Melanoma: Guggisberg D

Guggisberg D, Cerottini JP, Krischer J, Braun R, Dietrich PY, Liénard D, Anonymous00229. · Département hospitalo-universitaire romand de dermatologie et vénéréologie, Lausanne et Genève. · Rev Med Suisse Romande. · Pubmed #11887568 No free full text.

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Autier P, Doré JF, Négrier S, Liénard D, Panizzon R, Lejeune FJ, Guggisberg D, Eggermont AM. · Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy. · J Natl Cancer Inst. · Pubmed #10433619 links to  free full text

Abstract: BACKGROUND: In epidemiologic studies, sunscreen use is associated with increased risk of cutaneous melanoma, basal cell skin cancer, and higher numbers of nevi. It has been proposed that sunscreens may encourage prolonged sun exposure because they delay sunburn occurrence. We examined whether, under habitual conditions of sunscreen use, the sun-protection factor (SPF) had an influence on sun-exposure duration. METHODS: Before the 1997 summer holidays, we randomly assigned 87 French and Swiss participants who were 18-24 years of age to receive an SPF 10 or an SPF 30 sunscreen. Neither medical personnel nor study participants were aware of their sunscreen assignment. Participants were asked to complete daily records of their sun exposure. To avoid influencing the recreational sun-exposure habits of the study participants, no recommendation was made about sun exposure or sun protection. Furthermore, participants were told that the trial end point was the number of pigmented skin lesions before and after the holidays. One subject was lost to follow-up. All statistical tests were two-sided. RESULTS: The SPF 10 (n = 44) and SPF 30 (n = 42) groups had equivalent mean holiday durations (19.4 days versus 20.2 days) and mean quantities of sunscreen used (72.3 g versus 71.6 g). The mean cumulative sun exposures for the two groups were 58.2 hours and 72.6 hours, respectively (P =.011). The mean daily durations of sunbathing were 2.6 and 3.1 hours, respectively (P =.0013), and, for outdoor activities, they were 3.6 and 3.8 hours, respectively (P =.62). There was no difference in sunburn experience between the two groups. CONCLUSIONS: Use of higher SPF sunscreen seems to increase the duration of recreational sun exposure of young white Europeans.

Willi JP, Matter M, Buchegger F, Antonescu C, Guggisberg D, Cerottini JP, Krischer J, Braun R, Marie Kurt A, Roche B, Lemoine R, Rimoldi D, Lejeune FJ, Liénard D, Bischof Delaloye A. · Service de Médecine Nucléaire, University Hospital Geneva, Rue Mucheli-du-Crest 24, 1211 Genève 14, Switzerland. · Nuklearmedizin. · Pubmed #18084679 No free full text.

Abstract: AIM: The clinical relevance of sentinel lymph node (SLN) analysis was evaluated prospectively and compared with other known risk factors of relapse in early stage melanoma. METHODS: Surgery was guided by lymphoscintigraphy, blue dye and gamma probe detection. SLN were analysed by haematoxylin eosin (HE) histochemistry and multimarker immunohistochemistry (IHC). Disease free survival (DFS) was evaluated with Kaplan-Meier plots according to different parameters and Cox analyses of variance. RESULTS: From 210 patients a total of 381 SLN were excised. Lymphoscintigraphy identified all excised SLN with only 2 false positive lymphatic lakes. Fifty patients (24%) had tumour positive SLN. With a mean follow-up of 31.3 months, 29 tumour recurrences were observed, 19 (38%) in 50 SLN positive and 10 (6%) in 160 SLN negative patients. Strong predictive factors for early relapse (p < 0.0005) were SLN positivity and a high Breslow index. CONCLUSION: SLN tumour positivity is an independent factor of high risk for early relapse with a higher power of discrimination than the Breslow index.

Rimoldi D, Lemoine R, Kurt AM, Salvi S, Berset M, Matter M, Roche B, Cerottini JP, Guggisberg D, Krischer J, Braun R, Willi JP, Antonescu C, Slosman D, Lejeune FJ, Liénard D, Anonymous00094. · Ludwig Institute for Cancer Research, Lausanne Branch, University of Lausanne, Epalinges, Switzerland. · Melanoma Res. · Pubmed #14512793 No free full text.

Abstract: The technique of sentinel lymph node (SLN) dissection is a reliable predictor of metastatic disease in the lymphatic basin draining the primary melanoma. Reverse transcription-polymerase chain reaction (RT-PCR) is emerging as a highly sensitive technique to detect micrometastases in SLNs, but its specificity has been questioned. A prospective SLN study in melanoma patients was undertaken to compare in detail immunopathological versus molecular detection methods. Sentinel lymphadenectomy was performed on 57 patients, with a total of 71 SLNs analysed. SLNs were cut in slices, which were alternatively subjected to parallel multimarker analysis by microscopy (haematoxylin and eosin and immunohistochemistry for HMB-45, S100, tyrosinase and Melan-A/MART-1) and RT-PCR (for tyrosinase and Melan-A/MART-1). Metastases were detected by both methods in 23% of the SLNs (28% of the patients). The combined use of Melan-A/MART-1 and tyrosinase amplification increased the sensitivity of PCR detection of microscopically proven micrometastases. Of the 55 immunopathologically negative SLNs, 25 were found to be positive on RT-PCR. Notably, eight of these SLNs contained naevi, all of which were positive for tyrosinase and/or Melan-A/MART-1, as detected at both mRNA and protein level. The remaining 41% of the SLNs were negative on both immunohistochemistry and RT-PCR. Analysis of a series of adjacent non-SLNs by RT-PCR confirmed the concept of orderly progression of metastasis. Clinical follow-up showed disease recurrence in 12% of the RT-PCR-positive immunopathology-negative SLNs, indicating that even an extensive immunohistochemical analysis may underestimate the presence of micrometastases. However, molecular analyses, albeit more sensitive, need to be further improved in order to attain acceptable specificity before they can be applied diagnostically.

Berset M, Cerottini JP, Guggisberg D, Romero P, Burri F, Rimoldi D, Panizzon RG. · Department of Dermatology (CHUV/DHURDV), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. · Int J Cancer. · Pubmed #11241315 No free full text.

Abstract: In this study we assessed the expression of the Melan-A/MART-1 antigen by immunohistochemistry using monoclonal antibody A103 in 73 primary cutaneous melanomas and its correlation with tumor staging and patient survival. Melan-A/MART-1 was expressed in 90% of primary tumors, with loss of expression increasing with Breslow thickness. Kaplan-Meier analysis demonstrated a significantly reduced disease-free interval and overall survival rate for patients not expressing this antigen. The poor prognosis of such patients was even worse for those presenting with a primary melanoma and a Breslow thickness of > or = 1 mm. Thus, Melan-A/MART-1 is not only a useful and specific additional marker for the diagnosis of primary cutaneous melanoma, but it may also help refine the prognosis of patients with malignant melanoma.

Panizzon RG, Guggisberg D. · Service de Dermatologie et Vénéréologie, CHUV, Lausanne. · Ther Umsch. · Pubmed #10420811 No free full text.

Abstract: The annual incidence of melanoma is continually increasing. Melanomas can easily be diagnosed because they are readily visible on the skin. The prognosis is excellent for melanoma when it is diagnosed in an early stage. The clinical diagnosis of melanomas is made by the simple A-B-C-D-E-rule. Clinically, we distinguish the following melanoma types by the order of frequency: the melanoma of the superficial spreading type (SSM), the melanoma with nodular type (NM), the lentigo maligna melanoma (LMM) and the acro-lentiginous melanoma (ALM). Other clinical subtypes of melanoma are congenital giant nevus and melanoma of the mucous membranes. With help of histogenesis, we can distinguish similar forms for melanoma of the SSM-type, melanoma of the NM-type, the lentigo maligna melanoma (LMM) and the melanoma of the ALM-type. In this case, it is preferable to use the terminology acanthotic-lentiginous melanoma since acro-lentiginous is the clinical expression and not a histopathological one. Further subtypes can be distinguished histopathologically such as the desmoplasic melanoma which has been recently described as melanoma from a dysplasic nevus as well as melanoma of the lichen cleanness type. Furthermore, due to histopathology other particular forms can be distinguished such as the melanoma of the nevus Spitz type and melanoma originating from a blue nevus. Most important for the histopathological report is the thickness of the melanoma in millimeters related to the Breslow index as well as the invasion level in the skin by the Clark classification since the melanoma thickness is the most important risk factor for the melanoma patient.