Cartilage-sparing surgery for melanoma of the external ear.
J Plast Reconstr Aesthet Surg. 2018 Sep 04;:
Authors: Harrison C, Wade C, Potter M, Cassell O
BACKGROUND: The excision of melanoma of the external ear poses a challenge to surgeons, who must achieve adequate oncological control while minimising impact on form and function. Cartilage-preserving surgery is an attractive option, as it leaves behind a scaffold for immediate reconstruction with a variety of techniques including full-thickness skin grafts (FTSGs) and local flaps. This manuscript will review the literature comparing cartilage-sparing surgery with composite excision of the skin and the cartilage for the treatment of auricular melanoma. We report the results of a 17 year experience of using both techniques, together with sentinel node biopsy at our centre.
METHODS: A structured review of MEDLINE and EMBASE was conducted to evaluate all studies reporting local recurrence or survival rates for melanoma of the external ear treated with cartilage-preserving surgery. A retrospective review of all patients undergoing wide local excision (WLE) and sentinel lymph node biopsy (SLNB) for auricular melanoma at our centre between 2000 and 2017 was performed.
RESULTS: Of 40 patients identified, 29 underwent cartilage-preserving surgery with no local recurrences or evidence of perichondral involvement. There was one local recurrence out of 11 patients who had their cartilage excised. There were no significant differences in recurrence rates or melanoma-specific survival rates when comparing cartilage-preserving and cartilage-sparing surgery. Our results are supported by the literature review, which suggests that cartilage-sparing surgery is gaining acceptance as a safe practice.
PMID: 30243556 [PubMed - as supplied by publisher]
A population-based registry study on relative survival from melanoma in Germany stratified by tumor thickness for each histological subtype.
J Am Acad Dermatol. 2018 Sep 19;:
Authors: Brunssen A, Jansen L, Eisemann N, Waldmann A, Weberpals J, Kraywinkel K, Eberle A, Holleczek B, Zeissig SR, Brenner H, Katalinic A, GEKID Cancer Survival Working Group
BACKGROUND: Differences in melanoma relative survival (RS) between histologies were discussed to be mainly caused by tumor thickness.
OBJECTIVE: To investigate RS from melanoma, stratified by tumor thickness for each histological subtype, and identify survival trends.
METHODS: Using cancer registry data on melanoma cases (ICD-10: C43.0-C43.9) diagnosed in Germany in 1997-2013, 5- and 10-year age-standardized RS stratified by histology and stratified or standardized by T-stage was estimated using standard and modelled period analyses. We restricted 10-year RS analyses to patients younger than 75 years.
RESULTS: We analyzed 82,901 cases. Overall, 5- and 10-year RS was 91.7% and 90.8%, respectively. Prognosis worsened with increasing T-stage for all histologies but T-stage distribution varied substantially. Survival differences by histology were strongly alleviated after adjustment for T-stage, but remained significant. Overall, 5-year RS increased significantly by 3.8 percentage points between 2002-2005 and 2010-2013. This increase was no longer seen after adjustment for T-stage.
LIMITATIONS: Exclusion of cases due to missing information on T-stages, changes in the definition of T-stages, and lack of information on screening and treatment limit our analyses.
CONCLUSION: Differences in RS between histologies were strongly mediated by tumor thickness. Over time, melanoma RS increased due to changes in T-stage distribution.
PMID: 30244061 [PubMed - as supplied by publisher]
Reflectance confocal microscopy as novel tool for pre-surgical identification of basal cell carcinoma biopsy site.
J Am Acad Dermatol. 2018 Sep 19;:
Authors: Navarrete-Dechent C, Mori S, Cordova M, Nehal KS
PMID: 30244067 [PubMed - as supplied by publisher]
The Use of Cytologic Material in Melanoma for PD-L1 Immunostaining.
Cytopathology. 2018 Sep 22;:
Authors: Bashover E, Arriola AG, Joseph CT, Staerkel G, Wang WB, Roy-Chowdhuri S
OBJECTIVE: Interest in immune therapies has exploded since the 2014 approval of first generation programed cell death 1 (PD-1) blocking antibodies for use in advanced melanoma. Clinical trials have focused primarily on histologic material as the gold standard for evaluating PD-L1 by immunoperoxidase (IPOX) studies. Studies validating the use of cytologic specimens in the assessment of PD-L1 by IPOX staining are needed to optimize tissue utilization in complementary diagnostic testing.
METHODS: Twenty three melanoma surgical biopsies (SBx) with an IPOX stain for PD-L1 clone 28-8, and a corresponding cytologic specimen from the same patient, adequate for PD-L1 evaluation, were selected. Cell-transfer cell blocks (CTCB) and conventional cell blocks (CB), were used to perform PD-L1 testing. Tumor proportion scores (TPS) were generated and the results were correlated with the corresponding SBx.
RESULTS: Overall agreement (OA) using a ≥1% TPS cutoff for SBx compared to CB was 88.9%, positive percent agreement (PPA) was 87.5%, and negative percent agreement (NPA) was 100%, OA using a ≥5% TPS cutoff was 55.6%, PPA was 42.9%, and NPA was 100%. SBx compared to CTCB using a ≥1% TPS cutoff had an OA of 65.2%, a PPA of 55.6%, and a NPA of 100%, while a ≥5% TPS cutoff generated an OA of 52.2%, a PPA of 35.7%, and a NPA of 77.8%.
CONCLUSION: Our results demonstrate that cytologic material, particularly conventional CB, are a viable alternative for evaluating PD-L in melanoma cases and suggest that a lower threshold (≥1%) may be beneficial when evaluating cytologic material. This article is protected by copyright. All rights reserved.
PMID: 30244524 [PubMed - as supplied by publisher]