Morning sessions

Antonella Romanini
Overview of the challenges in melanoma

Some ideas
Early diagnosis -lead time bias

cancer discovered with screening -you discover
- just 80% of the survivors
- 50% of the survivors
-is very difficult to give percentages when you take a picture in some point.

Why is important to catch early melanoma
e.g. 360 000 people were screened in Germany- (2003-2004), melanoma discovered early is curable.


Nevio Dubbini
Communication in Primary and secondary prevention

Aims
Target audiences  -example: students
checking the efficacy of prevention campaign by performing post campaigns surveys

Smart technology;
-downloaded by 2000 people
-targeting audiences you reach young adults

Secondary prevention
-measure how effective is the prevention
-involve MDs if some patients need treatment -to facilitate the track from the screening to the first visits

Recruiting people
-permanently
-campaigns
 Regular screening lower selection (RS)
Very important to work in small communities

Campaigns: scalp (performed with hair dressers)
measure the outcome and improve methods
a toll for communication
Perspectives: develop a risk calculator for health professionals

 The app Happy Sun , by dr. physicist Emilio Simione

To raise UV light awareness
To change the behaviour of people related to the sun!

Some characteristics:

• fluctuation during season
• use real time images from satellites
• UV -intensity
• UV sunbathing decisions
• sources of radiation everywhere (clouds, sand, umbrella filters 50%)
• no need for calibration sensors
• exposures related to different sun creams 
• has scientific validation (university of Naples, ACM, Italian Ministry of Health)

Italians go very often in between 10-14.00 o clock to sunbathing

Can be downloaded for free almost everywhere in Europe! 

www.happysun.co.uk

Vitamin D - the message is NOT to totally avoid the sun exposure
Indoor activities during the year  -exposure to sun is mainly occasional and intensive, so there is a need for balancing the exposure to sun and indoor activities
HappySun App is connected to the pharmacies -if the pharmacy find high risk nevi or other signals they announce dermatologists.

Conclusions
Solar radiation can be controlled
Satellites and support technology

Is useful for public health education, life style vs skin skin data acquisition and correlation analysis
Improvements or extentions:
- mother
- children use
- the app is in English and Italian
- translation in other languages  -Dutch, East Europeans etc

Antonella Romaniani (part II)
Diagnosis of melanoma  

How risky is a melanoma lesion
Need high expertise
good tools (dermatoscope)

Role of pathologist is crucial-diagnosis is done by pathologist
Mitoses
Melanoma of 4 mm is much worst as prognosis than the one present in limphnodes.
Surgeon does usually the measurement of the primary lesion- not always a corect evaluation, so a second excision is acccepted by guideline

SLNB-sentinel limphnode biopsy -is for staging purposes , but NOT a treatment

• is important for the subsequent treatment especially now with the new treatments in adjuvant setting;
• high level of  errors: finding negative limphnodes
• are the protocols respected?
• there is a high false negative rate!

PCR- detecting tyrosinaze -50% false drops to 4%!!!
(Tyrosinase is an enzyme for controlling the production of melanin). 

Having adenectomy immediately after SNLB or later -do not make difference in OS (overall survival)

Recommending adenectomy
non sentinel lymph-nodes - some risk factors (satellitos, micrometastasis > 2 mm, etc)


Treatment of stage III -meta-analysis -interferon, peg intereferon; speaker pleading for their use when no other terapies available.

- ipilimumab in adjuvant seting; (why not also pembro and nivo; clinical trials are going on with nivo and pembro in adjuvant setting)






Treatments for metastatic melanoma (the known ones- more to come Sunday, 12th June:
News from ASCO2016)

Word, emotions and communication in the brain
Pietro Pietrini-Lucca

-humans: prefrontal lob development
-what is making us different:

-not using tools and instruments (is not characteristic only to humans)
-not simply the use language to communicate- we are not the only ones ( animals communicate too)

What is making us unique is:
-ability of imagining the future
-ability to ask why 
-we are able to forecast our actions
-words are transferred in pictures in our mind (ekphrasis)

Tools to investigate -MRI (Resonance Magnetic Imaging )

Emotions and words are closely related
Emotions induce images
Images induce emotions

e.g. Divina comedia - words can re-build not only past stories but even the emotions around that old story
Scaling behavioural and brain functional data
Using behavioural data- is predetermined

Is depression a question of life of death (changes in hypocampus)?
Questions:
- can you train the brain to not react with panic/fear in front of bad news
- good references for the role of depression in dealing with the disease
-  drugs or meditation as antidepresants in cancer?
Psychotherapy works but drugs are working better (speaker opinion)
Psychological assistance -the way to respond to the events of the life (part of support in cancer)
Aesthetic aspects - characteristic to humans

''Depression is not a choice!''