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Cirocchi R, Cicoletti M, Arcangeli F, Tebala GD, Bruzzone P, Avenia S, Poli G, Trastulli S, Matteucci M. Preliminary Study of Axillary Lymphatic Drainage in Cutaneous Melanoma Patients: A Cross-Sectional Study. Medicina (Kaunas) 2023; 59:1357. [PMID: 37629647 PMCID: PMC10456326 DOI: 10.3390/medicina59081357] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/10/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
Background: The axilla is a region of fundamental importance for the implications during oncological surgery, and there are many classifications of axillary lymph node subdivision: on the basis of studies on women with breast cancer, we used Clough's and Li's classification. However, currently we do not have a gold-standard classification regarding axillary lymphatic drainage in melanoma patients. Purpose: Our aim was to evaluate how these classifications could be adapted to sentinel lymph node evaluation in skin-melanoma patients and to look for a possible correlation between the most recent classifications of axillary lymph node location and Oeslner's classification, one of the most common anatomical classifications still widespread today. Methods: We analyzed data from 21 patients who underwent sentinel lymph node biopsy between January 2021 and January 2022. Results: Our study demonstrates that, to an extent, there is a possible difference in the use of the various classifications, hinting at possible limits of each. The data we obtained underline how cutaneous melanoma presents extremely heterogenous lymphatic drainage at the level of the axillary cavity. However, the limited data in our possession do not allow us to obtain, at the moment, results that are statistically significant, although we are continuing to enroll patients and collect data. Conclusions: Results of this study support the evidence that the common classifications used for breast cancer do not seem to be exhaustive. Therefore, a specific axillary lymph node classification is necessary in skin melanoma patients.
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Affiliation(s)
- Roberto Cirocchi
- Department of Medicine and Surgery, University of Perugia, 05100 Terni, Italy; (R.C.); (S.A.)
| | - Michela Cicoletti
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Fabrizio Arcangeli
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Giovanni D. Tebala
- Department of Surgery, S. Maria Hospital, 06129 Perugia, Italy; (G.D.T.); (S.T.)
| | - Paolo Bruzzone
- Department of Surgery, Sapienza University, 00189 Rome, Italy
| | - Stefano Avenia
- Department of Medicine and Surgery, University of Perugia, 05100 Terni, Italy; (R.C.); (S.A.)
| | - Giulia Poli
- Section of Pathology, Department of Medicine and Surgery, University of Perugia, 05100 Terni, Italy;
| | - Stefano Trastulli
- Department of Surgery, S. Maria Hospital, 06129 Perugia, Italy; (G.D.T.); (S.T.)
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Cirocchi R, Metaj G, Cicoletti M, Arcangeli F, De Sol A, Poli G, Bruzzone P, Gioia S, Anagnostou C, Loreti F, Francesconi S, Ricci L, Laurenti ME, Capotorti A, Artico M, D’Andrea V, Henry BM, Fedeli P, Carlini L. Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma. J Clin Med 2021; 10:jcm10235544. [PMID: 34884243 PMCID: PMC8658642 DOI: 10.3390/jcm10235544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/13/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/03/2022] Open
Abstract
In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.
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Affiliation(s)
- Roberto Cirocchi
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
| | - Giulio Metaj
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
- Correspondence:
| | - Michela Cicoletti
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Fabrizio Arcangeli
- Dermatologic Clinic, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (M.C.); (F.A.)
| | - Angelo De Sol
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
| | - Giulia Poli
- Section of Pathology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy;
| | - Paolo Bruzzone
- Department of General and Specialist Surgery “Paride Stefanini”, Sapienza University, 00100 Rome, Italy;
| | - Sara Gioia
- Azienda Ospedaliera Santa Maria Terni, Legal Medicine, University of Perugia, 05100 Terni, Italy;
| | - Christos Anagnostou
- Nuclear Medicine Service, “S. Maria” Hospital, 05100 Terni, Italy; (C.A.); (F.L.)
| | - Fabio Loreti
- Nuclear Medicine Service, “S. Maria” Hospital, 05100 Terni, Italy; (C.A.); (F.L.)
| | - Simona Francesconi
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy; (S.F.); (L.R.); (M.E.L.)
| | - Linda Ricci
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy; (S.F.); (L.R.); (M.E.L.)
| | - Maria Elena Laurenti
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 06121 Perugia, Italy; (S.F.); (L.R.); (M.E.L.)
| | - Andrea Capotorti
- Department of Mathematics and Informatics, University of Perugia, 06121 Perugia, Italy;
| | - Marco Artico
- Department of Sensory Organs, “Sapienza” University of Rome, 00100 Rome, Italy;
| | - Vito D’Andrea
- Department of Surgical Science, “Sapienza” Università di Roma, 00100 Rome, Italy;
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
| | - Piergiorgio Fedeli
- School of Law, Legal Medicine, University of Camerino, 62032 Camerino, Italy;
| | - Luigi Carlini
- Department of Surgery, S. Maria Hospital, University of Perugia, 05100 Terni, Italy; (R.C.); (A.D.S.); (L.C.)
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Papini M, Cicoletti M, Fabrizi V, Landucci P. Skin and nail mycoses in patients with diabetic foot. GIORN ITAL DERMAT V 2013; 148:603-608. [PMID: 24442040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Diabetes mellitus affects all socioeconomic and age groups and its incidence is rapidly increasing worldwide. The diabetic foot complication represents one of the most complex and serious complications in these patients. Fungal infections can also contribute to the severity of the diabetic foot. The aim of the present study was to evaluate the prevalence of foot skin and toenail mycosis in a group of 75 patients with diabetic foot complication and in a matched control group. Diabetic patients showed onychomycosis in 53.3% and foot skin mycosis in 46.7% of the cases, with a prevalence of both fungal infections significantly higher than that observed in the control group. At least one type of these fungal infections was present in 69.3% of diabetic subjects with a highly significant difference compared to control group (P<0.001). Trichophyton rubrum and Trichophyton interdigitale were the most common species responsible of both nail and skin infections. Candida spp, Fusarium spp, Aspergillus spp and other moulds. were found in about 1/3 onychomycosis. Previous toe amputation was significantly associated with both skin and nail mycosis. The present study confirms that both tinea pedis and onychomycosis have a high prevalence in subjects suffering from diabetic foot complication, and that the problem of fungal infections of the foot in diabetic subjects is still highly underestimated. Consequently, there is an important clinical rationale for careful mycological examination of diabetic foot and an adequate treatment tailored for each individual patient according to the fungal species involved.
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Affiliation(s)
- M Papini
- Terni Dermatologic Clinic, University of Perugia S. Maria Hospital, Terni, Italy -
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