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Objective: In this study, we aimed to examine the association of demographic and socioeconomic factors with cutaneous melanoma that required admission., Methods: A cross-sectional study utilizing the Nationwide Inpatient Sample database, 2003-2009, was merged with County Health Rankings Data., Results: A total of 2,765 discharge -records were included. Men were more likely to have melanoma in the head, neck, and trunk regions (p < 0.001), while extremities melanoma was more common in women (p < 0.001). Males had a higher risk of lymph node metastasis on presentation (OR 1.54, 95% CI [1.27-1.89]). Blacks and Hispanics were more likely to present with extremities melanoma. Patients with low annual income were more likely to be treated by low-volume surgeons and in hospitals located in high-risk communities (p < 0.05 each). Patients with Medicaid coverage were twice as likely to present with distant metastasis and were more likely to be managed by low-volume surgeons (p < 0.05 each)., Conclusions: The presentation and outcomes of cutaneous melanoma have a distinct pattern of distribution based on patients' characteristics., (© 2018 S. Karger AG, Basel.)

Objective: Head and neck cutaneous melanoma represents a distinct entity of skin cancer. We aim to examine management and survival of patients with head and neck cutaneous melanoma., Methods: A retrospective cohort study utilizing the National Cancer Database, 2004-2012., Results: A total of 20,322 (21.2%) head and neck melanomas and 75,547 (78.8%) melanomas of other sites were included. The median follow-up time of head and neck melanoma was 41.6 months (interquartile range: 22.9-68.2 months). Patients with melanoma of the head and neck were more likely to be ≥65 years old, male, and/or white (p < 0.001 each). Positive surgical margin was more prevalent in head and neck melanoma [OR: 2.19, 95% CI: (2.03, 2.37)], and was associated with a lower survival [HR: 1.41, 95% CI: (1.28, 1.57)]. High positive lymph node ratio was associated with a lower survival [HR: 2.00, 95% CI: (1.13, 3.57)]. Adjuvant immunotherapy was associated with an improved survival [HR: 0.67, 95% CI: (0.57, 0.80)]., Conclusion: Head and neck cutaneous melanoma is associated with certain demographics. Surgical margin status, lymph node ratio, and immunotherapy are independently associated with overall survival., (© 2017 S. Karger AG, Basel.)

Objective: The aim of this study was to evaluate disease-specific survival and cost related to radioactive iodine therapy (RAI) utilization in patients with early-stage papillary thyroid carcinoma (PTC)., Methods: This was a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database, 2004-2012., Results: A total of 38,374 patients with PTC were identified. Of those, 56.3% had adjuvant RAI. RAI administration was not associated with a survival advantage in patients with PTC stage I (hazard ratio [HR] 1.26, 95% confidence interval [CI] 0.11, 14.54; p = 0.85) or stage II (HR 0.50, 95% CI 0.05, 4.88; p = 0.55). Patients with PTC stage III who underwent adjuvant RAI had an improved survival (HR 0.30, 95% CI 0.10, 0.91; p = 0.033). In 2012, RAI was used in 45.5% of patients with stage I and in 71.4% of patients with stage II. The total expenditure on adjuvant RAI for PTC stage I throughout the study period was estimated to be USD 82.3 million with an annual average of USD 9.1 (±2.0) million/year. If the decline rate in the utilization of RAI continued, the model projected that the annual expenditure would decrease by USD 0.14 million/year., Conclusion: There is a high prevalence of adjuvant RAI utilization for early-stage PTC that is causing financial burden on the health system with no evidence of survival benefit., (© 2017 S. Karger AG, Basel.)

Background: Black thyroid pigmentation is a rare entity. The risk of malignancy is higher in black thyroid compared to non-black thyroid glands. We aimed to examine the effect of age and race on the risk of malignancy in black thyroid glands., Methods: We identified a series of consecutive patients who underwent thyroidectomy at an academic institution between January 1998 and May 2013. Patient demographics, clinical characteristics, and histopathology data were reviewed., Results: Among 925 patients who underwent thyroidectomy, 112 (12.1%) patients with black thyroid glands were identified. The incidence of thyroid cancer was 55.4% in black thyroid glands compared to 32.8% in non-black thyroid glands (p < 0.0001). The incidence of papillary thyroid cancer among the black and non-black thyroid glands was 34.8 and 20%, respectively (p < 0.001). The mean age (± SD) for patients with black thyroid glands and those with non-black thyroid was 54.3 ± 12.8 and 51.2 ± 15.7 years, respectively (p = 0.05). Black thyroid glands were also associated with a higher incidence of microcarcinomas (76 vs. 59%, p = 0.02). Among patients with black thyroid glands, Caucasians had a higher malignancy rate (63.4%) than African-Americans (37%; p = 0.03)., Conclusion: The incidence of malignancy is higher in black thyroid compared to non-black thyroid glands, specifically in Caucasians., (© 2015 S. Karger AG, Basel.)

Background: Lithium treatment has been associated with hyperparathyroidism (HPT). However, there are conflicting data regarding the rate of single- (SGD) versus multiple-gland disease (MGD) as well as the optimum surgical approach in these cases., Methods: Published data were identified through systematic electronic literature searches. Studies that fulfilled the preset inclusion criteria were analyzed (n = 12)., Results: These studies documented 210 lithium-associated HPT (LAH) cases. Of these, 103 (49%) were due to SGD and 107 (51%) due to MGD. The unadjusted odds ratio of having multiple LAH compared to sporadic HPT was 3.44 (95% confidence interval 2.5907-4.5633; p < 0.0001). The sensitivity of preoperative sestamibi and sonography for SGD was 66-100 and 75-82%, respectively. The sensitivity for MGD was 9-67% for both. Intraoperative parathyroid hormone monitoring was utilized in 6 studies. Three studies recommended minimally invasive parathyroidectomy (MIP), while the other 3 recommended bilateral exploration., Conclusion: LAH is a relatively frequent condition among patients on lithium, and calcium monitoring should be performed initially and longitudinally. Almost half of the LAH cases are due to SGD. MIP should be the optimum surgical approach., (© 2015 S. Karger AG, Basel.)

Background: We sought to describe a robotic technique of transaxillary gasless parathyroidectomy for the management of primary hyperparathyroidism (PHPT) due to a parathyroid adenoma., Methods: All consecutive patients who underwent robotic parathyroidectomy for a parathyroid adenoma by a single surgeon were included. Data was obtained by a retrospective review of patients' medical charts., Results: Nine patients with confirmed PHPT underwent robotic parathyroidectomy. Curative resection was established in all patients with the aid of intraoperative parathyroid hormone monitoring. One patient required bilateral cervical exploration of multiglandular disease. There were no complications. Patients were followed up for a period exceeding 6 months without any evidence of persistent or recurrent hyperparathyroidism., Conclusions: Our initial experience demonstrates that this technique is safe and effective for the treatment of PHPT. We believe that the use of robotic technology for endoscopic parathyroid surgeries could overcome the limitations of conventional techniques in the management of parathyroid lesions.

Background: We sought to determine certain factors predicting postoperative need for hormone replacement therapy (HRT) after hemithyroidectomy., Methods: A PubMed search was conducted to identify articles with separate cohorts for total and hemithyroidectomy. Outcomes of interest included hypothyroidism and complications., Results: Of 50,445 patients, 15,412 (30.6%) underwent hemithyroidectomy. The reported incidence rate of postoperative hypothyroidism was 10.9-48.8%. The pooled mean preoperative thyroid-stimulating hormone (TSH) level was 1.06 µIU/l (0.83-1.29) higher in hypothyroid patients. A preoperative TSH level >2.5 µIU/l was associated with a relative risk (RR, 95% CI) of 3.16 (2.03-4.90) for postoperative hypothyroidism. There was a significant pooled RR of 3.52 (2.55-4.86) for thyroid antibodies and 3.30 (2.49-4.36) for thyroiditis on pathology for postoperative HRT. The pooled RR for postoperative complications was 10.67 (5.75-19.31) for temporary hypocalcemia, 3.17 (1.72-5.83) for permanent hypocalcemia, 1.69 (1.30-2.20) for temporary injury to the recurrent laryngeal nerve (RLN), 1.85 (1.28-2.69) for permanent RLN injury and 2.58 (1.69-3.93) for hemorrhage in patients who underwent total thyroidectomy compared to hemithyroidectomy., Conclusion: Higher preoperative TSH levels, presence of anti-thyroid antibodies and thyroiditis predict postoperative need for HRT. It is imperative to counsel patients with these findings regarding their higher risk of developing postoperative hypothyroidism and need for HRT after hemithyroidectomy., (Copyright © 2013 S. Karger AG, Basel.)

Introduction: Graves' disease (GD) is considered a relative contraindication for endoscopic approaches to the thyroid gland, due to a larger gland size and increased vascularity., Methods: A retrospective analysis of a single surgeon's experience was performed. We included all patients who underwent thyroidectomy for the treatment of GD over a 3-year period., Results: Twenty-five patients with GD were identified. Twelve of them underwent robotic thyroidectomy and 13 patients underwent conventional thyroidectomy. Age, gender, and BMI were similar in both groups (p > 0.05). The conventional approach allowed for resection of larger thyroid volumes (147.3 ± 153.6 ml), as compared to the robotic approach (62.3 ± 47.8 ml, p = 0.08). The average total operative times were similar in both groups (p = 0.98). There was no difference with respect to intraoperative blood loss (p = 0.49), duration of hospital stay (p = 0.38), and complication rates (p = 0.99)., Conclusion: Robotic thyroidectomy is feasible and can be safely performed in appropriately selected patients with GD., (© 2014 S. Karger AG, Basel.)

Background: Cervical lymph node metastasis commonly occurs in papillary thyroid cancer. Emerging evidence from large population-based studies demonstrates decreased survival with regional lymph node metastasis. There is considerable debate in the literature regarding the optimal initial treatment for papillary thyroid cancer. We hypothesized that overall survival is influenced by the extent of neck involvement and neck dissection., Methods: The Surveillance, Epidemiology and End Results database was used to identify all patients with papillary thyroid cancer who underwent thyroidectomy. Patients with distant metastasis, invalid, or missing staging, and neck dissection information were excluded. A Kaplan-Meier survival estimate and a multivariate adjusted Cox regression model were used to estimate survival rates of patients undergoing selective, modified, and radical neck dissection as compared to those who did not have a neck dissection., Results: 3,439 eligible patients were included in this analysis. The mean age was 45 years; 76% were females and 86% were white. 2,414 (70.1%) of the patients underwent thyroidectomy without any neck dissection, whereas selective (limited), modified and radical neck dissections were performed on 19.3, 7.9 and 2.7% of the patients, respectively. Five-year patient survival rates were 96.6, 96.4, 89.5 and 80.9% among patients who had no neck dissection, selective, modified, and radical neck dissections, respectively. After adjusting for age, gender and race, the hazard ratios and 95% confidence intervals of survival for modified and radical neck dissection were 2.35 (95% CI: 1.46-3.78) and 4.48 (95% CI: 2.57-7.84), respectively, as compared to no neck dissection (p < 0.001). Similar associations were also noted after stratifying by localized or regional tumor., Conclusions: Extensive neck dissection among patients with papillary thyroid cancer did not result in an improved survival benefit. Further study is warranted to better understand the extent and requirement of neck dissection among this group of patients., (Copyright © 2011 S. Karger AG, Basel.)

Background/aims: Sestamibi scintigraphy and neck ultrasonography have both been proposed as screening modalities for the detection of abnormal parathyroid glands in patients with primary hyperparathyroidism. As a result, many surgeons use both techniques prior to surgery. The goal of this study was to independently evaluate both ultrasound and sestamibi as single-modality preoperative screening tools for primary hyperparathyroidism., Methods: A retrospective review of consecutive patients who underwent surgery for primary hyperparathyroidism from January 1999 to December 2009. Imaging results were compared to surgical findings., Results: 440 patients were found to meet inclusion criteria. Sensitivities for correct localization of a single parathyroid adenoma for sestamibi versus ultrasound were: 83% (95% CI 78-86) versus 72% (95% CI 67-76). Ultrasound operator had no influence on sensitivity, and ultrasound identified nodular thyroid disease in 31% of patients., Conclusion: Ultrasonography alone can be used as the primary screening modality in patients with primary hyperparathyroidism. Ultrasound sensitivity is conserved despite operator variability, and identifies concomitant thyroid pathology., (Copyright © 2011 S. Karger AG, Basel.)

Background: Ultrasound-guided fine-needle aspiration cytology (FNAC) sampling of the thyroid represents a standard diagnostic procedure in the evaluation of thyroid nodules. The specimen can be acquired using either of two different techniques. In the first, the short axis is used with observation only of the tip of the needle whilst in the nodule. In the second technique, the long axis is used with the observation of the entire length of the needle. The decision to sample utilizing either technique was done randomly. This study is a retrospective review performed to compare these two techniques with regard to specimen adequacy., Methods: Ultrasound-guided FNACs were performed in 80 thyroid nodules between May 2008 and February 2009. One physician acquired the cytology specimens using one of these two methods after localization. Data on the type of technique and its diagnostic accuracy were collected., Results: Forty-nine of 80 thyroid nodules were sampled using the long-axis technique. The overall and deep-lesion diagnostic adequacies of specimens were significantly higher using this technique (93.9 and 95.1%, respectively, p < 0.01) than the short-axis technique. When comparing the long and short axes for superficial lesions, there was no significant difference in adequacy of the samples (p = 0.92)., Conclusions: This is the first study to compare long- and short-axis techniques with regard to specimen adequacy for thyroid nodules. The long-axis technique decreased the rate of inadequate material and provided more accurate cytological evaluation for deeper lesions., (Copyright © 2011 S. Karger AG, Basel.)

FcRn is an Fc receptor that structurally resembles the major histocompatibility complex class I molecule. In this study, we isolated the human gene encoding the heavy chain of FcRn (FCGRT) and mapped it by fluorescence in situ hybridization to chromosome band 19q13.3. Thus, like its mouse counterpart, the human FCGRT gene is located outside the major histocompatibility complex.