Melanoma is increasing worldwide
and UK death rates from melanoma
have more than doubled from 1.2 per
100,000 in 1971 to 2.6 per 100,000 in
2007. Cancer Research UK predicts
that by 2024, rates of malignant
melanoma in people aged 60 to 79 will
rise by a third.peer-reviewe

Pace, Joseph L.

English

OAR@UM

Microwave (MW) ablation offers many of the advantages of RF ablation while possibly overcoming some of the limitations. Since MN ablation does not rely on conduction of electricity into tissue, it is not limited by charring and does not require grounding. Therefore, temperatures greater than 100°C are readily achieved, which potentially results in a larger zone of ablation, faster treatment time, and more complete tumor kill. Because the cooling effect of blood flow is most pronounced within the zone of ronductive rather than active heating, a larger power field may also enhance treatment of perivascular tissue. Thus there is some evidence that microwaves tend to suffer less from "heat-sink effects· than RF. Liver tumors are particularly suited to RF or microwave ablation. Primary liver lesions (particularly hepatocellular carcinomas) and metastases may be treated effectively with this technique (Figures 4 & 5). Palliative tumor ablation in a 62-year-old man with a painful 7 -cm hepatocellular carcinoma in his liver. ...... Figure 4{1I) CT scan obtained before ablation shows internal caldflcatlons (arrows). Figure 4(b) CT scan shows microwave antennae in the center of the lesion. Figure 4{e) Post-procedural CT scan obtained with contrast material enhancement shows a large area of therrno-coagulation (arrows). Microwave ablation of a hepatic metastasis in an 82-year-old woman with metastatic colon cancer to both lung and liver. She had responded well to chemotherapy and had only one hepatic lesion left, measuring approximately 4.3 cm in segment 7 Figure S(a) CT-guided Microwave ablation Figure 5(b) - : Contrast enhanced CT scan post ablation showing an area of necrosis (arrows). The number of lesions and their location would determine approach and suitability for thermo-ablation. Lung lesions (both primary and metastatic) have also been successfully treated with RF and microwave ablation (Figure 6). Both experimental and now fairly extensive dinical work illustrates the potential clinical applications and advantages of RF and microwave ablation. The technique requires considerable experience with imaging guided lesion localisation and is time-consuming and expensive. It requires an interventional operating theatre with facilities for general anaesthesia, expensive probes and imaging equipment and a full team of specialised staff. The full potential of this technology is still under evaluation and further clinical implementation will help improve experience and contribute to both curative and palliative care of patients with cancer. Microwave ablation of primary lung cancer in an 86-year-old man. Figure 8(11) ) CT scan shows a microwave antenna in the mass along its superior portion. Dermatology Figure 6(b) On a post-procedural contrast-enhanced CT scan shows no enhancement within the lesion. Looking for Melanoma by Joseph L. Pace Melanoma is increasing worldwide and UK death rates from melanoma have more than doubled from 1.2 per 100,000 in 1971 to 2.6 per 100,000 in 2007. Cancer Research UK predicts that by 2024, rates of malignant melanoma in people aged 60 to 79 will rise by a third. Genetic factors are the most important of the known risk factors, induding the familial tendency to develop melanoma, prominent moles, and atypical moles. Overexposure to ultraviolet radiation in sunlight is believed to be a contributing factor to some cases of melanoma; short periods of intense exposure, such as sunbathing is associated with a 2-fold increase in melanoma risk. Indeed, both cheaper package holidays to sunny destinations and the excessive use of sunbeds from the 1970'8 are said to be related to increased melanoma risk. Matta has not been spared and in the decade between 1998 and 2008 reported cases trebled from just under 20 to 60 per annum. Some of these will be due to increased awareness among both doctors and public and many will be curable melanomas in situ, but nevertheless this increase is in keeping with the experience of other countries. The outcome in each case depends on the extent of the lesion in particular the depth of skin affected. When melanoma is detected at its early stage, simple surgical removal cures the disease in most cases, but when spread to lymph nodes, the 5-year survival rate is 30-40%, falling to a dismal 12% with spread to distant organs. Thin melanomas therefore have an exccellent prognOSiS, unlike thicker lesions. With the realisation that for cases with metastases there is relatively Ii available in the wa:y of consistently successful therapy, the onus is on ~ ~­dermatologist to make a crucial diagnosis when cure becomes and not the exception. According to The Melanoma Latter, a publication of the Skin Cancer Foundation, a dermatologist using a quality hand lens will only make a correct diagnosis in 65% of cases. The arrival of the dermoscopy technique (surface microscopy) which utilises a microscope to identify characteristic melanoma patterns not otherwise visible was a major landmark enabling the experienced dermatologist to Rgure BCe) CT scan obtained at 9-mooth foDow-up shows interval shrinkage and no enhancement of the mass (snow). • diIIgo I0IO ". 10 •• i!IIiIiar .-d h.It melee • IT'09 • , .... to a.nIND ~ ... i. It In 1ddiklI. the rvnbGr d •• ....... tt rnaIios IWl1CMd '),II1II n 0lIl"" _ ....,.. _I to iii Iii iIII I ~ In .... 11 ... I:iI*r.-.cl1'r"iCn cat dIct. __ . • _ "-I r d IMt oro t'ItiI: Dti Ii "*""PJ' IIIID IonoM'I .. 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Looking for melanoma

https://www.um.edu.mt/library/oar/bitstream/handle/123456789/12746/Looking%20for%20melanoma.pdf?sequence=1&isAllowed=y

Looking for melanoma

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