Gerald W.PeskinMDGerald W.PeskinMD
We have several articles related to melanoma this month. The first of these deals with the ethnicity of those with melanoma. A study from the University of Hawaii reports that melanoma is a multiethnic disease that appears to be thicker, more ulcerated, and more advanced with positive nodes in the nonwhite population (357 white subjects, 67 nonwhite subjects). Even the anatomical distribution was different between the 2 groups with more lesions noted on the sole and subungual area in the nonwhite group. The overall survival, stratified by stage at initial examination, however, was the same as in the white group. Thus, although a potential biological component is suggested, the outcomes suggest a need for earlier diagnosis and interaction in nonwhite individuals.
An article by Essner et al suggests that it is worthwhile to pursue curative resection in patients with American Joint Committee on Cancer stage IV melanomas to improve longevity. Of 4426 patients, 35% underwent surgical resection, and the 5-year survival rate for solitary nodules of melanoma and skin and lymph node metastases was significantly improved. Patients with limited sites and number of metastases should be considered for excision regardless of the location of the disease.
Is obesity an independent risk factor of mortality in severely injured blunt trauma patients? According to the article by Neville et al, it is. They reviewed the medical records of 242 consecutive patients admitted to the intensive care unit following severe blunt trauma and found that the obese group (those with a body mass index >30 kg/m2), although possessing similar demographics and injury patterns as the nonobese group, had an adjusted odds ratio of 5.7 (P= .003).
Mortenson et al reviewed the medical records of 128 women who underwent mastectomy across an 8-year period ending in 2002 and divided them into 4 groups according to whether immediate breast reconstruction was performed and whether they underwent postoperative chemotherapy. Although they found a greater incidence of wound complications in the immediate reconstruction group, as others have, these complications did not delay initiation of postoperative chemotherapy; thus, immediate breast reconstruction should remain an important treatment option after mastectomy, even when postoperative chemotherapy is anticipated.
Enger et al studied 1376 women, aged 24 to 81 years, diagnosed with breast cancer between 1988 and 1996 for whom complete medical records were available. Among patients with early disease (stages I and IIA), they observed a relationship of increasing weight (175 lb or more) with an increasing likelihood of dying of breast cancer (P= .02). The results were similar for body mass index. Estrogen receptor status was also an important predictor of breast cancer death in early-stage disease.
This article deals with the prevalence of community-acquired methicillin-resistant Staphylococcus aureus(MRSA) in patients with soft tissue infections treated in a specialized unit for a medically underserved urban population. Of the 6156 patients, 1876 were homeless, 4980 had no health insurance, and 5164 were either homeless or had no health insurance. Approximately two thirds of the time, surgical procedures were used to treat the infections. Approximately two thirds of the cultures contained MRSA. Thus, the prevalence of MRSA soft tissue infections in medically underserved patients is high with transmission in the community. Antibiotic therapy may not be needed.
This Month in Archives of Surgery. Arch Surg. 2004;139(9):929. doi:10.1001/archsurg.139.9.929