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Despite advances in melanoma management, there remains room for improvement in the accuracy of sentinel lymph node biopsy. The authors analyzed a prospective cohort of patients with primary cutaneous melanoma who underwent sentinel lymph node biopsy with lymphoscintigraphy and indocyanine green fluorescence to evaluate the quality and accuracy of this technique.

Consecutive primary cutaneous melanoma patients who underwent sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green fluorescence from 2012 to 2018 were prospectively enrolled. Analysis was performed of melanoma characteristics, means of identifying sentinel lymph nodes, sentinel lymph node status, and recurrence.

Five hundred ninety-four melanomas and 1827 nodes were analyzed; 1556 nodes (85.2 percent) were identified by radioactivity/fluorescence, 255 (14 percent) by radioactivity only, and 16 (0.9 percent) with indocyanine green only. There were 163 positive sentinel nodes. One hundred forty-seven (90.2 percent) were identified by radioactivity/fluorescence, 13 (8 percent) by radioactivity only, and three (0.6 percent) with fluorescence only. Of the 128 patients with a positive biopsy, eight patients' (6.3 percent) nodes were identified by radioactivity only and four (3.4 percent) with fluorescence only. There were 128 patients with a positive biopsy, 454 with a negative biopsy, and 12 patients who had a negative biopsy with subsequent nodal recurrence. Mean follow-up was 2.8 years.

In the study of the largest cohort of patients with primary cutaneous melanoma who underwent a sentinel lymph node biopsy with radioisotope lymphoscintigraphy and indocyanine green-based technology, the quality and accuracy of this technique are demonstrated. This has important implications for melanoma patients, as the adoption of this approach with subsequent accurate staging, adjuvant workup, and treatment may improve survival outcomes. .

Diagnostic, II.

Diagnostic, II.

Identifying a donor for facial vascularized composite allotransplant recipients can be a lengthy, emotionally challenging process. Little is known about the relative distribution of key donor characteristics among potential donors. Data on actual wait times of patients are limited, making it difficult to estimate wait times for future recipients.

The authors retrospectively reviewed charts of nine facial vascularized composite allotransplant patients and provide data on transplant wait times and patient characteristics. In addition, they analyzed the United Network for Organ Sharing database of dead organ donors. After excluding donors with high-risk characteristics (e.g., active cancer or risk factors for blood-borne disease transmission), the authors calculated the distribution of relevant donor-recipient matching criteria (i.e., ethnicity, body mass index, age, ABO blood group, cytomegalovirus, Epstein-Barr virus, hepatitis C virus) among 65,201 potential donors.

The median wait time for a transplantt times vary considerably. Deutivacaftor Although most patients experience acceptable wait times, some with underrepresented characteristics exceed acceptable levels. Cytomegalovirus-seropositive donors present a large portion of the donor pool, and exclusion for seronegative patients may increase wait time. Hepatitis C-seropositive donors may constitute a donor pool for underrepresented patient groups in the future.

Nasal defects following Mohs resection are a reconstructive challenge, demanding aesthetic and functional considerations. Many reconstructive modalities are available, each with varying utility and efficacy. The goal of this study was to provide an algorithmic approach to nasal reconstruction and illustrate lessons learned from decades of reconstructing Mohs defects.

A retrospective review was conducted of consecutive patients who underwent nasal reconstruction after Mohs excision from 2003 to 2019 performed by the senior author (J.F.T.). Data were collected and analyzed regarding patient and clinical demographics, defect characteristics, reconstructive modality used, revisions, and complications.

A total of 2553 cases were identified, among which 1550 (1375 patients) were analyzed. Defects most commonly affected the nasal ala (48.1 percent); 74.8 percent were skin-only. Full-thickness skin-grafts were the most common reconstructive method (36.2 percent); 24.4 percent of patients underwent forehead flaps and 17.0 percent underwent nasolabial flaps. The overall complication rate was 11.6 percent (n = 181), with poor wound healing being most common. Age older than 75 years, defects larger than 2 cm2, and active smoking were associated with increased complication rates.

Nasal reconstruction can be divided based on anatomical location, and an algorithmic approach facilitates excellent results. Although local flaps may be suitable for some patients, they are not always the most aesthetic option. The versatility and low risk-to-benefit profile of the forehead flap make it a suitable option for elderly patients. Although reconstruction is still safe to be performed without discontinuation of anticoagulation, older age, smoking, and large defect size are predictors of complications.

Therapeutic, IV.

Therapeutic, IV.

Giant congenital melanocytic nevi are large skin lesions associated with a risk of malignant transformation. The authors developed a novel treatment to reconstruct full-thickness skin defects by combining an inactivated nevus as the autologous dermis and a cultured epidermal autograft. The first-in-human trial of this treatment was performed.

Patients with melanocytic nevi that were not expected to be closed by primary closure were recruited. The full-thickness nevus of the target was removed and inactivated by high hydrostatic pressurization at 200 MPa for 10 minutes. The inactivated nevus was sutured to the original site, and a cultured epidermal autograft was grafted onto it 4 weeks later. Patients were followed for up to 52 weeks.

Ten patients underwent reimplantation of the pressurized nevus, and one patient dropped out. The recurrence of nevus at 52 weeks was not detected by pathological diagnosis in any patients. The L* value at 52 weeks was significantly higher than that of the target nevus. One patient received skin grafting due to contracture of the reconstructed skin.