Search

The treatment of cutaneous squamous cell carcinoma in situ by Mohs micrographic surgery is currently deemed as appropriate by the Mohs Appropriate Use Criteria. However, squamous cell carcinoma in situ is a very superficial, indolent, low-risk tumor amenable to destructive and non-surgical treatments. It is uncommon for squamous cell carcinoma in situ to have progressed to invasive malignancy subsequent to definitive management. The suggestion that squamous cell carcinoma in situ on certain anatomic locations has a poorer prognosis is widely assumed but lacks an evidence base. We recommend that most primary squamous cell carcinoma in situ in non-immunosuppressed patients be scored inappropriate or uncertain for Mohs micrographic surgery by the Mohs Appropriate Use Criteria. Multiple other efficacious treatment options exist for managing squamous cell carcinoma in situ, including curettage and cryotherapy, curettage and electrodessication, and topical therapies.

Background Objective Method Results Conclusion The American Joint Committee on Cancer (AJCC) method of staging melanoma is dated and inaccurate. It ignores important prognostic melanoma features, especially the patient's age. BAUSSS is more accurate in determining survival risk for primary cutaneous melanoma patients who have no clinical or imaging evidence of nodal or distant metastases. BAUSSS is an algorithm incorporating analysis of Breslow thickness, Age, Ulceration, Subtype of melanoma, Sex and Site. These are the six features from the patient history along with the details from the melanoma pathology report that are most predictive of mortality outcome.To develop a single‐page document that allows the clinician to determine BAUSSS biomarker‐predicted prognosis in consultation with the patient.From various data sources, we developed an algorithm to predict melanoma mortality using the BAUSSS biomarker system. The single‐page algorithm was made available to download at https://globalmelanoma.net/bausss‐survival‐chart, thus being readily available without charge to all clinicians and their patients.BAUSSS method of determining melanoma prognosis is more accurate and less costly than the AJCC staging system. The only surgery the patient requires is wide local excision of the primary tumour. This method of ascertaining melanoma risk does not require added surgery, costs, hospitalization, tests and anaesthesia, such as would be required if sentinel lymph node biopsy was undertaken. BAUSSS can be a useful tool in determining which primary melanoma patients are at sufficiently high risk to be considered for adjuvant drug therapy.We encourage clinicians to download and print in colour this single‐page BAUSSS mortality prediction tool, laminate it, and use it face to face with the patient in consultations. Not only will the patient be able to recognize his/her long‐term prognosis but will also be able to see how their tumour severity compares with others. [ABSTRACT FROM AUTHOR]

The article discusses the validation of the BAUSSS biomarker as a risk staging tool for patients with primary melanoma. The BAUSSS algorithm incorporates Breslow thickness, age, ulceration, subtype, sex, and site to assess prognosis. The authors compare the BAUSSS biomarker to other nomograms and conclude that Lifemath is the most reliable online tool for melanoma prognosis. They address concerns raised by another study and maintain that BAUSSS is a simple and effective predictor of survival risk in melanoma patients. The addition of sentinel lymph node biopsy status to BAUSSS improves accuracy but may not be meaningful in all cases. [Extracted from the article]

Background: Maximizing survival for patients with primary cutaneous melanomas (melanomas) depends on an early diagnosis and appropriate management. Several new drugs have been shown to improve survival in high-risk melanoma patients. Despite well-documented guidelines, many patients do not receive optimal management, particularly when considering patient age. Objective: to provide an update on melanoma management from the time of the decision to biopsy a suspicious skin lesion. Methods: We reviewed melanoma-management research published between 2018 and 2023 and identified where such findings impact and update the management of confirmed melanomas. Pubmed, Google Scholar, Ovid and Cochrane Library were used as search tools. Results: We identified 81 publications since 2017 that have changed melanoma management; 11 in 2018, 12 in 2019, 10 in 2020, 12 in 2021, 17 in 2022 and 18 in 2023. Discussion: Delayed or inaccurate diagnosis is more likely to occur when a partial shave or punch biopsy is used to obtain the histopathology. Wherever feasible, a local excision with a narrow margin should be the biopsy method of choice for a suspected melanoma. The Breslow thickness of the melanoma remains the single most important predictor of outcome, followed by patient age and then ulceration. The BAUSSS biomarker, (Breslow thickness, Age, Ulceration, Subtype, Sex and Site) provides a more accurate method of determining mortality risk than older currently employed approaches, including sentinel lymph node biopsy. Patients with metastatic melanomas and/or nodal disease should be considered for adjuvant drug therapy (ADT). Further, high-risk melanoma patients are increasingly considered for ADT, even without disease spread. Invasive melanomas less than 1 mm thick are usually managed with a radial excision margin of 10 mms of normal skin. If the thickness is 1 to 2 mm, select a radial margin of 10 to 20 mm. When the Breslow thickness is over 2 mm, a 20 mm clinical margin is usually undertaken. In situ melanomas are usually managed with a 5 to 10 mm margin or Mohs margin control surgery. Such wide excisions around a given melanoma is the only surgery that can be regarded as therapeutic and required. Patients who have had one melanoma are at increased risk of another melanoma. Ideal ongoing management includes regular lifelong skin checks. Total body photography should be considered if the patient has many naevi, especially when atypical/dysplastic naevi are identified. Targeted approaches to improve occupational or lifestyle exposure to ultraviolet light are important. Management also needs to include the consideration of vitamin D supplementary therapy. [ABSTRACT FROM AUTHOR]

For packed beds of low tube‐to‐particle diameter ratio (N<10), pressure drop has been found to increase at low Re <100 and decrease at high Re >1000, compared to that in unbounded beds. Particle‐resolved CFD (PRCFD) in the low Re viscous region shows that widely accepted corrections overestimate the wall effect, and an improved correction formula is given. In the inertial region at high Re it is important to use accurate and consistent values for void fraction, which strongly affects pressure drop. Literature data show reasonable agreement with a correlation developed for unbounded beds (Dixon AG., AIChE J. 2023;69(6):e18035), when the void fractions for the bounded beds are used. PRCFD simulations also confirm this agreement, and only a small further correction is suggested for the remaining wall effects on fixed bed pressure drop in the inertial range, since the correlation uses the correct limit for fk as Re increases. [ABSTRACT FROM AUTHOR]

The numbers per tiller (abundance) and per unit area of ground (population density) of the dominant cereal aphids in winter wheat crops, Sitobion avenae (Fabricius) and Metopolophium dirhodum (Walker) (Hemiptera: Aphididae) were recorded from 2000–2015. The results were used to test the hypothesis that at the population peak and 4 weeks previously, the population density of aphids in winter wheat crops (Triticum aestivum L., Poaceae) is uniformly distributed with respect to surface area and, as a result, their abundance is high in sparse stands (SPA) where the colonizing aphids are scattered among a small number of tillers (ca. 80 m−2), and low in dense stands (DEN) where they are scattered among a larger number of tillers (ca. 440 m−2). This prediction was verified for S. avenae, the population density of which did not significantly differ between SPA and DEN stands throughout this period. This species feeds mainly on the ears, whose nutritional quality for aphids varies little with crop density and during the course of ripening. In contrast and contrary to our prediction, the population density of M. dirhodum increased throughout this period more rapidly in SPA than in DEN stands. This species lives on leaves whose quality is better and remain present for longer during the course of ripening of the crop in SPA than DEN stands. The abundance of both species was higher in SPA than in DEN stands. Greater direct damage to cereal crops can be expected when using technologies and cultivars of winter wheat that need to be planted sparsely. [ABSTRACT FROM AUTHOR]

The article discusses the use of sentinel lymph node biopsy (SLNB) in the management of melanoma. The authors respond to criticisms of their previous work, arguing that combining data from different online platforms is valid because the populations are comparable. They also address discrepancies in SLNB predictions between different algorithms and emphasize the importance of using the BAUSSS biomarker for prognostic models. The authors disagree with the notion that SLNB has intrinsic therapeutic benefit and suggest that the risks and costs associated with the procedure outweigh any potential benefits. They conclude by encouraging the use of the BAUSSS biomarker in melanoma prognostic models. [Extracted from the article]