Electrochemotherapy in the treatment of cutaneous malignancy: Outcomes and subgroup analysis from the cumulative results from the pan-European International Network for Sharing Practice in Electrochemotherapy database for 2482 lesions in 987 patients (2008-2019).

BACKGROUND: Electrochemotherapy (ECT) is a treatment for both primary and secondary cutaneous tumours. The international Network for sharing practices on ECT group investigates treatment outcomes after ECT using a common database with defined parameters. METHODS: Twenty-eight centres across Europe prospectively uploaded data over an 11-year period. Response rates were investigated in relation to primary diagnosis, tumour size, choice of electrode type, route of bleomycin administration, electrical parameters recorded and previous irradiation in the treated field. RESULTS: Nine hundred eighty-seven patients, with 2482 tumour lesions were included in analysis. The overall response (OR) rate was 85% (complete response [CR]: 70%, partial response rate: 15%, stable disease: 11%, and progressive disease: 2%). For different histologies, OR and CR rates for metastases of malignant melanoma were 82% and 64%, basal cell carcinoma were 96% and 85%, breast cancer metastases were 77% and 62%, squamous cell carcinoma were 80% and 63% as well as Kaposi's sarcoma were 98% and 91%, respectively. Variance was demonstrated across histotypes (p < 0.0001) and in accordance with size of lesion treated (dichotomised at diameter of 3 cm (p < 0.0001). Hexagonal electrodes were generally used for larger tumours, but for tumours up to 3 cm, linear array electrodes provided better tumour control than hexagonal electrodes (80%:74%, p < 0.003). For tumours more than 2 cm, intravenous administration was superior to intratumoural (IT) administration (p < 0.05). Current recorded varied across tumour histologies and size but did not influence response rate. In previously irradiated areas, responses were selectively lower for IT administration. CONCLUSIONS: These cumulative data endorse efficiency of ECT across a broad range of histotypes. Analysis of 2482 lesions details subgroup analysis on treatment response informing future treatment choices.

CDKN2A and BAP1 germline mutations predispose to melanoma and mesothelioma.

BAP1 germline mutations predispose to a cancer predisposition syndrome that includes mesothelioma, cutaneous melanoma, uveal melanoma and other cancers. This co-occurrence suggests that these tumors share a common carcinogenic pathway. To evaluate this hypothesis, we studied 40 Italian families with mesothelioma and/or melanoma. The probands were sequenced for BAP1 and for the most common melanoma predisposition genes (i.e. CDKN2A, CDK4, TERT, MITF and POT1) to investigate if these genes may also confer susceptibility to mesothelioma. In two out of six families with both mesothelioma and melanoma we identified either a germline nonsense mutation (c.1153C > T, p.Arg385*) in BAP1 or a recurrent pathogenic germline mutation (c.301G > T, p.Gly101Trp) in CDKN2A. Our study suggests that CDKN2A, in addition to BAP1, could be involved in the melanoma and mesothelioma susceptibility, leading to the rare familial cancer syndromes. It also suggests that these tumors share key steps that drive carcinogenesis and that other genes may be involved in inherited predisposition to malignant mesothelioma and melanoma.

Minimum acceptable sensitivity of intraoperative gamma probes used for sentinel lymph node detection in melanoma patients.

The aim of this study was to determine the suspension level for the sensitivity of an intraoperative scintillation gamma probe in the detection of the sentinel lymph node (SLN) in melanoma patients. Thirty-eight consecutive patients with melanoma were enrolled in the study during a 12-month period and underwent lymphatic scintigraphy after the peritumoral intradermal administration of about 14 MBq of (99m)Tc-nanocolloids. The SLNs were successfully removed during the surgical intervention about 4 h later. To identify and localize the SLN, a scintillation NaI(Tl) collimated probe was used. Predictably, the probe sensitivity decreased as the photopeak energy window was progressively narrowed, from 6.9 ± 0.7 counts per second (cps)/kBq (designated as the 'optimum,' or 'OPT,' sensitivity) to 2.5 ± 0.3 cps/kBq (LOW sensitivity) and to 1.4 ± 0.2 cps/kBq (VLOW sensitivity). Maximum lymph node count rates (cps) were determined for the foregoing energy windows prior to skin incision (PREOPT, PRELOW, PREVLOW, respectively) and in vivo after incision (INVOPT, INVLOW, INVVLOW). Forty-three SLNs were removed with a mean source-to-detector distance of 46 ± 24 mm (min 12 mm, max 92 mm). Four SLNs could not have been detected using PRELOW. This figure would have decreased to 34, with nine undetectable lymph nodes, with PREVLOW. One SLN could not have been identified using INVLOW and four could not have be identified using INVVLOW. In the clinical scenario of SLN detection in melanoma patients, a system sensitivity of 2.5 cps/kBq represents a suspension level, that is, a level under which the equipment must be suspended from clinical use and the poor performance must be investigated.

Clinical series of patients with cutaneous melanoma followed-up at the Novara Melanoma Centre from 1983 to 2009: description of the cohort and prognostic factors.

AIM: The aim of this study was to review our experience with regards to patients with cutaneous melanoma diagnosed from 1983 to 2009, followed-up in our Dermatological Department of Novara. METHODS: A retrospective study of 762 patients diagnosed with cutaneous melanoma in the Dermatological Department of Novara between 1983 and 2009 was conducted. Information was extracted from our melanoma patient database. The database included demographical, clinical and pathological variables of the patient. Clinical and pathological factors predicting survival were analyzed using the Kaplan-Meier curves and the Log-Rank Test (univariate analysis). RESULTS: Staging (American Joint Committee on Cancer 2001) of patients (P=0.000), Breslow thickness (P=0.000), primary ulceration and regression of the lesion (P=0.000), type of first (P<0.039) and second recurrence (P<0.011) were strongly correlated with overall and disease free survival. Sentinel lymph node biopsy was not correlated with disease free survival (P=0.153), it influences only overall survival (P=0.007) CONCLUSION: Our results confirms that sentinel node biopsy, Breslow thickness, ulceration, regression, staging, first and second recurrence are important variable for overall survival and disease free survival, sentinel lymph node status influence only overall survival instead.

[Transverse mesocolon herniation. Description of a clinical case]. / Ernia trans-mesocolica. Descrizione di un caso clinico.

A case of herniation of small bowel through a defect of the transverse meso-colon with secondary herniation through the gastrocolic ligament and re-entry into the greater peritoneal cavity is reported. This form of lesser sac hernia is rare and only one hundred half cases have been reported in literature.

[The autologous splenic reimplant in the rat]. / Reimpianto splenico autologo nel ratto.

In order to evaluate the clinical utility of autologous splenic transplantation in the omental pouch, a pneumococcal challenge was performed in 3 groups of rats, after demonstration of vitality of the intraperitoneal inoculum: Group A: splenectomized rats; Group B: reimplanted rats; Group C: sham operation. No statistically significant difference was found between the first two groups regarding resistance against infection (p less than 0.982), while normal rats proved more resistant (p less than 0.031). Between group A and B significant differences (p less than 0.001) exists only for a more precocious mortality in the first group. The poor clinical utility of the technique is demonstrated.