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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.

Resumen La elastolisis de la dermis media es una enfermedad infrecuente que se caracteriza por la perdida en banda de las fibras elasticas en la dermis media. Con frecuencia se presenta en la clinica en forma de placas bien delimitadas de piel sutilmente arrugada. Presentamos el caso de una mujer de 38 anos con una clinica de eritema y finas arrugas que cumplian los criterios clinicos e histologicos de la elastolisis de la dermis media. La paciente referia como unico antecedente de interes el uso de anticonceptivos orales 3 meses antes del inicio de las lesiones, asi como 2 partos previos sin complicaciones.

Background: Porokeratosis (PK) is a group of cutaneous entities characterized by disordered epidermal keratinization and by a predisposition to develop malignant transformation. The molecular mechanism of this carcinogenesis remains unclear, but p53 has been proposed as a mediator of this process. p53 overexpression, detected by immunohistochemistry, has frequently been reported in PK, and p53 mutations are direct results of ultraviolet (UV) skin exposure and are directly involved in most common skin cancers. Methods: Eleven cases of Mibelli-type PK, one of them associated with a squamous cell carcinoma, were reviewed. Formalin-fixed, paraffin-embedded archival tissue from these cases was immunostained for p53 and used for DNA extraction for the analysis of p53 mutations by polymerase chain reaction and single-strand conformation polymorphism. Results: Increased p53 expression was confirmed in all cases. Most of them showed a discontinuous labeling, often stronger at the base of the cornoid lamella. No relation with sun exposure was observed. Finally, no p53 mutations were found at the gene levels more frequently damaged in human cancers called ‘hot spots’. Conclusions: p53 alterations can be involved in the pathogenesis of the PK and the carcinogenesis arising in some of the lesions. Since p53 gene inactivation in human cancer is related to mutation and/or loss, the absence of genetic damage could indicate that p53 alterations are only at the protein level, leading to an abnormal cell-cycle control. UV exposure does not seem to play a main role in the process.

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.

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.We present a new case of Merkel cell carcinoma with sarcomatous differentiation.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.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.

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.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.Dermatologists and pediatricians should be aware of this benign entity in order to avoid unnecessary treatment.