Connettiviti: oltre la terapia

Le connettiviti sono un gruppo di malattie caratterizzate dalla degenerazione del tessuto connettivo, con accumulo tra le fibre collagene di un materiale denso e omogeneo detto sostanza fibrinoide. Le alterazioni del collagene sono una manifestazione secondaria, in quanto la causa risiede in un meccanismo di tipo autoimmune ed alcune forme di connettiviti presentano dei sintomi che si manifestano a livello epidermico, come per esempio il LES, il LED, la sclerodermia, , la dermatomiosite, etc., provocando nel paziente anche danni a livello psicologico. La terapia farmacologia dura molti anni, pertanto, mascherare con il Camouflage le manifestazioni cutanee di queste patologie deve essere considerato come un presupposto essenziale affinché il paziente accetti la condizione di malattia e segua le prescrizioni terapeutiche migliorando il suo stato di saluto generale. Presso il Policlinico Universitario Federico II di Napoli e l’Ospedale S.Eugenio di Roma sono attivi i Laboratori di Camouflage Dermoestetico Correttivo dove si insegna ai pazienti affetti da inestetismi cutanei come mascherare le proprie imperfezioni. Negli ultimi due anni si sono rivolti ai due centri 493 pazienti ; di questi il 4,3 % era affetto da patologie del connettivo, aveva età compresa tra 21-50 anni e l’ 85% era di sesso femminile. Vengono presentati gli eccellenti risultati ottenuti con questa nuova tecnica

The surgical treatment of non-metastatic melanoma in a Clinical National Melanoma Registry Study Group (CNMR): a retrospective cohort quality improvement study to reduce the morbidity rates

Background: Reproducible, high-quality surgery is a key point in the management of cancer patients. Quality indicators for surgical treatment of melanoma has been presented with benchmarks but data on morbidity are still limited. This study presents the quality indicators on morbidity after surgical treatment for non-metastatic skin melanoma in an Italian registry. Methods: Data were extracted from the Central National Melanoma Registry (CNMR) promoted by the Italian Melanoma Intergroup (IMI). All surgical procedures (WE, SNLB or LFND) for non-metastatic skin melanoma between January 2011 and February 2017 were evaluated for inclusion in the study. Only centers with adequate completeness of information (> 80%) were included in the study. Short-term complications (wound infection, dehiscence, skin graft failure and seroma) were investigated. Results: Wound infection rate was 1.1% (0.4 to 2.7%) in WE, 1.3% (0.7 to 2.5%) in SLNB and 4.1% (2.1 to 8.0%) in LFND. Wound dehiscence rate was 2.0% (0.8 to 5.1%) in WE, 0.9% (0.2 to 3.0%) in SLNB and 2.8% (0.9 to 8.6%) in LFND. Seroma rate was 4.2% (1.5 to 11.1%) in SLNB and 15.1% (4.6 to 39.9%) in LFND. Unreliable information was found on skin graft failure. Conclusions: Our findings contribute to available literature in setting up the recommended standards for melanoma centers, thus improving the quality of surgery offered to patients. A consensus on the core issues around surgical morbidity is needed to provide practical guidance on morbidity prevention and management

Real Life Clinical Management and Survival in Advanced Cutaneous Melanoma: The Italian Clinical National Melanoma Registry Experience

Background: Cutaneous melanoma (CM) is one of the most aggressive types of skin cancer. Currently, innovative approaches such as target therapies and immunotherapies have been introduced in clinical practice. Data of clinical trials and real life studies that evaluate the outcomes of these therapeutic associations are necessary to establish their clinical utility. The aim of this study is to investigate the types of oncological treatments employed in the real-life clinical management of patients with advanced CM in several Italian centers, which are part of the Clinical National Melanoma Registry (CNMR). Methods: Melanoma-specific survival and overall survival were calculated. Multivariate Cox regression models were used to estimate the hazard ratios adjusting for confounders and other prognostic factors. Results: The median follow-up time was 36 months (range 1.2-185.1). 787 CM were included in the analysis with completed information about therapies. All types of immunotherapy showed a significant improved survival compared with all other therapies (p=0.001). 75% was the highest reduction of death reached by anti-PD-1 (HR=0.25), globally immunotherapy was significantly associated with improved survival, either for anti-CTLA4 monotherapy or combined with anti-PD-1 (HR=0.47 and 0.26, respectively) and BRAFI+MEKI (HR=0.62). Conclusions: The nivolumab/pembrolizumab in combination of ipilimumab and the addition of ant-MEK to the BRAFi can be considered the best therapies to improve survival in a real-world-population. The CNMR can complement clinical registries with the intent of improving cancer management and standardizing cancer treatment