Factors predicting iliac metastasis and overall survival in malignant melanoma of the lower extremities

BACKGROUND

To analyse the patient-related, disease-related and treatment-related factors in a group of melanoma patients to assess their impact on iliac metastasis and on overall survival.

METHODS

Medical records of thirty-nine patients with lower extremity malignant melanoma were retrospectively reviewed to confirm all of the clinical data. Age and gender were recorded as patient-related factors. Tumor location, size, histology, ulceration status, and TNM stage, Breslow thickness, Clark level, presence of inguinal LN metastases, and locoregional metastases (local recurrences, in transit metastases and regional LN metastases) were evaluated as disease-related factors. Type of surgery (en block excision of primary tumor, en block excision of primary tumor and inguinal lymph node dissection, en block excision of primary tumor and ilioinguinal lymph node dissection) and postoperative chemotherapy were taken into account as treatment-related factors.

RESULTS

The presence of inguinal lymph node metastases was significantly associated with iliac metastasis (p = 0.015). Tumor size (p = 0.046), tumor TNM stage (p = 0.009), Breslow thickness (p = 0.033), Clark level (p = 0.029), presence of in transit metastases (p = 0.010) and postoperative chemotherapy (p = 0.002) has been related to impaired overall survival rate.

CONCLUSIONS

Therapeutic lymph node dissection appears to carry a small but definite therapeutic benefit. Selection of appropriate patients for the more extensive procedure would be ideal, but at present there are no well proven selection criteria. The authors advocate therapeutic dissection when the inguinal lymph nodes are involved.

Kinetics of swelling-breakdown of a W/O/W multiple emulsion: possible mechanisms for the lipophilic surfactant effect

The properties and behavior of a W/O/W multiple emulsion formulation were analyzed during a swelling-breakdown process. Various experimental analyses, such as granulometry, rheology and conductimetry were performed, as well as a micropipette aspiration method. The predominant role of the lipophilic surfactant during the swelling phase confirmed. Two different mechanism can be proposed. Both imply the migration of the lipophilic surfactant from one interface to another and probably take place successively. The lipophilic surfactant could diffuse from the first to the second interface, thus rigidifying the membrane, or from the oily phase to the first interface, resulting in delayed coalescence of the aqueous droplets during swelling.