Skin Cancer & Melanoma

SAN DIEGO--The results of a series of five free annual skin cancer screenings has demonstrated that community education and early detection are valuable tools in addressing cancer prevention, said Rosemary Giuliano, ARNP, MSN. She is national clinical research coordinator in the Cutaneous Oncology Program’s Department of Surgery at the H. Lee Moffitt Cancer Center & Research Institute, University of South Florida, Tampa.

A study published in the Journal of the American Academy of Dermatology (44:807-813, 2001) reported an almost 90%

NEW YORK-Among men over age 50 with an additional melanoma risk factor, diagnostic yield of melanoma screening is 1 in 219, data from the American Academy of Dermatology (AAD) National Skin Cancer Screening Program show. That yield is high, suggesting the potential cost-effectiveness of this intervention, according to Barbara A. Gilchrest, MD, professor and chairman of dermatology, Boston University.

NEW YORK-A variety of simple dietary interventions could prove effective in inhibiting carcinogenesis and reducing the incidence of skin cancers, said James M. Spencer, MD, associate professor of dermatology, Mount Sinai School of Medicine, New York.

NEW YORK-Many persons who apply sunscreen before spending time outdoors are nevertheless increasing their risk of skin cancer by not applying sunscreen frequently enough to prevent sunburn, recent studies involving skiers at high altitudes suggest.

WASHINGTON-Node-negative patients with intermediate-to-thick melanomas who underwent node staging by sentinel lymph node (SLN) biopsy had a significant survival advantage over those staged by elective lymph node dissection (ELND) or clinical examination, said Sophie Dessureault, MD, of the University of South Florida H. Lee Moffitt Cancer Center, Tampa. She spoke on behalf of the AJCC (American Joint Committee on Cancer) Melanoma Staging Committee.

Patients with both melanoma of the skin and positive lymph nodes may suffer regional relapse after lymphadenectomy, according to a report in the Annals of Surgical Oncology (8[2]:109-115, 2001). The report cites a study by John Gibbs, md,

FREEPORT, NY-In a phase III clinical trial of 30 patients with xeroderma pigmentosum, use of a topically applied DNA repair enzyme (T4N5 liposome lotion) for 1 year reduced the incidence of basal cell carcinoma by 30% and actinic keratoses by 68%, compared with placebo.

VENICE, Italy-Adjuvant therapy with the investigational vaccine Melacine helps prevent relapses in patients with stage IIA melanoma, investigators from the Southwest Oncology Group (SWOG) 9035 Study Group announced at the Fifth World Conference on Melanoma. Mela-cine, being developed by Corixa (Seattle), consists of a mixture of allogeneic melanoma cell lysates plus an immunologic adjuvant (Detox).

NEW YORK-An antisense drug that targets a protein that interferes with the actions of chemotherapeutic agents is entering phase III trials, said Raymond P. Warrell, Jr., MD, president and chief executive officer, Genta Inc., Berkeley Heights, New Jersey.

NEW YORK-For some stage IV melanoma patients who achieve only a partial response or stable disease on a regimen of biochemotherapy, a maintenance strategy using interleukin-2 (IL-2) may prolong survival and in some instances produce durable complete responses, California researchers have discovered. Steven J. O’Day, MD, associate director, medical oncology, John Wayne Cancer Institute at St. John’s Health Center, Santa Monica, reported the encouraging results of a pilot study of the biotherapy maintenance strategy at the Chemotherapy Foundation Symposium XVIII.

Sentinel lymph node biopsy has rapidly evolved into the standard of care for node-negative melanoma. It has been used at the Roswell Park Cancer Institute (RPCI) since 1993, and through periodic reviews of results, several modifications have been

BETHESDA, Md-The FDA’s Oncologic Drugs Advisory Committee (ODAC) declined in a unanimous vote to recommend that the agency approve histamine hydrochloride injections (Maxim Pharmaceuticals) for adjuvant use with interleukin-2 (IL-2) in the treatment of adult patients with advanced melanoma that has metastasized to the liver.

Although melanoma is a relatively chemoresistant malignancy, systemic chemotherapy remains the primary treatment for metastatic melanoma. The observation of vasculogenic mimicry in aggressive melanoma has

HAMBURG, Germany-Attempts to improve on interferon-based regimens for melanoma with alternative immuno-stimulant strategies are proving less successful than originally hoped, according to presentations at the 25th Congress of the European Society of Medical Oncology (ESMO).

SEATTLE-Melanoma patients with specific human leukocyte antigen (HLA) phenotypes may respond better to an investigational therapeutic vaccine known as Melacine than those without the phenotype, Vernon Sondak, MD, reported for the Southwest Oncology Group (SWOG) at the Society of Biological Therapy annual meeting.

Temozolomide, an oral alkylating agent, has shown activity against metastatic melanoma. The drug is schedule dependent and is given daily for 5 days. Altering the schedule may enhance its activity by depletion of the protein O6-alkylguanine-DNA

NEW ORLEANS-Management of some patients with melanoma of the lower extremity could potentially stop with sentinel lymph node (SLN) biopsy, according to results presented at the 68th Annual Scientific Meeting of the American Society of Plastic and Reconstructive Surgeons. The study suggests that regional micrometastases of melanoma in the lower extremity are likely confined to the sentinel lymph nodes harvested by lymphadenectomy in some patients, said Lee L.Q. Pu, MD, PhD, resident in plastic surgery, University of South Florida, Tampa.

In the left image, a collar-button shaped choroidal melanoma is seen at lower right. Note the wrinkles in the macular retina caused by tumor growth. At right, after palladium-103 plaque radiation therapy, the choroidal melanoma appears darker and smaller as evidenced by resolution of the macular retinal folds. These photographs of this rare ocular cancer are from the extensive collection of NYU ophthalmologist Paul T. Finger, MD. More ocular images can be seen on the Eye Cancer

PITTSBURGH-An immunomod-ulating agent, histamine dihydrochloride (Maxamine), used in combination with interleukin-2 (IL-2) may improve survival in certain patients with stage IV malignant melanoma.

The SIAscope uses light and sophisticated computer software to construct an image of each part of the skin. The technique shows when a mole is invading deeper into the skin than normal, allowing early diagnosis of malignant melanoma. The SIAscope, based on spectrophotometric intracutaneous analysis (SIA), was researched at Birmingham University and developed by Cambridge-based Astron Clinica. It is in clinical trials at various sites in the United Kingdom. Dr. Marc Moncrieff (pictured, left) is one of the doctors conducting the trials.

NEW ORLEANS-A prospective study in colorectal cancer patients has found that sentinel lymph node (SLN) mapping correctly predicts the presence or absence of nodal metastases, with a very low incidence of skip metastases (disease in a non-SLN), as it does in melanoma and breast cancer.

NEW ORLEANS-Long-term follow-up of patients who underwent surgical excision of intermediate-thickness melanomas offers valuable information regarding the risk of local recurrence, especially as it relates to treatment.

Avax Technologies, Inc., has released 9-year follow-up data of stage III melanoma patients from company-sponsored phase II studies of M-Vax, an individualized cell-based vaccine for cancer. Ernest W. Yankee, PhD, the company’s executive vice-president, presented the data at the 26th annual meeting of the Clinical Oncological Society of Australia in Melbourne.

MANCHESTER, UK-Oral temo-zolomide (Temodar) is as effective as intravenous dacarbazine (DTIC) in advanced metastatic malignant melanoma and is a reasonable alternative for many patients, according to a phase III trial. Temozolomide

WASHINGTON-Insufficient evidence exists to support or reject the inclusion of routine skin cancer screenings in Medicare coverage, according to a new report by the Institute of Medicine (IOM). A second IOM report urges the Health Care Financing Administration (HCFA) to end uncertainties about whether it will cover routine care for patients taking part in clinical trials by stating that it will.

SILVER SPRING, Md-With some uncommonly strong and negative comments to Food and Drug Administration staff, the Oncologic Drugs Advisory Committee (ODAC) refused to recommend approval of Roferon-A (interferon alfa-2a recombinant, Hoffmann-La Roche) for use as an adjuvant treatment of surgically resected malignant melanoma without clinical evidence of nodal disease.

IOWA CITY, Iowa-A surprising new study shows that some melanoma cells can form themselves into vascular channels and provide a tumor’s blood supply without the need for angiogenesis (the growth of new blood vessels from existing blood vessels). The resulting channels, which are lined by melanoma cells and basement membrane (see Figure 1), function as a vascular system for the tumor without the endo-thelium-lined blood vessels produced through angiogenesis.

Haigh et al provide thoughtful, detailed summary of 3 decades of intensive work aimed at developing active, specific immuno-therapies (vaccines) for patients with melanoma. However, as the 20th century draws to a close, the key question is: Can any vaccine be considered an effective therapy for patients with melanoma? To rephrase the question: What constitutes proof of efficacy for a melanoma vaccine, and have any vaccines met those criteria? In a word, the answer to the first question is “no.” The answer to the second question, however, requires more elaboration.

In organizing this brief, but informative review of human melanoma vaccines, Haigh et al have provided an important service to the readers of oncology and are to be commended for their efforts. Their descriptions of the variety of vaccine technologies currently under development and their assessment of the strengths and weakness of each are, for the most part, fair and conservative.