Lymph node dissection in patients with malignant melanoma is associated with high risk of morbidity.

INTRODUCTION: Malignant melanoma is one of the most rapidly increasing cancer types globally, and it is by far the most serious skin cancer. Patients with a melanoma ≥ 1 mm in Breslow thickness are offered sentinel node (SN) biopsy and subsequent radical lymph node dissection if the biopsy is positive. The objective in the present paper was to describe post-operative complications in this group of patients. A standard operation and drainage regime was used. MATERIAL AND METHODS: This was a retrospective study based on 96 consecutive SN-positive patients with primary cutaneous malignant melanoma who underwent subsequent radical axillary or inguinal lymph node dissection. Fisher's exact test and Mann-Whitney U-test were used to evaluate associations. RESULTS: In all, 57 patients were male and 39 female. A total of 71 had an axillary and 25 an inguinal operation. The median drainage period was seven days (2-15 days). Forty patients developed seroma which needed puncture; three of these cases were chronic, there was no difference between the two groups. Seroma puncture was only associated with infection in the inguinal group (p = 0.04). 25% in the axillary group were diagnosed with lymph oedema after three months versus 48% in the inguinal group (p = 0.04). A body mass index ≥ 25 kg/m2 was associated with a slight, but non-significant increase in complications (p = 0.08). No association was found for smoking or co-morbidity. CONCLUSION: Patients undergoing axillary or inguinal lymph node dissection experience a significant number of complications, especially seroma and lymph oedema. Long-term complications are severe and can profoundly impact the patient's quality of life.

A case of collision tumor or transdifferentiation between malignant melanoma and leiomyosarcoma.

A 73-year-old woman was referred to the hospital due to a pigmented, asymptomatic nevus on her right arm that had changed in size and color. The histopathological examination showed a superficial spreading malignant melanoma, Clark level III, 2.26 mm in thickness. Two years later, the patient presented a 10 cm rapidly growing mass in her right axilla. The mass in the axilla measured 12.5΄9΄cm. It revealed a lymph node metastases with a tumor growth composed of two different contiguous morphological and immunohistochemical components, respectively, melanosomes and leiomyosarcoma. The combination of a melanocytic nevus with other tumor of epidermal or adnexal origin has been described before, but still the co-existence of two different neoplasms within a lesion is still uncommon. The most common combination is basal cell carcinoma and melanocytic nevus or one of them together with a seborrheic keratosis. There have also been occasional reports of rhabdomyosarcomatous differentiation. However, mesenchymal differentiation, and in this case leiomysarcoma, with formation of heterologous elements in melanocytic tumor is very rare. Another plausible explanation may be that malignant melanoma cells could have transdifferentiated into a leiomyosarcomatoid phenotype with resulting metastases of either type. Malignant melanomas have shown a wide variety of cytological changes and can mimic carcinomas, lymphomas, and sarcomas. Spindle cell melanomas commonly simulate spindle cell carcinomas. It has also been documented that desmoplastic melanomas can change into fibroblastic, Schwannian, and myofibroblastic differentiation.

Tympanotomy and sealing of the round window for treatment of sudden deafness.

INTRODUCTION: The objective of this study was to evaluate the effectiveness of explorative tympanotomy and sealing of the round window in patients diagnosed with sudden deafness. MATERIAL AND METHODS: A retrospective study of 22 patients presenting with sudden deafness who were treated with exploratory tympanotomy and sealing of the round window. The patients initially received conservative therapy for one month. If conservative treatment had no effect, exploratory tympanotomy and sealing of the round window was performed. RESULTS: The median pure tone average was 67 dB before surgery. Post-operatively, it was reduced to 55 dB. This is equivalent to a 12 dB (p = 0.008) improvement. Five patients improved beyond 30 dB and three patients out of 22 fulfilled the Belfast criteria for binaural hearing at the end of the observation period. Furthermore, three months after surgery, the incidence of vertigo and tinnitus had decreased from 58% to 8% and from 50% to 17%, respectively (p < 0.001 and p = 0.04). None of the patients experienced any severe or life-threatening complications. CONCLUSION: The results suggest that explorative tympanotomy and sealing of the round window may improve hearing and reduce tinnitus and vertigo after spontaneous remission has come to an end. However, randomized controlled studies are needed.

[Kikuchi-Fujimoto syndrome]. / Kikuchi-Fujimoto-syndrom.

This article concerns a 25-year-old woman, with clinical symptoms of Kikuchi-Fujimoto Syndrome (KFS). The patient arrived ten days after symptom onset. She initially discovered lymphadenopathy on the right side of her neck. She had no fever, pruritus or weight loss. Fine needle aspiration biopsy indicated a lympho-proliferative disease, which was confirmed by a lymph node biopsy. KFS is histologically characterized by necrotizing lymphadenitis. The cardinal symptoms are fever, lymphadenopathy and night sweat.