Characteristics of Giant Nodular Melanomas in Special Locations: a Case Series and Review of the Literature.

INTRODUCTION: Nodular melanoma (NM) is a rare subtype of melanoma, responsible for more than 40% of melanoma deaths, characterized by rapid growth and high metastatic potential. Only a few case studies concerning the dermoscopic presentations of giant nodular melanoma have been reported so far. OBJECTIVES: The aim of the study was to assess dermoscopic features of giant nodular melanomas in special locations, along with their clinical and histopathologic aspects. METHODS: Among 120 patients with histopathologically confirmed melanoma treated by the Skin Cancer and Melanoma Team between September 2020 and February 2021, we identified six patients with giant nodular melanoma in special locations. We retrospectively assessed the archived dermoscopic images to determine the dermoscopic features of these tumors. RESULTS: The group consisted of six cases of giant melanoma in special locations, including the scalp (4/6) and the heel (2/6). The giant tumors were large in size (at least 5 cm in diameter). The most common dermoscopic structures in polarized light included asymmetric distribution of dermoscopic structures, the presence of structureless, multicolored zones (showing three or more colors), and the presence of white perpendicular lines or small, pink globules. CONCLUSIONS: It seems that there are no significant differences in dermoscopy between small and giant melanomas; however, further studies should be conducted on a larger scale.

Feasibility of laparoscopic enucleation for hemangioma in special hepatic segments.

Background and aim: This study aims to evaluate the safety and efficacy of laparoscopic enucleation for liver hemangioma in special hepatic segments. Methods: We retrospectively reviewed 58 patients who underwent laparoscopic surgery for hepatic hemangioma at a single center from January 2016 to January 2022. Segments I, IVa, VII, and VIII are defined as special hepatic segments, attributing to the bad visualization and adjacent to important vessels such as hepatic veins and inferior vena cava that lead to a high risk in laparoscopic surgery. Patients were categorized into a special location group (SLG) and a normal location group (NLG) according to the location of hemangioma. General data, intraoperative and postoperative outcomes, and postoperative complications of the two groups were compared and analyzed. Results: There were no significant differences in age (p = 0.288), gender (p = 0.331), body mass index (p = 0.168), the maximum diameter of hemangioma (p = 0.330), ASA risk grading (p = 0.615), and comorbidities (p > 0.05) between the two groups. The operation time (p < 0.001), intraoperative blood loss (p < 0.001), and intraoperative blood transfusion rate (p = 0.047) were significantly higher in the SLG. The rate of conversion to laparotomy was higher in the SLG, but there was no significant difference (p = 0.089). In addition, the exhaust time (p = 0.03) and postoperative hospital stay (p < 0.01) were significantly shorter in the NLG. The postoperative complications were comparable between the two groups, and there were no perioperative deaths. Conclusion: Laparoscopic enucleation of hemangioma in special hepatic segments is difficult and has a critical risk of massive bleeding during surgery. Meanwhile, it is also safe, feasible, and effective.

Development and evaluation of an improved laparoscopic myomectomy adopting intracapsular rotary-cut procedures.

OBJECTIVES: To develop and evaluate the efficacy and feasibility of Intracapsular Rotary-cut Procedure (IRCP) in laparoscopic myomectomy (LM). STUDY DESIGN: It is a retrospective study conducted in Peking University Shenzhen Hospital (PUSH) in Shenzhen, China. A total of 96 patients who were treated with LM because of big and moderate size of myomas in PUSH from January 2013 and December 2015 were enrolled in this study. Among them 35 were managed with IRCP -integrated LM as the study group, while the other 61 were treated with normal LM as the control group. The core steps of IRCP include minimized uterine incision, rotary cuttings in the fibroid inside the pseudocapsule, and preserving the fibers and vessels of the fibroid pseudocapsule. The operation data and outcome variables of each patient in the two groups were collected and compared to evaluate the efficacy and feasibility of this new improved surgery procedure. RESULTS: The ages, body mass indexes, main indication for myomectomy, and the diameters, numbers and types of the fibroids of patients in the two groups were similar. There is no significant difference in enucleation time and days of postoperative in-hospital staying between the two groups. In comparison with normal LM, application of IRCP significantly reduced the length of uterine incisions (P=0.000), the overall time of operations (P=0.001), and the time for uterine cavity suturing (P=0.000), and application of IRCP was also associated with less operation bleeding (P=0.003) and postoperative hemoglobin dropping (P=0.001). Five cases (8.2%) in the control group were referred to laparotomy, while no case was done so in the study group. No patient in the study group needed blood transfusion but six patients (9.8%) in the control group did. Follow-up to all the patients showed no uterine malignant tumor. CONCLUSIONS: Our study provided strong supportive evidences showing that Intracapsular Rotary-cut Procedures is safe and practicable. The less uterine incision length, less surgery time, and less bleeding than the normal LM procedures all suggests that IRCP should be adopted in LM for facilitation to the operation procedures, minimization of operative invasiveness, and protection to patients' infertility.

Clinical efficacy of precise liver resection of liver tumors adjacent to the main pipeline / 中华消化外科杂志

Objective To investigate the clinical efficacy of precise liver resection of liver tumors adjacent to the main pipeline.Methods The retrospective and descriptive study was conducted.The clinical data of 22 patients who underwent precise resection of liver tumors adjacent to the main pipeline in the Affiliated Tumor Hospital of Zhengzhou University between December 2014 and June 2016 were collected.According to preoperative precise evaluation and fully intraoperative exposed tumors,different methods of blood flow occlusion were choosed timely,and then precise resection of the liver was evaluated based on tumor location and size,relationship between tumor and blood vessels and the degree of liver cirrhosis.The operation procedures,operation time,time of liver resection,volume of intraoperative blood loss,number of patients with perioperative blood transfusion,postoperative complications,duration of postoperative hospital stay and follow-up were observed.The follow-up was performed by outpatient examination and telephone interview up to September 2016.Tumor recurrence of patients with hepatocellular carcinoma (HCC) was monthly detected by alpha-fetoprotein retest and color Doppler ultrasound of the liver or computed tomography (CT) within 3 months postoperatively.Tumor recurrence of patients with cholangiocarcinoma was monthly detected by tumor marker retests,color Doppler ultrasound of the liver or CT,and then patients without tumor recurrence received reexamination once every 2 months after 3 months.Patients with liver hemangioma were followed up once every 2-3 months and once every 6 months after half a year,and follow-up included the liver function,ultrasound and other imaging examinations to detect the tumor recurrence.Measurement data with normal distribution were represented as-x±s.Results All the 22 patients underwent successful precise resection of liver tumors.Twenty patients received intraoperative ultrasound localization.Blood flow occlusion of 22 patients:Pringle was conducted in 6 patients,treatment of the corresponding hepatic pedicle in 3 patients,selective hepatic blood flow occlusion in 8 patients,total hepatic blood flow occlusion in 2 patients and non-hepatic portal occlusion in 3 patients.Precise resection of the liver of 22 patients:1 patient underwent right trisegrnentectomy,2 underwent left hepatectomy,2 underwent segment Ⅳ a resection of the liver,2 underwent segment Ⅳ resection of the liver,3 underwent segment Ⅴ resection of the liver,3 underwent segment Ⅷ resection of the liver,1 underwent middle lobe resection of the liver and 8 underwent partial resection of the liver.Operation time,time of liver resection,volume of intraoperative blood loss and number of patients with perioperative blood transfusion were (213±39) minutes,(57± 19) minutes,(518± 98) mL and 3,respectively.Of 22 patients,5 with postoperative complications were improved after symptomatic treatment,including 2 with effusion at surgical site,2 with right pleural effusion and 1 with bile leakage.The duration of postoperative hospital stay of 22 patients was (8.9± 1.6)days.Twenty-one patients were followed up for 3-20 months,with a median time of 12 months.Two of 22 patients had recurrence during the follow-up,and no recurrence at surgical site was detected.Conclusion Precise resection of liver tumors adjacent to the first and second hepatic hilum is safe and feasible,with the advantages of less intraoperative bleeding and low incidence of postoperative complications.