Background Many patients with head and neck cancer (HNC) will require feeding tube placement for nutritional support using percutaneous endoscopic gastrostomy (PEG) tube. Rarely, HNC metastases have been reported at the PEG site, a morbidity associated with a poor outcome. Methods Along with a case report, an evaluation of PEG placement methods with metastases from the literature was completed along with a statistical analysis of the literature to determine PEG site metastases and method of placement correlations. Results The incidence of PEG metastases in patients with HNC with the “pull” method is statistically identical to that of patients receiving any other method for PEG placement. Conclusions When considering options for the placement of PEG tubes in patients with HNC, the “pull” method should not be considered as a technique which will put patients at risk for PEG site metastases more than any other method of placement.

Melanoma confers an estimated lifetime risk of one in 50 for 2016. Clinicopathologic staging and sentinel lymph node biopsy (SLNB) have been the standard of care for T2 and T3 lesions. Molecular biomarkers identified in the primary lesion suggestive of metastatic potential may offer a more conclusive prognosis of these lesions. Our purpose was to investigate molecular mutations in primary melanoma that were predictive for micrometastasis as defined by a positive sentinel lymph node (SLN) in a case-controlled manner: nine patients with negative SLN and nine with positive SLN. The two cohorts were statistically identical as shown by a t-test for age (P=0.17), race (P=0.18), Breslow depth (P=0.14), Clark level (P=0.33), host response (P=0.17), ulceration (P=0.50), satellite nodules (P=0.17), lymphovascular invasion (P=0.50), and mitotic activity (P=0.09). While no single gene was significantly associated with SLN status, multivariate analysis using classification and regression tree assessment revealed two unique gene profiles that completely represented regional metastases in our cohort as defined by a positive SLN: PIK3CA (+) NRAS (-) and PIK3CA (-) ERBB4 (-) TP53 (+) SMAD4 (-). These profiles were identified in 89% of the patients with positive SLN; none of these profiles were identified in the SLN-negative cohort. We identified two unique gene profiles associated with positive SLN that do not overlap other studies and highlight the genetic complexity that portends the metastatic phenotype in cutaneous melanoma.