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The global healthcare sector faced immense challenges due to the COVID‐19 pandemic. Oncologists noted reduced cancer screening, which impacted melanoma diagnosis and treatment, leading to concerns about delayed care and poorer outcomes. This review analyzes how the pandemic influenced melanoma ulceration risk and Breslow thickness index through a meta‐analysis of published studies. Following PRISMA guidelines, we conducted a systematic review of literature from January 2021 to December 2022 on cutaneous melanoma before and during the COVID‐19 pandemic. Upon screening 1854 manuscripts, the review led to 13 studies meeting inclusion standards. The quality assessment followed MINORS and Newcastle‐Ottawa Scale criteria. Regarding ulceration, post‐COVID ulceration surpassed pre‐COVID levels significantly, with a risk ratio of 1.31 and an estimated odds ratio of 1.41, indicating a 44% rise post‐COVID. As for Breslow thickness, studies show a rising trend in the Breslow index post‐COVID, but less significantly, with an effect size of 0.08 regarding the meta‐analysis model (P = 0.02) with a pre‐COVID mean Breslow of 1.56 mm and post‐COVID of 1.84 mm. This meta‐analysis concluded that post‐COVID ulceration rates significantly surpassed pre‐COVID levels. Considering that ulcerated melanomas usually undergo sentinel lymph node biopsy and are more likely to benefit from adjuvant therapies, this indicates important implications, as many patients might have missed the opportunity to start therapy appropriately, regardless of their Breslow thickness status. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although breast surgery has undergone a drastic de-escalation in recent decades, axillary dissection is still indicated in some selected cases. Unfortunately, in 3–85% of cases, complications such as seroma formation occur, highlighting the need for more accurate hemostasis systems. The aim of this study is to evaluate the effectiveness of absorbable polysaccharide hemostatic such as HaemocerTM in preventing postoperative seroma. Materials and Methods: Patients referred to two surgery centers for a diagnosed breast cancer and candidates for axillary lymph node dissection were retrospectively evaluated and included in Group A (treated with HaemocerTM) and B (control group). The primary endpoints were the drain output after 48 h, the daily amount just before the removal, and the duration of axillary drainage placement. Secondary endpoints included the presence of seroma at the ultrasound (US) follow-up, significant blood loss, hematoma, the duration of surgery, and postsurgical complications. Results: The drain output within 48 h was 196 ± 93 vs. 286 ± 38 mL in Groups A and B, respectively (p = 0.013). The daily output before the removal was 40 ± 7 mL in Group A and 47 ± 2 mL in Group B (p = 0.049). The duration of axillary drainage placement was shorter in the experimental group (7 ± 3 days) compared to the control group (10 ± 1 days) with a statistically significant difference (0.037). During the US follow-up, on days 7, 15, and 30, the number of patients affected by seroma and the volumes were lower in the experimental group. Conclusions: The adsorbable hemostatic powder proved to be effective both in reducing the volume of drained fluid postoperatively and in decreasing the number and volume of reported seromas during the US follow-up. [ABSTRACT FROM AUTHOR]

Background and Objectives: Axillary lymph node (ALN) staging is crucial for the management of invasive breast cancer (BC). Although various radiological investigations are available, ultrasound (US) is the preferred tool for evaluating ALNs. Despite its immediacy, widespread use, and good predictive value, US is limited by intra- and inter-operator variability. This study aims to evaluate US and Elastosonography Shear Wave (SW-ES) parameters for ALN staging to develop a predictive model, named the Cassandra score (CS), to improve the interpretation of findings and standardize staging. Materials and Methods: Sixty-three women diagnosed with BC and treated at two Italian hospitals were enrolled in the study. A total of 529 lymph nodes were surgically removed, underwent intraoperative US examination, and were individually sent for a final histological analysis. The study aimed to establish a direct correlation between eight US-SWES features (margins, vascularity, roundness index (RI), loss of hilum fat, cortical thickness, shear-wave elastography hardness (SWEH), peripheral infiltration (PI), and hypoechoic appearance) and the histological outcome (benign vs. malignant). Results: Several statistical models were compared. PI was strongly correlated with malignant ALNs. An ROC analysis for Model A revealed an impressive AUC of 0.978 (S.E. = 0.007, p < 0.001), while in Model B, the cut-offs of SWEH and RI were modified to minimize the risk of false negatives (AUC of 0.973, S.E. = 0.009, p < 0.001). Model C used the same cut-offs as Model B, but excluded SWEH from the formula, to make the Cassandra model usable even if the US machine does not have SW-ES capability (AUC of 0.940, S.E. = 0.015, p < 0.001). A two-tiered model was finally set up, leveraging the strong predictive capabilities of SWEH and RI. In the first tier, only SWES and RI were evaluated: a positive result was predicted if both hardness and roundness were present (SWES > 137 kPa and RI < 1.55), and conversely, a negative result was predicted if both were absent (SWES < 137 kPa and RI > 1.55). In the second tier, if there was a mix of the results (SWES > 137 kPa and RI > 1.55 or SWES < 137 kPa and RI < 1.55), the algorithm in Model B was applied. The model demonstrated an overall prediction accuracy of 90.2% in the training set, 87.5% in the validation set, and 88.9% across the entire dataset. The NPV was notably high at 99.2% in the validation set. This model was named the Cassandra score (CS) and is proposed for the clinical management of BC patients. Conclusion: CS is a simple, non-invasive, fast, and reliable method that showed a PPV of 99.1% in the malignancy prediction of ALNs, potentially being also well suited for young sonographers. [ABSTRACT FROM AUTHOR]

Background: Breast localization plays a key role in early breast cancer (BC) surgery. The current gold standard is wire-guided localization (WGL), despite the known disadvantages. The patients often experience anxiety and discomfort due the metallic wire placed in the breast, and surgeons are compelled to perform the surgery on the same day as the radiological release of the wire to prevent migrations or breakages. Various wireless systems have been proposed as alternative to WGL. LOCalizerTM offers the advantage of providing the exact distance from the marker called Tag. The combined technique using LOCalizerTM and US allows for determining the distance from the BC margin, a critical surgical goal for oncological radicality. Methods: Patients referred for breast surgery to two Italian hospitals were enrolled and divided into two groups: Group A, including patients undergoing a combined approach, and group B, including patients treated with conventional WGL. Results: The combined approach with LOCalizerTM and US was associated with better outcomes in terms of oncological radicality, cosmetic results, and patients' satisfaction. Conclusions: In the current study, LOCalizerTM associated with US could be considered an excellent approach for localizing non-palpable BC. Further larger comparative studies are needed to address this issue. [ABSTRACT FROM AUTHOR]