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Melanoma: HELP
Articles by Sophie Dalac
Based on 18 articles published since 2009
(Why 18 articles?)
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Between 2009 and 2019, S. Dalac wrote the following 18 articles about Melanoma.
 
+ Citations + Abstracts
1 Guideline French updated recommendations in Stage I to III melanoma treatment and management. 2017

Guillot, B / Dalac, S / Denis, M G / Dupuy, A / Emile, J F / De La Fouchardiere, A / Hindie, E / Jouary, T / Lassau, N / Mirabel, X / Piperno Neumann, S / De Raucourt, S / Vanwijck, R. ·Dermatology Department, CHU Montpellier. · Dermatology Department, CHU Dijon. · Laboratory of Biochemistry, CHU Nantes. · Dermatology Department, CHU Rennes. · Laboratory of Pathology, AP-HP Ambroise Paré Hospital, Boulogne, France. · Laboratory of Pathology, Centre Léon Bérard Lyon. · Department of Nuclear medicine, CHU Bordeaux. · Dermatology Department, CH Pau. · Department of Radiology, Institut Gustave Roussy Villejuif. · Department of Radiotherapy, Centre Oscar Lambret Lille. · Institut Curie, Paris, France. · 1 Avenue du 6 Juin, 1945, 14000 Caen, France. · Louvain Catholic University, Brussels, Belgium. ·J Eur Acad Dermatol Venereol · Pubmed #28120528.

ABSTRACT: As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Société Française de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorité de Santé in France. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2 cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in Stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of Stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3 years) is recommended for patients, but with greater emphasis on imaging.

2 Guideline [Update to the recommendations for management of melanoma stages I to III]. 2016

Guillot, B / Dalac, S / Denis, M G / Dupuy, A / Emile, J-F / De La Fouchardière, A / Hindie, E / Jouary, T / Lassau, N / Mirabel, X / Piperno Neumann, S / De Raucourt, S / Vanwijck, R. ·Département de dermatologie, hôpital Saint-Éloi, CHU de Montpellier, 34295 Montpellier cedex 5, France. Electronic address: b-guillot@chu-montpellier.fr. · Service de dermatologie, hôpital du Bocage sud, CHU de Dijon, BP 1542, 21079 Dijon cedex, France. · Laboratoire de biochimie, institut de biologie, 9, quai Moncousu, 44093 Nantes cedex, France. · Service de dermatologie, CHU de Rennes, Rennes, France. · Service d'anatomie pathologique, CHU Ambroise-Paré-Boulogne, 92104 Boulogne cedex, France. · Centre anticancéreux Léon-Bérard, 28, rue Laennec, 69008 Lyon, France. · Service de médecine nucléire Sud et Pellegrin, CHU de Bordeaux, Bordeaux, France. · Service de médecine, centre hospitalier de Pau, 64000 Pau, France. · Service d'imagerie médicale, institut Gustave-Roussy, 94800 Villejuif, France. · Centre Oscar-Lambret, 3, rue Fréderic-Combemale, 59000 Lille, France. · Institut Curie, 26, rue d'Ulm, 75005 Paris, France. · 1, avenue du 6-Juin, 14000 Caen, France. · Université catholique de Louvain, 10, avenue Hippocrate, 1200 Bruxelles, Belgique. ·Ann Dermatol Venereol · Pubmed #27527567.

ABSTRACT: As knowledge continues to develop, regular updates are necessary concerning recommendations for practice. The recommendations for the management of melanoma stages I to III were drawn up in 2005. At the request of the Société Française de Dermatologie, they have now been updated using the methodology for recommendations proposed by the Haute Autorité de Santé. In practice, the principal recommendations are as follows: for staging, it is recommended that the 7th edition of AJCC be used. The maximum excision margins have been reduced to 2cm. Regarding adjuvant therapy, the place of interferon has been reduced and no validated emerging medication has yet been identified. Radiotherapy may be considered for patients in stage III at high risk of relapse. The sentinel lymph node technique remains an option. Initial examination includes routine ultrasound as of stage II, with other examinations being optional in stages IIC and III. A shorter strict follow-up period (3years) is recommended for patients, but with greater emphasis on imaging.

3 Guideline [Guidelines for stage I to III melanoma]. 2016

Guillot, Bernard / Dalac, Sophie / Denis, Marc / Dupuy, Alain / Emile, Jean François / De La Fouchardiere, Arnaud / Hindie, Elif / Jouary, Thomas / Lassau, Nathalie / Mirabel, Xavier / Piperno Neumann, Sophie / De Raucourt, Sixtine / Vanwijck, Romain. ·Département de dermatologie, hôpital Saint-Eloi, CHU de Montpellier, 34295 Montpellier cedex 5, France. Electronic address: b-guillot@chu-montpellier.fr. · Service de dermatologie, hôpital du Bocage sud, CHU de Dijon, BP 1542, 21079 Dijon cedex, France. · Laboratoire de biochimie, institut de biologie, 9, quai Moncousu, 44093 Nantes cedex, France. · Service de dermatologie, CHU de Rennes, Rennes, France. · Service d'anatomie pathologique, CHU Ambroise-Paré Boulogne, 92104 Boulogne cedex, France. · Centre anticancéreux Léon-Bérard, 28, rue Laennec, 69008 Lyon, France. · Service de médecine nucléire sud et pellegrin, CHU de Bordeaux, Bordeaux, France. · Service de médecine, CH de Pau, 64000 Pau, France. · Service d'imagerie médicale, institut Gustave-Roussy, 94800 Villejuif, France. · Centre Oscar-Lambret, 3, rue Fréderic-Combemale, 59000 Lille, France. · Institut Curie, 26, rue d'Ulm, 75005 Paris, France. · Sixtine, 1, avenue du 6 juin, 14000 Caen, France. · Université catholique de Louvain, avenue Hippocrate, 10 B-1200 Bruxelles, Belgique. ·Bull Cancer · Pubmed #27456259.

ABSTRACT: -- No abstract --

4 Clinical Trial STAT3 Mediates Nilotinib Response in KIT-Altered Melanoma: A Phase II Multicenter Trial of the French Skin Cancer Network. 2018

Delyon, Julie / Chevret, Sylvie / Jouary, Thomas / Dalac, Sophie / Dalle, Stephane / Guillot, Bernard / Arnault, Jean-Philippe / Avril, Marie-Françoise / Bedane, Christophe / Bens, Guido / Pham-Ledard, Anne / Mansard, Sandrine / Grange, Florent / Machet, Laurent / Meyer, Nicolas / Legoupil, Delphine / Saiag, Philippe / Idir, Zakia / Renault, Victor / Deleuze, Jean-François / Hindie, Elif / Battistella, Maxime / Dumaz, Nicolas / Mourah, Samia / Lebbe, Celeste / Anonymous3181409. ·Service de Dermatologie, and CIC (Centre d'Investigations Cliniques), AP-HP, Hôpital Saint-Louis, Paris, France; INSERM, UMR-976, AP-HP, Hôpital Saint-Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: julie.delyon@aphp.fr. · Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Biostatistique et Information Médicale, AP-HP, Hôpital Saint-Louis, Paris, France. · Unité Onco-dermatologie, Hôpital François Mitterrand, Pau, France. · Service de Dermatologie, CHU Dijon Bourgogne, Dijon, France. · Cancer Research Center of Lyon, INSERM U1052, CNRS UMR5286, Claude Bernard Lyon 1 University, Institut de Cancérologie des Hospices Civils de Lyon, Lyon, France. · Montpellier University Hospital, Montpellier, France. · Service de Dermatologie, CHU Amiens-Picardie, Amiens, France. · Service de Dermatologie, AP-HP, Hôpital Cochin, Paris, France; Université Paris Descartes, Paris, France. · Unité d'oncologie thoracique et cutanée, Hopital Dupuytren, Limoges, France. · Service de Dermatologie, Centre hospitalier régional d'Orléans, Orléans, France. · Dermatology Department, CHU de Bordeaux, Bordeaux, France. · Dermatology Department, CHU de Clermont Ferrand, Clermont Ferrand, France. · Dermatology Department, Reims University Hospital, Reims, France. · Department of Dermatology, Centre Hospitalier Regional et Universitaire (CHRU) de Tours, Tours, France; Inserm U930, University Francois Rabelais de Tours, Tours, France. · Dermatologie, Institut Universitaire du Cancer et CHU de Toulouse, Toulouse, France; Inserm UMR 1037, CRCT, Toulouse, France. · Dermatology Department, University Hospital of Brest, Brest, France. · Université de Versailles St-Quentin, EA 4340, Boulogne-Billancourt, France; Service de Dermatologie Générale et Oncologique, AP-HP, Hôpital Ambroise Paré, Boulogne-Billancourt, France. · AP-HP, Département de la Recherche Clinique et du Développement, AP-HP, Hôpital Saint-Louis, Paris, France. · Laboratory for Bioinformatics, CEPH-Fondation Jean Dausset, Paris, France. · Centre National de Génotypage, CEA, Evry, France; CEPH-Fondation Jean Dausset, Paris, France. · Service de Médecine Nucléaire, CHU de Bordeaux, LabEx TRAIL, Université de Bordeaux, Bordeaux, France. · Université Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM, UMR_S1165, Paris, France; Pathology department, Hopital Saint-Louis, AP-HP, Paris, France. · INSERM, UMR-976, AP-HP, Hôpital Saint-Louis, Paris, France. · INSERM, UMR-976, AP-HP, Hôpital Saint-Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Laboratoire de Pharmacologie Biologique, AP-HP, Hôpital Saint-Louis, Paris, France. · Service de Dermatologie, and CIC (Centre d'Investigations Cliniques), AP-HP, Hôpital Saint-Louis, Paris, France; INSERM, UMR-976, AP-HP, Hôpital Saint-Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. ·J Invest Dermatol · Pubmed #28843487.

ABSTRACT: Mutated oncogenic KIT is a therapeutic target in melanoma. We conducted a multicenter phase II trial on the KIT inhibitor nilotinib in patients with unresectable melanoma harboring KIT alteration. The primary endpoint was the response rate (complete response or partial response following Response Evaluation Criteria in Solid Tumors criteria) at 6 months. Pharmacodynamic studies using KIT sequencing, qPCR array, and immunostaining of downstream KIT effectors were performed during treatment. Twenty-five patients were included and received 400 mg oral nilotinib twice daily. At 6 months, nilotinib induced tumor response in four patients. The best overall response rate was 20% and the disease control rate was 56%, limited to patients harboring exon 11 or 13 mutations. Four patients exhibited durable response, including three persisting (3.6 and 2.8 years for two patients with stage IIIC and 2.5 years for one with IVM1b melanoma). A reduction in signal transducer and activator of transcription (STAT) 3 phosphorylation and its effectors (BCL-2, MCL-1) in tumors during follow-up was significantly associated with clinical response. In the KIT-mutated melanoma cell line M230, nilotinib reduced STAT3 signaling and STAT inhibitors were as efficient as KIT inhibitors in reducing cell proliferation. Our study evidences a significant association between STAT3 inhibition and response to nilotinib, and provides a rationale for future research assessing STAT inhibitors in KIT-mutated melanoma.

5 Article Quality-of-life assessment in French patients with metastatic melanoma in real life. 2019

Kandel, Marguerite / Dalle, Stéphane / Bardet, Aurélie / Allayous, Clara / Mortier, Laurent / Dutriaux, Caroline / Guillot, Bernard / Leccia, Marie-Thérèse / Dalac, Sophie / Legoupil, Delphine / Saiag, Philippe / Montaudie, Henri / Arnault, Jean-Philippe / Brunet-Possenti, Florence / Grob, Jean-Jacques / DeQuatrebarbes, Julie / Beylot-Barry, Marie / Lesimple, Thierry / Aubin, François / Maubec, Eve / Granel-Brocard, Florence / Stoebner, Pierre-Emmanuel / Dupuy, Alain / Dreno, Brigitte / Michiels, Stefan / Lebbe, Céleste / Borget, Isabelle. ·Biostatistics and Epidemiology Service, Gustave Roussy Institute, Villejuif, France. · Center for Research in Epidemiology and Population Health, University of Paris-Saclay, University of Paris-Sud, and Versailles-Saint-Quentin-en-Yvelines University, French Institute of Health and Medical Research (INSERM), Villejuif, France. · Dermatology Unit, Cancer Research Center of Lyon, Lyon University Hospital, Claude Bernard University, Lyon, France. · Dermatology Unit, Clinical Investigation Center, Public Hospital of Paris (AP-HP), INSERM Unit 976, Paris Diderot University-Saint-Louis Hospital, Paris, France. · ONCO-THAI, INSERM Unit 1189, Lille University, Lille Hospital, Lille, France. · Dermatology Unit, Bordeaux Saint-Andre Hospital, Bordeaux, France. · Dermatology Unit, Montpellier Hospital, Montpellier, France. · Dermatology Unit, Grenoble Hospital, Grenoble, France. · Dermatology Unit, Dijon Hospital, Dijon, France. · Dermatology Unit, Brest Hospital, Brest, France. · Dermatology Unit, Ambroise Pare Hospital, AP-HP, Boulogne-Billancourt, France. · Dermatology Unit, Nice Hospital, Nice, France. · Dermatology Unit, Amiens Hospital, Amiens, France. · Dermatology Unit, Bichat Hospital, AP-HP, Paris, France. · Dermatology Unit, La Timone Hospital, Marseilles, France. · Dermatology Unit, Annecy Hospital, Annecy, France. · Dermatology Unit, Bordeaux Haut-L'eveque Hospital, Bordeaux, France. · Rennes Eugene Marquis, Cancer Center, Rennes, France. · Dermatology Unit, Besancon Hospital, Besancon, France. · Dermatology Unit, Avicennes Hospital, AP-HP, Paris, France. · Dermatology Unit, Nancy Hospital, Nancy, France. · Dermatology Unit, Nimes Hospital, Nimes, France. · Dermatology Unit, Rennes Hospital, Rennes, France. · Dermatology Unit, Nantes Hospital, Nantes, France. · Research Group in Law and Health Economics, University Paris-Sud, Paris, France. ·Cancer · Pubmed #31639198.

ABSTRACT: BACKGROUND: Significant progress was recently observed in the treatment of metastatic melanoma (MM). With >50% of patients now reaching a second line of treatment and a significant improvement in the survival rate, an assessment of quality of life (QoL) during the whole course of the disease becomes necessary. The objective of this study was to describe the QoL of patients with MM in France, from their diagnosis of advanced disease to their death, in real life. METHODS: QoL data were collected through MelBase, a prospective, French, multicentric cohort dedicated to the follow-up of adults with MM. QoL was assessed using the EuroQoL-5D questionnaire and the Functional Assessment of Cancer Treatment (FACT)-Melanoma questionnaire at the time of study inclusion, every 3 months, and at the time of each treatment change until death. To assess longitudinal changes from baseline to death, mixed-effect models for repeated-measures analyses were used to control for baseline covariates. RESULTS: QoL was assessed in 1435 patients who were included in the study between 2013 and 2018. The median follow-up was 9.4 months, and 47% of patients died during follow-up. During first-line treatment, the model-based, mean utility score was 0.830 (95% CI, 0.818-0.843), the mean FACT-General score was 77.22 (95% CI, 76.23-78.22), and the mean FACT-Melanoma score was 129.46 (95% CI, 128.02-130.90). At the time of a change in treatment line, there was a decrease of -0.027 (95% CI, -0.03, -0.02) in the utility score, -1.82 (95% CI, -1.88, -1.76) in the FACT-General score, and -2.98 (95% CI, -3.05, -2.91) in the FACT-Melanoma score compared with first-line treatment. CONCLUSIONS: In the MelBase cohort, the QoL among patients with MM seems to be fairly stable over the whole disease course, although a small but significant decrease at time therapy is changed is observed.

6 Article Association of Time From Primary Diagnosis to First Distant Relapse of Metastatic Melanoma With Progression of Disease and Survival. 2019

Vallet, Anaïs / Oriano, Bastien / Mortier, Laurent / Dalle, Stéphane / Dutriaux, Caroline / Guillot, Bernard / Leccia, Marie-Thérèse / Dalac, Sophie / Saiag, Philippe / Lacour, Jean-Philippe / Legoupil, Delphine / De Quatrebarbes, Julie / Brunet-Possenti, Florence / Lesimple, Thierry / Arnault, Jean-Philippe / Aubin, François / Granel-Brocard, Florence / Stoebner, Pierre-Emmanuel / Maubec, Eve / Dreno, Brigitte / Allayous, Clara / Porcher, Raphaël / Lebbé, Céleste / Anonymous2111367. ·Department of Dermatology, Hôpital St Louis, Paris, France. · Department of Biostatistics, Hôpital Hôtel Dieu, Paris, France. · Department of Dermatology, CHRU Lille, Lille, France. · Department of Dermatology, Hôpital des Hospices Civils de Lyon, Lyon, France. · Department of Dermatology, CHU de Bordeaux St-André, Bordeaux, France. · Department of Dermatology, CHU Montpellier, Montpellier, France. · Department of Dermatology, CHU Grenoble, Grenoble, France. · Department of Dermatology, CHU Dijon, Dijon, France. · Department of Dermatology, CHU Ambroise Paré, Boulogne-Billancourt, France. · Department of Dermatology, CHU Nice, Nice, France. · Department of Dermatology, CHU Brest, Brest, France. · Department of Dermatology, CH Annecy Genevois, Epagny Metz-Tessy, France. · Department of Dermatology, Hôpital Bichat, Paris, France. · Department of Dermatology, CLCC Rennes Eugène Marquis, Rennes, France. · Department of Dermatology, CHU Amiens-Picardie, Amiens, France. · Department of Dermatology, CHRU Besançon, Besançon, France. · Department of Dermatology, CHRU Nancy, Vandoeuvre-Les-Nancy, France. · Department of Dermatology, CHU Nîmes, Nîmes, France. · Department of Dermatology, Hôpital Avicenne, Bobigny, France. · Department of Dermatology, CHU de Nantes, Nantes, France. ·JAMA Dermatol · Pubmed #31042256.

ABSTRACT: Importance: The prognosis of advanced melanoma has been greatly improved by new therapeutic agents and clinicians rely on dynamic signals to drive their therapeutic choices. Although the kinetics of metastatic disease seem to be correlated with survival, progression of the localized disease is not predictable. Objective: To assess whether progression of metastatic disease is associated with the time to the first distant recurrence of melanoma. Design, Setting, and Participants: This study was conducted from March 1, 2013, to September 1, 2017, among 638 adults with unresectable stage III or IV melanoma within the French multicentric prospective cohort MelBase. Patients treated with first-line immunotherapies, targeted therapies, or chemotherapy were included. Patients with unknown primary or de novo metastatic melanoma were not included. Data were analyzed from March 1, 2013, to December 1, 2017. Main Outcomes and Measures: The date of primary excision and time to first distant recurrence, progression-free survival, and overall survival were collected. Cox proportional hazards regression models were planned to assess the association between time to first distant recurrence and progression-free survival or overall survival, which was evaluated in terms of hazard ratio (HR). Time to recurrence was analyzed both as a continuous and categorical variable (<12 months, 12-24 months, and >24 months). Results: A total of 638 patients (272 women and 366 men; median age, 64 years [interquartile range, 52-73 years]) were included in the study. The median time from primary excision to first distant recurrence was 25 months (interquartile range, 12-55 months). There was no evidence of association of the time to recurrence with progression-free survival, both when analyzed as a continuous variable (HR, 0.99; 95% CI, 0.99-1.01) or after categorization (12-24 months: HR, 0.75; 95% CI, 0.56-1.02; >24 months: HR, 0.62; 95% CI; 0.47-1.01). There was no evidence of association of the time to recurrence with overall survival, both when analyzed as a continuous variable (HR, 0.99; 95% CI, 0.98-1.02) or after categorization (12-24 months: HR, 0.76; 95% CI, 0.54-1.07; >24 months: HR, 0.61; 95% CI, 0.54-1.03). Those results remained nonsignificant after stratification by treatment. Conclusions and Relevance: In the MelBase cohort, time to recurrence of metastatic melanoma appears not to be associated with progression-free survival or overall survival.

7 Article Impact of radiotherapy administered simultaneously with systemic treatment in patients with melanoma brain metastases within MelBase, a French multicentric prospective cohort. 2019

Tétu, Pauline / Allayous, Clara / Oriano, Bastien / Dalle, Stéphane / Mortier, Laurent / Leccia, Marie-Thérèse / Guillot, Bernard / Dalac, Sophie / Dutriaux, Caroline / Lacour, Jean-Philippe / Saiag, Philippe / Brunet-Possenti, Florence / De Quatrebarbes, Julie / Stoebner, Pierre-Emmanuel / Legoupil, Delphine / Beylot-Barry, Marie / Lesimple, Thierry / Aubin, François / Dreno, Brigitte / Mohamed, Sameh / Ballon, Alice / Porcher, Raphaël / Lebbe, Céleste. ·APHP Dermatology, Department of Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France. Electronic address: pauline.tetu@hotmail.fr. · APHP Dermatology, Department of Dermatology, Paris 7 Diderot University, INSERM U976, Hôpital Saint-Louis, Paris, France. · Clinical Epidemiology Center, AP-HP, Hôtel-Dieu, Paris, France. · Hospices Civils De Lyon, Pierre-Bénite, France. · Dermatology Department, CHRU Lille, Lille, France. · Dermatology Department, CHU Albert Michalon, Grenoble, University of Grenoble, Grenoble, France. · Dermatology Department, Universitary Hospital of Montpellier, CHU Montpellier, Montpellier, France. · Dermatology, University Hospital of Dijon, Dijon, France. · Dermatology and Pediatric Dermatology Department, Bordeaux Hospital, Bordeaux, France, Bordeaux, France. · Dermatology Department, Nice Hospital, Nice, France, Nice, France. · AP-HP, Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France. · AP-HP, Dermatology, Bichat Hospital, Paris, France. · Dermatology, CHR Annecy Genevois, Annecy, France. · Dermatology, CHU de Nimes, Nimes, France. · Dermatology, CHU Brest, Brest, France. · Dermatology, Hôpital Saint-André, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France. · Centre d'Oncodermatologie CLCC/CHU de Rennes, Rennes, France. · Dermatology, CHU de Besançon, Besançon, France. · Dermatology, CHU de Nantes, Nantes, France. · Data Management, AP-HP, Hôpital Saint-Louis, Paris, France. ·Eur J Cancer · Pubmed #30909072.

ABSTRACT: BACKGROUND: Melanoma brain metastases (MBMs) are historically associated with poor prognosis. Radiation therapy is conventionally associated with a high local control rate. Development of targeted therapy and immunotherapy has improved overall survival (OS) and intracranial response rate, but about 50% of patients failed to respond to these novel therapies. The objective of this study was to assess the impact of combined radiotherapy (cRT) on overall survival in a large multicenter real-life prospective cohort of patients with MBM treated with immunotherapy or targeted therapy. PATIENTS AND METHODS: Clinical data from 262 patients with MBM were collected via MelBase, a French multicentric biobank prospectively enrolling unresectable stage III or IV melanoma. Two groups were defined: patients receiving cRT (cRT group) or not receiving cRT (no-cRT group). Primary end-point was OS. Propensity score weighting was used to correct for indication bias. RESULTS: Among the 262 patients, 93 (35%) received cRT (cRT group). The patients were treated with immunotherapy in 69% and 60% and with targeted therapy in 31% and 40% of the cRT and no-cRT groups, respectively. With a median follow-up of 6.9 months, median OS was 16.8 months and 6.9 months in the cRT and no-cRT groups, respectively. After propensity score weighting, cRT was associated with longer OS (hazard ratio = 0.6, 95% confidence interval: 0.4-0.8; p=0.007). Median OS after ponderation was 15.3 months and 6.2 months in the cRT and no-cRT groups, respectively. CONCLUSION: This study shows that cRT may be associated with a significant decrease of 40% in the risk of death in patients with MBM treated with systemic therapy.

8 Article Update of survival and cost of metastatic melanoma with new drugs: Estimations from the MelBase cohort. 2018

Kandel, M / Allayous, C / Dalle, S / Mortier, L / Dalac, S / Dutriaux, C / Leccia, M T / Guillot, B / Saiag, P / Lacour, J P / Legoupil, D / Lesimple, T / Aubin, F / Beylot-Barry, M / Brunet-Possenti, F / Arnault, J P / Granel-Brocard, F / Stoebner, P E / Dupuy, A / Maubec, E / Grob, J J / Dreno, B / Rotolo, F / Ballon, A / Michiels, S / Lebbe, C / Borget, I. ·Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, France; University Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France. Electronic address: marguerite.kandel@gustaveroussy.fr. · Dermatology and CIC, Assistance Publique des Hôpitaux de Paris, INSERM U976, University Paris Diderot-Saint-Louis Hospital, Paris, France. · Dermatology, Hospices Civils de Lyon Hospital, Cancer Research Center of Lyon, Claude Bernard University, Lyon France. · Dermatology, Lille Hospital, Lille, France. · Dermatology, Dijon Hospital, Dijon, France. · Dermatology, Bordeaux Saint-André Hospital, Bordeaux, France. · Dermatology, Grenoble Hospital, Grenoble, France. · Dermatology, Montpellier Hospital, Montpellier, France. · Dermatology, Assistance Publique des Hôpitaux de Paris, Ambroise Paré Hospital, Boulogne-Billancourt, France. · Dermatology, Nice Hospital, Nice, France. · Dermatology, Brest Hospital, Brest, France. · CLCC Rennes Eugène Marquis, France. · Dermatology, Besançon Hospital, Besançon, France. · Dermatology, Bordeaux Haut-L'évêque Hospital, Bordeaux, France. · Dermatology, Assistance Publique des Hôpitaux de Paris, Bichat Hospital, Paris, France. · Dermatology, Amiens Hospital, Amiens, France. · Dermatology, Nancy Hospital, Nancy, France. · Dermatology, Nîmes Hospital, Nîmes, France. · Dermatology, Rennes Hospital, Rennes, France. · Dermatology, Assistance Publique des Hôpitaux de Paris, Avicennes Hospital, University Paris 13, France. · Dermatology, La Timone Hospital, Marseille, France. · Dermatology, Nantes Hospital, Nantes, France. · Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, France; University Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France. · Gustave Roussy, Service de Biostatistique et D'Epidémiologie, Villejuif, France; University Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France; GRADES, University Paris-Sud, France. ·Eur J Cancer · Pubmed #30384014.

ABSTRACT: PURPOSE: Since 2011, significant progress was observed in metastatic melanoma (MM), with the commercialisation of seven immunotherapies or targeted therapies, which showed significant improvement in survival. In France, in 2004, the cost of MM was estimated at €1634 per patient; this cost has not been re-estimated since. This study provided an update on survival and cost in real-life clinical practice. METHODS: Clinical and economic data (treatments, hospitalisations, radiotherapy sessions, visits, imaging and biological exams) were extracted from the prospective MelBase cohort, collecting individual data in 955 patients in 26 hospitals, from diagnosis of metastatic disease until death. Survival was estimated by the Kaplan-Meier method. Costs were calculated from the health insurance perspective using French tariffs. For live patients, survival and costs were extrapolated using a multistate model, describing the 5-year course of the disease according to patient prognostic factors and number of treatment lines. RESULTS: Since the availability of new drugs, the mean survival time of MM patients has increased to 23.6 months ( CONCLUSION: This study is the first that evaluated the impact of immunotherapies and targeted therapies both on survival and cost in real-life conditions. Alongside the introduction of breakthrough therapies in the first and subsequent lines, MM has been associated with a significant increase in survival but also in costs, raising the question of financial sustainability.

9 Article Prospective study of the evolution of blood lymphoid immune parameters during dacarbazine chemotherapy in metastatic and locally advanced melanoma patients. 2014

Mignot, Grégoire / Hervieu, Alice / Vabres, Pierre / Dalac, Sophie / Jeudy, Geraldine / Bel, Blandine / Apetoh, Lionel / Ghiringhelli, François. ·INSERM, UMR866, Dijon, France; Faculté de Médecine, Université de Bourgogne, Dijon, France. · INSERM, UMR866, Dijon, France; Faculté de Médecine, Université de Bourgogne, Dijon, France; Service de Dermatologie, Centre Hospitalier Universitaire le Bocage, Dijon, France. · Faculté de Médecine, Université de Bourgogne, Dijon, France; Service de Dermatologie, Centre Hospitalier Universitaire le Bocage, Dijon, France. · Service de Dermatologie, Centre Hospitalier Universitaire le Bocage, Dijon, France. · INSERM, UMR866, Dijon, France; Faculté de Médecine, Université de Bourgogne, Dijon, France; Oncologie médicale, Centre Georges François Leclerc, Dijon, France. ·PLoS One · Pubmed #25170840.

ABSTRACT: BACKGROUND: The importance of immune responses in the control of melanoma growth is well known. However, the implication of these antitumor immune responses in the efficacy of dacarbazine, a cytotoxic drug classically used in the treatment of melanoma, remains poorly understood in humans. METHODS: In this prospective observational study, we performed an immunomonitoring of eleven metastatic or locally advanced patients treated with dacarbazine as a first line of treatment. We assessed by flow cytometry lymphoid populations and their activation state; we also isolated NK cells to perform in vitro cytotoxicity tests. RESULTS: We found that chemotherapy induces lymphopenia and that a significantly higher numbers of naïve CD4+ T cells and lower proportion of Treg before chemotherapy are associated with disease control after dacarbazine treatment. Interestingly, NK cell cytotoxicity against dacarbazine-pretreated melanoma cells is only observed in NK cells from patients who achieved disease control. CONCLUSION: Together, our data pinpoint that some immune factors could help to predict the response of melanoma patients to dacarbazine. Future larger scale studies are warranted to test their validity as prediction markers.

10 Article Distinctive features of melanoma and its management in elderly patients: a population-based study in France. 2013

Ciocan, Dragos / Barbe, Coralie / Aubin, Francois / Granel-Brocard, Florence / Lipsker, Dan / Velten, Michel / Dalac, Sophie / Truchetet, François / Michel, Catherine / Mitschler, Audrey / Arnoult, Gwendoline / Buemi, Antoine / Dalle, Stéphane / Bernard, Philippe / Woronoff, Anne-Sophie / Grange, Florent. ·Unité d'Aide Méthodologique, Hôpital Robert Debré, Reims, France. ·JAMA Dermatol · Pubmed #23945633.

ABSTRACT: IMPORTANCE: Life expectancy is increasing in most developed countries, and elderly people have the highest incidence of melanoma. OBJECTIVE: To identify characteristics of melanoma and its management in the elderly compared with younger patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective population-based study of incident cases of primary melanoma in 1621 patients with stage I or II melanoma in 2004 and 2008. Questionnaires administered to physicians and a survey of cancer registries and pathology laboratories were used to obtain data. The study was conducted in 5 regions in northeastern France. MAIN OUTCOMES AND MEASURES: Characteristics of patients and tumors, circumstances of diagnosis, and further management in older patients (≥70 years, 487 patients [30.0%]) compared with younger ones (<70 years, 1134 [70.0%]). RESULTS: Older patients had more frequent melanomas of the head and neck (29.4% vs 8.7%; P < .001) and of the nodular, lentigo maligna, or acral lentiginous histologic subtypes. They had thicker and more frequently ulcerated tumors, categorized as T3 or T4 in 36.7% of cases vs 20.1% in younger patients. Diagnosis of melanoma occurred more frequently in a general practice setting and less frequently in direct consultation with a dermatologist or regular screening for skin cancer. Time to definitive excision was longer in older patients, and 16.8% of them compared with 5.0% of the younger population had insufficient excision margins (P < .001). A sentinel lymph node biopsy was performed in 23.3% of the older patients with melanoma thicker than 1 mm vs 41.4% in the younger patients (P < .001). Adjuvant therapy was less frequently started in older patients and was prematurely stopped in a higher proportion of that population. CONCLUSIONS AND RELEVANCE: Age-related variations are observed at every step of melanoma management. The most important concerns are access of elderly people to settings for early diagnosis and excision with appropriate margins.

11 Article Diagnosis and management of melanoma with regional lymph node metastases: a population-based study in France. 2013

Lévy-Sitbon, C / Barbe, C / Granel-Brocard, F / Lipsker, D / Aubin, F / Dalac, S / Truchetet, F / Michel, C / Mitschler, A / Arnoult, G / Le Clainche, A / Dalle, S / Bernard, P / Grange, F. ·Service de Dermatologie, Hôpital Robert Debré, Reims, France. ·J Eur Acad Dermatol Venereol · Pubmed #22845015.

ABSTRACT: BACKGROUND: Stage III melanoma represents a borderline situation regarding the potential curability of this potentially aggressive cancer and consequently, regional lymph node metastases (RLNM) are a major challenge for melanoma management. OBJECTIVE: To describe the management of melanoma with RLNM as practised in France in 2008 and compare results with previous data from 2004, considering that new French recommendations were published in 2005. METHODS: Retrospective population-based study in five regions of France totalling 8.3 million inhabitants, targeting all incident cases of RLNM diagnosed in 2008. Questionnaires were mailed to physicians to identify cases and collect data, with verification by cancer registries for cases diagnosed concomitantly with the primary tumour using sentinel lymph node biopsies (SLNB). RESULTS: Data were collected for 101 patients in 2008, and compared to 89 cases treated in 2004. Palpation by a dermatologist was the most common circumstance of diagnosis of RLNM in 2008 (36%), followed by SLNB (29%), self-palpation by the patient (16%) and lymph node ultrasonography (6%), without significant modification from 2004. After lymphadenectomy an adjuvant therapy was proposed in 62% of cases, mainly consisting in high-dose interferon (HD-IFN) (80%). Overall, HD-IFN was proposed in 49% of cases, but effectively started in only 40% of cases after being proposed, and prematurely withdrawn in 28%, showing major changes as compared with 2004 (33%, 77% and 67%, respectively, P < 0.05). Adjuvant chemotherapy was not proposed to any patients in 2008, compared to 29% in 2004. Surveillance procedures included medical imaging less often in 2008 (76%) than in 2004 (92%) (P = 0.004), but more often included FDG-PET (23% vs. 12%, P = 0.09). CONCLUSION: Overall, actual practice was in accordance with French recommendations. The main developments from 2004 to 2008 were the disappearance of adjuvant chemotherapies and a more accurate selection of patients for adjuvant interferon.

12 Article Clinical and sociodemographic characteristics associated with thick melanomas. A population-based, case-case study in France. 2012

Grange, Florent / Barbe, Coralie / Aubin, Francois / Lipsker, Dan / Granel-Brocard, Florence / Velten, Michel / Dalac, Sophie / Truchetet, François / Michel, Catherine / Mitschler, Audrey / Arnoult, Gwendoline / Buemi, Antoine / Dalle, Stéphane / Bernard, Philippe / Woronoff, Anne-Sophie. ·Service de Dermatologie, Hôpital Robert Debré, Reims, Avenue du Général Koenig, 51092 Reims CEDEX, France. fgrange @chu-reims.fr ·Arch Dermatol · Pubmed #22986518.

ABSTRACT: OBJECTIVE: To identify clinical and sociodemographic factors associated with very thick melanoma (VTM) (Breslow thickness, 3 mm) in France. DESIGN: Retrospective, population-based, case-case study using a survey of cancer registries and questionnaires to practitioners. SETTING: Five regions covering 19.2% of the French territory and 8.2 million inhabitants. CASES: Cases included all incident melanomas with a Breslow thickness of 3 mm or greater (ie, VTM), diagnosed between January 1 and December 31, 2008, in residents of the study area (Alsace, Bourgogne, Champagne-Ardenne, Franche-Comte', and Lorraine, France), and a randomly selected sample of melanomas thinner than 3 mm. MAIN OUTCOME MEASURES: Circumstances of diagnosis,clinical and pathological characteristics of melanomas,and sociodemographic characteristics of patients(age, sex, residence, home and family life conditions, educational level, and smoking habits). RESULTS: Among 898 melanomas, 149 (16.6%) were VTMs. Very thick melanomas were more often diagnosed in a general-practice setting than thinner melanomas.The rate of immediate clinical recognition by dermatologists was lower for VTMs than for thinner melanomas. In a multivariate logistic regression analysis,factors associated with VTM were the nodular and acrolentiginous types; the head and neck and lower limb locations; older age; male sex; and being single, separated,divorced, or widowed. When only factors related to patients were taken into account, older age, male sex,and living alone were independent risk factors for VTM.The most significant risk was observed for patients living alone. CONCLUSIONS: Intrinsic factors related to the tumor and socio demographic characteristics of patients contribute to the occurrence of VTM. These factors should be better targeted in future secondary prevention programs.

13 Article The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France. 2012

Grange, F / Barbe, C / Mas, L / Granel-Brocard, F / Lipsker, D / Aubin, F / Velten, M / Dalac, S / Truchetet, F / Michel, C / Mitschler, A / Arnoult, G / Buemi, A / Dalle, S / Reuter, G / Bernard, P / Woronoff, A S / Arnold, F. ·Service de Dermatologie, Hôpital Robert Debré, Université de Reims-Champagne-Ardenne, avenue du général Koenig, 51092 Reims Cedex, France. fgrange@chu-reims.fr ·Br J Dermatol · Pubmed #22834687.

ABSTRACT: BACKGROUND: Little data are available concerning the role of general practitioners (GPs) in the diagnosis of melanoma. OBJECTIVES: To evaluate the actual role of GPs in a population-based study covering five regions of France and 8·2 million inhabitants. MATERIALS AND METHODS: A survey of cancer registries and pathology laboratories, and questionnaires to practitioners were used to identify incident melanomas in 2008, and evaluate characteristics of patients (age, sex, area of residence, social isolation), tumours (Breslow, ulceration, location, histological type), and GPs (training, conditions of practice), and their influence on patterns of diagnosis and Breslow thickness. RESULTS: Among 898 melanomas, 376 (42%) were first diagnosed in a general practice setting (GP group). Breslow thickness was much higher in the GP group than in other melanomas (median: 0·95 vs. 0·61 mm, P < 0·0001). Multivariate analysis identified an older age, lower limb location, nodular subtype and Breslow thickness as factors associated with the GP group. Within this group, 52·5% of melanomas were detected by patients (median Breslow thickness: 1·30 mm) and 47·5% by GPs (median Breslow thickness: 0·80 mm, P = 0·0009), including 8% during a systematic full-body skin examination. Previous GP training on melanoma was associated with active detection by GPs. Male sex and social isolation of patients were associated with thicker melanomas, whereas active detection by GPs was associated with thinner CMs. CONCLUSIONS: GPs play a key role in melanoma diagnosis in France, but still frequently detect thick tumours. Increasing awareness and training of GPs and focusing attention on male and/or socially isolated patients should help to improve early detection of melanoma.

14 Article [Complications associated with sentinel lymph node biopsy for cutaneous melanoma. A retrospective study of 127 patients]. 2012

Duvernay, A / Henault, B / Danino, M A / Trost, O / Dalac, S / Aubriot-Lorton, M-H / Zwetyenga, N. ·Service de chirurgie plastique, chirurgie de la main, chirurgie maxillofaciale, hôpital du Bocage, CHU de Dijon, France. alainduvernay@gmail.com ·Ann Chir Plast Esthet · Pubmed #22265920.

ABSTRACT: BACKGROUND: Sentinel lymph node (SLN) biopsy for patients with cutaneous melanoma has become a routine procedure. Its purpose is to confirm the potential presence of micrometastases in the first lymph node basin. Therefore, staging of the melanoma can be determined. Somehow, only few studies assess the morbidity of this procedure. Our study was performed in order to list and analyze SLN biopsy-related complications in melanoma-affected patients. PATIENTS AND METHODS: This mono-institutional, retrospective study enrolled patients, operated on from May 2001 until August 2008, who had undergone SLN biopsy that found no metastatic colonization. Patients with positive SLN biopsy underwent subsequent completion lymph node dissection (CLND) and, therefore, were not included in this study. Thus, CLND-related complications did not interfere with SLN biopsy-related ones. Median follow-up was 19 months. RESULTS: One hundred and twenty-seven patients, 58 men and 69 women were evaluated. Nine patients (7,1%) were diagnosed with one complication. We noticed seven early complications occurring during the first month (four seromas, one lymphocele, one infection with dehiscence of wound, one deep veinous thrombosis) and two late complications occurring beyond this period (one neuroma, one cicatricial bridle). Four (44%) among these complications arose in the groin. CONCLUSION: SLN biopsy is known as a simple and minimally invasive surgical technique. Somehow, some potentially severe complications may arise. These must be clearly explained to obtain the patient's informed consent prior to surgery.

15 Article A SUMOylation-defective MITF germline mutation predisposes to melanoma and renal carcinoma. 2011

Bertolotto, Corine / Lesueur, Fabienne / Giuliano, Sandy / Strub, Thomas / de Lichy, Mahaut / Bille, Karine / Dessen, Philippe / d'Hayer, Benoit / Mohamdi, Hamida / Remenieras, Audrey / Maubec, Eve / de la Fouchardière, Arnaud / Molinié, Vincent / Vabres, Pierre / Dalle, Stéphane / Poulalhon, Nicolas / Martin-Denavit, Tanguy / Thomas, Luc / Andry-Benzaquen, Pascale / Dupin, Nicolas / Boitier, Françoise / Rossi, Annick / Perrot, Jean-Luc / Labeille, Bruno / Robert, Caroline / Escudier, Bernard / Caron, Olivier / Brugières, Laurence / Saule, Simon / Gardie, Betty / Gad, Sophie / Richard, Stéphane / Couturier, Jérôme / Teh, Bin Tean / Ghiorzo, Paola / Pastorino, Lorenza / Puig, Susana / Badenas, Celia / Olsson, Hakan / Ingvar, Christian / Rouleau, Etienne / Lidereau, Rosette / Bahadoran, Philippe / Vielh, Philippe / Corda, Eve / Blanché, Hélène / Zelenika, Diana / Galan, Pilar / Anonymous1370708 / Aubin, François / Bachollet, Bertrand / Becuwe, Céline / Berthet, Pascaline / Bignon, Yves Jean / Bonadona, Valérie / Bonafe, Jean-Louis / Bonnet-Dupeyron, Marie-Noëlle / Cambazard, Fréderic / Chevrant-Breton, Jacqueline / Coupier, Isabelle / Dalac, Sophie / Demange, Liliane / d'Incan, Michel / Dugast, Catherine / Faivre, Laurence / Vincent-Fétita, Lynda / Gauthier-Villars, Marion / Gilbert, Brigitte / Grange, Florent / Grob, Jean-Jacques / Humbert, Philippe / Janin, Nicolas / Joly, Pascal / Kerob, Delphine / Lasset, Christine / Leroux, Dominique / Levang, Julien / Limacher, Jean-Marc / Livideanu, Cristina / Longy, Michel / Lortholary, Alain / Stoppa-Lyonnet, Dominique / Mansard, Sandrine / Mansuy, Ludovic / Marrou, Karine / Matéus, Christine / Maugard, Christine / Meyer, Nicolas / Nogues, Catherine / Souteyrand, Pierre / Venat-Bouvet, Laurence / Zattara, Hélène / Chaudru, Valérie / Lenoir, Gilbert M / Lathrop, Mark / Davidson, Irwin / Avril, Marie-Françoise / Demenais, Florence / Ballotti, Robert / Bressac-de Paillerets, Brigitte. ·1] INSERM, U895 (équipe 1), Equipe labélisée Ligue Contre le Cancer, C3M, 06204 Nice, France [2] Université of Nice Sophia-Antipolis, UFR Médecine, 06204 Nice, France [3] Centre Hospitalier Universitaire de Nice, Service de Dermatologie, 06204 Nice, France [4]. ·Nature · Pubmed #22012259.

ABSTRACT: So far, no common environmental and/or phenotypic factor has been associated with melanoma and renal cell carcinoma (RCC). The known risk factors for melanoma include sun exposure, pigmentation and nevus phenotypes; risk factors associated with RCC include smoking, obesity and hypertension. A recent study of coexisting melanoma and RCC in the same patients supports a genetic predisposition underlying the association between these two cancers. The microphthalmia-associated transcription factor (MITF) has been proposed to act as a melanoma oncogene; it also stimulates the transcription of hypoxia inducible factor (HIF1A), the pathway of which is targeted by kidney cancer susceptibility genes. We therefore proposed that MITF might have a role in conferring a genetic predisposition to co-occurring melanoma and RCC. Here we identify a germline missense substitution in MITF (Mi-E318K) that occurred at a significantly higher frequency in genetically enriched patients affected with melanoma, RCC or both cancers, when compared with controls. Overall, Mi-E318K carriers had a higher than fivefold increased risk of developing melanoma, RCC or both cancers. Codon 318 is located in a small-ubiquitin-like modifier (SUMO) consensus site (ΨKXE) and Mi-E318K severely impaired SUMOylation of MITF. Mi-E318K enhanced MITF protein binding to the HIF1A promoter and increased its transcriptional activity compared to wild-type MITF. Further, we observed a global increase in Mi-E318K-occupied loci. In an RCC cell line, gene expression profiling identified a Mi-E318K signature related to cell growth, proliferation and inflammation. Lastly, the mutant protein enhanced melanocytic and renal cell clonogenicity, migration and invasion, consistent with a gain-of-function role in tumorigenesis. Our data provide insights into the link between SUMOylation, transcription and cancer.

16 Article [Sentinel node procedure in head and neck cutaneous melanoma]. 2011

Roche, M / Duvernay, A / Dalac, S / Malka, G / Zwetyenga, N / Trost, O. ·Service de Chirurgie Maxillofaciale et Stomatologie, Chirurgie Plastique, Esthétique et Réparatrice, Chirurgie de la Main, CHU de Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033 Dijon, France. ·Rev Stomatol Chir Maxillofac · Pubmed #21269653.

ABSTRACT: INTRODUCTION: Sentinel lymph node (SLN) biopsy is frequently discussed in the management of cutaneous melanoma, especially in head and neck localizations where SLN biopsy is much more demanding. The benefits of SLN protocol are not proved yet. The aim of our study was to present our experience of SLN biopsy in head and neck cutaneous melanoma. PATIENTS AND METHODS: This retrospective study included all patients managed for head and neck malignant melanoma from 2002 to 2006. We reviewed the technique, implementation and difficulties of the procedure, postoperative outcome, and complications. RESULTS: Nineteen patients were included. An average of 2.2 lymph nodes were localized per patient using lymphoscintigraphy. Biopsy was impossible for one patient because the deep spinal node was not found. An average of 1.2 nodes was biopsied per patient. One patient presented with micrometastases. Another presented with lymphorrhea. DISCUSSION: Sentinel node biopsy is widely performed in the management of cutaneous melanoma but remains an option for these indications in the last update of the French Society of Dermatology. SLN biopsy is difficult to implement because of the complexity of head and neck lymphatic system.

17 Article The role of circumstances of diagnosis and access to dermatological care in early diagnosis of cutaneous melanoma: a population-based study in France. 2010

Durbec, Frédérique / Vitry, Fabien / Granel-Brocard, Florence / Lipsker, Dan / Aubin, François / Hédelin, Guy / Dalac, Sophie / Truchetet, François / Michel, Catherine / Batard, Marie-Laure / Domissy-Baury, Beatrice / Halna, Jean-Michel / Schmutz, Jean Luc / Delvincourt, Christian / Reuter, Georges / Dalle, Stéphane / Bernard, Philippe / Danzon, Arlette / Grange, Florent. ·Service de Dermatologie, Hôpital Robert Debré, Avenue du général Koenig, Reims CEDEX, France. ·Arch Dermatol · Pubmed #20231493.

ABSTRACT: OBJECTIVES: To describe circumstances of the diagnosis and access to dermatological care for patients with cutaneous melanoma (CM) and to investigate factors associated with early detection. DESIGN: Retrospective population-based study of incident cases of invasive CM in 2004, using questionnaires to physicians and a survey of cancer registries and pathology laboratories. SETTING: Five regions in northeastern France. PATIENTS: Six hundred fifty-two patients who were referred to dermatologists by general practitioners (group 1) or by other specialists (group 2), who directly consulted a dermatologist for CM (group 3), or who were diagnosed as having CM during a prospective follow-up of nevi (group 4) or when consulting a dermatologist for other diseases (group 5). MAIN OUTCOME MEASURES: Characteristics of patients, tumors, and patients' residence in each group, including the geographical concentration of dermatologists. We performed multivariate analysis of these factors to determine association with Breslow thickness. RESULTS: Age, tumor location, Breslow thickness, ulceration, histological type, and geographical concentration of dermatologists significantly differed among groups. Patients consulting dermatologists directly formed the largest group (45.1%). Those referred by general practitioners (26.1%) were the oldest and had the highest frequency of thick (>3 mm), nodular, and/or ulcerated CM. Patients from groups 4 (8.4%) and 5 (14.1%) had the thinnest CMs. Ulcerated and/or thick tumors were absent in group 4. In multivariate analysis, histological types superficial spreading melanoma and lentigo maligna melanoma, younger age, high concentration of dermatologists, and detection by dermatologists were significantly associated with thinner CMs. CONCLUSION: Easy access of patients to dermatologists, information campaigns targeting elderly people, and education of general practitioners are complementary approaches to improving early detection.

18 Article Management and outcome of metastatic melanoma during pregnancy. 2010

Pagès, C / Robert, C / Thomas, L / Maubec, E / Sassolas, B / Granel-Brocard, F / Chevreau, C / De Raucourt, S / Leccia, M-T / Fichet, D / Khammari, A / Boitier, F / Stoebner, P-E / Dalac, S / Celerier, P / Aubin, F / Viguier, M. ·Service de Dermatologie, Université Paris VII, Hôpital Saint-Louis, INSERM U697, 1 Avenue Claude-Vellefaux, 75475 Paris Cedex 10, France. ·Br J Dermatol · Pubmed #19804595.

ABSTRACT: BACKGROUND: Although metastatic melanoma occurrence during pregnancy challenges the physician in several ways, only a few studies have been published. OBJECTIVES: Our aim was to investigate therapeutic management together with maternal and fetal outcomes in pregnant women with advanced melanoma. METHODS: A French national retrospective study was conducted in 34 departments of Dermatology or Oncology. All patients with American Joint Committee on Cancer (AJCC) stage III/IV melanoma diagnosed during pregnancy were included. Data regarding melanoma history, pregnancy, treatment, delivery, maternal and infant outcomes were collected. RESULTS: Twenty-two women were included: 10 AJCC stage III and 12 stage IV. Abortion was performed in three patients. Therapeutic abstention during pregnancy was observed in three cases, 14 patients underwent surgery, four patients received chemotherapy and one patient was treated with brain radiotherapy alone. The median gestational age was 36 weeks amenorrhoea. Neither neonatal metastases nor deformities were observed. Placenta metastases were found in one case. Among 18 newborns, 17 are currently alive (median follow up, 17 months); one died of sudden infant death. The 2-year maternal survival rates were 56% (stage III) and 17% (stage IV). CONCLUSIONS: Faced with metastatic melanoma, a majority of women chose to continue with pregnancy, giving birth, based on our samples, to healthy, frequently premature infants. Except during the first trimester of pregnancy, conventional melanoma treatment was applied. No serious side effect was reported, except one case of miscarriage after surgery. Mortality rates do not suggest a worsened prognosis due to pregnancy but larger prospective controlled studies are necessary to assess this specific point.