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Prevention and treatment of lymphedema after lymph node dissection in patients with cutaneous melanoma
998 modality for cutaneous or subcutaneous metastases that allows the delivery of non-permanent drugs into cells. ECT has been used in the palliative management of metastatic melanoma to improve patients’ quality of life. This is, to our knowledge, the first application of ECT as neoadjuvant treatment for metastatic subcutaneous melanoma. Methods: In 2004, a 44-year-old Caucasian woman underwent extensive surgical resection of a melanoma, with a Breslow thickness of 1.5 mm, located on the right side of the scalp. No further treatment was given and the woman remained well until October 2010, when a large nodule appeared on her right cheek. The standard uptake value (SUV) obtained from F18-fluorodeoxyglucose positron-emission tomography (18-FDG PET) total body scan was 19.5. No other diseases were detected. Fine needle aspiration cytology confirmed the presence of metastatic melanoma. The patient underwent two sessions of ECT by means of a CliniporatorTM as elective treatment. Results: A PET-CT scan 1 month later showed a decrease in the SUV of the lesion to 3. Monthly follow-up with PET-CT was performed. Multiple cytology examinations showed necrotic tissue. Conservative surgery was carried out 3 months after the second ECT session. Reconstruction was easily achieved with a rotation flap. Pathological examination of the specimen showed necrotic tissue without residual melanoma. One year after the last ECT treatment, the patient was disease-free as determined by CT and PET-CT, with a good functional and aesthetic result. Conclusions: ECT is a safe and effective therapeutic approach associated with clear benefits in terms of quality of life (minimal discomfort, mild posttreatment pain and short duration of hospital stay) and may, in the neoadjuvant setting as reported here, offer the option of more conservative surgery and an improved cosmetic effect with complete local tumor control.
Prevention and treatment of lymphedema after lymph node dissection in patients with cutaneous melanoma F. Boccardo, MD, PhD1,*, F. De Cian, MD2, C.C. Campisi, MD3, G. Villa, MD5, L. Molinari, MD1 , G. Talamo, MD1 , Campisi Caterina, MD 4, P.L. Santi, MD3, A. Parodi, MD4, C. Campisi, MD, PhD, FACS1 1 Department of Surgery e Unit of Lymphatic Surgery 2 Unit of Surgical Oncology 3 Unit of Plastic and Reconstructive Surgery 4 Unit of Dermatology 5 Unit of Nuclear Medicine IRCCS S. Martino Hospital-Cancer Institute (IST) University of Genoa, Genoa, Italy * Corresponding author: Francesco Boccardo, IRCCS San Martino - IST, Dip. di Chir., Unita di Chirurgia dei Linfatici, Largo R.Benzi 10, 16132 Genova, Italy. Tel.: +39 010 56001; Fax 010 532778. E-mail address: [email protected] (F. Boccardo). Background: Notwithstanding the development of minimal access dissection techniques, superficial groin dissection alone and other recommendations to reduce morbidity in melanoma treatment, the incidence of lymphedema is still significant. The aim of this study was to assess the efficacy of microsurgical methods to limit the morbidity of inguinal lymphadenectomy. Methods: A retrospective review of patients undergoing groin dissection for melanoma from February 2006 to April 2009 was performed. Of a total of 59 melanoma patients with positive groin lymph nodes, 18 patients (T-group) presented with melanoma on the trunk and 41 patients (E-group) with melanoma on the extremities. The 18 patients (T-group) had received primary lymphedema prevention with microsurgical lymphatic-venous anastomosis (LVA) performed simultaneously with groin dissection; the 41 patients (E-group) underwent LVA to treat secondary lymphedema of the lower extremity following groin dissection, after accurate oncological assessment. Limb volume measurement and lymphoscintigraphy were performed pre- and postoperatively to assess short- and long-term outcome. Results: No lymphedema developed in the patients who had received a microsurgical primary preventive procedure. Significant (average
ABSTRACTS reduction of 80% in pre-operative excess volume) reduction in lymphedema was observed after microsurgery performed for secondary leg lymphedema. Lymphoscintigraphy was performed postoperatively in 35 patients and demonstrated patent microsurgical anastomoses in all cases. The average follow-up period was 42 months. Conclusions: Microsurgical LVA as primary prevention was found to reduce lymphedema after inguinal lymphadenectomy. Lymphatic-venous multiple anastomosis also proved to be a successful treatment for clinically evident lymphedema, above all if treated at early stages. Nodal metastasis in early melanoma G. Benassai * , V. Desiato, S. Perrotta, G.L. Benassai, S. Di Palma, E. Furino, G. Quarto Dipartimento Universitario di Chirurgia Generale, Geriatrica, Oncologica e Tecnologie Avanzate Facolta di Medicina e Chirurgia, Universita degli Studi di Napoli Federico II. Italy * Corresponding author: Prof. Giacomo Benassai - AOU Policlinico Via S. Pansini n.5, 80131 Naples. Tel.: +39 081 7462823. E-mail address: [email protected] (G. Benassai). Background: According to current guidelines, the treatment for thin melanoma (T1a) is limited to surgical excision with a margin >1 cm. The prognostic factors in treatment planning must surely be re-evaluated, because we have encountered distant recurrence in patients with early melanoma so treated. Methods: Between January 2004 and November 2010, we observed 6 patients with lymph node metastasis from early melanoma (Breslow depth, 0.3 - 0.9 mm, not ulcerated tumor, mitosis/ mm2 <1). All patients were biopsied with a margin <1 cm and then re-operated to obtain a greater safety margin for cancer. No patient had received a prior sentinel lymph node biopsy. The series comprised: melanoma of the abdominal region with inguinal lymph node metastasis (n¼1); melanoma of the back with metastasis to the ipsilateral groin (n¼1); melanoma of the upper limb with ipsilateral axillary metastasis (n¼1); and lower limb melanomas with metastasis to the ipsilateral groin (n¼3). The time of occurrence of lymph node metastases was between 6 and 20 months. Diagnosis was confirmed by fine-needle aspiration cytology (FNAC). All patients underwent enlarged lymphadenectomy of the involved lymphatic stations and cancer re-staging. Results: Pathological lymph node examination consistently confirmed metastatic melanoma. All patients were referred to the oncologist for adjuvant therapy. The average duration of follow-up as of December 2012 is 51.5 months. Metastatic disease was detected in locations distant from the operated lymph nodes in 3 patients. One patient died; the remaining 4 patients are in follow-up without evidence of disease to date. Conclusions: Current guidelines for the treatment of melanoma include sentinel lymph node biopsy only in cases of primary tumor thickness 1 mm according to Breslow depth or in cases of ulcerated tumor, or even in cases of Breslow depth <1 mm with evidence of one or more mitoses/mm2. It is now accepted that in the event of a thickness <1 mm the probability of finding a positive sentinel lymph node is about 3-7%. Our experience, supported by the cases described and the literature, advocates sentinel lymph node biopsy in all patients, given the procedure’s low morbidity and important prognostic role, in addition to the possibility to reduce the incidence of lymph node metastases. Iliac obturator laparoscopic lymphadenectomy in metastatic melanoma: When, how and why P. De Paolis1, A. Farnetti2,*, A. Ronco2, R. Mattio2, F. Deluca2, V. Schiavone2, P. Pochettino3, L. Santoro2 1 S.C. Chirurgia Generale e Presidio Ospedaliero Gradenigo e Turin, Italy 2 Servizio di Dermochirurgia Oncologica e Presidio Ospedaliero Gradenigo e Turin, Italy 3 S.C. Oncologia e Presidio Ospedaliero Gradenigo e Turin, Italy
Prevention and treatment of lymphedema after lymph node dissection in patients with cutaneous melanoma F. Boccardo, MD, PhD1,*, F. De Cian, MD2, C.C. Campisi, MD3, G. Villa, MD5, L. Molinari, MD1 , G. Talamo, MD1 , Campisi Caterina, MD 4, P.L. Santi, MD3, A. Parodi, MD4, C. Campisi, MD, PhD, FACS1 1 Department of Surgery e Unit of Lymphatic Surgery 2 Unit of Surgical Oncology 3 Unit of Plastic and Reconstructive Surgery 4 Unit of Dermatology 5 Unit of Nuclear Medicine IRCCS S. Martino Hospital-Cancer Institute (IST) University of Genoa, Genoa, Italy * Corresponding author: Francesco Boccardo, IRCCS San Martino - IST, Dip. di Chir., Unita di Chirurgia dei Linfatici, Largo R.Benzi 10, 16132 Genova, Italy. Tel.: +39 010 56001; Fax 010 532778. E-mail address: [email protected] (F. Boccardo). Background: Notwithstanding the development of minimal access dissection techniques, superficial groin dissection alone and other recommendations to reduce morbidity in melanoma treatment, the incidence of lymphedema is still significant. The aim of this study was to assess the efficacy of microsurgical methods to limit the morbidity of inguinal lymphadenectomy. Methods: A retrospective review of patients undergoing groin dissection for melanoma from February 2006 to April 2009 was performed. Of a total of 59 melanoma patients with positive groin lymph nodes, 18 patients (T-group) presented with melanoma on the trunk and 41 patients (E-group) with melanoma on the extremities. The 18 patients (T-group) had received primary lymphedema prevention with microsurgical lymphatic-venous anastomosis (LVA) performed simultaneously with groin dissection; the 41 patients (E-group) underwent LVA to treat secondary lymphedema of the lower extremity following groin dissection, after accurate oncological assessment. Limb volume measurement and lymphoscintigraphy were performed pre- and postoperatively to assess short- and long-term outcome. Results: No lymphedema developed in the patients who had received a microsurgical primary preventive procedure. Significant (average
ABSTRACTS reduction of 80% in pre-operative excess volume) reduction in lymphedema was observed after microsurgery performed for secondary leg lymphedema. Lymphoscintigraphy was performed postoperatively in 35 patients and demonstrated patent microsurgical anastomoses in all cases. The average follow-up period was 42 months. Conclusions: Microsurgical LVA as primary prevention was found to reduce lymphedema after inguinal lymphadenectomy. Lymphatic-venous multiple anastomosis also proved to be a successful treatment for clinically evident lymphedema, above all if treated at early stages. Nodal metastasis in early melanoma G. Benassai * , V. Desiato, S. Perrotta, G.L. Benassai, S. Di Palma, E. Furino, G. Quarto Dipartimento Universitario di Chirurgia Generale, Geriatrica, Oncologica e Tecnologie Avanzate Facolta di Medicina e Chirurgia, Universita degli Studi di Napoli Federico II. Italy * Corresponding author: Prof. Giacomo Benassai - AOU Policlinico Via S. Pansini n.5, 80131 Naples. Tel.: +39 081 7462823. E-mail address: [email protected] (G. Benassai). Background: According to current guidelines, the treatment for thin melanoma (T1a) is limited to surgical excision with a margin >1 cm. The prognostic factors in treatment planning must surely be re-evaluated, because we have encountered distant recurrence in patients with early melanoma so treated. Methods: Between January 2004 and November 2010, we observed 6 patients with lymph node metastasis from early melanoma (Breslow depth, 0.3 - 0.9 mm, not ulcerated tumor, mitosis/ mm2 <1). All patients were biopsied with a margin <1 cm and then re-operated to obtain a greater safety margin for cancer. No patient had received a prior sentinel lymph node biopsy. The series comprised: melanoma of the abdominal region with inguinal lymph node metastasis (n¼1); melanoma of the back with metastasis to the ipsilateral groin (n¼1); melanoma of the upper limb with ipsilateral axillary metastasis (n¼1); and lower limb melanomas with metastasis to the ipsilateral groin (n¼3). The time of occurrence of lymph node metastases was between 6 and 20 months. Diagnosis was confirmed by fine-needle aspiration cytology (FNAC). All patients underwent enlarged lymphadenectomy of the involved lymphatic stations and cancer re-staging. Results: Pathological lymph node examination consistently confirmed metastatic melanoma. All patients were referred to the oncologist for adjuvant therapy. The average duration of follow-up as of December 2012 is 51.5 months. Metastatic disease was detected in locations distant from the operated lymph nodes in 3 patients. One patient died; the remaining 4 patients are in follow-up without evidence of disease to date. Conclusions: Current guidelines for the treatment of melanoma include sentinel lymph node biopsy only in cases of primary tumor thickness 1 mm according to Breslow depth or in cases of ulcerated tumor, or even in cases of Breslow depth <1 mm with evidence of one or more mitoses/mm2. It is now accepted that in the event of a thickness <1 mm the probability of finding a positive sentinel lymph node is about 3-7%. Our experience, supported by the cases described and the literature, advocates sentinel lymph node biopsy in all patients, given the procedure’s low morbidity and important prognostic role, in addition to the possibility to reduce the incidence of lymph node metastases. Iliac obturator laparoscopic lymphadenectomy in metastatic melanoma: When, how and why P. De Paolis1, A. Farnetti2,*, A. Ronco2, R. Mattio2, F. Deluca2, V. Schiavone2, P. Pochettino3, L. Santoro2 1 S.C. Chirurgia Generale e Presidio Ospedaliero Gradenigo e Turin, Italy 2 Servizio di Dermochirurgia Oncologica e Presidio Ospedaliero Gradenigo e Turin, Italy 3 S.C. Oncologia e Presidio Ospedaliero Gradenigo e Turin, Italy