Stephen Scoville

124 statements · 2 topics

Soft Tissue Sarcoma (lymph nodes) · guest expert

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before those trials came out, there was a much higher rate of uh completion lymph node dissection even in in kids. And then after those trials, the rate has gone down, but it's still higher than what's done uh typically in adults.

quote · Metastatic Disease

for most children we can, um while the disease is thought to be more severe, you can still observe these patients with sentinel lymph nodes and not uh move forward with um completion lymph node dissection

quote · Metastatic Disease

Only 21% of patients that underwent completion lymph node dissection had additional nodes discovered and findings of additional nodal disease did not significantly correlate with recurrence.

quote · Soft Tissue Sarcoma (lymph nodes)

we didn't find any statistical difference between those that underwent completion lymph node dissection versus uh sentinel lymph node with um ultrasound observation

quote · Soft Tissue Sarcoma (lymph nodes)

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Stephen's statements about Metastatic Disease 62 statements

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BOB in Ped Surg 2023 - IPSO Winner - Steven Scoville, MD

Quotation Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old. Open

Statement There is no pediatric data to support ultrasound observation versus completion lymph node dissection Open

Statement Childhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement compared to adults Open

Quotation there is no pediatric data to support one versus the other Open

Quotation Management of pediatric melanoma is based on adult studies. Open

Statement Two adult trials (Decog SLT and MSLT2) showed no significant difference in outcomes for patients with positive sentinel lymph node biopsies followed with ultrasound observation versus completion lymph node dissections Open

Statement Tumors less than 8 millimeters thick are largely managed with wide local excision Open

Statement Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old Open

Statement Tumors greater than or equal to 8 millimeters or less than 8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies Open

Statement Management of pediatric melanoma is based on adult studies despite differences in disease mechanisms Open

Statement Breslow depth ranged from 2 millimeters to 20 millimeters with a median of 2.55 millimeters Open

Statement Study included 252 patients less than or equal to 18 years old diagnosed with cutaneous melanoma between 2010 and 2020 from 14 institutions Open

Quotation we found nearly equal distribution of age, tumor location, while race was predominantly white, consistent with prior literature Open

Statement Of 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 had positive sentinel lymph node biopsies (approximately 51%) Open

Statement There was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups Open

Quotation there was no significant differences between recurrence or death from disease between these two groups Open

Statement Patients who underwent completion lymph node dissection were significantly older and more likely to receive adjuvant therapy Open

Quotation Only 21% of patients that underwent completion lymph node dissection had additional nodes discovered and findings of additional nodal disease did not significantly correlate with recurrence. Open

Statement Rate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden Open

Statement Only 21% of those who underwent completion lymph node dissection had additional positive nodal disease Open

Statement Positive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group Open

Statement Recurrence was associated with positive nodal disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death Open

Quotation Recurrence did most strongly associate with positive sentinel lymph node biopsies and deeper Breslow depth. Open

Statement Management of nodal disease had no significant impact on disease outcomes with respect to recurrence or death from disease Open

Statement Pediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate Open

Quotation we didn't find any statistical difference between those that underwent completion lymph node dissection versus uh sentinel lymph node with um ultrasound observation Open

Quotation before those trials came out, there was a much higher rate of uh completion lymph node dissection even in in kids. And then after those trials, the rate has gone down, but it's still higher than what's done uh typically in adults. Open

Statement For most children with positive sentinel lymph nodes, observation is appropriate without moving forward with completion lymph node dissection Open

Statement Before the Decog and MSLT2 trials, there was a much higher rate of completion lymph node dissection in children, and after those trials the rate has gone down but is still higher than in adults Open

Quotation for most children we can, um while the disease is thought to be more severe, you can still observe these patients with sentinel lymph nodes and not uh move forward with um completion lymph node dissection Open

Statement Not all patients with positive sentinel lymph nodes receive adjuvant therapy; decision depends on genetic makeup of melanoma and overall risk factors including tumor size Open

Statement If a lymph node becomes clinically positive during ultrasound surveillance, the likely approach would be to move forward with systemic therapy rather than completion lymph node dissection Open

Quotation I think the the answer would more likely just be to move forward with systemic therapy. Uh I don't think people would move forward with the completion lymph node at that time. You would just go with advent therapy. Open

BOB Ped Surg 2023 - Steven Scoville, IPSO - Presentation

Quotation Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old. Open

Statement Pediatric melanoma has approximately 500 new cases diagnosed annually in children less than or equal to 18 years old. Open

Statement Compared to adults, childhood melanoma is associated with delayed diagnosis and more frequently has nodal involvement. Open

Quotation Compared to adults, we know that childhood melanoma is associated with delayed diagnosis and therefore, not surprisingly, more frequently has nodal involvement. Open

Statement Childhood melanoma has unique disease mechanisms compared to adult melanoma. Open

Quotation Despite these differences though, management of pediatric melanoma is based on adult studies. Open

Statement Management of pediatric melanoma is based on adult studies despite differences from adult disease. Open

Statement Melanoma management is largely based on depth of the tumor and presence of metastatic disease. Open

Statement Tumors less than 0.8 millimeters thick are largely managed with wide local excision. Open

Statement Tumors greater than or equal to 0.8 millimeters or less than 0.8 millimeters with high risk features without metastatic involvement typically undergo wide local excision with sentinel lymph node biopsies. Open

Statement If sentinel lymph node biopsy is positive, patients typically undergo ultrasound observation versus completion lymph node dissection, which has a high risk of morbidity. Open

Statement Two adult trials (DCOG SLT and MSLT2) showed no significant difference in outcomes for low to intermediate risk patients with positive sentinel lymph node biopsies who were followed with ultrasound observation versus completion lymph node dissections. Open

Quotation However, there is no pediatric data to support one versus the other. Open

Statement There is no pediatric data to support ultrasound observation versus completion lymph node dissection for positive sentinel lymph node biopsies. Open

Statement In this study of 252 pediatric melanoma patients, race was predominantly white, consistent with prior literature. Open

Statement Breslow depth ranged from tumor in situ to 20 millimeters with a median of 2.55 millimeters. Open

Statement Of 227 patients who underwent wide local excision with sentinel lymph node biopsies, 115 (approximately 51%) had positive sentinel lymph node biopsies. Open

Statement Patients who underwent completion lymph node dissection were more likely to receive adjuvant therapy compared to ultrasound observation. Open

Statement Patients who underwent completion lymph node dissection were significantly older than those who underwent ultrasound observation. Open

Statement There was no significant difference in recurrence or death from disease between ultrasound observation and completion lymph node dissection groups. Open

Statement Positive sentinel lymph node biopsies had significantly higher rate of disease recurrence at 18% compared to 3% for negative sentinel lymph node biopsy group. Open

Statement Only 21% of patients who underwent completion lymph node dissection had additional positive nodal disease. Open

Statement Rate of recurrence was not significantly different between completion lymph node dissection patients with or without additional nodal burden. Open

Statement Recurrence was associated with positive sentinel lymph node disease, deeper Breslow depth, greater use of adjuvant therapy, and higher rate of death. Open

Statement Pediatric melanoma presents as advanced disease with nearly 50% positive sentinel lymph node biopsy rate. Open

Quotation Management of nodal disease had no significant impact on disease outcomes with respect to recurrence or death from disease. Open

Statement Management of nodal disease (ultrasound observation vs completion lymph node dissection) had no significant impact on disease outcomes with respect to recurrence or death from disease. Open

Statement Findings of additional nodal disease in completion lymph node dissection did not significantly correlate with recurrence. Open

Statement Recurrence most strongly associated with positive sentinel lymph node biopsies and deeper Breslow depth. Open

Stephen's statements about Soft Tissue Sarcoma (lymph nodes) 62 statements

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