13May 2018

CUTANEOUS MALIGNANT MELANOMAS: EPIDEMIOLOGICAL, CLINICAL AND THERAPEUTIC ASPECTS. EXPERIENCE OF THE PLASTIC SURGERY DEPARTMENT IN MOHAMMED VI HOSPITAL OF MARRAKECH- MOROCCO.

  • Department of Plastic and Reconstructive Surgery in CHU Mohamed VI, Marrakech, Morocco.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Melanoma is a tumor proliferation developed at the expenseof melanocytes,the incidence of melanomais increasingworldwidemakesita realpublic health concern,the severity of thismalignancy tumor isassociated witha strong ability tometastasize,involvingthe prognosisof the patientif the lesionis notdetected early henceimproving earlydiagnosis remainsa major challenge. The objective of ourwork is to studythe epidemiological ,pathological,, therapeutic, prognostic and preventive aspects of melanomathrough aretrspective studyof 33patientscollectedfrom January 2010 to January 2017 inin plasticsurgery andburnsofthe CHUMohammed VIMarrakech. The average age of our patients was 61 years with a female predominance. Sun exposure was found in 91 % of our patients which supports the important role complained of sun exposure in the development of melanoma. The location the sole of the foot is by far the most frequent (73% of our patients). On histological level, Acrolentigineux (61%) and nodule (24%) types are the most common, with a Breslow thickness varies between 2 mm and 12 mm and Clark level varies between IV and V in 75% of our patients, reflecting the significant delay between the start of the lesion and the consultation which is estimated at 2 years and consequently the lack of effective means of screening for patients at risk in our population. On therapeutically level, at the initial stage, only surgical excision, constituting the gesture that allows both diagnosis and treatment of the lesion which must be done as soon as possible to ensure prolonged survival. At the loco-regional stage, surgical resection with regional lymph node dissection is the standard of care. The sentinel node biopsy provides very precise classification of cutaneous melanoma, but has not been reported to have a significant impact on survival. The dissection effect on survival is a subject of inquiry. Two distinct approaches have emerged to try to prolong the survival of patients with metastatic melanoma: Immunomodulation with anti- CTLA4 monoclonal antibodies and targeted therapy with inhibitors of BRAF or MEK for melanoma with BRAF mutated, recent studies have shown that the combination of inhibitors of BRAF and inhibitors of MEK may improve the progression-free survival and eventually increase overall survival, the choice of therapy should be individualized in each case depending on various factors such as BRAF mutation status, age, co-morbidities and topography of metastases ,while chemotherapy and radiation therapy can be used to relieve the symptoms without significant impact on patient survival. Preventing melanoma is a real public health problem requires education of the general population on the need for sunscreen and awareness of melanoma and encouraging early diagnosis with the training of health professionals.


  1. Stoitchkov et T. Le Bricon?: Marqueurs biologiques actuels de progression du m?lanome cutan?.Annales de biologie clinique 2000; 8 (2):157-65
  2. M?lanomes malins cutan?s.Objectif Peau 1994 : 24-28.
  3. Mich?le M. Delaunay.M?lanome cutan?: le diagnostic pr?coce, un devoir d?efficacit?.La revue du praticien 2004; 54: 1179-1180.
  4. Jean-luc Bulliard, Brian Cox. Cutaneous malignant melanoma in New Zealand: trends by anatomical site 1969-1993.International Journal of Epidemiology 2000; 29: 416-423
  5. Laurence Ch?rie-Challine, Jean-Michel Halna et Laurent Remontet.
  6. Situation ?pid?miologique du m?lanome cutan? en France et impact en termes de pr?vention. Bulletin Epid?miologique Hebdomadaire 2004 ; 2: 5-8.
  7. Bellut, I. Vivard, R. Unvois et al. Nouveaux cas de m?lanomes en Lorraine en 2000 et 2001 : enqu?te prospective sur deux ans r?alis?e par l?Union r?gionale des m?decins lib?raux de Lorraine. Nouv Dermatol 2003 ; 22 : 154-157.
  8. El Mesbahi, K. Zhouhair, T. El Ouzzani, S. Azzouzi, H. Lakhdar. M?lanome malin ? casablanca : une tumeur ? ne pas m?conna?tre ; Service de dermatologie, v?n?rologieCHU Ibn Rochd- Casablanca. Journal du praticien 2005 ; tome XIV suppl?ment : 21.
  9. Benzekri, R. Chraibi, J. Bouhlab, H. Chraibi, K. Senouci, M. Ait ourghroul, B. Hassam. mLes cancers cutan?s ? Rabat ; Service de dermatologie CHU Ibn Sina Rabat.Journal du praticien 2005 ; tome XIV suppl?ment : 202-206
  10. Bennouna Biaz, M. Ait Ourghroui, Habib-Dine et al. Le m?lanome au Maroc. Les nouvelles dermatologiques 1998; 17 (2) : 56-59.
  11. Nina M. Fisher, julie V. Schaffer, Marianne Berwick et al. Breslow depth of cutaneous melanoma: impact of factors related to surveillance of the skin, including prior skin biopsies and family history of melanoma. J Am Acad dermatol 2005; 53 (3): 393-406.
  12. Michel Halna, M. Grandadam, A. Buemi. Etude ?pid?miologique des cancers cutan?s bas?e sur la population d?un d?partement fran?ais de 1988 ? 1996. R?sultats du registre du cancer du Haut-Rhin. Nouv Dermatol 2000; 19 : 48-56
  13. Mathiey Boniol, bruce K. Armstrong, Jean-fran?ois dor?. Variation in incidence and fatality of melanoma by season of diagnosis in New South Wales Ausrtralia. Cancer Epidemiol Biomarkers Prev 2006; 15 (3): 524-528
  14. American Cancer Society. Cancer Facts & Figures 2015. Atlanta, Ga: American Cancer Society; 2015.The Office for National Statistics on request UK,
  15. July 2013, disponiblesur:(http://www.ons.gov.uk/ons/search/index.html?newquery=cancer+registrations 15- Wagner JD, Gordon MS, Chuang TY, Coleman JJ 3rd. Current therapy of cutaneous melanoma. Plast Reconstr Surg. 2001, 105: 1774-1799.
  16. Zanetti R, Rosso S, Martinez C, et al.: Comparison of risk patterns in carcinoma and melanoma of the skin in men: a multi-centre case-case-control study. Br J Cancer 94 (5): 743-51, 2006.
  17. Neale RE, Forman D, Murphy MF, et al.: Site-specific occurrence of nonmelanoma skin cancers in patients with cutaneous melanoma. Br J Cancer 93 (5): 597-601, 2005
  18. Nelemans PJ, Rampen FH, Ruiter DJ, et al.: An addition to the controversy on sunlight exposure and melanoma risk: a meta-analytical approach. J Clin Epidemiol 48 (11): 1331-42, 1995.
  19. Elwood JM, Jopson J: Melanoma and sun exposure: an overview of published studies. Int J Cancer 73 (2): 198-203, 1997. [PUBMED Abstract]
  20. Gandini S, Sera F, Cattaruzza MS, et al.: Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer 41 (14): 2040-59, 2005
  21. Bennouna Biaz F, Ait-Ourhrouil M, habib-Dine, Lakhdar H, El Guedari B,Souadka A et al. Le m?lanome au Maroc. Nouv Dermatol 1998; 1 7:56-59
  22. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39.
  23. Boniol M, Autier P, Boyle P, et al. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ 2012;345:e4757 doi: 10.1136/bmj.e4757.
  24. Diffey BL. A quantitative estimate of melanoma mortality from ultraviolet A sunbed use in the U.K. Br J Dermatol 2003;149:578-81.
  25. Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: Systematic review and meta-analysis. J Am Acad Dermatol 2014;70(5):847-857.
  26. Bishop JN, Harland M, Bishop DT: The genetics of melanoma. Br J Hosp Med (Lond) 2006, 67 (6): 299-304,
  27. Scherer D, Kumar R: Genetics of pigmentation in skin cancer, a review. Mutat Res 705 (2): 141-53, 2010
  28. Olsen CM, Carroll HJ, Whiteman DC. Estimating the attributable fraction for melanoma: a meta-analysis of pigmentary characteristics and freckling. Int J Cancer 2010;127:2430-45
  29. Goggins WB, Tsao H: A population-based analysis of risk factors for a second primary cutaneous melanoma among melanoma survivors. Cancer 97 (3): 639-43, 2003.
  30. Begg CB, Orlow I, Hummer AJ, et al.: Lifetime risk of melanoma in CDKN2A mutation carriers in a population-based sample. J Natl Cancer Inst 97 (20): 1507-15, 2005
  31. van der Leest RJ, Liu L, Coebergh JW, et al. Risk of second primary in situ and invasive melanoma in a Dutch population-based cohort: 1989-2008. Br J Dermatol 2012;167(6):1321-30.
  32. Marghoob AA, Slade J, Salopek TG, et al.: Basal cell and squamous cell carcinomas are important risk factors for cutaneous malignant melanoma. Screening implications. Cancer 75 (2 Suppl): 707-14, 1995.
  33. Rosenberg CA, Khandekar J, Greenland P, et al.: Cutaneous melanoma in postmenopausal women after nonmelanoma skin carcinoma: the Women's Health Initiative Observational Study. Cancer 106 (3): 654-63, 2006
  34. Brandt A, Sundquist J, Hemminki K: Risk of incident and fatal melanoma in individuals with a family history of incident or fatal melanoma or any cancer. Br J Dermatol 165 (2): 342-8, 2011.
  35. Hemminki K, Zhang H, Czene K: Incidence trends and familial risks in invasive and in situ cutaneous melanoma by sun-exposed body sites. Int J Cancer 104 (6): 764-71, 2003. Goldstein AM, Chan M, Harland M, et al.:
  36. High-risk melanoma susceptibility genes and pancreatic cancer, neural system tumors, and uveal melanoma across GenoMEL. Cancer Res2006, 66 (20): 9818-28.
  37. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst 2011;103:1827-39. Singh S, Nagpal SJ, Murad MH, et al.
  38. Inflammatory Bowel Disease Is Associated With an Increased Risk of Melanoma: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2013 doi: 10.1016/j.cgh.2013.04.033
  39. Dinh QQ, Chong AH: Melanoma in organ transplant recipients: the old enemy finds a new battleground. Australas J Dermatol 48 (4): 199-207, 2009
  40. Olsen CM, Knight LL, Green AC. Risk of melanoma in people with HIV/AIDS in the pre- and post-HAART eras: a systematic review and meta-analysis of cohort studies. PLoS One 2014;9(4):e95096.
  41. Phan, S. Touzet,* S. Dalle, S. Ronger-Savle', B. Balme and L. Thomas. Acrallentiginous melanoma: histopathological prognostic features of 121 cases. British Journal of Dermatology 2007 1 57, pp311 -31 8
  42. Kaskel P, Kind P, Sander S, Peter RU, Krahn G (2000) Trauma and melanoma formation: a true association. Br J Dermatol; 143:749-53. Les m?lanomes malins cutan?s : aspects ?pid?miologiques, clinques et th?rapeutiques. Exp?rience du service de chirurgie plastique au CHU Mohammed VI de Marrakech - 147 -
  43. Sanlorenzo M, Wehner MR, Linos E, et al. The Risk of Melanoma in Airline Pilots and Cabin Crew: A Meta-analysis.. JAMA Dermatol 2015;151(1):51-8.
  44. Dos Santos Silva I, De Stavola B, Pizzi C, et al. Cancer incidence in professional flight crew and air traffic control officers: Disentangling the effect of occupational versus lifestyle exposures. Int J Cancer 2012.
  45. Gun RT, Pratt N, Ryan P, et al.: Update of mortality and cancer incidence in the Australian petroleum industry cohort. Occup Environ Med 63 (7): 476-81, 2006.
  46. Zhang YP, Chu RX, Liu H. Vitamin A intake and risk of melanoma: a meta-analysis.. PLoS One 2014 Jul;9(7):e102527.
  47. Grob JJ, Bonerandi JJ. The 'ugly duckling' sign: identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Arch Dermatol 1998;134(1):103-104.
  48. Vestergaard ME, Macaskill P, Holt PE, Menzies SW. Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: a meta-analysis of studies performed in a clinical setting. Br J Dermatol. Sep 2008;159(3):669-7
  49. Balch CM, Gershenwald JE, Soong SJ, et al. Final version of 2009 AJCC melanoma staging and classification. J Clin Oncol. 2009;27(36):6199?6206.
  50. Tran KT, Wright NA, Cockerell CJ. Biopsy of the pigmented lesion?when and how. J Am Acad Dermatol. 2008;59(5):852?871.
  51. Lavie, C. Desouches, D. Casanova, J. Bardot, J.-J. Grob,R. Legr?, G. Magalon. Mise au point sur la prise en charge chirurgicale du m?lanome
  52. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Melanoma, version 1.2013.
  53. Jecan C.R. Raducu L. Filip I.Hernik D. A REVIEW OF FREQUENT CUTANEOUS MALIGNANCIES University of Medicine ?Carol Davila? Bucharest Department of Plastic and Reconstructive Microsurgery, Clinical Emergency Hospital ?Prof. dr. Agrippa Ionescu? Bucharest RoJCED 2014; 1(1):46-51
  54. Donald Buck, II, MD, Vinay Rawlani, MD, Jeffrey Wayne, MD, Gregory A Dumanian, MD, Robert Galiano, MD, and John YS Kim, Cosmetic outcomes following head and neck melanoma reconstruction: The patient?s perspective, MD Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA Plast Surg. 2012 Spring; 20(1): e10?e15.
  55. Hayashi T1, Furukawa H, Oyama A, Funayama E, Saito A, Yamamoto Y.
  56. An analysis of cheek reconstruction after tumor excision in patients with melanoma. the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.2014;25(2):e98-101.doi: 10.1097/SCS.0000000000000397.*
  57. National cancer institute. Melanoma Treatment (PDQ?) November 7, 2014 Disponible sur(http://www.cancer.gov/cancertopics/pdq/treatment/melanoma
  58. Chapman PB, Hauschild A, Robert C, et al.:
  59. Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 364 (26): 2507-16, 2011. /HealthProfessional/page4)
  60. American Cancer Society. Cancer Facts & Figures 2015 available on (http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-key-statistics)
  61. Jean-Emmanuel Bibault, Sylvain Dewas, Xavier Mirabel, Laurent Mortier, Nicolas Penel, Adjuvant radiation therapy in metastatic lymph nodes from melanoma , Academic Radiotherapy Departement, CLCC Oscar Lambret Comprehensive Cancer Center, Lille-Nord de France University, LILLE, France 6 February 2011
  62. Shen, P.; Guenther, J.M.; Wanek, L.A.; Morton, D.L. Can elective lymph node dissection decrease the frequency and mortality rate of late melanoma recurrences? Ann. Surg. Oncol. 2000,
  63. Nathanson, S.D. Insights into the mechanisms of lymph node metastasis. Cancer 2003, 98, 413-423.
  64. Kingham, T.P.; Panageas, K.S.; Ariyan, C.E.; Busam, K.J.; Brady, M.S.; Coit, D.G. Outcome of patients with a positive sentinel lymph node who do not undergo completion lymphadenectomy. Ann. Surg. Oncol. 2010, 17, 514-520.
  65. Balch, C.M.; Houghton, A.N.; Sober, A.J.; Soong, S. Cutaneous Melanoma, 4th edition; Quality Medical Publishing: St. Louis, MO, USA, 2003.

[Ouafaa DhaidahOuafaa Dhaidah, Mahdi Sahibi, Abdelkodus Bhihi, Mariem Quaboul, Adil Dehhaze, Moulay Driss Elamrani, Yassine Benchamkha and Salwa Ettalbi. (2018); CUTANEOUS MALIGNANT MELANOMAS: EPIDEMIOLOGICAL, CLINICAL AND THERAPEUTIC ASPECTS. EXPERIENCE OF THE PLASTIC SURGERY DEPARTMENT IN MOHAMMED VI HOSPITAL OF MARRAKECH- MOROCCO. Int. J. of Adv. Res. 6 (May). 23-35] (ISSN 2320-5407). www.journalijar.com


Ouafaa Dhaidah


DOI:


Article DOI: 10.21474/IJAR01/7005      
DOI URL: http://dx.doi.org/10.21474/IJAR01/7005