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Journal of the American College of... Jan 2023Inguinal lymph node dissection (ILND) is used for diagnosis and treatment in penile cancer (PC), vulvar cancer (VC), and melanomas draining to the inguinal lymph nodes....
BACKGROUND
Inguinal lymph node dissection (ILND) is used for diagnosis and treatment in penile cancer (PC), vulvar cancer (VC), and melanomas draining to the inguinal lymph nodes. However, ILND is often characterized by its morbidity and high wound complication rate. Consequently, we aimed to characterize wound complication rates after ILND.
STUDY DESIGN
The NSQIP database was queried for ILND performed from 2005 to 2018 for melanoma, PC, or VC. Thirty-day wound complications included wound disruption and superficial, deep, and organ-space surgical site infection. Multivariable logistic regression was performed with covariates, including cancer type, age, American Society of Anesthesiologists score ≥3, BMI ≥30, smoking history, diabetes, operative time, and concomitant pelvic lymph node dissection.
RESULTS
A total of 1,099 patients had an ILND with 92, 115, and 892 ILNDs performed for PC, VC, and melanoma, respectively. Wound complications occurred in 161 (14.6%) patients, including 12 (13.0%), 17(14.8%), and 132 (14.8%) patients with PC, VC, and melanoma, respectively. Median length of stay was 1 day (interquartile range 0 to 3 days), and median operative time was 152 minutes (interquartile 83 to 192 minutes). Readmission rate was 12.7%. Wound complications were associated with longer operative time per 10 minutes (odds ratio 1.038, 95% CI 1.019 to 1.056, p < 0.001), BMI ≥30 (odds ratio 1.976, 95% CI 1.386 to 2.818, p < 0.001), and concomitant pelvic lymph node dissection (odds ratio 1.561, 95% CI 1.056 to 2.306, p = 0.025).
CONCLUSIONS
Predictors of wound complications after ILND include BMI ≥30, longer operative time, and concomitant pelvic lymph node dissection. There have been efforts to decrease ILND complication rates, including minimally invasive techniques and modified templates, which are not captured by NSQIP, and such approaches may be considered especially for those with increased complication risks.
Topics: Male; Humans; Inguinal Canal; Lymph Node Excision; Penile Neoplasms; Melanoma; Lymph Nodes
PubMed: 36519902
DOI: 10.1097/XCS.0000000000000438 -
Danish Medical Journal Mar 2017Malignant melanoma is a rare type of cancer in the vagina and vulva associated with a poor prognosis due to late diagnosis and early dissemination. Only a limited amount...
INTRODUCTION
Malignant melanoma is a rare type of cancer in the vagina and vulva associated with a poor prognosis due to late diagnosis and early dissemination. Only a limited amount of literature exists on the condition. This study elucidates the effect of current treatment.
METHODS
All patients diagnosed with malignant melanoma in the vagina or vulva at Aarhus University Hospital, Skejby, Denmark, in the period from 1996 to 2013 were included. Data were collected from the electronic patient records and from the Danish Pathology Register.
RESULTS
A total of 17 patients were included. The average age at the time of diagnosis was 77 years and the median overall survival time was 21.9 months. The five-year survival in this study was 17.7%. The majority of the melanomas were nodular and all of the superficially spreading melanomas were found in the vulva only. Malignant melanoma in the vagina has a poorer prognosis than in the vulva as it is diagnosed later.
CONCLUSIONS
Early diagnosis and staging of this cancer is important. Positron emission tomography-computed tom-ography should be the standard method for staging the disease. Older women with vaginal discharge should always have a gynaecological examination. The primary treatment is resection of the tumour, but future treatment might be a combination of resection and immunotherapy.
FUNDING
none.
TRIAL REGISTRATION
not relevant. .
Topics: Aged; Aged, 80 and over; Denmark; Female; Humans; Melanoma; Middle Aged; Registries; Retrospective Studies; Vaginal Neoplasms; Vulvar Neoplasms
PubMed: 28260594
DOI: No ID Found -
Romanian Journal of Morphology and... 2008A rare case of amelanotic vulvar melanoma is presented. The patient was a 71-year-old woman complaining of vulvar itching and yellowish vaginal discharge who underwent a... (Review)
Review
A rare case of amelanotic vulvar melanoma is presented. The patient was a 71-year-old woman complaining of vulvar itching and yellowish vaginal discharge who underwent a complete gynecological evaluation during which a suspicious grey-whitish mass on her vulva was observed. The tumor presented superficial ulceration and was located in the upper half of the labia minora and clitoris. Initially it was suspected to be a vulvar carcinoma. A biopsy was taken and a histopathological suspicion of amelanotic melanoma was rendered. The mass was radically excised and the diagnosis was confirmed using HMB-45, Melan-A and anti-S-100 protein antibodies. Malignant melanoma is readily diagnosed by the presence of melanin granules. Although amelanotic melanoma contains a few melanin granules, it is often difficult to differentiate it from other non-epithelial malignant tumors. This report describes a case of amelanotic melanoma of the vulva, which was correctly diagnosed by immunohistochemical staining with the HMB-45, Melan-A antibody and for the S-100 protein.
Topics: Aged; Antigens, Neoplasm; Female; Humans; MART-1 Antigen; Melanoma, Amelanotic; Melanoma-Specific Antigens; Neoplasm Proteins; S100 Proteins; Vulvar Neoplasms
PubMed: 18516330
DOI: No ID Found -
BMC Cancer Jun 2021Malignant melanoma of the female genital tract is relatively uncommon and accounts for 3-7% of all melanoma localizations. This study aimed to identify driver genes in...
BACKGROUND
Malignant melanoma of the female genital tract is relatively uncommon and accounts for 3-7% of all melanoma localizations. This study aimed to identify driver genes in melanoma of the female genital tract with the purpose of enhancing understanding of disease pathogenesis and identifying potential new therapeutic targets to develop effective therapies.
METHODS
KIT (CD117) and BRAF expression were detected immunohistochemically. Polymerase Chain Reaction (PCR) and Sanger sequencing techniques were performed to identify the mutational status of BRAF, NRAS, KRAS, NF1, KIT, PDGFRA and SF3B1 on 19 melanomas of the female genital tract, paired with 25 cutaneous melanomas, 18 acral melanomas and 11 melanomas of nasal cavity.
RESULTS
Somatic variant analysis identified KRAS (6/19; 32%) as the most commonly mutated gene, followed by KIT (4/19; 21%), SF3B1 (3/19; 16%) and NRAS (1/19; 5%). None of the cases were found to harbor BRAF, NF1 and PDGFRA mutations in melanomas of the female genital tract. However, none of the cases were found to harbor SF3B1 and KIT mutations in cutaneous melanomas, acral melanomas and melanomas of nasal cavity. Recurrent KIT mutations, as well as mutations in the less frequently mutated genes NRAS and SF3B1, were exclusively detected in vulvovaginal melanomas, but not in tumors arising in the cervix. However, recurrent KRAS mutations were detected in similar frequencies in tumors of the vulva, vagina, and cervix. Additionally, recurrent KRAS and KIT mutations occurred predominantly in polygonal and epithelioid cell types of melanoma in the female genital tract. Immunohistochemistry revealed moderate or strong cytoplasmic CD117 expression in 6 of the 19 cases (31.6%).
CONCLUSIONS
We observed that gynecologic melanoma harbored distinct mutation rates in the KIT, BRAF, SF3B1, KRAS, and NRAS genes. Our findings support the notion that gynecologic melanoma is a distinct entity from non-gynecologic melanoma, and these findings offer insights into future therapeutic options for these patients.
Topics: Adult; Aged; Female; Genital Neoplasms, Female; High-Throughput Nucleotide Sequencing; Humans; Melanoma; Middle Aged; Mutation; Phosphoproteins; Proto-Oncogene Proteins c-kit; Proto-Oncogene Proteins p21(ras); RNA Splicing Factors
PubMed: 34102999
DOI: 10.1186/s12885-021-08427-x -
Seminars in Nuclear Medicine Nov 2019Gynecologic cancers are one of the most important causes of women death worldwide. The sentinel lymph node concept was introduced by Cabanas in 1977 for the penile... (Review)
Review
Gynecologic cancers are one of the most important causes of women death worldwide. The sentinel lymph node concept was introduced by Cabanas in 1977 for the penile cancer. This technique was proven safe and feasible in selected cancers such as breast cancer, melanoma, or some gynecologic cancers. Sentinel lymph node mapping is increasingly used in early stages of cervical or vulvar cancer in particular due to the safety, high detection rate, and sensitivity of the technique. In this review, we will discuss in depth the most recent evidence of nuclear medicine and other techniques used to determine the status of the sentinel lymph node in women affected by gynecologic neoplasms. Although significant efforts have been already done in order to address several issues, there are still determined questions without a clear answer, in particular for endometrial, ovarian, and vaginal neoplasms.
Topics: Female; Genital Neoplasms, Female; Humans; Sentinel Lymph Node Biopsy
PubMed: 31630736
DOI: 10.1053/j.semnuclmed.2019.06.012 -
American Journal of Clinical Dermatology Apr 2020Vulvar melanoma (VuM) and vaginal melanoma (VaM) represent a unique subgroup of malignant melanomas with important differences in biology and treatment.
BACKGROUND
Vulvar melanoma (VuM) and vaginal melanoma (VaM) represent a unique subgroup of malignant melanomas with important differences in biology and treatment.
OBJECTIVE
The objective of this study was to describe the epidemiology and prognosis of VuM and VaM in a large representative cohort.
METHODS
Women with invasive VuM or VaM were identified from the Surveillance, Epidemiology and End Results-18 population representing 27.8% of the US population. Data on age, ethnicity, stage, location, histopathology, primary surgery, and lymphadenectomy were collected. The Kaplan-Meier method was used to analyze disease-specific and overall survival. Univariate and multivariate regression models were used to identify factors with a significant association with disease-specific survival.
RESULTS
A total of 1400 VuM and 463 VaM were included for further analysis; 78.6% and 49.7% of women with VuM and VaM underwent surgery, but only 52.9% of women with non-metastatic VuM and 42.9% of women with non-metastatic VaM undergoing surgery had lymph node assessment; one third of these had positive nodes. Superficial spreading was the most common subtype in VuM, and nodular melanoma in VaM (p < 0.001). The median disease-specific survival was 99 months (95% confidence interval 60-138) and 19 months (95% confidence interval 16-22), respectively. Survival was significantly associated with age at diagnosis, ethnicity, stage, surgery, lymph node metastases, histologic subtype, ulceration, mitotic count, and tumor thickness in VuM, and stage, surgery, and lymph node involvement in VaM. In the Cox model, lymph node status and number of mitoses remained independent predictors of outcome in VuM; in VaM, only lymph node status remained significant.
CONCLUSIONS
The overall prognosis of VuM and VaM remains poor. The American Joint Committee on Cancer staging system is applicable and should be used for VuM; however, lymph node status and mitotic rate are the most important predictors of survival. Lymph node status should be assessed and patients with positive nodes may be candidates for adjuvant treatment.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Cohort Studies; Female; Humans; Melanoma; Middle Aged; SEER Program; United States; Vagina; Vaginal Neoplasms; Vulva; Vulvar Neoplasms; Young Adult
PubMed: 31784896
DOI: 10.1007/s40257-019-00487-x -
International Journal of Medical... 2017The gold standard for the detection of urothelial carcinoma is represented by urethro-cystoscopy and biopsy. Both procedures are invasive and expensive and therefore... (Review)
Review
The gold standard for the detection of urothelial carcinoma is represented by urethro-cystoscopy and biopsy. Both procedures are invasive and expensive and therefore cytology is often used as first approach to investigate on a possible neoplasia, being a safe and cost-effective diagnostic modality of evaluation. Because cytology alone is not highly sensitive for detection of low grade urothelial carcinoma and recurrence of the disease, several adjunct markers and urine based tests for urothelial carcinoma have been developed, which can help in the final diagnosis. In particular, ProEx C is an immunohistochemical cocktail containing antibodies direct against topoisomerase IIα (TOP2A) and minichromosome maintenance 2 (MCM2) proteins. It proved to be a valid biomarker especially in detecting squamous intraepithelial lesions in cervical liquid-based samples and in discerning these lesions from their mimickers, as well as in ovarian, endometrial, vulvar, primary and metastatic melanomas, breast, pancreatic and renal cell carcinomas. This brief review covers the effective utility of ProEx C as adjunct tool in assessing the urothelial lesions in urine cytology, also providing prognostic and therapeutic information to help in clinical decisions.
Topics: Antibodies; Biomarkers, Tumor; Cytodiagnosis; DNA Topoisomerases, Type II; Female; Humans; Minichromosome Maintenance Complex Component 2; Poly-ADP-Ribose Binding Proteins; Prognosis; Reagent Kits, Diagnostic; Urologic Neoplasms; Vaginal Smears
PubMed: 28638271
DOI: 10.7150/ijms.17890 -
International Journal of Gynecological... Jul 2019
Topics: Adult; Female; Humans; Immunotherapy; Melanoma; Vulvar Neoplasms
PubMed: 31196869
DOI: 10.1136/ijgc-2019-000610 -
Annals of Oncology : Official Journal... Aug 2002There is a clear rationale for using hyperthermia in cancer treatment. Treatment at temperatures between 40 and 44 degrees C is cytotoxic for cells in an environment... (Review)
Review
There is a clear rationale for using hyperthermia in cancer treatment. Treatment at temperatures between 40 and 44 degrees C is cytotoxic for cells in an environment with a low pO(2) and low pH, conditions that are found specifically within tumour tissue, due to insufficient blood perfusion. Under such conditions radiotherapy is less effective, and systemically applied cytotoxic agents will reach such areas in lower concentrations than in well perfused areas. Therefore, the addition of hyperthermia to radiotherapy or chemotherapy will result in at least an additive effect. Furthermore, the effects of both radiotherapy and many drugs are enhanced at an increased temperature. Hyperthermia can be applied by several methods: local hyperthermia by external or internal energy sources, regional hyperthermia by perfusion of organs or limbs, or by irrigation of body cavities, and whole body hyperthermia. The use of hyperthermia alone has resulted in complete overall response rates of 13%. The clinical value of hyperthermia in addition to other treatment modalities has been shown in randomised trials. Significant improvement in clinical outcome has been demonstrated for tumours of the head and neck, breast, brain, bladder, cervix, rectum, lung, oesophagus, vulva and vagina, and also for melanoma. Additional hyperthermia resulted in remarkably higher (complete) response rates, accompanied by improved local tumour control rates, better palliative effects and/or better overall survival rates. Generally, when combined with radiotherapy, no increase in radiation toxicity could be demonstrated. Whether toxicity from chemotherapy is enhanced depends on sequence of the two modalities, and on which tissues are heated. Toxicity from hyperthermia cannot always be avoided, but is usually of limited clinical relevance. Recent developments include improvements in heating techniques and thermometry, development of hyperthermia treatment planning models, studies on heat shock proteins and an effect on anti-cancer immune responses, drug targeting to tumours, bone marrow purging, combination with drugs targeting tumour vasculature, and the role of hyperthermia in gene therapy. The clinical results achieved to date have confirmed the expectations raised by results from experimental studies. These findings justify using hyperthermia as part of standard treatment in tumour sites for which its efficacy has been proven and, furthermore, to initiate new studies with other tumours. Hyperthermia is certainly a promising approach and deserves more attention than it has received until now.
Topics: Antineoplastic Agents; Body Temperature; Clinical Trials as Topic; Combined Modality Therapy; Humans; Hyperthermia, Induced; Neoplasms
PubMed: 12181239
DOI: 10.1093/annonc/mdf280 -
Scientific Reports Jan 2020Mucosal melanomas are primary malignant neoplasias originated from melanocytes within mucous membranes in any part of mucosal surface lining, more commonly, in the nasal...
Mucosal melanomas are primary malignant neoplasias originated from melanocytes within mucous membranes in any part of mucosal surface lining, more commonly, in the nasal cavity and accessory sinuses, oral cavity, lips, pharynx, vulvar, vaginal, cervix and anorectal mucosa. Epidemiology data regarding mucosal melanomas in Brazil is scarce, hence the motivation to conduct this research paper. The χ2 test was used to compare categorical variables. Forward stepwise logistic regression method was used in the multivariate analysis to identify independent predictors of early death. A total of 801 patients were included in the analysis. Surgical resection is frequently the first approach to primary tumours (65.3%), even though the utility of lymph node surgery and radiation therapy is not well established. Advanced stage was observed in more than two thirds of patients. Early death was observed in 28.3%. MM cases with regional or distant metastases as well as those located in unusual locations had almost 4 times more risk for early death. Besides that, MM located in lips, oral cavity and pharynx and those receiving chemotherapy had 2 times more risk of early death.
Topics: Brazil; Female; Humans; Logistic Models; Male; Melanoma; Mucous Membrane; Neoplasm Metastasis; Neoplasm Staging; Survival Analysis
PubMed: 31949210
DOI: 10.1038/s41598-019-57253-6