Spectrum of morphologic alterations of regression in cutaneous melanoma--potential for improving disease prognosis.

INTRODUCTION: Regression occurs as a complex interaction between tumor cells and host's immune response; neither biologic mechanisms, nor regression prognostic significance are deciphered to date but promising anti-cancer vaccine strategies were thus developed. METHODS: We analyzed 127 superficial spreading melanomas identifying melanoma with regression (segmentary (SR), partial (PR) and segmentary & partial (SR-PR)) or without regression (AR). Several histopathologic parameters were registered; statistical analysis was performed (level of significance P < 0.05). RESULTS: Regression was present in 52% cases, less frequently in pT4 melanomas. Ulceration and vascular invasion were similarly present in pT2-pT4 melanomas with regression and significantly less in pT1 ones; their incidence increased with stage in AR (P < 0.001). SR and SR-PR melanomas showed significantly more tumor infiltrating lymphocytes within the non-regressed tumor than AR melanomas (P < 0.05). SR melanomas presented significantly less frequent mitoses than PR (P = 0.04), SR-PR (P = 0.04) or AR ones (P = 0.03). Marked inflammation and more numerous melanophages were present regressed areas advanced stage melanomas. More numerous plasma cells were identified in advanced stages; in SR and SR-PR melanomas less numerous plasma cells were present in pT1 than in advanced stages. Vascular hyperplasia was significantly higher in SR than SR-PR cases. CONCLUSIONS: Differences in perception of regression might be the result of labeling with similar name of various processes comprising inflammation and tumor cells destruction; at least in thin melanomas, PR and SR seem to belong to different spectrum of alteration, SR bearing a more favorable potential. Further studies will be performed in order to further elucidate the mechanisms involved in regression in melanoma.

Incidental findings during ENT routine examination for head and neck trauma.

Several patients with head and neck disorders are incidentally diagnosed during clinical examination for traumatic events. Our study refers to 76 patients with head and neck trauma evaluated in the emergency ward of Phonoaudiology and ENT Functional Surgery Dr. Dorin Hociota Institute in 2007. During routine ENT consultation, 13 patients were identified with trauma unrelated lesions: nasal septum deviations (5 cases), basal cell carcinomas (3 cases), lentiginous malignant melanoma, keratoacantoma, branchial cyst, nasal lobular capillary hemangioma, squamous cell carcinoma of the tongue (one case each). We strongly recommend ENT examination in patients with head and neck trauma not only for establishing the gravity and the extend of the traumatic lesions in the forensic approach but also for revealing unknown underlying disease in some cases with incredible results for the well-being of the patient.

[The reconstruction of the oral and maxillofacial defects with free vascularized flaps and microsurgical anastomoses]. / Plastia reconstructiva a defectelor oro-maxilo-faciale prin lambouri liber vascularizate si anastomozate microchirurgical.

The reconstruction of the oral and maxillofacial defects is difficult, because of the high specialisation of the tissues. In cancer resection, the post-operatory defects are quite important, because of the oncological principle of assuring free margins. The free flap is a modem and nowadays very used method in oral and maxillofacial reconstruction, after the removal of the malignant tumors with this localisation. These flaps are indicated for large defects, when the reconstruction with local or regional flaps is not possible. The wide variety of the raised tissues allows better results, making them the flaps of choice for large defects of the lip and cheek. The main advantages are related to the tri-dimensional extension of the free margins, assuring the quality of life and allowing early initiation of the radiotherapy in oncological patients.