The Optimum Excision Margin and Regional Node Management for Primary Cutaneous T3 Melanomas (2–4 mm in Thickness)

Abstract Background Positron-emission tomography (PET) is widely used to detect malignancies, but consensus on its prognostic value in oropharyngeal cancer has not been established. The purpose of this study was to analyze the PET parameters associated with tumor extent and survival in resectable oropharyngeal cancer. Methods The PET parameters in oropharyngeal cancer patients with regional node metastasis who underwent surgery and postoperative radiotherapy between January 2005 and January 2019 were analyzed. We calculated the SUVmax, tumor-to-liver ratio (TLR), metabolic tumor volume (MTV, volume over SUV 2.5), and total lesion glycolysis (TLG, MTV x mean SUV) of the primary lesion and metastatic nodes. Histologic findings, patient survival, and recurrence were reviewed in the medical records. Results Fifty patients were included, and the PET parameters were extracted for 50 primary lesions and 104 nodal lesions. In the survival analysis, MTV and TLG of the primary lesions showed significant differences in overall survival (OS) and recurrence-free survival (RFS). In the multiple regression analysis, TLG of the primary lesion was associated with the depth of invasion (DOI). MTV of the nodes was a significant factor affecting extranodal extension (ENE). Conclusions PET parameters could be related with OS, RFS, DOI of the primary tumor, and ENE. PET would be expected to be a useful diagnostic tool as a prognosticator of survival and pathologic findings in oropharyngeal cancer.

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Regional Node Basin Recurrence in Melanoma Patients: More Common After Node Dissection for Macroscopic Rather than Clinically Occult Nodal Disease

Annals of Surgical Oncology ◽

10.1245/s10434-019-08086-0 ◽

2019 ◽

Vol 27 (6) ◽

pp. 1970-1977 ◽

Cited By ~ 1

Author(s):

Abhineet Uppal ◽

Stacey Stern ◽

John F. Thompson ◽

Leland Foshag ◽

Nicola Mizzollo ◽

...

Keyword(s):

Node Dissection ◽

Nodal Disease ◽

Regional Node ◽

Melanoma Patients

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Skin lesions suspicious for melanoma: New Zealand excision margin guidelines in practice

Journal of Primary Health Care ◽

10.1071/hc17055 ◽

2018 ◽

Vol 10 (3) ◽

pp. 210 ◽

Cited By ~ 2

Author(s):

Tess Brian ◽

Michael B. Jameson

Keyword(s):

New Zealand ◽

Standard Deviation ◽

Cutaneous Melanoma ◽

Positive Margin ◽

Skin Lesions ◽

Excision Biopsy ◽

Excision Margin ◽

Biopsy Specimens ◽

Deep Margin ◽

Horizontal Margin

ABSTRACT INTRODUCTION New Zealand guidelines for cutaneous melanoma management recommend excision biopsy specimens of suspected lesions have a 2 mm horizontal margin, and a deep margin into upper subcutis. AIM To assess guideline compliance of suspicious lesion biopsies taken in the community and in a hospital. METHODS Patients admitted to Waikato Hospital, Hamilton, for diagnostic or treatment melanoma surgery during the year ending February 2016 were retrospectively identified, and their demographic and biopsy characteristics examined. RESULTS In total, 140 patients had excision biopsies: 61.4% were performed outside the hospital. Biopsy data were available for 126 specimens. Mean horizontal margin was greater (P = 0.001) in hospital biopsies (4.8 mm, standard deviation (s.d.) 3.7 mm) than biopsies performed elsewhere (2.8 mm; s.d. 1.8 mm). Horizontal margins >2.0 mm occurred in 70.6% of specimens; 21.6% of ≤2.0 mm specimens had a tumour-positive margin. Subsequent wide local excision identified residual melanoma in 9.6% of specimens, which was not associated (P = 0.3) with primary horizontal margin ≤2.0 mm. Mean deep margin of hospital biopsies (6.5 mm; s.d. 2.7 mm) was greater (P < 0.001) than in other biopsies (4.1 mm; s.d. 2.7 mm). Horizontal margin >2.0 mm specimens had greater (P < 0.001) mean deep margin (5.9 mm; s.d. 2.7 mm) than specimens with horizontal margin ≤2.0 mm (mean deep margin 3.3 mm; s.d. 2.7 mm). Deep margin ≤2.0 mm (19.0%) was independently associated with the facility where biopsy was performed (P = 0.001) and horizontal margin (P < 0.001). DISCUSSION The New Zealand biopsy deep margin recommendation does not lend itself to meaningful audit. Compliance with the horizontal margin recommendation was low, but of uncertain clinical significance.

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