Oncologic General Surgery 4 - Melanoma and Eye Tumors

MISSION 

Our mission is to address all clinical and research aspects related to melanoma and other non-melanoma skin cancers, as well as all clinical aspects from diagnostics to surgery, with a particular focus on loco-regional therapies and cutting-edge immunological and biological treatments. 
Our Unit includes also the Eye Tumors Oncologic Surgery Unit, which deals with uveal melanoma and other ocular tumors (lymphoma and retinoblastoma). 

STRUCTURE 

Our unit carries out its specific activities according to internal quality protocols, which are periodically reviewed and updated. 
Our Pathway of Diagnosis and Therapy (PDTA) is, of course, compliant with the most accredited national and international guidelines. 

 
Our surgical ward is comprised of 10 inpatient beds located on the 5th floor of our Institute, Block F. It includes: 
- 12 attending surgeons and physicians (2 of which with high-level specialization and experience) 

- 2 contract staff funded by external grants 

- 1 senior administrative assistant (responsible for coordinating clinical trials and the scientific secretariat)  

1 administrative assistant assigned to the inpatient ward secretariat 

Staff activity is carried out in the operating room on ordinary inpatients, Day Surgery (DH) and outpatients as follows: 

2 long (whole-day) surgery sessions per week;  

1 DH session per week; 2 DH sessions per month with sedation and anesthesiology support;  

4 outpatient surgery sessions per week; 

6 outpatient clinics for wound dressings and medical visits (on shifts, for 5 days per week): 

- Cutaneous Oncology Outpatient Clinic: first medical visits for oncological skin examinations and dermatoscopy of pigmented lesions on external novel patients, as well as any emergencies sent by family physicians 

- Level 2 First Visit Outpatient Clinic: where patients with oncological diagnoses referred by specialists are admitted 

- Melanoma Follow-up Outpatient Clinic: follow-up visits of patients with a previous history of melanoma and who were already treated are performed. 

- Children Cutaneous Oncology Outpatient Clinic: an outpatient clinic dedicated to children who need an initial examination of pigmented skin lesions with the aid of dermatoscopy 

- Wound Dressing Outpatient Clinic: Wound management and follow-up of patients discharged a few days prior from the Melanoma Surgery Unit. 

- Level 2 outpatient clinic: dedicated to secondary prevention, therefore examinations of patients with difficult pigmented lesions are performed with the use of state-of-the-art videodermatoscopy and confocal microscopy for dermatological “imaging” applications which allows rapid differentiation of healthy vs. pathological tissue and early diagnosis of the following major diseases: Melanoma, Pigmented lesions, Non-melanoma skin tumors (epitheliomas), Dermatitis 

- Physicians on staff: 1 Chief of the Melanoma General Surgery Unit, 7 attending physicians and surgeons, 3 ophthalmologists 

Approximately 700 patients with melanoma are admitted to our ordinary inpatient care each year, while about 600 patients are admitted to our day hospital; outpatient services performed in one year: 22,600  

A Multidisciplinary Melanoma and Skin Cancer Group has been active for several years, granting integrated evaluation with multiple specialists of complex cases. Monitoring and treatment of patients are also included in clinical research studies. 

Melanoma and Skin Cancer Outpatient Clinics 

3 full-time outpatient clinics/week for first visits and follow-up 

10 part-time outpatient clinics/week for first visits and follow-up 

4 part-time outpatient clinics/week for wound dressings 

1 part-time outpatient clinic/week for multidisciplinary visits 

1 full-time outpatient clinic/week for pediatric visits 

Eye Tumors Surgery Unit 

1 – Uveal melanoma: 

a. Early treatment of small melanomas by suprachoroidal drug injection and laser photoactivation: international randomized phase 2 study 

b. Systemic neoadjuvant treatment of large uveal melanomas for subsequent conservative radiation treatment instead of enucleation: prospective international phase 2 study 

c. Development of prognostic biopsy in uveal melanoma and its inclusion in the care pathway of all patients. Inclusion of this pathology in the institutional molecular tumor board as well. 

d. Systematic use of vitreoretinal surgery for the prevention of toxic tumor syndrome in patients with medium-sized melanomas treated with radiotherapy 

2 – Ocular surface tumors: 

a. Use of medical therapy (immunotherapy and checkpoint inhibitors) as neoadjuvant or adjuvant in locally advanced or recurrent ocular surface tumors (conjunctival melanoma and squamous cell carcinoma).  

b. Application of a new imaging device (Corneal dome lens) for documentation and follow-up of ocular surface neoplasms 

3 – Ocular and orbital lymphomas: 

a. Consolidation of the multidisciplinary pathway allowing early diagnosis and personalized medical/radiation treatment based on biopsy typing. 

b. Prospective study of ocular surface changes induced by low-dose radiotherapy of the orbital region. 

4 – Retinoblastoma: initiation of patient recruitment in the national AIEOP protocol. 

Eye Tumors Surgery Unit Outpatient Clinics 

8 full-time outpatient clinics/week for first visits and follow-up 

1 part-time outpatient clinic/week for multidisciplinary visits 

1 part-time outpatient clinic/week for pediatric visits 

1 full-time outpatient clinic/week for topical chemotherapy 

1 part-time outpatient clinic/week for ocular laser therapy 

1 part-time outpatient clinic/week for wound dressings