rome and Skin-Neoplasms

The incidence of non-melanoma skin cancers (NMSC) is increasing worldwide and these skin cancers have become an important health issue. An integrated care pathway (ICP) is a multidisciplinary outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition. The aim of this paper is to define the ICP for patients affected by NMSC referring to the Istituto Dermopatico dell'Immacolata - IRCCS of Rome and Villa Paola, Italy. This ICP is multidisciplinary and included various specialists like dermatologist, oncologist, general surgeon, plastic surgeon, anatomopathologist, molecular biologist and epidemiologist. This ICP is based on the most recent acquisitions in the literature, referring in particular to the national (EADO and SIDEMAST) and international guidelines (EDF and NCCN). We firstly valued the current practice for patients affected by NMSC referring to our Institute to define the multidisciplinary process map. This process delineated the activities and the responsibilities performed during delivery of care to the patients and the potential problem areas or opportunities for improvements. Subsequently, we defined the final ICP process. This ICP of NMSC represents an innovative strategy to provide high quality healthcare. This allows to ensure all the necessary procedures for the patient, optimizing the "continuum" of care and the use of health services, and improving the organization of the Institute regarding an important health issue.

Topics: Critical Pathways; Delivery of Health Care, Integrated; Humans; Incidence; Rome; Skin Neoplasms

Acral melanoma is an uncommon type of melanoma in Caucasian patients. However, acral melanoma is the most common type of melanoma in African and Asian patients. Comparison analyses between hand-acral melanoma and foot-acral melanoma have been rarely reported in the literature. Acral melanoma is an uncommon melanocytic tumor characterized by an intrinsic aggressiveness, with specific histological and clinicopathological features. Acral melanoma involves the palms, soles and sub-ungueal sites.. A total of 244 patients with acral melanoma were included in our analysis. The current study was performed in three different medical centers: Sapienza University of Rome, San Gallicano Institute of Rome and University of Magna Graecia (Italy). The Kaplan-Meier product was used to estimate survival curves for disease-free survival and overall survival. The log-rank test was used to evaluate differences between the survival curves. Assuming that the effects of the predictor variables are constant over time, the independent predictive factors were assessed by Spearman's test and subsequently data were analyzed performing Cox proportional-hazard regression.. In both univariate and multivariate analyses Breslow thickness (p < 0.0001) and ulceration (p = 0.003) remained the main predictors. General BRAF mutation was detected in 13.8% of cases. We found that median Breslow value and the percentage of recurrences were similar in hand-acral melanoma and foot-acral melanoma, as well as there were no differences in both short and long-term.. The absence of differences in survival between hand-acral melanoma and foot-acral melanoma shows that the aggressiveness of the disease is related to distinct mutational rate, as well as to anatomical site-specific features, rather than to the visibility of the primary lesion.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Disease-Free Survival; Female; Foot; Hand; Humans; Italy; Male; Melanoma; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Rome; Skin Neoplasms; Young Adult

Metatypical cell carcinoma (MTC) is a quite rare malignancy accounting for 5% of all non melanoma skin cancers, with features of basal cell carcinoma and squamous cell carcinoma. It can be described as coexistence of basal cell carcinoma and squamous cell carcinoma with no transition zone between them.. Our review identified a correlation between gender and MTC affected region.. We performed a retrospective study of 312 consecutive patients, diagnosed for MTC localized on face and scalp. Statistical analysis was made to determinate most affected areas, gender prevalence, average age, presence of ulceration and infiltration and peripheral clearance rate.. A relevant difference came out between two genders. χ2 test emphasized a relation between males and the presence of carcinoma on the scalp. In addition a strong correlation between mixed subtype and ulceration was evident. A strong relation between intermediate subtype and positive surgical margin was found; this data could identify a more aggressive behavior of intermediate type.. In our findings an important correlation between sun exposition and this tumor was found. Moreover, due to the difficulties that can occur in preserving the aesthetic subunits in the surgical treatment of these regions, the prevention of this pathology has an important role.

Topics: Aged; Carcinoma, Basal Cell; Carcinoma, Squamous Cell; Chi-Square Distribution; Facial Neoplasms; Female; Head and Neck Neoplasms; Humans; Male; Neoplasms, Complex and Mixed; Prevalence; Prognosis; Retrospective Studies; Risk Factors; Rome; Scalp; Sex Factors; Skin Neoplasms; Smoking; Squamous Cell Carcinoma of Head and Neck; Sunlight

In the Institute of Dermatology of the University of Rome 'La Sapienza' (IDURLS) from 1989 to 1994, 2198 immigrants from countries outside the European Community were seen as out-patients. Their personal and pathological data were collected by a particular software 'Questio', set up together with colleagues of the Interdepartimental Center for Scientific Calculous (ICSC) of the University of Rome 'La Sapienza'. The number of patients has been increasing from 326 in 1989 to 436 in 1994. Most of the people were coming from Africa, but from 1989 to 1994 the number of patients from the regions of ex-Yugoslavia has been increasing. About one third of the immigrants were unemployed, whereas 40% of them had a job (worker or employee), and the remaining 20% was composed by students and housewives. Most immigrants (1474 patients) were 20-39-year-old. Their data were compared with those of a control group composed by 2100 Italian people of the same age and sex, seen as out-patients in IDURLS in the same period. The most frequent skin disorders observed in immigrants were skin infectious or parasitic diseases, above all scabies. Excluding people with scabies, both immigrants and Italian patients shared the same skin diseases typical of young adult people: many fungal infections, many contact dermatitis and very few skin malignant tumors.

Topics: Adolescent; Adult; Africa; Age Factors; Aged; Aged, 80 and over; Child; Child, Preschool; Dermatomycoses; Emigration and Immigration; Employment; Female; Humans; Infant; Italy; Male; Middle Aged; Outpatients; Rome; Scabies; Skin Diseases; Skin Neoplasms; Software; Spouses; Students; Unemployment; Yugoslavia

The incidence of Kaposi's sarcoma (KS) in patients transplanted at the Organ Transplant Center of Catholic University in Rome appears to have increased in recent years.. To describe the clinical characteristics of KS in a group of transplant recipients.. Over 8 years, a total of 302 renal-transplant recipients were followed. When KS was suspected, histology and staging procedures were performed.. Ten cases of KS have been diagnosed (8 males, 2 females; age 46.4 +/- 9.4 years); 4 of them were on triple therapy. All the patients were HIV-1 seronegative. The onset of KS occurred 3 months to 4 years after transplantation (21.1 +/- 17.6 months). The disease was limited to the skin in 6 cases and involved internal organs in the remaining 4. Four patients experienced complete remission of the disease following reduction of the immunosuppressive therapy.. The high incidence of KS in this population (2.98%), as compared to that reported in other transplant patient groups, suggests that, besides viral infection, genetic predisposition may play a pathogenetic role. However, immunosuppression is the leading factor in transplant patients.

Topics: Adult; Anti-Inflammatory Agents; Azathioprine; Cyclosporine; Female; Follow-Up Studies; HIV Seronegativity; Humans; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Methylprednisolone; Middle Aged; Muromonab-CD3; Neoplasm Staging; Prednisone; Remission Induction; Rome; Sarcoma, Kaposi; Skin Neoplasms; Virus Diseases

Cutaneous lesions can be a significant problem in kidney transplant recipients. The AA report a clinical spectrum of iatrogenic, infectious, preneoplastic and neoplastic skin diseases in 140 renal transplant recipients observed, from march 1988 to july 1991, at the Catholic University in Rome. Iatrogenic skin manifestations were the most common, followed by infections of the skin and preneoplastic and neoplastic cutaneous lesions.

Topics: Adult; Female; Humans; Iatrogenic Disease; Immunosuppressive Agents; Incidence; Kidney Transplantation; Male; Precancerous Conditions; Rome; Skin Diseases; Skin Diseases, Infectious; Skin Neoplasms

Chronically sun-exposed facial skin of three females aged 68, 71, and 78 years, and of a male aged 78, was examined by electron microscopy in order to study the condition of the epidermal melanocytes. Considerable heterogeneity of morphological and functional characteristics of the cells was observed. The majority of melanocytes were large, active, with occasionally lobulated or double nuclei, an appearance indicative of hyperstimulation. Some cells exhibited an appearance of having reached the end of an active life cycle and were labelled "aged." Others, in the upper end of the outer root sheath of hair follicles and adjacent interfollicular epidermis, presented a typically inactive appearance, indistinguishable from that of fetal melanocytes, or of those in unexposed skin of younger subjects. A cell with indented nucleus, fully melanised melanosomes, and hypertrophic Golgi apparatus was sporadically seen. Minute foci of dissociation of keratocytes were present, and melanocytes included in these were frequently disrupted. Swelling of mitochondria and cytoplasmic lipid droplets occurred sporadically within all the above variants of melanocytes. It proved difficult to establish criteria of specific sun damage of melanocytes. It is suggested that either the melanocytes exhibiting stimulation or the relatively inactive ones could be the precursors of the proliferating cells of lentigo maligna.

Topics: Aged; Cell Nucleus; Cellular Senescence; Female; Golgi Apparatus; Humans; Lentigo; Melanocytes; Melanoma; Microscopy, Electron; Reference Standards; Rome; Skin Neoplasms; Sunlight

Topics: Adult; Female; Follow-Up Studies; Humans; Male; Melanoma; Middle Aged; Prognosis; Rome; Sex Factors; Skin Neoplasms; Time Factors

An epidemiological study was conducted in the city of Rome and the incidence of malignant melanoma was determined retrospectively for the years 1970-9. All patients had legal residence in Rome and a histological diagnosis of melanoma during that period; only cases of malignant melanoma of the skin (ICD 172, 8th revision) were considered. A total of 17 public and 82 private hospitals were involved in the study with 11 081 and 6127 hospital beds respectively. All the hospitals in the study had one of the following therapeutic and diagnostic facilities: internal medicine, dermatology, oncology, radiology, surgery, plastic surgery, histopathology. Analyses of incidence are based on 500 cases, 237 males and 263 females, collected in the period 1970-9. The data indicate a positive time trend in incidence; the average annual increase is 0.27 cases/year per 100 000. The data show that in a Mediterranean and Latin country such as Italy the incidence of melanoma presents the same ascending trend as that of other Caucasian countries, whether European or not, the slope of the curves is similar for both sexes. The distribution of the primary site for both sexes is closely parallel to that described for all Caucasian populations, the lower limbs being more affected in females and the trunk in males.

Topics: Adult; Age Factors; Female; Humans; Male; Melanoma; Middle Aged; Retrospective Studies; Rome; Sex Factors; Skin Neoplasms

Topics: Adolescent; Adult; Age Factors; Aged; Female; Humans; Male; Melanoma; Middle Aged; Rome; Sex Factors; Skin Neoplasms; Urban Population