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1.
Dermatol Surg ; 50(5): 407-411, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38349855

RESUMO

BACKGROUND: Avelumab, a programmed death ligand-1 inhibitor, has shown success in providing durable responses for difficult-to-treat Merkel cell carcinomas (MCCs). OBJECTIVE: Evaluate the efficacy and safety of avelumab in the treatment of advanced MCC. METHODS: Studies reporting the use of avelumab as a monotherapy or in combination with other agents in the treatment of stage III or IV (advanced) MCC were included. The primary outcomes were overall response rate, overall survival (OS), and treatment-related adverse events. RESULTS: A total of 48 studies were included, involving 1,565 patients with advanced MCC. Most patients were male (1,051, 67.3%) with stage IV MCC (517, 97.0%). The overall response rate was 46.1% (partial response-25.4% and complete response-20.7%) after a mean follow-up period of 9.5 months. Kaplan-Meier survival curves for the pooled stage III and IV group demonstrated OS rates of 58% at 1 year, 47% at 2 years, and 28% at 5 years after completion of treatment with avelumab (median OS: 23.1 months). The most common treatment-related adverse events consisted of constitutional (44%), gastrointestinal (19%), and dermatologic (12%) symptoms. CONCLUSION: Avelumab monotherapy and combination therapy have shown success in the overall response rate and survival for patients with advanced MCC.


Assuntos
Anticorpos Monoclonais Humanizados , Carcinoma de Célula de Merkel , Neoplasias Cutâneas , Carcinoma de Célula de Merkel/tratamento farmacológico , Carcinoma de Célula de Merkel/patologia , Humanos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/mortalidade , Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Estadiamento de Neoplasias , Antineoplásicos Imunológicos/uso terapêutico , Antineoplásicos Imunológicos/efeitos adversos , Resultado do Tratamento , Taxa de Sobrevida
2.
Dermatol Surg ; 47(3): 327-332, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34328285

RESUMO

BACKGROUND: Traditional letters of recommendation used for postgraduate medical training applications have multiple limitations, including a lack of clarity, inflated and overly flattering assessments, and low reliability between interpreting faculty. A micrographic surgery and dermatologic oncology (MSDO) standardized letter of recommendation (SLOR) was created to improve the efficiency, validity, and stratification of applicants to dermatology fellowship training programs. OBJECTIVE: To analyze the MSDO SLOR for trends in grading based on letter-writer and applicant characteristics and to evaluate its ability to demonstrate differences between applicants. METHODS: Standardized letter of recommendations received by 4 fellowship programs from the 2019 San Francisco Match application cycle were reviewed retrospectively. RESULTS: Two hundred forty-nine SLORs were analyzed from 140 applicants. Grade inflation and limited variability in scores were evident. Higher scores correlated with the length of the relationships between letter-writers and applicants and with female letter-writer gender. There was no applicant gender or ethnicity bias detected. CONCLUSION: Despite score inflation, the MSDO SLOR allows for differentiation between fellowship applicants. Future studies are needed to further evaluate the reliability of the SLOR and find ways to improve its content.


Assuntos
Correspondência como Assunto , Dermatologia/educação , Oncologia/educação , Cirurgia de Mohs/educação , Seleção de Pessoal/normas , Competência Clínica , Bolsas de Estudo , Feminino , Humanos , Internato e Residência , Masculino , Estudos Retrospectivos
3.
Dermatol Surg ; 46(4): 501-507, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31688234

RESUMO

BACKGROUND: Telemedicine is an emerging field with numerous applications within medicine. Previous review articles describe its use within plastic surgery and otolaryngology but none, to the authors' knowledge, within dermatologic surgery. OBJECTIVE: To provide a review of the applications of telemedicine within dermatologic surgery. MATERIALS AND METHODS: A PubMed search of articles published on teledermatology was conducted in July 2018. Articles were selected based on their relevance to dermatologic surgery and reviewed for their discussion of the applications of telemedicine in surgical and cosmetic dermatology. RESULTS: The initial search resulted in 156 articles. Eleven ultimately met inclusion criteria: 2 in referral and consultation, 5 in telepathology, 2 in intraoperative uses, and 2 in postprocedural care. CONCLUSION: For preoperative consultation, teledermatology enables the surgeon to plan ahead and increases access to care by reducing the number of clinic visits. Telepathology has the potential to allow intraoperative consultation with a dermatopathologist to achieve accurate tumor clearance without delay. Smartglasses represent a promising technology for greater care coordination and a teaching tool. Postprocedural monitoring via text messaging provides convenient access to expert advice and early detection of postoperative complications. With increasing technologic advancements, telemedicine holds great potential to augment the dermatologic surgeon's daily practice.


Assuntos
Dermatologia/métodos , Cuidados Intraoperatórios/métodos , Cuidados Pré-Operatórios/métodos , Telemedicina/tendências , Técnicas Cosméticas/instrumentação , Técnicas Cosméticas/tendências , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Procedimentos Cirúrgicos Dermatológicos/tendências , Dermatologia/instrumentação , Dermatologia/tendências , Humanos , Cuidados Intraoperatórios/instrumentação , Cuidados Intraoperatórios/tendências , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/tendências , Encaminhamento e Consulta/tendências , Óculos Inteligentes , Telemedicina/instrumentação
4.
J Am Acad Dermatol ; 78(3): 445-454, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29229573

RESUMO

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin associated with a high risk of local recurrence and distant metastases. It most commonly occurs on sun-exposed areas of white patients >65 years of age. The Merkel cell polyomavirus (MCV) is thought to be responsible for malignant transformation in approximately 80% of cases in the northern hemisphere, while ultraviolet radiation-induced DNA damage is implicated in MCV-negative tumors. The overall incidence of MCC is low, with approximately 1600 cases diagnosed annually in the United States. The rate is much higher in patients with lymphoproliferative malignancies, solid organ transplants, and HIV infection. The low overall incidence of this tumor makes it challenging to conduct prospective clinical trials with sufficient power. As a result, most management recommendations are based on case series, retrospective reviews, and expert opinion. The pathogenesis, diagnosis, and staging of MCC was discussed in the first article in this continuing medical education series. This article focuses on current management guidelines and promising new therapies in development. Because of the complexity, aggressive nature, and individuality of each case, MCC is best treated by a multidisciplinary team.


Assuntos
Carcinoma de Célula de Merkel/secundário , Carcinoma de Célula de Merkel/terapia , Vigilância da População , Linfonodo Sentinela/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Antineoplásicos/uso terapêutico , Terapia Combinada , Procedimentos Cirúrgicos Dermatológicos , Humanos , Imunoterapia , Metástase Linfática , Margens de Excisão , Terapia de Alvo Molecular , Guias de Prática Clínica como Assunto , Radioterapia , Biópsia de Linfonodo Sentinela
5.
J Am Acad Dermatol ; 78(3): 433-442, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29229574

RESUMO

Merkel cell carcinoma (MCC) is an uncommon primary cutaneous neuroendocrine cancer. It most commonly presents as an indurated plaque or nodule on sun-damaged skin in elderly patients and is characterized by high rates of local recurrence and nodal metastasis. Survival at 5 years is 51% for local disease and as low as 14% for distant disease, which underscores the aggressive nature of this tumor and challenges in management. Advances in immunology and molecular genetics have broadened our understanding of the pathophysiology of MCC and expanded our therapeutic arsenal. With this comprehensive review, we provide an update of MCC epidemiology, pathogenesis, clinical presentation, diagnostic evaluation and prognostic markers. The second article in this continuing medical education series explores the evolving landscape in MCC management.


Assuntos
Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/secundário , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Carcinoma de Célula de Merkel/epidemiologia , Humanos , Estadiamento de Neoplasias , Prognóstico , Neoplasias Cutâneas/epidemiologia
7.
J Drugs Dermatol ; 14(1): 80-3, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25607912

RESUMO

Skin infections are not uncommon after cosmetic laser procedures. Infection rates following ablative laser resurfacing procedures are reported to be as high as 7.6%, compared to 1.9% for fractional ablation. An infrequent yet important infectious complication of ablative laser treatment is that caused by non-tuberculous mycobacteria (NTM).


Assuntos
Técnicas Cosméticas/efeitos adversos , Terapia a Laser/efeitos adversos , Infecções por Mycobacterium não Tuberculosas/etiologia , Dermatopatias Bacterianas/etiologia , Idoso , Feminino , Humanos , Terapia a Laser/métodos , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/microbiologia
8.
J Am Acad Dermatol ; 71(4): 684-90, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24993599

RESUMO

BACKGROUND: Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Immunosuppression is associated with increased incidence of MCC. OBJECTIVE: We sought to determine whether solid organ transplant recipients (SOTR) with MCC had decreased progression-free, disease-specific, and overall survival compared with immunocompetent patients. METHODS: We conducted a retrospective cohort study examining 8 SOTR with MCC and 89 immunocompetent control subjects. Cox regression models were generated for outcomes of progression, disease-specific death, and death from any cause, adjusted for patient sex, age at diagnosis, and stage at presentation. RESULTS: SOTR had a 4.1-fold increased hazard for progression (95% confidence interval 1.57-10.95, P=.004), a 10.5-fold increased hazard for all-cause mortality (95% confidence interval 3.06-35.98, P<.0001), and an 11.9-fold increased hazard for MCC-specific death (95% confidence interval 2.67-53.08, P=.001), adjusted for sex, age, and stage at presentation. SOTR had decreased 1-year overall survival, 46.8% versus 88.6%, and decreased 1-year MCC-specific survival, 56.3% versus 95.2%. LIMITATIONS: This is a single-center study from a tertiary academic care center, and may not be generalizable to all patient populations. CONCLUSIONS: SOTR have a significant reduction in overall, MCC-specific, and progression-free survival compared with immunocompetent patients. Further studies will determine whether aggressive treatment may improve outcomes in this high-risk population.


Assuntos
Carcinoma de Célula de Merkel/imunologia , Carcinoma de Célula de Merkel/mortalidade , Transplante de Órgãos/mortalidade , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/mortalidade , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Carcinoma de Célula de Merkel/cirurgia , Estudos de Casos e Controles , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Imunocompetência/fisiologia , Hospedeiro Imunocomprometido/imunologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Transplante de Órgãos/métodos , Modelos de Riscos Proporcionais , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Neoplasias Cutâneas/cirurgia , Análise de Sobrevida , Resultado do Tratamento
9.
J Am Acad Dermatol ; 70(4): 637-643, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24521828

RESUMO

BACKGROUND: The effects of primary tumor size on nodal involvement and of number of involved nodes on survival have not, to our knowledge, been examined in a national database of Merkel cell carcinoma (MCC). OBJECTIVE: We sought to analyze a retrospective cohort of patients with MCC from the largest US national database to assess the relationships between these clinical parameters and survival. METHODS: A total of 8044 MCC cases in the National Cancer Data Base were analyzed. RESULTS: There was a 14% risk of regional nodal involvement for 0.5-cm tumors that increased to 25% for 1.7-cm (median-sized) tumors and to more than 36% for tumors 6 cm or larger. The number of involved nodes was strongly predictive of survival (0 nodes, 76% 5-year relative survival; 1 node, 50%; 2 nodes, 47%; 3-5 nodes, 42%; and ≥6 nodes, 24%; P < .0001 for trend). Younger and/or male patients were more likely to undergo pathological nodal evaluation. LIMITATIONS: The National Cancer Data Base does not capture disease-specific survival. Hence, relative survival was calculated by comparing overall survival with age- and sex-matched US population data. CONCLUSION: Pathologic nodal evaluation should be considered even for patients with small primary MCC tumors. The number of involved nodes is strongly predictive of survival and may help improve prognostic accuracy and management.


Assuntos
Carcinoma de Célula de Merkel/mortalidade , Carcinoma de Célula de Merkel/patologia , Linfonodos/patologia , Recidiva Local de Neoplasia/mortalidade , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/cirurgia , Estudos de Coortes , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Humanos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Recidiva Local de Neoplasia/parasitologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/cirurgia , Análise de Sobrevida , Carga Tumoral , Estados Unidos
10.
Semin Cutan Med Surg ; 33(2): 76-82, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25085666

RESUMO

Merkel cell carcinoma is an aggressive neuroendocrine tumor with a high incidence of local recurrence, regional nodal and distant metastasis, and a high mortality rate. It has been linked to a polyomavirus in addition to immune suppression. Traditionally, treatment options have been limited to surgery and radiation therapy. Better understanding of the molecular pathways of infection and carcinogenesis has provided potential molecular targets and potential immunotherapies which are discussed in this review.


Assuntos
Antineoplásicos/uso terapêutico , Carcinoma de Célula de Merkel/terapia , Imunoterapia , Neoplasias Cutâneas/terapia , Anticorpos Monoclonais/uso terapêutico , Benzamidas/uso terapêutico , Biomarcadores/análise , Antígeno CD56/imunologia , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/epidemiologia , Carcinoma de Célula de Merkel/virologia , Eletroquimioterapia , Receptor Celular 2 do Vírus da Hepatite A , Humanos , Mesilato de Imatinib , Imunoterapia Adotiva , Indazóis , Proteínas Inibidoras de Apoptose/metabolismo , Interferons/uso terapêutico , Interleucina-12/genética , Interleucina-2/uso terapêutico , Ipilimumab , Metástase Linfática , Proteínas de Membrana/antagonistas & inibidores , Poliomavírus das Células de Merkel , Oligonucleotídeos Antissenso , Piperazinas/uso terapêutico , Infecções por Polyomavirus/virologia , Prognóstico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Pirimidinas/uso terapêutico , Receptores de Somatomedina/antagonistas & inibidores , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/virologia , Somatostatina/análogos & derivados , Sulfonamidas/uso terapêutico , Survivina , Serina-Treonina Quinases TOR/antagonistas & inibidores , Tionucleotídeos/uso terapêutico
11.
J Am Acad Dermatol ; 68(1): 167-72, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23103201

RESUMO

BACKGROUND: Cigarette smoking is the leading cause of preventable death and a major public health concern. Numerous clinical and experimental studies have examined the effect of nicotine on wound healing and surgical procedures, but there are limited published reports in the dermatologic surgery literature. OBJECTIVE: This article seeks to develop evidence-based recommendations regarding the effect of tobacco use in patients undergoing dermatologic surgery procedures. METHODS: This article reviews the existing published English-language literature pertaining to the effects of tobacco on wound healing and surgical complications. RESULTS: Tobacco use is associated with a higher incidence of postoperative complications including wound dehiscence, flap or graft necrosis, prolonged healing time, and infections. LIMITATIONS: This review article only summarizes past reports and studies. CONCLUSION: Recommendations for smoking cessation before dermatologic surgery are provided based on the available data.


Assuntos
Técnicas Cosméticas , Procedimentos Cirúrgicos Dermatológicos , Dermatopatias/cirurgia , Fumar/efeitos adversos , Sobrevivência de Enxerto , Humanos , Deiscência da Ferida Operatória/etiologia , Infecção da Ferida Cirúrgica/etiologia , Cicatrização
12.
Dermatol Surg ; 39(9): 1323-33, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23777452

RESUMO

BACKGROUND: Merkel cell carcinoma (MCC) is among the deadliest of cutaneous malignancies. A lack of consensus evaluation and treatment guidelines has hindered management of this disease. The utility of simultaneous positron emission tomography and computed tomography (PET/CT) has been demonstrated for a variety of tumors yet remains underinvestigated for MCC. OBJECTIVES: To report the value of fluorodeoxyglucose PET/CT imaging in the initial staging and ongoing management of individuals with MCC and to determine whether any patient or tumor characteristics may predict when PET/CT is more likely to have greater influence on medical decision-making. MATERIALS AND METHODS: A single-institution retrospective chart review was conducted of all patients diagnosed with MCC who underwent FDG-PET/CT scanning from 2007 to 2010. The outcome of each of these studies was evaluated as to the influence on patient staging and management. Patient clinical information and information on gross and microscopic tumor characteristics were collected and analyzed. RESULTS: Twenty patients underwent 39 PET/CT scans. Results of PET/CT imaging revealed previously unknown information related to MCC in four (20%) patients, leading to changes in management in three of these four cases. Three previously unknown neoplasms were detected. CONCLUSION: Fluorodeoxyglucose-positron emission tomography and computed tomography is a valuable tool for initial staging and to assess response to therapy of patients diagnosed with MCC. Larger prospective studies would be required to establish the optimal timing for this imaging modality.


Assuntos
Carcinoma de Célula de Merkel/diagnóstico por imagem , Carcinoma de Célula de Merkel/secundário , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/terapia , Feminino , Fluordesoxiglucose F18 , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Neoplasias Cutâneas/terapia
13.
Res Sq ; 2023 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-38168253

RESUMO

Primary cutaneous squamous cell carcinoma (cSCC) is responsible for ~10,000 deaths annually in the United States. Stratification of risk of poor outcome (PO) including recurrence, metastasis and disease specific death (DSD) at initial biopsy would significantly impact clinical decision-making during the initial post operative period where intervention has been shown to be most effective. In this multi-institutional study, we developed a state-of-the-art self-supervised deep-learning approach with interpretability power and demonstrated its ability to predict poor outcomes of cSCCs at the time of initial biopsy. By highlighting histomorphological phenotypes, our approach demonstrates that poor differentiation and deep invasion correlate with poor prognosis. Our approach is particularly efficient at defining poor outcome risk in Brigham and Women's Hospital (BWH) T2a and American Joint Committee on Cancer (AJCC) T2 cSCCs. This bridges a significant gap in our ability to assess risk among T2a/T2 cSCCs and may be useful in defining patients at highest risk of poor outcome at the time of diagnosis. Early identification of highest-risk patients could signal implementation of more stringent surveillance, rigorous diagnostic work up and identify patients who might best respond to early postoperative adjunctive treatment.

14.
J Cutan Pathol ; 39(10): 911-7, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22882157

RESUMO

Merkel cell carcinoma (MCC) represents a cutaneous malignancy with high associated mortality. Numerous studies have attempted to define characteristics to more accurately predict outcome. Two recent studies have demonstrated that Merkel cell polyomavirus (MCPyV) seropositivity correlated with a better prognosis, while a third study revealed no difference. Expression of p63 by tumor cell nuclei has been shown to be associated with a worse prognosis in a European cohort. To better understand the relationship between prognosis and MCPyV or p63 status, we used immunohistochemistry to evaluate both attributes in 36 US patients with MCC. Our results show that when considered as a binary variable, p63 expression represents a strong risk factor (p < 0.0001, hazards ratio (HR) = ∞) for shortened survival. In addition, our results show that MCPyV status does not correlate with survival (p = 0.6067, HR = 1.27). Our study corroborates the European observation that p63 immunoexpression is useful as a prognostic tool. Larger studies will need to be performed in order to determine whether p63 status should be included in MCC staging, since our study is limited by its relative small size.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma de Célula de Merkel/metabolismo , Proteínas de Membrana/biossíntese , Infecções por Polyomavirus/complicações , Neoplasias Cutâneas/metabolismo , Infecções Tumorais por Vírus/complicações , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Célula de Merkel/mortalidade , Carcinoma de Célula de Merkel/virologia , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Masculino , Proteínas de Membrana/análise , Pessoa de Meia-Idade , Polyomavirus , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/virologia
16.
Laryngoscope ; 132(9): 1753-1759, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-34904721

RESUMO

OBJECTIVES/HYPOTHESIS: To quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color match. We hypothesize that split-thickness skin grafts (STSG) placed atop de-epithelialized free tissue produces better facial skin color match than free tissue with intact epithelium. STUDY DESIGN: Cross sectional photographic study of reconstructed facial skin color match. METHODS: Sixty-eight adults, who underwent head and neck reconstructive surgery, were divided into six categories based on cutaneous reconstructive technique: cervicofacial flap, radial forearm free flap (RFFF), fibula free flap, anterolateral thigh free flap (ALT), STSG over adiopofascial flap (STAFF), and STSG over myogenous flap (STMF). Averaged color samplings of the reconstructed defect and adjacent normal skin were taken from digital photographs. The color difference was calculated using the delta-E calculation. Blinded expert observers also rated the degree of color match. Nonparametric cohort contrast and correlation statistical analyses were performed. RESULTS: The mean delta-E's and 10-point Likert ratings for the ALT, fibula, RFFF, STAFF, STMF, and cervicofacial flaps were 11.6, 10.0, 7.7, 6.3, 8.8, and 4.7, and 5.1, 6.4, 2.4, 3.2, 2.7, and 1.1, respectively. Likert scale inter-rater correlation was strong, with coefficient = 0.80. CONCLUSIONS: On average, STSG over de-epithelialized myogenous and adipofascial free tissue transfers produced a better color match than the skin paddles of donor sites, with the exception of the radial forearm donor site. Delta-E values obtained from photos correlated well with expert ratings of color match. This reliable technique for quantifying color match may be used in future studies. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1753-1759, 2022.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Adulto , Estudos Transversais , Retalhos de Tecido Biológico/transplante , Humanos , Procedimentos de Cirurgia Plástica/métodos , Pigmentação da Pele , Transplante de Pele/métodos
17.
J Am Acad Dermatol ; 64(6): 1051-9, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21255868

RESUMO

BACKGROUND: The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing. Although most patients achieve complete remission with surgical treatment, those with advanced disease have a poor prognosis. The American Joint Committee on Cancer (AJCC) is responsible for the staging criteria for all cancers. For the past 20 years, the AJCC cancer staging manual has grouped all nonmelanoma skin cancers, including cSCC, together for the purposes of staging. However, based on new evidence, the AJCC has determined that cSCC should have a separate staging system in the 7th edition AJCC staging manual. OBJECTIVE: We sought to present the rationale for and characteristics of the new AJCC staging system specific to cSCC tumor characteristics (T). METHODS: The Nonmelanoma Skin Cancer Task Force of AJCC reviewed relevant data and reached expert consensus in creating the 7th edition AJCC staging system for cSCC. Emphasis was placed on prospectively accumulated data and multivariate analyses. Concordance with head and neck cancer staging system was also achieved. RESULTS: A new AJCC cSCC T classification is presented. The T classification is determined by tumor diameter, invasion into cranial bone, and high-risk features, including anatomic location, tumor thickness and level, differentiation, and perineural invasion. LIMITATIONS: The data available for analysis are still suboptimal, with limited prospective outcomes trials and few multivariate analyses. CONCLUSIONS: The new AJCC staging system for cSCC incorporates tumor-specific (T) staging features and will encourage coordinated, consistent collection of data that will be the basis of improved prognostic systems in the future.


Assuntos
Carcinoma de Células Escamosas/patologia , Estadiamento de Neoplasias/classificação , Neoplasias Cutâneas/patologia , Carcinoma de Células Escamosas/classificação , Diferenciação Celular , Humanos , Metástase Linfática , Invasividade Neoplásica , Prognóstico , Neoplasias Cutâneas/classificação
18.
J Cutan Pathol ; 38(10): 801-7, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21883364

RESUMO

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine carcinoma of the skin. Disease progression usually occurs via lymphatic spread to regional lymphatic draining basins, followed by distant metastasis. We report the clinical course, histopathology and genetic analysis of a 69-year-old woman with likely hematogenous spread of cutaneous neuroendocrine carcinoma manifesting as a single metastatic lesion to a distant cutaneous site. Although the possibility of two cutaneous primary MCCs was considered, array comparative genomic hybridization (aCGH) identified identical distal amplification of a region of chromosome 12p, and synchronous loss of chromosomes 8p and 17p, effectively ruling out the possibility of independent primaries. We propose that this represents a primary cheek MCC with rapid, isolated cutaneous metastasis to the contralateral ankle via hematogenous spread. The distinction between a second primary MCC and a distant cutaneous metastasis clearly has important implications with regard to staging, treatment and prognosis. To our knowledge, this represents the first report of the use of aCGH to clarify the relationship of multiple synchronous cutaneous MCCs and the first report of a single distant cutaneous focus of hematogenous spread. Our data calls into question prior reports alleging multiple cutaneous primaries of this very rare tumor.


Assuntos
Carcinoma de Célula de Merkel/patologia , Segunda Neoplasia Primária/etiologia , Neoplasias Cutâneas/patologia , Idoso , Carcinoma de Célula de Merkel/genética , Carcinoma de Célula de Merkel/terapia , Terapia Combinada , Hibridização Genômica Comparativa , DNA de Neoplasias/análise , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Cutâneas/genética , Neoplasias Cutâneas/terapia
19.
Adv Radiat Oncol ; 6(6): 100764, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485762

RESUMO

PURPOSE: Radiation of the draining lymph node basin remains controversial for Merkel cell carcinoma, particularly in the era of sentinel lymph node biopsy (SLNB). METHODS AND MATERIALS: Based on a 20-year experience using SLNB-guided adjuvant radiation therapy (RT), we conducted a retrospective review of clinically node-negative patients testing 2 hypotheses: (1) whether nodal RT could be safely omitted in SLNB-negative Merkel cell carcinoma and (2) whether the excised primary site should always be radiated. Clinically node-positive patients were excluded. RESULTS: Among 57 clinically node-negative patients who underwent SLNB and wide local excision (WLE), 42 (74%) had a negative SLNB, and 15 (26%) had a positive SLNB. At a median follow-up of 43 months (range, 5-182), SLNB-negative patients irradiated to the primary site had improved 4-year disease-specific survival (100% vs 65%, P = .008), local recurrence-free survival (100% vs 76%, P = .009), and distant recurrence-free survival (100% vs 75%, P = .008), but not overall survival (87.5% vs 57.7%, P = .164) compared with SLNB-positive patients receiving comprehensive RT. Among SLNB-negative patients treated with WLE only, 67% (6/9) had a disease relapse, half of which were local relapses (33%). CONCLUSIONS: In this single-institution retrospective review, after negative SLNB and WLE, RT given only to the primary site provided 100% disease control without a need for nodal RT. Among SLNB-negative patients who had WLE, omission of postoperative primary-site RT was associated with 67% cancer relapse, of which half was local.

20.
J Am Acad Dermatol ; 63(5): 751-61, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20646783

RESUMO

BACKGROUND: The management of Merkel cell carcinoma (MCC) has been complicated by a lack of detailed prognostic data and by the presence of conflicting staging systems. OBJECTIVE: We sought to determine the prognostic significance of tumor size, clinical versus pathologic nodal evaluation, and extent of disease at presentation and thereby derive the first consensus staging/prognostic system for MCC. METHODS: A total of 5823 prospectively enrolled MCC cases from the National Cancer Data Base had follow-up data (median 64 months) and were used for prognostic analyses. RESULTS: At 5 years, overall survival was 40% and relative survival (compared with age- and sex-matched population data) was 54%. Among all MCC cases, 66% presented with local, 27% with nodal, and 7% with distant metastatic disease. For cases presenting with local disease only, smaller tumor size was associated with better survival (stage I, ≤2 cm, 66% relative survival at 5 years; stage II, >2 cm, 51%; P < .0001). Patients with clinically local-only disease and pathologically proven negative nodes had better outcome (76% at 5 years) than those who only underwent clinical nodal evaluation (59%, P < .0001). LIMITATIONS: The National Cancer Data Base does not capture disease-specific survival. Overall survival for patients with MCC was therefore used to calculate relative survival based on matched population data. CONCLUSION: Although the majority (68%) of patients with MCC in this nationwide cohort did not undergo pathologic nodal evaluation, this procedure may be indicated in many cases as it improves prognostic accuracy and has important treatment implications for those found to have microscopic nodal involvement.


Assuntos
Carcinoma de Célula de Merkel/mortalidade , Carcinoma de Célula de Merkel/patologia , Estadiamento de Neoplasias/métodos , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consenso , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Linfonodos/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias/normas , Prognóstico , Reprodutibilidade dos Testes , Análise de Sobrevida
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