Diagnosis and Pattern Identification of Intrathoracic Malignant Melanoma Metastasis: A Retrospective Single Center Analysis

Round 1

Reviewer 1 Report

The topic of the article is very actual and interesting. The article is well structured.

The writing is clear. English language is adequate and correct.

The statistical analysis is appropriate.

The tables are of good quality.

 

1. Introduction

In this section the authors stated that “Malignant melanoma is a skin neoplasm”. This statement is not completely true because there are other types of melanoma: mucosal melanoma, uveal melanoma, conjunctival melanoma. In particular, cutaneous melanoma and uveal melanoma derive from melanocytes that share the same embryonic origin, nevertheless the biological behaviours of these melanomas are different. Also uveal melanoma can give lung metastases, although the liver represents the primary site of metastatization.

The authors should make this clarification in the introduction; in this regard they may cite the following articles and other articles they deem appropriate:

·       Pandiani C, Béranger GE, Leclerc J, Ballotti R, Bertolotto C. Focus on cutaneous and uveal melanoma specificities. Genes Dev. 2017 Apr 15;31(8):724-743. doi: 10.1101/gad.296962.117. PMID: 28512236; PMCID: PMC5435887.

·       van der Kooij MK, Speetjens FM, van der Burg SH, Kapiteijn E. Uveal Versus Cutaneous Melanoma; Same Origin, Very Distinct Tumor Types. Cancers (Basel). 2019 Jun 19;11(6):845. doi: 10.3390/cancers11060845. PMID: 31248118; PMCID: PMC6627906.

·       Foti, P.V.; Inì, C.; Broggi, G.; Farina, R.; Palmucci, S.; Spatola, C.; Liardo, R.L.E.; Milazzotto, R.; Raffaele, L.; Salamone, V.; Caltabiano, R.; Puzzo, L.; Russo, A.; Reibaldi, M.; Longo, A.; Vigneri, P.; Venturini, M.; Giurazza, F.; Avitabile, T.; Basile, A. Histopathologic and MR Imaging Appearance of Spontaneous and Radiation-Induced Necrosis in Uveal Melanomas: Initial Results. Cancers 2022, 14, 215. https://doi.org/10.3390/cancers14010215

 

In the Materials and Methods section, the authors should also specify (when known) if the primary tumor in their case series is cutaneous melanoma or other type of melanoma (e.g. uveal).

 

2. Materials and Methods

This section must be improved.

In their study the authors employed interventional pulmonology techniques, in particular endoscopic techniques, as well as radiologic techniques (computed tomography, magnetic resonance imaging) and nuclear medicine techniques (PET-FDG). A brief description of instrumentation and technical parameters of these diagnostic tools is needed; to this end, one or more summarizing tables could be useful and adequate.

I suggest the authors to subdivide this section into different subsections (e.g. Patients, Diagnostic techniques, Statistical analysis).

 

Figures

Figure legends are quite lacking and must be improved.

Figure 1. A, B and C. Please describe the CT findings and PET-FDG finding.

Figure 2. A. Please specify the scan plane and the pulse sequence shown in the figure. B. Please provide a more detailed description of the CT image (exact location and morphology of the lesion).

Figure 3. A and B. Please specify X-ray projection and describe X-ray and CT findings.

Figure 4. Please describe PET-FDG findings.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 2 Report

The article research topic is of great interest with very good representation. Well done.

Please review the conclusion part and take in account:

state the purpose of your study, then describe how your findings differ or support those of other studies and why.

As well as indicate opportunities for future research

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Reviewer 3 Report

Although this was a single center retrospective study, and the sample of cases was not very large. However, there are limited studies about intrathoracic metastasis of melanoma. The imaging data of this study were comprehensive, including CT, PET and endoscopy, and the prognosis was followed up. I think it has potential  worth to publishing. But I think there are many flaws in the structure and content of the article at this time.

 

In general, descriptions need to be more accurate such as:

1. In case 2, MRI sequence “T2WI/FLAIR ”should be added； In case 1, the scan technique description “enhanced” CT should be added.

2. The standard way to write PET-FDG is FDG-PET

3. In case 3, the temporal lobe metastasis is best accurately written as right temporal lobe metastasis.

4. Language ambiguity. Just an example, when the authors said “groups ”in Abstract and Materials and Methods, it is really hard to follow which specific groups they are referring to.

 

Missing details in the Methods and Results. For example:

5. The case selection process and diagnostic gold criteria need more details.

6. How exactly were the patients classified in this study. For example, how to distinguish “multiple masses” and “diffuse parenchymal infiltration of the lung”. From the cases of the paper, I think "diffuse lung involvement" was manifested as "miliary pulmonary nodules" or "lymphangitic infiltration". The terms need to be clearly defined.

 

Results:

7. As a Original research rather than a Case series article, it is rare to single specific description of each case. It is better to put it in the figure illustration with briefly description.

 

Discussion:

8. Based on the inference of the authors, or whether it has been analyzed in the literature, what is the reason that the survival from metastasis presentation with lung involvement is worse than those with a dominant nodal involvement or pleural/parietal involvement？

 

Conclusions need to be simple and clear, and redundant content is suggested to move to the Discussion.

Author Response

Please see the attachment.

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

I think the manuscript is much improved.