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Melanoma: HELP
Articles from Moffitt Cancer Center and Research Institute
Based on 362 articles published since 2008
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These are the 362 published articles about Melanoma that originated from Moffitt Cancer Center and Research Institute during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15
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 Editorial The Blood Brain Barrier and BRAF inhibitors: Implications for patients with melanoma brain metastases. 2018

Smalley, Keiran S M / Forsyth, Peter A. ·The Department of Tumor Biology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA; The Department of Cutaneous Oncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA. Electronic address: keiran.smalley@moffitt.org. · The Department of Neurooncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, USA. ·Pharmacol Res · Pubmed #29146209.

ABSTRACT: -- No abstract --

3 Editorial Improving clinical outcomes with pembrolizumab in patients with advanced melanoma. 2017

Kim, Dae Won / Zager, Jonathan S / Eroglu, Zeynep. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida, USA. Zeynep.Eroglu@moffitt.org. ·Chin Clin Oncol · Pubmed #28285535.

ABSTRACT: -- No abstract --

4 Editorial Resistance patterns to anti-PD-1 therapy in metastatic melanoma. 2016

Ozgun, Alpaslan / Sondak, Vernon K / Markowitz, Joseph. ·Department of Cutaneous Oncology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, and Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA. joseph.markowitz@moffitt.org. ·Chin Clin Oncol · Pubmed #27701871.

ABSTRACT: -- No abstract --

5 Editorial Prediction is Difficult, Especially About the Future: Clinical Prognostic Tools in Melanoma. 2016

Sondak, Vernon K / Messina, Jane L. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA. vernon.sondak@moffitt.org. · Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA. vernon.sondak@moffitt.org. · Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA. · Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA. · Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL, USA. · Departments of Pathology and Cell Biology, Dermatology and Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL, USA. ·Ann Surg Oncol · Pubmed #27198510.

ABSTRACT: -- No abstract --

6 Editorial Vitamin D and Melanoma: What Do We Tell Our Patients? 2016

Sondak, Vernon K / McIver, Bryan / Kanetsky, Peter A. ·Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, FL vernon.sondak@moffitt.org. · Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, FL. ·J Clin Oncol · Pubmed #27044934.

ABSTRACT: -- No abstract --

7 Editorial Up close and personal: the challenges of precision medicine in melanoma. 2014

Smalley, Keiran S M / Weber, Jeffrey S. ·Affiliations of authors: Department of Cutaneous Oncology (KSMS, JSW), Department of Molecular Oncology (KSMS), Melanoma Research Center of Excellence (KSMS, JSW), Moffitt Cancer Center, Tampa, FL. ·J Natl Cancer Inst · Pubmed #24511111.

ABSTRACT: -- No abstract --

8 Editorial Long-term effects of BRAF inhibitors in melanoma treatment: friend or foe? 2014

Sloot, Sarah / Fedorenko, Inna V / Smalley, Keiran S M / Gibney, Geoffrey T. ·Moffitt Cancer Center, Department of Cutaneous Oncology , 12902 Magnolia Drive, SRB4, Tampa, FL 33612 , USA sarahsloot@gmail.com. ·Expert Opin Pharmacother · Pubmed #24456413.

ABSTRACT: The clinical development of selective BRAF inhibitors for metastatic BRAF V600 mutant melanoma patients has been a major breakthrough in targeted therapeutics. Objective response rates of approximately 50% have been observed in the Phase III studies of the BRAF inhibitors vemurafenib and dabrafenib. The side effects can be relatively common, including proliferative skin toxicities. The latter range from hyperkeratosis and keratoacanthomas (KAs) to squamous cell carcinomas (SCCs) and new primary melanomas. In addition, case reports on the emergence of gastric/colonic polyps and RAS mutant malignancies have been described during BRAF inhibitor therapy. These events have been attributed to paradoxical activation of the MAPK pathway in BRAF wild-type cells exposed to selective BRAF inhibitors in addition to increased RAS activity. Combined BRAF and MEK inhibition appears to improve clinical outcomes and reduce cutaneous proliferation events as fewer KAs and SCCs have been observed with combination therapy. Next-generation pan-RAF inhibitors ('paradox breakers') and ERK inhibitors may further enhance clinical activity in metastatic BRAF-mutant melanoma patients and mitigate this paradoxical oncogenesis. Further investigation into the potential long-term effects of selective BRAF inhibitors is warranted as expanded use of these agents is expected in patients with BRAF-mutant melanoma and other malignancies.

9 Editorial Recent advances in the treatment of melanoma. 2013

Zager, Jonathan S / Sarnaik, Amod A / Gibney, Geoffrey T / Kudchadkar, Ragini R. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA. Jonathan.Zager@Moffitt.org. ·Cancer Control · Pubmed #24077400.

ABSTRACT: -- No abstract --

10 Review Do Not Forget About the Importance of Loco-Regional Therapy in Melanoma Management. 2019

Wuthrick, Evan J / Chablani, Priyanka. ·Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL. Electronic address: evan.wuthrick@moffitt.org. · Department of Internal Medicine, New York University, New York, NY. ·Semin Radiat Oncol · Pubmed #30827455.

ABSTRACT: Immunotherapy agents have significantly changed the landscape of melanoma treatment over the past decade. Paradigm shifts in treatment require reanalysis of the treatment algorithms in melanoma. Despite surgical excision, certain high risk patients with desmoplastic melanoma remain at high risk for local recurrence and retrospective data suggests improvement in local control with adjuvant radiation therapy. Likewise, despite surgical excision and effective systemic therapy agents, patients with extracapsular extension and other high risk features are at substantial risk of nodal basin (regional) recurrence. Adjuvant radiation therapy has been demonstrated to reduce the local recurrence risk. Despite these benefits, adjuvant radiation therapy in melanoma remains controversial in part because its use has not been definitively demonstrated to improve overall or disease-free survival in a randomized prospective study.

11 Review Engineered oncolytic viruses to treat melanoma: where are we now and what comes next? 2018

Rothermel, Luke D / Zager, Jonathan S. ·a Surgical Oncology , Moffitt Cancer Center , Tampa , FL , USA. · b Department of Cutaneous Oncology and Sarcoma , Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Biol Ther · Pubmed #30392405.

ABSTRACT: INTRODUCTION: Melanoma treatments have evolved rapidly in the past decade and have included the use of intratumoral injections of engineered oncolytic viruses. One such oncolytic virus is talimogene laherparepvec (T-VEC), which is the first approved therapy of its kind for use in recurrent, unresectable stage IIIB-IVM1a melanoma. Additional oncolytic viruses and their uses in combination with other interventions are currently under investigation. Areas covered: Oncolytic viruses are being evaluated as immunotherapies for a variety of advanced malignancies. In this article, we review T-VEC, the only FDA-approved engineered oncolytic virus, in addition to ongoing research regarding other oncolytic viruses for the treatment of advanced melanomas. Finally, we discuss opportunities to improve these therapies through viral, host, and tumor-related modifications. Expert opinion: Engineered and naturally oncolytic viruses have demonstrable local and systemic efficacy as immunotherapies in cancer. T-VEC leads the way with improved survival outcomes for unresectable, stage IIIB-IVM1a melanoma as a monotherapy, and is demonstrating superior results in combination with systemic checkpoint inhibitors. Additional viral vectors show acceptable safety profiles and varying degrees of efficacy in targeting melanoma. The indications for use of oncolytic viruses will expand as their efficacy and appropriate usage is better understood in coming years.

12 Review Regional therapies for locoregionally advanced and unresectable melanoma. 2018

Weitman, Evan S / Zager, Jonathan S. ·Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Dr., MKC 4123, Tampa, FL, 33612, USA. jonathan.zager@moffitt.org. ·Clin Exp Metastasis · Pubmed #29736626.

ABSTRACT: Locoregionally advanced and unresectable disease can be seen in up to 10% of melanoma patients. Treatment options for these patients have been evolving most notably over the past few decades and have demonstrated efficacy through multiple intra-arterial as well as intralesional therapies. Isolated limb perfusions and isolated limb infusions have been utilized to treat locoregionally advanced melanoma of the extremity with overall response rates up to 90% in some reports. Intralesional therapies, for in transit metastatic melanoma, such as Bacille Calmette-Guerin, talimogene laherparepvec, and PV-10 (Rose Bengal) have all demonstrated efficacy in the treatment of unresectable cutaneous melanoma. The treatment effect due to intralesional injection has been identified in directly injected lesions as well as in distant uninjected "bystander lesions" with some injectables. This bystander effect is likely an immunologic reaction due to tumor antigen release, antigen-presenting cell uptake, T cell activation and subsequent bystander tumor destruction in uninjected lesions. Treatment options for unresectable melanoma metastases limited to the liver include isolated hepatic perfusion, which can now be performed through a minimally invasive approach known as percutaneous hepatic perfusion. These intra-arterial and intralesional regional therapies offer a variety of effective treatment modalities for unresectable disease and may potentially be combined with systemic treatments, such as immunotherapy, in the future treatment of locoregionally advanced melanoma.

13 Review Review of diagnostic, prognostic, and predictive biomarkers in melanoma. 2018

Ankeny, Jacob S / Labadie, Brian / Luke, Jason / Hsueh, Eddy / Messina, Jane / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Dr., MKC 4th 11.4123, Tampa, FL, 33612, USA. · Biological Sciences Division, University of Chicago, 5841 S. Maryland Ave., Chicago, IL, 60637, USA. · Department of Surgical Oncology, St. Louis University, 3655 Vista Ave., 1st Floor, St. Louis, MO, 63110, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 McKinley Dr., MKC 4th 11.4123, Tampa, FL, 33612, USA. jonathan.zager@moffitt.org. ·Clin Exp Metastasis · Pubmed #29722000.

ABSTRACT: Melanoma is an aggressive cutaneous malignancy with rapidly rising incidence. Diagnosis of controversial melanocytic lesions, correct prognostication of patients, selection of appropriate adjuvant and systemic therapies, and prediction of response to a given therapy remain very real challenges. Despite these challenges, multiple high throughput, nucleic-acid based biomarkers have been developed that can be assayed from histologic tissue specimens. FISH, CGH, Decision-Dx, and other multi-marker assays have been combined to improve overall predictability. This review discusses some of the most promising nucleic acid based assays that can be obtained from tissue specimens to assist with diagnosis, prognostication, and prediction of treatment response.

14 Review Pharmacokinetic drug evaluation of talimogene laherparepvec for the treatment of advanced melanoma. 2018

Burke, Erin E / Zager, Jonathan S. ·a Moffitt Cancer Center , Tampa , FL , USA. · b Department of Cutaneous Oncology , Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Drug Metab Toxicol · Pubmed #29557682.

ABSTRACT: INTRODUCTION: Current treatment of advanced melanoma is rapidly changing with the introduction of new and effective therapies including systemic as well as locoregional therapies. An example of one such locoregional therapy is intralesional injection with talimogene laherparepvec (T-VEC). Areas covered: T-VEC has been shown in a number of studies to be an effective treatment for patients with stage IIIB, IIIC and IVM1a melanoma. In this article the effectiveness, pharmacokinetics and safety profile of T-VEC is reviewed. Additionally, new research looking at combinations of T-VEC and systemic immunotherapies is reviewed. Expert opinion: Overall, T-VEC is an easily administered, safe, well tolerated and effective oncolytic viral therapy for the treatment of stage IIIB, IIIC, IVM1a unresectable and injectable metastatic melanoma. Recently published studies are showing promising results when T-VEC is combined with systemic therapy and this may be the way of the not too distant future in how we treat metastatic melanoma. Continued work regarding the use of T-VEC with other systemic agents will provide new and more effective treatment strategies for advanced melanoma.

15 Review Intralesional therapy as a treatment for locoregionally metastatic melanoma. 2018

Miura, John T / Zager, Jonathan S. ·a Departments of Cutaneous Oncology and Sarcoma, Moffitt Cancer Center , University of South Florida School of Medicine , Tampa , FL , USA. ·Expert Rev Anticancer Ther · Pubmed #29466885.

ABSTRACT: INTRODUCTION: The emergence of novel intralesional therapies have dramatically changed the treatment landscape for melanoma. The heterogeneous presentation of melanoma continues to pose challenges for clinicians, especially when dealing with advanced locoregional disease. Intralesional therapies have the benefit of causing local tumor destruction, while minimizing systemic toxicity. Moreover, the integration of immunotherapeutic agents into intralesional compounds has resulted in the additional benefit of a bystander effect, whereby untreated distant lesions also derive a benefit from treatment. Intralesional therapy has assumed an important role in the management of unresectable, locoregional disease for melanoma. Areas covered: Multiple intralesional agents have been studied over the years, with only a few demonstrating promising results. This review will provide an overview of the different intralesional agents for melanoma. Mechanisms of action, clinical efficacy, and side effects will be the primary focus. Expert commentary: Treatment options for advanced melanoma continue to evolve. Attractive new therapies delivered by an intralesional route has demonstrated promising results, with minimal side effects. The ideal treatment strategy for melanoma will remain a multimodal approach; intralesional therapy provides an additional tool in the treatment armamentarium for melanoma.

16 Review The biology and therapeutic management of melanoma brain metastases. 2018

Abate-Daga, Daniel / Ramello, Maria C / Smalley, Inna / Forsyth, Peter A / Smalley, Keiran S M. ·The Department of Immunology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, United States. · The Department of Tumor Biology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, United States. · Department of Neurooncology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, United States. · The Department of Tumor Biology, The Moffitt Cancer Center & Research Institute, 12902 Magnolia Drive, Tampa, FL, United States. Electronic address: keiran.smalley@moffitt.org. ·Biochem Pharmacol · Pubmed #29278675.

ABSTRACT: The recent years have seen significant progress in the development of systemic therapies to treat patients with advanced melanoma. Use of these new treatment modalities, which include immune checkpoint inhibitors and small molecule BRAF inhibitors, lead to increased overall survival and better outcomes. Although revolutionary, these therapies are often less effective against melanoma brain metastases, and frequently the CNS is the major site of treatment failure. The development of brain metastases remains a serious complication of advanced melanoma that is associated with significant morbidity and mortality. New approaches to both prevent the development of brain metastases and treat established disease are urgently needed. In this review we will outline the mechanisms underlying the development of melanoma brain metastases and will discuss how new insights into metastasis biology are driving the development of new therapeutic strategies. Finally, we will describe the latest data from the ongoing clinical trials for patients with melanoma brain metastases.

17 Review Current standards of surgical management in primary melanoma. 2018

Perez, Matthew C / Orcutt, Sonia T / Zager, Jonathan S. ·Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA. · Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA - Jonathan.zager@moffitt.org. ·G Ital Dermatol Venereol · Pubmed #28895666.

ABSTRACT: Melanoma accounts for the majority of skin cancer-related deaths, and its incidence continues to rise worldwide. While advanced disease has historically been associated with poor long-term survival, early-stage disease has a favorable prognosis and therefore, early diagnosis is paramount. Resection of primary melanoma requires a balance of maximizing oncological outcome while minimizing morbidity. Wide excision with 1-2 cm margins, depending on depth of the tumor, is the standard of care for surgical treatment of primary, invasive melanoma. Sentinel lymph node biopsy is indicated for patients with clinically node-negative, intermediate-thickness primary melanomas but should also be considered in selected patients with thin and thick primaries. In this article, historical perspectives and key clinical trials regarding the current guidelines for the surgical management of primary melanoma are discussed.

18 Review The role of nitric oxide in melanoma. 2017

Yarlagadda, Keerthi / Hassani, John / Foote, Isaac P / Markowitz, Joseph. ·Department of Cutaneous Oncology, Moffitt Cancer Center Tampa, FL 33612, United States. · Department of Cutaneous Oncology, Moffitt Cancer Center Tampa, FL 33612, United States. Electronic address: joseph.markowitz@moffitt.org. ·Biochim Biophys Acta Rev Cancer · Pubmed #28963068.

ABSTRACT: Nitric oxide (NO) is a small gaseous signaling molecule that mediates its effects in melanoma through free radical formation and enzymatic processes. Investigations have demonstrated multiple roles for NO in melanoma pathology via immune surveillance, apoptosis, angiogenesis, melanogenesis, and on the melanoma cell itself. In general, elevated levels of NO prognosticate a poor outcome for melanoma patients. However, there are processes where the relative concentration of NO in different environments may also serve to limit melanoma proliferation. This review serves to outline the roles of NO in melanoma development and proliferation. As demonstrated by multiple in vivo murine models and observations from human tissue, NO may promote melanoma formation and proliferation through its interaction via inhibitory immune cells, inhibition of apoptosis, stimulation of pro-tumorigenic cytokines, activation of tumor associated macrophages, alteration of angiogenic processes, and stimulation of melanoma formation itself.

19 Review Novel Opportunities to Use Radiation Therapy with Immune Checkpoint Inhibitors for Melanoma Management. 2017

Ahmed, Kamran A / Kim, Sungjune / Harrison, Louis B. ·Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA. · Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA. Electronic address: louis.harrison@moffitt.org. ·Surg Oncol Clin N Am · Pubmed #28576186.

ABSTRACT: Immunotherapy has revolutionized the systemic management of numerous malignancies. Nowhere has the proven benefit of these agents in clinical practice been more evident than in the management of advanced melanoma. Numerous preclinical studies have revealed the potential benefit of immune-priming radiotherapy in stimulating tumor-specific immune responses. This signal for immune activation may lead to clinically relevant synergy with immune checkpoint inhibitors against malignant cells. In this review, the authors summarize the current data outlining the role radiation therapy may play in the management of advanced melanoma alongside immune checkpoint inhibitors.

20 Review Chemosaturation With Percutaneous Hepatic Perfusion in Unresectable Hepatic Metastases. 2017

Glazer, Evan S / Zager, Jonathan S. ·Division of Surgical Oncology, Department of Surgery, University of Tennessee Health Sciences Center, Memphis,TN. · Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL. Jonathan.Zager@Moffitt.org. ·Cancer Control · Pubmed #28178721.

ABSTRACT: BACKGROUND: In patients with hepatic metastases from solid-organ malignancies, surgical resection may be a potentially curative option, but it is not possible in most cases. Chemosaturation with percutaneous hepatic perfusion was developed for the management of unresectable metastases to the liver. METHODS: Relevant medical literature was summarized with regard to the outcomes and limitations of chemosaturation with percutaneous hepatic perfusion. RESULTS: Six articles were identified that contained data on 91 individuals who received chemosaturation with percutaneous hepatic perfusion. More than 60% of these study patients were diagnosed with ocular melanoma. The overall response rate was 48% and the rate of disease control was 90%. Chemosaturation with percutaneous hepatic perfusion improved the rates of overall and hepatic progression-free survival (PFS). The data are limited but suggest that the rate of PFS was improved in study patients with isolated melanoma hepatic metastases who received chemosaturation with percutaneous hepatic perfusion compared with those assigned to standard care. CONCLUSIONS: Our results suggest that chemosaturation with percutaneous hepatic perfusion produces favorable tumor response rates in select individuals with unresectable hepatic metastases from multiple primary cancers, particularly ocular and cutaneous melanomas. Data from a single randomized clinical trial have also shown that chemosaturation with percutaneous hepatic perfusion can affect hepatic PFS in certain patients.

21 Review The safety of talimogene laherparepvec for the treatment of advanced melanoma. 2017

Gangi, Alexandra / Zager, Jonathan S. ·a Department of Cutaneous Oncology , Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Drug Saf · Pubmed #27989216.

ABSTRACT: INTRODUCTION: Talimogene laherparepvec (T-VEC, IMLYGIC) is an oncolytic herpes virus type I used as intralesional therapy for the treatment of unresectable metastatic melanoma in a cutaneous, subcutaneous, or nodal location. Talimogene laherparepvec selectively replicates within and lyses tumor cells while producing granulocyte macrophage colony-stimulating factor (GM-CSF), which may promote an immune mediated antitumor response. Areas covered: The US Food and Drug Administration approved Talimogene laherparepvec in late 2015 following the completion of phase I, II and III trials that demonstrated safety and efficacy. Current NCCN practice guidelines have added Talimogene laherparepvec as a primary treatment for stage IIIB/C and stage IVM1a melanoma patients with evidence of good durable response rates, and this article sets out to review the use and safety and efficacy of T-VEC Expert opinion: Treatment options for locally advanced and metastatic melanoma are expanding with new developments in immunotherapy and immune checkpoint inhibitors. The ideal treatment of metastatic melanoma continues to be multimodal, combining systemic treatments, intralesional and regional therapies, surgery and radiotherapy to achieve optimal outcomes. Use of talimogene laherparepvec as intrelsional therapy has demonstrated promising effects in select patients with advanced melanoma. Future directions for Talimogene laherparepvec include combination therapies with other systemic immunotherapies such as anti-CTLA-4 antibody and anti-PD-1 drugs.

22 Review Intralesional and systemic immunotherapy for metastatic melanoma. 2016

Luu, Carrie / Khushalani, Nikhil I / Zager, Jonathan S. ·a Department of Cutaneous Oncology , H. Lee Moffitt Cancer Center , Tampa , FL , USA. · b Department of Cutaneous Oncology , Director of Regional Therapies Moffitt Cancer Center , Tampa , FL , USA. ·Expert Opin Biol Ther · Pubmed #27602429.

ABSTRACT: INTRODUCTION: Immunotherapy has revolutionized the treatment of metastatic melanoma and dramatically improved patient outcomes. Ipilimumab, an inhibitor of cytotoxic T-lymphocyte antigen-4 (CTLA-4), was the first immunotherapeutic agent to demonstrate improved survival in advanced melanoma. More recently, other immune checkpoint inhibitors, including the programmed death-1 (PD-1) inhibitors pembrolizumab and nivolumab, have demonstrated efficacy in locally advanced unresectable and metastatic melanoma. In addition to systemically delivered immunotherapies, intralesional therapies such as talimogene laherparepvec (TVEC) play an important role in the treatment of locoregionally advanced and metastatic melanoma. Areas covered: This review provides an overview of the mechanisms behind immune checkpoint inhibitors. Clinical evidence of their efficacy is presented and discussion of new patterns of response and associated immune related adverse events associated with immunotherapy are provided. Expert opinion: Treatment options for locally advanced and metastatic melanoma are expanding with new developments in immunotherapy and immune checkpoint inhibitors. The utility of these novel therapies in the adjuvant setting is currently being explored. The ideal treatment of metastatic melanoma continues to be multimodal, combining systemic treatments, intralesional and regional therapies, surgery and radiotherapy to achieve optimal outcomes.

23 Review A Comprehensive Approach to Pediatric Atypical Melanocytic Neoplasms with Comment on the Role of Sentinel Lymph Node Biopsy. 2016

Sondak, Vernon K / Reed, Damon / Messina, Jane L. ·Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida. · Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; All Children's Hospital, St. Petersburg, Florida. ·Crit Rev Oncog · Pubmed #27481000.

ABSTRACT: Pediatric melanoma has been rising in incidence in recent years and its management poses challenges that are frequently exacerbated by diagnostic uncertainty about the benign or malignant nature of many pediatric melanocytic neoplasms. Sentinel lymph node biopsy (SLNB), originally described by Dr. Donald L. Morton, has been incorporated selectively into the management of pediatric atypical melanocytic neoplasms (AMNs), but its value and significance in this scenario have been controversial. Herein, we describe a comprehensive approach to the evaluation and management of pediatric AMNs that involves SLNB as a diagnostic, staging, and potentially therapeutic tool. We also describe our approach to educating patients and their families about the inherent uncertainties involved in diagnosing and predicting the ultimate behavior of pediatric melanocytic lesions. In addition, we stress the importance of long-term follow-up, as well as ongoing research to improve our understanding of the prognostic factors and histopathologic characteristics that may one day allow us to minimize or eliminate entirely this diagnostically uncertain category of skin lesions.

24 Review A rare case of leptomeningeal carcinomatosis in a patient with uveal melanoma: case report and review of literature. 2016

Fedorenko, Inna V / Evernden, Brittany / Kenchappa, Rajappa S / Sahebjam, Solmaz / Ryzhova, Elena / Puskas, John / McIntosh, Linda / Caceres, Gisela / Magliocco, Anthony / Etame, Arnold / Harbour, J William / Smalley, Keiran S M / Forsyth, Peter A. ·Departments of aTumor Biology bNeurooncology cAnatomic Pathology dCutaneous Oncology eMorsani Molecular Diagnostics Laboratory, Moffitt Cancer Center & Research Institute, Tampa fBascom Palmer Eye Institute, Sylvester Comprehensive Cancer Center and Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida, USA gDepartment of Oncology, Tom Baker Cancer Center & University of Calgary, Calgary, Alberta, Canada. ·Melanoma Res · Pubmed #27285292.

ABSTRACT: Uveal melanoma is a rare subtype of melanoma, accounting for only 3-5% of all melanoma cases in the USA. Although fewer than 4% of uveal melanoma patients present with metastasis at diagnosis, approximately half will develop metastasis, more than 90% of which disseminate to the liver. Infrequently, a number of malignancies can lead to leptomeningeal metastases, a devastating and terminal complication. In this case report, we present an exceedingly rare case of a patient with uveal melanoma who developed leptomeningeal carcinomatosis as the sole site of metastasis. After conventional methods to diagnose leptomeningeal carcinomatosis fell short, a diagnosis was confirmed on the basis of identification and genomic analysis of melanoma circulating tumor cells in the cerebrospinal fluid.

25 Review Improving patient outcomes to targeted therapies in melanoma. 2016

Eroglu, Zeynep / Smalley, Keiran S M / Sondak, Vernon K. ·a The Department of Cutaneous Oncology , The Moffitt Cancer Center & Research Institute , Tampa , FL , USA. · b The Department of Tumor Biology , The Moffitt Cancer Center & Research Institute , Tampa , FL , USA. ·Expert Rev Anticancer Ther · Pubmed #27137746.

ABSTRACT: INTRODUCTION: The arrival of targeted therapies has led to significant improvements in clinical outcomes for patients with BRAFV600 mutated advanced melanoma over the past five years. AREAS COVERED: In several clinical trials, BRAF and MEK inhibitors have shown improvement in progression free and overall survival, along with much higher tumor response rates in comparison to chemotherapy, with the combination of these drugs superior to monotherapy. These agents are also being tested in earlier-stage patients, in addition to alternative dosing regimens and in combinations with other therapeutics. Efforts are also ongoing to expand the success found with targeted therapies to other subtypes of melanoma, including NRAS and c-kit mutated melanomas, uveal melanomas, and BRAF/NRAS wild type melanomas. Expert Commentary: We aim to provide an overview of clinical outcomes with targeted therapies in melanoma patients.

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