Clinical and diagnostic features of in situ melanoma and superficial spreading melanoma: a hospital based study.

BACKGROUND: Despite the incidence of in situ melanoma is continuously rising; few studies have investigated its clinical and diagnostic features. OBJECTIVE: To investigate clinical and diagnostic features of in situ melanoma compared to superficial spreading melanoma (SSM). METHODS: This is a hospital based, case-control study. Ninety consecutive patients with an in situ melanoma and 90 age and gender matched patients with SSM were enrolled. Main outcome measures were differences in clinical signs that aroused suspicion of in situ melanoma, detection modalities (self-detection vs. incidental detection by a physician), factors conditioning time between first noticing the suspect lesions and the physician visit. RESULTS: Median diameter of in situ melanoma was smaller than SSM (7.5 vs. 9.0 mm, P < 0.024), and 47.8% of in situ melanomas were smaller than 6 mm, in contrast to 25.6% of SSM (P < 0.002). In situ melanoma was mainly detected by a dermatologist (Odds Ratio 2.95 P = 0.018), and in patients with more than 10 melanocytic naevi (Odds Ratio 3.12, P = 0.008). Clinical factors independently associated to early request of dermatological consultation were age older than 45 years (Odds ratio 3.47, P = 0.002) and location of lesion in a difficult observation skin site (Odds ratio 4.20, P = 0.001), but not Breslow's thickness. CONCLUSIONS: Our findings show that in situ melanoma and SSM share similar clinical characteristics and early warning signs. However, in situ melanoma is smaller in size than SSM. This may have important implications for early diagnosis and prevention strategies.

Attitude to treatment of patients with psoriasis attending spa center.

AIM: The aim of this paper was to investigate beliefs and preferences towards treatment of patients with psoriasis attending Comano SPA (Trentino, Italy) in comparison to patients referring to the University Hospital of Verona. METHODS: Patient with psoriasis referring to Comano SPA and to the University Hospital of Verona were visited, their clinical data were collected and they were administered a questionnaire investigating their knowledge about psoriasis, as well as their attitude and preferences towards conventional therapies and SPA treatments. RESULTS: [Corrected] A total of 288 patients with chronic plaque psoriasis were recruited, 169 from Comano SPA and 119 from Verona Hospital. There were no differences regarding demographic data, severity of psoriasis, impact on quality of life and prevalence of cardio-metabolic comorbidities between the two groups. SPA patients more rarely believed that pharmacological treatments are safe and effective (6.5% vs. 21.8% P=0.001), had less trust in physician (32.5% vs. 67.2%; P=0.001) and preferred alternative therapies like balneotherapy compared to hospital patients (55.6% vs. 30.3%; P=0.0001), because they assumed they were more safe and effective than systemic drugs (37.3% vs. 1.7%; P=0.001). SPA patients preferred living with psoriasis rather than taking drugs to treat it more commonly than hospital patients (26.6% vs. 5%; P=0.001). CONCLUSION: Patients attending a SPA centre tend to trust conventional drug treatments less often than those attending a hospital clinic, and prefer balneotherapy as a dedicated alternative therapy. Fear of adverse events is a major concern among patients with psoriasis, especially those attending a SPA center.