Sentinel lymph node biopsy versus observation in high-risk cutaneous squamous cell carcinoma in immunosuppressed and immunocompetent patients: An inverse probability of treatment weighting study.

BACKGROUND: The survival benefit of sentinel lymph node biopsy (SLNB) in immunocompetent and immunosuppressed patients with high-risk cutaneous squamous cell carcinoma (cSCC) has not been established. OBJECTIVE: To determine whether SLNB improves disease-specific survival (DSS) in high-risk cSCC. Secondary objectives were to analyse disease-free survival, nodal recurrence-free survival and overall survival (OS). METHODS: Multicentre, retrospective, observational cohort study comparing survival outcomes in immunosuppressed and immunocompetent patients treated with SLNB or watchful waiting. Inverse probability of treatment weighting was used to adjust for possible confounding effects. RESULTS: We studied 638 tumours in immunocompetent patients (SLNB n = 42, observation n = 596) and 173 tumours in immunosuppressed patients (SLNB n = 28, observation n = 145). Overall, SLNB was positive in 15.7% of tumours. SLNB was associated with a reduced risk of nodal recurrence (NR) (hazard ratio [HR], 0.05 [95% CI, 0.01-0.43]; p = 0.006), disease specific mortality (HR, 0.17 [95% CI, 0.04-0.72]; p = 0.016) and all-cause mortality (HR, 0.33 [95% CI, 0.15-0.71]; p = 0.004) only in immunocompetent patients. CONCLUSIONS: SLNB was associated with improvements in NR, DSS and OS in immunocompetent but not in immunosuppressed patients with high-risk cSCC.

Low-Level Expression of p-S6 Is Associated with Nodal Metastasis in Patients with Head and Neck Cutaneous Squamous Cell Carcinoma.

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. The incidence of metastasis for cSCC is estimated to be around 1.2-5%. Ribosomal protein S6 (p-S6) and the p21 protein (p21) are two proteins that play central roles in other cancers. These proteins may be equally important in cSCC, and together, these could constitute a good candidate for metastasis risk assessment of these patients. We investigate the relationship of p-S6 and p21 expression with the impact on the prognosis of head and neck cSCC (cSCCHN). p-S6 and p21 expression was analyzed by immunohistochemistry on paraffin-embedded tissue samples from 116 patients with cSCCHN and associations sought with clinical characteristics. Kaplan-Meier estimators and Cox proportional hazard regression models were also used. The expression of p-S6 was significantly inversely associated with tumor thickness, tumor size, desmoplastic growth, pathological stage, perineural invasion and tumor buds. p21 expression was significantly inversely correlated with >6 mm tumor thickness, desmoplastic growth, and perineural invasion. p-S6-negative expression significantly predicted an increased risk of nodal metastasis (HR = 2.63, 95% CI 1.51-4.54; p < 0.001). p21 expression was not found to be a significant risk factor for nodal metastasis. These findings demonstrate that p-S6-negative expression is an independent predictor of nodal metastasis. The immunohistochemical expression of p-S6 might aid in better risk stratification and management of patients with cSCCHN.

Do patients with inflammatory bowel disease really know what other immune-mediated inflammatory diseases they are diagnosed with?

BACKGROUND AND AIMS: The association of inflammatory bowel disease (IBD) with other immune-mediated inflammatory diseases (IMIDs) in the same patient is well known. We aimed to evaluate the degree of knowledge that patients with IBD have regarding the coexistence of other IMIDs and to analyze the factors associated with the concordance between self-reported and confirmed medical information. METHODS: Patients with IBD at a tertiary hospital answered a questionnaire on the presence of 54 IMIDs (self-reported diagnosis), and their IMID diagnosis was confirmed in their medical records (reference diagnosis). Agreement between the self-reported IMID and the IMID according to medical records was evaluated. The association between concordance and different predictors was evaluated using logistic regression models. RESULTS: A total of 1,620 patients were included. Six hundred and twenty-six (39%) patients were diagnosed with at least one IMID, and 177 (11%) with two or more. Overall agreement between patients´ self-report and medical records was k:0.61. When we grouped IMIDs according to affected organs or systems, agreement on rheumatic IMIDs was moderate (k:0.58), whereas agreement on cutaneous (k:0.66), endocrine (k: 0.74) and ocular (k:0.73) IMIDs was substantial. Among patients who had IMIDs, the factor associated with greater concordance was female gender, while lower concordance was associated with a lower educational level and the fact that the IMID had been diagnosed at the same time or later than IBD. CONCLUSION: The knowledge that patients with IBD have regarding the coexistence of other IMIDs is poor, especially in rheumatic IMIDs.

Dermatitis anular liquenoide de la infancia / Annular lichenoid dermatitis of youth

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Nódulo subcutáneo doloroso / Painful subcutaneous nodule

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Vasculitis IgA como forma de presentación de la infección por el virus de inmunodeficiencia humana / IgA vasculitis as a presentation of human immunodeficiency virus infection

La vasculitis IgA es una vasculitis de pequeño vaso mediada por inmunocomplejos. Clínicamente se caracteriza por la púrpura palpable en miembros inferiores, la afectación articular en forma de artralgias o artritis y la afectación gastrointestinal y renal (esta última marcará el mal pronóstico en adultos). Es frecuente encontrar procesos infecciosos como desencadenantes, principalmente de vías respiratorias altas. Por otro lado, el VIH causa una disfunción inmunitaria que desencadena una hipergammaglobulinemia y puede desencadenar alteraciones autoinmunes. En ocasiones este efecto se realiza sobre el endotelio vascular dando lugar a cuadros vasculíticos, aunque como forma de inicio los casos descritos en la literatura son escasos

IgA vasculitis is a small-vessel vasculitis mediated by immune complexes. In clinical terms, it is characterized by palpable purpura in the lower limbs, joint involvement in the form of arthralgia or arthritis, and gastrointestinal and renal involvement (this will mark a poorer prognosis in adults). Infectious processes, mainly in the upper respiratory tract, are frequently found to be triggers. On the other hand, human immunodeficiency virus (HIV) causes immune dysfunction, which triggers hypergammaglobulinemia and can trigger autoimmune disorders. At times, this can affect the vascular endothelium, giving rise to vasculitic manifestations, although there are few reports in the literature of its role in the presentation of HIV

Nódulo tiroideo como primer signo de progresión de carcinoma de cervix uterino / Thyroid nodule as a first sign of progression in uterine cervical carcinoma

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Criptococosis cutánea / Cutaneous cryptococcosis

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Adenomatosis hepática: una causa infrecuente de trasplante hepático / Hepatic adenomatosis: a rare cause of liver transplant

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Zosteriform cutaneous metastasis from a breast carcinoma

Las metástasis cutáneas de carcinomas internos son infrecuentes y con patrón zosteriforme son raras. Para estudiar las características de las metástasis zosteriformes estudiamos 38 casos de la literatura y una paciente vista en nuestro Servicio. Métodos: Estudiamos la edad y sexo de cada paciente, la localización del tumor primario, la anatomía patológica del primario y las lesiones cutáneas, localización de las lesiones cutáneas y presencia o ausencia de dolor en los 39 casos. Resultados: La localización más frecuente del cáncer primario fue la mama (7 pacientes) y el carcinoma escamoso de piel (6 pacientes). El sitio más común de las metástasis en la piel fue la pared abdominal (21 pacientes). Conclusión: Esta revisión realza la importancia de incluir las metástasis cutáneas dentro del diagnóstico diferencial de las enfermedades con distribución zosteriforme. Se deben considerar las metástasis cutáneas y es necesario realizar una biopsia de piel para confirmar el diagnóstico. Nosotros pensamos que este patrón de enfermedad metastásica es más frecuente de lo recogido en la literatura

Cutaneous metastases from internal malignancies or primary skin cancers are uncommon, and a zosteriform pattern is very rare. In order to elucidate the characteristics of zosteriform metastatic skin cancer we reviewed 38 cases from the medical literature and 1 case seen in our clinic. Methods: The age and sex of each patient, location of the primary tumor, pathology of primary and metastatic lesions, location of the skin cancer and presence of pain were determined for the 39 cases. Results: The most frequent site of the primary tumor was the breast (7 cases) and skin squamous all carcinoma (6 cases). The most common site of the skin metastases was the chest wall (21 cases). Conclusion: This review highlights the importance of including cutaneous metastases within the differential diagnosis of zosteriform eruptions. Skin metastases should be considered and a skin biopsy is necessary to confirm the diagnosis. We think that this pattern of metastatic disease is more frequent than is indicated in the literature

Linfoma anaplásico de células grandes asociado a ictiosis adquirida / Anaplastic large-cell lymphoma associated with acquired ichthyosis

El linfoma anaplásico de células grandes (LACG) es un linfoma no-Hodgkin de alto grado caracterizado por su morfología celular y la expresión del marcador CD30. Puede dividirse en dos grandes grupos: primario cutáneo y el ganglionar sistémico, el más frecuente. Presentamos un caso de un paciente que consultó por la aparición de unas lesiones pruriginosas en tronco. En la exploración física se objetivó la presencia de máculas rasposas al tacto en tronco y extremidades y la existencia de una masa a nivel cervical, infiltrada, dura, y recubierta de piel eritematosa. El estudio histológico de ambos procesos reveló: una ictiosis adquirida en la piel y un linfoma anaplásico de células grandes ganglionar con extensión subcutánea, respectivamente. El proceso cutáneo siguió un curso paralelo al linfoma, con una remisión parcial de las lesiones tras la quimioterapia y reaparición de las mismas al extenderse el linfoma ganglionar. La ictiosis adquirida es un síndrome paraneoplásico raro, se ha descrito asociado a procesos linfoproliferativos, aunque sólo en cinco ocasiones a linfoma anaplásico de células grandes (AU)

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Epidemiología básica para dermatólogos / Basic epidemiology for dermatologists

La epidemiología es la ciencia que estudia la frecuencia de las enfermedades. Los estudios epidemiológicos se dividen en dos grupos, el primero de ellos engloba los dirigidos a determinar la frecuencia de enfermedad y los segundos las asociaciones entre frecuencia y exposición. Se revisan los conceptos básicos del primer grupo de estudios y se describe el segundo tipo con los errores que se presentan más frecuentemente. Se hace especial hincapié en la calidad y validez de los estudios epidemiológicos y en la evaluación y aplicación de los resultados de los estudios de tests diagnósticos (AU)

Síndrome linfocutáneo por Mycobacterium marinum en un joven aficionado a los acuarios / Lymphocutaneous syndrome due to Mycobacterium marinum in a young aquarium fond

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