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Toia F, Cajozzo M, Rosatti F, Di Lorenzo S, Rinaldi G, Mazzucco W, Cordova A. Effectiveness of clinical and instrumental follow-up for cutaneous melanoma. Surg Oncol 2022; 44:101821. [PMID: 35947885 DOI: 10.1016/j.suronc.2022.101821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/05/2022] [Accepted: 07/24/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Follow-up guidelines for melanoma greatly differ in the methods of screening for recurrence, and timing and duration of the follow up, with many areas of controversy and a lack of general consensus. The aims of this study are to present our protocol and case series for follow up and to summarize and discuss current literature on melanoma follow-up guidelines/recommendations in different countries. METHODS We retrospectively reviewed 539 patients operated for melanoma between 2004 and 2013 at the same Institution. Data on the diagnostic role of the different clinical and instrumental detection methods were adjusted for sex, age at diagnosis, staging and evaluated by Fisher's exact test and multivariate analysis. Recommendations from the literature were summarized and discussed. RESULTS Local recurrences and second melanoma were always identified through physical examination, irrespectively of melanoma staging. Regional metastases were most often identified through physical examination and ultrasound, being more frequent in stage II and III, while distant metastases were most often identified through CT scans. Surveillance follow-up schedules vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Similarities and controversies in the different follow-up protocols are presented and discussed. CONCLUSION Our clinical series showed that physical examination is very powerful in identifying local recurrences and second melanomas. Physical examination and ultrasound are equally powerful in identifying regional metastases, and alternating them over time could allow to reduce the number of follow-up visits. CT scans, differently from chest x-ray, showed a high power in identifying distant metastases. Surveillance follow-up schedules in the literature vary significantly depending on country, physician specialty, and stage of disease, with a lack of evidence on the efficacy of the different schemes. Standard protocols are desirable for a better evaluation of results.
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Affiliation(s)
- Francesca Toia
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Marta Cajozzo
- Plastic and Maxillofacial Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fernando Rosatti
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy.
| | - Sara Di Lorenzo
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
| | - Gaetana Rinaldi
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Surgical Oncological and Oral Sciences (DICHIRONS), University of Palermo, Palermo, Italy
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Gonzalez-Lara L, Bonsang B, Zimmermann U, Blom A, Chapalain M, Tchakerian A, Serra M, Aouidad I, Chaplain L, Roger A, Longvert C, Saiag P, Funck-Brentano E. Formalin-fixed tissue Mohs surgery (slow Mohs) for trichoblastic carcinoma. J Eur Acad Dermatol Venereol 2022; 36:e827-e828. [PMID: 35686623 DOI: 10.1111/jdv.18309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- L Gonzalez-Lara
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - B Bonsang
- Research Unit EA 4340 "Biomarkers in Cancerology and in Hemato-oncology", University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France.,Department of Pathology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - U Zimmermann
- Research Unit EA 4340 "Biomarkers in Cancerology and in Hemato-oncology", University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France.,Department of Pathology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - A Blom
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - M Chapalain
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - A Tchakerian
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - M Serra
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - I Aouidad
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - L Chaplain
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - A Roger
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - C Longvert
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - P Saiag
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France.,Research Unit EA 4340 "Biomarkers in Cancerology and in Hemato-oncology", University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France
| | - E Funck-Brentano
- Department of Dermatology, Ambroise Paré Hospital, Boulogne-Billancourt, France.,Research Unit EA 4340 "Biomarkers in Cancerology and in Hemato-oncology", University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Boulogne-Billancourt, France
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3
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Dekerle L, Cortese S, Salleron J, Rauch P, Mastronicola R, Beulque E, Chatard M, Hamitouche S, Alao O, Dolivet G. Long-term survival after head and neck cancer surgery with immediate free flap reconstruction. ANN CHIR PLAST ESTH 2021; 66:357-363. [PMID: 33824027 DOI: 10.1016/j.anplas.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/04/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Head and neck cancer is one of the most frequent cancers worldwide. A combination treatment including surgery is known to have a better survival rate than exclusive radiotherapy-chemotherapy. In extreme cases of non-metastatic patients who have voluminous tumor, or complex location, surgery with immediate reconstruction by free flap could be an option to improve long term survival. PURPOSE To share experience of long-term survival of patients with head and neck cancer who underwent oncologic surgery with immediate free flap reconstruction, and to analyze influencing factors. METHODS All consecutive patients treated with free flaps for reconstruction of extensive defects after resection of head and neck cancer in our center (Nancy, France) were retrieved from the hospital database. Data was recorded in a systematic way. Bivariate and multivariate Cox proportional hazards models were used for statistical analysis. RESULTS Between 1997 and December 2007, 70 patients underwent surgical resection of head and neck tumor with free flap reconstruction. 11 patients were excluded because of missing data. Follow-up time was 7.4 years, IQR from 4.3 to 11.3. Overall survival was 53.8%, 95% CI [39.9%; 65.8%] at 5 years and 38.6% [24.8%; 52.3%] at 10 years. Age>60 years at the surgery HR 2,373 (1,143; 4,927) and TNM score 3-4 HR 2,524 (1,093; 5,828) were statistically associated to a lesser survival rate. CONCLUSION The ability to successfully and safely perform free flaps increases treatment options for patients with advanced head and neck cancer in a selected population. it seems worthwhile to perform these microvascular reconstructions.
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Affiliation(s)
- L Dekerle
- Department of Plastic and Reconstructive Surgery, Nancy University Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France.
| | - S Cortese
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - J Salleron
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - P Rauch
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - R Mastronicola
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - E Beulque
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
| | - M Chatard
- Department of Plastic and Reconstructive Surgery, Nancy University Hospital, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54000 Nancy, France
| | - S Hamitouche
- Department of Head and neck surgery, Nancy University Hospital, Nancy, France
| | - O Alao
- Department of Digestive Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - G Dolivet
- Department of Oncologic Surgery "Institut de Cancérologie de Lorraine", Nancy, France
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4
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Prognostic significance of positive surgical margins for scalp angiosarcoma. J Formos Med Assoc 2020; 120:217-225. [PMID: 32446755 DOI: 10.1016/j.jfma.2020.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 04/05/2020] [Accepted: 04/14/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Scalp angiosarcomas (AS) are aggressive soft tissue sarcomas that present with outcomes different from other AS of the head and neck region. Due to the rarity of the disease, limited data on the clinical outcome of scalp AS are available. In particular, the prognostic significance of surgical margins remains controversial and the impact of margin status on survival has not been documented. METHODS We retrospectively reviewed 41 scalp AS patients, including 30 patients with localized disease and 11 patients with initial distant metastasis, treated in our institution between 1997 and 2017. Survival was determined by Kaplan-Meier analysis. In the 30 patients without distant metastasis (localized disease), univariate and multivariate analysis using the Cox proportional hazards model were used to determine clinicopathologic characteristics associated with recurrence free survival (RFS), locoregional control (LRC), and overall survival (OS). RESULTS Totally 41 patients diagnosed with scalp AS were identified, including 30 patients with localized disease and 11 patients with initial distant metastasis on diagnosis. Overall, the median follow-up period was 19.3 (range 0.3-128.5) months. The median survival time was 16.6 (range 0.3-144.3) months and the 5-year OS (95% Confidence Interval (CI)) rate was 22% (12%-42%). In the 30 patients with localized disease, univariate analysis showed that positive margins, either lateral-side or deep-side, were significant prognostic factors for RFS, LRC, and OS (p < 0.05). On multivariate analysis, positive margins emerged as adverse prognostic factors for RFS (Hazard Ratio (HR) 4.29, 95% CI, 1.71-10.75, p = 0.002), LRC (HR 6.35, 95% CI, 2.19-18.37, p = 0.001), and OS (HR 4.73, 95% CI, 1.71-13.07, p = 0.003). CONCLUSION Scalp AS is associated with high local recurrence rates and poor survival outcomes. Positive surgical margins are adverse prognostic factors for survival.
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Bernstock JD, Shafaat O, Hardigan A, Fox BM, Moore LS, Chagoya G, Elsayed G, Gessler F, Ilyas A, Yamashita D, McGrew B, Fisher WS, Hackney J, Sotoudeh H. Angiosarcoma of the Temporal Bone: Case Report and Review of the Literature. World Neurosurg 2019; 130:351-357. [PMID: 31330332 DOI: 10.1016/j.wneu.2019.07.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Angiosarcomas are rare malignant tumors of endothelial origin. Nearly one half of all angiosarcomas occur in the head and neck. Temporal bone angiosarcomas are extremely uncommon. We present a case of temporal bone angiosarcoma and a review of the relevant data. CASE DESCRIPTION We present the case of a 20-year-old man with a painful right postauricular mass after a closed head injury. Radiologic studies demonstrated a large right osteolytic and heterogeneously enhancing mass. The patient underwent right transpetrosal craniectomy for resection. Histologic studies confirmed high-grade sarcoma. Immunohistochemical staining demonstrated a uniformly positive ERG endothelial marker, CD31 staining with cytoplasmic and membranous patterns of immunopositivity, positive nuclear staining for FLI-1, positive cytoplasmic and membranous staining for CD99 and STAT6, and negative smooth muscle actin stains in the neoplastic cells. Ki-67 staining showed ∼94% positivity in the neoplastic cell nuclei. Postoperative follow-up imaging studies demonstrated evidence of metastatic right cervical lymphadenopathy. CONCLUSIONS Angiosarcoma of the temporal bone is extremely uncommon. In the present case report, we explored a relationship between trauma and angiosarcoma of the temporal bone. We reviewed the reported data regarding the pathogenesis, diagnosis, treatment, radiologic findings, and histologic characteristics of angiosarcoma of the temporal bone.
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Affiliation(s)
- Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Omid Shafaat
- Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Andrew Hardigan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandon M Fox
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsay S Moore
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daisuke Yamashita
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin McGrew
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James Hackney
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Houman Sotoudeh
- Department of Neuroradiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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6
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Chen JX, Kozin ED, O'Malley J, Chebib I, Hedley-Whyte ET, Faquin W, Nadol J, Quesnel AM. Otopathology in Angiosarcoma of the Temporal Bone. Laryngoscope 2018; 129:737-742. [PMID: 30536838 DOI: 10.1002/lary.27281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Investigate the otopathology of angiosarcoma of the temporal bone, which has not been previously described in the literature. STUDY DESIGN Postmortem evaluation and literature review. METHODS Postmortem histological evaluation of the temporal bones and review of the literature for the treatment and prognosis of this rare disease were performed. RESULTS A 50-year-old male with right chronic otitis media presented with progressive hearing loss, disequilibrium, otalgia, and acute facial paresis. Biopsy of the external auditory canal was unrevealing, but specimens from a canal wall down tympanomastoidectomy later showed high-grade angiosarcoma. Magnetic resonance imaging demonstrated an unresectable middle ear and mastoid mass extending superiorly into the temporal lobe. The patient received induction chemotherapy followed by proton beam radiation therapy and concurrent paclitaxel and bevacizumab. His course was complicated by a cerebrospinal fluid leak and cauda equina syndrome from leptomeningeal sarcomatosis. The patient died after developing meningitis and a temporal lobe abscess. Postmortem otopathology revealed persistent angiosarcoma in the internal auditory canal, although none was found in the middle ear or mastoid. There was inflammatory infiltrate throughout the mastoid, with direct extension of neutrophils and bacteria into the cochlea and through the tegmen into the middle cranial fossa. CONCLUSIONS Angiosarcoma of the temporal bone can arise in the setting of chronic otitis media. In this case, postmortem temporal bone sections demonstrated viable cancer despite chemoradiation. Inflammatory infiltrates crossing from the middle ear/mastoid into the labyrinth and central nervous system illustrate pathways for the development of otogenic meningitis. LEVEL OF EVIDENCE 4 Laryngoscope, 129:737-742, 2019.
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Affiliation(s)
- Jenny X Chen
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Jennifer O'Malley
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Ivan Chebib
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - William Faquin
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Joseph Nadol
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Otology and Neurotology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Alicia M Quesnel
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Division of Otology and Neurotology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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[Why is it important to differentiate trichoblastic carcinomas (CT) from basal cell carcinomas (CBC). About 21 cases]. ANN CHIR PLAST ESTH 2017; 62:212-218. [PMID: 28385570 DOI: 10.1016/j.anplas.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
Abstract
Trichoblastic carcinoma is a rare epithelial malignant epithelial tumor, its diagnosis is difficult and the therapeutic management is non-consensual. This retrospective study, carried out between 2009 and 2015, covered 21 cases and analyzed the diagnostic and therapeutic characteristics of trichoblastic carcinomas. Sex ratio is 2. Trichoblastic carcinoma predominated in the face (65% of cases), particularly in perinasal (30% of cases). Its clinical presentation is in 95% of cases as basal cell carcinoma, which is the first clinical diagnosis evoked. The average size of the tumors was 2.3cm in diameter (from 0.7cm to 15cm). The treatment of these tumors is surgical: the margins retained were on average 0.7cm (0.5cm to 1cm). The first excision was mostly performed under local anesthesia, healthy borders were found in less than 40% of cases, requiring another intervention under general anesthesia with reconstruction by flap or skin graft in nearly 80% of cases. The lymph node metastasis rate was 5%. Three cases of recurrence (17%) occurred between 18 months and 6 years follow-up, despite complete resection. One case recurred three times. These results highlight the difficulty of diagnosing trichoblastic carcinomas, often confused with basal cell carcinomas. Though larger, poorly limited and infiltrating, trichoblastic carcinomas are not really distinguished from basal cell carcinomas. Only the anatomopathological examination of the excision piece make it possible to conclude, the biopsy being most often insufficient. Their local aggressiveness requires a greater margin of excision. The micrographic analysis of Mohs, for the periorificial lesions of the face, would reduce margins, increase their reliability and limit the number of surgical revisions. Finally, the literature reports a high rate of ganglion and visceral metastases (between 9.5 and 11%). Initial search for distal lymph node or metastatic involvement is essential, as well as regular clinical follow-up.
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Saporito F, Charalampoudis P, Kinney M, Knox S. Reader Comments: Operative Management of Dermatofibrosarcoma Protuberans of the Breast. Proc (Bayl Univ Med Cent) 2017; 30:128-129. [DOI: 10.1080/08998280.2017.11929558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | | | | | - Sally Knox
- Baylor University Medical Center at Dallas
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Reconstruction of lateral defects of the tip and supratip less than 1.5 cm in diameter. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:59-61. [PMID: 26778443 DOI: 10.1016/j.anorl.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The authors describe the surgical technique as well as the indications and limitations of the East-West flap for repair of lateral defects of the tip/supratip of the nose less than 1.5 cm in diameter. This easy and reliable technique is based on the use of skin from the lower third of the nose to repair the defect. This tissue presents the same thickness and colour characteristics, which limits excessive thickness, distortion and dyschromia phenomena.
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