RESUMEN
Axillary node dissection was performed in 133 patients with malignant melanoma. The nodes were histologically negative for disease in 67 patients and positive in 66 patients. Disease-free survival rate varied according to the histologic and clinical status of the nodes and to the number of the nodes involved by tumor. The lymphocele rate was 7%; the wound infection rate was 5%; and the skin edge necrosis rate was 0.8%. One patient (0.8%) experienced both lymphocele and wound infection. Neurapraxia developed in the distribution of the musculocutaneous nerve in two patients (2%); this resolved completely in 3 to 4 weeks and was not observed again, since hyperextension of the arm has been carefully avoided during the procedure. Transient arm edema was noted postoperatively in five patients (4%), and the edema responded promptly and completely to elevation of the arm for 1 to 2 weeks. There was no permanent edema even after ligation and resection of the distal portion of the axillary vein (six patients). Permanent arm edema has not developed in any of the 133 patients, indicating that axillary node dissection as performed for malignant melanoma is not associated with the long-term complications occurring after mastectomy and axillary node dissection.
Asunto(s)
Escisión del Ganglio Linfático , Melanoma/cirugía , Tejido Adiposo/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Axila , Vena Axilar/cirugía , Femenino , Humanos , Masculino , Melanoma/mortalidad , Melanoma/patología , Persona de Mediana Edad , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia , Factores de TiempoRESUMEN
One hundred eighty patients with hematogenous metastases from malignant melanoma were reviewed. Complete resection of the gross tumor was technically feasible in 33 percent of the cases. Patients who had complete resection of the gross tumor had an estimated median survival time of 11.4 months and an estimated 5 year survival rate of 14 percent. Patients with solitary lesions removed had a median survival time of 22.8 months and a 5 year survival rate of 23 percent. Patients with distant subcutaneous metastases completely removed had a median survival time of 31.9 months and a 5 year survival rate of 29 percent. Surgical resection of distant metastases, when technically feasible, particularly for solitary lesions and subcutaneous locations, increases the length of survival of patients with disseminated melanoma.
Asunto(s)
Melanoma/cirugía , Neoplasias Cutáneas/cirugía , Femenino , Humanos , Masculino , Melanoma/mortalidad , Melanoma/secundario , Pronóstico , Neoplasias Cutáneas/mortalidad , Factores de TiempoRESUMEN
The histopathologic results of 360 consecutive preoperative needle localizations of nonpalpable breast lesions performed at two community hospitals in New York State were analyzed for comparison with national data. Seventy-eight (21.6%) samples were malignant lesions. Sixty of the 78 (76.4%) were infiltrative lesions, and 18 (23.6%) were in situ carcinomas. Overall, axillary lymph node metastases were noted in five (8.3%) samples. We conclude that needle localization permits detection of occult carcinoma at an early stage and that detection of occult carcinoma in patients seen in a community hospital corresponds well with published national data.