Mark R Rowe | PubMed Health

PubMed2006

Pediatric melanoma of the head and neck: a single institutions experience.

OBJECTIVES: The objectives of this study were to review our experience with pediatric melanoma of the head and neck and discuss proper diagnostic protocols and suggest a possible treatment algorithm. STUDY DESIGN: The authors conducted a retrospective chart review of patients under the age of 18 who underwent treatment for melanoma of the head and neck at a tertiary care university hospital. RESULTS: Six patients were identified in the last 25 years at our institution. Four patients had melanomas in the auricle, one in the cheek, and one in the forehead. All occurrences identified presented in the past 7 years. All were treated with wide local excision. Three patients received sentinel lymph node biopsy, one received a neck dissection after identification of positive sentinel nodes, and two patients received postoperative interferon therapy. No surgical complications were reported. At the time of this submission, no patients were found to have recurrence of the disease. CONCLUSIONS: Pediatric melanoma of the head and neck may be managed effectively using current techniques used in treating adult patients. The use of sentinel lymph node biopsy is recommended when the depth of invasion cannot be determined from original biopsy, the original pathologic diagnosis is ambiguous, or depth of invasion from biopsy is sufficient to warrant its use. In addition, the use of adjuvant interferon alpha-2b is recommended in patients at high risk for recurrence.

Antineoplastic Agents↗

PubMed2005

Velopharyngeal dysfunction: evolving developments in evaluation.

PURPOSE OF REVIEW: Otolaryngologists are increasingly being called upon to assist in the differential diagnosis of velopharyngeal valving disorders for speech, assisting in treatment planning and the assessment of treatment outcomes. RECENT FINDINGS: The most commonly used methods for direct visualization of velopharyngeal function remain nasendoscopy and videofluoroscopy. Literature supporting the use of either nasendoscopy followed by videofluoroscopy or the reverse can be found. Several studies also suggest that magnetic resonance imaging can make important contributions to the evaluation of velopharyngeal anatomy and function. The routine use of magnetic resonance imaging for evaluating the velopharynx is neither practical nor probable at the present time. Although magnetic resonance imaging may be as effective as videofluoroscopy or nasendoscopy, the cost of magnetic resonance imaging and the radiation exposure of videofluoroscopy will likely dictate that nasendoscopy continues to be the most common technique for evaluating velopharyngeal function during speech. Several recent studies have documented the use of instrumental assessment of velopharyngeal function for assigning patients to a given surgical procedure, predicting surgical success or complications, and evaluating treatment outcomes. SUMMARY: There are still discussions and conflicting results regarding the best method for evaluating velopharyngeal function. Opinions conflict regarding the various methods, which suggests that no single method is best. The decision regarding the most appropriate evaluation protocol should be guided by the information that the clinician is attempting to obtain and the relative benefits and risks of each method. Increasingly, these evaluation methods are used by the otolaryngologist to assist in the differential diagnosis of velopharyngeal valving disorders, the assignment of patients to various treatment options, and the evaluation of treatment outcomes.

Ear Diseases↗