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BACKGROUND: The increase of the number of new cases for year of basal cell carcinoma (BCC) has brought also an increase of BCC difficult to treat (extensive, locally advanced and high risk forms). OBJECTIVE: To evaluate retrospectively the results obtained with dermatologic radiotherapy (RT) for better defining the indications respect to new emerging treatments. METHODS: A series of extensive 115 BCC treated with RT from 1977 to 2014 were selected for the study, since endowed with histological diagnosis on the amount of 181 extensive BCC. RT was performed with conventional energies (50-160 kV) administering a total dose ranging from 47 to 85 Gy (median 55 Gy). The mean follow up was 40.66 months (median 21 months). A statistical evaluation was performed with chi-square test to analyse the possible correlations among therapeutic and cosmetic results and size, localisation and clinical type of the lesions. RESULTS: A complete remission (CR) was obtained in 70.43%, a partial remission (PR) in 20% of the lesions treated, while in 9.56% a no response (NR) or not evaluable response (NER) was registered. In 19% of the lesions a relapse was observed, with a five-year cure-rate of 55.13%. Cosmetic results were good in 28%, acceptable in 50% and not acceptable in 22% of the lesions in CR. In six lesions, localised at the trunk region, a chronic radiodermatitis developed. A statistically significative correlation was observed between therapeutic results and size, between cosmetic results and size and between therapeutic results and clinical type of BCC. CONCLUSION: The treatment of extensive BCC is still a challenge and radiotherapy is one of the possible choices, preferred in the elderly, in relapsing cases, after incomplete excision, and in difficult localisations of the face. Radiotherapy might be included in sequential schedules of treatment to improve final results.

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BACKGROUND: Radiotherapy (RT) is one of the treatments of choice as skin-directed therapy in Mycosis Fungoides (MF), both in first stages of the disease as total skin electron beam irradiation and in tumoural stage as localized treatment with conventional energies or electrons. OBJECTIVE: Through a retrospective study, to evaluate the results of localized superficial RT in a series of 100 patients affected by MF. METHODS: All the patients, after diagnosis supported by histological and immunophenotyping investigations, have been treated with conventional RT (range 50-150 kV) and a total dose ranging from 9 to 40 Gy. RESULTS: Complete remission of the irradiated lesion has been observed in 88%, partial remission in 6% and non-response in 2%. Four patients were lost to follow-up. Local relapse has been observed in 13 lesions, with a local control rate of 85% after 5 years from the end of RT. Cosmetic results have been good and acceptable in 93% of cases. The treatment has been always well tolerated. The results confirm to be dose dependent, and show that better response is found in the range of higher energies. CONCLUSION: Localized RT is an effective and safe tool in the care and palliation of MF.

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BACKGROUND: The morphea-type basal cell carcinoma (MBCC) is a rare form of basal cell carcinoma (BCC) with lower response to treatments than other types of BCC.Objective To evaluate the role of radiotherapy (RT) in the therapeutic strategy of MBCC. METHODS: A retrospective study was performed on 127 patients affected with MBCC, who underwent RT in the period 1982-2013. RT was delivered with conventional energies ranging from 50 to 120 kV and the administration of a total dose ranging from 40 to 70 Gy (mean 56.17 Gy). The irradiated fields included a margin of 1.5 cm around the lesion. RESULTS: The median follow-up time was 29 months (range 1-324 months). Complete remission was observed in 122 patients (96.06%), partial remission in one (0.78%). Three cases were non-responsive (2.36%). In one case (0.78%), the lesion failed to heal after RT, since the onset of radiodermatitis histologically ascertained. The cure rate was 81.08% after 5 years and 78.02% after 10 years from the end of RT. Twelve cases relapsed (10.2%). CONCLUSION: Because of the frequent diagnostic delay and its ill-defined margins, MBCC is difficult to cure. Our results after 5 years from RT (cure rate 81.08%) are more satisfactory respect to the others reported in the literature (69% and 72.3%), but less good than those obtained in other forms of primary malignant neoplasms of the skin (92.43%). Nevertheless,we consider that RT plays an important role in the therapeutic strategy of MBCCs. In fact, it can be applied easily in elderly patients, and in peculiar localization of the disease (eyelid, nose and ear), without being invasive.

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AIM: Epithelial cancer of the skin is the most common human neoplasm. In spite of the multiple modalities of treatment available, about 10 % of these tumours results resistant to them. Therefore, improving the therapeutic strategies is mandatory. METHODS: A retrospective study has been carried out on 905 patients affected by 986 basal and squamous cell carcinoma, histologically ascertained, localized on eyelids and on skin overlying the cartilages of the nose treated with conventional radiotherapy. All the lesions were classified according to TNM classification. RESULTS: Follow-up ranged from 1 to 425 months. The five-year cure-rate was 96.38% for eyelids neoplasms and 92.43% for those localized on skin covering nose cartilages, respectively. The percentage of relapse was 5.47%.The graphic representation shows how the risk of relapse remains high for the first five years. On the whole cosmetic and functional outcomes were good. CONCLUSION: Our results confirm dermatologic radiotherapy as a treatment proper to afford very high cure-rates, and support the importance of a correct follow-up. The knowledge of these data and the possibility to compare them with others obtained by different therapies and endowed with histopathologic investigation, TNM classification, adequate follow-up and significant clinical series would result in improvement of the management of skin epithelial neoplasms.

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AIM: Idiopathic photodermatoses (IP) are a recurrent, acquired sunlight-induced rash of delayed onset, appearing after exposure to ultraviolet radiation in susceptible individuals. The aim of this study was to assess the photoprotective activity of polypodium leucotomos (PL) in IP. METHODS: Fifty-seven patients affected by IP were recruited for the study (53 with polymorphic light eruption and 4 with solar urticaria). The use of UV protection filters or other drugs that could in some way interfere with exposure to light were excluded. All patients exposed themselves to sunlight while consuming 480 mg/day of PL extract orally. A statistical evaluation of the basal clinical conditions compared to those after sunlight exposure with PL was performed. RESULTS: About 73.68% of the patients had a benefit from the administered PL, with a significant reduction of skin reaction and subjective symptoms. No side effects were observed. Results were statistically significant (P<0.05). CONCLUSION: PL complete absence of toxicity combined with its multifactorial protection, makes it an effective and safe treatment for photoprotection in IP.

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BACKGROUND: The skin overlying the nose cartilage is a particularly frequent localization of skin carcinoma (about 25% of all carcinomas occurring on the head and neck). It is therefore of great practical interest to identify the best therapy, able to combine effectiveness with a good cosmetic and functional result. OBJECTIVE: To verify both the therapeutic effectiveness of dermatologic radiotherapy and its 'toxicity' in the treatment of a large number of skin carcinomas overlying the cartilage of the nose. METHODS: A retrospective study was done on 671 basal and squamous cell carcinomas treated by kilovoltage radiotherapy in the period 1972-2007. RESULTS: The mean follow-up time was 38.016 months (range, 1-351 months). The 5-year cure rate was 88.09%. Cosmetic results were evaluated as 'good' or 'acceptable' in 96.84% of the treated lesions in complete remission. So far, no complication or sequelae to the radiologic treatment have been observed. CONCLUSION: Dermatologic radiotherapy showed to be a safe, effective and non-invasive method, superior, on the basis of the literature data, to any other available therapeutic modality in the management of basal and squamous cell skin carcinomas localized over the nasal cartilages.

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AIM: Narrowband UVB (NBUVB)phototherapy has been used for vitiligo for years, but today there are no standardized protocols of treatment and follow-up data. A long-term study on 53 patients with localized or diffuse vitiligo is presented with the aim at improving the data availability in the literature. METHODS: Phototherapy was administered two times a week on non-consecutive days; the treatment was continued for one year. The mean total dose administered was 201.28 J/cm2.The response to phototherapy was expressed as percentage of repigmentation: a repigmentation greater than 75% was considered excellent, a repigmentation between 74% and 50% good, a repigmentation between 49% and 25% moderate, a repigmentation less than 24% mild. In case of absence of repigmentation, the patient was judged as non-responder RESULTS: Three point eight percent of patients showed excellent response, 32.05% good response, 32.05% moderate response, 28.3% mild response, while the remaining 3.8% was not responsive. According to statistical analysis best responses, were observed in non-acral areas (P<0.001), in patients with recent vitiligo (P=0.003), in patients with negative family history for vitiligo (P=0.038), and in those not exposed to previous therapies (P=0.005). In 36 patients a mean follow-up of 19.78 months was obtained. CONCLUSION: NBUVB phototherapy is useful and safe for vitiligo, but in the future it will be necessary to compare results of different studies using the same treatment protocols and to obtain data of series endowed with an adequate follow-up.

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BACKGROUND: The lesions of the various forms of Kaposi's sarcoma (KS), which are relatively radiosensitive, have been treated with different modalities of radiotherapy, with heterogeneous aims and results. OBJECTIVE: To verify the effectiveness and safety of radiotherapy on a large number of lesions endowed (classic KS) with a prolonged follow-up. METHODS: A retrospective study was done on 711 lesions of classic KS and 771 lesions of human immunodeficiency virus (HIV)-related KS, treated with traditional X-ray therapy. RESULTS: In classic KS, a cure rate of 98.7% resulted after 13.5 years from the end of radiotherapy. In three lesions (0.42%) in the same patient, an acute radiodermatitis occurred after traumatic action. In HIV-related KS, a complete remission was obtained in 91.43% of the lesions, partial remission in 6.74% and non-response in 0.51% at 1 to 46 months from the end of radiotherapy. CONCLUSION: Radiotherapy showed to be a safe and effective method, with relevant importance in the therapeutic strategy of KS.

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BACKGROUND: The incidences of idiopathic photodermatoses (IP) are increasing and the available therapeutic methods are often inadequate. AIM: To evaluate whether, in subjects affected by IP not responding to the usual available therapies, the oral administration of an extract of Polypodium leucotomos (PL) could provide an effective photoprotective activity. METHODS: 26 patients with polymorphic light eruption and two with solar urticaria were recruited to enter the study. The protocol excluded the use of ultraviolet protection filters or other drugs that could in some way interfere with exposure to light. All patients exposed themselves to sunlight while consuming 480 mg/day of PL orally. The response of the skin to sunlight exposure of 25 evaluable patients was compared with that occurring previously without administration of PL. RESULTS: With PL, we observed a relevant and statistically significant reduction of skin reaction and subjective symptoms. The tolerance of the drug has been excellent. CONCLUSION: PL extract administration has shown to be an effective and safe method, leading to a significant protection of skin in IP.

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BACKGROUND: The possibility of treating skin carcinomas of the pinna with radiotherapy is somewhat under discussion and scarcely known. Therefore the aim of the study was to evaluate the effectiveness and safety of dermatologic radiotherapy in a series of patients affected by basal or squamous cell carcinoma of the pinna. METHODS: A retrospective study was performed on 108 patients affected by 115 carcinomas of the pinna (99 basal cell carcinomas, 16 squamous cell carcinomas) without involvement of the external auditory canal. Radiotherapy was performed with kilovoltage techniques (55-120 kV) and the total doses administered ranged from 45 to 70 Gy (105 Gy in one case only), with different fractionations. RESULTS: The mean follow-up was 28.80 months. Complete remission was obtained in 111 lesions (96.52%) and partial remission in one (0.87%), as evaluated 1 month after the end of radiotherapy. No response was observed in two lesions (1.74%). The response was not evaluable in one lesion (0.87%). During follow up a relapse was observed in 12 lesions (all basal cell carcinomas): nine central and three marginal to the irradiation field. The 5-year cure-rate from the end of radiotherapy was 78%. The cosmetic results were evaluated as good or acceptable in 88.28% of lesions. No complications nor sequelae to the treatment were observed. CONCLUSIONS: The results obtained confirm the possibility of treating epithelial skin neoplasms of the pinna with dermatologic radiotherapy, which can afford high-remission percentages without damaging cartilaginous tissue.

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There is now evidence that bone marrow (BM) can generate cells expressing neuronal antigens in adult mouse brain. In the present study, we examined the spinal cord and dorsal root ganglia (DRG) of adult mice 3 months after BM cell transplantation from transgenic donor mice expressing the enhanced green fluorescent protein (GFP). To determine whether GFP(+) cells acquire neuroectodermal phenotypes, we tested, by immunocytochemistry followed by confocal analysis, the coexpression of the astrocytic marker glial fibrillary acidic protein (GFAP) and the neuronal markers NeuN, neurofilament (NF), and class III beta-tubulin (TuJ1). Rare GFP(+) cells coexpressing TuJ1, NF, and NeuN were found both in spinal cord and in sensory ganglia. These cells have small dimensions and short cytoplasmic processes, probably reflecting an immature phenotype. Double GFP and GFAP positivity was found only in spinal cord. To determine whether cell fusion with endogenous cells occurred, we investigated the nuclear content of cells coexpressing GFP and neuronal or astrocytic markers, demonstrating that these cells have only one nucleus and a DNA ploidy that it is not different from that of surrounding neurons and astrocytes. Large numbers of GFP(+) cells are also positively stained for F4/80, a microglial-recognizing antibody, and present a characteristic microglial-like morphology both in spinal cord and, with a higher frequency, in sensory ganglia. These data support a potential role for BM-derived stem cells in spinal cord neuroneogenesis. They also confirm that the microglial compartment within the CNS and in DRG undergoes a relatively fast turnover, with the contribution of hematopoietic stem cells. Both these findings might prove useful for the development of treatments for spinal cord neurodegenerative and acquired disorders.

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It is of great practical utility to assess which is the best therapeutic choice in the management of basal and squamous cell skin carcinomas recurring after different treatments (RBSCSC). To this aim, we have performed a retrospective review of 249 recurrent lesions in 229 patients treated with dermatological radiotherapy in the period 1982-1999. The total doses of ionizing radiations administered ranged from 45 to 70 Gy, with different dose fractionations, according to the technique employed. The five-year cure-rate was 83.62%. Cosmetic results were evaluated as "good" or "acceptable" in 92.62% of the treated lesions in complete remission. So far no complications or sequelae to the radiological treatment have been observed. Our results suggest two considerations about the choice in the treatment of RBSCSC (following non radiological therapies): 1. radiotherapy is a safe treatment and the most effective after Mohs surgery; 2. radiotherapy is a first-line treatment in those patients who cannot undergo extensive surgery for a variety of different reasons (age, general health conditions, etc.).

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BACKGROUND: Ionizing radiation therapy has a well-defined role among several therapeutic options available for the management of cutaneous neoplasms. However, many dermatologists today are not aware of its potential. OBJECTIVE: Our purpose was to evaluate the effectiveness and safety of radiotherapy in a large series of patients with primary malignant epithelial neoplasms (PMENs), who had been subjected to radiotherapy between 1982 and 1995. METHODS: A retrospective study was performed on 1188 patients with a total of 2002 PMENs that had been treated by contact, superficial, and intermediate x-ray therapy. RESULTS: Complete remission was obtained in 98.7% of the irradiated lesions. The 5-year cure rate was 90.73%. Cosmetic results were evaluated as "good" or "acceptable" in 84.01% of the treated lesions. Acute complications occurred in 1.94% and chronic complications in 0.34%. To date, neither radio-induced skin neoplasms nor late stochastic effects have been observed. CONCLUSION: This study confirms that dermatologic radiotherapy is an effective and reliable form of treatment of PMENs and has a favorable cure rate/toxicity ratio.

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