Analysis of user-satisfaction with the use of a teleconsultation system in oncology.

There is an increasing interest in assessing telemedicine as alternative method of delivering high quality cancer treatment to patients living in rural areas. In the Province of Trento (north-east Italy) a tele-oncology system was implemented to provide non-surgical oncological consultation to district general hospitals. The aim of this study was to explore user-satisfaction with the system after 6 months of experimentation. During the on-field validation two questionnaires with open and closed-response questions were distributed to 80 physicians and nurses 6 months apart to investigate the users' expected benefits vs. perceived ones. The two questionnaires were compared to assess how perceived benefits differed from expected ones. Significant differences were found regarding improvements in: the standardization of diagnostic-therapeutic procedures using the Electronic Patient Record (EPR)]; information sharing; data updating; consultation speed; and the possibility to diminish patients' travels through the use of teleconsultation (TC). Physicians' responses showed a significant difference regarding the EPR's effects on relationship with patient, the nurses' responses with regards to its effects on care quality. Physicians felt that both modalities of teleconsultation were useful in enhancing communication with colleagues (86% for the synchronous TC, 80% for the asynchronous TC). Responses indicated that the major difficulties encountered were in the introduction of the system into the daily routine. Despite this, user expectations for its future use in clinical field were considerably high.

Dermatoscopy: usefulness in the differential diagnosis of cutaneous pigmentary lesions.

Dermatoscopy has been reported to give valid information in the differential diagnosis of cutaneous pigmentary lesions. Using a dermatoscopy Delta 10 Heine optotechnique, we evaluated 220 pigmented lesions during a health campaign for the early diagnosis of cutaneous melanoma and compared clinical and dermatoscopic diagnosis. Histologic diagnosis was carried out after removal of the lesions. Sensitivity, specificity, positive predictive value, negative predictive value and overall agreement were evaluated. In our experience clinical and dermatoscopic diagnosis gave similar results; sensitivity and specificity were slightly better for dermatoscopy than for clinical diagnosis. The agreement between clinical and dermatoscopic diagnosis was better in histologically negative lesions. Dermatoscopy is useful in the diagnosis of pigmentary lesions, but clinical diagnosis by experienced dermatological staff, is unreplaceable, especially during a health campaign for the early diagnosis of cutaneous melanoma.

p53 Protein expression in nevi and melanomas.

p53 Protein immunohistochemical expression is a wide-spread feature of the malignant phenotype; most melanomas are reported as p53 positive, while nevi are reported as p53 negative. We investigate a series of 75 benign nevi and 47 melanomas (40 primary and seven metastatic) to evaluate their pattern of p53 immunoreactivity with a panel of specific antibodies (PAb1801, PAb240, DO7, and CM1) in view of a possible diagnostic role of p53 immunostaining. Our results demonstrate that 15% of nevi show p53 immunoreactive nuclei (usually in less than 1% of the cells) and that 30% of melanomas show p53 immunoreactive nuclei (one case with 20% immunoreactive cells, six cases with 1% to 5% positive cells, and four cases with less than 1% positive nuclei). p53 Positivity was seen also in basal and suprabasal keratinocytes. p53 Positivity in nevi is at variance with literature data supporting that nevi are p53 negative. p53 Positivity in nevi and in epidermis may be related to mechanisms of DNA repair, apoptosis, or to a specific phase of the cell cycle. In our series, p53 expression in melanomas is not as frequent as reported in the literature. Population-based differences or differences in case selection and sample handling may account for the above discrepancies. The demonstration of p53 positivity in benign skin lesions greatly hinders the possibility of a diagnostic use of p53 immunostaining in dermatopathology.

Effectiveness of the health campaign for the early diagnosis of cutaneous melanoma in Trentino, Italy.

BACKGROUND: To reduce the mortality rate from cutaneous melanoma in Trentino, a health campaign for early diagnosis aimed at the general public was organized. OBJECTIVE: The mortality rate from cutaneous melanoma in Trentino before and after our health campaign was analyzed and compared with the mortality rates in three neighboring regions where no campaigns were carried out. METHODS: The mortality for cutaneous melanoma was analyzed using data from the death certificates provided by ISTAT for the pre- and postcampaign periods. The two summary methods: cumulative rate and the standard mortality ratio were used. RESULTS: The cumulative mortality rates in the neighboring regions show a tendency to increase over the three periods whereas the increase in Trentino is less evident. The standard mortality ratios confirmed this result. CONCLUSION: We feel that this type of campaign is to be recommended in the reduction of mortality from cutaneous melanoma.

Analysis of the cost-effectiveness ratio of the health campaign for the early diagnosis of cutaneous melanoma in Trentino, Italy.

BACKGROUND: The cost-effectiveness ratio of a health campaign for the early diagnosis of cutaneous melanoma (CM), currently the only means to reduce mortality from this melanoma, was calculated for the Trentino region in Italy. METHODS: Health campaigns in Trentino were carried out, and comparisons were made with neighboring regions where there had been no campaigns. To do this, the trend of the mortality rates calculated according to sex and age using the direct standardized method and data provided by ISTAT (the Central Italian Institute of Statistics) was considered. RESULTS: It was determined that 22.3 lives were saved by early diagnosis during the period 1977-1985, resulting in a savings of $494,636 to the Italian National Health Service in avoided treatments. The total cost to the Health Service of the campaign was $70,800. The cost per year of lives saved was calculated to be $400. CONCLUSIONS: The outcome of this campaign was a recommendation for the use of such programs in other countries and regions.

Phase II study of interferon alpha-2a and dacarbazine in advanced melanoma.

Based on the report of some activity of combination therapy with dacarbazine (DTIC) and interferon alpha-2a (rIFN alpha-2a) in disseminated melanoma, we conducted a phase II study to determine the feasibility and efficacy in a large series of patients. DTIC was administered in 79 patients at the dose of 800 mg/m2 every 3 weeks and rIFN alpha-2a was given daily at the dose of 9 X 10(6) IU for the first 10 weeks and three times a week thereafter. Among the 75 evaluable patients, 25% achieved an objective response, with 8% complete and 17% partial remissions. The regression occurred within a mean time of 1.9 +/- 1.03 months from starting therapy and the mean duration of response was 8.2 +/- 4.2 months. The major side effects were vomiting, anorexia, fever, fatigue, and myalgia. There was one death related to sepsis after myelosuppression. In the other patients bone marrow and liver toxicities were not remarkable. Our data reveal that a combination regimen of rIFN alpha-2a with a cytotoxic agent has some therapeutic activity in the management of advanced malignant melanoma.

Bath-photo-therapy with the thermal water of Comano: treatment of psoriasis.

Association between baths with the thermal water of Comano Springs and selective photo-therapy UVB (bath-photo-therapy) has proved to be effective in 94% of psoriatic patients with non-extensive disease. Therefore bath-photo therapy represents a valid alternative to traditional topical treatments and can be used as a adjuvant in the interval periods of the aggressive modern therapy.

Risk factors for cutaneous malignant melanoma in a northern Italian population.

The relationship between cutaneous malignant melanoma (CMM) and the colour of skin, hair and eyes, the extent of sun exposure and reaction to it, education, and the occurrence of skin neoplasms in patients and their families was evaluated in a case-control study of 103 cases of CMM and 205 control subjects hospitalized for acute conditions other than malignant or hormonal disease. A significantly higher risk was associated with fair skin as compared to dark/medium skin (RR = 4.0; 95% CI: 1.5-10.5) and positive family history for CMM (RR = 8.1; 95% CI: 1.0-200.9). CMM seemed to occur more frequently, but not significantly so, in individuals with brown or blond hair, higher education and clinically diagnosed dysplastic naevi. Outdoor occupation and heavy sun exposure in the last 20 years seemed to increase the risk of CMM in sun-exposed sites but to be negatively associated with CMM in normally unexposed sites.

Aspiration cytology of cutaneous metastatic melanoma and epidermoid carcinoma of the penis.

Aspiration biopsy cytology is an accurate, safe, innocuous alternative to excisional biopsy in diagnosing the nature of concomitant superficial nodules or lymphadenopathy in patients with known cutaneous malignancy. In patients with penile cancer, aspiration biopsy cytology may avoid the morbidity (30-50%) and mortality (3%) of groin dissection staging. A positive aspirate is conclusive of Stage III tumor and, in patients with occult nodal metastases, may lead to early curative lymphadenectomy. In the present study of 28 patients with known cutaneous malignant melanoma, the aspiration biopsy cytology of 31 superficial nodules resulted in a cytologic diagnosis of metastasis in 29 nodules from 26 patients. In the management of patients with known melanoma, the positive cytology of superficial nodules is conclusive of metastatic disease and requires an accurate radiologic study to establish or exclude disseminated disease. Surgical removal of a metastatic superficial nodule is indicated when the lesion is considered localized disease and the patient, having been accurately examined, is determined to be apparently free of disease in other sites and organs. When systemic diffuse melanoma is found, the excision of metastatic superficial nodules is unnecessary. Positive aspiration cytology may avoid risk from ill-judged surgical procedures and indicate appropriate palliative treatment of the disease.

[Early diagnosis of cutaneous melanoma and its precursors. Importance of the clinical characteristics of thin melanoma]. / Diagnosi precoce del melanoma cutaneo e dei precursori. Importanza delle caratteristiche cliniche del melanoma sottile.

The diagnosis and removal of precursor and early lesions is the only method to improve the prognosis and survival rate in malignant melanomas of the skin since the aetiology of the disease is unknown and treatment ineffective when the neoplasm is diagnosed at an advanced stage. A campaign for the prevention and early diagnosis of melanoma is based on the health education of the entire population with the distribution of illustrative material that by teaching people to examine their skin will show up suspicious pigmentary lesions that can be examined and removed by the dermatologist. Thin melanoma is always curable when removed and constitutes the basic tumour to be described to the public as it is easily identified and has constant, typical features. Among the precursors the most interesting lesions is the sporadic or familial dysplastic nevus despite the controversy over its pathogenic significance and morphological aspect. The other pigmentary neoplasias (congenital and acquired nevus) only must to be removed when they present changes resembling thin melanoma.

[Clinico-statistical study on hydropinic and balneothermal therapy of psoriatic patients using the low mineral-content waters of the Comano springs]. / Indagine clinico-statistica sulla terapia idropinica e balneotermale con acqua oligominerale delle Terme di Comano in soggetti affetti da psoriasi.

The authors report the results obtained treating 39 subjects affected from psoriasis with hydropinic therapy and thermal balneo-therapy, using the thermal water of Comano. At the end of the treatment the results were rather bad with an inclusive reduction of 8.5% of the lesions as regards the initial data, but after 3-6 months an average per cent reduction of the lesions about 50% and in some cases quite a total regression of the psoriasis has been noted. No kind of collateral effects has been noted.

The role of etretinate (Tegison; Tigason) in the management of keratoacanthoma.

Four patients with keratoacanthomas 2 to 3 cm in size were treated with etretinate. All the patients demonstrated early response and complete regression of the lesions. Follow-up (of 24 months in one case) did not reveal any recurrence.

Aromatic retinoid in the chemoprevention of the progression of nevoid basal-cell carcinoma syndrome.

The management of nevoid basal-cell carcinomas in this syndrome is sometimes very difficult, because of the high number of tumors and of their particular localizations. The authors reviewed the literature and here report their experience in the treatment of nevoid basal-cell carcinoma syndrome with aromatic retinoid etretinate (RO 10-9359; Tigason).

A gigantic, metastasizing keratoacanthoma. Report of a case and discussion on classification.

A case of a gigantic metastasizing keratoacanthoma in a woman who had impaired cellular immunity and autoimmune hemolytic anemia is described. The case suggests that disorders of humoral and cellular immunity may be responsible for development of recurrent and metastasizing keratoacanthomas.

Case of bilateral ovarian metastasis from regressed melanoma.

The Authors report an exceedingly unusual case of bilateral ovarian metastasis from regressed melanoma (spontaneous regression of skin malignant melanoma) in a patient who had undergone removal of a pigmented nevus from left forearm. The diagnosis was established histologically following on the bilateral adnexectomy with total hysterectomy the patient underwent for suspect ovarian tumour. Given the rareness of the clinical from and the diagnostic problems involved the Authors examine the literature dealing with this subject and look for the most adequate diagnostic means.