January 25, 2012 — Melanoma frequently metastasizes to the lungs. However, a study that investigated suspicious lung nodules in patients with metastatic melanoma found that nearly one third had nonmelanoma pathology.
The findings, from 229 patients with metastatic melanoma treated at the Memorial Sloan-Kettering Cancer Center in New York City, were published online last year in the Annals of Oncology.
The "initially surprising high incidence of nonmelanoma pathology at biopsy" reported in this study reinforces an important message, write Mark Middleton, MD, and colleagues from the Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom, in an editorial published online December 26, 2011, in the same journal.
"It tells us that it is not safe to assume that lung lesions found at presentation or during follow-up for melanoma represent disease relapse," they write. "The message has to be: if in doubt — biopsy."
Standard of Care
The biopsy allows pathologists to differentiate lung cancers that represent a metastasis and those that are primary.
"Histological confirmation of metastases is the standard of care at our institution," write the researchers from Memorial Sloan-Kettering Cancer Center. They note that the National Comprehensive Cancer Network guidelines recommend that initial clinical recurrence should be confirmed pathologically by biopsy wherever possible.
In their study, 229 patients with metastatic melanoma had a biopsy of a suspicious new lung lesion from 1996 to 2006. In this group, 12% of the lesions were benign on biopsy, and although the majority (88%) of lesions were malignant, only 69% were melanoma.
Among those found to have nonmelanoma pathology were 14% of patients who had a new potentially curable primary lung cancer, underscoring the need to make an accurate diagnosis, they write.
"In clinical situations in which one would expect a diagnosis of melanoma, another diagnosis was made in 31% of cases," the authors note.
"It is not only crucial to distinguish between benign and malignant disease, but also necessary to establish a definitive histological diagnosis before initiation of therapy," they add.
Problem for Oncologists
"The management of pulmonary nodules detected in patients followed-up after a diagnosis of melanoma presents a particular problem for oncologists," the editorialists note.
It can make a big difference to patient survival. They note that patients who have a complete resection of pulmonary metastases achieve a 5-year survival rate of 21% to 22%, but this falls to 0% to 13% in patients who have an incomplete resection, and to less than 10% in patients who receive medical therapy.
In addition, the authors note that 5-year survival as high as 39% has been reported in patients with solitary pulmonary lesions who underwent pulmonary metastasectomy.
"Our study highlights the importance of tissue diagnosis before decision making regarding treatment for these patients," the authors conclude.
The authors have disclosed no relevant financial relationships.
Ann Oncol. Published online August 4, 2011, and December 26, 2011. Abstract, Editorial
The findings, from 229 patients with metastatic melanoma treated at the Memorial Sloan-Kettering Cancer Center in New York City, were published online last year in the Annals of Oncology.
The "initially surprising high incidence of nonmelanoma pathology at biopsy" reported in this study reinforces an important message, write Mark Middleton, MD, and colleagues from the Oxford National Institute for Health Research Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom, in an editorial published online December 26, 2011, in the same journal.
"It tells us that it is not safe to assume that lung lesions found at presentation or during follow-up for melanoma represent disease relapse," they write. "The message has to be: if in doubt — biopsy."
Standard of Care
The biopsy allows pathologists to differentiate lung cancers that represent a metastasis and those that are primary.
"Histological confirmation of metastases is the standard of care at our institution," write the researchers from Memorial Sloan-Kettering Cancer Center. They note that the National Comprehensive Cancer Network guidelines recommend that initial clinical recurrence should be confirmed pathologically by biopsy wherever possible.
In their study, 229 patients with metastatic melanoma had a biopsy of a suspicious new lung lesion from 1996 to 2006. In this group, 12% of the lesions were benign on biopsy, and although the majority (88%) of lesions were malignant, only 69% were melanoma.
Among those found to have nonmelanoma pathology were 14% of patients who had a new potentially curable primary lung cancer, underscoring the need to make an accurate diagnosis, they write.
"In clinical situations in which one would expect a diagnosis of melanoma, another diagnosis was made in 31% of cases," the authors note.
"It is not only crucial to distinguish between benign and malignant disease, but also necessary to establish a definitive histological diagnosis before initiation of therapy," they add.
Problem for Oncologists
"The management of pulmonary nodules detected in patients followed-up after a diagnosis of melanoma presents a particular problem for oncologists," the editorialists note.
It can make a big difference to patient survival. They note that patients who have a complete resection of pulmonary metastases achieve a 5-year survival rate of 21% to 22%, but this falls to 0% to 13% in patients who have an incomplete resection, and to less than 10% in patients who receive medical therapy.
In addition, the authors note that 5-year survival as high as 39% has been reported in patients with solitary pulmonary lesions who underwent pulmonary metastasectomy.
"Our study highlights the importance of tissue diagnosis before decision making regarding treatment for these patients," the authors conclude.
The authors have disclosed no relevant financial relationships.
Ann Oncol. Published online August 4, 2011, and December 26, 2011. Abstract, Editorial
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