Exploring the biphasic dose-response effects of photobiomodulation on the viability, migration, and extracellular vesicle secretion of human adipose mesenchymal stem cells.

Photobiomodulation (PBM) is a well-established medical technology that employs diverse light sources like lasers or light-emitting diodes to generate diverse photochemical and photophysical reactions in cells, thereby producing beneficial clinical outcomes. In this study, we introduced an 830 nm near-infrared (NIR) laser irradiation system combined with a microscope objective to precisely and controllably investigate the impact of PBM on the migration and viability of human adipose mesenchymal stem cells (hADSCs). We observed a biphasic dose-response in hADSCs' viability and migration after PBM exposure (0-10 J/cm2), with the 5 J/cm2 group showing significantly higher cell viability and migration ability than other groups. Additionally, at the optimal dose of 5 J/cm2, we used nanoparticle tracking analysis (NTA) and found a 6.25-fold increase in the concentration of extracellular vesicles (EVs) derived from hADSCs (PBM/ADSC-EVs) compared to untreated cells (ADSC-EVs). Both PBM/ADSC-EVs and ADSC-EVs remained the same size, with an average diameter of 56 nm measured by the ExoView R200 system, which falls within the typical size range for exosomes. These findings demonstrate that PBM not only improves the viability and migration of hADSCs but also significantly increases the EV yield.

Efficacy of Laser in Hair Removal: A Network Meta-analysis.

BACKGROUND: Laser hair removal is an increasingly prevalent trend of cosmetic procedures. The purpose of this study was to assess the effectiveness of hair reduction among several types of laser interventions. METHODS: The selected studies searched in PubMed and EMBASE were assessed for quality of evidence, and extracted data on absolute hair count and hair reduction rate. Qualitative data were synthesized using standardized mean difference (SMD) in frequentist network meta-analysis because various measurement units were used among selected studies. Inconsistency and small study effects were examined by design-by-treatment interaction model and comparison-adjusted funnel plot. RESULTS: A total of 13 randomized controlled trials (RCTs) (n = 652) were contributed to network meta-analysis. Pooled results revealed that diode laser showed significantly lower absolute hair count within three-month (SMD = -13.21, 95% confidence interval [CI]: -22.25 to -4.17) and around six months follow-up (SMD = -11.01, 95% CI: -18.24 to -3.77) as compared with those in control group, but no significant difference among laser interventions. All side effects observed were transient without leaving any permanent scars. CONCLUSION: Eliminating unwanted hair with lasers or intense pulsed light is safe and effective; however, which type of intervention is more beneficial in the long-term process should be studied with a longer follow-up time.

Biophotonic Effects of Low-Level Laser Therapy on Adipose-Derived Stem Cells for Soft Tissue Deficiency.

PURPOSES: The objectives of this study are to use diode lasers for low-level laser therapy (LLLT) and to assess its applicability and effects in adipose-derived stem cell (ADSC) growth processes. METHODS: Studies were conducted on the diode laser with wavelengths of 622.7, 527.1, and 467.3 nm. The mechanism of action of LLL illumination was studied on ADSCs, isolated from human tissue, and then cultured by examining different wavelengths to determine the relevant light parameters for optimal responses. We used enzyme-linked immunosorbent assay and real-time polymerase chain to determine the percentages of fibroblast-mediated procollagen type 1 and matrix metallopeptidase 1 (MMP-1), MMP-2, and MMP-9 production at different wavelengths. The levels of lactate dehydrogenase produced by ADSCs after LLL illumination were assessed as well. Clinical results from 20 patients treated for soft tissue deficiency were collected for assessment of ADSC-assisted lipotransfer. RESULTS: Low-level laser (622.7 nm) illumination on cell cultures in vitro increased ADSCs proliferation, type 1 procollagen expression, collagen production, as well as MMP-1, MMP-2, and MMP-9 relative expression. Statistical analysis demonstrated a significant difference in red light (622.7 nm) versus green light (527.1 nm) and blue light (467.3 nm, P < 0.05). No significant differences were noted between the effects of green and blue lights. In clinical application, all patients attained significant improvement with treatment in the final outcome assessment after 6 months. CONCLUSIONS: Low-level laser illumination may affect ADSCs growth processes and ADSC-assisted lipotransfer for soft tissue deformity, scar treatment, wound healing, and other reconstructive surgery.

Imaging and Histopathological Analysis of Microvascular Angiogenesis in Photodynamic Therapy for Oral Cancer.

The objective of this study is to use imaging and histopathological analysis to characterize and monitor microvascular responses to photodynamic therapy (PDT). In vivo chicken chorioallantoic membranes (CAMs) and a stimulated malignant oral lesions animal model were used to determine the blood flow and the biological activities of Photofrin® (2.5 mg/kg) exposed to different laser power densities at 630 nm. The vascular changes, the velocity of the blood flow, the speckle flow index (SFI) of fluorescence changes, and ultrastructure damage in the microvasculature before and after PDT were recorded. The subcellular localization of Photofrin® revealed satisfactory uptake throughout the cytoplasm of human red blood cells at 10 s and 20 s before PDT. The mean blood-flow velocities of the veins and arteries were 500 ± 40 and 1500 ± 100 µm/s, respectively. A significant decrease in the velocities of the blood flow in the veins and arteries was detected in the CAM model after PDT. The veins and arteries of CAMs, exposed to the power densities of 80, 100, and 120 mW/cm2, had average blood-flow velocities of 100 ± 20, 60 ± 10, and 0 µm/s and 300 ± 50, 150 ± 30, and 0 µm/s, respectively. In the stimulated malignant oral lesions animal model, the treated tumors exhibited hemorrhage and red blood cell extravasation after PDT. The oxyhemoglobin and total hemoglobin levels decreased, which resulted in a decrease in tissue oxygen saturation, while the deoxyhemoglobin levels increased. PDT using Photofrin® has the ability to cause the destruction of the targeted microvasculature under nonthermal mechanisms selectively.

Endoscopic-Assisted Abdominoplasty.

Advantages of standard endoscopic surgery include diminished incidence of scarring, numbness, bleeding, and edema, making endoscopic surgery preferable to the conventional suprapubic approach. Endoscopic-assisted abdominoplasty can also treat diastasis recti deformity with minimal excess skin. For enhanced results, a learning curve is expected to achieve optimal technical expertise.

Single Cell Effects of Photobiomodulation on Mitochondrial Membrane Potential and Reactive Oxygen Species Production in Human Adipose Mesenchymal Stem Cells.

Photobiomodulation (PBM) has recently emerged in cellular therapy as a potent alternative in promoting cell proliferation, migration, and differentiation during tissue regeneration. Herein, a single-cell near-infrared (NIR) laser irradiation system (830 nm) and the image-based approaches were proposed for the investigation of the modulatory effects in mitochondrial membrane potential (ΔΨm), reactive oxygen species (ROS), and vesicle transport in single living human adipose mesenchymal stem cells (hADSCs). The irradiated-hADSCs were then stained with 2',7'-dichlorodihydrofluorescein diacetate (H2DCFDA) and Rhodamine 123 (Rh123) to represent the ΔΨm and ROS production, respectively, with irradiation in the range of 2.5-10 (J/cm2), where time series of bright-field images were obtained to determine the vesicle transport phenomena. Present results showed that a fluence of 5 J/cm2 of PBM significantly enhanced the ΔΨm, ROS, and vesicle transport phenomena compared to the control group (0 J/cm2) after 30 min PBM treatment. These findings demonstrate the efficacy and use of PBM in regulating ΔΨm, ROS, and vesicle transport, which have potential in cell proliferation, migration, and differentiation in cell-based therapy.

Laser hair removal following forehead flap for nasal reconstruction.

The forehead flap is a dependable option for nasal reconstruction owing to its reliability and anatomic likeness to nasal skin. For patients with low hairlines, the vertical design of the paramedian forehead flap can intrude into the scalp, thus incorporating hair into the nasal reconstruction. The inadequate length of the forehead flap or shift to an oblique design may result in eyebrow elevation and asymmetry. Therefore, laser hair removal (epilation) on the forehead flap has been proposed to improve esthetic results. An alexandrite laser (755 nm, 10 to 20 ms, 18-mm spot size) with a Dynamic Cooling Device™ (DCD™) cooling system was used for hair removal in 22 patients (16 male and 6 female patients) after nasal reconstructions using forehead flaps from December 2011 to September 2016. All patients received cryogen spray cooling laser treatment (CSC-LT). The mean follow-up period was 24 months, with a range between 18 and 50 months. The average duration of treatment was 1.8 months (range, 1-5 months). The energy density ranged from 14 to 18 J/cm2 with an average of 17.2 J/cm2. The number of treatments ranged from 2 to 4 (mean 2.8). Patients had satisfactory esthetic results over 11.1 months (range, 8-18 months). Residual white hairs were observed in 3 patients, and 4 patients had tiny black residual hairs without deteriorating cosmesis. Using an alexandrite laser to remove hair on the forehead is safe and reliable in nasal reconstruction with superior recipient site cosmesis.

Long Term Follow-up of Intralesional Laser Photocoagulation for Head and Neck Lymphatic Malformations Using Neodymium-Yttrium-Aluminium-Garnet Laser.

BACKGROUND: Lymphatic malformations remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional laser photocoagulation (ILP) for treating vascular anomalies. BACKGROUND DATA: The objective of our study is to review the long-term results of a large series of lymphatic malformations in patients treated with ILP. MATERIALS AND METHODS: A retrospective review of 190 head and neck lymphatic malformations in patients were treated by ILP with an neodymium-yttrium-aluminum-garnet (Nd:YAG) laser (1064 nm) over a period of 20 years (January 1997-January 2016). Patients' ages ranged from 10 months to 12 years and 6 months (mean, 1 year and 11 months). The patient group consisted of 98 female and 92 male patients. RESULTS: Patients were treated with an Nd:YAG laser (Sharplan Inc, Allendale, New Jersey) delivered through a 600-µm optical fiber. Laser power was set at 7 to 15 W and delivered with a pulse duration of 7 to 15 seconds. All patients demonstrated improvement as judged by clinical assessment of the reduction in lesion size (range, 65%-100%; mean reduction, 85%). One hundred fifty-two (80%) patients had a more than 65% reduction of the volume in lymphatic malformations at 3 months after 1 treatment, and 171 (90%) patients had a more than 85% reduction of the volume after 2 treatments. Excellent results were seen in 19 (10%) patients after 3 treatments. Postoperative complications were related to photocoagulation that was delivered too extensively or superficially, with resultant ulceration, infection, induration, and scarring. CONCLUSIONS: Throughout the course of our long-term study, ILP using an Nd:YAG laser is an effective treatment modality for lymphatic malformations. Complications can be avoided if the potential for harm is kept in mind.

Continuous cooling system in conjunction with laser surgery for ear reshaping.

When the cartilage on the prominent ears is reshaped, the arising stress returns the tissue to its initial configuration. Laser irradiation of areas of maximal stress leads to stress relaxation and results in a stable configuration. Sixty auricles were harvested from 30 New Zealand white rabbits and cut into a rectangle measuring 50 mm by 25 mm with an average thickness of approximately 1.3 mm. Bilateral skin was included for ex vivo studies. Continuous cryogen spray cooling (CSC) with laser energy was delivered to the exposed cartilage for reshaping. In clinical applications, from January 2006 to December 2016, a total of 50 patients with 100 bat ears who underwent CO2 laser reshaping (otoplasty) were assessed. A continuous cooling system (4 °C) in conjunction with a CO2 laser was applied to make a retroauricular-approached incision and reshape the ear cartilage. The well cartilage bending correlated with the different parameters demonstrated in the continuous CSC protected group. All 100 (100%) of the subjects experienced early complications (≤ 1 month) related to laser exposure with swelling, while 5 (5%) experienced ecchymosis, 2 (2%) minimal hematoma, 2 (2%) scarring, 1 (1%) minor infection, 1 (1%) under correction, 1 (1%) overcorrection, and 1 (1%) relapse. These problems were corrected and/or had resolved after 3 months. All patients achieved good to excellent results in our final outcome assessment (> 6 months). Laser reshaping has a potential use in certain surgical procedures involving the cartilage. The appropriate conditions for laser ear reshaping clearly depend on the laser wavelength used, energy controlling, and tissue optical properties.

Endovenous Photocoagulation Using a Diode Laser for Complicated Varicose Veins Related to Stasis Ulcers.

BACKGROUND: The objective of this study was to assess the efficacy and safety of endovenous laser photocoagulation (EVLP) at a wavelength of 810 nm for treating complicated venous insufficiency associated with venous ulcers. MATERIALS AND METHODS: A retrospective review of 110 patients with 180 legs having chronic venous insufficiencies associated with varicose veins treated over an 8-year period was conducted. Patients ranged from 16 to 80 years of age and included 85 women and 25 men. Of the 110 patients, 32 (29.10%) patients with 40 legs having varicose veins were defined as having complicated varicose veins associated with venous ulcers. All 32 patients received EVLP treatment using a diode laser. Complications were evaluated at 3 weeks (early), 6 weeks (late), and 6 months (final) after EVLP treatment. The primary efficacy and final outcome measurement were determined through quantitative assessment using Hach's and clinical, etiological, anatomical, and pathophysiological classification. Safety was evaluated for each treatment group by monitoring adverse effects. RESULTS: Early complications were swelling, local paresthesia, pigmentation, minor superficial thermal injury, superficial phlebitis, and localized hematomas. All complications and ulcerations resolved completely within 2 weeks. No recurrence occurred after the study's 6-month follow-up period. Based on paired t test analysis, clinically significant differences in severity scores were discovered, which were based on Hach's classification before and after EVLP treatment at a wavelength of 810 nm. All patients achieved improvement from clinical, etiological, anatomical, and pathophysiological class C6 to C5. Permanent adverse effects were not observed. CONCLUSIONS: Endovenous laser photocoagulation at the wavelength of 810 nm permitted the use of appropriate light doses for treating complicated varicose veins associated with venous ulcers and resulted in significant improvement in lesions.

Topical application of Photofrin® for photodynamic diagnosis of malignant cutaneous neoplasms.

OBJECTIVES: The prognosis of patients suffering from malignant cutaneous neoplasms can be improved by early diagnosis. Exact demarcation of tumor margins could contribute to optimum results in surgical excision and reconstruction. The purpose of our study is to evaluate Photofrin® with a new diagnostic procedure, photodynamic diagnosis (PDD), for the detection of Bowen's disease (squamous cell carcinoma (SCC) in situ), SCC, and basal cell carcinoma (BCC). MATERIALS AND METHODS: Sixty patients with cutaneous neoplasms received 2.5 mg/mL Photofrin® solution topically. After a period of 3 hours, the patients underwent fluorescence illumination (λex = 370-450 nm). Guided by their visible fluorescence, lesions were biopsied at four suspicious sites in each patient. All specimens were analyzed and measured by a pathologist. A quantitative analysis of the fluorescence contrast between the neoplasms and healthy tissue was performed using the Red, Blue, and Green (RGB) Mode and Gray Scale (GS). Statistical analysis was performed by the analysis of variance (ANOVA) test for multiple comparisons. RESULTS: Of the 60 patients (20 Bowen's disease, 20 SCC, and 20 BCC), malignant neoplasms could be clearly distinguished from adjacent healthy tissue under fluorescence illumination (P < 0.0001). The sensitivity of the malignant neoplasms evaluated using the RGB and GS modes combined showed 92.74% in image results. The specificity of the malignant neoplasms evaluated using the RGB and GS modes combined showed 95.77%. CONCLUSION: Light-induced fluorescence detection using topical Photofrin® provides a sensitive, noninvasive technique for the early identification of malignant cutaneous neoplasms.

Comparing the effectiveness of laser vs. conventional endoforehead lifting.

The objective of this study was to compare the efficacy and safety of laser versus conventional endoforehead lifting. Over a period of 12 years (January 2000-January 2012), a total of 110 patients with hyperactive muscles over the frontal region have been collected for a retrospective study. The SurgiLase 150XJ CO2 laser system, in conjunction with the flexible FIBERLASE, was used. The endoscope was 4 mm in diameter with an angle of 30°. The primary efficacy measurement was the assessment of the final outcome for using laser vs. conventional methods. Both groups were observed at three weeks, six weeks and six months after surgery. The most common complication in early convalescence (three weeks) was swelling. This was followed by local paraesthesia, ecchymosis, localized hematomas and scar with alopecia. All these problems disappeared completely after the 6-month study period. Based on a chi-square analysis, there were clinically and statistically significant differences favouring the laser endoforehead surgery in the operative time, early and late complications. All patients achieved significant improvement after both laser and conventional endoforehead surgery in the final outcome. However, the early and late complications indicated a greater difference in the laser group.

Comparison of Steroid and Botulinum Toxin Type A Monotherapy with Combination Therapy for Treating Human Hypertrophic Scars in an Animal Model.

BACKGROUND: The authors evaluated the efficacy of a combined regimen of botulinum toxin type A (Botox) and a steroid (triamcinolone acetonide) for treating hypertrophic scars in comparison with the treatment with each drug alone. METHODS: Twenty excised human hypertrophic scar fragments obtained from surgically treated burn patients were divided into four groups: negative control (group A), triamcinolone alone (group B), Botox alone (group C), and a combination of triamcinolone and Botox (group D). These specimens were implanted into the backs of nude mice after intralesional injection from each group and were observed for 4 weeks. In total, 12 mice and 48 scars were studied. After 4 weeks, the hypertrophic scars were removed from the backs. The authors compared the scar weights, decorin staining, and the Cell Counting Kit-8 assay to evaluate treatment efficacy. RESULTS: Significant differences in scar weight reduction were observed among the four groups (group A, 10 percent; group B, 17 percent; group C, 23 percent; and group D, 30 percent; p < 0.05). Treatment groups (groups B, C, and D) showed strong decorin staining. Significant differences in reduction of fibroblast proliferation were observed among the four groups (group A, 0.58; group B, 0.44; group C, 0.21; and group D, 0.08; p < 0.05). Botox or triamcinolone intralesional monotherapy showed significant therapeutic efficacy compared with the control group. The combined therapy further exhibited a significant therapeutic effect compared with monotherapy. CONCLUSION: This study indicates the potential of Botox and triamcinolone when combined for intralesional therapy in treating hypertrophic scars.

Anterolateral Thigh Flap for Reconstruction in Postburn Axillary Contractures.

BACKGROUND: Reconstruction of postburn axillary contractures is difficult and particularly challenging without healthy adjacent soft tissue for axillary scar resurfacing. In this case, a free soft-tissue transfer is among the best treatment options. Here, we describe our experience with free anterolateral thigh (ALT) flap for reconstruction in postburn axillary contractures. METHODS: We enrolled 10 patients with postburn axillary contractures from August 2003 to July 2015. They all underwent wide scar contracture release through a transverse incision from the anterior axillary fold to the posterior axillary fold. The ALT flap was subfascially raised. The huge soft tissue defect after scar release was resurfaced with the ALT flap. RESULTS: Eight male patients and 2 female patients (age, 16-64 years; mean, 46 years) were included. The mean total burn surface area, follow-up time, duration between injury onset and free-flap transfer surgery, and flap size were 48%, 27 months, 7.7 months, and 12 × 23 cm, respectively. The most common recipient vessels were the thoracodorsal artery and vein (77%). The mean improvement in the range of motion of shoulder abduction was 86 degrees (range, 60-130 degrees). The mean operative time was 7 hours. All flaps survived without reexploration or failure. All but 1 donor site was managed by split-thickness skin grafting. No infection, hematoma, or deaths were noted postoperatively. Transient brachial palsy was noted in a 16-year-old male patient postoperatively, with full recovery 3 months after. CONCLUSIONS: For postburn axillary contractures without healthy adjacent soft tissue for scar resurfacing, ALT flap reconstruction represents a suitable treatment option. It allows simultaneous surgery on both the donor and recipient sites, without the need to change the patient's position. Furthermore, the ALT flap provides sufficient soft tissue and blood flow for reconstruction, leading to satisfactory functional outcomes.

Nasolabial and forehead flap reconstruction of contiguous alar-upper lip defects.

BACKGROUND: Defects of the nasal ala and upper lip aesthetic subunits can be challenging to reconstruct when they occur in isolation. When defects incorporate both the subunits, the challenge is compounded as subunit boundaries also require reconstruction, and local soft tissue reservoirs alone may provide inadequate coverage. In such cases, we used nasolabial flaps for upper lip reconstruction and a forehead flap for alar reconstruction. METHODS: Three men and three women aged 21-79 years (average, 55 years) were treated for defects of the nasal ala and upper lip that resulted from cancer (n = 4) and trauma (n = 2). Unaffected contralateral subunits dictated the flap design. The upper lip subunit was excised and replaced with a nasolabial flap. The flap, depending on the contralateral reference, determined accurate alar base position. A forehead flap resurfaced or replaced the nasal ala. Autologous cartilage was used in every case to fortify the forehead flap reconstruction. RESULTS: Patients were followed for 25.6 months (range, 1-4 years). All the flaps survived, and there were no complications. Satisfactory aesthetic results were achieved in every case. With the exception of a small vertical cheek scar and a vertical forehead scar, all incisions were concealed within the subunit borders. CONCLUSION: From preliminary experience, we advocate combining nasolabial flap reconstruction of the upper lip with a forehead flap reconstruction of the ala to preserve normal facial appearance. This combination addresses an important void in the algorithmic approach to central facial reconstruction.

Donor Site Aesthetic Enhancement With Preoperative Botulinum Toxin in Forehead Flap Nasal Reconstruction.

BACKGROUND: Donor site scarring after forehead flap nasal reconstruction is acceptable. However, as aesthetic outcomes standards for cosmetic and reconstructive surgery merge, we aim to enhance results. We recently demonstrated the cosmetic benefit of botulinum toxin type A (BTX-A) for cleft lip cheiloplasty outcomes. We hypothesize that similar mechanism(s) benefit forehead flap donor scars. METHODS: A single surgeon performed 26 forehead flap reconstructions. Indications were cancer (n = 17), trauma (n = 3), and congenital deformity (n = 6). In this split-scar study half the forehead was pretreated with BTX-A and half with normal saline after random assignment. Photographs were evaluated at most recent follow-up. Scar evaluation was based on photographs by 3 plastic surgeons using a composite subjective visual analogue score (VAS). RESULTS: Photographic follow-up was 27 months (range, 10-60 months). Botulinum toxin type A was assigned to the upper forehead in 16 cases and lower forehead in 10 cases. Intrarater reliability among 4 evaluators of 104 VAS scores was 78.1%. Upper forehead VAS (7.9 ± 1.2) was not different than lower forehead VAS (7.9 ± 1.2) regardless of treatment (P = 0.62). The VAS score of BTX-A-treated scars (8.5 ± 1.0) was significantly higher than the control (7.3 ± 1.1; P < 0.0001). Among 104 individual comparisons (26 patients × 4 observers), there were 73 instances (70.2%) where the experimental VAS score was higher than the control. CONCLUSIONS: Preoperative BTX-A injection is feasible and enhances donor site scar appearance after forehead flap nasal reconstruction in an Asian population.

Real-time photothermal imaging and response in pulsed dye laser treatment for port wine stain patients.

BACKGROUND: This study was performed to assess the photothermal response of highly focused laser energy using infrared thermal imaging instrument to detect and assess the actual temperature distribution during flash lamp pumped pulsed dye laser (FLPPDL) treatment for port wine stain (PWS) patients and avoiding its complications. METHODS: A retrospective review of 40 patients with PWS birthmark treated with FLPPDL (l = 585 nm, tp = 1500 ms, 7 mm spot) was conducted over a 2-year period. Subjects' ages ranged between 28 and 46 years (mean 29 years); there were 24 females and 16 males. Twenty patients received non-cooling laser treatment (NC-LT) using light dosages of 5-12 J/cm 2 . Another 20 patients received cryogen spray cooling laser treatment (CSC-LT) using light dosages of 5-12 J/cm 2 . A real-time infrared thermal imaging and the thermal wave equation were used for assessment. The results of temperature distributions related to the energy change were analyzed. RESULTS: Proper temperature measurement using infrared thermal imaging instrument and thermal wave equation in non-cooled PWS patients showed that the energy density of pulsed dye laser (PDL) higher than 7 J/cm 2 can reach >44°C and result in burn injury. However, when energy densities beyond 10 J/cm 2 were administered, along with using CSC, thermal damage was could still be minimized without the risk of damage to the treated area. CONCLUSION: Using infrared thermal imaging instrument and thermal wave equation, we can predict the skin temperature distribution in FLPPDL for PWS patients during the treatment. In conjunction with CSC, the complications can be minimized.

Prognostic factors for Taiwanese patients with cutaneous melanoma undergoing sentinel lymph node biopsy.

BACKGROUND/PURPOSE: Sentinel lymph node biopsy (SLNB) is a standard procedure in the management of clinically node-negative melanoma. However, few studies have been performed on SLNB in Asia, which is an acral melanoma-prevalent area. This study evaluated the clinicopathologic prognostic factors of disease-free survival (DFS) and overall survival (OS) in Taiwanese patients with cutaneous melanoma who received wide excision and SLNB. The prognosis of patients with false-negative (FN) SLNB was also evaluated. METHODS: Malignant melanoma cases were reviewed for 518 patients who were treated between January 2000 and December 2011. Of these patients, 127 patients with node-negative cutaneous melanoma who received successful SLNB were eligible for inclusion in the study. RESULTS: The SLNB-positive rate was 34.6%. The median DFS was 51.5 months, and the median OS was 90.9 months at the median follow-up of 36.6 months. Multivariate analysis revealed that patients whose melanoma had a Breslow thickness greater than 2 mm had a significantly shorter DFS than patients whose melanoma had a Breslow thickness of 2 mm or less [hazard ratio (HR), 3.421; p = 0.005]. Independent prognostic factors of OS were a Breslow thickness greater than 2 mm (HR, 4.435; p = 0.002); nonacral melanoma (HR, 3.048; p = 0.001); and an age older than 65 years (HR, 2.819; p = 0.036). During the follow-up period, 13 of 83 SLN-negative patients developed a regional nodal recurrence. The SLNB failure rate was 15.7% and the FN rate was 22.8%. Compared to patients with a true-positive SLNB, patients with FN SLNB had a significantly shorter DFS (p = 0.001) but no significant difference in OS (p = 0.262). CONCLUSION: Except for the pathologic subtypes, prognostic factors in Taiwan are similar to those used in other melanoma-prevalent countries. Identifying and closely monitoring patients at risk of nodal recurrence after a negative SLNB is important.