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Melanoma: HELP
Articles by Marc D. S. Moncrieff
Based on 27 articles published since 2010
(Why 27 articles?)
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Between 2010 and 2020, M. Moncrieff wrote the following 27 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 Review The scope of nanoparticle therapies for future metastatic melanoma treatment. 2014

Bombelli, Francesca Baldelli / Webster, Carl A / Moncrieff, Marc / Sherwood, Victoria. ·School of Pharmacy, University of East Anglia, Norwich, Norfolk, UK; CEN-European Centre For Nanomedicine, C/O Dipartimento di Chimica, Materiali ed Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milan, Italy. · School of Pharmacy, University of East Anglia, Norwich, Norfolk, UK. · Norfolk and Norwich University Hospital, Norwich, Norfolk, UK. · School of Pharmacy, University of East Anglia, Norwich, Norfolk, UK. Electronic address: v.sherwood@uea.ac.uk. ·Lancet Oncol · Pubmed #24384491.

ABSTRACT: Metastatic melanoma is a highly aggressive malignancy that has traditionally been very difficult to treat. However, after decades of basic research into the signal transduction pathways that promote cancer cell survival, chemoresistance, growth, and crosstalk with the immune system, targeted therapies have now been developed that offer improved survival for patients with metastatic melanoma. Some of the most promising therapies that have been developed include ipilimumab, an anti-cytotoxic T lymphocyte antigen 4 antibody that enhances T-cell activity in the tumour, and selective BRAF inhibitors, such as vemurafenib that blocks tumour cell proliferation in patients with activating BRAF mutations. Although these treatments offer substantial hope for patients, they are not without their drawbacks, which include adverse side-effects, drug resistance, and eventual relapse. Nanotherapeutics holds significant promise to circumvent these shortcomings and has the additional advantage of potentially functioning as a diagnostic device. We will discuss the scope of the use of such multimodal nanoparticles for melanoma treatment and ask whether such particles can offer patients with metastatic melanoma improved prognoses for the future.

4 Review Setting up an effective and efficient sentinel node biopsy service for malignant melanoma within the NHS. 2012

Fawzy, M / Garioch, J / Igali, L / Skrypniuk, J V / Moncrieff, M D S. ·The Norfolk and Norwich University Hospital, Colney Lane, Norwich, UK. monicafawzy@doctors.org.uk ·J Plast Reconstr Aesthet Surg · Pubmed #22178369.

ABSTRACT: Sentinel lymph node biopsy provides prognostic information for melanoma patients, and the Department of Health states that it should be available across the country by 2012. We review the setting up of a melanoma sentinel lymph node biopsy service with specific consideration to resources, service implications and patient outcomes. In total, 164 patients underwent sentinel lymph node biopsy for melanoma from August 2008 until March 2010. The median time for sentinel lymph node excision was 26 min. The median total operative time, which includes melanoma excision and sentinel node biopsy was 65 min, compared with 22 min for excision of the melanoma performed during the previous 19 months. The complication rate was 8.5%, with only 1.2% requiring operative treatment. After the initial outlay for two gamma probes, it was possible to deliver a cost neutral service within the National Tariff. Despite a significant increase in demand for the service in the second half of the study period, and 106% increase in the number of regional lymphadenectomies, only 1 patient (0.6%) breached the 'Going Further on Cancer Waits' target. In conclusion, a sentinel lymph node biopsy service for malignant melanoma can be effectively delivered within the majority of UK plastic surgery departments.

5 Clinical Trial 1 Versus 2-cm Excision Margins for pT2-pT4 Primary Cutaneous Melanoma (MelMarT): A Feasibility Study. 2018

Moncrieff, Marc D / Gyorki, David / Saw, Robyn / Spillane, Andrew J / Thompson, John F / Peach, Howard / Oudit, Deemesh / Geh, Jenny / Dziewulski, Peter / Wilson, Ewan / Matteucci, Paolo / Pritchard-Jones, Rowan / Olofsson Bagge, Roger / Wright, Frances C / Crampton, Nic / Cassell, Oliver / Jallali, Navid / Berger, Adam / Kelly, John / Hamilton, Stephen / Durrani, Amer / Lo, Serigne / Paton, Elizabeth / Henderson, Michael A. ·Norfolk & Norwich University Hospital, Norwich, UK. marc.moncrieff@nnuh.nhs.uk. · Peter MacCallum Cancer Centre, Melbourne, Australia. · Melanoma Institute Australia, Sydney, Australia. · Leeds Teaching Hospitals, Leeds, UK. · Christie NHS Trust, Manchester, UK. · Guy's & St Thomas's NHS Trust, London, UK. · St Andrew's Centre for Burns & Plastic Surgery, Chelmsford, UK. · North Bristol NHS Trust, Bristol, UK. · Hull & East Yorkshire NHS Trust, Hull, UK. · Mersey Centre for Burns & Plastic Surgery, Liverpool, UK. · Sahlgrenska University Hospital, Göteborg, Sweden. · Sunnybrook Health Sciences Centre, Toronto, Canada. · Gold Coast Melanoma Clinic, Queensland, Australia. · Oxford University Hospitals NHS Trust, Oxford, UK. · Imperial Hospital NHS Trust, London, UK. · Jefferson University Hospitals, Philadelphia, USA. · The Alfred Hospital, Melbourne, Australia. · Royal Free Hospital NHS Trust, London, UK. · Cambridge University Hospitals, Cambridge, UK. · Australia & New Zealand Melanoma Trials Group, North Sydney, Australia. ·Ann Surg Oncol · Pubmed #29850955.

ABSTRACT: BACKGROUND: There is a lack of consensus regarding optimal surgical excision margins for primary cutaneous melanoma > 1 mm in Breslow thickness (BT). A narrower surgical margin is expected to be associated with lower morbidity, improved quality of life (QoL), and reduced cost. We report the results of a pilot international study (MelMarT) comparing a 1 versus 2-cm surgical margin for patients with primary melanoma > 1 mm in BT. METHODS: This phase III, multicentre trial [NCT02385214] administered by the Australia & New Zealand Medical Trials Group (ANZMTG 03.12) randomised patients with a primary cutaneous melanoma > 1 mm in BT to a 1 versus 2-cm wide excision margin to be performed with sentinel lymph node biopsy. Surgical closure technique was at the discretion of the treating surgeon. Patients' QoL was measured (FACT-M questionnaire) at baseline, 3, 6, and 12 months after randomisation. RESULTS: Between January 2015 and June 2016, 400 patients were randomised from 17 centres in 5 countries. A total of 377 patients were available for analysis. Primary melanomas were located on the trunk (56.9%), extremities (35.6%), and head and neck (7.4%). More patients in the 2-cm margin group required reconstruction (34.9 vs. 13.6%; p < 0.0001). There was an increased wound necrosis rate in the 2-cm arm (0.5 vs. 3.6%; p = 0.036). After 12 months' follow-up, no differences were noted in QoL between groups. DISCUSSION: This pilot study demonstrates the feasibility of a large international RCT to provide a definitive answer to the optimal excision margin for patients with intermediate- to high-risk primary cutaneous melanoma.

6 Clinical Trial Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. 2017

Faries, Mark B / Thompson, John F / Cochran, Alistair J / Andtbacka, Robert H / Mozzillo, Nicola / Zager, Jonathan S / Jahkola, Tiina / Bowles, Tawnya L / Testori, Alessandro / Beitsch, Peter D / Hoekstra, Harald J / Moncrieff, Marc / Ingvar, Christian / Wouters, Michel W J M / Sabel, Michael S / Levine, Edward A / Agnese, Doreen / Henderson, Michael / Dummer, Reinhard / Rossi, Carlo R / Neves, Rogerio I / Trocha, Steven D / Wright, Frances / Byrd, David R / Matter, Maurice / Hsueh, Eddy / MacKenzie-Ross, Alastair / Johnson, Douglas B / Terheyden, Patrick / Berger, Adam C / Huston, Tara L / Wayne, Jeffrey D / Smithers, B Mark / Neuman, Heather B / Schneebaum, Schlomo / Gershenwald, Jeffrey E / Ariyan, Charlotte E / Desai, Darius C / Jacobs, Lisa / McMasters, Kelly M / Gesierich, Anja / Hersey, Peter / Bines, Steven D / Kane, John M / Barth, Richard J / McKinnon, Gregory / Farma, Jeffrey M / Schultz, Erwin / Vidal-Sicart, Sergi / Hoefer, Richard A / Lewis, James M / Scheri, Randall / Kelley, Mark C / Nieweg, Omgo E / Noyes, R Dirk / Hoon, Dave S B / Wang, He-Jing / Elashoff, David A / Elashoff, Robert M. ·From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica (M.B.F., D.S.B.H.), and the Departments of Pathology (A.J.C.), Biomathematics (H.-J.W., D.A.E., R.M.E.), and Medicine (D.A.E.), University of California, Los Angeles - both in California · Melanoma Institute Australia and the University of Sydney, Sydney (J.F.T., O.E.N.), Peter MacCallum Cancer Centre, Melbourne, VIC (M.H.), Princess Alexandra Hospital, Brisbane, QLD (B.M.S.), and Newcastle Melanoma Unit, Waratah, NSW (P.H.) - all in Australia · Huntsman Cancer Institute, Salt Lake City (R.H.A., R.D.N.), and Intermountain Healthcare Cancer Services-Intermountain Medical Center, Murray (T.L.B.) - both in Utah · Istituto Nazionale dei Tumori Napoli, Naples (N.M.), Istituto Europeo di Oncologia, Milan (A.T.), and Istituto Oncologico Veneto-University of Padua, Padua (C.R.R.) - all in Italy · H. Lee Moffitt Cancer Center, Tampa, FL (J.S.Z.) · Helsinki University Hospital, Helsinki (T.J.) · Dallas Surgical Group, Dallas (P.D.B.) · Universitair Medisch Centrum Groningen, Groningen (H.J.H.), and Netherlands Cancer Institute, Amsterdam (M.W.J.M.W.) - both in the Netherlands · Norfolk and Norwich University Hospital, Norwich (M. Moncrieff), and Guy's and St. Thomas' NHS Foundation Trust, London (A.M.-R.) - both in the United Kingdom · Swedish Melanoma Study Group-University Hospital Lund, Lund, Sweden (C.I.) · University of Michigan, Ann Arbor (M.S.S.) · Wake Forest University, Winston-Salem (E.A.L.), and Duke University, Durham (R.S.) - both in North Carolina · Ohio State University, Columbus (D.A.) · University of Zurich, Zurich (R.D.), and Centre Hospitalier Universitaire Vaudois, Lausanne (M. Matter) - both in Switzerland · Penn State Hershey Cancer Institute, Hershey (R.I.N.), Thomas Jefferson University (A.C.B.) and Fox Chase Cancer Center (J.M.F.), Philadelphia, and St. Luke's University Health Network, Bethlehem (D.C.D.) - all in Pennsylvania · Greenville Health System Cancer Center, Greenville, SC (S.D.T.) · Sunnybrook Research Institute, Toronto (F.W.), and Tom Baker Cancer Centre, Calgary, AB (G.M.) - both in Canada · University of Washington, Seattle (D.R.B.) · Saint Louis University, St. Louis (E.H.) · Vanderbilt University (D.B.J., M.C.K.), Nashville, and University of Tennessee, Knoxville (J.M.L.) - both in Tennessee · University Hospital Schleswig-Holstein-Campus Lübeck, Lübeck (P.T.), University Hospital of Würzburg, Würzburg (A.G.), and City Hospital of Nürnberg, Nuremberg (E.S.) - all in Germany · SUNY at Stony Brook Hospital Medical Center, Stony Brook (T.L.H.), Memorial Sloan Kettering Cancer Center, New York (C.E.A.), and Roswell Park Cancer Institute, Buffalo (J.M.K.) - all in New York · Northwestern University Feinberg School of Medicine (J.D.W.) and Rush University Medical Center (S.D.B.), Chicago · University of Wisconsin, Madison (H.B.N.) · Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (S.S.) · M.D. Anderson Medical Center, Houston (J.E.G.) · Johns Hopkins University School of Medicine, Baltimore (L.J.) · University of Louisville, Louisville, KY (K.M.M.) · Dartmouth-Hitchcock Medical Center, Lebanon, NH (R.J.B.) · Hospital Clinic Barcelona, Barcelona (S.V.-S.) · and Sentara CarePlex Hospital, Hampton, VA (R.A.H.). ·N Engl J Med · Pubmed #28591523.

ABSTRACT: BACKGROUND: Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear. METHODS: In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis. RESULTS: Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group. CONCLUSIONS: Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .).

7 Clinical Trial Magnetic Technique for Sentinel Lymph Node Biopsy in Melanoma: The MELAMAG Trial. 2016

Anninga, Bauke / White, Samantha H / Moncrieff, Marc / Dziewulski, Peter / L C Geh, Jenny / Klaase, Joost / Garmo, Hans / Castro, Fernanda / Pinder, Sarah / Pankhurst, Quentin A / Hall-Craggs, Margaret A / Douek, Michael / Anonymous6490858. ·Division of Cancer Studies, King's College London, London, UK. · Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, UK. · St Andrew's Anglia Ruskin (StAAR) Research Unit, Anglia Ruskin University, Chelmsford, UK. · Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, UK. · Department of Surgery, Medical Spectrum Twente, Enschede, The Netherlands. · UCL Healthcare Biomagnetics Laboratory, University College London, London, UK. · Centre for Medical Imaging, University College London, London, UK. · Division of Cancer Studies, King's College London, London, UK. michael.douek@kcl.ac.uk. ·Ann Surg Oncol · Pubmed #26895751.

ABSTRACT: BACKGROUND: Sentinel lymph node biopsy (SLNB) in melanoma is currently performed using the standard dual technique (radioisotope and blue dye). The magnetic technique is non-radioactive and provides a brown color change in the sentinel lymph node (SLN) through an intradermal injection of a magnetic tracer, and utilizes a handheld magnetometer. The MELAMAG Trial compared the magnetic technique with the standard technique for SLNB in melanoma. METHODS: Clinically node-negative patients with primary cutaneous melanoma were recruited from four centers. SLNB was undertaken after intradermal administration of both the standard (blue dye and radioisotope) and magnetic tracers. The SLN identification rate per patient, with the two techniques, was compared. RESULTS: A total of 133 patients were recruited, 129 of which were available for final analysis. The sentinel node identification rate was 97.7 % (126/129) with the standard technique and 95.3 % (123/129) with the magnetic technique [2.3 % difference; 95 % upper confidence limit (CL) 6.4; 5.4 % discordance]. With radioisotope alone, the SLN identification rate was 95.3 % (123/129), as with the magnetic technique (0 % difference; 95 % upper CL 4.5; 7.8 % discordance). The lymph node retrieval rate was 1.99 nodes per patient overall, 1.78 with the standard technique and 1.87 with the magnetic technique. CONCLUSIONS: The magnetic technique is feasible for SLNB in melanoma with a high SLN identification rate, but is associated with skin staining. When compared with the standard dual technique, it did not reach our predefined non-inferiority margin.

8 Clinical Trial Accuracy of SIAscopy for pigmented skin lesions encountered in primary care: development and validation of a new diagnostic algorithm. 2010

Emery, Jon D / Hunter, Judith / Hall, Per N / Watson, Anthony J / Moncrieff, Marc / Walter, Fiona M. ·General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, 328 Stirling Highway, Claremont, WA 6010, Australia. jon.emery@uwa.edu.au ·BMC Dermatol · Pubmed #20868511.

ABSTRACT: BACKGROUND: Diagnosing pigmented skin lesions in general practice is challenging. SIAscopy has been shown to increase diagnostic accuracy for melanoma in referred populations. We aimed to develop and validate a scoring system for SIAscopic diagnosis of pigmented lesions in primary care. METHODS: This study was conducted in two consecutive settings in the UK and Australia, and occurred in three stages: 1) Development of the primary care scoring algorithm (PCSA) on a sub-set of lesions from the UK sample; 2) Validation of the PCSA on a different sub-set of lesions from the same UK sample; 3) Validation of the PCSA on a new set of lesions from an Australian primary care population. Patients presenting with a pigmented lesion were recruited from 6 general practices in the UK and 2 primary care skin cancer clinics in Australia. The following data were obtained for each lesion: clinical history; SIAscan; digital photograph; and digital dermoscopy. SIAscans were interpreted by an expert and validated against histopathology where possible, or expert clinical review of all available data for each lesion. RESULTS: A total of 858 patients with 1,211 lesions were recruited. Most lesions were benign naevi (64.8%) or seborrhoeic keratoses (22.1%); 1.2% were melanoma. The original SIAscopic diagnostic algorithm did not perform well because of the higher prevalence of seborrhoeic keratoses and haemangiomas seen in primary care. A primary care scoring algorithm (PCSA) was developed to account for this. In the UK sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.50 (0.18-0.81); specificity 0.84 (0.78-0.88); PPV 0.09 (0.03-0.22); NPV 0.98 (0.95-0.99). In the Australian sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.44 (0.32-0.58); specificity 0.95 (0.93-0.97); PPV 0.52 (0.38-0.66); NPV 0.95 (0.92-0.96). In an analysis of lesions for which histological diagnosis was available (n = 111), the PCSA had a significantly greater Area Under the Curve than the 7-point checklist for the diagnosis of melanoma (0.83; 95% CI 0.71-0.95 versus 0.61; 95% CI 0.44-0.78; p = 0.02 for difference). CONCLUSIONS: The PCSA could have a useful role in improving primary care management of pigmented skin lesions. Further work is needed to develop and validate the PCSA in other primary care populations and to evaluate the cost-effectiveness of GP management of pigmented lesions using SIAscopy.

9 Article Sequencing in management of in-transit melanoma metastasis: Diphencyprone versus isolate limb infusion. 2020

Lo, Michelle Ci / Garioch, Jennifer / Moncrieff, Marc Ds. ·Plastic & Reconstructive Surgery Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK. Electronic address: michelle.lo@nhs.net. · Dermatology Department, Norfolk & Norwich University Hospital, Norwich, UK; Norwich Medical School, University of East Anglia, Norwich, UK. · Plastic & Reconstructive Surgery Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; Norwich Medical School, University of East Anglia, Norwich, UK. ·J Plast Reconstr Aesthet Surg · Pubmed #32245735.

ABSTRACT: BACKGROUND: In-transit metastases (ITMs) in melanoma are associated with poor prognosis, however a significant proportion of these patients survive for extended periods without further disease progression. We routinely use locoregional treatment e.g. Diphencyprone (DPCP) and/or isolated limb infusion (ILI) as long-term palliation. This study aimed to identify correct sequencing of these therapies based on disease burden and progression. METHOD: Retrospective evaluation of all melanoma patients with ITMs treated with DPCP/ILI/both from 2010 to 2017 at our Cancer Centre was performed. Patients were initially assessed in a multidisciplinary setting and empirically prescribed DPCP for low-disease burden, ILI for high-disease burden. Patient demographics, tumour characteristics, response to therapy, ITM progression and patient outcomes were analysed. RESULTS: 78 patients (M:F = 30:48), aged 47-95years (median 74years) treated with DPCP/ILI/both (n = 44/21/13) were identified. Progression-free survival (PFS) was significantly increased in patients responsive to DPCP or ILI as initial treatment. Patients who failed on DPCP and subsequently treated with ILI had a significantly increased PFS compared to DPCP alone (p = 0.026, HR = 0.048). This was not the case with patients who were treated with DPCP following failed ILI. All patients who failed to respond to the initial therapy progressed within 6 months. CONCLUSION: Our study shows that careful stratification ITM patients according to disease burden is fundamental to optimal outcomes. High-disease burden patients benefit from initial ILI; low-disease burden patients should commence on DPCP. ILI can be considered in DPCP patients who fail early. Systemic therapy should be considered when locoregional therapies fail after 12 months or after rapid relapse following ILI.

10 Article The neutrophil-lymphocyte ratio and locoregional melanoma: a multicentre cohort study. 2020

Robinson, Alyss V / Keeble, Claire / Lo, Michelle C I / Thornton, Owen / Peach, Howard / Moncrieff, Marc D S / Dewar, Donald J / Wade, Ryckie G. ·Leeds Institute for Medical Research, University of Leeds, Leeds, UK. · Leeds Institute for Data Analytics, University of Leeds, Leeds, UK. · Plastic and Reconstructive Surgery Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK. · Trinity College Dublin, The University of Dublin, Dublin, Ireland. · Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK. · Norwich Medical School, University of East Anglia, Norwich, UK. · Leeds Institute for Medical Research, University of Leeds, Leeds, UK. ryckiewade@gmail.com. · Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK. ryckiewade@gmail.com. ·Cancer Immunol Immunother · Pubmed #31974724.

ABSTRACT: OBJECTIVES: The neutrophil-lymphocyte ratio (NLR) is an inflammatory biomarker which is useful in cancer prognostication. We aimed to investigate the differences in baseline NLR between patients with localised and metastatic cutaneous melanoma and how this biomarker changed over time with the recurrence of disease. METHODS: This multicentre cohort study describes patients treated for Stage I-III cutaneous melanoma over 10 years. The baseline NLR was measured immediately prior to surgery and again at the time of discharge or disease recurrence. The odds ratios (OR) for sentinel node involvement are estimated using mixed-effects logistic regression. The risk of recurrence is estimated using multivariable Cox regression. RESULTS: Overall 1489 individuals were included. The mean baseline NLR was higher in patients with palpable nodal disease compared to those with microscopic nodal or localised disease (2.8 versus 2.4 and 2.3, respectively; p < 0.001). A baseline NLR ≥ 2.3 was associated with 30% higher odds of microscopic metastatic melanoma in the sentinel lymph node [adjusted OR 1.3 (95% CI 1.3, 1.3)]. Following surgery, 253 patients (18.7%) developed recurrent melanoma during surveillance although there was no statistically significant association between the baseline NLR and the risk of recurrence [adjusted HR 0.9 (0.7, 1.1)]. CONCLUSION: The NLR is associated with the volume of melanoma at presentation and may predict occult sentinel lymph metastases. Further prospective work is required to investigate how NLR may be modelled against other clinicopathological variables to predict outcomes and to understand the temporal changes in NLR following surgery for melanoma.

11 Article Reconstructive burden and financial implications of wider excision margins for invasive primary cutaneous melanoma. 2020

Lo, Michelle Chin / Heaton, Martin J / Snelling, Andrew / Moncrieff, Marc Ds. ·Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK. Electronic address: michelle.lo@nhs.net. · Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK. · Department of Plastic & Reconstructive Surgery, Norfolk & Norwich University Hospital, Norwich NR4 7UY, UK; Norwich Medical School, University of East Anglia, UK. ·J Plast Reconstr Aesthet Surg · Pubmed #31680028.

ABSTRACT: BACKGROUND: For invasive primary cutaneous melanoma, wider excision is advocated to reduce local recurrence risk and improve patient outcomes. Excision detail is controversial, especially in intermediate- and high-risk primary melanoma (AJCC pT2-pT4). Guidance varies from sizes 1 to 3 cm (translating into large defects of 2-6 cm). The aim of this study was to determine the reconstructive and resource burden of wider excision margins (EMs). METHODS: Data analysis from our prospective database (2008-2017) included 1184 patients (563F:621 M) with cutaneous melanoma (pT1b-pT4b). Procedure tariff data were sourced from our financial services department. RESULTS: Two hundred twenty-nine patients had a narrower EM (1 cm) and 995 (80.7%) had a wider EM (2-3 cm). Reconstructive requirement significantly increased with a wider EM collectively (11.3% vs 29.3%, odds ratio (OR) = 3.2; p < 0.0001), in the extremities (15.2% vs 42.0%; p < 0.0001), and in the head and neck (H&N) (23.5 % vs 64.7%; p < 0.0001). Reconstruction significantly increased hospitalisation rates (26.6% vs 63.0%, OR = 4.7; p < 0.0001) collectively, in the H&N (26.8 % vs 53.9%), and in the upper (18.9 % vs 42.3%) and lower extremities (34.8% vs 77.3%). Narrower EMs significantly reduced hospitalisation rates in the upper and lower extremities (7.1% vs 28.5%; p = 0.004, 37.9% vs 58.5%; p = 0.005, respectively). Overall procedure cost significantly increased by £180 (mean, p < 0.0001) and £346 (median, p = 0.0004) per patient when reconstruction was required. CONCLUSIONS: Our data suggest substantial impact of wider EM on patients, which more than doubled in the functionally and cosmetically sensitive extremities and the H&N region. Reconstructions add significant financial and healthcare service burden. Without randomised controlled trial (RCT) evidence demonstrating increased efficacy of wider EM, narrower EM is advocated whilst awaiting future planned RCT results specifically investigating on this.

12 Article Current role of sentinel lymph node biopsy in the management of cutaneous melanoma: A UK consensus statement. 2020

Peach, H / Board, R / Cook, M / Corrie, P / Ellis, S / Geh, J / King, P / Laitung, G / Larkin, J / Marsden, J / Middleton, M / Moncrieff, M / Nathan, P / Powell, B / Pritchard-Jones, R / Rodwell, S / Steven, N / Lorigan, P. ·Leeds Teaching Hospitals NHS Trust, United Kingdom. Electronic address: h.peach@nhs.net. · Lancashire Teaching Hospitals, United Kingdom. · Royal Surrey County Hospital NHS Trust, United Kingdom. · Addenbrookes Hospital, Cambridge, United Kingdom. · Guys and St.Thomas's Hospital, United Kingdom. · Royal Cornwall Hospital, United Kingdom. · Royal Marsden Hospital, United Kingdom. · Oxford University Hospitals, NHS Foundation Trust, United Kingdom. · Norfolk and Norwich University Hospital, United Kingdom. · Mount Vernon Cancer Centre, United Kingdom. · St.George's University Hospitals, United Kingdom. · University of Liverpool Hospital, United Kingdom. · CEO Melanoma Focus, United Kingdom. · Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom. · The Christie NHS Foundation Trust, United Kingdom. ·J Plast Reconstr Aesthet Surg · Pubmed #31477493.

ABSTRACT: Sentinel node biopsy (SNB) has been at the forefront of the surgical staging of melanoma patients for the past 15 years. The high accuracy of this prognostic staging procedure is now recognised in all international guidelines for melanoma. However during this period there have been a number of important changes in the management of melanoma, many occurring within the past five years. The outcomes of five recent randomised Phase 3 trials have established the role of adjuvant targeted therapy and immunotherapy in resected Stage 3 and Stage 4 disease and have potentially changed the role of SNB. Two landmark international prospective studies have examined the benefit of performing a completion lymph node dissection (CLND) following the detection of microscopicallyinvolved sentinel nodes. Finally, the marked increase in the incidence of melanoma and the role of SNB in potentially guiding therapy has resulted in a significant increase in the pathological workload of the dermatopathology services. To address these issues a multi-disciplinary consensus meeting involving many melanoma experts from the UK was convened in May 2018. Three main areas were considered: oncology, surgery and pathology. This report is a summary of the conclusions reached, which were agreed by the clinicians attending the meeting and then externally peer reviewed. The recommendations summarised in this Consensus Statement.

13 Article Survival outcomes and interval between lymphoscintigraphy and SLNB in cutaneous melanoma- findings of a large prospective cohort study. 2018

O'Leary, Fionnuala M / Beadsmoore, Clare J / Pawaroo, Davina / Skrypniuk, John / Heaton, Martin J / Moncrieff, Marc D. ·Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. Electronic address: fionnuala.o'leary@nhs.net. · Department of Nuclear Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. · Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK. · Department of Plastic & Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk, NR4 7UY, UK; Norwich Medical School, University of East Anglia Norwich Research Park, Norwich, NR4 7TJ, UK. ·Eur J Surg Oncol · Pubmed #30343702.

ABSTRACT: INTRODUCTION: Sentinel lymph node biopsy (SLNB) in cutaneous melanoma (CM) is performed to identify patient at risk of regional and distant relapse. We hypothesized that timing of lymphoscintigraphy may influence the accuracy of SLNB and patient outcomes. METHODS: We reviewed prospective data on patients undergoing SLNB for CM at a large university cancer-center between 2008 and 2015, examining patient and tumor demographics and time between lymphoscintigraphy (LS) and SLNB. Kaplan-Meier survival analysis assessed disease-specific (DSS) and overall-survival (OS), stratified by timing of LS. Cox multivariate regression analysis assessed independent risk factors for survival. RESULTS: We identified 1015 patients. Median follow-up was 45 months (IQR 26-68 months). Univariate analysis showed a 6.8% absolute DSS (HR 1.6 [1.03-2.48], p = 0.04) benefit and a 10.7% absolute OS (HR 1.64 [1.13-2.38], p = 0.01) benefit for patients whose SLNB was performed < 12 h of LS (n = 363) compared to those performed >12 h (n = 652). Multivariate analysis identified timing of LS as an independent predictor of OS (p = 0.007) and DSS (p = 0.016) when competing with age, sex, Breslow thickness (BT) and SLN status. No difference in nodal relapse rates (5.2% v 4.6%; p = 0.67) was seen. Both groups were matched for age, sex, BT and SLN status. CONCLUSION: These data have significant implications for SLNB services, suggesting delaying SLNB >12 h after LS using a Tc99-labelled nanocolloid has a significant negative survival impact for patients and should be avoided. We hypothesise that temporal tracer migration is the underlying cause and advocate further trials investigating alternative, 'stable' tracer-agents.

14 Article Baseline Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios as Biomarkers of Survival in Cutaneous Melanoma: A Multicenter Cohort Study. 2018

Wade, Ryckie G / Robinson, Alyss V / Lo, Michelle C I / Keeble, Claire / Marples, Maria / Dewar, Donald J / Moncrieff, Marc D S / Peach, Howard. ·Faculty of Medicine and Health, Worsley Building, University of Leeds, Leeds, UK. ryckiewade@gmail.com. · Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK. ryckiewade@gmail.com. · Faculty of Medicine and Health, Worsley Building, University of Leeds, Leeds, UK. · Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK. · Leeds Cancer Centre, St James's University Hospital, Leeds, UK. · Department of Plastic and Reconstructive Surgery, Leeds General Infirmary, Leeds, UK. · Norwich Medical School, University of East Anglia, Norwich, UK. ·Ann Surg Oncol · Pubmed #30066226.

ABSTRACT: BACKGROUND: In the peripheral blood, the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) change in response to malignancy. These biomarkers are associated with adverse outcomes in numerous cancers, but the evidence is limited in relation to melanoma. This study sought to investigate the association between these biomarkers and survival in Stages I-III cutaneous melanoma. METHODS: This multicenter cohort study investigated a consecutive series of patients who underwent wide excision of biopsy-proven cutaneous melanoma and sentinel lymph node biopsy during a 10-year period. The baseline NLR and PLR were calculated immediately before sentinel lymph node biopsy. Adjusted hazard ratios (HRs) for overall and melanoma-specific survival were generated. RESULTS: Overall, 1351 patients were included in the study. During surveillance, 184 of these patients died (14%), with 141 of the deaths (77%) attributable to melanoma. Worse overall survival was associated with a baseline NLR lower than 2.5 [HR 2.2; 95% confidence interval (CI) 2.0 to 2.3; p < 0.001] and a baseline PLR lower than 100 (HR 1.8; 95% CI 1.7 to 1.8; p < 0.001). Melanoma-specific survival also was worse, with a baseline NLR lower than 2.5 (HR 1.9; 95% CI 1.6 to 2.2; p < 0.001) and a baseline PLR lower than 100 (HR 1.9; 95% CI 1.7 to 2.2; p < 0.001). The 5-year survival for patients with sentinel lymph node metastases and a low NLR and PLR was approximately 50%. CONCLUSION: This study provides important new data on biomarkers in early-stage melanoma, which contrast with biomarker profiles in advanced disease. These biomarkers may represent the host inflammatory response to melanoma and therefore could help select patients for adjuvant therapy and enhanced surveillance.

15 Article Neuropathic pain and quality of life after wide local excision and sentinel lymph node biopsy for melanoma: a multicentre study. 2017

Thomson, Collette H / Cassell, Oliver / Peach, Howard / Holloway, Samantha / Garioch, Jennifer / Moncrieff, Marc. ·aDepartment of Plastic Surgery, Norfolk and Norwich University Hospital, NorwichbDepartment of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, OxfordcDepartment of Plastic Surgery, Leeds Teaching Hospitals NHS Trust, LeedsdSchool of Medicine, Centre for Medical Education, Cardiff University, Cardiff, UK. ·Melanoma Res · Pubmed #28253208.

ABSTRACT: Wide local excision and sentinel lymph node biopsy is the mainstay of treatment for patients with melanoma. As survival outcomes improve, longer term quality of life questions become more pertinent and this study aims to assess the factors which may play a role following surgery. A total of, 221 patients who underwent wide local excision and sentinel lymph node biopsy for melanoma (AJCC stage I and II) were recruited from three UK centres. These patients completed a patient outcome questionnaire, which included demographic and treatment data as well as quality of life and pain questionnaires. Pain was the only significant factor influencing the quality of life with a negative correlation seen between pain and quality of life scores (P<0.001). In total, 34% of patients reported pain at their surgical site and four (1.8%) patients scored as high risk for neuropathic pain. Patients experiencing pain were significantly younger that those not reporting pain (median 55.0 vs. 63.5 years, P<0.001). Length of time since surgery did not correlate with pain nor quality of life scores. Our results suggest that following this common procedure a sizeable proportion of patients experience pain and poorer quality of life which does not improve with time. The level of pain experienced is clinically significant and merits evaluation and treatment in this group of patients who are increasingly surviving their melanoma diagnosis. Further investigation into potential prophylactic measures is suggested.

16 Article A UK feasibility and validation study of the VE1 monoclonal antibody immunohistochemistry stain for BRAF-V600E mutations in metastatic melanoma. 2016

Lo, Michelle Chin I / Paterson, Anna / Maraka, Jane / Clark, Richard / Goodwill, Joseph / Nobes, Jenny / Garioch, Jennifer / Moncrieff, Marc / Rytina, Ed / Igali, Laszlo. ·Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK. · Department of Histopathology (Box 235), Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 2QQ, UK. · Department of Cellular Pathology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK. · Department of Clinical Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK. · Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK. · Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK. ·Br J Cancer · Pubmed #27336602.

ABSTRACT: BACKGROUND: Determining the BRAF mutation status of patients with advanced metastatic melanoma is essential in order to assess patients' eligibility for targeted BRAF inhibitor therapy. The aim of this study was to validate the utility of immunohistochemistry (IHC) to rapidly obtain the BRAF status in the UK cancer centre setting. METHODS: All samples sent for molecular testing for detection of the BRAF mutation over a 26-month period were prospectively tested using the VE1 monoclonal antibody IHC stain. RESULTS: Two-hundred and nineteen samples from 214 patients were identified. All patients were AJCC stage III/IV, except one. There was an overall 95.0% (208/219) concordance rate, with a sensitivity of 94.4% (84/89) and a specificity of 95.4% (124/130) when using genomic assays as the gold standard. Discordance resulted from the inability of the molecular technique to detect the V600E2 mutation and an inability of the IHC staining technique to detect non-V600E mutations. Molecular testing on smaller tumour deposits was also unreliable. CONCLUSIONS: IHC staining has good sensitivity and excellent specificity for BRAF V600E mutations. BRAF IHC can be incorporated into a BRAF mutation testing algorithm for UK cancer centres to as a feasible first-line assay and identify a subset of cases that require subsequent genomic testing. It has the additional major advantages of reduced cost and rapid turnaround time.

17 Article Excision margins for melanomas: how wide is enough? 2016

Moncrieff, Marc. ·Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich NR4 7UY, UK. Electronic address: marc.moncrieff@nnuh.nhs.uk. ·Lancet Oncol · Pubmed #26790923.

ABSTRACT: -- No abstract --

18 Article Intraoperative use of Mohs' surgery for the resection of major cutaneous head and neck cancer under general anaesthetic: Initial experiences, efficiency and outcomes. 2015

Ridha, Hyder / Garioch, Jennifer J / Tan, Eunice K / Heaton, Martin J / Igali, Laszlo / Moncrieff, Marc D. ·Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK. Electronic address: hyder.ridha@gmail.com. · Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK; University of East Anglia, Norwich, UK. · Department of Dermatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. · Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK. · Department of Pathology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK. · Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK; University of East Anglia, Norwich, UK. ·J Plast Reconstr Aesthet Surg · Pubmed #26342654.

ABSTRACT: BACKGROUND: Complete excision of high-risk extensive non-melanoma skin cancers in the head and neck is paramount to achieving loco-regional control. However, achieving clear margins still remains a significant challenge. Mohs' micrographic surgery (MMS) provides the most accurate method of intraoperative mapping and histological assessment of tumour margins. We have developed a technique combining MMS with reconstruction as a single-stage procedure performed under general anaesthetic. We present our experience and results. MATERIALS AND METHODS: Following regional skin cancer multidisciplinary team (MDT) discussion, patients considered appropriate for management as a single-stage combined procedure were referred for assessment. At surgery, a two-team approach was employed consisting of an MMS resection team and a reconstructive team, allowing simultaneous resection and elevation of any free tissue required for reconstruction. Outcome data were retrieved from a prospectively collated MMS database. RESULTS: Twenty-six cases were performed between January 2010 and January 2013. Fifty-eight percent of cases were basal cell carcinomas. Clear margins were achieved in 50% of cases following the first Mohs' layer. Free tissue reconstruction was required in 13 cases. Mean anaesthetic time was 445 min. Loco-regional control was achieved in 96% of patients, at a mean follow-up period of 29 months (range 11-50 months). CONCLUSIONS: This study shows that the combined single-stage MMS and reconstruction surgical model is safe, results in a low recurrence rate and improved patient care. It is a model that can be replicated in other tertiary skin cancer units.

19 Article Tumor-infiltrating lymphocyte grade is an independent predictor of sentinel lymph node status and survival in patients with cutaneous melanoma. 2012

Azimi, Farhad / Scolyer, Richard A / Rumcheva, Pavlina / Moncrieff, Marc / Murali, Rajmohan / McCarthy, Stanley W / Saw, Robyn P / Thompson, John F. ·Melanoma Institute Australia, 40 Rocklands Rd, North Sydney NSW 2060, Australia. ·J Clin Oncol · Pubmed #22711850.

ABSTRACT: PURPOSE: To determine whether density and distribution of tumor-infiltrating lymphocytes (TILs; TIL grade) is an independent predictor of sentinel lymph node (SLN) status and survival in patients with clinically localized primary cutaneous melanoma. METHODS: From the Melanoma Institute Australia database, 1,865 patients with a single primary melanoma ≥ 0.75 mm in thickness were identified. The associations of clinical and pathologic factors with SLN status, recurrence-free survival (RFS), and melanoma-specific survival (MSS) were analyzed. RESULTS: The majority of patients had either no (TIL grade 0; 35.4%) or few (TIL grade 1; 45.1%) TILs, with a minority showing moderate (TIL grade 2; 16.3%) or marked (TIL grade 3; 3.2%) TILs. Tumor thickness, mitotic rate, and Clark level were inversely correlated with TIL grade (each P < .001). SLN biopsy was performed in 1,138 patients (61.0%) and was positive in 252 (22.1%). There was a significant inverse association between SLN status and TIL grade (SLN positivity rates for each TIL grade: 0, 27.8%; 1, 20.1%; 2, 18.3%; 3, 5.6%; P < .001). Predictors of SLN positivity were decreasing age (P < .001), decreasing TIL grade (P < .001), ulceration (P = .003), increasing tumor thickness (P = .01), satellitosis (P = .03), and increasing mitoses (P = .03). The 5-year MSS and RFS rates were 83% and 76%, respectively (median follow-up, 43 months). Tumor thickness (P < .001), ulceration (P < .001), satellitosis (P < .001), mitotic rate (P = .003), TIL grade (P < .001), and sex (P = .01) were independent predictors of MSS. Patients with TIL grade 3 tumors had 100% survival. CONCLUSION: TIL grade is an independent predictor of survival and SLN status in patients with melanoma. Patients with a pronounced TIL infiltrate have an excellent prognosis.

20 Article The prognostic value of tumor mitotic rate and other clinicopathologic factors in patients with locoregional recurrences of melanoma. 2010

Murali, Rajmohan / Moncrieff, Marc D / Hong, Jonathan / Cooper, Caroline L / Shingde, Meena V / Samuel, David G / Thompson, John F / Scolyer, Richard A. ·Royal Prince Alfred Hospital, Sydney, Camperdown, NSW, Australia. rajmohan.murali@sswahs.nsw.gov.au ·Ann Surg Oncol · Pubmed #20425144.

ABSTRACT: BACKGROUND: Tumor mitotic rate (MRP) is an independent prognostic factor in clinically localized primary cutaneous melanoma, but the prognostic importance of mitotic rate in melanoma recurrences (MRR) is not known. In this study, we sought to determine the prognostic value of MRR and other clinicopathologic factors in recurrent melanoma. METHODS: Patients with primary cutaneous melanoma diagnosed between 1979 and 2006, who subsequently developed recurrence(s), were studied. Histologic sections of primary and first locoregional recurrences of melanoma were examined, and MRP and MRR were measured. Relationships between MRR, known prognostic parameters in melanoma, time to first recurrence (TTR), and postrecurrence survival were analyzed. RESULTS: A total of 279 patients (172 men, 107 women) had AJCC stage I (n = 97) or stage II (n = 182) melanoma. Median MRP and MRR were 4/mm(2) (0-34) and 4/mm(2) (0-51), respectively. There was weak association between MRP and MRR (R (2) = 0.02, p = 0.02). Independent predictors of poorer postrecurrence survival were shorter TTR (hazard ratio, 0.74; 95% confidence interval, 0.61-0.90, p = 0.003) and recurrence type (10-year postrecurrence survival for local, lymph node, and in-transit recurrences: 70%, 21.5%, and 11.1%, respectively; p = 0.04). MRR >0 was associated with poorer 10-year postrecurrence survival (39.1%) than if MRR = 0 (51.2%), but the difference did not reach statistical significance (p = 0.15). However, the difference in survival between patients with MRR >0 and those with MRR = 0 increased with time. CONCLUSIONS: TTR is an independent predictor of postrecurrence survival. Because survival in patients with MRR >0 decreases with time (relative to those with MRR = 0), MRR should be routinely measured so that future studies can determine whether MRR has any independent predictive value.

21 Minor A feasibility study of indocyanine green fluorescence mapping for sentinel lymph node detection in cutaneous melanoma. 2019

Lo, Michelle C I / White, Samantha H / Nunney, Ian / Skrypniuk, John / Heaton, Martin J / Moncrieff, Marc D S. ·Plastic & Reconstructive Surgery Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom. Electronic address: michelle.lo@nhs.net. · Plastic & Reconstructive Surgery Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom; Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom. · Faculty of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, United Kingdom. · Department of Nuclear Medicine, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom. · Plastic & Reconstructive Surgery Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom. ·J Plast Reconstr Aesthet Surg · Pubmed #30467004.

ABSTRACT: -- No abstract --

22 Minor Sentinel lymph node biopsy remains the most accurate method of obtaining staging and prognostic information for patients with primary cutaneous melanomas. 2019

Friedman, Erica B / Moncrieff, Marc D / Lo, Serigne / Scolyer, Richard A / Thompson, John F. ·Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia. · Department of Plastic and Reconstructive Surgery, The Norfolk & Norwich University Hospital, Norfolk, UK. · Norwich Medical School, University of East Anglia, Norwich, UK. · Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia. · Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. ·Australas J Dermatol · Pubmed #30294907.

ABSTRACT: -- No abstract --

23 Minor Monitoring vitamin D in the patient with melanoma: impact of sun avoidance on vitamin D levels of patients with melanoma at a U.K. tertiary-referral melanoma service. 2017

Lo, M C I / Maraka, J / Garioch, J / John, W G / Moncrieff, M. ·Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, U.K. · Department of Dermatology, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, U.K. · Norwich Medical School, University of East Anglia, Norwich, U.K. · Department of Clinical Biochemistry, Norfolk and Norwich University Hospitals, Colney Lane, Norwich, NR4 7UY, U.K. ·Br J Dermatol · Pubmed #27639181.

ABSTRACT: -- No abstract --

24 Minor Topical diphencyprone for the treatment of locoregional intralymphatic melanoma metastases of the skin; the 5-year Norwich experience. 2016

Moncrieff, M / Fadhil, M / Garioch, J. ·Skin Tumour Unit, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, U.K. ·Br J Dermatol · Pubmed #26598951.

ABSTRACT: -- No abstract --

25 Minor MSLT-I: it's all about the lymph nodes…. 2015

Moncrieff, M / Garioch, J. ·Plastic and Reconstructive Surgery Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, U.K. · Department of Dermatology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, U.K. ·Br J Dermatol · Pubmed #26013183.

ABSTRACT: -- No abstract --

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