Sentinel lymph node positivity in melanoma: Which risk prediction tool is most accurate?

Background: Sentinel lymph node biopsy for melanoma determines treatment and prognostic factors and improves disease-specific survival. To risk-stratify patients for sentinel lymph node biopsy consideration, Memorial Sloan Kettering Cancer Center and Melanoma Institute Australia developed nomograms to predict sentinel lymph node positivity. We aimed to compare the accuracy of these 2 nomograms.

Factors Associated With Upstaging of Melanoma Thickness on Final Excision.

Introduction: The incidence and risk factors associated with upstaging from initial biopsy to definitive excision in cutaneous melanoma have not been established. The aim of this study was to determine the incidence of tumor stage upstaging and associated risk factors using the National Cancer Database.

Methods: A retrospective study of the National Cancer Database between 2012 and 2016 was performed.

COVID-19 is Affecting the Presentation and Treatment of Melanoma Patients in the Northeastern United States.

Background: Covid-19 significantly affected healthcare delivery over the past year, with a shift in focus away from nonurgent care. Emerging data are showing that screening for breast and colon cancer has dramatically decreased. It is unknown whether the same trend has affected patients with melanoma.

Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction.

Unlabelled: National guidelines recommend sentinel lymph node biopsy (SLNB) be offered to patients with > 10% likelihood of sentinel lymph node (SLN) positivity. On the other hand, guidelines do not recommend SLNB for patients with T1a tumors without high-risk features who have < 5% likelihood of a positive SLN. However, the decision to perform SLNB is less certain for patients with higher-risk T1 melanomas in which a positive node is expected 5%-10% of the time.

Simultaneous primary invasive breast carcinoma and ipsilateral cutaneous melanoma of the back: Surgical approach and considerations, a case report.

Introduction And Importance: A patient presented with ipsilateral, synchronous primary malignancies of left upper back melanoma and left breast invasive ductal carcinoma. This complex presentation was managed with a multidisciplinary approach.

Case Presentation: A 61-year-old female presented with multiple cutaneous lesions, revealed to be several foci of melanoma in situ as well as a T4b melanoma of the left upper back.

Evaluation of a Gene Expression Profiling Assay in Primary Cutaneous Melanoma.

Background: A significant proportion of deaths from cutaneous melanoma occur among patients with an initial diagnosis of stage 1 or 2 disease. The Decision-Dx Melanoma (DDM) 31-gene assay attempts to stratify these patients by risk of recurrence. This study aimed to evaluate this assay in a large single-institution series.

Concomitant Aorto-Caval Reconstruction for Inferior Vena Cava Leiomyosarcoma.

Background: Leiomyosarcoma of the inferior vena cava (IVC) is a rare smooth muscle neoplasm typically presenting in the fifth to sixth decades of life with both intraluminal and extraluminal growth patterns. Surgical resection remains the gold standard for nonmetastatic disease and often requires vascular reconstruction. We present an atypical case of leiomyosarcoma involving both the IVC and infrarenal abdominal aorta necessitating reconstruction with intraoperative veno-venous bypass.

Esophagectomy for cancer in octogenarians: should we do it?

Purpose: Inconsistent data exists regarding esophagectomy outcomes in octogenarians undergoing transhiatal esophagectomy for esophageal cancer.

Methods: A retrospective review was performed for esophagectomy cancer patients between 2000 and 2012 at our tertiary referral center. Outcome data for octogenarians was compared to younger patients aged 20 to 79 years.

Surgical Management of Melanoma.

The surgical management of melanoma has undergone considerable changes over the past several decades, as new strategies and treatments have become available. Surgeons play a pivotal role in all aspects of melanoma care: diagnostic, curative, and palliative. There is a high potential for cure in patients with early-stage melanoma and the selection of an appropriate operation is very important for this reason.

Notch signaling drives stemness and tumorigenicity of esophageal adenocarcinoma.

Esophageal adenocarcinoma ranks sixth in cancer mortality in the world and its incidence has risen dramatically in the Western population over the last decades. Data presented herein strongly suggest that Notch signaling is critical for esophageal adenocarcinoma and underlies resistance to chemotherapy. We present evidence that Notch signaling drives a cancer stem cell phenotype by regulating genes that establish stemness.

Developments in the treatment of locally advanced and metastatic squamous cell carcinoma of the skin: a rising unmet need.

Squamous cell carcinoma of the skin (SCCS) is a common malignancy with potentially devastating consequences in patients with locally advanced or metastatic disease. Its rising incidence, primarily a result of an aging population and increased ultraviolet (UV) radiation exposure, characterize an emerging unmet need. A firm understanding of the biology of this disease, likely distinct from that of other squamous malignancies because of the influence of UV radiation, is necessary in the evaluation of treatment paradigms.

Tracheobronchial injury in the setting of an esophagectomy for cancer: postoperative discovery a bad omen.

Background: A tracheobronchial injury is an uncommon complication of an esophagectomy. Differences in outcomes may exist for patients with injuries detected intraoperatively and postoperatively.

Methods: A retrospective review was performed for patients who underwent an esophagectomy for cancer at Jackson Memorial Hospital/University of Miami from January 2000 to June 2012.

Identification of accessory spleens during laparoscopic splenectomy is superior to preoperative computed tomography for detection of accessory spleens.

Background: Missed accessory spleen (AcS) can cause recurrence of hematologic disease after splenectomy. The objective of the study was to determine whether detection of AcS is more accurate with preoperative computed tomography (CT) scan or with exploration during laparoscopic splenectomy.

Methods: A retrospective chart review was performed for 75 adult patients who underwent laparoscopic splenectomy for various hematologic disorders from 1999 to 2009.

Non-Hodgkin's Lymphoma as a Risk Factor for Persistent Chylothorax After Transhiatal Esophagectomy.

We report a case of an 82 years old female with Non-Hodgkin Lymphoma (NHL) in remission whom underwent a transhiatal esophagectomy (THE) for esophageal adenocarcinoma. The post-operative course was complicated by severe chylothorax requiring an additional thoracotomy for ligation of the thoracic duct. The influence of the patient's history of NHL on the development of such a severe chylothorax is under question.

Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease.

Background And Objectives: Discovery of incidental gallbladder cancer (IGC) has become more frequent due to adoption of laparoscopy. Gallbladder spillage during operation can disseminate cancer and worsen the prognosis.

Methods: Patients who underwent laparoscopic or open cholecystectomy for benign gallbladder disease January 1996 to August 2011 at two tertiary care facilities were reviewed.

Adjuvant therapy of gastrointestinal stromal tumors.

Purpose Of Review: The treatment of gastrointestinal stromal tumors (GISTs) with tyrosine kinase inhibitors (TKIs), such as imatinib and sunitinib, has produced improved outcomes and survival. However, patients with high-risk tumors still have unacceptably high rates of recurrence and disease progression. In the current review, we examine the various strategies for optimizing the treatment of GISTs.

Role of sentinel lymphadenectomy in thin cutaneous melanomas with positive deep margins on initial biopsy.

Introduction: Breslow thickness (BRES) on initial melanoma biopsy determines need for sentinel lymph node (SLN) biopsy. In presence of positive deep margins, BRES is indeterminate. We hypothesized that thin (BRES <0.

Portal hypertension from nodular regenerative hyperplasia of the liver treated with distal splenorenal shunt.

Portal hypertension (PH) is a devastating sequelae of several pathologic entities, with alcoholic cirrhosis being the most common cause in the western world and endemic schistosomiasis worldwide. A much less common aetiology of non-cirrhotic PH is nodular regenerative hyperplasia (NRH) of the liver. The hallmark of NRH is a benign remodeling of the hepatic parenchyma into regenerative nodules in the absence of fibrosis (1).

Factors influencing the outcome of intestinal anastomosis.

Anastomotic leak (AL) is one of the most serious complications after gastrointestinal surgery. All patients aged 16 years or older who underwent a surgery with single intestinal anastomosis at Morristown Medical Center from January 2006 to June 2008 were entered into a prospective database. To compare the rate of AL, patients were divided into the following surgery-related groups: 1) stapled versus hand-sewn, 2) small bowel versus large bowel, 3) right versus left colon, 4) emergent versus elective, 5) laparoscopic versus converted (laparoscopic to open) versus open, 6) inflammatory bowel disease versus non inflammatory bowel disease, and 7) diverticulitis versus nondiverticulitis.

Laparoscopic splenectomy: outcome and efficacy for massive and supramassive spleens.

Background: Massive and supramassive splenomegaly are relative contraindications to pure laparoscopic splenectomy (LS).

Methods: A retrospective review of adult patients was conducted for splenectomy occurring from 1999 to 2009. Massive and supramassive spleens were defined as craniocaudad length ≥ 17 cm or weight ≥ 600 g and craniocaudad length ≥ 22 cm or weight ≥ 1,600 g, respectively.