Human PapillomaVirus (HPV) vaccination has been introduced in recent years in clinical practice as the most effective primary prevention strategy for cervical cancer and HPV-induced lesions, either ...pre-malignant or benign. Since its introduction, HPV vaccination has been progressively demonstrated as extremely effective in preventing extra-genital and male diseases also; furthermore, non only adolescents but adult subjects have been investigated and reported as positively responding to vaccine immunostimulation. More recently, effectiveness of post-treatment vaccine administration has been preliminarily investigated with very promising results in terms of decreased recurrences. On this basis, we report an Italian-focused picture of the state of the art and take a position in favour of the extension of HPV vaccination to male adolescents, to older age groups and to already treated subjects.
Summary
Background
Vulvar melanoma (VM) is rare and is often diagnosed late. Dermoscopy may aid in its recognition, differentiating VM from other more common vulvar lesions, such as melanosis and ...naevi. However, little is known about the dermoscopic features of thin VM.
Aim
To retrospectively analyse a series of histopathologically diagnosed thin VMs and to highlight their most suggestive dermoscopic features.
Methods
A multicentre, retrospective study was conducted, including histopathologically proven thin VMs, either intraepidermal or with Breslow thickness ≤ 0.5 mm, diagnosed during the period 2016–2018. We particularly focused on their dermoscopic characteristics to highlight the most suggestive dermoscopic diagnostic clues.
Results
In total, 14 cases of early‐stage VM were included, in women with a mean age at diagnosis of 64.86 years. The most frequently affected sites were the labia minora. Of these, 11 cases were unifocal. Dermoscopy most often revealed structureless areas, grey globules and areas, irregular black–brown dots, blue and white structures, and red areas.
Conclusions
In our experience, early‐stage VM often exhibits dermoscopic features that are more typical of thicker cutaneous melanomas. Dermoscopy may provide useful clues for the prompt diagnosis of thin VM.
Objective To assess whether changes over time in neonatal survival and infants’ neurodevelopmental outcome among very low birthweight (VLBW) infants was correlated with the obstetric aetiology of ...VLBW.
Design A cohort study of 773 VLBW infants.
Setting A University hospital in Northern Italy.
Population All the VLBW infants born over a 20‐year period (1983–2002) at a single institution.
Methods Evaluation of neonatal mortality and neurodevelopmental outcome of the surviving infants at 2 years of corrected age. Logistic regression analysis was used to compare the improvements of neonatal outcome associated with obstetric risk factors over time.
Main outcome measures The risk reduction of neonatal death or cerebral palsy associated with each obstetric category responsible for VLBW over time.
Results The overall rates of neonatal mortality and cerebral palsy were 38.7% (43/111) and 17% (9/53) in the period 1983–87 and 13.7% (34/24) and 6.3% (13/205) in the period 1998–2002, respectively. The adjusted decrement per 5‐year period was 33.1% (95% CI = 7.9–51.4) for neonatal death and 29.1% (95% CI = 25.3–32.7) for cerebral palsy, respectively. The adjusted rise in the rate of intact survival at 2 years of corrected age was 7.6% (95% CI = 3.1–12.3) per quinquennium. In logistic models with neonatal death or cerebral palsy as a combined outcome variable, and gestational age, corticosteroid use, surfactant use, and time of birth as explanatory variables, fetal growth restriction (P < 0.001) and pre‐eclampsia (P= 0.011) interacted significantly with period of birth. The adjusted decrement in the rate of neonatal death or cerebral palsy as a combined variable was 27.5% per 5 years (95% CI = 13–39.6) in the overall population, 54.5% per 5 years (95% CI = 46.8–61.2) (P < 0.001 compared with overall population) among growth‐restricted infants and 50.3% per 5 years (95% CI = 42.5–57.1) (P= 0.003 compared with overall population) in infants born to mothers with pre‐eclampsia.
Conclusions Over a period of 20 years, the decrement in the rate of neonatal death or cerebral palsy was higher in growth‐restricted fetuses than in other VLBW infants. This reduction was not obtained at the expense of an increased rate of neurodevelopmental impairments in surviving infants.
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