Purpose: Isolated limb infusion (ILI) offers a minimally invasive alternative to isolated limb perfusion (ILP) for the treatment of locally advanced extremity melanoma for limb salvage. The purpose of this study was to evaluate the safety and efficacy of ILI in elderly patients in an Australian multicenter setting. Methodology: The results of 316 ILI procedures, performed between 1992-2008 in 5 Australian institutions, were analyzed. All institutions used the same protocol. Responses were determined using the WHO criteria and limb toxicity was assessed using the Wieberdink scale. Results: Characteristics of patients ≥75 years (n=148) were similar to those <75 years (n=168). Median drug circulation times were lower in the older group (21 vs. 24 minutes; p=0.04). Older patients experienced less limb toxicity after ILI compared with younger patients (grade III/IV toxicity in 22% and 37% respectively; p=0.003). A complete response was seen in 27% of patients ≥75 years and in 38% of patients <75 years (p=0.06), while overall response rates were 72% and 77% respectively (p=0.30). No difference in survival was seen with a median follow-up of 40 months for both groups (p=0.69). Conclusions: ILI was a safe and effective technique for advanced extremity melanoma in elderly patients. They experienced lower toxicity following ILI compared with younger patients, possibly due to shorter drug circulation times. Complete response rates were higher in the younger patients, although not significantly, while overall responses were equal. Optimization of perioperative factors in elderly patients may allow response rates to be raised further, while maintaining low toxicity. Purpose: When there is clinically apparent metastatic melanoma in cervical lymph nodes surgeons may be hesitant to recommend a therapeutic complete lymph node dissection (TCLND) if the patient is elderly or has major comorbidities. A limited nodal excision (of the clinically positive nodes) followed by adjuvant radiotherapy to the entire node field may be an effective alternative to TCLND in such patients. Methodology: All patients who had presented with a primary head and neck melanoma or an unknown primary site and who had subsequently undergone limited nodal excision and adjuvant radiotherapy for macroscopi-cally involved cervical nodes between 1993 and 2010 at a tertiary referral center were selected for study. Results: Twenty-eight patients were identified, with a median age of 78 years and a median of 2 major comorbidities. The 5-year regional control, disease-free survival, and overall survival rates were 69%, 44% and 50%, respectively. At the time of data analysis, 7 patients were alive without evidence of disease. Twenty-one patients had died, 11 of mela-noma (4 with neck recurrence) and 10 of other causes (2 with neck recurrence). Conclusion: Excision of clinically-positive metastatic cervical lymph nodes followed by radiotherapy provides satisfactory regional disease control without risking serious morbidity or mortality in melanoma patients whose gene...
In this study, the frequency of positive patch test reactions to the hydroperoxides of linalool is 20% (19/96), and the frequency of positive reactions to the hydroperoxides of D-limonene is 8% (7/90). These high frequencies suggest that patch testing to the hydroperoxides of linalool and limonene should be performed in all patients with suspected fragrance allergy.
Cutaneous squamous cell carcinoma (cSCC) currently affects over 700 000 patients per year in the USA alone, and its incidence continues to rise in recent years. A known risk factor for cSCC is chronic inflammation; a cSCC that develops at a site of chronic inflammation is known as Marjolin's ulcer. We present the case of a 76-year-old man with end-stage renal disease requiring chronic haemodialysis who developed an invasive cSCC at the cannulation site of an underlying arteriovenous (AV) fistula. In this instance, treatment with standard surgical excision or Mohs surgery would pose unique risks associated with injury to an otherwise functional AV fistula. Thus, the lesion was treated with electron beam radiation therapy, which offers a similar efficacy to surgery while minimising risk to the fistula. This resulted in a successful oncological outcome with no complications.
and psychiatrists should be involved in the early stages of treatment. The limitation of our study is that we could not measure the actual disease duration between psoriasis and the mental health disorders. However, our study was strengthened by the use of standardized, large-population data to identify an association between psoriasis and mental health disorders. The present results demonstrate that psoriasis is associated with a higher risk for developing mental health disorders; therefore, dermatologists should play a role in detecting mental health disorders in patients with psoriasis, and in assembling a multidisciplinary team of medical professionals to treat these patients.
CT-based limb volume measurement is feasible for chemotherapy dosing in patients undergoing ILI for melanoma and has predictive value with respect to clinical response and toxicity.
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