Metastatic Melanoma: A Consequence of the COVID-19 Pandemic.

Metastatic melanoma, though less common than other skin cancers, remains one of the deadliest, particularly in late-stage disease. Our report aims to highlight the importance of early detection and treatment to reduce the morbidity, mortality, and significant disfigurement associated with advanced melanoma. The subject of this case is an 81-year-old female who presented to our emergency department as a trauma patient after being found lying down by a neighbor for an unknown amount of time. She was discovered to have a large fungating nasal mass which was subsequently diagnosed as highly invasive melanoma. A thorough workup revealed a metastatic cerebellar lesion, a large ulcerated basal cell carcinoma eroding her calvarium, and a hemorrhagic lesion within her internal capsule that left her with right-sided hemiparesis. During hospitalization, she underwent palliative resection of the primary nasal mass with flap reconstruction, radiation therapy for her cerebellar lesion, and daily physical therapy. Additional surgery was required for hematoma evacuation and pedicle dissection. Though lockdowns were an important part of the pandemic, they were not without their drawbacks, many of which are still being elucidated. Particularly, by utilizing telehealth services, our patient may have had earlier recognition of her melanoma and a better outcome. Regardless, enhancing patient education and maintaining access to care even through lockdowns poses a potential target for improving melanoma survivability while decreasing associated morbidity.

An evaluation of colonoscopy surveillance guidelines: are we actually adhering to the guidelines?

BACKGROUND: National guidelines put forth by the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Gastroenterology provide recommendations regarding colorectal cancer screening and follow-up surveillance. Practice patterns may differ from these guidelines. This study analyzes the concordance between a tertiary equal access system and national guidelines for colorectal cancer and polyp surveillance. METHODS: We performed a retrospective database review of all patients at a single institution undergoing screening colonoscopy from 2010 to 2011. Patient demographics, indication for colonoscopy, pathologic findings, and follow-up recommendations documented by the provider were analyzed. Multivariate analysis was performed in an attempt to identify predictors of discordant recommendations. RESULTS: One thousand four hundred twenty patients were identified (mean age, 54.3 ± 7.7 years, 48.6% women). The gastroenterology service performed the majority of colonoscopies (87.2%) compared with the surgery service (11.6%). The major indications were routine screening (84.4%) and a strong family history of colorectal cancer (12.2%). The adenoma detection rate for the entire cohort was 27.4%. Other pathologic conditions identified included hyperplastic polyps (16%), lymphoid aggregates (3.5%), and invasive adenocarcinoma (0.1%). Overall, follow-up recommendations correlated with established guidelines in 97% of cases. By multivariate analysis, only the final pathologic finding of lymphoid aggregates was associated with discordant recommendations (odds ratio [OR], 4.62; 95% confidence interval [CI], 1.64 to 12.99; P = .004). When comparing discordant recommendations between specialties, there was a statistically significant difference between gastroenterology (1.6%) and surgery (7.6%) (P < .0001) providers; surgeons trended toward recommending earlier follow-up examinations (P = .37). CONCLUSIONS: Overall, surveillance recommendations correlated well with current national guidelines. Concordance rates were higher with gastroenterologists in this cohort. Alterations based on final pathologic examination and individual cases remain clinically important.