Melanoma patterns of distant relapse: a study of 108 cases from a South Brazilian center

Abstract Background: The incidence of cutaneous melanoma has increased over the last decades. Recurrences occur most frequently within the first 2-3 years after diagnosis but patients carry a lifelong risk of relapse. Nevertheless, there is no consensus in the literature on what screening tests patients should undergo. Objectives: To evaluate the most common melanoma metastasis sites among a South Brazilian population from a city with one of the highest melanoma rates, and establish the best screening method for these patients. Methods: A cross-sectional retrospective study of 108 consecutive melanoma patients followed up at a center from 2009 to 2013. Data were collected on demographic and tumoral characteristics, as well as the site of the first diagnosed metastasis. Results: Patients were divided into 3 groups for analytical purposes: Non-visceral metastases (48% of patients), visceral metastasis (39%) and brain metastasis (13%). We tried to correlate age, gender, mean Breslow thickness, mitosis and death rates with the aforementioned groups but none showed any statistically significant association. Conclusion: Melanoma patients must be monitored to detect early relapse and subsequent effective treatment but the best follow-up strategy remains to be established.

Sequelas de queimaduras: retração cervical / Sequelae of burns: cervical retraction

Objetivo: O objetivo é relatar e observar resultado de reconstrução, em região cervical, pós-sequela de queimaduras há 18 anos. Relato do caso: Paciente do sexo masculino, 28 anos, com sequela de queimadura por cera aquecida, há 24 anos, resultando em retração cicatricial importante da região cervical, com repercussão sobre a face. O paciente foi internado para tratamento cirúrgico, sendo proposta ressecção completa da cicatriz, miotomia do platisma, enxerto de matriz dérmica em primeiro tempo e, em segundo tempo, enxerto de pele, de espessura de 0,2 mm em tiras. Discussão: A lesão por queimadura não é apenas uma urgência médica, mas desencadeia sérios problemas físicos, psicológicos e mesmo sociais para o paciente, sua família e sociedade. As crianças do sexo masculino e com idade entre 7 e 11 anos são as mais atingidas por queimaduras. Nessa faixa etária, as queimaduras parecem estar relacionadas a brincadeiras com álcool e outros materiais inflamáveis que, em nossa cultura, são mais comuns entre o sexo masculino. Estatísticas revelam que são realizados mais de 34 milhões de procedimentos cirúrgicos relacionados à lesão por queimadura. Na matriz de regeneração dérmica, a camada interna funciona como um scafold, promovendo o crescimento celular organizado e a síntese de colágeno de forma mais natural. É indicado em caso de feridas limpas e queimaduras de 2° grau profundo e 3° grau. As contraturas são elementos importantes ao analisar as sequelas de queimaduras. As queimaduras da região cervical também são de difícil condução cirúrgica, tanto para a realização do desbridamento quanto para a enxertia de pele, e devem ser realizadas na fase aguda dentro da primeira ou segunda semana após o trauma.

Objective: To describe and observe the result of reconstruction in the cervical region, post burn sequelae for over 18 years. Case report: Male patient, 28 years, burn sequelae wax heated for 24 years, resulting insignificant scar retraction of the cervical region, with repercussions on the face and hospitalized for surgical treatment. Proposed treatment with complete resection of the scar, platysma myotomy, dermal matrix graft for the first time and second time the skin graft, thick strips of 0.2 mm. Discussion: The burn injury is not just a medical emergency, but triggers serious physical, psychological and even social to the patient, family and society. The children were male and aged between 7 and 11 years were the most affected by burns. At this age, burns appear to be related to the games with alcohol and other flammable materials that in our culture, are more common among males. Statistics show that is performed more than 34 million surgical procedures related to burn injury. In the matrix of regenerating dermal layer acts as an internal scafold, organized to promote cell growth and collagen synthesis more natural. It is indicated in case of clean wounds and burns deep 2nd degree and 3rd degree. Contractures are an important element in analyzing the consequences of burns. The burning of the neck are also difficult to conduct surgical both for the realization of debridement and for skin grafting, and must be performed in the acute stage within the first or second week after the trauma.he trauma.