Surgical Breast Pathology and Its Therapeutic Implications

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S116-S117
Author(s):  
A Ibarra ◽  
K Baksai ◽  
M Vial
Keyword(s):  
Complementary Therapies ◽  
Ductal Carcinoma ◽  
Breast Disease ◽  
Second Opinion ◽  
Multidisciplinary Teams ◽  
Histopathological Diagnosis ◽  
Breast Pathology ◽  
Therapeutic Implications ◽  
Diagnostic Changes

Abstract Introduction/Objective Histopathological diagnosis determines surgical management and complementary therapies in patients with breast cancer. There has been reported significant diagnostic divergences, between 7.8 and 26%, and in tumor markers between 3.4 and 41%. We evaluate the agreement between diagnoses of general pathologists and specialists of our center, in which serious discrepancies could have therapeutic repercussions. Methods Method: A retrospective study from 2012 to 2019. The cases were classified in benign and malignant. The atypical lesions were included with benign. Major disagreements were considered when there was a change in diagnosis from benign to malignant or vice versa, variation from intraepithelial to microinvasive carcinomas, infiltrating to intraductal carcinomas or vice versa. When necessary, we repeat routine stains and/or immunostains, or add new immunostains. Material: 295 cases. 294 women and 1 man. 228 biopsies and 67 immunostains of prognostic-predictive factors. Results We found diagnostic differences in 46/295 cases (15.6%). Major discrepancies in 32 cases (10.8%). In morphological diagnoses 11/228 (4.8%) and in immunodeterminations 20/67 (29.9%). In diagnostic changes, they highlighted 3 cases of ductal carcinoma in situ (DCIS) to benign, 2 cases of benign lesions to DCIS, 1 benign to invasive ductal carcinoma (IDC), 1 DCIS to IDC and 1 IDC to DCIS. Conclusion We found serious diagnostic divergences in 32 of 295 cases, 10.8%, which could have varied the therapeutic approach. In morphological interpretation 4.8% and in immunohistochemical results 29.9%. This should motivate multidisciplinary teams to routinely use the second opinion in surgical breast disease

scholarly journals Malignancy Rate of Indeterminate Findings on FDG-PET/CT in Cutaneous Melanoma Patients

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 883
Author(s):  
Ken Kudura ◽  
Florentia Dimitriou ◽  
Daniela Mihic-Probst ◽  
Urs J. Muehlematter ◽  
Tim Kutzker ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Fdg Pet ◽  
Clinical Management ◽  
Clinical Routine ◽  
Malignancy Rate ◽  
Pet Ct ◽  
Malignant Lesions ◽  
Melanoma Patients ◽  
Fdg Pet Ct ◽  
The Impact

Background: The use of 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT in clinical routine for staging, treatment response monitoring and post treatment surveillance in metastatic melanoma patients has noticeably increased due to significant improvement of the overall survival rate in melanoma patients. However, determining the dignity of the findings with increased metabolic activity on FDG-PET/CT can be sometimes challenging and may need further investigation. Purpose: We aimed to investigate the malignancy rate of indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients. Methods: This single-center retrospective study included cutaneous melanoma patients who underwent FDG-PET/CT in clinical routine between 2015 and 2017 with findings reported as indeterminate and therefore requiring further evaluation. The dignity of the included findings was determined by subsequent imaging and, if required, additional histopathology. The impact of the outcome on the clinical management was also reported. Results: A total of 842 FDG-PET/CT reports of 244 metastatic cutaneous melanoma patients were reviewed. Sixty indeterminate findings were included. Almost half of all indeterminate findings were lymph nodes, lung nodules and cerebral lesions. In total, 43.3% of all included findings proved to be malignant. 81% of all malignant lesions were metastases of cutaneous melanoma, while 19% of all malignant lesions could be attributed to other primary malignancies, such as lung, breast, thyroid and colorectal cancers. Malignant findings influenced clinical management in 60% of the cases. Conclusion: Indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients should be further investigated. Almost one out of every two indeterminate findings on FDG-PET/CT is malignant. The majority of the findings are melanoma manifestations, however, in a significant percentage, other primary tumors are found. Upon verification, patient management is changed in most cases.

Association of HERV-K and LINE-1 hypomethylation with reduced disease-free survival in melanoma patients

Epigenomics ◽  
2020 ◽  
Vol 12 (19) ◽  
pp. 1689-1706
Author(s):  
Maurizio Cardelli ◽  
Remco van Doorn ◽  
Lares Larcher ◽  
Michela Di Donato ◽  
Francesco Piacenza ◽  
...  
Keyword(s):  
Independent Predictor ◽  
Disease Free Survival ◽  
Endogenous Retrovirus ◽  
Human Endogenous Retrovirus ◽  
Free Survival ◽  
Melanocytic Lesions ◽  
Long Interspersed Nuclear Elements ◽  
Melanoma Patients ◽  
And Gender ◽  
Disease Free

Aim: To evaluate CpG methylation of long interspersed nuclear elements 1 (LINE-1) and human endogenous retrovirus K (HERV-K) retroelements as potential prognostic biomarkers in cutaneous melanoma. Materials & methods: Methylation of HERV-K and LINE-1 retroelements was assessed in resected melanoma tissues from 82 patients ranging in age from 14 to 88 years. In addition, nevi from eight patients were included for comparison with nonmalignant melanocytic lesions. Results: Methylation levels were lower in melanomas than in nevi. HERV-K and LINE-1 methylation were decreased in melanoma patients with clinical parameters associated with adverse prognosis, while they were independent of age and gender. Hypomethylation of HERV-K (but not LINE-1) was an independent predictor of reduced disease-free survival. Conclusion: HERV-K hypomethylation can be a potential independent biomarker of melanoma recurrence.

scholarly journals Prevalence of BRAF and NRAS mutations in cutaneous melanoma patients in Taiwan

2016 ◽  
Vol 115 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Yi-Shuan Sheen ◽  
Yi-Hua Liao ◽  
Jau-Yu Liau ◽  
Ming-Hsien Lin ◽  
Yi-Chun Hsieh ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Melanoma Patients

Adjuvant PD-1 inhibitor versus high-dose interferon α-2b for Chinese patients with cutaneous and acral melanoma: A retrospective cohort analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21516-e21516
Author(s):  
Jiuhong Wang ◽  
Jingjing Li ◽  
Xing Liu ◽  
Xizhi Wen ◽  
Dandan Li ◽  
...  
Keyword(s):  
Cutaneous Melanoma ◽  
Chinese Patients ◽  
Interferon Α ◽  
High Dose ◽  
Free Survival ◽  
Acral Melanoma ◽  
Treatment Groups ◽  
Melanoma Patients ◽  
Metastatic Sites ◽  
High Dose Interferon

e21516 Background: The clinical efficacy of PD-1 inhibitors as an adjuvant treatment for Asian melanoma patients has not yet been determined. Methods: Thus, this single-centre, retrospective study analysed the clinical data of 90 Chinese patients with completely resected, stage III cutaneous or acral melanoma who received either adjuvant PD-1 inhibitor or high-dose interferon α-2b (HDI). Propensity score matching (PSM) was used to control baseline differences between the two treatment groups. The primary end point was recurrence-free survival (RFS), and the secondary end points included distance metastasis-free survival (DMFS) and incidence of first distant metastatic sites. Results: Anti-PD-1 treatment resulted in significantly longer RFS (18-month RFS, 53.3% versus 26.7%; 95% CI, 0.097-0.975; P < 0.05) and DMFS (18-month DMFS, 70.9% versus 46.1%; 95% CI, 0.13-0.945; P < 0.05) than HDI in cutaneous melanoma patients. However, adjuvant anti-PD-1 treatment had no advantage over HDI in acral melanoma patients (18-month RFS, 30.0% versus 35.9%; P > 0.05; 18-month DMFS, 36.5% versus 63.6%; P > 0.05). The incidence of lung metastasis at first in the anti-PD-1 group was found to be significantly lower (12.5% versus 48.5%; P < 0.05) in cutaneous melanoma patients than in acral melanoma patients, but no difference in metastatic sites were observed between the two treatment groups among acral melanoma patients. The incidence of treatment-related AEs was similar between the two treatment groups. Conclusions: In conclusion, adjuvant anti-PD-1 treatment was well tolerated and yielded a significantly better prognosis than HDI in Chinese patients with stage IIIB/C cutaneous melanoma, but a significant difference was not observed in those with acral melanoma.

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