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Current approaches in melanoma screening

Arenberger, P.

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doi: 10.1097/01.cmr.0000382778.06064.87
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Malignant melanoma belongs to the most malignant tumors of the skin and mucous membranes, particularly due to its aggressive biological behavior and tendency to generate early metastases. Therefore, there is a demand on a new, improved method, which would be able to predict the clinical prognosis of the patient. Imaging methods nowadays are able to inform us about the presence of lymph node or visceral metastasis only in an advanced stage. It should be useful to develop a noninvasive examination which could detect early melanoma metastasis. The detection of circulating melaoma cells has been proposed as a sensitive method for selecting patients who are in a high risk to relapse. However, since the original description of molecular monitoring of circulating melanoma cells by reverse transcriptase-PCR (RT-PCR), controversial data on sensitivity and clinical relevance of this method have been reported. There are two possible reasons for the conflicting results: (a) a single marker detection (b) conventional or semiquantitative RT-PCR assay. Heterogeneity of the expression of the tumor antigens poses one of the major problems in detection of circulating melanoma cells. Single marker detection has a limited value as a prognostic marker and the multiple marker assay including other tumor associated antigens is suggested to increase the sensitivity and specificity of this method. Moreover, the majority of these studies investigated tyrosinase as a unique marker, however its usefulness as a melanoma marker is highly debated (b).

Detection of melanoma cells in peripheral blood is a promissing method for monitoring hematogenous spread of melanoma cells and thus to detect early metastasis and to better stratify candidates for adjuvant immunotherapy. Inconsistent data on the sensitivity and clinical relevance of this method have been reported. Recently, a multimarker real-time RT-PCR for quantification of 5 melanoma markers: Melan-A, gp 100, MAGE-3, MIA and tyrosinase was developed and will be discussed.

© 2010 Lippincott Williams & Wilkins, Inc.