Search

OBJECTIVE: Patients with nonmelanoma skin cancer (NMSC)-ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)-have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). MATERIAL AND METHODS: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. RESULTS: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). CONCLUSION: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.

Resumen Antecedentes y objetivo Previamente se habia iniciado el proceso metodologico para la validacion transcultural al idioma espanol de la escala Hair Specific Skindex-29 (HSS-29), que mide el impacto de la alopecia androgenica femenina sobre la calidad de vida relacionada con la salud (CVRS). Para finalizar el proceso, el objetivo del estudio fue completar la validacion a traves de la determinacion de su sensibilidad al cambio y su correlacion con una escala generalista de CVRS (SF-12). Material y metodo Se establecieron dos visitas, una basal y otra tras 6 meses de tratamiento con suplemento alimenticio con actividad inhibidora de la enzima 5-alfa reductasa. En cada visita, investigadores y pacientes valoraron la gravedad de la alopecia mediante la escala Sinclair, el estado de la apariencia del cabello, y se administraron las escalas HSS-29 y SF-12. Resultados Participaron 983 mujeres con alopecia androgenica. La media de puntuacion en la escala HSS-29 cambio de 27,5 ± 18,7 en la visita basal a 19,3 ± 15,7 en la de seguimiento, y sus dimensiones funcional, emocional y sintomatica tambien cambiaron significativamente. Tanto las diferencias entre basal y seguimiento en el indice HSS-29 global como en cada una de sus dimensiones se correlacionaron significativamente con las diferencias encontradas en las dimensiones de SF-12. Los coeficientes de correlacion de Pearson oscilaron entre −0,1 y −0,4, y en todos los casos el grado de significacion fue p Conclusiones La version en espanol de la escala HSS-29 posee sensibilidad, es decir, detecta cambios relacionados con la calidad de vida cuando las condiciones objetivas varian. Igualmente, se observo una correlacion entre las escalas HSS-29 y SF-12.

Resumen Las manifestaciones dermatologicas de las leucemias incluyen lesiones especificas e inespecificas (infecciones oportunistas, purpura y equimosis, sindrome de Sweet, etc.). La infiltracion de leucocitos neoplasicos en la piel se conoce como leucemia cutis, y es de especial interes el diagnostico por su implicacion pronostica. Hemos recogido los casos de leucemia cutis en nuestro servicio entre 1994 y 2014, con un total de 17 pacientes, y hemos evaluado sus caracteristicas (edad, sexo, historia medica), la morfologia de las lesiones y su relacion con la enfermedad sistemica. En nuestra serie la mayoria de los pacientes fueron varones, y la asociacion mas frecuente fue con leucemia mieloide aguda y se presento como nodulos o papulas eritematosas en las extremidades de forma mayoritaria. Presentamos nuestra experiencia en el diagnostico y manejo de esta entidad en los ultimos 20 anos, llamando la atencion sobre las caracteristicas clinicas para un diagnostico precoz.

Resumen Introduccion La condrodermatitis nodular del helix (CNH) es un proceso idiopatico, degenerativo y doloroso que afecta a la piel y al cartilago del helix o del antehelix. Recientemente se ha descrito la utilidad de la nitroglicerina (NTG) topica a 2% en el tratamiento de la CNH con buenos resultados, aunque con una tasa de efectos secundarios en el 17% de los casos. Es probable que a una concentracion menor se pueda mantener el mismo efecto mejorando la tolerancia. Nuestra finalidad fue evaluar la efectividad y seguridad de la NTG topica al 0,2% para el tratamiento de la CNH. Material y metodos Se llevo a cabo un estudio observacional retrospectivo entre los anos 2012 y 2014 en 2 centros hospitalarios espanoles. La efectividad se determino a traves de la evaluacion clinica, realizada mediante seguimiento fotografico, y de los sintomas de la lesion, medido mediante una escala numerica verbal. Resultados Veintinueve pacientes recibieron el tratamiento, de los cuales el 93% manifestaron una mejoria clinica con una duracion media del tratamiento de 1,8 meses y un tiempo de seguimiento medio en los pacientes respondedores de 5,9 meses. La tolerancia fue buena en general en todos los casos. Conclusion La NTG topica al 0,2% se plantea como una opcion conservadora, efectiva y bien tolerada para el tratamiento de la condrodermatitis nodular del helix que mejora tanto la apariencia clinica como la sintomatologia en la mayoria de los pacientes.

Resumen El carcinoma epidermoide cutaneo, con una incidencia en la poblacion general de aproximadamente un 10% a lo largo de la vida, es la segunda neoplasia mas frecuente dentro del grupo del cancer cutaneo no melanoma. La mayoria de los carcinomas epidermoides cutaneos muestran un comportamiento benigno y pueden ser completamente erradicados mediante cirugia y otros procedimientos dermatologicos. Sin embargo, existe un subgrupo de esta entidad que se asocia con una mayor capacidad de desarrollar metastasis nodal y, por tanto, con una elevada morbimortalidad. En el presente articulo se analizan los diferentes factores que definen al carcinoma epidermoide cutaneo de comportamiento agresivo. Proponemos un metodo de definicion del carcinoma epidermoide de alto riesgo basado en el establecimiento de una serie de criterios mayores y menores. Este hecho supondra una mejor evaluacion pronostica y un manejo personalizado de este grupo de enfermos, que puede resultar en un aumento de la supervivencia global.

Resumen Introduccion Los carcinomas cutaneos agresivos que aparecen en el cuero cabelludo se desarrollan habitualmente en pacientes de edad avanzada que presentan multiples comorbilidades. La exeresis completa de estos tumores incluye en muchos casos el periostio, lo que conlleva que la reconstruccion de este tipo de defectos se convierta en un reto. Objetivo Se evalua la utilidad de un parche de colageno porcino tipo I como tratamiento coadyuvante o definitivo en el cierre quirurgico de este tipo de defectos cutaneos. Material y metodos Se realizo un estudio prospectivo en el que se incluyeron aquellos pacientes que presentaron defectos de mas de 5 cm en el cuero cabelludo, en los que el periostio tuvo que ser extirpado para alcanzar margenes libres de enfermedad entre enero de 2009 y noviembre de 2011. Resultados La tumoracion mas prevalente fue el carcinoma epidermoide cutaneo recurrente. El defecto posquirurgico oscilo entre 5 y 7 cm de diametro. En el grupo de casos en los que se coloco un injerto posparche (n = 4), en el 100% de los casos el tejido prendio completamente. En el caso de aquellos pacientes en los que el parche fue el recurso definitivo (n = 6) el tejido de granulacion generado por el material biosintetico de colageno porcino ocupo el defecto quirurgico, dejandolo completamente restituido en aproximadamente 3,5 meses. Conclusiones El parche de colageno porcino tipo i es una herramienta sencilla, barata y eficaz en el tratamiento coadyuvante o definitivo del cierre de defectos quirurgicos del cuero cabelludo de mas de 5 cm que carecen de periostio.

Resumen Introduccion El queratoacantoma es considerado hoy dia un carcinoma epidermoide in situ que aparece principalmente en pacientes mayores de 70 anos. Se trata de un tumor de buen pronostico que, en algunos casos, muestra resolucion espontanea. El tratamiento de este tipo de tumoracion es la exeresis simple. Sin embargo, la localizacion preferente en las regiones facial y acral, el tamano y su rapido crecimiento son factores que hacen que la cirugia sea en algunos casos agresiva y antiestetica. Objetivo El objetivo principal del estudio es evaluar la eficacia de la infiltracion intralesional de metotrexato en la reduccion del tamano prequirurgico de la lesion y del correspondiente defecto quirurgico resultante de la intervencion. Material y metodos Se realizo un estudio prospectivo aleatorizado en el que se incluyeron todos aquellos pacientes atendidos en nuestro Servicio diagnosticados de queratoacantoma de al menos 1,5 cm de tamano entre enero de 2009 y enero de 2010. Se establecieron dos grupos, uno en el que los pacientes recibieron una infiltracion de metotrexato previamente al acto quirurgico y otro en el que se realizo directamente la cirugia. Resultados De los 25 pacientes incluidos en el estudio, 10 casos recibieron neoadyuvancia con metotrexato intralesional (grupo A) y 15 casos fueron intervenidos mediante cirugia aislada (grupo B). Los pacientes del grupo A mostraron una reduccion en el tamano tumoral en el momento de la cirugia que oscilo entre un 50 y un 80%. Ninguno de los pacientes presento complicaciones relacionadas con la inoculacion del metotrexato ni con la intervencion quirurgica. En el grupo B solo uno de los casos mostro una discreta disminucion de sus dimensiones en el momento del acto quirurgico. El resto de las lesiones mostraron una estabilidad (4 casos; 26%) e incluso un aumento de las dimensiones del tumor (10 casos; 66%) en el momento de la intervencion. Cinco de los casos incluidos en este ultimo grupo requirieron ingreso hospitalario en relacion con la intervencion quirurgica. Conclusiones El metotrexato intralesional como terapia neoadyuvante es una medida bien tolerada, que permite evitar cirugias agresivas en pacientes de edades avanzadas que presentan un queratoacantoma de diametro superior a 1,5 cm localizado en la region facial y acral.

Resumen Introduccion y objetivos Objetivo: evaluar la validez de la teledermatologia diferida y su aplicacion como herramienta de apoyo a Atencion Primaria y servicios de Urgencias hospitalarias (consultas presenciales evitadas). Comparar validez y manejo del paciente (presencial vs teledermatologia) segun el origen del paciente y el grupo diagnostico. Material y metodos se compararon los diagnosticos emitidos sobre 100 pacientes por 20 dermatologos observadores con el emitido en la consulta presencial (patron oro) y se comparo el manejo entre los grupos de pacientes. Resultados porcentaje de acuerdo completo (AC): 69,05 (IC 95%: 66,9-71,0). Porcentaje de acuerdo agregado (AG): 87,80 (IC 95%: 86,1-89,0). Pacientes manejados de manera presencial: 60% (58-61). Pacientes manejados por teledermatologia: 40% (38-41). Los pacientes provenientes de Atencion Primaria y el grupo de patologia infecciosa presento mayor validez diagnostica (76,1 AC y 91,8 AG; p Conclusiones la teledermatologia diferida presenta una elevada validez diagnostica, especialmente en casos remitidos de Atencion Primaria y para patologia infecciosa, y es util en el manejo y diagnostico a distancia de pacientes, ya que evitaria el 40% de las consultas presenciales.

Resumen A pesar de que el carcinoma basocelular (CBC) es una de las formas mas comunes de cancer, esta neoplasia cutanea raramente ocurre en la axila, con solo 31 casos recogidos en la literatura. La incidencia del CBC metastasico es excepcional, siendo aun mas infrecuente en areas no fotoexpuestas. Se presenta un nuevo caso de CBC axilar con metastasis nodal y se realiza una revision extensa de la literatura de aquellos casos publicados previamente. El CBC localizado en la axila es un raro evento, pero el desarrollo de metastasis es excepcional. Otros factores diferentes a la radiacion ultravioleta probablemente contribuyan a su desarrollo. El colgajo en la isla pectoral lateral fue la tecnica aplicada en el cierre quirurgico. Este resulta util en la reconstruccion de defectos quirurgicos axilares y obtiene excelentes resultados tanto esteticos como funcionales. Por estas razones, la realizacion de este colgajo deberia considerarse ante importantes defectos quirurgicos en la region axilar.

Acquired progressive lymphangioma is a rare vascular tumor with a locally aggressive behavior. Histologically it is characterized by a proliferation of numerous, dilated, thin-walled vessels lined by flat endothelial cells with no nuclear atypia. The vessels appear to dissect between the collagen fibers. It usually presents as an asymptomatic, slow-growing, reddish-brown plaque. We present the case of a 32-year-old man with acquired progressive lymphangioma. The tumor was in the hypogastric region and had arisen on a congenital vascular lesion previously diagnosed as multifocal cutaneous angiomatosis. It was very painful and impeded walking, for which reason it was decided to perform excision. Dermatologists and pathologists must be aware of acquired progressive lymphangioma as early surgical treatment, while the lesion is still small, is curative and prevents subsequent complications due to growth.

Resumen Introduccion La papulosis linfomatoide es un proceso linfoproliferativo de celulas T CD30+ poco frecuente y de pronostico excelente que generalmente afecta a adultos y, en menor medida a ninos, por lo que tanto el espectro clinico-patologico como el riesgo de progresion a otro tipo de linfoma en el grupo pediatrico no esta bien establecido. Objetivo Analizar las caracteristicas de la papulosis linfomatoide infantil a partir de la descripcion de nuevos casos y de la revision de la literatura. Material y metodo Se realizo un estudio retrospectivo de 9 pacientes menores de 18 anos diagnosticados de papulosis linfomatoide atendidos en nuestro servicio entre 1995 y 2009. Resultados Se incluyeron 7 ninos y 2 ninas de edades entre 2 y 17 anos. Las lesiones de papulosis linfomatoide se vieron precedidas en 2 casos y seguidas en 1 de otras compatibles con pitiriasis liquenoide aguda. La resolucion de las lesiones fue espontanea, dejando hiperpigmentacion (77%) o hipopigmentacion postinflamatoria (23%) y cicatrices en el 77% de los casos. Histologicamente todos los casos presentaron el patron tipo A de papulosis linfomatoide. El estudio molecular mostro monoclonalidad en los 3 casos en los que fue realizado. Conclusiones La papulosis linfomatoide infantil es una entidad rara que se manifiesta clinicamente como la forma adulta. Esta enfermedad linfoproliferativa, que ocasionalmente se asocia a pitiriasis liquenoide aguda, muestra hallazgos histologicos compatibles con el patron histiocitoide o tipo A. El desarrollo de otros procesos linfoproliferativos malignos en el seguimiento posterior es menos frecuente en la papulosis linfomatoide infantil comparado con la variante adulta. La frecuente asociacion de pitiriasis liquenoide y de papulosis linfomatoide encontrada en nuestro analisis, asi como la dificultad que supone en algunos casos el diferenciar entre ambos procesos, permite sugerir que ambas patologias podrian formar parte de un espectro clinico-patologico comun.

Resumen El desarrollo de una erupcion dermatomiositis- like y de ulceras cutaneas de evolucion torpida, en el contexto de un tratamiento mantenido a largo plazo con hidroxiurea, es un fenomeno muy infrecuente y parcialmente descrito en la literatura. El hecho de que las caracteristicas clinicas y evolutivas de este tipo de lesiones son tipicas y que su resolucion completa solo se alcanza mediante la suspension inmediata del tratamiento, hace necesario que el dermatologo conozca este cuadro, con el fin de evitar el retraso diagnostico. Presentamos el caso de una paciente de 76 anos que desarrollo una erupcion dermatomiositis- like junto a un proceso ulcerativo cronico en los miembros inferiores en el contexto de un tratamiento con hidroxiurea mantenido a largo plazo.

Even though malignant melanoma accounts for 4 % of all skin cancers, it is the type responsible for most deaths. The pathogenesis of melanoma is currently not well understood, although an interaction of environmental and genetic factors doubtlessly plays a role. Molecular biology in medicine has progressed increasingly rapidly in recent years. In dermatology, application of molecular biology techniques to the study of malignant melanoma has led to important advances in our knowledge of the main molecular pathways implicated in its development. These findings not only can improve our knowledge of the pathogenesis of the disease but may also have practical implications. Thus, molecular characterization of malignant melanoma may be of great help in differentiating between benign and malignant melanocytic lesions when histopathological features prove insufficient as is the case, for example, in Spitz nevus and spitzoid melanoma. In addition, knowledge of the abnormal molecular pathways in different malignant melanoma lesions can point to new therapeutic targets for treating patients with melanomas with distant metastases, in whom current chemotherapy has failed to extend life expectancy. At present, lack of availability is the main barrier to use of these techniques in dermatology--they are often limited to research, so not generally available in most hospitals. This problem will, however, be overcome when the molecular patterns become standardized, allowing a prognostic and therapeutic characterization of this important disease.

Resumen Actualmente existe un incremento del numero de casos de patologia oral en los servicios de Dermatologia. Dentro de las diversas lesiones que forman parte de esta amplia area de conocimiento destacamos la leucoplasia oral, por ser la lesion mucosa precancerosa mas frecuente y la que mayores problemas origina tanto en su diagnostico como en su manejo terapeutico. En esta revision, ademas de definir la leucoplasia, establecemos un diagnostico diferencial con el resto de las patologias orales mas importantes y analizamos los diversos parametros clinicos, histologicos y moleculares que definen el riesgo de transformacion maligna de esta patologia. Finalmente se establece un algoritmo terapeutico que nos ayuda a optimizar su manejo clinico.

Introduction and objectives. Microcystic adnexal carcinoma is a rare and aggressive tumor that manifests clinically as a subcutaneous nodule located on the head or neck. The tumor can be confused clinically and histologically with other benign and malignant skin lesions, often leading to inappropriate initial treatment. The chief concern with microcystic adnexal carcinoma is the elevated morbidity and the high rate of recurrence after wide local excision. Recent preliminary studies point to higher cure rates with Mohs micrographic surgery. Material and methods. We reviewed the medical histories of 6 consecutive patients with microcystic adnexal carcinoma who underwent Mohs micrographic surgery in our dermatology department between 1995 and 2007. Results. In all cases, lesions were located on the head and were primary tumors. Seventy percent of the tumors were wrongly diagnosed initially as basal cell carcinoma. Perineural invasion was not detected in any patient, and all were free of recurrence after between 1 and 12 years of postoperative follow-up. Conclusions. The absence of perineural involvement and substantial cell atypia can be attributed to the lesions being primary tumors. This would provide a rationale for definitive radical treatment of the primary tumor from the outset to avoid the complications associated with recurrence. The site and the absence of recurrence in all our patients who underwent Mohs micrographic surgery support the use of this technique as the treatment of choice in microcystic adnexal carcinoma.

Dermatologic manifestations of leukemia can be both specific and nonspecific (e.g., opportunistic infections, purpura and ecchymosis, Sweet syndrome). Leukemia cutis refers to the infiltration of the skin with neoplastic leukocytes and its early diagnosis has important prognostic implications. We report on 17 cases of leukemia cutis seen in our department between 1994 and 2014 and describe the characteristics of the patients (age, sex, medical history), the morphology of the lesions, and associations with systemic disease. Most of the patients were male and the most common associated malignancy was acute myeloid leukemia. The most frequent dermatologic manifestations were nodules or erythematous papules on the limbs. We describe our experience with the diagnosis and management of leukemia cutis over a period of 20 years and emphasize the importance of clinical signs in the early diagnosis of this condition.

Chondrodermatitis nodularis helicis (CNH) is a painful idiopathic degenerative condition involving the skin and cartilage of the helix or antihelix of the ear. Topical nitroglycerin 2% is a relatively recent treatment option for CNH that has produced good results, although with adverse effects (17% of cases). The use of a lower concentration would probably achieve similar results with fewer adverse effects. The aim of this study was to evaluate the effectiveness and safety of topical nitroglycerin 0.2% in the treatment of CNH.We performed a retrospective observational study of patients treated in 2 Spanish hospitals between 2012 and 2014. The effectiveness of treatment was determined by clinical photography and assessment of symptoms using a verbal numerical rating scale.Of the 29 patients treated, 93% showed clinical improvement. In the group of responders, mean treatment duration was 1.8 months and mean follow-up was 5.9 months. Overall tolerance was good in all cases.Topical nitroglycerin 0.2% is an effective and well-tolerated conservative treatment option that improves the appearance of lesions and provides symptomatic relief in the majority of patients with CNH.

Resumen La papulosis linfomatoide es un linfoma cutaneo con un comportamiento clinico indolente, caracterizado por la aparicion cronica en la piel de lesiones recurrentes, autolimitadas, en forma de papulas necroticas y con una histopatologia sugestiva de un linfoma de celulas T. La afectacion mucosa por papulosis linfomatoide es un hecho extremadamente raro, pero que ya ha sido descrito en la literatura. Suele acontecer en pacientes con diagnostico previo de papulosis linfomatoide, y se manifiesta en forma de ulceras. Desde el punto de vista histologico se caracteriza por un infiltrado de linfocitos atipicos CD 30 positivos, junto con un infiltrado inflamatorio mixto de eosinofilos, neutrofilos, histiocitos y celulas plasmaticas. Presentamos el caso de un varon con diagnostico previo de papulosis linfomatoide que desarrollo dos lesiones ulcerosas en la lengua y cuya biopsia confirmo el diagnostico de afectacion de mucosa oral por papulosis linfomatoide.

Papillary dermal elastolysis similar to pseudoxanthoma elasticum is an elastolytic disorder characterized by cutaneous lesions on the neck and in the supraclavicular region that are clinically similar to pseudoxanthoma elasticum, with no systemic complications. The histological examination shows a loss of elastic fibers in the papillary dermis. We report a case in a 76-year-old woman with typical lesions on the neck.

Background Aggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct. Objective To evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum. Materials and methods We performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5 cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins. Results The most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7 cm. In 100% of the patients who received a graft after dressing removal (n=4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n=6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months. Conclusions The use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5 cm in which periosteum has been removed proved to be simple, inexpensive, and effective.

With a lifetime incidence of approximately 10% in the general population, cutaneous squamous cell carcinoma (CSCC) is the second most common type of nonmelanoma skin cancer. Most CSCCs are benign and can be completely eradicated by surgery or other dermatological procedures. There is, however, a subgroup associated with an increased likelihood of lymph node metastases and, therefore, with high morbidity and mortality. This article analyzes the various factors that define aggressive CSCC. We propose a method for defining high-risk SCC on the basis of a series of major and minor criteria. This method will allow better prognostic evaluation and enable personalized management of patients with high-risk SCC, possibly leading to improved overall survival.

Acquired progressive lymphangioma is a rare vascular tumor with a locally aggressive behavior. Histologically it is characterized by a proliferation of numerous, dilated, thin-walled vessels lined by flat endothelial cells with no nuclear atypia. The vessels appear to dissect between the collagen fibers. It usually presents as an asymptomatic, slow-growing, reddish-brown plaque. We present the case of a 32-year-old man with acquired progressive lymphangioma. The tumor was in the hypogastric region and had arisen on a congenital vascular lesion previously diagnosed as multifocal cutaneous angiomatosis. It was very painful and impeded walking, for which reason it was decided to perform excision. Dermatologists and pathologists must be aware of acquired progressive lymphangioma as early surgical treatment, while the lesion is still small, is curative and prevents subsequent complications due to growth.

Background Lymphomatoid papulosis is a rare CD30+ T-cell lymphoproliferative disease with an excellent prognosis. It is usually seen in adults and is rare in children. The clinical and pathologic manifestations and the risk of progression to other types of lymphoma are thus not clearly defined in the pediatric age group. Objective To describe the characteristics of lymphomatoid papulosis in a group of children and perform a review of the literature. Patients and methods A retrospective study was performed of 9 patients under 18 years of age diagnosed with lymphomatoid papulosis and treated in our department between 1995 and 2009 Results The study included 7 boys and 2 girls aged between 2 and 17 years. Lesions compatible with pityriasis lichenoides acuta appeared before the lymphomatoid papulosis in 2 cases and afterwards in 1 case. The lymphomatoid papulosis lesions resolved spontaneously, leaving postinflammatory hyperpigmentation (77%) or hypopigmentation (23%). Scarring occurred in 77% of cases. Histologically, all cases showed features compatible with lymphomatoid papulosis type A. Molecular studies showed monoclonality in all 3 cases in which this technique was performed. Conclusions Lymphomatoid papulosis is a rare disease in childhood and the manifestations are similar to the adult form. This lymphoproliferative disease, occasionally associated with pityriasis lichenoides acuta, has histological features compatible with a type A or histiocytoid pattern. Progression to other lymphoproliferative disorders during followup is less common in the childhood form than in adults. The frequent association of pityriasis lichenoides acuta and lymphomatoid papulosis observed in our study, and the difficulty distinguishing between these 2 conditions in some cases, suggest that these diseases could be part of a single clinical-pathological spectrum.

Background Keratoacanthoma is currently considered to be an in situ squamous cell carcinoma that mainly affects patients over 70 years of age. The tumor has a good prognosis and, in some cases, can resolve spontaneously. Treatment involves simple excision. However, since the tumors generally occur on the face or extremities and display rapid growth, aggressive surgery may be required and the cosmetic results may be poor. Objective The primary study objective was assessment of the efficacy of presurgical intralesional methotrexate infiltration to reduce the size of the tumor and the corresponding surgical defect. Material and methods A prospective, randomized study was undertaken in patients with a diagnosis of keratoacanthoma of at least 1.5 cm who were seen in our service between January 2009 and January 2010. Two groups were established: one receiving a single infiltration of methotrexate prior to surgery and another that did not receive methotrexate. Results Of the 25 patients included in the study, 10 received neoadjuvant intralesional methotrexate (group A) and 15 underwent surgery without prior infiltration of methotrexate (group B). The patients in group A displayed a reduction of between 50% and 80% in the size of the lesion prior to surgery. No complications were observed either in relation to methotrexate infusion or surgery. In group B, only 1 patient had a slight reduction in the dimensions of the lesion prior to surgery. In the remaining cases, the lesions remained similar (4 cases, 26%) or had increased in size (10 cases, 66%) at the time of surgery. Five patients in this group required hospital admission following surgery. Conclusions Neoadjuvant intralesional methotrexate is well tolerated and reduces the need for aggressive surgery in elderly patients with keratoacanthoma measuring more than 1.5 cm on the face or extremities.

Although basal cell carcinoma (BCC) is one of the most common forms of cancer worldwide, it rarely occurs in the axilla. Only 31 cases have been reported in the literature. The incidence of metastatic BCC, particularly in areas not exposed to the sun, is very low. We present a new case of axillary BCC with lymph node metastases and the results of an extensive review of cases previously reported in the literature. BCC in the axilla is rare and metastasis is exceptional. Factors other than UV radiation probably contribute to its development. The lateral pectoral island flap was used for surgical closure. This method is useful for the reconstruction of axillary defects, obtaining excellent cosmetic and functional results. This flap should therefore be considered for the repair of large surgical defects in the axilla.

The onset of a dermatomyositis-like rash and persistent skin ulcers during long-term treatment with hydroxyurea is a very rare event that has not been fully described in the literature. The fact that these lesions have a typical clinical presentation and course, and that complete resolution can only be achieved by immediate withdrawal of the drug, means that dermatologists should be aware of this condition in order to avoid a delay in diagnosis. We present the case of a 76-year-old woman who developed a dermatomyositis-like eruption associated with chronic ulcers on the lower limbs during long-term treatment with hydroxyurea.

Dermatology departments are currently seeing an increase in the number of cases of oral diseases. Of note among the range of lesions covered by this broad area of knowledge is oral leukoplakia-the most common precancerous lesion and the most problematic in terms of both diagnosis and therapeutic management. In addition to defining leukoplakia, this review also establishes a differential diagnosis with the other most important oral diseases and analyzes the different clinical, histologic, and molecular features that can provide an indication of the risk of malignant transformation. Finally, a therapeutic algorithm is presented to help us optimize clinical management of the disease.

Microcystic adnexal carcinoma is a rare and aggressive tumor that manifests clinically as a subcutaneous nodule located on the head or neck. The tumor can be confused clinically and histologically with other benign and malignant skin lesions, often leading to inappropriate initial treatment. The chief concern with microcystic adnexal carcinoma is the elevated morbidity and the high rate of recurrence after wide local excision. Recent preliminary studies point to higher cure rates with Mohs micrographic surgery.We reviewed the medical histories of 6 consecutive patients with microcystic adnexal carcinoma who underwent Mohs micrographic surgery in our dermatology department between 1995 and 2007.In all cases, lesions were located on the head and were primary tumors. Seventy percent of the tumors were wrongly diagnosed initially as basal cell carcinoma. Perineural invasion was not detected in any patient, and all were free of recurrence after between 1 and 12 years of postoperative follow-up.The absence of perineural involvement and substantial cell atypia can be attributed to the lesions being primary tumors. This would provide a rationale for definitive radical treatment of the primary tumor from the outset to avoid the complications associated with recurrence. The site and the absence of recurrence in all our patients who underwent Mohs micrographic surgery support the use of this technique as the treatment of choice in microcystic adnexal carcinoma.

Papillary dermal elastolysis similar to pseudoxanthoma elasticum is an elastolytic disorder characterized by cutaneous lesions on the neck and in the supraclavicular region that are clinically similar to pseudoxanthoma elasticum, with no systemic complications. The histological examination shows a loss of elastic fibers in the papillary dermis. We report a case in a 76-year-old woman with typical lesions on the neck.

Varon de 50 anos que ingreso para reconstruccion de una colostomia realizada tres meses antes por un cancer colorrectal (T3N0M0). Durante el ingreso inicio un cuadro febril de 37,8 °C con hemocultivos positivos para Staphylococcus aureus, administrandose tratamiento antibiotico intravenoso con ceftazidima (1 g/8 horas) y con paracetamol (1 g/8 horas). Tras dos semanas del inicio del antibiotico se produjo un nuevo episodio febril de 38,5 °C asociado a escalofrios y linfadenopatias laterocervicales dolorosas, junto al desarrollo de manifestaciones cutaneas.

La enfermedad de Behcet se caracteriza por la triada de aftas orales y genitales, lesiones cutaneas y afectacion ocular. Tambien es posible observar afectacion articular, neurologica, vascular, gastrointestinal o pulmonar1-3. Una mujer de 38 anos consulto por unas lesiones localizadas en las piernas aparecidas hacia 10 dias. Se trataba de varios nodulos eritematosos, mal delimitados, calientes al tacto y dolorosos a la palpacion (fig. 1). La paciente habia desarrollado fiebre de hasta 38,5 °C desde 5 dias antes de la consulta. Se practico una biopsia donde se pudo observar, bajo una epidermis y una dermis respetada, un vaso de mediano calibre trombosado. La pared de dicho vaso estaba necrosada y presentaba un intenso infiltrado inflamatorio compuesto predominantemente por neutrofilos, pero tambien por linfocitos y eosinofilos. El infiltrado inflamatorio se extendia hasta los lobulillos del tejido celular subcutaneo, en forma de paniculitis de predominio lobulillar (fig. 2). La tincion con orceina puso de manifiesto que se trataba de una arteriola. Estos hallazgos histologicos eran compatibles con una panarteritis nodosa. La paciente volvio a consulta antes de lo previsto, porque pocos dias antes habia desarrollado lesiones orales y genitales. Se trataba de varias lesiones en el paladar duro, en forma de ulceras dolorosas con membrana amarillenta en superficie sobre base eritematosa (fig. 3). En la vulva presentaba una lesion de 1 cm de las mismas caracteristicas. La paciente refirio que habia presentado brotes recurrentes de este tipo de lesiones dolorosas en mucosa oral y genital desde hacia tres anos. Siguiendo los criterios diagnosticos establecidos se diagnostico a la paciente de enfermedad de Behcet con lesiones cutaneas tipo panarteritis nodosa. Durante un ano la paciente ha tenido brotes repetidos de lesiones cutaneas tipo eritema nodoso y papulopustulas y aftas orales y genitales, por lo que ha necesitado tratamiento oral con prednisona durante largos periodos de tiempo para controlar las lesiones y colchicina como tratamiento de mantenimiento. Las lesiones tipo eritema nodoso son una manifestacion cutanea frecuente en la enfermedad de Behcet. Se caracterizan clinicamente por nodulos eritematosos, calientes y dolorosos, localizados principalmente en la cara anterior de las piernas. Desde el punto de vista histopatologico estas lesiones no estan del todo caracterizadas, pero existen distintos trabajos que ponen de manifiesto que este tipo de lesiones, que clinicamente son indistinguibles de un eritema nodoso tipico, presentan una histopatologia distinta a este tipo de paniculitis. Se suele encontrar un infiltrado inflamatorio en la dermis, paniculitis de predominio lobulillar, aunque tambien mixta, y vasculitis, tanto leucocitoclastica como linfocitaria4,5. Cartas al director