A Preliminary Study for Quantitative Assessment with HFUS (High- Frequency Ultrasound) of Nodular Skin Melanoma Breslow Thickness in Adults Before Surgery: Interdisciplinary Team Experience

Abstract

Background: Cutaneous melanoma is one of the most severe skin diseases. Nodular melanoma is the second melanoma subtype in order of frequency. The prognosis of skin melanoma depends on the vertical growth of the tumor (Breslow index). For this measurement, excisional biopsy is strongly recommended. This is, however, an invasive procedure and may cause damage to the lymphatic drainage system. The HFUS system, , can be extremely useful for determining tumor thickness in the preoperative phase, given its high resolution capacity. The aim of this preliminary study is to define the role of HFUS for the nodular skin melanoma Breslow thickness in adults before surgery by making a comparison with histological features. Methods: In this study, 14 melanocytic lesions (8 male and 6 female) were evaluated with dermatoscopic clinical features strongly indicative of nodular melanoma. Out of these, excisional biopsy of 7 lesions was requested. The ultrasounds were performed preoperatively. The images were acquired through the first ultrasound scanner with ultra-high frequency probes (range from 50MHz to 70 MHz) available on the market under the EEC mark (Vevo "MD, FUJIFILM Visual Sonics, Amsterdam, the Netherlands) equipped with a linear probe of 50-70 MHz. Results: From the ultrasonographic analysis of 14 nodular melanoma thickness was determined for the presence of two hyperechogenic laminae, separated by a hypo / anechoic space. The twelve lesions were in situ while the other two lesions showed ultrasonography for example; the satellite lesions (less than two centimeters from the primary lesion) and in transit (localizable to more than two centimeters from the primary lesion). Four of these lesions were ulcerated. A comparsion was made the 7 lesions on between the thickness calculated with this method, and that obtained on the bioptic piece. The presence of a positive concordance has been evident in all of the cases. Conclusions: If further studies are needed to support its widespread clinical use, its is believed that, in expert hands and with an interdisciplinary team, HFUS is already capable to reliably calculate a Breslow index in a large majority of patients with cutaneous melanoma.

Primary Cutaneous Anaplastic Large Cell Lymphoma (pcALCL) in Elderly, the Importance of a Sport Activity Training

“…The complete surgical excision and local radiotherapy are the first line gold standard therapy of pcALCL with solitary or grouped localized lesions (up to T2N0M0) [25]. In the more advanced stage of the illness with cutaneous dissemination and in the relapsing/refractory disease, the administration of brentuximab vedotin (BV), an anti-CD30 antibody-conjugate, has shown low toxicity and a high percentage of remissions and has been recommendable in the elderly patient [26][27].…”

Endoscopic Treatment and Pulmonary Rehabilitation for Management of Lung Abscess in Elderly Lymphoma Patients

“…Lung abscess is an infectious disease that often does not respond to antibiotic treatment, requiring invasive therapies such as the placement of percutaneous drainage. The suppurative process can be a primary event and a direct consequence of the aspiration of alimentary material, of necrotizing pneumonia or caused by states of immunodepression (e.g., steroid therapy, chemotherapy, immunosuppression in transplanted patients) [1][2][3][4][5][6][7].…”

Post-Operative Chronic Pain Control in Mediastinal Lymphomas in An Elderly Population: the Role of Physical Activity

“…Instead, both activated B and T lymphocytes have an inhibitory action on pain for the production of IL-10, the cytokine with the highest inhibitory action on the secretion of IL-1β, IL-6 and TNF-α [13][14][15]. Especially in lymphomas, but also in other neoplasms, the mechanisms involving these cells are altered, helping to not amplify neuropathic pain [16][17][18][19][20]. It is evident that the complexity of the pathogenesis of neuropathic pain does not allow unambiguous solutions in these patients who should be mobilized immediately after surgical In our study 51 elderly patients who had undergone a transthoracic biopsy to verify one suspect of mediastinal lymphoma were examined for pain reduction with oral opioids, effect of epidural analgesia and paravertebral block [33][34][35][36].…”