Federica Marenco

Predicting patients at risk for pain associated with electrochemotherapy

Abstract Background. Electrochemotherapy describes the use of electric pulses to enhance chemotherapy uptake, and has proven highly efficient in treating cutaneous metastases. Patients referred for electrochemotherapy present with diverse clinical pictures, from multiple small lesions to large, ulcerated lesions. Post-electrochemotherapy pain has been observed in some patients. The objectives of this study were to evaluate pain scores before and after electrochemotherapy, and to investigate if patients at risk of post-procedure pain could be identified. Methods. Seven cancer centres in the International Network for Sharing Practices on Electrochemotherapy (INSPECT) consecutively and prospectively reported to a common database. Electrochemotherapy consisted of intratumoural or intravenous injection of bleomycin, followed by delivery of electric pulses in local or general anesthesia. Results. Of 121 patients 39% had metastatic melanoma, 18% squamous cell carcinoma, 16% breast cancer, 13% basal-cell carcinoma, and 14% other malignancies. Median size of the largest nodules was 2.3 cm (range 0.3–40 cm). A majority of patients presented with low pain scores, and this continued through follow-up (74%). A subset of patients had moderate (13%) or severe pain (13%) after treatment. Post-procedure pain was statistically significantly associated with: 1) moderate or severe pain before treatment (p < 0.0001); 2) size of the largest treated lesion (p < 0.01); 3) previous irradiation (p < 0.02); and 4) high treatment current value (p < 0.0001). Conclusion. The majority of patients had no or mild pain after electrochemotherapy. Patients at risk for post-procedure pain could be identified at the pre-treatment visit, and/or at the time of treatment, enabling a pain management strategy for this group.

Clinical and prognostic reports from 270 patients with multiple primary melanomas: a 34-year single-institution study.

Background  Development of more than one primary melanoma in a sole patient is frequent, accounting for 1.2–8.2% of melanoma patients in most recent series.

Prognostic differences across sexes in melanoma patients: What has changed from the past?

Differences across the sexes include epidemiological trends, distribution of clinical features and prognostic relevance in melanoma patients. The aims of this single-institution hospital-based cohort study were as follows: to assess the trends over time of the male/female ratio; to analyse the clinicopathologic features according to sex and their modifications following the introduction in 1999 of sentinel lymph node biopsy; to ascertain the metastatic pathways across sexes and the prognostic role of sex in the disease-free interval (DFI), disease-specific survival (DSS) and survival after recurrence. The patient population included 4310 stage I–II melanoma patients, diagnosed, treated and followed up in our institution from 1975. Patients were divided into two groups on the basis of the introduction of sentinel lymph node biopsy in 1999. A female prevalence was observed until 1999; thereafter, the male/female ratio approached 1 (period 1999–2003), with a subsequent increasing trend suggesting a potential male prevalence. Longer DFI and DSS were observed after 1999 and men showed greater improvement compared with women. In multivariate analyses, sex showed a lower impact on DFI and survival after recurrence following the introduction on sentinel lymph node biopsy. No sex-related differences in terms of DSS were observed before and after 1999 among patients with melanoma located on the trunk. However, among patients with primary lesions not located on the trunk, sex maintained a significant prognostic role in both groups. The results of this study suggest that in the last few years, the prognosis of men could have improved more than that in women. The changing surgical/therapeutic interventions can influence sex disparities in melanoma.

High-dose immunoglobulines and extracorporeal photochemotherapy in the treatment of febrile ulceronecrotic Mucha-Habermann disease

Febrile ulcero‐necrotic Mucha‐Habermann disease (FUMHD) is a rare subtype of pityriasis lichenoides et varioliformis acuta (only 41 cases described to date), characterized by an acute onset of ulcero‐necrotic papules accompanied by high fever and severe constitutional symptoms. We report a case of a 23‐year‐old man with a steroid‐resistant FUMHD treated by intravenous immunoglobulins (IVIG) combined with methotrexate. Only one case of FUMHD treated by IVIG has been reported to date in literature. Also in our case, IVIG proved to be effective in inducing a dramatic improvement of ulceration and in arresting the appearance of new lesions. Moreover, in our experience we decided to perform a maintenance treatment with extracorporeal photochemotherapy (ECP), to the best of our knowledge not previously used in the treatment of pityriasis lichenoides et varioliformis acuta. ECP, which involves extracorporeal exposure of peripheral blood mononuclear cells to photo‐activated 8‐methoxypsoralen, induces an immunological reaction against auto‐reactive T cell clones, without immune‐depression and thus could potentially be useful particularly in FUMHD avoiding the risk of an infective reactivation.

Cutaneous Melanoma Metastases Arising on a Split-Skin Graft Donor Site

A primary ulcerated melanoma on the right supraclavicular region, 2.2 mm thick, Clark level IV, of a 40year-old man was treated with surgical excision in July 2007. On October 2007, small multiple cutaneous metastases merging into a nodular lesion were localized on the surgical scar; a swelling of the right axillary lymph nodes was also present (Figure 1). The patient underwent radical node dissection associated with the excision of cutaneous metastases. The defect was repaired using a full-thickness skin graft (0.8 cm) taken with an electric dermatome from the patient’s left thigh. The histological examination confirmed the presence of melanoma cells in the skin and in six of 30 axillary lymph nodes. One month later, multiple blackbluish papulonodular lesions, ranging from 1 to 10 mm in diameter, developed on the skin graft donor site, whereas contiguous areas were uninvolved (Figure 2); similar lesions were also present in the supraclavicular engrafted site (Figure 3). Histological analyses confirmed the metastatic nature of the lesions. Computed tomography scan showed disseminated lung and liver involvement. Blood samples from this patient were positive for tyrosinase messenger RNA (mRNA) expression as tested using reverse transcriptase polymerase chain reaction (RT-PCR) technology. Despite palliative chemoimmunotherapy performed with dacarbazine, cisplatin, vindesine, interleukin-2, and alpha-interferon, the patient died in 2 months.

Melanoma of the lower extremities: foot site is an independent risk factor for clinical outcome

Despite the better prognosis of melanomas localized on lower extremities, some studies have suggested that melanomas on the foot are related to a poorer survival and should be considered separately.

Functional and Phenotypical Impairment of Polymorphonuclear Cells in Atopic Dermatitis: An Additional Cause for the Known Susceptibility to Infections?

Background: Atopic dermatitis (AD) patients present an high susceptibility to infections. The phagocytic activity of polymorphonuclear granulocytes (PMNs) is mediated by the interactions between Toll-like receptors (TLRs) and pathogen-associated molecular patterns. Objective: To investigate functional activity and phenotype of PMNs in AD patients. Methods: In vitro PMN phagocytosis and intracellular killing towards Klebsiella pneumoniae were evaluated in 24 AD patients; flow cytometry was applied to analyze PMN phenotype. Results: PMNs from AD patients displayed both reduced phagocytic activity and intracellular killing against K. pneumoniae than healthy subjects (HS). CD11b, CD66b, TLR2, TLR4 and TLR5 median fluorescence intensity (MFI) on PMN membrane were significantly higher in AD patients than in HS. Conclusion: PMN functional impairment in AD patients could represent an additional cause of skin infections, coupled with other known defects in the innate immune system. The increased MFI of adhesion molecules and TLRs is rather a consequence of the increased skin barrier permeability to bacterial molecules capable of stimulating immunological reactions.

Effectiveness of electrochemotherapy in treatment of a recurrent squamous cell carcinoma of the scalp.

ejd.2011.1334 Auteur(s) : Federica Marenco, Tiziana Nardo, Paola Savoia paola.savoia@unito.it, Maria Grazia Bernengo Department of Biomedical Sciences and Human Oncology, v. Cherasco 23, 10126 Torino, Italy Electrochemotherapy (ECT) has recently emerged as a treatment for cutaneous and subcutaneous lesions from different malignancies, including squamous cell carcinoma (SCC), with curative or palliative intent [1]. It combines the delivery of electric pulses into the lesions with the effect of anticancer [...]