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Retrospective case series of mucosal melanoma at the royal Melbourne Hospital and literature review
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Oral Presentation
and neck cancer patients. Selection of hypoxic tumors has therapeutic and prognostic relevance. Objectives: The aim of this study was to establish the survival predictive value of selected hypoxia related biomarkers in a large retrospective tongue carcinoma cohort. Methods: A cohort of 229 primary tongue carcinoma cases with a TMA of 139 representative patient core and peripheral tissue samples were established. Demographic data was gathered and staining for a selected number of biomarkers was established. Statistical analysis with univariate and multivariate analysis were used to link biomarker expression to overall and disease specific survival. Findings: HIF1␣ is predictive for overall survival (OS) P < 0.05, OPN, CAIX were the most predictive for OS independently and together with known pathological risk factors (P < 0.05) CK19 was the sole predictor for a statistically significant improved disease specific survival (DSS), however HIF1␣ and CAIX selected for DSS within the supposedly good prognosis N0 subgroup. P16 alone or in combination with selected biomarkers was not predictive for a statistically significant improved survival. Conclusions: Apart from some known histological predictive factors, biomarkers are playing an increasing role of selecting the most relevant therapy in head and neck cancer. CK19 was the overall the most sensitive predictive factor. Hypoxia related biomarkers, especially HIF1 ␣ and CAIX played an important role in predicting prognosis in a low risk subgroup (N0) in this tongue carcinoma cohort and may dictate treatment options in the future. http://dx.doi.org/10.1016/j.ijom.2015.08.483 Retrospective case series of mucosal melanoma at the royal Melbourne Hospital and literature review O. Breik ∗ , F. Sim, T. Wong, D. Wiesenfeld The Royal Melbourne Hospital, Victoria, Australia Introduction: Mucosal malignant melanoma of the head and neck (HNMM) is an aggressive and rare neoplasm. It accounts for 0.72% of all melanoma cases, most commonly affecting the sinonasal area and oral cavity. To date, few case series have been published on outcomes of patient’s treated for mucosal head and neck melanoma (HNMM). Aim: To complete a retrospective chart review of HNMM from a tertiary institution within Victoria over a 15 year period (2000–2015). The clinical features and treatment modalities were identified and correlated with outcomes. Methods: Data was collected from the Royal Melbourne Hospital’s ACCORD head and neck database and it is predecessor database with subsequent medical record review. Results: A total of 15 cases were found. Two were excluded due to inaccessible data. Out of 13 cases, the majority were sinonasal melanomas (8/13). The remaining 4 originated in the oral cavity. Sinonasal tumour patients presented with epistaxis or visual impairment. Oral melanoma patients presented commonly with a visually pigmented lesion or ulceration. All patients were offered surgical excision. Four patients underwent post-operative radiotherapy. Follow up ranged from 8 months to 7 years (mean 4 years). The overall 2-year and 5-year survival rates were 62% and 37.5% respectively. Four patients died due to distant metastasis despite clear surgical margins. One of these patients had a locoregional recurrence resected. Only one patient was still alive at 7 years follow up.
Conclusion: MM is a rare and aggressive malignancy in the head and neck region associated with poor long term outcomes. Despite technically adequate surgical management, 80% of deaths were due to distant metastasis. Further research of this rare tumour is required to determine the ideal treatment protocol. http://dx.doi.org/10.1016/j.ijom.2015.08.484 Isolated cleft of the hard palate – incidence, variations, classification and reconstruction K.W. Bütow 1,∗ , H. Engelbrecht 2 , S. Naidoo 3 1
University of Pretoria, Pretoria, University of KwaZulu-Natal, Durban and Suite A2 Wilgers Hospital, Pretoria, South Africa 2 The Royal Dental Hospital of Melbourne, Australia 3 University of Pretoria, Pretoria, South Africa Background: Isolated cleft of the hard palate (hP),1 refers to the anterior part of the embryological secondary palate occurring between the bony palatal shelves. Objectives: 4096 facial cleft cases were analyzed to determine incidence and variation. The cleft type is classified according to the clinical appearances. The reconstruction is determined according to the extent and type of the deformity. Methods: Study population of 31 years was drawn from the records of Facial Cleft Deformity Clinic (FCDC) and was evaluated retrospectively for its incidence, variations and frequencies of the hP. The variation of the cleft type determined the type of reconstruction. Findings: Of the 4096 cleft patients, 37 (0.9%) cases presented an isolated cleft hP deformity. Three different variations were noted: (I) a complete cleft, where all the layers are congenitally separated, totally (1) or partially (23), in length of hP; (II) an incomplete or submucosal cleft, where a lack of bony fusion promotes a blind soft tissue fistula allowing food/foreign body impaction (4); (III) (a) a submucosal (7) or (b) a complete cleft (2), where the vomer septum intercedes between the palatal shelves, preventing the bony fusion. Conclusion: The isolated hP cleft, an extremely rare phenomenon, is recorded at 0.9% in CLAP clinic, been subdivided into three distinct variations. The reconstruction was done by means of a double-layered Von Langenbeck procedure or single-nasal-layered procedure, without major dissection of the mucoperiosteum, in conjunction with a PdLAlLA resorbable sheet.
Reference Bütow, K.-W., & Zwahlen, R. (2015). Cleft ultimate treatment (vol. 39) Durban: Reach Publishers., p. 205, 209, ISBN 978-0-620-TBC.
http://dx.doi.org/10.1016/j.ijom.2015.08.485
Oral Presentation
and neck cancer patients. Selection of hypoxic tumors has therapeutic and prognostic relevance. Objectives: The aim of this study was to establish the survival predictive value of selected hypoxia related biomarkers in a large retrospective tongue carcinoma cohort. Methods: A cohort of 229 primary tongue carcinoma cases with a TMA of 139 representative patient core and peripheral tissue samples were established. Demographic data was gathered and staining for a selected number of biomarkers was established. Statistical analysis with univariate and multivariate analysis were used to link biomarker expression to overall and disease specific survival. Findings: HIF1␣ is predictive for overall survival (OS) P < 0.05, OPN, CAIX were the most predictive for OS independently and together with known pathological risk factors (P < 0.05) CK19 was the sole predictor for a statistically significant improved disease specific survival (DSS), however HIF1␣ and CAIX selected for DSS within the supposedly good prognosis N0 subgroup. P16 alone or in combination with selected biomarkers was not predictive for a statistically significant improved survival. Conclusions: Apart from some known histological predictive factors, biomarkers are playing an increasing role of selecting the most relevant therapy in head and neck cancer. CK19 was the overall the most sensitive predictive factor. Hypoxia related biomarkers, especially HIF1 ␣ and CAIX played an important role in predicting prognosis in a low risk subgroup (N0) in this tongue carcinoma cohort and may dictate treatment options in the future. http://dx.doi.org/10.1016/j.ijom.2015.08.483 Retrospective case series of mucosal melanoma at the royal Melbourne Hospital and literature review O. Breik ∗ , F. Sim, T. Wong, D. Wiesenfeld The Royal Melbourne Hospital, Victoria, Australia Introduction: Mucosal malignant melanoma of the head and neck (HNMM) is an aggressive and rare neoplasm. It accounts for 0.72% of all melanoma cases, most commonly affecting the sinonasal area and oral cavity. To date, few case series have been published on outcomes of patient’s treated for mucosal head and neck melanoma (HNMM). Aim: To complete a retrospective chart review of HNMM from a tertiary institution within Victoria over a 15 year period (2000–2015). The clinical features and treatment modalities were identified and correlated with outcomes. Methods: Data was collected from the Royal Melbourne Hospital’s ACCORD head and neck database and it is predecessor database with subsequent medical record review. Results: A total of 15 cases were found. Two were excluded due to inaccessible data. Out of 13 cases, the majority were sinonasal melanomas (8/13). The remaining 4 originated in the oral cavity. Sinonasal tumour patients presented with epistaxis or visual impairment. Oral melanoma patients presented commonly with a visually pigmented lesion or ulceration. All patients were offered surgical excision. Four patients underwent post-operative radiotherapy. Follow up ranged from 8 months to 7 years (mean 4 years). The overall 2-year and 5-year survival rates were 62% and 37.5% respectively. Four patients died due to distant metastasis despite clear surgical margins. One of these patients had a locoregional recurrence resected. Only one patient was still alive at 7 years follow up.
Conclusion: MM is a rare and aggressive malignancy in the head and neck region associated with poor long term outcomes. Despite technically adequate surgical management, 80% of deaths were due to distant metastasis. Further research of this rare tumour is required to determine the ideal treatment protocol. http://dx.doi.org/10.1016/j.ijom.2015.08.484 Isolated cleft of the hard palate – incidence, variations, classification and reconstruction K.W. Bütow 1,∗ , H. Engelbrecht 2 , S. Naidoo 3 1
University of Pretoria, Pretoria, University of KwaZulu-Natal, Durban and Suite A2 Wilgers Hospital, Pretoria, South Africa 2 The Royal Dental Hospital of Melbourne, Australia 3 University of Pretoria, Pretoria, South Africa Background: Isolated cleft of the hard palate (hP),1 refers to the anterior part of the embryological secondary palate occurring between the bony palatal shelves. Objectives: 4096 facial cleft cases were analyzed to determine incidence and variation. The cleft type is classified according to the clinical appearances. The reconstruction is determined according to the extent and type of the deformity. Methods: Study population of 31 years was drawn from the records of Facial Cleft Deformity Clinic (FCDC) and was evaluated retrospectively for its incidence, variations and frequencies of the hP. The variation of the cleft type determined the type of reconstruction. Findings: Of the 4096 cleft patients, 37 (0.9%) cases presented an isolated cleft hP deformity. Three different variations were noted: (I) a complete cleft, where all the layers are congenitally separated, totally (1) or partially (23), in length of hP; (II) an incomplete or submucosal cleft, where a lack of bony fusion promotes a blind soft tissue fistula allowing food/foreign body impaction (4); (III) (a) a submucosal (7) or (b) a complete cleft (2), where the vomer septum intercedes between the palatal shelves, preventing the bony fusion. Conclusion: The isolated hP cleft, an extremely rare phenomenon, is recorded at 0.9% in CLAP clinic, been subdivided into three distinct variations. The reconstruction was done by means of a double-layered Von Langenbeck procedure or single-nasal-layered procedure, without major dissection of the mucoperiosteum, in conjunction with a PdLAlLA resorbable sheet.
Reference Bütow, K.-W., & Zwahlen, R. (2015). Cleft ultimate treatment (vol. 39) Durban: Reach Publishers., p. 205, 209, ISBN 978-0-620-TBC.
http://dx.doi.org/10.1016/j.ijom.2015.08.485