Disclosures. SLNB for Melanoma 25/02/2014 SENTINEL LYMPH NODE BIOPSY FOR MELANOMA: CURRENT GUIDELINES AND THEIR CLINICAL APPLICATION
|
|
- Scarlett Houston
- 5 years ago
- Views:
Transcription
1 8 th Canadian Melanoma Conference February 22, 2014 Rimrock Resort Hotel, Banff, Alberta SENTINEL LYMPH NODE BIOPSY FOR MELANOMA: CURRENT GUIDELINES AND THEIR CLINICAL APPLICATION Christopher Bichakjian, MD Associate Professor Cutaneous Surgery and Oncology University of Michigan Disclosures I do not have any relationships with industry. SLNB for Melanoma 1
2 SLNB for Melanoma Historical perspective Snow H. Lancet. 1892;2:872 4 Snow H. Lancet. 1892;2:
3 The danger lies in the diffusion of malignant cell particles from this primary focus; these always implicate the nearest lymph glands which intercept them for a time. Palpable enlargement of these glands is unfortunately but a late symptom of deposit therein; Snow H. Lancet. 1892;2:872 4 We further see the paramount importance of securing, whenever possible, the perfect eradication of those lymph glands which will necessarily be first infected; Lancet. 1907;1;927,996 Elective Complete Lymph Node Dissection 1892 Dr. Herbert Snow 1907 Dr. William Handley removal of 2 inches of subcutaneous tissue to muscle fascia with radical removal of lymph nodes. Guided surgical nodal treatment of melanoma for nearly a century 3
4 Dr. Donald Morton Introduced preoperative and intraoperative lymphatic mapping and sentinel lymphadenectomy in early 1990s as a minimally invasive alternative to routine elective complete lymph node dissection. Multicenter Selective Lymphadenectomy Trial (MSLT I) Morton DL, et al. N Engl J Med. 2014;370(7): SLNB for Melanoma Current Rationale for SLNB Sentinel Lymph Node Biopsy Status of SLN is most important prognostic indicator for disease specific survival in patients with primary cutaneous melanoma 4
5 SLNB Staging and Prognosis 88 93% 50 67% Gershenwald JE, et al. J Clin Oncol. 1999;17: Morton DL, et al. N Engl J Med. 2014;370(7): Survival of Melanoma > 4mm by Sentinel Lymph Node Status SLN SLN SLN+ SLN+ Overall Survival Distant Disease Free Survival Gajdos C, et al. Cancer. 2009;15: Accuracy and Prognostic Value of SLNB in the Head and Neck Erman AB, et al. Cancer. 2012;118: patients 352 SLNs identified (99.7%) 19.6% positivity 25% additional positive nonsentinel nodes Patients with local control and SLNB 4.2% failed regionally SLN status most prognostic predictor of recurrence free and overall survival 5
6 SLNB Regional Control Macroscopic Microscopic IHC Postoperative Complications after Inguinal Lymph Node Dissection for + SLNB vs Palpable Disease ILND for positive SLNB (132) ILND for clinical disease (80) P value # positive nodes positive nodes 9% 29% <0.001 Extranodal 5% 47% <0.001 extension Wound 14% 28% 0.02 complication lymphedema 24% 41% ILND inguinal lymph node dissection; SLNB sentinel lymph node biopsy Sabel MS, et al. Surgery. 2007;141: SLNB for Merkel Cell Carcinoma 6
7 SLNB Impact on Survival Multicenter Selective Lymphadenectomy Trial 1 (MSLT 1) Largest, multi continent, randomized trial comparing SLNB versus nodal observation in melanoma. Final report with 10 year follow up published last week. Study underpowered to detect significant treatment related difference in 10 year melanoma specific survival in overall study population. Morton DL, et al. N Engl J Med. 2014;370(7): SLNB Impact on Survival Multicenter Selective Lymphadenectomy Trial 1 (MSLT 1) 10 year disease free survival significantly improved in SLNB group. For patients with intermediate depth melanoma and nodal metastases, SLNB based management significantly improved 10 year distant diseasefree survival and melanoma specific survival. Cumulative rates of nodal metastases in both groups very similar. Morton DL, et al. N Engl J Med. 2014;370(7): SLNB for Melanoma Global Guidelines for SLNB 7
8 AAD Melanoma Guidelines of Care Biopsy Pathology Report Staging Workup and Follow up Surgical Management Nonsurgical Treatments Sentinel Lymph Node Biopsy Bichakjian CK, et al. J Am Acad Dermatol. 2011;65: Melanoma Treatment Guidelines American Academy of Dermatology (AAD) National Comprehensive Cancer Network (NCCN) Cancer Care Ontario (CCO) British Association of Dermatologists (BAD) Cancer Council Australia European Dermatology Forum (EDF); European Association of Dermato Oncology (EADO); European Organization for Research and Treatment of Cancer (EORTC) European Society for Medical Oncology (ESMO) Cancer Care Ontario SLNB provides good staging and prognostic information and potentially improved locoregional control. (Based on the evidence review in the Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand 2008) Wright F, et al. Clin Oncol. 2011;23(9):
9 Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand SLN status provides accurate prognostic information for disease free and overall survival for melanomas stage T1b or greater. Patients with melanoma >1.0 mm should be given the opportunity to discuss SLNB. SLNB should be performed only, following discussion of options, in a unit with access to appropriate surgical, nuclear medicine, and pathology services. Australian Cancer Network Melanoma Guidelines Revision Working Party. Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand. Cancer Council Australia and Australian Cancer Network, Sydney and New Zealand Guidelines Group, Wellington (2008) British Association of Dermatologists SLNB can be considered in stage IB melanoma and upwards in Specialist Skin Cancer Multidisciplinary Teams. Patients should be introduced to the concept of SLNB as a staging procedure but should also understand that it has no proven therapeutic value. Surgical risks of SLNB, the possibility of failure to find a SLN, and of a false negative result, should also be explained. Marsden JR, et al. Br J Dermatol. 2010;163: European Dermatology Forum European Association of Dermato Oncology European Organization for Research and Treatment of Cancer SLNB has been established as a valuable staging tool. Positivity rate for melanomas <1 mm is so low that it is normally not recommended, although some centres take additional poor prognostic features into account. Seems appropriate to concentrate SLNB in larger centres where experience can be acquired. Garbe C, et al. Eur J Cancer. 2012;48:
10 European Society for Medical Oncology SLNB in melanoma >1 mm and/or ulceration is necessary for precise staging. SLNB has no proven effect on overall survival. SLNB should be carried out only by skilled teams in experienced centers. Dummer R, et al. Ann Oncol. 2012;23 (Sup 7):vii86 91 American Academy of Dermatology Status of SLN is most important prognostic indicator for diseasespecific survival; impact on survival remains unclear. SLNB not recommended for in situ or T1a melanoma. SLNB should be considered for melanoma >1 mm. In T1b, mm, SLNB should be discussed; in T1b 0.75 mm, SLNB should generally not be considered, unless other parameters are present. Bichakjian CK, et al. J Am Acad Dermatol. 2011;65: National Comprehensive Cancer Network SLNB is an important staging tool; the impact on overall survival is unclear. SLNB should be discussed and offered for melanoma >1 mm. In general, SLNB not recommended for 0.75 mm. Other than thickness, little consensus what other conventional features predict SLN positivity in melanoma <1 mm. Coit DG, et al. J Natl Compr Canc Netw. 2013;11:
11 NCCN EORTC CCO SLNB BAD AAD CCA SLNB for Melanoma Clinical Implications and Real Decisions Case 1 56 y/o healthy male Ulcerated nodular melanoma, right upper back 2.8 mm Breslow thickness 5 mitoses/mm2 IIB (T3b N0 M0) WLE wide local excision; SLNB sentinel lymph node biopsy 11
12 2010 AJCC T Classification T Classification Thickness (mm) Ulceration Status/Mitoses T1 1.0 a: w/o ulceration and <1 mitosis/mm 2 or 1 mitosis/ mm 2 T a: w/o ulceration T a: w/o ulceration T4 > 4.0 a: w/o ulceration Balch CM, et al. AJCC Cancer Staging Manual p Case 2 64 y/o healthy female Non ulcerated superficial spreading melanoma, left forearm 0.6 mm Breslow thickness 0 mitoses/mm2 IA (T1a N0 M0) WLE wide local excision 2010 AJCC T Classification T Classification Thickness (mm) Ulceration Status/Mitoses T1 1.0 a: w/o ulceration and <1 mitosis/mm 2 or 1 mitosis/ mm 2 T a: w/o ulceration T a: w/o ulceration T4 > 4.0 a: w/o ulceration Balch CM, et al. AJCC Cancer Staging Manual p
13 Cases 3 & 4 24 y/o healthy female Ulcerated superficial spreading melanoma, left shoulder 0.92 mm Breslow thickness 3 mitoses/mm2 IB (T1b N0 M0) 39 y/o healthy male Non ulcerated superficial spreading melanoma, right shoulder 0.82 mm Breslow thickness 1 mitosis/mm2 IB (T1b N0 M0) 2010 AJCC T Classification T Classification Thickness (mm) Ulceration Status/Mitoses T1 1.0 a: w/o ulceration and <1 mitosis/mm 2 or 1 mitosis/ mm 2 T a: w/o ulceration T a: w/o ulceration T4 > 4.0 a: w/o ulceration Balch CM, et al. AJCC Cancer Staging Manual p SLNB Thin Melanoma 24 retrospective studies reporting SLNB for melanoma 1.0 mm Breslow depth: 1.0 mm: 184/3635 (5.1%) mm: 72/1166 (6.2%) 0.75 mm: 22/829 (2.7%) AJCC survival T1aN0M0: 5 year survival rate: 97% 10 year survival rate: 93% Andtbacka RH, et al. J Natl Compr Canc Netw. 2009;7: Balch CM, et al. J Clin Oncol 2009;27:
14 Survival Curves by Number of Mitoses/mm2 Thompson J F et al. JCO 2011;29: by American Society of Clinical Oncology Age and Mitotic Rate as Predictors of SLN Positivity UM Experience Breslow Depth held constant at 1.0 mm 429 patients Sondak VK, et al. Ann Surg Oncol. 2004;11: Azzola MF, et al. Cancer. 2003;97: SLNB Thin Melanoma Melanoma Institute Australia (SMU) Retrospective review 1mm patients SLN positivity rate 6.7% Only factors associated with SLN positivity: Breslow thickness (p = 0.012) Lymphovascular invasion (p = 0.018) Mitotic rate significant predictor of survival, but not SLN positivity Murali R, et al. Ann Surg. 2012;255:
15 Patients Preferences Adjuvant chemotherapy in early breast cancer. What makes it worthwhile? Half judged 1 day or 0.1% sufficient to make adjuvant chemotherapy worthwhile Disconnect between patient and provider preferences Duric V, et al. Ann Oncol. 2005;16: Duric V, et al. Lancet Oncol. 2001;2:691 7 SLNB for Melanoma Future Role of SLNB 15
16 New Systemic Therapies for Melanoma Anti CTLA4 mab ipilimumab Anti PD1 mab nivolumab lambrolizumab BRAF inhibitors vemurafenib dabrafenib MAPK kinase (MEK) inhibitor trametinib Future Role for SLNB in Melanoma Determine need for adjuvant therapy? Determine type of adjuvant therapy? Melanoma the unlikely poster child for personalized cancer care. Smalley KS, Sondak VK. N Engl J Med. 201o; 363(9):
Translating Evidence into Practice: Primary Cutaneous Melanoma Guidelines. Sentinel Lymph Node Biopsy
American Academy of Dermatology 2018 Annual Meeting San Diego, CA, February 17, 2018 Translating Evidence into Practice: Primary Cutaneous Melanoma Guidelines. Sentinel Lymph Node Biopsy Christopher Bichakjian,
More informationRebecca Vogel, PGY-4 March 5, 2012
Rebecca Vogel, PGY-4 March 5, 2012 Historical Perspective Changes In The Staging System Studies That Started The Talk Where We Go From Here Cutaneous melanoma has become an increasingly growing problem,
More informationUpdates on Melanoma: Are You Following the Latest Guidelines of Care? Jerry Brewer, MD
Updates on Melanoma: Are You Following the Latest Guidelines of Care? Jerry Brewer, MD Disclosure Statement Update on Melanoma Are You Following the Latest Guidelines of Care? I, Jerry D. Brewer, MD, do
More informationTalk to Your Doctor. Fact Sheet
Talk to Your Doctor Hearing the words you have skin cancer is overwhelming and would leave anyone with a lot of questions. If you have been diagnosed with Stage I or II cutaneous melanoma with no apparent
More informationNo Benefit to Routine Completion Lymphadenectomy for Sentinel Lymph Node Positive Melanoma
No Benefit to Routine Completion Lymphadenectomy for Sentinel Lymph Node Positive Melanoma Michael Lowe, MD Assistant Professor of Surgery Winship Cancer Institute Emory University School of Medicine July
More informationAJCC 8 Implementation January 1, 2018 Melanoma of the Skin. Suraj Venna
AJCC 8 Implementation January 1, 2018 Melanoma of the Skin Suraj Venna Personalized Medicine AJCC 8 th Edition This Time It s Personal Traditional AJCC (TNM) population-based analyses of large databases
More informationTopics for Discussion. Malignant Melanoma. Surgical Treatment. Current Treatment of Cutaneous Melanoma 5/17/2013. Lymph Regional nodes:
Topics for Discussion What is a sentinel lymph node (SLN)? Utility of sentinel lymph biopsies: therapeutic or staging? Current Treatment of Cutaneous Melanoma Carlos Corvera, M.D. Associate Professor of
More informationDesmoplastic Melanoma: Surgical Management and Adjuvant Therapy
Desmoplastic Melanoma: Surgical Management and Adjuvant Therapy Dale Han, MD Assistant Professor Department of Surgery Section of Surgical Oncology No disclosures Background Desmoplastic melanoma (DM)
More informationControversies and Questions in the Surgical Treatment of Melanoma
Controversies and Questions in the Surgical Treatment of Melanoma Giorgos C. Karakousis, M.D. Assistant Professor of Surgery Division of Endocrine and Oncologic Surgery University of Pennsylvania School
More informationUpdate on SLN and Melanoma: DECOG and MSLT-II. Gordon H. Hafner, MD, FACS
Update on SLN and Melanoma: DECOG and MSLT-II Gordon H. Hafner, MD, FACS No disclosures The surgery of malignant disease is not the surgery of organs, it is of the lymphatic system. Lord Moynihan Lymph
More informationPatient age and cutaneous malignant melanoma: Elderly patients are likely to have more aggressive histological features and poorer survival
MOLECULAR AND CLINICAL ONCOLOGY 7: 1083-1088, 2017 Patient age and cutaneous malignant melanoma: Elderly patients are likely to have more aggressive histological features and poorer survival FARUK TAS
More informationSentinel Node Alphabet Soup: MSLT-1, DeCOG-SLT, MSLT-2, UNC
Sentinel Node Alphabet Soup: MSLT-1, DeCOG-SLT, MSLT-2, UNC David W. Ollila MD James and Jesse Millis Professor of Surgery University of North Carolina, Chapel Hill Disclosures: None July 15, 2018 AJCC
More informationNodal Treatment in Melanoma: Snow to MSLT-II
Nodal Treatment in Melanoma: Snow to MSLT-II Mark B. Faries, MD, FACS Director, Donald L. Morton Melanoma Research Program Program Director, JWCI Complex General Surgical Oncology Fellowship Director,
More informationAn estimated 76,690 patients will be diagnosed with invasive
SONDAK ET AL Evidence-Based Clinical Practice Guidelines on the Use of Sentinel Lymph Node Biopsy in Melanoma Vernon K. Sondak, MD, Sandra L. Wong, MD, Jeffrey E. Gershenwald, MD, and John F. Thompson,
More informationMelanoma Surgery Update James R. Ouellette, DO FACS Premier Health Cancer Institute Wright State University Chief, Surgical Oncology Division
Melanoma Surgery Update 2018 James R. Ouellette, DO FACS Premier Health Cancer Institute Wright State University Chief, Surgical Oncology Division Surgery for Melanoma Mainstay of treatment for potentially
More informationMelanoma Patients and the Sentinel Lymph Node (SLN) Procedure: An Oncologic Surgeon s Perspective
Melanoma Patients and the Sentinel Lymph Node (SLN) Procedure: An Oncologic Surgeon s Perspective Giorgos C. Karakousis, M.D. Associate Professor of Surgery Hospital of the University of Pennsylvania Disclosures
More informationMelanoma 10/12/18 Justin J. Baker, M.D.
Objectives Review Incidence Risk Factors for Development Detection 10/12/18 Justin J. Baker, M.D. Treatment of Surgery Medicine Radiation What is Incidence Cancer of Melanocytes Melanocytes are normal
More informationSentinel Lymph Node Biopsy Is Valuable For All Cancer. Surgery Grand Rounds Debate October 6, 2008 Joel Baumgartner
Sentinel Lymph Node Biopsy Is Valuable For All Cancer Surgery Grand Rounds Debate October 6, 2008 Joel Baumgartner History Lymphatics first described by Rasmus Bartholin in 1653 Rudolf Virchow postulated
More informationClinico-pathological Features of Patients with Melanoma and Positive Sentinel Lymph Node Biopsy: A Single Institution Experience
2015;23(2):122-129 CLINICAL ARTICLE Clinico-pathological Features of Patients with Melanoma and Positive Sentinel Lymph Node Biopsy: A Single Institution Experience Damir Homolak 1, Mirna Šitum 2,3, Hrvoje
More informationPrinted by Martina Huckova on 10/3/2011 3:04:54 PM. For personal use only. Not approved for distribution. Copyright 2011 National Comprehensive
Table of Contents NCCN Categories of Evidence and Consensus Category 1: Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Category 2A: Based upon lower-level
More informationORIGINAL ARTICLE PROGNOSTIC IMPLICATION OF SENTINEL LYMPH NODE BIOPSY IN CUTANEOUS HEAD AND NECK MELANOMA
ORIGINAL ARTICLE PROGNOSTIC IMPLICATION OF SENTINEL LYMPH NODE BIOPSY IN CUTANEOUS HEAD AND NECK MELANOMA Benjamin E. Saltman, MD, 1 Ian Ganly, MD, 2 Snehal G. Patel, MD, 2 Daniel G. Coit, MD, 3 Mary Sue
More informationWhen Do I Consider Myself Cured?
The Melanoma Patient Symposium - Science to Survivorship When Do I Consider Myself Cured? 26 September 2009 Jeffrey E. Gershenwald, MD, FACS Professor of Surgery, Dept. of Surgical Oncology Professor,
More informationGenetic Testing: When should it be ordered? Julie Schloemer, MD Dermatology
Genetic Testing: When should it be ordered? Julie Schloemer, MD Dermatology Outline Germline testing CDKN2A BRCA2 BAP1 Somatic testing Gene expression profiling (GEP) BRAF Germline vs Somatic testing
More informationSurgical Issues in Melanoma
Surgical Issues in Melanoma Mark B. Faries, MD, FACS Director, Donald L. Morton Melanoma Research Program Director, Surgical Oncology Training Program Professor of Surgery John Wayne Cancer Institute Surgical
More informationSentinel Lymph Node Biopsy: Current Evidence for its Role in Managing Melanoma
Sentinel Lymph Node Biopsy: Current Evidence for its Role in Managing Melanoma John A Zitelli MD Adjunct Clinical Associate Professor Dermatology, Otolaryngology, Plastic Surgery University of Pittsburgh
More informationORIGINAL ARTICLE. Clinical Node-Negative Thick Melanoma
ORIGINAL ARTICLE Clinical Node-Negative Thick Melanoma George I. Salti, MD; Ashwin Kansagra, MD; Michael A. Warso, MD; Salve G. Ronan, MD ; Tapas K. Das Gupta, MD, PhD, DSc Background: Patients with T4
More informationWork-up/Follow-up: Baseline and Surveillance Studies for Cutaneous Melanoma Patients
2018 AAD Annual Meeting, San Diego, CA Work-up/Follow-up: Baseline and Surveillance Studies for Cutaneous Melanoma Patients Susan M. Swetter, MD, FAAD Professor of Dermatology Director, Pigmented Lesion
More informationYou Are Going to Cut How Much Skin? Locoregional Surgical Treatment. Justin Rivard MD, MSc, FRCSC September 21, 2018
You Are Going to Cut How Much Skin? Locoregional Surgical Treatment Justin Rivard MD, MSc, FRCSC September 21, 2018 Presenter Disclosure Faculty/Speaker: Justin Rivard Relationships with financial sponsors:
More informationMelanoma and Dermoscopy. Disclosure Statement: ABCDE's of melanoma. Co-President, Usatine Media
Melanoma and Dermoscopy Richard P. Usatine, MD, FAAFP Professor, Family and Community Medicine Professor, Dermatology and Cutaneous Surgery Medical Director, University Skin Clinic University of Texas
More informationMolecular Enhancement of Sentinel Node Evaluation
Cochran Illustrations 060104 Molecular Enhancement of Sentinel Node Evaluation Alistair Cochran, MD and Rong Huang MD Departments of Pathology and Laboratory Medicine and Surgery, David Geffen School of
More informationIs There a Benefit to Sentinel Lymph Node Biopsy in Patients With T4 Melanoma?
Is There a Benefit to Sentinel Lymph Node Biopsy in atients With T4 Melanoma? Csaba Gajdos, MD 1 ; Kent A. Griffith, MH, MS 2 ; Sandra L. Wong, MD 1 ; Timothy M. Johnson, MD 1,3 ; Alfred E. Chang, MD 1
More informationAdvances in Surgical Management of Primary Melanoma: Identifying Patients Who Need More than Conventional Wide Local Excision
Advances in Surgical Management of Primary Melanoma: Identifying Patients Who Need More than Conventional Wide Local Excision Christopher J. Miller, MD Director of Penn Dermatology Oncology Center Associate
More informationReference No: Author(s) September Approval date: committee. Operational Date: August Review:
Reference No: Title: Author(s) Ownership: Approval by: Operational Date: Systemic Anti-Cancer Therapy (SACT) guidelines for the management of malignant melanoma Dr Vicky Coyle Consultant Medical Oncologist
More informationMalignant Melanoma in Turkey: A Single Institution s Experience on 475 Cases
Malignant Melanoma in Turkey: A Single Institution s Experience on 475 Cases Faruk Tas, Sidika Kurul, Hakan Camlica and Erkan Topuz Institute of Oncology, Istanbul University, Istanbul, Turkey Received
More informationMelanoma Quality Reporting
Melanoma Quality Reporting September 1, 2013 December 31, 2016 Laurence McCahill, MD Surgical Oncologist Metro Health Surgical Oncology Metro Health Professional Building 2122 Health Drive SW Wyoming,
More informationCutaneous Melanoma: Epidemiology (USA) The Sentinel Node in Head and Neck Melanoma. Cutaneous Melanoma: Epidemiology (USA)
The Sentinel Node in Head and Neck Melanoma Cutaneous Melanoma: Epidemiology (USA) 6 th leading cause of cancer among men and women 68,720 new cases of invasive melanoma in 2009 8,650 deaths from melanoma
More informationMelanoma: Therapeutic Progress and the Improvements Continue
Melanoma: Therapeutic Progress and the Improvements Continue David W. Ollila, MD Professor of Surgery Jesse and James Millis Professor of Melanoma Research May 20, 2016 Disclosures: NONE Outline 2016 Therapeutic
More informationCase Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors
CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior
More informationSentinel Lymph Node Biopsy for Head and Neck Cutaneous Melanoma
Sentinel Lymph Node Biopsy for Head and Neck Cutaneous Melanoma S. Ross Patton, MD - PGY III Faculty Mentor: Susan McCammon, MD The University of Texas Medical Branch (UTMB Health) Department of Otolaryngology
More informationMorphological characteristics of the primary tumor and micrometastases in sentinel lymph nodes as a predictor of melanoma progression
Morphological characteristics of the primary tumor and micrometastases in sentinel lymph nodes as a predictor of melanoma progression M.N. Kukushkina, S.I. Korovin, O.I. Solodyannikova, G.G. Sukach, A.Yu.
More informationSurgery for Melanoma and What s on the Horizon
and What s on the Horizon Giorgos C. Karakousis, M.D. Assistant Professor of Surgery Perelman School of Medicine at the University of Pennsylvania Background/Overview 76,870 cases of melanoma estimated
More informationMelanoma Update: 8th Edition of AJCC Staging System
Melanoma Update: 8th Edition of AJCC Staging System Rosalie Elenitsas, M.D. Professor of Dermatology Director, Dermatopathology University of Pennsylvania DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY None
More informationHow can we reduce the mortality from melanoma in Australia?
How can we reduce the mortality from melanoma in Australia? Professor Grant McArthur MB BS PhD Peter MacCallum Cancer Centre Melbourne, Australia University of Melbourne, Parkville, Australia What is melanoma?
More informationSkin lesions suspicious for melanoma: New Zealand excision margin guidelines in practice
Skin lesions suspicious for melanoma: excision margin guidelines in practice Tess Brian MBBS; 1 Michael B. Jameson MBChB, FRACP, FRCP, PhD 2,3 1 Department of Plastic and Reconstructive Surgery, Waikato
More informationTumor Mitotic Rate Added to the Equation: Melanoma Prognostic Factors Changed?
Ann Surg Oncol (2015) 22:2978 2987 DOI 10.1245/s10434-014-4349-3 ORIGINAL ARTICLE MELANOMAS Tumor Mitotic Rate Added to the Equation: Melanoma Prognostic Factors Changed? A Single-Institution Database
More informationUpdate on Lymph Node Management in Melanoma
Update on Lymph Node Management in Melanoma John T. Vetto MD, FACS Professor of Surgery Division of Surgical Oncology Oregon Health & Science University Portland, Oregon Lymph Nodes in Melanoma Outline
More informationRadionuclide detection of sentinel lymph node
Radionuclide detection of sentinel lymph node Sophia I. Koukouraki Assoc. Professor Department of Nuclear Medicine Medicine School, University of Crete 1 BACKGROUND The prognosis of malignant disease is
More information1
www.clinicaloncology.com.ua 1 Prognostic factors of appearing micrometastases in sentinel lymph nodes in skin melanoma M.N.Kukushkina, S.I.Korovin, O.I.Solodyannikova, G.G.Sukach, A.Yu.Palivets, A.N.Potorocha,
More informationWHAT DOES THE PATHOLOGY REPORT MEAN?
Melanoma WHAT IS MELANOMA? Melanoma is a type of cancer that affects cells called melanocytes. These cells are found mainly in skin but also in the lining of other areas such as nose and rectum, and also
More informationNCCN Guidelines for Cutaneous Melanoma V Meeting on 06/20/18
ME-1, ME-3, ME-B Submission from Castle Biosciences, Inc (05/30/18) to consider inclusion of the DecisionDx-Melanoma test in the guidelines as a prognostic test that provides stratification according to
More informationUpdate on Sentinel Node Biopsy in Endometrial Cancer: Feasibility, Technique, Impact
Update on Sentinel Node Biopsy in Endometrial Cancer: Feasibility, Technique, Impact Bjørn Hagen, MD, PhD St Olavs Hospital Trondheim University Hospital Trondheim, Norway Endometrial Cancer (EC) The most
More informationPAPER. Prognostic Information From Sentinel Lymph Node Biopsy in Patients With Thick Melanoma
PAPER Prognostic Information From Sentinel Lymph Node Biopsy in Patients With Thick Melanoma Charles R. Scoggins, MD, MBA; Adrianne L. Bowen, MD; Robert C. Martin II, MD, PhD; Michael J. Edwards, MD; Douglas
More informationLocally Advanced and Metastatic Melanoma. Relevant disclosures 6/23/2018. What is the median survival of metastatic melanoma? Abel D.
Locally Advanced and Metastatic Melanoma Abel D. Jarell, MD, FAAD Adjunct Dartmouth School of Medicine, Hanover, NH Northeast Dermatology Associates, Portsmouth, NH Relevant disclosures What is the median
More informationSentinel Lymph Node Biopsy: Past and Present Implications for the Management of Cutaneous Melanoma with Nodal Metastasis
American Journal of Clinical Dermatology (2018) 19 (Suppl 1):S24 S30 https://doi.org/10.1007/s40257-018-0379-0 REVIEW ARTICLE Sentinel Lymph Node Biopsy: Past and Present Implications for the Management
More informationWhat are the new AJCC Staging System changes, and how will they affect my patients?
What are the new AJCC Staging System changes, and how will they affect my patients? Emily Y. Chu, M.D., Ph.D. Assistant Professor of Dermatology & Pathology and Laboratory Medicine University of Pennsylvania
More informationSENTINEL LYMPH node (SLN) biopsy has become
COMMENTARY Sentinel Lymph Node Biopsy for Melanoma: Controversy Despite Widespread Agreement By Kelly M. McMasters, Douglas S. Reintgen, Merrick I. Ross, Jeffrey E. Gershenwald, Michael J. Edwards, Arthur
More informationMelanoma Underwriting Presented at 2018 AHOU Conference. Hank George FALU
Melanoma Underwriting Presented at 2018 AHOU Conference Hank George FALU MELANOMA EPIDEMIOLOGY 70-80,000 American cases annually Majority are in situ or thin > 20% are diagnosed age 45 8-9,000 melanoma
More informationSentinel Lymph Node Biopsies in Cutaneous Melanoma: A systematic review of the literature. Sasha Jenkins
Sentinel Lymph Node Biopsies in Cutaneous Melanoma: A systematic review of the literature By Sasha Jenkins A Master s Paper submitted to the faculty of the University of North Carolina at Chapel Hill in
More informationReport Back 12 th Canadian Melanoma Conference February 22 24, 2018
1 Report Back 12 th Canadian Melanoma Conference February 22 24, 2018 2 Below is a report back of major themes gleaned from the 12 th Annual Canadian Melanoma Conference along with some photos, anecdotes,
More informationPredictive Factors for the Positivity of the Sentinel Lymph Node in Malignant Melanoma
ORIGINAL RESEARCH SURGERY // ANATOMO-PATHOLOGY Predictive Factors for the Positivity of the Sentinel Lymph Node in Malignant Melanoma Călin Crăciun, Orsolya Hankó- Bauer, Zalán Benedek, Sorin Sorlea, Marius
More informationMetastatic Melanoma. Cynthia Kwong February 16, 2017 SUNY Downstate Medical Center Department of Surgery Grand Rounds
Metastatic Melanoma Cynthia Kwong February 16, 2017 SUNY Downstate Medical Center Department of Surgery Grand Rounds Case Presentation 77 year old male with previous history of scalp melanoma and thyroid
More informationClinical Case Conference Melanoma
Clinical Case Conference Melanoma Epidemiology ~60,000 cases and 8,000 deaths per year in US Caucasian:African American = 10:1 15% arise from existing nevi 91% are cutaneous 15% are LN+ at presentation
More informationResearch Article Prediction of Sentinel Node Status and Clinical Outcome in a Melanoma Centre
Skin Cancer Volume 2013, Article ID 904701, 7 pages http://dx.doi.org/10.1155/2013/904701 Research Article Prediction of Sentinel Node Status and Clinical Outcome in a Melanoma Centre Vera Teixeira, 1
More informationSurgical Oncology Perspective of Melanoma
Surgical Oncology Perspective of Melanoma Hans F. Schoellhammer, MD, FACS Assistant Clinical Professor Division of Surgical Oncology September 20, 2018 Nothing to disclose DISCLOSURE Discussion Objectives
More informationClinical Pathological Conference. Malignant Melanoma of the Vulva
Clinical Pathological Conference Malignant Melanoma of the Vulva History F/48 Chinese Married Para 1 Presented in September 2004 Vulval mass for 2 months Associated with watery and blood stained discharge
More informationCitation for published version (APA): Francken, A. B. (2007). Primary and metastatic melanoma: aspects of follow-up and staging s.n.
University of Groningen Primary and metastatic melanoma Francken, Anne Brecht IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check
More informationSurgical Treatment of Melanoma Across the Disease Spectrum:
AOCD Annual Fall Meeting October 28 th, 2017 New Orleans, Louisiana Surgical Treatment of Melanoma Across the Disease Spectrum: Standards of Care and Evolving Paradigms Merrick Ross, M.D. Professor of
More informationImpact of Prognostic Factors
Melanoma Prognostic Factors: where we started, where are we going? Impact of Prognostic Factors Staging Management Surgical intervention Adjuvant treatment Suraj Venna, MD Assistant Clinical Professor,
More informationSkin Malignancies Non - Melanoma & Melanoma Marilyn Ng, MD Dept. of Surgery M&M Conference Downstate Medical Center July 19, 2012
Skin Malignancies Non - Melanoma & Melanoma Marilyn Ng, MD Dept. of Surgery M&M Conference Downstate Medical Center July 19, 2012 Case Presentation 57 yo man with 3 month hx of a nonhealing < 1 cm right
More informationDr Rosalie Stephens. Mr Richard Martin. Medical Oncologist Auckland City Hospital Auckland
Dr Rosalie Stephens Medical Oncologist Auckland City Hospital Auckland Mr Richard Martin General Surgeon Melanoma Unit Team Waitemata District Health Board Auckland 8:30-9:25 WS #99: Interactive Case Studies
More informationPrecision Surgery for Melanoma
Precision Surgery for Melanoma Giorgos C. Karakousis, M.D. Assistant Professor of Surgery Perelman School of Medicine at the University of Pennsylvania Background 87,110 cases of melanoma estimated in
More informationQuality ID #397: Melanoma Reporting National Quality Strategy Domain: Communication and Care Coordination
Quality ID #397: Melanoma Reporting National Quality Strategy Domain: Communication and Care Coordination 2018 OPTIONS FOR INDIVIDUAL MEASURES: CLAIMS ONLY MEASURE TYPE: Outcome DESCRIPTION: Pathology
More informationEpidemiology. Objectives 8/28/2017
Case based Discussion of Head and Neck Melanoma: Review of Epidemiology, Risk Factors, Identification, Treatments and Prevention Jacqueline M. Doucette MS FNP-C Objectives Define and identify melanoma
More informationIncreasing Age Is Associated with Worse Prognostic Factors and Increased Distant Recurrences despite Fewer Sentinel Lymph Node Positives in Melanoma
Increasing Age Is Associated with Worse Prognostic Factors and Increased Distant Recurrences despite Fewer Sentinel Lymph Node Positives in Melanoma A. J. Page, Emory University A. Li, Emory University
More informationTHE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC)
THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) I.Kostadinova, Sofia, Bulgaria CMM some clinical facts The incidence
More informationPractical Tips for Caring for Melanoma Patients
Practical Tips for Caring for Melanoma Patients Caroline C. Kim, MD, Director Assistant Professor, Department of Dermatology Harvard Medical School Director, Pigmented Lesion Clinic Associate Director,
More information6/22/2015. Original Paradigm. Correlating Histology and Molecular Findings in Melanocytic Neoplasms
6 Correlating Histology and Molecular Findings in Melanocytic Neoplasms Pedram Gerami MD, Associate Professor of Dermatology and Pediatrics at Northwestern University Disclosures: I have been a consultant
More information> 6000 Mutations in Melanoma. Tests That Cay Be Employed. FISH for Additions/Deletions. Comparative Genomic Hybridization
Winter Clinical 2017: The Assessment and Diagnosis of Melanoma Whitney A. High, MD, JD, MEng Associate Professor, Dermatology & Pathology Director of Dermatopathology (Dermatology) University of Colorado
More informationDENOMINATOR: All melanoma pathology reports for primary malignant cutaneous melanoma
Quality ID #397: Melanoma Reporting National Quality Strategy Domain: Communication and Care Coordination Meaningful Measure Area: Transfer of Health Information and Interoperability 2019 COLLECTION TYPE:
More informationPrimary Cutaneous Melanoma Pathology Reporting Proforma DD MM YYYY. *Tumour site. *Specimen laterality. *Specimen type
Primary Cutaneous Melanoma Pathology Reporting Proforma Includes the International Collaboration on Cancer reporting dataset denoted by * Family name Given name(s) Date of birth DD MM YYYY Sex Male Female
More information1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter.
Skin Cancer follow up guidelines If NEW serious diagnosis given: 1. Written information to patient /GP: fax ASAP to GP & offer copy of consultation letter. 2. Free prescription information details. 3.
More informationMeasure #397: Melanoma Reporting National Quality Strategy Domain: Communication and Care Coordination
Measure #397: Melanoma Reporting National Quality Strategy Domain: Communication and Care Coordination 2017 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Outcome DESCRIPTION: Pathology reports
More informationEpithelial Cancer- NMSC & Melanoma
Epithelial Cancer- NMSC & Melanoma David Chin MB, BCh, BAO, LRCP, LRCS (Ireland) MCh(MD), PhD (UQ), FRCS, FRACS (Plast) Plastic & Reconstructive Surgeon Visiting Scientist Melanoma Genomic Group & Drug
More information1. Opdivo + Ipilumimab is now the first line therapy for metastatic melanoma.
Melanoma UpToDate: Introduction: Risk Factors: 1. Opdivo + Ipilumimab is now the first line therapy for metastatic melanoma. Median age = 50 yrs Incidence is rising - Sun exposure: UVB (290-320nm) > UVA
More informationCarol Davila University of Medicine and Pharmacy, Bucharest, Romania b
Mædica - a Journal of Clinical Medicine MAEDICA a Journal of Clinical Medicine 2015; 10(3): 226-230 ORIGINAL PAPERS Improving Melanoma Path Reports: the Importance of Histopathological Parameters in Diagnosis
More informationDr. Brent Doolan, BSc MBBS MPH
Impact of partial biopsies on the need for complete excisional surgery in the management of cutaneous melanomas: A multi-centre review Dr. Brent Doolan, BSc MBBS MPH Peter MacCallum Cancer Centre, Melbourne
More informationManagement of Cutaneous Melanoma of the Head and Neck and a bit about SCCA/BCC. Irvin Pathak
Management of Cutaneous Melanoma of the Head and Neck and a bit about SCCA/BCC Irvin Pathak Objectives Risk Factors Biopsy techniques Current surgical treatment Current Status of Adjuvant Therapies Epidemiology
More informationTreatment and management of advanced melanoma: Paul B. Chapman, MD Melanoma Clinical Director, Melanoma and Immunotherapeutics Service MSKCC
Treatment and management of advanced melanoma: 2018 Paul B. Chapman, MD Melanoma Clinical Director, Melanoma and Immunotherapeutics Service MSKCC Disclosure Paul B. Chapman, MD Nothing to disclose. Off
More information23/04/2015. Recent advances in Melanoma and Non Melanoma Skin Cancer
Recent advances in and Non Skin Cancer Rodney Sinclair Professor of Dermatology University of Melbourne & Epworth Hospital 86.5% increase 120% increase 37.5% increase 1 To ascertain incidence of NMSC De
More informationPosition Statement on Management of the Axilla in Patients with Invasive Breast Cancer
- Official Statement - Position Statement on Management of the Axilla in Patients with Invasive Breast Cancer Sentinel lymph node (SLN) biopsy has replaced axillary lymph node dissection (ALND) for the
More informationSentinel Lymph Node Biopsy in Other Tumours: Sentinel Lymph Node Biopsy in Other Tumours. Methodology. Results. Key Questions to Consider
Sentinel Lymph Node Biopsy in Other Tumours Dr. Rona Cheifetz Surgical Oncology Update November 24, 2006 Sentinel Lymph Node Biopsy in Other Tumours: An Operation Looking for an Application Dr. Rona Cheifetz
More informationTherapeutic Lymph Node Dissection in Melanoma: Different Prognosis for Different Macrometastasis Sites?
Ann Surg Oncol (01) 19:91 91 DOI.14/s44-01-401- ORIGINAL ARTICLE MELANOMAS Therapeutic Lymph Node Dissection in Melanoma: Different Prognosis for Different Macrometastasis Sites? K. P. Wevers, MD, E. Bastiaannet,
More informationThin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis
Ann Surg Oncol DOI 10.1245/s10434-016-5646-9 ORIGINAL ARTICLE MELANOMAS Thin Melanoma with Nodal Involvement: Analysis of Demographic, Pathologic, and Treatment Factors with Regard to Prognosis Giorgos
More informationPrimary Excision Margins and Sentinel Lymph Node Biopsy in Cutaneous Melanoma
A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Primary Excision Margins and Sentinel Lymph Node Biopsy in Cutaneous Melanoma F. Wright, L.H. Souter, S. Kellett,
More informationPrognosis of Sentinel Node Staged Patients with Primary Cutaneous Melanoma
Prognosis of Sentinel Node Staged Patients with Primary Cutaneous Melanoma Otmar Elsaeßer 1., Ulrike Leiter 1 *., Petra G. Buettner 2, Thomas K. Eigentler 1, Friedegund Meier 1, Benjamin Weide 1, Gisela
More informationSentinel Lymph Node Biopsy for Breast Cancer
Sentinel Lymph Node Biopsy for Breast Cancer Registrar Tutorial Adam Cichowitz Surgical Registrar The Royal Melbourne Hospital Sentinel Lymph Node Biopsy Axillary LN status important prognostic factor
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Malignant Melanoma
Nth of Scotland Cancer Netwk Clinical Management Guideline f Malignant Melanoma Based on WOSCAN CMG with further consultation within NOSCAN UNCONTROLLED WHEN PRINTED Prepared by Approved by Issue date
More informationCitation for published version (APA): Francken, A. B. (2007). Primary and metastatic melanoma: aspects of follow-up and staging s.n.
University of Groningen Primary and metastatic melanoma Francken, Anne Brecht IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check
More informationHosts. Anees Chagpar, MD Associate Professor of Surgical Oncology. Steven Gore, MD Director of Hematological Malignancies. Melanoma Awareness 2015
Hosts Anees, MD Associate Professor of Surgical Oncology Steven Gore, MD Director of Hematological Malignancies Melanoma Awareness 2015 Guest Experts: Jennifer, MD Assistant Professor of Dermatology; Director,
More informationPoor prognosis for thin ulcerated melanomas and implications for a more aggressive approach to treatment
Poor prognosis for thin ulcerated melanomas and implications for a more aggressive approach to treatment Makenzie L. Hawkins, MSPH 1 Matthew J. Rioth, MD 1,2 Megan M. Eguchi, MPH 1 Myles Cockburn, Phd
More information