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Challenges in the Complex Management of Neglected Cutaneous Melanomas in the Head and Neck Area: A Single Center Experience. J Clin Med 2023; 12:jcm12051910. [PMID: 36902697 PMCID: PMC10004111 DOI: 10.3390/jcm12051910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Familiar controversies in the management of head and neck melanomas are more remarkable in locally advanced cases, and they represent a treatment challenge both surgically and oncologically. In our retrospective study, patients with surgically treated primary malignant melanoma of the head and neck region larger than 3 cm in diameter were included. Five patients met our inclusion criteria. In all cases, wide excision and immediate reconstruction were performed without sentinel lymph node biopsy. The defect on the scalp was covered by a split skin graft, with local flaps chosen for reconstruction on the face on an individual basis. After a 2-6 year follow-up, a good oncological, functional, and esthetic result was achieved. Our results show that in the case of large, locally advanced melanomas, surgical treatment still plays a crucial role that can provide long-term local control and support the effect of systemic treatment.
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Hlongwa KN, Mokoala KMG, Matsena-Zingoni Z, Vorster M, Sathekge MM. The Use of 18F-FDG PET/CT Metabolic Parameters in Predicting Overall Survival in Patients Undergoing Restaging for Malignant Melanoma. Diagnostics (Basel) 2022; 12:diagnostics12030595. [PMID: 35328148 PMCID: PMC8947629 DOI: 10.3390/diagnostics12030595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/11/2022] [Accepted: 02/19/2022] [Indexed: 12/04/2022] Open
Abstract
Malignant melanoma is one of the more aggressive cancers in the skin, with an increasing incidence every year. Melanoma has a better prognosis if diagnosed early and survival tends to decrease once the disease has metastasized. Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) has been used extensively over the past two decades in staging and assessing responses to therapy in patients with melanoma. Metabolic PET parameters have been demonstrated to be independent prognostic factors for progression-free survival (PFS) and overall survival (OS) in different malignancies, melanoma included. In our study, we evaluated the metabolic parameters of 18F-FDG PET/CT (flourodeoxyglucose positron emission tomography/computed tomography) in predicting the overall survival in patients with malignant melanoma who presented for restaging. Metabolic PET parameters (maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG)) of the primary tumor, as well as whole-body MTV and TLG of the metastatic disease, were measured. Survival curves for OS were constructed and mortality rates were determined using the different PET variables. Forty-nine patients who presented for a PET/CT restaging in melanoma were included in this study. We found that non-survivors had significantly higher median MTV (11.86 cm3 vs. 5.68 cm3; p-value = 0.022), TLG (3125 vs. 14; p-value = 0.0357), whole-body MTV (53.9 cm3 vs. 14.4 cm3; p-value = 0.0076) and whole-body TLG (963.4 vs. 114.6; p-value = 0.0056). This demonstrated that high MTV and TLG values of the primary tumor and whole-body TLG as quantified by 18F-FDG PET/CT were prognostic factors for overall survival. The findings may potentially guide clinicians in decision making and identifying patients with a poorer prognosis.
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Affiliation(s)
- Khanyisile N Hlongwa
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Kgomotso M G Mokoala
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of Witwatersrand, Johannesburg 2193, South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria 0001, South Africa
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Willcox JL, Spriet M, Zwingenberger AL, Phillips KL, Burton JH, Skorupski KA, Hansen KS, Affolter VK, Woolard KD, Beylin D, Giuffrida MA. Evaluation of accuracy for 18 F-FDG positron emission tomography and computed tomography for detection of lymph node metastasis in canine oral malignant melanoma. Vet Comp Oncol 2021; 19:463-472. [PMID: 32892513 DOI: 10.1111/vco.12651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/05/2020] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
Tumour stage has been demonstrated to have prognostic significance in canine oral malignant melanoma (OMM). Various evaluation techniques of positron emission tomography/computed tomography (PET/CT) have been reported for staging of head-and-neck tumours in people, but canine-specific data are limited, and reports for CT accuracy have been variable. In this prospective study, the head/neck of client-owned dogs with cytologically or histologically diagnosed OMM were imaged with 18 Fluorine-fluorodeoxyglucose (18 F-FDG) PET/ CT. Bilateral mandibular lymphadenectomy was performed for histopathologic assessment. Two evaluation techniques for CT and PET were applied by four independent observers. CT evaluation utilized both a standardized grading scheme and a subjective clinical interpretation. PET evaluation was first performed solely on 18 F-FDG-uptake in lymph nodes compared to background on a truncated scan excluding the oral cavity. Subsequently, the entire head/neck scan and standardized uptake value (SUV) measurements were available. Receiver operating characteristic analysis was performed with histopathology as gold standard. Twelve dogs completed the study and metastatic OMM was identified in six mandibular lymph nodes from five dogs. Of the CT-interpretation techniques, use of clinical grading performed best (sensitivity = 83% and specificity = 94%). Both PET techniques resulted in 100% sensitivity, but primary tumour site evaluation and use of SUV increased specificity from 78% to 94%. The SUVmax cut-point, 3.3, led to 100% sensitivity and 83% specificity. In this population of dogs, PET appeared to be highly sensitive but at risk of being less specific without use of appropriate parameters and thresholds.
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Affiliation(s)
- Jennifer L Willcox
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
| | - Mathieu Spriet
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
| | - Allison L Zwingenberger
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
| | - Kathryn L Phillips
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
| | - Jenna H Burton
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
| | - Katherine A Skorupski
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
| | - Katherine S Hansen
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
| | - Verena K Affolter
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, California, USA
| | - Kevin D Woolard
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, California, USA
| | - David Beylin
- Brain Biosciences, Inc, Rockville, Maryland, USA
| | - Michelle A Giuffrida
- Department of Veterinary Surgery and Radiology, University of California, Davis, Davis, California, USA
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