Josef Koller

Prognostic factors for survival and factors associated with long-term remission in patients with advanced melanoma receiving cytokine-based treatments: second analysis of a randomised EORTC Melanoma Group trial comparing interferon-α2a (IFNα) and interleukin 2 (IL-2) with or without cisplatin

The aim of this study was to define prognostic factors for survival, and especially for long-term survival in a mature data-set of patients with stage IV melanoma treated within a randomised trial of cytokine-based protocols. Long-term follow-up data on patients enrolled into a European Organization for Research and Treatment of Cancer (EORTC) trial comparing interferon-alpha (IFNalpha) plus interleukin-2 (IL-2) with or without cisplatin were collected. Univariate and multivariate Cox regression analyses were performed to define prognostic factors for survival. The characteristics of patients alive at 2 and 5 years after randomisation were compared with the entire cohort using the chi(2) test. The minimum potential follow-up of the 131 evaluable patients was 5 years. 18 patients (14%) were alive 2 years after randomisation, and 11 (8%) 5 years after randomisation. Pretreatment performance status (PS), serum lactate dehydrogenase (LDH) and tumour mass were significant predictors for survival, whereas site of metastases and number of sites were non-significant. PS and LDH were the only independent prognostic factors. All except 1 patient alive at 2 and 5 years had a pretreatment PS of 100%, and only three long-term survivors had elevated pretreatment LDH. There was no association between the site of metastases and long-term survival. Response to treatment was a major predictor for long-term survival, whereas addition of cisplatin did not impact upon overall survival probability or on long-term survival. The probability of long-term survival in stage IV melanoma patients after IL-2-based treatments is governed by pretreatment PS, serum LDH and response to treatment. Site of metastases, the basis for the M-subcategories of the new AJCC staging system, was not informative in this study.

German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids).

© Deutsche Dermatologische Gesellschaft • Journal compilation

Intermittent High-Dose Intravenous Interferon Alfa-2b for Adjuvant Treatment of Stage III Melanoma: Final Analysis of a Randomized Phase III Dermatologic Cooperative Oncology Group Trial

PURPOSE To evaluate the efficacy, safety, tolerability, and quality of life (QoL) in patients receiving intravenous, intermittent high-dose interferon alfa-2b (IFN-α-2b [iHDI]) compared with standard high-dose IFN-α-2b (HDI). PATIENT AND METHODS Patients with stage III resected lymph node or in-transit metastasis from cutaneous malignant melanoma were randomly assigned to receive either a standard HDI regimen or three courses of IFN-α-2b 20 MIU/m(2) administered intravenously 5 days a week for 4 weeks then repeated every 4 months. Distant metastasis-free survival was the primary end point for efficacy analysis. In addition, relapse-free survival, overall survival, safety as determined by Common Terminology Criteria for Adverse Events criteria, and QoL were secondary end points. RESULTS Of 649 patients enrolled, 22 patients were excluded from the intent-to-treat analysis. The remaining 627 patients were well balanced between the arms according to sex, age, and stage. After a median follow-up of 55 months, a multivariable Cox model revealed no significant differences for distant metastasis-free survival (hazard ratio [HR], 1.21; P = .12) or overall survival (HR, 1.01; P = .85). In contrast, the difference for relapse-free survival was significant (HR, 1.27; P = .03), favoring standard HDI. Early termination of treatment because of adverse events or QoL occurred significantly more often with HDI than with iHDI (26.0% v 14.8%; P < .001). CONCLUSION Although the safety and QoL profiles for the intermittent regimen were favorable, no significant difference was observed for survival while the HR for relapse with iHDI was increased. Therefore, an iHDI regimen, as tested here, cannot be recommended as adjuvant treatment for high-risk melanoma.

Modified subcutaneously pedicled flap

The subcutaneously pedicled flap, also known as V‐Y flap, belongs to the group of island flaps whose blood supply (unlike the horizontally perfused advancement and transposition flaps) comes from subcutaneous blood vessels perpendicular to the skin surface. Because of the outstanding perfusion of this type of flap, we remove up to one‐third of the cranial flap pedicle to form a skin flap (3–4 mm thick), resulting in a significant increase in the defect size able to be covered by the V‐Y flap. Moreover, in the infraorbital region – as far as topographically feasible – this flap is pulled further cranially (in the direction of the defect to be closed) by an obliquely placed periosteal suture. This offsets any potential distal tension on the flap and has thus proven beneficial in preventing an ectropion.

Liposuction - a surgical procedure in dermatology

Liposuction is an integral part of the wide range of surgical procedures in dermatology. Dermatologists established tumescent local anesthesia in combination with the use of micro‐cannulas; especially dermatologists from Germany and Austria actively designed and developed these new techniques. In this position paper, we discuss the history, various interdisciplinary aspects, the significance, and the treatment indications for this procedure as well as its role within dermatologic training programs and research. For quality reasons, members of the Germany Society of Dermatologic Surgery and the Austrian Society of Dermatologic Surgery discuss several fundamental professional aspects as well as the historical development of liposuction.

Deutsche S2k Leitlinie zur Therapie pathologischer Narben (hypertrophe Narben und Keloide)

© Deutsche Dermatologische Gesellschaft • Journal compilation

Tumoren der Kopfhaut: CME Article

Kopfhauttumoren zeigen ein beeindruckend breites, heterogenes Entitätsspektrum und nicht selten relevante lokalisationsbezogene Eigenheiten im Vergleich zu ihren Pendants am restlichen Integument. Wiewohl großenteils benigner Natur, können erschwerte Einsehbarkeit und verzögerte Wahrnehmung, lokale anatomische Verhältnisse, verstärkte Exposition gegenüber (exogenen) Noxen, distinkte histomorphologische Muster wie auch das häufig vorgeschrittene Alter der Betroffenen die Behandlung zu einer diagnostischen und therapeutischen Herausforderung werden lassen. Letztes gilt umso mehr für die seltenen bösartigen Tumoren an der Kopfhaut mit häufig schlechter Prognose. Interdisziplinär akkordierte Behandlungsstrategien sind deshalb von besonderer kontextualer Relevanz. Vor diesem komplexen Hintergrund werden allgemeine Prinzipien und relevante Spezifika der wichtigsten Kopfhauttumoren dargestellt.

Long-term outcomes following sweat gland excision for axillary hyperhidrosis

Axillary hyperhidrosis is a functional disorder of the sweat glands that is associated with considerable social and occupational impairment. Treatment is primarily based on the severity of the symptoms and includes both conservative and surgical methods [ 1, 2 ] . Surgical treatment is aimed at either destroying/removing the sweat glands or interrupting their innervation, which results in permanent symptomatic relief [ 3 ] . The objective of the present study was to ascertain long-term functional and aesthetic outcomes following sweat gland excision in axillary hyperhidrosis patients who had previously not responded to conservative treatment.

Efficacy of long-term intralesional triamcinolone in Morbihan's disease and its possible association with mast cell infiltration

Morbihans disease is characterized by chronic persistent facial edema of the upper half of the face, absence of typical diagnostic findings, and refractoriness to treatment. A 44‐year‐old man was diagnosed with Morbihans disease based on clinical signs and histopathology, which showed dermal edema in upper dermis, discrete lymphocytic infiltrate without granulomatous reaction, and mast cell infiltration. After long‐term therapy with intralesional triamcinolone a remarkable objective and subjective clinical response was observed. Reported cases of Morbihans disease are reviewed, with respect to their treatment and histopathological findings. Mast cell infiltration has been observed on histopathology in most patients who responded to intralesional triamcinolone, suggesting a possible marker of response. The long‐lasting response seen in our case indicates the efficacy of intralesional triamcinolone in this rare condition.

Die modifizierte subkutan gestielte Lappenplastik

Die subkutan gestielte Plastik, auch VY‐Plastik genannt, gehört zur Gruppe der Insellappenplastiken, deren Blutversorgung (im Gegensatz zu den horizontal perfundierten Verschiebe‐ und Transpositionslappenplastiken) durch senkrecht zur Hautoberfläche führende subkutane Blutgefäße erfolgt. Aufgrund der hervorragenden Perfusion dieses Lappentyps entfernen wir bis zu einem Drittel des kranialen Lappenstiels und bilden dort einen 3–4 mm dicken Hautlappen, woraus ein wesentlicher Zugewinn im Hinblick auf die mit dem VY‐Lappen deckbare Defektgröße resultiert. Darüber hinaus wird dieser Lappen in der Infraorbitalregion, soweit dies topographisch möglich ist, im kranialen Bereich durch eine schräg gesetzte Periostnaht weiter nach kranial in Richtung des zu verschließenden Defektes gezogen. Dadurch wird ein eventuell vorhandener Zug des Lappens nach distal aufgehoben, was sich zur Verhinderung eines Ektropiums bewährt hat.