Alessandra Buja

Background: Atypical Spitz tumours (ASTs) sit between Spitz naevi and spitzoid melanoma; age may modulate morphology and outcome. Objectives: To compare recurrence-free survival (RFS) across prespecified age groups and test associations with histological aggressiveness and sentinel lymph node biopsy (SLNB) status. Methods: A retrospective cohort study of patients with ASTs was carried out at two Italian tertiary centres (1 January 2002–31 December 2022). Patients were grouped according to age: ≤18, 19–25, 26–39 and ≥40 years. The primary endpoint was RFS from definitive excision. The secondary endpoints were Breslow thickness, mitotic rate and SLNB positivity. Kaplan–Meier and nonparametric tests were carried out; data were missing in <5% of cases. Results: A total of 187 patients (57 male and 130 female individuals; mean age 37 years) were included. Mean Breslow thickness (2.33 mm in patients aged ≤18 years vs. 0.88 mm in patients aged ≥ 40 years; P < 0.001) and mean mitotic activity (1.89 mitoses mm–2 in patients aged ≤18 years vs. 0.15 mitoses mm–2 in patients aged ≥ 40 years; P < 0.001) decreased with age. Of 148 patients who underwent re-excision, 44 (29.7%) underwent SLNB; 12 of 44 (27%) were positive (42% in children; 9% in adults). Median follow-up was 40 months (interquartile range 18–79); one local recurrence occurred in a 47-year-old patient, later reclassified as conventional melanoma. There were no distant metastases or melanoma-related deaths. Five-year RFS was 100% for patients aged ≤ 39 years and 98% for those aged ≥ 40 years (log-rank P = 0.30). SLNB positivity did not predict recurrence (0/12 positive vs. 1/32 negative). Conclusions: Across this 20-year, dual-centre series, ASTs had excellent outcomes at all ages. Paediatric ASTs were thicker and more mitotically active yet clinically indolent. These findings support conservative excision without routine SLNB in children and a selective, multidisciplinary approach in adults.

Introduction: Breast cancer (BC) is one of the most common and leading causes of cancer-related deaths among women. Cost analysis of BC treatment provides essential information for health policy planning, including resource allocation. This study aims to present real-world data on the cost components of BC care, categorized by cancer stage and HER2 status. Methods: This retrospective, population-based cohort study examined 1,232 new BC cases diagnosed in 2021 across three Local Health Units in the Italian northeastern Veneto Region. The study calculated per-patient costs for all three years following BC incidence. Care costs were categorized by items and analyzed by cancer stage and HER2 BC status. Results: Over a three-year post-diagnosis period, care costs increased from € 25,630 to € 90,924. Total hospitalization costs increased from €6,500 in stage I to €15,488 in stage IV, with a ratio of 2.4. Outpatient costs increased from €11,143 to €25,296, with a ratio of 2.3. In-hospital drug administration rose from €4,427 to €34,210, with a ratio of 7.7. Across all stages, the mean overall cost increased from €27,817€ in HER2-negative patients to €52,193€ in HER2-positive patients, while the breast cancer–specific cost increased from €17,881€ to €36,564€, respectively. HER2-positive cancers incurred almost twice the cost of HER2-negative BC. Conclusions: The overall cost of BC care increases with the stage of cancer at diagnosis, which also affects the allocation of costs among various cost components. In the early stages, expenses mainly relate to surgical and outpatient procedures. For more advanced BC, care costs rise substantially, mainly due to systemic therapies and hospital-based care. The HER status at cancer presentation significantly impacts care costs across all cancer stages.

Background/Objectives: During the pandemic, access to healthcare was severely disrupted, inevitably affecting melanoma diagnosis. While this was clearly evident during the pandemic itself, it is less clear whether clinical presentation has returned to baseline levels in subsequent years. Our study aimed to compare the current clinical presentation of melanoma with that in the pre-pandemic setting. Methods: We conducted a retrospective multicenter study involving Italian melanoma referral centers within the SICO network. Patients with a newly diagnosed primary cutaneous melanoma were included in the study and were grouped into four time periods: pre-pandemic (March 2019 to February 2020); pandemic (March 2021 to February 2022); the first post-pandemic year (March 2022 to February 2023); and the second post-pandemic year (March 2023 to February 2024). Our focus was on clinically relevant features at diagnosis, including Breslow thickness, ulceration, stage and sentinel lymph node status. We evaluated differences across periods using regression models that accounted for the multicenter design. Results: A total of 4938 patients were included in the study. Compared with the pre-pandemic period, melanomas diagnosed during and after the pandemic were thicker, more frequently ulcerated and more likely to be in stages II–III. The rate of sentinel lymph node positivity also increased. Notably, these patterns did not normalize over time, remaining evident even in the second post-pandemic year. The results were consistent after adjusting for age and sex. Conclusions: In this large Italian study, melanoma continues to be diagnosed at a later stage than in the pre-pandemic period. This persistent shift may reflect a combination of delayed access to care and ongoing system-level constraints. These findings emphasize the importance of restoring timely access to dermatological evaluation and reinforcing early detection strategies.

Objective Unplanned hospital readmissions within 30 days of discharge measure the quality of healthcare. This study aims to identify the characteristics of patients at higher risk of readmission. Design Retrospective cohort study. Setting North-east Italy (Marca Trevigiana Local Health Authority). Data source The study examined a total of 39 467 index admissions from hospital discharges (SDO) in the 890 000-inhabitant area during 2022. Outcome measure Readmission rates and 95% CIs were computed by risk factor, age and type of admission (surgical or medical). A logistic mixed-effects model was used to estimate readmission OR, adjusting for potential confounders. Results A total of 2197 readmissions occurred within 30 days of the index admission, resulting in an overall rate of 30-day readmissions of 6.7% (CI 6.4% to 7.0%). The median time to readmission was 11 days (IQR 5 to 20). In the multivariate analysis, after adjusting for age and sex, the following clinical conditions were associated with a higher risk of readmission: alcohol-related disease (OR=2.06, CI 1.36 to 3.13), metastatic cancer (OR=1.98, CI 1.57 to 2.50), epilepsy (OR=1.93, CI 1.36 to 2.75), dialysis or end-stage kidney disease (OR=1.92, CI 1.39 to 2.66), chronic obstructive pulmonary disease (OR=1.88, CI 1.49 to 2.36), stoma (OR=1.72, CI 1.22 to 2.44), transplant (OR=1.62, CI 1.03 to 2.55), being bedridden (OR=1.57, CI 1.28 to 1.93), anaemia (OR=1.57, CI 1.35 to 1.83), urinary tract infection (OR=1.54, CI 1.30 to 1.83), pneumonia (OR=1.52, CI 1.31 to 1.75), dementia (OR=1.49, CI 1.24 to 1.79), diabetes (OR=1.37, CI 1.17 to 1.61) and transfusion (OR=1.34, CI 1.03 to 1.73). Conclusion Several chronic and acute conditions at index admission significantly increased the risk of readmission. Strengthening transitional care, outpatient services and palliative care could mitigate readmissions.

Introduction: The Mediterranean diet (MD) is widely recommended as a healthy eating pattern for children because of its many benefits for growth, development, and long-term well-being. Eating habits during childhood are significantly influenced by parental behavior and may lead to lasting eating habits in later life. The purpose of this study is to examine the link between three different parenting styles (social, didactic, disciplinant) and children’s adherence to the MD. Methods: A total of 332 fifth-grade students, ages 10–12, participated in a cross-sectional survey as part of an educational intervention called “Le Buone Abitudini” [Good Habits]. The children’s mothers were asked to respond anonymously to a self-administered online multiple-choice questionnaire that investigated children’s adherence to the MD (using the KidMed score) and variables related to their lifestyles, behavioral characteristics, socioeconomic factors, and Parenting Styles Questionnaire (PSQ). Multivariable stepwise linear regression was performed to test the association between children’s KidMed score and parental adherence to three types of behavior: social, didactic, and disciplinant, adjusting for covariates. Findings: According to the KidMed score, 86.2% of children in the sample had medium or high adherence to the MD. Multivariable analysis revealed a direct correlation between didactic parenting style and increased compliance with MD (regression coefficient 0.95, p < 0.001). Conclusion: The present study emphasizes that parental behavior can significantly influence children’s adoption of healthy habits. A didactic parenting style that combines caring guidance with the enforcement of age-appropriate rules is most effective in enhancing children’s adherence to the MD. Health promotion programs should teach parents this aspect of education to equip them with the best tools for fostering healthy eating habits in their children.

The increasing incidence of cutaneous melanoma (CM) is a significant public health issue. However, few studies have focused on how comorbidity patterns may