A Red Nodule on the Cheek - a Case Report

Abstract Introduction: Merkel cell carcinoma (MCC) is a rare, very aggressive neuroectodermal tumor of the skin typically located on sun-exposed areas and frequently found in Caucasian men between 70 and 80 years of age. Case Report: We present a case of a 86-year-old woman who was referred to our Skin Cancer Unit with a red and well defined nodule located on her left commissure of the mouth, that grew during a couple of months and was completely asymptomatic. Dermoscopic examination revealed a reddish background with linear and arborizing irregular vessels, some out of focus vessels and whitish areas. The lesion was excised, histological examination showed that the tumor was hypercellular and composed of round epithelial elements with large nuclei and scant cytoplasm suggestive of MCC. Immunohistochemical stains confirmed a diffuse positivity with cytokeratin (CK) 2 chromogranin, and synaptophysin; CK7 and thyroid transcription factor-1(TTF-1) were negative. Sentinel lymph node biopsy was done, resulting negative for neoplastic cells, and computed tomography (CT) of the chest, abdomen and pelvis showed no distant metastasis. Adjuvant radiotherapy on the tumor site and on homolateral neck lymph nodes was also done. Conclusion: Merkel cell carcinoma presents as an asymptomatic, rapidly growing nonpigmented nodule without specific characteristics. Dermoscopic features may help to distinguish MCC from other similar tumors: linear irregular vessels, milky pink areas, architectural disorders and structureless areas, even if not specific, when present are strongly suggestive of MCC. Wide excision with 2 cm margins with adjuvant radiotherapy is the treatment of choice in high-risk primary tumors, while sentinel lymph node biopsy and computed tomography scans are necessary for early diagnosis of metastatic disease

Can we improve melanoma detection methods?

N

Logistics chain responsiveness to war impacts: A case study in North Adriatic Region

The Russian-Ukraine conflict outbreak abruptly interrupted the sea-road intermodal service which provided some metal companies in the Italian region of Friuli Venezia Giulia with semi-finished steel products coming from the Ukrainian port of Mariupol. Those companies were then forced to find an alternative supply source to feed their production system, which entailed the arrival of oceanic vessels with a greater cargo load, but at a lower frequency. Such changes implied significant consequences both on the maritime and the land side and requested the employment of trucks, train and barges to transfer the increased volume of goods. Moreover, those variations generated additional costs for all the involved operators, threating the survivability of the whole supply chain and, thus, of an important share of the regional economy. In this paper, a methodology combining process modelling and quantitative analysis has been applied, first, to gain an in-depth understanding of the case study and then, to suggest modifications to existing policies. Such investigation techniques enabled, on one hand, to identify process bottlenecks and, on the other hand, to examine infrastructural and financial consequences for each considered transport mode. Results revealed the need of adjusting the current strategic vision especially with reference to the development of the infrastructural networks, the introduction of incentive schemes and the availability of skilled people operating in logistics. The proposed lines of action are meant to foster the resilience of the analysed supply chain at economic, environmental and social level

Image Gallery: Brain? no, melanoma

N

Occurrence of Paraleucilla magna Klautau et al., 2004 (porifera : Calcarea) in Malta

The calcareous sponge Paraleucilla magna, first recorded from the Mediterranean in 2001 (southern Tyrrhenian, southern Adriatic and northwest Ionian coasts of Italy), is recorded from Malta (Central Mediterranean) where it was found forming part of the fouling community on small, surface marker-buoys around a fish-farm in Marsaxlokk Bay.peer-reviewe

Comparing Power Supply Technologies for Public Transport Buses through the AHP and the Fuzzy DEMATEL Method

The selection of power supply technology for buses is a critical task given the increasing attention paid to environmental sustainability in the public transport sector. Indeed, the compliance of vehicle operational requirements with service characteristics is essential to provide users with an efficient offer. To this end, this study investigates the factors affecting such choices by performing two evaluation procedures, with the integration of different techniques and the engagement of an expert panel. The Analytic Hierarchy Process (AHP) method was used to identify the best power supply technology among a few solutions in both procedures, which differed in the number of analyzed criteria. A literature review suggested a wide set of criteria considered in the first assessment, which were then limited to the most influential criteria using the fuzzy DEcision-MAking Trial and Evaluation Laboratory (DEMATEL) method. Notably, the latter enabled the reduction in the number of the criteria owing to the revealing of cause–effect relationships among them. The methodology was applied to a case study in the city of Trieste, Italy, comparing rankings obtained from the two appraisal procedures, which showed the predominance of internal combustion engine buses over hybrid and electric buses in terms of operational and financial aspects, despite their environmental impact

Broadening the List of Basal Cell Carcinoma Mimickers: Dermoscopic Features of Trichoadenoma

N/

What is New in Melanoma Genetics and Treatment?

New therapies for advanced melanoma have led to major advances, which, for the first time, showed improved survival for patients with this very challenging neoplasm. These new treatments are based on gene-targeted therapies or stimulation of immune responses. However, these treatments are not without challenges in terms of resistance and toxicity. Physicians should be aware of these side effects as prompt treatment may save lives. Melanoma genetics is also unravelling new genetic risk factors involving telomere genes as well as new gene pathways at the somatic level which may soon become therapeutic targets. It is also shedding new light onto the pathology of this tumour with links to neural diseases and longevity

Fibroepithelioma of Pinkus: Solitary tumor or sign of a complex gastrointestinal syndrome

Fibroepithelioma of Pinkus (FEP), which is considered to be an uncommon variant of basal cell carcinoma, has been described in association with other systemic diseases. However, no specific studies are currently available on this subject. The aim of our study was to evaluate the clinical and morphological characteristics of FEP and investigate whether this rare tumor is a single entity or seen in the context of a more complex syndrome. We retrospectively analyzed 49 cases of FEP diagnosed and excised in a single academic institution from 1995 to 2011. The tumors were mainly located on the trunk (77.55%), followed by the lower extremities (12.20%) and the head and neck (10.20%). In 9 of the 49 cases (18%), FEP was associated with gastrointestinal tumors. The abovementioned cases are presented in an attempt to make clinicians more aware of a possible association between FEP and gastrointestinal cancer. Although a possible underlying common genetic background between FEP and gastrointestinal tumors was not provided, our study suggests that patients with FEP should be screened for the occurrence of gastrointestinal tumors

Aquaculture and Restoration: Perspectives from Mediterranean Sea Experiences

In this paper, the different possibilities and innovations related to sustainable aquaculture in the Mediterranean area are discussed, while different maricultural methods, and the role of Integrated Multi-Trophic Aquaculture (IMTA) in supporting the exploitation of the ocean’s resources, are also reviewed. IMTA, and mariculture in general, when carefully planned, can be suitable for environmental restoration and conservation purposes. Aquaculture, especially mariculture, is a sector that is progressively increasing in parallel with the increase in human needs; however, several problems still affect its development, mainly in relation to the choice of suitable sites, fodder production, and the impact on the surrounding environment. A current challenge that requires suitable solutions is the implementation of IMTA. Unfortunately, some criticisms still affect this approach, mostly concerning the commercialization of new products such as invertebrates and seaweeds, notwithstanding their environmentally friendly character. Regarding the location of a suitable site, mariculture plans are currently displaced from inshore to offshore, with the aim of reducing the competition for space with other human activities carried out within coastal waters. Moreover, in open water, waste loading does not appear to be a problem, but high-energy waters increase maintenance costs. Some suggestions are given for developing sustainable mariculture in the Mediterranean area, where IMTA is in its infancy and where the scarce nutrients that characterize offshore waters are not suitable for the farming of both filter feeder invertebrates and macroalgae. From the perspective of coupling mariculture activity with restoration ecology, the practices suggested in this review concern the implementation of inshore IMTA, creating artificially controlled gardens, as well as offshore mussel farming coupled with artificial reefs, while also hypothesizing the possibility of the use of artificially eutrophized areas