High prevalence of the G101W germline mutation in the CDKN2A (P16(ink4a)) gene in 62 Italian malignant melanoma families.

CDKN2A germline mutation frequency estimates are commonly based on families with several melanoma cases. When we started counseling in a research setting on gene susceptibility analysis in northern and central Italy, however, we mostly found small families with few cases. Here we briefly characterize those kindred, estimate CDKN2A/CDK4 mutation test yields, and provide indications on the possibility of implementing formal DNA testing for melanoma-prone families in Italy.

Selective lymph node dissection in patients with intermediate thickness melanoma: our experience.

The role of elective lymph node dissection (ELND) for the treatment of cutaneous melanoma has been debated for many years. Actually, the value of ELND is seriously questioned because an increasing of overall survival rates has not been demonstrated. The lymphatic mapping technique, initially performed by an intradermic injection of vital blue dye, subsequently improved by the use of radioguided surgery (RGS), proved effective for the detection of clinical occult lymph node metastasis.

Characterization of ligurian melanoma families and risk of occurrence of other neoplasia.

Germline mutations impairing the p16(INK4)-function have previously been demonstrated to be responsible for genetic predisposition in at least one half of melanoma-prone kindreds of North European origin. Familial melanoma kindreds have also been found to present an increased risk of pancreatic cancer and other cancers, but results relative to more common neoplasias incidence, in particular, are heterogeneous. We report here a clinical-epidemiological study, including the presence of additional neoplasias, in 14 apparently unrelated kindreds coming from a small geographic region of Northern Italy (Liguria), having therefore lived for generations in similar environmental conditions.

Intercellular adhesion molecule-1 (ICAM-1) and granulocyte-macrophage colony stimulating factor (GM-CSF) co-expression in cutaneous malignant melanoma lesions.

The expression of intercellular adhesion molecule-1 (ICAM-1) and granulocyte-macrophage colony stimulating factor (GM-CSF) was investigated in 25 melanoma patients by evaluating 34 fresh biopsy specimens. ICAM-1 in situ hybridization and immunochemistry for ICAM-1 and GM-CSF were performed. Most of the metastatic melanoma samples (12 out of 18) and a few of the primary melanoma lesions (three out of 16) showed ICAM-1 expression.

Sentinel node biopsy in patients with cutaneous melanoma.

The role of elective lymph node dissection (ELND) for treatment of cutaneous melanoma is still debated. Initially, lymphatic mapping technique was performed by an intradermic injection of vital blue dye; subsequently, it was improved by the use of radioguided surgery (RGS). Preliminary experience with this technique proved effective for detection of clinical occult lymph node metastasis; it may also enable the surgeon to perform a selective lymph node dissection (SLND) to concentrate on pathologic node-positive patients for the same potential benefits that have been provided by ELND.

MEL-P, a GM-CSF-producing human melanoma cell line.

A human melanoma cell line, MEL-P, expressing granulocyte-macrophage colony-stimulating factor (GM-CSF) and its specific receptor was newly established from a primary nodular lesion of a patient with a particularly unfavourable prognosis. Cytogenetic, immunophenotypic, cytokine and intercellular adhesion molecule (ICAM)-1 production analyses confirmed that this cell line was similar to the fresh melanoma cells from which it had been established. MEL-P constitutes a valuable model for the study of multistep tumour progression and the role of biologically active GM-CSF production in human malignant melanoma.

Multinucleate cell angiohistiocytoma. A review and report of four cases.

Multinucleate cell angiohistiocytoma (MCA) was first characterized by Smith & Wilson-Jones. Although only a few cases have been published, this very characteristic benign tumor is probably not rare. The clinical pictures are firm circumscribed papules, mainly of the hands, which progress slowly over the years.

[Reconstructive method for the repair of substantial loss of the head and neck area, following the excision of malignant melanoma].

The general increase in the incidence of malignant melanoma has caused a more massive presence at the level of special sites such as the face, posing problems of the reconstruction from a cosmetic point of view. The widespread move away from large margins of exercise (3-5 cm) towards margins of approximately 1 cm surrounding the lesion, together with the improved prognosis for this pathology on the face compared to other sites, calls for greater attention to be paid to the reconstructive techniques used. Since surgery is the only solution "quoad vitam" for the patient, it is now preferable to attempt to offer the patient both a complete exeresis of the neoplasia and a satisfactory cosmetic result.

Cytokine expression in human primary and metastatic melanoma cells: analysis in fresh bioptic specimens.

In recent years, several studies have documented that melanoma cell lines produce various cytokine/growth factors and their receptors. Since cell lines can acquire altered properties, such as changes in growth requirements, we studied constitutive cytokine gene expression in melanoma cells from 20 fresh surgical specimens: seven primary melanomas and 13 metastases (12 lymph-node metastases and one subcutaneous metastasis). After tumour cell isolation by discontinuous gradient, we tested for mRNA expression by means of reverse-transcriptase polymerase chain reaction.

[Isolated hyperthermic antiblastic perfusion in recurrent melanoma of the extremities].

Twenty-two patients with recurrent melanoma of the limbs, underwent Hyperthermic Antiblastic Perfusion (HAP). HAP lasted 60 min, with maximal local temperature of 40.5-42 degrees C and melphalan 10 mg/L limb volume as antiblastic agent.

Radiotherapy and hyperthermia in the treatment of primary Merkel cell carcinoma of the skin: a case report.

We report a case of a large Merkel cell skin tumor (left cheek) in an 83 year-old woman treated by a combination of radiotherapy and hyperthermia. A complete response to the treatment was observed and without side effects. The patient has now been followed for 12 months without signs of recurrence, nodal disease, or distant metastasis.

Results of the association of intralesional recombinant alpha-interferon-2a (alpha-IFN) plus 13-cis-retinoic Acid (13cra) in the treatment of Basal-cell carcinomas (bcc) of the skin.

In this phase II study, twenty-four patients (median age 72 years) with BCC of the skin were treated with intralesional alpha-IFN plus 13cRA. Alpha-IFN was administered intralesionally at the dose of 3x10(6) I.U.

In vitro antimicrobial effects of fresh split skin, homologous-cultured epithelium and porcine split skin grafts for wound coverage.

Various biological dressings, for example, human fresh and cadaver skin grafts, homologous cultured human epithelium and deep frozen porcine split skin (Lyocutis), have been used to treat skin loss. Each of these biological dressings has its advantages and disadvantages. The antimicrobial properties of each dressing type are important since bactericidal activity influences the lifespan of the transplanted tissue.

Unilateral reduction mammaplasty: sculpturing the breast from the undersurface.

Various traditional mammaplasty techniques have been suggested for unilateral breast reduction, and an inverted-T incision is still the most popular approach. However, unilaterally performed traditional techniques can rarely provide long-lasting symmetry because the operated and the unoperated breasts react differently to aging, weight changes, and pregnancy. Considerable residual scarring, interference with clinical and mammographic evaluation, and limited versatility are all major drawbacks of traditional procedures.

Immediate reconstruction of the penis using an inferiorly based rectus abdominis myocutaneous flap.

A new method for reconstruction of the penis using an inferiorly based rectus abdominis myocutaneous flap is described that seems to be particularly suitable for immediate one-stage reconstruction. Function of the residual portion of rectus muscle is preserved, and the abdominal wall is not significantly weakened.

Transposition of myocutaneous flaps in breast reconstruction following radical mastectomy: latissimus dorsi vs. rectus abdominis flap.

We evaluated two homogeneous groups of patients (20 each) who had undergone radical mastectomy and who underwent breast reconstruction in our department by transposition of a latissimus dorsi or of a rectus abdominis myocutaneous flap. The results achieved were very similar (in terms of postoperative hospitalization, complication rate, thoracic symmetry). We therefore believe that both these techniques should be considered as first choice in breast reconstruction following radical mastectomy.

Present day role of plastic surgery in management of chronic radiation wounds: our experience.

Traditional procedures to resurface soft tissues defects following excision of chronic radiation wounds involve the use of skin grafts or skin flaps. However, the poor vascularity of the recipient bed is the reason for the high failure rate of skin grafts. Local skin flaps will often fail because of radiation injury to tissues within the flap itself.

Long-lasting complications with the use of polyurethane-covered breast implants.

Polyurethane-covered breast implants have been recommended by some authors for aesthetic and reconstructive procedures, since with these implants the incidence of capsular contracture is insignificant and risks of implant displacement or exposure are reduced. Reports on the use of these implants focus merely on aesthetic aspects, and risks associated with disintegration and incorporation of the polyurethane-coating are often overlooked. The authors have observed several complications associated with the use of these prostheses; two cases of long-lasting complication are described, which are ascribed to difficult removal of infected fragments of the coat and to delayed foreign body reaction to polyurethane.

Anterior transposition of the latissimus dorsi muscle through minimal incisions.

Latissimus dorsi transposition is a useful procedure for the correction of various congenital and acquired thoracic deformities. The authors describe a surgical technique which allows anterior transposition of the whole muscle through minimal incisions. The technique has been used in 33 patients with post-mastectomy or post-subcutaneous mastectomy deformities, Poland's syndrome, deep radionecrosis, quadrantectomy, or breast underdevelopment following burns.