Regional recurrences are one of the most common first manifestations of progression of clinically localized cutaneous melanoma. They are caused by subclinical metastases in the lymph nodes. Biopsy of the sentinel lymph nodes is the most effective method of detection of hidden regional metastases. It allows to appropriately increase the volume of surgical treatment prior to dissection of the affected lymph collector and perform adjuvant therapy with the most effective drugs. This, in its turn, allows for significant improvement of regional and systemic control of the disease and long-term treatment outcomes.Data obtained in several randomized trials on the effectiveness of lymph node dissection in patients with sentinel lymph node metastasis showed that this procedure significantly improves regional control of the disease but does not affect long-term treatment outcomes. Additionally, some studies showed that assignment of responsibility for regional control to adjuvant therapy does not meet the expectations. Therefore, the most effective method of regional control of cutaneous melanoma is surgery. All of these studies show that it is necessary to develop criteria for identification of patients with high risk of metastases in the non-sentinel lymph nodes who require lymph node dissection for regional disease control and creation of the best conditions for adjuvant systemic therapy. This requires identification of predictors of multiple involvement of regional lymph nodes justifying indications for radical lymph node dissection. Studies in this area are being performed but their results are ambiguous and sometimes contradictory.Aim. To evaluate the effectiveness of lymph node biopsy and radical lymph node dissection in patients with cutaneous melanoma and subclinical involvement of the sentinel lymph node.
The article presents a clinical case of perineal defect reconstruction using a VRAM flap in a patient with vulvar cancer. Stepwise surgical treatment method is described. A multidisciplinary meeting allows to realize a plan of surgical help for such patients with the goal of treating oncological process and its complications.We have proposed a variant of perineal defect reconstruction through transfer of a vertical rectus abdominis musculocutaneous flap with a vascular pedicle.
Introduction. Melanoma skin is a tumor with a high metastatic potential. Often, its lymphogenous spread is realized in the first place. That is why the assessment of the state of the regional zones of lymph drainage is a prognostically significant aspect of the diagnosis of this disease. The study objective – to estimate the possible predictive value of the results of preoperative lymphoscintigraphy for multiple regional lymph node involvement in clinically localized cutaneous melanoma.Materials and methods. The study involved 89 patients with clinically localized cutaneous melanoma who underwent sentinel lymph node biopsyand regional lymphadennectomy. Morphological findings were compared with the results of preoperative lymphoscintigraphy. Results. In this paper, quantitative data such as the number of lymphatic drainage areas, the number of sentinel lymph nodes in one anatomic region and their combination were considered. Conclusion. It was impossible to determine unambiguously the number of involved lymph nodes. However, the lymphoscintigraphic findings were suggestive of a higher risk for multiple lymph node involvement in patients with several accumulation zones and several lymphatic drainage areas.
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