Abstract
PurposeMalignant melanoma (MM) is rare in India. Indian data on demography and treatment outcome on advanced MM is very limited in the literature.Materials & methodsThis is a retrospective study of advanced MM treated between January 2013 and December 2020. We evaluated the clinicopathologic features, mutational profiles, survival outcome and prognostic factors in advanced MM patients.ResultsOut of a total 460 patients, 185 (42%) had metastatic disease at presentation and were enrolled in this study with a median age of 63 years (range: 28–93) and male:female ratio of 94:91. The mucosal primary was predominant (n = 110, 59%) than cutaneous primary (38%) and anorectum was the most common site (n = 84, 45%). Tumour mutational analysis was performed in 65 (35%) patients. BRAF mutations were detected in 12 patients and KIT mutations in 7 patients. Thirteen patients didn’t have any mutations and 22 patients had mutations other than KIT & BRAF. Only 59 (32%) patients took any systemic treatment – immune checkpoint inhibitors (ICIs) in 17, temozolomide in 18 and paclitaxel/carboplatin in 18, tyrosine kinase inhibitors in 6 patients. After a median follow-up of 26 months (95% confidence interval (CI): 11.6–not reached), median progression-free survival (PFS) was 7.1 months (95% CI: 4.4–9.1) and median overall survival was 14.8 months (95% CI: 7.7–18.2 months). The use of ICI emerged as an only significant good prognostic factor (p ≤ 0.001) for PFS, on multivariate analysis.ConclusionMucosal origin was more common than cutaneous primary with anorectum being the most common site. BRAF mutation was less as compared to published literature. Very few patients received systemic therapy and the use of ICI showed superior PFS.
Highlights
Malignant melanoma (MM) is an aggressive cutaneous malignancy and ranked 17th in incidence amongst all malignancies globally with a reported annual incidence of 324,635 cases as per Global Cancer Observatory (GLOBOCAN) 2020 data [1]
After a median follow-up of 26 months (95% confidence interval (CI): 11.6–not reached), median progression-free survival (PFS) was 7.1 months and median overall survival was 14.8 months
The use of immune checkpoint inhibitors (ICIs) emerged as an only significant good prognostic factor (p ≤ 0.001) for PFS, on multivariate analysis
Summary
Malignant melanoma (MM) is an aggressive cutaneous malignancy and ranked 17th in incidence amongst all malignancies globally with a reported annual incidence of 324,635 cases as per Global Cancer Observatory (GLOBOCAN) 2020 data [1]. The incidence of cutaneous melanoma is increasing globally with an estimated 5-year related survival of 93.3% [2]. MM ranked 32nd spot in India as per yearly incidence and recorded 3,916 cases (0.3% of all cases) as per GLOBOCAN 2020 data [3]. Mucosal MM most often arises from head and neck sinuses and oral cavity, anorectum, vulva and vagina, any other site of the gastrointestinal tract or urogenital tract [5] and constitutes less than 5% of all melanoma cases [6]. BRAF mutation was highest in patients with MM without chronic sun exposure (56%) whereas KIT aberration was mostly found in those of acral, mucosal MM and those with chronic sun exposure (28%–39%) [8]
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