Sentinel lymph node biopsy for cutaneous melanoma in a real life setting: analysis of 47 cases treated at a private clinic in Brazil

Background: Sentinel Lymph Node (SLN) status has been shown to be the strongest independent prognostic factor of cutaneous melanoma (CM) stage I-II patients. Few papers on CM at private clinics (PC) are available. Objective: To present clinical and histologic data, complications and frequency of SLN involvement in CM patients diagnosed and followed at a dermatology/cutaneous oncology PC in São Paulo/Brazil, who were submitted to SLNB. Methods: Retrospective, single-center cohort of patients who attended PC from June 1998 to Jan 2020. Electronic files were selected and analyzed. Minimum period for considering the patient eligible was 1 year. Results: 215 CM lesions were identified in 184 patients(1.2 melanoma/patient). Forty-seven patients (25.5%) were submitted to SLNB and 59 SLN for histologic examination (1.2 SLN/patient). 10,9% tested positive. SLN identification happened in 95.7%. In 38/47 (80,8%) patients single LBD was found, while multiple-LBD was found in 9/47(19.1%). Eighteen(72,0%) out of 25 trunk lesions drained to single basin, while in 7 patients multiple LBD was found. Complication rate was 6,0%. Conclusions: Percentage of CM patients that undergo SLNB, node positivity for metastasis, draining basins and complications in this study were similar to studies in northern hemisphere patients. Clinical and epidemiologic characteristics of CM patients differ markedly between PC and PHS patients

Low-level laser therapy in the management of skin wound healing

Introduction: Tissue repair and skin wound healing are complex processes that involve a series of dynamic events, including coagulation, inflammation, granulation tissue formation, wound contraction and tissue remodeling. The need to care for patients with difficulties in wound healing is a growing challenge and requires innovative strategies. One approach that stands out in the treatment of these injuries is low-power laser therapy. This study aims to demonstrate the applicability and results of a low-power laser therapy protocol in the management of skin wound healing. Methods: This is a retrospective case review study reporting the use of laser in the treatment of skin wounds in a single center. Results: We evaluated the results of the implementation of this low-power laser therapy protocol and reported five cases of patients with skin wounds that did not improve with conventional treatment. The lesions were located in different places, with lesions on the trunk, upper limb and lower limb. The five cases showed a good response to laser therapy, evolving with wound healing in a short period of time, with an average healing time of 48 days. Conclusion: It is concluded that low power laser therapy when applied to skin wounds suggests a beneficial, promising action and has the potential to increase the therapeutic options available to the surgeon, however as we report a number of five cases, further studies are needed for check laser efficiency on wounds

Twelve-month safety and visual acuity results from a feasibility study of intraocular, epiretinal radiation therapy for the treatment of subfoveal CNV secondary to AMD

Purpose: The purpose of this study was to evaluate the short-term safety and feasibility of intraocular, epiretinal delivery of beta radiation for the treatment of subfoveal choroidal neovascularization secondary to age-related macular degeneration for 12 months. A 3-year follow-up period is planned to assess the long-term safety of the procedure.Methods: In this nonrandomized, multicenter feasibility study, 34 treatment-naive patients with predominantly classic, minimally classic, or occult lesions due to subfoveal choroidal neovascularization secondary to age-related macular degeneration received a single treatment with either 15 Gray (Gy) (8 patients) or 24 Gy (26 patients) beta radiation (strontium-90) using a novel intraocular delivery device. Adverse events and safety end-points were observed and recorded. Visual acuity was measured preoperatively and postoperatively using standard Early Treatment Diabetic Retinopathy Study vision charts.Results: Twelve months after treatment, no adverse events associated with exposure to radiation were observed. All patients in both 15 Gy (n = 4) and 24 Gy cohorts (n = 17) who met inclusion criteria and were treated according to protocol lost fewer than three lines of vision. Fifty percent (2/4) of the 15 Gy-treated patients and 76% (13/17) of the 24 Gy-treated patients improved or maintained their visual acuity at 12 months. In the 24 Gy group, 29% (5/17) gained three lines or more in visual acuity. The mean change in visual acuity observed at month 12 was +10.3 letters in the 24 Gy study cohort and -1.0 letters in the 15 Gy cohort.Conclusion: The short-term safety and efficacy of intraocular, epiretinal delivery of beta radiation for the treatment of subfoveal choroidal neovascularization was promising in this small study group and should be studied in a larger cohort of patients.Univ Fed Goias, Ctr Referencia Oftalmol, Goiania, Go, BrazilUniv Fed Sao Paulo, Dept Oftalmol, Sao Paulo, BrazilUniv Guadalajara, SC Ctr Med Puerta Hierro, Ctr Retina Med Quirurg, Guadalajara 44430, Jalisco, MexicoBeyoglu Eye Res & Training Hosp, Eye Dept, Istanbul, TurkeyNeoVista Inc, Fremont, CA USAUniv Fed Sao Paulo, Dept Oftalmol, Sao Paulo, BrazilWeb of Scienc

Genome-wide DNA methylation profile of leukocytes from melanoma patients with and without CDKN2A mutations

Melanoma is a highly aggressive cancer, accounting for up to 75% of skin cancer deaths. A small proportion of melanoma cases can be ascribed to the presence of highly penetrant germline mutations, and approximately 40% of hereditary melanoma cases are caused by CDKN2A mutations. The current study sought to investigate whether the presence of germline CDKN2A mutations or the occurrence of cutaneous melanoma would result in constitutive genome-wide DNA methylation changes. The leukocyte methylomes of two groups of melanoma patients (those with germline CDKN2A mutations and those without CDKN2A mutations) were analyzed together with the profile of a control group of individuals. A pattern of DNA hypomethylation was detected in the CDKN2A-negative patients relative to both CDKN2A-mutated patients and controls. Additionally, we delineated a panel of 90 CpG sites that were differentially methylated in CDKN2A-mutated patients relative to controls. Although we identified a possible constitutive epigenetic signature in CDKN2A-mutated patients, the occurrence of reported SNPs at the detected CpG sites complicated the data interpretation. Thus, further studies are required to elucidate the impact of these findings on melanoma predisposition and their possible effect on the penetrance of CDKN2A mutations

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care