e20049 Background: At our institution, patients with metastatic melanoma who achieve partial response (PR) to HD IL-2 therapy undergo monthly maintenance treatment with IL-2 and GM-CSF with the thought that the continuous stimulation of the immune system may improve response. Our aim was to describe our experience with maintenance treatment following HD IL-2 therapy. Methods: A retrospective chart review was performed on patients with metastatic melanoma seen at Saint Louis University from January 1999-June 2011 who were partial responders to HD IL-2 therapy (720,000 IU/kg per dose intravenously; 14 doses, 2 cycles per course, maximum 2 courses) that received maintenance IL-2 therapy (continuous 42 hour infusion of three consecutive doses of 18,000,000 IU/m 2 over 6, 12 hours, then 24 hours) and GM-CSF (daily subcutaneous injection of 125 mcg/m 2 for 3 days) every 4 weeks for 13 cycles or until disease progression. Duration of response for this cohort was compared to established data for partial responders using the Mann-Whitney test. Results: Five patients were included in the analysis. Median duration of response was 9 months (3.9-53.4 months). Median overall survival was 20.6 months (15-53.4+ months). One patient who initially showed PR to HD IL-2 therapy converted to complete response during maintenance IL-2 and has the longest duration of response in the study dataset. Duration of response for the maintenance group (9 months) was longer than a benchmark of 5.9 months as reported in the literature and package insert for partial responders to HD IL-2 without maintenance therapy, p = 0.068. Conclusions: Subjects who received maintenance IL-2 and GM-CSF therapy had a longer duration of response compared to previous reports, which trended toward statistical significance in this small sample. Maintenance IL-2 and GM-CSF after HD IL-2 therapy may help to prolong partial response, possibly lead to conversion to complete response and is worthy of additional study.
BACKGROUND The nasal trumpet has been used in emergency resuscitation, anesthesia, and facial burns to maintain nares openings. The dermatologic surgery literature is not as familiar with this device to improve respiratory function during the postoperative period after reconstruction of large defects on the nose. OBJECTIVE To present a novel way of using a modified nasal trumpet orthosis to maintain nasal valve patency and improve nasal valve respiratory function postoperatively following a melolabial interpolation flap. MATERIALS A sterile nasal trumpet orthosis. CONCLUSION We present a novel way of using a modified nasal trumpet orthosis after a melolabial interpolation flap procedure. For large defects involving the nares and/or nasal valve of the nose, the nasal trumpet is well tolerated by the patient and can lead to increased postoperative respiratory function while acting as a "bolster" for the closure.
Background: Perineural invasion (PNInv) is a significant risk factor for metastasis and death in cutaneous squamous cell carcinoma (cSCC). Despite this known association, factors contributing to the presence of PNInv are not well characterized.Aims: To determine risk factors associated with the presence of PNInv using the high-risk cSCC criteria developed by the National Comprehensive Cancer Network (NCCN).Methods: After receiving Institutional Review Board approval for this retrospective review, the presence of NCCN high-risk factors for cSCC were recorded for patients treated at a tertiary referral academic medical center, from January 1, 2010 to March 31, 2012. Stepwise logistic regression was used to identify factors associated with the presence of PNInv.Results: PNInv was present in 34 of 507 cSCCs (6.7%). Moderately or poorly differentiated histology (P < .001, OR 6.6 [95% CI, 3.2-13.7]), acantholytic, adenosquamous, or desmoplastic subtype (P =.01, OR 1.8 [95% CI, 0.8-4.2]), and tumors in areas M (≥10mm) and H ( ≥6mm) (P = .05, OR 5.0 [95% CI, 1.2-21.0]) were significantly associated with the presence of PNInv.Conclusions: This data suggests clinicians should have a higher suspicion and may be able to identify PNInv in high-risk cSCC based on the presence of specific high-risk factors.
Abstract Background Nevoid basal cell carcinoma syndrome (NBCCS) is a rare genetic disease which causes a variety of dermatological lesions, especially basal cell carcinomas (BCCs), often on the face, neck, and head. Methods Persons attending a national NBCCS support group meeting were asked to participate in survey‐based assessments of quality of life and depressive symptoms. Inclusion criteria required a self‐reported NBCCS diagnosis, voluntary agreement to participate, and age over 18 years. Exclusion criteria included cognitive impairment. Skin‐related quality of life was assessed with Skindex‐29, completed by 32 participants. Depressive symptomatology was determined with the Center for Epidemiological Studies Depression Scale (CES‐D), completed by 18 participants. Sociodemographic, medical, and social variables were also analyzed. Results Median Skindex‐29 scores for the emotions, symptoms, and functioning scales were 42.50, 32.14, and 28.13, respectively (means: 41.17, 37.05, and 29.30, respectively). These scores were slightly higher than those observed in patients with neurofibromatosis type 1, a similar genetic disease with skin symptoms. The CES‐D scores (median = 15.50, mean = 17.50) suggested that 50% of participants had significant depressive symptomatology. Variables showing moderate associations with the scores included diet, number of affected family members, and treatment type. Interestingly, the number of BCCs had no effect. Conclusions Nevoid basal cell carcinoma syndrome impacts the quality of life of its subjects in a similar manner to other genodermatoses. Depressive symptoms are particularly prevalent. Several demographic, medical, and social characteristics affect these outcomes. Thus, the psychological impact of this disorder should be evaluated in the course of considering the care of persons with NBCCS.
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Objective: To determine the ability of fluorodeoxyglucose F 18 positron emission tomography (FDG-PET) to image basal cell carcinoma (BCC).Design: Case series study.Setting: Mohs surgery practice in a tertiary university hospital.Patients: Six patients with BCC larger than 1.0 cm of the head and neck region were identified.Results: Patients were imaged using FDG-PET before surgery.In 3 patients, PET imaging correlated well with the size and extent of the soft tissue invasion.Histologically, all 3 tumors were of the nodular subtype.The remaining 3 patients failed to demonstrate identifiable tumor activ-ity on PET.Two of these 3 tumors were of the infiltrative histologic subtype, and 1 was of the nodular subtype.Perineural spread was detected by tissue biopsy in 1 infiltrative tumor, but not by FDG-PET imaging.Conclusions: In our study, FDG-PET imaging was able to image and identify BCC in the head and neck region in 3 of 6 patients.In some cases, anatomic accuracy and the extent of soft tissue invasion were observed.The histologic subtype of the BCC appears to affect the ability of FDG-PET detection, with the nodular histologic subtype more likely to test positive on PET.This is a preliminary study, and future investigation is needed to evaluate the role of PET imaging in the management of patients with BCC.
