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Melanoma: HELP
Articles by Jeffrey E. Gershenwald
Based on 127 articles published since 2008
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Between 2008 and 2019, J. E. Gershenwald wrote the following 127 articles about Melanoma.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline Guidelines of care for the management of primary cutaneous melanoma. 2019

Swetter, Susan M / Tsao, Hensin / Bichakjian, Christopher K / Curiel-Lewandrowski, Clara / Elder, David E / Gershenwald, Jeffrey E / Guild, Valerie / Grant-Kels, Jane M / Halpern, Allan C / Johnson, Timothy M / Sober, Arthur J / Thompson, John A / Wisco, Oliver J / Wyatt, Samantha / Hu, Shasa / Lamina, Toyin. ·Department of Dermatology, Stanford University Medical Center and Cancer Institute, Stanford, California; Veterans Affairs Palo Alto Health Care System, Palo Alto, California. Electronic address: sswetter@stanford.edu. · Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Wellman Center for Photomedicine, Boston, Massachusetts. · Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan; Comprehensive Cancer Center, Ann Arbor, Michigan. · Division of Dermatology, University of Arizona, Tucson, Arizona; University of Arizona Cancer Center, Tucson, Arizona. · Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. · Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. · AIM at Melanoma Foundation, Plano, Texas. · Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pathology, University of Connecticut Health Center, Farmington, Connecticut; Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut. · Department of Dermatology, Memorial Sloan-Kettering Cancer Center, New York, New York. · Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. · Division of Oncology, University of Washington, Seattle, Washington; Seattle Cancer Care Alliance, Seattle, Washington. · Department of Dermatology, Oregon Health and Science University, Portland, Oregon. · Decatur Dermatology, Decatur, Alabama. · Department of Dermatology, University of Miami Health System, Miami, Florida. · American Academy of Dermatology, Rosemont, Illinois. ·J Am Acad Dermatol · Pubmed #30392755.

ABSTRACT: The incidence of primary cutaneous melanoma continues to increase each year. Melanoma accounts for the majority of skin cancer-related deaths, but treatment is usually curative following early detection of disease. In this American Academy of Dermatology clinical practice guideline, updated treatment recommendations are provided for patients with primary cutaneous melanoma (American Joint Committee on Cancer stages 0-IIC and pathologic stage III by virtue of a positive sentinel lymph node biopsy). Biopsy techniques for a lesion that is clinically suggestive of melanoma are reviewed, as are recommendations for the histopathologic interpretation of cutaneous melanoma. The use of laboratory, molecular, and imaging tests is examined in the initial work-up of patients with newly diagnosed melanoma and for follow-up of asymptomatic patients. With regard to treatment of primary cutaneous melanoma, recommendations for surgical margins and the concepts of staged excision (including Mohs micrographic surgery) and nonsurgical treatments for melanoma in situ, lentigo maligna type (including topical imiquimod and radiation therapy), are updated. The role of sentinel lymph node biopsy as a staging technique for cutaneous melanoma is described, with recommendations for its use in clinical practice. Finally, current data regarding pregnancy and melanoma, genetic testing for familial melanoma, and management of dermatologic toxicities related to novel targeted agents and immunotherapies for patients with advanced disease are summarized.

2 Editorial Melanoma Staging: American Joint Committee on Cancer (AJCC) 8th Edition and Beyond. 2018

Gershenwald, Jeffrey E / Scolyer, Richard A. ·Departments of Surgical Oncology and Cancer Biology, Unit 1484, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. jgershen@mdanderson.org. · Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. jgershen@mdanderson.org. · Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia. · Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. · Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. ·Ann Surg Oncol · Pubmed #29850954.

ABSTRACT: -- No abstract --

3 Editorial Stemming the Rising Incidence of Melanoma: Calling Prevention to Action. 2016

Gershenwald, Jeffrey E / Guy, Gery P. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. · Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia jgershen@mdanderson.org. ·J Natl Cancer Inst · Pubmed #26563358.

ABSTRACT: -- No abstract --

4 Editorial Teens and indoor tanning: time to act on the US Food and Drug Administration's black-box warning. 2015

Gottlieb, Mark / Balk, Sophie J / Geller, Alan C / Gershenwald, Jeffrey E. ·Public Health Advocacy Institute, Northeastern University School of Law, Boston, MA, USA. ·Ann Surg Oncol · Pubmed #25515195.

ABSTRACT: -- No abstract --

5 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 --

6 Editorial The challenge of defining guidelines for sentinel lymph node biopsy in patients with thin primary cutaneous melanomas. 2012

Gershenwald, Jeffrey E / Coit, Daniel G / Sondak, Vernon K / Thompson, John F. · ·Ann Surg Oncol · Pubmed #22868918.

ABSTRACT: -- No abstract --

7 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 --

8 Review Lifestyle Modifications and Policy Implications for Primary and Secondary Cancer Prevention: Diet, Exercise, Sun Safety, and Alcohol Reduction. 2018

LoConte, Noelle K / Gershenwald, Jeffrey E / Thomson, Cynthia A / Crane, Tracy E / Harmon, Gil E / Rechis, Ruth. ·From the Carbone Cancer Center and University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Surgical Oncology, Melanoma and Skin Center, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona Cancer Center, Tucson, AZ; Biobehavioral Health Sciences Division, College of Nursing, University of Arizona Cancer Center, Tucson, AZ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; Be Well Communities, Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX. ·Am Soc Clin Oncol Educ Book · Pubmed #30231343.

ABSTRACT: Improved cancer treatments and cancer detection methods are not likely to completely eradicate the burden of cancer. Primary prevention of cancer is a logical strategy to use to control cancer while also seeking novel treatments and earlier detection. Lifestyle modification strategies to improve primary prevention and risk reduction for the development of cancer include choosing a healthy diet with an emphasis on plant sources, maintaining a healthy weight throughout life, being physically active, regularly using sunscreen and wearing protective clothing, limiting sun exposure during the hours of 10 AM to 2 PM, avoiding indoor tanning, and reducing or eliminating alcohol use. In addition to continued use of ongoing education of the public, health care providers, and cancer support communities, other policy and public health efforts should be pursued as well. Examples of supported and successful policy approaches are included in this article, including efforts to limit indoor tanning and improve community-wide interventions to reduce ultraviolet radiation exposure as well as to formally support various alcohol policy strategies including increasing alcohol taxes, reducing alcohol outlet density, improving clinical screening for alcohol use disorders, and limiting youth exposure to alcohol marketing and advertising. These prevention strategies are expected to have the largest impact on the development of melanoma as well as breast, colorectal, head and neck, liver, and esophageal cancers. The impact of these strategies as secondary prevention is less well understood. Areas of additional needed research and implementation are also highlighted. Future areas of needed research are the effects of these modifications after the diagnosis of cancer (as secondary prevention).

9 Review The eighth edition American Joint Committee on Cancer (AJCC) melanoma staging system: implications for melanoma treatment and care. 2018

Keung, Emily Z / Gershenwald, Jeffrey E. ·a Department of Surgical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA. · b Melanoma and Skin Center , The University of Texas MD Anderson Cancer Center , Houston , TX , USA. ·Expert Rev Anticancer Ther · Pubmed #29923435.

ABSTRACT: INTRODUCTION: The eighth edition of the American Joint Committee on Cancer (AJCC) melanoma staging system was implemented in the United States on 1 January 2018. Areas covered: This article provides an overview of important changes in the eighth edition AJCC staging system from the seventh edition based on analyses of a large international melanoma database. The clinical implications of these changes for melanoma treatment are also discussed. Expert commentary: A standardized and contemporary cancer staging system that facilitates accurate risk stratification is essential to guide patient treatment. The eighth edition of the AJCC staging system is currently the most widely accepted approach to melanoma staging and classification at initial diagnosis.

10 Review Critical Assessment of Clinical Prognostic Tools in Melanoma. 2016

Mahar, Alyson L / Compton, Carolyn / Halabi, Susan / Hess, Kenneth R / Gershenwald, Jeffrey E / Scolyer, Richard A / Groome, Patti A. ·Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada. · Arizona State University, Phoenix, AZ, USA. · School of Medicine, Mayo Clinic, Rochester, MN, USA. · Department of Biostatistics and Bioinformatics, Alliance Statistics and Data Center, Duke University, Durham, NC, USA. · Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. · Melanoma Institute Australia, Sydney, NSW, Australia. · Sydney Medical School, The University of Sydney, Sydney, NSW, Australia. · Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. · Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada. groomep@queensu.ca. ·Ann Surg Oncol · Pubmed #27052645.

ABSTRACT: The 7th edition American Joint Committee on Cancer (AJCC) melanoma staging system classifies patients according to prognosis. Significant within-stage heterogeneity remains and the inclusion of additional clinicopathologic and other host- and tumor-based prognostic factors have been proposed. Clinical prognostic tools have been developed for use in clinical practice to refine survival estimates. Little is known about the comparative features of tools in melanoma. We performed a systematic search of the scientific published literature for clinical prognostic tools in melanoma and web-based resources. A priori criteria were used to evaluate their quality and clinical relevance, and included intended clinical use, model development approaches, validation strategies, and performance metrics. We identified 17 clinical prognostic tools for primary cutaneous melanoma. Patients with stages I-III and T1 or thin melanoma were the most frequently considered populations. Seventy-five percent of tools were developed using data collected from patients diagnosed in 2006 or earlier, and the well-established factors of tumor thickness, ulceration, and age were included in 70 % of tools. Internal validity using cross-validation or bootstrapping techniques was performed for two tools only. Fewer than half were evaluated for external validity; however, when done, the appropriate statistical methodology was applied and results indicated good generalizability. Several clinical prognostic tools have the potential to refine survival estimates for individual melanoma patients; however, there is a great opportunity to improve these tools and to foster the development of new, validated tools by the inclusion of contemporary clinicopathological covariates and by using improved statistical and methodological approaches.

11 Review Principles of Melanoma Staging. 2016

Boland, Genevieve M / Gershenwald, Jeffrey E. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. gmboland@mdanderson.org. · Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. jgershen@mdanderson.org. ·Cancer Treat Res · Pubmed #26601861.

ABSTRACT: Although now commonplace in contemporary cancer care, the systematic approach to classification of disease-specific cancers into a formalized staging system is a relatively modern concept. Overall, the goals of cancer staging are to characterize the status of cancer at a specific moment in time, risk stratify, facilitate prognostication, and inform clinical decision making. The revisions to the American Joint Committee on Cancer (AJCC) melanoma staging system over time reflect changes in our understanding of the biology of the disease. Since the 1st edition, where tumor thickness was defined anatomically by its relationship to the reticular or papillary dermis (Clark level) as well as tumor thickness (Breslow thickness), there have been significant strides in our use of clinicopathological variables to stratify low- versus high-risk patients. Management of the regional nodal basin has also changed dramatically over time, impacted by techniques such as lymphatic mapping and sentinel lymph node biopsy (SLNB) and changes in pathological evaluation of the regional lymph nodes. Additionally, stratification of distant metastases has evolved as survival outcomes have been shown to vary based upon anatomic site of metastases and serum lactate dehydrogenase levels. The variables in use in the current (7th edition) AJCC staging system are surrogate markers of biology with validated impact of survival outcomes. Going forward, it is likely that these and additional clinicopathological factors will be integrated with molecular and other correlates of melanoma tumor biology to further refine and personalize melanoma staging.

12 Review Melanoma. 2015

Schadendorf, Dirk / Fisher, David E / Garbe, Claus / Gershenwald, Jeffrey E / Grob, Jean-Jacques / Halpern, Allan / Herlyn, Meenhard / Marchetti, Michael A / McArthur, Grant / Ribas, Antoni / Roesch, Alexander / Hauschild, Axel. ·Department of Dermatology, University Duisburg-Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany. · German Cancer Consortium (DKTK), Heidelberg, Germany. · Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. · Department of Dermatology, University Tübingen, Tübingen, Germany. · Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. · Department of Dermatology and Skin Cancers, APHM Timone Hospital Aix-Marseille University, Marseille, France. · Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA. · Melanoma Research Center, Wistar Institute, Philadelphia, Pennsylvania, USA. · Division of Cancer Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. · Departments of Medicine, Surgery, and Medical and Molecular Pharmacology, University of California Los Angeles, Los Angeles, California, USA. · Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Kiel, Germany. ·Nat Rev Dis Primers · Pubmed #27188223.

ABSTRACT: Melanoma is a common cancer in the Western world with an increasing incidence. Sun exposure is still considered to be the major risk factor for melanoma. The prognosis of patients with malignant (advanced-stage) melanoma differs widely between countries, but public campaigns advocating early detection have led to significant reductions in mortality rates. As well as sun exposure, distinct genetic alterations have been identified as associated with melanoma. For example, families with melanoma who have germline mutations in CDKN2A are well known, whereas the vast majority of sporadic melanomas have mutations in the mitogen-activated protein kinase cascade, which is the pathway with the highest oncogenic and therapeutic relevance for this disease. BRAF and NRAS mutations are typically found in cutaneous melanomas, whereas KIT mutations are predominantly observed in mucosal and acral melanomas. GNAQ and GNA11 mutations prevail in uveal melanomas. Additionally, the PI3K-AKT-PTEN pathway and the immune checkpoint pathways are important. The finding that programmed cell death protein 1 ligand 1 (PDL1) and PDL2 are expressed by melanoma cells, T cells, B cells and natural killer cells led to the recent development of programmed cell death protein 1 (PD1)-specific antibodies (for example, nivolumab and pembrolizumab). Alongside other new drugs - namely, BRAF inhibitors (vemurafenib and dabrafenib) and MEK inhibitors (trametinib and cobimetinib) - these agents are very promising and have been shown to significantly improve prognosis for patients with advanced-stage metastatic disease. Early signs are apparent that these new treatment modalities are also improving long-term clinical benefit and the quality of life of patients. This Primer summarizes the current understanding of melanoma, from mechanistic insights to clinical progress. For an illustrated summary of this Primer, visit: http://go.nature.com/vX2N9s.

13 Review Biology of advanced uveal melanoma and next steps for clinical therapeutics. 2015

Luke, Jason J / Triozzi, Pierre L / McKenna, Kyle C / Van Meir, Erwin G / Gershenwald, Jeffrey E / Bastian, Boris C / Gutkind, J Silvio / Bowcock, Anne M / Streicher, Howard Z / Patel, Poulam M / Sato, Takami / Sossman, Jeffery A / Sznol, Mario / Welch, Jack / Thurin, Magdalena / Selig, Sara / Flaherty, Keith T / Carvajal, Richard D. ·Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA. ·Pigment Cell Melanoma Res · Pubmed #25113308.

ABSTRACT: Uveal melanoma is the most common intraocular malignancy although it is a rare subset of all melanomas. Uveal melanoma has distinct biology relative to cutaneous melanoma, with widely divergent patient outcomes. Patients diagnosed with a primary uveal melanoma can be stratified for risk of metastasis by cytogenetics or gene expression profiling, with approximately half of patients developing metastatic disease, predominately hepatic in location, over a 15-yr period. Historically, no systemic therapy has been associated with a clear clinical benefit for patients with advanced disease, and median survival remains poor. Here, as a joint effort between the Melanoma Research Foundation's ocular melanoma initiative, CURE OM and the National Cancer Institute, the current understanding of the molecular and immunobiology of uveal melanoma is reviewed, and on-going laboratory research into the disease is highlighted. Finally, recent investigations relevant to clinical management via targeted and immunotherapies are reviewed, and next steps in the development of clinical therapeutics are discussed.

14 Review Evidence-based clinical practice guidelines on the use of sentinel lymph node biopsy in melanoma. 2013

Sondak, Vernon K / Wong, Sandra L / Gershenwald, Jeffrey E / Thompson, John F. ·From the Department of Cutaneous Oncology, Moffitt Cancer Center, and Departments of Oncologic Sciences and Surgery, University of South Florida, Tampa, FL; Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI; Departments of Surgical Oncology and Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX; Melanoma Institute Australia and the University of Sydney, Sydney, Australia. ·Am Soc Clin Oncol Educ Book · Pubmed #23714536.

ABSTRACT: Sentinel lymph node biopsy (SLNB) was introduced in 1992 to allow histopathologic evaluation of the "sentinel" node, that is, the first node along the lymphatic drainage pathway from the primary melanoma. This procedure has less risk of complications than a complete lymphadenectomy, and if the sentinel node is uninvolved by tumor the likelihood a complete lymphadenectomy would find metastatic disease in that nodal basin is very low. SLNB is now widely used worldwide in the staging of melanoma as well as breast and Merkel cell carcinomas. SLNB provides safe, reliable staging for patients with clinically node-negative melanomas 1 mm or greater in thickness, with an acceptably low rate of failure in the sentinel node-negative basin. Evidence-based guidelines jointly produced by ASCO and the Society of Surgical Oncology (SSO) recommend SLNB for patients with intermediate-thickness melanomas and also state that SLNB may be recommended for patients with thick melanomas. Major remaining areas of uncertainty include the indications for SLNB in patients with thin melanomas, pediatric patients, and patients with atypical melanocytic neoplasms; the optimal radiotracers and dyes for lymphatic mapping; and the necessity of complete lymphadenectomy in all sentinel node-positive patients.

15 Review Sentinel lymph node biopsy for melanoma: a critical update for dermatologists after two decades of experience. 2013

Ross, Merrick I / Gershenwald, Jeffrey E. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. mross@mdanderson.org ·Clin Dermatol · Pubmed #23608449.

ABSTRACT: The technique of lymphatic mapping and sentinel node biopsy represents a minimally invasive approach to accurately stage the regional lymph node basin as a component of the initial management of selected patients with stage I and II cutaneous melanomas. In addition to its significant role in accurate regional nodal staging and prognosis, important goals of this procedure include improved regional disease control and possible survival benefit. After 20 years of experience, questions and some controversy persist. This review provides the dermatology community with a critical analysis of major publications that have defined the role of sentinel node biopsy, addresses several contemporary issues, and provides recommendations for appropriate patient referral.

16 Review Variability in melanoma post-treatment surveillance practices by country and physician specialty: a systematic review. 2012

Cromwell, Kate D / Ross, Merrick I / Xing, Yan / Gershenwald, Jeffrey E / Royal, Richard E / Lucci, Anthony / Lee, Jeffrey E / Cormier, Janice N. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030-4009, USA. ·Melanoma Res · Pubmed #22914178.

ABSTRACT: There are no evidence-based guidelines for the surveillance of patients with melanoma following surgical treatment. We carried out a systematic review to identify by country and physician specialty the current stage-specific surveillance practices for patients with melanoma. Three major medical indices, MEDLINE, the Cochrane Library database, and Scopus, were reviewed to identify articles published from January 1970 to October 2011 that included detailed information about the surveillance of patients with melanoma after the initial surgical treatment. Data on surveillance intervals and recommended evaluation were extracted and categorized by country and, when reported, physician specialty. One hundred and four articles from 10 countries and four physician specialties (dermatology, surgical oncology, medical oncology, and general practice) fulfilled the inclusion criteria, including 43 providing specific patient-level data. The articles showed a wide variation with respect to the surveillance intervals and recommended evaluations. The variation was greatest for patients with stage I disease, for whom the follow-up frequency ranged from one to six visits per year during years 1 and 2 after treatment. All four physician specialties agreed that for years 1-3, the follow-up frequency should be four times per year for all patients. For years 4 and 5, surgical oncologists recommended two follow-up visits per year, whereas general practitioners, dermatologists, and medical oncologists recommended four visits per year. Recommended imaging and laboratory evaluations were most intense in the UK and most minimalist in the Netherlands. Although general practitioners did not recommend routine laboratory or imaging tests for surveillance, all other specialties utilized both in their surveillance practice. Self skin-examination was recommended for surveillance in all countries and by all practitioner specialties. There are significant intercountry and interspecialty variations in the surveillance of patients with melanoma. As the number of melanoma survivors increases, it will be critical to examine the benefits and costs of various follow-up strategies to establish consensus guidelines for melanoma post-treatment surveillance.

17 Review Sentinel lymph node biopsy in melanoma. 2012

Boland, Genevieve M / Gershenwald, Jeffrey E. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. ·Cancer J · Pubmed #22453020.

ABSTRACT: The technique of lymphatic mapping and sentinel lymph node (SLN) biopsy for melanoma has emerged during the last 2 decades as a minimally invasive approach to evaluate regional lymph node basins in patients with intermediate- and high-risk primary cutaneous melanoma and has changed our approach to the clinically negative lymph node basin in melanoma during the same period. This review focuses on preoperative assessment and operative strategies, pathologic evaluation of the SLN, issues related to regional lymph node basin control, and current clinical practice guidelines. Predictors of SLN status, the prognostic significance of the SLN, and areas of controversy are also discussed.

18 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).

19 Review Evidence-based treatment of early-stage melanoma. 2011

Ross, Merrick I / Gershenwald, Jeffrey E. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. mross@mdanderson.org ·J Surg Oncol · Pubmed #21858828.

ABSTRACT: The vast majority of patients with newly diagnosed melanoma are "early-stage" - ie, clinically localized to the primary cutaneous site. For such patients, surgery represents the mainstay of treatment; current standards of surgical management have evolved based on evidence obtained from randomized trials, large multi-center and single institutional databases, and consensus panels. Treatment strategies include wide excision of the primary site with margins dictated by important biological features such as Breslow tumor thickness, and sentinel node biopsy to surgically evaluate the regional nodal basins at risk. Sentinel node biopsy has become an important component of the initial management of many of these patients for accurate staging of regional lymph nodes, as well as enhanced regional disease control and improved survival in the patients with microscopically involved nodes. Evidence is presented that supports the rational use of these surgical strategies and reconciles some of the controversies that have emerged. The degree to which established national treatment guidelines are followed and the consequences of non-compliance with these guidelines have become the focus of recent clinical investigations; results of these efforts are also discussed.

20 Review Sentinel-lymph-node biopsy for cutaneous melanoma. 2011

Gershenwald, Jeffrey E / Ross, Merrick I. ·Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77230-1402, USA. jgershen@mdanderson.org ·N Engl J Med · Pubmed #21542744.

ABSTRACT: -- No abstract --

21 Review Cutaneous melanoma: a model to study cancer metastasis. 2011

Leong, Stanley P L / Gershenwald, Jeffrey E / Soong, Seng-Jaw / Schadendorf, Dirk / Tarhini, Ahmad A / Agarwala, Sanjiv / Hauschild, Axel / Soon, Christopher W M / Daud, Adil / Kashani-Sabet, Mohammed. ·Center for Melanoma Research and Treatment and Department of Surgery, California Pacific Medical Center and Research Institute, San Francisco, California 94115, USA. leongsx@cpmcri.org ·J Surg Oncol · Pubmed #21480247.

ABSTRACT: Nodal status in melanoma is a critically important prognostic factor for patient outcome. The survival rate drops to <10% when melanoma has spread beyond the regional lymph nodes and includes visceral involvement. In general, the process of melanoma metastasis is progressive in that dissemination of melanoma from the primary site to the regional lymph nodes occurs prior to systemic disease. The goal of this review article is to describe melanoma as a clinical model to study cancer metastasis. A future challenge is to develop a molecular taxonomy to subgroup melanoma patients at various stages of tumor progression for more accurate targeted treatment.

22 Review Multimethod imaging, staging, and spectrum of manifestations of metastatic melanoma. 2011

Patnana, M / Bronstein, Y / Szklaruk, J / Bedi, D G / Hwu, W-J / Gershenwald, J E / Prieto, V G / Ng, C S. ·Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ·Clin Radiol · Pubmed #21295201.

ABSTRACT: The incidence of melanoma has been steadily increasing. Imaging plays an important role in tumour assessment as metastatic melanoma can involve multiple organs. Computed tomography (CT) is currently the most widely used technique for tumour staging, surveillance and assessment of therapeutic response, but ultrasound, magnetic resonance imaging (MRI) and positron-emission tomography (PET)-CT also play important roles in the imaging of this tumour. In this article, we review the pathways of spread, staging according to the recently updated TNM classification, pathology, typical and atypical imaging features at common and uncommon sites, and treatment of metastatic melanoma.

23 Review Targeted therapy for melanoma: a primer. 2011

Davies, Michael A / Gershenwald, Jeffrey E. ·Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 7455 Fannin, 1SCRB2.3019, Unit 0904, Houston, TX 77054, USA. mdavies@mdanderson.org ·Surg Oncol Clin N Am · Pubmed #21111965.

ABSTRACT: Melanoma is the most aggressive form of skin cancer. Unfortunately, despite recent improvements for some solid tumors, the prevalence and mortality of melanoma continue to increase. The identification of activating mutations in melanoma, combined with a growing appreciation of the different pattern of genetic changes in the anatomically defined melanoma subtypes, has become the focus of a concerted effort to translate these discoveries into personalized therapeutic approaches for this disease. This article reviews the known mutations, amplifications, and deletions in kinase signaling pathways that have been implicated in melanoma; the prevalence of these genetic events in clinicopathologically defined melanoma subtypes; and the results of clinical trials that use targeted therapy approaches to block aberrantly activated pathways resulting from these mutations. The challenges that must be overcome to achieve improved outcomes with targeted therapies in melanoma in the future are also discussed.

24 Review Sentinel lymph node biopsy for melanoma: critical assessment at its twentieth anniversary. 2011

Ross, Merrick I / Thompson, John F / Gershenwald, Jeffrey E. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA. ·Surg Oncol Clin N Am · Pubmed #21111959.

ABSTRACT: The technique of lymphatic mapping and sentinel lymph node (SLN) biopsy was introduced 20 years ago as an important advance in the management of patients with stage I and II melanoma. After 2 decades of experience, SLN biopsy and the practice of selective lymphadenectomy represents a minimally invasive standard of care that facilitates the accurate staging of the clinically negative regional lymph node basin, provides durable regional disease control, and improves survival in node-positive patients.

25 Review Staging and prognosis of cutaneous melanoma. 2011

Dickson, Paxton V / Gershenwald, Jeffrey E. ·Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 444, Houston, TX 77030, USA. ·Surg Oncol Clin N Am · Pubmed #21111956.

ABSTRACT: Staging of cutaneous melanoma continues to evolve through identification and rigorous analysis of potential prognostic factors. In 1998, the American Joint Committee on Cancer (AJCC) Melanoma Staging Committee developed the AJCC melanoma staging database, an international integrated compilation of prospectively accumulated melanoma outcome data from several centers and clinical trial cooperative groups. Analysis of this database resulted in major revisions to the TNM staging system reflected in the sixth edition of the AJCC Cancer Staging Manual published in 2002. More recently, the committee's analysis of an updated melanoma staging database, including prospective data on more than 50,000 patients, led to staging revisions adopted in the seventh edition of the AJCC Cancer Staging Manual published in 2009. This article highlights these revisions, reviews relevant prognostic factors and their impact on staging, and discusses emerging tools that will likely affect future staging systems and clinical practice.

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