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Purpose We aimed to evaluate reliability of self-reported information on skin cancer among individuals aged >65 years with cutaneous squamous cell carcinoma (SCC). Methods A test-retest was performed with patients completing two questionnaires one month apart. Results Among 102 recruited patients the response rate was 97.1% (mean age 80.9 years, 74.8% men). The majority of items showed substantial agreement: history of skin cancer screening (k=0.88), past skin cancer in general (k=0.92), basal cell carcinoma (k=0.75), patient delay (k=0.64) and total delay (k=0.86). Agreement was high also for ages >80 years. Recall of past SCCs (k=0.48) and sunscreen use (k=0.38) was less accurate. Conclusions Our study provided evidence on the reliability of patient reported skin cancer information among elderly individuals, who represent the majority of affected cases.

The aim of this study was to analyse the potential of fast dynamic subtraction magnetic resonance (MR) imaging in differentiating in vivo melanomas from benign melanocytic lesions. Dynamic MR imaging was performed after intravenous administration of gadopentetate dimeglumine (Gd-DTPA) in 18 patients with melanocytic skin lesions. Using a post-processing algorithm, time-signal intensity curves were obtained for the lesions and classified according to their shapes as type I (steady enhancement increase), type II (plateau of signal intensity) or type III (wash-out of signal intensity). Other parameters evaluated for their potential to differentiate melanomas from benign lesions were the enhancement rate (percentage of signal intensity increase) in the first minute after Gd-DTPA administration, the peak value of the enhancement rate, and the wash-out slope. The pigmented lesions were then surgically excised and the MR results compared with the histological assessment. In melanomas, the mean value of the enhancement rate in the first minute was 611%, whereas in benign lesions it was 131% (P = 0.001). The distribution of curve types was also different: seven of the nine naevi showed type I curves, while eight of the nine melanomas displayed a type III curve. In addition, distinctive wash-out dynamics were observed: the enhancement rate began to decrease between the first and third minutes for melanomas, but continued to increase until the sixth minute for naevi (P = 0.000). These findings, which are most likely related to the neoangiogenesis present in melanomas, indicate that dynamic MR imaging can be helpful in the differential diagnosis of pigmented skin lesions.

The purpose of this paper was to present our 4-year experience with sentinel node biopsy in the treatment of malignant melanoma. We will present technical details that influence the efficacy of the procedure and discuss the clinical, therapeutic and prognostic advantages of this technique. A total of 259 consecutive patients with primary skin melanoma (T2–3 N0 M0) underwent sentinel node biopsy between March 1996 and May 2000. All patients underwent previous excisional biopsy of the primary lesion and clinical and radiographic examination to exclude lymphatic or systemic macroscopic spread of the disease. Preoperative lymphoscintigraphy (99mTc-nanocoll) was routinely performed in the last 184 patients. Intraoperative detection of the sentinel node was performed by perilesional, intradermal injection of blue dye associated with a gamma probe (Neoprobe 2000) in the last 141 patients. For each anatomical site of dissection (inguinal, axillary, head and neck), detection rates with or without gamma probe were compared, focusing on the main reasons for failure. Sentinel nodes, serially sectioned, were all hematoxylin-eosin and immunohistochemically stained. All patients positive for micrometastasis underwent radical lymphadenectomy. Comparative analysis was performed between the incidence of metastasis in sentinel and non-sentinel nodes, according to the clinical stage of the disease. The overall detection rate of sentinel nodes was 96%. Relevant differences were found according to the site of dissection and the use of a gamma probe. The gamma probe makes the procedure more effective, less invasive, and less expensive. Timing and accuracy of the preoperative lymphoscintigraphy are basic steps in the procedure. The overall incidence of positive sentinel node was 14.6% with differences correlated with thickness of primary lesion (0.75–1.5 mm: 7.3%; 1.5–3 mm: 14.9%; 3–4 mm: 30.5%). Metastasis in other non- sentinel nodes was found only with primary tumor thickness exceeding 2 mm. Correlation between sentinel node metastasis and prognosis as well as adjuvant therapy will be discussed. Sentinel node biopsy is a procedure requiring a multidisciplinary approach (surgery, nuclear medicine, and pathology). A specific learning phase (>30 patients) is recommended for reliable results. An improvement in survival rates by sentinel node biopsy has not yet been demonstrated, but this more accurate N-staging procedure offers clear advantages in terms of the patient’s quality of life, prognosis, and indication for adjuvant therapy.

The Authors describe a case of primary localized amyloidosis of the eyelids, focusing on diagnosis and possible treatment. The involment of several structures of the eyelid such as muscles, conjunctiva and puncta lacrimalia, as well as peculiar features of these proteinaceous deposits, suggest different combined procedures and precise timing in choosing the appropriated therapy.

Large cutaneous squamous cell carcinoma (SCC) is associated with a higher risk of disfigurement, local recurrence, and metastasis; however, little is known about factors associated with tumor size at diagnosis.We sought to evaluate factors associated with SCC size, including diagnostic/treatment delay and patient and tumor characteristics.We studied a stratified sample of 308 patients with SCC recently treated at a dermatologic referral center in Italy. Medical records were reviewed and telephone interviews conducted. Multiple logistic regression was used to examine factors associated with SCC size.With univariate analyses, among both invasive and in situ cases, SCC greater than 2 cm was significantly associated with male gender, tumors arising in chronic lesions, and tumors located on not easily visible sites. Long delay before surgical removal was significantly associated with large SCC size only for invasive SCC (P.001). Among patients with invasive SCC, when controlling for age and gender, multivariate analysis showed a significantly higher likelihood of SCC greater than 2 cm with a total delay longer than 18 months before surgical removal (odds ratio=4.18; 95% confidence interval 2.45-7.13) and for tumors arising in chronic lesions (odds ratio=6.42; 95% confidence interval 3.13-13.2).The study was cross-sectional and based on a single center.Long total delay in removal significantly increased the likelihood of invasive SCC greater than 2 cm. Our findings highlight the importance of early detection and treatment to prevent large invasive SCCs, which are associated with a higher risk of disfigurement, recurrence, and metastasis. Particular attention should be paid to chronic skin lesions and not easily visible body sites during physician- and patient-performed examinations.

Aims Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer. The metastatic potential is generally low. However, there are subgroups of patients at higher risk, for whom sentinel lymph node biopsy (SLNB) might be useful. SLNB might allow the timely inclusion of high risk patients in more aggressive treatment protocols, sparing at the same time node-negative patients the morbidity of potentially unnecessary therapy. Our aim was to introduce the concept of SLNB for patients with high risk cutaneous SCC. Patients and methods We examined a consecutive series of high risk cutaneous SCC patients undergoing SLNB at our large dermatological hospital, and performed a literature review and pooled analysis of all published cases of SLNB for cutaneous SCC. Results Among the 22 clinically node-negative patients undergoing SLNB at our hospital, one patient (4.5%) showed a histologically positive sentinel node and developed recurrences during follow-up. Sentinel node-negative patients showed no metastases at a median follow-up of 17 months (range: 6–64). The incidence of positive sentinel nodes in previous reports ranged between 12.5% and 44.4%. Pooling together patients from the present and previous studies (total 83 patients), we calculated an Odds Ratio of 2.76 (95% CI 1.2–6.5; p = 0.02) of finding positive sentinel nodes for an increase in tumor size from 3 cm. Conclusions Our case series and the pooled analysis support the concept that SLNB can be performed for high risk cutaneous SCC. Prospective multicenter studies are needed to examine the role, utility and cost-effectiveness of SLNB for this population.

Is to evaluate the role of the sentinel node (SN) radiolocalisation and its prognostic value in state T2N0M0 squamous cell carcinomas (SCC) of the lip.Between November 1999 and June 2002 we enrolled 11 consecutive patients (8m,3f) affected with lower lip SCC (7 pts.), labio-commissure (3 pts.) and upper lip (1 pt). Lymphoscintigraphy was performed three hours before surgery. After topical anaesthesia (Lidocaine spray 10%), 30-50MBq of Nanocoll-Tc99m diluted in a 0.3 ml physiological solution was injected intradermally, divided into two peri-lesional points. Planar static acquisition began immediately after the injection in order to visual lymph drainage pathways (lateral and/or anterior view, 512x512 matrix, 5 min. pre set time, LEGP collimator). All patients underwent only selective lymph adenectomy of the SN.SN were visible in all patients within 5 minutes after the injection. In all patients the SNs were observed in the submandibular area (I neck level) in three patients a second SN was localized in latero cervical area (II neck level). All patients were staged SN negative. The average disease free interval for patients who underwent a selective lymph adenectomy of the SN was 20 months with continuing follow-up.We must stress the importance of performing an immediate exploratory dynamic or static scintigraphy within the first minutes of the radio tracer injection, in order to acquire a precise SN localisation and an accurate mapping of the tumour lymphatic pathways. SN radio localisation is especially beneficial in T2N0 stage patients where immediate lymphadenectomy is not necessary. It also saves time and cuts costs, which are specific goals in the current climate of health service management. Although our results are encouraging, a larger data base from multi centre trials with a five year follow-up would confirm the validity of our approach.

Aims and background Sentinel node (SN) biopsy has been introduced to solve the controversy concerning the effectiveness of prophylactic lymphadenectomy in intermediate thickness melanoma. The aim of this study was to evaluate the rate of metastases, the technical details of the procedure, and the main reasons of failure. Methods 235 patients affected by intermediate thickness melanoma (tumor thickness >0.75 mm and 0M0) were submitted to sentinel node biopsy between 1996 and 2000. Preoperative lymphoscintigraphy was routinely performed in the last 184 patients. Intraoperative mapping with gamma probe was combined with the use of vital dye for identification of sentinel nodes in the last 113 patients. Results The SN detection rate was 95.6%, with significant differences depending on the site of dissection and the use of a gamma probe. The overall rate of micrometastases was 14.7%, but relevant differences were recorded between different subgroups of patients (T2, 5.1%; T3a, 19.6%; T3b, 29%). Conclusions Sentinel node biopsy requires a multidisciplinary approach (surgery, pathology and nuclear medicine) for reliable results. The association of vital dye and intraoperative gamma probe for sentinel node harvesting has made the procedure more effective, less time-consuming and less invasive. Failures may be due not only to surgical mistakes, but also to improper nuclear medicine procedures or inaccurate histological evaluation of SNs. Methods for histological examination of the SN are still debated and not standardized but promising results have recently been obtained with molecular oncology techniques (RT-PCR).

The most common complications in plastic surgery are tissue reactivity, infections, and wound dehiscence. In the literature, there are only a few studies with sample sizes large enough and methods of statistical analysis appropriate for evaluating the role of suture materials in inducing such complications. In the 1000 plastic surgery outpatients in this study, the association of different suture materials, individual patient characteristics, surgeon skill, and wound site and length with postoperative wound complications (i.e., tissue reactivity, infection rate, and wound dehiscence) were investigated. No substantial differences were found between the different suture materials and suturing techniques. A moderate increase in the risk of tissue reactivity for silk and polyglactin 910 and a protective effect of thinner internal sutures were observed. In multivariate analysis, such differences were not statistically significant. Male sex [odds ratio (OR), 1.7; 95 percent confidence interval (CI), 1.06 to 2.72] and older age (OR, 2.34; 95 percent CI, 1.36 to 4.05) were found to be the most important risk factors for tissue reactivity and infection rate (male sex: OR, 5.1; 95 percent CI, 1.7 to 15.9; older age: OR, 5.6; 95 percent CI, 1.9 to 16), whereas younger age was associated with an increased risk of dehiscence (OR, 3.06; 95 percent CI, 1.41 to 6.65). Wounds on the lower limbs showed a lower risk of tissue reactivity and wounds on the back a higher risk of dehiscence. Wound length was associated with the risk of tissue reactivity in one-layer sutures (OR, 2.92; 95 percent CI, 1.51 to 5.65). An increased risk of both tissue reactivity (OR, 1.53; 95 percent CI, 1.03 to 2.27) and dehiscence (OR, 2.44; 95 percent CI, 1.1 to 5.43) was observed for operations performed by less-experienced surgeons. Rather than factors related to suture materials and different surgical techniques, and with the exception of surgeon experience, general characteristics of the patients (i.e., sex and age) and of the wounds (i.e., length and site) seemed to be primarily responsible for local wound complications.