| 1. |
- Chakera, Annette H., et al.
(författare)
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EANM-EORTC general recommendations for sentinel node diagnostics in melanoma
- 2009
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Ingår i: European Journal of Nuclear Medicine and Molecular Imaging. - : Springer Science and Business Media LLC. - 1619-7070 .- 1619-7089. ; 36:10, s. 1713-1742
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Forskningsöversikt (refereegranskat)abstract
- The accurate diagnosis of a sentinel node in melanoma includes a sequence of procedures from different medical specialities (nuclear medicine, surgery, oncology, and pathology). The items covered are presented in 11 sections and a reference list: (1) definition of a sentinel node, (2) clinical indications, (3) radiopharmaceuticals and activity injected, (4) dosimetry, (5) injection technique, (6) image acquisition and interpretation, (7) report and display, ( 8) use of dye, ( 9) gamma probe detection, (10) surgical techniques in sentinel node biopsy, and (11) pathological evaluation of melanoma-draining sentinel lymph nodes. If specific recommendations given cannot be based on evidence from original, scientific studies, referral is given to "general consensus" and similar expressions. The recommendations are designed to assist in the practice of referral to, performance, interpretation and reporting of all steps of the sentinel node procedure in the hope of setting state-of-the-art standards for good-quality evaluation of possible spread to the lymphatic system in intermediate-to-high risk melanoma without clinical signs of dissemination.
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| 2. |
- Chakera, Annette H., et al.
(författare)
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Sentinel node imaging
- 2006
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Ingår i: Current Medical Imaging Reviews. - : Bentham Science Publishers Ltd.. - 1875-6603 .- 1573-4056. ; 2:3, s. 341-346
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Forskningsöversikt (refereegranskat)abstract
- Breast cancer and melanoma metastasize predominantly via the lymphatic route. It has long been known that invasion into one or a few nodes draining the primary tumour, the sentinel nodes (SN), is the most important, early sign of dissemination. If no malignant cells are detected in the SN, dissemination is unlikely to be expected. For the last 10 years SN biopsy has become an important tool in staging cancers. Two kinds of tracers are used for SN detection: The blue dye, injected during operation, and radioactively labelled colloid, injected before operation. The lymphatic drainage can then be mapped by following the blue dye by visual inspection during the operation, and with gamma camera imaging before and probe detection during the operation. The variations in the tracers used, and the injection and imaging techniques are discussed. The pathologic examination has also undergone a rapid evolution with more detailed analysis including immunohistochemistry. The use of the SN technique has quickly spread worldwide for melanoma and breast cancer but is also being tested in several other cancers. Reports on the influence on morbidity and mortality reduction are becoming increasingly convincing. The near future of SN examination is finally briefly outlined.
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| 3. |
- Gillgren, Peter, et al.
(författare)
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2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial
- 2011
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Ingår i: The Lancet. - 1474-547X. ; 378:9803, s. 1635-1642
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Tidskriftsartikel (refereegranskat)abstract
- Background Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin. Methods We undertook a randomised controlled trial in nine European centres. Patients with cutaneous melanoma thicker than 2 mm, at clinical stage IIA-C, were allocated to have either a 2-cm or a 4-cm surgical resection margin. Patients were randomised in a 1:1 allocation to one of the two groups and stratified by geographic region. Randomisation was done by sealed envelope or by computer generated lists with permuted blocks. Our primary endpoint was overall survival. The trial was not masked at any stage. Analyses were by intention to treat. Adverse events were not systematically recorded. The study is registered with ClinicalTrials.gov, number NCT01183936. Findings 936 patients were enrolled from Jan 22, 1992, to May 19, 2004; 465 were randomly allocated to treatment with a 2-cm resection margin, and 471 to receive treatment with a 4-cm resection margin. One patient in each group was lost to follow-up but included in the analysis. After a median follow-up of 6.7 years (IQR 4.3-9.5) 181 patients in the 2-cm margin group and 177 in the 4-cm group had died (hazard ratio 1.05, 95% CI 0.85-1.29; p=0.64). 5-year overall survival was 65% (95% CI 60-69) in the 2-cm group and 65% (60-70) in the 4-cm group (p=0.69). Interpretation Our findings suggest that a 2-cm resection margin is sufficient and safe for patients with cutaneous melanoma thicker than 2 mm.
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| 4. |
- Wadt, Karin A W, et al.
(författare)
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Molecular characterization of melanoma cases in denmark suspected of genetic predisposition.
- 2015
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:3
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Tidskriftsartikel (refereegranskat)abstract
- Both environmental and host factors influence risk of cutaneous melanoma (CM), and worldwide, the incidence varies depending on constitutional determinants of skin type and pigmentation, latitude, and patterns of sun exposure. We performed genetic analysis of CDKN2A, CDK4, BAP1, MC1R, and MITFp.E318K in Danish high-risk melanoma cases and found CDKN2A germline mutations in 11.3% of CM families with three or more affected individuals, including four previously undescribed mutations. Rare mutations were also seen in CDK4 and BAP1, while MC1R variants were common, occurring at more than twice the frequency compared to Danish controls. The MITF p.E318K variant similarly occurred at an approximately three-fold higher frequency in melanoma cases than controls. To conclude, we propose that mutation screening of CDKN2A and CDK4 in Denmark should predominantly be performed in families with at least 3 cases of CM. In addition, we recommend that testing of BAP1 should not be conducted routinely in CM families but should be reserved for families with CM and uveal melanoma, or mesothelioma.
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