Tiziano Pergolizzi

Background: Sarcomas are rare, aggressive cancers, most commonly arising in the extremities. Most patients treated with curative intent undergo limb salvage surgery. Given the extent of surgery required, this can result in damage to lymphatic and blood vessels, leading to secondary lymphedema. Unfortunately, despite the significant impact of lymphedema on patients, there has been little research to investigate the prevalence of lymphedema and the risk factors associated with its development in sarcoma patients. Material and methods: All patients treated with limb-salvage surgery for extremity sarcoma at our service between July 2012 and July 2017 were identified from a prospective database. Lymphedema severity was evaluated according to the International Society of Lymphology classification system, and information on risk factors was collected from clinical records. Binary logistic regression was used to evaluate the role of risk factors in the development of lymphedema. Results: A total of 282 patients were identified as suitable for inclusion in the study. A total of 49 patients (17.4%) developed lymphedema during follow-up, with a median time to development of 6 months. Sarcomas arising in the lower extremity [odds ratio (OR) 5.661, P < 0.001], early post-operative complications such as seroma or wound infection (OR 4.612, P < 0.001), and radiotherapy (OR 8.876, P < 0.001) were all associated with an increased risk of lymphedema development, all remaining significant at the multivariate level. Conclusion: Lymphedema is a significant long-term complication that affects a high proportion (17.4%) of patients with extremity sarcoma. Further work is needed both to prevent this complication and to improve the early identification and management of these patients.

Background/Objectives: Solar elastosis, a key histopathological alteration in skin photodamage, results from chronic UV exposure and photoaging. Clinically, it manifests as deep wrinkles, laxity, and a dull complexion. The growing demand for effective treatments has spurred the development of numerous therapeutic strategies. This systematic review aims to synthesize and critically evaluate the scientific evidence regarding interventions for treating the clinical and histological manifestations of solar elastosis, to provide an updated overview and guide future clinical practice. Methods: PubMed, Scopus, ProQuest, and Web of Science databases were searched for articles published in the last ten years. Clinical studies on adults with signs of solar elastosis and photoaging, evaluating therapeutic interventions, were included. Primary outcomes were clinical and histopathological improvements, while secondary outcomes included skin elasticity, safety, and patient satisfaction. This review was registered in the PROSPERO database under registration number CRD420251086680. Results: Twenty-two studies, totaling 608 participants, were included. The analyzed therapies comprised a wide range of strategies, including energy-based devices (laser, radiofrequency), stem cell derivatives, bioactive topical compounds, and growth factor-rich plasma. Device-assisted and biologically augmented interventions consistently improved visible photoaging outcomes and skin elasticity, with selective histologic remodeling, heterogeneous effects on barrier function, and an overall acceptable safety profile, with mild and transient adverse events. Patient satisfaction was consistently high. Conclusions: Therapeutic strategies in solar elastosis and photoaging, particularly those combining energy-based devices with regenerative agents, have proven effective in improving the structural and functional aspects of photodamaged skin. Although the results are promising, the current literature is limited by methodological heterogeneity and small sample sizes. High-quality randomized controlled trials with long-term follow-up are needed to establish standardized, evidence-based protocols.