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Melanoma is diagnosed within a wide range of ages, beginning in the third decade of life: it occurs slightly more commonly in women younger than 40, and represents the second most frequently diagnosed malignant tumor in patients 15 to 29 years of age. The overall incidence of melanoma in pregnancy is about 0.14 to 0.28 cases per 1000 births, accounting for 8% of malignancies diagnosed during pregnancy; although occurring extremely rarely; melanoma is one of the most common tumors known to metastasize to the placenta and the fetus. From the recent literature, we can conclude that chest radiography with radiation protection and abdominal ultrasounds are safe; Computed Tomography (CT) with intravenous contrast and positron emission tomography are generally contraindicating because of emission of high dose of radiation; Magnetic Resonance (MR) is safer than CT, but it is contraindicated during 1st trimester of pregnancy because it employs heart tissues and exposes the fetus to excessive noise than can cause high-frequency hearing loss in neonates. There is no conclusive evidence that pregnancy significantly affects melanoma aggressiveness in terms of increasing metastases incidence or lowering overall survival. Two recent investigations have reported increased mortality in women with pregnancy.associated malignant melanoma. Some data suggest that increased mortality of the melanoma patients with recent childbirth is mainly due to a stage-independent causal pathway: the pregnancy-associated immune suppression may permit some melanomas with high malignant potential to progress and come to clinical diagnosis in the short term following childbirth. However, some other data analysis shows no difference in tumour location and stage at diagnosis between women with PAMM and non-PAMM; furthermore, no evidence of a worse prognosis was found in women given the diagnosis of PAMM. Given these results, the authors conclude that counselling and monitoring women with PAMM do not need to be different from those provided for women with non-PPAMM. The main goals of melanoma treatment during pregnancy are to cure the neoplasia and avoid complications for the fetus; irrespective of pregnancy status, wide local excision around the melanoma site with margins proportional to the microstage of the primary lesion, is the treatment oflocalized melanomas. In more advanced cases (>4mm depth), adjuvant therapy with high dose interferon must be considered; although interferon is safely administered in pregnant patients with haematological malignancies, adjuvant therapy with high dose interferon has not been studied in pregnancy associated melanoma and therefore is not routinely recommended.

Thyroid disease is common and affects 1% to 2% of pregnant women. Pregnancy outcomes can depend on optimal management of thyroid disease, and the course of thyroid disease may be modified by pregnancy. During pregnancy, the evaluation of a thyroid nodule includes a serum TSH and a US assessment of the neck and thyroid gland. Fine needle aspiration (FNA) cytology should be performed for predominantly solid thyroid nodules >1cm discovered in pregnancy. The incidence of thyroid carcinoma is about threefold higher in women than in men, particularly during women’s reproductive years; however, results from case-control and prospective studies showed weak and inconsistent results on the associations between pregnancy, parity, menstrual cycle regularity, exogenous hormone use and menopausal status and thyroid carcinoma risk. Two guidelines on thyroid and pregnancy were developed in October 2011 and August 2012 by American Thyroid Association and Endocrine Society, respectively. A recent case report underlines the importance of the trimester of pregnancy: if well-differentiated thyroid cancer is diagnosed prior to the mid-trimester, it is possible to carry out the surgical intervention in the mid-trimester. During late pregnancy, resection after delivery is the option of choice. There is no indication for termination of pregnancy. Radioiodine or 131I (RAI) is an effective treatment of differentiated thyroid carcinoma (DTC) in both preventing relapses and treating metastases. The possibility of genetic or physical damage to the offspring in terms of congenital malformation and childhood malignancies is a real concern, but several studies did not find a statistically significant association between previous RAI exposure and unfavourable pregnancy outcome. There is a general agreement to defer the thyroid surgery to the second trimester and avoid conception within one year after RAI, allowing RAI clearance and hormonal stabilization.

Uterine metastases from extragenital cancer are rarely reported in the literature. More frequently, the female genital tract is involved by direct extension from an adjacent pelvic organ. A 37-year-old woman had a myoma of the uterine wall and hypermenorrhea. The mass was laparoscopically enucleated, and frozen section examination was performed because it was macroscopically suspicious for sarcomatoid degeneration. The final diagnosis was metastatic carcinoma in the uterus of probable breast origin.

Whether the biological effect of melatonin in humans is directly related to the circulating levels of the hormone, has not heretofore been investigated. In this study, we investigated whether previously described hypothermic melatonin properties are dose related. The nocturnal decline of the body temperature (BT) observed in 16 early follicular phase women, following placebo administration at 18.00 h, was compared with that observed during the preceding or following night, after melatonin suppression with the beta 1-adrenergic antagonist atenolol (100 mg). In 6 subjects (37.5%) with lower nocturnal melatonin levels (p0.05) atenolol induced a complete melatonin suppression and an attenuation of the nocturnal BT decline (p0.02), whereas in the remaining 10 subjects (62.5%) atenolol induced an incomplete melatonin suppression with no modification of the nocturnal BT decline. During a 3rd night, 2 of the 6 subjects with complete and 6 of the 10 subjects with incomplete melatonin suppression blindly received atenolol plus melatonin (1 mg at 19.30 h and 0.75 mg at 21.00 and 23.00 h). Exogenous melatonin restored the full expression of the nocturnal BT decline in the 2 subjects with complete melatonin suppression, but did not modify the BT decline in the 6 subjects with atenolol-induced incomplete melatonin suppression. Our data show that markedly, but not completely attenuated nocturnal melatonin levels are sufficient to exert maximal thermoregulatory effects, indicating rather a threshold than a dose-response effect of melatonin action on human BT.

On the basis of a case series of 577 patients affected by carcinoma of the endometrium treated during the period 1963-1989 in the Gynecologic Institute of the Padua University, the present work examines the reliability of endometrial biopsy aiming at the correct histopathologic diagnosis, through comparison with the subsequent histologic examination of the surgical specimen. It is shown how simple biopsy alone allows for correct diagnosis of histotype in 91.6% of cases of adenocarcinoma, while the reliability of such an examination is reduced, respectively, to 30.7% in adenoacanthoma and to 37.5% in adenosquamous histotypes.

In the last twenty years a new philosophy in the management of gynaecological cancer has begun: the goal of the therapy is now not only to save the life but also the patient's quality of life. To this end, on the basis of a century's experience and of progress in the oncologic field, therapies have been progressively personalized and modulated, considering both the surgical pathological staging and the effective possibilities in terms of survival and quality of life, in order to avoid over or undertreatments. Moreover, in the last few years also the patients submitted to surgery for gynaecological malignancies are beginning to ask gynaecologists for access to hormonal replacement therapy in order to prevent the symptoms typical of menopause, and physicians have to decide when that is possible. Consequently gynaecologist oncologists have to bear in mind the therapy's real cost/benefit balance for the patients, also from a psychological point of view, and in any case, treatments must be performed only if they are unquestionably useful and if they involve the patient's consciousness in choices and decisions.