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Melanoma: HELP
Articles by Charles M. Balch
Based on 42 articles published since 2009
(Why 42 articles?)
||||

Between 2009 and 2019, C. Balch wrote the following 42 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Guideline Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. 2018

Wong, Sandra L / Faries, Mark B / Kennedy, Erin B / Agarwala, Sanjiv S / Akhurst, Timothy J / Ariyan, Charlotte / Balch, Charles M / Berman, Barry S / Cochran, Alistair / Delman, Keith A / Gorman, Mark / Kirkwood, John M / Moncrieff, Marc D / Zager, Jonathan S / Lyman, Gary H. ·Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. · The Angeles Clinic and Research Institute, Santa Monica, CA, USA. · American Society of Clinical Oncology, Alexandria, VA, USA. guidelines@asco.org. · St Luke's Cancer Center, Easton, PA, USA. · Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. · Memorial Sloan Kettering Cancer Center, New York, NY, USA. · MD Anderson Cancer Center, Houston, TX, USA. · Broward Health, Fort Lauderdale, FL, USA. · Los Angeles Center for Health Services, University of California, Los Angeles, CA, USA. · Emory University, Atlanta, GA, USA. · , Silver Spring, MD, USA. · University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA. · Norfolk and Norwich University Hospital, Norwich, UK. · H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. · Fred Hutchinson Cancer Research Center, Seattle, WA, USA. ·Ann Surg Oncol · Pubmed #29236202.

ABSTRACT: PURPOSE: To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. METHODS: An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. RESULTS: Nine new observational studies, two systematic reviews and an updated randomized controlled trial (RCT) of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. RECOMMENDATIONS: Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (non-ulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or <0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of >1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors, and details of the reference patient populations are included within the guideline.

2 Guideline Sentinel Lymph Node Biopsy and Management of Regional Lymph Nodes in Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Clinical Practice Guideline Update. 2018

Wong, Sandra L / Faries, Mark B / Kennedy, Erin B / Agarwala, Sanjiv S / Akhurst, Timothy J / Ariyan, Charlotte / Balch, Charles M / Berman, Barry S / Cochran, Alistair / Delman, Keith A / Gorman, Mark / Kirkwood, John M / Moncrieff, Marc D / Zager, Jonathan S / Lyman, Gary H. ·Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH · Mark B. Faries, The Angeles Clinic and Research Institute, Santa Monica · Alistair Cochran, University of California, Los Angeles Center for Health Services, Los Angeles, CA · Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA · Sanjiv S. Agarwala, St Luke's Cancer Center, Easton · John M. Kirkwood, University of Pittsburgh Cancer Institute, Pittsburgh, PA · Timothy J. Akhurst, Peter MacCallum Cancer Centre, Victoria, Australia · Charlotte Ariyan, Memorial Sloan Kettering Cancer Center, New York, NY · Charles M. Balch, MD Anderson Cancer Center, Houston, TX · Barry S. Berman, Broward Health, Fort Lauderdale · Jonathan S. Zager, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL · Keith A. Delman, Emory University, Atlanta, GA · Mark Gorman, Silver Spring, MD · Marc D. Moncrieff, Norfolk and Norwich University Hospital, Norwich, United Kingdom · and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA. ·J Clin Oncol · Pubmed #29232171.

ABSTRACT: Purpose To update the American Society of Clinical Oncology (ASCO)-Society of Surgical Oncology (SSO) guideline for sentinel lymph node (SLN) biopsy in melanoma. Methods An ASCO-SSO panel was formed, and a systematic review of the literature was conducted regarding SLN biopsy and completion lymph node dissection (CLND) after a positive sentinel node in patients with melanoma. Results Nine new observational studies, two systematic reviews, and an updated randomized controlled trial of SLN biopsy, as well as two randomized controlled trials of CLND after positive SLN biopsy, were included. Recommendations Routine SLN biopsy is not recommended for patients with thin melanomas that are T1a (nonulcerated lesions < 0.8 mm in Breslow thickness). SLN biopsy may be considered for thin melanomas that are T1b (0.8 to 1.0 mm Breslow thickness or < 0.8 mm Breslow thickness with ulceration) after a thorough discussion with the patient of the potential benefits and risk of harms associated with the procedure. SLN biopsy is recommended for patients with intermediate-thickness melanomas (T2 or T3; Breslow thickness of > 1.0 to 4.0 mm). SLN biopsy may be recommended for patients with thick melanomas (T4; > 4.0 mm in Breslow thickness), after a discussion of the potential benefits and risks of harm. In the case of a positive SLN biopsy, CLND or careful observation are options for patients with low-risk micrometastatic disease, with due consideration of clinicopathological factors. For higher-risk patients, careful observation may be considered only after a thorough discussion with patients about the potential risks and benefits of foregoing CLND. Important qualifying statements outlining relevant clinicopathological factors and details of the reference patient populations are included within the guideline. Additional information is available at www.asco.org/melanoma-guidelines and www.asco.org/guidelineswiki .

3 Guideline Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. 2012

Wong, Sandra L / Balch, Charles M / Hurley, Patricia / Agarwala, Sanjiv S / Akhurst, Timothy J / Cochran, Alistair / Cormier, Janice N / Gorman, Mark / Kim, Theodore Y / McMasters, Kelly M / Noyes, R Dirk / Schuchter, Lynn M / Valsecchi, Matias E / Weaver, Donald L / Lyman, Gary H / Anonymous1300731 / Anonymous1310731. ·University of Michigan, Ann Arbor, MI, USA. ·J Clin Oncol · Pubmed #22778321.

ABSTRACT: PURPOSE: The American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) sought to provide an evidence-based guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma. METHODS: A comprehensive systematic review of the literature published from January 1990 through August 2011 was completed using MEDLINE and EMBASE. Abstracts from ASCO and SSO annual meetings were included in the evidence review. An Expert Panel was convened to review the evidence and develop guideline recommendations. RESULTS: Seventy-three studies met full eligibility criteria. The evidence review demonstrated that SLN biopsy is an acceptable method for lymph node staging of most patients with newly diagnosed melanoma. RECOMMENDATIONS: SLN biopsy is recommended for patients with intermediate-thickness melanomas (Breslow thickness, 1 to 4 mm) of any anatomic site; use of SLN biopsy in this population provides accurate staging. Although there are few studies focusing on patients with thick melanomas (T4; Breslow thickness, > 4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control. There is insufficient evidence to support routine SLN biopsy for patients with thin melanomas (T1; Breslow thickness, < 1 mm), although it may be considered in selected patients with high-risk features when staging benefits outweigh risks of the procedure. Completion lymph node dissection (CLND) is recommended for all patients with a positive SLN biopsy and achieves good regional disease control. Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II.

4 Guideline Sentinel lymph node biopsy for melanoma: American Society of Clinical Oncology and Society of Surgical Oncology joint clinical practice guideline. 2012

Wong, Sandra L / Balch, Charles M / Hurley, Patricia / Agarwala, Sanjiv S / Akhurst, Timothy J / Cochran, Alistair / Cormier, Janice N / Gorman, Mark / Kim, Theodore Y / McMasters, Kelly M / Noyes, R Dirk / Schuchter, Lynn M / Valsecchi, Matias E / Weaver, Donald L / Lyman, Gary H / Anonymous11110730 / Anonymous11120730. ·University of Michigan, Ann Arbor, MI, USA. ·Ann Surg Oncol · Pubmed #22766987.

ABSTRACT: PURPOSE: The American Society of Clinical Oncology (ASCO) and Society of Surgical Oncology (SSO) sought to provide an evidence-based guideline on the use of lymphatic mapping and sentinel lymph node (SLN) biopsy in staging patients with newly diagnosed melanoma. METHODS: A comprehensive systematic review of the literature published from January 1990 through August 2011 was completed using MEDLINE and EMBASE. Abstracts from ASCO and SSO annual meetings were included in the evidence review. An Expert Panel was convened to review the evidence and develop guideline recommendations. RESULTS: Seventy-three studies met full eligibility criteria. The evidence review demonstrated that SLN biopsy is an acceptable method for lymph node staging of most patients with newly diagnosed melanoma. RECOMMENDATIONS: SLN biopsy is recommended for patients with intermediate-thickness melanomas (Breslow thickness, 1-4 mm) of any anatomic site; use of SLN biopsy in this population provides accurate staging. Although there are few studies focusing on patients with thick melanomas (T4; Breslow thickness, >4 mm), SLN biopsy may be recommended for staging purposes and to facilitate regional disease control. There is insufficient evidence to support routine SLN biopsy for patients with thin melanomas (T1; Breslow thickness, <1 mm), although it may be considered in selected patients with high-risk features when staging benefits outweigh risks of the procedure. Completion lymph node dissection (CLND) is recommended for all patients with a positive SLN biopsy and achieves good regional disease control. Whether CLND after a positive SLN biopsy improves survival is the subject of the ongoing Multicenter Selective Lymphadenectomy Trial II.

5 Guideline Mayo Clinic consensus recommendations for the depth of excision in primary cutaneous melanoma. 2011

Grotz, Travis E / Markovic, Svetomir N / Erickson, Lori A / Harmsen, William S / Huebner, Marianne / Farley, David R / Pockaj, Barbara A / Donohue, John H / Sim, Franklin H / Grant, Clive S / Bagaria, Sanjay P / Shives, Thomas C / Balch, Charles M / Jakub, James W / Anonymous2190696. ·Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA. ·Mayo Clin Proc · Pubmed #21628616.

ABSTRACT: Currently, no data from randomized controlled clinical trials are available to guide the depth of resection for intermediate-thickness primary cutaneous melanoma. Thus, we hypothesized that substantial variability exists in this aspect of surgical care. We have summarized the literature regarding depth of resection and report the results of our survey of surgeons who treat melanoma. Most of the 320 respondents resected down to, but did not include, the muscular fascia (extremity, 71%; trunk, 66%; and head and neck, 62%). However, significant variation exists. We identified variability in our own practice and have elected to standardize this common aspect of routine surgical care across our institution. In light of the lack of evidence to support resection of the deep muscular fascia, we have elected to preserve the muscular fascia as a matter of routine, except when a deep primary melanoma or thin subcutaneous tissue dictates otherwise.

6 Editorial Revolutionary Advances in Immunotherapy for Melanoma Are Coming into the Surgical Arena: Are We Ready? 2018

Balch, Charles M. ·University of Texas MD Anderson Cancer Center, Houston, TX, USA. cmbalch@mdanderson.org. ·Ann Surg Oncol · Pubmed #29752603.

ABSTRACT:

7 Editorial Excision Margins of Melanoma Make a Difference: New Data Support an Old Paradigm. 2016

Ross, Merrick I / Balch, Charles M. ·Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. charles.balch@UTSouthwestern.edu. ·Ann Surg Oncol · Pubmed #26561402.

ABSTRACT: -- No abstract --

8 Editorial Uncertainties in the management of melanoma nodal metastasis. 2015

Zoras, O / Lasithiotakis, K / Balch, C M. ·Department of Surgical Oncology, University Hospital of Crete, Voutes, 71100, Greece. Electronic address: ozoras@med.uoc.gr. · Department of General Surgery, York Teaching Hospital NHS Foundation Trust, The York Hospital Wigginton Road, York, North Yorkshire, YO31 8HE, UK. Electronic address: kwstaslasith@yahoo.gr. · Division of Surgical Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Mail Code 8548, Dallas, TX, 75390-8548, USA. Electronic address: charles.balch@utsouthwestern.edu. ·Eur J Surg Oncol · Pubmed #25980747.

ABSTRACT: -- No abstract --

9 Editorial Decreased Survival Rates of Older-Aged Patients with Melanoma: Biological Differences or Undertreatment? 2015

Balch, Charles M. ·University of Texas Southwestern Medical Center, Dallas, TX, USA, Charles.balch@utsouthwestern.edu. ·Ann Surg Oncol · Pubmed #25840561.

ABSTRACT: -- No abstract --

10 Editorial Clinical value of the sentinel-node biopsy in primary cutaneous melanoma. 2014

Balch, Charles M / Gershenwald, Jeffrey E. ·From the University of Texas Southwestern Medical Center, Dallas (C.M.B.) · and the Department of Surgical Oncology, Melanoma and Skin Center, University of Texas M.D. Anderson Cancer Center, Houston (J.E.G.). ·N Engl J Med · Pubmed #24521113.

ABSTRACT: -- No abstract --

11 Editorial Identifying early melanomas at higher risk for metastases. 2012

Balch, Charles M / Balch, Glen C / Sharma, Rohit R. · ·J Clin Oncol · Pubmed #22412128.

ABSTRACT: -- No abstract --

12 Editorial Melanoma in the older patient: measuring frailty as an index of survival. 2011

Lange, Julie R / Kang, Sewon / Balch, Charles M. · ·Ann Surg Oncol · Pubmed #21879274.

ABSTRACT: -- No abstract --

13 Editorial 2010 TNM staging system for cutaneous melanoma...and beyond. 2010

Gershenwald, Jeffrey E / Soong, Seng-jaw / Balch, Charles M / Anonymous3450655. · ·Ann Surg Oncol · Pubmed #20300965.

ABSTRACT: -- No abstract --

14 Editorial Microscopic satellites around a primary melanoma: another piece of the puzzle in melanoma staging. 2009

Balch, Charles M. · ·Ann Surg Oncol · Pubmed #19247717.

ABSTRACT: -- No abstract --

15 Review Durable benefit and the potential for long-term survival with immunotherapy in advanced melanoma. 2014

McDermott, David / Lebbé, Celeste / Hodi, F Stephen / Maio, Michele / Weber, Jeffrey S / Wolchok, Jedd D / Thompson, John A / Balch, Charles M. ·Department of Hematology/Oncology, Beth Israel Deaconess Medical Center, 375 Longwood Ave, Mailstop: MASCO 428, Boston, MA 02215, USA. Electronic address: dmcdermo@bidmc.harvard.edu. · APHP Department of Dermatology, CIC, U976 Hôpital Saint-Louis University Paris Diderot, 1 Avenue Claude Vellefaux, Paris 75010, France. Electronic address: celeste.lebbe@sls.aphp.fr. · Center for Immuno-Oncology, Melanoma Center, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA. Electronic address: Stephen_Hodi@dfci.harvard.edu. · Medical Oncology and Immunotherapy, Department of Oncology, University Hospital of Siena, Siena 53100, Italy. Electronic address: mmaiocro@gmail.com. · Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA. Electronic address: jeffrey.weber@moffitt.org. · Ludwig Center for Cancer Immunotherapy, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA. Electronic address: wolchokj@mskcc.org. · Seattle Cancer Care Alliance, 825 Eastlake Ave E, G4-830, Seattle, WA 98109, USA. Electronic address: jat@uw.edu. · Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. Electronic address: charles.balch@utsouthwestern.edu. ·Cancer Treat Rev · Pubmed #25060490.

ABSTRACT: Historically, the median overall survival for patients with stage IV melanoma was less than 1 year and the 5-year survival rate was ∼10%. Recent advances in therapy have raised 5-year survival expectations to ∼20%. Notably, a subset of melanoma patients who receive immunotherapy with high-dose interleukin-2, and now ipilimumab, can achieve long-term survival of at least 5 years. A major goal in melanoma research is to increase the number of patients who experience this overall survival benefit. In this review, we discuss the attributes of immunotherapy and newer targeted agents, and consider how combination strategies might improve the chances of achieving durable benefit and long-term survival. We also discuss three areas that we believe will be critical to making further advances in melanoma treatment. To better understand the clinical profile of patients who achieve long-term survival with immunotherapy, we first present data from ipilimumab clinical trials in which a subset of patients experienced durable responses. Second, we discuss the limitations of traditional metrics used to evaluate the benefits of immunotherapies. Third, we consider emerging issues that clinicians are currently facing when making treatment decisions regarding immunotherapy. A better understanding of these novel treatments may improve survival outcomes in melanoma, increase the number of patients who experience this overall survival benefit, and inform the future use of these agents in the treatment of other cancer types.

16 Review Update on the melanoma staging system: the importance of sentinel node staging and primary tumor mitotic rate. 2011

Balch, Charles M / Gershenwald, Jeffrey E / Soong, Seng-Jaw / Thompson, John F. ·Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. balchch@jhmi.edu ·J Surg Oncol · Pubmed #21858832.

ABSTRACT: The 7(th) Edition of the AJCC Staging Manual includes a detailed summary of melanoma staging and prognosis. The revisions are summarized in this article, along with details on two key aspects of melanoma staging: the incorporation of mitotic rate of the primary melanoma and the key role of the sentinel lymph node biopsy (SLNB) in determining accurate staging for clinically occult nodal metastases. Primary tumor mitotic rate was introduced as a major criterion for melanoma staging and prognosis that replaces the Clark's level of invasion, and is now proven to be an important independent adverse predictor of survival. Analysis of the AJCC melanoma staging database demonstrated a significant inverse correlation between primary tumor mitotic rate (histologically defined as mitoses/mm(2) ) and survival. The use of SLNB reliably identifies melanoma patients with nodal micrometastases, enabling clinicians to identify patients with occult nodal metastases that would otherwise take months or years to become clinically palpable The number of nodal metastases was the most significant independent predictor of survival among all patients with stage III disease, including among patients with nodal micrometastases, and continues to be a primary criterion for defining Stage III melanoma. A clinical scoring system model and multivariate predictive tool under the auspices of the AJCC has led to a first-generation web-based predictive tool (www.melanomaprognosis.org).

17 Review How pathologic staging informs the surgical management of primary cutaneous melanoma. 2010

Tsai, S / Balch, C M. ·Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. ·G Ital Dermatol Venereol · Pubmed #20467392.

ABSTRACT: In this brief review, the authors will summarize recent changes in the American Joint Committee on Cancer (AJCC) staging system, with a particular emphasis on the prognostic importance of mitotic rate and microsatellitosis, and address continuing controversial aspects of the surgical management of cutaneous melanoma.

18 Review Epidemiology and treatment of melanoma in elderly patients. 2010

Tsai, Susan / Balch, Charles / Lange, Julie. ·Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA. ·Nat Rev Clin Oncol · Pubmed #20142815.

ABSTRACT: The number of melanoma cases in the elderly (>65 years) will rise over the coming decades, making it an important public health problem. Elderly white men are the demographic group who are at highest risk of being diagnosed with melanoma and of dying from this cancer. Among patients with melanoma, older age is recognized as an independent poor prognostic factor, but it remains unclear whether this relationship is due to a change in the biology of the disease with increasing patient age, declining host defenses, or both. Most elderly patients can have surgery to control locoregional disease, but might not be candidates for intensive biologic therapies for advanced melanoma because of comorbidities and inability to tolerate the adverse side effects of these treatments. Early detection remains an important strategy for the management of melanoma. Further research is needed to determine why older melanoma patients have a worse prognosis than their younger counterparts, even when matched for all other clinical and pathological predictors of survival outcomes.

19 Review Surgical excision margins for primary cutaneous melanoma. 2009

Sladden, Michael J / Balch, Charles / Barzilai, David A / Berg, Daniel / Freiman, Anatoli / Handiside, Teenah / Hollis, Sally / Lens, Marko B / Thompson, John F. ·Department of Medicine, University of Tasmania, Launceston General Hospital, Launceston, Tasmania, Australia, 7250. ·Cochrane Database Syst Rev · Pubmed #19821334.

ABSTRACT: BACKGROUND: Cutaneous melanoma accounts for 75% of skin cancer deaths. Standard treatment is surgical excision with a safety margin some distance from the borders of the primary tumour. The purpose of the safety margin is to remove both the complete primary tumour and any melanoma cells that might have spread into the surrounding skin.Excision margins are important because there could be trade-off between a better cosmetic result but poorer long-term survival if margins become too narrow. The optimal width of excision margins remains unclear. This uncertainty warrants systematic review. OBJECTIVES: To assess the effects of different excision margins for primary cutaneous melanoma. SEARCH STRATEGY: In August 2009 we searched for relevant randomised trials in the Cochrane Skin Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), MEDLINE, EMBASE, LILACS, and other databases including Ongoing Trials Registers. SELECTION CRITERIA: We considered all randomised controlled trials (RCTs) of surgical excision of melanoma comparing different width excision margins. DATA COLLECTION AND ANALYSIS: We assessed trial quality, and extracted and analysed data on survival and recurrence. We collected adverse effects information from included trials. MAIN RESULTS: We identified five trials. There were 1633 participants in the narrow excision margin group and 1664 in the wide excision margin group. Narrow margin definition ranged from 1 to 2 cm; wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. AUTHORS' CONCLUSIONS: This systematic review summarises the evidence regarding width of excision margins for primary cutaneous melanoma. None of the five published trials, nor our meta-analysis, showed a statistically significant difference in overall survival between narrow or wide excision.The summary estimate for overall survival favoured wide excision by a small degree [Hazard Ratio 1.04; 95% confidence interval 0.95 to 1.15; P = 0.40], but the result was not significantly different. This result is compatible with both a 5% relative reduction in overall mortality favouring narrower excision and a 15% relative reduction in overall mortality favouring wider excision. Therefore, a small (but potentially important) difference in overall survival between wide and narrow excision margins cannot be confidently ruled out.The summary estimate for recurrence free survival favoured wide excision [Hazard Ratio 1.13; P = 0.06; 95% confidence interval 0.99 to 1.28] but again the result did not reach statistical significance (P < 0.05 level).Current randomised trial evidence is insufficient to address optimal excision margins for primary cutaneous melanoma.

20 Article National practice patterns of completion lymph node dissection for sentinel node-positive melanoma. 2018

Hewitt, D Brock / Merkow, Ryan P / DeLancey, John Oliver / Wayne, Jeffrey D / Hyngstrom, John R / Russell, Maria C / Gerami, Pedram / Balch, Charles M / Bilimoria, Karl Y. ·Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · Northwestern Institute for Comparative Effectiveness Research in Oncology (NICER-Onc), Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. · Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania. · Division of General Surgery, Huntsman Cancer Institute, University of Utah Health Care, Salt Lake City, Utah. · Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia. · Division of Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas. ·J Surg Oncol · Pubmed #30098302.

ABSTRACT: BACKGROUND AND OBJECTIVES: Close observation may be an appropriate alternative to completion lymph node dissection (CLND) for selected patient populations, especially those with minimal tumor burden in the sentinel lymph node (SLN). In this study, we examined the practice patterns of CLND utilization. METHODS: Using the National Cancer Database, we examined CLND utilization in SLN-positive patients diagnosed with clinically node-negative Stage III melanoma from 2012 to 2015. Hierarchical logistic regression models were constructed to assess the factors associated with observation after positive SLN biopsy (SLNB). RESULTS: Of the 131 171 patients identified, 55 688 (42.5%) underwent SLNB and 7200 (12.9%) had an SLN with a metastatic disease. CLND was performed in 57.0% of the patients with a positive SLNB. Patients were more likely to forgo CLND if the primary tumor was located on the lower extremity (odds ratio [OR], 1.65, 95% confidence interval [CI], 1.40-1.94), were older (P < 0.001), had multiple comorbidities (OR, 1.61, 95% CI, 1.19-2.20), or were diagnosed with melanoma in 2015 (OR, 1.33, 95% CI, 1.13-1.56 vs 2012). CONCLUSIONS: CLND utilization varied based on patient factors and decreased over time. As evidence supports close observation in selected patient populations with low SLN tumor burden, monitoring is needed to ensure that CLND is performed in the appropriate patient populations. However, this will require improvements in the data collected by cancer registries.

21 Article Detection of melanoma metastases with the sentinel node biopsy: the legacy of Donald L. Morton, MD (1934-2014). 2018

Balch, Charles M. ·University of Texas MD Anderson Cancer Center, Houston, TX, USA. cmbalch@mdanderson.org. ·Clin Exp Metastasis · Pubmed #29855858.

ABSTRACT: Dr. Donald L. Morton was clearly the pioneer of the sentinel node biopsy, which was a major advance in oncology that has improved the management of cancer patients worldwide. He conducted a series of practice-changing clinical trials to validate the important staging role of the sentinel lymph node biopsy for melanoma, and also spawned other studies that demonstrated its staging value in multiple other cancer types, most notably in breast cancer, gastric cancer, and colorectal cancer. His many contributions in this field have provided a unique opportunity to study host/tumor relationships, since the sentinel lymph node is the first location were the host immune defenses are confronted with metastasis arising from the primary cancer.

22 Article Multifactorial Analysis of Prognostic Factors and Survival Rates Among 706 Mucosal Melanoma Patients. 2018

Cui, ChuanLiang / Lian, Bin / Zhou, Li / Song, Xin / Zhang, XiaoShi / Wu, Di / Chi, ZhiHong / Si, Lu / Sheng, XiNan / Kong, Yan / Tang, BiXia / Mao, LiLi / Wang, Xuan / Li, SiMing / Dai, Jie / Yan, XieQiao / Bai, Xue / Balch, Charles M / Guo, Jun. ·Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China. · Yunnan Cancer Hospital, Kunming, China. · SUN YAT-SEN University Cancer Center, Guangzhou, China. · The First Hospital of Jilin University, Changchun, China. · University of Texas MD Anderson Cancer Center, Houston, TX, USA. cmbalch@mdanderson.org. · Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Renal Cancer and Melanoma, Peking University Cancer Hospital & Institute, Beijing, China. guoj307@126.com. ·Ann Surg Oncol · Pubmed #29748886.

ABSTRACT: BACKGROUND: The hypothesis that mucosal melanomas from different anatomic sites would have different prognostic features and survival outcome was tested in a multifactorial analysis. METHODS: Complete clinical and pathological information from 706 mucosal melanoma patients from different anatomical sites was compared for overall survival (OS) and prognostic factors. RESULTS: Mucosal melanomas arising from different anatomical sites did not have any significant differences in OS in a multivariate analysis (p = 0.721). Among all 706 stage I-IV mucosal melanoma patients, depth of tumor invasion (p < 0.001), number of lymph node metastases (p < 0.001), and sites of distant metastases (p < 0.001) were independent prognostic factors for OS; among 543 stage I-III patients, depth of tumor invasion (p < 0.001) and number of lymph node metastases (p < 0.001) were independent prognostic factors for OS; and among 547 stage IV patients, depth of tumor invasion (p = 0.009), number of lymph node metastases (p < 0.001), and combined distant metastases and elevation of serum lactate dehydrogenase (LDH; p < 0.001) were independent prognostic factors for OS. The presence of c-KIT or BRAF mutations was not predictive of survival. CONCLUSIONS: This is the first large-scale study comparing outcomes of mucosal melanomas from different anatomic sites in a multifactorial analysis. There were no significant survival differences among mucosal melanomas arising at different sites when matched for staging and prognostic and molecular factors, thus rejecting our hypothesis. We concluded that prognostic characteristics of mucosal melanomas can be staged as a single histological group, regardless of the anatomic site of the primary tumor.

23 Article Management of Sentinel-Node Metastasis in Melanoma. 2018

Caulley, Lisa / Balch, Charles M / Ross, Merrick I / Robert, Caroline. · ·N Engl J Med · Pubmed #29298143.

ABSTRACT: -- No abstract --

24 Article Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. 2017

Gershenwald, Jeffrey E / Scolyer, Richard A / Hess, Kenneth R / Sondak, Vernon K / Long, Georgina V / Ross, Merrick I / Lazar, Alexander J / Faries, Mark B / Kirkwood, John M / McArthur, Grant A / Haydu, Lauren E / Eggermont, Alexander M M / Flaherty, Keith T / Balch, Charles M / Thompson, John F / Anonymous2651279. ·Professor of Surgery and Cancer Biology, Department of Surgical Oncology; Medical Director, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX. · Conjoint Medical Director, Melanoma Institute Australia; Clinical Professor, The University of Sydney, Sydney, New South Wales, Australia. · Senior Staff Pathologist, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. · Professor, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX. · Chair, Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL. · Conjoint Medical Director and Chair of Melanoma Medical Oncology and Translational Research, Melanoma Institute Australia, The University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia. · Professor of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. · Professor of Pathology, Dermatology, and Translational Molecular Pathology; Director, Melanoma Molecular Diagnostics, The University of Texas MD Anderson Cancer Center, Houston, TX. · Co-Director, Melanoma Program; Head, Surgical Oncology, The Angeles Clinic and Research Institute, Los Angeles, CA. · Professor of Medicine, Dermatology, and Translational Science, The University of Pittsburgh School of Medicine, Pittsburgh, PA. · Executive Director, Victorian Comprehensive Cancer Center, Melbourne, Victoria, Australia. · Manager, Clinical Data Management Systems, The University of Texas MD Anderson Cancer Center, Houston, TX. · Director General, Gustave Roussy Cancer Institute, Villejuif, France. · Director, Termeer Center for Targeted Therapy, Massachusetts General Hospital Cancer Center, Boston, MA. · Professor of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX. · Professor of Melanoma and Surgical Oncology, Melanoma Institute Australia, The University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. ·CA Cancer J Clin · Pubmed #29028110.

ABSTRACT: Answer questions and earn CME/CNE To update the melanoma staging system of the American Joint Committee on Cancer (AJCC) a large database was assembled comprising >46,000 patients from 10 centers worldwide with stages I, II, and III melanoma diagnosed since 1998. Based on analyses of this new database, the existing seventh edition AJCC stage IV database, and contemporary clinical trial data, the AJCC Melanoma Expert Panel introduced several important changes to the Tumor, Nodes, Metastasis (TNM) classification and stage grouping criteria. Key changes in the eighth edition AJCC Cancer Staging Manual include: 1) tumor thickness measurements to be recorded to the nearest 0.1 mm, not 0.01 mm; 2) definitions of T1a and T1b are revised (T1a, <0.8 mm without ulceration; T1b, 0.8-1.0 mm with or without ulceration or <0.8 mm with ulceration), with mitotic rate no longer a T category criterion; 3) pathological (but not clinical) stage IA is revised to include T1b N0 M0 (formerly pathologic stage IB); 4) the N category descriptors "microscopic" and "macroscopic" for regional node metastasis are redefined as "clinically occult" and "clinically apparent"; 5) prognostic stage III groupings are based on N category criteria and T category criteria (ie, primary tumor thickness and ulceration) and increased from 3 to 4 subgroups (stages IIIA-IIID); 6) definitions of N subcategories are revised, with the presence of microsatellites, satellites, or in-transit metastases now categorized as N1c, N2c, or N3c based on the number of tumor-involved regional lymph nodes, if any; 7) descriptors are added to each M1 subcategory designation for lactate dehydrogenase (LDH) level (LDH elevation no longer upstages to M1c); and 8) a new M1d designation is added for central nervous system metastases. This evidence-based revision of the AJCC melanoma staging system will guide patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. CA Cancer J Clin 2017;67:472-492. © 2017 American Cancer Society.

25 Article The natural history and patterns of metastases from mucosal melanoma: an analysis of 706 prospectively-followed patients. 2017

Lian, B / Cui, C L / Zhou, L / Song, X / Zhang, X S / Wu, D / Si, L / Chi, Z H / Sheng, X N / Mao, L L / Wang, X / Tang, B X / Yan, X Q / Kong, Y / Dai, J / Li, S M / Bai, X / Zheng, N / Balch, C M / Guo, J. ·Department of Renal Cancer & Melanoma, Peking University Cancer Hospital & Institute, Beijing, China. · Department of Melanoma, Yunnan Cancer Hospital, Kunming, China. · Department of Melanoma, SUN YAT-SEN University Cancer Center, Guangzhou, China. · Department of Melanoma, The First Hospital of Jilin University, Changchun, China. · Clinical Pharmacology Research Centre, Peking University Cancer Hospital & Institute, Beijing, China. · Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA. ·Ann Oncol · Pubmed #28039178.

ABSTRACT: Background: We examined whether mucosal melanomas are different in their clinical course and patterns of metastases when arising from different anatomic sites. Our hypothesis was that metastatic behavior would differ from primary mucosal melanomas at different anatomical sites. Patients and methods: Clinical and pathological data from 706 patients were compared for their stage distribution, patterns of metastases, CKIT/BRAF mutation status, and overall survival for different anatomical sites. Results: The anatomic sites of the primary mucosal melanomas were from the lower GI tract (26.5%), nasal cavity and paranasal sinuses (23%), gynecological sites (22.5%), oral cavity (15%), urological sites (5%), upper GI tract (5%), and other sites (3.0%). At initial diagnosis, 14.5% were stage I disease, 41% Stage II, 21.5% Stage III, and 23.0% stage IV. Predominant metastatic sites were regional lymph nodes (21.5%), lung (21%), liver (18.5%), and distant nodes (9%). Oral cavity mucosal melanoma had a higher incidence of regional nodal metastases (31.7% versus 19.8%, P = 0.009), and a higher incidence of lung metastases (32.5% versus 18.5%, P = 0.007) compared to other primary mucosal melanomas. There was a 10% incidence of CKIT mutation and 12% BRAF mutation. Mucosal melanomas from nasal pharyngeal and oral, gastrointestinal, gynecological, and urological had a similar survival with a 1-year survival rate (88%, 83%, 86%), 2-year survival rate (66%, 57%, 61%), 5-year survival rate (27%, 16%, 20%), respectively. Conclusions: The largest sample size allows, for the first time, a comparison of primary melanoma stage and patterns of metastases across anatomical sites. With few exceptions, the presenting stages, incidence of nodal and distant metastases, the site of predilection of distant metastases, or overall survival were similar despite different primary anatomic sites. These findings suggest that clinical trials involving mucosal melanomas and the administration of systemic therapy can be applied equally to mucosal melanomas regardless of their primary anatomic site.

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