One of the most recognizable aphorisms about the plight of Millennials is that we are overeducated and underpaid. The causes and effects of this have been detailed in the abstract, but for me this meant that when I joined Twitter on December 22, 2008, I was working two jobs to make my student loan payments every month. My supplemental job at a popular midrange clothing

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In this research we examine the advocacy and community building of transgender women on Twitter through methods of network and discourse analysis and the theory of networked counterpublics. By highlighting the network structure and discursive meaning-making of the #GirlsLikeUs network, we argue that the digital labor of trans women, and especially trans women of color, represents the vanguard of struggles over self-definition. We find that trans women on Twitter, led by Janet Mock and Laverne Cox, and in response to histories of misrepresentation and ongoing marginalization and violence, deliberately curate an intersectional networked counterpublic that works to legitimize and support trans identities and advocate for trans autonomy in larger publics and counterpublics.

IMPORTANCE Systemic therapy for metastatic melanoma has evolved rapidly during the last decade, and patient treatment has become more complex. OBJECTIVE To evaluate the survival benefit achieved through surgical resection of melanoma metastatic to the abdominal viscera in patients treated in the modern treatment environment. DESIGN, SETTING, AND PARTICIPANTS This retrospective review of the institutional melanoma database from the John Wayne Cancer Institute at Providence St Johns Health Center, a tertiary-level melanoma referral center, included 1623 patients with melanoma diagnosed as having potentially resectable abdominal metastases before (1969–2003) and after (2004–2014) advances in systemic therapy. MAIN OUTCOMES AND MEASURES Overall survival (OS). RESULTS Of the 1623 patients identified in the database with abdominal melanoma metastases, 1097 were men (67.6%), and the mean (SD) age was 54.6 (14.6) years. Of the patients with metastatic melanoma, 1623 (320 [19.7%] in the 2004–2014 period) had abdominal metastases, including 336 (20.7%) with metastases in the gastrointestinal tract, 697 (42.9%) in the liver, 138 (8.5%) in the adrenal glands, 38 (2.3%) in the pancreas, 109 (6.7%) in the spleen, and 305 (18.8%) with multiple sites. Median OS was superior in surgical (n = 392; 18.0 months) vs nonsurgical (n = 1231; 7.0 months) patients (P < .001). The most favorable 1-year and 2-year OS was seen after surgery for gastrointestinal tract (52% and 41%) and liver (51% and 38%) metastases, respectively. Multivariable analysis found increasing age (hazard ratio [HR], 1.01; 95% CI, 1.00–1.01; P = .02) and the presence of ulceration (HR, 1.21; 95% CI, 1.01–1.45; P = .04) were associated with a worse OS. Alternatively, treatment with metastasectomy (HR, 0.59; 95% CI, 0.46–0.74; P < .001) and metastases involving the gastrointestinal tract (HR, 0.65; 95% CI, 0.48–0.87; P = .004) were associated with a better OS. The systemic treatment era did not significantly affect outcomes (HR, 0.82; 95% CI, 0.67–1.02; P = .15). Overall, patients with gastrointestinal tract metastases undergoing complete, curative resection derived the greatest benefit, with a median OS of 64 months. CONCLUSIONS AND RELEVANCE To our knowledge, this series is the largest single-institution experience with abdominal melanoma metastases, demonstrating that surgical resection remains an important treatment consideration even in the systemic treatment era.