The objective of this study is to identify the incidence and characteristics of cases with positive margins on wide local excision for cutaneous melanoma of the head and neck (CMHN) and therefore provide a potential basis for selectively delaying reconstruction pending final histological clearance of melanoma. A systematic review of English language articles was performed on studies retrieved from PubMed and Web of Science. Original investigations published between July 1999 and June 2018 reporting on margin status of CMHN wide local excision specimens were included in the review. The incidence of positive margins after definitive resection for cutaneous melanoma in the literature ranges from 6 to 20.9%. The incidence is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, tumor thickness, and ulceration. Delayed reconstruction remains the most oncologically sound decision, allowing for interpretation of margin status on paraffin-embedded tissue sections. However, resection and the resultant defect closure in a single stage is more expedient and potentially a more efficient use of resources. The risk–benefit ratio of immediate versus delayed reconstruction must be considered for each case. The incidence of positive margins is higher in cases of advanced patient age, diagnosis by shave biopsy, lentigo maligna melanoma subtype, desmoplastic subtype, increasing tumor thickness, and the presence of ulceration; delayed reconstruction should be strongly considered in these cases.

Background The objective of this study was to determine survival outcomes in patients who underwent retreatment of recurrent cases of cutaneous melanoma of the head and neck (CMHN). Methods Retrospective review of all patients who were treated for primary clinical stage I or II CMHN between January 1, 2000 and December 31, 2015. Results Twenty percent (33/168) of the patients developed a recurrence. Sixty‐six percent (4/6) of patients who developed local recurrence first and 50% (3/6) of patients who developed regional recurrence first were alive without evidence (NED) of disease at last follow‐up, while 0% (0/21) of patients who developed distant or simultaneous recurrences first were NED at last follow‐up. Among the 7 patients who were NED, the mean time from recurrence to last follow‐up was 735 days. Conclusions Of patients with isolated local or regional recurrences, 58% (7/12) obtained durable curative treatment for recurrent melanoma.

Background: The extent to which individual clinical departments use Twitter™ is largely unknown. Further, impact of use has not been extensively studied. The purpose of this study was to identify and analyze Twitter™ utilization by orthopaedic surgery departments and to gauge the implications Twitter™ use has on the status of the department. Methods: We conducted a cross-sectional analysis of Twitter utilization for all Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopaedic surgery training programs. Tweets between May 1 and December 1, 2018 were categorized and Tweet impact was assessed using public interaction. Program rankings, as measured by Doximity and US News and World Report (USNWR), were correlated with various Twitter variables. Correlations were calculated with Pearson’s correlation coefficient. Results: Of the 153 ACGME-accredited orthopaedic surgery departments, 24 (15.7%) had Twitter accounts. The departments averaged 1079.35±713.47 followers and a mean of 16.16±13.83 tweets per month. Most tweets were internally generated “unique” tweets. Unique tweets had a mean of 4.50±0.04 likes and 1.10±0.12 retweets per tweet. Twitter account profile data and tweet content demonstrated equal numbers of tweets categorized as “educational” and “other”. Both Doximity and USNWR had more favorable ranks with increasing variables of all Twitter categories, and there was a statistically significant correlation between greater number of post “likes” and a higher USNWR score. Conclusions: Twitter is underutilized by orthopaedic surgery departments and has a small correlation with the reputation of the department. Level of Evidence: Level IV.

Soft tissue ulceration resulting from chronic venous insufficiency is a common condition that requires standardised long-term therapy, which has been thoroughly established. We report a patient with a five-year history of persistent venous stasis ulcers despite treatment consistent with traditional wound care. Resolution of the ulcers began only upon deviation from conventional therapy. This report considers non-standard treatments in patients with venous ulcers that do not progress.

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