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Paolino G, Pampena R, Di Ciaccio SM, Carugno A, Cantisani C, Di Nicola MR, Losco L, Bortone G, Mercuri SR, Costanzo A, Ardigò M, Valenti M. Thin Amelanotic and Hypomelanotic Melanoma: Clinicopathological and Dermoscopic Features. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1239. [PMID: 39202520 PMCID: PMC11356094 DOI: 10.3390/medicina60081239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Amelanotic/hypomelanotic melanomas (AHMs) account for 2-8% of all cutaneous melanomas. Due to their clinical appearance and the lack of specific dermoscopic indicators, AHMs are challenging to diagnose, particularly in thinner cutaneous lesions. The aim of our study was to evaluate the clinicopathological and dermoscopic features of thin AHMs. Identifying the baseline clinical-pathological features and dermoscopic aspects of thin AHMs is crucial to better understand this entity. Materials and Methods: We divided the AHM cohort into two groups based on Breslow thickness: thin (≤1.00 mm) and thick (>1.00 mm). This stratification helped identify any significant clinicopathological differences between the groups. For dermoscopic analysis, we employed the "pattern analysis" approach, which involves a simultaneous and subjective assessment of different criteria. Results: Out of the 2.800 melanomas analyzed for Breslow thickness, 153 were identified as AHMs. Among these, 65 patients presented with thin AHMs and 88 with thick AHMs. Red hair color and phototype II were more prevalent in patients with thin AHMs. The trunk was the most common anatomic site for thin AHMs. Patients with thin AHMs showed a higher number of multiple melanomas. Dermoscopic analysis revealed no significant difference between thin AHMs and thick AHMs, except for a more frequent occurrence of residual reticulum in thin AHMs. Conclusions: Thin AHMs typically affect individuals with lower phototypes and red hair color. These aspects can be related to the higher presence of pheomelanin, which provides limited protection against sun damage. This also correlates with the fact that the trunk, a site commonly exposed to intermittent sun exposure, is the primary anatomical location for thin AHMs. Multiple primary melanomas are more common in patients with thin AHMs, likely due to an intrinsic predisposition as well as greater periodic dermatologic follow-ups in this class of patients. Apart from the presence of residual reticulum, no other significant dermoscopic differences were observed, complicating the differential diagnosis between thin and thick AHMs based on dermoscopy alone.
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Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.P.); (S.R.M.)
| | - Riccardo Pampena
- La Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (S.M.D.C.)
| | | | - Andrea Carugno
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Carmen Cantisani
- Dermatologic Clinic, La Sapienza University of Rome, 00185 Rome, Italy; (C.C.); (G.B.)
| | - Matteo Riccardo Di Nicola
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.P.); (S.R.M.)
| | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy;
| | - Giulio Bortone
- Dermatologic Clinic, La Sapienza University of Rome, 00185 Rome, Italy; (C.C.); (G.B.)
| | - Santo Raffaele Mercuri
- Unit of Dermatology and Cosmetology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.P.); (S.R.M.)
- UniSr Vita-Salute San Raffaele University, 20132 Milano, Italy
| | - Antonio Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.C.); (M.A.); (M.V.)
| | - Marco Ardigò
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.C.); (M.A.); (M.V.)
| | - Mario Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.C.); (M.A.); (M.V.)
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Kim JY, Lee SY, Kwak Y, Kim BJ. Thickness of melanocytes in giant congenital melanocytic nevus for complete surgical excision: clinicopathological evaluation of 117 lesions according to the area and size. BMC Surg 2024; 24:90. [PMID: 38491443 PMCID: PMC10941407 DOI: 10.1186/s12893-024-02362-x] [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: 09/27/2023] [Accepted: 02/17/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Giant congenital melanocytic nevi (GCMN) are usually defined as nevi that exceed 20 cm in maximal diameter or 15% of the total body surface area. There have been reports of life-long malignant change risks arising from GCMN, leading to surgical excision of GCMN. This study aims to evaluate the thickness of melanocytes based on clinical factors in order to provide objective information for the complete resection of the lesion. METHODS Overall, 75 patients diagnosed with GCMN between 2000 and 2021 were included, and their clinical records were collected retrospectively. 117 pathologic slides obtained during excision were reviewed to measure nevus thickness. Clinical factors were assessed with a generalized estimated equation model for association with nevus thickness. RESULTS The thickness of nevus was significantly associated with the location and size. Nevus thickness was more superficial in the distal extremity than in the head and trunk (P = 0.003 [head]; P < 0.001 [trunk]; P = 0.091 [Proximal extremity]). Nevi sized 60 cm or more were significantly deeper than those measuring 20-29.9 cm (P = 0.035). An interaction between size and location existed (P < 0.001). Trunk and distal extremity lesions consistently exhibited uniform thickness regardless of lesion size, whereas head and proximal extremity lesions showed variations in thickness based on lesion size. CONCLUSION GCMNs have differences in thickness according to location and size. Therefore, it is necessary to devise an approach optimized for each patient to treat GCMN. In the study, it was emphasized that the thickness of GCMN is correlated with clinical factors, specifically the location and size of the nevus. Consequently, these findings underscore the need for individualized treatment plans for effective surgical intervention.
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Affiliation(s)
- Ji-Young Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Se Yeon Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Jun Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Russo R, Pentangelo P, Ceccaroni A, Losco L, Alfano C. Lower Lip Reconstruction after Skin Cancer Excision: A Tailored Algorithm for Elderly Patients. J Clin Med 2024; 13:554. [PMID: 38256687 PMCID: PMC10816608 DOI: 10.3390/jcm13020554] [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: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Lower lip reconstruction is crucial to restore oral integrity post-cancer excision. A perfect balance between form and function should be achieved. With an aging demographic, adapting surgical methods to meet the unique needs of the elderly becomes imperative. Our study aims to introduce a specialized algorithm for lower lip reconstruction; it was tailored to geriatric patients and emphasized the use of "simpler flaps". Additionally, "Pearls and Pitfalls" were provided for surgeons approaching lower lip reconstruction. METHODS Between January 2018 and June 2021, a retrospective study was carried out. Data collection included patient demographics, defect attributes, reconstructive approaches, flap viability assessment, wound healing, and complications. The follow-up was carried out for a period of a minimum of 6 months. RESULTS Among 78 patients, squamous cell carcinoma predominated with a mean defect area of 3308 cm2. Postoperative complications were recorded in two patients. All patients reported sensory restoration and overall satisfaction at the 6-month follow-up; secondary procedures were not necessary. CONCLUSION Our reconstructive algorithm, focused on elderly patients, prioritizes less invasive reconstructive techniques and introduces innovative modifications to the established methods to achieve both aesthetic and functional outcomes with a low complication rate. In patients undergoing lower lip reconstruction, the subjective microstomia was found to be less relevant than the objective microstomia.
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Affiliation(s)
| | | | | | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy; (R.R.); (P.P.); (A.C.); (C.A.)
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Diluiso G, Pozzi M, Liso FG, Mendes VM, Hannouille J, Losco L, Bolletta A, Cigna E, Schettino M. Mind the Gap: A Questionnaire on the Distance between Diagnostic Advances and Clinical Practice in Skin Cancer Treatment. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:155. [PMID: 38256415 PMCID: PMC10819365 DOI: 10.3390/medicina60010155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Significant progress has been made in skin cancer diagnosis, with a surge in available technologies in recent years. Despite this, the practical application and integration of these technologies in dermatology and plastic surgery remain uneven. Materials and Methods: A comprehensive 20-question survey was designed and distributed using online survey administration software (Google Forms, 2018, Google, Mountain View, CA, USA) from June 2023 to September 2023. The survey aimed to assess the knowledge and utilization of dermatologic diagnostic advancements among plastic surgeons in various European countries. Results: Data were obtained from 29 plastic surgeons across nine European countries, revealing a notable gap between diagnostic technologies and their routine use in surgical practice. The gap for some technologies was both cognitive and applicative; for electrical impedance spectroscopy (EIS) and multispectral imaging, only 6.9% of the sample knew of the technologies and no surgeons in the sample used them. In the case of other technologies, such as high-frequency ultrasound (HFUS), 72.4% of the sample knew about them but only 34.5% used them, highlighting a more significant application problem. Conclusions: Spotlighting this discrepancy provides a valuable foundation for initiating collaborative efforts between units and facilitating knowledge exchange among diverse specialists. This, in turn, contributes to advancing clinical practice by integrating the innovative opportunities presented by ongoing research.
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Affiliation(s)
- Giuseppe Diluiso
- Unit of Plastic Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.D.); (M.P.)
| | - Mirco Pozzi
- Unit of Plastic Surgery, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy; (G.D.); (M.P.)
| | | | - Vanessa Marron Mendes
- Service de Chirurgie Plastique, Hôpital CHIREC (Braine L’Alleud-Waterloo, Belgium), 1420 Braine-L’Alleud, Belgium; (V.M.M.); (M.S.)
| | - Jenna Hannouille
- Hôpital Delta (Bruxelles), ULB—Université Libre de Bruxelles, 1050 Bruxelles, Belgium;
| | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Alberto Bolletta
- Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (A.B.); (E.C.)
| | - Emanuele Cigna
- Plastic Surgery and Microsurgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (A.B.); (E.C.)
| | - Michela Schettino
- Service de Chirurgie Plastique, Hôpital CHIREC (Braine L’Alleud-Waterloo, Belgium), 1420 Braine-L’Alleud, Belgium; (V.M.M.); (M.S.)
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Metastatic Renal Cell Carcinoma to the Soft Tissue 27 Years after Radical Nephrectomy: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010150. [PMID: 36676774 PMCID: PMC9866450 DOI: 10.3390/medicina59010150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
Background and Objectives: Approximately 20-40% of patients affected with renal cell carcinoma (RCC) develop either distant metastatic or locally recurring disease following radical nephrectomy. Soft tissue, skin, and the central nervous system are less common metastatic sites. We present the case of a patient who has received a diagnosis of RCC; it was found that she had no metastases at the time of nephrectomy but had metastases in the soft tissue and subcutaneous tissue of the scalp 27 years later. As far as we can tell, this is the longest period elapsed between primary renal tumor and subcutaneous/soft tissue metastasis; moreover, this case is the first report of a combined soft tissue/subcutaneous metastasis from RCC. Case presentation: A 73-year-old woman underwent right radical nephrectomy 27 years earlier for clear cell renal cell carcinoma (CCRCC). She presented at our unit because she noticed swelling in the left temporal region; after radiological exams, a benign lesion was suspected. The patient underwent surgical eradication, but the massive bleeding did not allow the removal of the lesion. A biopsy of the mass was performed and the histological examination was consistent with RCC metastases. Conclusions: Metastases from renal cell carcinoma to the subcutaneous and soft tissues are rare. It is essential to take into account RCC metastases in the differential diagnostic of the new starting mass of the head and neck, and the necessity for close and continuous surveillance of patients diagnosed with renal cancer even after a long disease-free period should be emphasized.
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Li Y, Liao LM, Sinha R, Zheng T, Vance TM, Qureshi AA, Cho E. Fish intake and risk of melanoma in the NIH-AARP diet and health study. Cancer Causes Control 2022; 33:921-928. [PMID: 35676377 DOI: 10.1007/s10552-022-01588-5] [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: 12/01/2021] [Accepted: 04/27/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Prior epidemiological studies evaluating the association between fish intake and melanoma risk have been few and inconsistent. Few studies distinguished different types of fish intake with risk of melanoma. METHODS We examined the associations between intake of total fish and specific types of fish and risk of melanoma among 491,367 participants in the NIH-AARP Diet and Health Study. We used multivariable-adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS During 6,611,941 person-years of follow-up with a median of 15.5 years, 5,034 cases of malignant melanoma and 3,284 cases of melanoma in situ were identified. There was a positive association between higher total fish intake and risk of malignant melanoma (HR = 1.22, 95% CI = 1.11-1.34 for top vs. bottom quintiles, ptrend = 0.001) and melanoma in situ (HR = 1.28, CI = 1.13-1.44 for top vs. bottom quintiles, ptrend = 0.002). The positive associations were consistent across several demographic and lifestyle factors. There were also positive associations between tuna intake and non-fried fish intake, and risk of malignant melanoma and melanoma in situ. However, fried fish intake was inversely associated with risk of malignant melanoma, but not melanoma in situ. CONCLUSIONS We found that higher total fish intake, tuna intake, and non-fried fish intake were positively associated with risk of both malignant melanoma and melanoma in situ. Future studies are needed to investigate the potential biological mechanisms underlying these associations.
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Affiliation(s)
- Yufei Li
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Tongzhang Zheng
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
| | - Terrence M Vance
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
- Department of Dermatology, Warren Alpert Medical School, Brown University, 339 Eddy St., Providence, RI, 02903, USA
| | - Abrar A Qureshi
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA
- Department of Dermatology, Warren Alpert Medical School, Brown University, 339 Eddy St., Providence, RI, 02903, USA
| | - Eunyoung Cho
- Department of Epidemiology, Brown School of Public Health, Providence, RI, USA.
- Department of Dermatology, Warren Alpert Medical School, Brown University, 339 Eddy St., Providence, RI, 02903, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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Pinto M, Marotta N, Caracò C, Simeone E, Ammendolia A, de Sire A. Quality of Life Predictors in Patients With Melanoma: A Machine Learning Approach. Front Oncol 2022; 12:843611. [PMID: 35402230 PMCID: PMC8990304 DOI: 10.3389/fonc.2022.843611] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/25/2022] [Indexed: 12/20/2022] Open
Abstract
Health related quality of life (HRQoL) is an important recognized health outcome for cancer treatments, but also disease course with slower recovery and increased morbidity. These issues are of implication in melanoma, which maintains a risk of disease progression for many years after diagnosis. This study aimed to explore and weigh factors in the perception of the quality of life and possible relationships with demographic–clinical characteristics in people with melanoma via a machine learning approach. In this observational study, patients with melanoma, without metastatic disease, were recruited from January 2020 to December 2021 with a follow-up of at least one year. Demographic variables and clinics were collected, and the 12-Item Short-Form Health Survey (SF-12) was adopted as the physical and mental aspects of the Health-Related Quality of Life (HRQoL) measure. All the variables were processed in a random forest model to weigh at each node of each tree of this machine learning regression model, their actual weight in SF-12 score. We included 203 melanoma patients, mean aged 59.25 ± 15.1 years: 56 (27%) affecting the upper limbs and 147 (73%) affecting the trunk. The model of 142 patients with no missing value, generating 92 trees (MSE = 0.45, R2 of 0.78), reported that the lesion site was the most influencing variable on HRQoL based on the decrease in Gini impurity in variable weighing at each node intersection in forest generation. In this scenario, we built two distinct models for lesion sites and demonstrated that the variable that most influenced the quality of life in upper limb melanoma was lymphedema, while BMI was in the trunk. Given these results, random forest regressions could play a crucial role in the clinical and rehabilitation approach. The machine-learning model for detecting the HRQoL predictor in melanoma patients indicates that the experienced lymphedema and BMI may influence the HRQoL perception. This study suggests that the prevention and treatment of lymphedema and bodyweight reduction might improve the quality of life in melanoma.
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Affiliation(s)
- Monica Pinto
- Rehabilitation Medicine Unit, Strategic Health Services Department, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Nicola Marotta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Corrado Caracò
- Melanoma and Skin Cancer Surgery Unit, Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Ester Simeone
- Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori-Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-Fondazione G. Pascale, Naples, Italy
| | - Antonio Ammendolia
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Perforator-based Adipofascial Flaps and ADM: A Novel Combined Approach to Distal Lower Extremity Defects. Plast Reconstr Surg Glob Open 2022; 10:e4131. [PMID: 35198355 PMCID: PMC8856593 DOI: 10.1097/gox.0000000000004131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022]
Abstract
Due to the wide spectrum of lower extremity defect presentation, various reconstructive techniques are available. Classic adipofascial flaps are still a second choice. The authors described a new multistage reconstructive approach with perforator-based pedicled adipofascial flap.
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A Retrospective Study on Single-Stage Reconstruction of the Ear following Skin Cancer Excision in Elderly Patients. J Clin Med 2022; 11:jcm11030838. [PMID: 35160289 PMCID: PMC8836452 DOI: 10.3390/jcm11030838] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Ear reconstructive surgery aims to solve the deformities caused by cancer excision. Despite the numerous surgical procedures described, recreating the complex anatomy of the ear still represents a challenge, particularly for young surgeons. The purpose of this exploratory pilot study is to review our experience with single stage reconstruction of the partial defects of the auricle, and propose an algorithm based on defect size, location, and characteristics. We retrospectively reviewed patients who underwent ear reconstruction after cancer excision at our institution between February 2018 and November 2020. The data collected included patients’ demographics, defect characteristics, reconstructive technique used, complications, and outcomes. The patients were evaluated at a minimum follow-up time of 12 months. Forty-six patients were included in the study. The most common cause for ear reconstruction was basal cell carcinoma. The mean area of defect was 4.3 cm2 and the helix was the most frequent location of defect. Two patients experienced post-operative complications. At the one-year follow-up, difference in skin pigmentation was reported in 10 cases, a depressed contour of the ear was found in 4 cases, and moderate ear asymmetry was found in 11 cases. No patient needed a secondary procedure. In conclusion, the proposed reconstructive algorithm represents a reconstructive indication that is simple and characterized by low complication rates and good outcomes for both the patient and the surgeon.
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Derebaşınlıoğlu H. Distribution of skin cancers of the head and neck according to anatomical subunit. Eur Arch Otorhinolaryngol 2021; 279:1461-1466. [PMID: 34047838 DOI: 10.1007/s00405-021-06901-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/20/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The skin tumors can occur on any part of the body, these anatomical subunits are considered prognostic factors for localized carcinomas. Tumor size is a prognostic criterion that also varies according to the anatomical location of these tumors. Head and neck region is the most common location. This study aimed to investigate the distribution of BCC, SCC, and MM in the anatomical subunits of the head and neck region and their relationships with these anatomical subunits. MATERIALS AND METHODS Patients who underwent surgery for BCC, SCC, BSCC and/or MM in the head and neck region. The head and neck region was divided topographically into the following subunits: scalp, forehead, orbital region, ear and periauricular region, cheeks, nose, perioral region, and neck. Patients were analyzed according to age, sex, and tumor location, type, and size. RESULTS The SCC group was found to have significantly larger mean tumor size than the BCC group (p = 0.003). SCC was more frequently located in the perioral region (p = 0.001), BCC was more frequently located on the nose (p = 0.001), and MM was more frequently located on the forehead and scalp (p = 0.034, p = 0.49) when compared with the other types. BCC was more frequently located in the orbital region than SCC (p = 0.018) CONCLUSIONS: In this study, we observed statistically significant differences in the distribution of BCC, SCC, and MM, the most common types of skin cancer, among the topographical subunits of the head and neck region.
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Affiliation(s)
- Handan Derebaşınlıoğlu
- Plastic Reconstructive and Aesthetic Surgery Department, Sivas Cumhuriyet University Medical Faculty, 58140, Sivas, Turkey.
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11
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Reconstruction of the Nose: Management of Nasal Cutaneous Defects According to Aesthetic Subunit and Defect Size. A Review. ACTA ACUST UNITED AC 2020; 56:medicina56120639. [PMID: 33255524 PMCID: PMC7760386 DOI: 10.3390/medicina56120639] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023]
Abstract
The nose represents the most common site for the presentation of cutaneous cancer, especially in sun-exposed areas: ala, dorsum, and tip. Even the smallest loss of substance can create aesthetic and psychosocial concerns for patients; therefore, surgeons who perform nasal reconstruction should be strictly confident with the pertinent surgical anatomy in order to tailor the procedure to the patient’s condition and needs. Radical tumor excision and satisfactory aesthetic and functional results are primary targets. Restoring the original shape is the goal of any reconstruction: appropriate reshaping of three-dimensional geometry, proper establishment of symmetry, and excellent color and texture match to the adjacent structures are paramount features. Multiple options exist to re-establish functional and aesthetic integrity after surgical oncology; nevertheless, the management of nasal defects can be often challenging, and the gold standard is yet to be found. The current goal is to highlight some of the more common techniques used to reconstruct cutaneous defects of the nose with a specific focus on decision making based on the aesthetic subunit and defect size. The authors attempt to share common pitfalls and offer practical suggestions that they have found helpful in their clinical experience.
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Paolino G. Detection of False Negative Sentinel Lymph Node in Cutaneous Oncology: A General Reappraisal. J INVEST SURG 2020; 33:748-749. [PMID: 32772780 DOI: 10.1080/08941939.2018.1563663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Giovanni Paolino
- Unit of Dermatology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Department of Internal Medicine and Medical Specialties, Dermatology Clinic, La Sapienza-University of Rome, Rome, Italy
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Losco L, Aksoyler D, Chen S, Bolletta A, Velazquez‐Mujica J, Di Taranto G, Lo Torto F, Marcasciano M, Cigna E, Chen H. Pharyngoesophageal reconstruction with free jejunum or radial forearm flap as diversionary conduit: Functional outcomes of patients with persistent dysphagia and aspiration. Microsurgery 2020; 40:630-638. [DOI: 10.1002/micr.30623] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/05/2020] [Accepted: 06/19/2020] [Indexed: 01/22/2023]
Affiliation(s)
- Luigi Losco
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Pisa Italy
| | - Dicle Aksoyler
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
| | - Shih‐Heng Chen
- Department of Plastic SurgeryChang Gung Memorial Hospital Taipei Taiwan
| | - Alberto Bolletta
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
| | | | - Giuseppe Di Taranto
- Plastic Surgery Unit, Department of SurgerySapienza University of Rome Rome Italy
| | - Federico Lo Torto
- Plastic Surgery Unit, Department of SurgerySapienza University of Rome Rome Italy
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno Cecina, Piombino ElbaAzienda USL Toscana Nord Ovest Leghorn Italy
| | - Emanuele Cigna
- Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of Pisa Pisa Italy
| | - Hung‐Chi Chen
- Department of Plastic SurgeryChina Medical University Taichung Taiwan
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14
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Moser U, Andrianakis A, Pondorfer P, Wolf A, Graupp M, Weiland T, Holzmeister C, Wild D, Thurnher D. Sex-specific differences in patients with nonmelanoma skin cancer of the pinna. Head Neck 2020; 42:2414-2420. [PMID: 32369257 PMCID: PMC7496743 DOI: 10.1002/hed.26237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/20/2020] [Accepted: 04/22/2020] [Indexed: 02/04/2023] Open
Abstract
Background Generally, it is known that men are affected more frequently by nonmelanoma skin cancer (NMSC) than women. The aim of our study was to investigate the effect of sex on the characteristics of NMSCs of the pinna at the population that our center serves and to compare it with the international data. Methods We analyzed retrospectively the data of 225 patients with NMSC of the pinna. Sex‐specific differences were investigated for basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) subgroups. Results The ratio of BCC to cSCC was determined in male patients at 1:1.3, in contrast in females it was identified at 4:1 (P = .001). Conclusion In our study, a new aspect of the sex‐dependent distribution of cSCC and BCC of the pinna was demonstrated. Women are affected four times more frequently by BCC than by cSCC, whereas in men this ratio is approximately equal.
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Affiliation(s)
- Ulrich Moser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Alexandros Andrianakis
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Prisca Pondorfer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Axel Wolf
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Matthias Graupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Thomas Weiland
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Clemens Holzmeister
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Dominik Wild
- Department of Otorhinolaryngology, Krankenhaus der Barmherzigen Schwestern Ried, Ried im Innkreis, Austria
| | - Dietmar Thurnher
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
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15
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Badash I, Shauly O, Lui CG, Gould DJ, Patel KM. Nonmelanoma Facial Skin Cancer: A Review of Diagnostic Strategies, Surgical Treatment, and Reconstructive Techniques. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619865278. [PMID: 31384136 PMCID: PMC6657122 DOI: 10.1177/1179550619865278] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Nonmelanoma skin cancer is the most common form of cancer in the United States, and the face is a common area for skin cancer development due to its frequent exposure to the sun. This article focuses on the surgical management of facial nonmelanoma skin cancers, including diagnostic considerations, biopsy techniques, and staging. In addition, we discuss surgical treatment options, including indications, techniques, outcomes, and facial reconstruction following tumor excision.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Christopher G Lui
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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16
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Marcasciano M, Mazzocchi M, Kaciulyte J, Spissu N, Casella D, Ribuffo D, Dessy LA. Skin cancers and dermal substitutes: Is it safe? Review of the literature and presentation of a 2-stage surgical protocol for the treatment of non-melanoma skin cancers of the head in fragile patients. Int Wound J 2018; 15:756-768. [PMID: 29863792 DOI: 10.1111/iwj.12924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/27/2018] [Indexed: 11/29/2022] Open
Abstract
Non-melanoma skin cancers (NMSC) represent the most common skin tumours of the head region. We describe the use of dermal substitute in a 2-stage surgery protocol for selected fragile patients to remove NMSC of the head region. A review of the literature focusing on dermal substitutes' safety after skin tumours excision is provided. A total of 45 fragile patients with NMSC in the head region were selected and scheduled for the 2-stage surgical protocol. The first stage consisted of traditional surgical excision and immediate coverage with Hyalomatrix (Fidia Advanced Biopolymers, Abano Terme, Italy). After histology confirmed diagnosis and clearance of the margins, full-thickness skin autografts were performed. All of the patients reached complete tumour excision and wound healing. No local recurrences were registered during 24 months follow up. The 2-stage surgical therapeutic-diagnostic-reconstructive approach represents a less stressful and oncologically safe surgical protocol in selected fragile patients. When patients cannot tolerate invasive and long surgical procedures, general anaesthesia, and long hospitalisation, skin grafting following temporary skin substitute coverage can achieve oncological clearance and provide good functional and aesthetic results. The use of dermal substitutes represents a valid alternative surgical option in cases of ASA III, fragile patients non-eligible for complex reconstructive surgery. To our knowledge, this is the first paper reviewing literature focusing on dermal substitutes' applications and safety after skin tumour excision.
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Affiliation(s)
- Marco Marcasciano
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Marco Mazzocchi
- Unit of Plastic and Reconstructive Surgery, Department of Surgery, Ospedale Santa Maria Della Misericordia, Perugia (PG), Italy
| | - Juste Kaciulyte
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Noemi Spissu
- UOC di Chirurgia Generale, Ospedale San Francesco, di Nuoro, Italy
| | - Donato Casella
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
| | - Diego Ribuffo
- Department of Surgery "P. Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Policlinico Umberto I, Roma, Italy
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17
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Cronin CT, Allen J, Patterson K, O'Donoghue G. Are We Cutting Enough? A Five-Year Audit of Melanoma Excision Margins in the South East of Ireland. J INVEST SURG 2018; 32:264-269. [DOI: 10.1080/08941939.2017.1408717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Jack Allen
- Royal College of Surgeons, St. Stephen's Green, Dublin, Ireland
| | - Ken Patterson
- Department of Surgery, University Hospital Waterford, Dunmore, Waterford, Ireland
| | - Gerrard O'Donoghue
- Department of Surgery, University Hospital Waterford, Dunmore, Waterford, Ireland
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18
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Surgical Treatment with Locoregional Flaps for the Eyelid: A Review. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6742537. [PMID: 29226145 PMCID: PMC5684523 DOI: 10.1155/2017/6742537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022]
Abstract
Reconstruction of the eyelids after skin cancer excision can be challenging. Surgical treatment options are multiple; deep anatomy knowledge of lamellar components is mandatory to choose the most adequate surgical planning. Eyelids' role in vision and social relationship is critical; both function and aesthetics are tough to restore. Using a flap provides a satisfying texture and colour match with adjacent tissues and ensures short contraction during healing; furthermore, grafts are sometimes necessary to achieve pleasing results. Hundreds of surgical techniques have been described aiming for eyelid reconstruction; in our paper, we want to provide for our audience the most reliable and useful procedures for subtotal and total eyelid reconstruction following NMSC full-thickness excision.
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