Melanoma: van der Rhee HJ

van Everdingen JJ, van der Rhee HJ, Koning CC, Nieweg OE, Kruit WH, Coebergh JW, Ruiter DJ, Anonymous00197. · Kwaliteitsinstituut voor de Gezondheidszorg CBO, Postbus 20.064, 3502 LB Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #16128181 No free full text.

Abstract: The guidelines 'Melanoma' (3rd revision) are evidence-based in nature. A number of outcomes are summarised in this article. Dermatoscopy deserves a standard role in the clinical diagnosis of pigmented skin abnormalities. Pathological findings from a diagnostic excision should be recorded meticulously to include anatomical localisation, type of intervention used, excision margin, diagnosis, Breslow thickness, and the completeness of the removal. The sentinel node procedure should be reserved for patients who want to be as informed as possible about their prognosis. The procedure is not considered a part of standard diagnosis. Sentinel node assessment should include stains for specific markers and should be conducted in multiple sections. The following margins of non-affected skin are recommended for therapeutic re-excision of melanoma: in situ melanoma, 0.5 cm; Breslow thickness < or = 2 mm, 1 cm; Breslow thickness > 2 mm, 2 cm. Pathological assessment of a re-excised specimen depends on the completeness of the first excision. Systematic adjuvant treatment of patients with melanoma is not recommended outside the context of a clinical study. Patients with metastatic melanoma are preferably treated within a clinical study. Outside of a clinical study, these patients should be treated with dacarbazine. There is no evidence to suggest that survival is improved by frequent follow-up. However, follow-up can be a useful way to meet the information needs of patients and care requirements for physicians.

Groenewegen G, Osanto S, van der Rhee HJ, Punt CJ. · Afd. Interne Geneeskunde, Universitair Medisch Centrum Utrecht. · Ned Tijdschr Geneeskd. · Pubmed #11086492 No free full text.

Abstract: The Dutch melanoma group reconsidered their 1997 consensus statement on treatment of melanoma because new studies on adjuvant treatment with interferon(IFN)-alpha have been published. These have resulted in its registration for stage IIa; for stage IIb/III IFN-alpha was already registered. Overall survival should be the main endpoint of adjuvant clinical studies, especially when treatment is associated with toxicity. Since a benefit has not been unequivocally demonstrated in melanoma with Breslow thickness > 1.5 mm and/or regional lymph node metastases, there is no need to change the Dutch consensus statement. Drug registration authorities and medical professionals should cooperate more closely.

van der Rhee HJ, Coebergh JW. · Ziekenhuis Leyenburg, afd. Dermatologie, Den Haag. · Ned Tijdschr Geneeskd. · Pubmed #10416492 No free full text.

Abstract: Cutaneous melanoma exhibited a rapidly increasing incidence during the 70 s and 80 s. As a consequence primary and secondary prevention campaigns were developed, starting in Australia, where the incidence was by far the highest, but later also in the Netherlands. Mortality from melanoma in the Netherlands is stable at a rate of 2.4 per 100,000 person years since 1980. The melanoma incidence has stabilized since 1989 at a level of about 11 per 100,000. In the development of the melanoma it is not so much the accumulated exposure to sun that is of importance, as in squamous carcinoma, but rather incidental serious sunburn. It is especially exposure at an early age that increases the risk of melanoma as well as that of basal cell carcinoma. Primary prevention must be focussed on avoiding sunburn in young people. Secondary prevention can be realised by frequent controls of risk groups and a raised awareness for changing moles in the general population but also in physicians who see patients' skins for whatever reason.

van der Rhee HJ, van der Spek-Keijser LM, van Westering R, Coebergh JW. · Department of Dermatology, Leyenburg Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands. · Br J Dermatol. · Pubmed #10233267 No free full text.

Abstract: In summer 1989, a skin cancer campaign was organized in the coastal area of western Netherlands. In order to assess the impact of this and future campaigns on detection rates for melanomas of various thicknesses, a frame of reference for the epidemiology of cutaneous melanoma was established. We performed a retrospective investigation of all melanomas diagnosed in this region in the period 1980-95. A total of 3705 (2967 invasive and 738 in situ melanomas) cases was analysed. During the 1980s the age-adjusted incidence of invasive melanoma steadily increased (from five in 100,000 to 11 in 100,000 for men and from nine in 100,000 to 14 in 100,000 for women). Since 1988/89 the rate has remained stable for men and has increased only slightly among women. Detection rates for in situ melanomas followed the same pattern. Mortality rates remained largely unchanged for both sexes (European standard rates are about 2.6 in 100,000 for men and 2.2 in 100,000 for women). The median Breslow thickness decreased from 1.2 to 1.1 mm for men and from 1.1 to 0.8 mm for women. A marked increase occurred in the proportion of thin melanomas in comparison with intermediate and thick tumours, particularly among women. The female/male ratio declined in the period studied from 2.0 to 1.5. Directly after the campaign in 1989 a temporary increase occurred in the total number of melanomas diagnosed, largely due to more thin melanomas (</= 1.50 mm). These findings are discussed, particularly the possible implications of the most remarkable finding of this study: the stabilization of the incidence rates in recent years. We conclude, given the recent stabilization of rates and the relative favourable thickness, that screening or surveillance should be confined to high-risk groups.