Surgical management of primary and recurrent melanoma

Two-team-approached free flap reconstruction for plantar malignant melanoma: An observational (STROBE-compliant) trial

Reconstructive treatments of heel defects usually involve regional flap techniques such as medial plantar flap procedures due to the limited availability of adjacent soft tissues. Although free flaps have advantages in terms of function and aesthetics, they remain challenging due to the longer operation time required than for regional flaps. Thus, we introduce an appropriate 2-team surgical protocol to reconstruct plantar defects after wide excision of malignant melanoma using free flap coverage. From 2015 to 2020, a retrospective study was performed including 21 patients who underwent free flap surgeries to reconstruct defects due to plantar malignant melanoma. Lymphoscintigraphy was performed to localize sentinel lymph nodes, and the procedure was carried out by 2 teams working together, a tumor-ablative team and a reconstructive team. The present study is adhered to the STROBE guidelines for cohort studies. The average operation time was 241.4 minutes and was not significantly different even in cases with inguinal dissection (P value: 0.641). All flaps survived after 2 cases of venous insufficiency and 1 case of hematoma were resolved by immediate revision surgery. The 2-team approach to surgically reconstruct heel defects after wide excision of malignant melanoma using free flap coverage offers favorable results and lower morbidity than regional flap approaches.

LINC0638 lncRNA is involved in the local recurrence of melanoma following surgical resection

Melanoma is a rare malignancy in China and the treatment outcomes are generally satisfactory. However, postoperative recurrence can be life-threatening. The current study aimed to investigate the involvement of long intergenic non-protein coding RNA 1638 (LINC01638) long non-coding RNA (lncRNA) in the recurrence of melanoma. Expression of LINC01638 lncRNA in skin biopsies and plasma of patients with melanoma, patients with benign skin lesions and healthy controls was detected by reverse transcription-quantitative polymerase chain reaction. Diagnostic values of LINC01638 lncRNA for melanoma were analyzed by receiver operating characteristic curve analysis. The association between LINC01638 lncRNA and clinicopathological data of patients with melanoma was analyzed by χ² test. All patients were followed up for five years to record recurrence. LINC01638 lncRNA expression vectors and shRNAs were transfected into human melanoma cell lines and the effects of LINC01638 lncRNA overexpression and knockdown on cell proliferation were analyzed by cell counting kit-8 assay. LINC01638 lncRNA was significantly upregulated in patients with melanoma compared with the other two groups of patients, and upregulation of LINC01638 lncRNA distinguished patients with melanoma from patients with benign skin lesions and healthy controls. LINC01638 lncRNA expression was significantly associated with tumor size but not with other patient clinical data. Plasma levels of LINC01638 lncRNA were further increased during follow-up in patients with local recurrence but not in patients without recurrence. LINC01638 lncRNA overexpression promoted, while knockdown inhibited proliferation of cells of melanoma cell lines, C32 and SK-MEL-28, in vitro. The upregulation of LINC01638 lncRNA was likely associated with the local recurrence of melanoma following surgical resection.

Single-stage excision and sentinel lymph node biopsy in cutaneous melanoma in selected patients: a retrospective case-control study

Sometimes, diagnostic excision of a primary melanoma would already necessitate skin grafting or transposition skin flaps, especially in areas with an esthetic or functional importance. The utility of sentinel lymph node biopsy (SLNB) after skin reconstruction is controversial. We carried out a single-institution retrospective case-control study. In patients with a wide primary lesion at high clinical-dermatoscopic suspicion for invasive melanoma in anatomical region in which a reconstruction with a skin graft or a flap is required, we proposed the performance of a confocal microscopy examination and an incisional biopsy of the primary lesion. If these diagnostic methodologies confirmed the suspicion of melanoma, lymphatic mapping was performed before the wide excision (WE) of the primary lesion, and WE and SLNB were performed during the same operative procedure. The database evaluation showed 496 patients who had undergone a previous complete local excision and a subsequent SLNB (two-stage group), whereas 61 patients underwent WE and SLNB during the same surgical time (one-stage group). Histological results of the excisional biopsy confirmed the diagnosis of melanoma in all patients of the one-stage group. The false-negative rate was lower in the one-stage group (5.5%) than in the two-stage group (16.7%). Patients of the two groups showed a similar recurrence-free and overall survival period even when corrected for clinic-demographical variables. The concomitant execution of SLNB and WE after confocal microscopy examination and incisional biopsy appears to be a safe and accurate procedure in patients with a wide primary melanoma that requires a skin flaps or a skin graft to cover the residual defect.

Penile melanoma: a 20-Year analysis of six patients at the National Cancer Institute of Peru, Lima

Melanoma of the urogenital tract is extremely rare, accounting for less than 0.1% of melanoma cases. The global literature currently describes only 220 cases of penile melanoma, most commonly located on the glans penis.

RESULTS

Penile melanoma accounts for 0.7% of penile cancers and 0.18% of melanoma cases. The average patient age for the six cases we reviewed was 44.5 years. Three of these cases (50%) involved ulceration, one case (16.7%) involved lymphovascular invasion, and three cases (50%) involved mitosis ≥ 1 mm² (0.38-4.7 mm). The average depth of invasion (Breslow) in the five cases that reported this measure was 2.1 mm (0.38-4.7 mm). Applying the American Joint Committee on Cancer tumour, node, metastases (AJCC TNM) staging system, one case was Tx (16.7%), two cases were T1 (33.3%), one case was T2 (16.7%), one case was T3 (16.7%), and one case was T4 (16.7%). Five cases (83.3%) involved wide local resection, and only one case involved partial penile amputation. Four cases (66.7%) involved primary bilateral inguinocrural lymphadenectomy, and only one of those four cases involved lymphatic metastatic disease. One case (16.7%) involved lymphatic recurrence at 12 months in a patient who survived 38 months. One case (16.7%) involved local recurrence at 13 months in a patient who has survived 53 months. Eighty per cent of these patients remain alive, with no evidence of disease after an average follow-up of 96.7 months.

CONCLUSION

Penile melanoma prognosis depends on the initial clinical stage of the disease. The risk of lymphatic involvement seems to be related to the same risk factors used to assess cutaneous melanoma. Clinicians can thus assess penile melanoma using the AJCC staging system. The use of sentinel lymph node biopsy to determine staging is also becoming more common and could replace prophylactic bilateral inguinal dissection.

University Hospital Waterford: 5-year experience of cutaneous melanoma

INTRODUCTION

The incidence of cutaneous melanoma (CM) continues to rise in Ireland. Despite significant advances in melanoma molecular therapy, surgery remains the mainstay of treatment for CM. The University Hospital Waterford (UHW) prospectively maintained CM registry was established in 2010.

AIM

To summarize 5-year experience (2010-2015) of primary CM presenting to UHW.

METHODS

Data were retrospectively obtained from a central electronic pathology and radiology repository augmented by HIPE data and theatre logs. Data collected included patient demographics and clinico-pathological characteristics, specimen number, size, anatomical location, melanoma subtype, Breslow thickness, Clark's level, ulceration, and mitosis.

RESULTS

592 CMs were managed in UHW during the study period. Overall, females comprised the majority of cases with mean age at presentation 60.78 ± 18.29 years. The most commonly affected anatomical location was the lower limb (26.7%) followed by the back (15.1%), upper limb (15.07%), and face (14.40%). Superficial spreading and lentigo maligna were the most common histological subtype accounting for 19.8 and 20%, respectively. Overall, the mean Breslow depth was 2.4 ± 3.7 mm with corresponding Clark's Level III. Sentinel lymph node positivity was 39/103 (37.89%) most commonly located in the axilla (53.8%) and groin (30.7%).

CONCLUSION

There has been a steady increase in the number of cutaneous melanoma presentations over the past 5-years to the South East Cancer Centre. Patients are managed best by prompt surgical excision and multidisciplinary management. Our results are in keeping with international standards and work continues in determining overall 5-year survival and recurrence rates.