Publications by authors named "Serigne N Lo"

Background: There is compelling evidence that the incidence of melanoma in cigarette smokers is substantially lower than in non-smokers. However, the risks of both recurrence and death appear to be higher in smokers if melanoma does develop. The magnitude of these increased risks is poorly documented.

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Objective: Patient reported outcome measures (PROMs) are commonly collected in melanoma research. However, they are not used to guide immediate clinical care in Australia. This study explored the views and experiences of patients with Stage III melanoma and clinic staff during implementation of an electronic Patient-Reported Outcome Measures in melanoma (ePROMs-MEL) pilot to assess distress and quality of life.

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Background: Factors associated with nonadherence to guideline-recommended complete excision of suspicious cutaneous lesions are unclear.

Objective: The purpose of this study was to analyze patient, melanoma, and clinician factors associated with initial diagnostic biopsy type and determine whether unwarranted variation from guidelines occurred.

Methods: This population-based, cohort study involved the analysis of data from questionnaires completed by clinicians who managed patients with newly diagnosed, histopathologically confirmed primary invasive cutaneous melanomas reported to the New South Wales Cancer Registry between 2006 and 2007.

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Objective: To investigate the effectiveness of the Melanoma Care Programme when implemented into routine clinical practice coupled with fear of cancer recurrence (FCR) screening and a stepped-care model of intervention delivery.

Methods: Using a Type-I hybrid effectiveness-implementation design, individuals with stage 0-II melanoma and a Fear of Cancer Recurrence Inventory FCR severity score of ≥ 13 were offered the Melanoma Care Programme. The programme included a psychoeducational booklet and 3 to 5 psychotherapeutic telehealth sessions with a clinical psychologist, timed around routine dermatological appointments.

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Immune checkpoint inhibitors (ICI) can achieve durable responses in patients with advanced melanoma, and results from clinical trials suggest cure may be possible for a subset of patients. Despite clinical trial data, little is known about the risk, character, and clinical outcome of late recurrences after ICI. This study aimed to explore the disease outcomes and survival in a cohort of patients with long-term responses to ICI.

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Background: Although most melanomas drain to the more common major lymph node basins (axilla, groin, neck), rarely they drain to deep SLN locations such as intra-abdominal and intra-thoracic (including intercostal and internal mammary) sites, which pose a higher surgical risk and complexity for procurement. Our study is aimed at determining the rate of positivity and likelihood of recurrence in these nodal sites to guide management decisions for patients with truncal melanomas which drain to these 'deep' SLN locations.

Methods: Retrospective data collected between May 2008 and May 2022 including all patients with truncal melanomas who underwent lymphoscintigraphy resulting in the identification of deep SLNs in intra-abdominal and intra-thoracic sites were included.

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Importance: Most patients who present with primary cutaneous melanomas have thin tumors (≤1.0 mm in Breslow thickness, ie, pT1a and pT1b). Although their prognosis is generally considered to be excellent, there is limited precise information on the association of risk of death with specific Breslow measurements in thin lesions.

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Lentigo maligna (LM) is a growing problem worldwide and the main type of melanoma in situ in some Caucasian populations. It presents as a spectrum from atypical intraepidermal melanocytic proliferation (AIMP) to invasive lentigo maligna melanoma (LMM). Accurate diagnosis and staging are crucial for determining appropriate management strategies.

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Article Synopsis
  • Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of melanoma, but about 40% of patients still do not respond, making prediction of response difficult.
  • A new method combines immune-related gene expression patterns with tumor size to better forecast treatment success in advanced melanoma patients.
  • By analyzing tumor samples before and shortly after treatment, researchers found that the ratio of immune activity to tumor volume significantly improved the prediction of ICI response, indicating that a higher immune response compared to tumor burden is essential for effective treatment.
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  • Cutaneous confocal microscopy (CCCM) is a technique that allows for detailed imaging of the skin at a cellular level, and this study tested a remote version (Remote-CCM) to enhance access to skin cancer diagnoses.
  • In the study, 201 lesions were assessed, with Remote-CCM showing a sensitivity of 89% for detecting skin malignancies and a specificity of 64%, effectively reducing unnecessary biopsies in 90% of benign cases.
  • The findings suggest that while Remote-CCM is accurate and can lower biopsy rates, it may not be suitable for potential cases of squamous cell carcinoma (SCC), indicating a need for follow-up on uncertain melanoc
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  • - Tumoral melanosis (TM) is characterized by clusters of melanin-filled macrophages in tissues, commonly linked to regressed melanoma, and is increasingly recognized due to advancements in melanoma treatments.
  • - A study from 2006 to 2018 examined TM cases at a single institution, finding 79 patients with TM, predominantly in older males and often localized to the skin or lower limb, highlighting a strong correlation with melanoma cases.
  • - Results indicated that patients with TM showed improved melanoma-specific survival compared to non-TM cases, particularly those without prior treatment, although no significant differences were found in recurrence-free survival.
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The prognosis of a patient with a primary cutaneous melanoma is known to be related to the Breslow thickness of their tumor. This study sought to determine long-term (30-year) survival rates for the four AJCC 8th Edition T-categories by analyzing Australian registry data for 210,042 melanoma patients diagnosed from 1982-2014. The 30-year incidence rates of death due to melanoma and non-melanoma causes (with 95% confidence intervals) were 7.

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Background: Melanoma is increasingly recognized as a heterogeneous disease, with conflicting evidence regarding whether cutaneous head and neck melanoma (CHNM) represents a distinct entity.

Objective: Comparison of clinicopathological features and treatment outcomes of CHNM and cutaneous melanomas of other sites (CMOS).

Methods: Patients with CHNM and CMOS diagnosed between 2000 and 2018 were included.

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Background: There is a strong correlation between cigarette smoking and the development of many cancer types. It is therefore paradoxical that multiple reports have suggested a reduced incidence of melanoma in smokers. This study aimed to analyze all existing studies of melanoma incidence in smokers relative to nonsmokers.

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Immune checkpoint inhibitors and BRAF-targeted therapy each improve survival in melanoma. Immune changes early during targeted therapy suggest the mechanisms of each drug class could work synergistically. In the non-comparative, randomized, phase 2 NeoTrio trial, we investigated whether targeted therapy could boost the proportion of patients achieving long-term recurrence-free survival with neoadjuvant immunotherapy in resectable stage III BRAF-mutant melanoma.

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Objective: We investigated the association between sun protection behaviours and demographic and melanoma risk characteristics of patients attending Australian melanoma specialist clinics. This may assist in targeting and tailoring melanoma prevention patient education for people at high-risk and specific population subgroups.

Methods: A cross-sectional analysis of questionnaire data collected from participants attending the dermatology clinics at two major melanoma centres in Sydney, Australia between February 2021 and September 2023.

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Article Synopsis
  • In a study comparing neoadjuvant (before surgery) and adjuvant (after surgery) immunotherapy for stage III melanoma, neoadjuvant treatment showed greater effectiveness.
  • The trial involved random assignment of 423 patients to receive either two cycles of neoadjuvant ipilimumab plus nivolumab followed by surgery, or surgery followed by 12 cycles of adjuvant nivolumab.
  • Results indicated a significantly higher 12-month event-free survival rate in the neoadjuvant group (83.7%) compared to the adjuvant group (57.2%), with neoadjuvant therapy leading to better patient outcomes and more major pathological responses despite a higher incidence of severe adverse events.
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  • This study examines the effectiveness of a risk calculator for predicting sentinel lymph node (SLN) positivity in patients with AJCC T1-T2 melanomas at the Melanoma Institute Australia.
  • The analysis compared SLN biopsy rates and positivity between two time periods: before and after implementing the nomogram, with findings showing increased SLN biopsy rates in lower-risk melanoma patients post-nomogram.
  • The results suggest that the SLN risk calculator significantly impacts clinical practice, particularly for T1a and higher-risk T1b melanomas, indicating a need for updated guidelines to improve patient selection for SLN biopsies.
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Background: Neoadjuvant systemic therapy (NAST) for patients with stage III melanoma achieves high major pathologic response rates and high recurrence-free survival rates. This study aimed to determine how NAST with targeted therapies (TTs) and immune checkpoint inhibitors (ICIs) influences surgical outcomes after lymph node dissection in terms of complications, morbidity, and textbook outcomes.

Methods: Patients who underwent a lymph node dissection after either NAST in a clinical trial or upfront surgery for stage III melanoma between 2014 and 2022 were identified from an institutional research database.

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  • The study examines the effectiveness of combining anti-PD-1 and anti-CTLA-4 therapies compared to anti-PD-1 alone for advanced melanoma patients with liver metastases.
  • Results showed a higher objective response rate in the combination therapy group (47%) versus anti-PD-1 monotherapy (35%), though no significant differences were found in progression-free or overall survival rates.
  • The study concludes that combination therapy may offer better treatment responses, suggesting it should be considered for patients with liver metastases in future treatment plans.
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Background: Psoriasis is a risk factor for cardiovascular disease. Biologic agents have revolutionised psoriatic skin control. This study aims to assess the change in cardiovascular risk factors in a cohort of patients treated with 1 year of continuous biologic treatment.

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Background: The introduction of adjuvant systemic treatment for patients with high-risk melanomas necessitates accurate staging of disease. However, inconsistencies in outcomes exist between disease stages as defined by the American Joint Committee on Cancer (8th edition). We aimed to develop a tool to predict patient-specific outcomes in people with melanoma rather than grouping patients according to disease stage.

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