Melanoma: Saiag P

Saiag P, Bosquet L, Guillot B, Verola O, Avril MF, Bailly C, Cupissol D, Dalac S, Danino A, Dréno B, Grob JJ, Leccia MT, Renaud-Vilmer C, Négrier S, Anonymous00110. · Hôpital Ambroise Paré, 92104 Boulogne, Université Versailles-Saint Quentin, France. · Eur J Dermatol. · Pubmed #17540641 links to  free full text

This publication has no abstract.

Négrier S, Saiag P, Guillot B, Verola O, Avril MF, Bailly C, Cupissol D, Dalac S, Danino A, Dreno B, Grob JJ, Leccia MT, Renaud-Vilmer C, Bosquet L, Anonymous00209, Anonymous00210, Anonymous00211, Anonymous00212, Anonymous00213, Anonymous00214, Anonymous00215, Anonymous00216. · Centre Léon-Bérard, Lyon. · Bull Cancer. · Pubmed #16714227 links to  free full text

Abstract: CONTEXT: The National French federation of comprehensive cancer centres (FNCLCC) and the French society of dermatology (SFD) initiated together the update of clinical practice guideline for the management of patients with cutaneous melanoma in collaboration with the French national cancer institute and with specialists from French public universities, general hospitals and private clinics. This work is based on the methodology developed in the "Standards, Options and Recommendations" (SOR) project. OBJECTIVES: To update SOR guidelines for the management of patients with cutaneous melanoma previously validated in 1998 and French melanoma consensus conference published by SFD and ANAES in 1995. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been developed, they are reviewed by independent reviewers. RESULTS: This article is a summary version of the updated clinical practice guidelines with algorithms. The main questions addressed by the expert group in this update concerned (1) The new AJCC-UICC classification (2) Excision margins (3) Sentinel node biopsy (4) Adjuvant treatments (5) Initial staging and follow up of operated patients.

Négrier S, Saiag P, Guillot B, Verola O, Avril MF, Bailly C, Cupissol D, Dalac S, Danino A, Dreno B, Grob JJ, Leccia MT, Renaud-Vilmer C, Bosquet L, Anonymous00273, Anonymous00274. · Centre Léon-Bérard, Lyon. · Ann Dermatol Venereol. · Pubmed #16521904 No free full text.

This publication has no abstract.

Saiag P. · No affiliation provided · Ann Dermatol Venereol. · Pubmed #10394432 No free full text.

This publication has no abstract.

Sei JF, Chaussade V, Zimmermann U, Tchakerian A, Clerici T, Franc B, Saiag P. · Service de Dermatologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, CHU Paris-Ile de France Ouest, Université de Versailles-Saint Quentin en Yvelines, Boulogne. · Ann Dermatol Venereol. · Pubmed #15026745 No free full text.

Abstract: OBJECTIVES: To systematically review the literature for studies reporting on the role of Mohs' micrographic (MMS) surgery in the treatment of skin tumors. To show how it is performed in France. DESIGN: We reviewed with a quality grid all studies indexed in MEDLINE before 2003/01/01 and published in English or French. Data were extracted by two independent reviewers. MAIN OUTCOME MEASURES: Quality of clinical studies, recurrence rates, number of patients lost to follow-up. RESULTS: No randomized study was found among the 493 references found. Studies of lower quality, on procedures similar to MMS, or previous systematic reviews were therefore selected. In tumors such as basal (BCC) or spinous (SCC) cell carcinoma, microcystic adnexal carcinoma, dermatofibrosarcoma protuberans, and Merkel cell carcinoma, MMS commonly induced lower recurrence rates than figures reported for conventional treatments and/or reduced surgical margins. Studies on melanoma were of low quality. CONCLUSIONS: Although no evidence-based guidelines could be developed, MMS should be used mainly for larger, morphea, micronodular or infiltrative-type, or recurrent BCCs located in danger zones, but also (sometimes with a slightly modified procedure) in microcystic adnexal carcinomas, dermatofibrosarcoma protuberans, Merkel cell carcinoma, and in aggressive forms of SCC. Randomized, controlled studies should be performed.

Mahé E, Beauchet A, Aegerter P, Saiag P. · Service de Dermatologie, Centre Hospitalier Universitaire Ambroise Paré, 9 Ave Charles de Gaulle, 92100 Boulogne-Billancourt, France. · Pediatrics. · Pubmed #19403483 No free full text.

Abstract: OBJECTIVE: One of the most important risk factors for melanoma is the number of acquired common and atypical nevi in childhood. The role played by neonatal blue-light phototherapy in the increasing incidence of common and atypical melanocytic nevi in childhood or adolescence has been discussed recently with discordant results. PATIENTS AND METHODS: We designed a multicenter study to assess the effects of neonatal blue-light phototherapy on nevus count in a cohort of 9-year-old children. We counted back and arm nevi as a function of size in 828 children included in a French photoprotection educational campaign. History of neonatal phototherapy, phototype, skin, hair and eye color, and sunburn were assessed through questionnaires to which both parents and children responded, and a nevus count was performed by trained nurses blinded to phototherapy history. RESULTS: Mean nevus count was 16.7 per child. Twenty-two percent of the children had received neonatal blue-light phototherapy. Neonatal phototherapy had no effect on the nevus count irrespective of nevi location, nevi size, or phototype of the children. A light phototype, skin, and hair color; blue/green eyes; and history of sunburn were closely correlated with an increase in nevus count. CONCLUSIONS: This study found no evidence for a major role of blue-light phototherapy on nevus count in 9-year-old children. It underlines the dominant effect of phototype characteristics and history of sunburn in childhood on the early development of melanocytic nevi.

Guedj M, Bourillon A, Combadières C, Rodero M, Dieudé P, Descamps V, Dupin N, Wolkenstein P, Aegerter P, Lebbe C, Basset-Seguin N, Prum B, Saiag P, Grandchamp B, Soufir N, Anonymous00079. · Laboratoire Statistique et Génome, UMR CNRS 8071, INRA 1152, Université d'Evry Val d'Essonne, Evry, France. · Hum Mutat. · Pubmed #18683857 No free full text.

Abstract: In this study, we investigated whether variants in three key pigmentation genes-MC1R, MATP/SLC45A2, and OCA2--were involved in melanoma predisposition. A cohort comprising 1,019 melanoma patients (MelanCohort) and 1,466 Caucasian controls without skin cancers were studied. A total of 10 polymorphisms, including five functional MC1R alleles (p.Asp84Glu, p.Arg142His, p.Arg151Cys, p.Arg160Trp, and p.Asp294His), two nonsynonymous SLC45A2 variants (p.Phe374Leu and p.Glu272Lys), and three intronic OCA2 variants previously shown to be strongly associated with eye color (rs7495174 T>C, rs4778241 G>T, and rs4778138 T>C) were genotyped. As expected, MC1R variants were closely associated with melanoma risk (P value <2.20.10(-16); odds ratio [OR]=2.29 [95% confidence interval, CI=1.85-2.82 and OR=3.3 [95% CI=2.00-5.45], for the presence of one or two variants, respectively). Interestingly, the SLC45A2 variant p.Phe374Leu was significantly and strongly protective for melanoma (P-value=2.12.10(-15); OR=0.35 [95% CI=0.26-0.46] and OR=0.32 [95% CI=0.24-0.43], considering the genotypes Phe/Leu and Leu/Leu, respectively). MC1R and SLC45A2 variants had additive effects on melanoma risk, and after adjusting for pigmentation characteristics, the risk was persistent, even though both genes had a strong impact on pigmentation. Future studies may show whether genetic information could provide a useful complement to physical examination in predicting melanoma risk.

Sibon C, Chagnon S, Tchakérian A, Bafounta ML, Longvert C, Clerici T, Zimmermann U, Saiag P. · Department of Dermatology, Ambroise Paré Hospital, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint-Quentin-en-Yvelines, 92100 Boulogne-Billancourt, France. · Melanoma Res. · Pubmed #17625453 No free full text.

Abstract: To evaluate the ability of high-resolution ultrasonography (hrUS) to detect sentinel-node (SN) melanoma metastases preoperatively before sentinel-node biopsy (SNB), to define hrUS resolution, and to evaluate which US criteria should be used. During a 6.5-year period, 131 consecutive patients with 132 >or=1-mm thick or ulcerated cutaneous melanomas, who were followed up at a single center, were enrolled. All patients underwent preoperative regional lymph-node hrUS and SNB. We used the recently evaluated ultrasonographic stringent and nonstringent hrUS criteria to detect SN metastases. Sizes of the SN metastatic deposits were measured under light microscopy. Thirty-five (27%) patients had a positive SNB. HrUS identified only three positive SNs as being metastatic. Sensitivity and specificity using stringent criteria were 8.8% [95% confidence interval (CI, 2.3-24.8%) and 95.9% (95% CI, 89.3-98.7%)], respectively. Positive-predictive value was 42.9% (95% CI, 11.9-79.9%). The nonstringent criteria provided four additional true-positive results, but lowered specificity (89.8%; 95% CI, 81.6-94.7%) with no significant improvement in sensitivity (20.6%; 95% CI, 9.3-38.4%). Positive-predictive value using nonstringent criteria was 41.2% (95% CI, 19.3-66.4%). HrUS failed to detect all metastatic deposits <5 mm in diameter. HrUS assessment of early-stage melanomas cannot replace surgical SNB. Owing to its low positive-predictive value, hrUS was unable to identify patients who would have to proceed directly to completion lymphadenectomy.

Soufir N, Meziani R, Lacapère JJ, Bertrand G, Fumeron F, Bourillon A, Gérard B, Descamps V, Crickx B, Ollivaud L, Archimbaud A, Lebbe C, Basset-Seguin N, Saiag P, Grandchamp B, Anonymous00433. · Laboratoire de Biochimie Hormonale et Génétique, Hôpital Bichat-Claude Bernard, AP-HP, Faculté de Médecine, Paris VII, Paris, France. · J Natl Cancer Inst. · Pubmed #16145050 links to  free full text

Abstract: The endothelin signaling pathway plays a crucial role in melanocyte differentiation and migration. In this study, we investigated whether germline mutations of endothelin receptor B (EDNRB), a gene involved in Hirschsprung disease (HSCR), could also predispose for malignant melanoma (MM). The coding region of EDNRB was sequenced in 137 MM patients and in 130 ethnically matched Caucasian control subjects. Six nonsynonymous EDNRB variants were found in 15 patients (11%), but only two were found in four control subjects (3%, odds ratio [OR] = 3.87, 95% confidence interval [CI] = 1.25 to 12; P = .012). Overall, 14 out of 15 MM patients carried EDNRB mutations reported in HSCR, some of which had previously been shown to lead to loss of function. In multivariable logistic regression analysis including skin type, eye and hair color, number of nevi, and dorsal lentigines (freckles), the association between EDNRB mutations and MM risk remained statistically significant (OR = 19.9, 95% CI = 1.34 to 296.2; P = .03). Our data strongly suggest that EDNRB is involved in predisposition for two different multigenic disorders, HSCR and melanoma.

Jannot AS, Meziani R, Bertrand G, Gérard B, Descamps V, Archimbaud A, Picard C, Ollivaud L, Basset-Seguin N, Kerob D, Lanternier G, Lebbe C, Saiag P, Crickx B, Clerget-Darpoux F, Grandchamp B, Soufir N, Melan-Cohort. · Unite INSERM 535 'Génétique Epidémiologique et Structure des Populations Humaines', Hôpital Paul Brousse, Villejuif, France. · Eur J Hum Genet. · Pubmed #15889046 links to  free full text

Abstract: The occuloalbinism 2 (OCA2) gene, localized at 15q11, encodes a melanosomal transmembrane protein that is involved in the most common form of human occulo-cutaneous albinism, a human genetic disorder characterized by fair pigmentation and susceptibility to skin cancer. We wondered whether allele variations at this locus could influence susceptibility to malignant melanoma (MM). In all, 10 intragenic single-nucleotide polymorphisms (SNPs) were genotyped in 113 patients with melanomas and in 105 Caucasian control subjects with no personal or family history of skin cancer. By comparing allelic distribution between cases and controls, we show that MM and OCA2 are associated (p value=0.030 after correction for multiple testing). Then, a recently developed strategy, the 'combination test' enabled us to show that a combination formed by two SNPs was most strongly associated to MM, suggesting a possible interaction between intragenic SNPs. In addition, the role of OCA2 on MM risk was also detected using a logistic model taking into account the presence of variants of the melanocortin 1 receptor gene (MC1R, a key pigmentation gene) and all pigmentation characteristics as melanoma risk factors. Our data demonstrate that a second pigmentation gene, in addition to MC1R, is involved in genetic susceptibility to melanoma.

Saiag P, Bernard M, Beauchet A, Bafounta ML, Bourgault-Villada I, Chagnon S. · Service de Dermatologie, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris, Université Versailles-Saint-Quentin-en-Yvelines, Boulogne, France. · Arch Dermatol. · Pubmed #15724014 links to  free full text

Abstract: OBJECTIVES: Our aims were (1) to compare the respective ability of ultrasonography and palpation to detect nodal metastasis during initial staging and follow-up in patients having melanomas and (2) to assess, we believe for the first time, which ultrasound criteria should be used to define metastasis in cases of cutaneous or mucosal melanoma. DESIGN: Prospective single-center study. Nodal metastasis was confirmed by histopathologic evaluation. SETTING: Dermatology and radiology departments of a university hospital. PATIENTS: A total of 160 new consecutive patients with stage I to stage III melanoma. INTERVENTION: Experienced operators independently performed 391 paired palpation and ultrasonographic examinations. MAIN OUTCOME MEASURES: Firm enlarged nodes found on palpation were considered metastatic. On ultrasonographic examination, circular or oval hypoechoic lymph nodes lacking hyperechoic hila were considered metastatic (stringent criteria). Nodes with 2 or fewer of these patterns and other published signs of metastasis (ie, intranodal nodular hypoechoic focus and irregularity of the node margin) were considered suspicious. RESULTS: Over the 6-year study period 33 patients developed nodal metastasis. For palpation and ultrasonography using the stringent criteria, respectively, sensitivity was 41.5% (95% confidence interval [95% CI], 29.6-53.5) and 76.9% (95% CI, 66.7%-87.2%) (P<.001) and specificity was 95.7% (95% CI, 93.5%-97.9%) and 98.4% (95% CI, 97.1%-99.8%) (P<.05). Including ultrasonographically suspicious lymph nodes significantly lowered specificity (86.2% [95% CI, 82.5-89.9]) (P<.05) without improving sensitivity. Previous lymphadenectomy had little impact on ultrasonographic findings. CONCLUSION: Ultrasonography using stringent criteria of nodal metastasis, which are easy to identify and reliable, is superior to palpation for early detection of regional lymph node metastases of melanoma.

Bafounta ML, Beauchet A, Chagnon S, Saiag P. · Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, UFR Médecine Paris-Ile-de-France Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Boulogne, France. · Lancet Oncol. · Pubmed #15522655 No free full text.

Abstract: Because treatment of distant melanoma metastases is not very effective, nodal spread should be diagnosed early so that therapeutic lymphadenectomy can be started as early as possible. Physical examination alone often does not detect nodal metastases and palpable nodes cannot be clasified unambiguously. Whether lymph-node ultrasonography-an inexpensive procedure-improves detection of nodal invasion during the initial staging and follow-up of patients with melanoma is controversial. We used meta-analysis techniques for diagnostic tests to assess the merit of ultrasonography and palpation in detection of nodal invasion in patients with melanoma. Five databases were screened until December, 2003. 12 studies, including 6642 patients and 18?610 paired palpation and ultrasound examinations, were eligible. The main limitations were variations in the definition of false negatives, and verification bias. Ultrasonography had a higher discriminatory power (odds ratio 1755; 95% CI 726-4238) than did palpation (21 [4-111]; p=0.0001). Furthermore, positive-likelihood ratios were 41.9 (95% CI 29-75) for ultrasonography and 4.55 (2-18) for palpation; negative-likelihood ratios were 0.024 (0.01-0.03) and 0.22 (0.06-0.31), respectively. Our results showed clearly that ultrasonography detects lymph-node invasion more accurately than palpation, and should therefore probably be used routinely in patients with melanoma.

Saiag P, Grob JJ, Grosshans E. · No affiliation provided · Ann Dermatol Venereol. · Pubmed #12718142 No free full text.

This publication has no abstract.

Bafounta ML, Beauchet A, Aegerter P, Saiag P. · Service de Dermatologie, Hôpital Ambroise Paré, 9, av Charles-de-Gaulle, 92104 Boulogne CEDEX, France. · Arch Dermatol. · Pubmed #11594860 No free full text.

Abstract: OBJECTIVE: To assess, by means of meta-analysis techniques for diagnostic tests, the accuracy of dermoscopic (also known as dermatoscopy and epiluminescence microscopy) diagnosis of melanoma performed by experienced observers vs. naked-eye clinical examination. DATA SOURCES: MEDLINE, EMBASE, PASCAL-BIOMED, and BIUM databases were screened through May 31, 2000, without any language restrictions. STUDY SELECTION: Original studies were selected when the following criteria were met: spectrum of lesions well described, histologic findings as standard criterion, and calculated or calculable sensitivity and specificity. Eight of 672 retrieved references were retained. DATA EXTRACTION: Three investigators extracted data. In case of disagreement, consensus was obtained. Summary receiver operating characteristic curve analysis was used to describe the central tendency of the studies, and to compare dermoscopy and clinical examination. DATA SYNTHESIS: Selected studies represented 328 melanomas, mostly less than 0.76 mm thick, and 1865 mostly melanocytic benign pigmented skin lesions. For dermoscopic diagnosis of melanoma, the sensitivity and specificity ranges were 0.75 to 0.96 and 0.79 to 0.98, respectively. Dermoscopy had significantly higher discriminating power than clinical examination, with respective estimated odds ratios of 76 (95% confidence interval, 25-223) and 16 (95% confidence interval, 9-31) (P =.008), and respective estimated positive likelihood ratios of 9 (95% confidence interval, 5.6-19.0) and 3.7 (95% confidence interval, 2.8-5.3). The roles of the number of lesions analyzed, the percentage of melanoma lesions, the instrument used, and dermoscopic criteria used in each study could not be proved. CONCLUSION: For experienced users, dermoscopy is more accurate than clinical examination for the diagnosis of melanoma in a pigmented skin lesion.

Bafounta ML, Beauchet A, Poisson-Salomon AS, Saiag P. · Service de dermatologie, CHU Ambroise Paré, 9, avenue Charles de Gaulle, 92104 Boulogne France. · Ann Dermatol Venereol. · Pubmed #10612856 links to  free full text

Abstract: INTRODUCTION: Our aim was to assess the implication of French general practitioners in the follow up of patients surgically treated for stage I melanoma 2 years after the publication of the 1995 French consensus conference recommendations. MATERIAL AND METHODS: In 1997, we sent a questionnaire to all the general practitioners of Hauts-de-Seine department (n = 1000). In that department, specific training on this topic had been conducted in 1996. RESULTS: The response rate was 12.4 p. 100. Follow up was performed in association with a dermatologist or a oncologist by 97 p. 100. There was a high rate of non-response for questions concerning follow up which reached 30.4 p. 100 for thick melanomas. DISCUSSION: Because of the low response rate, the interpretation of these results must be interpreted with precaution. Dermatologists seem to be the general practitioners' preferred correspondents for patients with melanoma.

Bafounta ML, Beauchet A, Poisson-Salomon AS, Saiag P. · Service de dermatologie, Centre Hospitalier Universitaire Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92104 Boulogne, France. · Ann Dermatol Venereol. · Pubmed #10612855 links to  free full text

Abstract: INTRODUCTION: Our aim was to assess the impact of the 1995 French Consensus Conference (CC) on the follow up of patients surgically treated for WHO stage I (AJCC/UICC stages IA to IIB) melanoma, two years after the recommendations had been provided to French dermatologists and oncologists by direct mailing and literature. Prior to this CC, a study of French dematologists' intentions of practice and dermatologists and oncologists effective practices had revealed a lack of homogeneity and the prescription of many paraclinical tests. MATERIAL AND METHODS: In 1997, we sent a questionnaire similar to 1995's one to French dermatologists (3585 practitioners) and oncologists (686), with a pre-paid envelop for the response. The statistical analysis compared these results with those of 1995 for dermatologists, and the results for dermatologists and oncologists using chi(2) test. RESULTS: The response rate was 29 p. 100 for dermatologists, 15 p. 100 for oncologists. Only the number of dermatologists following patients in private practice was increased. Prescriptions of paraclinical tests by dermatologists during initial investigation as well as during follow up dramatically decreased (-30 p. 100 to -50 p. 100), mainly for thoracoabdominal and brain computerized tomography scans and biological tests, to a lesser extent for chest X-rays and abdominal ultrasonographies. Prescriptions of paraclinical tests were higher among oncologists. The frequency of clinical surveillance in 1997 was more often as recommended. Detection of a second melanoma in the patients and their family had improved. However, oncologists' intentions of practice complied less to the CC as compared to dermatologists. DISCUSSION: This study clearly showed an impact of the CC in French dermatologists' intentions of practice leading to both an improvement of patient follow up and a reduction in its cost. This impact was not as great among oncologists.

Lesur G, Bourgault I, Longvert C, El Hajjam M, Dubreuil O, Julié C, Saiag P, Clerici T. · No affiliation provided · Gastroenterol Clin Biol. · Pubmed #18678451 No free full text.

This publication has no abstract.

Soufir N, Ollivaud L, Bertrand G, Lacapère JJ, Descamps V, Vitoux D, Lebbe C, Wolkenstein P, Dupin N, Saiag P, Basset-Seguin N, Grandchamp B, Anonymous00197. · No affiliation provided · J Dermatol Sci. · Pubmed #17223014 No free full text.

This publication has no abstract.

Rodero M, Rodero P, Descamps V, Lebbe C, Wolkenstein P, Aegerter P, Vitoux D, Basset-Seguin N, Dupin N, Grandchamp B, Soufir N, Combadière C, Saiag P, Anonymous00196. · No affiliation provided · J Dermatol Sci. · Pubmed #17169533 No free full text.

This publication has no abstract.

Spica T, Portela M, Gérard B, Formicone F, Descamps V, Crickx B, Ollivaud L, Archimbaud A, Dupin N, Wolkenstein P, Vitoux D, Lebbe C, Saiag P, Basset-Seguin N, Fargnoli MC, Grandchamp B, Peris K, Soufir N, Anonymous00040. · No affiliation provided · J Invest Dermatol. · Pubmed #16614725 links to  free full text

This publication has no abstract.

Meziani R, Descamps V, Gérard B, Matichard E, Bertrand G, Archimbaud A, Ollivaud L, Saiag P, Lebbé C, Basset-Seguin N, Alberti C, Crickx B, Grandchamp B, Soufir N. · No affiliation provided · J Dermatol Sci. · Pubmed #16183259 No free full text.

This publication has no abstract.

Saiag P. · No affiliation provided · J Clin Oncol. · Pubmed #14512407 No free full text.

This publication has no abstract.