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Guiotto M, Oranges CM, Cherubino M, Maruccia M, Tedeschi P, Kalbermatten DF, Raffoul W, di Summa PG. Indications, outcomes, and complications of neoumbilical reconstruction: A systematic review. J Plast Reconstr Aesthet Surg 2024; 88:83-98. [PMID: 37972443 DOI: 10.1016/j.bjps.2023.10.094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/12/2022] [Accepted: 10/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Neoumbilicoplasty aims to reconstruct an aesthetically pleasing new umbilicus following agenesis, malignancy, anatomical distortion, or umbilicus loss. Despite the wide variety of surgical techniques described, literature is scarce when it comes to standardized categorization of these as well as the clear definition of patients' selections, specific indications, final outcomes, and possible complications. According to available literature, this work aims to evaluate different surgical approaches, and correlate them to specific surgical needs, to simplify the surgical choice and patient management. METHODS A systematic review was performed in December 2020 in PubMed, Web of Science, and MedLine Ovid databases according to the PRISMA guidelines. RESULTS A total of 41 studies and 588 patients were finally included. On the basis of the evidence of the literature collected, we divided the studies into four groups according to the neoumbilicoplasty techniques: single suture or purse-string suture, single flap, multiple flap, and skin graft. Patients' surgical comorbidities, neoumbilicoplasty indications, and aesthetic and surgical outcomes were investigated. Direct suture and single and multiple flap techniques assured overall, satisfactory cosmetic outcomes with a low rate of surgical complications. Whereas suture-only techniques were chosen mostly by general surgeons/urologists in laparoscopic surgery, the single flap was the preferred method to reconstruct the umbilicus in open abdominal surgery or combined abdominoplasty with herniorrhaphy. Multiple flap and skin grafts were adopted in abdominoplasty-related umbilicus reconstruction, although the latter option showed impactful aesthetic and surgical complications. CONCLUSIONS Umbilicoplasty can assure generally pleasant aesthetic outcomes with relatively low complication rates. Indications for specific techniques correspond to different patient populations and surgical scenarios.
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Affiliation(s)
- M Guiotto
- Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - C M Oranges
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hopitaux Universitaire Geneve (HUG), Geneve, Switzerland
| | - M Cherubino
- Plastic and Reconstructive Surgery, Microsurgery and Hand Surgery Unit, ASST Settelaghi, Ospedale di Circolo, Varese, Italy
| | - M Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari 70124, Italy
| | - P Tedeschi
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare, Bari 70124, Italy
| | - D F Kalbermatten
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hopitaux Universitaire Geneve (HUG), Geneve, Switzerland
| | - W Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - P G di Summa
- Department of Plastic, Reconstructive and Hand Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland.
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Picciotto F, Lesca A, Mastorino L, Califaretti E, Conti L, Quaglino P, Ribero S, Caliendo V, Deandreis D. SPECT/CT-Guided Surgical Removal of a Positive External Iliac Sentinel Node in Primary Umbilical Melanoma: Report of a Case, and Up-to-Date Review of the Literature. Front Oncol 2022; 11:772771. [PMID: 35111668 PMCID: PMC8801450 DOI: 10.3389/fonc.2021.772771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Primary umbilical melanoma is rare tumor, representing about 5% of all umbilical malignancies.The lymphatic drainage from the tumor is challenging and can be to inguinal, axillary and retroperitoneal nodes. Dynamic and static lymphoscintigraphy with single-photon emission tomography/computed tomography (SPECT/CT) and sentinel lymph node biopsy (SLNB) is a widely validated technique in patients with clinically localized melanoma to search for and quantify nodal spread of cutaneous melanoma. Moreover, it offers the surgeon the preoperative information about the number and location of the sentinel lymph nodes (SLNs), which makes SLNB easier and quicker. This is the first report of an ulcerated thick melanoma of the umbilicus metastasizing only to an external iliac lymph-node without involvement of superficial inguinal SLNs. The preoperative high-resolution ultrasound (HR-US) examination of the regional lymph node field had been normal. This case-report shows how addition of SPECT/CT to planar imaging in a patient with clinically localized umbilical melanoma can help avoid incomplete SLNB when a deep SLN is not removed. A literature review of umbilical melanoma is also provided.
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Affiliation(s)
- Franco Picciotto
- Dermatologic Surgery Section, Department of Surgery, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Adriana Lesca
- Division of Nuclear Medicine, Medical Sciences Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Luca Mastorino
- Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy
| | - Elena Califaretti
- Division of Nuclear Medicine, Medical Sciences Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Luca Conti
- Surgical Pathology Section, Oncology Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy
| | - Simone Ribero
- Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy
| | - Virginia Caliendo
- Dermatologic Surgery Section, Department of Surgery, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Désirée Deandreis
- Division of Nuclear Medicine, Medical Sciences Department, University of Turin, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
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Charles KB, Chan MP, Smith NR, Orsini AP, Noh IK, Kozlow JH, Johnson TM, Cha KB. Primary Cutaneous Umbilical Melanoma: The Michigan Experience. Dermatol Surg 2020; 46:312-8. [PMID: 31306273 DOI: 10.1097/DSS.0000000000002024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary cutaneous umbilical melanoma is rare. Thorough information regarding its characteristics and treatment, including use of sentinel lymph node biopsy (SLNB) staging, is difficult to obtain. The unique anatomy of the umbilicus adds to the complexity of diagnosing and treating melanoma at this site. OBJECTIVE To improve understanding of diagnosis and treatment of primary cutaneous umbilical melanoma through presenting 7 new cases and reviewing 39 cases in the literature. MATERIALS AND METHODS The University of Michigan melanoma database query and review of the literature regarding reported cases of primary umbilical melanoma. RESULTS In 7 new and 39 previously reported cases of primary cutaneous umbilical melanoma, we describe signs and symptoms, histopathologic features, differential diagnosis, relevant anatomical considerations, and definitive treatment including SLNB when applicable. CONCLUSION Our series, combined with a thorough literature review and compilation of findings, provides a better understanding and appreciation of melanoma in the unique anatomical site of the umbilicus, with a reminder to carefully examine the umbilicus during a full skin examination in patients at risk of melanoma. Primary umbilical melanoma presents and can be appropriately treated similarly to cutaneous melanoma in other sites, with attention to relevant anatomy.
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Di Monta G, Caracò C, Marone U, Grimaldi AM, Anniciello AM, Di Marzo M, Simeone E, Mori S. Clinicopathologic features and surgical management of primary umbilical melanoma: a case series. BMC Res Notes 2015; 8:147. [PMID: 25890364 PMCID: PMC4404075 DOI: 10.1186/s13104-015-1096-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/25/2015] [Indexed: 11/26/2022] Open
Abstract
Background Primary umbilical melanoma is an uncommon tumor that is poorly described in the medical literature. The umbilical region is a particular anatomic site owing to the presence of embryonal remnants, which can be a potential metastatic pathway, as well as the braided lymphatic network drainage. Hence, primary malignant neoplasms affecting the umbilicus require a different and more radical surgical approach compared with other melanomas. Case presentation In this report, we describe a series of three patients of Caucasian ethnicity who presented with primary umbilical melanoma at the National Cancer Institute of Naples, Italy. All patients underwent wide excision of the tumor including the underlying peritoneum. No surgical complications, either immediate or delayed, were observed in any of the patients. Sentinel lymph node biopsy was negative in two cases. Two of the patients developed metastatic disease and died after systemic medical therapy. The other patient is currently in follow-up, and remains disease-free after 21 months. Conclusions The umbilicus has vascular and embryological connections with the underlying peritoneum, so that early visceral involvement is more likely to occur with primary umbilical melanomas. As such, tumor resection including the underlying peritoneum is required to avoid local relapse, whilst sentinel lymph node biopsy appears to be of poor diagnostic value.
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Affiliation(s)
- Gianluca Di Monta
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Corrado Caracò
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Ugo Marone
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, National Cancer Institute "G. Pascale", 80131, Naples, Italy.
| | - Anna Maria Anniciello
- Department of Pathology, National Cancer Institute "G. Pascale", 80131, Naples, Italy.
| | - Massimiliano Di Marzo
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
| | - Ester Simeone
- Unit of Melanoma, Cancer Immunotherapy and Innovative Therapy, National Cancer Institute "G. Pascale", 80131, Naples, Italy.
| | - Stefano Mori
- Department of Surgery "Melanoma, Soft Tissues, Head and Neck, Skin Cancers", National Cancer Institute "G. Pascale", Via M. Semmola, 80131, Naples, Italy.
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Kluger N. Dermatoses ombilicales et péri-ombilicales. Ann Dermatol Venereol 2014; 141:224-35; quiz 223, 236. [DOI: 10.1016/j.annder.2013.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/17/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022]
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Heller DS. Lesions of the umbilicus: what the minimally invasive gynecologic surgeon needs to know about the belly button. J Minim Invasive Gynecol 2012; 19:680-3. [PMID: 23084669 DOI: 10.1016/j.jmig.2012.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 07/26/2012] [Accepted: 08/02/2012] [Indexed: 01/11/2023]
Abstract
The umbilicus is viewed as a portal by the laparoscopic surgeon, a doorway to the real business at hand. However, the umbilicus itself may be the site of a variety of lesional conditions. Some of these may be iatrogenic, caused by prior surgical interventions, such as endometriosis or seeding of a malignant neoplasm. Some may be the initial presenting complaint. This review discusses umbilical lesions that may be encountered by the minimally invasive gynecologic surgeon.
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Dessy LA, Maruccia M, Romanzi A, Onesti MG. Melanoma of the umbilicus: an incidental diagnosis during fat-harvesting donor-site selection. Aesthetic Plast Surg 2013; 37:489-90. [PMID: 23435508 DOI: 10.1007/s00266-013-0093-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 02/06/2013] [Indexed: 11/28/2022]
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Affiliation(s)
- Soraya Navysany
- Department of Dermatology, Skin Cancer Center, Ludwigshafen Hospital, Germany
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