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The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear.To analyze the role of health care provision determinants in the initial prognosis of MM.A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed.In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P.001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM.The primary potential limitation of this study is its retrospective nature.Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.

Background Dermatomyofibroma is a rare but distinct benign cutaneous mesenchymal neoplasm of fibroblastic/myofibroblastic differentiation. It is more common in adolescents and young adults, with a female preponderance. In most cases, the lesions are asymptomatic and small, measuring from 10 to 20 mm. Early and active lesions tend to be actin positive. Case report We present a) a new case of dermatomyofibroma in an 11-month-old male infant, the youngest case reported to date, and b) the second reported case of a giant annular dermatomyofibroma, measuring 10 cm × 6 cm, in a 52-year-old woman. In both cases, histological examination showed a spindle-cell proliferation embedded among the collagen fibers of the dermis, arranged predominantly parallel to the skin surface. In both cases the spindle cells stained positive for smooth muscle actin and the elastic fibers were increased and fragmented. Conclusion Dermatologists and pediatricians should be aware of this benign entity in order to avoid unnecessary treatment.

Background Poor prognostic factors in Merkel cell carcinoma include male sex, advanced stage at diagnosis, large tumor size (>5 mm), diffuse growth pattern, heavy lymphocytic infiltrate, and high mitotic rate. To date only six cases of Merkel cell carcinoma with sarcomatous or pseudosarcomatous differentiation and poor prognosis have been documented. Methods We present a new case of Merkel cell carcinoma with sarcomatous differentiation. Results The immunohistochemical staining patterns reflected the morphologic differentiation of the epithelial and sarcomatous pattern. After two months of follow-up, there were no signs of local recurrence or metastases. Conclusion In all cases of merkelomas with sarcomatous differentiation described to date, lymph node metastases have been found, except in the presented case. However, larger series of cases will be required to determine if sarcomatous differentiation represents another negative prognostic factor.

Resumen —Presentamos el caso de una nina de tres anos y medio diagnosticada de tumor de Wilms estadio IIIB que presento, con relacion a terapia combinada con citostaticos y radioterapia, unas placas eritematoviolaceas distribuidas en las zonas de radiacion que se identificaron en el estudio histopatologico como siringometaplasia escamosa ecrina (SEE). El fenomeno de evocacion es una dermatitis inducida por farmacos que se produce sobre una zona de piel tratada con radioterapia. La radioterapia induce cambios celulares subclinicos que favorecen la aparicion de un efecto toxico, generalmente por agentes antineoplasicos. La SEE es una forma excepcional de expresion del fenomeno de evocacion.

We present a new case of retiform hemangioendothelioma (RH), an entity first described by Calonje et al. in 1994. The tumor was intradermal and located on the toe of an 11-year-old boy. Histologically, in addition to the distinctive retiform pattern of proliferating vessels in RH there are intraluminal papillae with hyaline cores similar to those seen in malignant endovascular papillary angioendothelioma (Dabska's tumor), but usually they are infrequent, focal and poorly developed. In our case, these papillary structures were well formed and distributed in a diffuse way. They were most conspicuous in superficial areas where the blood vessels were dilated. In deep areas, where the pattern of neoplastic vessels was retiform, the papillae filled their lumina totally, resembling solid cords. Our case shares the clinical and morphologic features of both retiform hemangioendothelioma and Dabska's tumor, supporting a relationship between these two kinds of neoplasms. The benign behavior of this case, with no recurrence or metastases over a 4-year follow-up, corresponds to the low malignancy of this kind of vascular neoplasm.

We present a new case of a primary carcinoid tumour of the skin. The mitotic index (4/10 HPF) warrants classification of this case as atypical. The patient was a 58-year-old woman with a 1-year history of a mass on the scalp. Literature review showed this to be only the seventh case of primary carcinoid tumour of the skin. Importantly, the evolution has been favourable in all seven tumours, with a mean follow-up of 2.5 years for the previous six cases. Although the number of cases is too small to draw definitive conclusions, information to date suggests that this type of tumour can be expected to have a benign behaviour, despite the presence in some cases of criteria suggestive of uncertainty, such as the presence of mitosis.

We operated on a 23-year-old black Nigerian man with a 4-year history of a tumour on the left cheek associated with IgE hypergammaglobulinaemia and peripheral eosinophilia. The lesion recurred.

We report the first case of lupus-like lesions in an infant with chronic granulomatous disease during the treatment with voriconazole for chronic invasive aspergillosis. The lesions disappeared with termination of the treatment.

Histopathological study showed pseudoepitheliomatous hyperplasia of the epidermis and there was a granulomatous inlammatory iniltrate in the dermis composed of histiocytes, eosinophils, and polymorphonuclear cells. Globular structures with a thick, pigmented wall were seen scattered between the inlammatory cells, some of them arranged in the form of a rosary. hese structures stained with periodic acid-Schif (Figure 3), methenamine silver, and Fontana-Masson stains.

En el cultivo en agar glucosado de Sabouraud a 25 °C se apreciaban colonias de lento crecimiento de textura mucoide y color negro, tanto en el anverso como en el reverso (fig. 2). Se comprobo la ausencia de crecimiento a 40 °C. En el estudio microscopico con azul de lactofenol se observaban hifas tabicadas y pigmentadas, que se ramificaban formando conidias de color marron claro, ovales y agrupadas al extremo de anelides terminadas en punta.