Is Pediatric Melanoma Really That Different from Adult Melanoma? A Multicenter Epidemiological, Clinical and Dermoscopic Study.

PURPOSE: To improve the diagnostic accuracy and optimal management of pediatric melanomas. METHODS: We conducted a retrospective descriptive, multicenter study of the epidemiological, clinical, and dermoscopic characteristics of histopathologically proven melanomas diagnosed in patients less than 18 years old. Data on sociodemographic variables, clinical and dermoscopic characteristics, histopathology, local extension, therapy and follow-up, lymph node staging, and outcome were collected from the databases of three Italian dermatology units. We performed a clinical evaluation of the morphological characteristics of each assessed melanoma, using both classic ABCDE criteria and the modified ABCDE algorithm for pediatric melanoma to evaluate which of the two algorithms best suited our series. RESULTS: The study population consisted of 39 patients with a histologically confirmed diagnosis of pediatric melanoma. Comparing classic ABCDE criteria with the modified ABCDE algorithm for pediatric melanomas, the modified pediatric ABCDE algorithm was less sensitive than the conventional criteria. Dermoscopically, the most frequent finding was the presence of irregular streaks/pseudopods (74.4%). When evaluating the total number of different suspicious dermoscopy criteria per lesion, 64.1% of the lesion assessments recognized two dermoscopic characteristics, 20.5% identified three, and 15.4% documented four or more assessments. CONCLUSIONS: Contrary to what has always been described in the literature, from a clinical point of view, about 95% of our cases presented in a pigmented and non-amelanotic form, and these data must be underlined in the various prevention campaigns where pediatric melanoma is currently associated with a more frequently amelanotic form. All the pediatric melanomas analyzed presented at least two dermoscopic criteria of melanoma, suggesting that this could be a key for the dermoscopic diagnosis of suspected pediatric melanoma, making it possible to reach an early diagnosis even in this age group.

The use of cisplatin electrochemotherapy in nonmelanoma skin cancers: A single-center study.

Electrochemotherapy (ECT) is a well-known nonconventional skin cancer ablative method that was shown to be safe and effective for treating both locoregional disease spreading and disseminated cutaneous and subcutaneous lesions from different types of cancer. The most common medications used are bleomycin and cisplatin. In the last years many studies were performed on ECT, lead it to be a valid therapeutic option in many international guidelines. Nevertheless, there are still no clear indications regarding timing of its use. The main aim of this study was first to assess the safety and effectiveness of intralesional cisplatin ECT for treating different types of nonmelanoma skin cancer in a group of eligible patients. The second endpoint was to assess patients' tolerability and symptoms improvement through the treatment. A single-center prospective study was performed. Patients with squamous cell carcinoma, basal cell carcinoma, or skin metastases were selected during 1 month. The ideal setting was the presence of two or three lesions with a maximum diameter of 2 cm. Both primary, recurrent, and metastatic lesions were included. Before and 8 weeks after treatment, all patients were evaluated to assess the number, measurement, and anatomical site of skin lesions using photography and metric notation. The medical device for membrane electroporation was the CLINIPORATOR EPS02 model. The cisplatin concentration was at least 1 mg/mL. The dose for each single lesion was calculated based on its volume, as is the standard procedure for ECT. Local or systemic adverse events and changes in symptoms were evaluated with a questionnaire based on a visual analog scale that was administrated before and after ECT. Eight patients with a total of 18 lesions underwent the procedure (six men and two women). Four out of eight (50%) patients had a complete response to the treatment. However, all eight patients had an overall tumor response (100%), experiencing an improvement in symptoms including less pain and bleeding from the tumor. Our study clearly show that ECT with intralesional cisplatin is a valuable and safety procedure for nonmelanoma skin cancer and cutaneous tumor metastasis. ECT with cisplatin was able to achieve a good local disease control leading to complete response in an half of cases. The results were stable after 1 year of follow-up. The outer ear area displayed a really good response, due to both ear's anatomical configuration and intralesional cisplatin pharmacological characteristics.

Human Papilloma Virus-Associated Lips Verrucous Carcinoma in HIV-Infected Male.

Human papillomavirus (HPV) infection, widely known as the necessary cause of cervical cancer, has been established as a major etiologic factor for head and neck cancer (HNC). HIV-infected individuals are at higher risk of HPV-associated cancers than the general population. We describe a 45-year-old man with HIV and HPV coinfection, who presented progressively enlarging verrucous neoformations of the lips. The final diagnosis of verrucous carcinoma was delayed. Early detection of HPV lesions in oral mucosa and HPV screening activities could be important in improving the diagnostic sensitivity for the HIV-infected patients with oral cancer.

Surgical solutions for the reconstruction of the lower eyelid: canthotomy and lateral cantholisis for full-thickness reconstruction of the lower eyelid.

The lower eyelid is the most common site of tumors of the orbital region, usually of basocellular skin carcinoma, whose incidence is increasing with population aging in Western countries. The treatment must achieve the complete removal of the neoplasm in order to prevent recurrences, thus requiring eyelid and periocular reconstruction. Several techniques are described for eyelid defect reconstruction, aiming for direct suture eased by flaps, or considering the use of grafts. We report our experience with 22 patients operated on for basocellular carcinoma of the lower eyelid, for wich defects were repaired by means of a full-thickness reconstruction using a canthotomy and lateral cantholisis; in 13 patients the canthotomy was combined with a lateral-canthal flap. We achieved good results in terms of orbital function and aesthetic outcome, as long as radical removal of the tumor without local recurrences was attainable.

[Biopsy of the sentinel lymph node in the staging of patients with malignant melanoma]. / La biopsia del linfonodo senti nella nello staging dei pazienti affetti da melanoma maligno.

Sentinel node biopsy, in the treatment of stage I and II skin melanomas (according to the American Joint Cancer Committee classification), has been advocated by several authors as the best compromise between radical intent and minimal surgical invasiveness. The authors present their personal experience based on 64 sentinel node biopsies in patients with stage I and II skin melanoma of the trunk and limbs (30 males and 34 females; age range: 29-77 years). Sentinel node detection was radio-guided and was conducted in the armpit in 43 cases and in the groin in the remaining 21. Eleven patients who presented metastatic nodes underwent a regional lymphadenectomy (8 axillary and 3 groin dissections) with low morbidity and no perioperative mortality.