Aggressive scalp carcinoma with intracranial extension: a multidisciplinary experience of 25 patients with long-term follow-up.

Malignant skin cancer of the scalp with skull invasion, dural infiltration and brain involvement is a uncommon lesion. This scenario is most often encountered in patients where initial scalp lesions are not appropriately diagnosed or their extent is underestimated by the patient and/or the doctor. Our study is a retrospective review of 25 patients treated using a multidisciplinary approach (combined plastic surgery/neurosurgery procedure and neuro-oncological management). After a mean follow-up of 7 years, 22 patients did not show local recurrence or distant metastases of their primary disease. Overall, these 22 patients had excellent quality of life; however, three patients died from causes not related to their primary pathology. To obtain a complete and definitive cure, prompt diagnosis of scalp cancers followed by appropriate multidisciplinary management is strongly advised.

[Angioma in childhood: current criteria for therapy]. / Angiomi dell'infanzia: attuali criteri di terapia.

After examining the most recent literature on this subject, the authors assess the state of the art of current knowledge regarding cutaneous angioma in the light of their personal experience. The histological, biological and clinical characteristics are analysed and enable a new nosographic evaluation of this frequent pathology which must be differentiated from vascular malformations. In the light of these unique features, the authors examine the current forms of treatment for angioma using local, systemic or physical therapy. Cutaneous angioma may be present at birth or may appear during the first months of life, occasionally regressing spontaneously up until the child is seven years old. They also present a population of proliferating endothelial cells. This explains the possibility that these neoformations will spontaneously regress, an event that must be taken into account before commercing therapy. With regard to their diagnosis valuable information is provided by telethermography, ultrasonography, Doppler scan and CAT. If an angioma is present from the first weeks of life, a wait-and-see policy should be adopted unless the lesion is localised in an orbital, mammary, palpebral, subglottic, nasal or labial region. Local therapy of angioma using sclerosant substances is now controversial; the best results are obtained using periodical administrations of triamcinolone acetonide or betamethasone. Systemic treatment with prednisone is indicated in forms localised on the orbita where interlesional injections are frequently followed by complications such as hematoma and infections. Systemic treatment requires an interdisciplinary approach, especially in pediatrics, due to the repercussions which the use of high dose conrticosteroids provokes on hormone function in children. The use of alpha interferon with discordant results has recently been reported in the literature. In superficial forms physical therapy may be more appropriate. Cryotherapy provoked a lesion caused by cold: an ionic alteration of tissues through freezing leads to necrosis. Plesiotherapy has been now virtually abandoned due to the risks of growing tissue. In terms of therapy and application there has been a widespread increase in the use of argon laser over the past years: the "Tunable Dye Laser" present unique characteristics which allow the wave length to be modulated in relation to the colour and depth of the lesion to be treated, causing selective photothermolysis. Encouraging results can be obtained by subjecting immature angioma to applications every 3-4 weeks using an every of 7-8 J/cm2. The use of the tunable dye laser is, however, preferable in superficial angioma. Compressive therapy using elastic bandages or specially made garments is effective only in those localisation where it is possible to obtain compression, like limbs and the parotid region. From the above comments it can be seen that the treatment of immature angioma is extremely complex due to their clinical and evolutive variability. It is therefore vital to following the rules laid down by experience: waiting for the involution of the angioma, even if it is commonly observed event, is often difficult to achieve due to the scarce collaboration of parents. Moreover, it is important to achieve a close interdisciplinary collaboration between pediatrician, dermatologist and plastic surgeon.

[Surgical principles in the correction of loop ears]. / Principi chirurgici nella correzione delle orecchie ad ansa.

After listing the deformities which may be found in loop ears, a surgical technique for the correction of such deformities is presented. This technique is based on elements taken from several forms of surgery which, together with a small personal contribution, make it possible to totally correct such deformities, achieving excellent esthetic results. To reconstruct the anthelix an anterior surgical incision is made below the helix. The cartilage between the helix and the scafa is likewise interrupted thus preventing the helix from also bending along with the anthelix. When necessary the cartilage is resected in order to modify the diameter of the auricle. Exposing the anthelix cartilage makes it possible to optimize reconstruction of the anthelix body and crus. After only a few weeks the scar on the anterior helix sulcus proves unnoticeable. The one objection which may be made in this regard is that there is a scar in the anterior sulcus of the helix which, using another means of approach, may be avoided (especially in surgery were esthetic results must be optimal). The authors feel that the results obtained with this method are superior to those achieved with other methods (as they themselves had used in the past) and that the scar proves well hidden in the helix sulcus. In order to correct dislocation and hypertrophy of the conch, if present, a posterior retroauricular approach is employed. The conch is reduced as much as necessary, the ear brought closer to the mastoid and held in place with sutures knotted on oiled gauze inside the conch.(ABSTRACT TRUNCATED AT 250 WORDS)