Reliability of self-reported information on skin cancer among elderly patients with squamous cell carcinoma.

PURPOSE: We aimed to evaluate reliability of self-reported information on skin cancer among individuals aged > 65 years with cutaneous squamous cell carcinoma (SCC). METHODS: A test-retest was performed with patients completing two questionnaires one month apart. RESULTS: Among 102 recruited patients the response rate was 97.1% (mean age 80.9 years, 74.8% men). The majority of items showed substantial agreement: history of skin cancer screening (k = 0.88), past skin cancer in general (k = 0.92), basal cell carcinoma (k = 0.75), patient delay (k = 0.64) and total delay (k = 0.86). Agreement was high also for ages > 80 years. Recall of past SCCs (k = 0.48) and sunscreen use (k = 0.38) was less accurate. CONCLUSIONS: Our study provided evidence on the reliability of patient reported skin cancer information among elderly individuals, who represent the majority of affected cases.

Delay in diagnosis and treatment of squamous cell carcinoma of the skin.

Advanced squamous cell carcinomas (SCC) of the skin can cause significant tissue destruction and may metastasize. Understanding the determinants of patient delay could help prevent advanced presentation. The purpose of the present study was to examine patient- and healthcare-related factors associated with delay before the detection and treatment of SCC. A sample of 308 patients with SCC treated at a dermatological referral centre in Italy were interviewed. Clinical data were obtained from the medical records. The highest quartile patients reported > 9 months delay between noticing the lesion and the first medical visit (defined as long patient delay). Multivariate analysis showed that SCC arising on pre-existing chronic lesions were associated with long patient delay (odds ratio = 3.17; 95% confidence interval 1.1-9.3). Controlling for confounders, the first physician's advice to remove the lesion immediately was associated with a shorter treatment delay (p < 0.001). In conclusion, our work emphasizes the importance of seeing a doctor about any change in a pre-existing lesion, particularly in light of the fact that SCC on chronic lesions are at greater risk of metastasis and recurrence.

Factors associated with large cutaneous squamous cell carcinomas.

BACKGROUND: Large cutaneous squamous cell carcinoma (SCC) is associated with a higher risk of disfigurement, local recurrence, and metastasis; however, little is known about factors associated with tumor size at diagnosis. OBJECTIVES: We sought to evaluate factors associated with SCC size, including diagnostic/treatment delay and patient and tumor characteristics. METHODS: We studied a stratified sample of 308 patients with SCC recently treated at a dermatologic referral center in Italy. Medical records were reviewed and telephone interviews conducted. Multiple logistic regression was used to examine factors associated with SCC size. RESULTS: With univariate analyses, among both invasive and in situ cases, SCC greater than 2 cm was significantly associated with male gender, tumors arising in chronic lesions, and tumors located on not easily visible sites. Long delay before surgical removal was significantly associated with large SCC size only for invasive SCC (P < .001). Among patients with invasive SCC, when controlling for age and gender, multivariate analysis showed a significantly higher likelihood of SCC greater than 2 cm with a total delay longer than 18 months before surgical removal (odds ratio=4.18; 95% confidence interval 2.45-7.13) and for tumors arising in chronic lesions (odds ratio=6.42; 95% confidence interval 3.13-13.2). LIMITATIONS: The study was cross-sectional and based on a single center. CONCLUSIONS: Long total delay in removal significantly increased the likelihood of invasive SCC greater than 2 cm. Our findings highlight the importance of early detection and treatment to prevent large invasive SCCs, which are associated with a higher risk of disfigurement, recurrence, and metastasis. Particular attention should be paid to chronic skin lesions and not easily visible body sites during physician- and patient-performed examinations.

Primary amyloidosis of the eyelid: a case report.

The Authors describe a case of primary localized amyloidosis of the eyelids, focusing on diagnosis and possible treatment. The involment of several structures of the eyelid such as muscles, conjunctiva and puncta lacrimalia, as well as peculiar features of these proteinaceous deposits, suggest different combined procedures and precise timing in choosing the appropriated therapy.

[Sentinel node radiolocalisation and predictive value in lip squamous cell carcinoma].

PURPOSE: Is to evaluate the role of the sentinel node (SN) radiolocalisation and its prognostic value in state T2N0M0 squamous cell carcinomas (SCC) of the lip. MATERIALS AND METHODS: Between November 1999 and June 2002 we enrolled 11 consecutive patients (8m,3f) affected with lower lip SCC (7 pts.), labio-commissure (3 pts.) and upper lip (1 pt). Lymphoscintigraphy was performed three hours before surgery. After topical anaesthesia (Lidocaine spray 10%), 30-50MBq of Nanocoll-Tc99m diluted in a 0.3 ml physiological solution was injected intradermally, divided into two peri-lesional points. Planar static acquisition began immediately after the injection in order to visual lymph drainage pathways (lateral and/or anterior view, 512x512 matrix, 5 min. pre set time, LEGP collimator). All patients underwent only selective lymph adenectomy of the SN. RESULTS: SN were visible in all patients within 5 minutes after the injection. In all patients the SNs were observed in the submandibular area (I neck level) in three patients a second SN was localized in latero cervical area (II neck level). All patients were staged SN negative. The average disease free interval for patients who underwent a selective lymph adenectomy of the SN was 20 months with continuing follow-up. CONCLUSIONS: We must stress the importance of performing an immediate exploratory dynamic or static scintigraphy within the first minutes of the radio tracer injection, in order to acquire a precise SN localisation and an accurate mapping of the tumour lymphatic pathways. SN radio localisation is especially beneficial in T2N0 stage patients where immediate lymphadenectomy is not necessary. It also saves time and cuts costs, which are specific goals in the current climate of health service management. Although our results are encouraging, a larger data base from multi centre trials with a five year follow-up would confirm the validity of our approach.