Immediate versus delayed reconstruction of head and neck cutaneous melanoma
Bibliographic record
Abstract
OBJECTIVE: Controversy exists regarding the surgical management of cutaneous melanoma and the optimal timing of reconstruction. One approach to ensuring an oncologically sound outcome is a two-stage procedure, with reconstruction delayed for negative permanent section margins. Alternatively, a single-stage excision with immediate reconstruction is advantageous because it limits both resource use and patient morbidity from multiple procedures. We sought to examine available published data on the oncologic outcomes associated with immediate versus delayed reconstruction of cutaneous melanoma in the head and neck region. METHODS: We performed a systematic review using EMBASE, Ovid MEDLINE, and PubMed. We examined all English-language studies reporting oncologic outcomes (positive margins and/or local recurrence rates) of single-stage or delayed reconstruction of cutaneous melanoma in the head and neck region. Our primary outcomes of interest were rates of positive margins requiring re-excision and rates of local recurrence. A total of 1,557 studies were screened by three independent reviewers. RESULTS: Nine studies met inclusion criteria for final analysis. Two of the nine studies directly compared immediate versus delayed reconstruction and demonstrated lower rates of positive margins in the immediate reconstruction group (odds ratio 3.7, [95% CI 0. 79-17. 34]). CONCLUSION: There are a paucity of studies directly comparing oncologic outcomes associated with immediate versus delayed reconstruction following excision of head and neck cutaneous melanoma. Based on a limited amount of heterogeneous data, single-stage excision with immediate reconstruction may be an oncologically sound alternative to delayed reconstruction for head and neck cutaneous melanoma. LEVEL OF EVIDENCE: 3a. Laryngoscope, 2566-2572, 2018.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".