Primary Cutaneous Melanoma-Management in 2024.

Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.

Effects of chitosan and erythritol on labellar taste neuron activity, proboscis extension reflex, daily food intake, and mortality of male and female spotted-winged drosophila, Drosophila suzukii.

In recent years, there has been interest in reduced-risk materials with insecticidal properties for the invasive pest spotted-wing drosophila, Drosophila suzukii. Here, we compared the peripheral sensitivity (via the tip-recording technique, used to monitor the neural activity of gustatory receptor neurons [GRNs]) and palatability (via the Proboscis Extension Reflex [PER]) of chitosan, a polysaccharide derived from chitin, with that of erythritol, a sugar alcohol, to male and female D. suzukii. Because in some insect species it has previously been shown that chitosan has some insecticidal properties, then treatment effects on mortality rates of male and female D. suzukii were quantified. Physiological recordings from the l-type labellar sensilla showed that erythritol evoked responses from one GRN, while chitosan elicited spiked activity from a second one. The first PER bioassay revealed that the level of response to erythritol increased significantly for males and females as the concentrations increased, and the effect of fly sex was non-significant. The second PER bioassay compared the male and female response to chitosan and erythritol each at 0.125, 0.25, 0.5, 1, and 2% concentrations. The overall female PER to erythritol was significantly greater than that exhibited by males, and no differences were noted between sexes when chitosan was evaluated. These results indicate that chitosan alone can elicit PER responses in adult D. suzukii. In the third experiment, chitosan was toxic to D. suzukii. When combined with sucrose (2%), chitosan elicited high levels (80-100%) of mortality of adult D. suzukii within 3 days, particularly in males. The presence of erythritol did not seem to increase the toxic effect of chitosan.

Management of invasive melanoma.

BACKGROUND: Maximising survival for patients with invasive melanoma hinges on early diagnosis of primary melanoma and appropriate management. Despite well-documented guidelines, many patients with melanoma have not been managed ideally. OBJECTIVE: The aim of this paper is to identify suboptimal aspects of melanoma management. DISCUSSION: Delayed or erroneous diagnosis is more likely to occur when a shave or punch biopsy is used to obtain histopathology. Wherever feasible, local excision with a narrow margin is the preferred biopsy choice for a suspected melanoma. The Breslow thickness of the primary melanoma remains the greatest predictor of outcome. Ulceration is associated with a poorer prognosis. Most invasive melanomas are managed with a margin of ≥10 mm of normal tissue. Patients who have developed one primary melanoma are at high risk of a second tumour. Ongoing management includes regular lifelong skin checks. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet radiation are useful. Imaging is largely used when metastases are suspected on the basis of clinical symptoms or signs.