| Recent advances in the care of the patient with malignant melanoma. | |
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MedLine Citation:
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PMID: 8998115 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The authors review the recent advances in the surgical care, staging, and adjuvant treatment of the patient with melanoma. SUMMARY BACKGROUND DATA: Melanoma care has not changed significantly in the last 20 years, and the controversy of elective lymph node dissections in this disease continues to be discussed. Two advances in the care of the patient with melanoma have occurred in the last 3 years to make this an exciting time for clinicians and to offer more hope for the patients with this disease. The concept of the sentinel lymph node (SLN), defined by Morton as the first node in the lymphatic basin that drains the primary melanoma, has been documented to contain the first site of metastatic disease. This technology can be used to stage nodally the melanoma patient, identifying the subgroup of patients (stage III) who have a 5-year survival rate less than 50%. Members of this group are candidates for effective adjuvant therapies. METHODS: A review of the surgical techniques of melanoma care, including recently reported new studies of elective node dissection (ELND) and SLN biopsy in patients with melanoma was performed. In addition, the Eastern Cooperative Oncology Group (ECOG) 1684 trial, which was the basis for the Food and Drug Administration approval of adjuvant interferon-alpha-2b (IFN-alpha-2b) is discussed. RESULTS: The Intergroup Melanoma Trial has reported a survival benefit for performing ELND in patients with melanoma and tumor thickness between 1 and 2 mm or in patients that are younger than 60 years of age. With six reports in the literature that show there is an order to melanoma nodal metastases and that the SLN histology is reflective of the histology of the remainder of the nodal basin, the more conservative SLN biopsy can be performed to adequately stage nodally the patient with melanoma. Patients with nodal metastases who are rendered free of disease with surgical resection have the most to benefit from adjuvant IF-alpha-2b. If one considers only the lymph node-positive group of patients, the survival benefit associate with adjuvant IFN is significant (p = 0.008). CONCLUSIONS: New standards of care for the melanoma patient have been established. Patients at high risk for recurrence have been shown to experience a survival benefit with adjuvant IFN-alpha-2b. With these data, the argument can be made that all patients with melanoma greater than 1 mm should have a nodal staging procedure. Selective lymphadenectomy with SLN biopsy is the least morbid procedure that can be used to obtain this information. If surgeons do not have the nuclear medicine or pathology support to perform lymphatic mapping, then the guidelines of the Intergroup Melanoma Study should be used to apply ELND in a selective fashion. In this way, patients are identified with micrometastatic disease early in their clinical course and can be offered the survival benefit of adjuvant therapy. |
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Authors:
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D Reintgen; C M Balch; J Kirkwood; M Ross |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Annals of surgery Volume: 225 ISSN: 0003-4932 ISO Abbreviation: Ann. Surg. Publication Date: 1997 Jan |
Date Detail:
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Created Date: 1997-02-13 Completed Date: 1997-02-13 Revised Date: 2010-09-10 |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1-14 Citation Subset: AIM; IM |
Affiliation:
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Department of Cutaneous Oncology, Moffitt Cancer Center, University of South Florida, Tampa, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antineoplastic Agents
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therapeutic use Biopsy Clinical Trials as Topic Humans Interferon Alfa-2b / therapeutic use Intraoperative Care Lymph Node Excision Lymphatic Metastasis Melanoma / pathology, surgery*, therapy Neoplasm Staging / methods Patient Selection Prognosis Risk Factors Skin Neoplasms / pathology, surgery*, therapy |
| Chemical | |
Reg. No./Substance:
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0/Antineoplastic Agents; 99210-65-8/Interferon Alfa-2b |
| Comments/Corrections | |
Comment In:
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Ann Surg. 1998 Feb;227(2):316-7
[PMID:
9488537
]
Ann Surg. 1998 Apr;227(4):607-8 [PMID: 9563556 ] Ann Surg. 1997 Jan;225(1):15-6 [PMID: 8998116 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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