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1.
Clin Plast Surg ; 48(4): 607-616, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503721

RESUMO

Melanoma tumor thickness and ulceration are the strongest predictors of nodal spread. The recommendations for sentinel lymph node biopsy (SLNB) have been updated in recent American Joint Committee on Cancer and National Comprehensive Cancer Network guidelines to include tumor thickness ≥0.8 mm or any ulcerated melanoma. Mitotic rate is no longer considered an indicator for determining T category. Improvements in disease-specific survival conferred from SLNB were demonstrated through level I data in the Multicenter Selective Lymphadenectomy Trial (MSLT) I. The role for completion lymph node dissection has evolved to less surgery in lieu of recent domestic (MSLT II) and international (Dermatologic Cooperative Oncology Group Selective Lymphadenectomy Trial [DeCOG-SLT]) level I data having similar melanoma-specific survival. Treatment options for the prevention of treatment of lymphedema have progressed to include immediate lymphatic reconstruction, lymphovenous anastomosis, and vascularized lymph node transfer.


Assuntos
Linfedema , Melanoma , Neoplasias Cutâneas , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática , Linfedema/cirurgia , Melanoma/cirurgia , Estudos Multicêntricos como Assunto , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia
2.
Clin Plast Surg ; 48(4): 659-668, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503726

RESUMO

The incidence of melanoma is continuing to rise in the United States, and head and neck melanomas account for 25% of all cutaneous melanomas. The National Comprehensive Cancer Network guideline recommendations for surgical margins and sentinel lymph node biopsy in head and neck melanomas are the same as cutaneous melanoma located in other regions, but require special considerations when performing wide local excision, sentinel lymph node biopsy, and completion lymph node dissection and reconstruction taking into account the location of the melanoma and structures involved in and around the suggested margins.


Assuntos
Neoplasias de Cabeça e Pescoço , Melanoma , Neoplasias Cutâneas , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Excisão de Linfonodo , Linfonodos , Melanoma/epidemiologia , Melanoma/cirurgia , Pescoço , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia
3.
Clin Plast Surg ; 48(4): 687-698, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503729

RESUMO

Melanomas only account for 4% of all dermatologic cancers yet are responsible for 80% of deaths. Notably, melanomas of the hand and foot have a worse prognosis when compared with melanomas of other anatomic regions. Likely this is due to intrinsic biologic characteristics, delayed diagnosis, difficult surgical excision due to delicate anatomy, and lack of definitive diagnostic and therapeutic guidelines. The most common locations of melanoma of the hand, in order of decreasing frequency, are subungual area, dorsal surface, and palmar surface. The most common locations of melanoma of the foot are the plantar surface, dorsal surface, and subungual area, in decreasing frequency. Diagnosis of melanoma of the hand and foot can be difficult because the traditional "ABCDE" (asymmetric shape, border, color, diameter, evolution) rules do not apply. Newer acronyms have been proposed in literature including "CUBED" (colored, uncertain, bleeding, enlarged, delayed) and "ABC rule for Subungual Melanoma." Once diagnosed, treatment is primarily surgical excision and reconstruction. The goal for the surgeon is to maintain the function and anatomy of the hand or foot.


Assuntos
Melanoma , Neoplasias Cutâneas , Mãos/cirurgia , Humanos , Melanoma/diagnóstico , Melanoma/cirurgia , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia
4.
Clin Plast Surg ; 48(4): 699-705, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34503730

RESUMO

Rare variants of melanoma include melanoma in pregnancy and pediatric melanoma. Because of their low incidence, treatment recommendations are based on standards of treatment for cutaneous melanoma; however, each of these forms requires specific considerations during diagnosis, staging, and treatment.


Assuntos
Melanoma , Pediatria , Neoplasias Cutâneas , Criança , Feminino , Humanos , Incidência , Melanoma/diagnóstico , Melanoma/epidemiologia , Melanoma/terapia , Estadiamento de Neoplasias , Gravidez , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia
5.
Cesk Slov Oftalmol ; 77(4): 208-213, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34507497

RESUMO

AIM: We present the management of a severe case of recurrent periocular basal cell carcinoma, orbital invasion and exenteration. CASE REPORT: The present case is of a recurrent basal cell carcinoma in a 84-year-old male presenting with non-healing lesion above right eyelid. A tumor excision was performed in May 2014. Histopathology revealed a basal cell carcinoma (dg. C44.1 ICD-10-CM) with positive margins. The re-excision of the lesion was performed. After two years, there was a local recurrence and orbital invasion. Indication for external curative radiation therapy. Plastic surgery of the upper eyelid. Orbital exenteration was indicated in January 2018. After another year, a recurrence of the tumor was once again noted. Histopathology revealed a basal cell carcinoma (dg. C44.1 (TNM 7, pMx, pNx, pTx)). The patient was indicated for external radiotherapy. There were no indications for biological treatment. After another year, a progression of the local finding was noted. CONCLUSION: Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer of the periocular region. Primary treatment of basal cell carcinoma is surgical. Advanced lesions require extensive surgical interventions and other available treatment modalities. In some cases, mutilating surgery - exenteration of the orbit is inevitable. Despite a relatively small percentage of invasive diseases today, advanced stages may still occur; either as a result of the patient's late presentation, inadequate initial therapy aimed at maintaining critical periorbital structures, or due to high tumor aggression. The case report highlights necessity of radical resection of primary tumor with histological examination.


Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Idoso de 80 Anos ou mais , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/cirurgia , Pálpebras , Humanos , Masculino , Recidiva Local de Neoplasia , Exenteração Orbitária , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(9): 1177-1181, 2021 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-34523285

RESUMO

Objective: To explore the effectiveness of free-style perforator pedicled propeller flap to repair the wound after extensive resection of skin malignant tumor on the thigh. Methods: Between December 2016 and June 2019, 12 patients with skin malignant tumor on the thigh were treated. There were 9 males and 3 females, aged from 8 to 65 years (median, 38.5 years). The etiologies included basal cell carcinoma in 3 cases, squamous cell carcinoma in 7 cases, fibrosarcoma in 1 case, and malignant melanoma in 1 case. The disease duration ranged from 5 months to 10 years (median, 7.5 years). Color Doppler ultrasound was used to detect and mark at least one perforator vessel before operation. After extensive resection, the size of wound ranged from 5.0 cm×3.5 cm to 8.5 cm×6.5 cm. In the range of 1-3 cm from the edge of the lesion, the perforator vessels were explored again from the deep surface of the deep fascia to confirm and mark. The perforator vessel with diameter greater than 0.5 mm and closest to the edge of the lesion was taken as the rotation point of the flap. According to the wound size and shape, the free-style perforator pedicled propeller flap in size of 8.0 cm×3.5 cm to 12.5 cm×6.0 cm was designed. The wound was repaired with the big blade of the flap. The donor site was closed directly with the aid of the small blade. Results: The distal part of the skin flap was necrosis after operation, and healed after symptomatic treatment such as dressing change; the other flaps survived successfully and the wounds healed by first intention. All incisions at the donor site healed by first intention. All patients were followed up 5-24 months (mean, 10.2 months). During the follow-up, there was no recurrence of tumor. The flap had good elasticity and texture with no obvious swelling or scar hyperplasia, and the appearance was satisfactory; the hip and knee joint activities were normal. Conclusion: Based on the extensive skin blood supply and abundant perforator vessels of the thigh, the free-style perforator pedicled propeller flap is an ideal flap for repairing small or medium wound after extensive resection of skin malignant tumor on the thigh.


Assuntos
Carcinoma Basocelular , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Lesões dos Tecidos Moles , Feminino , Humanos , Masculino , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Resultado do Tratamento
7.
Ann Plast Surg ; 87(3): 271-277, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34397516

RESUMO

INTRODUCTION: Locally advanced nonmelanoma skin cancers of the head and neck are well described in the current literature. However, data about clinical and survival outcomes are lacking. We present survival data from a tertiary head and neck cancer unit in London. METHODS: A retrospective analysis of data collected from a single institution was conducted. All patients with locally advanced cutaneous scalp carcinomas invading the skull between 2011 and 2019 were included. Data included patient demographics, tumor, comorbidities, interventions, flap survival, and metal work exposure. Survival outcomes were examined using Kaplan-Meier analysis. RESULTS: Twenty-three patients were identified. The mean age was 72 years. Eighteen patients were male, and 5 were female. Five patients were immunosuppressed. Nineteen patients underwent outer cortex drill-down/full-thickness calvarial resection, followed by reconstruction with free tissue transfer. Six patients had titanium mesh reconstruction after segmental skull resections. Three patients underwent further surgery because of exposed metalwork. Disease-free survival at 3 years after surgery was 60%. CONCLUSIONS: Locally advanced nonmelanoma skin cancers invading the bone are sporadic. There are little published data on clinical and survival outcomes in this group. Despite the nature of these skin lesions, a high degree of local control can be obtained by extensive surgical resection, outer table drill-down, and calvarial resection. We conclude that aggressive management of the bony invasion improves disease-free survival and improves local control.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Cutâneas , Idoso , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Estudos Retrospectivos , Couro Cabeludo , Neoplasias Cutâneas/cirurgia , Crânio
8.
Pan Afr Med J ; 38: 365, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34367444

RESUMO

Dermatofibrosarcoma is a rare skin tumor. Morphological characteristics can be misleading and unknown to most of physicians. Diagnostic delay may affect patient´s management and prognosis. We here report the case of a young patient with lesions protruding from the abdominal wall mistaken for benign cysts. X-ray examination revealed subcutaneous adipose tissue mass. This was suspected of being a fibrosarcoma. The mass was resected with a macroscopic safety margin. The anatomo-pathological study confirmed the diagnosis of dermatofibrosarcoma. Clinical and radiological follow-up examinations didn´t show any recurrence. This study highlights the importance of suspecting this rare tumor requiring specialist treatment.


Assuntos
Abdome/patologia , Dermatofibrossarcoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adulto , Dermatofibrossarcoma/patologia , Dermatofibrossarcoma/cirurgia , Fibrossarcoma/diagnóstico , Seguimentos , Humanos , Masculino , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia
9.
Acta Derm Venereol ; 101(8): adv00525, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34396424

RESUMO

The aim of this study was to compare tumour burden in patients who underwent surgery for melanoma and cutaneous squamous cell carcinoma during nationwide lockdown in Spain due to COVID-19 (for the period 14 March to 13 June 2020) and during the same dates in 2019 before the COVID-19 pandemic. In addition, associations between median tumour burden (Breslow thickness for melanoma and maximum clinical diameter for cutaneous squamous cell carcinoma) and demographic, clinical, and medical factors were analysed, building a multivariate linear regression model. During the 3 months of lockdown, there was a significant decrease in skin tumours operated on (41% decrease for melanoma (n = 352 vs n = 207) and 44% decrease for cutaneous squamous cell carcinoma (n = 770 vs n = 429)) compared with the previous year. The proportion of large skin tumours operated on increased. Fear of SARS-CoV-2 infection, with respect to family member/close contact, and detection of the lesion by the patient or doctor, were related to thicker melanomas; and fear of being diagnosed with cancer, and detection of the lesion by the patient or relatives, were related to larger size cutaneous squamous cell carcinoma. In conclusion, lockdown due to COVID-19 has resulted in a reduction in treatment of skin cancer.


Assuntos
COVID-19 , Carcinoma de Células Escamosas , Melanoma , Neoplasias Cutâneas , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/cirurgia , Controle de Doenças Transmissíveis , Humanos , Melanoma/epidemiologia , Melanoma/cirurgia , Pandemias , SARS-CoV-2 , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia , Carga Tumoral
10.
Am J Case Rep ; 22: e932922, 2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34429392

RESUMO

BACKGROUND Pilonidal Sinus (PNS) is a small cutaneous orifice in the intergluteal region; symptoms include pain and swelling. Disparately, desmoplastic neurotropic melanoma (DNM) accounts for 1% of all melanomas and mostly occurs in the head and neck region. Because its appearance is generally benign, it typically comes to surgical attention only at an advanced stage or after recurrence. A perineural involvement occurs in 30-40% of the cases and is accompanied by symptoms such as paresthesia, paresis, and/or paralysis. To the best of our knowledge, the association between PNS and DNM has not been described in the literature before. Here, we present a patient with PNS that was diagnosed with DNM. CASE REPORT A 31-year-old healthy man presented with coccydynia and sacral cyst that had been present for about a year. While the initial diagnosis was of a PNS, after excision and biopsy, the pathology changed to PNS with DNM. The patient underwent a work-up for distant metastasis, which was negative. Wide local excision (WLE) with sentinel lymph node biopsy (SLNB) was also performed. CONCLUSIONS Due to the malignant potential of PNS, we support the routine of pathological examination of excised specimens. Once DNM is diagnosed, work-up for distant metastasis and further treatment with WLE as well as SLNB are recommended. The current report describes an association between PNS and DNM. While coccydynia may have been caused by the PNS or the melanoma, the presence of the PNS helped with an earlier diagnosis of the melanoma. Further research on the possible causative relationship between the conditions is required.


Assuntos
Melanoma , Seio Pilonidal , Neoplasias Cutâneas , Adulto , Humanos , Masculino , Melanoma/diagnóstico , Recidiva Local de Neoplasia , Seio Pilonidal/cirurgia , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia
11.
BMJ Case Rep ; 14(8)2021 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-34426433

RESUMO

Atypical fibroxanthoma (AFX) is a rare cutaneous ulcerative lesion with a good prognosis. Diagnosis is difficult and is usually made by exclusion from pleomorphic dermal sarcoma and squamous cell carcinoma. Definitive treatment varies from Mohs micrographic surgery to wide local excision. We present a case of 76-year-old woman with AFX over the dorsum of her left hand. The tumour was excised and the resulting defect was reconstructed with a local second dorsal metacarpal artery perforator flap.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Cutâneas , Idoso , Dorso , Feminino , Mãos/cirurgia , Humanos , Cirurgia de Mohs , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia
12.
Artigo em Chinês | MEDLINE | ID: mdl-34304476

RESUMO

Angiosarcoma of the scalp is an aggressive tumor with a high rate of local recurrence and distant metastasis. We present two cases of metastasis in parotid region at the time of one year after radical surgery of scalp angiosarcoma. It is suggested that regional lymph nodes should be treated more aggressively at the first treatment, which may achieve better results or, at least, prolong the time to local recurrence and distant metastasis.


Assuntos
Neoplasias de Cabeça e Pescoço , Hemangiossarcoma , Neoplasias Cutâneas , Neoplasias de Cabeça e Pescoço/cirurgia , Hemangiossarcoma/cirurgia , Humanos , Recidiva Local de Neoplasia/cirurgia , Região Parotídea , Couro Cabeludo , Neoplasias Cutâneas/cirurgia
13.
Nutrients ; 13(6)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34199802

RESUMO

Patients with newly resected stage II melanoma (n = 104) were randomized to receive adjuvant vitamin D3 (100,000 IU every 50 days) or placebo for 3 years to investigate vitamin D3 protective effects on developing a recurrent disease. Median age at diagnosis was 50 years, and 43% of the patients were female. Median serum 25-hydroxy vitamin D (25OHD) level at baseline was 18 ng/mL, interquartile range (IQ) was 13-24 ng/mL, and 80% of the patients had insufficient vitamin D levels. We observed pronounced increases in 25OHD levels after 4 months in the active arm (median 32.9 ng/mL; IQ range 25.9-38.4) against placebo (median 19.05 ng/mL; IQ range 13.0-25.9), constantly rising during treatment. Remarkably, patients with low Breslow score (<3 mm) had a double increase in 25OHD levels from baseline, whereas patients with Breslow score ≥3 mm had a significantly lower increase over time. After 12 months, subjects with low 25OHD levels and Breslow score ≥3 mm had shorter disease-free survival (p = 0.02) compared to those with Breslow score <3 mm and/or high levels of 25OHD. Adjusting for age and treatment arm, the hazard ratio for relapse was 4.81 (95% CI: 1.44-16.09, p = 0.011). Despite the evidence of a role of 25OHD in melanoma prognosis, larger trials with vitamin D supplementation involving subjects with melanoma are needed.


Assuntos
Colecalciferol/uso terapêutico , Suplementos Nutricionais , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Vitaminas/uso terapêutico , Idoso , Colecalciferol/administração & dosagem , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Melanoma/prevenção & controle , Melanoma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Neoplasias Cutâneas/prevenção & controle , Neoplasias Cutâneas/cirurgia , Vitaminas/administração & dosagem
15.
BMJ Case Rep ; 14(7)2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215636

RESUMO

We present the case of a 53-year-old woman with silicone breast implants who underwent excision of an abdominal melanoma and sentinel lymph node biopsy. Two lymph nodes were excised; both lying in the breast parenchyma adjacent to the intact right breast capsule. The lymph node histology revealed a subcapsular melanoma deposit along with silicone lymphadenopathy in the sentinel node. This case highlights that sentinel lymph nodes can be located in alternative locations to the common lymphatic basins and, therefore, the importance of preoperative lymphoscintigraphy. We also discuss subclinical breast implant rupture as a causative factor for silicone lymphadenopathy.


Assuntos
Melanoma , Neoplasias Cutâneas , Feminino , Humanos , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Melanoma/cirurgia , Pessoa de Meia-Idade , Micrometástase de Neoplasia , Biópsia de Linfonodo Sentinela , Silicones , Neoplasias Cutâneas/cirurgia
16.
Neurology ; 97(7 Suppl 1): S32-S41, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34230197

RESUMO

OBJECTIVE: To assess the reliability and variability of digital calipers, 3D photography, and high-frequency ultrasound (HFUS) for measurement of cutaneous neurofibromas (cNF) in patients with neurofibromatosis type 1 (NF1). BACKGROUND: cNF affect virtually all patients with NF1 and are a major source of morbidity. Reliable techniques for measuring cNF are needed to develop therapies for these tumors. METHODS: Adults with NF1 were recruited. For each participant, 6 cNF were assessed independently by 3 different examiners at 5 different time points using digital calipers, 3D photography, and HFUS. The intraclass correlation coefficient (ICC) was used to assess intrarater and interrater reliability of linear and volumetric measurements for each technique, with ICC values >0.90 defined as excellent reliability. The coefficient of variation (CV) was used to estimate the minimal detectable difference (MDD) for each technique. RESULTS: Fifty-seven cNF across 10 participants were evaluated. The ICC for image acquisition and measurement was >0.97 within and across examiners for HFUS and 3D photography. ICC for digital calipers was 0.62-0.88. CV varied by measurement tool, linear vs volumetric measurement, and tumor size. CONCLUSIONS: HFUS and 3D photography demonstrate excellent reliability whereas digital calipers have good to excellent reliability in measuring cNF. The MDD for each technique was used to create tables of proposed thresholds for investigators to use as guides for clinical trials focused on cNF size. These criteria should be updated as the performance of these end points is evaluated.


Assuntos
Neurofibroma/diagnóstico por imagem , Neurofibroma/cirurgia , Neurofibromatose 1/cirurgia , Neoplasias Cutâneas/patologia , Adulto , Ensaios Clínicos como Assunto , Humanos , Masculino , Neurofibromatose 1/diagnóstico por imagem , Fotografação/métodos , Reprodutibilidade dos Testes , Neoplasias Cutâneas/cirurgia
17.
Neurology ; 97(7 Suppl 1): S42-S49, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34230199

RESUMO

OBJECTIVE: To summarize existing biomarker data for cutaneous neurofibroma (cNF) and to inform the incorporation of biomarkers into clinical trial design for cNFs. METHODS: The cNF working group, a subgroup of the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) consortium, was formed to review and inform clinical trial design for cNFs. Between June 2018 and February 2020, the cNF working group performed a review of existing data on genetic biomarkers for cNFs in the setting of neurofibromatosis type 1. We also reviewed criteria for successful biomarker application in the clinic. The group then held a series of meetings to develop a consensus report. RESULTS: Our systematic literature review of existing data revealed a lack of validated biomarkers for cNFs. In our report, we summarize the existing signaling, genomic, transcriptomic, histopathologic, and proteomic data relevant to cNF. Finally, we make recommendations for incorporating exploratory aims for predictive biomarkers into clinical trials through biobanking samples. CONCLUSION: These recommendations are intended to provide both researchers and clinicians with best practices for clinical trial design to aid in the identification of clinically validated biomarkers for cNF.


Assuntos
Doenças do Tecido Conjuntivo/cirurgia , Neurilemoma/cirurgia , Neurofibroma/cirurgia , Neurofibromatoses/cirurgia , Neoplasias Cutâneas/cirurgia , Bancos de Espécimes Biológicos , Biomarcadores/análise , Humanos , Neurofibromatoses/metabolismo , Proteômica/métodos
18.
BMJ Case Rep ; 14(6)2021 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-34140333

RESUMO

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour, accounting for less than 1% of malignant tumours of the head and neck region. This tumour rarely presents metastatic disease, but has a high recurrence rate. Therefore, wide surgical excision with microscopically free margins is the therapeutic gold standard. Only five cases are described in literature of this tumour arising in the parotid region, a site that presents challenges both in achieving a wide demolition and in reconstructing the resulting defect. Here we describe two cases of DFSP arising in the parotid region that were treated surgically, achieving microscopically free margins. Reconstruction of the vast skin defect was achieved by means of a supraclavicular artery island flap, with good functional and aesthetic results.


Assuntos
Dermatofibrossarcoma , Neoplasias Cutâneas , Dermatofibrossarcoma/cirurgia , Humanos , Margens de Excisão , Recidiva Local de Neoplasia , Região Parotídea , Neoplasias Cutâneas/cirurgia
19.
Am Surg ; 87(6): 849-854, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34060947

RESUMO

BACKGROUND: Talimogene laherparepvec (TVEC) is an injectable attenuated oncolytic herpes simplex virus (HSV-1) used in the treatment of loco regionally metastatic melanoma. Lesions managed by TVEC are generally considered unresectable at time of initiation of intralesional therapy; however, a subset of patients go on to have surgical resection of loco regionally controlled disease. We sought to review our experience with surgical excision of treated lesions to offer an insight into the radiologic correlate, treatment effect, and pathological findings of intralesional TVEC therapy. METHODS: This is a retrospective descriptive case series of patients who underwent TVEC injection at Mayo Clinic, Rochester, MN, between October 2016 and July 2020. Institutional Institutional Review Board approval was obtained. RESULTS: Twenty-one patients underwent intralesional TVEC, met inclusion criteria, and were included in this series. Seven went on to surgical excision of the injected lesions after an initial course of TVEC. Of those 7 patients, 4 had residual melanoma in the specimen on final pathology, while 3 had a complete pathologic response. All 3 patients who had no residual disease on pathology continued to have fluorodeoxyglucose (FDG) avidity on preoperative positron emission tomography scan of the excised lesions. DISCUSSION: Despite ongoing FDG avidity on PET scan, patients who have well-controlled disease and stability over time of the injected lesions may benefit from surgical excision following a course of TVEC. This may render the patient clinically disease free and/or allow them a reprieve from TVEC treatment.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Produtos Biológicos/administração & dosagem , Melanoma/tratamento farmacológico , Melanoma/cirurgia , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Terapia Combinada , Fluordesoxiglucose F18 , Herpesvirus Humano 1 , Humanos , Injeções Intralesionais , Masculino , Melanoma/diagnóstico por imagem , Pessoa de Meia-Idade , Minnesota , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Ultrassonografia
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