Chest ultrasonography in health surveillance of asbestos-related lung diseases.

OBJECTIVES: Exposure to asbestos fibers can lead to different lung diseases, such as pleural thickening and effusion, asbestosis, mesothelioma, and lung cancer. These diseases are expected to peak in the next few years. The aim of the study was to validate ultrasonography (US) as a diagnostic tool in the management of lung diseases in subjects with a history of occupational exposure to asbestos. METHODS: Fifty-nine retired male workers previously exposed to asbestos were enrolled in the study. Chest US was performed in all the subjects. The US operator was blinded to earlier performed computed tomography (CT) scan reports and images. The sonographic pathological findings were pleural thickening (with or without calcifications), peripheral lung consolidation, and focal sonographic interstitial syndrome and diffuse pneumogenic sonographic interstitial syndrome (pulmonary asbestosis). Significant US findings were recorded, stored, and subsequently compared with CT scans. RESULTS: With some patients falling into more than one category, on CT scan, pleural thickening was reported in 33 cases (56%, 26 with calcifications), focal interstitial peripheral alterations in 23 (39%), asbestosis in 6 (10%), and peripheral lung consolidation in 13 cases (22%). Comparing each pathological condition to CT scan reports, US findings had high levels of sensitivity, specificity, positive, and negative predictive values. US did not prove effective for the detection of central lung nodules or diaphragmatic pleural thickenings. Chest US was considered to be the best technique to detect minimal pleural effusions (six subjects, 10%). CONCLUSIONS: Chest US might be considered an additional tool to follow up subjects occupationally exposed to asbestos who have already undergone CT scan examination and whose pathology is detectable by US as well.

Slow-growing melanoma: Report of five cases.

BACKGROUND: Epidemiologic data on melanoma reveal a considerable increase in incidence, especially of the early forms (melanoma in situ and early invasive melanoma), but the mortality rates are relatively stable. These data suggest the hypothesis of the existence of a melanoma with less aggressive biological behaviour. This hypothesis is, however, hard to be proven if the assumption is true that more and less aggressive melanomas very often exhibit overlapping clinical and histopathologic features. Digital dermoscopic imaging techniques permit today a detailed documentation of lesions over time and, therefore, represent an optimal tool to disclose the natural evolution of a given lesion. We present five case of slow-growing melanomas observed during a long-term period of follow-up. MAIN OBSERVATION: Five pigmented skin lesions from five patients with multiple atypical melanocytic nevi were examined at the baseline consultation and digital pictures were taken for monitoring purposes. The lesions have been followed-up for a long time because of the absence of significant changes over time. After a variable period of follow-up (1 to 10 years) all lesions were finally removed and subsequent histopathologic examination revealed early stage melanoma in all cases. CONCLUSION: Dermoscopy and digital follow up might be the key factors to improve the knowledge about the natural evolution of nevi and melanoma and the spectrum of undefined melanocytic proliferations.