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A L Dancey

Publications and source records attributed to A L Dancey.

7 recordsLinked to original sources
PubMed2006

Merkel cell carcinoma: a report of 34 cases and literature review.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare and aggressive skin cancer, with unclear histogenesis. To date there is no consensus on the optimal treatment of this neoplasm, with controversy surrounding the use of radiotherapy and chemotherapy. There are also limited data on biological behaviour and prognosis, with reported survival ranging from 31% at three years to 74% at five years. METHOD: The medical records of 34 patients with a diagnosis of primary MCC, treated at two NHS trusts in Birmingham and Coventry, were reviewed. An extensive review of the English literature was also performed. RESULTS: MCC occurred predominantly in Caucasians (97%) with a mean age of 75 years. Identified risk factors were a previous history of SCC (37%), BCC (18%) and AK (20%). Ten percent of patients showed evidence of immunocompromise. Most tumours were located on the extremity, where they reached a mean size of 2.1cm. Fifty percent had regional metastasis during the course of their disease. A sub group analysis of the excision margins showed that a 2-cm excision margin, extending to the deep fascia, resulted in a 50% incomplete excision rate and a 33% local recurrence rate. In contrast a 3-cm margin including deep fascia resulted in no incomplete excisions and a 10.5% local recurrence rate Prognosis was poor with a 40% 3-year survival. Combining the data from two trusts has produced a relatively large series and highlighted differences in patient characteristics and management between the units. We advocate a 3-cm excision margin, including fascia wherever possible, combined with post-operative radiotherapy to offer the best chance of local control. Survival is fairly dismal and in keeping with the aggressive nature of this tumour. The respective roles of radiotherapy and chemotherapy remain controversial.

Aged↗
PubMed2006

Experience with the modified hockey stick incision for block dissection of neck.

BACKGROUND: The modified hockey stick incision was originally described by Lahey in 1940. This allows elevation of a superiorly based cervical skin flap, with additional exposure of the parotid as necessary. METHODS: The longitudinal portion of the incision runs from the mastoid process downward, behind the anterior border of the trapezius muscle, and curves gently at the junction of the lateral one-third and medial two-thirds of the clavicle. The transverse component extends medially, approximately 2 cm below the clavicle. When parotidectomy is required, incision is extended in front of the ear and a forward cut is made for additional exposure. RESULTS: We present our experience with a series of 16 patients, undergoing a total of 17 neck dissections for various pathologies. The majority (11 patients) received postoperative radiotherapy. There were two episodes of minor skin necrosis which were not related to radiotherapy, but to patient co-morbidity, and settled with conservative management. All patients had a satisfactory cosmetic result. CONCLUSION: We find the modified hockey stick incision to be cosmetically superior and provide excellent exposure of the neck, with protection of the carotid vessels.

Aged↗
PubMed2006

Morphea of the breast. Two case reports and discussion of the literature.

UNLABELLED: Morphea, or localised scleroderma, is characterised by excess collagen deposition by lesional fibroblasts. This results in thickening and induration of the skin and subcutaneous tissues, often causing considerable morbidity. Radiation-induced morphea was mentioned as early as the 1900s, but since then awareness of this condition has declined. The incidence of radiation-induced morphea is said to be two in 1000. Extension of the morphea beyond the radiation ports occurs in approximately one quarter of cases. No proven effective treatments exist, and to our knowledge, surgical excision has not been attempted. CASE PRESENTATIONS: We present two cases of morphea of the breast. The first patient developed progressive morphea in the absence of any causative factors. This was treated by Wise pattern breast reduction, incorporating the morphea within the excised skin. The second patient developed morphea following a course of radiotherapy for breast carcinoma. She has declined any surgical intervention, but suffers from considerable morbidity. Morphea is a recognised sequelae of radiotherapy which should be distinguished from sclerotic recurrence of the original tumour. Surgical excision is possible in certain patients.

Adult↗
PubMed2004

Axillary metastases from recurrent oral carcinoma.

The rationale for surgical treatment of head and neck cancer is based on a predictable pattern of metastasis. There is aberrant or unpredictable spread rarely and typically only in recurrent disease. There are few published reports to our knowledge of axillary metastases from squamous cell cancer (SCC) of the head and neck. We present a patient who developed axillary node disease on the other side after recurrence of a squamous cell carcinoma of the floor of the mouth. She died 11 months after excision of the recurrence.

Axilla↗