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D Reintgen

Publications and source records attributed to D Reintgen.

83 records · Page 5Linked to original sources
PubMedDate not supplied

Metastatic melanoma to regional lymph nodes.

There is an epidemic of melanoma in the United States and throughout most parts of the word. Recent advancements in the management of this disease has provided the patient with more options. The emerging technology of lymphatic mapping and sentinel node biopsy results in a more conservative, less morbid procedure to obtain nodal staging information. At the same time, providing the pathologist the 1-2 nodes from the basin most likely to contain metastatic disease, allows for a more detailed examination of the sentinel lymph node. This more detailed examination may include serial sectioning, immunohistochemical staining or even molecular biology techniques based on RT-PCR to provide more accurate staging. National trials are ongoing to examine the clinical relevance of the disease that is detected and the 'upstaging' that occurs with more sensitive assays for occult metastases.

Clinical Trials as Topic↗
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Prevention and early detection of melanoma: a surgeon's perspective.

Americans are clearly losing the battle against malignant melanoma. In 1930, it was estimated that one in 1,500 people would develop melanoma sometime during their lifetimes, but by the year 2000, one in 75 people in the United States will develop the disease. Although the individual case prognosis is improving, the death rate has doubled in the last 35 years. The rising mortality rate has to be attributed to an escalating incidence that is not offset sufficiently by improved diagnosis and treatment. Malignant melanoma is a disease that lends itself to early detection and screening programs. Melanoma is highly prevalent and causes considerable morbidity and mortality. The natural history of the disease is known and it is well established that the earlier diagnosis of "thinner" lesions can reduce morbidity and mortality. There is also an acceptable, safe, inexpensive, and noninvasive screening test for melanoma, the skin examination. This work reviews the current evidence that melanoma screening may be effective, compares screening projects for this cutaneous tumor with other screening programs, and outlines a proposed project for melanoma screening.

Humans↗
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Histopathologic study of recurrent Clark level II melanomas.

Overall, the prognosis for thin lesions of melanoma (less than 0.76 mm) is excellent. However, a number of melanoma patients with seemingly innocuous lesions have been reported to develop recurrences. For this reason, we examined histologic sections taken from eight cases of Clark level II melanoma that unexpectedly recurred, and compared their histopathologic features with an equal number of nonrecurrent lesions in whom reliable clinical follow-up data were available. Prognostic variables including Breslow thickness, mitotic rate, ulceration, the presence or absence of regression, a vertical growth phase component, and an associated banal nevus were evaluated in a double blind manner. When attempts were made to predict outcome based on one or more prognostic variables, the only correlation of statistical significance was the Breslow thickness (P = 0.04). A Breslow thickness greater than 0.4 mm was associated with a significantly shorter disease free interval than a thickness below 0.4 mm. There was no significant correlation between predicted outcome based on the histologic features examined and the eventual outcome based on history of recurrence (P = 0.36). These data indicate that although prognostic models that predict outcome in melanoma are generally reliable, there is a sizable population of patients with thin melanomas that do worse than would be expected.

Adult↗
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Computer database for melanoma: a clinical management and research tool to ensure continuous quality assessment.

The need for an efficient method to handle data and for chart documentation is more apparent today than at any time in the past. High volume clinics for screening, diagnosis, and treatment are the rule rather than the exception in modern practice. A papermill medical record department or tumor registry fails on a day-to-day basis because of inefficiency of data collection, filing, storage, and abstraction. Requirements of the Joint Commission for the Accreditation of Health Care Organizations (JCAHO) include the setting of standards and the ability to query data to ensure the standards are met. A PC-based software program has been developed with the following features: (1) ongoing timed queries of the data are possible on any variable collected in the database to monitor trends in the standards established for care in the clinic; (2) a daily update of the database is performed so that it may be used as a clinical management tool, acting as an electronic medical record or as a clinical research tool; (3) the software will summarize the chart by abstracting a predetermined list of key data elements to improve clinical efficiency; (4) chart documentation is improved for Medicare coding requirements to maximize physician reimbursement; and (5) clinic notes and referral letters are generated the same day as the clinic visit to allow patients to have a copy of their clinic notes or for same day FAXing to the referring doctors. To date, > 1,200 patients with melanoma have been registered and entered into the system.(ABSTRACT TRUNCATED AT 250 WORDS)

Databases, Factual↗
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Treatment of the primary malignant melanoma: a review.

Treatment of the primary tumor in malignant melanoma includes a surgical excision of the surrounding skin and subcutaneous fat to remove tumor and occult focci. The most significant factor in predicting recurrence of melanoma at the primary tumor site is thickness of the primary tumor and the presence of ulceration. The margin of resection for lesions less than .76 mm is 1 cm and the margin of resection for lesions .76 mm or greater is 2 cm. However, we must remember that an additional margin of skin resection rarely compromises a satisfactory esthetic result and prognosis may be gravely affected by local recurrence of the tumor. The primary incisions may require special considerations if the underlying lymph nodes are also to be resected. On the face less margins may be advantageous for an optimal cosmetic result. The method of reconstruction depends upon the location and size of the defect, the functional and esthetic requirements of the patient, and the medical condition of the patient. Reconstructive methods with primary closure, split thickness skin grafts, full thickness skin grafts, local flaps, and regional flaps are discussed for different locations.

Humans↗
PubMedDate not supplied

Selective lymphadenectomy: emerging role for lymphatic mapping and sentinel node biopsy in the management of early stage melanoma.

The percentage of melanoma patients diagnosed at an early stage is increasing. Many of these patients, particularly those with primary tumors thicker than 1.5 mm, harbor occult metastases in regional nodes and are eligible for regional lymphadenectomy as part of their primary management. Until the results of recently completed prospective randomized trials are available the role for elective lymphadenectomy in terms of survival benefit remains a controversial issue. A new technique, intraoperative lymphatic mapping and sentinel node biopsy, has emerged as a simple way to determine whether or not metastatic disease is present. An intradermal injection of a vital blue dye at the site of the primary tumor allows identification of a "sentinel" node in the regional basin. A study of 237 patients was recently reported by Morton et al. (Arch Surg 127:392-399, 1992; Surg Oncol Clin North Am 1:247-259, 1992) demonstrating that the sentinel node can be readily identified > 80% of the time and that histologic examination of the node results in at least a 95% accuracy rate in staging the nodal basin for metastases. Our present series substantiates the results of the original study. An international multicenter trial has been proposed to further confirm the accuracy and universal feasibility of this technique. Acceptance of this technique will lead to a selective approach to regional lymphadenectomy, as only patients with proven micrometastases will undergo lymph node dissections. This approach should satisfy both the advocates and the opponents of elective regional lymphadenectomy.

Biopsy↗
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Identification of lymphatic drainage basins in patients with cutaneous melanoma.

Lymphoscintigraphy has been shown to be of assistance in predicting lymphatic basins at risk for the development of metastatic disease in patients with cutaneous malignant melanoma. To further establish the efficacy of this method, 212 patients presenting to the H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida with primary melanoma of the head, neck, and trunk have been studied. All patients had clinical stage 1 or 2 melanoma and were candidates for elective lymph node dissection. Drainage patterns identified by lymphoscintigraphy were compared to those predicted by historical anatomical guidelines and were found to be discordant in 63% of patients with tumors of the head and neck, and in 32% of those with primary lesions located on the trunk. Operative intervention was changed because of these findings in 47% of all patients, with 19% undergoing dissection of nonclassical lymph node basins. An additional 28% did not have a node dissection because of failure of the scintigram to demonstrate a predominant drainage basin or the demonstration of multiple drainage sites. After a mean follow-up of 2.8 years, there have been no recurrences in basins not positive by lymphoscintigraphy. The lymphatic drainage from cutaneous melanoma of the head, neck, and trunk cannot be reliably predicted by clinical judgment or classic anatomic guidelines, and lymphoscintigraphy is indicated in these patients prior to elective lymph node dissection.

Antimony↗
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Radiologic imaging in malignant melanoma: a review.

The role of imaging in the staging of malignant melanoma is reviewed. Computed tomography (CT) and magnetic resonance (MR) are useful for detecting liver, lung, and central nervous system (CNS) metastases in asymptomatic patients at high risk and in symptomatic patients. Plain films, bone scan, and gastrointestinal (GI) studies are useful in patients with skeletal or GI complaints. Additionally, imaging studies have a primary role for ascertaining the response, if any, to treatment.

Humans↗
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Chemotherapy for stage 4 melanoma: a three-year experience with cisplatin, DTIC, BCNU, and tamoxifen.

The management of metastatic melanoma has been frustrating from a clinician's point of view because of the relative unresponsiveness of the tumor to chemotherapy and the infrequency of clinically useful objective responses. Although no single agent can be recommended at this time, old standard drugs used in new combinations, immunomodulators, and systematic approaches to dose intensification have created more interest in the chemotherapy of melanoma. Forty-seven consecutive patients with Stage 4 melanoma with measurable disease were treated with combination chemotherapy, consisting of DTIC, BCNU, cisplatin, and tamoxifen. The cycle was repeated every 4 weeks and a total of 6 cycles were delivered. Patients were then restaged to assess the response. Nine patients who were registered during the same time period with Stage 4 disease and elected not to be treated served as the control population. Seventeen patients (46%) achieved a clinical response with six patients (12.7%) undergoing a complete response. The overall survival of all Stage 4 patients in the series was 18% at 3 years. There were significant differences noted in those patients who were treated and the no treatment controls (p = 0.004) and for those patients that received an objective response vs those that progressed on the protocol (p < 0.0001). It is recommended that all patients with Stage 4 melanoma be treated on protocol and results of other trials of systemic therapy for metastatic melanoma be compared to this cisplatin-based regimen instead of a no-treatment arm.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
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Identification of submicroscopic lymph node metastases in patients with malignant melanoma.

In order to detect micrometastatic disease, our laboratory has developed a method for evaluating lymph node sections from patients with stage 1 or 2 melanoma. Lymph nodes isolated from standard dissections are bivalved; one half is subjected to routine histopathological evaluation and the other half disrupted and placed into cell culture. The cultured cells are identified by cytologic examination, immunohistologic staining, and the presence of melanoma-associated antigens. Lymph nodes (448) from 62 patients with malignant melanoma were evaluated by tissue culture. Fifteen patients were upgraded from stage 1 or 2 to stage 3 disease after micrometastases were identified in lymph node cultures. Recurrence of disease in histologically node negative patients, during a mean 24-month follow-up, has only been observed thus far in patients with culture positive lymph nodes. In addition, these results add evidence to the belief that missed micrometastatic disease in regional nodes is a sign of occult systemic metastases that would account for the defined recurrence rate in histologically node negative patients.

Antigens, Neoplasm↗