Federica Papi

The use of silicone gel in the treatment of fresh surgical scars: a randomized study

Aim.  To evaluate the effectiveness of a silicone gel in treating surgical wounds compared with a control group of the same phenotype and same scar site for which a placebo was advised.

Oestrogen receptor beta and melanoma: a comparative study

Background  Oncological research has focused on evaluating oestrogen receptors (ERs) in oestrogen‐related tumours, and understanding the potential role of ERs in the pathophysiology of cancer.

Multiple primary melanoma: the impact of atypical naevi and follow up

Background  Patients with melanoma are especially encouraged to have regular follow‐up visits with their dermatologist and to perform total‐body skin examination on a routine basis to identify new pigmented lesions or detect significant changes in existing naevi.

Synchronous angiosarcoma, melanoma and morphea of the breast skin 14 years after radiotherapy for mammary carcinoma.

With the improvement in survival after breast cancer there has been increasing interest in the long-term effects of radiotherapy, including the development of tumours. Compared with the general population, breast cancer survivors have a 10-50% higher risk of developing a second cancer. Radiotherapy may play a role in the onset of such lesions. We describe here the case of a 68-year-old woman who developed synchronous cutaneous angiosarcoma, melanoma and morphea of the breast skin and the local area, 14 years after radiotherapy for breast carcinoma. Given the risk of post-radiation secondary primaries in breast cancer patients, long-term surveillance is necessary, with particular attention being paid to skin changes in the irradiation field. Radiation-induced morphea is a rare complication in which immunological abnormalities may stimulate malignant transformation. Long-term studies are required to clarify the pathogenesis of these rare associations.

Solitary cutaneous metastasis as the first sign of relapse of thyroid carcinoma: a clinical, dermoscopic-pathologic case study.

Cutaneous metastases are a rare event, representing 0.7% to 2.0% of all cutaneous malignant neoplasms. They may be the first sign of a previously undiagnosed visceral malignancy or the initial presentation of a recurrent neoplasm. The frequency of cutaneous metastases according to the type of underlying malignancies varies with sex. In men, the most common internal malignancies leading to cutaneous metastases are lung cancer, colon cancer, melanoma, squamous cell carcinoma of the oral cavity, and renal cell carcinoma. In women, breast cancer, colon cancer, melanoma, lung cancer, and ovarian cancer are the most common malignancies leading to cutaneous metastases.

Is skin self-examination for cutaneous melanoma detection still adequate? A retrospective study.

Objective: The aim of this retrospective study was to analyze the relationship between detection pattern, tumor thickness, patient demographics, and personal and family history of melanoma in the era of noninvasive diagnosis. Methods: All patients with primary cutaneous melanoma who presented to the Department of Dermatology at the University of Florence between January 2000 and November 2010 were interviewed at the time of their final histopathological diagnoses of melanoma as part of their clinical record. The treating physician specifically questioned all patients about who had first detected or suspected the lesion that resulted in the histological diagnosis of melanoma. Results: A total of 802 melanoma patients were analyzed. The spouse found approximately 16% of the melanomas, and a similar percentage was discovered by the general practitioner. The largest group of melanomas (36%) was discovered during regular annual skin examinations by dermatologists, while another large group (33%) were discovered by the patients themselves. The data that emerged from our study is that self-detection was associated with a greater probability of having a thick melanoma and, therefore, a poor prognosis (odds ratio 1.56). Conclusions: Because the current mortality of melanoma is still stable, we are convinced that a new message should be introduced to encourage high-risk patients to have an annual skin examination as a rule.

Superficial Cutaneous Leiomyosarcoma A Rare, Misleading Tumor

Leiomyosarcomas are rare malignant tumors of smooth muscles. Superficial leiomyosarcoma is generally a disease of middle age, most frequently encountered between 40 and 60 years of age. It is usually diagnosed late or misdiagnosed, since it is a very rare tumor of the head and neck. Awareness of the particularly misleading features of this tumor, especially in elderly patients, is important, as delayed diagnosis is correlated with larger size and invasiveness into contiguous structures, which influence the practicability of radical resection. We present the case of an 81-year-old man with cutaneous leiomyosarcoma on the forehead.

Dermoscopy in pigmented squamous cell carcinoma.

Background: The diagnosis of squamous cell carcinoma (SCC) is, generally, a clinical diagnosis, but in some cases, when the lesion is pigmented, as in our case, the differential diagnosis between pigmented SCC and other pigmented skin lesions, in particular melanocytic lesions, is difficult. Dermoscopy may improve the early diagnosis of SCC and thus play a role in its preoperative classification. However, its potential role has been hampered so far by the fact that little is known about the dermoscopic features of pigmented SCC. Objective: We report the case of a rare pigmented SCC dermoscopically mimicking a melanocytic lesion whose dermoscopic features have been investigated. Conclusion: On the basis of the literature and our experience, pigmented SCC can present dermoscopic features typical of melanocytic lesions, such as radial streaks, globules, and homogeneous blue pigmentation, and can lead dermatologists to diagnostic errors.

Sun exposure and children: what do they know? An observational study in an Italian school.

Melanoma, the most aggressive skin tumor, is very rare in subjects younger than 20 years of age, representing 1–3% of all malignancies (Bader et al., 1985; Boddie et al., 1978;Gibbs et al., 2000;Handfield-Jones and Smith, 1996; Ruiz-Maldonado andOrozco-Covarrubias, 1997; Saenz et al., 1999). Despite its rarity, recent studies report that the occurrence ofmelanoma in early life is increasing (Oliveria et al., 2009; Strouse et al., 2005). The incidence of malignant melanoma (MM) in people aged b20 years increased 2.9% per year from 1973 to 2001 (Mones and Ackerman, 2003). Understanding the cause of this rising incidence may have a significant impact on the primary prevention of melanoma, but it is difficult to determine the exact cause because several factors, both constitutional and environmental, affect the development of atypical nevi andMM in early life. There are discordant data regarding the impact of sun-protective behaviors on melanoma prevention, but this discordance might be the result of the use of nonstandardized measures and strategies for the control of confounding factors. It is well known that sunburns early in life increase a persons risk for melanoma later in life; therefore, we investigated childrens awareness and knowledge regarding sunexposure and relevantbehaviors.We report baseline results of an observational study in 11to 16year-old school children, completed for the first time, to our knowledge, in Italy. The study was conducted among children from a Florentine public school. Children were asked to complete a self-administered questionnaire regarding sun-protection practices and sun exposure. The questionnaire included 10 items that had been formulated by experienced dermatologists based on the most common mistakes and misconceptions about the sun exposure (Table 1). A total of 379 student surveys were collected. The mean (SD) age was 12.59 (1.06)years (range 11–16 years). Males slightly outnumbered females (194, 51.2% for males versus 185, 48.8% for females). The student responses to the questionnaire items were used for the analysis. Overall, we counted 16 (4.8%) missing responses. The majority of subjects (346, 91.3%) told us to apply a sunscreen, but only half (191, 50.4%) of the students put on sunblock several times during the day and repeated the application after bathing. It is interesting to highlight that up to 80% of the students declared that they protected their skin with sunblock or clothing evenwhen under an umbrella or on cloudy summer days. The old misconception that a bleeding mole, previously traumatized, is dangerous persists even in the new generations (313, 82.6%). Despite the ‘indicted’ andwidespread adolescent use of tanning beds, only 17 students (4.5%) admitted to using artificial tanning. Less than 10% of subjects believed that artificial tanning is no

Adding dermatoscopy to naked eye examination of equivocal melanocytic skin lesions: effect on intention to excise by general dermatologists

Background.  According to the literature, dermatoscopy can improve diagnostic accuracy for melanoma. However, a weak point of the studies in the literature is that most were carried out in a ‘privileged’ setting of dermatologists who are expert in dermato‐oncology, and who work in departments specializing in screening pigmented lesions. This study was set up to specifically evaluate whether the use of dermatoscopy by general dermatologists would also improve accuracy.