Diagnosis Of Cutaneous Melanoma Research Articles

Comparison of mortality and medical complications between older and younger malignant melanoma inpatients.

Previous studies have identified older age as a negative prognostic factor in malignant melanoma patients. To compare comorbidities, medical complications, and inpatient mortality between younger and older malignant melanoma inpatients. All adult patient encounters with a diagnosis of cutaneous malignant melanoma were identified using the 2003 to 2012 National Inpatient Sample database. Concurrent comorbidities and inpatient medical complications were queried. Comparisons were made between older and younger adults, defined as ≥65 years and 18 to 64 years, respectively. In total, 8153 patient encounters were identified in the database (51.6% older and 48.4% younger). Older adults had a higher prevalence of numerous comorbidities, including chronic pulmonary disease, chronic renal failure, congestive heart failure, diabetes mellitus, hypertension, hypothyroidism, peripheral vascular disease, and pulmonary circulation disorder (P < .001). In contrast, younger adults were more likely to have obesity (P < .001) and coagulopathy (P = .005). On multivariable analysis of medical complications, older adult inpatients were more likely to experience urinary tract infection (OR = 1.54, P = .021), but less likely to experience acute respiratory failure (OR = 0.46, P = .012) and venous thromboembolism (OR = 0.44, P = .026). Notably, inpatient mortality did not significantly differ. Older adult inpatients with malignant melanoma have different comorbidities than younger patients and have a larger overall comorbidity burden. Surprisingly, however, the odds of most inpatient medical complications and mortality were found to be similar in younger vs older patients.

Clinico-pathological Characteristics of Cutaneous Malignant Melanoma in Pakistan.

To analyse epidemiological and clinical characteristics of patients presenting with cutaneous malignant melanoma (CMM) in Pakistan; and to compare the results with other studies. Case series. Shaukat Khaum Memorial Cancer Hospital (SKMCH) from January 1997 to December 2017. All patients presenting to the study centre with a diagnosis of CMM were included in the study. Non-cutaneous melanoma cases were excluded. Patient demographics, tumor type, and tumor stage were recorded retrospectively. All data were analysed in SPSS and descriptive statistics were determined. A total of 169 CMM patients were registered during a 20-year period. The highest incidence of melanoma was seen in the age group 40-59 years (n=69, 40.8%). Most common clinical subtype was unspecified melanoma (n=154, 91%). The most frequently observed T-stage at presentation was Tx (n=124, 73.4%), followed by T4 (n=23, 13.6%). With regard to body distribution, CM was seen most commonly in the lower limb including hip. CMM is a rare disease in Pakistan. However, patients tend to present at a more advanced stage. Identification of risk factors and tumor characteristics is, therefore, of paramount importance in managing these patients. Key Words: Cutaneous malignant melanoma (CMM), Pakistan, Lower middle income country, Stage.

Study of cutaneous melanoma recurrences after sentinel node biopsy: Patterns of dissemination and use of complementary test in follow-up.

To investigate the patterns of melanoma recurrence in the local population, including factors that may influence in this event and timing of relapse, and to determine the mode of detection of them. This is a retrospective cohort study of patients with melanoma who underwent sentinel lymph node biopsy at the Complejo Hospitalario de Navarra (Spain) from 2002 to 2012. The following data were collected of each patient: age, gender, date of diagnosis, location of melanoma, histological subtype, Breslow thickness, ulceration, mitosis, sentinel node status, AJCC 8th edition stage, site of first diagnosed metastasis, mode of relapse, date of first relapse and time of death. Of 308 patients, 30% people suffered metastasis. The mean follow-up time was 68.63months. 51.1% of relapses were locoregional and 48.9% haemato-visceral. Sentinel node status was the only variable associated with higher risk of haemato-visceral metastasis (p<0.001). The mean time between diagnosis of melanoma and recurrence was 2.7years. Most recurrences were detected by the patient himself or had any type of symptoms and were consequently selected for a complementary test. It is important to follow-up all patients with diagnosis of cutaneous melanoma, essentially during the first 5years after diagnosis.

Medical Immunosuppression and Outcomes in Cutaneous Melanoma: A Population-Based Cohort Study.

Melanoma and the immune system are intimately related. However, the association of immunosuppressive medications (ISMs) with survival in melanoma is not well understood. The study evaluated this at a population level. A cohort of patients with a diagnosis of invasive cutaneous melanoma (2007-2015) was identified from the Ontario Cancer Registry and linked to identify demographics, stage at diagnosis, prescription of immunosuppressive medications (both before and after diagnosis), and outcomes. The demographics of patients with and without prescriptions for ISM were compared. Patients eligible for Ontario's Drug Benefit Plan were included to ensure accurate prescription data. The primary outcome was overall survival. Cox Proportional Hazards Regression models identified factors associated with mortality, including use of ISM as a time-varying covariate. Of the 4954 patients with a diagnosis of cutaneous melanoma, 1601 had a prescription for ISM. The median age of the patients was 74years. Overall, 58.4% of the patients were men (60.5% of those without ISM and 54% of those using ISM; p < 0.001). The use of oral immunosuppression was associated with an increased hazard of death (hazard ratio, 5.84; 95% confidence interval, 5.11-6.67; p < 0.0001) when control was used for age, disease stage at diagnosis, anatomic site, comorbidity, and treatment. Other factors associated with death were increasing age, male sex, increased disease stage, truncal location of primary melanoma, and inadequate treatment. In sensitivity analysiswith steroid-onlyISM use excluded, survival did not differ significantly (p = 0.355). The use of immunosuppressive steroids for melanoma is associated with worse overall survival. Use of steroids should be limited when possible.

S2953 Rare Metastatic Gastric Melanoma Causing Iron Deficiency Anemia

INTRODUCTION: Melanoma is the fifth most common cancer in males and sixth most common cancer in females in the United States and accounts for about 1% of all skin cancers. Melanoma is highly metastatic. The most common sites of metastasis are liver, bone and brain and rarely, the gastrointestinal (GI) tract. Within the GI tract, melanomas usually metastasize to the small intestine, followed by colon, rectum and stomach in that order. Here, we present a case of cutaneous melanoma metastatic to the stomach presenting as iron deficiency anemia. CASE DESCRIPTION/METHODS: A 74-year-old Caucasian male presented with progressive fatigue and generalized weakness due to iron deficiency anemia. He had a history of various skin cancers including cutaneous melanoma involving the scalp for which he had undergone Mohs micrographic surgery with adjuvant chemoradiation two years prior. Complete blood count showed a hemoglobin of 6.7 g/dl, MCV 83.8 fL, iron of 58 ug/dL, iron saturations of 4%, and ferritin of 18 ng/mL. An esophagogastroduodenoscopy (EGD) showed at least five, 10 to 15mm, umbilicated lesions, with central dark pigmentation within the antrum, body and fundus of the stomach. Biopsies revealed metastatic melanoma. A computed tomography of the chest, abdomen and pelvis revealed evidence of additional metastases involving bilateral lungs, liver and multiple lymph nodes within the abdomen and pelvis. He was treated with ipilimumab and novilumab as immunotherapy. DISCUSSION: Metastasis of cutaneous melanoma to stomach accounts for less than 5% of all gastrointestinal metastatic melanoma. In a case series of such patients, the median time from initial diagnosis of cutaneous melanoma to gastric metastasis was 2 years. Gastric metastatic melanoma can present with upper GI symptoms, iron deficiency anemia, and frank GI bleeding. Nodules with central umbilication, pigmentation and ulceration, described as “doughnut” or “bull’s eye” appearance is the most common endoscopic finding. Immunohistochemistry of biopsies show homogenous staining for S-100, MART1 and HMB45 proteins. Genetic analysis for BRAF V600 and NRAS mutations guides appropriate treatment with immunotherapy approved for the former. For those with NRAS mutations, gastric resection with adjuvant chemotherapy is required for treatment and palliation.Figure 1.: Multiple, 10 to 15mm, umbilicated lesions, with central dark pigmentation within the antrum, body and fundus of the stomach.Figure 2.: Rare endoscopic finding of metastatic melanoma to the stomach with a lesion with central umbilication, dark pigmentation and ulceration often described as “doughnut” or “bull's eye” appearance.

What is the accuracy of reflectance confocal microscopy (RCM) for the diagnosis of cutaneous malignant melanoma (MM) or melanoma in situ (MiS) in adults?

What is the accuracy of reflectance confocal microscopy (RCM) for the diagnosis of cutaneous malignant melanoma (MM) or melanoma in situ (MiS) in adults?

Clinicopathological Characteristics and Short-Term Survival Analyses of Cutaneous Malignant Melanoma.

ObjectiveCutaneous malignant melanoma (CMM) arises from melanocytes, which are pigment-producing cells in the skin. CMM constitutes less than 5% of all cutaneous malignancies worldwide but is associated with the highest mortality rate among all skin cancers. The objective of this study was to examine the profile of clinicopathological factors, survival analyses, recurrence rate, metastatic rates, and the management of CMM at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan.MethodologyAll patients with a diagnosis of CMM treated at our institute from 2014 to 2017 were included in the study. Demographic variables and clinicopathological characteristics were collected and short-term oncological outcomes were recorded. All data were entered and analyzed in SPSS Statistics version 21 (IBM, Armonk, NY).ResultsA total of 28 patients were included in the study. The median age of the patients was 46.5 ±15.9 years. There were 16 male and 12 female patients. A family history of melanoma was present in 7.1% (n=2) of the patients. All patients had a mean survival of 13.43 ±9.09 months. The lower limb was the most common site of tumor among all patients, accounting for 46.4% (n=13) of the cases. On histopathological analyses, ulceration was seen in 53.6% (n=15) of the patients. Unclassified tumor type was present in 75% (n=21) of the patients, followed by nodular in 21.4% (n=6), and superficial spreading in 3.5% (n=1). Clark level IV was the most common presentation, constituting 46.4% (n=13) of the cases. Metastasis was seen in 50% (n=14) of the patients. Local recurrence was observed in 60.7% (n=17) of the patients; 64.3% (n=18) of the patients were alive after one year of treatment.ConclusionCMM is a disease with very high fatality rates. Although it is a disease commonly associated with fair-skinned populations, the incidence of CMM is rising in our part of the world as well. Early diagnosis and prompt management of the disease are crucial in its treatment. However, the mortality rate associated with this disease is still not favorable.

Wavelet-based logistic discriminator of dermoscopy images

Proper diagnosis of cutaneous melanoma is a life-saving factor. The most important limitation is the early and sensitive recognition of melanoma relative to dysplastic nevi. We have studied wavelet-based features extracted from dermoscopic images as efficient signals of neoplastic changes.We recursively treat the dermoscopic images and all their transformation channels (wavelet packets) through the Mallat transform. All the four decomposition filters from each decomposition level are the source of features based on three functions of the pixel values. We train the logistic classifier regularized by either the Lasso or the Ridge penalty and test its AUC metric for a set of different wavelet bases, and as a function of image resolution.A total of three different data sets with respectively 185, 117, and 413 images, and 52 wavelet bases are tested. Classification performance as a function of the wavelet number strongly depends on the image resolution and image compression. There is also a large variation in the classification performance within the self same wavelet family. Degradation of image resolution makes the overall classification performance lower and more dispersed between the regularizes. Some wavelets do not lower, but increase the learning performance at the reduced image resolutions, which is consistent with the melanoma feature-extraction studies based on other learning paradigms.The logistic classifier can extract high-performance, resolution-invariant wavelet features of melanoma.

Abstract 3696: Determination of the expression patterns and functional implications of microRNAs in ulcerated cutaneous melanoma

Abstract Introduction: Ulcerated primary cutaneous melanomas have a poor prognosis and the underlying biology driving this aggressive behavior is largely unexplored. The presence of tumor ulceration at the time of diagnosis of cutaneous melanoma is among the top prognostic indicators for clinical outcome, associated with reduced disease free and overall survival. Thus, ulceration is employed as a clinical and histopathologic criterion for classification of melanomas into a higher tumor stage. microRNAs are small, non-coding RNAs that frequently exhibit dysregulated expression in cancer and can impact tumor biologic behavior via mediation of oncogene or tumor suppressor gene expression. While patterns of microRNA expression in melanoma have been identified that demonstrate their utility as predictive biomarkers of disease progression and metastasis, the microRNA expression profile of cutaneous melanomas with evidence of ulceration has not yet been assessed. Methods: We determined the microRNA expression profile in RNA isolated from formalin-fixed, paraffin-embedded samples of human ulcerated cutaneous melanoma relative non-ulcerated tumors (n=7 each) using the NanoString human miRNA assay platform. The impact of hsa-miR-1469, a novel microRNA demonstrating downregulated expression in ulcerated melanomas in this study, was examined using in vitro functional assays via transfection of melanoma cell lines A375, CHL-1, and MEL39 with a miR-1469 mimic construct. Results: The resultant microRNA expression data demonstrated at least 2-fold change in expression of 9 microRNAs between ulcerated and non-ulcerated melanoma tumors (p &amp;lt;0.01). Among the top differentially expressed miRs were hsa-miR-4286, hsa-miR-4488, and hsa-miR-1469, each with greater than 3.9-fold decreases in expression in the setting of ulceration relative to non-ulcerated tumors (p &amp;lt;0.0029). Restoration of miR-1469 expression resulted in significant reduction in the migration of melanoma tumor cells relative to untransfected and miR-scramble transfected controls in the CHL-1 model (0.41-fold decrease, p = 0.046 and 0.36-fold decrease, p = 0.013, respectively), with similar patterns observed in A375 and MEL39 cell lines. Transfection with a miR-1469 mimic also increased apoptosis in response to fludarabine (2.32-fold increase, p=0.044). Conclusions: The microRNA expression profile generated from this study highlights a subset of microRNAs that may impact disease progression in patients with ulcerated tumors via mediation of tumor cell functions, and provides further molecular characterization of a poorly understood clinical and histopathologic phenotype. Additional studies examining the expression and function of these microRNAs are necessary to determine their utility as predictive biomarkers and role in tumor progression in the setting of ulcerated cutaneous melanoma. Citation Format: Mallory J. DiVincenzo, Casey Ren, Lorena Suarez-Kelly, Maribelle Moufawad, Zoe Barricklow, Paolo Fadda, Lianbo Yu, John H. Howard, Alejandro A. Gru, William E. Carson. Determination of the expression patterns and functional implications of microRNAs in ulcerated cutaneous melanoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3696.

Impact of Biopsy Technique on Clinically Important Outcomes for Cutaneous Melanoma: A Systematic Review and Meta-analysis.

We performed a systematic review and meta-analysis to examine the relationship between the type of biopsy technique employed in the diagnosis of cutaneous melanoma and 4 clinically important outcomes: melanoma-specific mortality, all-cause mortality, Breslow tumor depth, or melanoma recurrence. Our database was obtained by searching PubMed, Ovid MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Library from inception until December 6, 2019. Studies were identified that compared biopsy techniques used to diagnose cutaneous melanoma with any of our study outcomes. We included 7 observational studies for our meta-analysis after screening 3231 titles and abstracts. Pooled data identified a significantly higher all-cause mortality in the punch biopsy group (risk ratio [RR], 1.520; P=.02). A higher, but nonsignificant, rate of melanoma-specific mortality (RR, 1.96; P=.22) and melanoma recurrence (RR, 1.20; P=.186) was also found for the punch biopsy group. Breslow tumor thickness was not significantly lower for punch incision (standardized mean difference, −0.42; P=.27). We found limited evidence for differences in clinically important outcomes across the spectrum of the most common methods employed in clinical practice for the initial diagnosis of cutaneous melanoma. A small, but significant, increase (P=.02) in all-cause mortality with punch biopsies was not seen for the other outcomes and was most likely due to small sample sizes and demographic differences in the included studies and unlikely represents a clinically important outcome. Our findings support the use of existing clinical practice guidelines for evaluating pigmented lesions suspicious for cutaneous melanoma.

Seasons influence diagnosis and outcome of cutaneous melanoma.

The effects of season changes on the diagnosis of cutaneous melanoma have already been concluded; however, its clinical significance has yet to be defined. The aim of this study was to assess the effects of seasons on both the diagnosis and outcome of melanoma. A total of 1258 adult Caucasian Turkish cutaneous melanoma patients who had been treated and followed up in a single tertiary cancer referral center were included in the study. The most frequently affected season was summer (29%) followed by spring (26.6%), autumn (23.1%), and winter (21.3%). Similarly, rate of the patients diagnosed in July compared to January was significantly higher (11% vs 6%). Most of the clinicopathological characteristics were not correlated with seasons. The 5-year overall survival rate was significantly higher for patients diagnosed in August (81%) than other months, and especially January (47%) (P = .002 and P = .0001, respectively). Similarly, the patients of July (65%) survived longer than those of January (P = .02). Furthermore, similar favorable outcomes for summer (70%) compared to other seasons and winter (51%) were shown (P = .005 and P = .001, respectively). In conclusion, there are seasonal fluctuations in diagnosis of melanoma with a peak in summer, and those diagnosed in summer have favorable survival outcomes.

Melanoma cutáneo en Uruguay: características clínico-epidemiológicas y sobrevida en cohorte de pacientes de dos centros de referencia en el período 2008-2017

Cutaneous melanoma is the tumour whose incidence has increased the most in recent years. This condition is highly lethal in advanced stages. In our country the annual average of cases adds up to 129 in men and 117 in women, there being 50 and 30 respectively, every year.Objective: to describe and analyse the clinical and epidemiological profile and survival in a cohort of patients who are carriers of cutaneous melanoma and were assisted in two reference centers in Montevideo between 2008 and 2017.Methods: we conducted a descriptive, retrospective, observational study of historical cohorts, based on a review of the medical records in patients with a diagnosis of cutaneous melanoma assisted in the Oncology Service of the University Hospital and the Skin Oncology Unit of the National Cancer Institute between 2008 and 2017, with a follow-up until March 31, 2018.Results: 173 pacientes were analysed, median age was 61.2 years old (14-89), 50.3% were men and 49.7% were women. Nodular anatomo-clinical presentation was the most frequent form (32.7%), followed by superficial spreading (28.9%), other forms being less frequent. Median global survival was not achieved, global survival after 5 years being 68.5% and 54.5% after 10 years. Median global survival in Stage 4 was 12 months (IC 95% 8.5-21.5).Conclusions: the results in our series are similar to those reported internationally, in terms of global survival, the same as in most of the clinical an epidemiological characteristics. This is the first study with a cutaneous melanoma survival report in our country.

Risk of skin cancer in patients with vitiligo in Denmark: A nationwide cohort study

BackgroundVitiligo is a depigmentation disorder associated with genetic loss of melanocytes and decreased melanin synthesis. The current literature is conflicting in regard to vitiligo patients' risk of cutaneous malignant melanoma and keratinocyte cancer.ObjectiveTo investigate the risk of cutaneous malignant melanoma and keratinocyte cancer in vitiligo patients.MethodsWe conducted a population-based study, including 2,339 subjects with a first-time vitiligo diagnosis between 1994 and 2017 and 23,293 age- and sex-matched (1:10) controls. To address surveillance bias, we included 12,380 subjects with a first-time diagnosis of lichen planus.ResultsAge was the only significant factor for cutaneous malignant melanoma in comparison of vitiligo with controls and lichen planus (hazard ratio 1.04, 95% confidence interval [CI] 1.03-1.05; and hazard ratio 1.02, 95% CI 1.01-1.04, respectively). Similarly, age was a significant factor for keratinocyte cancer in comparison of vitiligo with controls and lichen planus (hazard ratio 1.07, 95% CI 1.06-1.07; and hazard ratio 1.06, 95% CI 1.05-1.07). Male sex was an additional factor for keratinocyte cancer in comparison of vitiligo with lichen planus (hazard ratio 1.38; 95% CI 1.09-1.75). Phototherapy did not increase the risk of receiving a diagnosis of cutaneous malignant melanoma or keratinocyte cancer in the vitiligo cohort.ConclusionWe observed no significant difference in cutaneous malignant melanoma or keratinocyte cancer risk among vitiligo subjects. Phototherapy use was not associated with a higher skin cancer risk in vitiligo compared with other skin diseases.

RF - New Technologies That Promise to Revolutionize the Diagnosis of Cutaneous Melanoma

RF - New Technologies That Promise to Revolutionize the Diagnosis of Cutaneous Melanoma

Diagnosis of Cutaneous Melanoma: the Gap Between the Knowledge of General Practitioners and Dermatologists in a Brazilian Population.

The early diagnosis of cutaneous melanoma provides less aggressive treatment reducing mortality. General practitioners are responsible for cancer diagnoses in the Brazilian Public Health System and therefore play a crucial role in the prevention and early detection of melanoma. To assess the melanoma knowledge of a primary healthcare physician, the general practitioner, compared to a dermatologist. General practitioners and dermatologists answered a questionnaire about melanoma and the management of suspected cases. The results of both groups were compared. The sample consisted of 80 specialists and 160 general practitioners. When asked about the "ABCDE" rule, 96.2% of the dermatologists knew about it, compared to 34.4% of the general practitioners. The percentage of dermatologists who examined the whole skin of the patient at high risk for melanoma was 90% vs. 24.5% amongst general practitioners. The most cited reasons for the absence of the examination of patients at risk for melanoma were lack of time at the consultations (17.6% specialists, 66.1% generalists) and an excessive number of patients (17.6% specialists, 61.5% generalists). General practitioner has less knowledge about melanoma compared to the dermatologists and presents deficient behaviors about patients at risk or who have suspicious lesions, indicating the need for training and continuing education.

Detection of a progressive dysplastic nevus by a primary care physician: the way to the prevention and early diagnosis of cutaneous melanoma

Detection of a progressive dysplastic nevus by a primary care physician: the way to the prevention and early diagnosis of cutaneous melanoma

Predictive value of global dermoscopic pattern in patients diagnosed with cutaneous melanoma.

IntroductionDermoscopy is one of the most commonly used methods in early diagnosis of melanoma. It is conducted to differentiate between benign and malignant patterns in melanocytic lesions.AimTo determine if there is a predominance of one dermoscopic pattern in patients with melanoma and if there is a significant difference in dominant global dermoscopic pattern in patients with cutaneous melanomas correlated with patients’ sex and the location of the primary tumor.Material and methodsThe study included 162 patients with prior diagnosis of cutaneous melanoma. Dermoscopic and videodermoscopic pictures and patient data were analyzed with regard to the pattern: reticular, globular, homogeneous and mixed pattern (two-component pattern; reticular-globular pattern) with central or peripheral globules and multicomponent (mixed – at least 3 types of structures in one nevus).ResultsThe reticular pattern was significantly more prevalent in male patients (38.57%, 27 patients) in comparison to female patients (18.45%, 17 patients). We also found a statistically significant lower prevalence of reticular pattern in patients diagnosed with melanomas located on upper limbs. The homogeneous pattern was statistically significantly more prevalent in patients in whom primary tumors were located on the head and upper limbs.ConclusionsOur study suggests that predominant complex patterns are more commonly observed in patients diagnosed with cutaneous melanoma, although there is a significant number of patients with predominant reticular and homogeneous patterns, which are not often associated with an increased risk of development of melanoma.

European consensus-based interdisciplinary guideline for melanoma. Part 2: Treatment – Update 2019

A unique collaboration of multidisciplinary experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization for Research and Treatment of Cancer (EORTC) was formed to make recommendations on cutaneous melanoma diagnosis and treatment, based on systematic literature reviews and the experts' experience. Cutaneous melanomas are excised with 1- to 2-cm safety margins. Sentinel lymph node dissection shall be performed as a staging procedure in patients with tumour thickness ≥1.0 mm or ≥0.8 mm with additional histological risk factors, although there is as yet no clear survival benefit for this approach. Therapeutic decisions in stage III/IV patients should be primarily made by an interdisciplinary oncology team (“Tumor Board”). Adjuvant therapies in stage III/IV patients are primarily anti–PD-1, independent of mutational status, or dabrafenib plus trametinib for BRAF-mutant patients. In distant metastasis, either resected or not, systemic treatment is indicated. For first-line treatment, particularly in BRAF wild-type patients, immunotherapy with PD-1 antibodies alone or in combination with CTLA-4 antibodies shall be considered. In particular scenarios for patients with stage IV melanoma and a BRAF-V600 E/K mutation, first-line therapy with BRAF/MEK inhibitors can be offered as an alternative to immunotherapy. In patients with primary resistance to immunotherapy and harbouring a BRAF-V600 E/K mutation, this therapy shall be offered in second-line. Systemic therapy in stage III/IV melanoma is a rapidly changing landscape, and it is likely that these recommendations may change in the near future.

Malignant Melanoma in a Female Mallard Duck (Anas platyrhynchos)

Melanomas are malignant neoplasms originating from melanocytes. They reported in birds. In this case, macroscopic and microscopic (the histopathologic and IHC) findings supported a final diagnosis of cutaneous malignant melanoma in a mallard duck (Anas platyrhynchos). A female mallard duck (Anas platyrhynchos) was observed with a mass on the ventral portion of the neck. The bird was anes- thetized with Diazepam/Ketamine. A skin incision was made on the ventral surface of the mass and blunt dissection was performed to separate the mass. The incision was sutured by a simple interrupted suture pattern. Mass was surgically excised for histopathological evaluation. Histologically, the mass was composed of nests and sheets of anaplastic, epithelioid, multinucleated and polygonal cells con- taining variable amounts of brown to black granules of melanin. The neoplasm showed immunoreactiv- ity for S-100 and Melan-A in the cytoplasm of the neoplastic cells. Based on the histopathological and IHC findings, this is the first report of malignant melanoma in a mallard duck (Anas platyrhynchos).

Insulin Resistance as a Risk Factor for Cutaneous Melanoma. A Case Control Study and Risk-Assessment Nomograms.

Insulin resistance and obesity are suggested to have a key role in the molecular pathogenesis of various disorders, including several malignancies. Moreover, insulin resistance has recently been found to be associated with cutaneous and uveal melanoma, while a variable positive correlation between obesity and the risk of cutaneous melanoma was also found at least in men. The present trial aims at confirming whether insulin resistance, assessed with the homeostasis model assessment of insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI), is a risk factor for cutaneous melanoma. One hundred and thirty patients diagnosed with cutaneous melanoma and 130 age-, sex-, and skin phototype-matched controls were evaluated. At the univariate and multivariate analysis, the diagnosis of cutaneous melanoma was inversely related with insulin resistance (HOMA-IR) and positively with BMI (p = 0.0014 and p = 0.008, respectively). Consistently, insulin sensitivity (QUICKI) and BMI resulted positively associated with the diagnosis of cutaneous melanoma (p = 0.0001 and p = 0.0026, respectively). The results obtained are partially in agreement with those reported in the literature. By comparing our data with those generated by other studies, inconsistencies in key features among subgroups of different trials have emerged, possibly affecting final correlations. Based on insulin resistance/sensitivity, fasting insulinemia/glycemia, and BMI values collected from patients who participated in the present trial, two nomograms potentially assessing the risk of cutaneous melanoma have been generated. Molecular aspects sustain a role for insulin resistance in the carcinogenesis of cutaneous melanoma, but clinical data remain uncertain. Larger, well-balanced, correlative trials are still needed to define the potential role of insulin resistance in the carcinogenesis of cutaneous melanoma.