Sensory and pain outcomes of neurotized skin-grafted free gracilis muscle flaps for lower extremity reconstruction.

BACKGROUND: Skin-grafted free gracilis muscle flaps are commonly used for lower extremity reconstruction. However, the loss of sensory function may lead to increased patient morbidity. This study prospectively analyzed the sensory and neuropathic pain outcomes of neurotized skin-grafted free gracilis muscle flaps used for the reconstruction of lower extremity defects. METHODS: Patients undergoing lower extremity reconstructions between 2020 and 2022 with neurotized skin-grafted free gracilis muscle flaps were prospectively enrolled. Sensation was assessed at 3, 6 and 12 months postoperatively using monofilaments, two-point discrimination, a vibration device, and cold and warm metal rods. Sensations were tested in the center and periphery of the flaps, as well as in the surrounding skin. The contralateral side served as the control. Patients completed the McGill pain questionnaire to evaluate patient-reported neuropathic pain. RESULTS: Ten patients were included. At 12 months postoperatively, monofilament values improved by 44.5% compared to that of the control site, two-point discrimination, cold detection, warmth detection, and vibration detection improved by 36.2%, 48%, 50%, and 88.2%, respectively, at the reconstructed site compared to those at the control site. All sensory tests were significantly better than 3 and 6 months values (p < 0.05), but remained significantly poorer than the control site (p < 0.05). Sensation in the central flap areas were similar to peripheral flap areas throughout the follow-up period (p > 0.05). The surrounding skin reached values similar to the control site at 12 months (p > 0.05). Moreover, 50% of patients reported neuropathic pain at 3 months postoperatively, 40% at 6 months, and 0% at 12 months (p < 0.05). CONCLUSION: Mechanical detection, vibration detection, temperature detection, and two-point discrimination significantly improved over time but without reaching normal sensory function at 12 months postoperatively. Neuropathic pain resolved at 12 months.

Incidence Trends of Melanoma of the Lower Limbs and Hips in the United States: A Surveillance, Epidemiology, and End Results Analysis 2000-2019.

BACKGROUND/AIM: No specific studies on the changes in the incidence of melanoma in the lower limbs and hips have been performed. This article aimed to examine trends in incidence rates of melanoma of the lower extremities in the U.S. PATIENTS AND METHODS: Data from the SEER program provided by the National Cancer Institute were used to examine trends in melanoma incidence from 2000 to 2019. Data analysis was performed from October to December 2022. RESULTS: A total of 192,327 cases of melanoma of the lower limbs and hips were diagnosed from 2000 to 2019 and included in our study. The incidence rate increased from 9.78 to 13.65 cases per 100,000 person-year and by an average annual percent change (AAPC) of 2% (95%CI=1.4-2.9%). The incidence increased by an AAPC of 2.1% in men and 1.7% in women. The incidence among people under 50 remained stable but increased among those over 50 years. Localized stage disease was the only stage where a continuously increasing incidence was observed, with an AAPC of 1.7% (95%CI=0.9-2.5%). Lentiginous melanoma showed the highest incidence trend rate with an AAPC of 2.3% (95%CI=1.0-3.5%). CONCLUSION: The incidence rate of melanoma in the lower limbs and hips increased between 2000 and 2019, with a higher incidence in men, reversing the previously described trend of higher incidence among women. However, incidence among people under 50 remained stable, suggesting the efficacy of prevention campaigns in this population.

Melanoma of the Lower Limbs and Hips: A Surveillance, Epidemiology, and End Results Analysis of Epidemiology and Survival 2000-2019.

BACKGROUND/AIM: Melanoma, an aggressive skin cancer, poses a significant threat to patients' lives, with lower limbs and hips being among the most affected regions. Epidemiology and survival outcomes of patients with melanoma in the lower extremities were investigated and compared to other sites to better understand tumoral behavior and identify predictors of decreased survival. PATIENTS AND METHODS: The Surveillance, Epidemiology, and End Results (SEER) database was used to search for all skin melanoma cases between 2000 and 2019. Demographic, pathological, and therapeutic factors were compared between affected regions. Overall and disease specific survival were calculated and compared among subgroups. A multivariable analysis was conducted to identify independent prognostic factors. RESULTS: A total of 50,109 patients were diagnosed with melanoma in lower limbs and hips, while 224,121 patients had melanomas in other areas. More women (70.8%) and younger people (mean 55.2 years, SD 16.5) were affected with lower extremities melanoma, with better survival rates than other skin regions. Factors associated with better survival included female sex, younger age, horizontal growth pattern melanomas, and surgery with <1 cm margins. CONCLUSION: Melanoma affecting lower extremities is commonly diagnosed in young females. Prognosis depends on age, stage at diagnosis, and histologic subtype, but remains better compared to other locations.

Cutaneous Melanoma of the Lip: A SEER Analysis of Epidemiology and Survival Outcomes With Focus on Surgery and Other Treatment Options.

BACKGROUND/AIM: Cutaneous melanoma of the lip (LM) is a rare malignancy with a low overall survival (OS). Few studies exist in the literature to aid its diagnosis and treatment. The purpose of this study was to assess the different treatment modalities by collecting cases from a single database and to provide current information on the epidemiologic characteristics of cutaneous lip melanoma. PATIENTS AND METHODS: The SEER database was searched for demographic, clinical-pathological, and therapeutic characteristics. The Kaplan-Meier model was used to analyze the overall survival (OS) of the study population, and survival curves were modelled. Univariable analysis between subgroups was carried out using the log-rank test. Surgery was further assessed with a multivariable cox regression, where the surgical procedure was adjusted for Breslow thickness. RESULTS: Patients aged 62.4 years on average, and 62.7% of them were males. A total of 386 melanomas of the cutaneous lip were identified. Mean OS was 155.1 months, median OS was 187 months, and 67.4% had localized disease. CONCLUSION: LM has a poor prognosis with a 5-year OS of 75.2%. Surgery remains the mainstay of treatment, with less invasive surgical approaches yielding a comparable overall survival to surgery with greater margins.

Spiradenocarcinoma: SEER Study of Epidemiology, Survival, and Treatment Options.

(1) Background: Spiradenocarcinoma is an extremely rare malignant adnexal tumor and there are only few studies on survival outcomes. Our aim was to perform an analysis of the demographic and pathological characteristics, treatment patterns, and survival outcomes of patients affected by spiradenocarcinoma. (2) Methods: The Surveillance, Epidemiology, and End Results program database of the National Cancer Institute was searched for all cases of spiradenocarcinoma diagnosed between 2000 and 2019. This database is considered representative of the US population. Demographic, pathological, and treatment variables were retrieved. Overall and disease-specific survival were computed according to the different variables. (3) Results: 90 cases of spiradenocarcinoma (47 females, 43 males) were identified. Mean age at diagnosis was 62.8 years. Regional and distant disease at diagnosis were rare, occurring in 2.2% and 3.3% of cases, respectively. Surgery alone was the most frequent treatment (87.8%), followed by a combination of surgery and radiotherapy (3.3%) and radiation therapy only (1.1%). Five-year overall survival was 76.2% and five-year disease-specific survival was 95.7%. (4) Conclusions: Spiradenocarcinoma equally affects males and females. Regional and distant invasion rates are low. Disease-specific mortality is low and is probably overestimated in the literature. Surgical excision remains the main form of treatment.

Melanoma of the Upper Limb and Shoulder: A Surveillance, Epidemiology, and End Results Analysis of Epidemiology and Survival 2000-2019.

(1) Background: Melanoma is the most common life-threatening cancer among skin cancers. Almost all locations of the skin can be affected by melanoma, and the upper limbs are one of the most frequent locations. We aimed to study the epidemiology and survival outcomes of patients with melanoma localized in the upper extremities compared with other sites. (2) Methods: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) database is considered the most representative of the U.S. population; we extracted melanoma cases diagnosed between 2000 and 2019. Several characteristics, including demographical, pathological, and therapeutic, were recorded, and upper extremity melanomas and melanomas from other areas were compared. Overall survival was assessed, and the groups were compared. (3) Results: 69,436 patients had melanoma in the upper limbs and shoulders and 204,794 in other body parts. Overall, 35,267 patients with upper extremity melanoma were males, 34,169 were females, and the mean age was 60. For the rest of the body, there were 118,654 males and 86,140 females, with a mean age of 59. Surgery alone was the most commonly used treatment, while radiation therapy was the least used for all sites. Women appear to have better survival than men. Superficial spreading melanoma is the least lethal subtype, while nodular melanoma is the most dangerous. (4) Conclusion: Women under 50 are more at risk than men of the same age. The trend reverses after age 50 where men are at greater risk. In addition to gender and age, disease stage and major histologic subtypes influence survival.