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Journal of Clinical Medicine Mar 2024: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been...
: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. : to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. : We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. : We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. : Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy.
PubMed: 38541831
DOI: 10.3390/jcm13061607 -
Breast Cancer (Dove Medical Press) 2024Positive margins on lumpectomy specimens are associated with a twofold increased risk of local breast tumor recurrence. Prior literature has demonstrated various...
Does Nipple-Ward Positive Margin Contribute to a Higher Rate of Re-Excision Procedures After a Lumpectomy with Pathology-Confirmed Positive Margins? A Retrospective Study.
BACKGROUND
Positive margins on lumpectomy specimens are associated with a twofold increased risk of local breast tumor recurrence. Prior literature has demonstrated various techniques and modalities for assessing margin status to reduce re-excision rates. However, there is paucity of literature analyzing which margin contributes to the highest re-excision rates. Therefore, the primary aim of the study was to investigate whether the nipple-ward margins resulted in a higher rate of re-excision in our patient population.
METHODS
A retrospective chart review was performed on patients who had re-excision surgery. Nipple-ward margin was identified by correlating radiological and pathological reports. A cut-off of more than 25% was used to demonstrate correlation between nipple-ward margin and re-excision rate.
RESULTS
A total of 98 patients' data were analyzed, with 41 (41.8%), 14 (14.3%), 5 (5.1%), and 38 (38.8%) diagnosed with DCIS, IDC, ILC, and mixed pathology on their margins, respectively. Overall, 48% (n=47) of the positive margins were nipple-ward, with 44.7% (n=21) reporting DCIS. Upon stratification, 45 (45.9%) cases were single-margin positive, with 26 (57.8%) being nipple-ward. Furthermore, the remaining 53 (54.1%) patients had multiple positive margins, with 21 (39.6.7%) nipple-ward cases.
CONCLUSION
Positive nipple-ward margins significantly contribute to a higher re-excision rate p < 0.001; 48% of re-excision surgeries had positive nipple-ward margins, and 57.8% of positive single-margin cases were nipple-ward. Taking an additional shave during initial lumpectomy decreases re-excision rates. However, planning a lumpectomy procedure with a more elliptical rather than a spherical resection with additional cavity shave (ie, larger volume) in the nipple-ward direction and minimizing the remaining cavity shaves so the total volume resected remains unchanged. Nevertheless, future studies with larger sample sizes are required to bolster our findings.
PubMed: 38405107
DOI: 10.2147/BCTT.S425863 -
Antioxidants (Basel, Switzerland) Dec 2023UVB significantly impacts the occurrence of cutaneous disorders, ranging from inflammatory to neoplastic diseases. Polyphenols derived from plants have been found to...
UVB significantly impacts the occurrence of cutaneous disorders, ranging from inflammatory to neoplastic diseases. Polyphenols derived from plants have been found to exhibit photoprotective effects against various factors that contribute to skin cancer. During the fermentation of the polyphenol-enriched blueberry preparation (PEBP), small oligomers of polyphenols were released, thus enhancing their photoprotective effects. This study aimed to investigate the protective effects of PEBP on UVB-induced skin inflammation. Topical preparations of polyphenols were applied to the skin of dorsally shaved mice. Mice were subsequently exposed to UVB and were sacrificed 90 min after UVB exposure. This study revealed that pretreatment with PEBP significantly inhibited UVB-induced recruitment of mast and neutrophil cells and prevented the loss of skin thickness. Furthermore, the findings show that PEBP treatment resulted in the downregulation of miR-210, 146a, and 155 and the upregulation of miR-200c and miR-205 compared to the UVB-irradiated mice. Additionally, PEBP was found to reduce the expression of IL-6, IL-1β, and TNFα, inhibiting COX-2 and increasing IL-10 after UVB exposure. Moreover, DNA methylation analysis indicated that PEBP might potentially reduce the activation of inflammation-related pathways such as MAPK, Wnt, Notch, and PI3K-AKT signaling. Our finding suggests that topical application of PEBP treatment may effectively prevent UVB-induced skin damage by inhibiting inflammation.
PubMed: 38275645
DOI: 10.3390/antiox13010025 -
Current Oncology (Toronto, Ont.) Jan 2024Resection of additional tissue circumferentially around the cavity left by lumpectomy (cavity shave) was suggested to reduce rates of positive margins and re-excision....
Resection of additional tissue circumferentially around the cavity left by lumpectomy (cavity shave) was suggested to reduce rates of positive margins and re-excision. A single center retrospective study which analyzed margins status, re-excision, and surgical time in patients who underwent breast conserving surgery and cavity shave or intraoperative evaluation of resection margins. Between 2021 and 2023, 594 patients were enrolled in the study. In patients subjected to cavity shave, a significant reduction in positive, focally positive, or closer margins was reported 8.9% vs. 18.5% ( = 0.003). No difference was reported in terms of surgical re-excision ( < 0.846) (5% vs. 5.5%). Surgical time was lower in patients subjected to cavity shave (<0.001). The multivariate analysis intraoperative evaluation of sentinel lymph node OR 1.816 and cavity shave OR 2.909 were predictive factors for a shorter surgical time. Excluding patients subjected to intraoperative evaluation of sentinel lymph node and patients with ductal carcinoma in situ, patients that underwent the cavity shave presented a reduced surgical time (67.9 + 3.8 min vs. 81.6 + 2.8 min) ( = 0.006). Cavity shaving after lumpectomy reduced the rate of positive margins and it was associated with a significant reduction in surgical time compared to intraoperative evaluation of resection margins.
Topics: Humans; Carcinoma, Intraductal, Noninfiltrating; Lymphadenopathy; Margins of Excision; Mastectomy, Segmental; Operative Time; Retrospective Studies
PubMed: 38248120
DOI: 10.3390/curroncol31010035 -
Cureus Dec 2023Chromoblastomycosis is a neglected tropical disease typically found in endemic tropical and subtropical regions. Herein, we discuss a rare case of a 55-year-old man in...
Chromoblastomycosis is a neglected tropical disease typically found in endemic tropical and subtropical regions. Herein, we discuss a rare case of a 55-year-old man in Texas who presented with an exophytic papule on the forearm, diagnosed to have chromoblastomycosis by shave biopsy and subsequent histopathological analysis. Treatment options for chromoblastomycosis include long-term oral antifungal therapy with itraconazole, physical modalities such as heat therapy in conjunction with oral antifungals, and surgical interventions such as cryosurgery or surgical excision.
PubMed: 38164315
DOI: 10.7759/cureus.49791 -
Cureus Nov 2023A 65-year-old female with a history of multicentric invasive ductal breast carcinoma with lobular features and prior mastectomy presented with a chief complaint of two...
A 65-year-old female with a history of multicentric invasive ductal breast carcinoma with lobular features and prior mastectomy presented with a chief complaint of two new raised mildly erythematous lesions on the right upper arm. The lesions were visualized during examination, and the patient noted no symptoms associated with them. Tangential shave biopsies were obtained for each lesion and were sent to the lab for testing. Both lesions were found to be metastatic breast carcinoma. Wide local excisions were performed on each site. The patient followed up with radiation therapy and was prescribed Faslodex and Ibrance. FoundationOne testing on the lesions revealed BRCA2 loss in the tumor, and germline DNA testing was performed in light of this. The test yielded negative results for harmful BRCA1 and 2 mutations. The patient was treated with Lynparza (olaparib), and two years following the start of this medication has had no additional recurrences.
PubMed: 38161892
DOI: 10.7759/cureus.49600 -
Plastic and Reconstructive Surgery.... Dec 2023Patients determined to have margin-positive nonmelanoma skin cancer (NMSC) after initial shave or punch biopsy performed by a primary care physician or dermatologist are...
BACKGROUND
Patients determined to have margin-positive nonmelanoma skin cancer (NMSC) after initial shave or punch biopsy performed by a primary care physician or dermatologist are commonly referred to extirpative surgeons for definitive removal. Not infrequently, the residual tumor is not appreciable, and the exact location of the lesion is indiscernible. The consulting surgeon must decide to excise the presumed lesion or clinically monitor for recurrence.
METHODS
This single-center, retrospective review examined patients with squamous and basal cell carcinomas referred over a 5-year period to two senior authors.
RESULTS
In total, 233 patients had a total of 312 lesions excised. Thirty-nine (12.5%) of these lesions (in 33 patients) demonstrated no residual tumor on pathologic examination. Twelve patients were managed nonoperatively (5.15%) and observed to have had no tumor recurrence with a mean observation period of 14.66 months (range 1-54 months). Thus, approximately 19.3% of all patients referred had no residual tumor.
CONCLUSION
Based on our observations and low proclivity for metastases, nonoperative monitoring of NMSC may be a reasonable option for certain lesions less than 1 cm that are undiscernible at the time of referral.
PubMed: 38111724
DOI: 10.1097/GOX.0000000000005473 -
Indian Journal of Dermatology 2023Molluscum-like skin lesions in HIV patients can be the presenting feature of the vast array of diseases. Hence, laboratory investigations play a crucial role in making...
Molluscum-like skin lesions in HIV patients can be the presenting feature of the vast array of diseases. Hence, laboratory investigations play a crucial role in making an accurate etiological diagnosis. The studies that discuss the outcomes of commonly performed laboratory tests in molluscum-like lesions in HIV patients are very sparse. Hence, we conducted a study to bridge this literature gap. This study was conducted among four patients with HIV who had molluscum-like skin lesions. Shave biopsy was performed on all the patients and the specimens were sent for potassium hydroxide (KOH) mount/gram stain, fungal culture and histopathological examination. The tissue samples from cases 1, 2, 3 and 4 are mentioned as samples A, B, C and D, respectively. KOH mount showed yeast-like rounded bodies around 6 μm in size in samples A and B. The KOH mount in samples C and D showed septate branching hyphae. KOH mount in sample C also showed large rounded bodies around 35 μm which were identified as molluscum bodies. The histopathology of samples A and B showed features suggestive of talaromycosis whereas the histopathology of samples C and D showed features of molluscum contagiosum. Culture in Sabouraud Dextrose Agar grew T. marneffei in samples A, B and C. The commonly available laboratory tests immensely help in establishing the diagnosis of molluscum-like skin lesions. However, certain nuances in laboratory tests need to be understood lucidly. Studies with larger sample sizes need to be conducted to determine the possible co-infection of poxvirus and T. marneffei, as witnessed in sample C.
PubMed: 38099129
DOI: 10.4103/ijd.ijd_216_23 -
Frontiers in Medicine 2023The removal of unwanted hair is a widespread grooming practice adopted by both males and females. Although many depilatory techniques are now available, shaving remains...
INTRODUCTION
The removal of unwanted hair is a widespread grooming practice adopted by both males and females. Although many depilatory techniques are now available, shaving remains the most common, despite its propensity to irritate skin. Current techniques to investigate the impact of shaving regimes on skin health rely on costly and lengthy clinical trials, which hinge on recruitment of human volunteers and can require invasive biopsies to elucidate cellular and molecular-level changes.
METHODS
Well-characterised human skin equivalent technology was combined with a commonplace dermatological technique of tape stripping, to remove cellular material from the uppermost layer of the skin (). This method of exfoliation recapitulated aspects of razor-based shaving , offering a robust and standardised method to study inflammatory processes such as those invoked by grooming practices.
RESULTS
Tape strip insult induced inflammatory changes in the skin equivalent such as: increased epidermal proliferation, epidermal thickening, increased cytokine production and impaired barrier function. These changes paralleled effects seen with a single dry razor pass, correlated with the number of tape strips removed, and were attenuated by pre-application of shaving foam, or post-application of moisturisation.
DISCUSSION
Tape strip removal is a common dermatological technique, in this study we demonstrate a novel application of tape stripping, to mimic barrier damage and inflammation associated with a dry shave. We validate this method, comparing it to razor-based shaving and demonstrate the propensity of suitable shave- and skin-care formulations to mitigate damage. This provides a novel methodology to examine grooming associated damage and a platform for screening potential skin care formulations.
PubMed: 38020123
DOI: 10.3389/fmed.2023.1236790 -
Clinical Breast Cancer Jan 2024Intraoperative specimen radiography is a routinely used procedure to ensure adequate resection of non-palpable breast tumors. Intraoperative digital specimen mammography...
INTRODUCTION
Intraoperative specimen radiography is a routinely used procedure to ensure adequate resection of non-palpable breast tumors. Intraoperative digital specimen mammography (IDSM) is an alternative to conventional specimen radiography (CSR) which provides immediate specimen evaluation and can potentially decrease operation time. IDSM may also result in lower positive margin and re-excision rates. IDSM was implemented in our hospital in 2018. The objective of this study was to evaluate the effect of using IDSM versus CSR on operation time, margin status and re-excision rates in breast conserving surgery.
METHODS
The present study is a single-center retrospective cohort study with 2 patient cohorts: one which underwent CSR (n = 532) and one which underwent IDSM (n = 475). The primary outcome was the operation time. Secondary outcomes were the margin status of the primary surgery, the cavity shaving rate, and the re-excision rate. Differences between cohorts were compared using univariate statistics and multiple regression analyses to adjust for variables that were significantly different between the groups.
RESULTS
IDSM use was associated with an 8-minute reduction in surgery time (B = -8.034, 95% CI [-11.6, -4.5]; P < .001). Treatment variables independently associated with the operation time included use of IDSM, type of surgery, and performance of cavity shaving. Cavity shaves were more often performed when IDSM was used (24% for IDSM vs. 14% for CSR, P < .001), while the proportion of negative margin rates (93% for IDSM vs. 96% for CSR, P = .070) was comparable.
CONCLUSION
IDSM was associated with a modest reduction in operation time. Surgeons performed more cavity shaves since the introduction of IDSM, but this increase was not reflected by difference in negative margin rates.
Topics: Humans; Female; Breast Neoplasms; Mastectomy, Segmental; Retrospective Studies; Mammography; Breast; Reoperation; Margins of Excision; Carcinoma, Ductal, Breast
PubMed: 37926663
DOI: 10.1016/j.clbc.2023.10.002