The impact of Ets-1 oncoprotein and human endoglin (CD105) on the recurrence of non-melanoma skin cancers.

BACKGROUND: The aim of this study was to investigate if the expression of CD105 and Ets-1 was predictive of aggressive biologic behavior of non-melanoma skin cancers (NMSC) and to evaluate indicators of local recurrence. PATIENTS AND METHODS: A total of 144 patients with NMSC were included in the current study. Surgical specimens were independently examined for diagnosis confirmation and immunohistochemical expression of Ets-1 and CD105 by two dermatopathologists. RESULTS: The most common tumor type was basal cell carcinoma (n = 76), followed by squamous cell carcinomas (SCC) (n = 65). The most common anatomic location was the head and neck area (n = 115). The follow-up was ˃ 2 years in all examined cases. A statistically significant correlation was found between tumor local recurrence and age (P = 0.03), Ets-1 expression (P ˂ 0.0001) and CD105 expression (P ˂ 0.0001). CONCLUSIONS: Our data confirm that both Ets-1 and CD105 show promise as prognostic markers for local recurrence of NMSC. However, this statement is made with caution, and additional studies, with larger populations, are necessary to examine the correlation between these two markers and local recurrence. A better understanding of the pathogenesis of local recurrence in primary NMSC may result in potential therapeutic interventions.

Sentinel lymph node biopsy for cutaneous melanoma: a propos of 144 cases.

PURPOSE: The aim of this study was to identify the predictive factors of a positive sentinel lymph node (SLN) in patients with cutaneous malignant melanomas and tumor progression. METHODS: From October of 2000 to January of 2006, 144 patients with cutaneous malignant melanoma underwent SLN biopsy. Patients were divided into two groups according to the SLN status (positive vs negative) which were compared with regards to patient demographics and primary tumor characteristics. RESULTS: In 37 (25.69%) patients SLN biopsy was positive . Nodular melanomas (p=0.047), blood (p=0.010) and lymph (p<0.001) vessel infiltration, mitotic rate (p=0.019) and Breslow thickness (p=0.012) were predictive of a positive SLN biopsy. The overall recurrence, mortality and the overall disease free survival (DFS) rates were 6.25, 1.4 and 93.75, respectively. CONCLUSION: SLN biopsy is the most important predictor of early disease recurrence and survival in patients with cutaneous malignant melanoma. Considering all the examined factors, a positive SLN biopsy is related with Breslow thickness and lymph vessel infiltration.

Gracilis myocutaneous flap: evaluation of potential risk factors and long-term donor-site morbidity.

This study reviewed our experience with the gracilis myocutaneous (GMC) flap, potential risk factors for flap necrosis, and long-term morbidity at the donor-site. From 1993 to 2002, 29 GMC flaps were harvested from 27 patients (pedicled n = 21 and free n = 8). The overall incidence of flap necrosis was 13.79% (partial (n = 2) and total (n = 2) necrosis). Flap necrosis was correlated with body mass index >25 (P = 0.022), with smoking (P = 0.04 9) and with radiation therapy at the recipient site (P = 0.020). The long-term morbidity at the donor-site was low, except for scar appearance (17.24%), thigh contour deformity (58.62%), and hypoesthesia (17.24%). Significant age and gender differences were seen for ranking of scar ugliness, with females (P = 0.0061) and younger patients (age ≤55) (P = 0.046) assigned higher values. Significant age differences were seen for ranking of thigh contour deformity, with younger patients assigned higher values (P = 0.0012). In conclusion, patient overweight, smoking, and previous radiation therapy at the recipient site may be the "potential risk factors" for flap necrosis. The long-term morbidity at the donor-site was low, which was in agreement with previous reported studies. A larger series would be the subject of a future study.

Double scalping flap: a versatile technique in scalp reconstruction.

Scalp reconstruction is a challenging area in plastic surgery. The susceptibility of potentially exposed brain tissue is almost always a concern along with the provision of adequate soft tissue coverage in cases of full-thickness defects. The applied reconstructive strategy also affects efficiency in malignant disease treatment providing both local control of the disease and vigorous monitoring for recurrence or metastasis. The general condition of the patients presenting with malignant lesions of the scalp is often impaired because of old age or concomitant disease. Therefore, demanding, long-lasting, or multistage procedures may often be undesirable. The double scalping flap comprises a 1-stage procedure, which can be used in most full-thickness defects of the vertex of the scalp. Some of the primary advantages of the double scalping flap procedure are its versatility and arc of rotation, its minimal donor site morbidity, being relatively simple, and being a short technique. Disadvantages that may be considered are the loss of hair-bearing skin at the occipital region and the poor color and texture match between scalp skin and the split-thickness skin graft that is used on the donor site. We present 2 patients with exemplary case of neglected malignancy of the scalp and their successful treatment using the double scalping flap. Comparison and contrast of alternative reconstructive procedures are also included to further investigate scalp reconstruction.

Use of the hemifrontal flap in reconstruction of the forehead.

The hemifrontal flap is an efficient way of reconstructing large unilateral defects that involve the hemiforehead. Six patients had their foreheads reconstructed after the excision of neglected tumours in the frontal region. The flap was designed to provide adequate repair of large defects including the periosteum. The width of the flap above the eyebrow is almost equal to the vertical height of the forehead in the midline. Efficient reconstruction of the primary defect including surface and depth was achieved in all patients. There were no complications with the viability of the flap. The hairline and the line of the eyebrows were preserved in their original sites, with no alteration in the aesthetic landmarks of the forehead in 3 cases, where there was no invasion of tumour.

Nonmelanoma skin tumors involving the craniofacial region: our 22 years of experience.

Skin tumors comprise the largest group of malignancies of the head. Despite the accessibility of such lesions, the treatment of neglected, far advanced cancers, many of which have extended deeply into the facial bones and skull, is often required. The key to the cure of malignant tumors of the head is an accurate diagnosis and evaluation of the margins of an excised tumor. Reconstructive surgery of the head after resection of tumors requires a complete understanding of the anatomy of this region. From January 1986 to December of 2005, 31 patients underwent reconstructive surgery for nonmelanoma skin tumors involving the craniofacial region. Preoperative evaluation of the patients was performed in all cases. The results were estimated from the oncologic and functional point of view. The reconstruction, which was performed, included local, regional, and free flaps. In our series, the 5-year disease-free survival rate was 87%. The primary goal of surgical treatment of skin tumors with invasion of craniofacial bone structure is three-dimensional tumor resection with histologically clear margins. This goal has to be balanced, however, with an acceptable functional and aesthetic result. Resections are planned according to pathologic considerations rather than according to the anatomy involved.

Divided naevus of the eyelid, seven cases.

Divided naevus of the upper and lower lids is an infrequent congenital naevus of the human eyelids. It is also known as kissing naevus or split ocular naevus. The histological types of divided naevi may be melanocytic, cellular or compound. Until now about 30 such cases have been reported in the literature. In our clinic, in the last 20 years we have seen seven patients with divided naevus, four female and three male. Three patients, two children of 10 and 11 years and a 77-year-old nun, did not accept any treatment. The remaining four patients, three female and one male, accepted surgical treatment. None of them had received any treatment in the past. Three of these divided naevi were cellular and one was melanocytic. Treatment included a two stage reconstruction in three cases and a single stage procedure in one case. The lower eyelid was usually treated first, and upper eyelid full thickness grafts were mostly used. Lid shortening was common, particularly in the cellular naevi. The results were aesthetically and functionally good. No major complications were observed.

Rat epigastric flap survival and VEGF expression after local copper application.

BACKGROUND: Copper has been used in wound healing since ancient times, and copper insufficiency seems to impair wound healing. Much less is known about the local effects of copper application on wound healing. METHODS: The authors studied 30 male Sprague-Dawley rats weighing between 250 and 350 g for 5 days. Full-thickness random skin flaps, measuring 1.5 x 7.5 cm, were elevated on the epigastric region. The rats were randomized into two groups according to the local treatment that was used. In group 1 (20 animals), 1 ml of copper ointment was applied on the flap bed after flap suturing. In group 2 (10 animals), 1 ml of placebo ointment (petroleum jelly) was used. Intraperitoneal injection of 30 mg/kg body weight of Hypoxyprobe-1 was performed in each rat on the fourth postoperative day and all animals were killed 3 hours later. Histologic examination of the distal end of the flaps was used for detection of hypoxic tissue changes. Expression, density, and extent of vascular endothelial growth factor activity was detected with the aid of immunocytochemistry. RESULTS: All rats survived throughout the study period. This experimental study showed that local application of copper at the random flap bed may promote wound-related angiogenesis by inducing vascular endothelial growth factor expression. The authors demonstrated statistically significant flap survival after local copper application at the flap bed. CONCLUSION: The marked benefits of copper application in flap survival in this experimental model may guarantee its clinical application in flaps with questionable viability.

Neglected squamous cell carcinoma of the frontal area: a clinical report.

Neglected skin carcinomas are not very often in our days. It is known that skin is the most common site of malignancy Squamous cell carcinoma (SCC) is the second most common malignancy of the skin. We report a combined surgical treatment in an unusual case of a squamous cell carcinoma (T4 n0 m0) localized on scalp, presented primarily as a frontal ulcerative bloody mass, with no palpable lymph nodes and a whole body negative computed tomography. Three months after the first surgical procedure, the tumour reappeared presenting left frontal lobe invasion. A combined surgical management (neurosurgery and plastic surgery) was realized, in order to remove the tumour and to cover the defect. Three months later the tumour recrudesced invading the left antrum, infiltration of remained parotid gland and an ipsilateral mandible osteolysis, besides a 2 cm size distal metastasis at the right upper lobe of the lung was revealed. This article, through case report and a brief review of the literature, offers criteria for the surgical treatment of SCC that arise on the scalp.

Soft-tissue sarcomas and reconstruction options: twenty-two years of experience.

Soft tissue sarcomas (STS) are particularly rare malignancies that constitute less than 1% of all malignancies. In recent years, prognostic clinical factors have been defined that help to stratify patients regarding their risk for local and distant recurrence and death from disease. Tumor grade, size, depth, completeness of resection, and presentation status are among the independent prognostic factors. At present, the treatment of these tumors constitutes a wide or marginal excision, adequate primary reconstruction, and radiotherapy. Surgery has generally been recommended as the primary method of treatment for achieving local control. Modern reconstructive surgery, especially musculocutaneous, either pedicle or free flaps, has made more extensive resections possible, while providing acceptable cosmetic and functional results. This study deals with our experience in the treatment of resectable STS with selective combination of treatment modalities.

Orbitopalpebral repair after 835 excisions of malignant tumours.

Repair of any defect in the eyelid depends on its size and position and the state of the surrounding tissues. Basal cell carcinoma (BCC) is the most common malignant tumour of the eyelids, and squamous cell carcinoma (SCC), mixed carcinomas or basosquamous cell carcinomas (BSC), and cutaneous melanomas (CM), also invade the eyelids and periocular zones. Reconstruction of the eyelids and associated orbital structures after resection requires a complete understanding of the anatomy. The adequacy of the reconstruction is judged by the quality of functional restoration and the aesthetic appearance. The purpose of this study was to document various, simple or complex reconstructive procedures that may be used after excision of malignant tumours of the eyelids and to assess the outcome of surgical treatment.

Vertical trapezius musculocutaneous flap: a retrospective study.

From 1986 to 2001, 17 patients (aged 26-77 years) were treated using the vertical trapezius musculocutaneous flap. A two-stage procedure was used in 7 and a single-stage island flap in 10. The donor site was closed directly in all patients. Mean length of hospital stay was 16 days (range 12-25). There was no operative mortality. Complications were one partial flap necrosis and two seromas of the donor site, complicated by infection. With a minimum follow-up of more than two years, our study confirms the usefulness of the vertical trapezius musculocutaneous flap in head and neck reconstructive surgery. It is a reliable, thin flap of uniform thickness, which carries hairless skin. The length and thickness of its pedicle allows excellent mobility. The main disadvantage of the flap is the complete sacrifice of the muscle necessary for total mobilisation of the flap, and the intraoperative repositioning of the patient.