Development and validation of a nomogram incorporating gene expression profiling and clinical factors for accurate prediction of metastasis in patients with cutaneous melanoma following Mohs micrographic surgery.

BACKGROUND: There is a need to improve prognostic accuracy for patients with cutaneous melanoma. A 31-gene expression profile (31-GEP) test uses the molecular biology of primary tumors to identify individual patient metastatic risk. OBJECTIVE: Develop a nomogram incorporating 31-GEP with relevant clinical factors to improve prognostic accuracy. METHODS: In an IRB-approved study, 1124 patients from 9 Mohs micrographic surgery centers were prospectively enrolled, treated with Mohs micrographic surgery, and underwent 31-GEP testing. Data from 684 of those patients with at least 1-year follow-up or a metastatic event were included in nomogram development to predict metastatic risk. RESULTS: Logistic regression modeling of 31-GEP results and T stage provided the simplest nomogram with the lowest Bayesian information criteria score. Validation in an archival cohort (n = 901) demonstrated a significant linear correlation between observed and nomogram-predicted risk of metastasis. The resulting nomogram more accurately predicts the risk for cutaneous melanoma metastasis than T stage or 31-GEP alone. LIMITATIONS: The patient population is representative of Mohs micrographic surgery centers. Sentinel lymph node biopsy was not performed for most patients and could not be used in the nomogram. CONCLUSIONS: Integration of 31-GEP and T stage can gain clinically useful prognostic information from data obtained noninvasively.

The V-to-Y Advancement Flap for Distal Nasal Reconstruction: Our Experience With 39 Patients.

BACKGROUND AND OBJECTIVE: The V-to-Y advancement flap, also known as the island pedicle flap, is a single-stage repair option that can be used for defects on the distal nose. We report our experience using this flap for nasal defects following Mohs micrographic surgery, as well as describe optimal patient selection and flap design. MATERIALS AND METHODS: A retrospective review was conducted of all patient charts and operative photographs of nasal V-to-Y advancement flaps performed over 6 years at the Universtiy of Texas Southwestern Medical Center. Charts were reviewed for age, sex, tumour type and location, defect size, anticoagulation, immunosuppression, postoperative complications, revisions, and outcomes. RESULTS: Thirty-nine patients with defects ranging from 0.7 to 1.7 cm in size (median of 1 cm) were included. Most defects involved the inferior, paramedian nose, and after accounting for 7 postrepair interventions on 6 (15%) patients, 38 (97%) patients were noted to have good to excellent cosmetic outcomes while 1 patient experienced a persistent trapdoor effect. CONCLUSION: The V-to-Y advancement flap is an excellent single-stage option that can reliably provide good to excellent cosmetic results when used to repair small- to medium-size sized defects on the distal half of the nose.

Site-specific analysis of inflammatory markers in discoid lupus erythematosus skin.

Prior studies identified T cells, B cells, and macrophages in the inflammatory infiltrate and up-regulation of their protein products in discoid lupus erythematosus (DLE) skin; however, they lacked rigorous analyses to define their specific locations in skin. Thus, we compared expressions of selected T cell, B cell, and macrophage markers in five areas of DLE, psoriasis, and normal skin. Immunostainings for CD3, CD4, CD8, CD20, CD68, CXCR3, CXCL10, and TIA-1 were performed in biopsies of 23 DLE lesional skin, 11 psoriasis lesional skin, and 5 normal skin. Three independent observers used a graded scale to rate each marker's presence in the epidermis, dermatoepidermal junction (DEJ), perivascular area, periadnexal area, and deep dermis. DLE lesional skin contained an increased abundance of CD3(+), CD8(+), and CD68(+) cells at the DEJ, and CD20(+) and CD68(+) cells in the periadnexal area versus psoriasis and normal skin. CXCR3, CXCL10, and TIA-1 were elevated in periadnexal sites of DLE lesional skin versus psoriasis lesional skin. The aggregation of T cells, B cells, macrophages, and their protein products (CXCR3, CXCL10, and TIA-1) in the DEJ and periadnexal area of DLE lesional skin may contribute to the pathology of DLE through a coordinated, sophisticated process.