Melanoma: Epidemiological studies in the Nord-East of France

Transcription

1 Melanoma: Epidemiological studies in the Nord-East of France F Grange, 1 C Barbe, 2 F Vitry, 2 D Lipsker, 3 F Aubin, 4 G Hedelin, M Velten, 5 S Dalac, 6 F Truchetet, 7 C Michel, 8 ML Batard, 9 F Granel- Brocard, 10 A Le Clainche, 2 A Buemi, 5 S Dalle, 11 E Hibon, 12 P Bernard, 1 G, A Danzon, AS Woronoff 5 Service de dermatologie, CHU de Reims 1, Strabourg 3, Besançon 4, Dijon 6, Thionville 7, Mulhouse 8, Colmar 9, Nancy 10, Lyon 11, CRICAM Reims 2, FRANCIM (registres Bas- Rhin, Haut-Rhin, Doubs et territoire de Belfort) 5,

2 primary CM - 89 LN metastases - exhaustivity 81%

3 Passage en RCP (2004) 29% des cas Facteurs explicatifs RCP Filière hospitalière (p=0,0001) Région géographique (p=0,0001) Breslow > 1,5 mm (p=0,0005) < 1,5: 23% 1,5 3: 44% > 3mm: 57% Analyse multivariée

4 marges d exérèse Marge conforme recommandations : 76% Marge faible: 8% âge > 60 ans (p=0,001) siège tête et cou (p=0,01) Breslow > 1,5 mm (p=0,0001) Marge excessive: 16% Région géographique (p=0,03) Filière libérale (p=0,0007) Analyse multivariée Analyse multivariée

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6 Circonstances de diagnostic: 5 groupes Groupe I : «MG» : 26,1% 2004 Groupe II : «autre spécialiste» : 6,3% Groupe III : «venu directement» : 45% Groupe IV : «suivi prospectif naevus» : 8,4% Groupe V : «diagnostic fortuit par dermato» : 14,1% Arch Dermatol 2010; 146: 240-6

7 Densité de dermatologues / 1000 km 2 Arch Dermatol 2010; 146: 240-6

8 Facteurs associés à un Breslow fin Modèle linéaire multivarié Absence d ulcération Types histologique SSM et LMM Age jeune Diagnostic par un dermatologue (groupe IV et V) Dépt «haute densité» en dermato p<0,0001 p<0,0001 p<0,0001 p<0,001 p<0,001 Arch Dermatol 2010; 146: 240-6

9 Champagne-Ardenne melanoma registry (from 2004) : 838 CM (including 661 invasive CM) Mean Breslow: 2.02 mm vs 1.59

10 Second data collection primary CM - 89 LN metastases - exhaustivity 81% primary CM LN metastases - exhaustivity: improved recommendations - new legislation (2004): «parcours de soins, MT - communication on previous results

11 . Clinical and socio-demographic characteristics of thick melanomas: a population-based, case-case study in France F Grange, MD, PhD; C Barbe, MD; F Aubin, MD, PhD; D Lipsker, MD, PhD; F Granel-Brocard, MD; M Velten, MD, PhD; S Dalac, MD; F Truchetet, MD; C Michel, MD; A Mitschler, MD; G Arnoult; A Buemi, MD; S Dalle, MD, PhD; P Bernard, MD, PhD; AS Woronoff, MD Arch Dermatol (accepted, 2012)

12 Main results

13 Main results

14 . Diagnosis and management of melanoma with regional lymph node metastases: a population- based study in France C Lévy-Sitbon a, C Barbe b, F Granel-Brocard c, D Lipsker d, F Aubin e, S Dalac f, F Truchetet g, C Michel h, A Mitschler i, G Arnoult j, A Le Clainche j, S Dalle k, P Bernard a, F Grange a J Eur Acad Dermatol (accepted, 2012)

15 Main result: comparison 2004 / 2008 Disparition of adjuvant chemotherapy 2004: 29% 2008: 0 More accurate selection of patients for adjuvant interferon

16 The role of general practitioners in diagnosis of cutaneous melanoma: a population-based study in France F Grange, a C Barbe, b L Mas, a F Granel-Brocard, c D Lipsker, d F Aubin, e M Velten, f S Dalac, g F Truchetet, h C Michel, i A Mitschler, j G Arnoult, k A Buemi, l S Dalle, m G Reuter, n P Bernard, a AS Woronoff, o F Arnold p Br J Dermatol (revision, 2012)

17 Melanomas diagnosed in a GP setting (vs others) 2,05 mm (vs 1,32mm; p <0,001) Age - 60 y - > 60 y Location - lower limb Odd Ratio [ ] - other location 1.3 [ ] p Histologic type - non nodular - Nodular [ ] Breslow 1.06 [ ] 0.02

18 CM in the elderly (2004 and 2008) (preliminary) 2004 and 2008 N = 1621 CM < 70 y N=1134 (70%) > 70 y N =487 (30%) p Diagnosis by a GP 33% 43% <0.001 Mean Breslow 1.35 mm 2.34 mm <0.001 Definitive surgery, performed Delay to definitive surgery > 6 w 93% 77% < % 32% 0,01 Insufficient margins 5% 17% <0,001 Adjuvant therapy, proposed (for Breslow > 1.5 mm) 59% 19% <0,001

19 MELEXT study Subvention: CIRLCC Mélanoma of the hand and foot diagnosed in Champagne Ardenne (CA) or Franche-Comté (FC: Doubs, territoire de Belfort) from 2004 to cases (CA: 106; FC: 59) Largest European «population-based» series Data collection Clinical and histological characteristics Outcome, survival (endpoint 31/12/10) 19

20 Head and neck melanoma Champagne-Ardenne melanoma registry ( ) 279 cases Submitted: J Invest Dermatol

21 location of head and neck melanoma in men and women Peripheral area Central area Hommes (n=120) Femmes (n=155) 68 (57) 32 (21) 52 (43) 123 (79) P value <0,0001 Men n = 59 (69) Women n = 26 (31) Total n = 85 (100) Left Right P value 34 (58) 25 (42) 7 (27) 19 (73) 41 (48) 44 (52) 0,009

22 Future collaborations? Other rare forms of melanomas? Ano-rectal Genital Mucosal head and neck Evaluation «ici-ailleurs» of secondary prevention programs Others

23 Dermatologues libéraux de l Inter-Région Nord-Est Acknowledgement Services de Dermatologie F Aubin, CHU de Besançon ML Batard, CH Colmar F Grange, CHU Reims S Dalac, CHU de Dijon F Granel-Brocard, CHU de Nancy D Lipsker, CHU de Strasbourg C Michel, CH Mulhouse F Truchetet, CHR Metz-Thionville CRICAM CHU de Reims et OMECHA D Jolly, C Barbe, A Le Clainche G Arnoult, E Quantin, B Baury E Hibon Registres des cancers : M Velten et G Hedelin, Bas-Rhin, Strasbourg A Buemi et JM Halna, Haut-Rhin, Mulhouse A Danzon, M Mercier, AS Woronoff, Besançon Financeurs Fondation de France SFD Ligue Marne et Ligue nationale GRSP Champagne- Ardenne