Hippocrates: A Pioneer in Orthopaedics and Traumatology.

PURPOSE: Hippocrates, the ancient Greek physician, is considered the father of Medicine; however, his contributions to Orthopaedics and Traumatology have not been highlighted enough. The present historical review represents an effort to present and categorize his work, in this field, per clinical disorder and anatomical region. METHODS: The "Hippocratic Corpus" original text was thoroughly studied to identify all Hippocrates' contributions in Orthopaedics and Traumatology. Volume III of his works, especially "On Fractures", "On Joints", and "Mochlicon" includes a plethora of information regarding the management of traumas, as well as other disorders and clinical entities of the musculoskeletal system. RESULTS: In particular, Hippocrates describes reduction techniques for fractures, as well as joint dislocations, elaborates on the biology of the fractures' healing process and the basic principles of fracture management and fixation, presents the signs and symptoms of gangrene, teaches the treatment of osseous infections and offers valuable insight on the biomechanics and treatment of spinal diseases. CONCLUSIONS: Hippocrates' contributions in Orthopaedics and Traumatology are unprecedented, making him a true pioneer in this field, while the basic principles that he presented were further studied and confirmed in the 19th and 20th centuries.

Suggestion of a Novel Classification Based on the Anatomical Region and Type of Bilateral Fatigue Femoral Fractures.

Purpose: Bilateral fatigue femoral fractures (BFFF) represent an extremely rare clinical entity. The present study introduces a novel classification, in order to categorize the BFFFs and provide a thorough review of all these, so far in the literature, reported cases. Methods: The BFFF were classified taking into account the anatomical region of the femoral fracture; (fh): femoral head, (sc): sub-capital, (pt): peri-trochanteric, (st): sub-trochanteric, (s): shaft, (d): distal femur and the fracture type (complete or incomplete); type I: bilateral incomplete fractures, type II: unilateral incomplete fracture, and type III: bilateral complete fractures. Type III was further subdivided into type IIIA: bilateral non-displaced fractures, type IIIB: unilateral displaced fracture, and type IIIC: bilateral displaced fractures. Furthermore, a meticulous review of the PubMed and MEDLINE databases was conducted to locate all articles reporting these injuries. Results: A total of 38 patients (86.8% males), with a mean age of 25.3 years, suffering BFFFs were identified from the literature search. The mean time interval from symptoms' onset to diagnosis was 54 days. According to the proposed classification, 2.6% of the fractures were categorized as type I (h), 36.8% as type I (sc), 2.6% as type I(st/s), 7.9% as type I (s), 2.6% as type I (d), 5.4% as type II (fh), 26.3% as type II (sc), 2.6% as type IIIA (st), 2.6% as type IIIA (d), 5.4% as type IIIB (sc), 2.6% as type IIIB (d) and 2.6% as type IIIC (sc). Surgery was performed in 52.6%, while non-operative treatment was followed in 47.4% of the population. Regarding the fracture type, 75% of type I fractures were conservatively treated, while 91.7% and 66.6% of type II and III fractures were surgically treated. For patients treated conservatively, the mean time from diagnosis to return to previous status was 260 days, while for patients treated surgically, 343 days. Conclusions: BFFFs, although rare, may pose a diagnostic and therapeutic challenge. The present classification offers valuable information and may act as a guide for the management of these patients.

Characteristics of 637 melanomas documented by 27 general practitioners on the Skin Cancer Audit Research Database.

BACKGROUND AND OBJECTIVE: Most melanomas (including melanomas in situ), in Australasia, are treated by general practitioners (GPs). Previously undescribed, the characteristics of a series of melanomas treated by multiple GPs are examined. PATIENTS AND METHODS: Six hundred and thirty-seven melanomas treated by 27 Australasian GPs during 2013 and documented on the Skin Cancer Audit Research Database (SCARD) were analysed by anatomical site, subtype, Breslow thickness, diameter, associated naevi and linked adverse outcomes. RESULTS: Most melanomas (59.7%) were on males, mean age at diagnosis being 62.7 years (range 18-96). Most (65.0%) were in situ, with a high incidence of lentiginous melanoma (LM) (38.8%) and 32% were naevus associated. Most LM (86.4%) were in situ, compared to 55% of superficial spreading melanoma (SSM) (P < 0.0001). There was male predominance on the head, neck and trunk and female predominance on extremities. There was no significant association between Breslow thickness and diameter, with small melanomas as likely to be thick as large melanomas, and melanomas ≤3 mm diameter, on average, more likely to be invasive than larger melanomas. There was a positive correlation between age and both melanoma diameter and Breslow thickness. Seven cases progressed to melanoma-specific death: Five nodular melanoma (NM) and two SSM, one of which was thin (Breslow thickness 0.5 mm). CONCLUSIONS: A large series of melanomas treated by Australasian GPs were predominantly in situ, with a high proportion of LM subtype. With implications for GP training, NM linked to death was over-represented and there was a novel finding that older patients had larger diameter melanomas.

Chlamydia trachomatis transmission between the oropharynx, urethra and anorectum in men who have sex with men: a mathematical model.

BACKGROUND: It has been presumed that Chlamydia trachomatis is transmitted between men only through anal or oral sex, but no mathematical models have tested this presumption. METHODS: To test this presumption, we created 20 compartmental mathematical models of different sexual practices that included both oral and anal sex and calibrated these models to the observed rates of Chlamydia trachomatis infection at three anatomical sites from 4888 men who have sex with men (MSM) in Melbourne Sexual Health Centre during 2018-2019. RESULTS: A model that included only oral and anal sex could replicate the observed rates of single-site infection at the oropharynx, urethra and rectum alone, but could not replicate infection at more than one of these sites (multisite). However, if we included transmission from sexual practices that followed one another in the same sexual episode (e.g. saliva contamination of the penis from oral sex transmitting chlamydia to the rectum by anal sex), we significantly improved the calibration of multisite infection rates substantially. CONCLUSIONS: Our modelling study suggests that transmission routes other than just oral and anal sex are necessary to explain the high rate of Chlamydia trachomatis infection at more than one site.

Prevalence and anatomical sites of human papillomavirus, Epstein-Barr virus and herpes simplex virus infections in men who have sex with men, Khon Kaen, Thailand.

BACKGROUND: Human papillomavirus (HPV), Epstein-Barr virus (EBV) and herpes simplex virus (HSV) cause sexually transmitted diseases (STDs) that are frequently found in men who have sex with men (MSM) with human immunodeficiency viral (HIV) infection. METHODS: This study investigated the prevalence of infection and anatomical site distribution of these viruses in asymptomatic MSM. DNA, extracted from cells collected from the anorectum, oropharynx and urethra of 346 participants, was investigated for the presence of EBV, HPV and HSV using real-time PCR. Demographic data from the participants were analyzed. RESULTS: All three viruses were found in all sampled sites. EBV was the commonest virus, being detected in the anorectum (47.7% of participants), oropharynx (50.6%) and urethra (45.6%). HPV and HSV were found in 43.9% and 2.9% of anorectum samples, 13.8% and 3.8% of oropharynx samples and 25.7% and 2% of urethra samples, respectively. HPV infection of the anorectum was significantly associated with age groups 21-30 (odds = 3.043, 95% CI = 1.643-5.638 and P = 0.001) and 46-60 years (odds = 2.679, 95% CI = 1.406-5.101 and P = 0.03). EBV infection of the urethra was significantly correlated with age group 21-30 years (odds = 1.790, 95% CI = 1.010-3.173 and P = 0.046). EBV/HPV co-infection of the anorectum (odds = 3.211, 95% CI = 1.271-8.110, P = 0.014) and urethra (odds = 2.816, 95% CI = 1.024-7.740, P = 0.045) was also associated with this age group. Among HIV-positive MSM, there was a significant association between age-group (odds = 21.000, 95% CI = 1.777-248.103, P = 0.016) in HPV infection of the anorectum. A failure to use condoms was significantly associated with HPV infection of the anorectum (odds = 4.095, 95% CI = 1.404-11.943, P = 0.010) and urethra (odds = 7.187, 95% CI = 1.385-37.306, P = 0.019). Similarly, lack of condom use was significantly associated with EBV infection of the urethra (odds = 7.368, 95% CI = 1.580-34.371, P = 0.011). CONCLUSION: These results indicate that asymptomatic MSM in Northeast Thailand form a potential reservoir for transmission of STDs, and in particular for these viruses.

The reactivity of the back revisited. Are there differences in reactivity in different parts of the back?

BACKGROUND: In the contact dermatitis literature, it is regularly stated that the patch test reactivity on various areas of the back differs, which might have a large impact on the reproducibility of patch testing. OBJECTIVES: To investigate the reproducibility of patch testing on the upper back with regard to the left as opposed to the right side, and the medial as opposed to the lateral part of the upper back. The reproducibility over time and with regard to the reactivity pattern was also investigated. METHODS: Thirty-one subjects with contact allergy to the metals gold (n = 19) or nickel (n = 12) were patch tested with serial dilutions, in triplicate applications, on different locations on the upper back. The Friedman test was used for statistical calculations. RESULTS: No significant differences in the reactivity of the back were found. In all gold-allergic patients and 11 of 12 nickel-allergic patients, the allergy could be reproduced with regard to previous patch testing, but the degree of reactivity differed. CONCLUSIONS: When a high level of standardization of the patch test technique with the same test system was used, there were no differences in patch test reactions and sites of application on the upper back.

Risk factors of keloids in Syrians.

BACKGROUND: Keloid is a benign fibrous growth, which presents in scar tissue of predisposed individuals. It is a result of irregular wound healing, but the exact mechanism is unknown. However, several factors may play a role in keloid formation. To date, there are no studies of keloids in Syria, and limited studies on Caucasians, so we have investigated the risk factors of keloids in Syrians (Caucasians), and this is the main objective of this study. METHODS: Diagnosis of keloids was clinically made after an interview and physical examination. We did a histopathological study in case the physical examination was unclear. The following information was taken for each patient; sex, Blood groups (ABO\Rh), cause of scarring, anatomical sites, age of onset, number of injured sites (single\multiple) and family history. RESULTS: We have studied the clinical characteristics of 259 patients with keloids,130 (50.2 %) females and 129 (49.8 %) males. There were 209 (80.7 %) patients with keloids in a single anatomical site compared to 50 (19.3 %) patients with 130 keloids in multiple anatomical sites, 253 (97.68 %) patients with keloids caused by a single cause for each patient compared to 6 (2.32 %) patients with keloids caused by two different causes for each patient. Keloids could follow any form of skin injury, but burn was the most common (28.68 %). Also, keloids could develop at any anatomical sites, but upper limb (20 %) followed by sternum (19.17 %) was the most common. Over half of the patients developed keloids in the 11-30 age range. 19.3 % (50/259) of patients had family history, 76 % (38/50) of them had keloids located in the same anatomical sites of relative, also, 66 % (33\50) of them had keloids caused by the same cause. The following information was found to be statistically significant; people with blood group A (p = 0.01) compared with other blood groups, spontaneous keloids in patients with blood group A (p = 0.01), acne in males (p = 0.0008) compared to females, acne in someone who has a previous acne keloid (p = 0.0002), burn in someone who has a previous burn keloid (p = 0.029), family history, especially for spontaneous (p = 0.005), presternal (p = 0.039) and shoulder (p = 0.008) keloids, people in second and third decades (p = 0.02) (p = 0.01) respectively. CONCLUSION: Age of onset, sex, cause of scarring, blood groups, anatomical site, presence of family history and the number of site (multiple\single) were significant in keloid formation in Syrians.

The Correlation Between Candida Colonization of Distinct Body Sites and Invasive Candidiasis in Emergency Intensive Care Units: Statistical and Molecular Biological Analysis.

Both statistical and molecular biological methods were used to evaluate the association between Candida colonization of different body sites and invasive candidiasis (IC) and analyse the potential infection sources of IC. Candida surveillance cultures from the urine, sputum, rectum and skin were performed on patients admitted to an emergency intensive care units (EICU) of a tertiary care hospital in Shanghai, China, from February 2014 to January 2015. Specimens were collected once a week at admission and thereafter. The patients' clinical data were collected, and Candida isolates were genotyped using polymorphic microsatellite markers. A total of 111 patients were enrolled. Patients with positive urine (23.3 vs. 2.5 %, p = 0.001) and rectal swab (13.6 vs. 0 %, p = 0.010) cultures were more likely to develop IC. However, the risk for IC was not significantly different among patients with and without respiratory (10.0 vs. 5.8 %, p = 0.503) and skin (33.3 vs. 6.5 %, p = 0.056) colonization. Gene microevolution frequently occurred at rectal swab and urine sites, and IC with possible source of infection was caused by rectal isolates (2/7), urine isolates (4/7) and sputum isolate (1/7).The colonization of gut and urinary tract maybe more relevant indicators of IC, which should be taken into consideration when selecting practical body sites for Candida surveillance cultures.

Anatomic Region of Cutaneous Melanoma Impacts Survival and Clinical Outcomes: A Population-Based Analysis.

PURPOSE: The objective was to determine the effects of the anatomic site of a cutaneous melanoma on the survival outcomes of diagnosed individuals. METHODS: We conducted a cross-sectional study using data from the Surveillance, Epidemiology, and End Results Program (SEER) Database from 2004-2014 and included 178,892 cases of individuals diagnosed with cutaneous melanoma. Overall survival (OS) for each anatomic site as well as associated demographics, primary site, stage, and pathologic prognostic factors (Breslow's depth of invasion (DOI), level of mitoses, and ulceration), were analyzed. RESULTS: Lower extremity melanoma (LEM) was the most likely to have locoregional nodal spread, yet head and neck melanoma (HNM) was the most likely to present at the most advanced stage of disease (IV). Independent of other factors, HNM was associated with the greatest risk of death (HR 1.90 [95% CI, 1.85-1.96]) compared to other sites, and males experienced worse overall survival (OS) (HR 1.74 [95% CI, 1.70-1.78]) compared to females. The last and greatest risk of death is associated with LEM and HNM, respectively. CONCLUSION: Given these survival differences, consideration should be given to incorporating the primary site of melanoma into staging to ensure treatment is efficacious as possible.

Features of gastric cancer by anatomic subsite in northern China: A multi-center Health Science Report database study.

BACKGROUND: The features of gastric cancer based on the anatomic site remain unknown in northern China patients. AIM: To analyze gastric cancer features and associated trends based on the anatomical site in northern China patients. METHODS: This cross-sectional study used incident gastric cancer case data from 10 Peking University-affiliated hospitals (2014 to 2018). The clinical and prevailing local features were analyzed. RESULTS: A total of 10709 patients were enrolled, including antral (42.97%), cardia (34.30%), and stomach body (18.41%) gastric cancer cases. Cancer in the cardia had the highest male:female ratio, proportion of elderly patients, and patients with complications, including hypertension, diabetes, cerebrovascular, and coronary diseases (P < 0.001). gastric cancer involving the antrum showed the lowest proportion of patients from rural areas and accounted for the highest hospitalization rate and cost (each P < 0.001). The proportion of patients with cancer involving the cardia increased with an increase in the number of gastroesophageal reflux disease cases during the same period (P < 0.001). Multivariate analysis revealed that tumor location in the cardia increased the risk of in-hospital mortality (P = 0.046). Anatomical subsite was not linked to postoperative complications. CONCLUSION: The features of gastric cancer based on the anatomical site differ between northern China and other regions, both globally and within the country. Social factors may account for these differences and should affect policy-making and clinical practice.

Primary Site and Other Prognostic Factors for Fibrosarcoma: An Analysis of the National Cancer Database.

PURPOSE: Fibrosarcoma (FS) is a rare and malignant tumor that can occur in a variety of anatomic sites. The goal of this study is to use the National Cancer Database (NCDB) to analyze various factors affecting overall survival in FS and to be one of the rare studies to characterize the significance of the primary anatomic sites. METHODS: The study cohort included 2,278 patients diagnosed with fibrosarcoma who received surgery from the NCDB. Kaplan-Meier curves, log-rank tests, and a multivariable Cox proportional hazard model were used to analyze the significance of factors affecting overall survival. RESULTS: The head, face, and neck (HR = 1.44; 95% CI: 1.01-2.05; P = 0.046) and thorax anatomical sites (HR = 1.33; 95% CI: 1.02-1.73; P = 0.035) had a higher increased risk of death in comparison to the lower limb and hip. Compared to patients with private insurance, patients without insurance (HR = 1.99; 95% CI: 1.22 to 3.25; P = 0.006) and patients with Medicaid (HR = 1.99; 95% CI: 1.37 to 2.90; P < 0.001) had decreased overall survival. Patients associated with a zip code-level median household income ≥ $63,000 had a decreased risk of mortality when compared to lower income groups. CONCLUSION: In general, older patients with comorbidities, advanced-stage disease, and larger tumors who did not have private insurance and were from areas associated with lower income levels had poorer overall survival. No significant difference in overall survival was associated with receipt of neoadjuvant chemotherapy or neoadjuvant radiation.

Primary anatomical site as a prognostic factor for pleomorphic liposarcoma.

BACKGROUND: Pleomorphic liposarcomas (PLS) is an aggressive, high-grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia. METHODS: 750 patients diagnosed with pleomorphic liposarcoma from the National Cancer Database were analyzed. Kaplan-Meier survival tables, log-rank tests, and Cox proportional hazards analysis were utilized to compare survival between groups within variables. RESULTS: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while the retroperitoneum/abdomen had the lowest (50% and 18.4%). Compared to the thorax/lung site, the following sites demonstrated a decreased risk of death: lower limb/hip (HR = 0.54; 95% CI: 0.35-0.82, p = 0.004), pelvis (HR = 0.49; 95% CI: 0.28-0.84, p = 0.010), and the retroperitoneum/abdomen (HR = 0.54; 95% CI: 0.33-0.89, p = 0.015). Both adjuvant radiation (HR = 0.64; 95% CI: 0.48-0.85, p = 0.002) and neoadjuvant radiation (HR = 0.70; 95% CI: 0.49-1.00, p = 0.049) provided a survival benefit to patients. There was an increased risk of death for every 10-year increment in age (HR = 1.31; 95% CI: 1.12-1.45, p < 0.001). CONCLUSION: Statistically significant prognostic factors for PLS include primary anatomical site, age, Charlson-Deyo Comorbidity Index Scores and the use of neoadjuvant and adjuvant radiation.

Important prognostic factors in leiomyosarcoma survival: a National Cancer Database (NCDB) analysis.

BACKGROUND: Leiomyosarcoma (LMS) is an aggressive, malignant mesenchymal tumor with characteristic smooth muscle lineage accounting for 10-20% of all soft tissue tumors. The goal of this study is to determine the impact of prognostic factors on leiomyosarcoma survival irrespective of primary anatomical site. METHODS: There were a total of 7154 patients with primary leiomyosarcoma identified and analyzed from the National Cancer Database. Descriptive statistics, median survival, and 5- and 10-year survival probabilities were calculated along with a Cox proportional hazard model to determine independent prognostic factors. RESULTS: In this study, females comprised 68.3% of the cohort with a median age of 58 years. The most common primary anatomical sites were the extremities followed by female reproductive organs, abdomen, pelvis, thorax or lung, and head or neck. Tumors localized in the female reproductive organs had the worst survival (5-year survival probability: 45.3%), while tumors localized in the extremities had the best survival outcomes (5-year survival probability: 73.4%). Surgery with adjuvant radiation yielded better outcomes compared to surgery alone (HR 0.82, 95% CI 0.74-0.91). Microscopic and macroscopic margins resulted in a 32% and a 134% increased risk in mortality, respectively, when compared to negative surgical margins (p < 0.0001). CONCLUSION: This study showed a significantly higher risk of mortality associated with older patients, tumors localized to the female reproductive organs, African American patients, higher tumor stage, increased Charlson/Deyo scores, tumors treated with surgery alone without adjuvant radiation, and tumors with positive microscopic, macroscopic, or indeterminate surgical margins.

The importance of adjuvant treatment and primary anatomical site in head and neck basaloid squamous cell carcinoma survival: an analysis of the National Cancer Database.

PURPOSE: Basaloid squamous cell carcinoma (BSCC) of the head and neck is an aggressive and highly malignant variant of squamous cell carcinoma that accounts for 2% of head and neck cancers. Previous studies have not analyzed the significance of adjuvant chemoradiation and anatomical site within BSCC subtype and its impact on survival. METHODS: A cohort of 1999 patients with BSCC of the head and neck was formed from the National Cancer Database and analyzed with descriptive studies, median survival and 5- and 10-year survival. A multivariable Cox hazard regression was performed to determine the prognostic significance of anatomical site and adjuvant therapy. RESULTS: The most common primary anatomical site was the oropharynx (71.9%) followed by oral cavity (11.5%), larynx (10.1%), hypopharynx (3.5%), esophagus (1.9%), and nasopharynx (1.1%). The presence of metastasis increased the risk of mortality (HR = 2.14; 95% CI 1.40-3.26). Tumors localized to the oropharynx demonstrated better survival compared to all sites except nasopharynx, including the oral cavity (HR = 2.45; 95% CI 1.83-3.29), hypopharynx (HR = 2.58; 95% CI:1.64-4.05), and larynx (HR = 2.89; 95% CI:2.25-3.73). Adjuvant chemoradiation (HR = 0.36; 95% CI 0.23-0.58) and adjuvant radiation (HR = 0.38; 95% CI 0.23-0.64) had better survival outcomes compared to adjuvant chemotherapy. Patients with microscopic margins had better survival outcomes when compared to no surgery (HR = 0.38, 98% Cl 0.23-0.64) while there were no better survival outcomes of patients with macroscopic margins compared to no surgery. CONCLUSION: This study illustrated that tumors in the oropharynx, lower age, adjuvant chemoradiation and radiation, and microscopic margins were associated with greater survival.

Chinese Cancer Research in 2009-18 and the Disease Burden.

OBJECTIVE: We investigated the correlation of cancer research in China with its disease burden and national or provincial wealth. We also compared China's research output with that of other Asian countries. METHODS: Chinese publications on cancer research for 2009-18 were retrieved from the Web of Science with a special filter giving high precision and recall. Their volume relative to gross domestic product (GDP) was compared with those of 14 Asian countries, and provincial outputs with provincial GDPs. Their distribution by anatomical site was compared with China's disease burden, and by research type with that of Europe. RESULTS: Chinese cancer research publications (including those from Taiwan) have grown rapidly in the last 10 years, and overtook those of the USA in 2018. Relative to other Asian countries, Chinese output was approximately proportionate to its wealth. Relative to its cancer burden (as a percentage of the total disease burden), China published an appropriate amount of cancer research in 2009-13, but almost one-third more in 2014-18. Its distribution between the provinces reflected their wealth, but with comparatively greater outputs from Beijing and Shanghai. The distribution of China's cancer research portfolio by anatomical site corresponded to its disease burden quite well, with a heavy emphasis on liver and stomach cancer. However, China did relatively less research on screening, diagnosis, palliative care, or quality of life. CONCLUSION: The national and provincial cancer research in China in the past 10 years correlated relatively well with its disease burden and economic level, but over-emphasised basic research compared with prevention, screening and end-of-life care.

Primary anatomical site, adjuvant therapy, and other prognostic variables for dedifferentiated liposarcoma.

BACKGROUND: Dedifferentiated liposarcoma (DDLPS) is a high-grade, clinically aggressive tumor associated with low survival probabilities. Prognostic variables for DDLPS have not been previously reported in a large patient population. METHODS: A total of 3573 patients with primary DDLPS were analyzed from the National Cancer Data Base (NCDB). The 5- and 10-year survival probabilities were calculated, and the groups were compared using log-rank comparisons and multivariable Cox hazard regression analysis. Median survival was also calculated. RESULTS: Males comprised 65% of the cohort, the median age at diagnosis was 64 years of age, and 65.4% of the patients were between 51 and 75 years of age. The most common site for primary tumors is the retroperitoneum or abdomen (59.5%). Head or neck tumors had the best 5-year outcomes (86.4%) followed by extremities (67.1%), pelvis (65.8%), thorax or trunk (58.9%), and finally retroperitoneum or abdomen (42.6%). Best outcomes were noted in the 26- to 50-year-old age group (5-year survival:66.8%), < 10 cm size (5-year survival:66.1%), FNCLCC grade 1 (5-year survival:69.2%), and stage II disease (5-year survival:66.7%). Radiation therapy yielded the best 5-year and 10-year survival probabilities of 59% and 39.3%, respectively. Out of all the adjuvant therapies, the use of radiation resulted in the best 5-year survival of 63.4%. CONCLUSION: In the largest and most comprehensive study to date on DDLPS, major findings include primary site as a significant prognostic variable with age at presentation, sex, tumor stage, and type of adjuvant therapy significantly impacting overall survival.

Nodular Lesions on the Upper Trunk: An Uncommon Anatomical Site of Renal Tumor Metastases.

Renal cell carcinoma (RCC) is the most frequent cancer of the kidney and it accounts for 3% of all solid malignancies. Although rare, cutaneous metastases can be an important manifestation of RCC. We present a case of a 56-year-old male with a history of RCC, followed by the development of cutaneous metastases 4 years later with an uncommon clinical presentation. RCC is the most common genitourinary cancer to metastasize to the skin and accounts for 6.8% of cutaneous metastases. These patients have a poor prognosis. It is essential for these patients to perform a complete periodic dermatologic examination for proper restaging and treatment.

The presenting features of melanoma in New Zealand: implications for earlier detection.

OBJECTIVE: To examine the relationship between presenting features and histological characteristics of melanomas in New Zealand. METHODS: Cases were participants in a national melanoma case-control study. Histological data were extracted from a Cancer Registry download. Associations between categorical variables were assessed using the χ2 test; linear regression was used for continuous variables and multinomial logistic regression for non-binary categorical dependent variables. RESULTS: Most melanomas were self-detected. Lesions >2mm depth took longer to diagnose, predominantly due to patient delay. The commonest presenting feature was colour. After adjustment for depth, nodular melanomas were less likely than superficial spreading melanomas to present because of shape or colour, but more likely to be raised. After adjustment for subtype, thick melanomas were significantly more likely to be bigger, raised, bleeding or crusting, and inflamed, itchy or sore. CONCLUSIONS: Nodular and thick melanomas failed to fulfil the ABCDE criteria: the 'A', 'B' and 'C' discriminated poorly; and 'D' for diameter may exclude small but thick lesions. The 'E' criterion (elevation/enlargement/evolution) was perhaps best for detecting these melanomas. Implications for public health: Public education for earlier diagnosis in New Zealand needs to include the presenting features of nodular and thick melanomas and to strongly encourage seeking early physician advice.