Subject(s)
Head and Neck Neoplasms/pathology , Nerve Sheath Neoplasms/pathology , Scalp , Skin Neoplasms/pathology , Aged, 80 and over , Head and Neck Neoplasms/metabolism , Head and Neck Neoplasms/surgery , Humans , Immunohistochemistry , Male , Neoplasm Recurrence, Local , Nerve Sheath Neoplasms/metabolism , Nerve Sheath Neoplasms/surgery , Skin Neoplasms/metabolism , Skin Neoplasms/surgery , Skin TransplantationABSTRACT
BACKGROUND: Sentinel lymph node biopsy (SLNB) is a widely accepted procedure to accurately stage patients with cutaneous melanoma. Disadvantages of the SLNB procedure are the overall costs and potential side effects of the operation [J Dtsch Dermatol Ges 2009;7:318-327; J Am Dermatol 2010;62:737-748]. OBJECTIVE: The purpose of our study was to evaluate whether high-resolution ultrasound combined with power Doppler sonography (PDS) is an appropriate tool for preoperative identification and characterization of sentinel lymph nodes (SLNs) in patients with cutaneous melanoma. METHODS: In a prospective study eighty-one consecutive patients with cutaneous melanoma (33 females and 48 males) in whom dissection of SLNs was indicated underwent ultrasound examinations before and after the preoperative lymphoscintigraphy. RESULTS: A total of 170 SLNs (mean 2.1 per patient) were removed and examined by histopathology. High resolution ultrasound combined with PDS correctly identified 2 of 9 positive SLNs. The sensitivity, specificity, positive predictive value, and negative predictive values of ultrasound were 22.2% (95% confidence interval (CI) = 2.8-60.0), 100% (95% CI = 97.7-100.0), 100.0% (95% CI = 15.8-100.0), and 95.8% (95% CI = 91.6-98.3), respectively. CONCLUSIONS: Although high-resolution ultrasound combined with PDS cannot substitute SLNB, this technique offers earlier diagnosis of lymph node involvement in a small subgroup of patients (with subcapsular location of metastases), and introduces the possibility to exclude those patients from SLN procedure and directly prepare them for complete lymph node dissection (CLND).
Subject(s)
Melanoma/diagnostic imaging , Sentinel Lymph Node Biopsy , Skin Neoplasms/diagnostic imaging , Ultrasonography, Doppler , Adult , Aged , Female , Humans , Male , Melanoma/pathology , Middle Aged , Neoplasm Staging , Prospective Studies , Sensitivity and Specificity , Skin Neoplasms/pathologyABSTRACT
BACKGROUND: Galli-Galli disease (GGD) represents a rare genodermatosis that is clinically characterized by progressive reticulate hyperpigmentation of the flexures accompanied by itching and pain. To date, no convincing treatment options are known for GGD. We sought to examine the therapeutic potential of ablative laser treatment in a patient with genetically confirmed GGD. OBSERVATIONS: We describe a 68-year-old man with refractory bilateral axillary GGD accompanied by severe itching and pain. His clinical picture and histologic findings were consistent with GGD. Direct sequencing analysis of the KRT5 gene identified the causative mutation, c.418dupA, and confirmed the clinical diagnosis. The patient was treated with the erbium:YAG laser in 2 consecutive sessions for each side and was followed up for 12 months. Ablative laser treatment led to complete resolution of clinical symptoms and a good clinical result with only minimal scarring and dyspigmentation. CONCLUSIONS: This article demonstrates the efficacy of ablative laser treatment in a patient with genetically confirmed refractory GGD. However, further studies with longer follow-up are required to confirm these results.
