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JADA Specialty Scan - O & M Pathology
 
 
JADA Specialty Scan
 

Treatment of mucosal melanomas and patient outcomes

Mucosal melanomas are a rare clinical entity, representing 1% to 2% of all melanomas. In this retrospective study, published in the January issue of Medicine, the authors evaluated 75 patients with mucosal melanoma that were diagnosed from 1993 through 2015.

Researchers from the Department of Dermatology and Allergy, Hanover Medical School, Hanover, Germany, divided patients diagnosed with primary mucosal melanomas into 3 groups based on the tumor’s location: head/neck (n = 32), female genital tract (FGT) (n = 24), and anorectal (n = 19). Their population was staged, at initial diagnosis, as I, local tumor (n = 50); II, regional lymph node metastasis (n = 18); and III, distant metastasis (n = 7).

The median age of patients at the initial diagnosis was 66 years. Of the 75 patients, 43 were female, reflecting the FGT arm of the study. According to the medical records, 64 patients (85%) underwent total excision of the mucosal melanoma. Forty-three patients (57%) underwent total lymphadenectomy of the regional lymph nodes, 20 of whom had metastasis at the time of the initial diagnosis and 8 had a positive sentinel lymph node. In 15 of the 43 patients, total lymphadenectomy was performed on an elective basis.

The authors reported that 20 patients received adjuvant radiotherapy (17 for head/neck melanoma, 1 for FGT melanoma, and 2 for anorectal melanoma). Twenty-one patients received adjuvant interferon alpha (3 × 3 million units per week for 24 months). Five of these patients also underwent subsequent adjuvant radiotherapy.

Four patients with gene mutations were treated with targeted therapies; 1 experienced a short-term partial remission (PR), 1 achieved short-term stable disease (SD), and 1 experienced a 6-month PR (ipilimumab) followed by a 5-month PR (vemurafenib). Another 6 patients received ipilimumab therapy, 1 of whom achieved a 4.5-month SD. Of 7 patients who received programmed disease-1 checkpoint inhibitors, 1 achieved a 366-day PR and 1 achieved a 240-day PR.

The median follow-up time was 32 months. Of the 61 patients who underwent complete excision of the tumor, 48 (79%) experienced a recurrence. The recurrence was local or an in-transit metastasis in 18 patients, a regional lymph node metastasis in 8 patients, and a distant metastasis in 22 patients. The median time to first recurrence was 14 months.

During the follow-up period, 48 of the 75 patients (64%) died of the disease, while 1 patient died of another cause. The overall 5-year survival rate was 26.3%: 22.0% in the head/neck group, 33.2% in the FGT group, and 10.6% in the anorectal group.

Patients with stage 1 disease at the initial diagnosis were at a significant advantage in terms of overall survival (P = .04) and recurrence-free survival (P < .001) compared with patients with stage II or III disease, the authors wrote. In addition, postoperative radiotherapy significantly reduced (P = .02) the high rate of local recurrences in patients whose primary tumor was in the head/neck region.

Mucosal melanomas exhibited a poor prognosis in this study, with metastasis often already present at the time of diagnosis, the authors wrote. For patients with inoperable metastatic tumors, targeted therapies and immunotherapies with checkpoint inhibitors can be considered; however, further research is needed in this area.

Read the original article here.

 

Consulting Editor: Paul C. Edwards, MSc, DDS, FRCD(C)
Editor, American Academy of Oral and Maxillofacial Pathology
Professor, Department of Oral Pathology, Medicine and Radiology
School of Dentistry, Indiana University

 

Associate Consulting Editor: Zoya Kurago, DDS, PhD
Associate Professor of Oral Biology, Oral Health and Diagnostic Sciences,
Graduate Studies, Pathology
Department of Oral Health and Diagnostic Sciences
Dental College of Georgia, Augusta University
Chair, Research and Scientific Affairs Committee,
American Academy of Oral and Maxillofacial Pathology

 

Assessing dental evaluations and treatment protocols before initiating therapy for cancer

In this systematic review, researchers examined the prevalence of odontogenic-related infections in patients undergoing treatment for cancer and the efficacy of dental evaluations and treatment protocols before the start of cancer therapy. The study was published online July 22 in Supportive Care in Cancer.

Investigators conducted a literature search of PubMed and Embase databases for English-language articles published from January 1, 2009, through June 30, 2016. They included studies in peer-reviewed journals that assessed dental disease in patients of all ages who underwent treatment for cancer. Systematic or narrative reviews, opinion papers, case reports, abstracts, and animal model or in vitro studies were excluded. Studies evaluating dental treatment protocols before head and neck irradiation were also excluded because risks for these patients do not include immunosuppression and bloodstream infections.

Two reviewers independently examined each article using an electronic collection form customized for data pertaining to dental disease, the authors wrote. More than 1,000 titles and abstracts were identified in the literature search; 59 articles satisfied the inclusion criteria and were grouped into “dental infections,” “pre-cancer therapy dental clearance,” “prevention and treatment,” and “dental-related microorganisms.”

According to the authors, 11 studies assessed dental evaluations and treatment protocols before the start of antineoplastic chemotherapy and hematopoietic stem cell transplantation. They categorized these 11 studies into 3 broad groups: complete protocols in which all dental disease was treated, partial protocols in which only severe dental disease was treated (such as extraction of partially erupted third molars with purulence), and minimal protocols in which the patient was not evaluated or treated because of time constraints or in which treatment was administered only when the patient exhibited symptoms.

The study findings showed a relatively low weighted prevalence of dental infections and pericoronitis during treatment for cancer (5.4% and 5.3%, respectively). Postextraction complications typically were low (3%) except in cases of third-molar extractions (40%).

The authors concluded that partial dental evaluations and treatment protocols are feasible when time constraints do not allow complete patient evaluations and treatment of all dental disease before initiation of cancer therapy. The findings also illustrate the need for patients to use fluoride products to prevent dental caries and for clinicians to reinforce their use in light of the dramatic decline in compliance over time. Use of chlorhexidine mouthrinse once or twice daily (0.12%-0.2% concentration) was also recommended to reduce plaque and Streptococcus mutans counts after head and neck radiation treatment. These recommendations are supported by observations of an increase in cariogenic microbes in patients who underwent head and neck irradiation but not in those who received antineoplastic chemotherapy.

The authors also recommended use of resin-based composites, resin-modified glass ionomer cement, and amalgam restorations over conventional glass-ionomer cement in patients who comply with fluoride regimens.

Read the original article here.

 
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Mark your calendar for the 2018 Joint AAOMP and IAOP meeting
Join AAOMP and the IAOP for our Joint Meeting June 22-June 28, 2018 at the Westin Bayshore Hotel in Vancouver, BC, Canada. Visit www.aaomp.org for more details.

 

Examining the association between dietary fiber intake and cancer of the oral cavity/pharynx and larynx

Dietary fiber may play a protective role against cancer, although the evidence to date is limited. In this study, researchers examined the association between dietary fiber intake and cancer of the oral cavity/pharynx and larynx. The study was published online July 14 in International Journal of Cancer.

Researchers from several universities used data on dietary fiber intake from 10 case-control studies participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. The INHANCE was established in 2004 to examine the etiology of head and neck cancers (HNCs) by means of pooled analyses of individual-level data.

This study included cases originally classified as an invasive cancer of the oral cavity, oropharynx, hypopharynx, oral cavity or pharynx not otherwise specified, larynx, or HNC unspecified. Patients with cancers of the salivary glands or of the nasal cavity, ear, or paranasal sinuses were excluded. The analysis was based on 18,207 participants, of whom 5,959 had HNC and 12,248 served as control participants.

The researchers calculated participants’ intake of total energy, several nutrients, and food components including fiber by combining data from study-specific food frequency questionnaires with data from country-specific food composition databases. They adjusted for daily energy intake excluding alcohol by calculating nonalcohol energy-adjusted fiber intake for each case-control study.

More than 70% of study participants were white and male, the authors wrote. In addition, case participants were less educated than control participants and more likely to smoke and consume alcohol.

The researchers estimated odds ratios (ORs) and 95% confidence intervals (CIs) using unconditional multiple logistic regression applied to quintile categories of nonalcohol energy-adjusted fiber intake. They adjusted for tobacco and alcohol use, as well as for other known or putative confounders. For oral and pharyngeal cancer combined, the authors conducted separate analyses according to anatomic subsite (oral cavity, oropharynx/hypopharynx, and oral cavity or pharynx not otherwise specified). For both cancer sites, they performed stratified analyses by age, education, geographic region, body mass index, tobacco smoking status, and alcohol consumption. Using likelihood ratio tests, they also tested heterogeneity between and among strata.

The study findings showed that fiber intake was inversely associated with oral and pharyngeal cancer (OR for fifth versus first quintile, 0.49; 95% CI, 0.40 to 0.59; P for trend < .001) and with laryngeal cancer (OR, 0.66; 95% CI, 0.54 to 0.82; P for trend < .001). The researchers also observed decreasing ORs with higher intake of fiber across oral cavity and pharyngeal cancer subsites. Moreover, the study results showed an inverse association between dietary fiber intake and risk of oral cavity and pharyngeal cancer or laryngeal cancer in most strata.

Based on the results of this large-scale pooled analysis, the authors concluded that dietary fiber may play a protective role against HNC. Future studies should examine country-specific sources of fiber, such as fruits, vegetables, beans, nuts, and whole-grain breads, to determine which foods are the main determinants of the inverse relationship observed between fiber intake and incidence of HNC.

Read the original article here.

 

Investigating the co-prevalence of cervical and oropharyngeal HPV infection in patients with high-grade squamous intraepithelial lesions

Human papillomavirus (HPV) is the most common sexually transmitted virus in developed countries. Although most infections resolve spontaneously, about 10% to 40% persist and can lead to high-grade squamous intraepithelial lesions (HSILs). In this study, researchers investigated the co-prevalence of cervical and oropharyngeal HPV in patients with HSILs. The study was published in the July issue of Journal of Lower Genital Tract Disease.

Between February 2014 and June 2015, researchers from the University Medical Center Hamburg Eppendorf, Germany, and the Medical Center Hamburg Altona, Germany, conducted a prospective cohort study to determine the prevalence of oropharyngeal HPV infection in women with high-risk (HR) HPV-positive (HPV+) HSIL. The initial study cohort consisted of 235 patients between the ages of 18 and 45 years; 223 of these patients underwent cervical HPV testing, 221 underwent brushing of the tonsils, and 146 underwent oral lavage.

Of the 223 patients who underwent HPV testing, 207 were HPV+ at the cervix. In 161 of the 235 screened patients, an HSIL was histologically confirmed; 148 of these patients were HPV+ and 143 were HR-HPV+. The researchers excluded 8 patients because of missing oral samples or being older than 45 years. Thus, the final study cohort consisted of 135 patients with HR-HPV+ histologically confirmed HSIL.

The researchers reported that HPV DNA was detected in only 6 of the 135 oral specimens (4.4%). All 6 patients underwent cervical and tonsillar smear testing with both HPV tests, and 3 also underwent oral lavage testing. In 3 of the 6 patients, the same HPV type was detected in the tonsillar and cervical smears (HPV16, HPV35, and HPV45).

The investigators used a standardized questionnaire to collect demographic data from patients, as well as information pertaining to tobacco and alcohol use, history of sexually transmitted diseases, and sexual activity. Almost three-fourths of the participants lived in a long-term relationship and had fewer than 10 lifetime sexual partners. All patients with HPV+ oral specimens reported that they engaged in oral sex compared with 93% of patients with oral HPV- test results. In addition, 62 of 129 women (48%) who tested negative for oral HPV reported that they visited a dentist at least once per year compared with 1 of 6 women (17%) with positive oral HPV test results. However, information regarding dental visits was provided for only about one-half the women in both groups.

“More data are necessary to improve our understanding of viral transmission to the oral mucosa, [the] natural course of [these] infections, HPV-related oral carcinogenesis, and factors driving concomitant oral and genital HPV infection” in men and women, the authors wrote. Based on the results of this study, the researchers concluded that “simultaneous testing of oropharyngeal HPV infection in women with cervical dysplasia does not seem promising as a screening strategy for OSCC.”

Read the original article here.

 

2018 AAOMP and IAOP Joint Meeting set for June 2018

Join the American Academy of Oral and Maxillofacial Pathology and the International Association of Oral Pathologists at a Joint Meeting, June 23-June 28, 2018 in Vancouver, BC. The theme will be 21st Century Diagnostics: Molecular Genetics to Immunohistochemistry.

The conference will feature top international presenters speaking on topics including:

• Soft tissue and bone sarcomas of the head and neck with emphasis on ancillary studies to include IHC and molecular.
• Tumor microenvironment.
• Challenging cases in head and neck pathology.
• Dermatologic tumors for oral and maxillofacial pathologists.
• Case studies involving head and neck radiology.
• Molecular alterations in head and neck cancer/salivary gland tumors/thyroid cancer with emphasis on diagnosis and treatment.
• Odontogenic tumors: molecular pathology to personalized medicine.

For more information, visit www.aaomp.org

8 questions to ask before you choose digital radiographic equipment

Are you ready to make the leap from conventional film to digital imaging? Dr. Laurie Carter, professor and director of Oral and Maxillofacial Radiology at Virginia Commonwealth University, presents a list of important questions to ask before you buy. Read more in the Summer 2017 issue of Dental Practice Success — ADA Publishing’s award-winning e-magazine that features the latest tips from experts to help you improve your practice and your life.

This issue also features articles on managing practice growth and change, how to build on the single-tooth treatment concept, ergonomics tips, creating positive Facebook calls to action, learning to let go of stress, and the importance of having an estate plan.

 
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Mark your calendar for the 2018 Joint AAOMP and IAOP meeting
Join AAOMP and the IAOP for our Joint Meeting June 22-June 28, 2018 at the Westin Bayshore Hotel in Vancouver, BC, Canada. Visit www.aaomp.org for more details.

 

JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

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