Dr. Miguel Gonzalez Velez and Dr. Jason Wiseman from 🏥 Dignity Health Cancer Institute 🏥 stopped by the 📺 Arizona Daily Mix 📺 studio to talk with 🎤 Brad Perry 🎤 about treatment options for melanoma and sarcoma! dignityhealth.org/CancerInstituteAZ

At Dignity Health - Cancer Institute at St. Joseph’s Hospital and Medical Center, they believe in an interdisciplinary approach to precision medicine. This means they dig down to the molecular and genetic makeup of each patient to get to know their specific cancer. They don’t see a patient, they see unique human beings with unique ideas, unique concerns, and expectations. They get to know each patient, so that their treatment plan is built around their individual needs. They believe there’s a difference between curing a disease and healing the whole person. For more information about Dignity Health Cancer Institute at St. Joseph’s Hospital and Medical Center, or to schedule an appointment with melanoma and sarcoma specialists, Dr. Jason Wiseman or Dr. Miguel Gonzalez-Velez, visit dignityhealth.org/CancerInstituteAZ or call 602.406.8222.

Deviating from common topics today we are going to show you an instance of salvaging an upper limb involved by a massive exophytic sarcomatous growth arising from the dorsum of the forearm.
The 59 year old patient presented to our hospital with a large exophytic lesion. He said the reason why he avoided coming to the hospital for nine months was that he was afraid that he would be offered the option of amputation. When he was presented to us he showed us that his hand was fully functional & asked us to consider limb salvage if possible.
It was a pleomorphic sarcoma & there was no radiological evidence of any distal metastases. Limb salvage is of no use if coupled with oncological compromise especially with an aggressive sarcoma.
The lesion was more towards the ulnar side of the forearm.
So it was evident to us in order to have negative margins we need to sacrifice the ulnar nerve and the artery. However we knew that if we can preserve at least the median nerve & the radial artery we would be able to save the hand with more than 50% of its function.
The first task was to reach the bifurcation of the brachial artery at the cubital fossa.You can still see the bifurcation of the brachial artery in this.
We found the median nerve & the radial artery & traced them distally circumnavigating the tumour region.
Once that was done we started entering a deeper plane on the ulnar side & started dissecting distally hoping to pass deep to the tumour region. We were able to do this by sacrificing the ulnar artery & the nerve.
The tumour was excised en block.

The problem was to achieve wound closure. Free flap was not possible since the only supply being the radial artery.we therefore thought of leaving the wound open to granulate.
Histology showed a 5 mm -1 cm negative margin around the lesion.
You are seeing the end result just prior to radiotherapy. The function of the thumb is preserved in spite of an ulnar claw hand. An active thumb is equivalent to 50% of a functional hand.
The histology confirmed an angiosarcoma. Despite its aggressiveness, the patient still has not developed any identifiable metastases. We are happy at this result since limb amputation in sarcoma promises no known survival benefit over limb salvage without oncological compromise.


This channel is dedicated to everyone who is interested in the field of Oncological surgery & is conducted by Dr. Anuruddha Thewarapperuma MBBS MS, a Consultant Cancer Surgeon from Sri Lanka.
This includes a series of video classes & lectures on operative surgery with illustrations, valuable tips and advice.
Please feel free to comment, give suggestions & ask questions in the comment section below.
We hope this channel will be thought provoking and inspiring to all the surgeons, medical students, aspiring doctors, nurses and anyone in the surgical community who is interested in Cancer Surgery.
We wish you all the best!
Thank you!

Contact us cancersurgerymasterclass@gmail.com

A #sarcoma is a malignant #tumor, a type of #cancer that arises from transformed cells of #mesenchymal (connective tissue) origin. Connective tissue is a broad term that includes bone, cartilage, fat, vascular, or #hematopoietic tissues, and sarcomas can arise in any of these types of tissues. As a result, there are many sub types of sarcoma, which are classified based on the specific tissue and type of cell from which the tumor originates.
Sarcomas are primary connective tissue tumors, meaning that they arise in connective tissues.This is in contrast to secondary (or "metastatic") connective tissue tumors, which occur when a cancer from elsewhere in the body (such as the #lungs, #breast tissue or #prostate) spreads to the connective tissue.

Symptoms of bone sarcomas typically include bone pain, especially at night, and swelling around the site of the tumor.

Symptoms of soft-tissue sarcomas vary, but they often present as firm, painless lumps or nodules. #Gastrointestinal stromal tumors (a subtype of soft tissue sarcoma) often are asymptomatic, but can be associated with vague complaints of abdominal pain, a feeling of fullness, or other signs of intestinal obstruction.
Surgery is the most common form of the treatment for most sarcomas that have not spread to other parts of the body. #Limb-sparing surgery, as opposed to amputation, can now be used to save the limbs of patients in at least 90% of extremity (arm or leg) sarcoma cases. Additional treatments, including #chemotherapy and #radiationtherapy (also called "radiotherapy"), may be administered before surgery (called "neoadjuvant" chemotherapy or radiotherapy) or after surgery (called "adjuvant" chemotherapy or radiotherapy). The use of neoadjuvant or adjuvant chemotherapy and radiotherapy significantly improves the prognosis for many sarcoma patients. Treatment can be a long and arduous process, lasting about a year for many patients.

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