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Background: Isosulfan blue dye peripheral injection is used in preoperative sentinel lymph node (SLN) identification alone or, to increase sensitivity, in conjunction with radiocolloid mapping. However, isosulfan blue dye has certain drawbacks and limitations., Objective: This study assesses the authors' experience of SLN biopsy using only radiocolloid tracer., Materials and Methods: Between 2000 and 2008, 218 patients underwent SLN biopsy with radiocolloid mapping, preoperative localization by lymphoscintigraphy and intraoperative confirmation by gamma probe in primary malignant cutaneous melanoma., Results: Mean Breslow index was 2.1 mm. The SLN biopsy success rate was above 98% at all sites and 87% in head and neck locations. The 5-year overall survival rate was 90% and that of 5-year disease-free survival was 80%. False-negative rate, with a mean follow-up time of 41 months, was 5.5%., Conclusion: Sentinel lymph node biopsy can be successfully performed in patients with melanoma using only radiocolloid tracer without blue dye staining. In circumstances where blue dye cannot be used such as head and neck tumors, allergic reactions and pregnancy, radiocolloid tracer mapping alone is not a loss of chance for patients with melanoma.

Basal cell carcinomas with symptomatic perineural invasion are rare entities. We report the case of a 60year-old man (with a grafted kidney), surgically treated in 2007 for a sclerodermiform basal cell carcinoma infiltrating the left nostril. Five years later, a painful left hemifacial hypoesthesia associated with an ulcus rodens of the nasolabial fold appeared. A biopsy confirmed a recurrence. MRI showed an enhancement of the trigeminal ganglion. The patient had a trigeminal perineural invasion secondary to a cutaneous basal cell carcinoma. He received a local intensity-modulated radiotherapy alone (70Gy in 33 sessions), administered from the skin tumour to the skull base. Three years after the end of treatment, the patient is in radiological and clinical remission, with partial recovery of the hypoesthesia. Evolution was marked by iterative corneal ulcers and decreased visual acuity. Modalities of treatment by surgery and/or radiation therapy and complications are poorly described in the literature., (Copyright © 2016. Published by Elsevier SAS.)

Background: The predictive value of regression in melanoma is debated., Aim of the Study: A retrospective single-centre study to evaluate the correlation between regression in primary skin tumor and the presence of micrometastases in sentinel lymph nodes., Patients and Methods: Histological signs of regression in 84 melanomas (>1 mm) with corresponding sentinel lymph nodes were studied by two independent pathologists., Results: Regression was seen in 40 skin melanoma tumors while micrometastasis was seen in 24. Of the tumors with micrometastasis, only 10 were regressive (RR: 0.47, p=0.49). Breslow value>2 mm and male sex were predictive for node micrometastasis (RR: 4.6, p=0.03 and RR: 7.6, p=0.006, respectively). On multivariate analysis, these two factors were independent., Comments: These data suggest that regression in primary cutaneous melanoma is not predictive for lymph node metastasis.

Carcinoma of the face is the skin disease most frequently encountered by plastic surgeons in everyday practice. Although basal cell carcinomas and squamous cell carcinomas are generally easy to recognize, their treatment remains subject to various schools of thought, or even individual practices, which are often difficult to define. This article defines a general plan of management of these tumours; their histological duality corresponds to a therapeutic duality. Resection of a basal cell carcinoma requires safety margins of 3 to 4 mm, versus at least 5 mm for a squamous cell carcinoma. In a high-risk subject, with a sclerodermiform carcinoma or undifferentiated squamous cell carcinoma, this safety margin may be as much as 10 mm or more. Frozen section examination is preferable in these situations. Six anatomical regions are studied selectively to define the main rules of reconstruction: nasal region, orbitopalpebral region, labial region, malar region, frontal region and auricular region. Each region will be subdivided into several subterritories, each requiring different strategies. The objectives, methods and indications of each reconstruction are selectively defined. The final strategy proposed is based not only on the author's personal experience, but also on the results of the national survey on carcinomas. As a complement to these therapeutic guidelines, the authors raise the problem of incomplete resection, which requires the definition of a peripheral infiltration index predictive of the recurrence rate. Surgery obviously cannot constitute exclusive treatment carcinomas, hence the value of presenting other methods currently available in the therapeutic armamentarium. Surveillance is essential in every case, determined by the patient's risk of recurrence or even metastatic dissemination.

Progress in plastic surgery has allowed an ever increasing extension of the indications for facial reconstruction. Although carcinomas are now detected earlier and earlier, the practitioner is nevertheless faced, several times during his working life, with "historical" cases. Although it is fairly rare to observe long-term progression of squamous cell carcinomas, basal cell carcinomas can take on considerable proportions due to their very low metastatic risk. In these situations, the dilemma between conservative management and performing an inevitably major procedure is never easy to resolve. Moreover, it is often the discomfort experienced by the patient's family which encourages him to accept the operation. The objective of the procedure is more often aesthetic rather than curative, although this latter objective must always be attempted. Consequently, the practitioner should never hesitate to defer reconstruction for several months in order to ensure reliable local surveillance. The value of epitheses is clearly established in this situation. When a reconstruction can be performed, "major" measures are generally necessary, making use of all of the regional or even distant plastic surgery techniques used for facial surgery. However, microsurgery is a last resort indication, which should only be used when the various pedicle flaps have been exhausted. The microsurgical delay technique (Jean-Marie Servant's "apple turnover" technique) is particularly useful in these situations. In the light of seven clinical cases, the authors try to define the essential concepts of this type of management. In fact, the respective limits of active intervention and conservative management are defined by each surgeon's common sense and experience. The constant improvement of the quality of epitheses make them the current treatment of choice for the restoration of extensive defects. Lastly, one of the main factors to be considered before taking any treatment decision is the psychology of these patients, as it is always difficult to explain the discovery of lesions at this advanced stage.

The national survey concerning the therapeutic strategy for carcinomas of the face published here reviews the therapeutic strategies to this everyday disease. The 30 centres included in our statistics have a combined experience of several thousand cases. 61% of these centres operate on more than 50 carcinomas per year. The following conclusions can be drawn from these data. The general national option is for treatment of the defect by flaps than by skin graft, all reconstruction situations combined. In the case of skin grafts, the retroauricular and supraclavicular sites are the most frequently used. 71% of authors also perform skin grafts immediately after the initial resection. Directed healing is only indicated in the treatment of small defects with a preferential site: the medial canthus. Frozen section examination is requested at the time of the initial resection in an average of 24.3% of basal cell carcinomas versus 43.9% of squamous cell carcinomas, with a range of 0 to 100% in the two series. 16 resection sites were then proposed, to define the most frequent cases. Consensus was exceptional. At the very most, a fairly unified strategy was defined for defects of the eyelids and lips, where there is a preference for classical Abbé or Mustardé flaps for the lower eyelid. Similarly, kite flaps are usually preferred in the nasolabial region. In all other cases, the responses vary considerably and are submitted to statistical analysis, completed by a general discussion.