Infusion of in vitro expanded tumour-infiltrating lymphocytes and recombinant interleukin-2 in patients with surgically resected lymph node metastases of malignant melanoma: a pilot study.

A pilot study was set up in order to evaluate the feasibility and safety of infusing in vitro expanded tumour-infiltrating lymphocytes (TILs) and recombinant interleukin-2 (rIL-2) in a group of patients with advanced melanoma after radical resection of lymph node metastases. Twenty-four patients were eligible for the study and proliferating TILs were collected in 16. These patients were infused with TILs and then treated with rIL-2 and alpha-interferon. Short-term toxic effects (such as fever) were in general controlled by symptomatic drugs, whereas chronic toxicities were absent. The median follow-up period was 19 months; at present, 13 patients are alive and disease free, one patient is in progression and two patients have died. The approach was feasible and safe and the clinical results observed are comparable to those obtained by long-term treatment with other biological response modifiers.

Vessel-wall recovery after diode laser-assisted microvascular anastomosis: clinical and histologic analysis on long-term follow-up.

The authors recently reported an experimental study on diode laser-assisted microvascular anastomosis (LAMA) in the femoral arteries and veins of rats. Good success rates and very promising histologic results obtained in this preliminary phase suggested an extension of the investigation with a larger number of rats and for longer follow-up periods. In the present work, they describe an experimental study with two main goals: 1) improvements of the laser-assisted surgical procedure for reduction in the number of permanent stay sutures, with minimization of bleeding at the end of the intervention, compared with conventional microvascular sutured anastomosis (CMSA); and 2) providing more information on the repair mechanism(s) induced by laser treatment, obtained from clinical and histologic analyses extended up to 3 months of follow-up. In a total of 64 Wistar rats, 46 arterial and 22 venous LAMAs were performed, and 15 arterial and 11 venous CMSAs. The recorded success rates of LAMA in both arteries and veins were fairly high (67/68 at the time of surgery, and 54/55 in the follow-up), and substantially comparable with those of CMSA. Clear evidence of a superior healing process in the LAMAs was provided by histologic examinations. In particular, specific stains and immunohistochemistry analysis indicated that laser irradiation can induce wide proliferation of smooth muscle cells and negligible scar tissue which, together with diminished foreign-body reaction consequent to the reduction of suture material, result in a better restoration of vessel structures.

First recurrence analysis of 840 cutaneous melanomas: a proposal for a follow-up schedule.

AIMS AND BACKGROUND: A correct follow-up schedule for patients who underwent an excision for stage I cutaneous melanoma might allow the early detection of local and distant metastases. At present, there is no general agreement on follow-up protocols. In order to work out a follow-up guide, we have retrospectively evaluated the records of 840 stage I cutaneous melanoma patients surgically treated and followed during the postoperative period in the Division of Plastic Surgery of the University of Florence from 1975 to 1992. METHODS: We evaluated the patients' records by analyzing time, pathway and site of any first recurrence in relation to the main prognostic factors such as patient sex, site, histological type and depth of invasion of each primary melanoma. A statistical analysis was performed. RESULTS: To summarize, the salient results were the following: 80% of relapses occurred in the first 3 years and they occurred significantly earlier when the primary melanoma was localized in the trunk and significantly later when the melanoma was localized in the lower limbs and for < 1.5 mm lesions. The first recurrence occurred earlier by the lymphatic than by the hematic pathway regarding the overall number of patients. The hematic pathway was the most frequent (with respect to the overall percentage of hematic metastases) for the melanomas localized in the head and neck region and for lentigo malignant melanomas, whereas the lymphatic pathway was most frequent for melanomas of the lower limbs and > 3 mm in thickness. CONCLUSIONS: We suggest a follow-up schedule taking into consideration the postoperative behavior of stage I cutaneous melanoma patients (in terms of time and pathway of the first recurrence) in relation to the site and depth of invasion of the tumor.

Sonographic evaluation of dermis and subcutaneous tissue during and after skin expansion.

Soft-tissue thickness modifications were evaluated by high-resolution ultrasound sonography in six patients undergoing skin expansion, with the aim of investigating the possible use of this noninvasive method in the routine monitoring of soft tissues during and after skin expansion. Both during expansion (decrease) and in the postoperative period (increases up to 100 percent or more of the baseline preoperative value), changes in fat thickness occurred faster and were greater in magnitude than those in dermal tissue, overall gradual and limited. In our series, the values of fat thickness ranged between 44 (at full-expansion time) and 140 percent (2 months after expander removal), with a highly significant difference (p = 0.0003), while dermis thickness values ranged between 83 and 114 percent, respectively, showing no significant difference (p = 0.71). Some echo-structural dermal modifications were found by the 20-MHz probe at full skin expansion only. High-resolution ultrasound sonography may be proposed as a noninvasive method in the routine monitoring of soft tissues during and after skin expansion.

Reconstruction of a medial canthus defect with a myocutaneous flap.

Defects in the inner canthal area are generally repaired by full-thickness skin grafts, V-Y advancement flap, or frontal flap. Each of these techniques may give some problems in restoring the functional or aesthetic features of that region, or both. To avoid these inconveniences, we performed the reconstruction of the medial canthal area after tumor excision by using a myocutaneous rotation flap from the upper lid joined to a rotation flap from the lower lid and cheek. No scar resulted inside the aesthetic unit and a fine result was achieved from both the functional and the aesthetic point of view.

The use of high resolution ultrasound in preoperative evaluation of cutaneous malignant melanoma thickness.

High resolution ultrasound (HRUS) was tested in 58 cutaneous malignant melanomas to check its validity in evaluating tumor thickness in vivo before surgery. The values obtained with this method were compared with histologic values (measured according to Breslow); a highly significant correlation was found (r = 0.895, p less than 0.001). The accuracy of HRUS in distinguishing between low- and high-risk cutaneous malignant melanoma was also found to be quite high. Our data therefore justify the use of such a technique in the preoperative staging procedure.

Comparison of results with CO2 laser and traditional surgical treatment of stage I malignant melanoma.

The follow-up data on 39 cases of stage I malignant melanoma treated with CO2 laser are compared to those of an analogous group of cases treated by traditional surgical methods and selected for their clinical and pathologic similarities with the laser-treated group. The findings were expressed in terms of tumor-free time and were evaluated by variance analysis. The data showed that traditional methods gave better results. CO2 laser surgery requires longer healing time, which may have a negative effect on the course of the disease.