Is BRAF a prognostic factor in stage III skin melanoma? A retrospective study of 72 patients after positive sentinel lymph node dissection

BACKGROUND

BRAF was identified as an oncogene in skin melanoma in 2002, and since 2011 has been a therapeutic target in the treatment of metastatic melanoma. The role of BRAF mutation in tumour initiation and the disease course remains to be elucidated.

OBJECTIVES

The main objective of our study was to determine whether there is a relationship between BRAF status and overall survival in patients with a melanoma and a positive sentinel lymph node. We also sought an association between BRAF status and the clinicopathological features of the melanoma. Finally, we looked for a potential heterogeneity of BRAF status in primary and metastatic tumours.

METHODS

All patients (n = 72) treated for melanoma and with a positive sentinel lymph node at the University Hospital of Clermont-Ferrand, France, between January 2000 and January 2010 were enrolled in the study. We investigated BRAF status in primary melanoma and lymph node metastatic tissue in our molecular pathology laboratory and collected the clinical and survival data.

RESULTS

Of the 72 patients, 32 had at least one BRAF mutation. There was a statistically significant difference in overall survival between the BRAF-mutated and wild-type populations. The only clinical feature related to BRAF status was metastatic burden. Of the 25 patients in whom we obtained the status in both locations, five had a discordant result.

CONCLUSIONS

BRAF mutation is an indicator of poor prognosis in patients with stage III melanoma with a positive sentinel lymph node. BRAF status could be used in the staging of this population. BRAF has a role not only in cellular immortalization but also in metastatic spread.

[Maximal isometric bite force and sports. Preliminary study]

INTRODUCTION

The evaluation of the bite forces coupled with EMG activity of masseter muscles allows to point out temporo-mandibular joint disorders. The intense practice of sports induces stress which may affect the mandibular statics, due to an hyperfunction of the elevator masticatory muscles, especially the masseter muscles. This concept has led us to compare the maximum isometric bite forces of sedentary and physically trained subjects.

MATERIAL AND METHODS

The aim of this experimentation is to study the maximum isometric bite forces of the premolars, with a force transducer, for two groups of physically trained and sedentary volunteers (25 subjects), with distinction between male and female subjects. Subjects with normal denture and no temporo-mandibular joint disorder were retained. EMG and force recording were synchronized and recorded during 10 seconds of maximal contraction.

RESULTS

The male subjects developed a maximal bite-force significantly higher (p < 0.05) compared to the female subjects. There is no significant difference between subjects practising a sport (at least 6 hours a week) and sedentary ones. The evolution of force during the contraction is different between sexes. EMG activity allowed to control that subjects developed a maximal force and an increase in muscular fatigability of physically active females compared to sedentary ones was noticed.

DISCUSSION

The difference of maximal force between men and women is similar to the one found for the locomotor muscles. The analysis of the evolution of the force according to the contraction duration, might be linked to a different distribution of muscular fibers according to the sex. The practice of a sport might increase the fatigability of the masseter muscles and might be a factor inducing a muscular imbalance of the mandibular posture. But the relatively low number of subjects and the absence of well defined distinctions between different kinds of sport limit our conclusions.

[Cervical ganglioneuroma. Review, apropos of a case]

We describe a case of cervical ganglioneuroma, an uncommon benign tumor which develops slowly, predominantly in females and infants. Ganglioneuromas have a neuroectodermic origin and are localized along the sympathetic trunk. Most are unmasked fortuitously by palpation or by high serum catecholamine levels proportional to tumor size. After radiographic exploration and surgical excision, a pathologic study of the surgical specimen is required to identify this very differentiated tumor stemming from the neural crest.

[Facial epitheliomas: general considerations, surgical techniques and indications]

Carcinoma of the face is the skin disease most frequently encountered by plastic surgeons in everyday practice. Although basal cell carcinomas and squamous cell carcinomas are generally easy to recognize, their treatment remains subject to various schools of thought, or even individual practices, which are often difficult to define. This article defines a general plan of management of these tumours; their histological duality corresponds to a therapeutic duality. Resection of a basal cell carcinoma requires safety margins of 3 to 4 mm, versus at least 5 mm for a squamous cell carcinoma. In a high-risk subject, with a sclerodermiform carcinoma or undifferentiated squamous cell carcinoma, this safety margin may be as much as 10 mm or more. Frozen section examination is preferable in these situations. Six anatomical regions are studied selectively to define the main rules of reconstruction: nasal region, orbitopalpebral region, labial region, malar region, frontal region and auricular region. Each region will be subdivided into several subterritories, each requiring different strategies. The objectives, methods and indications of each reconstruction are selectively defined. The final strategy proposed is based not only on the author's personal experience, but also on the results of the national survey on carcinomas. As a complement to these therapeutic guidelines, the authors raise the problem of incomplete resection, which requires the definition of a peripheral infiltration index predictive of the recurrence rate. Surgery obviously cannot constitute exclusive treatment carcinomas, hence the value of presenting other methods currently available in the therapeutic armamentarium. Surveillance is essential in every case, determined by the patient's risk of recurrence or even metastatic dissemination.

[Treatment of fractures of the orbital floor: reconstruction using Teflon sheets. Analysis of the results after 5 years]

We report our experience with fractures of the orbital floor over the past five years, reporting 80 cases. Different anatomic and clinical forms were defined, particularly trap-door fractures. After a clinical and computed tomography study, we recommend treatment with Teflon implants. Results obtained were analyzed and compared with other series in the literature.

The osteocutaneous upper arm flap for mandibular reconstruction

The authors present the osteocutaneous upper arm flap as useful in segmental microsurgical mandibular reconstructions. This flap presents several advantages: easy and rapid dissection; a long and reliable pedicle; excellent segmental blood supply to the bone, allowing multiple osteotomies; remarkable mobility of the skin paddle relating to the underlying bone; and minimal donor-site morbidity. Among its few disadvantages are that the bone is predominantly cortical, and the bone shaft cannot exceed 11 x 2 cm. Nevertheless, this flap is an excellent alternative to conventional procedures, when a segmental reconstruction, requiring short bone segments and skin, is required. Eight consecutive clinical cases have been successfully treated and are reported.

The submental island flap: a new donor site. Anatomy and clinical applications as a free or pedicled flap

This paper describes the use of a new island flap based on the submental artery. Previously described cervical flaps have inherent problems ranging from limited mobility to unacceptable donor-site scars, to unpredictable outcomes. The flap design and technique were studied on 20 fresh cadavers and 8 patients who underwent radical neck dissections. The flap was then used successfully for reconstruction of orofacial defects in 8 patients. The flap has a long (up to 8 cm), reliable pedicle, and cutaneous dimensions can reach up to 7 x 18 cm. It can be used as a cutaneous, musculofascial (cervicofascial and platysma), or osteocutaneous flap. This flap has an excellent skin color match and a wide arc of rotation, and can extend to the whole homolateral face, except for a part of the forehead and the whole oral cavity. The anatomy, the technique, and clinical experiences are presented.

[Role of osteocutaneous external brachial flap in the treatment of composite loss of substance of the mandible]

The authors report on their research begun in 1987 on this flap and its uses in reconstruction of composite defects of the horizontal and symphysical parts of the mandible, regardless of the cause of the loss. For treatment of average sized defects (less than 7 centimeters), it is reliable flap, easy to remove and to model by osteotomies, giving a thin skin mobile with bone and the removal of which results in only moderate development of scar tissue at the donor site.

Mandibular reconstruction using a free vascularised osteocutaneous flap from the internal condyle of the femur

The authors present a preliminary report of a new microsurgical mandibular reconstruction procedure using a segment of the internal condyle of the femur as a free vascularised bone graft. It is possible to harvest a compound flap including a bony segment measuring 8 X 1.5 X 1.5 cm and a cutaneous saphenous flap with its nutrient pedicle arising from the descending genicular artery and vein. This surgical procedure provides a good cortico-cancellous bony segment and a separate skin flap. Dissection of the flap is sometimes difficult due to the inconsistency of its vascular anatomy; the donor site is left with minimal morbidity but, because of weakening of the femur, our patients are instructed not to return to full weight-bearing before the sixth postoperative week. We consider segmental reconstruction of the mandibular body to be one of the best indications for the flap.

Mucormycosis in an apparently normal host. Case study and literature review

Mucormycosis refers to an opportunistic fungal infection most often related to predisposing conditions, especially uncontrolled diabetes. It can occur as a rapidly extending rhinocerebral infection presenting a high mortality rate. The same micro-organism has, however, been identified in benign paranasal infections in the absence of a general debilitating condition, suggesting that host factors are of the utmost importance in the outcome of paranasal mucormycosis.

[The normal mouth in newborn infants]

The mouth is the place where the newborn begins his experience of life. An anatomical study of the mouth and of the airways-digestive tract junction can explain the particular physiological features of suction and deglutition. These functions bear witness to the neonatal brainstem maturation, improve the newborn's waking state and are the sources of novel acquisitions in the field of interrelations between mother and child.

Sequential combination of 5-fluorouracil, cis-platinum and irradiation. 1. Advanced head and neck cancers

Based on the synergistic action of 5-fluorouracil (5-FUra), cis-dichlorodiamminoplatinum(II) (cis-DDP) and gamma-rays, which was suggested in experiments on murine tumours, a sequential treatment combining irradiation and chemotherapy for human solid tumours known to be resistant to conventional treatments has been developed. A pilot study was carried out on 30 patients with recurring head and neck cancers previously treated by radiotherapy and surgery. The good tolerance and the initial results justified applying this protocol to previously untreated cases. The second study involved 40 patients with stage III and IV tumours. After 3 cycles of combined radio- and chemotherapy followed by a conventional radiotherapy, 78% were good responders (51% in complete remission). Oropharynx and oral cavity, without base of tongue, have a 51% actuarial survival at 3 years when they achieved an early complete remission.

[Contribution of radiological technics to the study of the mandibular canal. Application to human fossils and comparison with modern man and Pongidae]

Fossil mandibles from the "La Chapelle-aux-Saints" Man and Cro-Magnon "old man" are considered to be representative of Neanderthal and Cro-Magnon era. Radiographic studies of such mandibles - including C. T. Scan and panoramic views in common use in maxillofacial surgery - allowed the authors to make useful comments: the mandibular canals are nearly similar to those in Modern Man and quite different from those in Pongidae; the imaging was of adequate quality for a good evaluation of fossil internal structures.

[Neurologic manifestations of basal cell nevomatosis. A case]

The naevoid basal cell syndrome, also called Gorlin's syndrome, is a dysembryoplasia akin to the phakomatoses and which may affect the skin, the bones, the nervous system, the eyes, the endocrine glands and the genitalia. A case with numerous tumours and malformations is presented, together with a review of the literature.

[Prophylaxis of infectious complications in maxillo-facial surgery. Value of cefazolin. (A review of 400 cases)]

The value of short-term prophylaxis with antibiotics in maxillo-facial surgery and plastic facial surgery is studied. 200 patients were included in the study and compared to 200 controls who were given the usual systematic antibiotic therapy, with a different antibiotic, for more than 6 days. 400 case-reports were thus retrospectively analyzed. The results show that when the surgical procedure lasts for less than three hours, short-term prophylaxis with antibiotics is more effective than the usual systematic antibiotic therapy given for more than 6 days.

[Irradiation of basal cell epitheliomas of the face: a handicap for the surgeon in some cases of recurrence (author's transl)]

A case is reported which illustrates the progressive relapsing nature and local invasive character of certain irradiated basal cell epitheliomas. One such case, that involved the tragus initially, and had been irradiated on five occasions, successively invaded the lobe of the ear, the auditory canal, the helix, the mastoid, and the zygomatotemporal region in spite of six operations and the use of cryotherapy.