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Management of cutaneous melanoma: radiologists challenging and risk assessment

  • Diagnostic Imaging in Oncology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Melanoma patient remains a challenging for the radiologist, due to the difficulty related to the management of a patient more often in an advanced stage of the disease. It is necessary to determine a stratification of risk, optimizing the means, with diagnostic tools that should be optimized in relation to the type of patient, and improving knowledge. Staging and risk assessment procedures are determined by disease presentation at diagnosis. Melanoma staging is a critical tool to assist clinical decision-making and prognostic assessment. It is used for clinical trial design, eligibility, stratification, and analysis. The current standard for regional lymph nodes staging is represented by the sentinel lymph node excision biopsy procedure. For staging of distant metastases, PET-CT has the highest sensitivity and diagnostic odds ratio. Similar trend is observed during melanoma surveillance. The advent of immunotherapy, which has improved patient outcome, however, has determined new issues for radiologists, partly due to atypical response patterns, partly due to adverse reactions that must be identified as soon as possible for the correct management of the patient. The main objectives of the new ir-criteria are to standardize the assessment between different trials. However, these ir-criteria do not take into account all cases of atypical response patterns, as hyperprogression or dissociated responses. None of these criteria has actually been uniformly adopted in routine. The immune-related adverse events (irAEs) can involve various organs from head to toe. It is crucial for radiologists to know the imaging appearances of this condition, to exclude recurrent or progressive disease and for pneumonitis, since it could be potentially life-threatening toxicity, resulting in pneumonitis-related deaths in early phase trials, to allow a proper patient management.

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Acknowledgements

The authors are grateful to Alessandra Trocino, librarian at the National Cancer Institute of Naples, Italy.

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Authors and Affiliations

  1. Radiology Division, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia”, Via Mariano Semmola, Naples, Italy

    Vincenza Granata, Igino Simonetti, Sergio Venanzio Setola & Antonella Petrillo

  2. Medical Oncology Division, Igea SpA, Naples, Italy

    Roberta Fusco

  3. Hepatobiliary Surgical Oncology Division, “Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Naples, Italia”,, Via Mariano Semmola, Naples, Italy

    Francesco Izzo

  4. Department of Skin Cancers, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy

    Luigi Scarpato, Vito Vanella, Lucia Festino, Ester Simeone & Paolo Antonio Ascierto

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Granata, V., Simonetti, I., Fusco, R. et al. Management of cutaneous melanoma: radiologists challenging and risk assessment. Radiol med 127, 899–911 (2022). https://doi.org/10.1007/s11547-022-01522-4

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  • DOI: https://doi.org/10.1007/s11547-022-01522-4

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