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Kee Yang Chung - One of the best experts on this subject based on the ideXlab platform.
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comparison of negative pressure wound therapy and secondary intention healing after Excision of acral lentiginous melanoma on the foot
British Journal of Dermatology, 2013Co-Authors: Soohyeon Lee, K A Nam, H B Lee, Kee Yang ChungAbstract:Summary Background Melanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot and Wide Excision usually results in a substantial defect. Various repair methods, including free flap, full-thickness skin graft and secondary intention healing (SIH), are used to repair these defects. Recently, use of negative pressure wound treatment (NPWT) has been shown to accelerate wound healing in different types of wound. Objectives To compare the functional and cosmetic results of NPWT and SIH in patients who underwent Wide Excision of melanomas on the foot. Methods The wound defects of 22 patients after Wide Excision of melanoma on the foot were treated using SIH (n = 13) or NPWT (n = 9). Results There was no significant difference in time to complete wound healing between the two groups. However, evaluation using the Vancouver Burn Scar Assessment Scale at the time of complete healing showed that the mean score of the NPWT group was significantly lower than that of the SIH group. The NPWT group also had significantly better results than the SIH group in terms of total score, vascularity and height of the scars. As for complications, no wound infection was encountered in the NPWT group, whereas eight of the 13 patients in SIH group had wound infections during the course of treatment despite frequent and meticulous aseptic dressing changes. Conclusions These results show that, despite the drawback of rather prolonged healing time, NPWT is an excellent therapeutic option for wounds after Wide Excision of melanoma on the foot, with acceptable functional and cosmetic outcomes.
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comparison of secondary intention healing and full thickness skin graft after Excision of acral lentiginous melanoma on foot
Dermatologic Surgery, 2011Co-Authors: Jin-young Jung, Kee Yang ChungAbstract:BACKGROUND: Melanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot. After Wide Excision, substantial defects usually develop and they may endure insufficient vascular flow. In addition, the final scar must withstand the mechanical stress of daily walking. Various repair methods are used to repair these defects, but secondary intention healing has not been evaluated in the repair of wounds of the foot. OBJECTIVE: To compare the functional and cosmetic results of secondary intention healing and full-thickness skin graft after Wide Excision of melanoma on the foot. METHODS: Retrospective review of 25 patients who were treated using Excision for melanoma on the foot. The defects of 13 patients were healed by secondary intention (secondary intention healing group; SIHG), and those of 12 patients were repaired by full-thickness skin graft (skin graft group; SGG). RESULTS: The SGG showed more rapid healing than the SIHG, but the SIHG showed better functional and cosmetic outcomes at complete re-epithelialization than the SGG as evaluated by patients and independent physicians. CONCLUSIONS: Secondary intention healing after Excision of melanoma from the foot is a therapeutic option with acceptable functional and cosmetic outcomes.
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comparison of secondary intention healing and full thickness skin graft after Excision of acral lentiginous melanoma on foot
Dermatologic Surgery, 2011Co-Authors: Jin-young Jung, Hyo Jin Roh, Soo Hyun Lee, Kyoungae Nam, Kee Yang ChungAbstract:BACKGROUNDMelanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot. After Wide Excision, substantial defects usually develop and they may endure insufficient vascular flow. In addition, the final scar must withstand the mechanical stress of daily walking. Vario
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comparison of mohs micrographic surgery and Wide Excision for extramammary paget s disease korean experience
Dermatologic Surgery, 2009Co-Authors: Woo Gil Chung, Kee Yang ChungAbstract:BACKGROUND Extramammary Paget's disease (EMPD) is an uncommon tumor that usually occurs on the genitalia. It almost always extends beyond clinically apparent margins and has a high rate of recurrence. OBJECTIVE To establish treatment guidelines for EMPD in Asian patients. METHODS A retrospective review was done on pertinent demographic data, tumor data, treatment characteristics, and follow-up data of 35 patients between 1996 and 2006. Review of literature for treatment modalities and recurrence rates of EMPD was also performed. RESULTS Thirty-four of the 35 patients (30 men and 5 women) had lesions in the genital area and one patient in the axilla. Mean follow-up duration was 62.7 months (8–156 months) and two of 11 (18.2%) recurred after Mohs micrographic surgery (MMS), compared with eight recurrences of 22 (36.4%) after standard Wide Excision. Two patients treated with nonsurgical modalities did not achieve complete remission. Estimated 5-year tumor-free rate using Kaplan-Meier graph was 69.7% in all patients, with a rate of 81.8% for MMS and 63.6% for Wide Excision. CONCLUSIONS MMS is more effective, with lower recurrence rate than Wide Excision, and should be regarded as the first-line treatment for nonmetastatic EMPD.
John F Thompson - One of the best experts on this subject based on the ideXlab platform.
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final trial report of sentinel node biopsy versus nodal observation in melanoma
The New England Journal of Medicine, 2014Co-Authors: Donald L Morton, John F Thompson, Alistair J Cochran, Nicola Mozzillo, Omgo E Nieweg, Daniel F Roses, Harald J Hoekstra, C P Karakousis, C A Puleo, Brendon J CoventryAbstract:Background Sentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase 3 trial. Methods We evaluated outcomes in 2001 patients with primary cutaneous melanomas randomly assigned to undergo Wide Excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or Wide Excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group). Results No significant treatment-related difference in the 10-year melanoma-specific survival rate was seen in the overall study population (20.8% with and 79.2% without nodal metastases). Mean (±SE) 10-year disease-free survival rates were significantly improved in the biopsy group, as compared with the observation group, among patients with intermediate-thickness melanomas, defined as 1.20 to 3.50 mm (71.3±1.8% vs. 64.7±2.3%; hazard ratio for recurrence or metastasis, 0.76; P=0.01), and those with thick melanomas, defined as >3.50 mm (50.7±4.0% vs...
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final trial report of sentinel node biopsy versus nodal observation in melanoma
The New England Journal of Medicine, 2014Co-Authors: Donald L Morton, John F Thompson, Alistair J Cochran, Nicola Mozzillo, Omgo E Nieweg, Daniel F Roses, Harald J Hoekstra, C P Karakousis, C A Puleo, Brendon J CoventryAbstract:Background Sentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase 3 trial. Methods We evaluated outcomes in 2001 patients with primary cutaneous melanomas randomly assigned to undergo Wide Excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or Wide Excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group). Results No significant treatment-related difference in the 10-year melanoma-specific survival rate was seen in the overall study population (20.8% with and 79.2% without nodal metastases). Mean (±SE) 10-year disease-free survival rates were significantly improved in the biopsy group, as compared with the observation group, among patients with intermediate-thickness melanomas, defined as 1.20 to 3.50 mm (71.3±1.8% vs. 64.7±2.3%; hazard ratio for recurrence or metastasis, 0.76; P=0.01), and those with thick melanomas, defined as >3.50 mm (50.7±4.0% vs...
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surgical Excision margins for primary cutaneous melanoma
Sao Paulo Medical Journal, 2011Co-Authors: Michael J Sladden, Charles M Balch, David A Barzilai, Daniel Berg, Anatoli Freiman, Teenah Handiside, Sally Hollis, Marko B Lens, John F ThompsonAbstract:BACKGROUND: Cutaneous melanoma accounts for 75% of skin cancer deaths. Standard treatment is surgical Excision with a safety margin some distance from the borders of the primary tumour. The purpose of the safety margin is to remove both the complete primary tumour and any melanoma cells that might have spread into the surrounding skin. Excision margins are important because there could be trade-off between a better cosmetic result but poorer long-term survival if margins become too narrow. The optimal width of Excision margins remains unclear. This uncertainty warrants systematic review. OBJECTIVES: To assess the effects of different Excision margins for primary cutaneous melanoma. SEARCH STRATEGY: In August 2009 we searched for relevant randomised trials in the Cochrane Skin Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), Medline, Embase, Lilacs, and other databases including Ongoing Trials Registers. SELECTION CRITERIA: We considered all randomized controlled trials (RCTs) of surgical Excision of melanoma comparing different width Excision margins. DATA COLLECTION AND ANALYSIS: We assessed trial quality, and extracted and analyzed data on survival and recurrence. We collected adverse effects information from included trials. MAIN RESULTS: We identified five trials. There were 1633 participants in the narrow Excision margin group and 1664 in the Wide Excision margin group. Narrow margin definition ranged from 1 to 2 cm; Wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. AUTHORS’ CONCLUSIONS: This systematic review summarises the evidence regarding width of Excision margins for primary cutaneous melanoma. None of the five published trials, nor our meta-analysis, showed a statistically significant difference in overall survival between narrow or Wide Excision. The summary estimate for overall survival favoured Wide Excision by a small degree [Hazard Ratio 1.04; 95% confidence interval 0.95 to 1.15; P = 0.40], but the result was not significantly different. This result is compatible with both a 5% relative reduction in overall mortality favouring narrower Excision and a 15% relative reduction in overall mortality favouring Wider Excision. Therefore, a small (but potentially important) difference in overall survival between Wide and narrow Excision margins cannot be confidently ruled out. The summary estimate for recurrence free survival favoured Wide Excision [Hazard Ratio 1.13; P = 0.06; 95% confidence interval 0.99 to 1.28] but again the result did not reach statistical significance (P < 0.05 level). Current randomized trial evidence is insufficient to address optimal Excision margins for primary cutaneous melanoma. The review is fully available (through the Cochrane Journal Club) from: http://www.cochranejournalclub.com/surgical-Excision-margins-clinical/pdf/JC2_Excision_margins_full.pdf
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surgical Excision margins for primary cutaneous melanoma
Cochrane Database of Systematic Reviews, 2009Co-Authors: Michael J Sladden, Charles M Balch, David A Barzilai, Daniel Berg, Anatoli Freiman, Teenah Handiside, Sally Hollis, Marko B Lens, John F ThompsonAbstract:Background Cutaneous melanoma accounts for 75% of skin cancer deaths. Standard treatment is surgical Excision with a safety margin some distance from the borders of the primary tumour. The purpose of the safety margin is to remove both the complete primary tumour and any melanoma cells that might have spread into the surrounding skin. Excision margins are important because there could be trade-off between a better cosmetic result but poorer long-term survival if margins become too narrow. The optimal width of Excision margins remains unclear. This uncertainty warrants systematic review. Objectives To assess the effects of different Excision margins for primary cutaneous melanoma. Search methods In August 2009 we searched for relevant randomised trials in the Cochrane Skin Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), MEDLINE, EMBASE, LILACS, and other databases including Ongoing Trials Registers. Selection criteria We considered all randomised controlled trials (RCTs) of surgical Excision of melanoma comparing different width Excision margins. Data collection and analysis We assessed trial quality, and extracted and analysed data on survival and recurrence. We collected adverse effects information from included trials. Main results We identified five trials. There were 1633 participants in the narrow Excision margin group and 1664 in the Wide Excision margin group. Narrow margin definition ranged from 1 to 2 cm; Wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. Authors' conclusions This systematic review summarises the evidence regarding width of Excision margins for primary cutaneous melanoma. None of the five published trials, nor our meta-analysis, showed a statistically significant difference in overall survival between narrow or Wide Excision. The summary estimate for overall survival favoured Wide Excision by a small degree [Hazard Ratio 1.04; 95% confidence interval 0.95 to 1.15; P = 0.40], but the result was not significantly different. This result is compatible with both a 5% relative reduction in overall mortality favouring narrower Excision and a 15% relative reduction in overall mortality favouring Wider Excision. Therefore, a small (but potentially important) difference in overall survival between Wide and narrow Excision margins cannot be confidently ruled out. The summary estimate for recurrence free survival favoured Wide Excision [Hazard Ratio 1.13; P = 0.06; 95% confidence interval 0.99 to 1.28] but again the result did not reach statistical significance (P < 0.05 level). Current randomised trial evidence is insufficient to address optimal Excision margins for primary cutaneous melanoma.
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prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy
American Journal of Surgery, 1995Co-Authors: Christopher J Obrien, John F Thompson, Roger F Uren, Robert Howmangiles, Karin Petersenschaefer, Helen M Shaw, Michael J Quinn, William H MccarthyAbstract:Background: The technique of lymphoscintigraphy may allow a more selective approach to the management of clinically negative neck nodes among patients with cutaneous head and neck melanoma. Patients and methods: A group of 97 patients with cutaneous head and neck melanoma had preoperative lymphoscintigraphy using intradermal injections of technetium 99m antimony trisulfide colloid to identify sentinel nodes. Fifty-one patients were eligible for clinical analysis after initial definitive treatment by Wide Excision only (n = 11), Wide Excision and elective dissection of the neck (n = 19) or axilla (n = 1), or Wide Excision and a sentinel node biopsy procedure (n = 20). Results: Sentinel nodes were identified in 95 of 97 lymphoscintigrams, and 85% of patients had multiple sentinel nodes. In 21 patients (22%), sentinel nodes were identified outside the parotid region and the 5 main neck levels, mostly in postauricular nodes (n = 13). Lymphoscintigrams were discordant with clinical predictions in 33 patients (34%). Lymph nodes were positive in 4 elective dissections and 4 sentinel node biopsies. Among 16 patients evaluable after Wide Excision and a negative sentinel node biopsy, 4 patients subsequently developed metastatic nodes; however, confident identification of all nodes marked as sentinel nodes on lymphoscintigraphy was not achieved at the original biopsy procedure in 3 of these patients. Conclusions: Lymphoscintigraphy and sentinel node biopsy are more difficult to perform in the head and neck than in other parts of the body. The reliability of sentinel node biopsy based on lymphoscintigraphy may be improved by identifying and marking all nodes that are considered to receive direct lymphatic drainage from the primary melanoma, and by use of a gamma probe intraoperatively.
Randall K Roenigk - One of the best experts on this subject based on the ideXlab platform.
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five year outcomes of Wide Excision and mohs micrographic surgery for primary lentigo maligna in an academic practice cohort
Dermatologic Surgery, 2015Co-Authors: Kurtis B Reed, Clark C Otley, Richelle M Knudson, Sultan A Mirzoyev, Christine M Lohse, Marcus L Frohm, Jerry D Brewer, Randall K RoenigkAbstract:BACKGROUND: Wide local Excision with 5-mm margins is the standard of care for lentigo maligna (LM). Mohs micrographic surgery (MMS) is used increasingly to treat this tumor. OBJECTIVE: To study the authors' experience with these 2 approaches. MATERIALS AND METHODS: Primary LM cases treated at the authors' institution from January 1, 1995, through December 31, 2005, were studied retrospectively. Main outcome measures were recurrence and outcomes after treatment for recurrence. RESULTS: In total, 423 LM lesions were treated in 407 patients: 269 (64%) with Wide Excision and 154 (36%) with MMS. In the MMS group (primarily larger head and neck lesions with indistinct clinical margins), recurrence rates were 3 of 154 (1.9%). In the Wide Excision group (primarily smaller, nonhead and neck, or more distinct lesions), recurrence rates were 16 of 269 (5.9%). Each of the 16 recurrences was biopsy proven and treated surgically: 6 by standard Excision and 10 by MMS. CONCLUSION: This follow-up study of LM surgical treatments shows excellent outcomes for Wide Excision and MMS. Because this is a nonrandomized retrospective study, no direct comparisons between the 2 treatments can be made. When recurrences occurred, repeat surgery, either standard Excision or MMS, was usually sufficient to provide definitive cure.
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comparison of mohs micrographic surgery and Wide Excision for extramammary paget s disease
Dermatologic Surgery, 2003Co-Authors: William J Oconnor, Mark J Zalla, Maureen M Gagnot, Clark C Otley, Tri H Nguyen, Randall K RoenigkAbstract:Background. Extramammary Paget's disease is a rare cutaneous adenocarcinoma that occurs in an apocrine gland distribution mainly in the anogenital region. Objective. To formulate treatment recommendations for this rare disease, we examined clinical and follow-up data of patients with it. Methods. A retrospective review is given about the treatment and outcome for 95 patients at Mayo Clinic, Rochester, Minnesota, and Scottsdale, Arizona, between 1976 and 2001. The literature regarding diagnosis and treatment of this disease is also reviewed. Results. Of the 95 patients, 86 had primary disease and 9 had recurrent disease. At mean follow-up (Wide Excision, 65 months; Mohs surgery, 24 months), disease had recurred in 18 of 83 (22%) who underwent standard Wide Excision, compared with recurrence in 1 of 12 (8%) who had the Mohs micrographic Excision. Conclusion. Mohs micrographic surgery compares favorably with Wide Excision. Intraoperative immunostaining with cytokeratin 7 is helpful in delineating disease, as are preoperative scouting biopsies and photodynamic diagnosis.
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a comparison of mohs micrographic surgery and Wide Excision for the treatment of atypical fibroxanthoma
Dermatologic Surgery, 1997Co-Authors: Jaime L Davis, Mark J Zalla, Randall K Roenigk, Henry W Randle, David G BrodlandAbstract:background Atypical fibroxanthoma (AFX) is an uncommon spindle cell neoplasm occurring most often in actinically damaged skin of elderly patients. This tumor has invasive potential, may recur locally after Excision, and rarely metastasizes. To conserve tissue and improve the likelihood of cure, Mohs micro–graphic surgery (MMS) has been used for treatment. objective We review and discuss the Mayo Clinic experience treating AFX with MMS and retrospectively compare the clinical outcome with that in a similar cohort of patients treated with Wide local Excision (WE). methods The medical records of 45 patients were reviewed at three Mayo Clinic practices. Follow–up data were available for 44 patients: 19 treated with MMS and 25 with WE. results In patients treated with MMS, there were no recurrences after a mean follow–up of 29.6 months. There were three first recurrences in 25 patients (12%) treated with WE after a mean follow–up of 73.6 months. One patient had a single local recurrence, and two patients each had two local recurrences. Parotid node metastasis eventually developed in one of the patients with two local recurrences, so that the regional metastatic rate in this series was 4% (1 in 25 patients). conclusion Microscopic control of the surgical margins with MMS in the treatment of AFX results in a lower recurrence rate than that with WE and conserves normal tissue.
Jin-young Jung - One of the best experts on this subject based on the ideXlab platform.
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comparison of secondary intention healing and full thickness skin graft after Excision of acral lentiginous melanoma on foot
Dermatologic Surgery, 2011Co-Authors: Jin-young Jung, Kee Yang ChungAbstract:BACKGROUND: Melanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot. After Wide Excision, substantial defects usually develop and they may endure insufficient vascular flow. In addition, the final scar must withstand the mechanical stress of daily walking. Various repair methods are used to repair these defects, but secondary intention healing has not been evaluated in the repair of wounds of the foot. OBJECTIVE: To compare the functional and cosmetic results of secondary intention healing and full-thickness skin graft after Wide Excision of melanoma on the foot. METHODS: Retrospective review of 25 patients who were treated using Excision for melanoma on the foot. The defects of 13 patients were healed by secondary intention (secondary intention healing group; SIHG), and those of 12 patients were repaired by full-thickness skin graft (skin graft group; SGG). RESULTS: The SGG showed more rapid healing than the SIHG, but the SIHG showed better functional and cosmetic outcomes at complete re-epithelialization than the SGG as evaluated by patients and independent physicians. CONCLUSIONS: Secondary intention healing after Excision of melanoma from the foot is a therapeutic option with acceptable functional and cosmetic outcomes.
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comparison of secondary intention healing and full thickness skin graft after Excision of acral lentiginous melanoma on foot
Dermatologic Surgery, 2011Co-Authors: Jin-young Jung, Hyo Jin Roh, Soo Hyun Lee, Kyoungae Nam, Kee Yang ChungAbstract:BACKGROUNDMelanoma in dark-skinned individuals often develops in an acral lentiginous fashion on the foot. After Wide Excision, substantial defects usually develop and they may endure insufficient vascular flow. In addition, the final scar must withstand the mechanical stress of daily walking. Vario
Brendon J Coventry - One of the best experts on this subject based on the ideXlab platform.
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final trial report of sentinel node biopsy versus nodal observation in melanoma
The New England Journal of Medicine, 2014Co-Authors: Donald L Morton, John F Thompson, Alistair J Cochran, Nicola Mozzillo, Omgo E Nieweg, Daniel F Roses, Harald J Hoekstra, C P Karakousis, C A Puleo, Brendon J CoventryAbstract:Background Sentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase 3 trial. Methods We evaluated outcomes in 2001 patients with primary cutaneous melanomas randomly assigned to undergo Wide Excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or Wide Excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group). Results No significant treatment-related difference in the 10-year melanoma-specific survival rate was seen in the overall study population (20.8% with and 79.2% without nodal metastases). Mean (±SE) 10-year disease-free survival rates were significantly improved in the biopsy group, as compared with the observation group, among patients with intermediate-thickness melanomas, defined as 1.20 to 3.50 mm (71.3±1.8% vs. 64.7±2.3%; hazard ratio for recurrence or metastasis, 0.76; P=0.01), and those with thick melanomas, defined as >3.50 mm (50.7±4.0% vs...
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final trial report of sentinel node biopsy versus nodal observation in melanoma
The New England Journal of Medicine, 2014Co-Authors: Donald L Morton, John F Thompson, Alistair J Cochran, Nicola Mozzillo, Omgo E Nieweg, Daniel F Roses, Harald J Hoekstra, C P Karakousis, C A Puleo, Brendon J CoventryAbstract:Background Sentinel-node biopsy, a minimally invasive procedure for regional melanoma staging, was evaluated in a phase 3 trial. Methods We evaluated outcomes in 2001 patients with primary cutaneous melanomas randomly assigned to undergo Wide Excision and nodal observation, with lymphadenectomy for nodal relapse (observation group), or Wide Excision and sentinel-node biopsy, with immediate lymphadenectomy for nodal metastases detected on biopsy (biopsy group). Results No significant treatment-related difference in the 10-year melanoma-specific survival rate was seen in the overall study population (20.8% with and 79.2% without nodal metastases). Mean (±SE) 10-year disease-free survival rates were significantly improved in the biopsy group, as compared with the observation group, among patients with intermediate-thickness melanomas, defined as 1.20 to 3.50 mm (71.3±1.8% vs. 64.7±2.3%; hazard ratio for recurrence or metastasis, 0.76; P=0.01), and those with thick melanomas, defined as >3.50 mm (50.7±4.0% vs...
