Is a level III dissection necessary for a positive sentinel lymph node in melanoma?

Background: For melanoma patients with a positive axillary SLN, the extent of ALND remains controversial, with debate over whether a level III dissection is needed.

Methods: We queried our IRB approved prospective database for patients with a positive axillary SLN who had a level I/II dissection only, and compared recurrence and complication rates to the existing literature.

Results: Between 1998 and 2008, 270 patients had 285 level I/II ALNDs for a positive SLN.

Sentinel lymph node biopsy is accurate and prognostic in head and neck melanoma.

Background: Sentinel lymph node biopsy (SLNB) has emerged as a widely used staging procedure for cutaneous melanoma. However, debate remains around the accuracy and prognostic implications of SLNB for cutaneous melanoma arising in the head and neck, as previous reports have demonstrated inferior results to those in nonhead and neck regions. Through the largest single-institution series of head and neck melanoma patients, the authors set out to demonstrate that SLNB accuracy and prognostic value in the head and neck region are comparable to other sites.

The role of full-thickness scalp resection for management of primary scalp melanoma.

Background: Scalp melanoma is aggressive and has a proclivity for regional metastasis. We hypothesize that subperiosteal scalp melanoma resection reduces in-transit/satellite recurrence, when compared with subgaleal resection.

Methods: We identified patients with intermediate to deep, primary scalp melanoma referred to head/neck surgery over an 8-year period.

Features predicting sentinel lymph node positivity in Merkel cell carcinoma.

Purpose: Merkel cell carcinoma (MCC) is a relatively rare, potentially aggressive cutaneous malignancy. We examined the clinical and histologic features of primary MCC that may correlate with the probability of a positive sentinel lymph node (SLN).

Methods: Ninety-five patients with MCC who underwent SLN biopsy at the University of Michigan were identified.

Surgical management of primary disease.

Despite advancements in the treatment of melanoma, surgical management remains the cornerstone for treatment and long-term survival. The authors present their surgical approach to the patient with melanoma including evaluation, treatment, and reconstruction. In addition, management of melanoma occurring in difficult anatomic areas and in special patient populations is reviewed.

Is there a benefit to sentinel lymph node biopsy in patients with T4 melanoma?

Background: Controversy exists as to whether patients with thick (Breslow depth>4 mm), clinically lymph node-negative melanoma require sentinel lymph node (SLN) biopsy. The authors examined the impact of SLN biopsy on prognosis and outcome in this patient population.

Methods: A review of the authors' institutional review board-approved melanoma database identified 293 patients with T4 melanoma who underwent surgical excision between 1998 and 2007.

Prognostic significance of a positive nonsentinel lymph node in cutaneous melanoma.

Purpose: Sentinel lymph node (SLN) biopsy provides important prognostic information for patients with cutaneous melanoma. There may be additional prognostic significance to melanoma spreading from the SLN to nonsentinel lymph nodes (NSLN). We examined the implications of a positive NSLN for overall and distant disease-free survival.

Do micromorphometric features of metastatic deposits within sentinel nodes predict nonsentinel lymph node involvement in melanoma?

Introduction: Multiple attempts have been made to identify melanoma patients with a positive sentinel lymph node (SLN) who are unlikely to harbor residual disease in the nonsentinel lymph nodes (NSLN). We examined whether the size and location of the metastases within the SLN may help further stratify the risk of additional positive NSLN.

Methods: A review of our Institutional Review Board (IRB)-approved melanoma database was undertaken to identify all SLN positive patients with SLN micromorphometric features.

The effects of TeleWound management on use of service and financial outcomes.

This study investigated the effects of a TeleWound program on the use of service and financial outcomes among homebound patients with chronic wounds. The TeleWound program consisted of a Web-based transmission of digital photographs together with a clinical protocol. It enabled homebound patients with chronic pressure ulcers to be monitored remotely by a plastic surgeon.

Diagnosis and management of pressure ulcers.

Pressure ulcers represent a significant health issue and cost for the growing number of elderly and debilitated patients. The plastic surgeon, as part of the wound care team, has the ultimate responsibility of forming a plan to allow for the eventual closure of the wound. This plan should start with breaking the cycle and eliminating the risk factors that led to the development of the wound.

Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy.

Background: With the introduction of sentinel lymph node (SLN) biopsy for melanoma, inguinal lymph node dissections (ILND) are more commonly performed for microscopic disease than for clinically palpable disease. We sought to examine the effect this change has on the morbidity of the operation.

Methods: A retrospective review was performed of all patients who underwent an ILND for melanoma between October 1997 and April, 2006.

The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma.

Background: In addition to Breslow depth, the authors previously described how increasing mitotic rate and decreasing age predicted sentinel lymph node (SLN) metastases in patients with melanoma. The objectives of the current study were to verify those previous results and to create a prediction model for the better selection of which patients with melanoma should undergo SLN biopsy.

Methods: The authors reviewed 1130 consecutive patients with melanoma in a prospective database who underwent successful SLN biopsy.

Wide excision without radiation for desmoplastic melanoma.

Background: Adjuvant radiation has been proposed for the treatment of patients with desmoplastic melanoma, who reportedly have local recurrence rates as high as 40-60%. The authors investigated local recurrence rates at a tertiary referral center to determine the success of wide excision alone for patients with desmoplastic melanoma.

Methods: A review of a prospectively maintained melanoma clinical data base identified 65 patients between March 1997 and March 2004 with pure cutaneous desmoplastic melanoma.

Predictors of nonsentinel lymph node positivity in patients with a positive sentinel node for melanoma.

Background: Patients found to harbor melanoma micrometastases in the sentinel lymph node (SLN) are recommended to proceed to complete lymph node dissection (CLND), although the majority of patients will have no additional disease identified in the nonsentinel lymph nodes (NSLNs). We sought to assess predictive factors associated with finding positive NSLNs, and identify a subset of patients with low likelihood of finding additional disease on CLND.

Study Design: We queried our prospective melanoma database for patients from January 1996 to August 2003 with a positive SLN.

The use of a bovine collagen construct for reconstruction of full-thickness scalp defects in the elderly patient with cutaneous malignancy.

Full-thickness defects of the scalp following cancer resection are reconstructive challenges when bone is exposed. Local, regional, and/or free tissue transfer have all been described for reconstruction when the pericranium is exposed. We examined the surgical outcomes from 23 patients who underwent placement of bovine collagen constructs.

Cutaneous angiosarcoma of the scalp: a multidisciplinary approach.

Background: Angiosarcoma is a malignant tumor of vascular endothelial cells that arises in the head and neck. It is a rare, difficult to treat, and lethal tumor.

Methods: Clinical data from patients who were diagnosed with angiosarcoma of the scalp between 1975 and 2002 at the University of Michigan were reviewed.

The utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population.

Intraoperative lymph node mapping and sentinel lymph node biopsy have proven beneficial techniques in staging adult patients with melanoma of the head and neck, where there is great variability in lymphatic drainage. This technique has also been applied to pediatric patients with truncal cutaneous melanomas in an effort to determine nodal status without the morbidity associated with complete lymph node dissection. Nevertheless, the utility of sentinel lymph node biopsy in head and neck melanoma in the pediatric population has not been established.

Reliability of sentinel lymph node mapping with biopsy for head and neck cutaneous melanoma.

Objectives: To determine (1) the reliability of sentinel lymph node mapping with biopsy (SLNB) in head and neck cutaneous melanoma to accurately stage nodal basins and (2) the safety of SLNB in both the neck and parotid regions.

Design: Retrospective cohort study with a median follow-up of 25 months. All patients had a minimum follow-up of 1 year.

Role of glutathione redox dysfunction in diabetic wounds.

We propose that diabetic foot ulcers and diabetic mouse wounds have insufficient glutathione to maintain correct cellular redox potential. Therefore, tissue samples from the wound edge of diabetic foot ulcers, diabetic mice wounds and nondiabetic mice wounds were obtained. Levels of glutathione, cysteine, and mixed protein disulfide were determined and topical application of esterified glutathione in carboxymethylcellulose or carboxymethylcellulose alone was applied to the mice wounds.

MAP kinase pathways involving hsp27 regulate fibroblast-mediated wound contraction.

Background: Heat shock protein 27 (hsp27) has been shown to modulate actin arrays in a manner dependent on its phosphorylation status. Hsp27 is phosphorylated by mitogen-activated protein kinase-activated protein kinase 2/3, which is regulated by mitogen-activated protein (MAP) kinases. We hypothesize that hsp27 phosphorylation modulates wound contraction.