CURRENT MANAGEMENT OF MALIGNANT MELANOMA Edited by Ming Yu Cao Current Management of Malignant Melanoma Edited by Ming Yu Cao Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2011 InTech All chapters are Open Access articles distributed under the Creative Commons Non Commercial Share Alike Attribution 3.0 license, which permits to copy, distribute, transmit, and adapt the work in any medium, so long as the original work is properly cited. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published articles. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Davor Vidic Technical Editor Teodora Smiljanic Cover Designer Jan Hyrat Image Copyright SeDmi, 2011. Used under license from Shutterstock.com First published September, 2011 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Current Management of Malignant Melanoma, Edited by Ming Yu Cao p. cm. ISBN 978-953-307-264-7 Contents Preface IX Chapter 1 Clinical Cytology in the Diagnosis and Management of Melanoma 1 Neelaiah Siddaraju Chapter 2 Non-Invasive Determination of Breslow Index 29 Amouroux Marine and Blondel Walter Chapter 3 Current Controversies in the Surgical Management of Melanoma 45 Joyce DP, Prichard RS and Hill ADK Chapter 4 Challenging Problems in the Surgical Management of Melanoma 63 Asvin M. Ganapathi, Douglas S. Tyler and Paul J. Mosca Chapter 5 Immunotargeting of Melanoma 93 Jacek Mackiewicz and Andrzej Mackiewicz Chapter 6 Adjuvant Treatment of Melanoma 119 J. A. Moreno Nogueira, M. Valero Arbizu and C. Moreno Rey Chapter 7 Photodiagnosis and Photodynamic Therapy of Cutaneous Melanoma 141 Ekaterina Borisova, Irina Bliznakova, Vanya Mantareva, Ivan Angelov, Latchezar Avramov and Elmira Petkova Chapter 8 Update on Current Phase III Clinical Trials in Melanoma 157 Amy Q. Cao and Ming Yu Cao Chapter 9 Uvel Melanoma 181 Ozlem Yenice and Eren Cerman VI Contents Chapter 10 Expression of Tumour Associated Transcripts in Malignant Melanoma Metastases - with Methodological Aspects 189 Malin Farnebäck, Annika Håkansson, Leif Håkansson, Bertil Gustafsson and Bertil Kågedal Chapter 11 Epigenetics: A Possible Link Between Stress and Melanocyte Malignant Transformation 203 Fernanda Molognoni and Miriam Galvonas Jasiulionis Chapter 12 Antioxidant Defense and UV-Induced Melanogenesis: Implications for Melanoma Prevention 227 Uraiwan Panich Chapter 13 Adaptation to ER Stress as a Mechanism of Resistance of Melanoma to Treatment 253 Xu Dong Zhang, Peter Hersey, Kwang Hong Tay, Hsin-Yi Tseng, Chen Chen Jiang and Li Dong Preface Melanoma is the deadliest form of skin cancer. The incidence of malignant melanoma has increased exponentially in recent decades. Although there are some available treatments for melanoma, the mortality rate is still high. The stage of melanoma at diagnosis is directly related to the treatment options and the survival rate. In the last decade, much more efforts have been made in the understanding and the management of the disease. This book has contributions from experts in the field, and provides the most recent perspectives of basic research and clinical development for the management of melanoma. The purpose of this book is to provide a comprehensive source of information on melanoma, which includes the basic research, early diagnosis, prevention and treatment of melanoma, as well as development of new therapies or optimizing current treatments. The book should be especially useful for scientists and practicing physicians, to whom it offers an opportunity to keep abreast of recent advances in the field of melanoma. The editor wishes to especially thank the contributing authors, whose efforts and expertise made this project a success. The editor would also like to acknowledge the contribution of Amy Cao for her assistance of the final editing of this book. Dr. Ming Yu Cao, M.D., Ph.D. CERB, BGTD, Health Canada [...]... Current Management of Malignant Melanoma amelanotic melanoma; however, in view of the clinical diagnosis of recurrent soft tissue sarcoma, we offered a diagnosis of an undifferentiated malignant tumor with a possibility of amelanotic melanoma Subsequently, we learnt that it was diagnosed elsewhere, as a malignant peripheral nerve sheath tumor (MPNST), based on its immunoexpression of S-100 Histologically,... granules are also appreciated (MGG stain, X400) 4 Current Management of Malignant Melanoma 3.2 Naked eye examination of cytologic samples Gross nature of the cytologic material in cases of pigmented melanoma is usually blackish and often fluid-like (Artal et al., 2004) With respect to melanotic melanomas, this is our experience as well Rare cases of metastatic melanoma manifesting with blackish pleural effusion... appeared scanty, presence of obvious malignant cells with melanin pigment facilitated an easy diagnosis (Solo et al., 2009) 3.8 Melanoma of soft parts Melanoma of the soft parts (MSP)” or “clear cell sarcoma of the soft parts (CCSSP)” is a distinct entity with unique genetic rearrangement (t12;22) (q13;q12) Its morphologic, Clinical Cytology in The Diagnosis and Management of Melanoma 21 immunohistochemical... Diagnosis and Management of Melanoma 23 on cases of melanoma I also thank Dr Shramana Mandal, Assistant Professor of Pathology, JIPMER, Pondicherry, for providing one of her interesting cases of melanoma, which has been included in the present chapter I am also thankful to Dr Bhawana A Badhe and Dr Debdatta Basu, Professors of Pathology, JIPMER, Pondicherry, for their assistance in the final editing of the... diagnosing the primary pulmonary melanoma comprise clinical detection of a solitary lung tumor; absence of melanoma of the skin, mucous membrane and eye or, any other detectable tumor at the time of diagnosis; histologically demonstrable junctional changes like “dropping off” or “nesting” of melanoma cells just beneath the bronchial Clinical Cytology in The Diagnosis and Management of Melanoma 17 Fig 11 The... in 20 Current Management of Malignant Melanoma diagnosing iris ring melanomas is that, even in an optimal setting, the specimens are paucicellular, often leaving the cytopathologists in a diagnostic dilemma (Char et al., 2006) Cytology has a significant role in distinguishing pigmented lesions of the conjunctiva which can be benign, pre -malignant, or frankly malignant (melanoma) Conjunctival melanomas... for determination of the origin and extent of the lesions; the use of imprint cytology can minimise the frequency of biopsy in recurrent tumors and suspicious areas (Paridaens et al., 1992) Our experience with ocular melanomas is limited In one of our studies that evaluated the use of fine needle cytology in orbital and eyelid lesions, we had a single case of recurrent choroidal melanoma, which was... chiefly with the role of cytology in the clinical management of melanoma patients A careful evaluation of cytologic samples is of critical importance for a variety of reasons, going to be addressed subsequently in this chapter Despite the considerable, current knowledge about the cytomorphology of melanoma, owing to its inherent histomorphologic variation; a cytologic diagnosis is often difficult, especially,... the metastasis and prognosis of cutaneous melanomas Kalogeraki et al (2006) studied immunoexpression of these proteins on cytologic material by ICC, and found it to be significantly associated with ‘Clark levels’ In particular, HSP-70 expression is believed to be of value in the identification of melanoma patients with poor prognosis 22 Current Management of Malignant Melanoma (Kalogeraki et al., 2006)... Cytologic differential diagnosis of myxoid melanoma 3.4 Location-based cytologic interpretation of melanoma Differential diagnosis of melanoma depends not only on the overlapping cytomorphologic features or patterns, but also on the site of primary or metastatic involvement For example, an amelanotic melanoma of the cervix may have a differential diagnosis of rhabdomyosarcoma, mixed malignant mullerian tumor . stain, x400) Current Management of Malignant Melanoma 8 amelanotic melanoma; however, in view of the clinical diagnosis of recurrent soft tissue sarcoma, we offered a diagnosis of an undifferentiated. CURRENT MANAGEMENT OF MALIGNANT MELANOMA Edited by Ming Yu Cao Current Management of Malignant Melanoma Edited by Ming Yu Cao. Current Management of Malignant Melanoma 4 3.2 Naked eye examination of cytologic samples Gross nature of the cytologic material in cases of pigmented melanoma is usually blackish and often