BACKGROUND: Primary cutaneous melanoma still constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner. OBJECTIVES: This study evaluated the clinical, epidemiological and demographic aspects of this disease, and correlated them with patient prognosis. METHODS: Using epidemiologic and clinical data, we analyzed 84 patients with mild to severe primary cutaneous melanoma treated between 1990 and 2007. Slides containing surgical specimens were analyzed, and new slides were made from archived paraffin sections when necessary. RESULTS: The melanoma incidence was higher in areas of sun exposure, with lesions commonly observed in the trunk for males, and lower limbs for females. In addition to Breslow's thickness and ulceration (p = 0.043 and p < 0.001, respectively), the mitotic rate per mm² also correlated with worse patient outcome (p = 0.0007). The sum of ulceration (0 when absent or 1 when present), the Breslow index (1 when <1 mm, 2 when >1 mm and <4 mm, 3 when >4 mm) and the mitotic index (0 when absent or 1 when >1 per mm²) allowed the establishment of a prognostic score: if the sum was equal to or over three, nearly all (91.7%) patients had systemic disease. The 5-year survival was approximately seventy percent. CONCLUSION: Because American Join Committee of Cancer Staging will update the classification of malignant tumors (TNM) staging in the near future, and introduce mitosis as a prognostic factor, our results show the importance of such a feature. Additional studies are necessary to confirm the importance of a prognostic score as proposed herein.

A anastomose término-terminal entre os segmentos esofágicos, embora constitua a melhor solução para a atresia do esôfago do recém-nascido, pode resultar em fístulas, deiscências ou estenoses devidas à tensão na linha de sutura, principalmente nos casos de grande distância entre os cotos. A miotomia circular do segmento proximal (manobra de Livaditis) é a técnica de alongamento esofágico mais utilizada. No presente trabalho experimental, realizado em cães, procurou-se verificar se esta técnica diminui o índice de deiscência de anastomose entre cotos sob grande tensão e estudar se ela promove alterações morfológicas na cicatriz da anastomose. O projeto piloto demonstrou que seria necessário ressecar 40% do esôfago para se obterem índices elevados de deiscência. No projeto experimental, realizou-se tal ressecção, e os cães foram divididos em dois grupos (grupo controle, apenas anastomose, e grupo experimental, anastomose com miotomia circular). Os animais foram mortos no 14º dia de pós-operatório e a seguir submetidos a necropsia, avaliando-se a presença de deiscência e estenose da anastomose. A avaliação microscópica constou de análise histológica qualitativa e histomorfometria da cicatriz da anastomose. Os índices de deiscência foram iguais nos dois grupos. Nos animais do grupo controle a espessura da fibrose e o número de vasos neoformados foram maiores que no grupo experimental. A avaliação morfométrica revelou que a miotomia promoveu diminuição na espessura da fibrose cicatricial. Concluiu-se que a miotomia circular não diminui a possibilidade de deiscência, além de promover alterações deletérias na cicatrização da anastomose.

For esophageal reconstruction in newborns with esophageal atresia, esophageal reunion with an end-to-end anastomosis is the ideal procedure, although it may result in leaks and strictures due to tension on the suture line, mainly in cases with a wide gap between the ends. Circular myotomy (Livaditis' procedure) is the best method to elongate the proximal esophageal pouch and reduce anastomotic tension. This experimental investigation in dogs was undertaken to attempt to verify that circular myotomy decreases the anastomotic leak rate in newborns with wide gap esophageal atresia, and to analyze whether the technique promotes morphologic changes in the anastomotic scar. A pilot study demonstrated that it is necessary to resect more than 8 cm (40% of the total esophageal length) in order to obtain high leak rates. In the experimental project, such resection was performed in dogs divided into two groups (control group, anastomosis only, and experimental group, anastomosis plus circular myotomy in the proximal esophageal segment). The animals were killed in the 14th postoperative day, submitted to autopsy, and were evaluated as to the presence of leaks and strictures, as well as to the features (macroscopic and microscopic aspects) of the anastomosis. Leak rates were the same in both groups. Morphometric analysis revealed that in animals in the experimental group, the anastomotic scar was thinner than the control animals, and the isolated muscular manchette distal to the site of myotomy was replaced by fibrous tissue. Correspondingly, a decreased number of newly formed small vessels were noted in the experimental animals, compared to control animals. We concluded that circular myotomy does not decrease the incidence of anastomotic leaks, and it also promotes deleterious changes in anastomotic healing.