Elective Dissection Research Articles

A comparison of pre- and post-clinical education learning preferences among medical students who elected to dissect compared to those who did not during the COVID-19 pandemic.

Anatomy instructional methods varied widely during the COVID-19 pandemic and programs are assessing innovations for retention. Learning preferences were assessed among medical students dichotomized as elective dissectors (ED) or non-dissectors (ND) during the COVID-19 partial re-opening in 2020 (preclinical) and again in 2022 after clinical exposure (post-clinical) to assess the viability of elective dissection post-pandemic. A mixed-method approach was used for the assessment of test scores, learning preference surveys, learning activities rankings, and thematic analyses. No significant differences occurred in anatomy examination scores. Dissection was considered useful by both preclinical groups but significantly more so by ED, while the presence of an instructor was significantly preferred by ED although a majority of ND agreed. Elective dissection was significantly preferred by ND but also by a large minority of ED students. Pre- and post-clinical ND believed that elective dissection offered more academic flexibility, did not hinder clinical learning, and did not negatively impact medical education. The corresponding ED stated that confidence improved, clinical experiences were enhanced, and dissection was irreplaceable. Preclinical ND preferred self-learning, while ED students preferred online learning, but these differences largely disappeared post-clinically. Learning activity rankings were not significantly different among all groups (ND, ED, preclinical, and post-clinical). A hybrid laboratory with a virtual learning environment ranked highest across groups and preferences increased over time suggesting that students benefited from this instructional method during clinical exposure. The absence of laboratory experience ranked lowest, and preference decreased over time suggesting that anatomy dissection is valued.

Elective parotidectomy and neck dissection are not beneficial in cutaneous squamous cell carcinoma of the head

ObjectiveCutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended. MethodsWe retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection. ResultsWe diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period. ConclucionOur negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection. Level of evidenceHow common is the problem?Step 4 (Case-series)Is this diagnostic or monitoring test accurate? (Diagnosis)Step 4 (poor or non-independent reference standard)What will happen if we do not add a therapy? (Prognosis)Step 4 (Case-series)Does this intervention help? (Treatment Benefits)Step 4 (Case-series)What are the COMMON harms? (Treatment Harms)Step 4 (Case-series)What are the RARE harms? (Treatment Harms)Step 4 (Case-series)Is this (early detection) test worthwhile? (Screening)Step 4 (Case-series)

Occult Nodal Metastases in Individuals with Clinically Node-Negative Salivary Gland Malignancies.

Salivary gland malignancies comprise a heterogeneous group of pathologies, for which treatment of the clinically negative neck may vary depending on numerous factors. Herein we present data on occult nodal metastases (ONM) as well as survival and recurrence from a large series of cN0 salivary gland malignancies. Retrospective chart review was conducted on 532 patients, with 389 patients with major salivary gland cancers and 143 patients with minor salivary gland cancers. Demographic and treatment data were included and rates of ONM, overall survival, local recurrence, regional recurrence, and distant recurrence were analyzed. We found that the overall rate of ONM for parotid was 27% (63/235), for submandibular/sublingual was 35% (18/52), and for minor was 15% (4/26). Analysis of ONM rate at each nodal level was also performed, finding higher rates of level IV and V ONM than prior studies. Submandibular/sublingual and minor salivary gland malignancies showed a predominance of ONMs at levels I-III. Our survival and recurrence rates were similar to those found in previous studies. Our data also demonstrate a predominance of ONM in levels I-III for submandibular/sublingual and minor salivary gland cancers, suggesting elective dissection in these levels. 4 Laryngoscope, 134:1705-1715, 2024.

Indications and outcomes for elective dissection of level V in primary parotid cancer.

The extent of cervical lymphadenectomy required for primary parotid cancer is not well-established. In this retrospective case-control study, 84 patients who underwent primary parotidectomy and neck dissection for primary parotid cancer between 2010 and 2019 were identified and analyzed. Of the 84 patients, 37 underwent elective level V neck dissection. All six (16.0%) who had occult level V nodes had clinically evident, preoperative anterior cervical metastases, a statistically significant finding. No other clinical factors are correlated with posterior neck involvement. There was no significant difference in disease-free or overall survival for patients with occult level V disease relative to positive lymph nodes in other levels. Patients with clinically evident anterolateral cervical lymphatic metastases from parotid cancer preoperatively have high rates of occult level V nodes. Level V neck dissection can be avoided in cN0 patients and offered no survival advantage.

A multiparameter model for prediction of pathological nodal status in clinically early stage oral cancer using machine learning.

e18025 Background: The current approach to neck treatment in clinical T1-2 oral cancers is to offer elective nodal dissection to all patients, despite the fact that the majority of patients are pathologically node negative. This is due to the poor predictive ability of clinico-radiological assessment and subsequently poorer survival in those in whom neck dissection is omitted based on this. A robust prediction model for pathological nodal status may allow individualized decisions for neck dissection. Our aim was to develop a multiparameter prediction model to identify pathological node-negative status using machine learning. Methods: We identified 497 patients with cT1-2 oral cancer from a single institutional database from 2011-2018 who underwent primary resection and neck dissection. We compared the sensitivity, positive predictive value and accuracy of prediction of pathologically negative neck from clinico-radiological staging alone vs. a model created from multiple parameters including clinical features (clinico-radiological nodal status, ages, sex, subsite of primary lesion) and pathological features of the resected primary tumor (maximum dimension, depth of invasion, lymphovascular invasion, perineural invasion, grade and margins of resection). The multiparameter model was built from a training dataset of the first 400 patients using an ensemble of logistic regression, random forests and support vector machines. A cohort of 97 patients was used for independent validation. Results: In this cohort 232 (47%) were clinico-radiologically node negative, while 307(62%) were pathologically node negative. The sensitivity, positive predictive value and accuracy of the clinico-radiologically assigned nodal status was 56%, 74% and 61%, while that of the multiparameter machine learning model was 87%, 89% and 89% respectively. The area under curve (AUC) of the clinico-radiological prediction was 0.62 whereas that of the multiparameter predictive model was 0.91. In the validation dataset, 58/62 pathologically node negative patients were predicted correctly by the model. The accuracy of the model on the external validation dataset was 82%. Conclusions: The performance of the multiparameter predictive model was considerably superior to clinico-radiological neck staging for prediction of pathological node negative neck. This could be validated on an independent dataset. This could be considered for prospective clinical evaluation of individualized neck dissection.

The impact of ipsilateral central neck dissection on the 2015 American thyroid association risk stratification system and TNM staging in papillary thyroid carcinoma

<p class="abstract"><strong>Background:</strong> In patients with classic papillary thyroid carcinoma (PTC) and no clinical evidence of lymph node metastasis (cN0), elective central neck dissection remains controversial. This study evaluates whether elective ipsilateral central neck dissection (eICND) along with total thyroidectomy could modify the staging of these patients. Additionally, we aim to assess pN1 risk factors, the incidence of post-operative complications, and the correlation between pN1 and change in tumor classification according to the risk stratification score of the American thyroid association 2015 (ATA 2015-RSS) and the TNM Score.</p><p class="abstract"><strong>Methods:</strong> This is a prospective, observational study, involving 46 patients with cN0 PTC who underwent eICND along with total thyroidectomy. The number of metastatic lymph nodes, the largest lymph node metastasis, and the extra-nodal extension were assessed. </p><p class="abstract"><strong>Results:</strong> 22 out of 46 patients (47.8%; CI 32.9–63.1) presented lymph node metastasis. Seventeen out of the 45 patients initially classified as low or intermediate ATA 2015-RSS upgraded their risk staging (37.8%; CI 23.8–53.5). Fourteen out of these reclassified patients had their initial ATA 2015-RSS changed due to lymph node metastasis larger than 2 mm (mostly between 3 mm and 4 mm). Ten out of 46 (21.7%; CI 10.49–36.4) patients had their TNM staging reviewed. General complication rate was 17.4% (8/46).</p><p class="abstract"><strong>Conclusions:</strong> Elective dissection of levels VI ipsilateral and VII showed the ability to upgrade the initial ATA 2015-RSS and TNM staging in patients with cN0 PTC. However, further studies are necessary to evaluate the clinical impact of lymph node micro-metastasis.</p>

The relationship between primary tumour thicknesses in cancers of the oral cavity to subsequent lymph node metastasis

Background: Elective dissection of cervical lymph nodes in oral cavity cancers gives very precious data on its pathological state, judge for adjuvant therapy requirement plus its therapeutic effect but it has its morbidities that cannot be condoned. Tumor thickness (TT) in oral cavity cancers show an increasing value to be one of the most important and reliable factors that have a great relationship to regional node involvement.Methods: Forty-three patients with T1, T2 oral cavity squamous cell carcinoma with clinically and radiologically negative cervical L.Ns underwent elective neck dissection and the relation between the tumor thickness and the nodal metastasis was monitored. Tumor thickness was estimated preoperatively by using the intra-oral ultrasound and confirmed by histopathology postoperatively.Results: Only 12 out of 43 neck dissections (27.9%) showed positive L.Ns metastasis of primary tumor. The excised number of L.Ns ranged from 15 to 31 with mean±SD (21.58±3.59) L.Ns. The (TT) ranged from 1.4 mm to 7.8 mm. Our statistical results showed that there is a cutoff point which was 4 mm where (TT) > 4 mm showed significant results with histologically found positive cervical node metastasis compared to (TT) ≤4 mm specimens.Conclusions: Relationship of tumor thickness to lymph node metastasis was found to be significant as shown by this study. Our results clearly demonstrate that conservative elective neck dissection is indicated in patients with stage I/II oral cavity carcinoma whose tumors are > 4 mm in thickness as they mostly have latent metastasis.

Long-term Outcomes of cN0 Papillary Thyroid Carcinoma without Elective Central Compartment Neck Dissection.

Objective To determine the long-term outcomes of cN0 papillary thyroid carcinoma without elective central compartment neck dissection. Methods The clinical data of 180 patients with clinically lymph node negative papillary thyroid carcinoma who were treated in our center between 2000 and 2005 were retrospectively analyzed. All of these patients did not receive elective central compartment neck dissection. Clinicopathological characteristics including gender,age,surgical range,pathologic type,tumor size,and extrathyroidal extension(ETE)or not were collected. Results After a median follow-up period of 90 months,only one patient died of stroke without tumor. Sixteen patients had tumor recurrence:seven patients had a recurrent disease in residual thyroid tissue,two in the thyroid bed,six in central compartment,eight in lateral cervical compartment,and one in lung. The 10-year overall survival,disease-specific survival,and recurrence-free survival was 99.4%,100%,and 87.9%,respectively. The 10-year accumulative lymph node recurrence rate in central compartment and lateral compartment was 7.8% and 7.0%,respectively. ETE was an independent risk factor for central compartment lymph node recurrence. Male gender(P=0.010)and ETE(P=0.028)were independent risk factors for lateral compartment lymph node recurrence. Conclusions The prognosis of patients with cN0 papillary thyroid carcinoma without elective central compartment neck dissection is good after ten years of follow-up. Male gender and ETE are independent risk factors for lateral compartment lymph node recurrence.

Rate of Occult Cervical Lymph Node Involvement in Supraglottic Squamous Cell Carcinoma.

To assess the rate of cervical lymph node involvement in patients with supraglottic squamous cell carcinoma (SCC) with no lymph node in clinical assessments and radiological studies. Fifty-six patients who underwent elective dissection of the cervical lymph node of the second through fourth level were enrolled, and pathologic evaluation of the dissected lymph nodes was performed. Lymph node involvement and association between tumor grade, smoking and gender with lymph node involvement were assessed. The rate of the occult neck metastasis in this series was 37.5%. There was no statistically significant association between lymph node involvement and tumor grade, smoking, or gender. Based on the results of our study, we recommend elective bilateral neck dissection in all stages of N0 supraglottic SCC patients.

Factors influencing the incidence and prognosis of second primary tumors in patients with oral squamous cell carcinoma.

Although second primary tumors are common in patients with oral squamous cell carcinoma (OSCC), their predisposing factors and treatment guideline remain uncertain. Three hundred ninety-four patients with OSCC who received radical surgery from January 2002 to December 2009 were retrospectively reviewed. Forty-five patients developed oral second primary tumors. Areca quid chewing, tongue tumors, and nodal metastasis were risk factors for second primary tumors. Multivariate analyses revealed that no second primary tumor (hazard ratio [HR] = 5.046; 95% confidence interval [CI] = 3.704-12.246; p = .003), contralateral neck dissection for ipsilateral second primary tumors (HR = 6.254; 95% CI = 3.027-13.365; p = .007), and postoperative radiotherapy (RT; HR = 3.987; 95% CI = 1.099-10.381; p = .040) were independent favorable prognostic factors. Areca quid chewing, tongue tumors, and nodal metastasis predisposed patients with OSCC to second primary tumor development. Elective dissection of the contralateral neck in patients with second primary tumors ipsilateral to index tumors and postoperative RT for eligible patients should always be considered in the management of oral second primary tumors. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1466, 2016.

Prosection based gross anatomy lab for dental students

While developing a new dental specific gross anatomy lab curriculum at the U. of Utah, we were faced with the task of determining how best to use the cadaver lab for teaching first year dental students. Relative to the existing anatomy course for medical students, two problems emerged. First, the critical tissues for dental students, the head and neck, are among the most complex and difficult to dissect. For novice dissectors it is very difficult to do a quality dissection and preserve the structures of interest. Second, with only two hours each week, the time allotted for lab was not sufficient to create head and neck dissections, even for very skilled dissectors. To address these two issues, a prosection based lab curriculum was instituted. By using prosections that were prepared in advance by experienced dissectors, and forgoing traditional student dissection, we aimed to present detailed anatomy clearly and in an efficient manner. As the students arrived to lab they were divided into small groups and paired with an instructor to learn a specific set of objectives. Over the course of the lab, students would rotate through the stations, each of which had a prosection prepared to teach a specific set of anatomical structures. Where appropriate, non‐cadaver based activities were used to supplement and help integrate concepts and overriding principles. Students were also given access to the lab outside of scheduled lab teaching time so that they could come in and study using the prosections on their own. Critically, these high quality prosections have made it possible to teach students very detailed anatomy in a relatively short period of time. The prosections have also allowed the students to see structures and relationships that are often destroyed in a traditional lab setting where students do the dissections. Initial results have been encouraging. Student feedback has been positive, and scores on practical exams suggest students are learning the material. Our future plans include creation of a greater number of prosections to allow material to be taught both systemically and regionally, as well as a 4th year elective dissection course for senior dental students who wish to gain the skills that would come from the more traditional dissection experience.

Elective superior mediastinal dissection for laryngeal carcinoma involving subglottis

Conclusion: Despite the low incidence of superior mediastinal metastasis (SMM) we recommend elective superior mediastinal dissection (ESMD) and close follow-up for all patients with laryngeal carcinoma involving the subglottis, because higher peristomal recurrence (PR) rates and lower survival rates were observed in the presence of SMM numerically even though statistical support was lacking. Background: This study was undertaken to identify the incidence of SMM and to evaluate the need for ESMD in laryngeal tumors involving the subglottis. Methods: Medical records of patients who had undergone total laryngectomy for laryngeal carcinoma were reviewed retrospectively and 68 patients (45 with ESMD and 23 without ESMD) who had pathologically proven subglottic involvement were included in the study. Results: SMM was found in 3 of 45 (6.6%) patients who underwent ESMD. The PR rate was higher in patients with SMM (66.7%) than in patients without SMM (9.5%) and the presence of SMM was significantly related to PR (p = 0.043) in univariate analysis. However, this relationship was not preserved in multivariate analysis. The 3- and 5-year survival rates of patients with SMM were lower (both 66.7%) than patients without SMM (83.3% and 76.2%, respectively), but decreased survival rates did not differ statistically from the survival rates of 42 patients without SMM.

Central Compartment Lymph Node Dissection for Differentiated Thyroid Cancer: Review of the Literature

Central lymph node dissection (CLND) remains an important component of the surgical treatment of differentiated thyroid cancer. The indication for CLND is the presence of image-positive metastases in level VI lymph nodes; the elective dissection of radiographically normal central compartment lymph nodes in patients with differentiated thyroid cancer remains controversial. The different types of CLND will be discussed herein, and some of the surrounding controversies will be highlighted.

Prognostic factors affecting results of comprehensive treatment of hypopharyngeal carcinoma

To investigate the efficacy of surgery followed by adjuvant radiotherapy and the prognostic factors affecting the results of treatment in hypopharyngeal carcinoma. A retrospective review of 149 patients with hypopharyngeal carcinoma that received surgical treatment from Jun 2003 to Jun 2010 was accomplished. In the 149 patients, the site of origin were pyriform sinus (n = 121), posterior pharyngeal wall (n = 21) and postcricoid (n = 7). According to UICC 2002 criteria, there were 3 in stage I, 15 in stage II, 29 in stage III and 102 in stage IV. Surgical methods for primary tumor were: pyriform sinus resection or posterior pharyngeal wall resection in 22 cases, partial pharyngectomy and partial laryngectomy in 29 cases, partial pharyngectomy and total laryngectomy in 67 cases, total pharyngectomy and total laryngectomy in 16 cases, total pharyngolaryngectomy and partial esophagus resection in 12 cases, and total esophagus resection in 3 cases. All the patients received elective and/or radical neck dissection. Unilateral or bilateral thyroid lobectomy was performed in 98 cases. Eighty-seven patients received intensity modulation radiated therapy (IMRT) postoperatively in the cancer center of Provincial Hospital Affiliated to Shandong University. Individualized adjustment of the radiation field was made according to the surgical condition. Forty-nine cases received radiotherapy in other hospitals (dose 50-70 Gy). Laryngeal function was restored in 51 patients (34.2%). The risk clinicopathological factors of survival and the causes of death were analyzed. The survival rate was calculated with Kaplan-Meier method. The overall 3- and 5- year survival rates were 47.7% and 38.7%, respectively. There were no significant differences in 3-year survival between T1-2 and T3-4 groups, N0 and N+ groups, stage I-II and III-IV groups, laryngeal function preserved and unpreserved groups. The overall 3 years survival rate of patients received surgery and adjuvant radiotherapy was higher than those just received surgery alone (χ² = 6.851, P < 0.05). The 3-year survival rate in patients treated in comprehensive treatment group has showed a good trend, although still no statistical significance (χ² = 0.176, P > 0.05). The cause of death in 86 patients, including regional lymph nodes recurrence in 25 cases (29.1%). Of them, one was stoma recurrence and 9 were retropharyngeal lymph nodes metastasis; distant metastasis in 19 cases (22.1%); local recurrence in 13 cases, local or regional recurrence with distant metastasis in 8 cases (9.3%), and second primary cancer in 6 cases (7.0%). The overall prognosis of hypopharyngeal carcinoma was poor and dismal. In accordance with specific conditions of surgery, active adjustment of the personalized protocol of IMRT was the key of improving the efficacy of hypopharyngeal carcinoma.

Advanced dissection techniques: an elective for 4th‐year students to revisit anatomy, prepare for residency, and aid 1st‐year medical students beginning anatomy (721.1)

Our advanced dissection techniques course is designed for 4th‐year students to review and gain more advanced anatomy training especially for students embarking on “anatomy‐intense” residency programs such as surgery, physiatry, obstetrics &amp;amp; gynecology, urology and radiology. The duration of the electives are typically two weeks and they are specifically tailored to the students interests. The dissections conducted by the 4th‐year students are structured and targeted and not all inclusive as were the dissections performed during their first year of medical school. The elective dissections are designed to introduce new approaches, angles, and ways to see relationships between anatomical structures. These dissections, and expositions by the senior students, are also used to supplement the learning of anatomy for our first year students. The opportunity for first‐year students to see specialized anatomy, as presented in the electives, provides a unique exposure otherwise unavailable during the first year. This elective has a two‐fold benefit: it improves confidence in anatomy for 4th‐year students embarking on residency and these dissections are used as valuable teaching aids for the first year curriculum.

Accuracy of the determination of S100 protein expression in malignant melanoma using a polyclonal antibody directed against S100 and monoclonal antibodies specific for S100 alpha and beta

S100 proteins are present in a variety of tissues and perform regulatory functions in numerous metabolic processes. They have an important role in many human cancers, including malignant melanoma. Both polyclonal and monoclonal antibodies have been used to investigate S100 expression in melanoma tissue sections. This study aimed to determine the accuracy and sensitivity of these two types of antibodies in detecting S100 proteins in paraffin processed tissue cases of malignant melanoma. The study compared routinely used rabbit polyclonal anti-S100 antibody raised against both anti-S100A and B isoforms (Dako, Glostrup, Denmark), as per studies by Timar, and compared and contrasted findings with mouse monoclonal anti-S100A and anti-S100B antibodies (Santa Cruz Biotechnology, Inc., Santa Cruz, CA, USA). The study involved the assessment of formalin-fixed paraffin-embedded tissue blocks from 56 cases of malignant melanoma, consisting of 23 superficial spreading, nine nodular, eight lentigo maligna, five acral lentigenous forms, five metastatic melanomas (two sentinel lymph node positive cases and three cases of nodal involvement from cases of elective nodal groin dissections), and six cases of desmoplastic malignant melanoma (DMM). The slides were stained by immunohistochemical methods on an automated platform (BenchMark XT; Roche, USA) and employing the iView detection system. All slides were examined by routine light microscopy by two independent assessors. The best results for both intensity of staining and percentage of positive tumor cells were achieved with polyclonal anti-S100 antibody and monoclonal anti-S100B antibody. Anti-S100A antibody yielded weaker staining intensity (with mean intensity of 1·8, compared to 2·8 for both anti-S100B antibody and polyclonal anti-S100 antibody), and a lower percentage of positive melanoma cells (an average of 74% for anti-S100A, compared to 95% for both anti-S100B antibody and polyclonal anti-S100 antibody). This result was statistically significant (P<0·01). Staining in cases of DMM gave the same results (P<0·01). The conclusion from this study is that polyclonal anti-S100 antibody and monoclonal anti-S100B antibody are more suitable than monoclonal anti-S100A antibody for diagnostic investigations of malignant melanoma, irrespective of the histological type of melanoma.

Dominant lymph drainage in the upper extremity and upper trunk region: evaluation of lymph drainage in patients with skin melanomas

The objective of this study is to evaluate the lymph drainage from the primary focus to the regional lymph nodes in patients with melanomas of the upper extremity and upper trunk region. The study is a retrospective study of 20 patients with upper extremity melanomas and 14 patients with upper trunk melanomas treated with axillary lymph node dissection (ALND) or sentinel lymph node biopsy at the hospital. ALND was performed in 14 cases. In these cases, 12 were curative dissections and 2 were elective dissections. The dominant lymph drainage patterns from the primary regions were analyzed. Among the upper extremity and upper trunk region melanomas, lymph drainage to Level I was determined in all cases. In these two regions there were no cases of lymph drainage to Level II not passing through Level I. Furthermore, there were no cases where sentinel lymph node or metastasis of the lymph nodes was clearly determined in Level III. Among the upper extremity melanomas, lymph drainages to the cubital (10 %) and mid-arm nodes (5 %) were established. Among the scapular region melanomas, lymph drainages to the supraclavicular nodes (25 %) were determined. There was a dominant lymph drainage pattern of melanomas of the upper extremity and upper trunk region to Level I. No lymph node dissection of Level III in patients with melanomas of the upper extremity and upper trunk region is necessary unless preoperative examination determines a high possibility of metastasis-positive lymph nodes in level III.

Przypadek czerniaka małżowiny usznej o wyjątkowo skrytej lokalizacji

Melanoma is one of the most malignant neoplasm. Mostly it is located in skin but also can appear in every place where melanocytes are present. Approximately 25% of all of these tumours is located in head and neck region probably because of intensive sun exposure of the skin. The case of the 44-year-old, male patient with malignant melanoma of the external ear was shown in this paper. The patient was asymptomatic and diagnosed accidentally. The suspicion of metastatic lymph nodes of neck was based on CT and ultrasonography examination. The patient was treated by surgical excision (total resection of the right auricle) with one centimeters of free margins. Additionally elective neck's lymph nodes dissection was performed. The histopathological evaluation has shown radical excision of stage II (Clark's scale) malignant melanoma of the ear with negative margins and without metastatic lymph nodes of the neck. The patient was not qualified to radiotherapy by oncologist. No evidence of local recurrences or distant metastasis was detected during a 3 years follow-up period. The epidemiology, clinical and pathological classification of the tumour, diagnostic problems and therapy were described. The prognosis of melanoma depends mostly on the thickness of the tumour but also on level of invasion and presence of ulceration.

Level V in therapeutic neck dissections for papillary thyroid carcinoma

Neck dissection for papillary thyroid carcinoma (PTC) is the standard of care for patients with clinical evidence of regional metastases. However, the extent of neck dissection is debatable. The purpose of the current study was to develop evidence-based recommendations for when to include level V, or 1 of its sublevels, among patients with PTC undergoing neck dissection. A literature review of all studies evaluating the occurrence of metastases in level V in patients with regional metastases from PTC undergoing neck dissection was performed. Occurrence of metastases at level V is low in most series (5% to 10%), although a wide range was noticed. In cases in which metastases were found at level V, they occurred almost exclusively at sublevel VB. Sublevel VA was rarely, if ever, involved with metastatic lymph nodes. However, only recently have investigators begun to specify which sublevels of level V are at risk. Therapeutic dissection of level V is indicated when there is clinical evidence of disease involving this zone. Elective dissection of sublevel VB is indicated when there is involvement of level IV, or possibly multiple nodes at levels II and III. Under these circumstances, dissection of sublevel VB is indicated but sublevel VA may be spared.

Merkel cell carcinoma of the head and neck

Merkel cell carcinomas are uncommon, but aggressive, cutaneous malignancies of neuroendocrine differentiation. To the pathologist, these lesions appear as sheets of undifferentiated tumor cells with little cytoplasm and dense nuclear chromatin. They are members of the group of "small round blue cell tumors," which includes small cell carcinomas of the lung, lymphomas, and neuroblastomas. Analogous to other skin malignancies, Merkel cell carcinomas frequently arise in the head and neck region and are commonly found in the elderly population. Merkel cell carcinomas have a high propensity for regional and distant metastases, and recurrences are frequently seen. Surgical excision is the recommended first-line treatment followed by adjuvant radiation therapy. Because of the high incidence of occult regional metastasis, patients with clinical and radioghaphically negative necks should undergo elective dissection, irradiation, or preferably sentinel lymph node biopsy.