Wide Excision Margins Research Articles

Konzepte zur interdisziplinären Behandlung spinaler Metastasen

Spinal metastases represent a significant cause of morbidity in patients diagnosed with malignancies. The treatment paradigm involves a cohesive multidisciplinary approach that allows treatment plans to be made in the context of a patient' overall condition. Opinions vary widely as to the role of surgery, from none to wide margin excision. The treatment should be taylor made for the individual. The primary aim of any treatment is the improvement of the quality of life by treatment of pain and avoidance of new neurological deficits. In individual cases a long lasting tumor control can be achieved.

Management and outcomes for primary cardiac sarcomas (PCS): A retrospective study of the French Sarcoma Group (FSG).

10093 Background: PCS are very rare tumors with poor prognosis. The current study aimed to evaluate clinico-pathological characteristics, treatment and survival in a cohort of patients (pts) referred to the FSG Network. Methods: From June 1977 to January 2010, 123 pts with PCS were identified. Medical records and clinicopathologic data were collected. Results: There were 54 men (44%) and 69 females (56%) with a median age of 47 years (range 3-82). Median time between first symptoms and diagnosis was 1 months (mo) (range 0-53). The most frequent revealing clinical signs were dyspnea (41%), thoracic pain (22%), heart failure (13%) and pericarditis (5%). The median tumor size was 60 mm (range 8-100). The pathological diagnoses included poorly differentiated sarcoma (S) (n=45), angioS (n=40), leiomyoS (n=16), synovialoS (n=7), rhabdomyoS (n=6), Ewing S (n=4), lipoS (n=3) and chondroS (n=2). At diagnosis, 99 pts (80%) had a localized disease and 24 pts had metastases in one site (n=14) or in multiple sites (n=10). The most frequent metastatic sites were lung (n=9), liver (n=7), bone (n=7), brain (n=4). Tumors were mainly located in the atrial cavities (right atrium n=47; left atrium n=44). Other localization included right ventricle (n= 6), left ventricle (n=9) and pericardium (n=3). In 11 cases, the tumor was multifocal. A surgical approach was considered in the majority of pts with localized disease. Resection alone or in combination with doxorubicin-containing chemotherapy (CT) or with a radiotherapy and CT regimen was undertaken in 18, 43 and 16 pts respectively. Among these pts, surgical approaches included wide excision (n=10), marginal excision (n=22), intralesional excision (n=31) and heart transplant (n=5). The median follow up was 13 mo (0-153), the median overall survival (OS) for those who underwent R0 excision was 39 mo (range 8-96) versus 17 mo (range 0-153) for those with R1 or R2 resection. The median OS of pts with initial metastatic disease treated with doxorubicin-containing CT was 11 mo (range 2-95). Conclusions: Complete surgical excision is associated with long-term survival. However, the poor prognosis of this malignancy requires extensive multidisciplinary research studies.

Atypical papillary lesions after core needle biopsy and subsequent breast carcinoma

Abstract Background: Papillary lesions of the breast cause diagnostic problem because papillary structures are found in benign and malignant processes. Core needle biopsy is important to make an initial diagnosis, but it still has potential pitfalls. Comparison between core needle biopsy and excisional biopsy can predict the possibility of malignant change in atypical papillary lesions. Objective: Evaluate the concordance between core needle biopsy and excisional results in atypical papillary lesions of the breast. Materials and methods: The pathology database of University of Texas Medical Branch at Galveston, USA was searched for patients with atypical papillary lesions at core needle biopsy who subsequently underwent surgical excision. Pathology reports from the excisional biopsies was also examined to assign each case to one of three categories, downgrade to benign papilloma, no change (remained atypical papillary lesion), and upgrade to carcinoma. The mammograms and ultrasounds were reviewed for each case. They characterized the lesions according to multiple imaging criteria. Results: Twenty-four patients with atypical papillomas at core biopsy subsequently underwent surgical excision. The lesions were downgraded to benign papilloma in 25%, remained atypical papillary lesion in 33%, and upgraded to carcinoma in 42%. On mammographic presentations (n = 23), masses were in 61%, architectural distortion in 4.3%, mass with calcifications in 9%, mass with architectural distortion and calcifications in 4.3%, calcifications alone in 17.4%, and architectural distortion and calcifications in 4.3%. On ultrasound findings (n = 21), solid masses were in 90%, intracystic masses in 10%, peripheral in locations in 81%, and subareolar in location in 19%. Conclusion: Due to the high upgrade rate of atypical papillary lesions to carcinoma (42%), excision of all atypical papillary lesions with wide excision margin is recommended for cases with pathologic diagnosis of atypical papillary lesion on core-needle biopsy.

The Impact of Surgery on Survival of Patients With Cutaneous Melanoma

To quantify the impact of excision margins on disease-specific survival of patients with primary cutaneous melanoma. Current guidelines recommend narrow margins for the treatment of primary melanoma, although available evidence on this subject is not unequivocal and not always appropriately analyzed. A systematic review of randomized controlled trials (RCT) addressing the issue of wide versus narrow excision margins was performed. Meta-analysis methods for time-to-event data were used to extract hazard ratios(HR) and their 95% confidence intervals (CI) from eligible studies, and ultimately to estimate the summary effect of excision margins on patients' survival. The 5 eligible RCT enrolled a total of 3295 patients who were allocated to wide (3-5 cm) or narrow (1-2 cm) excision of their primary tumor. The data of locoregional disease-free (LDFS), disease-free (DFS),disease-specific (DSS), and overall (OS) survival were available for 3, 5, 3, and 5 RCT, respectively. The meta-analysis suggested that narrow margins might be associated with an increased risk of both locoregional disease recurrence (HR: 1.30, CI: 1.07-1.57; P = 0.01) and death by disease (HR: 1.28, CI:1.07-1.53, P = 0.01). As regards DFS, the borderline disadvantage (HR:1.13, CI: 0.995-1.28; P = 0.06) becomes significant when considering RCT that enrolled patients with thicker melanoma (HR: 1.19, CI: 1.02-1.39, P =0.03). When death by any cause (OS) was analyzed, no risk difference was found. The lack of DSS data from all the available RCT does not allow to draw definitive conclusions. However, current evidence appears sufficient to question the common belief that narrow excision margins are as safe as wide margins in the management of primary melanoma, that calls for further investigation in this field.

Surgical Management Modifications Following Systematic Additional Shaving of Cavity Margins in Breast-Conservation Treatment

Positive wide local excision margins are the most important risk factor of local breast-carcinoma recurrence. Shaving additional margins could lower the need for re-excisions when wide local excision margins are positive and cavity margins are negative. This retrospective study, from January 2007 to December 2008, included 99 women with breast carcinomas who underwent wide local excision with 4 additional, systematically shaved, surgical cavity margins. All therapeutic decisions concerning post-wide local excision treatment were made by consensus during multidisciplinary meetings. This systematic cavity-shaving strategy avoided 25 re-excisions (25.3%), and 6 patients required new surgery because of carcinoma found in the additional cavity-shaving margins, despite negative wide local excision margins. No preoperative factor predictive of positive cavity margins was identified. Systematic shaving of additional cavity margins changed the surgical management after breast-conservation treatment.

Wide Excision or Mohs Micrographic Surgery for the Treatment of Primary Dermatofibrosarcoma Protuberans

Dermatofibrosarcoma protuberans (DFSP) is a spindle cell tumor with a high local recurrence rate. Wide excision (WE) has been the standard treatment, but ideal margin width is poorly defined and Mohs micrographic surgery (MMS) has emerged as an alternative procedure. This study examines the use of WE versus MMS for the treatment of primary DFSP at a single institution. Retrospective review of 48 primary DFSP cases treated from 1971 to 2006. Patient demographics, tumor features, surgical modality (WE vs. MMS), final pathology, and clinical outcome were evaluated. Twenty-eight patients underwent WE versus 20 patients for MMS. Median age was 40 years. Median WE margin width was 2 cm. For MMS, the median number of layers required to clear the tumor was 2. Median maximal defect size was 10 cm for WE versus 9.4 cm for MMS. Advanced closure techniques were required for 18% WE versus 65% MMS (P = 0.001). Median operative time was significantly lower for WE at 77 minutes versus 257 minutes for MMS (P < 0.001). Positive margins were present in 21.4% (6/28) WE versus 0% MMS (P = 0.01). At a median follow-up of 49.9 months for WE and 40.4 months for MMS, local recurrence rates were 3.6% (1/28) and 0%, respectively (P = 1.0). From a surgical standpoint, WE was faster than MMS and resulted in a less complex defect/closure. Although positive margin resection was more common with WE, local control was ultimately similar for the 2 surgical modalities. The choice of WE versus MMS should be based on individualized patients/tumor characteristics and institutional expertise in these modalities.

Surgical resection margins do not influence health related quality of life or emotional distress in patients with cutaneous melanoma: Results of a prospective randomised trial

In a prospective randomised Scandinavian trial, patients with localised invasive cutaneous melanoma of the trunk or extremities with tumours more than 2 mm thick were randomly assigned to excision with narrow (2 cm) or wide (4 cm) margins after primary surgery. The aims of the present study were to find out if there were any differences in health-related quality of life (QoL) and emotional distress between patients in the two arms over time. Patients were assessed at four time points: before randomisation, and at 3, 9, and 15 months after inclusion, using the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale and the Impact of Event Scale. A study-specific questionnaire was used to assess patient-reported problems related to the scar. A total of 144 patients were included; 70 randomised to narrow excision and 74 to wide excision margins. The response rate was >85% at all assessment points. No differences between the two arms were found for health-related QoL or emotional distress. Emotional functioning, insomnia, anxiety, intrusion, and avoidance improved over time (p ≤ 0.0001). Thirty patients (32%) reported problems with the scar but there was no difference between the two arms. No differences in health-related QoL or emotional distress were found between the two arms, indicating that resection margins have limited impact on these variables.

Large aneurysmal bone cyst of iliac bone in a female child: a case report

BackgroundSymptomatic aneurysmal bone cysts in pediatric age group with an expansile lesion in ilium is a rare occurrence.CaseAn 11-year-old female presented with a swelling over her right iliac region and numbness along the medial aspect of thigh. Clinicoradiological diagnosis was aneurysmal bone cyst confirmed on fine needle aspiration cytology. Excision curettage (wide margin excision of the soft tissue tumor and intralesional curettage in the region of acetabulum) of the tumor was performed in view of proximity to acetabular roof and endangered hip stability.ResultAt follow up of 18 months, the child has full painless range of movements in the hip joint with no recurrence.ConclusionsPelvic aneurysmal bone cysts are distinctly rare in pediatric age. The lesion was associated with an atypical symptom of numbness along the femoral nerve distribution. Hip stability and range of movements were major concern in this patient. Although many treatment options are described, surgical excision still remains the mainstay. In our case, we performed excision curettage, with good outcome.

Alimentary-associated carcinomas in five Vietnamese potbellied pigs

5 Vietnamese potbellied pigs were evaluated for abdominal distress that had not responded to medical treatment (4 pigs) or a draining tract of the cranial abdomen of unknown duration (1 pig). Clinical signs in the pigs included anorexia, vomiting, and constipation. Physical examination revealed a palpable abdominal mass in all pigs. Radiography revealed distended loops of small intestine in 2 pigs. 3 pigs were treated successfully with wide-margin excision of the abdominal masses, and 2 were euthanized. Primary tumors were diagnosed at necropsy or through histologic evaluation of biopsy specimens obtained during surgery. Types of tumor included cholangiocellular carcinoma, transmural gastric carcinoma, small intestinal adenocarcinoma, metastatic hepatocellular carcinoma, and carcinoma. The tumors involved the stomach, small intestine, spiral colon, liver, and gall bladder. All 3 surgically treated pigs survived at least 9 months after surgery. Although rare, neoplasia of the alimentary system should be considered among the differential diagnoses for potbellied pigs with signs of abdominal distress. Wide-margin excision of the neoplastic tissue may result in a good outcome in affected pigs.

Surgical excision margins for primary cutaneous melanoma

BACKGROUND: Cutaneous melanoma accounts for 75% of skin cancer deaths. Standard treatment is surgical excision with a safety margin some distance from the borders of the primary tumour. The purpose of the safety margin is to remove both the complete primary tumour and any melanoma cells that might have spread into the surrounding skin. Excision margins are important because there could be trade-off between a better cosmetic result but poorer long-term survival if margins become too narrow. The optimal width of excision margins remains unclear. This uncertainty warrants systematic review. OBJECTIVES: To assess the effects of different excision margins for primary cutaneous melanoma. SEARCH STRATEGY: In August 2009 we searched for relevant randomised trials in the Cochrane Skin Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), Medline, Embase, Lilacs, and other databases including Ongoing Trials Registers. SELECTION CRITERIA: We considered all randomized controlled trials (RCTs) of surgical excision of melanoma comparing different width excision margins. DATA COLLECTION AND ANALYSIS: We assessed trial quality, and extracted and analyzed data on survival and recurrence. We collected adverse effects information from included trials. MAIN RESULTS: We identified five trials. There were 1633 participants in the narrow excision margin group and 1664 in the wide excision margin group. Narrow margin definition ranged from 1 to 2 cm; wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. AUTHORS’ CONCLUSIONS: This systematic review summarises the evidence regarding width of excision margins for primary cutaneous melanoma. None of the five published trials, nor our meta-analysis, showed a statistically significant difference in overall survival between narrow or wide excision. The summary estimate for overall survival favoured wide excision by a small degree [Hazard Ratio 1.04; 95% confidence interval 0.95 to 1.15; P = 0.40], but the result was not significantly different. This result is compatible with both a 5% relative reduction in overall mortality favouring narrower excision and a 15% relative reduction in overall mortality favouring wider excision. Therefore, a small (but potentially important) difference in overall survival between wide and narrow excision margins cannot be confidently ruled out. The summary estimate for recurrence free survival favoured wide excision [Hazard Ratio 1.13; P = 0.06; 95% confidence interval 0.99 to 1.28] but again the result did not reach statistical significance (P < 0.05 level). Current randomized trial evidence is insufficient to address optimal excision margins for primary cutaneous melanoma. The review is fully available (through the Cochrane Journal Club) from: http://www.cochranejournalclub.com/surgical-excision-margins-clinical/pdf/JC2_excision_margins_full.pdf

Surgical excision margins for primary cutaneous melanoma

Cutaneous melanoma accounts for 75% of skin cancer deaths. Standard treatment is surgical excision with a safety margin some distance from the borders of the primary tumour. The purpose of the safety margin is to remove both the complete primary tumour and any melanoma cells that might have spread into the surrounding skin.Excision margins are important because there could be trade-off between a better cosmetic result but poorer long-term survival if margins become too narrow. The optimal width of excision margins remains unclear. This uncertainty warrants systematic review. To assess the effects of different excision margins for primary cutaneous melanoma. In August 2009 we searched for relevant randomised trials in the Cochrane Skin Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 3, 2009), MEDLINE, EMBASE, LILACS, and other databases including Ongoing Trials Registers. We considered all randomised controlled trials (RCTs) of surgical excision of melanoma comparing different width excision margins. We assessed trial quality, and extracted and analysed data on survival and recurrence. We collected adverse effects information from included trials. We identified five trials. There were 1633 participants in the narrow excision margin group and 1664 in the wide excision margin group. Narrow margin definition ranged from 1 to 2 cm; wide margins ranged from 3 to 5 cm. Median follow-up ranged from 5 to 16 years. This systematic review summarises the evidence regarding width of excision margins for primary cutaneous melanoma. None of the five published trials, nor our meta-analysis, showed a statistically significant difference in overall survival between narrow or wide excision.The summary estimate for overall survival favoured wide excision by a small degree [Hazard Ratio 1.04; 95% confidence interval 0.95 to 1.15; P = 0.40], but the result was not significantly different. This result is compatible with both a 5% relative reduction in overall mortality favouring narrower excision and a 15% relative reduction in overall mortality favouring wider excision. Therefore, a small (but potentially important) difference in overall survival between wide and narrow excision margins cannot be confidently ruled out.The summary estimate for recurrence free survival favoured wide excision [Hazard Ratio 1.13; P = 0.06; 95% confidence interval 0.99 to 1.28] but again the result did not reach statistical significance (P < 0.05 level).Current randomised trial evidence is insufficient to address optimal excision margins for primary cutaneous melanoma.

Lateral mammaplasty reconstruction after surgery for breast cancer

Up to 60 per cent of cancers develop laterally in the breast and breast-conserving surgery frequently produces superolateral nipple-areolar complex (NAC) distortion aggravated by postoperative irradiation. Correction is technically demanding and the outcomes are variable. Lateral mammaplasty may allow wider excision margins and prevent such deformities. This was a review of 86 consecutive patients who had lateral mammaplasty: combined wide tumour excision with NAC repositioning on a reliable dermoglandular pedicle. Simultaneous axillary surgery was performed via a separate or combined incision. Aesthetic outcomes were assessed. The median age of the women was 54 (range 29-75) years; 55 (64 per cent) had palpable tumours and 73 (85 per cent) underwent simultaneous axillary surgery. Median radiological and histological tumour sizes were 29.8 and 33.6 mm, respectively, and median weight of excised tumour was 150 g. Two patients required haematoma evacuation. Eleven women required revisional surgery for involved or close margins. Aesthetic outcomes were excellent or good in 93 per cent. Lateral mammaplasty produced clear margins in 87 per cent of women. It is an option when a deformity is anticipated after breast-conserving surgery, and is particularly valuable when neoadjuvant chemotherapy has downgraded a large tumour.

Recurrence analysis in 66 cases with grade I and grade II chondrosarcomas in the extremities

We analyzed chondrosarcomas in long bones to assess whether Grade I and II chondrosarcomas should both be grouped as low grade malignant tumors (musculoskeletal Tumor Society Stage I or Stage II), and to explore rational surgical treatment for Grade I and II chondrosarcomas. We retrospectively reviewed 66 patients from January 1996 to December 2007 with Grade I and II chondrosarcoma of the extremities without metastases at the Department of Orthopaedics of Shanghai Sixth People's Hospital. Thirty-eight patients had undergone intralesional or marginal resection, and 28 patients had undergone wide marginal or radical excision based on imaging findings. The mean age of the patients was 43 years (range, 5-85) and the minimum follow-up was 31 months (mean, 48; range, 5-141). We analyzed grade diagnosis, therapeutic options, and local recurrence rate of the two grades of chondrosarcoma. Of all patients, 22 experienced local recurrence, making the local recurrence rate 33.3%. A statistically significant difference in outcome between patients with Grade I and Grade II tumors undergoing intralesional resection was identified. No significant difference according to surgical method was found between the two groups in total. Grade II chondrosarcomas should be grouped as high stage malignant tumors (Stage II) and grade I chondrosarcomas assigned to the low stage malignant tumor group (Stage I). Our experience suggests the surgical method should be related to radiographic margin status and oncologic classification. Wide resection should be considered for Grade II, while intralesional resection is suitable for Grade I.

More Than 2 Decades of Treating Atypical Fibroxanthoma at Mayo Clinic

Atypical fibroxanthoma (AFX) typically occurs on the head and neck of elderly white men. Usually considered a malignancy, it is treated with wide local excision (WLE) or total margin control using Mohs micrographic surgery (MMS). To determine the most appropriate treatment for this tumor based on a review of cases treated at Mayo Clinic. We reviewed the medical records of patients with AFX treated at Mayo Clinic from 1980 to 2004. We identified 91 patients with 93 tumors. Treatment information was available for 88 tumors (59 treated with MMS, 23 with WLE, and 6 by other means). There were no recurrences in the patients treated with MMS, with a median follow-up of 4.5 years (range 1.0-16.1 years). Two patients treated with WLE had single recurrences, with a median follow-up of 8.7 years (range 1.5-26.3 years). Total microscopic margin control using MMS was the most effective means of treating AFX.

Current treatment options in dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans (DFSP) is a rare malignant dermal neoplasm characterized by slow infiltrative growth, little metastatic potential but a high tendency to recur locally after surgical excision. DFSP is associated with a high cure rate. The optimal therapy is complete surgical resection. The recurrence potential of DFSP is directly related to the extent of resection. The need for wide excision margins has been amply documented. Wide local excision is a frequently used practice. Mohs micrographic surgery with continuous histological margin control is further propagated to reduce local recurrence rates. In more than 90% of DFSP, a specific chromosomal aberration is described, involving Chromosomes 17 and 22. It leads to a constitutive activation of the platelet-derived growth factor receptor (PDGFR) followed by continuous stimulation of the tumor cell growth. The use of targeted inhibitors of PDGFR is a good therapeutic option in the treatment strategy of unresectable locally advanced, recurrent or metastatic disease. With Imatinib, a selective PDGFR tyrosin kinase inhibitor, partial and complete remissions of DFSP could be achieved. This article reviews the current opinion and literature about DFSP and resulting therapy strategies.

Oncoplasty for lateral breast cancers.

Abstract Abstract #5158 Introduction: 65% of breast cancers develop in the lateral pole, particularly superiorly. Following conservative treatment, , tumourectomy may produce a typical deformity of superolateral nipple-areolar complex (NAC) deviation. This unaesthetic deformity, is exaggerated by the post-operative irradiation mandated by contemporary breast conserving therapy. Primary utilisation of the oncoplastic technique, 'lateral mammaplasty', allows both the avoidance of such deformities and wider excision margins.&amp;#x2028; Patients and methods: The principle behind the technique is the combination of a wide, wedge-shaped tumourectomy combined with NAC repositioning on a de-epithelialised dermoglandular pedicle. Sentinel lymph node biopsy or formal axillary dissection may be performed simultaneously either via a separate or combined incision for inferior and superior lateral mammaplasties respectively. Aesthetic outcomes were assessed on a five-point scale with 1 being excellent and 5 poor.&amp;#x2028; Results: eighty-six patients, with a mean age of 53 years (range 29 – 75) underwent lateral mammaplasty. Fifty-five (64%) were palpable and 73 (86%) had simultaneous axillary surgery. Mean tumour size pre- and post-operatively were 29.8 mm (8 – 81) and 33.6 mm (0 – 140) respectively. Mean excision weight was 150g (24 – 484). Eleven (12.8%) required revisional surgery due to involved or close margins and the aesthetic outcome was graded highly satisfying or satisfying in 68 (79%).&amp;#x2028; Discussion: lateral mammaplasty has been found to be simple to perform with a short learning-curve. With clear excision margins in 87.8%, it is oncologically sound and compares favourably with simple tumourectomy. It should be considered when the tumour-to-breast volume ratio anticipates an aesthetic deformity. We have found it to be particularly satisfactory after neo-adjuvant chemotherapy for large volume tumours when a positive clinical response allows conservative surgery. It is also useful for revisional surgery in cases of involved or close margins following initial tumourectomy.&amp;#x2028; Conclusion: lateral mammaplasty became routine in our institution as it allows, with the assistance of a simple oncoplastic procedure, highly satisfying aesthetic outcomes and the added security of wide excision margins. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5158.

Inflammatory Myofibroblastic Tumor of the Breast

Inflammatory myofibroblastic tumor (IMT) is an uncommon tumor which is composed of spindle cells admixed with mature plasma cells and inflammatory cells. IMT is most common in the lungs and in various organs. However, it is very rare in the breast. According to the organ, there are many clinical and histological characteristics. Breast IMT usually shows developed, movable nontender mass. Radiological findings of IMT are similar to primary breast malignancy. For accurate diagnosis, histologic correlation is needed. IMT is a benign lesion and excision is the treatment of choice, but wide local excision and negative resection margin is needed due to its tendency for recurrence. Understanding of the entity and its mimicry can be helpful in avoiding any unnecessary surgical procedures, such as mastectomy with or without lymph node dissection. Herein, the case of a 29-year-old woman found to have IMT of the breast. The patient underwent a wide local excision. The gross, microscopic and immunohistochemical findings were consistent with the diagnosis of IMT of the breast.

Differentiation of Melanoma from Non-Cancerous Tissue in an Animal Model Using Elastic Light Single-Scattering Spectroscopy

Cutaneous melanoma is the most serious form of skin cancer and is curable only if it is detected early. The most effective treatment for the melanoma is surgical excision of the lesion. Traditionally, wide margins of excision have been used for effective treatment, but are not always desirable due to increased risk of infection and esthetic reasons. Besides, safe surgical margins of the lesion are not always correlated well with the size of the lesions. We have previously developed a system using elastic light single-scattering spectroscopy to differentiate cancerous tissue from non-cancerous tissue and tested it in vitro. The goal of this study was, therefore, to determine the effectiveness of this system ex vivo by using a mouse model of melanoma. First, a melanoma cell line; B16F10 were injected subcutaneously at right mid flank region of C57BL6 mice (n=5) and allowed to develop for two weeks. Tumors were dissected and spectra were taken on tumor tissue and on normal looking skin tissue that was 10 mm distant from the incision. Since these tumors become markedly necrotic in the middle, spectra of necrotic area was also taken. Slopes of the spectra were positive taken on non-cancerous skin tissues that were later verified by histological examination. On the other hand, it gave negative slopes on melanomas. Increased sizes of the nuclei correlated with the negative slope while smaller nuclei found in non-cancerous tissue gave positive slope. Spectrum taken from necrotic area differed from both cancerous and non-cancerous tissue such that it gave a U-shaped spectrum. These results demonstrate that elastic light single-scattering spectroscopy system can differentiate cancerous tissue from non-cancerous and has potential to be used intraoperatively to determine the surgical margins.

Treatment of Dermatofibroma Sarcoma Protuberans Using Modified Mohs Micrographic Surgery: No Recurrences and Smaller Defects

The purpose of this study was to evaluate the use of modified Mohs micrographic surgery (MMS) for dermatofibroma sarcoma protuberans (DFSP) in a single institution by a single surgeon. The authors conducted a retrospective analysis of 25 patients with DFSP who were treated with modified MMS over the past 19 years at Scripps Clinic. Of the 25 patients treated with modified MMS for DFSP, there were no identifiable recurrences. The mean follow-up time was 101 months. The defect sizes of DFSP lesions treated by modified MMS are smaller than if the lesions had been treated with the standard wide local excision (WLE) margins of 3 cm. This is a retrospective analysis using the data of one surgeon. Five of the 25 patients were not examined in our office. Not all patients had 5-year follow-up. There were no cases of the fibrosarcomatous variant. Our data support the growing literature that modified MMS achieves excellent local control for DFSP with a possible benefit of smaller defects when compared with treatment with WLE. The authors have indicated no significant interest with commercial supporters.

Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients

Opinions vary widely as to the role of surgery (from none to wide margin excision) in the management of spinal metastases. In this study the authors set out to ascertain if surgery improves the quality of remaining life in patients with spinal metastatic and tumor-related systemic disease. The authors included 223 patients in this study who were referred by oncologists and physicians over a 2-year period. All underwent surgery. Surgery was classified according to extent of excision ranging from en bloc excision or debulking to palliative surgery. All patients had a histologically confirmed diagnosis of epithelial spinal metastasis, and an oncology specialist undertook appropriately indicated adjuvant therapy in almost half of the patients. The mean patient age was 61 years. Excisional en bloc or debulking surgery was performed in 74%; the rest had (minimal) palliative decompression. All patients considered for surgery were included in the study. Patients presented with pain in 92% of cases, paraparesis in 24%, and abnormal urinary sphincter function in 22% (5% were incontinent). Breast, renal, lung, and prostate accounted for 65% of the cancers, and in 60% of patients there were widespread spinal metastases (Tomita Type 6 or 7). The incidence of perioperative death (within 30 days of surgery) was 5.8%. Postoperatively 71% of the entire group had improved pain control, 53% regained or maintained their independent mobility, and 39% regained urinary sphincter function. The median survival for the cohort was 352 days (11.7 months); those who underwent excision survived significantly longer than those in the palliative group (p = 0.003). As with survival results, functional improvement outcome was better in those who underwent excision. Surgical treatment was effective in improving quality of life by providing better pain control, enabling patients to regain or maintain mobility, and offering improved sphincter control. Although not a treatment of the systemic cancer, surgery is feasible, has acceptably low mortality and morbidity rates, and for many will improve the quality of their remaining life.