Cutaneous melanoma (CM) is potentially the most dangerous form of skin tumor and causes 90% of skin cancer mortality. A unique collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO), and the European Organization of Research and Treatment of Cancer (EORTC) was formed to make recommendations on CM diagnosis and treatment, based on systematic literature reviews and the experts' experience. The diagnosis of melanoma can be made clinically and shall always be confirmed through dermatoscopy. If a melanoma is suspected, a histopathological examination is required. Sequential digital dermatoscopy and full-body photography can be used in risk persons to detect the development of melanomas at an earlier stage. Where available, confocal reflectance microscopy can improve clinical diagnosis in special cases. Melanoma shall be classified according to the 8th version of the AJCC classification. Thin melanomas up to 0.8 mm tumor thickness does not require further imaging diagnostics. From stage IB onwards, examinations with lymph node sonography are recommended, but no further imaging examinations. From stage IIC whole-body examinations with CT or PET-CT in combination with brain MRI are recommended. From stage III and higher, mutation testing is recommended, particularly for BRAF V600 mutation. It is important to provide a structured follow-up to detect relapses and secondary primary melanomas as early as possible. There is no evidence to support the frequency and extent of examinations. A stage-based follow-up scheme is proposed, which, according to the experience of the guideline group, covers the minimum requirements; further studies may be considered. This guideline is valid until the end of 2021.
- Klíčová slova
- AJCC classification, Confocal reflectance microscopy, Cutaneous melanoma, Dermatoscopy, Follow-up examinations, Imaging diagnostics, Mutation testing, Primary diagnosis, Sequential digital dermatoscopy, Total body photography,
- MeSH
- diagnostické zobrazování normy MeSH
- Evropská unie MeSH
- kombinovaná terapie MeSH
- konsensus MeSH
- lidé MeSH
- melanom klasifikace diagnóza terapie MeSH
- mezioborová komunikace * MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team ("Tumor Board"). Adjuvant therapies in stage III/IV patients are primarily anti-PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.
- Klíčová slova
- Adjuvant treatment, Cutaneous melanoma, Excisional margins, Interferon-α, Metastasectomy, Sentinel lymph node dissection, Systemic treatment, Tumour thickness,
- MeSH
- diagnostické zobrazování normy MeSH
- Evropská unie MeSH
- kombinovaná terapie MeSH
- konsensus MeSH
- lidé MeSH
- melanom klasifikace diagnóza terapie MeSH
- mezioborová komunikace * MeSH
- směrnice pro lékařskou praxi jako téma normy MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
The objective of our study was to compare the five different scoring methods of tumor-infiltrating lymphocytes (TILs) assessment in a group of 213 cases of superficial spreading and nodular melanoma. The scoring methods include (a) Clark scoring; (b) Melanoma Institute Australia system; (c) scoring system used in the study of Saldanha et al.; (d) scoring system used in the TCGA study and modified by Park et al.; and (e) the system recently proposed by the "International Immuno-Oncology Biomarker Working Group" for TILs scoring in all solid tumors. Prediction of survival with three main outcomes-disease-specific-free survival, local recurrence-free survival, and distant metastasis-free survival-was evaluated. The prognostic value of TILs showed statistical significance in univariate analysis regarding all three of the outcomes only for three of the five evaluated methods; the Clark scoring, the Melanoma Institute Australia system, and the system proposed by the "International Immuno-Oncology Biomarker Working Group". However, in multivariate analysis with covariants including Breslow thickness, type of melanoma, location, sex, and age, we did not find TILs to be an independent prognostic factor.
- Klíčová slova
- nodular melanoma, prognosis, superficial spreading melanoma, tumor-infiltrating lymphocytes,
- MeSH
- dospělí MeSH
- dvojitá slepá metoda MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanom klasifikace imunologie patologie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory kůže imunologie patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- tumor infiltrující lymfocyty imunologie MeSH
- výzkumný projekt MeSH
- zánět imunologie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
In the dermatopathological practice, there is a group of atypical melanocytic lesions with borderline histological features between benign simulants and malignant melanoma (MM), due to conflicting diagnostic criteria and inter-observer disagreement. In these cases, the dermatopathologist is authorized to seek consult with an established expert in the field, but even the most experienced specialist may not be sure about the correct diagnosis and the subsequent biological behavior. There is general consensus among qualified dermatopathologists that can be helpful to insert these ambiguous cases into two diagnostic categories: SAMPUS (Superficial Atypical Melanocytic Proliferations of Unknown Significance) and MELTUMP (MELanocytic Tumors of Uncertain Malignant Potential). According to the conception of MM progression through two phases, the radial growth phase and the vertical growth phase, it is possible to identify a novel subtype of thin melanoma (THIM) with uncertain metastatic potential, due to the presence of extensive regression ( 75% of the lesion volume), which we here define with the acronym THIMUMP (THIn Melanoma of Uncertain Metastatic Potential) for the first time in literature.Key words: malignant melanoma - thin melanoma - histology.
- MeSH
- lidé MeSH
- maligní melanom kůže MeSH
- melanom klasifikace patologie MeSH
- nádory kůže klasifikace patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Malignant melanoma is - in comparison with other skin tumors - a relatively rare malignant neoplasm with highly aggressive biologic behavior and variable prognosis. Recent data in pathology and molecular diagnostics indicate that malignant melanoma is in fact not a single entity but a group of different neoplasms with variable etiopathogenesis, biologic behavior and prognosis. New therapeutic options using targeted treatment blocking MAPK signaling pathway require testing of BRAF gene mutation status. This helps to select patients with highest probability of benefit from this treatment. AIM: This article summarizes information on the correlation of morphological findings with genetic changes, discusses the representation of individual genetic types in various morphological subgroups and deals with the newly proposed genetic classification of melanoma and the current possibilities, pitfalls and challenges in BRAF testing of malignant melanoma. It also describes the current testing situation in the Czech Republic - the methods used, the representation of BRAF mutations in the tested population and the future of testing. It also shows the limitations of the BRAF and MEK targeted treatment concept resulting from the heterogeneity of the tumor population. Mechanisms of acquired resistance to MAPK pathway inhibitors, possibilities of their detection, and issues of combination of targeted therapy and immunotherapy are discussed.Key words: malignant melanoma - BRAF - mutation - molecular targeted therapy - tumor microenvironment - tumor heterogeneity This work was supported by projects PROGRES Q40/11, BBMRICZ LM2015089, SVV 260398 and GACR 17-10331S. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.Submitted: 28. 3. 2017Accepted: 16. 5. 2017.
- MeSH
- lidé MeSH
- maligní melanom kůže MeSH
- melanom klasifikace genetika patologie MeSH
- nádory kůže klasifikace genetika patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The authors submit a review of histological findings and classification according to the TNM-classification of conjunctival tumours in patients under dispensary care at the First Ophthalmological Clinic of the Faculty Hospital and Medical Clinic of the Comenius University in Bratislava during a 10-year period (1989-1998). They included in the group 75 patients with clinically assessed conjunctival tumours (0.4% of the hospitalized patients). As to histological findings, 61 times (80.3%) a benign process was involved (naevus of the conjunctiva 12x) and 14x (19.7%) a malignant tumour, (7x times a primary malignant melanoma of the conjunctiva, 3x carcinoma). The authors recorded two relapses (one malignant melanoma of the conjunctiva, one melanoma penetrating into the orbit). The mean age of the patients was 47 years (from 1 to 82 years). In malignant melanoma of the conjunctiva stage T1 was detected in as many as 3/4 of the patients (6 times), whereby stage pT1, 2 was found in 7 patients. In carcinoma the authors did not detect stage T1, only stage T2 in 2 patients, T3 (pT3) in one patient.
- MeSH
- dítě MeSH
- dospělí MeSH
- karcinom klasifikace patologie MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- melanom klasifikace patologie MeSH
- mladiství MeSH
- nádory spojivky klasifikace patologie MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- kojenec MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- předškolní dítě MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- MeSH
- dospělí MeSH
- lidé MeSH
- melanom klasifikace diagnóza MeSH
- nádory mozečku klasifikace diagnóza MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
- MeSH
- elektronová mikroskopie MeSH
- lidé MeSH
- melanom klasifikace patologie MeSH
- nádory kůže klasifikace patologie MeSH
- névus patologie MeSH
- pigmentový névus patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
