Bone-Anchored Hearing Devices for Single-Sided Deafness: A New Preoperative Evaluation Protocol and Widening of Indications Proposal.

INTRODUCTION: Bone-anchored hearing devices (BAHD) are well-known good solution for single-sided deafness (SSD). Despite power extension of recently introduced BAHD with implanted active transducer, with indications up to 65 dB Hl of bone conduction (BC) threshold on the implanted side, their indications for SSD still remain better than 25 dB on the good ear, with regards to bone conduction thresholds. The aim of this study was to assess the possibility to enlarge BAHD indications for SSD by means of a newly proposed candidacy evaluation protocol, which includes a new software-aided method. METHODS: 20 SSD patients (mean age 56 years, 9 females, and 11 males) were divided into two groups: group A (10 patients, BC <25 dB Hl on the hearing side) and group B (10 patients, BC between 25 and 35 dB Hl). Recipients were submitted to bisyllabic words speech audiometry in silence and to authors' newly proposed IFastSRT50 test by means of software which shift noise intensity of a single word list on the basis of correct recipient recognition responses. A sound speaker for signal (bisyllabic words) and noise (babble) was disposed at 1 m from the deaf side of the patient. An earphone covering only the good ear of the recipient was used in order to perform its air conduction masking with white noise. A BAHD test device was disposed on the mastoid of the deaf side. Both signal and masking intensities were set to 55 dB SPL in order to mask airway conduction on the good ear without masking its bone way interaural conduction from the BAHD tester. RESULTS: With BAHD tester turned off, no recognition was detected. Speech audiometry with BAHD tester turned on revealed mean values of 92% for group A and 89% for group B, with a difference of 3.0% (χ2 = 0.285 and p = 0.5935). As for IFastSRT50 with BAHD tester turned on, mean signal-to-noise ratio value to obtain 50% of recognition was -6.89 for group A and -6, with a difference of 0.89 (t = 1,201 and p = 0.2453). CONCLUSION: BAHD are confirmed to be a good solution for SSD cases. The absence of statistically significant differences in our two tested groups suggests that newer implanted active transducer device indications should be extended up to 35 dB Hl on the hearing ear. The IFastSRT50 is a reliable and quick method to enhance preoperative candidacy evaluation.

Visuo-proprioceptive training reduces risk of falls in patients with multiple sclerosis.

Lack of balance and falls are common and disabling symptoms of multiple sclerosis. The aim of this study was to investigate the effectiveness of a novel visuo-proprioceptive feedback training in ameliorating balance and reducing the risk of falls. Patients with multiple sclerosis with unrestricted walking ability and healthy age/sex-matched controls were recruited. After a baseline clinical evaluation, including a postural assessment in double- (stabilometric test) and single-leg stance (monopodalic test) by a computerized postural recorder device, patients were submitted to a run-in period lasting 6 weeks without any rehabilitative intervention. Two further clinical and postural evaluations before and after a 6-week period of training were performed. The training protocol provided static and dynamic exercises both in double- and single-leg stance, with and without a translating Freeman-like board. Visual feedback was shown on the computer screen during the exercises. We recruited 40 consecutive patients and 12 controls. Patients had significantly poorer postural performances than controls. Twenty-eight patients completed the study follow-up. No significant changes in risk of falls emerged after the run-in period. A significant reduction in the median percentage of risk of falls in single-leg stance (open eyes: 39.3 versus 15.7; closed eyes: 67.3 versus 52.6; p < 0.001, respectively) were observed after rehabilitation. Moreover, an improvement in walking speed (median time: 7.4 s versus 6.3; p = 0.001) was detected in the absence of Expanded Disability Status Scale changes. We conclude that visuo-proprioceptive training improves balance and reduces falls in multiple sclerosis.

Good response to second-line bevacizumab and interferon-alpha in a sunitinib-refractory patient with metastatic renal cell carcinoma.

In recent years with the development of targeted agents such as bevacizumab, sunitinib, sorafenib, temsirolimus, and everolimus, the treatment of metastatic renal cell carcinoma has changed dramatically. In clinical practice, sunitinib and bevacizumab are reserved for first-line treatment, but despite various guidelines, optimal treatment is still uncertain. We present, for the first time, a case of a good response to second-line bevacizumab and interferon-alpha in a patient who failed classical sunitinib treatment.

Positive experience of intraperitoneal chemotherapy followed by intravenous chemotherapy in heavily pretreated patients with suboptimal residual ovarian cancer and primary peritoneal cancer.

AIMS AND BACKGROUND: To assess feasibility and toxicity of intraperitoneal administration of cisplatin and paclitaxel, followed by intravenous chemotherapy in pretreated patients with suboptimal ovarian cancer (residuum >1 cm) or primary peritoneal tumor, and suffering from ascites and/or intestinal obstruction. METHODS: Fourteen relapsed ovarian cancer patients, 5 of whom were platinum sensitive (platinum-free interval >6 mo), 7 platinum-resistant (platinum-free interval <6 mo), and 2 platinum-refractory, received one cycle of intraperitoneal cisplatin, 100 mg/m2 on day 1, and two cycles of intraperitoneal paclitaxel, 120 mg/m2 on days 8 and 14. Intravenous chemotherapy was administrated 4 weeks following the last intraperitoneal paclitaxel instillation. Blood and peritoneal fluid samples were harvested at 0, 1, 4 and 24 h after ending paclitaxel delivery to guarantee proper tumor exposure and patient safety. RESULTS: Intraperitoneal cisplatin determined 6 cases of vomiting grade 1-2 (40% of the morbidity). Intraperitoneal paclitaxel was associated with 6 events of grade 1-2 abdominal pain; the only grade 4 toxicity was one case of neutropenia and one of mucositis. Ascites decreased in 11 patients: the median time to first need for paracentesis was 5 months, compared to a median baseline paracentesis of 4 weeks. Three intestinal normalizations were obtained. The median overall survival was 10 months for our cohort of patients. Intraperitoneal paclitaxel clearance was significantly higher in patients with suboptimal tumor and symptomatic disease than in patients with smaller residual masses and without ascites (P = 0.004). CONCLUSIONS: Intraperitoneal treatment was feasible, and enhanced response to the following intravenous chemotherapy was seen in these patients.

The use of commercially available personal UV-meters does cause less safe tanning habits: a randomized-controlled trial.

UV Index information is currently recommended as a vehicle to raise public awareness about the risk of sun-exposure. It remains unknown to what extent this information can change personal sun-protective behavior. The aim of the study was to analyze the effects of UV-Index (UV-I) information provided by low cost, commercially available UV-I sensors on major indicators of sun-tanning behavior. A randomized-controlled trial was carried out on 94 healthy volunteers aged 21-23 years. After the exclusion of subjects with photosensitive disorders (n=3), 91 subjects were randomized in two arms after stratification based on phototype and sex. Both arms received a diary to be filled every day with a log of intentional sun-exposure during summer. Subjects in the intervention group also received a commercially available UV-I sensor. The UV-I sensors were switched on and the UV-value was recorded in 77% of days with sun-exposure. During days of sun-exposure, subjects randomized to the intervention group had longer average time of sun-exposure (227.7 vs 208.7 min per day, P=0.003), also between noon and 4 pm (P<0.001), and less frequently adopted sun protective measures than controls (hat [6.4%vs 10.2%, P=0.007], sunglasses [23.9%vs 30.8%, P=0.003], sunscreen [41.4%vs 47.2%, P=0.02]) and they experienced more frequent sunburns (27.8%vs 21.5%, P=0.004). The odd ratio of sunburns was 1.60 for subjects in the intervention group compared with controls (after adjustment for sex, sunscreen use and skin type). The mean UV-I value recorded by volunteers was lower (5.6 [SD+/-0.9]) than that (7.3 [SD+/-0.46]) recorded by a professional instrument in the same period at the same latitude. Poststudy laboratory tests showed that the sensor was able to detect only about 60% of the solar diffuse radiation. The use of UV-I sensors changed the sun protective behavior of sunbathers in the direction of less use of sun protective measures. One possible explanation is that the low cost UV-meters may have functioned incorrectly and under-reported UV exposure. This may have led to an underestimation of UV-I values, erroneously reassuring subjects and causing a less protective sunbathing behavior. Another hypothesis relies on a cognitive pitfall in the subjects' dealing with intermediate UV-I values, as they may have been discouraged in the use of sunscreen as they did not feel that they had yet been exposed to very harmful UV radiation.

Medical history, drug exposure and the risk of psoriasis. Evidence from an Italian case-control study.

BACKGROUND/AIMS: To evaluate the association of psoriasis with selected medical conditions and a number of drugs used before diagnosis. METHODS: Multicenter case-control study involving outpatient services of 20 general and teaching hospitals. Entry criteria for cases were a first diagnosis of psoriasis made by a dermatologist and a history of skin manifestations of no more than 2 years after the reported onset of the disease. Controls were the first eligible dermatological patients observed on randomly selected days in the same centers as cases. A total of 560 cases and 690 controls were recruited. RESULTS: The odds ratio (OR) of psoriasis was 0.8 (95% confidence interval, CI, 0.5-1.3) in hypertensive subjects, 1.1 (95% CI 0.6-2.0) in diabetics and 1.1 (95% CI 0.7-1.7) in hyperlipidemic subjects. Histamine 2 receptor antagonist exposure was negatively associated with psoriasis: OR 0.3 (95% CI 0.1-0.8). CONCLUSION: Our study rules out a strong association of psoriasis at its first ever diagnosis with common chronic conditions. The reported associations of psoriasis with relatively common conditions such as diabetes mellitus, hypertension and hyperlipidemia may represent a late effect of well-known risk factors for psoriasis such as smoking and overweight or reflect factors related to the long course of psoriasis itself.

Melanoma incidence in central Italy will go on increasing also in the near future: a registry-based, age-period-cohort analysis.

The aim of the study was to evaluate malignant melanoma incident trends in central Italy by means of an age-period-cohort approach. A total of 1977 malignant melanoma (15-84 years) incidents in the area of the Tuscany Cancer Registry between 1987 and 2001 were analysed. Poisson regression has been used to estimate age, cohort and period effect. A nonlinear regression model was used to estimate the expected number of new cases in the period 2002-2006. Incidence rates increased in all age, period and cohort groups. The model that best fitted the data included age and 'drift'. The linear effect ('drift') showed, in each age group, an increase of the risk of malignant melanoma diagnosis of about 36.6% every 5 years of period or cohort. For the period 2002-2006, 1112 new cases were predicted with a standardized rate (age 15-84 years) of 19.2x100.000. In the Tuscany Cancer Registry area, no clues for malignant melanoma incidence rates levelling off were documented. Growing rates and number of malignant melanoma are expected in the near future.

The melanoma epidemic debate: some evidence for a real phenomenon from Tuscany, Italy.

Our objective was to evaluate whether or not recent mortality data for the region of Tuscany confirm the hypothesis that an epidemic in the incidence of melanoma is an apparent phenomenon reflecting an overdiagnosis of indolent cases. We considered 1755 melanoma deaths in Tuscany in the period 1987-2003, and 2644 incidence cases of melanoma diagnosed in 1985-2003 in a subset of the same population. We calculated annual mortality and incidence trends using the National Cancer Institute's Joinpoint Program (version 2.6). We observed an increasing mortality from melanoma from 1987 to 2003 in both sexes, but mainly in women (estimated annual percentage changes=2.25; P<0.05). We also observed a statistically significant rise in melanoma incidence in both sexes, mainly of thin lesions. Furthermore, we observed an increase in thick lesions, especially in females (estimated annual percentage changes=2.9; P<0.05), and for lesions without Breslow definition. In conclusion, the rise in melanoma mortality and incidence, especially of thick lesions, suggests that the observed growth in melanoma incidence is not wholly apparent.

The p.G23S CDKN2A founder mutation in high-risk melanoma families from Central Italy.

We have investigated the frequency and spectrum of CDKN2A/CDK4 mutations in 23 cutaneous melanoma families from Central Italy (Tuscany). Three distinct mutations were identified in five families. One mutation, p.G23S, was present in three families. Several lines of evidence indicate that p.G23S is a pathogenic mutation: it is located in the functionally important first ankyrinic domain of p16, it was not detected in a sample of 100 control individuals, and it was present in all tested affected individuals from the three families. Haplotype analysis showed a common ancestral origin of the p.G23S mutation. Our data show that the p.G23S mutation is an important cause of hereditary melanoma in Tuscany.

Prognostic variables and prognostic groups for malignant melanoma. The information from Cox and Classification And Regression Trees analysis: an Italian population-based study.

The common way to analyse the prognostic role of selected variables in cutaneous melanoma patients is by means of Cox proportional hazard model. The prognostic effect of the simultaneous presence of more than one independent variable in the same patient is, however, difficult to establish. This hampers the possibility of tailoring a survival expectance for a selected patient as well as to communicate it to the patient himself/herself. The objectives of the study were to compare information on cutaneous melanoma prognosis from multivariate Cox proportional hazard model and from Classification And Regression Trees analysis. Classification And Regression Trees analysis is an automatic method that splits data by means of a binary recursive process creating a 'tree' of groups with different profiles according to the analysed outcome, for example, the risk of death. This approach automatically produces data that is easily interpreted by clinicians. A total of 1403 invasive cutaneous melanoma patients, 1110 from the Tuscan Cancer Registry and 293 from the Reggio Emilia Cancer Registry, Italy, were included. Cases were incident during 1996-2001 and followed up at the end of 2003. Cox proportional hazard model and Classification And Regression Trees analysis were applied to the following variables: age, sex, Breslow thickness, Clark level, registry, subsite and morphologic type. The Classification And Regression Trees analysis identified 10 categories with statistically different survival; this results were summarized into six classes of different risks based on Breslow thickness, age and sex. The best prognostic group (5-year observed survival, 98.1%) included those subjected with Breslow less than 0.94 mm and age 19-44 years. The same thickness but an older age (50-69 years) was associated with a statistically significant different prognosis (5-year observed survival, 92.8%). The Cox proportional hazard model found sex, age, Breslow thickness, Clark and morphologic type to have a significant independent prognostic value. In conclusion, compared with the conventional approach based on Cox hazard model, Classification And Regression Trees analysis produces data closer to the clinical need of defining the prognostic profile of a specific patient. This may help the clinician both in the communication of risk and in the follow-up strategy.

Baseline factors influencing decisions on digital follow-up of melanocytic lesions in daily practice: an Italian multicenter survey.

BACKGROUND: Guidelines for optimized use of digital follow-up of melanocytic lesions are not yet available, and little is known about inclusion criteria adopted in clinical practice. OBJECTIVE: Our purpose was to describe the frequency of digital follow-up adoption in melanoma screening, the characteristics of patients and lesions selected, and the predictors of duration of the intervals of digital follow-up. METHODS: Baseline characteristics of patients and lesions selected for digital follow-up in 12 Italian pigmented lesion clinics were examined. Predictors of a short follow-up interval (4.75) was associated only with a marginal effect on the scheduled duration of follow-up interval (OR 1.34, 95% CI 0.97-1.86). These findings were confirmed by a multivariate analysis. LIMITATIONS: The adoption of different digital dermoscopy systems in the participating centers may have limited the reliability of the TDS assigned by a central group to dermoscopy images. CONCLUSIONS: Practicing dermatologists who use digital epiluminescence microscopy in screening for melanoma decided to submit at least one melanocytic lesion to digital follow-up for approximately 1 patient for every 5 examined. This implies costs and time spent that need to be evaluated together with the benefits of this procedure from a large-scale perspective. The lack of well-defined guidelines for inclusion and exclusion criteria may hamper optimized use of digital follow-up in daily practice.

Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study.

We conducted a case-control study to analyse the association of psoriasis of recent onset with smoking habits, body mass index (BMI) and stressful life events. Cases (n=560; median age 38) were patients with a first diagnosis of psoriasis and a history of skin manifestations of no longer than two years after the reported disease onset. Patients with a new diagnosis of skin diseases other than psoriasis (n=690; median age 36) were selected as controls. The risk of psoriasis was higher in ex- and current smokers than in never-smokers, the relative risk estimates (OR) being 1.9 for ex-smokers and 1.7 for smokers. Smoking was strongly associated with pustular lesions (32 patients, OR=5.3 for smokers). The frequency of psoriasis varied significantly in relation to a family history of psoriasis in first degree relatives, BMI (OR=1.6 and 1.9 for over weighted, BMI 26-29, and obese, BMI >/= 30, respectively) and stressful life event score (compared to the lower index quartile, the OR being 2.2 for index values >/=115). Risk estimates, when taking into consideration the combined effect of these factors with smoking habits, were consistent with a multiplicative model of risk combination with no significant statistical interaction.

Seasonal variation in the diagnosis of cutaneous melanoma and non-cutaneous malignancies: an Italian population-based study.

The aim of the present study was to investigate whether or not the diagnosis of cutaneous melanoma and non-cutaneous tumours shows seasonal variations. Data from the Tuscany Cancer Registry, central Italy, for malignant cutaneous melanomas (no. 2062) and non-skin cancers (no. 114,755), diagnosed during 1985-2000, were used to evaluate the monthly variation in the number of diagnoses. The chi-squared test was used to evaluate the heterogeneity in the monthly number of cancer diagnoses throughout the year and to compare monthly proportions between groups. Poisson multivariate regression was used to estimate the monthly risk of cancer diagnosis. Clear monthly variations were evident for both melanoma and non-cutaneous cancers, but the monthly diagnosis distributions differed. Statistically significant peaks in June [relative risk (RR), 1.54] and July (RR, 1.40) and a lower risk for January (RR, 0.76), in comparison with the mean monthly value, were documented for melanoma. Monthly risks were similar for thin (< or =1 mm) and thick (>1 mm) melanomas and for males and females. A peak in May-June and October and significantly lower numbers of cases in August and December were detected for all non-skin cancers. The holiday periods may influence the seasonality in the diagnosis of melanomas and non-cutaneous cancers. However, the monthly fluctuation for melanoma differed from that for non-cutaneous cancers; the peak in July suggests an additional effect of summer clothing, with fewer clothes worn and more skin visible, on melanoma diagnosis.

Epirubicin plus paclitaxel regimen as second-line treatment of patients with small-cell lung cancer.

BACKGROUND/AIM: Most patients with small cell lung cancer (SCLC) experience relapse within one year after first-line treatment. The aim of this study was to describe activity and safety of second-line with epirubicin at 70 mg/m(2) followed by paclitaxel at 135 mg/m(2) on day 1 every three weeks for a maximum of six cycles. PATIENTS AND METHODS: This is a retrospective review of all patients with SCLC evaluated for second-line treatment between 2003 and 2013 at our Institution. RESULTS: Sixty-eight patients received the study regimen of epirubicin with paclitaxel. We observed partial response in 19 (30%), stable disease in 22 (34%) and total early failure rate in 23 (36%) patients. Median progression free and overall survival were 21.8 and 26.5 weeks, respectively. Haematological toxicities were as follows: grade 3-4 leukopenia and neutropenia in 18 (31%) and 30 (22%) of patients, respectively; grade 3 anaemia and grade 4 thrombocytopenia were reported in 2 (3%) and 5 (9%) of patients, respectively. CONCLUSION: Epirubicin with paclitaxel is an active and tolerable second-line regimen in patients with SCLC.

Unexpected reduction of mortality rates from melanoma in males living in central Italy.

A registry-based study has been carried out in central Italy to investigate cutaneous melanoma incidence and mortality trends. The incidence of invasive (1492 cases analysed) and in situ (224 cases) cutaneous melanomas increased significantly from 1985 to 1997, in both genders. The increase of invasive tumours was mainly due to 'thin' (

Dermatologist detection and skin self-examination are associated with thinner melanomas: results from a survey of the Italian Multidisciplinary Group on Melanoma.

OBJECTIVE: To investigate patterns of detection and variables associated with early diagnosis of melanoma in a population at intermediate melanoma risk. DESIGN: Survey. SETTING: Hospital and university centers belonging to the Italian Multidisciplinary Group on Melanoma. PATIENTS: Eight hundred sixteen patients who were consecutively diagnosed as having melanoma and treated at 11 participating centers. MAIN OUTCOME MEASURE: Relationship between patterns of detection and patient's and physician's delay with melanoma thickness, assessed by multivariate analysis. RESULTS: A statistically significant association with early diagnosis was found for female sex (odds ratio [OR] for a lesion >1 mm in thickness, 0.70; 95% confidence interval [CI], 0.50-0.97), higher educational level (OR, 0.44; 95% CI, 0.24-0.79), residence in northern and central Italy (compared with southern Italy) (OR, 0.44; 95% CI, 0.30-0.65 and OR, 0.24; 95% CI, 0.15-0.37, respectively), and the habit of performing a skin self-examination (OR, 0.65; 95% CI, 0.45-0.93). When adjusted for all the previously mentioned variables, only melanoma detection made by a dermatologist, maybe incidentally, was associated with a statistically significant additional effect on early diagnosis (OR, 0.45; 95% CI, 0.28-0.73). No significant effect of anatomical site (trunk compared with other sites: OR, 0.83; 95% CI, 0.59-1.17), presence of atypical nevi (OR, 0.78; 95% CI, 0.52-1.17), and patient's delay (>3 months compared with < or =3 months: OR, 1.12; 95% CI, 0.78-1.60) was found. CONCLUSION: Future melanoma early diagnosis strategies should adequately stress the role of skin self-examination among the adult population, and should recommend that dermatologists perform a total skin examination to identify suspect lesions (such an examination should also be performed during consultations for other reasons).

Frequency and characteristics of melanomas missed at a pigmented lesion clinic: a registry-based study.

To ensure the removal of all melanomas at an early phase, a number of benign lesions are currently excised for diagnostic evaluation. Nevertheless, little is known about the frequency of melanomas missed (neither recognized nor excised for diagnostic verification) by early detection practices. This study aimed to investigate the diagnostic performance of a specialized pigmented lesion clinic (PLC) through linkage with a local cancer registry. In 1997, 1741 individuals resident in the area of Florence and Prato, Italy, the catchment area of the Tuscany Cancer Registry (RTT), were consecutively examined at a specialized PLC that has been running since 1992 at the Department of Dermatology of Florence. The outcomes of dermatological consultations retrieved from PLC case notes were compared with all the diagnoses of both in situ and invasive melanoma recorded by the RTT until 31 December 1999. The performance of the PLC in detecting cutaneous melanoma was evaluated in terms of sensitivity, specificity and predictive values, with the RTT data as the gold standard. In the population examined at the PLC, 15 newly incident melanomas, all histologically demonstrated, were recorded by the RTT. In 13 of the 15 cases, excision of the lesion had been recommended by PLC staff, while two melanomas, one in situ and one level II 0.60 mm thick invasive, were missed and were subsequently excised 586 and 824 days, respectively, after the first PLC examination. The clinical and dermoscopic features of the invasive lesion were in agreement with a 'featureless' melanoma, and lacked the well-established parameters of malignancy. A total of 67 benign pigmented skin lesions were excised for diagnostic evaluation. Thus the PLC showed a sensitivity in detecting cutaneous melanoma of 86.7% (95% confidence interval [CI] 85.1-88.3%), a specificity of 95.4% (95% CI 94.3-96.3%), a positive predictive value of 13.7% (95% CI 12.1-15.3%) and a negative predictive value of 99.9% (95% CI 99.7-100.0%). The ratio of melanomas to benign skin lesions excised was 1:5.1. In conclusion, specialized examination of pigmented skin lesions at the PLC offered good level of diagnostic performance, with an acceptable cost in terms of benign lesions removed and overall a low risk of missing melanomas.

The problem of false-positive diagnosis in melanoma screening: the impact of dermoscopy.

The predictive value of melanoma diagnosis made by visual examination during pigmented lesion screening is low. This creates the problem of false-positive diagnoses, which lead to unnecessary treatment and scarring. The purpose of this study was to evaluate the impact of dermoscopy (epiluminescence microscopy, dermatoscopy) on the false-positive rate in the routine melanoma screening activity of a pigmented lesion clinic (PLC). In a series of 133 subjects consecutively referred to the PLC, lesions defined as suspicious or equivocal on visual examination were examined by dermoscopy. Only lesions also defined as suspicious on dermoscopy were excised; other lesions were observed at follow-up examinations. Among the 2542 pigmented lesions observed, clinical examination led to identification of 43 suspicious lesions, 13 of which were also suspicious on dermoscopy and were subsequently excised. Histopathological examination revealed three malignant melanomas. Compared with visual examination alone, the addition of dermoscopy to the subgroup of clinically equivocal lesions resulted in an increase in specificity from 98.4% to 99.6% and in positive predictive value from 6.9% to 23%. The specificity of the visit outcome 'subject to be referred for surgical excision' increased from 69.2% to 92.3%. No false-negative melanoma diagnoses on dermoscopy were observed during a follow-up period of 4 years. The addition of dermoscopy to routine PLC activity as a second-level examination led to a reduction in the number of false-positive diagnoses, thus producing an overall increase in the specificity and positive predictive value of melanoma diagnosis.

Relationship between cause of referral and diagnostic outcome in pigmented lesion clinics: a multicentre survey of the Italian Multidisciplinary Group on Melanoma (GIPMe).

Pigmented lesion clinics (PLCs) are permanent units to which subjects presenting with suspicious pigmented skin lesions can be rapidly referred and which can provide a prompt response to an individual's concern about melanoma. However, little is known about the melanoma detection rate in these clinics, in particular with regard to intermediate risk populations. We report a survey involving more than 1000 subjects consecutively referred by family doctors to six Italian PLCs. Using a histological diagnosis of melanoma as the endpoint, the pooled melanoma detection rate at these PLCs was 1.5% (one melanoma for diagnosed every 64 subjects examined), and the ratio between the number of melanomas and benign lesions excised for diagnostic verification was 1: 5.8 (16 melanomas and 93 benign lesions). Almost all the melanomas (15 out of 16) were detected in subjects who had requested referral for a specific doubtful lesion (group A) or for the presence of melanoma risk factors (previous melanoma, large number of common and atypical naevi, family history of melanoma) (group B). Only one melanoma was detected amongst the 418 subjects seeking consultation for concern about their moles (group C) (P = 0.004). The positive and negative predictive values of the referral groups A and B combined were 2.5% and 99.7%, respectively. Since the probability of detecting a melanoma in subjects referred only for reassurance about their moles, which nevertheless represented 43% of the subjects examined, is very low, an optimized role for PLCs in melanoma prevention would be to limit consultation to subjects who present for examination of a specific lesion or who have one or more risk factors for melanoma.

Changes from mid-1980s to late 1990s among clinical and demographic correlates of melanoma thickness.

Tumour thickness is the most relevant prognostic factor for cutaneous melanoma. Although the increasing incidence of melanoma is currently attributable to "thin" lesions, the incidence rates of "thick" melanomas have not declined. We want to identify the clinical and demographic characteristics of patients that are associated with diagnosis of thick (> 3 mm) cutaneous melanoma and whether they had changed from mid-1980s to late-1990s. Cutaneous malignant melanomas incidence in 1985-87 and in 1995-97 were retrieved from the Tuscany Cancer Registry, central Italy. Only cases with Breslow-thickness information (182/260 in 1985-87 and 387/490 in 1995-97) were included. Thickness was categorised in < = 1 mm, 1-3 mm and > 3 mm. Thickness was evaluated for each period of time according to gender, age, histological type, site and residence. For cases diagnosed in 1995-97 the effect of such variables in predicting the risk of a thick tumour (vs. a thin one) was analysed in a logistic model. In 1985-87 patients with thick melanoma were more likely to be - with a statistically significant difference - males (38.1 % of thick tumours) than females (19.4 %), over 70 (57.7 % of thick tumour), with nodular melanoma (62.1 %) and residents far from the city of Florence (30.3 %); no differences were evidenced according to site. From 1985-87 to 1995-97 there was a global shift towards thinner melanomas. In 1995-97 nodular type and old age were the only variables significantly associated with thick melanomas when other factors were taken into account in a multivariate analysis. According to most recent data, early detection activities should be focused on older patients and on nodular histotype. Male sex and residence was no longer found to be associated with late melanoma diagnosis.