Emerging Therapies in the Treatment of Advanced Melanoma
Great strides in immunotherapy and targeted therapy have revolutionized the management of previously devastating, advanced melanomas. Although these subfields continue to progress, novel approaches in intratumoral oncolytic therapy, adoptive cell therapy, and vaccine therapies are being developed as adjuncts or alternatives. Cytokines, meanwhile, are seeing a resurgence as a viable option as well. The array of effective agents will, in the next few years, provide options for therapy not only in the adjuvant or unresectable settings but also in the neoadjuvant settings. Perhaps, too, in earlier stage melanomas. (Source: Cli...
Source: Clinics in Plastic Surgery - August 5, 2021 Category: Cosmetic Surgery Authors: Sameer Massand, Rogerio I. Neves Source Type: research
Canonical Signaling Pathways in Melanoma
Melanoma is the most lethal type of skin cancer, originating from the uncontrolled proliferation of melanocytes. The transformation of normal melanocytes into malignant tumor cells has been a focus of research seeking to better understand melanoma ’s pathogenesis and develop new therapeutic targets. Over the past few decades, a conglomeration of studies has pinpointed several driver mutations and their associated signaling pathways. In this review, we summarize the key signaling pathways and the driver mutations involved in melanoma tumorig enesis and also discuss the potential underlying mechanisms. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - July 9, 2021 Category: Cosmetic Surgery Authors: Lillian Sun, Joshua Arbesman Source Type: research
Radiation Therapy for Local Cutaneous Melanoma
While primary treatment for melanoma consists of surgical resection and chemotherapeutics, radiation can be used as either definitive or adjuvant therapy in certain clinical scenarios. This chapter aims to explore the indications for primary definitive radiotherapy as well as adjuvant treatment following resection. Delivery, dose, fractionation, and toxicity of radiation treatment will be discussed. As our understanding of melanoma tumor biology increases, the role of radiotherapy may expand for more effective treatment of oligometastatic disease. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - July 9, 2021 Category: Cosmetic Surgery Authors: Parinaz J. Dabestani, Amanda J. Dawson, Michael W. Neumeister, C. Matthew Bradbury Source Type: research
Mucosal Melanoma
Mucosal melanoma is a rare but aggressive cancer arising in mucosal surfaces most commonly in the head and neck. The clinical presentation is often nonspecific and differs in relation to the site of origin so often diagnosis is delayed resulting in poor prognosis. Mucosal melanoma has a 5-year survival of only 25%. Surgery with negative margins is the mainstay of treatment but dependent on several variables including anatomic location, involved structures, and size of tumor. Although not well defined given the rarity of mucosal melanoma, there is a role for radiation and systemic therapy in the treatment of this disease. (...
Source: Clinics in Plastic Surgery - July 6, 2021 Category: Cosmetic Surgery Authors: Danielle Olla, Michael W. Neumeister Source Type: research
Melanoma Risk Factors and Prevention
In the Western population, 1 out of every 50 individuals will develop melanoma. The incidence of melanoma is increasing faster than any other malignancy. The development of melanoma is multifactorial arising from an interaction between genetic susceptibility and environmental exposures. Sixty to seventy percent of melanomas are thought to be caused by ultraviolet radiation. Most cutaneous melanomas are of increased risk. Prevention strategies involve mitigating the environmental risk factors and identifying individuals with phenotypic risk factors for increased surveillance. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - July 2, 2021 Category: Cosmetic Surgery Authors: William W. Dzwierzynski Source Type: research
Histopathologic and Molecular Diagnosis of Melanoma
Conventional histopathology is the primary means of melanoma diagnosis. Both architectural and cytologic features aid in discrimination of melanocytic nevi from melanoma. Communication between the clinician and pathologist regarding the history, examination, differential diagnosis, prior biopsy findings, method of sampling, and specimen orientation is critical to an accurate diagnosis. A melanoma pathology report includes multiple prognostic indicators to guide surgical and medical management. In challenging cases, immunohistochemistry and molecular diagnostics may be of benefit. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - July 2, 2021 Category: Cosmetic Surgery Authors: Morgan L. Wilson Source Type: research
Sentinel Lymph Node Biopsy, Lymph Node Dissection, and Lymphedema Management Options in Melanoma
Melanoma tumor thickness and ulceration are the strongest predictors of nodal spread. The recommendations for sentinel lymph node biopsy (SLNB) have been updated in recent American Joint Committee on Cancer and National Comprehensive Cancer Network guidelines to include tumor thickness ≥0.8 mm or any ulcerated melanoma. Mitotic rate is no longer considered an indicator for determining T category. Improvements in disease-specific survival conferred from SLNB were demonstrated through level I data in the Multicenter Selective Lymphadenectomy Trial (MSLT) I. The role for complet ion lymph node dissection has evolved to l...
Source: Clinics in Plastic Surgery - July 2, 2021 Category: Cosmetic Surgery Authors: Brian A. Mailey, Ghaith Alrahawan, Amanda Brown, Maki Yamamoto, Aladdin H. Hassanein Source Type: research
Dermatologic Follow-up and Assessment of Suspicious Lesions
As our knowledge and understanding of melanoma evolve, melanoma surveillance guidelines will reflect these findings. Currently, there is no consensus across international guidelines for melanoma follow-up. However, it is accepted that more aggressive surveillance is recommended for more advanced disease. When examining high-risk individuals, a systematic approach should be followed. Future considerations include the use of noninvasive imaging techniques, ‘liquid biopsies,’ and artificial intelligence to enhance detection of melanomas. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - June 26, 2021 Category: Cosmetic Surgery Authors: Julie Iacullo, Paola Barriera-Silvestrini, Thomas J. Knackstedt Source Type: research
Non-Operative Options for Loco-regional Melanoma
Malignant melanoma is the 5th most common cancer and stage IV melanoma accounts for approximately 4% of new melanoma diagnoses in the United States. The prognosis for regionally advanced disease is poor, but there have been numerous recent advances in the medical management of melanoma in-transit metastases. The goal of this paper is to review currently accepted treatment options for in-transit metastases and introduce emerging therapies. Therapies to be discussed include limb perfusion and infusion, immunotherapy, checkpoint inhibitors, and radiation therapy. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - June 26, 2021 Category: Cosmetic Surgery Authors: Rebecca Knackstedt, Timothy Smile, Jennifer Yu, Brian Gastman Source Type: research
Melanoma of the Hands and Feet (With Reconstruction)
Melanomas only account for 4% of all dermatologic cancers yet are responsible for 80% of deaths. Notably, melanomas of the hand and foot have a worse prognosis when compared with melanomas of other anatomic regions. Likely this is due to intrinsic biologic characteristics, delayed diagnosis, difficult surgical excision due to delicate anatomy, and lack of definitive diagnostic and therapeutic guidelines. The most common locations of melanoma of the hand, in order of decreasing frequency, are subungual area, dorsal surface, and palmar surface. The most common locations of melanoma of the foot are the plantar surface, dorsal...
Source: Clinics in Plastic Surgery - June 26, 2021 Category: Cosmetic Surgery Authors: Alexis M. Ruffolo, Ashwath J. Sampath, Jeffrey H. Kozlow, Michael W. Neumeister Source Type: research
American Joint Committee on Cancer Staging and Other Platforms to Assess Prognosis and Risk
The eighth edition of the American Joint Committee on Cancer melanoma staging system relies on assessments of the primary tumor (T), regional lymph nodes (N), and distant metastatic sites (M). Its notable updates include tumor thickness measurements to the nearest 0.1 mm, revision of T1a and T1b definitions, re-evaluation of N category descriptors, increased number of stage III subgroupings, and incorporation of a new M1d designation, among others. These changes were based on analyses of a large contemporary international melanoma database. Ultimately, these re visions were made to improve staging and prognostication, ri...
Source: Clinics in Plastic Surgery - June 24, 2021 Category: Cosmetic Surgery Authors: Paola Barriera-Silvestrini, Julie Iacullo, Thomas J. Knackstedt Source Type: research
Treacher Collins Mandibular Distraction
This article discusses strategies and considerations for surgically correcting the mandibular deformity associated with TCS using mandibular distraction osteogenesis and other related techniques. The proper implementation of these techniques can yield excellent results that greatly improve quality of life in this challenging patient population. (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - May 27, 2021 Category: Cosmetic Surgery Authors: Connor J. Peck, Joseph Lopez, John T. Smetona, Derek M. Steinbacher Source Type: research
Monobloc Distraction and Facial Bipartition Distraction with External Devices
Monobloc and bipartition advancement by external distraction plays a major role in the treatment of syndromic craniosynostosis. They can reverse the associated facial deformity and play a role in the management of ocular exposure, intracranial hypertension, and upper airway obstruction. Facial bipartition distraction corrects the intrinsic facial deformities of Apert syndrome. Both procedures are associated with relatively high complication rates principally related to ascending infection and persistent cerebrospinal fluid leaks. Modern perioperative management has resulted in a significant decline in complications. Extern...
Source: Clinics in Plastic Surgery - May 27, 2021 Category: Cosmetic Surgery Authors: David J. Dunaway, Curtis Budden, Juling Ong, Greg James, Noor ul Owase Jeelani Source Type: research
Craniofacial Distraction
CLINICS IN PLASTIC SURGERY (Source: Clinics in Plastic Surgery)
Source: Clinics in Plastic Surgery - May 27, 2021 Category: Cosmetic Surgery Authors: Roberto L. Flores Source Type: research
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Source: Clinics in Plastic Surgery - May 27, 2021 Category: Cosmetic Surgery Source Type: research
