The role of wide local excision for the treatment of severe hidradenitis suppurativa (Hurley grade III): Retrospective analysis of 74 patients.

BACKGROUND: Effective medical treatment for patients with severe hidradenitis suppurativa (HS) is limited. OBJECTIVES: We sought to measure the impact of wide local excision on quality of life in HS Hurley grade III patients and to examine the rate of postoperative complications, disease recurrences, and satisfaction with the cosmetic results. METHODS: Seventy-four patients were enrolled. Outcome measures included Dermatology Life Quality Index responses, disease duration, recurrence, previous therapies, postoperative complications, and satisfaction with cosmetic results. RESULTS: Most patients had inguinogenital/gluteal disease (68.9%, P < .001). Involvement of both the axillary and the inguinogenital/gluteal areas were pronounced in male patients (P = .018). None of the patients was treated with tumor necrosis factor-α inhibitors. Most patients (71.6%) had a disease history of >5 years at the time of presentation and multiple unsuccessful attempts with systemic and local therapeutic interventions. Wide local excision improved Dermatology Life Quality Index scores from initially 27.89 to 5.31 after surgery (P < .001), independent of localization (P = .195). Forty-seven percent of patients had postoperative complications, most frequently pain and scarring. The vast majority of patients (70.3%) were satisfied with the cosmetic results. LIMITATIONS: The retrospective nature of the study was a limitation. CONCLUSIONS: Wide local excision significantly improves the quality of life of HS patients. Local recurrence rates are low, and satisfaction with the cosmetic results is high.

S-classification of sentinel lymph node biopsy predicts the results of complete regional lymph node dissection.

The purpose of this study was to identify melanoma patients with positive sentinel lymph nodes (SLNs) at increased risk for further metastases in this specific lymph node basin. A series of consecutive patients with primary malignant melanoma stage I and II were evaluated retrospectively. The results of SLN biopsy in 26 patients with positive SLNs were compared with those of complete regional lymph node dissection (RLND) using the recently published S-classification of SLNs. The results of S-classification of SLNs were correlated with the outcome of complete RLND. There was a significant correlation between the S stage of positive SLNs and the results of complete RLND (P=0.02). Only patients with SIII stage (n=4) SLNs were found to have further metastases in the residual lymph node basin. The present study indicates that patients with SI stage and SII stage SLNs rarely have further metastases in the specific lymph node basin.

Positron emission tomography is not useful in detecting metastasis in the sentinel lymph node in patients with primary malignant melanoma stage I and II.

The most powerful predictor for recurrence and survival in patients with primary malignant melanoma is the presence or absence of lymph node metastases. In the present study, 18-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) findings were compared with histopathological results of sentinel lymph node biopsy (SNB). The purpose was to determine the value of FDG-PET in predicting regional lymph node involvement in patients with primary malignant melanoma stage I and II. Forty-eight consecutive patients with primary cutaneous melanoma stage I (Breslow thickness > 1 mm) and II underwent FDG-PET scans, preoperative lymphoscintigraphy, and SNB. The FDG-PET and SNB results were interpreted independently of each other and then compared. Of the 48 patients included in the study, eight (16.7%) had a positive SNB. PET was positive in only one patient with a positive SNB, yielding a sensitivity of 13%. All other positive sentinel nodes could not be detected by metabolic FDG-PET imaging. Our study revealed that FDG-PET is obviously not an adequate screening test for subclinical and sonographically inconspicuous lymph node metastases in patients with malignant melanoma stage I and II. The low sensitivity is probably due to the small size of metastatic deposits in sentinel nodes. Therefore, SNB remains the technique of choice for evaluating the histological status of lymph node basins in patients with early-stage cutaneous melanoma.