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The anatomical location of cutaneous melanoma is a relevant independent prognostic factor in melanoma. The aim of the study is to know the prognosis of lower limb cutaneous melanoma related to their location within the limb, regardless of the histological type, and if there are any other influencing variables. A real-world data observational study was developed. The lesions were divided depending on the location of the melanoma (thigh, leg and foot). Bivariate and multivariate analysis were performed, and melanoma-specific survival and disease-free survival rates were calculated. When these analysis were done, the results showed that, in melanomas of the lower limb, location on the foot presented a lower melanoma-specific survival rate compared to more proximal locations, and only the anatomical location presents statistical significance to discriminate cases with a higher mortality risk and a lower disease-free survival rate among distal melanomas (mainly on the foot). In conclusion, this study confirms that a more distal location of lower limb cutaneous melanoma is a relevant prognostic factor.Trial registration number NCT04625491 retrospectively registered.

Recently, the quantification of mitoses in cutaneous melanoma has been discharged from the main prognostic variables of the TNM classification. To investigate the prognostic value of the presence of mitoses in primary cutaneous melanoma and to establish the number of mitoses per mm2 that may have prognostic significance. A retrospective observational study was performed on 141 patients treated for cutaneous melanoma, who were assessed by the same pathologist, and who had a minimum follow-up of 2 years. Clinical, epidemiological, histopathological and follow-up variables were gathered and compared with the number of mitoses to distinguish the significance of differences by means of univariate, multivariate, and survival analyses. The cut-off level related to a better sensitivity and specificity was 1.50 mitoses per mm2. The presence of two or more mitoses/mm2 showed a better relationship with prognostic variables and both the overall and disease-free survival than the presence of 1 or more mitoses/mm2. This happens especially in melanomas thicker than 0.8 mm and it could affect the staging in cases with Breslow between 1 and 2 mm. A mitotic rate of two or more mitoses per mm2 in cutaneous melanoma should be considered as a more accurate prognostic factor than one or more mitoses per mm2, particularly in tumors equal or greater than 0.8 mm in thickness.

Nowadays, neoadjuvant chemotherapy (nCT) in breast cancer is more and more standardized, not only in advanced tumours but also in those for which there is an attempt to achieve breast-conserving surgery. In literature, we can find evidences of the relationship between several types of tumours and systemic inflammatory response. Our objective is to analyse the prognostic value of blood parameters (lymphocytes, neutrophils, monocytes, lymphocyte-to-monocyte ratio (LMR), neutrophil-to-monocyte ratio (NMR) and neutrophil-to-lymphocyte ratio (NLR) in breast cancer (BC) patients treated with nCT. A retrospective cohort of 150 breast cancer patients treated with nCT and subsequently with surgery was analysed. Data about the patients, histology, response to chemotherapy and peripheral blood values of lymphocytes, monocytes and neutrophils was collected, and used to calculate the LMR, NMR and NLR. Univariate and multivariate analyses were performed for the variables to see the relationship of the ratios to disease-free survival (DFS) and overall survival (OS). Patients with high LMR (≥5.46) and low NLR (

Surgical treatment is a fundamental aspect in the proper management of breast cancer. It is not only the mainstay of loco-regional treatment, but it also allows disease staging and optimization of adjuvant chemotherapy through histopathological and immunohistochemical analysis of the biopsied tissue. From a strict oncologic point of view, surgical treatment of breast cancer in young women does not differ greatly from that in older women, but the physical consequences of large breast resections can have a major impact on self image, and can result in significant emotional and psychosocial distress in younger women [1]. Moreover, the fact that the majority of women in this age group are of childbearing age calls for the need to consider distinct aspects of surgical treatment [2, 3]. When choosing between a conservative or a more radical surgical approach, it is also important to bear in mind that breast tumors in younger patients tend to be strongly associated with a family history of breast cancer, and therefore patients have an increased risk for carrying BRCA1 or BRCA2 (BRCA1/2) mutations [4]. In confirmed cases of BRCA1/2 mutations, risk-reducing salpingooophorectomy has been demonstrated to be the best strategy [5]. In patients with these mutations and established disease, radical mastectomy (RM), instead of breast-conserving surgery (BCS), is the most sensible approach [6]. Surgical treatment in localized disease

In this work we want to know the long-term rates of locoregional recurrence and distant metastasis in a population of breast cancer patients with pT1–pT2 tumours and one to three positive lymph nodes who were treated with mastectomy and axillary lymphadenectomy, and to study the relationship of certain clinical and histopathological parameters to their development. Ninety patients diagnosed with a breast tumour of less than 5 cm and one to three affected lymph node, and undergoing a modified radical mastectomy with axillary lymphadenectomy, were studied. The mean overall follow-up was 132 months, and the minimum follow-up for the living patients was 10 years. Locoregional recurrence and metastasis development rates were studied and clinical and pathological parameters were evaluated. We found locoregional recurrence in 22.5% of the patients, and systemic metastases in 30.3%. In the study of locoregional recurrences significant differences were found for tumour size (T2) (p=0.001) and metastasis were more frequent with extracapsular lymph node extension (p=0.02) and non-administration of chemotherapy (0.019). The parameter related to the development of locoregional recurrence was tumour size (stage T2) and those related to the development of metastasis were extracapsular lymph node extension and non-administration of chemotherapy.

Background Sentinel lymph node biopsy is an appropriate method to assess lymphatic involvement in cutaneous melanoma. We collated clinical and histo-pathological parameters of primary tumours to assess their predictive value of sentinel lymph node involvement.

We present a case of hamartoma of the breast. This is an infrequent tumour that requires the correct diagnosis to distinguish it from other histopathology types because it has a better prognosis. The characteristic image from a mammogram is useful in its diagnosis.

Cancer is as much an epigenetic disease as it is a genetic disease, and epigenetic alterations in cancer often serve as potent surrogates for genetic mutations. Because the epigenetic factors involved in the DNA damage response are regulated by multiple elements, therapies to target specific components of the epigenetic machinery can be inefficient. In contrast, therapies aimed at inhibiting the methionine cycle can indirectly inhibit both DNA and protein methylation, and the wide variety of genes and pathways that are affected by these methylations make this global strategy very attractive. In the present study, we propose an adjuvant therapy that targets the epigenetics of the DNA damage response in breast cancer cells and that results in efficient apoptosis and a reduction in distant metastases in vivo. We observed that a combined therapy designed to uncouple adenosine metabolism using dipyridamole in the presence of a new synthetic antifolate, 3-O-(3,4,5-trimethoxybenzoyl)-(−)-catechin, simultaneously and efficiently blocked both the folic cycle and the methionine cycle in breast cancer cells and sensitized these cells to radiotherapy. The treatment impeded the recruitment of 53BP1 and BRCA1 to the chromatin regions flanking DNA double-strand breaks and thereby avoided the DNA damage responses in breast cancer cells that were exposed to ionizing radiation. In addition, this hypomethylating therapy was also efficient in reducing the self-renewal capability of breast cancer-initiating cells and induced reversion of mesenchymal phenotypes in breast cancer cells.

Primary squamous cell carcinoma of the breast is an infrequent tumour, that requires to rule out a tumor from other location to be diagnosed. Several characteristics as big size, and necrosis or cyst presence, have been associated rather than adenocarcinoma, although clinic and radiological squamous cell carcinoma non-specific characteristics are difficult to distinguish from adenocarcinomas. We present a woman with a 4-cm primary squamus cell carcinoma of the breast. Pathogenic, diagnostic, and therapeutic aspects in accordance with medical literature, are discussed.

Sir, A recent work remarks the influence of molecular lymph node assay to diagnose micrometastases in the sentinel node of intraductal carcinoma of the breast (Osako et al, 2012). In fact, the detection of small epithelial cell aggregates became much more frequent as the sentinel lymph node biopsy replaced complete axillary dissection as a method of staging breast cancer patients. The implementation of much more sensitive and specific techniques into the clinical analysis of the sentinel node, such as techniques based on molecular biology, has increased the detection of minimum tumour loads. The OSNA technique (one step-nucleic acid-amplification) detects cytokine 19 mRNA expression after processing the node, and therefore, identifies the presence of cells from the breast tumour whenever this protein is expressed by the tumour. This method is so sensitive that it permits the detection of isolated tumour cells, and, consequently, its clinical use has led to an increase in the diagnosis of micrometastasis and submicrometastasis. At the same time, in the diagnosis of primary breast lesions, both the development of early detection programmes and technological advances in diagnostic image tests, especially mammography, have led to the diagnosis of carcinomas at increasingly earlier stages, thus reducing the probability of dissemination from the primary tumour. Definitive preoperative diagnosis is fundamentally based on the biopsy of the lesion by taking a sample using a core needle biopsy device. The use of this device makes it possible to obtain a sample for both the histological and cytological diagnosis, as well as permitting the use of inmunohistochemical analysis which is currently essential for planning the management of these tumours. By using a core needle biopsy, a diagnosis can be obtained, but a drawback is that we cannot know if this is representative of the whole of the tumour, as it only provides a sample. Therefore, it is usually repeated in different areas of the lesion. Related to the sentinel node biopsy, the classical concept of intradutal carcinoma contrasts with the following two findings: (a) ∼9% of the cases of all published series involve infiltrated lymph nodes when sentinel node analysis is used as the staging method (Smith, 2010); and (b) in 1–2% of the cases the patient presents with specific mortality related to breast cancer in the follow-up period in spite of appropriate treatment (Ernster et al, 2000). The most common explanation to this is that the pathologist's analysis was not thorough enough to detect the microinfiltration foci responsible for these events (Intra et al, 2008), although some other reasons have been suggested for the appearance of these cells in the sentinel node (Banys et al, 2012). For invasive breast cancer, some authors group these phenomena as benign mechanical transport, and two main modes have been proposed: surgery-induced tumour cell displacement (Osako et al, 2012) and breast massage used to facilitate the intraoperative localisation of sentinel nodes (Diaz et al, 2005). After reviewing the cases of intraductal carcinoma of the breast that had sentinel node biopsies with OSNA technique in our centres, we have found seven cases of node infiltration in which intraductal carcinoma was diagnosed after an exhaustive search involving the removal of the surgical piece without finding microinfiltration foci, and having ruled out any other breast focus of the carcinoma. The general characteristics of these cases are shown in Table 1, and two interesting facts should be highlighted: first, all of them presented with more than four biopsies, in other words at least four cylinders had been extracted in many other punctures of the lesion, and in one case in which a preoperative diagnosis was established by using fine needle aspiration, many passes were carried out until more than five extensions were obtained for cytological analysis; and second, a low tumour load was diagnosed, in which the number of copies of CK19 mRNA found was no greater than 1200, that is to say, they were cases of micrometastasis (three cases with