Melanomás betegek stádium szerinti megoszlása egy hazai centrumban

Bevezetés: A malignus melanoma túlélése elsősorban a TNM-stádium függvénye, azonban a Nemzeti Rákregiszter a daganatokat stádiumok alapján nem részletezi. Célkitűzés: A szerzők a Semmelweis Egyetem, Bőr-, Nemikórtani és Bőronkológiai Klinikán melanomával kezelt betegek stádiumfelmérését tűzték ki célul. Módszer: A vizsgálat 2004–2009 között diagnosztizált 1160 cutan melanomás betegre (558 férfi és 602 nő, átlagéletkoruk 60,5±16, illetve 57±17 év) terjedt ki. Eredmények: Nagy esetszámú nemzetközi vizsgálatokkal összehasonlítva az IA és IV-es stádiumban a klinika betegeinek aránya kedvezőnek bizonyult, azaz viszonylag magas százalékban fordultak elő a korai melanomák (IA: 34,8%), alacsony volt a késői, IV-es stádiumú daganatok előfordulása (0,4%). Az IB–IIA stádiumban már szignifikánsan alacsonyabb, a későbbi stádiumok (IIC, IIIA, IIIB) esetében magasabb volt a betegek aránya a nyugat-európai, ausztráliai, egyesült államokbeli adatoknál. Következtetések: A vizsgálat felhívja a figyelmet arra, hogy a korai diagnózis javítása, a nyugati országokhoz való felzárkózás érdekében további lépések, primer és szekunder prevenciós programok szükségesek. Orv. Hetil., 2013, 154, 969–976

A malignus melanóma molekuláris klasszifikációja és markerei [Molecular classification and markers of malignant melanoma]

Pathological classification of malignant melanoma did not change in the past decade, it was just completed with UV-induced skin alterations. A new feature, however, is the establishment of molecular classification of melanoma indicating that beside the most frequent genetic alterations (BRAF, NRAS, CKIT mutations) there is a wide variety of rare molecular subclasses. Unfortunately, none of these genetic alterations can be used to discriminate benign lesions from malignant ones. The frequently used "melanoma" markers are mostly melanosomal markers, therefore they are not helpful for this diagnostic purpose either. More recently, novel FISH kits have been developed analyzing characteristic copy number alterations specific for malignant melanoma. Though melanosomal markers are helpful in differencial diagnostics, the presence of normal melanocytes in various tissues (lymph nodes, intestine or brain) requires application of molecular techniques when melanoma metastasis is in question

Risk of Subsequent Primary Tumor Development in Melanoma Patients

Incidence of subsequent malignant tumor development in 740 patients with primary cutaneous melanoma verified between 2006 and 2010 at the Semmelweis University was studied retrospectively and was compared to data of sex and age matched Hungarian population. The follow-up period was 1499 person-years for the whole group from the diagnosis of index melanoma with an average of 2 years. Standardized incidence rate (SIR) was established as the ratio of observed and expected values. The risk of all subsequent malignancies was 15- and 10-fold higher in males (SIR: 15.42) and in females (SIR: 10.55) with melanoma, than in the general population. The increased cancer risk resulted mainly from the significantly higher skin tumor development: SIR values were 160.39 and 92.64 for additional invasive melanoma and 342.28 and 77.04 for subsequent in situ melanoma in males and females, respectively. Non-melanoma skin cancers also notably contributed to the higher risk, the SIR was elevated in both genders to the same extent (males: 17.12, females: 17.55). The risk was also significantly higher for extracutaneous tumor development like chronic lymphocytic leukemia, colon and kidney cancer (both genders), non-Hodgkin's lymphoma, cervical cancer (females), and bladder carcinoma (males). These data underline the importance of patient education and the necessity of frequent medical follow up, including a close-up dermatological screening of melanoma survivors for further malignancies

Ectopic lymphoid structures in primary cutaneous melanoma.

Ectopic lymphoid structures have been described in several tumor types including metastatic lesions, but not primary tumors, of patients with melanoma. Here we present evidence of B-cell follicles in primary cutaneous melanomas, being present in 39 of 147 cases (27 %). B-cell clusters were associated with T lymphocytes, most of which belonging to CD45RO+ memory T cells. A network of CD21+ follicular dendritic cells was demonstrated in 8 of 22 cases studied (36 %). MECA-79+ HEV-like venules were observed in the neighborhood of the follicles in the majority of cases, however, their presence was not confined to tumors hosting ectopic lymphoid structures. The appearance of B-cell aggregates did not show association with the outcome of the disease, although a trend for their higher prevalence was observed in thicker tumors. Our results show that neogenesis of lymphoid structures does occur in primary melanomas, albeit with lower frequency compared to that reported in metastases