Дифференциальная диагностика изменений в регионарных лимфатических узлах у больных меланомой кожи при ультразвуковом исследовании

В иллюстрированном обзоре литературы рассмотрены возможности ультразвукового исследования в дифференциальной диагностике опухолевых и неопухолевых изменений в регионарных лимфатических узлах. Охарактеризованы ультразвуковые критерии, позволяющие выявить злокачественное поражение лимфатических узлов, на основе использования современных методик ультразвуковой диагностики. Сделан акцент на ультразвуковые характеристики лимфатических узлов у больных меланомой кожи. В частности, рассмотрены критерии диагностики раннего вовлечения регионарных лимфатических узлов в опухолевый процесс и возможности ультразвукового исследования в пред операционном стадировании меланомы кожи. Ключевые слова: ультразвуковая диагностика, поверхностные лимфатические узлы, сторожевой лимфатический узел, регионарные лимфатические узлы, лимфаденопатия, меланома кожи, метастазы; ultrasound, superficial lymph nodes, regional lymph nodes, sentinel node, lymphadenopathy, cutaneous melanoma, metastases

Combination of Pembrolizumab with Electrochemotherapy in Cutaneous Metastases from Melanoma: A Comparative Retrospective Study from the InspECT and Slovenian Cancer Registry

Electrochemotherapy (ECT) is an effective locoregional therapy for cutaneous melanoma metastases and has been safely combined with immune checkpoint inhibitors in preliminary experiences. Since ECT is known to induce immunogenic cell death, its combination with immune checkpoint inhibitors might be beneficial. In this study, we aimed to investigate the effectiveness of ECT on cutaneous melanoma metastases in combination with pembrolizumab. We undertook a retrospective matched cohort analysis of stage IIIC–IV melanoma patients, included in the International Network for sharing practices of ECT (InspECT) and the Slovenian Cancer Registry. We compared the outcome of patients who received the following treatments: (a) pembrolizumab alone, (b) pembrolizumab plus ECT, and (c) ECT. The groups were matched for age, sex, performance status, and size of skin metastases. The local objective response rate (ORR) was higher in the pembrolizumab-ECT group than in the pembrolizumab group (78% and 39%, p < 0.001). The 1 year local progression-free survival (LPFS) rates were 86% and 51% (p < 0.001), and the 1 year systemic PFS rates were 64% and 39%, respectively (p = 0.034). The 1 year overall survival (OS) rates were 88% and 64%, respectively (p = 0.006). Our results suggest that skin-directed therapy with ECT improves superficial tumor control in melanoma patients treated with pembrolizumab. Interestingly, we observed longer PFS and OS in the pembrolizumab-ECT group than in the pembrolizumab group. These findings warrant prospective confirmation.

Topography of Protein Kinase C βII in Benign and Malignant Melanocytic Lesions

Background. Protein kinase C βII promotes melanogenesis and affects proliferation of melanocytic cells but is frequently absent or decreased in melanoma cells in vitro. Objective. To investigate PKC-βII expression and spatial distribution within a lesion in various benign and malignant melanocytic proliferations. Methods. Expression of PKC-βII was semiquantitatively assessed in the various existing compartments (intraepidermal [not nested], junctional [nested], and dermal) of benign (n = 43) and malignant (n = 28) melanocytic lesions by immunohistochemistry. Results. Melanocytes in the basal layer of normal skin or in lentigo simplex stained strongly for PKC-βII. Common nevi lacked completely PKC-βII. All other lesions expressed variably PKC-βII, with cutaneous melanoma metastases displaying the lowest rate of positivity (14%). In the topographical analysis within a lesion, PKC-βII expression was largely retained in the intraepidermal and junctional part of all other lesions (dysplastic nevus, lentigo maligna, and melanoma). Reduced expression of PKC-βII was found in the dermal component of benign and malignant lesions ( P = .041 vs intraepidermal). PKC-βII expression in the various compartments did not differ significantly between benign and malignant lesions. Conclusions. The current study revealed a significant correlation between PKC-βII expression and spatial localization of melanocytes, with the lowest expression found in the dermal compartment and the highest in the epidermal compartment.