Cutaneous malignant melanoma mortality in Spain from 1979 to 2018. Trends and new perspectives in the immunotherapy era.

BACKGROUND: Recent studies suggest that cutaneous melanoma mortality rates in Spain are stabilizing and even decreasing in younger cohorts. OBJECTIVES: To analyse mortality rates of melanoma from the last 40 years, focusing on changes related with the development of new therapeutic approaches. METHODS: Death records and mid-year population data were collected from the National Statistics Institute. By using the direct method, age-standardized mortality rates were calculated for overall population and for each sex and age group. Significant changes in mortality trends were identified by Joinpoint regressions. The independent effects of age, period and cohort (APC) and potential years of life lost (PYLL) due to melanoma were also analysed. RESULTS: Age-standardized melanoma mortality rates rose in Spain from 0.78 to 2.13 deaths per 100 000 from the first to the last quinquennium of the study (1979-1983 to 2014-2018) for the overall population. After a marked increase until 1995, mortality rates levelled off. Following this stabilization, from 2015 to 2018 there was a decrease in mortality rates for the overall population (average annual per cent change (AAPC): -4.3, not significant), more accused in males over 64 years old (yo). A period effect was observed from the beginning of 21st century, with mortality rates dropping to date. CONCLUSIONS: There is a decrease in melanoma mortality rates from 2015 in all age groups that confirms previous trends in mortality in younger cohorts. Improvement in diagnosis and development of new therapies for advanced melanoma may have a crucial role in this event. Close monitoring of melanoma mortality rates is necessary to confirm these trends.

Clinical and Epidemiological Characteristics of Merkel Cell Carcinoma in a Series of 38 Patients. / Características clínico-epidemiológicas del carcinoma de células de Merkel en una serie de 38 pacientes.

BACKGROUND: Merkel cell carcinoma is a rare yet aggressive cutaneous tumor with a poor prognosis. Few studies have analyzed series of patients from the same hospital. METHODOLOGY: We performed a retrospective, descriptive, observational study of all patients diagnosed with Merkel cell carcinoma at a tertiary care hospital between 2002 and 2017. We recorded epidemiological, clinical, and histologic data and information on treatments and survival. For analysis, the sample was divided into 2 groups from different periods: 2002-2009 and 2010-2017. We performed survival analysis using Kaplan-Meier curves and multivariate analysis using a Cox proportional hazards model. RESULTS: Thirty-eight patients (24 men and 14 women) with a mean age of 77.76 years were included. Mean follow-up time was 30.11 months. On comparing 2010-2017 with 2002-2009, we observed a 116% increase in the number of Merkel cell carcinoma cases (26 vs. 12), an older mean age at diagnosis (80.92 vs. 70.92 years, P<.05), and an increase in lesions located on the trunk and lower limbs (0% vs. 34.62%). Eleven patients died of Merkel cell carcinoma. Overall survival was 78.2% at 12 months and 69.3% at 24 months. In the univariate analysis, age over 70 years and lymph node involvement were associated with mortality, while tumor location on the upper extremities and wide surgical excision were associated with improved survival. Only lymph node involvement retained its prognostic significance in the multivariate analysis. CONCLUSIONS: In this series, we observed that Merkel cell carcinoma has become more common in recent years and is now diagnosed at an older age and found in new anatomic locations.

[Paediatric dermatology emergencies in a tertiary hospital]. / Urgencias dermatológicas pediátricas en un hospital de tercer nivel.

INTRODUCTION: In recent years, the increasing demand for dermatological consultations in the Emergency department has resulted in the publication of a variety of studies on this subject. However, most of them deal with the general population, without taking into account the changes in frequencies found in young children (ages 0-14). OBJECTIVES: To determine the frequency of various dermatological diagnoses made by the on-call paediatrician in the Emergency Department, and after referral to Paediatric Dermatology. MATERIAL AND METHODS: Firstly, a descriptive retrospective study was performed that included all patients aged between 0 and 14 years old who were seen after being referred to the emergency paediatric dermatologist by the on-call paediatrician from June 2010 to December 2013. Secondly, an analytical study was carried by calculating the kappa index calculus, in order to establish the diagnostic concordance between the emergency paediatrician and the paediatric dermatologist. RESULTS: A total of 861 patients, with a mean age of 4.5 years were included. More than half of the skin disorders analysed were eczema (27%) and infections (26%). The 5 main diagnoses were: atopic dermatitis (16%), acute prurigo simplex (5%), tinea (5%), pyogenic granuloma (4%), and molluscum contagiosum (4%). Additional tests were only required in 16% of the cases. The kappa index obtained was 0.206 (95% CI: 0.170-0.241). CONCLUSIONS: The dermatology consultations in the Emergency Department were shown to be frequent and mostly involved minor diseases. Collaboration between paediatricians and dermatologists resulted in a high treatment success rate, leading to a low percentage of additional tests required and a high rate of discharges.

Inpatient dermatology consultation in a Spanish tertiary care hospital: a prospective cohort study.

BACKGROUND AND OBJECTIVE: Although dermatology has traditionally been practiced through outpatient consultation, hospitalized patients often have dermatologic problems. The aim of this study was to describe and quantify the volume of interdepartmental consultation of the dermatology department of Hospital Universitario Virgen del Rocío. MATERIAL AND METHODS: In this year-long prospective observational cohort study of 429 patients we used a specific data collection form to record information on consultations for patients admitted between July 2010 and June 2011. RESULTS: The 429 consultations over the 12 months of study accounted for 1.56% of all first consultations with a dermatologist during the period. A mean of 1.75 new patients were attended each day. The mean (SD) age of the patients was 52.63 (19) years, and the ratio of men to women was 1.21. Immunocompromised patients accounted for more than a third of the cohort. The medical specialties consulting most often were internal medicine (n=115) and hematology (n=66). The most frequent diagnoses were inflammatory skin conditions (36.2%) and infectious skin diseases (26.5%). DISCUSSION AND CONCLUSIONS: To date, the role of interdepartmental consultation in dermatology has been little studied. Our results suggest that dermatology plays a fundamental role within the hospital. We have identified the most common skin problems in hospitalized patients and their clinical course.

Disseminated juvenile xanthogranuloma associated with follicular lymphoma in an adult: successful treatment with chemotherapy and rituximab. A review of the literature.

Juvenile xanthogranuloma is a non-Langerhans cell histiocytosis that typically affects children, but several cases have been reported in adults, some in connection with hematologic malignancies. We present the case of a 61-year-old woman with multiple xanthogranulomas who developed a follicular lymphoma after 4 years of follow-up. After 6 months of treatment with chemotherapy and rituximab, the cutaneous lesions disappeared and the patient achieved remission from lymphoma. We highlight this case because xanthogranuloma is a rare disorder that is difficult to diagnose in adults and also because this is the first report of an association between xanthogranuloma and follicular lymphoma. Excellent response was achieved with chemotherapy and rituximab. Finally, given the possible association between xanthogranulomas and hematologic diseases, these lesions may be a cutaneous manifestation of an occult malignancy.

An Internet-based programme to promote adequate UV exposure behaviour in adolescents in Spain.

BACKGROUND: The exponential rise in the incidence of cutaneous cancers underscores the need to promote primary prevention. Adolescents are highly familiar with the use of Internet, and new technologies and Internet systems have proven especially useful to educate this age group in other health problems. To date, there have been no reports of Internet-based primary prevention campaigns for adolescents against skin cancer. OBJECTIVES: To determine the knowledge and behaviour of a Spanish adolescent population in relation to sun exposure through an Internet-based system and to describe the use of an Internet-based school intervention programme to improve the sun exposure knowledge and behaviour in adolescents. METHODS: The cross-sectional study included 2170 school pupils aged between 12 and 16 years from public secondary schools. Pupils in the participating centres completed the survey via the website, which contained a total of 35 questions and three information blocks. For the intervention programme, a sub-sample of 12 secondary schools (total of 1290 pupils) was randomly selected. RESULTS: About 56.7% of the female pupils and 52.6% of the male pupils reported having suffered from sunburn in the previous summer. Sunburn risk increased with the frequency of sun exposure between 12 and 6 pm (OR of 3.59), null knowledge of the negative effects of sun exposure (OR of 2.102), the use of sun protection cream (OR of 0.695 for non-use) and physical sun protection measures (OR of 2.21 for 0-1 physical measures). A significant reduction in self-reported sunburns was observed in the quasi-experimental group in comparison with controls after adjusting for sex and inland or coastal location of the centre (OR = 0.45, 95% CI = 0.23-0.87, P = 0.018). Adjusted OR showed that there was a significant improvement in the use of physical measures, use of sun cream, frequency of sun cream application every 2 h and use of protection on cloudy days. CONCLUSIONS: This is the first study to demonstrate that a programme entirely conducted via Internet significantly reduces by half self-reported sunburn risk in an adolescent population achieving very high satisfaction rates.

[Propranolol for the treatment of severe hemangiomas of infancy: results from a series of 28 patients]. / Tratamiento con propranolol oral para hemangiomas infantiles graves: serie de 28 pacientes.

BACKGROUND AND OBJECTIVES: Recent reports have described the successful use of propranolol to treat severe hemangiomas of infancy. The few case series that have been reported, however, have included only a small number of patients. The aim of this study was to describe the results of oral propranolol treatment for severe hemangiomas of infancy in terms of treatment outcome and the occurrence of adverse events. PATIENTS AND METHODS: A descriptive, observational study was undertaken in a series of children with severe hemangiomas of infancy seen in the pediatric dermatology unit at Hospital Universitario Virgen del Rocío in Seville, Spain between July 2008 and December 2009. Patients were included if they had hemangiomas in the proliferative phase or involuting lesions with substantial residual deformity. All children were treated with oral propranolol (2 mg/kg/d) and followed until September 2010. Epidemiologic characteristics were analyzed along with treatment response at 3, 6, 9, 12, and 18 months; adverse events were also recorded at those times. RESULTS: Thirty-six hemangiomas were treated in 28 patients. Propranolol treatment was effective in all cases, with a good or complete response in 88.2% at 6 months. Effects were apparent within a few hours of treatment, which was effective in both growing and involuting hemangiomas. In ulcerated hemangiomas, the mean healing time was 61 days. Adverse events were mild and self-limiting. Only 2 patients discontinued treatment due to hypotension. CONCLUSIONS: In the majority of cases, oral propranolol produced rapid and sustained improvements in hemangiomas of infancy and shortened the natural course of the disease with few side effects. However, no significant reductions in symptoms or healing time were observed in ulcerated hemangiomas.