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Feinmesser G, Yogev D, Goldberg T, Parmet Y, Illouz S, Vazgovsky O, Eshet Y, Tejman-Yarden S, Alon E. Virtual reality-based training and pre-operative planning for head and neck sentinel lymph node biopsy. Am J Otolaryngol 2023; 44:103976. [PMID: 37480684 DOI: 10.1016/j.amjoto.2023.103976] [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: 05/24/2023] [Accepted: 07/04/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE Sentinel lymph node biopsy (SLNB) is crucial for managing head and neck skin cancer. However, variable lymphatic drainage can complicate SLN detection when using Single-Photon Emission Computed Tomography (SPECT) or lymphoscintigraphy. Virtual Reality (VR) can contribute to pre-operative planning by simulating a realistic 3D model, which improves orientation. VR can also facilitate real-patient training outside the operating room. This study explored using a VR platform for pre-operative planning in head and neck skin cancer patients undergoing SLNBs and assessed its value for residential training. MATERIALS AND METHODS In this prospective technology pilot study, attending surgeons and residents who performed 21 SLNB operations on patients with head and neck skin cancers (81% males, mean age 69.2 ± 11.3) used a VR simulation model based on each patient's pre-operative SPECT scan to examine patient-specific anatomy. After surgery, they completed a questionnaire on the efficiency of the VR simulation as a pre-operative planning tool and training device for residents. RESULTS The attending surgeons rated the VR model's accuracy at 8.3 ± 1.6 out of 10. Three-quarters (76%) of residents reported increased confidence after using VR. The physicians rated the platform's contribution to residents' training at 7.4 ± 2.1 to 8.9 ± 1.3 out of 10. CONCLUSION A VR SLNB simulation can accurately portray marked sentinel lymph nodes. It was rated high as a surgical planning and teaching tool among attending surgeons and residents alike and may play a role in pre-operative planning and resident training. Further studies are needed to explore its applications in practice.
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Affiliation(s)
- Gilad Feinmesser
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - David Yogev
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Arrow Project, Sheba Medical Center, Ramat Gan, Israel; Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel.
| | - Tomer Goldberg
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben Gurion University, Beer Sheva, Israel
| | - Shay Illouz
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Oliana Vazgovsky
- The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Eshet
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel
| | - Shai Tejman-Yarden
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; The Engineering Medical Research Lab, Sheba Medical Center, Ramat Gan, Israel
| | - Eran Alon
- School of Medicine, Tel Aviv University, Tel Aviv, Israel; Sheba Arrow Project, Sheba Medical Center, Ramat Gan, Israel; Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
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Pallara T, Annovazzi A, Cristiani R, Vinci F, Bertozzi E, Bonadies A, Romani C, Tedesco M, Bellei B, Papaccio F, Caputo S, Cota C, Sperduti I, Govoni FA, Morrone A, Migliano E. Nonvisualized sentinel node on preoperative lymphoscintigraphy in primary cutaneous melanoma: an 11-year retrospective survey. Nucl Med Commun 2023; 44:345-350. [PMID: 36826418 DOI: 10.1097/mnm.0000000000001671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
BACKGROUND Sentinel lymph node (SLN) biopsy in cutaneous melanoma patients evaluates the regional draining basin for occult micrometastatic disease. Occasionally, nonidentification of SLN impairs the acquisition of this important prognostic factor. OBJECTIVES To investigate the outcomes of melanoma patients with negative lymphoscintigraphic findings and patients who underwent SLN biopsy from 2004 to 2015 ( n = 1200) were retrospectively reviewed for tumor characteristics and clinical outcomes. METHODS Patients with nonvisualized lymph nodes (NV group) who underwent only preoperative lymphoscintigraphy were separated and compared with a cohort drawn from all melanoma patients who completed the surgical procedure within the same period (V group). RESULTS A negative lymphoscintigraphic scan was observed in 38 cases (3.2% of all patients). The NV group showed a significantly older age (median 66.0 vs. 48.3 years; P < 0.0001). Head and neck melanomas were more frequent in the NV group compared to the control group (25.1 vs. 7.8%; P = 0.009). Tumor characteristics such as ulceration and Breslow thickness do not influence the lymphoscintigraphy result. No differences were found in overall survival (OS) and disease-free survival (DFS) between the groups. CONCLUSIONS The nonvisualization of regional lymph nodes by lymphoscintigraphy is more frequent in older patients with head and neck melanomas. From the clinical point of view, no specific recommendation emerged for patients' management because the nonvisualization of the SLN did not show a significant influence on DFS and OS rates. However, lack of knowledge of lymph node status suggests performing a tighter follow-up eventually by ultrasound evaluation of all potential lymph node drainage basins.
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Affiliation(s)
- Tiziano Pallara
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
| | | | - Renzo Cristiani
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
| | - Federica Vinci
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
| | - Ettore Bertozzi
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
| | - Antonio Bonadies
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
| | - Claudia Romani
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
| | - Marinella Tedesco
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
| | - Barbara Bellei
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute IRCCS
| | - Federica Papaccio
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute IRCCS
| | - Silvia Caputo
- Laboratory of Cutaneous Physiopathology and Integrated Center of Metabolomics Research, San Gallicano Dermatological Institute IRCCS
| | - Carlo Cota
- Genetic Research, Molecular Biology and Dermatopathology Unit, San Gallicano Dermatological Institute IRCCS
| | - Isabella Sperduti
- Biostatistical Unit - Clinical Trials Center Regina Elena National Cancer Institute
| | | | - Aldo Morrone
- Scientific Director, San Gallicano Dermatological Institute IRCCS, Rome, Italy
| | - Emilia Migliano
- Department of Plastic and Reconstructive Surgery, San Gallicano Dermatological Institute IRCCS
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Hirshoren N, abd el Qadir N, Weinberger JM, Eliashar R, Ben‐Haim S. Sentinel Lymph Node Identification in Cutaneous Head & Neck Cancer - Lymphoscintigraphy Late Phase. Laryngoscope 2022; 132:2164-2168. [PMID: 35199860 PMCID: PMC9790693 DOI: 10.1002/lary.30076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/06/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Sentinel node (SN) biopsy following lymphoscintography is recommended for high-risk cutaneous malignancies. Herein, we investigate different lymphoscintography phases, focusing on the importance of the late static phase and the resultant discovery of distal echelon solitary positive sentinel nodes that would otherwise have been overlooked. METHODS In this retrospective cohort study, conducted in a tertiary referral medical center, we assessed SN localization and time from tracer injection to SN identification on lymphoscintigraphy. Findings on scan were compared with SN found in the surgical field, and with the final pathological investigation. RESULTS Seventy-three patients, undergoing SN biopsy for head and neck skin malignancies, were investigated. Most patients were male (n = 50). The average age was 65.7 (±15.7) years and the average follow-up time was 29.1 (±22.4) months. Overall, 101 SNs were histologically investigated, demonstrating 7 positive SN. Eleven patients (15%) benefited from the late lymphoscintigraphy phase. In four studies, an SN was identified only in the late static phase, one of which was positive for the disease. In seven patients, SN was identified in the early phase with additional, different, SN on the late phase, one of which was positive for the disease. Comparing the yield (positive SNs) of early versus late phases, demonstrated the same importance (p = 0.275). CONCLUSIONS The late lymphoscintigraphy phase has a crucial role in high-risk HN cutaneous cancer. LEVEL OF EVIDENCE 3 Laryngoscope, 132:2164-2168, 2022.
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Affiliation(s)
- Nir Hirshoren
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Narmeen abd el Qadir
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Jeffrey M. Weinberger
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Ron Eliashar
- Department of Otolaryngology / Head & Neck SurgeryHadassah Medical CenterJerusalemIsrael
| | - Simona Ben‐Haim
- Department of Biophysics and Nuclear MedicineHadassah Medical Center and Hebrew UniversityJerusalemIsrael,Institute of Nuclear MedicineUniversity College London and UCL Hospitals, NHS TrustLondonUK
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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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Abstract
OBJECTIVE. This article reviews thoracic lymphatic pathways and tributaries, discusses lymphatic anatomic variants and their clinical implications, and emphasizes common patterns of thoracic lymphadenopathy from extrapulmonary malignancies. CONCLUSION. Recognition of common patterns and pathways of thoracic lymphatic drainage can help identify the site of tumor origin and allow a more focused examination of disease extent, both of which are important for disease prognosis and management.
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6
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Montero-Vilchez T, Martinez-Lopez A, Salvador-Rodriguez L, Arias-Santiago S. RF-Sentinel Lymph Node Biopsy in Head and Neck Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2019.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Montero-Vilchez T, Martinez-Lopez A, Salvador-Rodriguez L, Arias-Santiago S. RF-Sentinel Lymph Node Biopsy in Head and Neck Melanoma. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:870-871. [PMID: 32888928 DOI: 10.1016/j.ad.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- T Montero-Vilchez
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España.
| | - A Martinez-Lopez
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - L Salvador-Rodriguez
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - S Arias-Santiago
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
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Wilkie MD, Chudek DA, Flynn CD, Gaskell P, Loh C, Tandon S, Roland NJ, Jones TM, Lancaster J. Outcomes and prognosticators in regionally recurrent cutaneous squamous cell carcinoma of the head and neck. Eur J Surg Oncol 2020; 46:2035-2041. [PMID: 32800595 DOI: 10.1016/j.ejso.2020.07.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/27/2020] [Accepted: 07/27/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Data regarding regionally metastatic cutaneous squamous cell carcinoma of the head and neck (cSCCHN) is limited and derived almost exclusively from Australian and United States (US) institutions. We report the first United Kingdom perspective, with the aims of benchmarking survival outcomes and identifying clinically relevant prognosticators. MATERIALS AND METHODS Ninety-one patients with regionally recurrent cSCCHN treated with curative intent over a ten-year period (2009-2018) were studied retrospectively. Time-to-event analyses were used to estimate oncological outcomes, and log-rank statistics and Cox proportional hazards models used to examine potential prognosticators. Receiver operating characteristics were also used to analyse the influence of nodal disease burden. RESULTS Parotid involvement (with or without neck involvement) was most common (79.2%), and time to recurrence in those with parotid disease alone significantly shorter than for any other disease distribution (p = 0.034). Respective five-year overall, disease-specific, and disease-free survival estimates were 43.8%, 63.8%, and 36.2%. Extracapsular spread (ECS) portended reduced DFS and DSS (p = 0.012 and p = 0.005 respectively). Increasing nodal burden (≥4 involved nodes) also reduced DSS (p = 0.020), while parotid disease alone predicted more favourable DSS (p = 0.008). ECS and isolated parotid involvement remained significant on multi-variate analysis (p = 0.014 and p = 0.028 respectively). CONCLUSIONS Oncological outcomes were unfavourable but broadly consistent with previous reports, notionally lending support to a more proactive approach in managing the clinically node negative neck/parotid in selected high-risk cases. Our data also support distinct parotid classification and consideration of involved lymph node number in future staging systems.
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Affiliation(s)
- Mark D Wilkie
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK.
| | - Dorota A Chudek
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Christian D Flynn
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Peter Gaskell
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Christopher Loh
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Sankalap Tandon
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Nicholas J Roland
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Terence M Jones
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL, UK
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9
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Carmichael H, King BBT, Friedman C, Torphy RJ, Medina T, Gleisner A, McCarter MD, Kwak JJ, Kounalakis N. Frequency and implications of occipital and posterior auricular sentinel lymph nodes in scalp melanoma. J Surg Oncol 2019; 120:1470-1475. [PMID: 31614003 DOI: 10.1002/jso.25715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/17/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with scalp melanoma have poor oncologic outcomes compared with those with other cutaneous sites. Sentinel lymph node (SLN) biopsy provides prognostic information but is challenging in the head and neck. We explore the anatomic distribution of scalp melanoma and describe the most common sites of SLN drainage and of SLN metastatic disease. METHODS Retrospective review of scalp melanoma patients who underwent SLN biopsy. Melanoma location was classified as frontal, coronal apex, coronal temporal, or posterior scalp. SLN location was classified by lymph node level and region. RESULTS We identified 128 patients with scalp melanoma. The most common primary tumor location was the posterior scalp (43%) and the most frequent SLN drainage site was the level 2 lymph node basin (48%). Total 31 patients (24%) had metastatic disease in an SLN. Scalp SLNs, classified as being in the posterior auricular or occipital region, were localized in 26% of patients. For patients in which a scalp SLN was identified, 30% had a positive scalp SLN (n = 10). CONCLUSIONS Scalp SLNs are frequent drainage sites for scalp melanoma and, when found, have a 30% chance of harboring metastatic disease. Surgeons, radiologists, and pathologists should be vigilant in identifying, removing, and analyzing scalp SLNs.
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Affiliation(s)
| | - Becky B T King
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Chloe Friedman
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Robert J Torphy
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Theresa Medina
- Division of Medical Oncology, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Ana Gleisner
- Department of Surgery, University of Colorado, Aurora, Colorado
| | | | - Jennifer J Kwak
- Department of Radiology-Nuclear Medicine, University of Colorado, Aurora, Colorado
| | - Nicole Kounalakis
- Melanoma and Sarcoma Specialists of Georgia, Northside Hospital, Atlanta, Georgia
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10
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Howard MD, Wee E, Wolfe R, McLean CA, Kelly JW, Pan Y. Anatomic location of primary melanoma: Survival differences and sun exposure. J Am Acad Dermatol 2019; 81:500-509. [DOI: 10.1016/j.jaad.2019.04.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/03/2019] [Accepted: 04/14/2019] [Indexed: 10/27/2022]
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11
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May MM, Lohse CM, Moore EJ, Price DL, Van Abel KM, Brewer JD, Janus JR. Wide local excision prior to sentinel lymph node biopsy for primary melanoma of the head and neck. Int J Dermatol 2019; 58:1184-1190. [DOI: 10.1111/ijd.14435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/03/2018] [Accepted: 02/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Matthew M. May
- Department of Otorhinolaryngology‐Head and Neck Surgery Mayo Clinic School of Medicine Rochester MN USA
| | - Christine M. Lohse
- Department of Health Sciences Research Mayo Clinic School of Medicine Rochester MN USA
| | - Eric J. Moore
- Department of Otorhinolaryngology‐Head and Neck Surgery Mayo Clinic School of Medicine Rochester MN USA
| | - Daniel L. Price
- Department of Otorhinolaryngology‐Head and Neck Surgery Mayo Clinic School of Medicine Rochester MN USA
| | - Kathryn M. Van Abel
- Department of Otorhinolaryngology‐Head and Neck Surgery Mayo Clinic School of Medicine Rochester MN USA
| | - Jerry D. Brewer
- Department of Dermatology Mayo Clinic School of Medicine Rochester MN USA
| | - Jeffrey R. Janus
- Department of Otorhinolaryngology‐Head and Neck Surgery Mayo Clinic School of Medicine Rochester MN USA
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12
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King BBT, Chapman BC, Gleisner A, Stewart C, Friedman C, Kwak JJ, McCarter MD, Kounalakis N. Postbiopsy Pigmentation is Prognostic in Head and Neck Melanoma. Ann Surg Oncol 2019; 26:1046-1054. [PMID: 30706226 DOI: 10.1245/s10434-019-07185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess postbiopsy pigmentation (PBP) as a prognostic feature in patients with cutaneous head and neck (H&N) melanoma. METHODS Retrospective review of patients undergoing sentinel lymph node biopsy (SLNB) for H&N melanoma (1998-2018). PBP was defined as visible remaining pigment at the scar or biopsy site that was documented on physical exam by both a medical oncologist and a surgeon at initial consultation. Variables associated with disease-free survival (DFS) and overall survival (OS) were analyzed using multivariable Cox proportional hazards models. RESULTS Among 300 patients, 34.3% (n = 103) had PBP and 44.7% (n = 134) had microscopic residual disease on final pathology after wide local excision. Prognostic factors associated with DFS included advanced age, tumor depth, ulceration, PBP, and positive SLNB (p < 0.05). Patients with PBP fared worse than their counterparts without PBP in 5-year DFS [44.1% (31.1-56.3%) vs. 73.0% (64.1-80.0%); p < 0.001] and 5-year OS [65.0% (50.0-76.6%) vs. 83.6% (75.7-89.2%); p = 0.005]. After multivariable adjustment, PBP remained associated with shorter DFS [hazard ratio (HR) 1.72, 95% confidence interval (CI) 1.01-2.93; p = 0.047], but was not prognostic of OS. CONCLUSIONS In patients with H&N melanoma, PBP is associated with significantly shorter DFS. Patients with PBP may warrant greater consideration for SLNB and closer postoperative surveillance.
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Affiliation(s)
- Becky B T King
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandon C Chapman
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ana Gleisner
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Camille Stewart
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Chloe Friedman
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer J Kwak
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Martin D McCarter
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Kounalakis
- Department of Surgery, Gastrointestinal Tumor and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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13
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Sibley R, Subramaniam RM. SPECT/CT: Looking Beyond Sentinel Lymph Node Identification for Improving Patient Outcomes. Ann Surg Oncol 2017; 25:1467-1468. [PMID: 29218428 DOI: 10.1245/s10434-017-6301-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Robert Sibley
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rathan M Subramaniam
- Division of Nuclear Medicine, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Harold Simmons Comprehensive Cancer Center, University of Texax Southwestern Medical Center, Dallas, TX, USA.
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