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Melanoma is one of the most immunologic malignancies based on its higher prevalence in immune-compromised patients, the evidence of brisk lymphocytic infiltrates in both primary tumors and metastases, the documented recognition of melanoma antigens by tumor-infiltrating T lymphocytes and, most important, evidence that melanoma responds to immunotherapy. The use of immunotherapy in the treatment of metastatic melanoma is a relatively late discovery for this malignancy. Recent studies have shown a significantly higher success rate with combination of immunotherapy and chemotherapy, radiotherapy, or targeted molecular therapy. Immunotherapy is associated to a panel of dysimmune toxicities called immune-related adverse events that can affect one or more organs and may limit its use. Future directions in the treatment of metastatic melanoma include immunotherapy with anti-PD1 antibodies or targeted therapy with BRAF and MEK inhibitors.

Cholesteatoma is a non-neoplastic, keratinized squamous epithelial lesion that affects the temporal bone. The middle ear is the most frequent, while the isolated cholesteatoma of the mastoid is rare. The aim of this study was to describe a rare case of isolated mastoid cholesteatoma with no involvement of aditus ad antrum and middle ear including a literature review of the topic. This case report describes the case of a 58 years old female with a cholesteatoma isolated in the mastoid region, evidenced by imaging (computer tomography and magnetic resonance). A mastoidectomy was performed: mastoid process was completely involved, but antrum was not reached. Moreover, it reached the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. In the literature few articles described cases of cholesteatoma isolated in the mastoid region. Research was conducted using PubMed and reference list and there were considered only reports about cholesteatoma exclusively located in the mastoid process without involvement of antrum or middle ear. Fourteen articles were included in this review, with a total number of 23 cases of cholesteatoma isolated in the mastoid region. All papers analyzed reported the cases of isolated mastoid cholesteatoma that presented a congenital origin. Its diagnosis is difficult, therefore, imaging evaluation is mandatory and surgery is the treatment of choice. Mastoid cholesteatomas without involvement of aditus ad antrum and middle ear are rare and only 23 cases are reported in literature. Our case is in line with all clinical and diagnostic features of this rare disease, but it is the only one that evidenced an exposure of the soft tissue of stylomastoid foramen as well as the posterior belly of the digastric muscle. The treatment of choice was the surgical one, avoiding damaging of important anatomo-functional structure.

Panoramica delle diverse maschere snorkelling modificate per la protezione intraoperatoria.Obiettivo: La pandemia di COVID-19 ha tuttora un impatto significativo sui sistemi sanitari di tutto il mondo. Il tasso di operatori sanitari italiani che hanno contratto linfezione e superiore al 10%. In questo drammatico scenario, la comunita scientifica si e impegnata nello sviluppo di nuovi dispositivi di protezione individuale. Il nostro studio si concentra sulluso di maschere da snorkelling modificate (MFFSM) come dispositivi di protezione individuali contro linfezione da virus COVID-19 durante procedure diagnostiche e terapeutiche sul tratto aerodigestivo superiore.Metodi: Cinque diversi tipi di MFFSM sono stati testati. I dati sono stati raccolti attraver-so un sondaggio online; solo per la maschera OceanReef Aria QR+ sono stati registrati i valori intraoperatori di pO2 e pCO2.Risultati: Tutte le MFFSM testate si sono rivelate di facile utilizzo e tutti gli operatori hanno riferito una sensazione di comfort, mantenendo una sensazione di sicurezza durante laprocedura.Conclusione: In futuro sara possibile lo sviluppo di specifiche maschere per laprotezione in sala operatoria e in terapia intensiva sulla base di una stretta collaborazione tra clinici e ingegneri. Lobiettivo per i medici sara definire con precisione le loro esigenze, mentre per le industrie produttrici sara mettere a disposizione il loro expertise per fornire dispositivi che incontrino le necessita sanitarie.Objective: The COVID-19 pandemic has caused significant impact on healthcare systems worldwide. The rate of infected healthcare workers is > 10% in Italy. Within this dramatic scenario, the development of new personal protective equipment (PPE) devices is mandatory. This study focuses on validation of modified full-face snorkel masks (MFFSM) as safe and protective equipment against SARS-CoV-2 infection during diagnostic and therapeutic procedures on the upper aerodigestive tract.Methods: Five different MFFSM were tested during otolaryngological surgery and in anaesthesia procedures. Data were collected through an online survey to assess the feedback of operators. pO2 and pCO2 monitoring values during procedures were recorded in selected cases.Results: All five MFFSM tested were easy to use and gave all operators a sound feeling of protection. All clinicians involved had common agreement regarding safety and the userfriendly format.Conclusions: In the future, specific development of different type of masks for protection in the operating room, intensive care units and/or office will be possible as a joint venture between clinicians and developers. Goals for clinicians include better definition of needs and priorities, while developers can devote their expertise to produce devices that meet medical requirements. The COVID-19 pandemic has caused significant impact on healthcare systems worldwide. The rate of infected healthcare workers is > 10% in Italy. Within this dramatic scenario, the development of new personal protective equipment (PPE) devices is mandatory. This study focuses on validation of modified full-face snorkel masks (MFFSM) as safe and protective equipment against SARS-CoV-2 infection during diagnostic and therapeutic procedures on the upper aerodigestive tract. Methods. Five different MFFSM were tested during otolaryngological surgery and in anaesthesia procedures. Data were collected through an online survey to assess the feedback of operators. pO2 and pCO2 monitoring values during procedures were recorded in selected cases. Results. All five MFFSM tested were easy to use and gave all operators a sound “feeling” of protection. All clinicians involved had common agreement regarding safety and the userfriendly format. Conclusions. In the future, specific development of different type of masks for protection in the operating room, intensive care units and/or office will be possible as a joint venture between clinicians and developers. Goals for clinicians include better definition of needs and priorities, while developers can devote their expertise to produce devices that meet medical requirements.