Background/Aim: To characterize the demographics, tumor staging and treatment of African American (AA) patients diagnosed with melanoma in the United States. Patients and Methods: The National Cancer Database was used to extrapolate data from patients with melanoma between January 1, 2004, and December 31, 2015. The patients were then further divided based on ethnicity (AAs vs. Caucasians) to compare patient efficacy of treatment. Results: The mean time for AA patients to receive treatment was 20.37 days compared with 11.25 days for Caucasians (p<0.001), while time to surgery was 38.86 days compared to 31.12 days for Caucasians (p<0.001). Moreover, AA race was a predictor of American Joint Committee on Cancer stage greater than II, tumor diagnosed at autopsy, presence of ulceration, and distribution in the extremities. Conclusion: AA patients with melanoma are more likely to have worse tumor staging, treatment delay, treatment at an Integrated Cancer Program, and diagnosis at autopsy. African American's (AA) have a decreased likelihood of developing melanoma when compared to other ethnicities due to the protective action of melanin (1). The incidence of melanoma amongst AAs is 1 to 1.2 per 100,000 (2). However, melanoma in AA patients is frequently diagnosed at an advanced stage due to the difficulty in differentiating between skin tone and cancer combined with lower socioeconomic levels (3, 4). In addition, melanoma survival is lower in AA patients undergoing surgical treatment compared to all other ethnicities (5). Etiologies of these disparities are difficult to assess and poorly understood (1-5). Treatment disparity in minority populations is a debated topic that deserves attention from the scientific community (6). In this study, we aimed to assess the difference in melanoma characteristics, patient population, tumor staging and treatment in AA compared to the Caucasian population. Furthermore, we speculated that significant differences exist between the two populations. Patients and MethodsThis study was considered nonregulated by the institutional review board. The National Cancer Database (NCDB), an initiative driven by the American Cancer Society and the American College of Surgeons' Commission on Cancer that registers 70% of all cancers diagnosed in the USA, was used to extrapolate data (7, 8).Eligible patients were identified according to the NCDB's variable "Race". Data were extracted for all patients diagnosed with melanoma between January 1, 2004, and December 31, 2015. The cohort was then split into two groups based on race: 1) AA or 2) Caucasian. Patients identified with others races, such as Asian or Native American, were excluded as this analysis focused on the comparison between AA patients and Caucasian patients, the largest cohort of patients with melanoma.Data was extracted on patient demographics, facility/treatment type, and tumor characteristics. Patients demographics included age, sex, insurance (Uninsured, Private, Medicaid, Medicare, Other Government, Unknown), and population density (...

Breast cancer-related lymphedema (BCRL) incidence has been increasing overtime. Currently, there is not a preferred imaging tool for diagnosis, staging, and assessment of the disease. We aim to review the use of ultrasound elastography (UE) in BCRL patients. A systematic review was performed by querying PubMed, EMBASE, Ovid Healthstar, and Ovid Medline databases for studies that evaluated the use of UE in BCRL. The keywords "elastography" AND "lymphedema" in titles and abstracts were used for the search. The search retrieved 12, 12, 5 and 6 articles in each database, respectively. From these, only 4 met the inclusion criteria. UE methods included two-dimensional strain imaging, shear wave elastography (SWE), and global UE. Two of the studies evaluated the use of UE in the assessment of BCRL, while only 1 considered its use for diagnosis and staging. Based on our systematic review, UE appears to be a great tool in the assessment of BCRL to differentiate affected from non-affected arms.

Lymph node transfer is a surgical treatment that is becoming more prevalent. The lymph nodes from the groin and neck are most frequently used. Iatrogenic lymphedema can be a consequence of the dissection of the groin nodes; thus, some surgeons prefer to use the neck as a donor site. Literature reporting surgical algorithms for the treatment of lymphedema is scarce. Thus, we conducted a systematic review of vascularized omentum lymph node transfer (VOLT) in patients with lymphedema to provide more information about this increasingly common procedure. We hypothesize that the analyzed studies will show that VOLT has positive outcomes. Two reviewers (G.J.C., D.B.) performed independent searches using the PubMed database without timeframe limitations initially through title and abstract descriptions and then by full-text review. The search was done using the following keywords: Breast cancer lymphedema OR lymphedema AND lymph node transfer OR lymph node flap OR lymph node graft AND omental OR omentum OR gastroepiploic. Eligibility criteria included publications evaluating patients with lymphedema in the upper extremity and lower extremity, who underwent VOLT. Our search yielded 35 potential papers in the literature, but only six studies fulfilled the study eligibility criteria. The total number of patients was 137. Three studies described single VOLT, two studies described double VOLT and one study described two cohort patients, one that was treated with single VOLT and another one that was treated with double VOLT. Postoperative reduction of arm circumference, arm volume, and symptoms of the upper extremity were reported in all patients. Nonetheless, in one study, seven patients did not notice any extremity circumference reduction during the follow-up period and four patients noticed an increase in arm volume. Flap loss was reported by two authors in a total of two patients. Overall, patients experienced successful lymphedema treatment with VOLT. All authors presented results with reduced circumferential size of the affected upper and lower limbs, as well as reduction of the infectious intercurrences, such as cellulitis, with a small incidence of associated complications.

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Breast cancer-related lymphedema is a long-term condition that affects almost half of breast cancer survivors. Clinical studies have looked at the benefits of lymphaticovenular anastomosis (LVA) for the treatment of upper extremities lymphedema after breast cancer, however, there is still controversy if it improves lymphedema. This study aimed to analyze the studies and outcomes related to LVA for breast cancer-related lymphedema. A PubMed/Medline search was performed using "lymphovenous bypass", "upper extremity lymphedema", "arm lymphedema after breast cancer treatment", and "lymphaticovenular anastomosis" as key words. Only English articles reporting outcomes after LVA were included. We found 22 articles that met the inclusion criteria. Positive outcomes were found in 21 studies with an objective volume reduction and subjective symptoms relief after LVA. This literature review concluded that LVA has demonstrated a significant decrease in upper extremity volumes and an improvement in subjectively reporting symptoms in breast cancer-related lymphedema patients.