Local control of primary oropharyngeal malignant melanomas with limited tissue excision: a report of three cases

WOS: 000227443000002PubMed: 15455245Mucosal malignant melanomas are rare lesions, and they have different characteristics from their cutaneous counterparts. Since extended excisions of mucosal malignant melanomas located in the oropharyngeal region cause significant morbidity, limited surgical excision comes into consideration. Three cases of extensive oropharyngeal malignant melanomas were resected with 0.5-1.5-cm healthy tissue margins. The cases were followed for local recurrences. Case 1 applied radiotherapy and chemotherapy in addition to immunotherapy, and the patient is still alive without any local recurrences 18 months after surgery. The patient in case 2 underwent radiotherapy and immunotherapy and died 6 months after surgery. The patient in case 3 received chemotherapy in addition to immunotherapy and died 12 months after surgery as a result of distant metastasis. All cases were without any local recurrences. Surgical excision with limited tumor-free tissue margins may be the surgery of choice to prevent morbidity associated with wide resection of oropharyngeal malignant melanomas if other authors also reconfirm these results with many more cases in the future

Feasibility of salvage selective neck dissection after primary irradiation of pharyngeal and laryngeal carcinoma

Introduction: The concept of neck dissection (ND) in the management armamentarium of head and neck squamous cell carcinoma has evolved throughout the years. Nowadays, ND becomes more functional. Methodology: A retrospective study of 865 patients was performed at Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital to investigate the feasibility of selective ND (SND). All patients with squamous cell carcinoma of the pharynx and larynx who received primary radiation and underwent salvage ND were included in the study. Result: A total of 29 NDs were analyzed. In 17 neck sides, viable metastases were found (58%), whereas in the other 12 specimens there were no viable metastases. In 16 of the 17 necks (94%), the metastases were located either in level II, III, or IV or in a combination of these 3 levels. Level V was involved in only 1 case (6%). Conclusion: It is well justified to perform a salvage SND (levels II, III, and IV) for pharyngeal and laryngeal carcinoma after primary radiation. In carefully selected cases of supraglottic and oropharyngeal carcinoma, a superselective ND also appears as an efficient option

Adjuvant photodynamic therapy in head and neck cancer after tumor-positive resection margins

ObjectiveIn case of close or positive resection margins after oncological resection in head and neck surgery, additional treatment is necessary. When conventional options are exhausted, photodynamic therapy (PDT) can play a role in achieving clear margins. The purpose of the current study was to evaluate the clinical benefit of PDT as adjuvant therapy next to surgery with positive resection margins. The role of the time interval between surgery and PDT on survival outcomes also was investigated. Study DesignRetrospective cohort analysis. MethodsAdjuvant PDT was performed in patients with a malignancy in the head and neck region with close or positive resection margins who were not eligible for conventional treatment options. The primary endpoint was progression-free survival. Secondary endpoints were disease-free survival, overall survival, and optimal time interval between surgery and PDT. ResultsFifty-four patients were treated with surgery followed by meta-tetrahydroxyphenylchlorin-mediated PDT. There was a large diversity in tumor location and histopathology, as well as in time interval between surgery and PDT. The 2-year progression-free survival rate was 30%; 2-year disease-free survival rate was 28%; and 2-year overall survival was 51%. Disease-free survival was significantly better when the time interval between surgery and PDT was 6 weeks (P = 0.02). ConclusionPDT can be applied as adjuvant therapy after surgery in cases of a malignancy with close or positive tumor resection margins. However, the clinical benefits are yet to be determined. There is a significantly better disease-free survival with a time interval between surgery and PDT of minimal 6 weeks. Level of Evidence4. Laryngoscope, 128:657-663, 201