Melanoma in the elderly.

BACKGROUND: Among older patients, melanoma in general presents biological features related to a more aggressive biology, such as more locally advanced tumor. Management of melanoma in elderly may be difficult, mainly due to comorbidities. We report the experience of the Melanoma Unit of ASST Spedali Civili in Brescia, Italy. METHODS: Study subjects were drawn from 3444 patients with histological confirmed melanoma. Data were extracted from electronic database of the Melanoma Unit of ASST Spedali Civili in Brescia, Italy. Patients who received diagnosis of cutaneous melanoma at age of 65 years or older were retrospectively evaluated. For each diagnosed melanoma, histological characteristics, treatment, and outcomes were evaluated. RESULTS: Of the 805 patients described in this study, 444 were males and 361 females. Statistically significant differences were found between patients aged 65-80 years and those aged >80 years considering melanoma prognostic factors, such as Breslow thickness, number of mitoses/mm2 and ulceration. CONCLUSIONS: Older age is recognized as an independent poor prognostic factor in melanoma patients, and melanoma in older patients have a distinct natural history. It was found that management of cancer in old person represents a major challenge to medical practice. We believe that the choice of therapy should be individualized and based upon the individual's overall health and that, particularly in these cases, management often requires interdisciplinary cooperation between dermatologist, surgical specialist, oncologist and geriatrician.

Treatment of keloids and hypertrophic scars with bleomycin and electroporation.

BACKGROUND: Keloids and hypertrophic scars are the result of abnormal healing responses and dermal tissue proliferation; current surgical procedures can give rise to exuberant scarring and permanent functional loss or disfigurement. Considering the promising results reported when treating keloids and hypertrophic scars with intralesional bleomycin injection and the enhanced effect of bleomycin when combined with electroporation, the authors hypothesized that electrochemotherapy should be used to treat keloids and hypertrophic scars when other treatments have failed. METHODS: Twenty patients with keloids or hypertrophic scars were treated with one or more sessions of electrochemotherapy and followed prospectively. Bleomycin was administered intravenously followed by application of electrical pulses to the lesion site. Treatment efficacy was determined either by clinical evaluation (e.g., volume, flattening, pliability, erythema) or by the patient's self-reported symptomatology (e.g., pruritus, pain). RESULTS: Treatment was well tolerated by patients, and no serious adverse events were observed. A median reduction of 87 percent (range, 41 to 100 percent) was observed in volume size, and 33 lesions (94 percent) showed a volume reduction of more than 50 percent. Scar pliability and erythema scores were also significantly reduced (p < 0.0001). A reduction in hitching was observed in 89 percent of patients (p < 0.0001), and a reduction in pain was observed in 94 percent (p < 0.0001). Only one recurrence was observed after 18 months. CONCLUSION: Electroporation in combination with bleomycin is an effective treatment for patients affected by large keloids or hypertrophic scars or patients who are nonresponders to other treatments. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Nodal staging in localized melanoma. The experience of the Brescia Melanoma Unit.

BACKGROUND AND OBJECTIVES: We report our experience with patients affected by cutaneous melanoma undergoing sentinel node (SN) biopsy. METHODS: From November 1997 to October 2000 we performed 128 selective lymphadenectomies (SN biopsy) on 127 patients with cutaneous melanoma with Breslow thickness>1 mm or regression or ulceration. Age, sex, tumour location ad histology were recorded. RESULTS: Two hundred and thirty eight SNs were identified by lymphoscintigraphy in 167 lymphatic stations, 236 of them were identified intraoperatively using a gamma probe and patent blue V injection. Twenty-one patients had SNs with melanoma metastases (15.8%), 12 patients in the groin, eight patients in the axilla and one patient in the neck. After therapeutic lymphadenectomy eight more lymph nodes with metastases of melanoma were found in the specimens of three patients. After a follow-up ranging from 10 to 56 months the results are that 111 patients are free of disease. Ten patients died. Three patients have visceral metastases and are alive. One patient has developed two more melanomas. One patient was lost to follow-up. CONCLUSIONS: Our data confirm the clinical reliability of the SN technique in melanoma; for optimisation of the therapeutic strategy, this technique might be considered the standard method of nodal staging in the evaluation of melanoma patients.