04 Malignant Skin Lesions

83 despite some advances in therapy overall survival

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Unformatted text preview: expansion of tumor-specific T lymphocytes in vivo, which was associated with a significant clinical response.82 In a 2005 study, transfer of a T cell receptor gene from a 4 Malignant Skin Lesions — 9 patient with a significant antitumor response conferred impressive T cell responses.83 Despite some advances in therapy, overall survival for patients with stage IV melanoma has not improved over the past 20 years. Overall 5-year survival remains lower than 5%, with a median survival of only 7.5 months.84 The best hope for future improvements probably lies in the treatment of micrometastatic disease by means of targeted chemotherapy and immunotherapy. Operative Technique The inguinal nodes drain the anterior and inferior abdominal wall, the perineum, the genitalia, the hips, the buttocks, and the thighs. A superficial groin dissection removes the inguinal nodes, whereas a deep groin dissection incorporates the iliac and obturator nodes. Palpable nodes can be marked on the patient before operation. SUPERFICIAL GROIN DISSECTION The patient is placed in a supine position on the operating table, with the hip slightly abducted and with the hip and knee slightly flexed and supported by a pillow. A Foley catheter is inserted, and the skin is prepared and draped. The femoral artery, the anterior superior iliac spine, the pubic tubercle, and the apex of the femoral triangle are marked. A diagonally oriented skin incision is made that extends from a point medial to MEDIAL DISSECTION Inguinal Ligament Spermatic Cord Pectineal Muscle Lymphatics Skin Specimen Long Adductor Muscle Fascia Distal Portion of Great Saphenous Vein Ligated Figure 5 Superficial groin dissection. The incision is deepened to include the deep muscular fascia. © 2006 WebMD, Inc. All rights reserved. ACS Surgery: Principles and Practice 3 BREAST, SKIN, AND SOFT TISSUE Inguinal Ligament Specimen Retracted 4 Malignant Skin Lesions — 10 Lymphatics Continue under Inguinal Ligament Medial to Femoral Vein Great Saphenous Vein Stump Pectineal Muscle LATERAL DISSECTION Nodal Tissue Fascia Femoral Sheath Being Entered Fascia Branch of Femoral Nerve Sartorius Muscle Figure 6 Superficial groin dissection. The investing fascia overlying the femoral nerve and vessels is removed. the anterior superior iliac spine down to the apex of the femoral triangle; the incision is formed in the shape of an S so as not to cross the thigh flexion crease at a right angle. An incision oriented and shaped in this manner will cause the least possible interference with the musculocutaneous and cutaneous vascular territories of the skin, will minimize ischemia to the skin flaps, and will avoid a flexion contracture. Flaps are raised to allow identification of the medial border of the sartorius, the lateral border of the adductor longus, and the external oblique fascia on the lower abdominal wall. Fat and nodal tissue are swept inferiorly off the external oblique aponeurosis, the spermatic cord, and the inguinal ligament [see Figure 5] and are reflected inferiorly.The fat and lymph nodes are then dissected from the femoral triangle, sta...
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This note was uploaded on 03/21/2011 for the course ONC 01 taught by Professor Dzodic during the Spring '11 term at Multimedia University, Cyberjaya.

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