Malignant melanoma (non-metastatic)
Identifieur interne : 004762 ( Pmc/Curation ); précédent : 004761; suivant : 004763Malignant melanoma (non-metastatic)
Auteurs : Philip SavageSource :
- BMJ Clinical Evidence [ 1752-8526 ] ; 2007.
Abstract
The incidence of malignant melanoma has increased over the past 25 years in the UK, but death rates have remained fairly constant. Five-year survival ranges from 20% to 95% depending on disease stage. Risks are greater in white populations and in people with higher numbers of skin naevi.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent malignant melanoma? Is there an optimal surgical margin for the primary excision of melanoma? What are the effects of elective lymph node dissection in people with malignant melanoma with clinically uninvolved lymph nodes? What are the effects of sentinel lymph node biopsy in people with malignant melanoma with clinically uninvolved lymph nodes? What are the effects of adjuvant treatment for malignant melanoma? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 30 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant vaccines; elective lymph node dissection; low-, intermediate-, and high-dose adjuvant interferon alfa; sentinel lymph node biopsy; suncreens; surveillance for early recurrence; and wide excisions.
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PubMed: 19454081
PubMed Central: 2943794
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Malignant melanoma (non-metastatic)</title><author><name sortKey="Savage, Philip" sort="Savage, Philip" uniqKey="Savage P" first="Philip" last="Savage">Philip Savage</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19454081</idno><idno type="pmc">2943794</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943794</idno><idno type="RBID">PMC:2943794</idno><date when="2007">2007</date><idno type="wicri:Area/Pmc/Corpus">004763</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004763</idno><idno type="wicri:Area/Pmc/Curation">004762</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">004762</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Malignant melanoma (non-metastatic)</title><author><name sortKey="Savage, Philip" sort="Savage, Philip" uniqKey="Savage P" first="Philip" last="Savage">Philip Savage</name></author></analytic><series><title level="j">BMJ Clinical Evidence</title><idno type="eISSN">1752-8526</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>The incidence of malignant melanoma has increased over the past 25 years in the UK, but death rates have remained fairly constant. Five-year survival ranges from 20% to 95% depending on disease stage. Risks are greater in white populations and in people with higher numbers of skin naevi. </p></sec><sec><title>Methods and outcomes</title><p>We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent malignant melanoma? Is there an optimal surgical margin for the primary excision of melanoma? What are the effects of elective lymph node dissection in people with malignant melanoma with clinically uninvolved lymph nodes? What are the effects of sentinel lymph node biopsy in people with malignant melanoma with clinically uninvolved lymph nodes? What are the effects of adjuvant treatment for malignant melanoma? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). </p></sec><sec><title>Results</title><p>We found 30 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.</p></sec><sec><title>Conclusions</title><p>In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant vaccines; elective lymph node dissection; low-, intermediate-, and high-dose adjuvant interferon alfa; sentinel lymph node biopsy; suncreens; surveillance for early recurrence; and wide excisions.</p></sec></div></front></TEI><pmc article-type="review-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Clin Evid</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Clin Evid</journal-id><journal-id journal-id-type="publisher-id">Clinical Evidence</journal-id><journal-title-group><journal-title>BMJ Clinical Evidence</journal-title></journal-title-group><issn pub-type="epub">1752-8526</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">19454081</article-id><article-id pub-id-type="pmc">2943794</article-id><article-id pub-id-type="publisher-id">1705</article-id><article-categories><subj-group subj-group-type="heading"><subject>Skin Disorders</subject></subj-group><subj-group subj-group-type="secondary-section"><subject>Oncology</subject></subj-group></article-categories><title-group><article-title>Malignant melanoma (non-metastatic)</article-title><alt-title alt-title-type="abridged">Non-metastatic melanoma</alt-title></title-group><contrib-group><contrib contrib-type="author" deceased="no"><name><surname>Savage</surname><given-names>Philip</given-names></name><degrees>PhD FRCP</degrees><role>Consultant in Cancer Medicine</role><aff><institution>Charing Cross Hospital</institution><addr-line>London</addr-line><country>UK</country></aff></contrib></contrib-group><author-notes><fn><p>PS and TC declare that they have no competing interests.</p></fn></author-notes><pub-date pub-type="epub"><day>01</day><month>6</month><year>2007</year></pub-date><pub-date pub-type="collection"><year>2007</year></pub-date><volume>2007</volume><elocation-id>1705</elocation-id><permissions><copyright-statement>© BMJ Publishing Group Ltd, All Rights Reserved</copyright-statement><copyright-year>2007</copyright-year></permissions><self-uri xlink:type="simple" xlink:href="http://www.clinicalevidence.bmj.com/ceweb/pmc/2007/06/1705/">This article is available from http://www.clinicalevidence.bmj.com/ceweb/pmc/2007/06/1705/</self-uri><abstract><sec><title>Introduction</title><p>The incidence of malignant melanoma has increased over the past 25 years in the UK, but death rates have remained fairly constant. Five-year survival ranges from 20% to 95% depending on disease stage. Risks are greater in white populations and in people with higher numbers of skin naevi. </p></sec><sec><title>Methods and outcomes</title><p>We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent malignant melanoma? Is there an optimal surgical margin for the primary excision of melanoma? What are the effects of elective lymph node dissection in people with malignant melanoma with clinically uninvolved lymph nodes? What are the effects of sentinel lymph node biopsy in people with malignant melanoma with clinically uninvolved lymph nodes? What are the effects of adjuvant treatment for malignant melanoma? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). </p></sec><sec><title>Results</title><p>We found 30 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.</p></sec><sec><title>Conclusions</title><p>In this systematic review we present information relating to the effectiveness and safety of the following interventions: adjuvant vaccines; elective lymph node dissection; low-, intermediate-, and high-dose adjuvant interferon alfa; sentinel lymph node biopsy; suncreens; surveillance for early recurrence; and wide excisions.</p></sec></abstract><abstract abstract-type="key-points"><title>Key Points</title><p>The incidence of malignant melanoma has increased over the past 25 years in the UK, but death rates have remained fairly constant. Five year survival ranges from 20% to 95% depending on disease stage.
<list list-type="bullet"><list-item><p>Risks are greater in white populations and in people with higher numbers of skin naevi.</p></list-item><list-item><p>Prognosis depends on depth of tumour, ulceration, and number of lymph nodes involved. Survival may be better in women compared with men, and for lesions on the limbs compared with the trunk.</p></list-item><list-item><p>Lesions can recur after 5-10 years, so long term surveillance may be required.</p></list-item></list></p><p><xref ref-type="sub-article" rid="BMJ_1705_I1">Sunscreens</xref> have not been shown to reduce the risk of malignant melanoma, but sunscreen use does not necessarily correlate with reduced total ultraviolet light exposure.</p><p><xref ref-type="sub-article" rid="BMJ_1705_I5">Wide (3 cm) excision</xref> of lesions leads to reduced local recurrence compared with narrow (1 cm) excision in people with tumours greater than 2 mm Breslow thickness.
<list list-type="bullet"><list-item><p>Wide (3-5 cm) excision is unlikely to be more beneficial than narrow (1-2 cm) excision in people with tumours of less than 2 mm Breslow thickness, and may increase the need for skin grafts.</p></list-item></list></p><p>Elective <xref ref-type="sub-article" rid="BMJ_1705_I7">lymph node dissection</xref> is unlikely to increase survival in people without clinically detectable lymph node metastases.
<list list-type="bullet"><list-item><p>We don't know whether <xref ref-type="sub-article" rid="BMJ_1705_I6">sentinel lymph node biopsy</xref> is beneficial.</p></list-item></list></p><p>We don't know whether adjuvant treatment with <xref ref-type="sub-article" rid="BMJ_1705_I3">vaccines</xref>, <xref ref-type="sub-article" rid="BMJ_1705_I2">high dose interferon alfa</xref>, or <xref ref-type="sub-article" rid="BMJ_1705_I4">surveillance</xref> for early treatment of recurrence improve survival.
<list list-type="bullet"><list-item><p>Low and intermediate dose interferon are unlikely to improve relapse rates or survival compared with no adjuvant treatment.</p></list-item><list-item><p>High dose interferon alfa may increase the time until relapse compared with no adjuvant treatment, but overall survival seems to be unchanged.</p></list-item><list-item><p>Severe adverse effects occur in 10-75% of people receiving interferon alfa treatment.</p></list-item></list></p></abstract><counts><table-count count="5"></table-count><ref-count count="46"></ref-count></counts></article-meta><notes notes-type="disclaimer"><sec><title>Disclaimer</title><p>The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients.To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.</p></sec></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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