[CROATIAN SOCIETY FOR MEDICAL ONCOLOGY CLINICAL GUIDELINES FOR DIAGNOSIS, TREATMENT AND FOLLOW-UP OF PATIENTS WITH MELANOMA]. / KLINICKE PREPORUKE HRVATSKOG DRUSTVA ZA INTERNISTICKU ONKOLOGIJU HLZ-A ZA DIJAGNOZU, LIJECENJE I PRACENJE BOLESNIKA/CA OBOLJELIH OD MELANOMA KOZE.

Melanoma in the Western world has an increasing incidence. One of the most important factor for the increase in incidence is sporadic, uncontrolled exposure to the sun. The basis for the treatment of primary melanoma is surgical treatment. Treatment of metastatic disease of melanoma in recent years experienced significant changes. BRAF and MEK inhibitors, immunotherapy with programmed cell-death immune checkpoint inhibitors (anti-PD-1-antibodies) are new options for the treatment of metastatic disease. A mulitidisiplinary team of Croatian Society for Medical Oncology provides recommendations for diagnosis, treatment and follow-up of melanoma primarily driven to the discovery of new drugs and therapeutic options, that change the prognosis of patients with metastatic melanoma.

[Skin care and wound management in patients with inherited bullous epidermolysis]. / Njega koze i zbrinjavanje rana u bolesnika s nasljednom buloznom epidermolizom.

Inherited epidermolysis bullosa is a group of diseases characterized by skin/mucous membrane fragility and development of blisters and erosions after insignificant mechanical trauma. It is a multisystemic disease with complications occurring on numerous organs other than the skin. As there is no cure for these diseases, treatment consists of early recognition and therapy of complications, quality wound care and skin protection. Optimal wound treatment depends primarily on the type of the disease, localization and type of wounds. Apart from good skin care, treatment of these patients requires intensive supportive therapy in which various specialists must be involved.

Photodynamic therapy in dermatology: current treatments and implications.

This article provides an update on photodynamic therapy by discussing each of the essential components in sequence: mechanisms of action, common photosensitizers, typical light sources, and indications. In dermatology, photodynamic therapy (PDT) is mainly used in the treatment of superficial skin cancers: actinic keratoses, Bowen's disease and superficial basal cell carcinomas. However the range of indications has been expanding continuously. PDT is also used for the treatment of other oncological indications and non-malignant conditions such as acne vulgaris and photoaged skin. The 5-aminolevulinic acid (ALA) or its methyl ester (MAL) is applied topically as photosensitizer before activation with visible light. The advantages of topical PDT are: ability to treat multiple lesions simultaneously, low invasiveness, good tolerance and excellent cosmetic results.

From pemphix to desmogleins.

In the not so distant past, the word pemphigus or pemphix was common for describing various diseases characterized by blistering as well as various disorders that do not originate from a blistering pathology. Patients with these conditions were grouped in "other" skin diseases. Step by step, during the past, we were introduced to these severe conditions. First, we learned from sporadic case reports, then new differentiations were reported according to histology, later immunopathology was developed, and now there are discoveries of new molecules. Immense progress with new approaches to therapy has been achieved, but much improvement is still needed. The modern definition of pemphigus undoubtedly represents a group of rare, intraepidermal autoimmune bullous diseases characterized by intraepidermal blisters and circulating autoantibodies desmogleins against the keratinocytes cell surface.

Sexual health difficulties in a population-based sample of Croatian women aged 18-35 and the effects of the dual (career and motherhood) role.

INTRODUCTION: The prevalence of sexual health difficulties among women in Croatia is presently unknown. Although women under 40 years of age may be exposed to the most intense demands of the dual role (career and motherhood), they are often assumed to be at lower risk for sexual difficulties. AIM: To assess the prevalence of sexual difficulties in a population-based study of women aged 18-35 and to explore the possible impact of the dual role on female sexual health. METHODS: The study was carried out in April 2010 on a multistage probability sample of 1,000 women aged 18-35 years. The response rate was 37.3% (1,680 women refused to participate). Multivariate logistic regression was used to analyze the correlates of sexual difficulties, including the dual role. MAIN OUTCOME MEASURES: The prevalence of the four most common female sexual health difficulties (lack of desire, lubrication difficulties, inability to reach orgasm, and pain during intercourse) were measured using the one-item indicators from the Global Study of Sexual Attitudes and Behaviors. RESULTS: Among coitally experienced women (N = 870), 27.6% reported having a lack of desire, 23.6% pain during sexual intercourse, 23.1% inability to reach orgasm, and 18.5% difficulties with genital lubrication. All four difficulties were negatively associated with sexual satisfaction, but only the lack of sexual interest and inability to reach orgasm seemed to substantially decrease sexual well-being. In multivariate analyses, age, education, being in a steady relationship or married, and partner communication about sexuality were significant correlates of reported sexual difficulties. The dual role was not a significant predictor of sexual health difficulties. CONCLUSIONS: A substantial proportion of participants reported one or more sexual health difficulties that lasted for at least 2 months. Women in the dual role were not at an increased risk of experiencing difficulties in sexual functioning.

Focal porokeratosis of nuchae: case report.

Porokeratosis is the common name of several diseases of unknown pathogenesis, which are similar in clinical appearance. It was first described in 1893 and was thought to be a disorder of sweat glands, hence the name porokeratosis. The lesion that can be found in all cases is annular, with atrophic center, and hyperkeratotic outer ring. Cases of porokeratosis have been linked with genetic heritage, excessive ultraviolet exposure, kidney failure, and state of immunosuppression, but no definitive link has been established. As a rare condition, its main feature is that the correct diagnosis can be delayed for a significant period of time. Porokeratotic lesions have a high incidence of malignant transformation and are considered premalignant. We present a case where a porokeratotic lesion was unsuccessfully treated as a psoriatic lesion for more than a year in a patient with previously diagnosed psoriasis. A skin biopsy was performed at our department, which revealed classic cornoid lamella and thus led to the correct diagnosis. The lesion was excised. Additional diagnostic tests revealed normal kidney function and intact immune system. A follow-up protocol was established for the patient, ensuring timely diagnosis of any future porokeratotic lesions. Porokeratosis, especially when there are only few lesions, is not difficult to manage - once it is diagnosed. A diagnosis of porokeratosis may also aid in identifying a serious systemic disease such as kidney failure. Importantly, a misdiagnosis of porokeratosis may lead to development of skin cancer.

Electrosurgery--have we forgotten it?

The recent appearance of lasers has made electrosurgical methods almost obsolete. They seem to be routinely avoided by both dermatologists and their patients. In this paper, the benefits of electrosurgery are emphasized, pointing out that these are easy to master, efficient and low-cost procedures. An overview of the five types of cutaneous electrosurgery (electrodesiccation, electrofulguration, electrocoagulation/electrocutting, electrocautery, and electrolysis) is provided. Special attention is given to the use of electrosurgery in patients with electromedical implants. When performed with care, electrosurgery remains a safe, efficient and low-cost treatment option.