Eva Månsson-Brahme

Publications (14)90.27 Total impact

• Article: Interobserver Variability of Histopathological Prognostic Parameters in Cutaneous Malignant Melanoma: Impact on Patient Management.

  Hanna Eriksson, Margareta Frohm-Nilsson, Mari-Anne Hedblad, Henrik Hellborg, Lena Kanter-Lewensohn, Kamilla Krawiec, Barbro Lundh Rozell, Eva Månsson-Brahme, Johan Hansson
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  ABSTRACT: Clinical management of primary cutaneous melanomas is based on histopathological staging of the tumour. The aim of this study was to investigate, in a non-selected population in clinical practice, the agreement rate between general pathologists and pathologists experienced in melanoma in terms of the evaluation of histopathological prognostic parameters in cutaneous malignant melanomas, and to what extent the putative variability affected clinical management. A total of 234 cases of invasive cutaneous malignant melanoma were included in the study from the Stockholm-Gotland Healthcare Region in Sweden. Overall interobserver variability between a general pathologist and an expert review was 68.8-84.8%. Approximately 15.5% of melanomas ≤ 1 mm were re-classified either as melanoma in situ or melanomas >1 mm after review. In conclusion, review by a pathologist experienced in melanoma resulted in a change in recommendations about surgical excision margins and/or sentinel node biopsy in subgroups of T1 melanomas.
  Acta Dermato-Venereologica 01/2013;
• Article: 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial.

  Peter Gillgren, Krzysztof T Drzewiecki, Marianne Niin, Hans P Gullestad, Henrik Hellborg, Eva Månsson-Brahme, Christian Ingvar, Ulrik Ringborg
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  ABSTRACT: Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin. We undertook a randomised controlled trial in nine European centres. Patients with cutaneous melanoma thicker than 2 mm, at clinical stage IIA-C, were allocated to have either a 2-cm or a 4-cm surgical resection margin. Patients were randomised in a 1:1 allocation to one of the two groups and stratified by geographic region. Randomisation was done by sealed envelope or by computer generated lists with permuted blocks. Our primary endpoint was overall survival. The trial was not masked at any stage. Analyses were by intention to treat. Adverse events were not systematically recorded. The study is registered with ClinicalTrials.gov, number NCT01183936. 936 patients were enrolled from Jan 22, 1992, to May 19, 2004; 465 were randomly allocated to treatment with a 2-cm resection margin, and 471 to receive treatment with a 4-cm resection margin. One patient in each group was lost to follow-up but included in the analysis. After a median follow-up of 6·7 years (IQR 4·3-9·5) 181 patients in the 2-cm margin group and 177 in the 4-cm group had died (hazard ratio 1·05, 95% CI 0·85-1·29; p=0.64). 5-year overall survival was 65% (95% CI 60-70) [corrected] in the 2-cm group and 65% (40-70) in the 4-cm group (p=0·69). Our findings suggest that a 2-cm resection margin is sufficient and safe for patients with cutaneous melanoma thicker than 2 mm. Swedish Cancer Society and Stockholm Cancer Society.
  The Lancet 11/2011; 378(9803):1635-42. · 38.28 Impact Factor
• Article: Surgical resection margins do not influence health related quality of life or emotional distress in patients with cutaneous melanoma: results of a prospective randomised trial.

  Mia Bergenmar, Eva Månsson-Brahme, Johan Hansson, Yvonne Brandberg
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  ABSTRACT: In a prospective randomised Scandinavian trial, patients with localised invasive cutaneous melanoma of the trunk or extremities with tumours more than 2 mm thick were randomly assigned to excision with narrow (2 cm) or wide (4 cm) margins after primary surgery. The aims of the present study were to find out if there were any differences in health-related quality of life (QoL) and emotional distress between patients in the two arms over time. Patients were assessed at four time points: before randomisation, and at 3, 9, and 15 months after inclusion, using the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. A study-specific questionnaire was used to assess patient-reported problems related to the scar. A total of 144 patients were included; 70 randomised to narrow excision and 74 to wide excision margins. The response rate was >85% at all assessment points. No differences between the two arms were found for health-related QoL or emotional distress. Emotional functioning, insomnia, anxiety, intrusion, and avoidance improved over time (p <or= 0.0001). Thirty patients (32%) reported problems with the scar but there was no difference between the two arms. No differences in health-related QoL or emotional distress were found between the two arms, indicating that resection margins have limited impact on these variables.
  Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 06/2010; 44(3):146-55. · 0.94 Impact Factor
• Article: MC1R variation and melanoma risk in the Swedish population in relation to clinical and pathological parameters.

  Veronica Höiom, Rainer Tuominen, Max Käller, Diana Lindén, Afshin Ahmadian, Eva Månsson-Brahme, Suzanne Egyhazi, Klas Sjöberg, Joakim Lundeberg, Johan Hansson
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  ABSTRACT: The genetic background of cutaneous malignant melanoma (CMM) includes both germ line aberrations in high-penetrance genes, like CDKN2A, and allelic variation in low-penetrance genes like the melanocortin-1 receptor gene, MC1R. Red-hair colour associated MC1R alleles (RHC) have been associated with red hair, fair skin and risk of CMM. We investigated MC1R and CDKN2A variation in relation to phenotype, clinical factors and CMM risk in the Swedish population. The study cohort consisted of sporadic primary melanoma patients, familial melanoma patients and a control group. An allele-dose dependent increase in melanoma risk for carriers of variant MC1R alleles (after adjusting for phenotype), with an elevated risk among familial CMM patients, was observed. This elevated risk was found to be significantly associated with an increased frequency of dysplastic nevi (DN) among familial patients compared to sporadic patients. MC1R variation was found to be less frequent among acral lentiginous melanomas (ALM) and dependent on tumour localisation. No association was found between CDKN2A gene variants and general melanoma risk. Two new variants in the POMC gene were identified in red haired individuals without RHC alleles.
  Pigment Cell & Melanoma Research 01/2009; 22(2):196-204. · 5.06 Impact Factor
• Article: Monitoring of kindreds with hereditary predisposition for cutaneous melanoma and dysplastic nevus syndrome: results of a Swedish preventive program.

  Johan Hansson, Mia Bergenmar, Per-Ake Hofer, Göran Lundell, Eva Månsson-Brahme, Ulrik Ringborg, Ingrid Synnerstad, Annika Ternesten Bratel, Ann-Marie Wennberg, Inger Rosdahl
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  ABSTRACT: To evaluate a program initiated in 1987 by the Swedish Melanoma Study Group aiming to provide preventive surveillance to kindreds with hereditary cutaneous melanoma and dysplastic nevus syndrome. Overall, 2,080 individuals belonging to 280 melanoma families were followed for 14 years between 1987 and 2001 at 12 participating centers. Data were registered in a central database. Among 1,912 skin lesions excised during follow-up, 41 melanomas were removed in 32 individuals. Of these, 15 (37%) were in situ melanomas and 26 (63%) invasive melanomas. The median tumor thickness of invasive melanomas was 0.5 mm. Ulceration was absent in 24 of 26 invasive melanomas (92%) and 12 (46%) lacked vertical growth phase. Compared with melanomas in the general Swedish population, the melanomas identified in these kindreds during follow-up had better prognostic characteristics. All melanomas except one were diagnosed in families with two or more first-degree relatives with melanoma. Diagnosis of melanoma occurred in three of eight kindreds with germline CDKN2A mutations, supporting that families with such mutations are at increased risk for melanoma development. Of the 32 individuals who developed melanoma during follow-up, 21 (66%) had had at least one previously diagnosed melanoma. This study shows that a coordinated program aimed at detecting and offering skin surveillance in kindreds with hereditary cutaneous melanoma results in a low incidence of melanomas during the follow-up period and that the tumors that do arise have favorable prognostic characteristics.
  Journal of Clinical Oncology 08/2007; 25(19):2819-24. · 18.37 Impact Factor
• Article: NRAS and BRAF mutations in melanoma tumours in relation to clinical characteristics: a study based on mutation screening by pyrosequencing.

  Esther Edlundh-Rose, Suzanne Egyházi, Katarina Omholt, Eva Månsson-Brahme, Anton Platz, Johan Hansson, Joakim Lundeberg
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  ABSTRACT: We have previously demonstrated the use of pyrosequencing to investigate NRAS [neuroblastoma RAS viral (v-ras) oncogene homolog] mutations in melanoma biopsies. Here, we expanded the analysis to include BRAF (V-raf murine sarcoma viral oncogene homolog B1), another member of the Ras-Raf-mitogen-activated protein kinase (MAPK) signalling pathway, and analysed a total of 294 melanoma tumours from 219 patients. Mutations in BRAF exons 11 and 15 were identified in 156 (53%) tumours and NRAS exon 2 mutations in 86 (29%) tumours. Overall, mutations in NRAS or BRAF were found in 242 of 294 tumours (82%) and were found to be mutually exclusive in all but two cases (0.7%). Multiple metastases were analysed in 57 of the cases and mutations were identical in all except three, indicating that BRAF and NRAS mutations occur before metastasis. Association with preexisting nevi was significantly higher in BRAF mutated tumours (P=0.014). In addition, tumours with BRAF mutations showed a significantly more frequent moderate to pronounced infiltration of lymphocytes (P=0.013). NRAS mutations were associated with a significantly higher Clark level of invasion (P=0.022) than BRAF mutations. Age at diagnosis was significantly higher in tumours with NRAS mutations than in those with BRAF mutations (P=0.019). NRAS and BRAF mutations, however, did not influence the overall survival from time of diagnosis (P=0.7). In conclusion, the separate genotypes were associated with differences in several key clinical and pathological parameters, indicating differences in the biology of melanoma tumours with different proto-oncogene mutations.
  Melanoma Research 01/2007; 16(6):471-8. · 2.19 Impact Factor
• Source

  Available from: Giuseppe Masucci

  Article: Alternating chemo-immunotherapy with temozolomide and low-dose interleukin-2 in patients with metastatic melanoma.

  Giuseppe Valentino Masucci, Eva Månsson-Brahme, Boel Ragnarsson-Olding, Bo Nilsson, Gunnar Wagenius, Johan Hansson
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  ABSTRACT: Temozolomide is a rapidly absorbed chemotherapeutic agent, achieving significant central nervous system penetration. Previous clinical trials suggested that temozolomide in sequence with low-dose recombinant human interleukin-2 might be an efficacious and relatively non-toxic chemo-immunotherapeutic treatment, which may synergistically eliminate tumours. The primary objective was to determine the safety and tolerance of temozolomide administered orally 200 mg/m days 1-5, in sequential combination with subcutaneous injections of 4.5x10 IU recombinant human interleukin-2 on days 8-11, 15-18 and 22-25 in patients with measurable, progressive metastatic malignant melanoma without radiological signs of central nervous system metastases. The secondary objectives were to determine tumour response and time to progression. Twenty-seven patients were included, of which four were non-evaluable for response. Twenty-three patients tolerated the regimen with side effects below grade 3 according to the World Health Organization (WHO) scale. Three patients suspended the treatment because of WHO grade 3 side effects already during the first 3 days of the first course of temozolomide. Seven patients showed no tumour progression during the first four treatment cycles. Two patients had complete responses, three partial responses and two stable disease at the end of the four cycles defined by the protocol and they continued the treatment until signs of relapse or a maximum of 21 courses. Five of these patients are still alive. Thrombocytopenia was significantly more pronounced in patients with objective response and stable disease than in non-responders to therapy. The median time to progression for all patients was 3.1 months and for responding and stable disease patients was 15 months. Five of 23 treated patients (22%) developed brain metastases during follow-up. Temozolomide in combination with recombinant human interleukin-2 is a well-tolerated regimen for outpatient treatment and the bio-chemotherapy combination induced durable clinical responses. Thrombocytopenia might be a positive predictive factor for response to therapy.
  Melanoma Research 09/2006; 16(4):357-63. · 2.19 Impact Factor
• Article: Loco-regional control of cutaneous metastases of malignant melanoma by treatment with miltefosine (Miltex).

  Boel Ragnarsson-Olding, Eva Djureen-Mårtensson, Eva Månsson-Brahme, Johan Hansson
  Acta Oncologica 02/2005; 44(7):773-7. · 3.33 Impact Factor
• Article: Trends in incidence of cutaneous malignant melanoma in a Swedish population 1976-1994.

  Eva Månsson-Brahme, Hemming Johansson, Olle Larsson, Lars E Rutqvist, Ulrik Ringborg
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  ABSTRACT: The incidence of cutaneous malignant melanoma has been increasing in Sweden for several decades. In the Stockholm-Gotland area educational activities for healthcare professionals were started in the late 1970s and public primary and secondary prevention campaigns were initiated in the mid-1980s. Melanoma incidence trends have been studied in Sweden, with special reference to trends in the Stockholm-Gotland area where these prevention campaigns were first started. During 1976-1994 the average annual increase of age-standardized incidence in the Stockholm-Gotland area was about 5%, the increase being associated mainly with thin tumors and melanoma in situ. During the 1990s, the incidence among males leveled off. In contrast, no such shift in trend was observed among females, or among males or females residing outside the Stockholm-Gotland area. The campaigns may have contributed to a trend towards earlier diagnosis but there is still no clear effect of the primary prevention efforts.
  Acta Oncologica 02/2002; 41(2):138-46. · 3.33 Impact Factor
• Article: Information to patients with malignant melanoma: a randomized group study

  Yvonne Brandberg, Mia Bergenmar, Christina Bolund, Helena Michelson, Eva Månsson-Brahme, Ulrik Ringborg, Per-Olow Sjödén
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  ABSTRACT: An information programme for patients with cutaneous malignant melanoma, Stage I, aiming at increasing satisfaction with information, was carried out at the Department of Oncology (Radiumhemmet). The programme consisted of a group meeting and a brochure. A total of 231 consecutive patients were included, and 149 (65%) reported interest in participation and were randomized to the Information group (n = 77) or to the Control group. A total of 67 patients (29%) were not interested (the NI-group). To evaluate the programme, the patients in the three groups completed questionnaires regarding satisfaction with information, knowledge of melanoma and psychological and psychosomatic variables before randomization and at the first visit for follow-up at Radiumhemmet. After the information programme, the Information group was significantly more satisfied with information, had a higher level of knowledge and a lower proportion requested further information as compared with the Control group. No differences were found on the psychological and psychosomatic variables.
  Patient Education and Counseling 06/1994; · 2.31 Impact Factor
• Article: Psychological reactions in public melanoma screening

  Yvonne Brandberg, Christina Bolund, Helena Michelson, Eva Månsson-Brahme, Ulrik Ringborg, Per-Olow Sjödén
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  ABSTRACT: Participants in public screening for malignant melanoma (n = 190) completed a questionnaire containing items regarding cognitive and emotional responses to skin examination on two occasions, before screening and 7 months later. The results suggest subjective susceptibility to melanoma in participants in public screening, especially in women. No increase in psychosomatic problems, anxiety or depressive symptoms or signs of “false security” were seen as an effect of the screening, neither in the total sample nor in those who at the screening were recommended further medical procedures.
  European Journal of Cancer 02/1993; · 5.54 Impact Factor
• Article: Psychological effects of participation in a prevention programme for individuals with increased risk for malignant melanoma

  Yvonne Brandberg, Mia Bergenmar, Christina Bolund, Eva Månsson-Brahme, Ulrik Ringborg, Per-Olow Sjødén
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  ABSTRACT: The Swedish Melanoma Study Group runs a programme aimed at prevention and early detection of premalignant and malignant melanoma in families with two or more members having malignant melanoma. Psychological consequences of participation in this programme were studied. A questionnaire containing items concerning cognitive and emotional responses to the programme was completed by 115 consecutive individuals at their first visit to the clinic. The same questionnaire was administered by mail 7 months later. The levels of psychological and psychosomatic problems were relatively low at both points of assessment. No negative psychological effects were found, neither in the group with dysplastic naevus syndrome (DNS) with increased risk for malignant melanoma, nor in the group without dysplastic naevi. Only one variable, “emotional responses to the visit” differentiated between the groups, with higher scores in the group without DNS. A majority of the individuals expressed positive attitudes to the clinic.
  European Journal of Cancer 02/1992; · 5.54 Impact Factor
• Article: Perceived Susceptibility to and Knowledge of Malignant Melanoma: Screening Participants vs the General Population

  Yvonne Brandberg, Cristina Bolund, Helena Michelson, Eva Månsson-Brahme, Ulrik Ringborg, Per-Olow Sjödén
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  ABSTRACT: Background.The incidence of and mortality from melanoma are increasing and no effective treatment for disseminated disease exists. Studies of factors influencing participation in prevention and early detection of melanoma are therefore warranted. In the present study, participants in public melanoma screening were compared with a sample of the Swedish population with respect to concern for nevi, perceived risk for melanoma, knowledge about melanoma, and sources of information. Gender differences were studied.Method.Consecutive participants in public melanoma screening (Participants) received questionnaires at registration for skin examination; 235 (96%) responded. Questionnaires were distributed by mail to a random sample of the Swedish population (Public); 1,070 (63%) responded.Results.Participants were more concerned about nevi, and a higher proportion had previously consulted physicians for suspected lesions compared with the Public. Participants were better informed in terms of the number of sources of information and knowledge of melanoma and risk factors. There were no differences regarding perceived risk and there was a mixed picture concerning knowledge of sun effects and sun protection. Gender differences were found for perceived susceptibility to, knowledge of, and number of sources of information about melanoma, favoring women.Conclusion.The preventive aspects of screening as well as the good prognosis of melanoma detected early should be stressed in invitations to skin cancer screening. New approaches for reaching men are warranted.
  Preventive Medicine 25(2):170-177. · 3.22 Impact Factor
• Article: [Paradigmatic shift in oncology: individualized melanoma treatment].

  Johan Hansson, Eva Djureen-Mårtenson, Franziska Edvinsson, Johan Falkenius, Signe Friesland, Giuseppe Masucci, Eva Månsson-Brahme, Boel Ragnarsson-Olding, Helena Sjödin, Maria Wolodarski, Margareta Frohm-Nilsson, Jan Lapins
  Lakartidningen 108(20):1092-3.