Office-based radiation therapy for cutaneous carcinoma: evaluation of 710 treatments.

Skin cancers are the most common malignancies and, historically, ionizing radiation has played an important role in their treatment. However, less experienced dermatologists generally consider radiation last in the line of therapeutic options. The authors sought to evaluate the effectiveness and safety of office-based elective radiation therapy for cutaneous carcinoma. A retrospective study of 604 basal cell carcinomas (BCCs) and 106 squamous cell carcinomas (SCCs) irradiated between 1971-96 was performed. The percentage of patients who developed tumor recurrence during the follow-up period was calculated using Kaplan-Meier survival curves. Cox's proportional model was used to assess the prognostic factors that might have influenced the recurrences. The recurrence rates for BCC and SCC were 11.5 and 16.5 per 1000 patient-years, respectively. The 5-year cure rates were 94.4% for BCC and 92.7% for SCC, and the 15-year cure rates were 84.8% and 78.6%, respectively. Tumor location on the nasolabial fold (OR 4.4; 95% IC, 1.3-14.7) and tumor size > or = 10 mm (OR 2.14; 95% IC, 1.03-4.45) were independent predictors of BCC recurrence. This study suggested that radiation therapy is an effective treatment for BCC and SCC and should be considered as a first option in many cases.

[Vitiligo. Treatment of 12 cases with topical tacrolimus]. / Vitíligo. Tratamiento de 12 casos con tacrolimus tópico.

INTRODUCTION: Vitiligo is a frequent dyschromia, characterized by achromic macules that reflect the absence of melanocytes. The cause of this selective destruction seems to be due to an autoimmune phenomenon. Tacrolimus is an immunomodulator produced by Streptomyces tsukubaensis, whose topical use has been approved for atopic dermatitis. It has been tested in other dermatoses where immunological phenomena are involved. MATERIAL AND METHODS: During the period from September 1, 2003 to April 30, 2004, an open study was carried out on 12 cases of vitiligo treated with topical tacrolimus 0.1 % twice a day. The degree of repigmentation was analyzed using digital photography at the initial visit, and at three and six months. The response in each case was taken into consideration, as well as the response by treated area. Possible adverse effects during the treatment period were also noted. RESULTS: 50 % of the patients treated showed repigmentation with good (50 %-75 %) or excellent (> 75 %) improvement after 6 months. All of the patients with facial involvement achieved repigmentation of over 50 % in this location. Repigmentation in all cases took place homogeneously and centripetally, rather than in a perifollicular pattern. Repigmentation began before three months of treatment had elapsed in 10 patients, and after three months in the remaining two. We did not find any evidence of adverse effects except pruritus in the eyelid area in two patients during the first week of treatment. CONCLUSION: We believe that tacrolimus 0.1 % applied topically for a minimum of six months may be a valid alternative in the treatment of vitiligo in the facial area, especially the eyelids, where other therapeutic modes are not recommended because of the possible side effects.

Nódulos subcutáneos en un recién nacido / Subcutaneous nodules in a newborn

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Vitíligo. Tratamiento de 12 casos con tacrolimus tópico / Vitiligo. Treatment of 12 cases with topical tacrolimus

La lipoidoproteinosis es una enfermedad poco frecuente, debida al depósito de un material hialino PAS+ diastasa resistente en la piel y en el tracto respiratorio, aunque también puede depositarse en órganos internos, de forma generalmente asintomática. La manifestación clínica más temprana es la ronquera. La sintomatología cutánea es más tardía, en forma de lesiones hiperqueratósicas localizadas en tronco, codos, axilas, ingles, dorso de manos, palmas y plantas. Una lesión típica de la enfermedad es la blefarosis moniliforme, que consiste en pápulas arrosariadas en el borde libre de párpados. Es también característica la presencia de calcificaciones intracraneales en forma de coma en los lóbulos temporales. El curso de la enfermedad es progresivo, con una esperanza de vida normal. Afecta por igual a hombres y mujeres con una distribución mundial. El diagnóstico se basa en la sintomatología y la histología. No existe hasta el momento un tratamiento eficaz de la enfermedad. Presentamos un caso de lipoidoproteinosis en una mujer de 23 años, con características clínicas e histológicas típicas

Lipoid proteinosis is an infrequent disease characterized by the deposition of a PAS-positive diastase-resistant hyaline material in the skin and respiratory tract, although it can also be deposited in internal organs, in a generally asymptomatic manner. The earliest clinical manifestation is hoarseness. Clinical cutaneous manifestations come later, in the form of hyperkeratotic lesions located on the trunk, elbows, axillae, groins, backs of hands, palms and soles. A lesion typical of the disease is moniliform blepharosis, which consists of beaded papules along the eyelid margins. Also characteristic is the presence of comma-shaped intracranial calcifications in the temporal lobes. The course of the disease is progressive, with a normal life expectancy. It affects men and women equally, with worldwide distribution. The diagnosis is based on the clinical symptoms and the histology. At this time, there is no effective treatment for the disease. We present a case of lipoid proteinosis in a 23-year-old woman, with typical clinical and histological characteristics

Pitiriasis rosada eritrodérmica / No disponible

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Vasculopatía livedoide (atrofia blanca) generalizada en pacientes adultos con dermatomiositis / Widespread livedoid vasculopathy (white atrophy) in adult patients with dermatomyositis

La presencia de úlceras en la dermatomiositis del adulto es un hecho infrecuente, que suele asociarse a un peor pronóstico. Hasta la fecha, estos casos no han sido estudiados desde el punto de vista etiopatogénico. Se presentan 2 casos de dermatomiositis del adulto asociados a úlceras cutáneas: un varón de 42 años afectado de una dermatomiositis agresiva que le llevó a la muerte por sepsis, y una mujer de 58 años con una dermatomiositis amiopática de 3 años de evolución. Ambos casos presentaban úlceras cutáneas en distintas localizaciones que, al curar, dejaban una cicatriz atrófica y blanquecina. El estudio histopatológico mostraba trombos de fibrina en ausencia de infiltrado inflamatorio y dilataciones luminales con una pared engrosada que contenía un material hialino, hallazgos que sugerían una vasculopatía livedoide (AU)