scholarly journals Primary reconstruction of neck defect after excision of metastatic melanoma of unknown primary site with regional pectoral myocutaneous flap

2016 ◽  
Vol 144 (7-8) ◽  
pp. 436-439
Author(s):  
Asen Velickov ◽  
Predrag Kovacevic ◽  
Aleksandra Velickov ◽  
Shahram Ghanaati
Keyword(s):  
Metastatic Melanoma ◽  
Primary Tumor ◽  
Primary Melanoma ◽  
Muscle Flap ◽  
Neck Region ◽  
Unknown Primary ◽  
Large Tumor ◽  
Tumor Mass ◽  
Regional Flap ◽  
Tissue Defects

Introduction. Metastatic melanoma of unknown primary (MMUP) is already a well described oncologic phenomenon in the literature, whereas tissue defects? reconstructions on the neck region always present a challenge for the reconstructive surgeon. Two cases of giant metastatic, skin infiltrative neck tumor masses are presented. In both cases MMUP was diagnosed. Both intraoperative tissue defects were reconstructed using pectoralis major (PM) regional flap. Outline of cases. The first patient was admitted with giant tumor mass on the right side of the neck. The fast growing mass appeared two months prior to the admission. Thorough examination showed no signs of primary tumor. Removal surgery was performed and the defect was reconstructed using the PM musculocutaneous flap. The second patient was admitted with large tumor mass on the left side of the neck. Thorough examination displayed no signs of any primary tumor. After the excision, the tumor mass and subsequent neck dissection, reconstruction followed, using the pedicled PM muscle flap and partial thickness skin transplants. There were no major complications in either case. The histopathological examinations presented metastatic melanoma diagnoses. Conclusion. Clinical outcome of MMUP described in literature is rather variable. Different studies have shown that prognosis in patients with MMUP is better than that in patients with diagnosed primary melanoma with metastatic disease. Therefore, the best initial course of action in those cases would be surgery, according to oncological principles, if possible. Neck defects? reconstructions should fulfill both functional and esthetic demands. Due to the reliability and low cost of the procedure, PM regional flap presents a very good and trustworthy reconstruction modality.

Can the plasma PD-1 levels predict the presence and efficiency of tumor-infiltrating lymphocytes in metastatic melanoma patients?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14035-e14035
Author(s):  
Daniele Fanale ◽  
Lorena Incorvaia ◽  
Gaetana Rinaldi ◽  
Lidia Terruso ◽  
Giuseppe Badalamenti ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Primary Tumor ◽  
Primary Melanoma ◽  
Tumor Infiltrating Lymphocytes ◽  
Rank Test ◽  
Expression Levels ◽  
Kaplan Meier ◽  
Melanoma Patients ◽  
Infiltrating Lymphocytes ◽  
First Time

e14035 Background: The immune response to melanoma has been shown to be locally affected by presence of tumor-infiltrating lymphocytes (TILs), generally divided into brisk (infiltrating the entire base of the invasive tumor), non-brisk (infiltrating only focally) and absent. Several studies showed that greater presence of TILs, especially brisk, in primary melanoma is associated with a better prognosis and a higher survival rate. Since recent studies revealed an association between PD-1/PD-L1 expression levels and tumor response, the aim of our study was to investigate the correlation between plasma PD-1 and presence/absence/class of TILs in metastatic melanoma patients. Methods: The plasma PD-1 levels were analyzed in 28 patients with metastatic melanoma using a specific ELISA assay. The characterization of TILs in tumor tissue was performed by immunohistochemistry. Statistical analysis was assessed using t-Student and ANOVA tests. Survival curves were estimated by using the Kaplan-Meier method and log-rank test to evaluate significant differences among them. Results: 16 out of 28 patients showed the presence of TILs in primary tumor, 10 of which brisk and 6 nonbrisk. The plasma PD-1 levels were analyzed in relation to the presence/absence of TILs (p = 0.022), brisk TILs versus nonbrisk/absent TILs (p = 0.014), and brisk vs nonbrisk vs absent TILs (p = 0.032). In particular, low plasma PD-1 levels have been shown to be associated with brisk TILs in primary melanoma, intermediate values with nonbrisk TILs, and high expression with absent TILs. Although the low number of samples did not allow us to obtain a statistically significant association between the plasma PD-1 expression levels and overall survival (OS) depending on the absence or presence of TILs (brisk/nonbrisk), however the median survival of patients having brisk TILs was five months higher than other 2 groups of patients with absent and nonbrisk TILs, respectively. Conclusions: This work highlights, for the first time, the potential ability of using the plasma PD-1 levels to predict prognosis also in patients with metastatic melanoma at diagnosis for which it is not possible to identify the primary tumor.

scholarly journals TRICHILEMMAL CYSTIS IN METASTATIC MELANOMA: A CASE REPORT

2017 ◽  
Vol 39 (1) ◽  
pp. 86-87
Author(s):  
I Savarese ◽  
M Grazzini ◽  
A Gori ◽  
A D’Errico ◽  
L Doni ◽  
...  
Keyword(s):  
Case Report ◽  
Systemic Sclerosis ◽  
Malignant Melanoma ◽  
Brain Metastasis ◽  
Metastatic Melanoma ◽  
Primary Melanoma ◽  
Paraneoplastic Syndromes ◽  
Frontal Region ◽  
Unknown Primary ◽  
Paraneoplastic Pemphigus

The malignant melanoma is a neoplasm associated with a wide variety of cutaneous paraneoplastic syndromes, as dermatomyositis, systemic sclerosis, paraneoplastic pemphigus. We describe a case of four multiple trichilemmal cystis arising on frontal region in the same patient with brain metastasis and unknown primary melanoma and discuss their relationship.

Unknown primary tumor high-risk melanoma as a unique patient population with distinct prognosis in the adjuvant setting: An ECOG-ACRIN E1609 study analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22090-e22090
Author(s):  
Ahmad A. Tarhini ◽  
Sandra J. Lee ◽  
F. Stephen Hodi ◽  
Gary Irvin Cohen ◽  
Uma Rao ◽  
...  
Keyword(s):  
High Risk ◽  
Primary Tumor ◽  
Primary Melanoma ◽  
Initial Presentation ◽  
Unknown Primary ◽  
Total Study Population ◽  
High Risk Melanoma ◽  
Risk Melanoma ◽  
Study Population ◽  
Risk Of Relapse

e22090 Background: E1609 enrolled 1670 adult patients (pts) with resected AJCC7 stages IIIB, IIIC, M1a, M1b melanoma and compared adjuvant ipilimumab at 3 or 10 mg/kg (ipi3 and ipi10) to high dose interferon-alfa (HDI). With over 5 years of follow up, the risk of relapse and death by primary tumor status and by stage group is expected to inform the design of future adjuvant trials and ultimately, clinical practice. Methods: Unknown primary melanoma status was defined as initial presentation with cutaneous, nodal or lung metastasis that was completely resected without a history of known primary melanoma. We evaluated the pt distribution by the initial site of metastasis. Further, we evaluated the risk of relapse and death by primary tumor status and by stage group. Five-year relapse-free survival (RFS) and overall survival (OS) rates and 95% CIs were estimated by Kaplan-Meier method. Stratified (by stage) log-rank test was used to compare RFS and OS by primary tumor status. Two-sided p-values were derived. Results: Unknown primary melanoma represented 12.8% of the total study population including 11.7% on the ipi arms and 14.7% on HDI. Site of metastasis at initial presentation among unknown primary cases included cutaneous and nodal (97%) and lung (3%). Among the overall study population, M1a stage group included the highest proportion of pts with unknown primary (42.2%). Stratifying by stage, RFS (p = 0.001) and OS (p = 0.009) were significantly better for pts with unknown primary compared to known primary. Including only ipi3 and ipi10 pts, RFS (p = 0.005) and OS (p = 0.023) were consistently significantly better in favor of unknown primary. Five-year RFS and OS rates by primary tumor status and stage group among pts treated with ipi (ipi3 and ipi10) are summarized in Table. Conclusions: Unknown primary status represents a unique population among high-risk melanoma pts treated with ipi with improved RFS and OS outcomes that support their separate assessment in future immunotherapy adjuvant trials. In-depth analyses of the tumor biology and host immunology are ongoing. Outcome analyses by the overall study stage groups and the HDI arm will be reported at the meeting. Clinical trial information: NCT01274338. [Table: see text]

scholarly journals Biologic subtypes of melanoma predict survival benefit of combination anti-PD1+anti-CTLA4 immune checkpoint inhibitors versus anti-PD1 monotherapy

2021 ◽  
Vol 9 (1) ◽  
pp. e001642
Author(s):  
April A N Rose ◽  
Susan M Armstrong ◽  
David Hogg ◽  
Marcus O Butler ◽  
Samuel D Saibil ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Immune Checkpoint ◽  
Primary Tumor ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Advanced Melanoma ◽  
Unknown Primary ◽  
Tumor Type ◽  
Multivariable Analyses ◽  
Primary Tumor Type

PurposeAnti-programmed cell death protein 1 (PD1)±anti-cytotoxic T-lymphocyte associated protein 4 (CTLA4) immune checkpoint inhibitors (ICIs) are standard therapeutic options for metastatic melanoma. We assessed whether biologic subtype according to primary tumor type or genomic subtype can function as predictive biomarkers for anti-PD1±anti-CTLA4 ICI in patients with advanced melanoma.MethodsWe performed a single-center retrospective cohort analysis of patients who received anti-PD1±anti-CTLA4 ICI for advanced melanoma between 2012 and 2019. Primary tumor type, BRAF and NRAS mutation status, and other covariates were abstracted from chart review. Log-rank tests and multivariable Cox regression models were used to assess differences in clinical progression-free (cPFS) and overall survival (OS).ResultsWe identified 230 patients who received 249 lines of anti-PD1±anti-CTLA4 ICI for unresectable or metastatic disease. Of these patients, 74% were cutaneous, 11% mucosal, 8% unknown primary and 7% acral. BRAF and NRAS mutations were identified in 35% and 28% of patients, respectively. In multivariable analyses of the entire cohort, acral or mucosal primary tumor type, >3 metastatic sites, elevated LDH were predictive of shorter cPFS and OS. Combination ICI therapy was associated with longer cPFS (HR 0.57, 95% CI 0.38 to 0.86, p=0.007) and OS (HR 0.42, 95% CI 0.28 to 0.65, p<0.001). Combination ICI was significantly associated with longer OS in unknown primary and mucosal melanoma. There was a non-significant trend toward longer OS with anti-PD1+anti-CTLA4 in cutaneous melanoma, but not in acral melanoma. In multivariable analyses, combination ICI was associated with longer OS in NRAS (HR 0.24, 95% CI 0.10 to 0.62, p=0.003, n=69) and BRAF V600E/K (HR 0.47, 95% CI 0.24 to 0.90, p=0.024, n=86) mutant melanoma but not BRAF/NRAS wild-type (n=94) melanoma.ConclusionsIn our cohort, primary melanoma tumor type and genomic subtype were independent predictive markers of cPFS and OS for patients with metastatic melanoma receiving anti-PD1 ICI. Primary tumor type and genomic subtype—including NRAS—should be further evaluated in prospective clinical trials to determine their value as predictive markers. Biologic subtypes may facilitate clinical decision-making when recommending combination ICI treatment (anti-PD1±anti-CTLA4) versus anti-PD1 alone for patients with metastatic melanoma.

scholarly journals A Solitary Melanoma Metastasis Confined to the Submandibular Gland

2021 ◽  
pp. 957-962
Author(s):  
Senne Gorris ◽  
Celia Perdaens ◽  
Veerle Delvaux ◽  
Vincent Vander Poorten ◽  
Bart Neyns ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Submandibular Gland ◽  
Neck Region ◽  
Surgical Excision ◽  
Unknown Primary ◽  
Melanoma Metastasis ◽  
Cutaneous Lesions ◽  
Cancer Society ◽  
Small Subgroup ◽  
The Face

Malignant melanoma is a type of cancer that most commonly originates from the skin, less frequently from mucosal surfaces, the eye, or meninges [<i>Annu Rev Pathol</i>. 2014;9(1):239–71]. In 2019, this type of malignancy was the third most frequent cancer to be diagnosed in males and the fifth most in females according to the American Cancer Society and the National Cancer Institute [<i>CA Cancer J Clin</i>. 2019;69(5):363–85]. The majority of the malignant melanomas in the head and neck region (85–90%) are cutaneous lesions, most often arising in the skin of the face [<i>Head Neck</i>. 2016;38:147–155]. In sharp contrast are the histological findings of metastatic melanoma with an unknown primary site: they are much more scarce and histologically difficult to diagnose. The literature is limited to case studies or small cohorts. In 2–6% of all patients suffering from metastatic melanoma, after clinical examination of the skin and mucosa, imaging, and other diagnostic examination, a primary tumor cannot be found [<i>Eur J Cancer</i>. 2004;40(9):1454–5]. A very small subgroup (0.5%) presents with a single focus of melanoma within the dermis or subcutaneous tissues [<i>Arch Dermatol</i>. 2000;136(11):1397–9]. We hereby report a case in this subgroup of a solitary melanoma metastasis found in the submandibular gland in a 59-year-old male. The tumor was discovered incidentally after surgical excision of this gland because of nodular enlargement.

scholarly journals Pan-cancer analysis of CD274 (PD-L1) mutations in 314,631 patient samples and subset correlation with PD-L1 protein expression

2021 ◽  
Vol 9 (6) ◽  
pp. e002558
Author(s):  
Richard S.P. Huang ◽  
Brennan Decker ◽  
Karthikeyan Murugesan ◽  
Matthew Hiemenz ◽  
Douglas A. Mata ◽  
...  
Keyword(s):  
Protein Expression ◽  
Checkpoint Inhibitors ◽  
Endometrial Adenocarcinoma ◽  
Primary Melanoma ◽  
B Cell Lymphoma ◽  
Unknown Primary ◽  
Future Research ◽  
Tumor Type ◽  
Missense Mutations ◽  
L1 Protein

BackgroundThe effects of non-amplification short variant (SV) mutations in CD274 (programmed death-ligand 1 (PD-L1)) on PD-L1 protein expression and immune checkpoint inhibitors (ICPIs) therapy are unknown. Here, we present a retrospective analysis of CD274 mutations detected by comprehensive genomic profiling (CGP) and correlate these results with tumor-cell PD-L1 immunohistochemistry (IHC)-based expression assessment to better understand the relationship between mutations and protein expression of PD-L1.MethodsCGP was performed on hybridization-captured, adaptor ligation-based libraries using DNA and/or RNA extracted from 314,631 tumor samples that were sequenced for up to 406 cancer-related genes and select gene rearrangements. PD-L1 IHC was performed on a subset of cases (n=58,341) using the DAKO 22C3 PD-L1 IHC assay and scored with the tumor proportion score (TPS).ResultsOverall, the prevalence of CD274 SV mutations was low (0.3%, 1081/314,631) with 577 unique variants. The most common CD274 SV mutations were R260H (n=51), R260C (n=18), R125Q (n=12), C272fs*13 (n=11), R86W (n=10), and R113H (n=10). The prevalence of CD274 mutations varied depending on tumor type with diffuse large B-cell lymphoma (1.9%, 19/997), cutaneous squamous cell carcinoma (1.6%, 14/868), endometrial adenocarcinoma (1.0%, 36/3740), unknown primary melanoma (0.9%, 33/3679), and cutaneous melanoma (0.8%, 32/3874) having the highest frequency of mutations. Of the R260H cases concurrently tested with PD-L1 IHC, most (81.8%, 9/11) had no PD-L1 expression, which contrasts to the five E237K cases where most (80%, 4/5) had PD-L1 expression. In addition, we saw a significantly lower level of PD-L1 expression in samples with a clonal truncating variant (nonsense or frameshift indel) when compared with samples with a subclonal truncating variants (mean: TPS=1 vs TPS=38; p<0.001), and also in clonal versus subclonal missense mutations (mean: TPS=11 vs TPS=22, respectively; p=0.049)ConclusionsWe defined the landscape of CD274 mutations in a large cohort of tumor types that can be used as a reference for examining CD274 mutations as potential resistance biomarkers for ICPI. Furthermore, we presented novel data on the correlation of CD274 mutations and PD-L1 protein expression, providing important new information on the potential functionality of these mutations and can serve as a basis for future research.

scholarly journals Uveal Melanoma and Secondary Angle-Closure Crisis: A Case Report and Literature Review

2021 ◽  
pp. 476-480
Author(s):  
Tung Thanh Hoang ◽  
Tuan Anh Hoang ◽  
Peter McCluskey ◽  
John Grigg
Keyword(s):  
Retinal Detachment ◽  
Uveal Melanoma ◽  
Vision Loss ◽  
Serous Retinal Detachment ◽  
Anterior Segment ◽  
Angle Closure ◽  
Large Tumor ◽  
Tumor Mass ◽  
Healthy Female ◽  
Life Threatening

A 66-years-old Vietnamese healthy female patient presented with prolonged severe right ocular pain and complete vision loss in that eye. Anterior segment assessment including gonioscopy identified angle-closure configuration. A suspected ciliary body melanoma was seen through the pupil. Posterior segment examination revealed a large tumor mass and 360° retinal detachment (kissing configuration). An ultrasound examination was consistent with a uveal tumor. The painful, blind right eye with a tumor mass was enucleated. Histopathology confirmed a type A uveal spindle cell melanoma associated with total serous retinal detachment without evidence of tumor necrosis, epithelioid cells, scleral, or optic nerve infiltration. There was no evidence of metastasis after 1-year of follow-up. It is critically important to differentiate primary and secondary angle closure, especially in cases with life-threatening ocular malignancy as uveal melanoma.

Whole body turbo STIR MRI in unknown primary tumor detection

1998 ◽  
Vol 8 (3) ◽  
pp. 751-753 ◽  
Author(s):  
Stephen Eustace ◽  
Richard Tello ◽  
Victor Decarvalho ◽  
John Carey ◽  
Elias Melhem ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Tumor Detection ◽  
Whole Body ◽  
Unknown Primary ◽  
Unknown Primary Tumor ◽  
Primary Tumor Detection
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