Regional aspects of melanoma diagnosis and treatment
|PhD ceremony:||Ms A.M. (Annemarleen) Huismans|
|When:||March 23, 2015|
|Supervisors:||prof. H.J. Hoekstra, prof. J. Thompson|
|Co-supervisor:||dr. H.M. Kroon|
|Where:||Academy building RUG|
|Faculty:||Medical Sciences / UMCG|
This thesis describes several aspects of diagnosis and treatment of melanoma metastases. The first part of the thesis covers isolated limb infusion (ILI). ILI was developed in the 1990s as a simplified minimal invasive alternative to isolated limb perfusion (ILP). Both procedures can be used to treat unresectable melanoma confined to a limb with a single high dose of chemotherapy in the affected extremity. After its introduction, small modifications to the ILI protocol have been made as experience with the procedure increased. This thesis shows that this process has led to improved treatment outcomes. Adjustment of the chemotherapy dose in patients with overweight is not likely to further decrease toxicity. A systematic review of the literature shows that treatment with ILI is associated with low regional toxicity and comparable response rates to ILP.
Part two of this thesis shows that sentinel lymph node biopsy (SLNB) is not yet used in all eligible patients in the Netherlands. Patients with head-and-neck melanomas, elderly and those with lower socio-economic status are less likely to undergo SLNB.
Part three demonstrates that scalp melanoma metastasizes more often to the brain compared to melanoma located elsewhere on the body. More intensive follow-up of patients with scalp melanoma should be considered since with the recent development of new treatment options early detection of brain metastases may improve quality of life and survival.
In conclusion, this thesis shows the ongoing progress in disease management of melanoma, which leads to more effective staging and improved treatment outcomes.