RESUMO
Abstract Large defects in plantar surface secondary to acral melanoma excision can be difficult to repair with local flaps, and skin grafts in weight-bearing surfaces often suffer necrosis causing prolonged disability. Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure. Despite their high cost and the requirement of two surgical procedures, this alternative may offer excellent functional and aesthetic results in acral defects.
Assuntos
Humanos , Neoplasias Cutâneas/cirurgia , Procedimentos de Cirurgia Plástica , Derme Acelular , Melanoma/cirurgia , Retalhos Cirúrgicos , Transplante de PeleRESUMO
Large defects in plantar surface secondary to acral melanoma excision can be difficult to repair with local flaps, and skin grafts in weight-bearing surfaces often suffer necrosis causing prolonged disability. Acellular dermal matrices represent an easy alternative to cover deep wounds or those with bone or tendon exposure. Despite their high cost and the requirement of two surgical procedures, this alternative may offer excellent functional and aesthetic results in acral defects.
Assuntos
Derme Acelular , Melanoma , Procedimentos de Cirurgia Plástica , Neoplasias Cutâneas , Humanos , Melanoma/cirurgia , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Retalhos CirúrgicosRESUMO
INTRODUCTION: Histological ulceration in cutaneous melanoma carries a high risk of metastasis and has a poor prognosis. However, some epidemiological and survival studies of patients with cutaneous melanoma do not consider histological ulceration as one of the main prognostic factors. MATERIALS AND METHODS: Epidemiological, clinical, histological and survival characteristics of all patients diagnosed with cutaneous melanoma over a 10-year period (1994- 2003) were retrospectively analysed. RESULTS: Ulcerated melanoma was observed in 77 of 423 patients (18.2%). Ulceration was significantly associated with male sex, deeper tumour thickness, positive sentinel lymph node biopsy and metastasis (p<0.001). Histological ulceration indicates a high relative risk (RR) of death from melanoma (RR 9.41; 95% CI 4.52-19.59) and a significant risk of metastasis (RR 5.72; 95% CI 3.56-9.19) (p<0.001). CONCLUSIONS: Histological ulceration is associated with lower overall survival and disease-free survival in patients with cutaneous melanoma. Presence of ulceration must be included in the clinical history of patients with melanoma to ensure a careful diagnostic work-up and follow-up.
Assuntos
Melanoma/complicações , Melanoma/diagnóstico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/etiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Melanoma/mortalidade , Melanoma/patologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/patologia , Espanha/epidemiologia , Análise de SobrevidaRESUMO
Introducción: La incidencia del melanoma cutáneo ha aumentando durante las últimas décadas en todo el mundo. Los trabajos sobre epidemiología y supervivencia de los pacientes diagnosticados de melanoma en nuestro país son escasos. Material y métodos: Se obtuvieron de forma retrospectiva los datos referentes a todos los pacientes diagnosticados de melanoma cutáneo durante un período de 17 años (1991-2007) en el Hospital General Universitario ®Gregorio Marañón¼ de Madrid. Resultados: Se describen las características epidemiológicas, clínicas e histopatológicas de 879 melanomas, así como la evolución de estos pacientes. Se analizan los posibles factores con influencia en la supervivencia global y en la aparición de metástasis o tiempo libre de enfermedad. Discusión: La incidencia de melanoma en nuestra población se ha duplicado en la pasada década. La mayoría de los melanomas se encuentran en estadio I en el momento del diagnóstico (45%). Sin embargo, se sigue diagnosticando una importante proporción de melanomas en estadios avanzados (III-IV; 14.5%). Los siguientes factores se asocian de forma significativa con una supervivencia global inferior: edad avanzada, sexo masculino, estadio clínico avanzado, tipo nodular, espesor superior a 4 mm (o nivel de Clark V), presencia de ulceración y positividad en la biopsia del ganglio centinela.