What is the incidence of a new cutaneous melanoma lesion after immunotherapy?

I am asked this fairly often.  Mostly by those who are just worrying and rarely by those who have lived it.  Here's the deal per this single center study of 2,251 melanoma patients treated with immunotherapy ~

Incidence of New Primary Cutaneous Melanoma in Patients With Metastatic Melanoma Treated With Immune Checkpoint Inhibitors: A Single-Center Cohort Study.  Nanda, Dusza, Navarrete-Dechent, et al. JAMA Dermatol.  Jan 2021.

Importance: The development of new primary cutaneous melanoma (CM) after starting immune checkpoint inhibitor (ICI) therapy is poorly characterized.

Objective: To determine the incidence of new CM in patients treated with ipilimumab, nivolumab, and/or pembrolizumab for metastatic melanoma.

Design, setting, and participants: Single-center, retrospective, observational cohort study using an institutional database to identify patients diagnosed with melanoma at a tertiary care cancer hospital in New York, New York.

Exposures: Ipilimumab, nivolumab, and/or pembrolizumab treatment for metastatic melanoma.

Main outcomes and measures: Primary outcomes were the incidence proportion, the incidence rate, and the 5-year cause-specific cumulative risk.

Results: A total of 2251 patients were included in the study; mean (SD) age at the time of ICI start was 62.8 years. The majority were male (63.8%), White (92.7%), and non-Hispanic (92.1%). Forty-two of 2251 patients who received ipilimumab, nivolumab, and/or pembrolizumab were diagnosed with 48 new CMs at a median (range) of 397.5 (39-2409) days after ICI initiation. The median age of affected patients at the time of ICI first dose was 66.5 years. The majority were male (66.7%), White (92.9%), and non-Hispanic (100.0%). There were no differences in age, sex, race, and ethnicity among patients who did and did not develop a new CM. Patients who developed a new CM were more likely to have a family history of melanoma (23.8% vs 16.3%). Most new CMs (n = 30, 62.5%) were diagnosed after the last date of ICI administration. Twenty-seven (56.3%) new CMs were in situ and 21 (43.8%) were invasive. Of the invasive CMs with a reported Breslow thickness (n = 20), the median (range) thickness was 0.4 (0.1-8.4) mm. The overall incidence proportion of new CM was 1.9% (1.4%-2.5%) and the incidence rate was 1103 cases per 100 000 person-years (815-1492). The 5-year cumulative cause-specific risk of new CM was 4.9%.

So, there you have it.  The chance of another cutaneous lesion is low.  Take me.  Cutaneous lesion, Stage IIIb in 2003.  Second cutaneous lesion in 2007.  Stage IV with brain and lung mets in April 2010.  Phase 1 nivo only 2 1/2 year trial begun in December 2010.  NO melanoma since.  But, we all know melanoma sucks great big green stinky hairy wizard balls.  Live large, but stay vigilant my peeps!

For what it's worth - c

Sew Chaotically ! ~ One more summer scrap buster!! Vogue 8944

 A simple pretty make, with a bit of a back story!!!

A couple of years ago, my dear friend and neighbor went through her stash and gifted me several pieces.  It included two embroidered table runners (?).  One more burgundy and the other a bit more peach toned.  I used the latter to make this wrap skirt for Roo in 2020.  Bet you can guess where I used the other runner!

While the runner was pretty much sufficient to complete a skirt, it was not going to finish up a dress.  Enter - New Look 0926, stitched up from a nice weight linen blend in 2016.  Back then I chose patterns based on easy to sew lines and no closures!!!  It served me well and was worn to bits!  Below it is pictured on a trip that began in Chicago and took us across country to Montana and Glacier National Park, then on to Vancouver, Victoria, and Seattle!!!

However, when I pulled it out this spring, it just wasn't working.  Don't know if it was me or the fabric had stretched out with wash and wear, but it just hung.  Too big and lifeless.  I tried twisting and stitching up the shoulder seams per Roo's suggestion and wore it that way a couple of times, but....nope.  But, when organizing my stash, I found a bit of this same fabric left and it matched the runner perfectly!!!  Hmmm....  What could I do with that?  Which brought me to this dress ~

I made this dress up in a stable knit back in 2017.  It too has traveled across the country as well as a large part of the globe and is well used in my wardrobe still!  Further, it is made up in three sections.  Perfect for using the table runner, the scrap of linen, and the New Look dress itself, once it was disassembled!

It worked!!!  I stitched up a size 12, but as before had to take in the sides of the bodice a couple of inches.  This time I had no problem with loose fabric at the back of the bodice as I had before.  Not sure if that was a novice sewist's error or the fact that the knit stretched out as this is not a pattern for knits!!  And though the pattern calls for a lining I finished the arms and neck with bias binding made with the last scrap of the runner!

Pretty proud of how I utilized the design in making the darts!!!

Happy to have given an old dress and unused table runner new life!!!  I love it!  Sew, make and live sustainably and chaotically! ~ les

Sew Chaotically! ~ Summer project of scrap busting summer tops! And a study in hems...

Throughout the summer, I've worked on what turned out to be a fun and useful little project.  In an effort to do some stash/scrap busting and come up with some functional easy tops I got to play, practice different hemming/sewing techniques, and achieve my goal.

First up was the FREE pattern, Frances, from Fibre Mood.  

I used almost the last bit of this pretty blue crepe - more on that below!  It was first used to make Sew Liberated's Matcha Top back in 2018 ~ 

When they say this top is "loose fitting" - that is no exaggeration!  I ended up making size XS, though my measurements indicated size M per the instructions, and it is perfectly loose and flowy.  The pattern is designed to have the neckline dip lower in the back than the front.  Since I am not a fan of that, I just used the back piece for the front and front for the back!   It worked a treat!  I finished the neckline with home-made binding, made with leftover fabric bits from a skirt I made 20 plus years ago!  It is so pretty!  Due to fabric constraints I pieced the back.  Here, I used my rolled hem foot.  It provides a beautiful result, though you have to keep a very consistent placement of the fabric to the foot or you will have a bit of a mess. Stopping and starting can also be a challenge.  There are many good tutorials on using the foot so I won't even try to explain, but this was a good garment to practice on!

Next up was my attempt to salvage some fabric I used in making a bias cut skirt from one of the Big 4 pattern companies back in 2012.  Between my negligible sewing skills (I didn't start sewing in earnest until 2017) and the machine I had at the time (He was not kind to fragile fabrics!) - it was a disaster!!!!  The seams were a bungled mess and my handstitched hem wasn't much better.  I wore it as a beach coverup for a bit and then it languished in a box of scraps.  But, the fabric was still pretty and surely it could become something!  I took it apart and after combining some artful piecing with my TNT Tate Top, also generously free, from Workroom Social....

...Ta dah!!!  I think she's pretty!  I used bias binding made from some shirting that remained after hacking this York Top!  I machine stitched it on, but hand stitched it down.  For this one, given the bias pieces and fragility of the fabric, I u-tubed some tuts, and did a hand rolled hem.  It was surprisingly easy and fairly quick to do.  I think it was a good choice for this fabric.

This next top was perfect for the final smidge of the blue crepe above and a remaining silk panel, previously used in making a couple of Lindens by Grainline Studio back in 2017 ~

I used a new to me pattern and technique for creating a rouleau button loop or thin spaghetti strap ~ Maison Fauve's Panama.  I stitched a size 40, which is my usual in French patterns.  I probably could have gone down one size or taken in the side seams just a bit, but I wanted an easy fit so this worked out just fine.  The pattern came together very nicely!  The back finish on the bodice is so pretty!

Roo shared a tutorial with me in which a cord is stitched within your loop or strap for ease of turning such a narrow piece.  I didn't have an appropriate cord on hand, but did have this bit of a tie from a ready-to-wear garment (see pic below).  I used that and it worked very well!  After practicing here, I will no longer be put off when I see those pretty little rows of buttons done up with rouleau closures!  For this hem I chose a "baby" hem, which I've used before. There are many nice tutorials out there, but Marcy Harriell's of OonaBalloona fame, is really good!  Overall, I'm very tickled with this pretty little blouse.

View of hem from inside the garment...

...and the outside.

Another FREE pattern!  In The Folds/Peppermint, Peplum top.  I made my usual size D, lengthening the bodice by 3 1/2 inches.  The fabric is a bit left over after finally stitching the ubiquitous M7969 earlier this spring.  The fabric was probably purchased from Hancock's more than twenty years ago!!!  It is actually a lovely soft woven cotton.  Though it turned out to  be too warm to be worn much at that time, I'm sure it will get good wear soon. This little top on the other hand, has been great for summer and will move nicely into fall with a cardi on top.  Finished with bias binding and simple hem.

Since I was on a roll and there was the tiniest bit of this lovely Liberty of London fabric left from making Le Laboratoire Familial's Scarlett Blouse, what better use, than my old stand by?  Another Tate!!!  Pieced in the back and cropped, but just perfect for summer or layered come fall!  Also finished with bias binding and a conventional hem.

Between stitching up these tops, little bits and bobs for the Jammer, and back-to-school skirts for Roo, I've have really enjoyed creating these mostly "free" and useful pieces this summer.  It makes me happy to use all the remnants of precious fabric to stitch up something pretty and functional rather than have them languish in the bin.  Not to mention, nothing feels too precious to risk experimenting and learning on.  As an added bonus, my fabric stash and sewing area are now very neat, tidy and manageable! 

Sew and live chaotically! ~ les

August Reads

Braiding Switchgrass - Robin Kimmerer.  Lots to think about as the world experiences horrible flooding far and wide, droughts that diminish water for people, crops and river commerce, heatwaves in areas unprepared.  Kimmerer's comparisons between the knowledge of indigenous peoples, conventional farming techniques and modern science gave me much to think about.  A bit redundant at times, but when she leans into story telling it is lovely and enlightening.

Pachinko - Min Jin Lee.  A really beautiful story of love, loyalty, parenting, family.  Taking place in the early 1900's the characters deal with the effects of World War I in both Korea and Japan - a part of world history that I was sadly uninformed about until reading The Island of Sea Women and doing some background research.  Historical fiction with powerful characters that live with you beyond the book's cover.

Such a Fun Age - Kiley Reid. With no prior expectations, I was pleasantly surprised by this story! Characters are well wrought, especially loved the toddler at the center of the tale.  A young black woman is accused of kidnapping the white child for whom she is the sitter.  As you read, her life and that of the family for which she works unfolds.  A part of me couldn't help but root for a complicated love affair, but in truth, the story resolved exactly as it should.

Cloud Cuckoo Land - Anthony Doer.  A strange but compelling story.  Reminiscent of the methods employed in one of my very favorite books - Cloud Atlas - characters across time and place are connected via an imagined story by Diogenes.  Fourteen year old Konstance on an interstellar ship in the (?) 22nd century.  Anna, an orphan in 15th century Constantinople, working with her sister in an embroidery house.  Omeir, born in 1439 in a small village, shunned and feared because of his cleft lip and palate, yet his ability with his oxen team finds him in the midst of the sultan's huge army in their attack on Constantinople.  Zeno, born in 1940s middle America, realizes he is gay in his youth, but societal pressures do not allow him to live freely.  We follow him through the Korean War and into his life as an old man.  Seymour's autistic behaviors and poverty contribute to his inability to fit in with his fellow students in mid-western modern America.  He finds his calming place with the help of a librarian (a through line for all the characters) who fosters his interest in owls and nature, but "progress" leads to tragedy.  All in all - an ode to the power of stories, books, and those who share them - no matter the human condition.  

The Little Paris Bookshop - Nina George.  Monsieur Perdue has a floating bookshop on the Seine in Paris.  Despite using questionable techniques to cope with difficulties in his own life, he is gifted in choosing the perfect book for his client's lives and emotions.  When a letter he has put off reading for 20 years reveals truths he never anticipated, he pulls anchor on his barge and takes off down the Seine.  On his journey through Antibes and Avignon to the south of France, he and his fellow travelers (a cook and frustrated writer) begin to make sense of their lives.  It was a pleasure to travel along, through books and places I too have loved.

The Little French Bistro - Nina George.  After 41 years of an unhappy marriage, Marianne attempts to take her life by drowning in the Seine.  Unsuccessful, she heads to Brittany, finally creating a life of her own.  Pros - multiple characters over 50 have productive, adventurous, sexual lives while accepting changes and and embracing their past.  Cons - a bit derivative of The Little Paris Bookshop.  I would swear, one sentence was identical, but didn't have the strength to look it up.

The Bookish Life of Nina Hill - Abbi Waxman.  Eleanor Oliphant lite.  Fun read.  Nina, who works in a bookshop and loves reading more than most things, has thoughts and commentary that will make you laugh out loud.  Engaging cast of characters.

Reading always surprises me with its tangential connections even when the books were not selected to do so.  This month's reading was filled with characters who are doing their best to make sense of their existence and live peaceful but fulfilling lives.  Certain themes recurred ~ the value of written words and libraries echoed throughout.  The need for us to protect the earth from ourselves if we want to continue to have a place in it.  And, a final connection to recent reads, the incredible history of Korea, impacting lives across the globe.

Read chaotically! ~ les