Melanoma: Halpern AC

Coit DG, Andtbacka R, Bichakjian CK, Dilawari RA, Dimaio D, Guild V, Halpern AC, Hodi FS, Kashani-Sabet M, Lange JR, Lind A, Martin L, Martini MC, Pruitt SK, Ross MI, Sener SF, Swetter SM, Tanabe KK, Thompson JA, Trisal V, Urist MM, Weber J, Wong MK, Anonymous00048. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #19401060 No free full text.

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Sober AJ, Chuang TY, Duvic M, Farmer ER, Grichnik JM, Halpern AC, Ho V, Holloway V, Hood AF, Johnson TM, Lowery BJ, Anonymous00178. · No affiliation provided · J Am Acad Dermatol. · Pubmed #11568750 No free full text.

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Scope A, Halpern AC. · No affiliation provided · Cutis. · Pubmed #16475488 No free full text.

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Marghoob AA, Halpern AC. · No affiliation provided · Arch Dermatol. · Pubmed #15724018 No free full text.

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Halpern AC, Marghoob AA. · No affiliation provided · J Clin Oncol. · Pubmed #15302907 No free full text.

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Marghoob AA, Changchien L, DeFazio J, Dessio WC, Malvehy J, Zalaudek I, Halpern AC, Scope A. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. · Australas J Dermatol. · Pubmed #19178485 No free full text.

Abstract: Due to its particularly lethal nature and tendency to affect relatively young individuals, the timely diagnosis of melanoma remains of paramount importance for clinicians and their patients. Unfortunately, melanomas can mimic benign lesions that are overwhelmingly more common in the population than are melanomas, and misdiagnosis or delay in diagnosis of melanoma can occur. Misdiagnosis of melanoma serves as one of the most common causes for malpractice litigation brought against medical practitioners. In this review we describe seven clinical scenarios that represent challenges in melanoma diagnosis and discuss potential strategies for avoiding the errors that commonly give rise to those scenarios.

Psaty EL, Halpern AC. · Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA. · Clin Dermatol. · Pubmed #19095152 No free full text.

Abstract: Relative to other specialties, dermatologists have been slow to adopt advanced technologic diagnostic aids. Most skin disease can be diagnosed by simple visual inspection, and the skin is readily accessible for a diagnostic biopsy. Diagnostic aids, such as total body photography and dermoscopy, improve the clinician's ability to diagnose melanoma beyond unaided visual inspection, however, and are now considered mainstream methods for early detection. Emerging technologies such as in vivo reflectance confocal microscopy are currently being investigated to determine their utility for noninvasive diagnosis of melanoma. This review summarizes the currently available cutaneous imaging devices and new frontiers in noninvasive diagnosis of skin disease. We anticipate that multimodal systems that combine different imaging technologies will further improve our ability to detect, at the bedside, melanoma at an earlier stage.

Esmaeili A, Scope A, Halpern AC, Marghoob AA. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. · Semin Cutan Med Surg. · Pubmed #18486018 No free full text.

Abstract: The ability to detect early melanoma remains of paramount importance in our efforts to curtail deaths related to this malignancy. Fortunately, our clinical skills at recognizing the varied clinical presentation of early melanomas are continuously improving. Our enhanced clinical acumen together with improved awareness of the danger signs of melanoma has resulted in a greater proportion of thin melanomas being diagnosed today as compared to the past. The implementation and utilization of in vivo imaging technologies in clinical practice promises to further enhance our ability to detect melanoma while this cancer is still thin and easily curable. This article describes the utility and application of the in vivo imaging technologies that are currently in clinical use today including dermoscopy, total body photography, individual lesion photography, and reflectance confocal microscopy.

Marghoob AA, Borrego JP, Halpern AC. · Memorial Sloan-Kettering Cancer Center, New York, NY, USA. · Semin Cutan Med Surg. · Pubmed #18395671 No free full text.

Abstract: Congenital melanocytic nevi can be cosmetically disfiguring, give rise to melanoma, and suggest the presence of neurocutaneous melanocytosis. Management decisions must be tailored for each patient and each nevus, taking into consideration the risk for developing malignancy, risk for developing symptomatic neurocutaneous melanocytosis, cosmetic implications of having the nevus, cosmetic implications of any resultant surgical scars from their removal, adverse effects that the nevus may have on psycho-social development, and the adverse effects and long-term sequelae of any surgical intervention. The advantages and disadvantages of different modalities used in the treatment of congenital melanocytic nevi are discussed. Organizational flow diagrams are presented to help clinicians in managing patients with different sized congenital melanocytic nevi.

Wang SQ, Halpern AC. · Dermatology Division, Memorial Sloan-Kettering Cancer Center, 160 East 53rd-St, New York, NY 10022, USA. · Adv Dermatol. · Pubmed #18159897 No free full text.

Abstract: The damaging impact of cutaneous melanoma on individuals and society is apparent. As dermatologists, we are in a unique position to help each patient on a personal level and make contributions with sweeping effects on a societal level. On an individual level, the successful care of each patient involves accurate and early diagnosis, proper education, sufficient biopsy, adequate surgical and medical managements, and long-term follow-up. It is also imperative to remember that each patient presents with his or her own set of unique challenges and needs. The general assessment of risk factors and predictions on survival outcome should only serve as a starting point for discussion during the consultation. A significant percentage of patients will defy these predictions. On a public health level, the concerted endeavor until now to reduce the incidence of the disease should be viewed as a partial success, considering the recent trends in the incidence and mortality rate of the disease. However, there are still many questions that need to be addressed before the implementation of more comprehensive and effective strategies to control MM mortality. It is only through this unrelenting pursuit by the medical and scientific community that may eventually lead to understanding, and perhaps a cure for, this deadly skin cancer that is easily visualized but has thus far proven difficult to control.

Halpern AC, Lieb JA. · Memorial Sloan-Kettering Cancer Center, New York, New York, USA. · Curr Opin Oncol. · Pubmed #17272982 No free full text.

Abstract: PURPOSE OF REVIEW: Early diagnosis has the greatest potential for short-term impact on melanoma mortality. We highlight recent trends in early melanoma detection and address the related challenges and opportunities. RECENT FINDINGS: Significant strides have been made in the early diagnosis of melanoma. Success has been achieved through improved awareness of early signs of melanoma and identification of high-risk cohorts. Detection pressure, however, may also be resulting in the diagnosis of indolent disease, leading to unnecessary morbidity and cost. A looming imbalance of supply and demand for melanoma detection services is anticipated with the aging of the baby boom generation. Prioritization of other preventive services and a growing emphasis on cosmetic dermatology are anticipated to exacerbate this imbalance. While a paucity of hard data have precluded adoption of formal screening recommendations for melanoma, general consensus supports opportunistic screening and identification of high-risk individuals who may benefit from specialized surveillance with dermoscopy and whole-body photography. Research is needed to distinguish biologically indolent and aggressive melanoma, to develop and test evolving technologies to aid diagnosis, and to assess the utility of specific public health strategies for melanoma detection. SUMMARY: Significant strides have been made in early melanoma detection, but multiple challenges remain.

Halpern AC, Mandal SK. · Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. · J Natl Compr Canc Netw. · Pubmed #16884671 No free full text.

Abstract: Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.

Oliveria SA, Sachs D, Belasco KT, Halpern AC. · Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. · J Am Acad Dermatol. · Pubmed #14576692 No free full text.

Abstract: The identification and diagnosis of early melanoma will reduce unnecessary operations and may be important in reducing mortality from melanoma and impacting cost savings to the health system. New technologies are being developed and used at some specialized centers to facilitate the detection and diagnosis of early melanoma for patients at high risk. These technologies include but are not limited to digital photography, dermoscopy, computerized image analysis systems, and confocal scanning laser microscopy. To most effectively implement these novel approaches, it is important to identify the key factors that influence the adoption or diffusion of new medical technologies. We propose patient-, physician-, and health care system-related factors that influence the diffusion of new technologies for the early detection of skin cancer. Studies involving physicians and patients in a variety of clinical settings need to be conducted to achieve a greater understanding of the barriers to the adoption of these new technologic tools that are intended to aid in skin cancer screening.

Marghoob AA, Swindle LD, Moricz CZ, Sanchez Negron FA, Slue B, Halpern AC, Kopf AW. · Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. · J Am Acad Dermatol. · Pubmed #14576657 No free full text.

Abstract: The principal objective of screening individuals at risk for melanoma is detection of cutaneous melanoma during the curable stages of its early evolution. Unaided visual inspection of the skin is often suboptimal at diagnosing melanoma. Improving the diagnostic accuracy for melanoma remains an area of active research. These research efforts have focused on both the detection of early melanoma and the in-depth evaluation of suspicious pigmented lesions for the presence or absence of melanoma. Numerous instruments are under investigation to determine their usefulness in imaging and ascertaining a correct in vivo diagnosis of melanoma. It is anticipated that some of these tools, alone or in combination, will improve our ability to differentiate, in vivo, melanoma from its simulators. Ultimately, these advances may prevent unnecessary biopsies (increased specificity) while increasing the sensitivity for diagnosing melanoma. This article reviews the current instruments and new technologies for the in vivo diagnosis of melanoma.Learning objective At the conclusion of this learning activity, participants should be acquainted with the instruments designed to facilitate the early detection of melanoma. They should also be familiar with the basic technology behind these instruments and should recognize the potential benefits and limitations inherent in each.

Marghoob AA, Borrego JP, Halpern AC. · Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Semin Cutan Med Surg. · Pubmed #12773011 No free full text.

Abstract: Congenital melanocytic nevi can be cosmetically disfiguring, give rise to melanoma, and suggest the presence of neurocutaneous melanocytosis. Management decisions must be tailored for each patient and each nevus, taking into consideration the risk for developing malignancy, risk for developing symptomatic neurocutaneous melanocytosis, cosmetic implications of having the nevus, cosmetic implications of any resultant surgical scars from their removal, adverse effects that the nevus may have on psycho-social development, and the adverse effects and long-term sequelae of any surgical intervention. The advantages and disadvantages of different modalities used in the treatment of congenital melanocytic nevi are discussed. Organizational flow diagrams are presented to help clinicians in managing patients with different sized congenital melanocytic nevi.

Halpern AC. · Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA. · Semin Cutan Med Surg. · Pubmed #12773009 No free full text.

Abstract: Total body skin imaging (TBSI) is being increasingly used as an aid to melanoma detection in high-risk individuals. In this article, we review the rationale, techniques, advantages, and potential pitfalls of TBSI as an aid to melanoma detection. We highlight the technical and clinical considerations relevant to implementation of TBSI in clinical practice.

Argenziano G, Soyer HP, Chimenti S, Talamini R, Corona R, Sera F, Binder M, Cerroni L, De Rosa G, Ferrara G, Hofmann-Wellenhof R, Landthaler M, Menzies SW, Pehamberger H, Piccolo D, Rabinovitz HS, Schiffner R, Staibano S, Stolz W, Bartenjev I, Blum A, Braun R, Cabo H, Carli P, De Giorgi V, Fleming MG, Grichnik JM, Grin CM, Halpern AC, Johr R, Katz B, Kenet RO, Kittler H, Kreusch J, Malvehy J, Mazzocchetti G, Oliviero M, Ozdemir F, Peris K, Perotti R, Perusquia A, Pizzichetta MA, Puig S, Rao B, Rubegni P, Saida T, Scalvenzi M, Seidenari S, Stanganelli I, Tanaka M, Westerhoff K, Wolf IH, Braun-Falco O, Kerl H, Nishikawa T, Wolff K, Kopf AW. · Department of Dermatology, Second University of Naples, Italy. · J Am Acad Dermatol. · Pubmed #12734496 No free full text.

Abstract: BACKGROUND: There is a need for better standardization of the dermoscopic terminology in assessing pigmented skin lesions. OBJECTIVE: The virtual Consensus Net Meeting on Dermoscopy was organized to investigate reproducibility and validity of the various features and diagnostic algorithms. METHODS: Dermoscopic images of 108 lesions were evaluated via the Internet by 40 experienced dermoscopists using a 2-step diagnostic procedure. The first-step algorithm distinguished melanocytic versus nonmelanocytic lesions. The second step in the diagnostic procedure used 4 algorithms (pattern analysis, ABCD rule, Menzies method, and 7-point checklist) to distinguish melanoma versus benign melanocytic lesions. kappa Values, log odds ratios, sensitivity, specificity, and positive likelihood ratios were estimated for all diagnostic algorithms and dermoscopic features. RESULTS: Interobserver agreement was fair to good for all diagnostic methods, but it was poor for the majority of dermoscopic criteria. Intraobserver agreement was good to excellent for all algorithms and features considered. Pattern analysis allowed the best diagnostic performance (positive likelihood ratio: 5.1), whereas alternative algorithms revealed comparable sensitivity but less specificity. Interobserver agreement on management decisions made by dermoscopy was fairly good (mean kappa value: 0.53). CONCLUSION: The virtual Consensus Net Meeting on Dermoscopy represents a valid tool for better standardization of the dermoscopic terminology and, moreover, opens up a new territory for diagnosing and managing pigmented skin lesions.

Lamb LA, Halpern AC, Hwu WJ. · Department of Internal Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA. · Semin Oncol Nurs. · Pubmed #12638378 No free full text.

Abstract: OBJECTIVES: To describe the clinical features and histologic subtypes of cutaneous melanoma; to review the diagnosis, clinical, and pathologic staging of melanoma and the associated prognostic factors; and to review the treatment and management of AJCC stage I and II melanoma. DATA SOURCES: Scientific and review articles, textbooks, and clinical practice. CONCLUSIONS: Management of melanoma depends on accurate diagnosis, staging, and interpretation of prognostic factors. The treatment of choice for stage I and II melanoma is surgery, ranging from simple excision to lymph node dissection. IMPLICATIONS FOR NURSING PRACTICE: Familiarity with the clinical features of melanoma assists nurses in the screening and early detection of melanoma. Knowledge of AJCC staging guides education regarding treatment and lifelong surveillance.

Halpern AC, Altman JF. · Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. · Curr Opin Oncol. · Pubmed #10188079 No free full text.

Abstract: Here we review recent insights in the genetics of skin cancer susceptibility as gleaned from studies of three hereditary syndromes: basal cell nevus syndrome, familial melanoma/dysplastic nevus syndrome, and xeroderma pigmentosum. We provide a brief synopsis of the recent findings related to these syndromes in an attempt to illustrate several emerging themes in the genetics of skin cancer. These themes include 1) the recent identification of multiple cancer susceptibility genes that occur in a myriad of cellular regulatory pathways; 2) the relative specificity of certain regulatory pathways to the development of specific types of cancer; and 3) the important role of DNA damage caused by ultraviolet radiation and defective DNA repair mechanisms in the development of skin cancer. We also review the implications of this knowledge to clinical practice relative to risk assessment, primary prevention, and therapy.

Scope A, Benvenuto-Andrade C, Agero AL, Halpern AC, Gonzalez S, Marghoob AA. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. · Arch Dermatol. · Pubmed #17309998 links to  free full text

Abstract: OBJECTIVE: To determine the utility of reflectance confocal microscopy (RCM) in the in vivo evaluation of dermoscopic structures of melanocytic lesions. DESIGN: For each described dermoscopic feature, we evaluated by RCM at least 2 melanocytic lesions. A digital camera connected to the confocal computer enabled direct analysis of the dermoscopic structures. To ascertain precision of correlation, the orientation of the dermoscopic and RCM images were compared using a superimposed grid. SETTING: Dermatology clinic specializing in pigmented lesions. Patients Eleven patients with melanocytic lesions, including 2 melanomas, 1 Spitz nevus, 7 dysplastic nevi, and 1 compound nevus. Main Outcome Measure Direct correlation of structures seen using dermoscopy with those seen using RCM. RESULTS: There was a good correlation between the global dermoscopic pattern and findings on the 4 x 4-mm mosaic of confocal images at the level of the dermoepidermal junction. The atypical network correlated with variability in the size and shape of dermal papillae. Globules corresponded with aggregates of bright cells, and darker shades of brown on dermoscopy appeared brighter on RCM. In peripheral streaks, RCM showed dense aggregates of pleomorphic cells of variable brightness and ill-defined cellular borders. These aggregates were continuous with the bright mesh that composed the central bulk of the lesion. A blue-white veil correlated with disruption of the rimmed papillae meshlike pattern and sometimes with the presence of bright cells corresponding to melanophages. CONCLUSION: Correlating dermoscopic structures to RCM features is possible and a necessary step toward understanding the potential benefits of RCM in the clinical setting.

Oliveria SA, Dusza SW, Phelan DL, Ostroff JS, Berwick M, Halpern AC. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York 10022, USA. · Am J Prev Med. · Pubmed #14751328 No free full text.

Abstract: BACKGROUND: Results from a single case-control study suggest that skin self-examination (SSE) has the potential to reduce mortality from melanoma by 63%. Despite these encouraging results, SSE rates are low. Few prospective studies of interventions to increase SSE in high-risk cohorts have been performed. The purpose of this study was to assess the impact of a brief nurse-delivered intervention using digital photographs on patients' adherence to performing SSE. DESIGN SETTING/PARTICIPANTS: Patients at high risk for melanoma skin cancer (five or more dysplastic nevi) (N=100) were recruited from the outpatient Pigmented Lesion Clinic at Memorial Sloan-Kettering Cancer Center. All participants had baseline whole-body digital photography as part of their clinical evaluation. INTERVENTION: Patients were randomized: Group A (n =49) received a teaching intervention (physician and nurse education module) with a photo book (personal whole-body photographs compiled in the form of a booklet, with nurse instruction on how to use the photographs); and Group B (n =51) received the teaching intervention only without a photo book. MAIN OUTCOMES/MEASURES: Self-administered questionnaires were provided at three intervals: baseline, post-teaching intervention, and at the 4-month post-baseline visit. To assess adherence with SSE, patients were asked, "How many times in the past 4 months did you (or someone else) usually, thoroughly examine your skin?" RESULTS: In Group A (teaching intervention with photo book), 10.2% of the patients at baseline reported skin examination three or more times during the past 4 months, while 61.2% reported skin examination three or more times at the 4-month follow-up (p =0.039 for paired comparison). In Group B (teaching intervention only), nearly 20% of the patients at baseline reported skin examination three or more times during the past 4 months, while 37% reported skin examination three or more times at the 4-month follow-up (p =0.63). The increase in reported skin examination was compared between the two groups (>51% v >17.6%, p =0.001). CONCLUSIONS: The results suggest that a brief nurse-delivered intervention is effective at increasing patient adherence with SSE. Utilizing digital photographs as an adjunct to screening appeared to increase patient adherence to performing SSE.

Phelan DL, Oliveria SA, Christos PJ, Dusza SW, Halpern AC. · Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. · Oncol Nurs Forum. · Pubmed #14603360 No free full text.

Abstract: PURPOSE/OBJECTIVES: To compare the effect of providing high-risk patients with standard brochures versus personalized photo books as part of a comprehensive nursing intervention on knowledge, awareness, and confidence with skin self-examination (SSE) performance, as well as compliance in performing SSE. DESIGN: Randomized intervention design. SETTING: The Lawrence E. Rockefeller Ambulatory Outpatient Cancer Center at Memorial Sloan-Kettering Cancer Center in New York, NY. SAMPLE: 100 patients at high risk for melanoma. METHODS: Patients completed a baseline questionnaire before their initial photographs were taken and at the end of a nurse-teaching intervention at the clinic. MAIN RESEARCH VARIABLES: Skin cancer knowledge, awareness, and self-confidence in SSE. FINDINGS: A two-way analysis of variance with repeated measures was performed to examine differences within and among groups in relation to knowledge, awareness, and confidence. The group-time interaction was not significant. In group A (nursing intervention with photo book), 10% of the patients at baseline reported performing SSE three or more times during the prior four months. Mean knowledge scores, awareness, and confidence scores all increased. In group B (nurse-teaching intervention using brochures only, without a photo book), 20% reported practicing SSE three or more times during the prior four months. Mean knowledge, awareness, and confidence scores increased. CONCLUSIONS: The main difficulty that patients experience with self-detection of melanoma is their limited recall of skin appearance; therefore, photographic records may be the most effective aid for detecting changes at longer intervals. The use of a photo book may help to diminish that difficulty. IMPLICATIONS FOR NURSING: This study supports the fact that education can increase knowledge, awareness, and confidence regarding SSE, which is consistent with the findings of other investigators. Therefore, nurses should incorporate teaching patients how to perform SSE into their practice and recognize that personal involvement in health care has become a dominant theme in the cancer education literature in recent years. With this new emphasis, important self-care activities, such as testicular self-examination, breast self-examination, and now SSE, are being stressed because early detection has shown favorable effects in improving the prognosis of cancer.

Terushkin V, Halpern AC. · Dermatology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA. · Hematol Oncol Clin North Am. · Pubmed #19464598 No free full text.

Abstract: Recognizing early forms of melanoma may have significant impact on decreasing mortality from this malignancy. As a result, multiple efforts have focused on developing new and improving current early detection strategies. These include educating patients about the importance of performing skin self-examination, increasing rates of complete skin examinations by physicians in the context of routine care, initiating mass screening campaigns, creating specialized skin cancer clinics, and developing better diagnostic tools through advances in technology. In this article, the current state of these efforts is reviewed.

Oliveria SA, Hay JL, Geller AC, Heneghan MK, McCabe MS, Halpern AC. · Department of Medicine, Dermatology Service, Memorial Sloan-Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA. · J Cancer Surviv. · Pubmed #18648948 No free full text.

Abstract: INTRODUCTION: The rising incidence and mortality rates of melanoma, the most fatal form of skin cancer, are among the greatest increases of all preventable cancers over the past decade. However, because of recent advances in early detection, secondary prevention efforts, and treatment, the number of melanoma survivors is increasing. Little research has been conducted on melanoma survivors and important opportunities exist for research in this understudied population. Here, we outline the important research opportunities related to the study of melanoma survivorship and summarize the paucity of literature currently available. MATERIALS AND METHODS: A computerized literature search was performed of the MEDLINE database of the National Library of Medicine from 1966-2005. The scope of the search was limited to those studies published in English. The search was conducted using the following MeSH headings: melanoma, neoplasms, skin neoplasms, survival, and survival rate. The reference lists of relevant book chapters and review articles were further reviewed, and printed materials from recent scientific meetings addressing this topic were obtained. RESULTS: Several factors that affect melanoma survivors warrant further study, including: physiologic long-term effects; psychosocial, behavioral, and cognitive factors; demographic characteristics; surveillance practices; recurrences, secondary primaries, and other cancers; family members of survivors; and economic issues, access to health care/life insurance. CONCLUSIONS: Understanding recurrence and second primary cancer risk, psychosocial and cognitive characteristics, behaviors, surveillance patterns, economic sequelae, and family issues of melanoma survivors is important from a public health standpoint to promote the health and well-being of this cohort. IMPLICATIONS FOR CANCER SURVIVORS: Melanoma is an understudied cancer, and the incidence and mortality of this disease are increasing. Describing the long term burden of this cancer and identifying factors that contribute to them will facilitate efforts to develop responsive secondary prevention strategies.

Neuman HB, Patel A, Ishill N, Hanlon C, Brady MS, Halpern AC, Houghton A, Coit DG. · Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room H1221, New York, NY, 10065, USA. · Ann Surg Oncol. · Pubmed #18465172 No free full text.

Abstract: BACKGROUND: Survival of patients with stage IV melanoma is poor. In the current American Joint Committee on Cancer (AJCC) staging system, site of distant disease and lactate dehydrogenase (LDH) are the only prognostic factors included for stage IV disease. We sought to validate the current AJCC staging system in a contemporary, prospectively collected cohort of patients and explore additional factors that may influence prognosis. METHODS: Our prospective database was searched to identify patients with stage IV melanoma; only patients seen at our institution before developing stage IV disease were included (n = 589). Demographic, clinical, and tumor characteristics were abstracted. Univariate and multivariate assessment of prognostic factors associated with survival were performed by Cox regression. RESULTS: Overall median survival was 9 months. Differential survival by AJCC substage was observed (P < .001). For each site of disease described within the AJCC staging system, an abnormal LDH level was associated with a poorer prognosis. By multivariate analysis, older age at diagnosis (as a continuous variable, hazard ratio [HR] 1.02, 95% confidence interval [95% CI]) 1.01-1.02), an abnormal LDH (HR 1.42, 95% CI 1.11-1.82), site of disease (lung HR 1.22, 95% CI .89-1.66; other viscera 1.61, 95% CI 1.18-2.21), more than one organ involvement (HR 1.27, 95% CI 1.01-1.60), and more than one metastasis (HR 2.27, 95% CI 1.65-3.14) were independently associated with poorer survival. Sex, antecedent stage, and disease-free interval were not statistically significant. CONCLUSION: In our patient cohort, the AJCC staging system was valid. The strongest predictor of survival-the number of metastases present at the diagnosis of stage IV disease-represents a variable to consider in future staging systems.