Cutaneous malakoplakia.

Malakoplakia is a form of chronic, granulomatous, inflammatory condition which usually affects the genitourinary tract or other internal organs of immunocompromised patients. It is usually caused by acquired bactericidal incapacity of macrophages in connection to Eschericia coli infection. This case report presents an extremely rare case of cutaneous malakoplakia in the left axilla of a 48-year-old male patient, who had undergone kidney transplant one year earlier. The clinical presentation of cutaneous malakoplakia varies from nodules to plaques and moist wounds. The primary treatment is long-term antibiotic therapy.

[Glomuvenous malformations can be very painful and cause diagnostic challenges].

This case report describes three different cases of glomuvenous malformations, which is a rare, autosomal dominant inherited cutaneous venous disease. There is a broad variation in the clinical appearance of these lesions, from flat blue elements to raised purple element with cobblestone appearance. One of the patients in this report experienced intense pain in her lesions, but after surgical resection the pain resolved. All diagnoses were confirmed with biopsy. If in doubt of the diagnosis, biopsy of vascular lesions is important.

Simple Reshaping of the Breast in Massive Weight Loss Patients: Promising Preliminary Results.

BACKGROUND: The challenging breast reshaping after massive weight loss (MWL) has been increasingly performed as the number of bariatric surgery procedures increase worldwide. The breasts often appear wide, lateralized, and deflated, with significant ptosis. OBJECTIVES: The aim of this article is to share our initial experience using the lower pole subglandular advancement mastoplasty (LOPOSAM) technique to reshape the breasts in MWL patients and to elaborate the technical details and simplicity of the method in the attached video. MATERIALS AND METHODS: We performed 30 LOPOSAM procedures in 15 MWL women aged 24 to 63 years from February to September 2015. We used a wise pattern mark-up and a superior based pedicle for the relocation of the nipple areola complex. The key step for the autoaugmentation was an inferior and central mound based parabola-shaped flap, which was placed in a subglandular pocket to reshape the breast and lift the inframammary crease. RESULTS: The median operation time for the LOPOSAM procedure was 81 minutes (range, 35-160 minutes) by 2 surgeons. The median weight loss was 64 kg (range, 45-103) and 22 body mass index units (range, 16-33) per patient. The median follow-up was 240 days (range, 105 Powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation to 345). The surgical goal was achieved in all cases. Four complications occurred in 3 patients, 1 major, a hematoma-requiring surgery and 3 minor wound dehiscence. The self-reported patient satisfaction was high, 13 were very satisfied with the result, 1 satisfied, and 1 less satisfied. CONCLUSIONS: The LOPOSAM technique is quick and simple to perform, and the preliminary results are promising. However, a longer follow-up is needed to confirm this.

The Danish Melanoma Database.

AIM OF DATABASE: The aim of the database is to monitor and improve the treatment and survival of melanoma patients. STUDY POPULATION: All Danish patients with cutaneous melanoma and in situ melanomas must be registered in the Danish Melanoma Database (DMD). In 2014, 2,525 patients with invasive melanoma and 780 with in situ tumors were registered. The coverage is currently 93% compared with the Danish Pathology Register. MAIN VARIABLES: The main variables include demographic, clinical, and pathological characteristics, including Breslow's tumor thickness, ± ulceration, mitoses, and tumor-node-metastasis stage. Information about the date of diagnosis, treatment, type of surgery, including safety margins, results of lymphoscintigraphy in patients for whom this was indicated (tumors > T1a), results of sentinel node biopsy, pathological evaluation hereof, and follow-up information, including recurrence, nature, and treatment hereof is registered. In case of death, the cause and date are included. Currently, all data are entered manually; however, data catchment from the existing registries is planned to be included shortly. DESCRIPTIVE DATA: The DMD is an old research database, but new as a clinical quality register. The coverage is high, and the performance in the five Danish regions is quite similar due to strong adherence to guidelines provided by the Danish Melanoma Group. The list of monitored indicators is constantly expanding, and annual quality reports are issued. Several important scientific studies are based on DMD data. CONCLUSION: DMD holds unique detailed information about tumor characteristics, the surgical treatment, and follow-up of Danish melanoma patients. Registration and monitoring is currently expanding to encompass even more clinical parameters to benefit both patient treatment and research.

The role of FDG-PET/CT in preoperative staging of sentinel lymph node biopsy-positive melanoma patients.

BACKGROUND: On April 1, 2015, Odense University Hospital (OUH) began a new diagnostic strategy, wherein all malignant melanoma (MM) patients in the Region of Southern Denmark with a positive sentinel lymph node biopsy (SLNB) underwent FDG-PET/CT preoperatively prior to lymph node dissection (LND). The purpose of this study is to determine FDG-PET/CT's efficacy in finding distant metastasis in the first year after the implementation of this new strategy, and to what extent these findings influence subsequent diagnostic testing and treatment in this patient group. We conducted a retrospective multicenter cohort study which included all patients with MM from all hospitals in the Region of Southern Denmark from April 1, 2015 to April 1, 2016 found to be SLNB-positive who subsequently underwent FDG-PET/CT. Patient information was acquired from the Danish Melanoma Database and was cross-referenced with OUH's patient records. The data was analyzed for a number of parameters including FDG-PET/CT findings and treatment strategy. Median follow-up time was 7 months. RESULTS: A total of 47 patients were eligible from the first year of this new diagnostic strategy. One patient was excluded due to undergoing LND prior to FDG-PET/CT. Thus, 46 patients were included in this study. Ultimately, preoperative FDG-PET/CT neither uncovered any distant metastases nor led to any alterations in treatment strategy in this patient group. CONCLUSIONS: Surprisingly, this new diagnostic strategy did not find any MM metastases or uncover anything else of relevance. FDG-PET/CT did, however, provide false positive findings in 13 % (6/46) of these patients. These scans triggered additional, predominantly invasive, procedures, which did not ultimately have an impact on the therapeutic strategy. Thus, these findings indicate a need for re-evaluation of this new diagnostic strategy as well as the necessity for further clinical trials evaluating FDG-PET/CT's utility in this clinical setting.

Trends in melanoma in the elderly in Denmark, 1980-2012.

BACKGROUND: The incidence of melanoma is rising in Denmark. In the present paper we describe incidence, mortality and survival in Denmark from 1980 to 2012 focusing on age, comparing persons aged 70 years or more with those aged less than 70 years. MATERIAL AND METHODS: Melanoma was defined as ICD-10 code C43. Data derived from the NORDCAN database with comparable data on incidence, mortality, survival in the Nordic countries, where the Danish data were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up until the end of 2013. RESULTS: In 1980, 21.4% of the patients diagnosed with melanoma were older than 70 years compared to 28.4% in 2012. In persons aged less than 70 years, the incidence rate was higher among women than in men, but men aged 70-89 years had an incidence rate almost twice that of women. Incidence rates were increasing, particularly among the elderly. In 1980, 32.6% of the patients who died from melanoma were older than 69 years compared to 56.2% in 2012. In 1980, the mortality rate was 121.4 per 100,000 person years, increasing to 353.1 in 2012. For the younger patients, the mortality rates are only slight increasing, but for the elder patients the mortality rates are increasing dramatically. In general the survival has increased for all age groups over the years. CONCLUSION: The incidence rates for all age groups are rising. The increase was mainly caused by a rising incidence among the elderly. Mortality among Danish patients with melanoma is increasing and especially the mortality in the elderly. This important knowledge must be kept in mind when future treatment strategies are planned.

FDG PET/CT in cancer: comparison of actual use with literature-based recommendations.

PURPOSE: The Region of Southern Denmark (RSD), covering 1.2 of Denmark's 5.6 million inhabitants, established a task force to (1) retrieve literature evidence for the clinical use of positron emission tomography (PET)/CT and provide consequent recommendations and further to (2) compare the actual use of PET/CT in the RSD with these recommendations. This article summarizes the results. METHODS: A Work Group appointed a professional Subgroup which made Clinician Groups conduct literature reviews on six selected cancers responsible for 5,768 (62.6 %) of 9,213 PET/CT scans in the RSD in 2012. Rapid Evidence Assessment was applied, using the methodology of systematic reviews with predefined limitations to search PubMed, Embase and the Cochrane Library for articles published in English/Danish/Swedish/Norwegian since 2002. PICO questions were defined, data recorded and quality appraised and rated with regard to strength and evidence level. Consequent recommendations for applications of PET/CT were established. The actual use of PET/CT was compared with these, where grades A and B indicated "established" and "useful" and grades C and D "potentially useful" and "non-recommendable" indications, respectively. RESULTS: Of 11,729 citations, 1,729 were considered for review, and 204 were included. The evidence suggested usefulness of PET/CT in lung, lymphoma, melanoma, head and neck, and colorectal cancers, whereas evidence was sparse in gynaecological cancers. The agreement between actual use of PET/CT and literature-based recommendations was high in the first five mentioned cancers in that 96.2 % of scans were made for grade A or B indications versus only 22.2 % in gynaecological cancers. CONCLUSION: Evidence-based usefulness was reported in five of six selected cancers; evidence was sparse in the sixth, gynaecological cancers. Actual use of PET/CT agreed well with recommendations.

Staging patients with cutaneous malignant melanoma by same-day lymphoscintigraphy and sentinel lymph node biopsy: a single-institutional experience with emphasis on recurrence.

BACKGROUND AND OBJECTIVES: Different techniques have been employed in mapping sentinel lymph nodes (SLN) in patients with malignant melanoma (MM). We present a single-institutional experience. METHODS: Sentinel lymph node biopsies were performed in a consecutive series of 278 patients with 279 cutaneous MMs in clinical stage I. All underwent dynamic lymphoscintigraphy with 15-20 MBq 99mTc-rhenium-colloid followed on the same day by radioprobe-guided surgery completed approximately 4 hr after injection of radiopharmaceutical. RESULTS: In 274 (98.2%) cases, a median of two SLNs (range 1-7) were removed. In five patients, no SLN was removed. Seventy-nine patients (28%) had metastatic SLNs. Median Breslow thickness in this group was 2.3 mm. Nodal dissection of the positive basin was done in 75 of these 79 patients and revealed further positive lymph nodes in 10 (13%). Eighteen of the 79 (23%) patients died after a median of 17.5 months post-operatively from metastatic disease. In 195 cases (194 patients) (70%), removed SLNs were negative. The median Breslow thickness in this group was 1.6 mm. Four patients (2%) had regional lymph node recurrence ("false negative SLN procedures"). Eight of the 194 patients (4.1%) died after a median of 24.5 months post-operatively from metastatic disease. One of these was one of the four patients with a false negative SLN procedure, and in all eight, histological re-evaluation of SLNs was negative. Local recurrence occurred in 6 of the 195 cases. The rate of recurrence at any site among the SLN-negative cases was 8.8%. The complication rate was 5%. CONCLUSIONS: Same-day lymphoscintigraphy and radioprobe-guided surgery identified, with a high sensitivity and a low false negative rate, MM patients with microscopic nodal disease. Our results do at least equal other comparable studies.

[Sentinel lymph node biopsy in patients with cutaneous malignant melanoma]. / "Sentinel node"-diagnostik hos patienter med kutant malignt melanom.

INTRODUCTION: In the Department of Plastic Surgery of Odense University Hospital patients having cutaneous melanoma from 1 to 4 mm underwent sentinel lymph node (SLN) biopsy. The aim of this study was to evaluate results and complications. MATERIAL AND METHODS: During the first three years one hundred and sixteen patients underwent SLN biopsy, one patient was excluded from the study. All patients were operated in general anaesthesia and followed according to recommendations of the Danish Melanoma Group. RESULTS: Median follow-up was 16 months. 76% had negative SLN and 24% had positive SLN. No significant difference was recorded in median thickness in the two groups. In two patients SLN were false negative; in both patients the primary melanoma was located in the face. The complication rate was 8.5%. DISCUSSION: We conclude that SLN biopsy is a reliable method in staging the regional lymph nodes and determining the need of elective lymphadenectomy and that our results match the ones of international standard.