Comparación entre los melanomas de cabeza y cuello con los de tronco y extremidades

Background: Head and neck melanomas (HNMs) have been associated with prognostic factors different from those on other locations. Objective: The goal of the present study was to compare the demographic and clinical characteristics and the outcomes of surgical treatment between patients with HNM and those with trunk and extremity melanoma (TEM). Material and methods: The clinical records of patients undergoing surgery for melanoma between October 2014 and April 2018 were retrospectively reviewed. Fifteen patients (22.3%) had HNM and 52 (77.7) presented TEM. Results: There were no differences in age between both groups (63.8 ± 21.1 versus 58.5 ± 16), but there was a trend toward higher percentage of men in the HNM group (80% versus 61.3%). Patients with HNM had lower tumor thickness than those with TEM (2.07 versus 5.5 mm), higher incidence of melanoma in situ [5 (33.3%) versus 8 (15.3%)]; lymph node resection was more common (33% versus 25%) as well as reconstruction of the primary defect with local and musculocutaneous flaps. During follow-up, two patients in the HNM group developed local recurrences that were excised and three presented distant metastases in the lung, small bowel and abdomen and finally died due to the disease. In the TEM group, one patient had local recurrence and five died due to systemic metastases. The sample size was not sufficient to assess statistically significant differences. Conclusion: Head and neck melanomas occur in a wide age range and stages and has some clinical differences with TEM. The defects produced after the excision of the primary lesion often require more complex procedures and should be managed with a multidisciplinary approach.

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Distant metastases from an originally diagnosed melanoma in situ primary tumor

International Journal of Dermatology ◽

10.1111/ijd.15994 ◽

2021 ◽

Author(s):

Shoshana Zhang ◽

Kristan Schiele ◽

Clay J. Cockerell ◽

Roopal Bhatt

Keyword(s):

Primary Tumor ◽

Distant Metastases ◽

Melanoma In Situ

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Penile Melanoma In Situ: Long Term Follow Up

Urology ◽

10.1016/j.urology.2020.03.027 ◽

2020 ◽

Vol 141 ◽

pp. e51-e52

Author(s):

Kevin Krughoff ◽

Amichai Kilchevksy ◽

Wayne Stadelmann ◽

Timothy Gorman ◽

Ramiro Madden-Fuentes

Keyword(s):

Melanoma In Situ ◽

Long Term Follow Up

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Resultados del tratamiento quirúrgico de sarcomas de partes blandas en adultos

Revista Argentina de Cirugía ◽

10.25132/raac.v111.n3.1427.es ◽

2019 ◽

Vol 111 (3) ◽

pp. 143-161

Author(s):

Matías H. Loccisano ◽

◽

María F. Montesinos ◽

Pedro A. Brégoli ◽

Eugenia Paradeda ◽

...

Keyword(s):

Postoperative Radiotherapy ◽

Soft Tissue Sarcomas ◽

Free Flaps ◽

Distant Metastases ◽

High Rate ◽

High Grade ◽

Mesenchymal Tumors ◽

Reconstructive Procedures ◽

Clinical Records

Background: Soft-tissue sarcomas (STS) are rare mesenchymal tumors with several histologic subtypes and different clinical patterns. Objective: The aim of this study was to describe the clinical and pathological characteristics and surgical outcomes of a series of patients with STS. Material and methods: The clinical records of 2403 undergoing surgery between October 2014 and April 2018 were retrospectively reviewed. Twenty-two patients (0.91%) presented STS. Results: Mean age was 52 years (range: 19-92) and 13 (59%) were women. The tumors were located in the lower extremities in 12 cases, head and neck in five, trunk in three and upper extremities in two. Fourteen cases (63.6%) were high-grade tumors. Pleomorphic sarcoma was the most common histologic type (32%) followed by synovial sarcoma (18%), liposarcoma (14%), and other types (36%). All the tumors were completely resected and five patients (35.7%) required amputation, four in the lower extremity and on in the upper extremity. Different reconstructive procedures were performed accor- ding to tumor size and location, including three free flaps. Those patients with high-grade sarcomas or with positive margins received postoperative radiotherapy. After a mean follow-up of 16 months, six patients presented local recurrences and four patients had synchronous metastatic disease in the lungs; all these patients had high-grade tumors. Overall survival was 86.4%. Conclusion: STS are rare and invasive neoplasms, widely distributed, requiring aggressive and occa- sionally complex surgical procedures. It is necessary to consider adjuvant treatments in selected cases and to maintain regular follow-up due to the high rate of recurrences and distant metastases.

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Sinonasal mucosal melanomas in Quito, Ecuador

International Surgery Journal ◽

10.18203/2349-2902.isj20170852 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1009

Author(s):

Luis Pacheco-Ojeda

Keyword(s):

Local Recurrence ◽

Head And Neck ◽

Postoperative Radiotherapy ◽

Distant Metastases ◽

Tertiary Referral ◽

Tumor Patients ◽

Presenting Symptoms ◽

Local Disease ◽

The Social ◽

Clinical Records

Background: Head and neck mucosal melanoma account for 2 to 8% of head and neck melanomas, the majority of which arises in the nasal cavity or paranasal sinuses. The aim of this report was to review our experience on sinonasal malignant melanomas (SNMM) treated over a long period of time at a tertiary referral hospital.Methods: Clinical records of all of the patients operated on for SNMM at the Social Security Hospital and private clinics in Quito, Ecuador, were reviewed. Nineteen patients had histologically proven diagnosis. Eleven patients were men and mean age was 64. The most common presenting symptoms were nasal obstruction and epistaxis. Most tumors were located at the nasal fossa. Extranasal extension was present in 11 patients. Twelve had stage III- IV tumors. All patients were treated by surgery. Postoperative radiotherapy was given to 7.Results: Local recurrence (11 events) occurred in 9 cases. These 11 events were treated with surgery in 8, eventually associated to radiation therapy (RT) and chemotherapy (CT). Eight out of these 9 patients died. Five overall survival was 46%. Death was related to local disease and distant metastases. All stage I tumor patients are alive.Conclusions: Most sinunasal melanomas have a poor prognosis, mainly attributed to initial advanced local disease, local recurrence and distant metastasis. Surgery is the mainstay treatment, followed by radiotherapy, according to the T category.

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Treatment of Head and Neck Melanoma In Situ With Staged Contoured Marginal Excisions

Annals of Plastic Surgery ◽

10.1097/sap.0000000000000949 ◽

2017 ◽

Vol 78 (6) ◽

pp. 663-667 ◽

Cited By ~ 4

Author(s):

Evan S. Glazer ◽

Caitlin F. Porubsky ◽

Jeffrey D. Francis ◽

Jamie Ibanez ◽

Nicholas Castner ◽

...

Keyword(s):

Head And Neck ◽

Melanoma In Situ ◽

Head And Neck Melanoma

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Evaluation of outpatient discharge in patients with cutaneous melanoma

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015002002 ◽

2015 ◽

Vol 42 (2) ◽

pp. 70-74

Author(s):

Nurimar C. Fernandes ◽

Flauberto de Sousa Marinho

Keyword(s):

Cutaneous Melanoma ◽

Cross Sectional Study ◽

The Other ◽

Stage Iiic ◽

Cross Sectional ◽

Melanoma In Situ ◽

Stage Ia ◽

The One

OBJECTIVE: to evaluate discharge in a group of patients with cutaneous melanoma according to recently established criteria. METHODS: we conducted an observational, cross-sectional study with 32 patients at the Hospital Universitário Clementino Fraga Filho (HUCFF) / Universidade Federal do Rio de Janeiro (UFRJ), between 1995 and 2013, in the following stages: IA (17 cases, 53.12%), IB (4 cases, 12.5%), IIA (3 cases, 9.37%), IIC (1 case, 3.12%), IIIB (1 case, 3.12%), IIIC (3 cases, 9.37%), melanomas in situ (2 cases, 6.25%), Tx (1 case, 3.12%). RESULTS: the follow-up time varied from one to 20 years (stage IA), five to 15 years (stage IB), six to 17 years (stage IIA), 20 years (stage IIC), 23 years (stage IIIB) and 14 to 18 years (stage IIIC). One melanoma in situ (subungueal) was discharged in the fourth year of follow-up and the other was promptly discharged. The Tx melanoma was followed for 12 years. We observed no relapses or recurrences in the period. CONCLUSION: although a controversial issue, it was possible to endorse the discharge of the patients since our follow-up time had already exceeded the one recommended by the other authors.

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Sclerosing melanocytic lesions (sclerosing melanomas with nevoid features and sclerosing nevi with pseudomelanomatous features) – an analysis of 90 lesions

Radiology and Oncology ◽

10.2478/raon-2018-0003 ◽

2018 ◽

Vol 52 (2) ◽

pp. 220-228

Author(s):

Biljana Grcar-Kuzmanov ◽

Emanuela Bostjancic ◽

Juan Antonio Contreras Bandres ◽

Joze Pizem

Keyword(s):

Melanocytic Nevus ◽

Lymph Node Biopsy ◽

Female Age ◽

Melanoma In Situ ◽

Melanocytic Lesions ◽

Pagetoid Spread ◽

Mitotic Figures ◽

Age Range ◽

Diffuse Sclerosis

Abstract Background Sclerosing melanocytic lesions, which are characterized by either focal or diffuse sclerosis in the dermal component and atypical proliferation of predominantly nevoid melanocytes, remain poorly defined. Our aim was to analyze systematically their morphologic spectrum, especially the distinction between sclerosing melanocytic nevus and sclerosing melanoma, which has not been well documented. Patients and methods We collected 90 sclerosing melanocytic lesions, occurring in 82 patients (49 male, 33 female; age range from 21 to 89 years). A four probe fluorescent in situ hybridization (FISH) assay was performed in 41 lesions to substantiate the diagnosis of sclerosing melanomas. Results A prominent full-thickness pagetoid spread of melanocytes was identified in 44 (48%) lesions, and a melanoma in situ adjacent to the sclerosis in 55 (61%) lesions. In the intrasclerotic component, maturation was absent in 40 (44%) and mitotic figures were identified in 18 (20%) lesions. Of the 90 lesions, 26 (29%) were diagnosed morphologically as nevi and 64 (71%) as melanomas (Breslow thickness from 0.4 to 1.8 mm), including 45 (50%) melanomas with an adjacent nevus. A four-probe FISH assay was positive in the sclerotic component in 14 of 25 lesions diagnosed morphologically as melanomas and none of 16 nevi. A sentinel lymph node biopsy was performed for 17 lesions and was negative in all cases. Conclusions Sclerosing melanocytic lesions form a morphologic spectrum and include both nevi and melanomas. The pathogenesis of sclerosis remains obscure but seems to be induced by melanocytes or an unusual host response in at least a subset of lesions.

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Reevaluation of Salivary Lymphadenoma

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2019-0702-oa ◽

2020 ◽

Author(s):

Chunye Zhang ◽

Ting Gu ◽

Yuhua Hu ◽

Jingjing Sun ◽

Ronghui Xia ◽

...

Keyword(s):

Differential Diagnosis ◽

Epithelial Cells ◽

Mucoepidermoid Carcinoma ◽

Clinicopathologic Features ◽

Prognostic Features ◽

Lymphoid Stroma ◽

Histologic Evaluation ◽

Age Range

Context.— Both salivary lymphadenomas (LADs) and Warthin-like mucoepidermoid carcinoma (MEC) contain components of epithelium and lymphoid stroma and their differential diagnosis can be difficult on the basis of morphology alone. Objective.— To clarify whether Warthin-like MEC was diagnosed as a LAD, and to compare their clinicopathologic features. Design.— A total of 16 LAD cases were analyzed for MAML2 rearrangement by using fluorescence in situ hybridization, and the clinical, histologic, immunohistochemical, and prognostic features were compared between MAML2 rearrangement–positive and MAML2 rearrangement–negative groups. Results.— Among the 16 cases investigated, 9 harbored a MAML2 rearrangement and were reclassified as Warthin-like MEC. The remaining 7 cases were classified as LADs with 1 nonsebaceous and 6 sebaceous cases. The patients with Warthin-like MEC had a wider age range (10–75 years) than the patients with LADs (36–68 years). Histologically, 2 of the 9 Warthin-like MECs (22.2%) showed focal invasion, whereas all the LADs had complete capsules. Warthin-like MECs exhibited a diverse epithelial cell morphology, including basaloid, glandular, cuboidal, epidermoid, with mucinous cells, although these cytologic features were seen only focally in some cases. Nonsebaceous LAD was composed of basaloid and glandular epithelial cells predominantly. In sebaceous LAD, the epithelial cells were composed of basaloid and large foamy sebaceous cells. In all cases, the stroma was composed mainly of lymphocytes accompanied by lymphoid follicles, although plasma cell infiltration could be much heavier in Warthin-like MEC. All the patients had a good outcome after a longer follow-up (3∼166 months). Conclusions.— Warthin-like MEC can be misdiagnosed as a LAD owing to overlap in clinicopathologic features of the 2 entities. Careful histologic evaluation and detection of MAML2 rearrangement can facilitate their differential diagnosis.

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Comparison of subjective evaluation versus objective algorithm in the interpretation of follow-up FDG-PET/CT scans after radiochemotherapy in head and neck cancer patients

Nuklearmedizin ◽

10.1055/a-0859-6518 ◽

2019 ◽

Vol 58 (02) ◽

pp. 93-100 ◽

Cited By ~ 1

Author(s):

Alexander Kohler ◽

Steffen Löck ◽

Steffen Appold ◽

Anna Bandurska-Luque ◽

Sebastian Hoberück ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Head And Neck ◽

Fdg Pet ◽

Distant Metastases ◽

Ct Scans ◽

Experienced Observer ◽

Pet Ct ◽

Objective Classification ◽

Fdg Pet Ct

Abstract Aim Retrospective evaluation of serial FDG-PET/CT scans in head and neck squamous cell cancer (HNSCC) patient’s follow-up after primary radiochemotherapy (RCTx), to assess the diagnostic accuracy of an experienced observer vs. an objective classification compared to standard clinical follow-up examinations. Methods Sixty-nine patients with locally advanced HNSCC were included, who received curative RCTx. Follow-up included serial FDG-PET/CT at the following time intervals t1: ≤ 270 d, t2: 271–540 d, t3: > 540 d after curative RCTx. The likelihood to detect local recurrences, nodal and distant metastases were compared between (i) experienced observer, (ii) an objective classification system by Zundel et al. 25, and (iii) routine clinical follow-up examinations. Results Twenty-two local recurrences, 7 nodal and 17 distant metastases were recorded during the follow-up. The diagnostic accuracy for local recurrence of the experienced observer vs. objective classification was 78 % vs. 77 % for t1, 83 % vs. 79 % for t2 and 100 % vs. 84 % for t3.The classification (ii) and the conventional follow-up (iii) resulted in a relatively high amount of equivocal findings reducing the diagnostic accuracy. Conclusion Evaluation of FDG-PET/CT by an experienced observer in follow-up of HNSCC patients after curative RCTx resulted in the highest diagnostic accuracy in comparison to an objective classification and to routine clinical examination.HNSCC is a malignant tumor with a high likelihood of recurrence, especially in the first two years after curative RCTx. Early detection of recurrence is of high clinical importance, since there are several effective second line therapies that may have curative potential in some patients.

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