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Tzelnick S, de Almeida JR, Yao CMKL, Kibel S, Kuehne N, Grewal R, Butler MO, Saibil S, Spreafico A, Easson A, Goldstein DP. Nodal Metastases in Stage 3 Head and Neck Melanoma: Patterns of Metastases and Patterns of Failure. Laryngoscope 2024. [PMID: 38828642 DOI: 10.1002/lary.31515] [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: 02/07/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Stage 3 patients with clinically positive nodal metastasis are treated with therapeutic neck dissection and adjuvant systemic therapy. The aim of our study was to examined the predictability of pre-operative CT as a nodal drainage assessment tool. METHODS Retrospective review of all patients with clinically positive head and neck cutaneous melanoma between 2010 and 2019. Clinical disease was diagnosed as radiological suspicious, biopsy-proven node. A pre-operative CT evaluation for nodal metastasis was compared to pathology report. RESULTS A total of 53 patients were included. Forty patients (75.5%) were males with a mean age of 59 (SD 15.52). The majority of patients (26.4%) had an unknown primary site. The most common sites for primary were the cheek in eight patients (15.1%) followed by forehead (9.4%) and lateral neck (9.4%). Preoperative CT predicted nodal disease in 84.6% of cases. The primary region that mainly failed from the previously described clinical prediction was the upper anterior neck with 83.3% parotid involvement. A total of 10 patients (18.9%) were diagnosis with non-clinical nodes on pathology with a median non-clinical node of 1 (range 1-2). Of them, 9 (90%) were in the same clinical levels detected by CT. Pre-operative CT was associated with a neck level accuracy of 98.1%. CONCLUSION Stage 3 head and neck melanoma with clinically positive nodal metastasis that are eligible for an adjuvant systemic treatment, may benefit from a highly selective neck dissection according to their pre-operative imaging studies. This should be further evaluated in a large-scale clinical trial. LEVEL OF EVIDENCE 3 Laryngoscope, 2024.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Seth Kibel
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Nathan Kuehne
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Rajan Grewal
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marcus O Butler
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Sam Saibil
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Alexandra Easson
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of General Surgery, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Chieng CY, Nazir H, Sayan A, Ilankovan V. The role of neck dissection in management of patients with clinically apparent parotid metastatic melanoma - systematic review. Br J Oral Maxillofac Surg 2024:S0266-4356(24)00111-6. [PMID: 38945797 DOI: 10.1016/j.bjoms.2024.05.004] [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: 03/25/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 07/02/2024]
Abstract
Patients with cutaneous melanoma with metastatic deposits in the parotid gland have poor prognosis due to the high risk of developing distant metastasis. In the era of effective immunotherapy, there is no consensus amongst head and neck surgeons about the extent of neck dissection required for patients presenting with clinically apparent parotid metastasis. This review aims to determine the incidence and pattern of occult neck disease for patients with parotid metastasis reported in literature to help guide clinicians on the extent of neck dissection required. The systematic review search was conducted using PubMed, EMBASE and Medline, using PRISMA guidelines. The inclusion criteria include cases treated with parotidectomy and neck dissection for patients with parotid melanoma metastasis. A narrative synthesis was carried out due to heterogeneity of studies. A total of 14 studies was included. We found no study reporting on outcomes with surgery and adjuvant immunotherapy in this cohort of patients. The incidence of distant metastasis reported was variable but remains high for patients with parotid metastasis. Patients with parotid and neck involvement have poorer prognosis than patients with parotid only metastatic disease. The effect and extent of neck dissection in patients with clinically apparent parotid nodes remains unclear in the era of effective immunotherapy. There is a need for further well-designed studies evaluating the outcomes for such patients following surgery and adjuvant immunotherapy.
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Affiliation(s)
- C Y Chieng
- Barts and The London School of Medicine and Dentistry, United Kingdom
| | - H Nazir
- Manchester University NHS Foundation Trust, United Kingdom
| | - A Sayan
- Oral & Maxillofacial Surgery Department, Oxford University Hospital NHS Foundation Trust, United Kingdom
| | - V Ilankovan
- Oral & Maxillofacial Surgery Department, Poole Hospital NHS Foundation Trust, United Kingdom
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Nishio T, Maeda T, Ishikawa K, Murao N, Fuyama K, Yamamoto Y, Hayashi T. Lymphatic drainage patterns of malignant skin tumors in the head and neck region: a single-center retrospective study. Int J Clin Oncol 2024; 29:582-591. [PMID: 38554214 DOI: 10.1007/s10147-024-02487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/09/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND This study aimed to clarify the relationship between primary site and lymphatic drainage pattern for malignant skin tumors in the head and neck region. Malignant melanoma and squamous cell carcinoma in the head and neck region are known to have poor prognosis because of lymph node metastasis. Nevertheless, numerous aspects of lymphatic drainage patterns remain elusive. METHODS We statistically analyzed data of 47 patients with malignant skin tumors in the head and neck region. Information was collected on the patients' clinical characteristics, primary tumor site, and lymphatic drainage patterns. RESULTS The parotid lymph nodes drained the greatest amount of lymph from skin tumors of the head and neck. Important lymphatic drainage pathways were the superficial cervical nodes for primary tumors in the buccal/nasal region, level IA and level IB nodes for primary tumors in the lip region, the occipital nodes, posterior auricular nodes, and level VA nodes in the parietal/occipital region, and the preauricular nodes in the auricular region. CONCLUSION These findings have considerable significance in terms of understanding lymphatic drainage patterns for malignant skin tumors in the head and neck and may be useful for clinical decision-making and when planning treatment. Further research and clinical applications are expected to contribute to an improved prognosis in patients with cutaneous head and neck malignancies.
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Affiliation(s)
- Takuya Nishio
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan
| | - Taku Maeda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kosuke Ishikawa
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Murao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kanako Fuyama
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yuhei Yamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihiko Hayashi
- Department of Plastic and Reconstructive Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka-Higashi, Asahikawa, Hokkaido, 078-8510, Japan.
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Han AY, John MAS. Predictors of Nodal Metastasis in Cutaneous Head and Neck Cancers. Curr Oncol Rep 2022; 24:1145-1152. [PMID: 35394247 PMCID: PMC9468084 DOI: 10.1007/s11912-022-01249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The complex and varied drainage patterns in the head and neck present a challenge in the regional control of cutaneous neoplasms. Lymph node involvement significantly diminishes survival, often warranting more aggressive treatment. Here, we review the risk factors associated with lymphatic metastasis, in the context of the evolving role of sentinel lymph node biopsy. RECENT FINDINGS In cutaneous head and neck melanomas, tumor thickness, age, size, mitosis, ulceration, and specific histology have been associated with lymph node metastasis (LNM). In head and neck cutaneous squamous cell carcinomas, tumor thickness, size, perineural invasion, and immunosuppression are all risk factors for nodal metastasis. The risk factors for lymph node involvement in Merkel cell carcinoma are not yet fully defined, but emerging evidence indicates that tumor thickness and size may be associated with regional metastasis. The specific factors that predict a greater risk of LNM for cutaneous head and neck cancers generally include depth of invasion, tumor size, mitotic rate, ulceration, immunosuppression, and other histopathological factors.
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Affiliation(s)
- Albert Y Han
- Department of Head and Neck Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA
- UCLA Head and Neck Cancer Program, UCLA Medical Center, 10833 Le Conte Ave, 62-132 CHS, Los Angeles, CA, 90095, USA
- Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, CA, USA
| | - Maie A St John
- Department of Head and Neck Surgery, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
- UCLA Head and Neck Cancer Program, UCLA Medical Center, 10833 Le Conte Ave, 62-132 CHS, Los Angeles, CA, 90095, USA.
- Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, CA, USA.
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Berger DMS, Verver D, van der Noort V, Grünhagen DJ, Verhoef C, Al-Mamgani A, Zuur CL, van Akkooi ACJ, Balm AJM, Klop WMC. Therapeutic neck dissection in head and neck melanoma patients: Comparing extent of surgery and clinical outcome in two cohorts. Eur J Surg Oncol 2021; 47:2454-2459. [PMID: 33867173 DOI: 10.1016/j.ejso.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/21/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The extent of surgical management of regional lymph nodes in the treatment of cutaneous head and neck melanoma on and anterior to O'Brien's watershed line is controversial. By comparing patients' cohorts of two separate melanoma expert centers we investigate the effectiveness of comprehensive versus (super-) selective neck dissection approach. METHODS Sixty patients with macroscopic (palpable) neck node metastases (N2b) from anterior scalp and face melanoma were retrospectively studied. Forty therapeutic modified radical neck dissections (MRND; levels I-V) combined with elective parotidectomy from The Netherlands Cancer Institute (NCI) were compared with 16 (super-) selective neck dissections [(S)SND; 3-4 levels] and 4 solely MRNDs from Erasmus Medical Center (EMC). Cohorts were analyzed for site of recurrence, overall survival (OS), melanoma-specific survival (MSS), and disease-free survival (DFS). RESULTS Clinical characteristics of patients were equal in both groups. In the NCI cohort 62.5% (n = 25) of patients recurred versus 65% (n = 13) in the EMC cohort. None of the NCI recurrences affected the parotid gland in contrast to 3 patients in the EMC group. Survival characteristics were not different between the two groups: OS (p = 0.56), MSS (p = 0.98), DFS (p = 0.92). CONCLUSION This study does not support to continue the practice of routine elective parotidectomy and MRND in melanoma patients undergoing a lymph node dissection for macroscopic (palpable) nodal disease and justifies (S)SND.
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Affiliation(s)
- Danique M S Berger
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
| | - Danielle Verver
- Department of Surgical Oncology, Erasmus MC-Cancer Institute, Rotterdam, the Netherlands
| | - Vincent van der Noort
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Dirk J Grünhagen
- Department of Surgical Oncology, Erasmus MC-Cancer Institute, Rotterdam, the Netherlands
| | - Cees Verhoef
- Department of Surgical Oncology, Erasmus MC-Cancer Institute, Rotterdam, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Charlotte L Zuur
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, the Netherlands
| | - W Martin C Klop
- Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, the Netherlands.
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Üstün F, Taştekin E, Taş A, Altun GD. The Clinical Significance of Incidental Parotid Uptake in a PET/CT Study: A Diagnostic Algorithm. Curr Med Imaging 2020; 15:326-333. [PMID: 31989884 DOI: 10.2174/1573405614666171213160244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/28/2017] [Accepted: 12/02/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients diagnosed with cancer do not have sufficient clinical data for the management of incidental parotid lesions. We aimed to reveal the importance of randomized parotid lesions encountered during oncologic F-18 fluorodeoxyglucose positron emission tomography (FDG PET/CT) imaging in our clinical practice and the diagnostic algorithm of such lesions. METHODS We performed a database search of PET/CT records generated from 2009 to 2015 for "parotid" in reports of patients who underwent PET/CT examination for a known malignancy elsewhere, or cancer screening. RESULTS Incidental parotid FDG uptake on PET/CT had a prevalence of 1.1%. The incidence of parotid metastasis in our series was 36.4%, and 75% of them had malign melanoma metastasis. Of the 11 cases, 5 were of Warthin tumours, and Warthin tumours showed stronger GLUT1 expression than metastatic parotid lesions. CONCLUSION In patients with malignancy elsewhere, focal involvement of FDG by the parotid gland, especially if malignant melanoma or SCC is absent, should not be considered a metastatic disease without histopathologic confirmation. If parotid disease would change the patient's treatment plan and disease stage, the parotid lesion should be evaluated by additional methods, such as fine needle aspiration biopsy.
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Affiliation(s)
- Funda Üstün
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Ebru Taştekin
- Department of Pathology, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Abdullah Taş
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Trakya University, Edirne, Turkey
| | - Gülay Durmuş Altun
- Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey
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Berger DMS, van Veen MM, Madu MF, van Akkooi ACJ, Vogel WV, Balm AJM, Klop WMC. Parotidectomy in patients with head and neck cutaneous melanoma with cervical lymph node involvement. Head Neck 2019; 41:2264-2270. [PMID: 30762921 DOI: 10.1002/hed.25670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/21/2018] [Accepted: 01/15/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Parotidectomy in melanoma of the coronal scalp and face with clinically involved cervical lymph node metastasis is based on predicted cervical lymphatic drainage described by O'Brien. METHODS In total, 40 parotidectomies with en bloc therapeutic neck dissection were retrospectively analyzed. RESULTS Lymphatic spread of melanoma to the parotid lymph nodes was observed in 10 of 40 specimens (25%). Eight of the 10 parotid-positive patients developed a recurrence vs 17 of the 30 parotid-negative patients (P = 0.28). There were no differences in overall survival, melanoma-specific survival, and disease-free survival between the parotid-positive and parotid-negative patients. CONCLUSION Although in this series no survival differences were found, parotidectomy still merits a sustained role in therapeutic neck dissection procedures to improve regional control and to prevent facial nerve damage after surgery for a second relapse from occult metastases in the parotid.
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Affiliation(s)
- Danique M S Berger
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Martinus M van Veen
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Max F Madu
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Alexander C J van Akkooi
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Wouter V Vogel
- Department of Nuclear Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Radiotherapy, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Alfons J M Balm
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Willem M C Klop
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
- Department of Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Namin AW, Cornell GE, Thombs LA, Zitsch RP. Patterns of recurrence and retreatment outcomes among clinical stage I and II head and neck melanoma patients. Head Neck 2019; 41:1304-1311. [PMID: 30629324 DOI: 10.1002/hed.25562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/10/2018] [Accepted: 11/14/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN). METHODS Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015. RESULTS Twenty percent (33/168) of the patients developed a recurrence. Sixty-six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow-up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow-up. Among the 7 patients who were NED, the mean time from recurrence to last follow-up was 735 days. CONCLUSIONS Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.
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Affiliation(s)
- Arya W Namin
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri, Columbia, Missouri
| | | | - Lori A Thombs
- Department of Statistics, University of Missouri, Columbia, Missouri
| | - Robert P Zitsch
- Department of Otolaryngology - Head and Neck Surgery, University of Missouri, Columbia, Missouri
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Zhang D, Li X, Xiong H, Yang C, Lv F, Huang X, Li Q, Tang Z, Luo T. Tuberculosis of the parotid lymph nodes: clinical and imaging features. Infect Drug Resist 2018; 11:1795-1805. [PMID: 30349336 PMCID: PMC6188200 DOI: 10.2147/idr.s164993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objectives To characterize clinical, computed tomography (CT) and magnetic resonance imaging (MRI) features of tuberculosis (TB) of the parotid nodes. Materials and methods CT (n=21) and MR (n=7) images, and clinical data from 25 patients with TB of the parotid nodes were retrospectively analyzed by two experienced radiologists who reached consensus. Results Younger patients (aged <50 years) accounted for 72%. Eighty percent of patients were asymptomatic, and had no history of TB exposure. According to clinical and imaging findings, 64% and 60% patients were misdiagnosed as having tumors, respectively. A total of 43 lesions were identified. Thirty-eight (88.4%) lesions involved the superficial lobe. Fourteen (56%) cases had multiple lesions. There were four types of changes in the parotid fascia: local thickening (40%, n=10); local rupture with thickened adjacent skin (28%, n=7); focal bulge (20%, n=5); and no changes (12%, n=3). Cervical lymphadenopathy was seen in 14 out of 25 cases (56%). The lesions were contrast-enhanced in four patterns on CT images: homogeneous enhancement (37.1%, n=13), irregular cyst-like enhancement (37.1%, n=13), thick-walled ring enhancement (14.2%, n=5), and garland-like enhancement (11.4%, n=4). On MRI, the signal intensity of lesions was isointense on T1-weighted image, hyperintense on T2-weighted image, markedly hyperintense on diffusion-weighted imaging, and low on the apparent diffusion coefficient map. The surrounding parotid parenchymal edema was identified clearly on coronal MR images. Conclusion TB of the parotid nodes tend to simulate tumors clinically and radiologically. Their preferential sites are the superficial lobe. In young patients with positive purified protein derivative skin test and lesions accompanied by cervical lymphadenopathy, changes in the parotid fascia and parotid parenchymal edema adjacent to the lesions on CT and MRI may be helpful in the diagnosis and to facilitate differential diagnosis.
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Affiliation(s)
- Dan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China, .,Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Xiaojiao Li
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Hua Xiong
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Chao Yang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China,
| | - Xianlong Huang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Qi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China,
| | - Zhuoyue Tang
- Department of Radiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China, .,Molecular and Functional Imaging Laboratory, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 400014, China,
| | - Tianyou Luo
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China,
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Townsend KL, Milovancev M, Bracha S. Feasibility of near-infrared fluorescence imaging for sentinel lymph node evaluation of the oral cavity in healthy dogs. Am J Vet Res 2018; 79:995-1000. [DOI: 10.2460/ajvr.79.9.995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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11
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Kashiwagi N, Murakami T, Toguchi M, Nakanishi K, Hidaka S, Fukui H, Kimura M, Kitano M, Tomiyama N. Metastases to the parotid nodes: CT and MR imaging findings. Dentomaxillofac Radiol 2016; 45:20160201. [PMID: 27635667 DOI: 10.1259/dmfr.20160201] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To present and characterize CT and MR imaging findings of metastases to the parotid nodes. METHODS CT (n = 10) and MR (n = 11) images from 14 patients with metastases to the parotid nodes were reviewed. The primary tumour sites were the ocular adnexa in five patients, facial skin in four patients, upper aerodigestive tract in four patients and thyroid gland in one patient. CT and MR images were evaluated with emphasis on the size and number of parotid tumours, their location in the parotid gland, the presence of associated clinically pathological cervical nodes or previous history of cervical node metastasis, margin characteristics and the presence of central necrosis. RESULTS A total of 18 tumours were identified in 14 patients, with an average maximal cross-sectional diameter of 19 mm (7-44 mm). 12 patients had a single parotid tumour and 2 patients had unilateral multiple tumours; 12 tumours in 10 patients were located in the parotid tail, 6 tumours in 4 patients were located in the superficial lobe and no tumour was noted in the deep lobe. In the superficial lobe, four of six tumours were located in the pretragal area. Three of nine patients whose primary sites were the ocular adnexa or skin had associated clinically pathological cervical nodes. None of these patients had a previous history of cervical node metastasis. All five patients with other primary sites had associated pathological cervical nodes or a history of such. 11 tumours had well-defined margins and 7 tumours had ill-defined margins. Post-contrast images showed central necrosis in 2 of 11 tumours. CONCLUSIONS Metastases to the parotid nodes tend to present as solitary parotid masses with two preferential sites.
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Affiliation(s)
- Nobuo Kashiwagi
- 1 Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takamichi Murakami
- 1 Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masafumi Toguchi
- 2 Department of Radiology, Ryukyus University Faculty of Medicine, Okinawa, Japan
| | - Katsuyuki Nakanishi
- 3 Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Shojiro Hidaka
- 1 Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hideyuki Fukui
- 1 Department of Radiology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masatomo Kimura
- 4 Department of Pathology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Mutsukazu Kitano
- 5 Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Noriyuki Tomiyama
- 6 Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka, Japan
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Role of SPECT-CT in sentinel lymph node biopsy in patients diagnosed with head and neck melanoma. Rev Esp Med Nucl Imagen Mol 2016. [DOI: 10.1016/j.remnie.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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López-Rodríguez E, García-Gómez FJ, Álvarez-Pérez RM, Martínez-Castillo R, Borrego-Dorado I, Fernández-Ortega P, Zulueta-Dorado T. Role of SPECT-CT in sentinel lymph node biopsy in patients diagnosed with head and neck melanoma. Rev Esp Med Nucl Imagen Mol 2015; 35:22-8. [PMID: 26150109 DOI: 10.1016/j.remn.2015.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 05/21/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Assess the role of SPECT-CT in sentinel lymph node (SLN) biopsy in the accurate anatomical location of the SNL in patients with cutaneous head and neck melanoma. MATERIAL AND METHODS A retrospective study was conducted from February 2010 to June 2013 on 22 consecutive patients with a diagnosis of cutaneous head and neck melanoma (9 female, 13 male), with a mean age of 55 years old and who met the inclusion criteria for SLN biopsy. Patients underwent preoperative scanning after peri-scar injection of (99m)Tc-labeled-nanocolloid. Planar images of the injection-site, whole-body, and SPECT-CT scanning were acquired. RESULTS Detection rate of SLN reached up to 91% (20/22 patients) by planar lymphoscintigraphy and 95.4% (21/22 patients) by SPECT-CT. SPECT-CT provided an accurate location of SLN in 14/22 patients, enabling to improve the surgical approach (clinical impact: 63.6%). SLN was positive for metastatic cells in 9.1% patients. CONCLUSION SPECT-CT provides detailed anatomical SLN location and allows detecting a higher number of SLN than planar lymphoscintigraphy. Routine use of SPECT-CT is recommended in order to optimise the SLN detection and location in patients with head and neck melanoma.
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Affiliation(s)
- E López-Rodríguez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - F J García-Gómez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R M Álvarez-Pérez
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - R Martínez-Castillo
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - I Borrego-Dorado
- Servicio de Medicina Nuclear, Unidad de Diagnóstico por la Imagen, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P Fernández-Ortega
- Servicio de Cirugía Plástica General, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - T Zulueta-Dorado
- Servicio de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, España
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Green K, Boston SE. Bilateral removal of the mandibular and medial retropharyngeal lymph nodes through a single ventral midline incision for staging of head and neck cancers in dogs: a description of surgical technique. Vet Comp Oncol 2015; 15:208-214. [DOI: 10.1111/vco.12154] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/13/2015] [Accepted: 04/14/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K. Green
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL USA
| | - S. E. Boston
- Department of Small Animal Clinical Sciences; College of Veterinary Medicine, University of Florida; Gainesville FL USA
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Boston SE, Lu X, Culp WTN, Montinaro V, Romanelli G, Dudley RM, Liptak JM, Mestrinho LA, Buracco P. Efficacy of systemic adjuvant therapies administered to dogs after excision of oral malignant melanomas: 151 cases (2001-2012). J Am Vet Med Assoc 2015; 245:401-7. [PMID: 25075823 DOI: 10.2460/javma.245.4.401] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine prognostic factors for and compare outcome among dogs with oral malignant melanoma following excision with or without various systemic adjuvant therapies. DESIGN Retrospective case series. ANIMALS 151 dogs with naturally occurring oral malignant melanomas treated by excision with or without adjuvant therapies from 2001 to 2012. PROCEDURES Case accrual was solicited from Veterinary Society of Surgical Oncology members via an email list service. Information collected from case records included signalment, tumor staging, tumor characteristics, type of surgical excision, histologic diagnosis, adjuvant therapy, and survival time. RESULTS The overall median survival time was 346 days. Results of multivariate analysis indicated that tumor size, patient age, and intralesional excision (vs marginal, wide, or radical excision) were considered poor prognostic indicators. All other demographic and clinical variables were not significantly associated with survival time after adjusting for the aforementioned 3 variables. A clear survival benefit was not evident with any systemic adjuvant therapy, including vaccination against melanoma or chemotherapy; however, the number of dogs in each treatment group was small. Ninety-eight dogs received no postoperative adjuvant therapy, and there was no difference in survival time between dogs that did (335 days) and did not (352 days) receive systemic adjuvant therapy. CONCLUSIONS AND CLINICAL RELEVANCE For dogs with oral malignant melanoma, increasing tumor size and age were negative prognostic factors. Complete excision of all macroscopic tumor burden improved survival time. Long-term survival was possible following surgery alone. Although systemic adjuvant therapy was not found to improve survival time, this could have been due to type II error.
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Affiliation(s)
- Sarah E Boston
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608
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Lagier A, Pénicaud M, Le Corroller T, Guenoun D, Cammilleri S, Champsaur P, Dessi P, Grob JJ, Giovanni A, Fakhry N. [Lymphatic drainage of skin areas of head and neck: in vivo approach by the location of the sentinel node]. Morphologie 2014; 98:32-9. [PMID: 24637042 DOI: 10.1016/j.morpho.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 01/01/2014] [Accepted: 01/07/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of the study was to determine the preferential territories of drainage of skin areas of the face and neck. This knowledge can guide the strategies of diagnostic (search for primary tumor skin to cervical lymphadenopathy) and treatment (determination of the extent of neck dissection to achieve in case of skin tumor). MATERIALS AND METHODS This is a retrospective study of the surgical procedures of sentinel node research between January 2003 and April 2011. The lymphoscintigraphic and intraoperative localization of the initial tumor site and sentinel lymph node were collected. RESULTS AND DISCUSSION One hundred and thirty-seven patients were included in the study. The parotid gland is a privileged territory of drainage of the head and neck skin. At cervical level, the submental region drains the lower and median part of the face (lips and chin). The posterior segments (IIb and V sector) were represented for the posterior locations of the head (ear, vertex), and cervical region.
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Affiliation(s)
- A Lagier
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France; Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
| | - M Pénicaud
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - T Le Corroller
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - D Guenoun
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - S Cammilleri
- Service de médecine nucléaire, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - P Champsaur
- Laboratoire d'anatomie, faculté de médecine de Marseille, Aix-Marseille université, 27, boulevard Jean-Moulin, 13385 Marseille cedex 05, France
| | - P Dessi
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - J J Grob
- Service de dermatologie et cancérologie cutanée, CHU Timone Adultes, 264, rue Saint-Pierre, 13885 Marseille cedex 05, France
| | - A Giovanni
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
| | - N Fakhry
- Service d'ORL et chirurgie cervico-faciale, CHU Timone Adultes, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France
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Ettl T, Irga S, Müller S, Rohrmeier C, Reichert TE, Schreml S, Gosau M. Value of anatomic site, histology and clinicopathological parameters for prediction of lymph node metastasis and overall survival in head and neck melanomas. J Craniomaxillofac Surg 2013; 42:e252-8. [PMID: 24216129 DOI: 10.1016/j.jcms.2013.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 07/02/2013] [Accepted: 09/13/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Head and neck melanoma compromises a group of aggressive tumours with varying clinical courses. This analysis was performed to find anatomic and clinicopathological parameters predictive for lymph node metastasis and overall survival. MATERIAL AND METHODS Data and outcome of 246 patients with a malignant melanoma in the head and neck region were retrospectively analyzed for predictive parameters. RESULTS Lentigo maligna melanoma (n = 115) was the most frequent histology, followed by superficial spreading (n = 63) and nodular melanoma (n = 52). More than half of the melanomas (n = 138) were in the face. Tumours of the face and anterior scalp metastasized to lymph nodes of the neck and parotid gland, whereas tumours of the posterior scalp and neck also metastasized to the nuchal region. Advanced Clark level, presence of tumour ulceration and younger age were the strongest predictors of lymph node metastasis in multivariate regression analysis (p < 0.05), but anatomic site, histological subtype and tumour thickness were also associated with lymph node metastasis. Lymph node metastases, distant metastases, ulceration, nodular subtype and non-facial site of origin were the strongest negative prognostic parameters for disease-specific overall survival (p < 0.05). In contrast, the width of resection margin (<1 cm vs. 1-2 cm vs. >2 cm) did not correlate with tumour recurrence and overall survival (p > 0.05). CONCLUSION Histological subtype diagnosis, anatomic site of origin as well as the established factors tumour thickness, ulceration and depth of invasion are prognostic indicators of cervical lymph node metastasis and overall survival. A resection margin of at least 1 cm seems sufficient in head and neck melanoma. The status of sentinel lymph node biopsy and neck dissection has to be proven within the next years.
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Affiliation(s)
- Tobias Ettl
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
| | - Serkan Irga
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Steffen Müller
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Christian Rohrmeier
- Department of Otorhinolaryngology (Chair: Prof. J. Strutz, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Torsten E Reichert
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Stephan Schreml
- Department of Dermatology (Chair: Prof. M. Landthaler, MD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery (Chair: Prof. T.E. Reichert, MD, DMD, PhD), University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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