ABSTRACT
The change toward breast-conserving surgery for cancer has altered the role of the initial biopsy. We retrospectively analyzed two methods, traditional excisional biopsy (n = 47) and lumpectomy (n = 44) to evaluate their usefulness as the initial procedure for breast-conserving surgery. Lumpectomy required more time (mean +/- SEM, 53 +/- 3 minutes) than traditional biopsy (37 +/- 2 minutes). Margins were verified by microscopic examination to be clear in 73% of the patients in the lumpectomy group and in only 17% of patients in the traditional biopsy group. Patients in the lumpectomy group subsequently underwent more axillary dissections than patients in the traditional biopsy group (31% vs 4%, respectively) and fewer modified radical mastectomies (49% vs 71%, respectively). A correlation between extensive intraductal components and positive margins was found in the lumpectomy group. These data suggest that as the initial biopsy method, lumpectomy more often provides adequate margins and may decrease the number of subsequent procedures on the breast for breast-conserving surgery.
Subject(s)
Breast Neoplasms/pathology , Mastectomy, Segmental , Adult , Aged , Aged, 80 and over , Biopsy/methods , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Combined Modality Therapy , Female , Humans , Mastectomy, Modified Radical , Middle Aged , Retrospective StudiesABSTRACT
Thirty-one patients with subungual melanoma representing 2.6 per cent of all patients with limb melanoma were treated by isolated regional perfusion. Acral lentiginous melanoma prevalent on subungual and volar skin was the most common histologic type. The subungual lesions primarily occurred on the lower limbs (61%) and great toe (48%). At diagnosis, most patients had advanced disease; 53 per cent of stage I patients had lesions with level IV invasion or greater. The median thickness of the primary lesion was 2.35 mm. All patients were treated by isolated regional perfusion and amputation of the involved digit, as well as regional lymph-node dissection where clinically indicated. The mean survival rate for all stages at five years was 35 per cent. Patients with stage I disease had the best survival rates, 61 per cent at five years and 54 per cent at ten years; however, patients with advanced disease, stage III (M.D. Anderson classification), had only a 17 per cent survival rate at five years and 8 per cent at 10 years. Women had slightly better survival rates than men, and patients with upper-limb lesions had the better prognosis.
Subject(s)
Antineoplastic Agents/administration & dosage , Chemotherapy, Cancer, Regional Perfusion , Melanoma/drug therapy , Nail Diseases/drug therapy , Adult , Aged , Aged, 80 and over , Amputation, Surgical , Chemotherapy, Cancer, Regional Perfusion/methods , Combined Modality Therapy , Female , Fingers/surgery , Humans , Male , Melanoma/mortality , Melanoma/surgery , Middle Aged , Nail Diseases/mortality , Nail Diseases/surgery , Toes/surgeryABSTRACT
Retroperitoneal leiomyosarcomas are rare tumors with a poor prognosis. These tumors are often deemed unresectable because of their large size when diagnosed. This study presents two recent patients who show that retroperitoneal leiomyosarcomas can be resected successfully. Adjuvant radiotherapy is useful in treatment of patients with residual disease. Although the contribution of chemotherapy in prophylaxis and treatment of these tumors remains undefined, various chemotherapeutic regimens are currently under investigation.
