Skin Cancer

Skin Cancer
 

• Pehamberger H, Soyer HP, Steiner A,  et al [Univ of Vienna; Univ of Graz, Austria; Univ of Innsbruck, Austria; et al]
  Adjuvant Interferon Alfa-2a Treatment in Resected Primary Stage II Cutaneous Melanoma
  J Clin Oncol 16: 1425-1429, 1998
   
  Primary cutaneous malenoma with a Breslow thickness of 1.5 mm or more after excision were assigned to adjuvant subcutaneous interferon alfa-2a[IFNa2a], 3Miu daily for 3 weeks or observator after this induction duration patients received  IFNa2a, 3Miu  subcutaneously 3 times a week for one year as maintenance.
   
  Disease free survival was longer in IFNa2a group than in the control.
     

• Cascinelli N, Morabito A, Santinami M, et al [ Casa di Cura S Pio X, Milano, Italy; Univ of Milano, Italy; Univ of Glasgow, Scotland; et al]
  Immediate or Delayed Dissection of Regional Nodes in Patients With Melanoma of the Trunk: A Randomized Trial
  Lancet 351: 793-796, 1998
   
  This study of 252 patients with melanoma of 1.5 mm or the skin was randomised to immediate regional node dissection or a regional node dissection until recurrence.
   
  The 5 year survival rate was 51.3% in delayed node dissection versus 61.7% with immediate node dissection prognosis was poorest for those in patients with regional nodes that became clinically and histologically positive during follow-up.
    
  The interpretation of this study suggest that those with micrometastases in the lymph node if not resected had poor prognosis and hence identification of sentinel lymph node would be beneficial.
   

• Mraz-Gernhard S, Sagebiel RW, Kashani-Sabet M, et al [Univ of California, San Francisco; Stanford Univ, Calif]
  Prediction of Sentinel Lymph Node Micrometastasis by Histological Features in Primary Malignant Melanoma
  Arch Dermatol 134: 983-987, 1998
   
  This study of 215 patients with stage I or II cutaneous malignant melanoma were assessed in a retrospective study to identify the prognostic indicator for micrometastasis.
   
  This article suggest that ulceration, high mitotic rate, angiolymphatic invasion, and demonstration of microsatellite lesions all correlate highly with findings of a positive sentinel lymph node.
     

• Johnston SRD, Constenla DO, Moore J, et al [Royal Marsden NHS Trust, London; St George’s Hosp Med School, Tooting, London]
  Randomized Phase II Trial of BCDT [Carmustine [BCNU], Cisplastin, Dacarbazine [DTIC] and Tamoxifen] with or Without Interferon Alpha [IFN-a] and Interleukin [IL-2] in Patients with Metastatic Melanoma
  Br J Cancer 77: 1280-1286, 1998
      
  This study of 66 patients with metastatic melanoma were randomized to BCDT combination or to chemoimmunotherapy, consisting of chemotherapy along with IL-2 and interferon. The median survival was about 5 months in each group. Although chemoimmunotherapy produced immune activation by the parameter studied in this trial, which did not lead to patient benefit in terms of response rate, progression free survival or overall survival.
    
  The editor comments that the sequence of administration of immunotherapy prior to chemotherapy could be the reason for poor result in this study.
       

• Koops HS, and the North American Perfusion Group Southwest Oncology Group-8593 [ Univ Hosp, Groningen, The Netherlands; Netherlands Cancer Inst, Amsterdam; Univ Hosp, Nijmegen, The Netherlands; et al]
  Prophylactic Isolated Limb Perfusion for Localized, High-Risk Limb Melanoma: Results of a Multicenter Randomized Phase III Trial
  J Clin Oncol 16: 2906-2912, 1998
      
  This study of 422 patients were randomized to wide excision [WE] or WE followed by isolated limb perfusion [ILP]. The ILP reduced the occurrence of intransit metastasis from 6.6 to 3.3% and occurrence of regional lymph node metastases from 16.7% to 12.6%. ILP conferred no survival or time to distant metastasis benefit but had side effects such as pain and nerve injury.
    
  The editor comments that ILP can not be applied routinely in clinical practice.
       

• Legha SS, Ring S, Eton O, et al [ Univ of Texas, Houston]
  Development of a Biochemotherapy Regimen With Concurrent Administration of Cisplatin, Vinblastine, Decarbazine, Interferon Alfa, and Interleukin-2, for Patients With Metastatic Melanoma
  J Clin Oncol 16: 1752-1759, 1998
     
  This phase I-II study of 53 patients with confirmed metastatic melanoma with measurable lesions, and an Eastern Co-operative Oncology Groups performance status of 2 or less received chemotherapy [ Cisplatin, Vinblastine, Dacarbazine ] along with biotherapy [ IL-2 & IFN-a]. The objective response rate of 64% included 21% complete response and 43% partial response, 9% of patients had a durable response after 50 months. The toxicity is severe but manageable on an inpatient basis. The editor comments that biochemotherapy, with perhaps surgery and addition of vaccine therapy may further improve the results. 
      

• Rosenberg SA, Yang JC, Schwartzentruber DJ, et al [ Natl Cancer Inst, Bethesda, Md]
  Immnologic and Therapeutic Evaluation of a Synthetic Peptide Vaccine for the Treatment of Patients with Metastatic Melanoma
  Nature Med 4: 321-327, 1998
    
  This study of 51 patients with metastatic melanoma received a cancer vaccine combined with adjuvant IL-2. The vaccine composed of the immunodominent peptides of the melanoma associated antigen gp100 & IFA . The gp100 peptide was modified by changing a specific amino acid to improve both its ability to bind to the histocompatability leukocyte antigen. A2 Molecule and to activate T cells. Tumor regression was possible in 42% of patients with metastatic melanoma.
    

• Vergier B, for the French Study Group on Cutaneous Lymphomas [Universite de Bordeaux, France; et al]
  Transformation of Mycosis Fungoides: Clinicopathological and Prognostic Features of 45 Cases
  Blood 95: 2212-2218, 2000
        
  Mycosis fungoides a cutaneous lymphoma may transform to a high grade, large cell lymphoma which has poor prognosis. The authors criteria for transformation were the presence of large T lymphocytes four times the size of a small lymphocyte or larger in more than 25% of the infiltrate. The progression for a cutaneous transformation was 7.8% at 5 years survival and this was still poor for patients at least 60 years of age and if extracutaneous progression is there.
         

• Allen PJ, Zhang Z-F, Coit DG (Mem Sloan-Kettering Cancer Ctr, New York)
  Surgical Management of Merkel Cell Carcinoma
  Ann Surg 229: 97-105, 1999
     
  This study of 109 patients of merkel cell carcinoma (MCC) of which 102 had adequate follow-up data were reviewed. The primary tumor was located in the skin of head and neck region most commonly.
    
  The prognosis depends on the stage at presentation and for patients with stage I disease on tumor size at presentation. Elective lymph node dissection should be considered for stage I disease because it improves the relapse-free survival.
    
  The editor mentions that MCC is a neuroendocrine cutaneous malignancy, which is linked to a small cell carcinoma, which is sensitive to chemotherapy and with favorable prognosis and hence the role of chemotherapy in MCC has yet to be determined.
      

• Gershenwald JE, Thompson W, Mansfield PF, et al (Univ of Texas, Houston; H Lee Moffitt Cancer Ctr and Research Inst, Tampa, Fla)
  Multi-institutional Melanoma Lymphatic Mapping Experience: The Prognostic Value of Sentinel Lymph Node Status in 612 Stage I or II Melanoma Patients
  J Clin Oncol 17: 976-983, 1999
     
  The retrospective study of 612 patients with primary cutaneous melanoma underwent lymphatic mapping and SLN biopsy. Of 580 patients in whom SLN could be identified 15% had positive SLN by conventional histology.
     
  On analysis (univariate and multivariate) SLN status was the strongest prognostic factor for both disease free and disease specific survival for those with negative SLN tumor thickness and ulceration remained significant prognostic factor for survival.
     

• Corry J, Smith JG, Bishop M, et al (Peter MacCallum Cancer Inst, East Melbourne, Australia)
  Nodal Radiation Therapy for Metastatic Melanoma
  Int J Radiat Oncol Biol Phys 44: 1065-1069, 1999
      
  This study of 113 patients who received local radiation to treat malignant melanoma with distant metastasis. These were divided into 2 sub groups. 42 patients with no residual macroscopic disease after surgery and 71 patients with either no surgery or had macroscopic residual disease after surgery (palliative group).
     
  In the adjuvant group 26% were failure free at 5 years as compared to 4% in palliative group and distant metastasis occurred in 52% of patients in adjuvant as compared to 25% in palliative group.
     
  The authors recommend adjuvant postoperative irradiation along with interferon in high risk patient.
     

• Ott MJ, Tanabe KK, Gadd MA, et al (Harvard Med School, Boston)
  Multimodality Management of Merkel Cell Carcinoma
  Arch Surg 134: 388-393, 1999
     
  Merkel cell carcinoma is a rare dermal neuroendocrine tumor, which is aggressive and that commonly metastasizes to the nodes.
     
  31 patients with merkel cell carcinoma underwent local lymphadenectomy with or without radiotherapy. Patient with merkel tumors have the worst prognosis. Local regional recurrence is associated with inadequate surgical margins and lack of radiotherapy.