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Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20-22 February 2020.

ABSTRACT: Introduction: There are a lack of established guidelines for the surveillance of high-risk cutaneous melanoma patients following initial therapy. We describe a novel approach to the development of a national expert recommendation statement on high-risk melanoma surveillance (HRS). Methods: A consensus-based, live, online voting process was undertaken at the 13th and 14th annual Canadian Melanoma Conferences (CMC) to collect expert opinions relating to "who, what, where, and when" HRS should be conducted. Initial opinions were gathered via audience participation software and used as the basis for a second iterative questionnaire distributed online to attendees from the 13th CMC and to identified melanoma specialists from across Canada. A third questionnaire was disseminated in a similar fashion to conduct a final vote on HRS that could be implemented. Results: The majority of respondents from the first two iterative surveys agreed on stages IIB to IV as high risk. Surveillance should be conducted by an appropriate specialist, irrespective of association to a cancer centre. Frequency and modality of surveillance favoured biannual visits and Positron Emission Tomography Computed Tomography (PET/CT) with brain magnetic resonance imaging (MRI) among the systemic imaging modalities available. No consensus was initially reached regarding the frequency of systemic imaging and ultrasound of nodal basins (US). The third iterative survey resolved major areas of disagreement. A 5-year surveillance schedule was voted on with 92% of conference members in agreement. Conclusion: This final recommendation was established following 92% overall agreement among the 2020 CMC attendees.

SUBMITTER: Lee CW

PROVIDER: S-EPMC8161801 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND: Current resuscitation guidelines recommend 3:1 Compression:Ventilation (C:V) ratio, however the most effective C:V ratio in newborns remains controversial. We recently demonstrate that if chest compressions (CC) are superimposed by sustained inflations (SI) return of spontaneous circulation (ROSC) and mortality are improved in asphyxiated newborn piglets when compared to standard coordinated 3:1 resuscitation. However, this has not been studied in newborns. OBJECTIVES: To determine if CC superimposed with SI impacts ROSC in infants <33 weeks with bradycardia or asystole compared to coordinated 3:1 C:V resuscitation. DESIGN/METHODS: In a pilot study, infants born <33 weeks gestational age with an heart rate <60/min or asystole were randomized to receive either “3:1 C:V” or “SS+CC”. Infants randomized to 3:1 received coordinated CC and ventilation according to the current resuscitation guidelines. Infants randomized to “SI+CC” received uninterrupted CC at a rate of 90/min superimposed by a SI of 30 sec. The default settings for airway pressures were peak inflation pressure of 24 cm H2O and a positive end expiratory pressure of 6 cm H2O. The primary outcome was duration of CC to achieve ROSC. Deferral of consent was approved by the institutional ethics committee. The trial was registered at ClinicalTrials.gov: NCT02083705. RESULTS: Five infants were randomized to each group; the mean (range) gestational age was 25 (24–27) weeks vs. 26 (23–28) weeks in the in the SI+CC and 3:1 group (P=0.433), respectively. Mean (SD) birth weight in the SI+CC group was 797 (208) g vs. 808 (182) g in the 3:1 group, (P=0.465) respectively. Mean (SD) ROSC was significantly decreased in the SI+CC group with 31 (8) sec vs. 138 (72) sec in the 3:1 group (P=0.011). One infant in each group died and only one infant in the 3:1 group received epinephrine. One infant in the SI+CC group and three in the 3:1 had intracranial hemorrhage grade 3 or greater. Three infants in the SI+CC group had necrotizing enterocolitis vs. one infant in the 3:1 group (P=0.197). CONCLUSION: Preterm infants <33 weeks had significant shorter ROSC when CC were superimposed by SI compared to using 3:1.

Dataset Information

Canadian Melanoma Conference Recommendations on High-Risk Melanoma Surveillance: A Report from the 14th Annual Canadian Melanoma Conference; Banff, Alberta; 20-22 February 2020.

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