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Background: Health-related quality of life (HRQoL) is an important issue in the rapidly evolving field of adjuvant treatment for stage III melanoma. Dendritic cell vaccination is one of the adjuvant forms of therapy currently investigated. Methods: We enrolled adults with stage III melanoma to receive adjuvant dendritic cell vaccination after a complete radical lymph node dissection. HRQoL assessment was one of the secondary endpoints of this trial and investigated with the EORTC-QLQ-C30 questionnaire at baseline and week 26. Results: Fifteen patients with a median age of 50 years were included in the study, with twelve evaluable patients on study at time of the second questionnaire. Global health status and role functioning improved clinically relevant with a mean difference of 15 (p = 0.010) and 26 points (p = 0.005), respectively. Discussion: Despite the small number of patients, we found a clinically relevant improved global health status. Besides, compared to the other investigated therapies, toxicity of dendritic cell vaccination is low, which supports our finding. Conclusion: This is the first description of HRQoL in melanoma patients receiving dendritic cell vaccination. We show the expected improvement in global health status after surgical treatment of stage III melanoma. Thus, adjuvant dendritic cell vaccination does not seem to hamper this improvement, as shown in our small explorative study. [ABSTRACT FROM AUTHOR]

Background: Malign melanoma continues to present a severe health problem, and the incidence is still raising. Nodal status and ulceration of the primary melanoma are strong prognostic factors. The main treatment of node-positive melanomas (stage III) is complete lymph node dissection. The aim of this study was to describe the outcome in patients with stage III melanoma who underwent completion lymphadenectomy at a department of plastic surgery. Methods: Retrospectively, we included all patients who underwent complete lymph node dissection in the period from 2008 to 2012 subsequent to a positive sentinel node biopsy or palpable metastasis from a cutaneous malign melanoma. Primary outcomes were disease-free survival and melanoma-specific survival. Results: We included 150 patients with an average age of 57 (16-82) years. Melanoma thickness was 3.1 (0.53-15) mm. Ulceration of primary tumor was present in 35 %. Complete lymph node dissection was performed in the neck, axilla, inguinal region, and aberrant region. There was no difference in occurrence of nodal metastases comparing the regions. Seroma was most frequent in the axilla (23.5 %) and inguinal region (18.9 %). Lymphedema occurred in the inguinal region (15.1 %) and the axilla (4.7 %), and wound infection occurred in the inguinal region (30.2 %), the axilla (15.3 %), and the neck (11.1 %). The 5-year nodal recurrence rate was 16.9 % [95 % CI 8.2-33.1 %] and the 5-year rate of distant metastases was 48.3 % [95 % CI 36.5-61.8 %]. Overall survival was 51.8 % [95 % CI 35.6-65.8 %]. More than two nodal metastases worsened the prognosis (reference: <2 lymph nodes). Level of Evidence: Level IV, risk/prognostic study. [ABSTRACT FROM AUTHOR]

New prognostic markers are needed for malignant melanoma. Inducible nitric oxide synthase (iNOS) and cyclooxygenase type 2 (COX-2) have been described to correlate with progression of melanoma. Moreover, activating mutations in BRAF/NRAS oncogenes are often detected in melanoma. The BRAF/NRAS mutation status and expression of COX-2 and iNOS were examined to compare their prognostic value for overall survival (OS) in stage III malignant cutaneous melanoma. The expression of iNOS and COX-2 in metastatic lymph nodes from 21 rapidly progressing (OS from date of diagnosis of stage III disease ≤14 months) and 17 slowly progressing (OS ≥60 months) stage III cutaneous melanoma patients was examined by immunohistochemistry. The presence of BRAF/NRAS mutations was analyzed using direct DNA sequencing. χ2 exact trend test and logistic regression analysis were used for statistical analysis. Both iNOS ( P = 0.002) and COX-2 ( P = 0.048) alone significantly predicted OS. The BRAF/NRAS mutation status did not significantly differ between patient groups, although iNOS significantly ( P = 0.013) correlated with BRAF mutation frequency. Furthermore, the odds ratio (OR) with respect to OS of iNOS (OR = 10.4) was higher than that of COX-2 (OR = 5.6) and was stable in the multivariate analysis of OS together with disease stage IIIB/C, ulceration, number of metastatic lymph nodes, and Breslow tumor thickness. Our data show that iNOS is an independent and stronger prognostic factor for OS in stage III malignant cutaneous melanoma than COX-2. [ABSTRACT FROM AUTHOR]

Background: This study addresses the yield and clinical impact of computed tomography (CT) imaging in otherwise asymptomatic patients with stage III melanoma metastatic to the regional nodes. Methods: The database from the University of Michigan Mutlidisciplinary Melanoma Clinic was reviewed and identified 127 asymptomatic patients with stage III melanoma (regional nodal disease) who received CT scans of the head, chest, abdomen, and/or pelvis. Scans were confirmed as true positive, false positive, and normal. Results: Four hundred twenty-six head and body CT scans were performed at the time of presentation of stage III disease. Twenty patients had a true-positive CT scan revealing unsuspected metastases. Fifteen patients had abnormal CT scans subsequently shown to be a benign process or second malignancy. The incidence of true-positive CT scans was not different between the groups of patients who had clinically apparent versus occult nodal disease. There was a significantly higher incidence of abdominal and pelvic metastatic sites identified by CT scan in patients with inguinal nodal disease compared with axillary or head and neck node-positive patients. Conclusions: The yield of detection of unsuspected metastases by CT scans in asymptomatic patients with stage III melanoma was not insignificant. Because patients with resected stage III disease are recommended to have adjuvant interferon-α for 1 year, CT staging plays an important role in identifying appropriate candidates for treatment. The toxicity of interferon-α therapy is not insignificant. The value of routine CT in asymptomatic patients with nodal metastasis deserves further prospective study. [ABSTRACT FROM AUTHOR]