Search

Objective:To evaluate the features and prognosis of melanoma of glans penis and urethra, with the presentation of a significant case report.Materials and methods:A systematic literature review was performed using the MEDLINE (PubMed) and Cochrane Libraries databases to identify all cases of male mucosal melanoma reported.Results:Two hundred fifty-two patients with male mucosal primary melanoma were found. Glans penis and fossa navicularis as primary site includes the 81.6% of all lesions considered. Median Breslow’s depth is 2.1 mm, whereas nine in situ melanomas have been reported. At the diagnosis, the disease was at a non-localized stage in 21.4% for glans penis melanomas and 11.7% urethral lesions, respectively. The 2 and 5-year survival for glans melanoma is 62.5% and 38.4%; higher rates were observed in the 2012–2020 period (76% and 58.8%, respectively). Two-year survival for urethral melanomas is 66.7%, while 5-year survival is 12.5%. 22 patients survived over 5 years with a Breslow’s depth reported always Conclusion:Melanoma of the glans penis and urethra is a rare neoplasm associated with a poor prognosis, however recent reports show higher survival rates. Surgery remains the mainstay for a localized disease. Taking into account the small number of cases reported, topical imiquimod seems to be a valid non-surgical alterative for melanoma in situ. The use of immunotherapy and targeted therapy should be considered only in an adjuvant setting according to the recommendations of cutaneous melanoma; however, additional clinical data on male mucosal melanoma are needed to draw definitive conclusions.

Previous studies have reported an association between sun exposure and the increased survival of patients with cutaneous melanoma (CM). The present study analyzed the association between ultraviolet (UV) light exposure and various prognostic factors in the Italian Clinical National Melanoma Registry. Clinical and sociodemographic features were collected, as well as information concerning sunbed exposure and holidays with sun exposure. Analyses were performed to investigate the association between exposure to UV and melanoma prognostic factors. Between December 2010 and December 2013, information was obtained on 2,738 melanoma patients from 38 geographically representative Italian sites. A total of 49% of the patients were >55 years old, 51% were men, 50% lived in the north of Italy and 57% possessed a high level of education (at least high school). A total of 8 patients had a family history of melanoma and 56% had a fair phenotype (Fitzpatrick skin type I or II). Of the total patients, 29% had been diagnosed with melanoma by a dermatologist; 29% of patients presented with a very thick melanoma (Breslow thickness, >2 mm) and 25% with an ulcerated melanoma. In total, 1% of patients had distant metastases and 13% exhibited lymph node involvement. Holidays with sun exposure 5 years prior to CM diagnosis were significantly associated with positive prognostic factors, including lower Breslow thickness (P

Tricholemmal carcinoma is a malignant cutaneous adnexal tumor showing outer root sheath differentiation, thought to be the malignant counterpart of trichilemmoma. Although the real existence of tricholemmal carcinoma continues to be a matter of debate, it has been introduced in the recently published 4th edition of World Health Organization classification of skin tumors. Herein, we evaluated whether immunohistochemistry (EMA, CK7, CK5/14, p63, p16, and Ber-EP4) supports tricholemmal carcinoma as a separate entity and whether it could be useful in this differential diagnosis. A total of 9 cases, 3 tricholemmal carcinomas and 6 clear-cell squamous cell carcinomas were evaluated on the basis of histological criteria suggested by the WHO. In our opinion, although these results need to be validated in larger series, they support tricholemmal carcinoma as a separate entity and suggest an immunohistochemical profile (clear-cell squamous cell carcinomas: EMA diffusely positive, CK7 negative; tricholemmal carcinoma: EMA negative, CK7 patchy or moderately positive) that could be useful for this differential diagnosis.

Nevus comedonicus is a rare, benign hamartoma of the pilosebaceous unit that may be isolated or part of the nevus comedonicus syndrome. Although rare in children, complication by hidradenitis suppurativa-like lesions has been described. We present a report of a 9-year-old girl in whom surgical excision was curative, with a review of the relevant literature.

Introduction Eyelid malignant melanoma represents less than 1 % of all skin melanomas and approximately 1 % of all malignant neoplasms of the eyelid skin. Because of its relative rarity, there is a paucity of descriptive papers reporting only small series of reconstructed patients. The repair of eyelid defects represents a reconstructive challenge. Ideally, the reconstruction of the defect must guarantee function with tissue of the same color, texture, and thickness of that of the removed skin and at the same time avoid complications such as ectropion and lagophthalmos. Materials and Methods We describe a consecutive series of 11 patients affected by cutaneous melanoma of the lower lid who underwent full-thickness excision of the neoplasm and subsequent wide excision. All the patients were treated in one-stage reconstruction modality with a modified monopedicle myocutaneous flap, harvested from omolateral upper eyelid, tunneled under the lateral canthus skin and armed with a conchal auricular cartilage framework. Four patients underwent the sentinel lymph node biopsy during reconstructive procedure. No major complications were reported. In our experience, the proposed myocutaneous flap allows to obtain excellent results, both aesthetically and functionally. Conclusions This technique has the advantage of avoiding multi-staged procedures, with respect for the oncological excision indication for head and neck melanoma, decreasing the incidence of associated major complications.

The treatment of complex wounds often requires multiple surgical debridement and eventually reconstruction with skin grafts or flaps, under local or general anesthesia. When the patient's general conditions contraindicate surgical procedures, topical negative pressure with Vacuum Assisted Closure (VAC ®) device can achieve wound healing with reduction of healing time and simpler management. We treated with VAC ® device four patients with complex wounds and important contraindications to surgery. In all the patients, we used VAC ® device with common protocol of topical negative pressure. The healing was obtained in a period variable between 18 and 40 days; the results were satisfactory in three cases, one patient developed an aesthetically unpleasant scar. We present our experience to propose VAC ® when surgical procedures are contraindicated.

Many techniques have been described in the literature for the reconstruction of congenital or acquired defects of the earlobe. Most techniques for earlobe reconstruction use adjacent tissue to compose a pedicled or bilobed flap, but usually require a two-stage procedure, or need a skin graft; more rarely reconstructive methods that led to a satisfactory result and a pleasant appearance in one-stage procedure have been described. We describe a personal and geometrical modification of the double-lobed flap according to Gavello's original technique, which allows to shape the anatomical curvature of the earlobe and to reduce the skin retraction without adding any scars or skin graft. In our opinion, the revisited reconstructive technique provides lots of advantages, improves aesthetical results and provides more natural appearance.

Photodynamic therapy (PDT) is a relatively new therapy in dermatology that uses the topical application of a porphyrin derivative to selectively destroy a cutaneous target. The action is implemented by the application of a specific light frequency. The ability of porphyrin to selectively target tumor tissue has been known since the 1960s. In the late 1970s, the underlying mechanism was defined, and Dougherty’s discovery of the first chromophore led to the production and commercialization of Photofrin®. Many other chromophores that can act as photosensitizers have been studied since then, with aminolevulinic acid currently the most commonly used chromophore in clinical practice. PDT is simple, minimally invasive and can be administered on an outpatient basis. The efficacy of PDT has been proven for actinic keratosis, Bowen’s disease and basal cell carcinoma; another of its well-known applications is the treatment of photoaging. Indications for its use are continuously increasing, and promising results are reported for various skin diseases. In this paper we report the mechanism of action of PDT with aminolevulinic acid, the literature concerning the most common diseases treated with PDT and the subsequent level of evidence.

ObjectiveMany techniques have been proposed to reconstruct acquired vulvar defects. In our experience, every type of vulvar defect can be repaired with 2 pedicled flaps, namely, the pedicle deep inferior epigastric perforator (DIEP) flap and the lotus petal flap (LPF).Materials and MethodsWe report our reconstructive algorithm for vulvar reconstruction, based on the topography of the defect, applied in 22 consecutive patients from 2000 to 2012. According to the proposed algorithm, DIEP flap and LPF (monolateral or bilateral type) can repair all kinds of wide vulvar defects. Surgical defects were classified as type I (IA and IB) and type II in relation to the anatomy of the defect.ResultsNo major complications were reported in our series. All patients reported satisfactory results, both functionally and aesthetically.ConclusionsWe propose an easy classification of acquired vulvar defects separating the ones consequent only to the vulvar resection, with preservation of vagina (type I), by the wider defects after vaginal and vulvar resection (type II); type I can be subclassified into defects consequent to half-vulvar resection (type IA) or to total vulvar resection (type IB). Type I defects (IA and IB) can be reconstructed with monolateral or bilateral LPF; in type II resections, we have a great wound that required more tissue to fill the pelvic dead space, so we prefer pedicle DIEP flap.

The purpose of epiluminescence microscopy (ELM), also referred to as dermoscopy, dermatoscopy , or skin surface microscopy , is to complement the clinical examination of pigmented skin lesions (PSLs) to improve the differential diagnosis between nonmelanocytic and melanocytic lesions and the recognition of early cutaneous malignant melanoma (CMM). 14 In three sections, this article addresses the relationship between Breslow thickness and ELM features of CMM. Section one suggests the essential theoretical background of the association between Breslow thickness and ELM features of the disease. The main events of histogenesis, 3, 4, 6 particularly in the intraepidermal phase and the initial invasion of dermis, can be considered the rationale for interpreting the ELM characteristics of CMM in relation to tumor thickness. The second section briefly reviews previous clinical studies that have reported the relationship between thickness and ELM presentation. Generally, such a crucial issue has been the subject of a limited number of specific reports. Some studies have formally considered the prevalence of ELM features according to thickness 1, 5 ; others have focused on a detailed morphologic analysis of ELM structures and features in relation to thickness, with no statistical evaluation of the observed differences between thin and thick lesions. 8, 10, 11 Some reports have addressed the ELM characteristics of CMM as a function of the histologic type of the lesion, 23 or have compared in situ lesions with invasive CMM 13, 16 ; although indirectly, the latter type of studies has provided useful and important details for the purposes of this review. The third section consists of selected iconographic material from the Skin Cancer Clinic of Ravenna 19, 20, 21, 22 and is aimed at providing thickness-specific ELM images to further clarify the ELM features of CMM in different growth phases. The images have been captured with digital ELM equipment consisting of a Leica Wild M-650 stereomicroscope (Leica AG, Heerbrugg, Switzerland), a Sony 3CCD DXC-930P color video camera, an AT-Vista Videographics adapter, an IBM personal computer, a Sony Trinitron Analog PVM-2043MD monitor, and the DBDERMO MIPS software (Dell'Eva/Burroni, Florence/Siena, Italy). 19, 20, 21, 22 The digital images were processed at 768 × 576 pixels and 16 bytes per pixel.

Vaser-assisted lipoplasty (VAL) presents a fundamental change in the treatment and subsequent removal of targeted fatty tissues. The advantage of Vaser mode is that the peak energy is delivered in short burst (the “on” condition) and is strong enough to emulsify fatty tissue while the average energy delivered over time is reduced compared to continuous mode. Vaser technology and Vaser technique are described.

Granular cell tumor of Abrikossoff is a rare neoplasm that may occur in a wide variety of cutaneous and visceral sites. Granular cell tumor generally shows benign behavior. However, malignant outcome with metastatic spread has also been reported. Until now, no data were available on the most useful imaging approach for diagnosis and staging. We present a case of F-18 fluorodeoxyglucose positron emission tomography in Abrikossoff tumor, suggesting that F-18 fluorodeoxyglucose positron emission tomography may have a potential role in the management of this neoplasm.

18015 Background: There is increasing evidence that the expression of Cyclo-oxygenase 2 correlates with development and progression of malignant melanoma. Celecoxib (C) has demonstrated some kind of activity in monotherapy in melanoma. Temozolomide (T) has consistent activity in melanoma, either as monotherapy or in combination. We designed a phase II study to determine the efficacy and toxicity of the combination of Celecoxib and Temozolomide in advanced melanoma as first line of therapy Methods: From January 2004 to October 2005, 13 patients with metastatic melanoma were enrolled in the study. There were 4 males and 9 females. The median age was 59 years. Patients received Temozolomide 200/mg/mq day po for 5 days every 4 weeks and Celecoxib 400 mg BID for 10 days every 4 weeks. Results: Among 12 evaluable patients there were 4 partial responses (30.8%), no complete response or disease stabilization. Progression occurred in 8 patients (61.5%). The median TTP was 3.14 months and the median survival was 9.06 months. The median number of cycles was 2, only 2 patients completed four cycles of treatment. Most commonly seen toxicities were nausea/vomiting (46%), fatigue (93%), thrombocytopenia (15.3%), leukopenia (7.6%). Two patients discontinued the treatment due to grade 4 thrombocytopenia. Conclusions: The combination of Temozolomide and Celecoxib is safe, manageable and provides clinical benefit, but its activity is not superior to standard therapy. No significant financial relationships to disclose.