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A Retrospective Multicenter Evaluation of Cutaneous Melanomas in Turkey

  • Gamsizkan, Mehmet (Department of Pathology, Maresal Cakmak Military Hospital) ;
  • Yilmaz, Ismail (GATA Haydarpasa Education and Research Hospital) ;
  • Buyukbabani, Nesimi (Istanbul Medical School, Istanbul University) ;
  • Demirkesen, Cuyan (Cerrahpasa Medical School, Istanbul University) ;
  • Demiriz, Murat (School of Medicine, Gulhane Military Medical Academy) ;
  • Cetin, Emel Dikicioglu (Acibadem Kadikoy Hospital) ;
  • Ince, Umit (School of Medicine, Acibadem University) ;
  • Akalin, Taner (School of Medicine, Ege University) ;
  • Demirkan, Nese Calli (School of Medicine, Pamukkale University) ;
  • Lebe, Banu (School of Medicine, Dokuz Eylul University) ;
  • Erdem, Ozlem (School of Medicine, Gazi University) ;
  • Gokoz, Ozay (School of Medicine, Hacettepe University) ;
  • Sakiz, Damlanur (Bakirkoy Dr. Sadi Konuk Education and Research Hospital) ;
  • Demireli, Peyker Temiz (School of Medicine, Celal Bayar University) ;
  • Astarci, Hesna Muzeyyen (School of Medicine, Abant Izzet Baysal University) ;
  • Adim, Saduman Balaban (School of Medicine, Uludag University) ;
  • Zemheri, Itir Ebru (Goztepe Education and Research Hospital, Medeniyet University) ;
  • Acikalin, Arbil (School of Medicine, Cukurova University) ;
  • Yaman, Banu (School of Medicine, Ege University) ;
  • Aydin, Ovgu (Cerrahpasa Medical School, Istanbul University) ;
  • Bassorgun, Cumhur Ibrahim (School of Medicine, Akdeniz University)
  • Published : 2015.01.06

Abstract

Background: We defined melanoma distribution in a large series of Turkish patients and evaluated the prognostic parameters of melanomas. Materials and Methods: A total of 1574 patients' data was retrospectively collected at 18 centers in Turkey. Demographic characteristics were questioned and noted. Prognostic parametres were evaluated based on sentinel lymph node involvement. Results: Mean age was 56.7 (4-99) years. While 844 (53.6%) cases were male, 730 (46.4%) cases were female. One thousand four hundred forty-seven (92%) cases were invasive melanoma and 127 (8%) cases were in-situ melanoma. The most common histopathological form was the superficial spreading melanoma (SSM) which was found in 549 patients (37.9%). It was followed by nodular melanoma in 379 (26.2%), acral lentiginous melanoma (ALM) in 191 (13.2%) and lentigo maligna melanoma in 132 (9.1%), respectively. On univariate analysis, lymphovascular invasion (p<0.001), tumor thickness (p<0.001), histopathological subtype (p<0.001), Clark level (p=0.001), ulceration (p<0.001), ${\geq}6/mm^2$ mitosis (p=0.005), satellite formation (p=0.001) and gender (p=0.03) were found to be associated with sentinel lymph node positivity. Regression was associated with sentinel lymph node negativity (p=0.017). According to multivariate analysis, lymphovascular invasion and tumor thickness were significant independent predictive factors of SLN positivity. Patient age, tumor localization, precursor lesions, lymphocytic infiltration and neurotropism were not related with sentinel lymph node involvement. Conclusions: In this retrospective analysis, it was found that the prevalence of SSM is at a lower rate while the prevalence of ALM is at a higher rate when compared to western countries. According to Breslow index; most of the melanoma lesions' thickness were greater than 2 mm, corresponding Clark IV. Vascular invasion and tumor thickness are the most important factors for sentinel lymph node involvement.

Keywords

Melanoma;skin;prognostic factors

References

  1. Gajda M, Kaminska-Winciorek G (2014) Do not let to be late: overview of reasons for melanoma delayed diagnosis. Asian Pac J Cancer Prev, 15, 3873-7. https://doi.org/10.7314/APJCP.2014.15.9.3873
  2. Gimotty PA, Van Belle P, Elder DE, et al (2005). Biologic and prognostic significance of dermal Ki67 expression, mitoses, and tumorigenicity in thin invasive cutaneous melanoma. J Clin Oncol, 23, 8048-56. https://doi.org/10.1200/JCO.2005.02.0735
  3. Gyrylova SN, Aksenenko MB, Gavrilyuk DV, et al (2014). Melanoma incidence mortality rates and clinico-pathological types in the Siberian area of the Russian Federation. Asian Pac J Cancer Prev, 15, 2201-4. https://doi.org/10.7314/APJCP.2014.15.5.2201
  4. Guitart J, Lowe L, Piepkorn M, et al (2002). Histological characteristics of metastasizing thin melanomas: a casecontrol study of 43 cases. Arch Dermatol, 138, 603-8.
  5. Ivan D, Prieto VG (2011). An update on reporting histopathologic prognostic factors in melanoma. Arch Pathol Lab Med, 135, 825-9.
  6. Jones EL, Jones TS, Pearlman NW, et al (2013). Long-term follow-up and survival of patients following a recurrence of melanoma after a negative sentinel lymph node biopsy result. JAMA Surg, 148, 456-61. https://doi.org/10.1001/jamasurg.2013.1335
  7. Kashani-Sabet M, Sagebiel RW, Ferreira CM, et al (2001). Vascular involvement in the prognosis of primary cutaneous melanoma. Arch Dermatol, 137, 1169-73.
  8. LeBoit PE, Burg G, Weedon D, Sarasin A (2006). WHO classification of tumours, pathology and genetics of skin tumours, Lyon: IARCPress, 49-90.
  9. Lee HY, Chay WY, Tang MB, Chio MT, Tan SH (2012). Melanoma: differences between Asian and Caucasian patients. Ann Acad Med Singapore, 41, 17-20.
  10. Azzola MF, Shaw HM, Thompson JF, et al (2003). Tumor mitotic rate is a more powerful prognostic indicator than ulceration in patients with primary cutaneous melanoma: An analysis of 3,661 patients from a single center. Cancer, 97, 1488-98. https://doi.org/10.1002/cncr.11196
  11. Balch CM, Gershenwald JE, Soong SJ, et al (2009). Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol, 27, 6199-206. https://doi.org/10.1200/JCO.2009.23.4799
  12. Bartlett EK, Gupta M, Datta J, et al (2014). Prognosis of patients with melanoma and microsatellitosis undergoing sentinel lymph node biopsy. Ann Surg Oncol, 21, 1016-23. https://doi.org/10.1245/s10434-013-3388-5
  13. Bogunovic D, O'Neill DW, Belitskaya-Levy I, et al (2009). Immune profile and mitotic index of metastatic melanoma lesions enhance clinical staging in predicting patient survival. Proc Natl Acad Sci U S A, 106, 20429-34. https://doi.org/10.1073/pnas.0905139106
  14. Burton AL, Roach BA, Mays MP, et al (2011). Prognostic significance of tumor infiltrating lymphocytes in melanoma. Am Surg, 77, 188-92.
  15. Chang JW, Yeh KY, Wang CH, et al (2004). Malignant melanoma in Taiwan: a prognostic study of 181 cases. Melanoma Res, 14, 537-41. https://doi.org/10.1097/00008390-200412000-00016
  16. Clark WH, Elder DE, DuPont G 4th, et al (1989). Model predicting survival in stage I melanoma based on tumor progression. J Natl Cancer Inst, 81, 1893-904. https://doi.org/10.1093/jnci/81.24.1893
  17. Eser S, Yakut C, Ozdemir R, et al (2010). Cancer incidence rates in Turkey in 2006: a detailed registry based estimation. Asian Pac J Cancer Prev, 11, 1731-9.
  18. Ferlay J, Soerjomataram I, Ervik M, et al (2013). GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer.
  19. Fontaine D, Parkhill W, Greer W, Walsh N (2003). Partial regression of primary cutaneous melanoma: is there an association with sub-clinical sentinel lymph node metastasis? Am J Dermatopathol, 25, 371-6. https://doi.org/10.1097/00000372-200310000-00002
  20. Frishberg DP, Balch C, Balzer BL, et al (2009). Protocol for the examination of specimens from patients with melanoma of the skin. Arch Pathol Lab Med, 133, 1560-7.
  21. Fujisawa Y, Otsuka F; Japanese Melanoma Study Group (2012). The benefit of a sentinel lymph node biopsy and adjuvant therapy in thick (>4 mm) melanoma: multicenter, retrospective study of 291 Japanese patients. Melanoma Res, 22, 362-7. https://doi.org/10.1097/CMR.0b013e328355e558
  22. Alquier-Bouffard A, Franck F, Joubert-Zakeyh J, et al (2007). Regression in primary cutaneous melanoma is not predictive for sentinel lymph node micrometastasis. Ann Dermatol Venereol, 134, 521-5. https://doi.org/10.1016/S0151-9638(07)89262-3
  23. Azimi F, Scolyer RA, Rumcheva P, et al (2012). Tumorinfiltrating lymphocyte grade is an independent predictor of sentinel lymph node status and survival in patients with cutaneous melanoma. J Clin Oncol, 30, 2678-83. https://doi.org/10.1200/JCO.2011.37.8539
  24. Mandala M, Imberti GL, Piazzalunga D, et al (2009). Clinical and histopathological risk factors to predict sentinel lymph node positivity, disease-free and overall survival in clinical stages I-II AJCC skin melanoma: Outcome analysis from a single-institution prospectively collected database. Eur J Cancer, 45, 2537-45. https://doi.org/10.1016/j.ejca.2009.05.034
  25. Mervic L (2012). Prognostic factors in patients with localized primary cutaneous melanoma. Acta Dermatovenerol Alp Panonica Adriat, 21, 27-31.
  26. Minutilli E, Giannarelli D, Anza M, et al (2007). Sentinel node biopsy in cutaneous melanoma: Correlations between melanoma prognostic factors and sentinel node status. J Exp Clin Cancer Res, 26, 71-6
  27. Monshizadeh L, Hanikeri M, Beer TW, Heenan PJ (2012). A critical review of melanoma pathology reports for patients referred to the Western Australian Melanoma Advisory Service. Pathol, 44, 441-7. https://doi.org/10.1097/PAT.0b013e328355767e
  28. Namikawa K, Yamazaki N, Nakai Y, et al (2012). Prediction of additional lymph node positivity and clinical outcome of micrometastases in sentinel lymph nodes in cutaneous melanoma: a multi-institutional study of 450 patients in Japan. J Dermatol, 39, 130-7. https://doi.org/10.1111/j.1346-8138.2011.01318.x
  29. Shaikh L, Sagebiel RW, Ferreira CM, et al (2005).The role of microsatellites as a prognostic factor in primary malignant melanoma. Arch Dermatol, 141, 739-42.
  30. Simard EP, Ward EM, Siegel R, Jemal A (2012). Cancers with increasing incidence trends in the United States: 1999 through 2008. CA Cancer J Clin. [Epub ahead of print]
  31. Tas F, Kurul S, Camlica H, Topuz E (2006). Malignant melanoma in Turkey: a single institution's experience on 475 cases. Jpn J Clin Oncol, 36, 794-9. https://doi.org/10.1093/jjco/hyl114
  32. Taylor RC, Patel A, Panageas KS, et al (2007). Tumorinfiltrating lymphocytes predict sentinel lymph node positivity in patients with cutaneous melanoma. J Clin Oncol, 25, 869-75. https://doi.org/10.1200/JCO.2006.08.9755
  33. Testori A, Soteldo J, Powell B, et al (2013). Surgical management of melanoma: an EORTC Melanoma Group survey. Ecancermedicalscience, 28, 294.
  34. Uysal-Sonmez O, Tanriverdi O, Esbah O, et al (2013). Multicenter evaluation of patients with cutaneous malignant melanoma in Turkey: MELAS study. Asian Pac J Cancer Prev, 14, 533-7. https://doi.org/10.7314/APJCP.2013.14.1.533
  35. Weedon D (2010). Weedon's skin pathology, China: Elsevier, p 710-56.
  36. Wu CE, Hsieh CH, Chang CJ, et al (2013). Prognostic factors for Taiwanese patients with cutaneous melanoma undergoing sentinel lymph node biopsy. J Formos Med Assoc. [Epub ahead of print]

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