PhD ceremony Mr. K.P. Wevers: Progression in melanoma considerations and implications in dissecting nodal fields

PhD ceremony: Mr. K.P. Wevers, 16.15 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Progression in melanoma considerations and implications in dissecting nodal fields

Promotor (s): prof. H.J. Hoekstra

Faculty: Medical Sciences

Cutaneous melanoma, which is the most malignant skin cancer type, has one of the fastest increasing incidence rates of all cancers in the western world. In the Netherlands, its incidence has more than doubled over the past two decades. In 2013, about 5000 people in the Netherlands and will be diagnosed with melanoma.

The sentinel lymph node biopsy has enabled better selection of those melanoma patients who are most likely to benefit from dissection of their regional lymph node basin. However, still 80% of sentinel-node positive patients have no metastases found in the additionally dissected lymph nodes. Research shows that combining patient and tumour characteristics with the melanoma biomarker S-100B, enables risk stratification for narrowing the selection of patients for complete lymph node dissection. In case of clinically manifest nodal metastases, a regional lymph node dissection improves regional control and survival. Furthermore, it was shown that nodal metastases in the neck have a better prognosis compared to axillary and groin sites. Moreover, the preoperatively measured biomarker S-100B is one of the most important predictors of melanoma prognosis in these patients.

In conclusion, this thesis reveals different clinicopathological factors that improve the staging of melanoma patients with nodal metastases, as well as patient selection for lymph node dissection and experimental (neo)adjuvant systemic therapy. The results contribute to the optimization of the surgical management of melanoma patients with nodal metastases and their survival.