Temporal Recurrence of Cutaneous Melanoma: Analysis of a Case Series.

Introduction: The recurrence of cutaneous melanoma is one of the main reasons for surveillance after primary tumor treatment, and there is still little data on melanoma recurrence related to the Brazilian population. Objective: We sought to evaluate the profile of patients with cutaneous melanoma recurrence within five years of (early) and five years after (late) initial diagnosis. Methods: Patients diagnosed between 2006 and 2014 in a private reference service in Belo Horizonte, Brazil, were included. Demographic, clinical, histopathological, and disease evolution variables were collected and analyzed using the R version 4.0.0 program. A p-value less than 0.05 was considered significant. Results: The sample was composed of 331 patients with melanoma, and the 43 patients with recurrence presented with higher mean age (p=0.049), male predominance (p=0.030), a lower proportion of Breslow thickness under 0.8mm (p<0.001), and a more significant presence of mitosis (p=0.007). The 29 patients (8.8%) with early recurrence presented with tumors with ulceration (p<0.018). Late recurrence occurred in 14 patients (4.2%). Five patients relapsed after 10 years; most of them had tumors up to 1mm thick, without ulceration, regression, or satellitosis, but with the presence of mitosis. Conclusion: The possibility of cutaneous melanoma recurrence after five, and even 10, years, although rare, might indicate the need for longer medical follow-up. Multicenter studies may better characterize Brazilian patient profiles of those with early and late recurrence of melanoma.

Is a law enough to provide a better prognosis for Brazilian melanoma patients or education is still a gap?

According to Brazilian Law 12.732/12 ("60-day law"), cancer patients have 60 days after diagnosis for beginning treatment at the Unified Health System (SUS). The study aimed to evaluate the achievement and effectiveness of the '60-day law' for melanoma patients in a SUS cancer reference unit. A retrospective study analysed 58 medical charts from patients with the initial diagnosis performed before and after the "60-day law". The Law does not change the time interval between diagnosis and the beginning of treatment, and after the Law, patients presented a worse overall survival (p < 0.001). In conclusion, the '60-day law' was not effective.

Robotic surgery costs: Revealing the real villains.

BACKGROUND: This study aimed to evaluate the main drivers of robot assisted radical prostatectomy (RARP) hospitalization costs, in addition to assess perioperative predictors that impact costs. METHODS: Overall, 474 RARP were analyzed between February 2018 and December 2019. The association between perioperative variables and total direct costs was analyzed by simple and multiple linear regression. DISCUSSION: The main drivers of RARP hospitalization costs were robotic surgical supplies. Costs increased with American Society of Anesthesiologists score 3, a one-hour increase in OR time, increased utilization of polymeric clip packs and longer length of hospital stay. There was a 11.5% reduction in costs with the use of four robotic instruments instead of five. CONCLUSION: Costs of hospitalization were mainly influenced by the OR time, use of surgical supplies and length of hospital stay. Reducing the number of robotic instruments used in RARP represented the potentially modifiable factor with the greatest impact on cost reduction.

Assessment of retraction in surgical specimens in melanoma patients submitted to oncological amplification of margins.

INTRODUCTION: Skin cancer is the most common type of cancer and represents more than half of the diagnosed malignant tumors. There are more than one million new cases per year in the United States and about 120.000 new cases in Brazil. Cutaneous melanoma represents 5% of all primary cutaneous neoplasms; however, it has a worse prognosis. Adequate treatment of the primary lesion is the main cure factor, with free surgical margins, thus avoiding recurrences of the lesion. OBJECTIVES: The present study aims to evaluate and quantify the retraction of the surgical specimen in three moments, in-vivo, ex-vivo and in-vitro, and also evaluating possible factors related to retraction, such as formalin fixation, age, patient's gender, and lesion location. METHODS: This is a prospective, single-center cohort that evaluated 145 surgical specimens from patients who underwent oncological surgery of cutaneous melanoma margins enlargement. Lesions were marked with a standard brush, and surgical margins were measured with a sterile ruler, according to their initial staging. After resection, new surgical specimens measurements were obtained, and, after fixation in formalin, the last measurement was performed. The same oncological surgeon performed all procedures, and the same pathologist analyzed the specimens. RESULTS: Regarding the area of the specimens, there was a general median retraction of 38.15% between in-vivo and ex-vivo (p < 0.001), and 43.97% between in-vivo and in-vitro. When the measure of the specimen length (L) was evaluated, there was a 17% retraction between in-vivo and ex-vivo, and 20.42% between in-vivo and in-vitro, with statistical significance. The younger population has a higher rate of retraction, and lesions on the back have a lower rate of shrinkage on the opposite of lower limbs that had higher shrinkage. DISCUSSION: Corroborating the literature, this study showed an average shrinkage of 20.42% for length measurements between in-vivo and in-vitro, and the main predictors of greater or lesser retraction were age and location of the lesion. It is also noted that the most considerable retraction occurs immediately after surgical resection, indicating that skin characteristics, such as degree of elasticity and tension, are determinant for the retraction. Formalin action does not significantly impact retraction. This study shows the importance of adequate treatment of the primary lesion, with adequate surgical margins, and that the measure measured by the pathologist, in general, represents 80% of the margins performed in the perioperative time.

Journey of the Patient With Melanoma: Understanding Resource Use and Bridging the Gap Between Dermatologist, Surgeon, and Oncologist in Different Health Care Systems.

PURPOSE: New scientific evidence has led to modifications in the clinical practice of handling melanoma. In health care systems, there is currently a wide variety of clinical procedures to treat cancer, and the various routes have different effects on the survival of patients with cancer. Thus, this article aimed to evaluate the journey of patients with melanoma in the public and private health care systems in Brazil from the viewpoint of different medical professionals involved in the diagnosis and treatment of the disease. The study also considers the resources used for the complete delivery cycle of health care at different stages of the evolution of melanoma. METHODS: We conducted a behavioral study by applying a questionnaire to a group of medical professionals. A nonprobabilistic sampling method for convenience was used, justified by the heterogeneous national incidence and the limited availability of medical professionals who diagnose and treat melanoma. RESULTS: The questionnaire was answered by 138 doctors, including doctors from the Brazilian states with the highest concentration of medical specialists and regions with a higher melanoma incidence. The results of this study have the potential to enrich our understanding of the reality of Brazilian health care systems and, at the same time, allow us to discuss the multiple ways in which professionals from diverse specialist fields understand and explain decision making in health care. CONCLUSION: Health care decision making is complex and, among other factors, depends on the diversity of available health resources and the knowledge of which treatments provide the greatest benefit to patients and greatest value to the system as a whole. This work can inform debates and reflection that are applicable not only in Brazil, but also in various other countries with similar realities.

Digital Artery Aneurysm: A Case Report.

Digital artery aneurysms of the hand are atypical. We herein present a rare case of digital artery aneurysm. A 60-year-old man presented with a complaint of a mass on the back of his left hand. A radiological examination indicated a digital artery aneurysm. The patient underwent successful surgical excision of an aneurysm of the left dorsal digital artery on the ulnar face of the third finger of the left hand. We discuss the etiology and surgical management of digital artery aneurysms according to literature data. An accurate diagnosis and a preoperative blood flow assessment are required for appropriate surgical management of digital artery aneurysms.