Patient perspectives of early detection of melanoma: the experience at the Brescia Melanoma Centre, Italy.

AIM: Skin self-examination is usually recommended for early melanoma diagnosis. Given the current lack of a standardized Skin Self-Examination method, we raised the issue about the suitable approach to explain to patients what can be considered a suspicious lesion. Hereinafter, we report the results of a pilot-study carried out at the Melanoma Centre, University Hospital Spedali Civili Brescia, Italy. METHODS: A consecutive sample of 200 melanoma patients entered into the Melanoma Prevention Project. A detailed survey revealed who had the first suspicion of the melanoma lesion. When melanoma was Self- or Relative-detected, we investigated the signs/symptoms that had alerted patients with reference to the ABCDE rule. The study included also socio-demographic variables, family history of melanoma, skin type, number and type of nevi, and melanoma features. RESULTS: Eighty-seven melanoma had been Self-Detected and 44 Relative-Detected. Patients report most commonly signs/symptoms such as dark colour (58%) and changing in size (47%). Seventy-nine percent of these patients have less than ten nevi and 92% have small and regular moles. CONCLUSION: Sometimes the signs of melanoma seem to be easy to identify. Our patients say that they recognized melanoma on the base of the Colour and the Change in size. Therefore, we propose the short "CC" acronym that could facilitate the melanoma self-diagnosis. The aim is to give a short and effective message that leads patients to have the doubt of a suspicious lesion of melanoma so that they seek medical attention.

The controversial management of giant congenital melanocytic nevi. When would it be better "to wait and see"?

AIM: A giant congenital nevus is a melanocytic nevus present at birth with wide extent on the skin surface. The management of this nevus remains controversial and needs to be personalized for each patient. METHODS: A retrospective multicenter study was carried out in the Dermatological Departments of Brescia, Padua, and Pavia, Italy. The inclusion criterion was the diagnosis of a giant congenital melanocytic nevus on the basis of clinical observation. RESULTS: Nine patients with giant congenital nevus are reported. None developed melanoma, whereas giant congenital nevi have been slowly fading in pigmentation. CONCLUSION: Having regard to the doubts on treatment that persist in the literature, we should consider that decisional management of giant congenital melanocytic nevi can be really complex, because of the size and depth of lesions. Indeed, the ablative surgery or other treatments might cause significant troubles and complete excision of deeper layers of the lesion is almost impossible to achieve. Moreover, the treatment does not reduce the risk of melanoma and might lead to a greater difficulty in clinical and dermoscopic observation due to the scarring occurrence after therapy. In our retrospective study, the pigmentation of giant congenital melanocytic nevi slowly faded on its own and until now none developed melanoma. Therefore, we suggest a close regular follow-up which should be focused on the exclusion of possible complications. Perhaps, it would be better "to wait and see" since other procedures do not decrease the risk of melanoma, but rather might lead the patient to underestimate it.

Association between multiple cutaneous melanoma and other primary neoplasms.

BACKGROUND: The risk of a subsequent cancer is an important issue for patients with melanoma. The development of a second primary cancer in patients with a solitary melanoma has been discussed in several studies. However, to our knowledge, the incidence of second primary cancer (SPC) in patients with multiple primary melanoma (MPM) has not been thoroughly investigated. AIM: To quantify the incidence of SPC in patients with MPM, with the aim of possibly developing further preventive measures. METHODS: In a retrospective study, 76 patients with MPM were identified from 2155 patients being followed up at our unit. RESULTS: Of the 76 patients, 12 (16%) developed another neoplasm, with 59% of them having nonmelanoma skin cancer (NMSC), and 41% other noncutaneous cancers. By contrast, only 8% of those with single primary melanoma had other neoplasms (21% of whom had NMSC). CONCLUSIONS: Patients with MPM, especially men with skin phototype II, have a significantly increased incidence of developing SPC, particularly NMSC. Thus, careful monitoring is essential not only to detect recurrence of the original cancer or development of another primary melanoma, but also development of new malignancies of different types, particularly NMSC.

Interval sentinel lymph nodes: an unusual localization in patients with cutaneous melanoma.

Background. Recent studies have demonstrated that there exists a great variation in the lymphatic drainage in patients with malignant melanoma. Some patients have drainage to lymph nodes outside of conventional nodal basins. The lymph nodes that exist between a primary melanoma and its regional nodal basin are defined "interval nodes". Interval node occurs in a small minority of patients with forearm melanoma. We report our experience of the Melanoma Unit of University Hospital Spedali Civili Brescia, Italy. Methods. Lymphatic mapping using cutaneous lymphoscintigraphy (LS) has become a standard preoperative diagnostic procedure to locate the sentinel lymph nodes (SLNs) in cutaneous melanoma. We used LS to identify sentinel lymph nodes biopsy (SLNB) in 480 patients. Results. From over 2100 patients affected by cutaneous melanoma, we identified 2 interval nodes in 480 patients with SLNB . The melanomas were both located in the left forearm. The interval nodes were also both located in the left arm. Conclusion. The combination of preoperative LS and intraoperative hand-held gamma detecting probe plays a remarkable role in identifying these uncommon lymph node locations. Knowledge of the unusual drainage patterns will help to ensure the accuracy and the completeness of sentinel nodes identification.