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PRIMARY ORAL MUCOSA MELANOMA: A REPORT OF AN UNUSUAL CLINICOPATHOLOGICAL CASE

Primary oral melanoma is a rare malignancy with an aggressive behaviour. Up to date, the wide clinicalhistological variability of this oncological entity does not clarify the etiopathogenetic characteristics of these cancers and limit the therapeutic strategies. We report a case of a 64-year-old white female referred to the Dept. of Surgical, Oncological and Oral Sciences for a pigmented lesion of the mandibular gingiva, already arising 20 years ago but dimensionally increased in the last three months. Clinically, a black plaque-like pigmentation of the vestibular alveolar mucosa of the mandible (from 3.6 to 3.3) was observed. This lesions was still painless. CT dentalscan and ecography of the head and neck lymph nodes have showed no signs of bone and lymph nodes involvement. An incisional biopsy of the lesion was performed under local anaesthesia. Histopathologic examination showed a nodular proliferation of atypical melanocytic elements with epithelioid aspect and nuclear alterations; numerous abnormal mitotic figures were evident and the malignant melanocytes were characterized by marked intra/extracellular pigmentation. Immunohistochemical staining showed strong and diffuse positivity for Melan A and HMB45, 40% positive for Ki67 and positive/negative result for p16. These histopathologic features were suggestive for animal-type invasive melanoma. After diagnosis, the patient was referred to the Dept. of Head and Neck Surgery for staging and chirurgical approach of the lesion. At the best of our knowledge, only a very small number of animal-type melanomas have been reported in the oral cavity and usually with a more indolent behavior than conventional melanoma and a better prognosis. However, future reports are necessary to characterize the features of this cancer and to determine any factors that may correlate with outcome

Evidence of field cancerization of oral squamous cell carcinoma: a case report

Objectives. From 1953 (1) the term “field cancerization” has been used to describe an “increased risk of cancer de- velopment in the entire upper aerodigestive tract due to multiple genetic abnormalities in the whole region after pro- longed exposure to carcinogen” (2). This phenomenon implies the occurrence of multiple primary tumors/potentially malignant disorders as results of cell-molecular aberrations in different independent sites (polyclonal theory) or from the same site through widespread expansion or later spread across the mucosa (monoclonal theory). Case report. A 63-year-old female patient referred in June of 2014 for exophytic/ulcerative lesion in the hard palate. At the same time, several teeth (1.5, 1.6 and 3.6) with poor prognosis and an incisional biopsy were per- formed. The histological examination reported a diagnosis of oral squamous cell carcinoma (G1) and the manage- ment (imaging and TNM staging) was scheduled. Unfortunately, 30 days after exodontia, one of alveolar sites (3.6) showed proliferative tissue and not healing. A new biopsy was carried out, revealing an histological diagnosis of “epithelium with marked parakeratosis, acanthosis and papillomatosis associated with areas of moderate dys- plasia (IIC: PanCK)”. Conclusions. The features described in different areas of the oral cavity led us to make a diagnosis of oral field can- cerization. This condition still must be analyzed in order to clarify the onset and development but, most importantly, a protocol for manage these patients have to be developed. Chemoprevention and cessation of smoking and alcohol may impact new tumors. Amelioration of surgery, radiotherapy, chemotherapy and gene therapy may influence the morbidity and mortality of oral cancer patients, even if a short follow up and the secondary prevention may warrant a life-long surveillance

Triple simultaneus oral squamous cell carcinoma in a heavy smoker patient: a case report

Introduction. The presence of multiple malignancies in the aerodigestive tract is a rare disorder defined as multiple primary carcinoma (MPC)1, which lesions must be at different sites separated by normal mucosa and histologically confirmed, and should not be metastatic disease from the index carcinoma2. The reported incidence of MPC in the oral cavity has been reported to be 1.4%. MPC can be simultaneous (diagnosed at the same time as the index tumour), synchronous (additional primaries diagnosed within 6 months of the index tumour), or metachronous (primaries that develop more than 6 months after the index tumour)2. Case report. A 79-year-old edentulous male patient presented 3 different oral lesions: a) an erythro/leukoplasic le- sion on the soft palate and uvula (2,5x1cm), b) a verrucous/ulcerative lesion on the floor of the mouth (1x1cm), c) an exophytic/ulcerative lesion on the edentulus ridge of the 4th sextant (3,5x1cm). Lesions were not associated to any symptoms; the lesions b and c were bleeding and fixed to the underlying tissue. The patient reported no health concerns; he referred a 10-pack-year of cigarettes history followed by 50-pack-year of cigars. All the lesions presented a dark royal blue aspect after the toluidine blue staining3. Incisional biopsies were made and the histological examination reported a diagnosis of “oral squamous cell carcino- ma” in each of the tissue samples. Patient was referred to the Department of Oral Maxillofacial and Plastic Surgery for the TNM staging and the management. Conclusion. The MPC pathogenesis is uncertain involving genetic susceptibility, tumor immunity and environmental factors. Moreover, multiple cancers have a poor prognosis, 3-year survival rate of 50%, underlining that secondary prevention should be promoted and supported in adult heavy smokers, as the early diagnosis of oral carcinoma aris- es the probability of successful treatment

Gender and Sex in Medical Practice: An Exploratory Study on Knowledge, Behavior, and Attitude among Sicilian Physicians

Personalized medicine is a new paradigm in health care, and the concept of socio-cultural gender, as opposed to biological sex, emerged in several medical approaches. This exploratory study aimed to investigate the knowledge of sex and gender in clinical medicine among Sicilian physicians. Data collection was based on an online survey sent to the members of the Medical Councils of Sicily (Italy). The questionnaire included nine specific items about awareness and attitudes regarding gender medicine and its importance in clinical practice. 8023 Sicilian physicians received the solicitation e-mail and only 496 responded. Regarding the knowledge of gender medicine, 71.1% of participants stated that they know it, while 88.5% believe that gender medicine should be included in training programs. Similarly, a high percentage (77.6%) would like to keep up to date on this topic. Physicians sampled seem to understand the importance of gender medicine principles, although their experience of some gender issues (i.e., sex disparities in acute cardiovascular care and smoking cessation strategies) is low (55.44% and 21.57%, respectively). The results of this exploratory study should encourage facing the gender medicine gap in the current curricula of health professionals and should implement the transitional value of sex and gender principles in the clinical setting

Biofilm production and antibiotic resistance of human and veterinary Staphylococcus strains.

Staphylococcus spp. is widely distributed in medical and veterinary pathology and represents one of the most important causes of infection. Many strains are antibiotic-resistant even for the presence of an eso-polysaccharide matrix. The aim of this work was to individuate, among 396 different Staphylococci of human and animal origin, the slime producing strains and to correlate the presence of biofilm to the resistance to eight antibiotics. A total of 185 coagulase negative staphylococci (CNS) and 211 S. aureus isolated from different sources and identified with Sceptor System, were tested for antibiotic susceptibility (Kirby Bauer method) and for slime production (Polystyrene plates – stained with Alcian blue – Spectrophotometric reading at 450 nm). The strains were classified as weak, strong and no slime-producing on the basis of OD results. The results were submitted to statistical analysis using Student’s t-test and chi-square tests. Evaluating the differences of slime production among medical and veterinary strains, we found different statistical frequencies (P > 0.001). No statistical differences wereobtained between S. aureus and the other CNS. Instead, the statistical analysis on S. epidermidis vs. the other staphylococci has shown no statistical differences among average values using Student’s ttest (P < 0.052) and significant frequency differences using chi square tests (P < 0.02). Finally in the CNS, between S. epidermidis and the other strains, no statistical differences were found. The relation between slime production and the origin of strains was evaluated and no correlation was found. About the correlation between antibiotic-resistance and slime production a resistance increment of about 30% was obtained in strongly slime producing strains. Staphylococcus spp. is often involved in nosocomial infections as complication of post-surgery wounds, catheters and orthopaedic devices. The presence of antibiotic-resistant strains interferes in the therapy successes and seems to be strictly related to biofilm production beyond that genetically acquired. Human and veterinary strains have shown a similar behaviour towards biofilm production and antibiotic-resistance. The results confirm that S. epidermidis is one of the most slime-producer and introduce S. aureus as a new high slime-producer

Stomatitis and vR-TkI: a review of current literature in 4369 patients

the following review was performed to answer to the question \u201cWhat is the rate of incidence of oral stomatitis in patients treated with VegF tKis?\u201